Controlled Clinical Trials — Necessity and Progress
James L. MacPherson, Duke O. Kasprisin in Therapeutic Hemapheresis, 2019
However, it is not yet defined whether plasma infusion alone or plasma exchange is the preferred mode of therapy. Plasma infusion has been advocated by Byrnes who has described five cases of TTP who responded to this modality of therapy alone.8, 9Plasma is presumed to supply the “missing factor” that occurs in TTP which is necessary for the formation of prostacyclin. However, a response to plasma infusion alone does not always occur; Ansell has described a case of a 28-year-old woman with TTP who failed to respond to fresh frozen plasma infusion but subsequently responded to plasma exchange.10 A beneficial response to large volume plasma exchange has now been documented in several series;7, 11, 12, 13, 14 a total of 16 cases recovered completely. In one of these series,7antiplatelet drug therapy was thought to contribute significantly to the response 88% (7 of 8 cases). Whole blood exchange transfusion has also been described to be of benefit, with a clinical remission occurring in 10 of 16 cases described in two reports.15, 16 Plasma exchange or whole blood exchange transfusion is thought to be of benefit because of removal of toxic immune factors such as immune complexes, antiplatelet antibodies or anti-endothelial cell antibodies and this theory is supported by a report of two cases of TTP who responded to plasma exchange with 5% serum albumin and Ringer’s lactate.17 It must be stated that when fresh frozen plasma is used as replacement fluid in TTP, plasma exchange like plasma infusion may serve to replace a “missing plasma factor”.
Antidysrhythmic Drugs in Pediatrics
Sam Kacew in Drug Toxicity and Metabolism in Pediatrics, 1990
Nystagmus is associated with blood levels greater than 20 μg/ml, ataxia is associated with levels of 30 to 40 μg/ml, and coma and seizures occur at levels greater than 40 μg/ ml.153 Cardiac toxicity is unlikely following oral overdose; however, rapid intravenous administration may result in dysrhythmias and asystole.153,154 GI effects include nausea and vomiting. Hyperglycemia has been reported. Hypersensitivity reactions are manifested by skin rashes and fever.153 Other effects such as dermatitis, hepatitis, gingival hyperplasia, lymphoid hyperplasia, and hemotologic abnormalities are unlikely following acute overdose. A few patients have a hereditary defect in para-hydroxylation and may develop toxicity with therapeutic doses. Fetal hydantion embryopathy syndrome and coagulopathies have been reported in neonates.154 Treatment of intoxications should focus on symptomatic and sup-portative care.47,139,154 Diuresis, hemoperfusion, and hemodialysis are generally ineffective. Exchange transfusion remains controversial.
The Hematologic System and its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
Similar to mismatching, erythroblastosis fetalis is caused by an antibody reaction involving Rh factor. If an Rh positive father and Rh negative mother produce an Rh positive fetus, the Rh antigens in the fetal blood reach the maternal circulation. This causes the mother to develop Rh antibodies, which can cross the placental barrier and cause agglutination and hemolysis of the fetal blood. To offset this rapid destruction, the fetus produces red cells very quickly. Because of the speed of erythrocyte production, many early nucleated cells, including erythroblasts, are released into the circulation, giving the disease its name. Unable to match production to hemolysis, many infants with erythroblastosis fetalis are stillborn. Rare in the first Rh positive infant born to an Rh negative mother, it becomes more common with successive pregnancies. Treatment relies primarily on exchange transfusion. The condition usually can be avoided by administering anti-Rh gamma-globulin immediately after the birth to prevent the mother from becoming sensitized.
Tick-borne disease (babesiosis)
Published in Baylor University Medical Center Proceedings, 2021
Hanish Jain, Garima Singh, Rahul Mahapatra
Severe babesiosis often occurs in older and/or immunocompromised patients and is associated with parasitemia >10%.4 Severe babesiosis may also lead to complications, including persistent or relapsing disease. The most common complication is acute respiratory distress syndrome requiring intensive care.5 Shock, intravascular hemolytic anemia, and multiorgan dysfunction are also observed. Exchange transfusion facilitates partial to complete removal of patients’ red blood cells and replacement with allogeneic red blood cells. It is warranted for patients who have high-grade parasitemia >10%, severe hemolysis (hemoglobin <10 g/dL), or organ impairment, particularly pulmonary, liver, and/or renal impairment.6 Early use of exchange transfusion may prevent organ dysfunction and possibly death.7 The preferred antimicrobial regimen for mild to moderate babesiosis consists of oral azithromycin plus atovaquone; as an alternative, oral clindamycin plus quinine can also be used. The preferred treatment of severe babesiosis consists of intravenous azithromycin plus oral atovaquone; intravenous clindamycin plus oral quinine is an alternative option along with exchange transfusion.8
A Case of Fat Embolism Syndrome with Cerebral Involvement in Sickle Cell Anemia
Published in Hemoglobin, 2021
Rochelle G. Melvin, Zachary Liederman, Sumedha Arya, Lianne Rotin, Christie M. Lee
The management of FES involves supportive care, along with RBC exchange transfusion in patients with sickle cell disease [21,26]. Exchange transfusion works by substituting sickle cell disease RBCs with large numbers of normal erythrocytes [33]. This may halt the ‘sickling cycle’ and prevent further bone marrow necrosis and fat embolization [33]. Simple transfusions (i.e. transfusion of normal erythrocytes without removing sickle cell disease RBCs) provide some benefit but are inferior to exchange transfusions. Multiple simple transfusions can increase blood viscosity and paradoxically enhance the effects of sickling on bone marrow necrosis [27]. A review of FES cases in sickle cell disease demonstrated that mortality was affected by the use of transfusion, as the mortality rate was 23.0, 59.0 and 92.0%, respectively, in patients who received RBC exchange transfusions, simple transfusions and no transfusion, respectively [4,13,16]. It is advised that exchange transfusion be initiated as soon as the diagnosis of FES is suspected, as early intensive exchange transfusion targeting marked reduction in Hb S levels may be life-saving [4,15,27]. For centers that do not have access to exchange transfusion, transfer to a center with apheresis capacity should be facilitated and simple transfusions, up to a Hb of 10.0 g/dL, should be initiated in the interim.
Outcomes of a preoperative risk-based transfusion assignment protocol in sickle cell disease patients: a single-center retrospective study from Saudi Arabia
Published in Pediatric Hematology and Oncology, 2020
Naif Albolowi, Omima Mustafa, Mohammed Almohammadi, Mohammed Yasir Al-Hindi, Wasil Jastaniah
In a randomized study that compared the benefits of an exchange transfusion versus a simple transfusion, no difference was reported in complications between transfusion groups.10 Other two randomized studies compared preoperative transfusion vs. no transfusion. The results were different between the two studies.11,12 The transfusion alternatives preoperatively in sickle cell disease (TAPS) study, showed an increase in ACS in the no transfusion group participants.11 In contrast, a study from Saudi Arabia showed a 4.81 increase in the relative risk of SCD-related adverse events in the preoperative transfusion group.12 A meta-analysis of 10 studies, showed no difference between simple and exchange transfusion, or transfusion and no transfusion in prevention of perioperative complications.13 The overall rate of perioperative complications reported in studies ranged from approximately 10% to 40%.7,10–13,26–28 In the present study, the rate of complications observed was 6.4%. We attributed the low rate in our study to a number of factors. First, transfusion assignment was based on SCD severity in addition to surgical risk. Second, all patients included followed the clinical protocol guideline that included preoperative education, optimization of hydration, oxygenation, early mobilization, analgesia, and use of incentive spirometry (when applicable).
Related Knowledge Centers
- Allotransplantation
- Apheresis
- Autotransplantation
- Blood Transfusion
- Hemolytic Disease of The Newborn
- Polycythemia
- Blood
- Blood Product
- Sickle Cell Disease
- Hemolytic Disease of The Newborn
- Transfusion Therapy