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Biomedical subjects

D W Huestis

Publications and source records attributed to D W Huestis.

At least 19 recordsLinked to original sources
PubMed1992

An unexpected complication following immunoadsorption with a staphylococcal protein A column.

Extracorporeal immune adsorption with staphylococcal protein A (SPA) columns can remove immune complexes and immunoglobulins in the treatment of a variety of diseases. We present the case of an elderly man with neuropathy associated with monoclonal gammopathy, treated by 3 on-line SPA procedures. At the completion of these treatments his neuropathy relapsed, progressing to near-total paralysis. Return to a baseline clinical status required several months. The reason for this severe relapse is not clear. Possible explanations include SPA activation of T-lymphocytes, with release of gamma interferon and increased antigen recognition, or removal of an antiidiotype control mechanism. We advise caution in the application of immunoadsorption to conditions in which it has not yet been evaluated.

Hereditary Sensory and Motor Neuropathy↗
PubMed1992

Therapeutic cytoreduction in a 7-month-old baby with acute leukemia.

A 7-month-old girl with acute biphenotypic leukemia [t(4;11)] had accompanying anemia, thrombocytopenia, and a white blood cell count of 535,000/microL with 98% blasts. Before instituting chemotherapy, therapeutic leukapheresis was done to reduce the threat of complications from leukostasis. Using a Cobe Spectra blood cell separator primed with modified blood, we processed 1,395 mL of her blood, removing 201 mL of the buffy coat containing 5.8 x 10(10) white blood cells. This reduced the WBC count to 301,000/microL. Only a single procedure was done, without significant complications. The rationale of this preparatory cytoreduction is discussed critically. Subsequent chemotherapy resulted in a long-lasting remission.

Acute Disease↗
PubMed1989

Risks and safety practices in hemapheresis procedures.

In hemapheresis procedures carried out for the collection of blood components, healthy donors are subjected to the old familiar risks of blood donation, plus those specifically relating to the use of blood cell separators and to the selective extraction (and loss to the donor) of individual blood components. The responsible physician must actively control these procedures, from the point of view of effective component collection and protection of the donor from undesirable procedural reactions, as well as potentially dangerous blood component depletion. The application of similar hemapheretic techniques to patients is quite a different matter. Patients do not have the same tolerance of blood manipulative techniques as do healthy donors. Furthermore, therapeutic component depletions are usually much more radical than the procedures applied to donors. The physician responsible for such therapeutic operations must play an active, consultative role with the clinical physician in discussing the likely efficacy of such treatment, the identification of risk factors, obtaining informed consent, deciding on a schedule of operations, replacement solutions, supplementary therapy, and overall supervision of procedures.

Blood Component Removal↗
PubMed1985

Liquid preservation of human neutrophils stored in synthetic media at 22 degrees C: controlled observations on storage variables.

The purpose of this study was to use a chemically defined medium to identify essential substances and optimal conditions for the liquid storage of neutrophils at 22 degrees C. Several commercially available synthetic media were evaluated: L-15, McCoy's 5a, M199, minimum essential medium, Dulbecco's MEM, NCTC135, and RPMI 1640. Proteins, glucose, pH, and neutrophil concentration were systematically studied. Neutrophils were harvested by centrifugal cell separators or phlebotomy, and their maintenance was evaluated by monitoring cell counts, dye exclusion, phagocytosis, bacterial killing, and chemotaxis. Neutrophils stored equally well in all synthetic media except L-15; however, chemotaxis was poorly maintained in synthetic media as compared with autologous plasma. RPMI 1640 was arbitrarily selected as a basal medium to evaluate storage variables. RPMI 1640 supplemented with albumin to a concentration of 1% improved chemotaxis and was equivalent to plasma as a storage medium with regard to the in vitro functions tested. Cohn fractions IV-1, IV-4, and gamma globulin were not effective substitutes for albumin. Glucose is essential for neutrophil storage; its absence from the medium correlated with poor cell function. Optimal glucose requirements depend on the cell concentration. High glucose concentrations were toxic to neutrophils; at 1,000 mg/dL, chemotaxis was depressed by 58%. Glucose utilization was dependent on the initial pH of the medium and on the cell concentration. A wide range of hydrogen ion concentrations was tolerated, and the optimum pH range was 7.2 to 7.8. Cell concentration is an important variable because it affects the pH of the medium as well as glucose utilization.

Adult↗
PubMed1983

Leukapheresis: increasing the granulocyte yield with the Fenwal CS-3000.

By premedicating the donor with 60 mg prednisone in divided doses and processing more donor blood at higher flow rates than those specified by the manufacturer, one can obtain high yields of granulocytes and platelets (mean of 3.3 X 10(10) and 5.9 X 10(11), respectively) with the Fenwal CS-3000 blood cell separator. The steroid effect predominates over that of processing more blood. In the case of donors who are not stimulated by steroid, processing 10 L of donor blood at flow rates of 60 to 70 ml/minute results in a significantly improved yield of granulocytes (mean of 2.2 X 10(10) as opposed to 1.4 in the case of 7 L) and of platelets (6.1 X 10(11) versus 4.7). The concentrates contain about 50 to 60% less lymphocytes when donors are given steroid. With these modifications, the leukapheresis can still be accomplished in less than three hours and with minimal adverse effects on the donors.

Cell Separation↗
PubMed1982

Adverse effects of granulocyte donations.

Various reactions occur during cytapheresis by either intermittent or continuous flow centrifugation, because of the nature of the procedures themselves and because of the exposure of the donor to steroids, macromolecular agents, anticoagulants, and saline. Most reactions are vasovagal (commoner in intermittent flow procedures) and citrate-related (commoner in continuous flow). Only very rarely do these require the procedure to be stopped. Other less common reactions are discussed. In addition to actual reactions, blood component depletion may occur, especially with frequently repeated procedures in the same donor. Red cell, platelet, and plasma depletion can all force limitation of the frequency of cytapheresis. While most reactions are of little consequence, they can cause procedural failure or refusal of a donor to permit continuation of cytapheresis, and can interfere with donor recruitment.

Blood Donors↗