Search PubMed⌕ Search

Biomedical subjects

F Mercuriali

Publications and source records attributed to F Mercuriali.

67 records · Page 4Linked to original sources
PubMedDate not supplied

[Blood transfusion in oncologic surgery: the role of recombinant human erythropoietin (rHuEPO)].

Anemia is common in cancer patients. The pathophysiology is multifactorial, however the most common cause is the anemia of chronic diseases (ACD). In 20-50% of cancer patients, anemia restricts physical activity and quality of life and requires transfusion support. The percentage of patients necessitating transfusion dramatically increases when patients require surgery. The traditional belief that blood transfusion is an effective and safe therapy has been challenged by a heightened awareness of the infectious and immunologic risks associated with allogeneic blood administration. In cancer patients transfusion-induced immunomodulation may have the potential to significantly increase postoperative infections and cancer recurrence so that it seems reasonable to minimize allogeneic blood exposure. Several strategies have been adopted to reduce allogeneic transfusion in surgical patients, however to properly select the appropriate blood conservation strategies the blood transfusion requirements for each patient should be defined. Allogeneic blood transfusion in surgery can be reduced by the introduction of autologous blood (AB) programmes and by the use of rHuEPO, alone or in association with AB techniques. AB donation is currently a standard of care for elective surgical patients but its efficacy is limited by anemia that prevents the donation of the optimal number of AB units. rHuEPO has been shown to significantly increase the volume of AB that anemic patients can predeposit or, used perisurgically, to expand the circulating RBCs mass before surgery. Moreover clinical trials employed rHuEPO in anemic cancer patients with various solid tumors both on and off chemotherapy reporting a significantly increase in Hct in more than 50% of the treated patients. Recently different studies have shown the efficacy of rHuEPO in increasing the volume of AB also in patients with ACD and cancer, thus proving to be a useful addition to existing strategies of blood conservation to minimize exposure to allogeneic blood in surgical cancer patients.

Anemia↗
PubMedDate not supplied

[HLA typing in a neonate with posttransfusional graft vs host disease (PT-GVHD)].

The authors report a case of post-transfusion-graft-versus-host disease (PT-GVHD) in a premature infant after parental blood donation. This disease seems to be due to the transfusion of immunocompetent T lymphocytes into an immunodeficient recipient or into an immunocompetent host who shares an HLA haplotype with HLA-homozygous blood donors (i.e. relatives or members of inbred populations) and who is therefore unable to reject the graft cells. The results of HLA typing of the patient and his family demonstrated that the infant was identical with his father for HLA class II antigens (DR, DQ) and, concerning HLA class I, he had in common the remaining paternal haplotype (A29, B44). Prevention of this disease, performed by gamma irradiation of blood components before transfusion, appears to be effective in most cases.

Blood Donors↗
PubMedDate not supplied

[The role of human recombinant erythropoietin in oncologic surgery].

Anemia is common in cancer patients, especially in those with more advanced stages of progressive tumor growth, the frequency varying on type of cancer, stage and chemotherapy or radiation therapy used. The pathophysiology is multifactorial. However the most common anemia is the anemia whose features are similar to those seen in other chronic diseases (anemia of chronic disease--ACD). The pathophysiological mechanisms are: a mild decrease in red blood cells survival, a decreased re-utilization of bone marrow iron stores and an inadequate erythropoietin response to the degree of anemia. When anemia cannot be corrected through the administration of hematinics and anemia is severe enough to significantly restrict physical activity and quality of life, blood transfusion is requested. It has been reported that the percentage of patients requiring transfusion ranges from 20 to 50%. The transfusion of allogeneic blood exposes the recipient to immunological and infectious risks. There is evidence that allogeneic blood transfusions can have immunologic consequences and some argue that these immune changes can adversely affect the prognosis in cancer patient. Although this is still controversial, until it can be shown that blood transfusion is not harmful in the long term to patients with cancer, it seems reasonable to avoid it whenever possible. Recently the availability of recombinant DNA technology permitted large scale production of recombinant human erythropoietin (rHuEPO). To date several clinical trials employed rHuEPO in anemic cancer patients with various solid tumors both on and off chemotherapy. All these studies have reported a significantly increase in Hct than placebo in more than 50% of the treated patients. The problem of correcting anemia and of blood transfusion is even more important when cancer patients become candidate to major surgery. In such situation, the transfusion of a consistent number of units is generally required to cover the surgical blood loss. The use of homologous blood in surgery can be substantially reduced by the introduction of autologous blood transfusion (ABT) programmes in association with rHuEPO. A number of experimental and clinical studies on the effects of rHuEPO on AB donation and on erythropoiesis in the peri-operative period have demonstrated that it resulted to be effective in stimulating erythropoiesis, with a consequent increase in the volume of red cells produced during the course of treatment and in the number of units predeposited. It was also effective in correcting anemia induced by collection of blood units. The efficacy of rHuEPO in increasing the volume of autologous blood the patient can predeposit before surgery has been demonstrated also in patients with ACD and cancer. No significant adverse effects of rHuEPO administration have been reported in any of the studies published to date. It can be concluded that rHuEPO therapy may be safe and effective in selected surgical patients, in stimulating erythropoiesis, in expanding the circulating RBCs mass, in increasing the volume of AB that can be collected pre-operatively and, consequently, in reducing the exposure to homologous blood. Therapy with rHuEPO may prove to be a useful addition to existing strategies of blood conservation to minimize exposure to HB.

Anemia↗