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PubMed2000

Preoperative platelet-rich plasmapheresis and hemodilution with an autotransfusion device in total hip replacement surgery.

The effectiveness of both preoperative autologous donation (PAD) and intraoperative autotransfusion (IAT) with an autotransfusion device has recently been questioned. Preoperative apheresis, with separation of concentrated platelet rich-plasma (c-PRP) and erythrocyte concentrate (ERC), represents an aggressive use of the autotransfusion device. Can such a procedure replace PAD in total hip replacement surgery (THR)? Eighty patients undergoing THR were investigated in a prospective and randomized study. Forty patients underwent PAD, and 2 units of ERC + plasma were retrieved within 4 weeks preoperatively. Another 40 patients underwent an immediately preoperative apheresis with a concomitant hemodilution with 4% albumin, retrieving c-PRP (30% of the platelet pool) and 2 units of ERC. Both groups used IAT up to 2 hours postoperatively, with 3% dextran-60 as a plasma substitute according to our standard of care. There were no differences in blood loss, B-hemoglobin or allogeneic transfusions between the groups: 85% of the patients did not receive allogeneic blood. Both apheresis and reinfusion of c-PRP had minor impact on the coagulation parameters. Platelet count increased slightly but significantly (P<0.05) from 154 to 179 x 10(9)/L after the c-PRP at wound closure. Preoperative apheresis with an autotransfusion device, separating platelet-rich plasma and erythrocyte concentrate, is a useful alternative for patients who are unable to utilize the PAD technique for either religious or practical reasons.

Aged↗
PubMed1980

[Clinical aspects of hemodilution (author's transl)].

Acute normovolemic hemodilution is a most practicable method to avoid the transfusion of homologous blood in all those cases of surgical interventions which make expect an intraoperative loss of blood up to 30% of plasma volume. After introduction of anaesthesia 2-4 bags of blood are taken from the patient and simultaneously exchanged for an equal quantity of plasma substitutes. According to the amount of operative loss of blood the withdrawn blood will be retransfused still during operation or in the course of the same day. Under normovolemic hemodilution cardiac output. Coronary perfusion, and oxygen transport capacity of blood will increase due to decreased blood viscosity and consequently an optimum oxygen supply of tissues will be guaranteed, even if hematocrit has reached 25% (corresponding to 8 to 10 g% Hb). The main intention of Hemodilution is to be seen in minimizing the irreversible loss of valuable autologous blood cells and plasma components and therefore this method helps to use blood and plasma components more economically.

Animals↗
PubMed1989

Iatrogenic immunization with bovine thrombin: a mechanism for prolonged thrombin times after surgery.

Unexplained very-prolonged thrombin times (greater than 300 s) were found in plasma from four patients. Other coagulation variables were normal, and there was no history of coagulopathy. Mixing studies suggested the presence of thrombin inhibitors in patient plasma. Substitution of human thrombin for bovine thrombin in performing the thrombin time test resulted in normal clotting times, indicating that the inhibitory activity was directed primarily against bovine thrombin. Each patient had been treated with topical bovine thrombin during previous surgery. In the one patient with a preoperative thrombin time, the initial value was normal and prolongation began 16 days after surgery. An enzyme-linked immunoassay showed elevated levels of IgM or IgG antibodies to bovine thrombin in each patient tested. Affinity-purified antibodies to bovine thrombin from patient serum prolonged the thrombin time of normal plasma. These results suggest that iatrogenic immunization by intraoperative exposure to bovine thrombin is responsible for antibodies to bovine thrombin, which accounts for the prolonged thrombin times found in some patients after surgery.

Adolescent↗
PubMed1977

The ultrastructure of "brain death". II. Electron microscopy of feline cortex after complete ischemia.

Permanent, complete global cerebral ischemia was induced in cats by filling the cardiovascular system with a plasma substitute (37 degrees C). At variable intervals and up to 120 min thereafter, these feline brains were perfused with aldehydes and processed for electron microscopy. The resulting cellular alterations were homogeneous and uniform throughout the entire brain; they included early chromatin clumping, gradually increasing electron lucency of the cell sap, distention of endoplasmic reticulum and Golgi cisternae, transient mitochondrial condensation followed by swelling and appearance of flocculent densities, and dispersion of ribosomal rosettes. The marked contrast between the structural alterations in permanent, complete ischemia and incomplete cerebral ischemia, suggest differences in their pathogenesis. A basic determinant factor of the structural changes appears to be the volume of flow (serum, plasma, other) which is available at the time of the injury. This analysis of global cerebral ischemia provides some insight on the nature of cellular changes occurring shortly after somatic death.

Animals↗
PubMed1984

[Ascites as a complication of hepatic storage of hydroxyethyl starch in long-term dialysis].

Three adult dialysis patients developed ascites after having received repeatedly the plasma substitute hydroxyethyl starch (HES 40/0.5). In two cases (total dose 180, and 330 g HES, respectively) the ascites was reversible after discontinuation of the HES administration. In the third case (total dose 915 g HES) the ascites could be controlled only by implantation of a Denver shunt. In this latter case it was shown by histological, electron microscopical, and biochemical findings that the ascites was caused by hepatic sinusoidal obstruction due to an extreme storage of HES in the sinusoidal lining cells. Additional storage was detected in hepatocytes, bile duct epithelia, endothelial cells, and fibroblasts in the portal tracts. Biochemically HES was found in liver tissue at a concentration of 4% (w/w). Although in renal impairment plasma clearance of HES is not significantly different from normal individuals, long-term administration of HES must be regarded inadvisable because of tissue storage which apparently is especially significant in this condition.

Ascites↗
PubMed2001

Protransglutaminase (factor XIII) mediated crosslinking of fibrinogen and fibrin.

Plasma factor XIII (plasma protransglutaminase) circulates as an A2B2 tetramer bound to the gamma' variant chains of fibrinogen "2". During clotting the A subunits of fXIII are cleaved by thrombin to form fXIIIa (transglutaminase) and in the presence of calcium ions, activated A2* subunits dissociate from the B subunits. When purified plasma fXIII or recombinant cellular factor XIII (A2) was incubated with fibrinogen in the presence of calcium ions (> or =50 microM) a non-synerizing gel formed concomitant with formation of gamma dimers, followed by Agamma polymers, and eventually gamma trimers and gamma tetramers. As is the case of fXIIIa, the fXIII-mediated crosslinking rate was enhanced in the presence of thiols. After an initial lag period, fXIII catalyzed fibrinogen crosslinking at approximately 75% of the rate of fXIIIa under typical crosslinking conditions (100 Loewy u/ml, 5 mM CaCl2 & 500 microM DTT). Fibrin was crosslinked about 8 times more rapidly by fXIII than was fibrinogen, and after an initial lag period fXIII crosslinked fibrin at nearly the same rate as fXIIIa. Substituting plasma for purified fXIII as the source for fXIII resulted in robust fibrinogen crosslinking activity. In contrast to the high level of fXIII-mediated crosslinking activity observed with fibrinogen or fibrin as substrates, when transglutamination was measured using cadaverine incorporation into casein, fXIII was 30-fold less active than fXIIIa. Thus, factor XIII displays constitutive enzymatic activity with respect to fibrinogen and fibrin. The results further indicate that uncleaved fXIII in plasma provides a potent source of readily available crosslinking activity in clotting blood. Fibrinogen 2, whose gamma'chains bind fXIII B subunits, was crosslinked 3.5 times more slowly by fXIII than was fibrinogen 1 (lacking gamma' chains), suggesting that complex formation between fibrinogen 2 and plasma fXIII plays a significant role in down-regulating potential plasma fXIII-mediated crosslinking activity. Since fibrin is a considerably better substrate for fXIII than is fibrinogen, the rate at which crosslinking takes place in a fibrinogen-containing plasma environment is much lower than it would be if fibrin were present.

Calcium↗
PubMed2001

Intravenous immunoglobulin for Guillain-Barré syndrome.

BACKGROUND: Guillain-Barré syndrome is a potentially serious, acute, paralysing, probably autoimmune disease caused by inflammation of the peripheral nerves. Recovery has been shown to be speeded by plasma exchange which replaces the patient's own plasma with a plasma substitute. Intravenous immunoglobulin purified from donated blood is beneficial in other autoimmune diseases and is easier to administer. OBJECTIVES: To determine the efficacy of intravenous immunoglobulin in comparison with no treatment or other treatments for treating Guillain-Barré syndrome and to determine the most efficacious dose. SEARCH STRATEGY: Search of the Cochrane Neuromuscular Disease Group register using Guillain-Barré syndrome and acute polyradiculoneuritis as the search terms, bibliographies of trials and contact with their authors and other experts. SELECTION CRITERIA: Randomised and quasi-randomised trials. DATA COLLECTION AND ANALYSIS: Two reviewers examined the titles and abstracts of all the papers retrieved by the search, extracted the data onto forms designed for this review, and independently assessed the quality of the trials. MAIN RESULTS: The only trial comparing intravenous immunoglobulin with supportive treatment was inadequate to establish its value. Another Cochrane systematic review has shown that plasma exchange (PE) hastens recovery. Plasma exchange has become the gold standard against which other treatments need to be compared. We found three randomised trials that compared intravenous immunoglobulin with PE. We were able to combine the results of the two largest trials in a metaanalysis involving 398 patients. The primary outcome measure in this review was the change in a 7 grade disability scale four weeks after randomisation. The weighted mean difference of this measure was not significant, being only 0.11 (95% CI -0.14 to 0.37) of a disability grade more improvement in the intravenous immunoglobulin group than the PE group. There were also no significant differences in other outcome measures, including time to walk unaided, mortality, and proportion of patients unable to walk without aid after a year but some of these outcome measures were only available for one trial. We also reviewed one trial involving 249 patients which compared PE followed by intravenous immunoglobulin with PE alone and another involving 37 patients which compared immunoabsorption followed by intravenous immunoglobulin with immunoabsorption alone. Neither revealed any significant differences between the regimens with and without intravenous immunoglobulin. We did not discover any dose ranging studies of intravenous immunoglobulin except for one that is ongoing. REVIEWER'S CONCLUSIONS: There are no adequate trials to determine whether intravenous immunoglobulin is more beneficial than placebo. Intravenous immunoglobulin and plasma exchange have a similar ability to speed the recovery from Guillain-Barré syndrome. Giving intravenous immunoglobulin after plasma exchange is not significantly better than plasma exchange alone. Randomised trials are needed to decide whether intravenous immunoglobulin helps in mild Guillain-Barré syndrome or in disease which has lasted more than two weeks. Randomised trials also need to establish the optimal dose.

Child↗
PubMed1979

[Principles for intensive therapy of status epilepticus in children].

A total of 113 children with brain edema of infectious and toxic nature were studied. The main clinical syndrome in these conditions was an epileptical status. Among anticonvulsive drugs used seduxen appeared to be the most effective. The use of GABA, gas narcosis and myorelaxants is recommended as well. The rehydration by plasma, low molecular plasma substitutes and glucose-polyion solutions are discussed. The paper contains some information on contraindications for early dehydration and rehydration. Hypoxia is eliminated by providing adequate lung ventilation, oxygenotherapy or hyperbaric oxygenation, by using oxidative enzymes and drugs increasing the resistance of the brain to hypoxia and hypothermia. It is recommended that hormonal therapy should be used. The techniques of urgent measures and their sequence are given.

Adrenal Cortex Hormones↗
PubMed2004

Low-dose prostacyclin restores an increased protein permeability after trauma in cat skeletal muscle.

BACKGROUND: Increased microvascular permeability inducing leakage of plasma from the intravascular to the extravascular space after trauma is a pathophysiologic event of great clinical significance. A substance reducing an increased microvascular permeability, and especially an increased protein permeability, therefore could be of value to maintain normovolemia and to reduce the need for plasma substitution. Prostacyclin is suggested to have permeability-reducing properties as shown for fluid permeability, but its effects on protein permeability, which may be controlled by partly different mechanisms, are unclear. The present study evaluates whether prostacyclin at a low, clinically relevant, nonvasodilating dose can reestablish an increased protein permeability after trauma. METHODS: The study was randomized, blinded, and performed on surgically traumatized, autoperfused, and denervated cat calf muscle. Relative changes in the osmotic reflection coefficient for albumin after 1.5 hours of prostacyclin (1 ng/min/kg) (n = 7) or vehicle (n = 7) treatment were used as a measure of altered protein permeability from a state of increased permeability after trauma. RESULTS: We found that the osmotic reflection coefficient for albumin was increased by about 35% in the prostacyclin group compared with the vehicle-treated group (p < 0.001). CONCLUSION: If applicable to humans, prostacyclin is a potential therapy for reducing plasma leakage in the critically ill trauma patient by restoring permeability from an increased level.

Animals↗
PubMedDate not supplied

[Substitutive therapies in sepsis and acute renale failure].

Substitutive treatment of sepsis associated acute renal failure is an emergent challenge in the intensive care unit due to the number of cases and to the high mortality rate. Standard hemofiltration is unable to improve survival, since a high mortality rate is sustained by the septic process. New therapeutic approaches currently available are based on the increased clearance of molecules ranging 10-30 kDa considered important in the physiopathology of sepsis and multiorgan failure. Clinical experiences in progress are: (1) adsorption resins able to bind bacterial products, cytokines, anaphylotoxins and several inflammation mediators; (2) the bioartificial kidney, that is the addition to hemofilter of human tubular cell culture grown in devices in order to mimic metabolic tubular function to a traditional hemofilter; (3) increased exchange volumes (high volume hemofiltration), up to 0-100 L/24 hr and; (4) increased membrane permeability associated with either discarded ultrafiltrate (high cut-off membranes) or plasma substitution plasmapheresis with regeneration by sorbents technology (C FA). Generally, by applying these new technologies to septic shock patients, the observed survival was higher than that predicted by the gravity score. While these results are encouraging, they are not conclusive and need further study.

Acute Kidney Injury↗
PubMedDate not supplied

[Treatment of porphyria cutanea tarda using plasma exchange].

Results in the treatment of 5 patients with porphyria cutanea tarda by plasma exchange are presented. The procedure was applied every second or third day, 2-4 procedures in total. Saline solution, 5% or 12% albumin were used as plasma substitutes. The treatment lead to rapid fall in urine porphyrin level and improved clinical picture. The treatment was continued ambulatorily by 60 mg of vitamin E tbl. daily and Essentiale tbl. 3 X 1, which lead to further progressive fall in porphyrin level and improved clinical picture. In one patient citrate intoxication occurred which was prevented by Calcium Sandosten ampl. The importance of this method in the treatment of porphyria cutanea tarda and indications for this treatment are discussed.

Adult↗
PubMed2001

Effects of colloidal resuscitation fluids on the neutrophil respiratory burst.

BACKGROUND: Experimental studies have revealed that gelatin and HES produce increased neutrophil respiratory burst activity. It was investigated whether 3-percent gelatin (MW 35,000) and three types of 6-percent HES (MW 70,000; degree of substitution, 0.5; 200,000/0.5; 450,000/0.7) preparations can influence superoxide anion production during respiratory burst under clinical conditions. STUDY DESIGN AND METHODS: Blood samples were obtained from 40 patients before and 1 hour after the infusion, before anesthesia and surgical treatment. After stimulation with bacteria (Escherichia coli), the respiratory burst was measured by oxidation of nonfluorescent dihydrorhodamine 123 to the fluorescent rhodamine 123 by the use of flow cytometry. RESULTS: Respiratory burst activity decreased significantly (p = 0.004) from the baseline (60.0 +/- 6.5%) to 1 hour after the administration of the low-molecular-weight HES preparation (55.0 +/- 6.8%). No significant differences in respiratory burst activity could be found after the administration of gelatin or medium-molecular-weight or high- molecular-weight HES solution. CONCLUSION: The investigated administration of gelatin and medium- and high-molecular-weight HES preparations did not influence respiratory burst activity under clinical conditions. However, the neutrophil respiratory burst was impaired after the administration of low-molecular-weight HES. Neutrophil respiratory burst activity may vary according to the type of colloidal plasma substitutes administered.

Adult↗
PubMed1996

Randomised trial of prophylactic early fresh-frozen plasma or gelatin or glucose in preterm babies: outcome at 2 years. Northern Neonatal Nursing Initiative Trial Group.

BACKGROUND: Preterm babies are at risk of haemorrhagic and ischaemic brain injury. One controlled trial suggested that prophylactic fresh-frozen plasma (FFP) may reduce that risk but did not clarify whether the reduction in periventricular haemorrhage seen on ultrasonography was due to a haemostatic effect or stabilisation of intravascular volume by FFP. We undertook a trial of 776 babies of gestational age at birth less than 32 weeks to look at the short-term and long-term outcome after early prophylactic FFP. METHODS: The defined primary trial outcome was survival without identifiable major disability 2 years after birth. The babies were randomly allocated, within 2 h of birth, 20 mL/kg FFP followed by a further 10 mL/kg after 24 h; or the same volumes of a gelatin-based plasma substitute; or maintenance infusion of glucose (control). The three groups were similar at trial entry. Outcome at discharge from hospital after birth (reported elsewhere) was similar in the three groups. FINDINGS: No child was lost to follow-up, and all the surviving children underwent neurological and developmental assessment at the age of 2 years. The proportions dying (21.0%, 24.9%, 20.5%), and the proportions of survivors with a severe disability (11.3%, 11.2%, 14.1%) did not differ significantly between the randomised groups. The survivors had similar mean developmental quotients at age 2 (Griffiths' quotients 94, 97, and 95). INTERPRETATION: This trial provides no evidence that the routine early use of FFP, or some other form of intravascular volume expansion, affects the risk of death or disability in babies born more than 8 weeks before term.

Blood Volume↗
PubMed2000

Plasma volume expansion for suspected impaired fetal growth.

BACKGROUND: Failure of the normal expansion of plasma volume in the mother is associated with impaired fetal growth and pre-eclampsia. OBJECTIVES: The objective of this review was to assess the effects of plasma volume expansion for suspected impaired fetal growth. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: December 1999. SELECTION CRITERIA: Randomized or quasi-randomized trials of plasma volume expansion compared to no plasma volume expansion in women with suspected impaired fetal growth. DATA COLLECTION AND ANALYSIS: Trial quality was assessed. MAIN RESULTS: No studies were included. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the use of plasma volume expansion for suspected impaired fetal growth.

Female↗
PubMed1989

Non-IgE-mediated mast cell stimulation.

The effect of a variety of non IgE-mediated stimuli on histamine release from mast cells from different locations is described. Sensory neuropeptides are shown to resemble other polycationic compounds in preferentially activating mast cells from the rat while having a limited effect on human mast cells, except possibly those from skin. Similar results were obtained with the putative non-adrenergic, non-cholinergic neurotransmitter ATP, thereby questioning the role of neuronal mast cell activation in allergy and inflammation. Bradykinin also acted selectively against rat cells while complement-derived and formylmethionyl peptides were effective against human basophils and cutaneous mast cells. The latter results may indicate a role for the skin cell in local inflammatory responses involving complement activation and in host resistance to bacterial infection. Rat mast cells and human basophils were most responsive to hyperosmolar challenge but significant effects were obtained from human pulmonary mast cells obtained by bronchoalveolar lavage. The latter cells may thus be implicated in exercise-induced asthma. The plasma substitute dextran was a specific secretagogue for the rat while morphine sulphate largely induced histamine release from human cutaneous mast cells. The latter result may account for anaphylactoid reactions to the opiate. In total these data emphasize the functional heterogeneity of mast cells from different locations and highlight the particular pharmacological properties of the skin mast cell in man.

Animals↗
PubMed1988

Hydroxyethyl starch: an alternative to plasma for postoperative volume expansion after cardiac surgery.

Hydroxyethyl starch (HES) is a recently developed synthetic volume expander. Forty patients undergoing coronary artery surgery were randomized to receive either HES or plasma protein fraction (PPF) as non-blood volume replacement according to standard haemodynamic criteria. The two groups were comparable in all respects. The median colloid use in the first 24 h was 950 ml (range 500-1500) in the HES group and 975 ml (350-2000) in the PPF group (not significant). There was no difference in blood use, urine output or blood loss between the two groups. Tests of coagulation showed the postoperative changes usual in cardiac surgical patients. There was no difference between the two groups in thrombin time, prothrombin time, activated partial thromboplastin time, or fibrinogen concentration. Similarly, tests of platelet function and Factor VIII and von Willebrand Factor activity showed no difference between the two groups. We conclude that HES is a safe and effective volume expander, and its relative lack of expense and ease of availability make its routine use after cardiac surgery an attractive proposition.

Adult↗