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The effects on blood glucose concentrations of packed red blood cells (AS-1) (group I) versus washed red blood cells (group II) for cardiopulmonary bypass prime were compared in 20 infants weighing less than 10 kg undergoing cardiac surgical procedures. All patients were anesthetized with N2O/O2/isoflurane/fentanyl and received lactated Ringer's solution prior to bypass. Blood glucose concentrations prior to bypass were 85 +/- 15 mg/dl (mean +/- SD) in group I and 81 +/- 14 mg/dl in group II. Blood glucose concentrations were 210 +/- 21 mg/dl versus 78 +/- 14 mg/dl (P less than 0.001) 10 min after initiation of bypass, 241 +/- 48 mg/dl versus 107 +/- 28 mg/dl (P less than 0.001) prior to separation from bypass, and 214 +/- 52 mg/dl versus 97 +/- 19 mg/dl (P less than 0.001) after protamine administration in group I and group II, respectively. The use of washed red blood cells for cardiopulmonary bypass priming solution in infants significantly attenuates the increase in blood glucose concentration otherwise observed during cardiopulmonary bypass.
The influence of multiple systemic factors upon the blood velocities obtained from the orbital circulations was investigated. The velocities obtained by colour Doppler imaging from the ophthalmic artery, central retinal artery, and vein from 95 ophthalmologically healthy volunteers were analyzed. The effects of age, systemic blood pressure, and smoking habit were examined. In 24 volunteers blood viscosity was also measured and its relation with blood velocity assessed. Age was weakly negatively correlated with the blood velocities in the ophthalmic artery and weakly positively correlated with resistance to flow in the retinal circulation. Systolic blood pressure showed a positive correlation with the peak systolic velocities in the arteries while cigarette smoking was associated with lower ophthalmic artery velocities. Increased haematocrit and viscosity were positively correlated with resistance to flow proximal to the ophthalmic artery and red cell rigidity negatively correlated with the pulsatility of flow in the retinal vein. These results help to identify the roles of systemic conditions in the ocular circulation. The influence of blood viscosity on retinal venous flow may be relevant to the pathogenetic mechanisms of conditions such as central retinal vein occlusion.
BACKGROUND AND PURPOSE: Red blood cell (RBC) lysis contributes to brain edema formation after intracerebral hemorrhage (ICH), and RBC hemolysate (oxyhemoglobin) has been implicated to be a spasminogen in subarachnoid hemorrhage. Whether cerebral ischemia contributes to brain edema formation after ICH remains unclear, however. The aims of this study were to test whether extravasation of RBCs induces cerebral ischemia and/or blood-brain barrier disruption in a rat ICH model characterized by perihematomal brain edema. METHODS: In this study, 87 pentobarbital-anesthetized Sprague-Dawley rats were used. In each animal, saline, packed RBCs, or lysed RBCs were injected into the right caudate nucleus. Sham injections served as controls. Regional cerebral blood flow, brain water and ion contents, blood-brain barrier integrity, and plasma volume were measured. RESULTS: Intraparenchymal infusion of lysed RBCs caused severe brain edema by the first day but did not induce ischemic cerebral blood flows. In contrast, blood-brain barrier permeability increased during the first day after infusion of lysed RBCs (a 3-fold increase) and 3 days after infusion of packed RBCs (a 4-fold increase). CONCLUSIONS: These results suggest that ischemia is not present at 24 or 72 hours after hematoma induction by injection of intact or lysed RBCs. RBC constituents that appear after delayed lysis, however, increase blood-brain barrier permeability, which contributes to edema formation.
OBJECTIVE: To compare a standardized recommended procedure for drawing blood to measure blood lipid and lipoprotein levels with the procedure commonly used in clinical practice. The aim was to see if hemoconcentration and spuriously elevated lipid levels could be avoided. DESIGN: An open randomized crossover clinical trial. SETTING: The University of Calgary. PATIENTS: Twenty-five patients with dyslipidemia. INTERVENTIONS: Blood drawing using a standardized procedure in which the patient remained seated for 5 minutes before blood collection and tourniquet use was minimized or avoided. MAIN OUTCOME MEASURES: Differences in lipid levels between the usual clinical procedure and the recommended procedure for drawing blood. RESULTS: Prior to drawing blood, laboratories have sat patients for an average of 1.4 minutes (95% CI, 0.9 to 1.9) and used a tourniquet in every patient. In the standardized procedure, patients rested for an average of 5.6 minutes (95% CI 5.0 to 6.2), and a tourniquet was used briefly in only 3 of 23 patients. There were no differences in lipid and lipoprotein values and no clinically significant difference in hemoglobin or albumin levels or in the calculation of hemoconcentration. CONCLUSIONS: Efforts to rest patients and avoid tourniquet use when drawing blood for assessment of lipid levels are unlikely to be useful.
The preservation effectivity of slaughter animal blood for consumptive purposes was studied by a method of non-phrenic action with solidified CO2. The material for studies was full pig blood stabilized with sodium citrate. The course of the changes of the blood properties studied has been described by regression equations. Blood stabilization with solidified CO2 was found to reduce the rate of aerobic microflora growth and of proteolytic changes and to extend the stability period of the coagulation system. The results of sensory studies were related to the boundary values of the studied physicochemical and microbiological quality factors. The admissible periods of blood storage were determined from the results of the studies. It was found that practical preservation of blood stabilized with solidified CO2 was 15 full days at 5 degrees C, 6 days at 10 degrees C and 4 days at 15 degrees C, and it was two, three and four times greater at the three successive temperatures, as compared with the preservation of control blood.
OBJECTIVE: To investigate the risks of high and low blood pressure levels determined by ambulatory blood pressure monitoring and home blood pressure measurements. METHODS: A long-term prospective study of all-cause mortality and cardiovascular mortality has been conducted in Ohasama, Japan since 1987. RESULTS: The Cox proportional hazards model after adjusting for age and sex demonstrated that, during a 5-year follow-up period involving 893 of the subjects aged 50 years or more in this cohort, those with the lowest quintile of ambulatory blood pressure levels exhibited a significantly higher hazard ratio for cardiovascular and for all-cause mortality. During the same follow-up period, of 1226 subjects aged 50 years and more, those with the lowest and highest quintiles of home blood pressure levels demonstrated a significantly higher hazard ratio with respect to cardiovascular and all-cause mortality (i.e., a J-shaped relationship). CONCLUSION: These results suggest that there is a significant risk associated with low blood pressure levels, which can be determined by ambulatory and home blood pressure measurements, but not by casual blood pressure measurements.
BACKGROUND: Blood transfusion is often necessary in operations for total hip replacement (THR). This study was done to investigate the efficacy of three different methods of autologous blood conservation and transfusion in patients undergoing primary THR without cement. STUDY DESIGN: One hundred fifty-five patients with osteoarthritis underwent unilateral cementless THR using normotensive general anesthesia performed by a single surgeon. The patients were divided into four groups depending on which conservation method was used. Ten different demographic and hematologic parameters were recorded and analyzed by using analysis of the variance and multiple regression methods. RESULTS: All three methods were effective in reducing the need for homologous blood transfusions. The greatest benefit was realized when both preoperative autologous blood donation and intraoperative salvage using the Cell Saver were combined. The addition of postoperative salvage and retransfusion of wound drainage blood using the Solcotrans System did not significantly reduce further the chance of homologous blood transfusions. CONCLUSIONS: The data from this study were similar to previously published reports. Regression analysis confirmed the correlation among the different variables studied. We currently offer preoperative donation and intraoperative salvage with the Cell Saver to patients undergoing cementless total hip replacement.
We analyzed preoperative blood preparation and intraoperative blood transfusion in Kagawa Prefectural Central Hospital and evaluated the effectiveness of maximum surgical blood order schedule (MSBOS) and Type and Screen (T&S). Forty seven kinds of surgery were performed on 1,283 cases from May, 1991 to April, 1992. Transfusion was performed in 179 cases of them. All of 1,884 units of blood that had been prepared, were crossmatched and 1,078 of them were actually transfused. The Crossmatched to Transfused ratio (C/T ratio) was 1.71. If we adopted MSBOS and T&S in 13 elective surgery, 766 units of blood and labour work for preoperative blood preparation could have been saved. MSBOS and T&S are beneficial for efficient usage of blood transfusion in surgery.
Aim of the present paper is to study the modifications of some laboratory parameters most related to glycaemic metabolism during 24 hours of feed-back glycaemic control by artificial beta-cell. Twelve subjects affected by insulin dependent diabetes mellitus were submitted to GCIIS BIOSTATOR Miles evaluating, before and after 24 hours, blood tryglicerides, cholesterol, uric acid, sodium, potassium. A significant variation was found between the trygliceridemic values before and after automatic control. There was no variation in natriemic values before and after control. Variations, but not significant, were found in cholesterolemic, kaliemic and uricacidaemic values.
A man aged 42 years died from a hemorrhage resulting from stab wounds in his neck, chest and abdomen. The MN blood group and PGM1 phenotype of the victim's heart blood were inconsistent with those of the blood stains around the victim. The victim was transfused with 4000 ml of blood during the 9 hours before his death. Because PGM1 phenotypes obtained from blood stains at the scene of the crime and from the weapon corresponded with those from the victim's dental pulp, peripheral nerve and bone marrow, the victim's blood groups and isoenzymic phenotypes could be determined accurately.
OBJECTIVE: Our purpose was to compare the rate of consumption of maternally donated red blood cells with the rate of red blood cells from volunteers in fetuses affected by red blood cell alloimmunization. STUDY DESIGN: The rate of hemoglobin decline was calculated in 293 fetal transfusions in 52 pregnancies, in 43 patients affected by red blood cell alloimmunization from 1987 to 1996. Fifty-eight transfusions were excluded from analysis. Hemoglobin decline was stratified by gestational age. The rates of consumption were compared with use of unpaired t tests. RESULTS: The rates of hemoglobin decline (in grams per deciliter per day) were 18 to 24 weeks, 0.47 volunteer and 0.38 maternal (p = 0.174); 25 to 28 weeks 0.41 volunteer, 0.34 maternal (p = 0.46); 29 to 32 weeks, 0.35 volunteer, 0.33 maternal; > or = 33 weeks, 0.37 volunteer, 0.25 maternal, p = 0.048). Hemoglobin decline was less for the maternal donation group than for the volunteer donation group throughout gestation, becoming significant only in fetuses at > or = 33 weeks. CONCLUSION: In the red blood cell-alloimmunized fetus, there is less consumption of maternal than of volunteer red blood cells. This difference reaches a statistical significance only in late gestation.
The interrelationship of dietary calcium (Ca) intake, alcohol consumption, blood lead (BPb), blood cadmium (BCd), age, and body mass index (BMI) to blood pressure was examined in 267 peasant women 40-85 years of age. They were residents of two rural areas in Croatia and differed with regard to dietary Ca intake: 100 women with low Ca intake (approximately 450 mg/day) and 167 women with relatively high Ca intake (approximately 940 mg/day). All of the women were nonsmokers and consumed very little or no alcohol. Median and range BPb values were 74 (29-251) microg/L in women with low Ca intake and 59 (21-263) microg/L in women with high Ca intake (p < 0.0002), whereas corresponding BCd values were 0.6 (0.2-3.6) microg/L and 0.6 (0.3-4.5) microg/L (p > 0.10). Results of multiple regression showed a significant (p < 0.05) increase in systolic blood pressure with age, BMI, and BCd, and marginally with alcohol consumption (multiple r = 0.48, p < 10(- 6)). An increase in diastolic blood pressure was significantly (p < 0.05) associated with BMI, age, and residence area (i.e., it was higher in women with low Ca intake), and marginally with BCd, and alcohol consumption (multiple r = 0.38, p < 10(-6)) When the two groups of women with different Ca intake were subdivided into consumers and nonconsumers of alcohol, BPb was related positively to alcohol consumption and inversely to Ca intake. The highest BPb was found in the subgroup of alcohol consumers with low Ca intake, and the lowest BPb in the subgroup of nonconsumers with high Ca intake: 78 (42-251) microg/L and 51 (22-192) microg/L, respectively (p < 10(-8)). Diastolic blood pressure was significantly higher in the former subgroup as compared to the latter: 95 (72-130) mm Hg and 90 (60-120) mm Hg, respectively (p < 0.05). This cannot be explained by age, BMI, or BCd, which were comparable in the two subgroups. The results indicate that alcohol consumption and low Ca intake can increase BPb, which may significantly contribute to an increase in diastolic blood pressure in female nonsmokers even at relatively low-level Pb exposure.
Hypertension has been related to the development of brain damage, dementia and other CNS dysfunctions. Disruption of the blood-brain barrier (BBB) is thought to contribute to these disorders. In this study, the integrity of both blood-brain and blood-CSF barriers during chronic hypertension was investigated. For this, the entry of [14C]sucrose and of lanthanum into brain tissue, choroid plexus, and CSF was studied. Also brain regional blood flow and brain [14C]sucrose volume of distribution were measured using indicator fractionation and ventriculo-cisternal perfusion methods, respectively. The above measurements were performed in normotensive (WKY) rats and in the spontaneously hypertensive rats (SHR). Choroid plexus and CSF uptakes of [14C]sucrose were found to be significantly greater in SHR compared to WKY rats (P<0.05). Intercellular entry of lanthanum was observed in choroidal tissue of SHR but not in that of WKY rats and at the BBB. Choroid plexus blood flow was significantly greater in SHR, 2.82+/-0.21 ml g(-1) min(-1), compared to 2.4+/-0.08 ml g(-1) min(-1) in WKY (P<0.05). There were no significant differences (P>0.05) in brain % water content and extracellular fluid [14C]sucrose volume of distribution between SHR and WKY rats. However, choroid plexus showed greater % water content in SHR (85.7+/-1.9%) compared to the WKY rats (81.5+/-1.7%). These results suggest that chronic hypertension in SHR may cause more pronounced defects in the integrity of the blood-CSF barrier than in the BBB.
We describe an operating theater blood transaction system (OTBTS) that is a novel computer software system incorporating electronic crossmatch and the concept of a "self-service" blood banking system in the operating theater. Through this system, the surgeons and the anesthetists can issue blood units for intraoperative transfusion for the patients with a negative antibody screen without the need for a porter service or pneumatic tube system. Since implementation of the OTBTS, the time for obtaining compatible blood for intraoperative transfusion has been reduced from 20 to 30 minutes to around 1 minute. Furthermore, the crossmatch-transfusion ratio was reduced to 1.05. The 23% of patients who required extra blood units (i.e., more than originally anticipated) during surgery further benefited from the system. The blood stock reserved for patients undergoing surgery was reduced by 20%. Therefore, the OTBTS is a system that can greatly enhance the efficiency and safety of intraoperative transfusion and can also save workforce resources.
A simple, low pressure, blood scavenging system has been assessed in major abdominal vascular operations. The aim of this study was to assess the quality of blood obtained with this device and its suitability for reinfusion. Three areas of special interest, which have not been reported so far, are the fate of plasma complement, the load of fat aspirated after tissue dissection and the degree of bacterial contamination in the scavenged blood. The development of autologous blood scavenging systems is reviewed. The features which most affect the quality of scavenged blood are identified and their importance discussed by comparison with our experience. Key features of our system were: simplicity of the apparatus, controlled low-pressure aspiration, the use of systemic heparin and the avoidance of mechanical pumps. The blood obtained was of excellent quality with good preservation of cellular elements, platelets and fibrinogen. Plasma total haemolytic complement, C3 and C4 fractions were preserved in normal, though slightly reduced, quantities. Lipid (triglyceride) content was minimally increased after filtration. Bacterial contamination was present in all cases, but at a very low level provided that aspiration was limited to the peritoneal cavity. This low-level of contamination is not thought to be of great significance; its origin and importance are discussed.
Investigations were performed concerning the influence of the pH on the stability of factor VIII during the collection of blood and during the storage of blood and plasma for varying periods and at varying temperatures. It was found that the low pH of ACD anticoagulant solution (pH 4.9) caused a loss of factor VIII procoagulant activity of 10-15% during the collection of blood. However, when less acidic anticoagulant solutions were used, substantial losses of factor VIII occurred during the storage of blood. We concluded that the optimal pH of both the anticoagulant solution and the stored blood, should be between 6.7 and 7.0. However, no anticoagulant solution is known that meets these requirements. In practice ACD ensures the highest recovery of factor VIII in cryoprecipitate, at least in those cases where the blood donations are stored for several hours before separation and freezing of the plasma.
BACKGROUND AND OBJECTIVES: Currently, the bacterial contamination of blood constitutes one of the major infectious risks of transfusion. The aim of this study was to evaluate the bactericidal effect of blood on various bacterial species and to determine the influence of prestorage conditions and white blood cell (WBC) filtration on the reduction of the bacterial load in isolated red blood cells (RBCs). MATERIALS AND METHODS: The growth kinetics of eight different species of bacteria were studied at 20 degrees C in deliberately contaminated RBC units. Further experiments evaluated the effect of prestorage conditions and WBC filtration on the viability of two model bacteria (Klebsiella oxytoca and Staphylococcus epidermidis) in comparison to previous results obtained with Yersinia enterocolitica. RESULTS: For bacteria susceptible to the bactericidal effect of blood (mainly Gram-negative rods), a reduction of the bacterial load was obtained within 2 h of prestorage at 20 degrees C. When the prestorage period was prolonged beyond 3 h at 20 degrees C, rapid growth was observed with some Enterobacteriaceae. Whereas WBC filtration reduced dramatically the viability of Y. enterocolitica, it had only a minimal effect on the viability of S. epidermidis and K. oxytoca. However, the two latter species of bacteria did not survive prolonged storage at 4 degrees C. CONCLUSIONS: Experiments conducted under realistic conditions are needed to determine whether it would be worthwhile recommending the rapid storage of RBCs at 4 degrees C after WBC reduction of the blood product.