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At least 19 recordsLinked to original sources
PubMed2000

Fulminant babesiosis treated with clindamycin, quinine, and whole-blood exchange transfusion.

BACKGROUND: Babesiosis is an increasingly recognized parasitic infection with manifestations that range from a subclinical or mild flu-like illness to life-threatening disease. Risk factors that may be associated with a more severe clinical course include immunosuppression, splenectomy, and advanced age. The most effective chemotherapeutic regimen, clindamycin plus quinine, is sometimes ineffective in cases of severe disease. CASE REPORT: A previously healthy, 58-year-old man was infected by Babesia microti, presumably through a tick bite. He developed fulminant disease characterized by severe hemolytic anemia, disseminated intravascular coagulation, acute renal failure, and respiratory failure. There was no history of splenectomy or immunodeficiency. He was given oral clindamycin (300 mg/4x/day) 2 days before admission. Oral quinine (650 mg/3x/day) was added upon hospitalization. There was no clinical improvement despite antibiotic therapy with clindamycin and quinine. On the second hospital day, a whole-blood exchange transfusion was performed to simultaneously lower the parasite load and replace the patient's plasma. With an automated blood cell separator, 87 percent of the patient's total blood volume was exchanged. As replacement fluid, 6.7 L of packed RBCs reconstituted with FFP (average Hct, 33%) was used. The patient's Hct increased from 26.9 percent before the exchange to 28.3 percent after the exchange. The percentage of parasitized RBCs decreased from 13.8 percent just before exchange to 4.2 percent immediately after exchange. There was rapid clinical improvement after the whole-blood exchange transfusion. The patient's subsequent clinical course was marked by a disappearance of the parasitemia and continued slow, general improvement. Therapy with clindamycin was continued for 14 days after the exchange transfusion and quinine for 17 days. CONCLUSION: In cases of severe babesiosis, prompt institution of whole-blood exchange transfusion, in combination with appropriate antimicrobial therapy, can be life-saving.

Animals↗
PubMedDate not supplied

Use of whole blood exchange transfusion to supply neutrophils to septic, neutropenic neonates.

When neutropenia due to exhaustion of the marrow neutrophil reserve, develops in a neonate with bacterial sepsis the likelihood of survival is very small. We report such a case who was treated with a double-volume exchange transfusion using fresh unstored whole blood. We were able to determine a net gain of 5 x 10(8) neutrophils per kg. Then, in neutropenic neonatal animals, neutrophil transfusion by double-volume exchange transfusion with unstored blood was investigated.

Agranulocytosis↗
PubMed1980

Glucose perturbation in experimental hyperviscosity.

Hyperviscosity was produced in one member of each of 7 sets of twin newborn lambs by an exchange transfusion with 500 ml maternal packed red blood cells. The remaining seven control twin lambs underwent an identical exchange with maternal whole blood. Postexchange hematocrits were 63 +/- 6 and 29.0 +/- 3% (mean +/- S.E.), respectively (P less than 0.01). Whole blood viscosity measured at 3 rpm increased from 3.2 +/- 0.4 centipoise (cps) to 14.4 +/- 6.1 cps in the lambs made hyperviscous (P less than 0.01) and remained unchanged in the control lambs (2.2 +/- 0.1 versus 2.8 +/- 0.3 cps). A 2-hr steady state glucose infusion was performed on each lamb before and after the packed cell or whole blood exchange transfusion. Mean steady state plasma glucose concentrations were significantly decreased from pre-exchange steady state glucose infusion levels in the same lambs made hyperviscous (P less than 0.05), whereas steady state glucose levels increased from preexchange levels in the twin lambs exchanges with maternal whole blood. Mean plasma insulin and glucagon values for the hyperviscous and control lambs remained unchanged during the glucose infusion.

Animals↗
PubMed1983

Fulminant Plasmodium falciparum infection treated with exchange blood transfusion.

A 48-year-old physician, who was not undergoing malaria chemoprophylaxis, contracted Plasmodium falciparum while working in eastern Thailand. In the hospital, he had a peak parasitemia of 72% RBCs infected, associated with CNS dysfunction. As an adjunct to chemotherapy, a double-volume whole-blood exchange transfusion was performed on the first hospital day, dropping the parasitemia to less than 1% within 32 hours. The patient's clinical condition improved, with a prompt reversal of CNS, hepatic, and renal complications. These results, combined with those in previously reported cases, suggest that exchange transfusion should be considered more generally as a life-saving procedure in P falciparum infections.

Acute Disease↗
PubMed1998

Acute normovolemic red cell exchange for cardiopulmonary bypass in sickle cell disease.

A patient with sickle cell disease (hematocrit, 28.5%; hemoglobin S fraction, 79%), required mitral valve repair. Partial red cell removal and blood component sequestration with an autotransfusion device before cardiopulmonary bypass initially decreased the sickle red cell mass. This was followed by an acute one-volume whole blood exchange transfusion performed upon the initiation of cardiopulmonary bypass, resulting in a further reduction. Both techniques yielded fresh autologous plasma for use; sequestration yielded a platelet-pheresis product. Adequate postbypass hemostasis was demonstrated.

Adolescent↗
PubMed1995

Effect of transfusion in acute chest syndrome of sickle cell disease.

OBJECTIVE: To study the effects of transfusion on the clinical course and oxygenation indexes of children with sickle cell disease and acute chest syndrome. METHODS: During a 2-year period, 36 children with sickle cell disease admitted with a total of 40 episodes of acute chest syndrome were examined. Patients were given a clinical severity score indicative of the degree of respiratory distress. Arterial blood gas values were determined 4 to 24 hours before and 12 to 24 hours after transfusion, and indexes of oxygenation were calculated; six patients who were not given transfusions also had blood gases measured on admission and approximately 24 hours later for comparison. RESULTS: Blood transfusion was administered during 27 episodes (67.5%); 20 children received a simple packed cell transfusion, four had a partial packed cell exchange transfusion, and three had a simple transfusion followed by whole blood exchange transfusion because of worsening clinical symptoms. Although there was no significant change in oxygenation indexes for the six patients not treated with transfusion, there was significant improvement in all indexes after transfusion. The transfused group had more severe disease on admission, but there was no significant difference in duration of fever, tachypnea, retractions, or hospital stay between the transfusion and the nontransfusion groups. CONCLUSION: Blood transfusion, even simple transfusion of packed erythrocytes, significantly improves oxygenation in children with acute chest syndrome and is a valuable adjunct to therapy.

Acute Disease↗
PubMedDate not supplied

[Neonatal exchange transfusion with irradiated whole blood. Preliminary results].

Some clinical manifestations following exchange transfusion (ET) could result from graft versus host disease secondary to the introduction of viable foreign T lymphocytes: skin rash, fever, acute and sometimes bloody diarrhea or enterocolitis. Between February 1985 and January 1989 the blood used for 31 ET was irradiated at 40 grays. We compared the manifestations occurring during the days following ET to those occurring after 44 previous ET with non irradiated blood during the period January 1981 to January 1985. From 1981 to 1985, 13 of 44 infants developed problems within 3 days following ET: an erythematous macular skin rash in 4; gastrointestinal manifestations (diarrhea, vomiting and rectal bleeding, necrotizing enterocolitis) in 7; both skin lesions and a gastrointestinal problem in 2. Since 1985, 27 infants had no problems whereas only 4 developed gastrointestinal or cutaneous manifestations: NEC in a preterm infant, abdominal distension with rectal bleeding, fever and petechial rash in 2 infected infants. These data show a dramatic decrease of complications since the irradiation of blood products has been started: 30% with non irradiated, 13% with irradiated blood.

Exchange Transfusion, Whole Blood↗
PubMed1987

Hemodynamic consequences of neonatal polycythemia.

The hemodynamic consequences of neonatal polycythemic hyperviscosity and the effects of partial exchange transfusion were evaluated in 13 infants. Mean (+/- SD) venous hematocrit was 72% +/- 2.5%. After partial exchange transfusion, whole blood viscosity at a shear rate of 11.5 sec-1 decreased from 16.2 to 8.4 centipoise. There were significant (P less than 0.05) increases in heart rate (127 +/- 7.5 to 139 +/- 7.8 beats/min), Doppler-derived cardiac index (200 +/- 35 to 263 +/- 48 ml/kg/min), left ventricular stroke volume index (1.56 +/- 0.23 to 1.89 +/- 0.33 ml/kg), systemic oxygen transport (51.4 +/- 8.4 to 57.9 +/- 11.9 ml/kg/min), and laser-Doppler peripheral (cutaneous) blood flow (+80%) after partial exchange transfusion. The increase in cardiac index probably resulted from reductions in pulmonary and systemic vascular resistance index, the latter decreasing from 0.26 to 0.19 mm Hg/ml/min/kg-1. The greater increase in cutaneous blood flow (+80%) versus cardiac index (+32%) after exchange transfusion suggests hemodynamic compromise and a redistribution of blood flow away from organs that use little oxygen during polycythemia. Our data provide a possible basis for the symptoms of neonatal polycythemia, and demonstrate the acute hemodynamic benefits of partial exchange transfusion.

Blood Pressure↗
PubMedDate not supplied

Increasing whole blood oxygen affinity during rapid exchange transfusion: a potential hazard.

Whole blood cell separators are being used to achieve partial exchange transfusions in patients with hemoglobin S. The rate and extent of the alteration of whole blood oxygen affinity, incurred by this procedure, has been determined in a patient with Hb S/C disease. The implications in terms of oxygen delivery to the tissues are described for this patient and also for patients with the more severe disease associated with Hb S/S. It is concluded that whole blood cell separators should be used with an awareness of the possible detrimental effects of acute increases of whole blood oxygen affinity in these patients.

Adult↗
PubMed1987

Enzyme replacement therapy in a patient with hyperargininemia.

In a patient with hyperargininemia, enzyme replacement therapy such as whole blood exchange transfusion or erythrocyte transfusion was performed, and its effect was confirmed in vitro as well as in vivo. The patient has been treated with the restriction of protein intake, oral administration of an essential amino acid mixture, and sodium benzoate or phenylacetic acid. With these treatments, his plasma ammonia levels were controlled. On the other hand, plasma and CSF concentrations of arginine were not so well controlled. With whole blood exchange transfusion and erythrocyte transfusion, plasma arginine concentrations and plasma ammonia levels were controlled. These effects have continued for about 3 months. Furthermore, the effect of exchanged erythrocytes on the blood arginine levels was also confirmed by in vitro experimentation that mixes arginine with erythrocytes in the medium RPMI 1640. Arginine concentration of the medium did not decrease when arginine was mixed with erythrocytes of the patient, but when arginine was mixed with erythrocytes of mother or normal controls, it decreased rapidly. In calculation, 10(7) of erythrocytes of the mother or normal controls was presumed to metabolize 4-5 nmole of arginine per day. From these results, the erythrocyte exchange transfusion is considered to be effective for the control of clinical and biochemical abnormalities in this disorder.

Amino Acid Metabolism, Inborn Errors↗
PubMed2000

Usefulness of exchange transfusion in acute liver failure due to severe falciparum malaria.

Acute hepatic failure is a rare and serious complication of severe falciparum malaria. The management of uncomplicated falciparum malaria comprises of specific antimalarial drugs and supportive therapy. In a few patients who are critically ill because of severe falciparum malaria and heavy parasitaemia, exchange transfusion has been used. We describe a young male Saudi patient who presented with a 2-day history of fever, jaundice, and confusion. On examination he was deeply jaundiced, confused, and irritable. There were no signs of chronic liver disease. His laboratory workup revealed a markedly raised direct hyperbilirubinaemia and transaminases with prolonged prothrombin time. His serology was negative for HbsAg, HBc IgM, anti-HCV, HAV IgM, HEV IgM, and IgG. He was initially treated with parenteral quinine and other supportive treatment, without any improvement of his clinical and laboratory parameters. At this stage he was treated with whole blood exchange transfusion. He slowly improved, with complete normalization of his liver function tests and prothrombin time.

Adult↗