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Biomedical subjects

H E Heier

Publications and source records attributed to H E Heier.

At least 19 recordsLinked to original sources
PubMed2006

Transfusion vs. alternative treatment modalities in acute bleeding: a systematic review.

BACKGROUND AND METHODS: The practice of transfusion varies a great deal between countries and hospitals. Therefore, a systematic literature review was performed to evaluate the evidence underlying practice of transfusion and alternative treatment modalities in acute bleeding. After a stepwise evaluation, 79 out of 2438 abstracts were approved as the evidence base. RESULTS: Albumin for volume therapy is not better than artificial colloids or crystalloids and may be detrimental in trauma patients. No outcome difference has been proved between artificial colloids and crystalloids. Use of hypertonic solutions remains controversial, as do the concepts of delayed and hypotensive resuscitation. Healthy individuals tolerate acute, normovolaemic anaemia at 5 g haemoglobin/dl, but pre-operative haemoglobin < 6 g/dl gives increased mortality from surgical interventions. Keeping haemoglobin higher than 8-9 g/dl has not been associated with any positive effect on mortality or morbidity, even in patients with cardiovascular disease. The changes induced in erythrocytes by storage may be clinically insignificant. No alternative to erythrocyte transfusion was established. Evidence underlying the practice of thrombocyte and plasma transfusion is scarce. Available evidence on recombinant coagulation factor VIIa is insufficient to define its future role in acute bleedings. Antifibrinolytic drugs in general seem to reduce the need for transfusion. CONCLUSIONS: Intravenous volume replacement and transfusion policies seem largely based on local tradition and expert opinions. As a result of the difficulties in performing controlled studies in patients with acute bleeding and the large number of patients needed to prove effects, other scientific evidence should be sought to better define best practice in this important field.

Acute Disease↗
PubMed2005

Motivation, recruitment and retention of voluntary non-remunerated blood donors: a survey-based questionnaire study.

BACKGROUND AND OBJECTIVES: The aim of this study was to establish which motivational and socio-demographic factors are important for the development of a long-term commitment as a voluntary, non-remunerated blood donor. STUDY DESIGN AND METHODS: A cross-sectional sample survey of active blood donors in Oslo, Norway, was conducted. Donors filled in a self-administered questionnaire during donation. Data on motivation were analysed using factor analysis. RESULTS: The blood donors' socio-demographic characteristics were found to be similar to those of the population as a whole. The single, most important, recruitment channel was the influence of active blood donors. Five dimensions of blood-donor motivation were identified with factor analysis. These were: altruism and empathy; social reasons (such as the influence of friends and family); strengthening of one's self-esteem; positive experiences associated with donation; and a moral obligation to donate. Support for statements on altruistic motives for donation was strong and similar in long-time and short-time donors. In contrast, short-time donors were more likely to be motivated by factors related to self-esteem than were long-term donors. CONCLUSION: The 'good habit' of continued blood donation seems not to be exclusively linked to a high degree of reported other-regarding ('altruistic') reasons, but also to a combination of motives, including some modestly self-regarding motives.

Altruism↗
PubMed2001

Risk behavior in Norwegian blood donors.

BACKGROUND: Blood banks ensure the safety of blood components by testing them for a set of known infectious agents and by careful selection of donors based on a self-administered questionnaire and an interview. The purpose of this study is to describe the risk behavior for sexually transmitted diseases in Norwegian blood donors. STUDY DESIGN AND METHODS: A survey of the sexual habits of 5,859 blood donors in the capital of Norway was performed by using anonymous questionnaires. The results were compared with a previous survey of 10,000 randomly selected Norwegian subjects aged 18 to 60 years. The response rates were 70.3 percent and 48.4 percent, respectively. RESULTS: Blood donors had considerably more education than the general population. Their general sexual behavior was similar to that of the rest of the population, although the blood donors had later sexual debut, fewer new partners per year, and a lower frequency of intercourse. In addition, homosexual experience among males was much lower in the donor group. Blood donors were less likely to engage in risk behavior for sexually transmitted diseases than were the general population. Nevertheless, 1.5 percent of the donors reported behavior that would have led to deferral had the behavior been disclosed at the predonation interview. Deferrable donors were more likely to be male and young and to have had many partners. CONCLUSION: Anonymous questionnaires reveal information that is not given at the time of blood donation.

Adolescent↗
PubMed2000

The clinical expression of hemochromatosis in Oslo, Norway. Excessive oral iron intake may lead to secondary hemochromatosis even in HFE C282Y mutation negative subjects.

BACKGROUND: The prevalence of hereditary hemochromatosis in Norway is one of the highest reported in the world. However, the clinical presentation in patients with hemochromatosis in Norway seems to be different compared with recent studies elsewhere. The aim of this study was to investigate patients with hemochromatosis in one community hospital in Norway and to study the prevalence of the C282Y mutation. METHODS: One hundred and twenty patients were consecutively admitted to one medical department in Oslo. Serum transferrin and ferritin concentrations were measured in all patients, and a percutaneous liver biopsy was obtained in 108 of 120 (90%) patients. Stainable iron (Perls stain) in hepatocytes was graded from 0 to 4+ and fibrosis from 1 to 4. Genotyping for the C282Y and H63D mutation in the HFE gene was performed by PCR-RFLP. RESULTS: Forty-eight (40%) of the patients suffered from tiredness and astenia and 29 (24%) had typical arthropathy. Only 5 of 105 (4.5%) had biopsy confirmed cirrhosis and 5 had diabetes mellitus. Patients referred from a blood bank had significantly less symptoms and signs compared with other patients. Twenty-one of 120 (17.5%) patients were C282Y mutation negative. Seventeen (81%) of these patients (16 women and 1 man) had a history of extensive oral iron intake lasting from 5 to 50 years. When excluding those with extensive oral iron intake (n = 17), 92 of 103 (89%) were homozygous for the C282Y mutation, 7 (7%) were heterozygous including 3 compound heterozygous and 4 (4%) were mutation negative. CONCLUSIONS: Only a minority of our patients with hemochromatosis had a far advanced disease at the time of diagnosis (less than 5% had cirrhosis) and hemochromatosis in a majority of the C282Y mutation negative patients was associated with excessive oral iron intake for several years.

Adult↗
PubMed1998

[Genetic diagnostic test for hemochromatosis].

Haemochromatosis is an inherited, recessive trait and is among the most common genetic diseases in Norway. It is caused by a pathological increase in the absorption of iron from the intestine. This in turn leads to excessive deposits of iron in the organs of the body, e.g. in the liver and pancreas, with concomitant symptoms and frequently organ failure. The mutated gene (HFE), which causes the vast majority of cases of haemochromatosis, has recently been described in a study from the U.S. Based upon this finding, we have established a genotyping protocol for this mutation. We discuss our preliminary experiences using this test as a diagnostic tool, as well as the implications of how it will affect diagnosis. The test is of considerable value, and we suggest that its use should be mandatory in the diagnosis of haemochromatosis.

Adult↗
PubMed1998

[How soon will we have artificial blood?].

The development of red cell substitute oxygen-carriers has reached a stage where stroma-free haemoglobin solutions (SFHSs) and perfluorocarbon-based substitutes are undergoing clinical trials. However, there is no evidence to suggest that such products will become available, other than for restricted, well-defined indications. Where SFHSs are concerned, the supply of haemoglobin, the strictly limited shelf-life, and the short intravascular half-life are the most important problems to be solved, whereas the use of perfluorocarbons is limited, in particular due to the need of positive pressure ventilation to maintain high oxygen tension. Red cell substitutes for general use will remain a dream in the foreseeable future. Measures to enhance blood preservation and to promote the optimal use of blood products will be the most important areas of transfusion research in the immediate future.

Blood Substitutes↗
PubMed1998

Different genotypes causing indiscernible patterns of A expression on A(el) red blood cells as visualized by scanning immunogold electron microscopy.

BACKGROUND AND OBJECTIVES: The published sequence of the weak. A subgroup Ael gene from Swedish individuals showed a G insertion in exon VII, causing a frameshift at codon 268 (the A1 gene has 353 codons). We wished to sequence exons VI and VII of two Norwegian Ael individuals and compare the expression of A substance on RBC from different Ael individuals. MATERIALS AND METHODS: Exon VI and VII were amplified by PCR, cloned in M13 and sequenced. A structure expression on Ael RBC was studied by the immunogold technique. RESULTS: In contrast to the Swedish Ael individuals, the two Norwegians had consensus A1 sequences in exon VI and VII. However, the patterns of A expression were indiscernible from the Swedish cases as visualized by immunogold labeling in SEM. In both cases, a few (1-2%) RBC were very strongly labeled, some were weakly labeled and the majority (95%) were unlabeled. CONCLUSION: Although some Ael individuals have an inserted nucleotide in exon VII of the ABO gene, others have consensus A1 sequence in exon VI and VII. However, we could not find any differences in phenotype by immunogold labeling in SEM.

ABO Blood-Group System↗
PubMed1997

Prevalence of hemochromatosis among first-time and repeat blood donors in Norway.

BACKGROUND/AIMS: The observed prevalence of hemochromatosis has ranged considerably from 0.05 to 0.37% in studies requiring liver biopsy. We aimed to study the prevalence of genetic hemochromatosis among Norwegian blood donors. METHODS: We studied 10,552 healthy blood donors (5312 women and 5240 men) using serum ferritin as a screening parameter. If serum ferritin concentration was > or = 100 micrograms/l in women and > or = 200 micrograms/l in men, serum iron and transferrin (measured as total iron binding capacity = TIBC) were measured. Blood donors who repeatedly had a transferrin saturation above 40% and a ferritin concentration above these limits were referred to a hepatologist (H.B.). RESULTS: Serum ferritin was > or = 100 micrograms/l in 94/5312 (1.8%) women and > or = 200 microliters in 79/5240 (1.5%) men. Of these, 37 persons had a serum ferritin concentration above 100 micrograms/l (females) or above 200 micrograms/l (males) and a transferrin saturation above 40%. Nineteen of them (13 men and 6 women, median age 36 years, range 28-68) were identified as having hemochromatosis on the basis of increased hepatic iron index. Serum ferritin ranged from 111 to 1980 micrograms/l (median 357 micrograms/l and transferrin saturation from 50 to 100% (median 92%), hepatic iron from 48 to 471 mumol/g dry weight (median 118 mumol/g) and hepatic iron index from 1.5 to 12.1 (median 3.0). One person had cirrhosis and none had diabetes. The prevalence of hemochromatosis was significantly higher among first-time blood donors (12 out of 3500 [3.4/1000]) compared with repeat donors (7 out of 7052 [1/1000]), p < 0.005. CONCLUSIONS: The observed prevalence of hemochromatosis in Norwegian first-time blood donors of 0.34% is comparable to recently observed prevalences in other studies. However, the use of serum ferritin as a first-step screening tool may have failed to detect hemochromatosis in the early stage where iron overload has not yet occurred.

Adolescent↗
PubMed1996

[Quality adjusted life years in assessment of preventive measures. Should blood donors be tested for HTLV-I/II infections?].

In planning preventive health measures, quality adjusted life-years (QALYs) are useful as a measure of benefit. As an example, the question of whether blood donors should be routinely tested for antibodies to the Human T-lymphotropic viruses I and II (HTLV I/II) is analysed. A mathematical model was set up to describe the consequences, in terms of lost life-years and years with disease due to transfusion-mediated infection (if testing is not performed) or years with reduced quality of life (in the case of testing). These future outcomes were discounted and converted to QALYs. The cost per QALY is about NOK 2.33 million when the prevalence is 1 per 50,000 blood donors, and is reduced to 190,000 per QALY when the prevalence is 10 per 50,000. Using QALYs in evaluation of preventive medicine can be complicated, and calls for cooperation between epidemiologists and health economists.

Blood Donors↗
PubMed1996

[Maternal blood group 0 as a risk factor of neonatal hyperbilirubinemia requiring treatment].

The present prospective study indicates that children of mothers with blood group O run a double risk of hyperbilirubinemia requiring treatment as compared to children of mothers of blood group A, and 5-10 times increased risk of needing exchange transfusion. The most frequent cause of need for exchange transfusion was ABO-incompatibility between mother and child. A positive direct antiglobulin reaction in an ABO-incompatible child in need of treatment doubles the risk of exchange transfusion being required. Blood group O in the mother should be considered to be an independent risk factor for the child, and O-pregnant women should be ABO-grouped for this reason.

ABO Blood-Group System↗
PubMed1996

[Changing the use of albumin at the Oslo hospital].

An increasing demand for albumin in Oslo hospitals in the early 1990s instigated measures to reduce its use. During the autumn of 1993 a letter was sent to all doctors at Ullevål hospital informing them about the lack of documentation that albumin supplementation has a positive effect on outcome in critically ill with an albumin concentration of more than 20 g/l. In May 1994 the blood bank at Ullevål hospital stopped supplying 4% albumin solutions. A 20% reduction in use of albumin was observed after the letter of information, followed by a 50% reduction after the 4% solution was withdrawn. It is concluded that greater awareness of lack of information about the effects of albumin in critically ill patients has led to a more restrictive use of albumin. During the same period the use of polygeline increased, leading to the assumption that colloids other than albumin are being used for volume substitution.

Albumins↗
PubMed1996

Self-sufficiency for plasma and plasma proteins in Norway.

Self-sufficiency has been achieved in Norway with regard to all major blood products even with the collection of only 41,906 units of whole blood and 2,586 plasmapheresis sessions per million inhabitants (1994). Since 1989 the collaborative effort of the 'Norwegian Fractionation Project' has secured the self-sufficiency of virus-inactivated plasma and (high/ ultra-high purity) products of plasma proteins. Thus national self-sufficiency for plasma can be obtained by a combination of national guidelines, close collaboration to the clinicians, and a limiting plasmapheresis programme combined with the preparation of FFP from the majority of whole blood collections.

Blood Banks↗