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Biomedical subjects

H Rasche

Publications and source records attributed to H Rasche.

At least 37 records · Page 2Linked to original sources
PubMed1984

Treatment of refractory chronic idiopathic thrombocytopenic purpura with high dose intravenous immunoglobulin.

Three patients with a history of chronic idiopathic thrombocytopenic purpura stretching back over 20 years are reported. Despite splenectomy and immunosuppressive therapy satisfactory control of their disease has not been achieved. They had remained refractory to all therapeutic manoeuvres with corticosteroids and immunosuppressives for years with thrombocyte counts between 5,000 and 25,000/microliters and the concommitant risk of bleeding. This report describes the treatment of bleeding complications in these patients with high dose intravenous immunoglobulin; the peripheral blood thrombocyte count increased in all three patients from subnormal towards normal, but 2 to 4 weeks later returned to its initial low value. During the therapeutically induced raised thrombocyte count a normal bleeding time and only a moderate inhibition of thrombocyte adhesion and aggregation was observed resulting in reasonable haemostasis. High dose intravenous immunoglobulin is therefore a practical method for the control of bleeding complications in patients with refractory chronic idiopathic thrombocytopenic purpura. A clear explanation for its mode of action has not been found - the lymphocyte subpopulations remained unchanged and immunoglobulin production in vitro during the course of treatment was only minimally decreased.

Antibody Formation↗
PubMed1984

The treatment of haemophilia A inhibitor with high dose intravenous immunoglobulin.

In patients with Haemophilia A, the development of inhibitor is a life-threatening complication of treatment. These patients are at high risk for dangerous bleeding as a result of this acquired resistance to human Factor VIII concentrate. Although treatment of bleeding complications has been improved with the introduction of an activated prothrombin complex preparation, therapy remains unsatisfactory. Two patients with Haemophilia A inhibitor were treated with high dose intravenous immunoglobulin in the expectation of an immunosuppressive effect. A rise in the antibody titre at the same time as the administration of factor VIII concentrate showed that this treatment was ineffective in patients with Haemophilia A inhibitor.

Adolescent↗
PubMed1984

Impaired natural killer cell function in hemophiliacs with or without continuous substitution.

In the present study, 28 hemophiliacs substituted continuously and 5 hemophiliacs who had received almost no blood products were investigated. Cells of OKT 3+, OKT 4+, and OKT 8+ subsets were counted. Percoll separated fractions of peripheral blood mononuclear cells were examined by morphological criteria and were tested for NK cell activity. We found that the NK cell activity of both groups of hemophiliacs was decreased on testing Ficoll separated cells or low density Percoll separated cells. Normal NK cell activity was found in medium density cells of hemophiliacs. Two possible explanations are discussed: first, the NK cell activity may be suppressed in hemophiliacs and secondly, there may be a block in maturation of NK cell activity. It is unlikely that chronic substitution by blood products counts for these alterations. The possible role of chronic infections is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1984

[Diagnosis and therapy of hemostatic disorders in oncology. A short review].

Hemorrhagic and thrombophilic diathesis are important symptoms in patients with neoplastic diseases. From that point of view it is not surprising that malignancy is often complicated by bleeding or thromboembolism. These clinical manifestations are due to the interaction of the tumor and components of the hemostatic system (platelets, coagulation, and fibrinolytic factors). Specific and adequate therapy of the neoplasm will result in the disappearance of the hemostatic disorder. If no effective antitumor therapy is available drugs may be helpful, which influence the enhanced turnover of clotting factors. Furthermore, platelet transfusions are highly effective in thrombocytopenic bleeding.

Blood Coagulation Tests↗
PubMed1984

Membrane plasma separation: complications and monitoring.

During the last 3 years, 306 membrane plasma separations (MPS) were performed on 40 patients. Activated partial thromboplastin time (APTT), oncotic pressure (OP), blood count, free hemoglobin, prothrombin time, fibrinogen, and factors II, V, VII, VIII, IX, X, XI, and XIII were determined. The complication rate was evaluated. Mild complications were observed in 4.2% of the cases (extracorporeal coagulation 1.5%, hypotensive episodes 2%, allergic reactions 0.7%). Severe complications were not observed. A flexible heparinization schedule dependent on the APTT values is necessary. In general, 4,500-7,000 IU/MPS is required. The serum OP is maintained within the normal range using a 3-6% human albumin solution to prevent circulatory complications. A marked loss of fibrinogen occurs with short intervals between successive treatments. The remaining coagulation factors are reduced by an average of 32% and the prothrombin time by 28%. Control of the heparinization and OP is essential for monitoring plasma exchange therapy.

Blood Coagulation Factors↗
PubMed1983

[Thromboembolism prevention in surgical medicine: heparin or heparin-dihydroergotamine?].

This review summarizes clinical studies on prevention of venous thromboembolism by heparin or heparin and dihydroergotamine. Advantages and disadvantages of both drugs are described. The value of low-dose-heparin can no longer be seriously disputed. Up to now, however, there is no clear evidence that heparin-dihydroergotamine improves the efficacy and reduces the frequency of complications. The later drug is a new approach still under investigation.

Clinical Trials as Topic↗
PubMed1982

[Blood clotting factor XIII substitution in acute leukaemia: result of a randomized and controlled study].

A randomized and controlled study was undertaken to test whether substitution with factor XIII concentrates influences the clinical course in patients with acute leukaemia and acquired factor XIII deficiency (less than or equal to 60%). A control group of 31 patients was compared with a factor XIII-treated group of 29 patients. Partial factor XIII deficiency was successfully corrected by substitution. On the other hand, there was no statistically significant difference between the two patient groups in the frequency and severity of bleeding complications, transfusion requirements, and the number of remissions. Undesirable side-effects as a result of substitution treatment were not observed.

Acute Disease↗
PubMed1981

Malaria-induced thrombocytopenia.

Platelet counts were investigated in 26 patients with P. falciparum malaria and 39 patients with P. vivax malaria before and after treatment. Before schizontocidal treatment 22 of 26 (85%) patients with P. falciparum malaria and 30 of 39 (72%) patients with P. vivax malaria had depressed platelet counts below 150,000/microliters blood. There was a correlation between low platelet counts and high counts of malarial plasmodia (parasitized red blood cells) in P. falciparum and P. vivax infections (p less than 0.001). Platelet survival, studied by malonaldehyde formation in three patients during the period of decreasing parasitaemia, revealed a shortened life span to 2--3 days in comparison to 7--10 days in normal controls. In all patients platelet counts rose to threefold the initial values within 5 days after clearance of parasites. The results demonstrate that, first, thrombocytopenia is a common feature in human malaria, second, thrombocytopenia induced by malaria is due to shortened life span in the peripheral blood and, third, some interaction is present between platelets and malaria plasmodia or parasitized red cells.

Blood Platelets↗
PubMed1981

Granulocyte transfusions in acute leukaemia. Regeneration of granulopoiesis as determining factor of survival.

40 patients with acute leukaemia and severe granulocytopenia were treated with granulocyte transfusions for bacteriologically documented or clinically suspected septicaemia. The patients received an average of 5 transfusions each with 2.1 X 10(10) granulocytes per m2 body surface area per day. 26 patients showed clinical benefit from transfusion therapy as documented by the course of blood cultures, local lesions and fever. Only patients with regeneration of granulopoiesis had definite benefit from granulocyte transfusions. All other patients died ultimately from septicaemia.

Acute Disease↗
PubMed1979

[Effectiveness of gnotobiotic measures in the treatment of acute leukemia: the results of a prospective randomized clinical study].

60 adult patients with acute leukemia (AL) previously untreated or in relapse received induction chemotherapy with different types of supportive care. Group A was decontaminated by nonabsorbable antibiotics in strict reverse isolation, group B was isolated only and group C was treated under routine hospital conditions. There were less infections in group A and B compared with group C. 76% of patients in group A achieved remission, in contrast to 57% in group B and 59% in group C. Late evaluation three years after termination of the study showed that all patients were dead except four patients being in first remission after discontinuation of maintenance treatment. Three patients were treated in group A, one patient in group C. However, the differences of survival and remission rates were not significant. Failure to demonstrate significant advantage of isolation and decontamination in treatment of AL was caused by insufficient suppression of microbes by the applied antimicrobial measures. Thus, it is suggested to investigate better antimicrobial treatment before gnotobiotic care is accepted as routine supportive treatment in AL.

Acute Disease↗
PubMed1979

[Obstetrical problems in patients with Glanzmann's thrombasthenia. A casuistic presentation (author's transl)].

Glanzmann's thrombasthenia is a rare, autosomal recessive disorder of bleeding arrest. The differential diagnosis of this platelet defect with respect to recently gained knowledge is presented in the case of a pregnant woman. Because of pelvic presentation a cesarean section was performed after adequate platelet substitution, which did not involve excessive blood loss. A severe puerperal infection necessitated an abdominal hysterectomy after appropriate platelet transfusion. The difficulties in testing platelet function in the newborn are discussed. The effectiveness of a commercially available homologous phospholipide complex (Fibraccel) was tested on the patient in a noncritical phase. The results appear important for general procedure when pregnancy and platelet dysfunction concur.

Adult↗