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Biomedical subjects

H Trobisch

Publications and source records attributed to H Trobisch.

At least 19 recordsLinked to original sources
PubMed2006

[Disseminated coronary occlusions and massive pulmonary embolism in a 40-year-old woman].

HISTORY AND ADMISSION FINDINGS: A 40-year-old woman was admitted to the emergency room because of severe angina pectoris and dyspnoe at rest. She developed ventricular fibrillation a few minutes later from which she had to be resuscitated . After intubation and controlled ventilation immediate angiocardiography was performed while she was still in cardiogenic shock. Coronary angiography ten days before had been unremarkable. DIAGNOSTIC FINDINGS AND THERAPY: The second coronary angiogram revealed severe thrombotic lesion at the origin of the left anterior descending branch (LAD) and total occlusions of the peripheral LAD and of the first marginal branch. After intracoronary application of 10 mg abciximab and coronary stent implantation in the origin of the LAD the patient had good clinical improvement. Massive pulmonary embolism two days later, despite of effective heparinization and inhibition of platelet aggregation (as measured by partial thromboplastin time), was treated successfully by regional injection of 100 mg tissue plasminogen activator (t-PA). Tests for possible hypercoagulability showed no detectable changes in the clotting and fibrinolytic system with a normal platelet count. In a standardized aggregation test of platelets hyperaggregation in response to ADP and epinephrine, also at low test doses, revealed the presence of a sticky platelet syndrome. CONCLUSION: This case history suggests that enhanced platelet aggregation associated with sticky platelet syndrome may provoke myocardial infarction even in angiographically normal coronary arteries.

Adult↗
PubMed2004

Effects of extended storage of whole blood before leucocyte depletion on coagulation factors in plasma.

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the quality of leucocyte-depleted plasma produced from leucocyte-depleted whole blood, stored for different periods of times before filtration through polyurethane filters. MATERIALS AND METHODS: Whole blood was collected, from 48 voluntary donors, into quadruple blood bag sets with integrated whole-blood filters, and stored at room temperature for 1, 2, 6, or 18 h before filtration. Five samples were taken: one directly from the donor; one immediately after collection; one before and one after filtration; and one from plasma units before freezing. All samples were analysed for the following parameters: prothrombin time; activated partial thromboplastin time; prothrombin fragments F1+2; fibrinogen; factors VIII, XI and XII; von Willebrand factor antigen; ristocetin cofactor activity; collagen-binding capacity; multimers; and complement C3a-desArg. RESULTS: Different whole-blood storage times before filtration did not have a significant effect on the stability of coagulation factors. The activity of all investigated coagulation factors in plasma was generally above 90 U/dl, even after 18 h of storage of whole blood before filtration. von Willebrand factor multimeric distribution remained stable throughout the process. However, activation of complement did occur during storage. CONCLUSIONS: Leucodepleted plasma originating from leucodepleted whole blood maintains a satisfactory level of coagulation factors, even after the storage of whole blood for 18 h at room temperature before filtration.

Adult↗
PubMed2001

Rapid genotyping of human platelet antigen 5 with fluorophore-labelled hybridization probes on the LightCycler.

Genotyping of human platelet antigens (HPAs) can be useful for the diagnosis and therapy of alloimmune thrombocytopenic syndromes such as neonatal alloimmune thrombocytopenic purpura, post-transfusion purpura and refractoriness to platelet transfusion therapy. We developed a single-tube method for HPA-5 genotyping on the LightCycler that combines rapid-cycle polymerase chain reaction with allele-specific fluorescent probe melting for mutation detection. Our method is fast, robust and suitable for routine HPA-5 typing. This work extends recent studies on HPA-1 typing using the LightCycler.

Antigens, Human Platelet↗
PubMed2000

[Quality of whole blood as a result of storage and preparation (inline-leukocyte depletion). Evidence for autologous predeposit].

AIM OF THE STUDY: Investigation of various laboratory parameters in stored whole blood, with respect to duration of storage and kind of product. METHODS: Whole blood was donated by 12 healthy volunteers using CPDA1 stabilisator. Six units were filtered with the Leukotrap A1-System (PALL Comp., Dreieich, Germany) for leukocyte depletion. The twelve units were stored for 49 days. Several hematological, biochemical and coagulatory parameters were analysed during storage. RESULTS: There was an adequate reduction of lycocytes by filtration (< 3 x 10(6) white cells per unit). ATP decreased during storage to 45% of initial value at the 49th day, without any influence of the kind of preparation. The course of other parameters such as lactate and free haemoglobin (increase), PH-value (decrease), antithrombin III (decrease), prothrombin, protein C, thrombin-antithrombin-complex, alpha-2-Anti-plasmin (decrease or indifferent) did not show any influence of the kind of preparation. Coagulation factors V and VIII decreased in both preparations, which was significantly less pronounced in whole blood with leukocyte depletion. In contrast parameters of activated coagulation such as D-Dimere and fibrinmonomeric did not change during storage after leukocyte reduction but increased at the end of storage time in CPDA1-blood. CONCLUSIONS: Several parameters indicating quality of stored blood were constant in whole blood independent of the kind of preparation during a storage of 49 days. This is in contrast to the main part of specific scientific communications. A beneficial influence of leukocyte depletion was observed for some coagulation parameters whereas increasing characteristics of activated coagulation in CPDA1-stored whole blood at the end of storage time had to be observed. The preparation of whole CPDA1-blood is recommended for autologous predonation, if storage time does not exceed 30 days. Storage time of > 40 days seems to be possible for autologous whole blood after filtration for leucocyte depletion.

Adenosine Triphosphate↗
PubMed1999

[Significance of hemodynamic parameters of blood loss in orthognathic surgery].

INTRODUCTION: The hemodynamic parameters of 95 patients undergoing maxillary or bimaxillary orthognathic surgery in 1996 and 1997 at the Department of OMF Surgery/Plastic Surgery, Krefeld, Germany, were analyzed retrospectivly to study the effect of intraoperative blood loss. MATERIALS AND METHODS: The parameters included the blood loss volume, age, weight and sex of the patients, the mode of osteotomy and the operation time, the surgeon, the average blood pressure, the infusion volume, the anesthesiologist, the thrombocyte counts and their function, the activity of the coagulation factors II, V, VII, VIII, IX, X, XI, XII, XIII and von-Willebrand-factor, and the pathological coagulation factor counts of each patient, the rate of autologous blood donation and the rate of retransfusion. Statistical analysis was done using the Speraman-Rhotest. RESULTS: The average blood loss during maxillary osteotomy was 670 +/- 380 ml and during bimaxillary surgery 1120 +/- 510 ml. Men lost about 300 ml more than women. Operations of more than 3.5 h in length led to a blood loss of 1200 +/- 520 ml as opposed to 670 +/- 310 ml. The average blood loss among various surgeons was between 670 ml and 1180 ml of various anesthesiologists between 730 ml and 1200 ml, without statistical evidence. Some 17.9% of patients showed pathological thrombocytic function concerning medication with aspirin; 34.7% had pathological activities of coagulation factors, but only 2.1% with clinical significance. CONCLUSION: Mode of operation, maxillary or bimaxillary, und length of operation were the most significant factors of intraoperative blood loss. Patients with pathological coagulation had nearly the same rate of blood loss as patients with physiological coagulation. In most cases this was determined by restriction of aspirin. Analysis of the rate of autologous blood retransfusion showed a significant correlation to blood loss in bimaxillary surgery. Maxillary osteotomy led to a retransfusion of only 14.2% of autologous blood unit. This should be reviewed critically especially concerning costs.

Blood Coagulation↗
PubMed1992

[Alternative mechanical autotransfusion. Hemofiltration vs. hemoseparation].

The effect of haemoconcentration of shed blood from operative field during vascular surgery by either centrifugation (cell separation, n = 10) or haemofiltration (n = 10) was investigated. Interest in this in-vitro-study was focused on the quality of the blood concentrated. Various parameters were measured in the patient (before onset of anaesthesia), and in the blood after suction from operative field: 1. shed blood, 2./3. after haemoseparation/-filtration. Both procedures were easy to perform but haemofiltration produced whole blood quicker than the cell-separation technique (1.2:3.0 minutes). All patients had normal parameters. Suction led to an activation of plasma coagulation and an increase of free haemoglobin and elastase. Haemoseparation in contrast to filtration led to an elimination of thrombocytes, elastase, free hemoglobin and all proteins including antithrombin III and fibrinogen; concentration of red cells was more pronounced after separation (hct 55 vs. 35%). Heparin reduction was better after separation but plasma-heparin-levels were in a tolerable range after both procedures (0.21 vs. 0.75 U/ml). None of the procedures was followed by the appearance of activated clotting factors (F XII a). The data presented demonstrate that haemofiltration may be an alternative in intra- and postoperative autotransfusion. The particular advantage of this method is the preservation of plasma proteins after concentration procedure thus avoiding the need for additional application of fresh frozen plasma in patients with significant blood loss.

Blood Loss, Surgical↗
PubMed1991

Results of a quality-control study of lyophilized pooled plasmas which have been 'virally inactivated' using a solvent detergent method (modified Horowitz procedure).

The 'virus-free' lyophilized pooled plasmas supplied to our institute by the German Red Cross in Hagen did not meet the quality norms found in standard products. Indeed, with respect to all the major parameters, they deviated greatly from standard coagulative fresh frozen plasmas. In order to achieve a suitable substitution effect and approximate the properties of fresh plasma, it would be necessary to administer two to three times the amount of 'virus-free' plasma. At the same time it should be noted that by contrast to coagulative fresh plasma, the new product neither compensates for factors which activate or inhibit coagulation, nor for fibrinolytic factors. On the contrary, the ratio between these factors deviates dangerously from their physiological equilibrium. Grave therapeutic consequences can be expected therefrom. In addition, most of the tested batches already contain heparin in quantities within the therapeutic range in spite of the fact that the manufacturer neglects to mention this detail. Finally, the method of preparation pushes the pH values far into the alkaline range. This fact alone could have fatal consequences if this product was administered to severely ill patients. In general, we can only express our surprise that the Bundesgesundheitsamt (German Health Board), as the official body responsible for approving this product, has agreed to its distribution on the basis of notification that changes would be made to an existing approved product. The following facts, in our opinion, should have determined the renewal of the licence for sale: As opposed to the approved product--a plasma derived from individual donors--the 'virus-free' plasma is a pooled plasma. As opposed to the approved product--a deep-frozen plasma derived from individual donors--the 'virus-free' plasma is a pooled lyophilized plasma. As opposed to the approved product which is not subjected to any chemical processing, the 'virus-free' product is treated with tri(n)butylphosphate and an unspecified detergent. These virucidal properties are assumed on the basis of consequential logic rather than proven by hard experimentally determined fact. Data confirming the efficiency of the process based on legitimate animal experiments has not be presented. In spite of all the efforts to improve safety in transfusion medicine we believe that if certain nonprofit-making blood banks are to retain their credibility, they should be subjected to the same stringent laws and regulations that are applied to the rest of the German pharmaceutical industry.(ABSTRACT TRUNCATED AT 400 WORDS)

Antibodies, Viral↗
PubMed1991

[Quality control studies of 3 deep-frozen coagulation-active fresh frozen plasma preparations from various suppliers and a new virus-inactivated lyophilized pooled plasma preparation].

Fresh frozen plasma is the most important therapeutic agent in acquired coagulation disorders. We investigated the quality of three conventional fresh-frozen plasma preparations (groups I, II, IV) and one new virus-inactivated lyophilised pooled plasma preparation (group III). In the new plasma preparation we found a significant reduction in coagulation activity, a significantly higher pH value and a highly significant rise in plasma heparin levels. No significant difference in electrolytes, protein levels and concentration or complement activity was found in any of the groups. In conclusion, unlike conventional fresh-frozen plasma, this new virus-inactivated lyophilised pooled plasma preparation does not seem to be suitable for use in therapy of coagulation disorders.

Antiviral Agents↗
PubMed1991

[Effective autotransfusion thanks to cooperation].

A 61-year-old female patient scheduled for major vascular surgery had several diseases, including cardiovascular, pulmonary, renal and hepatic insufficiency. Prior operations--major vascular surgery, strumectomy--had led in most cases to severe bleeding complications owing to a known inherited thrombopathia. Therefore, it was questionable whether an operation would be possible at all. Coordination of three medical departments (vascular surgery, anesthesiology and hematology) created an individual transfusion program. Over a period of 6 weeks, autologous blood was collected in the Anesthesiology Department by means of the so-called leap-frog technique, resulting in the availability of 4 units of autologous packed cells plus 9 units of autologous fresh frozen plasma by the day of surgery. During the operation we used a Shiley autotransfusion device (Autotrans). Two days before the preoperation substitution with homologous thrombocytes was started (one highly concentrated unit per day). This was continued until the 4th postoperative day. Operative procedure performed included reconstruction of iliac artery, bilateral profunda plastic and iliac-femoral cross-over bypass grafting. Only autologous blood products were utilized; apart from thrombocytes no further homologous derivatives were required. The patient had a normal recovery period with no episodes of bleeding or hematoma. There was no need for a long hospital stay. The case presented stresses the importance of good cooperation between physicians for successful treatment of our patients in general and effective use of autotransfusion in particular.

Blood Transfusion, Autologous↗
PubMed1986

[Procedures for the isolation and characterization of human antithrombin III].

Antithrombin III, the most important inhibitor of activated coagulation factors (IIa, IXa, Xa, XIa, XIIa) was isolated from human plasma by affinity chromatography. The biochemical characterization of this highly purified inhibitor showed, that is was uniform by means of HPLC and PAA gradient gel electrophoresis. The molecular weight was determined to 70000 daltons and the isoelectric point was pH 4,5. The inhibition of factor Xa by AT III had been proofed as competitive by kinetic studies. AT III works as a "dead end inhibitor". Heparin seems to form a ternary complex with AT III and activated coagulation factors, so acting as a catalyst. The therapeutic value of AT III-concentrates will be discussed.

Antithrombin III↗
PubMed1984

[Comparative protein chemistry studies on Factor VIII concentrates].

Large amounts of Factor VIII concentrates are required for the treatment of haemophiliacs. Two batches each of nine commercial preparations were examined for their in vitro properties. The parameters studied were Factor VIII coagulation activity (F VIII: C), ristocetin cofactor activity (F VIII R: CoF), the Factor VIII antigen content (F VIII R: Ag), fibrinogen, fibronectin and immunoglobulins. The preparations were also tested to determine their hepatitis A and B marker content. In none of the investigated concentrates compared to the data given by the manufacturers was a marked F VIII: C deficit. All the preparations showed higher values for F VIII R: Ag than for F VIII: C. Factor VIII concentrate HS was the only concentrate in which the fibrinogen concentration was below the detection limit and only small amounts of fibronectin and immunoglobulins were detected. In two of the nine preparations tested possible contamination with hepatitis B viruses was more or less ruled out by means of hepatitis serology.

Antibodies, Viral↗
PubMed1982

[Fibrinolysis and complement-system profiles during aorto-femoral bypass implantation].

In 51 patients undergoing either implantation of an aortofemoral bypass (38 patients) or of an saphenous bypass (13 patients) the fibrinolytic and complement system profiles were determined. During the course of an aortofemoral bypass the plasminogen concentration decreased by 40%, alpha 2-macroglobulin by 25%, the complement factor C3c by 20% and the complement factor C4 by 40%. Antithrombin III concentration remained stable until the third postoperative day. The alpha 1-antitrypsin concentration increased postoperatively by 40% compared to the preoperative control. The concentrations of plasminogen, antithrombin III, alpha 2-macroglobulin and complement factor C4 did not change in the patients undergoing saphenous bypass operation. Intraoperatively the complement factor C3c decreased by 20%, while alpha 1-antitrypsin showed postoperatively an increase by 30%. Anaesthesia (neuroleptanaesthesia, halothane- or continuous thoracal epidural anaesthesia) had no influence on the fibrinolytic and complement system profiles. Neither could a correlation be shown between the intraoperative haemodynamic changes and the concentrations of the factors of the fibrinolytic and complement system.

Anesthesia, General↗
PubMed1981

[Retinal findings in thalassemia (author's transl)].

Two patients had neovascularizations, bleeding and enclosed vessels or pigmented foci on the retina. The analysis of the hemoglobin showed a raised HbA2 fraction, indicating that they could be considered heterozygous gene carriers of beta-thalassemia. An electrophoretic-spectrophotometric method of determining the hematologic changes is described by means of which thalassemia minima can be diagnosed reliably.

Diagnosis, Differential↗