Biomedical subjects

Mercy Kuriyan

Publications and source records attributed to Mercy Kuriyan.

5 recordsLinked to original sources

PubMed2006

Commentary on TRALI in leukemia.

The paper by Fung YL and Williams BA describes TRALI in leukemic children in order to raise awareness of the need to include this in the differential diagnosis of acute respiratory distress. Detection of TRALI in children with other co-morbidities is difficult. Well-documented cases of TRALI in children are few due to the lack of recognition and difficulty in identifying the antibodies since these may not be always present. Hematology/oncology patients who are chronically transfused and are allo-immunized are at greater risk than the general pediatric population. Thus an awareness of this reaction to blood transfusion helps facilitate prompt treatment and preventive measures.

Adolescent↗

PubMed2005

Anemia and clinical outcomes.

This article discusses the impact of anemia in the context of the perioperative setting. Relevant data from animal and human studies, the adaptive mechanisms in anemia, and current views on transfusion triggers are evaluated. Recommendations are provided for the anesthesiologist for transfusion of red blood cells.

Anemia↗

PubMed2004

Blood transfusion risks in the intensive care unit.

This article reviews transfusion risks with particular emphasis on the critically ill. It describes the various types of noninfectious,infectious, and mild-to-severe reactions that can occur in a trans-fused patient. The article describes differential diagnosis of these reactions and the handling and treatment of the patient. Diagnosis of the type of transfusion reaction by laboratory tests is detailed. Finally, the article discusses the dangers of human error with possible strategies to combat this problem using new technologies.

Critical Care↗

PubMed2003

Antineoplastic effects of partially HLA-matched irradiated blood mononuclear cells in patients with renal cell carcinoma.

PURPOSE: Vaccines, cytokines, and other biologic-based therapies are being developed as antineoplastic agents. Many of these agents are designed to induce an autologous immune response directed against the malignancy. In contrast, hematopoietic stem-cell transplantation is being developed as a form of allogeneic immunotherapy. This study tests the tolerance and antineoplastic activity of sequential infusions of partially HLA-matched allogeneic blood mononuclear cells (obtained from relatives) when administered outside of the context of a hematopoietic stem-cell transplantation. The cells are irradiated to prevent graft-versus-host disease. PATIENTS AND METHODS: Fifteen patients with relapsed or refractory malignancies for which no standard therapy was available were enrolled onto a clinical trial designed to assess the tolerability and antineoplastic effects of irradiated partially HLA-matched blood mononuclear cells obtained from relatives. RESULTS: There was disease regression in three patients with metastatic renal cell carcinoma during treatment. There was disease progression in six patients with metastatic renal cell carcinoma and two patients with metastatic melanoma during treatment. There was no change in disease state in several other patients. CONCLUSION: Irradiated allogeneic blood mononuclear cells administered outside the context of hematopoietic stem-cell transplantation may induce disease responses in patients with relapsed or refractory malignancies. Transfusion of irradiated allogeneic blood mononuclear cells should be developed further as a novel therapeutic antineoplastic approach.

Adult↗

PubMed2003

Heat insoluble cryoglobulin associated with gangrene in multiple myeloma.

Cryoglobulins are immunoglobulins that have tendency to precipitate in temperatures below 37 degrees C and dissolve with rewarming. Monoclonal cryoglobulins are usually associated with a distinct hematological disorder and often are asymptomatic. Heat insoluble cryoglobulin has been described with Sjogren's syndrome and glomerulonephritis but, not with multiple myeloma. Severe sensitivity to cold occurs with high thermal insolubility of the cryoprotein, with dramatic symptoms when exposed to minimal lowering of the temperature. We report a case of a 49 year old man with multiple myeloma and an unusual type I cryoglobulin that caused occlusive gangrene. The cryoglobulin appeared as a milky white precipitate that was resistant to re-suspension and did not dissolve at 37 degrees C. Immunoelectrophoresis of the cryoglobulin, which dissolved at 56 degrees C, showed it to be composed of a monoclonal IgG kappa protein (3.5 g/dl). Unlike most high thermal insoluble cryoglobulin, cold associated symptoms were not seen. In addition to steroids, plasmapheresis was initiated thrice a week with albumin fluid replacement. Plasmapheresis caused a marked decline in cryocrit levels from 21% to less than 0.5% in 9 days after 4 procedures with resolution of the gangrene of the feet and after 6 treatments, vasculitic symptoms improved dramatically. The cryoglobulin test was negative 2 weeks after initiation of treatment. The patient was treated for the myeloma and there was no recurrence of occlusive symptoms. Proper laboratory procedure and careful examination and handling of cryoglobulinemic samples facilitate detection of unusual cryoglobulins. This is a unique report of multiple myeloma with gangrene of lower extremities that has a heat insoluble cryoglobulin.

Cryoglobulinemia↗