[Treatment of thrombocytopenic thrombotic purpura].
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to P Rodríguez Vicente.
Explore the source record for details and available documents.
PURPOSE: Transfusion is not devoid of adverse effects; therefore every transfusional procedure must be indicated correctly. With this in mind in 1991 transfusion guidelines were published by our Hospital Transfusion Committee. Four years later, a retrospective audit was performed. MATERIAL AND METHODS: We have evaluated all blood component orders (order is a transfusion request) during one month, classifying them as appropriate or inappropriate according to the transfusion guidelines. The evaluation was performed 24 hours after transfusion. The results obtained were compared with the ones obtained before the published transfusion guidelines. RESULTS: 481 transfusion orders were studied. 87 percent (420/481) were considered appropriate according to the transfusion guidelines. These 481 orders referred to the transfusion of 1178 units to 293 patients. 12 percent of the transfused units was considered as inappropriate. 16 percent of the patients (48/239) had at least on inappropriate transfusion procedure. The comparison with the data obtained in 1991 showed a significant increase of the appropriate transfusion orders (74 versus 87 percent). The use of fresh frozen plasma showed the greatest incidence in inappropriate use, mainly in haemorrhagic disorders without factor deficit. The patients with haemoglobin levels between 70 and 100 g/L without signs of hypoxia were the most important cause of inappropriate use of red cell concentrates. And the patients with platelet levels > 20 x 10(9)/L were the major cause of inappropriate use of platelet concentrates. CONCLUSION: Transfusion guidelines knowledge improves the use of blood components.
OBJECTIVES: Several mechanisms in formation and destruction of platelets could be involved in thrombocytopenia associated with HIV infection (TP/HIV). This epidemiological study investigated the pathogenic role of immunoglobulins associated with platelets (IAP), circulant immunocomplexes (CIC) and anticardiolipin antibodies (ACA) in patients with TP/HIV: PATIENTS AND METHODS: A total of 207 adults patients infected with HIV were studied. Patients were classified as thrombocytopenic (platelet count < 100,000/mm3, n = 68); borderline thrombocytopenic (platelet count from 100,000 to 150,000/mm3, n = 23) and non-thrombopenic (platelet count > 150,000/m3, n = 116). IAP were investigated by an immunofluorescence technique with flow cytometry reading and eluate technique. CIC were investigated by C1q fixation measured by nephelometry. IgG-ACA determination was made with a commercially available ELISA technique. RESULTS: Prevalence of thrombocytopenia in the general cohort of seropositive patients was 16%. Fifteen per cent of these patients had severe TP. There were no significant differences in epidemiology or prognosis among patients with and without TP. Patients with TP/HIV had increase rates of IAP, CIC and ACA (78%, 42% and 89%). These parameters were also increased in a similar percentage of non-TP infected patients (73%, 52%, 94% respectively). No correlation was observed between platelet counts and values of these immunological phenomena. CONCLUSIONS: TP/HIV is common, mild, with no prognostic significance and occurs in an heterogeneous patient population. Immune phenomena associated with a decreased platelet survival occur nonspecifically and with an uncertain pathogenic meaning.
PURPOSE: Antibody formation against red blood cells' antigen is a very important complication due to transfusions, and it can make the following transfusions difficult. To avoid this, it has been proposed giving identical red blood cells for the antigens more frequently involved in sensitizations. To evaluate this fact, we have accomplished a study with the transfused patients in our Hospital since 1990. MATERIAL AND METHODS: 10,308 transfused patients in the Hospital Nitra. Sra. de Covadonga (Oviedo), between January 1990 and March 1994, were studied. The patients have been included in two groups: The first one was constituted by 4,226 patients from the Haematology and the Nephrology Departments, who received red blood cells units compatible with ABO and CcDEe antigens. The second group was formed by the remainding patients transfused with red blood cells compatible only with ABO and D antigens. RESULTS: All 165 antibodies were detected in 132 patients, which means an incidence of 1.3 percent. In 63 cases, antibodies were present before the first transfusion. In the remaining patients, an allosentitization of 0.2 percent in group 1 and 1 percent in group 2 (p < 0.0001) was shown. This difference cannot be explained only for transfusing red blood cells with the same Rh phenotype in the group 1, because a lower immune response had persisted when we analyzed the other antibodies. More than 70 percent of antibodies appeared before the 10th transfusion. DISCUSSION: A lower sensitization exist in the patients of group 1. This seems to be caused by a state of immunosuppression for their disease or their treatments. However, in some patients, the risk of allosensitization persists, so we think it is a good practice to transfuse red blood cells without the most immunogenic antigens in haematological and nephrological patients who already have one antibody.
We report a case of a graft-versus-host disease (GVHD) in a patient with non Hodgkin Lymphoma who received multiple blood transfusion for anemia and thrombocytopenia. Although WBC-reduction filters were used, the patient developed a transfusion associated graft-versus-host disease. We do not recommend WBC-reduction filters to prevent postransfusional-GVHD.
Explore the source record for details and available documents.