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R H Herzig

Publications and source records attributed to R H Herzig.

98 records · Page 6Linked to original sources
PubMedDate not supplied

The relationship between donor-recipient lymphocytotoxicity and the transfusion response using HLA-matched platelet concentrates.

Matching donor-recipient pairs for HLA antigens provides a logical starting point for selecting platelet donors for thrombocytopenic recipients who have demonstrated refractoriness to pooled random donor platelet transfusions. However, not all recipients achieve a compatible transfusion response with platelets selected by HLA type, indicating that additional selection methods are required. Because of studies indicating that a positive lymphocyte cross-match assay between recipient serum (antibody) and donor lymphocytes predict acute renal allograft rejection, it was hoped that this assay might be useful in predicting the platelet transfusion response for alloimmunized patients. The data herein indicate that the results of this assay in no way correlate with the platelet transfusion response. The lymphocyte cross-match would seem to be helpful in the selection of donors where known HLA antigen mismatches occur between donor and recipient. However, even in this situation, no correlation was observed between the transfusion response and donor-recipient lymphocytotoxicity reaction. Clearly additional assays are needed for the selection of compatible donors from those matched by HLA antigens.

Blood Donors↗
PubMedDate not supplied

Transfusion experience with platelet concentrates stored for 24 to 72 hours at 22 degrees C. Importance of storage time.

We studied the transfusion response from random donor platelet concentrates in 15 stable multitransfused, thrombocytopenic patients by comparing the platelet counts measured before and 20 hours after transfusion. The observed platelet increments were corrected (corrected increment, C.I.) for the number of units of platelet concentrate transfused and the patient's body surface area in square meters (platelets/microliter per unit/m2). Using platelet concentrates stored for less than 24 hours, the patients achieved a median C.I. of 9500 (range: 5000-18,000). When platelet concentrates stored for 24 to 48 hours or 48 to 72 hours were given, the median C.I. markedly decreased to 1000 (range: 0-4800) and 0 (range: 0-5100), respectively (p less than 0.001). These differences could not be explained by further recipient alloimmunization. Transfusion with platelet concentrates less than 24 hours old on a second occasion, bracketing the transfusions of older platelet concentrates, resulted in a median C.I. of 7200 (range: 5400-14,500). Similar results were obtained in three patients when HLA-identical sibling platelet concentrates were employed. In vitro tests, including pH, morphology, and aggregation, demonstrated no statistically significant differences among the platelet concentrates stored for less than 24 hours, 24 to 48 hours, and 48 to 72 hours. These studies suggest that, although platelet concentrates can be stored for 72 hours without loss of in vitro function, the in vivo recovery is significantly diminished after 24 hours of storage, and preferably patients should not be transfused prophylactically with platelet concentrates greater than 24 hours old.

Blood Platelets↗
PubMedDate not supplied

Cyclic parenteral nutrition during allogeneic bone marrow transplantation.

Two adolescents who underwent successful allogeneic bone marrow transplantation were nutritionally managed on a fat-free cyclic parenteral nutrition (PN) regimen. Serum concentrations of prealbumin, albumin, and transferrin were prospectively evaluated to assess the efficacy of nutritional therapy. Both patients tolerated the cyclic PN metabolically. Serial albumin and transferrin concentrations varied slightly and were less sensitive indices of changing nutritional status. In contrast, prealbumin concentrations decreased uniformly during periods of metabolic stress. At the cessation of Pn therapy, all serum proteins were within the normal range. Cyclic PN appears to be a safe, practical approach to the nutritional management of patients undergoing bone marrow transplantation.

Adolescent↗
PubMedDate not supplied

A prospective randomized trial of central venous catheter removal versus intravenous amphotericin B in febrile neutropenic patients.

Empiric amphotericin B therapy was compared to central venous catheter Githdrawal in a prospective randomized trial. Of 32 febrile, neutropenic patients with indwelling Broviac catheters and without documented infection, 14 had persistent fever while receiving broad spectrum antibacterial drugs. Six patients were randomized to catheter removal and eight patients received amphotericin B empirically. None of six patients responded to catheter removal and six of eight defervesced after receiving antifungal therapy (p less than 0.01). Of the six patients in whom catheters were removed, two later became afebrile while on subsequent therapy with amphotericin B. Culture and histologic evaluation of the removed catheters failed to implicate the prosthesis as an infectious source. Central venous catheters in a persistently febrile neutropenic host need not be removed, unless local difficulties or bacteremia with skin commensal organisms occur. Amphotericin B can be infused through a central venous catheter in febrile, neutropenic patients unresponsive to empiric antibacterial drugs, with many patients becoming afebrile as a result of this therapy.

Adult↗
PubMedDate not supplied

High-dose cytarabine for the treatment of blastic phase chronic myelogenous leukemia.

High-dose cytarabine chemotherapy regimens were given to 22 patients for the treatment of blastic phase chronic myelogenous leukemia. Bone marrow aplasia occurred in 21 of these patients; in one patient the marrow was not cleared of blasts. In five patients (26%), blastic phase promptly recurred. Eight patients (37%) died of infection or hemorrhage during the period of marrow aplasia before bone marrow recovery. Seven patients achieved complete remission and one achieved partial remission, but the duration of the remission was brief [median, 98 days (range, 52-345)]. One patient received consolidation therapy with an additional course of high-dose cytarabine and maintained remission for 345 days. These results suggest that alternative approaches to the treatment need to be explored.

Adult↗