| 1. |
- Lindahl, Tomas L, et al.
(författare)
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Methods for evaluation of platelet function.
- 2009
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Ingår i: Transfusion and apheresis science. - : Elsevier BV. - 1473-0502 .- 1878-1683. ; 41:2, s. 121-125
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Tidskriftsartikel (refereegranskat)abstract
- There are a multitude of platelet function tests available, reflecting the complex nature of the platelet in haemostasis. No simple single test will ever cover all aspects of platelet function. Some tests focus on the aggregation of platelets, for example aggregometry, other on the swelling in response to hypotonic solutions, i.e. the well-known hypotonic shock response, or adhesion or coagulation and clot retraction, for example thromboelastography. In general there is a lack of clinical studies showing a predictive value of analysis of platelet concentrates.
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| 2. |
- Palfi, Miodrag, 1954-, et al.
(författare)
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A case of severe Rh (D) alloimmunization treated by intensive plasma exchange and high-dose intravenous immunoglobulin
- 2006
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Ingår i: Transfusion and apheresis science. - : Elsevier BV. - 1473-0502 .- 1878-1683. ; 35:2, s. 131-136
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Tidskriftsartikel (refereegranskat)abstract
- Background: In extremely severe Rh (D) alloimmunization, during pregnancy, early diagnosis and treatment is essential to avoid hydrops fetalis. Intrauterine transfusion (IUT) is of utmost importance in the prevention of fetal anemia but it is usually feasible only after 20 weeks of pregnancy. Therefore, additional treatment options in early pregnancy are needed. Study design and methods: A 27-year-old severely D + C immunized woman was admitted at 8 weeks of gestation in her fifth pregnancy with an extremely high concentration of anti-D. Her first pregnancy was uneventful but resulted in D + C alloimmunization. The next two pregnancies were unsuccessful, because of hydrops fetalis resulting in fetal death in pregnancy week 20 and 24, respectively, despite treatment with high-dose intravenous immunoglobulin (IVIG) and IUT treatment. A fourth pregnancy was terminated with legal abortion. The patient was eager and persistent to accomplish a successful pregnancy. Therefore, a combination of treatments consisting of plasma exchange (PE) three times/week and IVIG 100 g/week was started in pregnancy week 12. PE was performed 53 times and totally 159 L of plasma was exchanged. Results: The anti-D concentration was 12 μg/mL (IAT titer 2000) before start of treatment by PE and IVIG in pregnancy week 12. The concentration of anti-D was gradually reduced to approximately 3 μg/mL after only two weeks of treatment and was maintained at that level until pregnancy week 22. In pregnancy week 26 and 27, signs of hydrops were detected by ultrasonography and IUT were performed at each occasion. Sectio was inevitable at pregnancy week 28 + 1 and a male baby was born: Hb 58 g/L (cord sample) and 68 g/L (venous sample), weight 1385 g, Apgar score = 4-5-7, Bilirubin 56-150 mmol/L (4 h). Exchange transfusion was performed on day two and day five. Phototherapy was also implemented for eight days. The newborn's recovery thereafter was uneventful and complete. Conclusion: A combination of PE and IVIG may be an efficient treatment possible to start in early pregnancy in patients with extremely severe Rh (D) alloimmunization, with a history of hydrops fetalis in previous pregnancies. © 2006 Elsevier Ltd. All rights reserved.
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| 3. |
- Palfi, Miodrag, 1954-, et al.
(författare)
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Hypocalcemic symptoms during plateletpheresis using the COBE Spectra : A comparison of oral combination of 600 mg calcium + 300 mg magnesium + 100 IU vitamin D3 vs. a 1000 mg calcium in symptomatic donors
- 2007
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Ingår i: Transfusion and apheresis science. - : Elsevier BV. - 1473-0502 .- 1878-1683. ; 36:3, s. 291-295
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to find an effective treatment for hypocalcemic symptoms during plateletpheresis and to evaluate if a combination of calcium, magnesium and vitamin D3 is more effective in comparison to routine calcium supplementation. Material and methods: A study group consisting of 10 donors, having a history of previous hypocalcemic symptoms during plateletpheresis, donated platelets twice in a one-month period. During the first donation combination tablets (600 mg Ca + 300 mg Mg + 100 IU vitamin D3) were used to treat hypocalcemic symptoms while routine treatment calcium carbonate tablets (1000 mg Ca) were used during the second donation. If symptoms persisted after 10 min the same dose was repeated. A control group, with no supplementation, consisting of five donors, with no history of hypocalcemic symptoms, were included. Donor subjective symptoms were graded and recorded on four occasions: at the start of plateletpheresis, when symptoms appeared, 10 min after the first tablet and at the end of donation. Samples for analysis of ionized calcium (iCa), magnesium and potassium were also taken at the same occasions. Results: All donors from the study group experienced minor or medium hypocalcemic symptoms and needed a second dose of supplementation. Calcium carbonate tablets completely relieved the hypocalcemic symptoms in six donors, it had no effect on three donors and one donor experienced aggravated symptoms. The combination tablets completely relieved the symptoms in three donors, one donor experienced a partial relief and six donors had no relief of symptoms. There were no significant differences in iCa, potassium and magnesium levels were noted in the study group irrespective of which tablets were used for treatment of hypocalcemic symptoms. After plateletpheresis the median iCa levels declined by 30% and potassium levels declined by 3-11% in all donors while the magnesium levels were not significantly affected. There was no correlation between the presence of symptoms and the changed levels of iCa or magnesium. Conclusion: Addition of magnesium and vitamin D3 to calcium seems to have no beneficial effect in the treatment of hypocalcemic symptoms in plateletpheresis donors. © 2007 Elsevier Ltd. All rights reserved.
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| 4. |
- Stegmayr, Bernd
(författare)
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Apheresis in patients with severe sepsis and multi organ dysfunction syndrome
- 2008
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Ingår i: Transfusion and apheresis science. - Oxford : Pergamon Press. - 1473-0502 .- 1878-1683. ; 38:3, s. 203-208
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Tidskriftsartikel (refereegranskat)abstract
- Apheresis is used as therapeutic approach to improve outcome of patients with severe sepsis, septic shock and multi organ dysfunction syndrome. The concept is to reduce the extent of toxins and cytokines as well as other activators of the various cascade systems. In addition the replacement of plasma, in some of the protocols, helps to substitute with substances that are consumed/complex bound by the inflammatory reactions during the severe clinical condition. This article reviews literature in the field of adsorption technologies as well as plasma exchange techniques.
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| 5. |
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| 6. |
- Stegmayr, Bernd
(författare)
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ESFH letter
- 2008
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Ingår i: Transfusion and apheresis science. - Oxford : Pergamon Press. - 1473-0502 .- 1878-1683. ; 38:2, s. 91-91
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Tidskriftsartikel (populärvet., debatt m.m.)
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| 7. |
- Stegmayr, Bernd, et al.
(författare)
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The new WAA apheresis registry
- 2006
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Ingår i: Transfusion and apheresis science. - : Elsevier. - 1473-0502 .- 1878-1683. ; 34:3, s. 259-262
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Tidskriftsartikel (refereegranskat)abstract
- The WAA (World Apheresis Association) registry for apheresis has been developed to enable registration through internet by centers all around the world. It is of no charge for the registering centers. The new version is available at the site www.iml.umu.se/medicin.Until now more than 5700 treatments have been registered from centers in 6 countries. It allows registration of acute or chronic therapeutic apheresis and also collection of stem cells, cellapheresis, photopheresis and various adsorption technologies.Registration includes diagnoses, access, anticoagulation, replacement fluids, mode of treatment, volumes processed, techniques used and adverse events that develop. Analyses of data enables improvement of quality of apheresis. The new registry enables you to change data that were wrongly entered as well as add data that was missed when you firstly entered the file. We cordially invite all of you to join the registration procedure.
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| 8. |
- Stegmayr, Bernd, et al.
(författare)
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World apheresis registry 2003-2007 data
- 2008
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Ingår i: Transfusion and apheresis science. - Oxford : Elsevier BV. - 1473-0502 .- 1878-1683. ; 39:3, s. 247-254
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Seventy-five centers from many countries have applied for a login code to the WAA apheresis registry. Fifteen centers from 7 countries have been actively entering data at the internet site from 2003 until 2007. We report on data from the registry so far. Methods: This is a web-based registry. A link is available from the WAA homepage (www.worldapheresis.org). So far data from 2013 patients (12,448 procedures) have been included. A median of 6 treatments have been performed (range 1140). Mean age 51 years (range 1-94 years; 45% women). Seven percent of the patients were <= 21 years and 4% were <= 16 years. Results: The purpose of the apheresis procedure was therapeutic in 67% and retrieval of blood components in 33% Main indications: neurological and hematological diseases, lipid apheresis and stemcell collection (autologous, and some allogeneic). Blood access: peripheral vessels (71%), central dialysis catheter through jugular (6.5%) or subclavian veins (6.7%), femoral vein (8%) and AV fistula (4%). ACD was used for anticoagulation in 73% of the procedures. Albumin was mainly used as replacement fluid. Adverse events (AE) were registered in 5.7% of the procedures. AE was graded as mild (2.5%), moderate (2.7%) or severe (0.5%). No death occurred due to treatment. The procedures were interrupted in 2.6%. Most frequent AEs were blood access problems (29%), tingling around the mouth (20%), hypotension (18%), and urticaria (9%). There were significant differences between the centers regarding mild and moderate AEs. Data indicate that centers using continuous infusion of calcium had fewer AEs. Conclusion: There was a limited number of severe AEs. Centers use various standard procedures for apheresis. By learning from the experience of others the treatment quality will improve further. In the near future, an update of the registry will enable more extensive evaluation of the data.
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| 9. |
- Stegmayr, Bernd, et al.
(författare)
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World apheresis registry report
- 2007
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Ingår i: Transfusion and apheresis science. - Oxford : Elsevier BV. - 1473-0502 .- 1878-1683. ; 36:1, s. 13-16
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Tidskriftsartikel (refereegranskat)abstract
- The establishment of national apheresis registries has been helpful to learn about therapeutic profiles and adverse event incidences. During 2003, the World Apheresis Registry was established and centers from all countries were invited to participate to register their apheresis activities (at www.iml.umu.se/medicin). Material: In this paper, we will report and analyze the first data retrieved from three centers, in 2 European countries, that registered a total of 388 therapeutic apheresis treatments in 122 patients, 95% due to acute indications. Statistical analyses were performed using an independent Student t-test and Fisher's test. A p-value of less than 0.05 was considered significant. Results: Fifty percent of the treated patients were women. The mean age of the patients was 51 years ( 17, range 16-84) and there was no difference between genders (w 50.4, m 51.6 years). Diagnoses for treatment were mainly neurological and vasculitis. In 63% peripheral access was used with a central double lumen catheter, 22% in the jugular vein, 8% in the subclavian vein and 6% the femoral vein. Significant inter-center differences were seen in regard to the access used. The main technique used was centrifugation for conventional plasma exchange (86%), while other modes were leukapheresis, erythrapheresis, platelet apheresis, LDL-apheresis and adsorption of antibodies. Citrate was the only anticoagulant in 92%. During plasma exchange procedures using centrifugation, replacement was by albumin only (58%) or plasma, the latter often in combination with albumin (42%). Adverse events (AEs) were noted in 11% of the procedures. Patients with hypocalcaemia side effects with tingling sensations were included in those data as mild AE and as moderate AEs if they received calcium (Ca) medication. No patient died due to adverse effects. A mild AE was present in 1.8% and moderate in 8.5%. During two procedures (0.5%), the AE was considered severe and therefore the procedure was interrupted. If those with AEs due to lower calcium were removed from analyses, 6.4% had AEs. Significantly more AEs were found when plasma was used as a replacement fluid (p=0.017, RR 2.05, CI 1.17-3.60). There were no differences in the incidence of AEs between genders. The number of procedures was too small to allow sub analyses of AEs in relation to the diagnoses. Adverse events were not related to the procedure used (p = 0.095). Those who received additional Ca infusion during the procedure had no A Es (40 sessions) while the others who received no prophylactic Ca had an AE on 45 occasions (p=0.0141, RR 1.116, CI 1.081.15). Conclusion: Data from the registry shows that centers have various approaches to apheresis. One can learn from each other's experience to reduce side effects and improve efficacy. From these data we noted that prophylactic Ca infusion reduced side effects.
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| 10. |
- Tynngård, Nahreen, et al.
(författare)
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Effects of intercept pathogen inactivation on platelet function as analysed by free oscillation rheometry
- 2008
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Ingår i: Transfusion and apheresis science. - : Elsevier BV. - 1473-0502 .- 1878-1683. ; 38:1, s. 85-88
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The Intercept Blood System, using InterSol as additive solution, is used for inactivation of contaminating pathogens in PCs, thus reducing the risk for transfusion transmitted infection and making it possible to prolong the storage period. This study aimed at investigating the ability of Intercept treated platelets to induce clot formation, as measured by coagulation time using free oscillation rheometry (FOR), and to compare with that of platelets in concentrates with the additive solution T-Sol or plasma. Methods: Seventy-four single-donor platelet units were diluted in InterSol (n = 27) or T-Sol (n = 47) to a mean plasma concentration of 38%. The Intercept treatment was performed by addition of amotosalen HCl to the InterSol PCs followed by UVA irradiation and treatment with a compound adsorption device (CAD). Forty-six units were collected and stored in 100% plasma for comparison. Clotting time was measured by FOR in fresh PCs (within 26 h after collection) after stimulation by a platelet activator. Soluble P-selectin was analysed as a marker of platelet activation in the Intercept and T-Sol PCs. Results: The clotting time was shorter for Intercept treated platelets compared to platelets in T-Sol and plasma (p < 0.05). There was no difference in clotting time between T-Sol and plasma PCs. Soluble P-selectin was higher for Intercept platelets than platelets in T-Sol (p < 0.05). Conclusions: The platelets treated with the Intercept procedure had good clot promoting capacity.
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