Current opinion in hematology
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It has long been believed that mammalian stem cells are irreversibly committed to the individual tissue in which they reside; however, several recent studies have challenged this assertion and suggest a remarkable plasticity of stem cells derived from various adult tissues. Hematopoietic stem cells have been central to this paradigm shift, and in this review, the authors discuss the recent advances in this rapidly growing field. Although several exciting findings in rodents have already led to clinical trials in humans, true stem cell plasticity has not rigorously been established in most, if not all, studies to date, and a number of issues remain unresolved. Large animal models should prove invaluable to the progress of the field.
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Curr. Opin. Hematol. · Nov 2001
ReviewPretransfusion compatibility testing for red blood cell administration.
The purpose of pretransfusion compatibility testing is to prevent incompatible red blood cell transfusions that could lead to immune mediated hemolytic transfusion reactions. Some hemolytic transfusion reactions may have serious sequelae including hemoglobinemia, disseminated intravascular coagulation, renal failure, and death. ⋯ Most of the laboratory practice data have been published in the College of American Pathologists Transfusion Medicine Survey Sets and in a national survey called the Pre-Transfusion Testing Survey. This article couples and trends the data of these comprehensive surveys with an assessment of the literature to present the current practice of pretransfusion compatibility testing.
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Curr. Opin. Hematol. · Nov 2001
Review Comparative StudyErythropoietin therapy versus red cell transfusion.
Erythropoietin therapy was approved for use as a blood conservation intervention beginning in 1989 for patients with medical anemia and in 1997 for surgical patients. The adoption of this strategy has been rapid in some settings (such as renal failure patients), progressive in others ( eg, cancer patients), and slow in others (surgery patients, for instance). ⋯ Erythropoietin therapy, with or without autologous blood procurement, is undergoing new scrutiny as an alternative to blood transfusion. This is not only because of traditional concerns regarding blood risks but because of new blood inventory and cost considerations.
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Curr. Opin. Hematol. · Sep 2001
ReviewUse of recombinant factor VIIa in hereditary bleeding disorders.
Recombinant factor VIIa is effective as a factor VIII or IX bypassing agent and is relatively safe for the management of bleeding and surgical procedures in patients with factor VIII or IX inhibitors (congenital or acquired hemophilia). It is one of several options in the overall treatment strategy for patients with these difficult conditions. ⋯ With expanding indications and more widespread use, thromboembolic complications must be carefully monitored, especially in patients at risk for thromboembolism. The high cost of this drug may be a limiting factor.
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Curr. Opin. Hematol. · Sep 2000
Reviewvon Willebrand factor and thrombotic thrombocytopenic purpura.
Recent advances in the understanding of platelet-dependent hemostasis and von Willebrand factor (vWF) functional regulation offer new insights into the pathogenesis of thrombotic microangiopathic disorders. The discovery of vWF-cleaving protease activity in normal plasma, and its deficiency in thrombotic thrombocytopenic purpura (TTP) patients, provides additional support for a pathologic role of ultra-large vWF in TTP. ⋯ Recent data indicate that vWF-cleaving protease activity correlates with clinical parameters in thrombotic microangiopathy patients. Therefore, determination of vWF-cleaving protease activity might prove useful in the future care of thrombotic microangiopathy patients and might be a rational basis for future classification of thrombotic microangiopathic disorders.