American journal of therapeutics
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A number of pharmacologic and nonpharmacologic technologies are in current use to minimize perioperative homologous blood use. Clinical trials, many of them randomized controlled trials, have been done evaluating these approaches and have demonstrated their efficacy. However, data on safety has relied mostly on case reports, uncontrolled studies, and, for the pharmacologic agents, extrapolation from the nonsurgical setting. ⋯ DDAVP is low-risk, provided it is not overused, which can induce hyponatremia. Autologous predonation probably has similar risks as homologous blood with respect to transfusion errors and bacterial infection. As with most medical interventions, we must be vigilant to prevent human error.
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In recent years, significant progress has been made in our understanding of the pathophysiology behind obstructive airway diseases in general and asthma in particular; this knowledge, however, has not translated to major breakthroughs in the treatment of these disorders. Current therapeutic options are less than optimal and frequently are associated with systemic adverse effects. Recent studies indicate that endogenous purine nucleotides, adenosine 5'-triphosphate (ATP) in particular, could play a mechanistic role in obstructive airway diseases through their actions on multiple cell types relevant to these disorders, including mast cells, eosinophils, dendritic cells, and neurons. The pharmacologic modulation of ATP signal transduction in these cells represents an attractive new therapeutic target.
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In general, transfusion guidelines for non-neonatal pediatric patients are similar to those for adults. However, some differences do exist and certain precautions may be necessary particularly in the setting of massive transfusions. ⋯ We include a discussion of the indications for transfusion and practical considerations such as dosing and administration. Finally, we briefly review the use of directed donations and specialized (irradiated, CMV seronegative) blood components.
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This review article discusses the development and implementation of a number of blood substitutes, including hemoglobin-based oxygen carriers (HBOCs) and perfluorocarbons. This review article will introduce the reader to blood substitutes by discussing an overview of an ideal blood substitute, the history of HBOCs and perfluorocarbons, strategies of oxygen carrying, side effects of HBOCs and perfluorocarbons, current clinical trials, and the future of blood substitutes.