Transfus Apher Sci
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Deficiency of C1 Inhibitor leads to unopposed activation of complement, with localized, unpredictable, and sometimes life-threatening attacks of angioedema. Treatment with plasma-derived C1 Inhibitor rapidly aborts attacks, and may be lifesaving, but is expensive, requires use of a pooled blood product, may need to be repeated and may not be effective in autoantibody mediated angioedema. ⋯ Specific drugs to replace the deficient C1 Inh have not been reported. The kallikrein inhibitor DX-88 (Dyax) has received orphan drug status in Europe and is undergoing clinical trial in Europe and the USA.
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Hereditary angioedema (HAE) is clinically characterized by recurrent and self-limiting skin, intestinal, and life-threatening laryngeal edema. This study describes the age at which laryngeal edema first occurred, the time between onset and full development, and the effectiveness of therapy and prophylaxis in 123 HAE patients. 61 (49.7%) patients experienced a total of 596 laryngeal edema episodes. The ratio of laryngeal edema episodes to skin swellings and abdominal pain attacks was approximately 1:70:54 in patients who had laryngeal edema. ⋯ Laryngeal edema may occur at any age, although young adults are at greatest risk. In adults, the interval between onset of symptoms and acute risk of asphyxiation is usually long enough to allow for use of appropriate emergency procedures. It is essential to instruct patients and their relatives about the first signs of laryngeal edemas and the necessary procedures to follow.
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Randomized Controlled Trial Clinical Trial
Malpositioning of Hickman catheters, left versus right sided attempts.
Central venous catheters (CVC) are frequently used for stem cell collection and recurrent therapeutic hemapheresis procedures for patients with poor peripheral venous access. There is a tendency to prefer a right sided approach for insertion of a CVC via the subclavian route. We designed a sequential randomized study to examine the issue of catheter insertion side and analyzed all the technical data on surgical skill and observed complications. ⋯ In this study the rate of malpositioning was greater in the right sided approach (p = 0.032) and the other mechanical complication rates did not differ for the two methods. Our results indicate that there is no need for hesitancy in using left sided attempts at CVC insertion.
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Gamma-radiation of blood products is considered the mainstay of transfusion-associated graft-versus-host disease prevention. Previous studies have detected lymphocyte inhibition rate in blood components just one time after irradiation but there is evidence of cellular variability with production of cytokines at different storage time which could be related with irradiation activity and cellular damage repair. IFN-gamma, a Th1 cytokine, and TNF-alpha, a pro-inflammatory one, had a central role in the stimulation of cellular and inflammatory reactions. ⋯ TNF-alpha levels both in lipopolysaccharide stimulated or unstimulated cells were always high. This data suggest that BBMC cells maintain the ability to produce cytokines after gamma-radiation. On the ground of this study seems to be necessary to evaluate hypothetical risk associated with the administration of cytokine via irradiated blood components.
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Clinical decision making in transfusion medicine has received greater attention in recent years driven by concern about the potential hazards, especially since the recognition that HIV can be transmitted by homologous blood transfusion. These concerns about the risks of homologous transfusion has precipitated interest in the appropriateness of many transfusions and in the decision making processes in transfusion medicine. There has been increasing expenditure on the blood supply side to address the real or perceived potential infectious hazards. ⋯ This imbalance is now being addressed with the development of evidence based clinical guidelines for individual blood components, transfusion monitoring systems and quality assurance programmes. In this review of the process of clinical decision making in transfusion medicine and the factors involved in the ensuring a patient receives a safe and effect transfusion are addressed. The responsibilities of the patient's clinical carers are emphasised.