Postgraduate medicine
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Postgraduate medicine · Apr 1993
ReviewHematologic emergencies. Management of transfusion reactions and crises in sickle cell disease.
Two hematologic emergencies are reviewed in this article: transfusion reactions and crises in patients who have sickle cell disease. Transfusion reactions may be due to incompatibility, IgA deficiency, allergy or, rarely, bacterial contamination of the blood product. A major hemolytic reaction due to incompatibility may progress to hypotension and shock. ⋯ The acute chest syndrome can be complicated by pneumonia; rapid respiratory failure may occur if multiple lobes are involved. Splenic or hepatic sequestration requires aggressive rehydration and transfusion. In patients who have had stroke or subarachnoid hemorrhage, a long-term exchange transfusion program is needed to keep hemoglobin S levels below 30%.
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Postgraduate medicine · Apr 1993
ReviewAcute interstitial nephritis. Why do the kidneys suddenly fail?
Acute interstitial nephritis is a clinical and pathologic entity with diverse causes. The most common cause at present is reaction to drug use, but infection, a concomitant uveitis syndrome, and other rare causes have been reported. Acute interstitial nephritis should always be considered in a patient with acute renal failure, because it is a treatable cause that may result in interstitial fibrosis and irreversible disease if not arrested.