Control de calidad del volumen de hemocomponentes obtenidos mediante equipo fraccionador automatizado COMPOMAT en el Servicio de Hemoterapia y Banco de Sangre del HNDAC - 2011 / Quality control of the volume of blood components obtained by automated fractionator equipment Compomat in Service of Hemotherapy and Blood Bank at the HNDAC - 2011

OBJETIVO: El objetivo del presente Trabajo de Investigación ha sido realizar el Control de Calidad del Volumen de los diferentes hemocomponentes obtenidos mediante el Equipo Fraccionador Automatizado COMPOMAT en el Servicio de Hemoterapia y Banco de Sangre del Hospital Nacional Daniel A. Carrión durante el año 2011, el mismo que se ha desarrollado en forma individualizada, considerando exclusivamente el volumen y en el 100 por ciento de hemocomponentes producidos. MATERIALES Y METODOS: Para la realización del presente Trabajo de Investigación se ha utilizado el Equipo Automatizado COMPOMAT con el programa de fraccionamiento para Bolsas colectoras de sangre cuádruples con anticoagulante SAG Manitol y sistema de tubuladura superior e inferior (TOP and BOTTOM). Al realizar el procedimiento se registró todos los volúmenes de los hemocomponentes fraccionados como son 2140 unidades de paquete globular, 2093 unidades de plasma fresco congelado y 1851 concentrados de plaquetas. El trabajo se desarrolló en el área de fraccionamiento sanguíneo del Servicio de Hemoterapia y Banco de Sangre del Hospital Nacional Daniel A. Carrión de la Región Callao, durante el periodo comprendido desde el mes de Octubre del año 2010 al mes de Marzo del año 2011 en que los datos obtenidos fueron registrados manualmente en un programa Microsoft Excel 2007 para el procesamiento de los mismos y para la realización de Curvas de Control de Calidad de Levey Jennings. RESULTADOS: De los 2140 paquetes globulares procesados, un 77 por ciento cumple con los parámetros de calidad establecidos para volumen. De los 2092 plasmas frescos congelados, el 98 por ciento cumple con los parámetros de calidad establecidos para volumen. De los 1851 concentrados de plaquetas procesadas, el 95 por ciento cumple con los parámetros de calidad establecidos para volumen. CONCLUSIONES: Se concluye que el volumen de los hemocomponentes obtenidos, tanto Paquete Globular, como Plasma Fresco Congelado y Plaquetas, cumple...

Orthostatic hypertension: profile of a Nigerian population

Background: The aim of this study was to determine the prevalence, age, sex distribution and blood pressure (BP) pattern of patients with orthostatic hypertension in a cohort of hypertensives. Method: A total of 179 patients on follow-up treatment in a hypertension clinic were assessed for age, sex and BP in the seated position, and after two minutes in the erect position, on three consecutive visits. Orthostatic hypertension was defined as an increase in systolic blood pressure (SBP) of ≥ 20 mmHg on more than one occasion in the erect position. Orthostatic hypotension was defined as a decrease in BP on more than one occasion, between the seated and erect SBP, of ≥ 20 mmHg. The mean ages of the participants with and without orthostatic hypertension were compared by t-test for any significant difference. The means of the seated SBP of participants with and without orthostatic hypertension were also compared with the t-test. The effect of gender on orthostatic hypertension was tested with a chi-square (χ²). The differences between the mean seated and mean erect SBPs of participants with and without orthostatic hypertension were compared with the paired t-test. Results: Thirty-eight (21.23%) of the participants had orthostatic hypertension. The mean age of those with orthostatic hypertension was not significantly different from that of the participants without orthostatic hypertension (p-value = 0.789). There was no significant effect of gender on orthostatic hypertension (p-value = 0.795). The mean of the seated SBP was significantly lower in the participants with orthostatic hypertension (p-value = 0.008). The mean seated SBP was significantly different from the mean erect SBP for those with orthostatic hypertension, compared to those without orthostatic hypertension (p-value = 0.000 vs. p-value = 0.169). Five (2.79%) of the participants had orthostatic hypotension. Conclusion: Orthostatic hypertension, a form of BP dysregulation, may be more common among treated hypertensives than what is presently known

Avaliação hemodinâmica em paciente criticamente enfermo: [revisão] / Hemodynamic assessment in the critically ill patient: [review]

Uma fração crescente das atividades clínicas dos nefrologistas é exercida nas unidades de terapia intensiva (UTIs). Ao avaliar pacientes com insuficiência renal aguda no contexto de choque circulatório, que também apresentam anasarca e/ou trocas gasosas ruins, o nefrologista precisa decidir entre duas condutas antagônicas: 1) remover volume através de diálise ou diureticoterapia para melhorar o quadro edematoso; 2) administrar volume para melhorar a hemodinâmica. Para minimizar a chance de decisões incorretas, é imperativo que o nefrologista conheça as ferramentas disponíveis para avaliação hemodinâmica invasiva e de estimativa de adequação da volemia no paciente com doença crítica. Neste artigo, fazemos uma breve revisão da fisiologia da regulação do volume do líquido extracelular e, em seguida, abordamos o diagnóstico de volemia, com base em critérios clínicos e hemodinâmicos.

A growing fraction of the clinical duties of Nephrologists is undertaken inside intensive care units. While assessing patients with acute renal failure in the context of circulatory collapse, which are also edematous and/or with impaired gas exchanges, the Nephrologist must decide between two opposing therapies: 1) remove volume with the aid of dialysis or diuretics to improve the edematous state; 2) volume expand to improve hemodynamics. To minimize the odds of making incorrect choices, the Nephrologist must be familiar with the tools available for determining the adequacy of volume status and for invasive hemodynamic monitoring in the critically ill patient. In this manuscript, we will briefly review the physiology of extra cellular fluid volume regulation and then tackle the issue of volume status assessment, based on clinical and hemodynamic criteria.

Combined scores of 64 multi-slice CT perfusion characteristics for evaluating solitary pulmonary nodules / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the bloody flow mode and the perfusion feature of solitary pulmonary nodules (SPN) on 64 multi-slice CT, and to evaluate the diagnostic value of combined scores in SPN.</p><p><b>METHODS</b>Fifty-two patients with SPN proved by pathology or follow-up underwent dynamic enhancement CT. Perfusion characteristics, including permeability (P), blood flow, blood volume, patlak blood volume, patlak R square (PRS), patlak residual, peak enhancement, perfusion curve, and false color image were analyzed by the body perfusion software. Perfusion characteristics were compared between benign and malignant nodules. Combined scores composed of significant difference observed parameters were used to differentiate benign or malignant SPN.</p><p><b>RESULTS</b>There were significant differences in the enhancement values at 20, 22, 24, 25, 26, 28, 30, and 34s, PRS, I or II type perfusion curve, and marginal uncomplete enhancement or patchy complete enhancement at 34s between benign and malignant SPN. With the multi-variant combined score > 0.5 as the threshold value to differentiate benign and malignant SPN, its sensitivity and specificity was 94.3% and 41.2%, respectively.</p><p><b>CONCLUSION</b>The combined scores of 64 multi-slice CT can help differentiate the benign or malignant SPN.</p>

Low hematocrit impairs gastric mucosal CO2 removal during experimental severe normovolemic hemodilution

OBJECTIVE: The net effects of acute normovolemic hemodilution with different hemoglobin levels on splanchnic perfusion have not been elucidated. The hypothesis that during moderate and severe normovolemic hemodilution, systemic and splanchnic hemodynamic parameters, oxygen-derived variables, and biochemical markers of anaerobic metabolism do not reflect the adequacy of gastric mucosa, was tested in this study. METHODS: Twenty one anesthetized mongrel dogs (16 ± 1 kg) were randomized to controls (CT, n = 7, no hemodilution), moderate hemodilution (hematocrit 2 5 percent ± 3 percent, n = 7) or severe hemodilution (severe hemodilution, hematocrit 15 percent ± 3 percent, n = 7), through an isovolemic exchange of whole blood and 6 percent hydroxyethyl starch, at a 20 mL/min rate, to the target hematocrit. The animals were followed for 120 min after hemodilution. Cardiac output (CO, L/min), portal vein blood flow (PVF, mL/min), portal vein-arterial and gastric mucosa-arterial CO2 gradients (PV-artCO2 and PCO2 gap, mm Hg, respectively) were measured throughout the experiment. RESULTS: Exchange blood volumes were 33.9 ± 3.3 and 61.5 ± 5.8 mL/kg for moderate hemodilution and severe hemodilution, respectively. Arterial pressure and systemic and regional lactate levels remained stable in all groups. There were initial increases in cardiac output and portal vein blood flow in both moderate hemodilution and severe hemodilution; systemic and regional oxygen consumption remained stable largely due to increases in oxygen extraction rate. There was a significant increase in the PCO2-gap value only in severe hemodilution animals. CONCLUSION: Global and regional hemodynamic stability were maintained after moderate and severe hemodilution. However, a very low hematocrit induced gastric mucosal acidosis, suggesting that gastric mucosal CO2 monitoring may be useful during major surgery or following trauma.

OBJETIVO: Os efeitos da hemodiluição normovolêmica com diferentes níveis de hemoglobina na perfusão esplâncnica são pouco conhecidos. Testamos a hipótese que durante a hemodiluição moderada e acentuada, os parâmetros hemodinâmicos sistêmicos e regionais e as variáveis relacionadas ao metabolismo de oxigênio não refletem a adequação da perfusão da mucosa gástrica. MÉTODOS: Vinte e um cães anestesiados com fentanil e vecurônio (16±1 kg) foram randomizados como controles (CT, n=7, sem hemodiluição normovolêmica), hemodiluição normovolêmica moderada (Ht 25±3 por cento, n=7) ou hemodiluição normovolêmica acentuada (Ht 15±3 por cento, n=7), pela troca isovolêmica entre o sangue total e hidroxietil amido a 6 por cento, 20 mL/min até o hematócrito pré-estabelecido para cada grupo. Os animais foram acompanhados por 120 min após a hemodiluição normovolêmica. Durante todo o experimento foram medidos o débito cardíaco (CO, L/min), o fluxo de veia porta (PVF, mL/min), e os gradientes de CO2 veia porta-arterial e mucosa gástrica-arterial (PV-artCO2 and PCO2-gap, mmHg, respectivamente). RESULTADOS: O volume de sangue trocado foi de 33,9±3,3 mL/kg para hemodiluição normovolêmica moderada e de 61,5±5,8 mL/kg para a hemodiluição normovolêmica acentuada. A pressão arterial e os níveis de lactato sistêmico e regional permaneceram estáveis em todos os grupos. Houve aumentos iniciais de débito cardíaco e de fluxo de veia porta, tanto na hemodiluição normovolêmica moderada quanto na hemodiluição normovolêmica acentuada; o consumo de oxigênio sistêmico e regional permaneceram estáveis, principalmente por conta de aumentos na taxa de extração de oxigênio. O PCO2-gap apresentou aumento significativo apenas nos animais submetidos a hemodiluição normovolêmica acentuada. CONCLUSÃO: Ocorre estabilidade hemodinâmica global e regional tanto na hemodiluição normovolêmica moderada quanto na acentuada. Entretanto, o hematócrito de 15 por cento induziu acidose moderada de mucosa gástrica, o que pode ser relevante em procedimentos cirúrgicos de grande porte ou no trauma.

Volume management in critically ill patients: new insights

Para ser efetivo em aumentar significativamente o volume sistólico um volume de fluido precisa preencher duas condições : 1- A infusão deste fluido tem que aumentar a pré-carga; 2- O aumento da pré-carga tem que promover uma elevação proporcional do volume sistólico.Em outras palavras o paciente pode ser não responsivo à infusão de volume em termos de volume sistólico, devido a quantidade de fluidos ainda não ser a necessária ou o coração já estar operando na faixa superior da curva de Frank-Starling. Os indicadores volumétricos da pré-carga cardíaca são úteis para verificar se esta pré-carga aumenta efetivamente durante a infusão de fluido. Em caso negativo, ou seja a pré-carga não aumenta, medidas adicionais como mais fluidos, venoconstrictores para aumentar o quantidade de sangue, ou aumento do retorno venoso por redução da pressão intratorácica podem ser efetivas para atingir a primeira condição: aumento da pré-carga. Delta PP pode ser útil para verificar se o volume sistólico aumenta com a infusão de fluidos. Isto não acontecendo somente drogas inotrópicas podem aumentar o débito cardíaco. Portanto, combinando os indicadores estáticos da pré-carga (PVC, pressão capilar pulmonar) com Delta PP, consegue-se a melhor opção para monitorar a resposta aos fluidos em pacientes críticos.

Assessment of stroke volume variation and intrathoracic blood volume index on the responsiveness to volume loading in mechanically ventilated canine with hemorrhagic shock / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the significance of stroke volume variation (SVV) and intrathoracic blood volume index (ITBI) on the responsiveness to volume loading in mechanically ventilated canine with hemorrhagic shock.</p><p><b>METHODS</b>Hemorrhagic shock canine model was established with the modified Wiggers' method. The heart rate (HR), mean artery pressure (MAP), central venous pressure (CVP), pulmonary artery wedge pressure (PAWP), intrathoracic blood volume index (ITBI) and stroke volume variation (SVV) were investigated by Swan-Ganz catheter or PiCCO monitor. Graded volume loading (VL) was performed. Successive responsive VLs were performed (increase in SV > 5% after VL) until continuous change in SV < 5% (unresponsive) was reached.</p><p><b>RESULTS</b>Fourteen canines were studied and a total of 134 VLs were performed. In 94 VLs, an increase in SV of more than 5% was reached. In the other 40 VLs, increase in SV was less than 5%. The change of HR, MAP, ITBI, SVV in responsive were more than those of unresponsive after VL. The change of CVP, PAWP in responsive were less than those of unresponsive. Significant correlation was found between DeltaSV after VL and the baseline values of ITBI, SVV. No correlation was found between DeltaSV and HR, MAP, CVP, PAWP. Significant correlations were also found between DeltaSV and DeltaCVP, DeltaPAWP, DeltaITBI, DeltaSVV after fluid loading. No correlation was found between DeltaSV and DeltaHR, DeltaMAP. By using receiver operating characteristic analysis, the area under the curve were 0.872 for SVV and 0.689 for ITBI, more than those of HR, MAP, CVP, PAWP statistically. As SVV value of 9.5% or more will predict an increase in the SV of at least 5% in response to a VL with a sensitivity of 92.6% and a specificity of 82.5%.</p><p><b>CONCLUSIONS</b>SVV and ITBI were more useful indicators than CVP and PAWP on the assessment of responsiveness to volume loading. SVV as a functional preload parameter and for on-line monitoring may help to improve the hemodynamic management.</p>

simple micro-assay method for estimating blood meal size of the sand fly, phlebotomus langeroni [diptera: psychodidae]

The accurate measurement of blood meal size in Phlebotomus langeroni, the potential vector of infantile visceral leishmaniasis in Egypt, is important to determine the number of parasites taken in fully engorged insects. A simple protein content micro-assay was introduced for that purpose. The accuracy of this method was confirmed by hemoglobin estimation method. Laboratory bred P. langeroni were fed artificially on defibrinated human blood and the fully engorged flies were carefully dissected on ice, within 1-10 minutes after feeding, since the time of dissection was critical. The serial concentrations of the defibrinated human blood were required as standards. The results showed that the full blood meal taken by P. langeroni ranged from 0.76 to 0.94 mm3 of blood with a mean volume of 0.85 +/- 0.02 mm3 and from 0.71 to 0.99 mm3 of blood with a mean volume of 0.83 +/- 0.02 mm3 as measured by protein content and hemoglobin estimation methods, respectively. Data showed that there was no significant difference between the two methods in estimating the blood meal size of P. langeroni. In addition, protein content micro-assay had the advantages of being accurate, rapid, sensitive and reliable

Correlation of blood volume values and pulmonary artery catheter measurements

To correlate the values generated by direct total blood volume measurement with pulmonary artery catheter parameters and commonly used laboratory values in the management of critically ill patients. This study was carried out at the Lutheran Medical Center, Brooklyn, New York, United States of America, during the period 1998-1999. We prospectively correlated the total blood volume [TBV] values generated by the blood volume analyzer [BVA]-100 using I131-tagged albumin, with the values obtained from pulmonary artery catheter [PAC] of central venous pressure, pulmonary capillary wedge pressure, cardiac output, and with laboratory values of hematocrit, lactate, arterial blood gas and mixed venous blood, in critically ill patients. Twenty-four intensive care unit [ICU] patients were studied. Inclusion criteria: Admission to the intensive care, pulmonary artery catheter insertion and [APACHE] II Acute Physiology and Chronic Health Evaluation score of 8-30 [mean=17.875]. Exclusion criteria: Pediatric patients, hemodynamically normal or stable patients, pregnancy, and critically ill patients that were managed in an ICU setting without PAC catheter. Height and weight were recorded. After the collection of an initial blood sample [5cc], one cc of I131-tagged albumin [15-25 microcuries] was injected using a patented syringe. Five venous samples were collected after the isotope injection. The collection times were entered into the BVA-100. Hematocrit measurements were performed in duplicate. Blood samples were centrifuged and one ml from the plasma of each sample was pipetted [in duplicate] into the sample tube then placed into the BVA-100. The results showed that the TBV did not correlate with either pulmonary capillary wedge pressure or central venous pressure, and except for the cardiac output, there is no correlation between pulmonary capillary wedge pressure readings or TBV results and the other parameters considered in this study. This method can be released from the research fields and can be safely incorporated into the clinical arena. It provides an accurate assessment of the volume status in intensive care unit patients

Aspectos psicológicos en pacientes con policitemia relativa hipovolémicos y normovolémicos / Phychological aspects in hypovolemic and normovolemic patients with relative polycythemia

En un grupo de 38 pacientes con policitemia relativa (PR) diagnosticados y atendidos en el IHI, se realizó un estudio retrospectivo de las características de personalidad y de elementos psicopatológicos a raíz de la nueva clasificación de PR normo e hipovolémica. No se encontraron diferencias significativas de las escalas psicológicas entre el total de pacientes hipovolémicos y el total de pacientes normovolémicos, aunque sí se hallaron diferencias entre los pacientes con valores extremos de las variables hematológicas. Los pacientes con mayores cifras de hematócritos se describen como más rígidos, oposicionistas, impulsivos, con tendencia a la acción y la propensión a brindar una imagen de masculinidad acentuada. Los sujetos que poseen los menores valores de índice plasmático se muestran como personas más dinámicas, enérgicas y emprendedoras, con tendencia a una mayor actitud defensiva ante la exploración de su área psicológica como resultado de una intención de ofrecer una imagen de rasgos socialmente deseables. El subgrupo de pacientes de mayores valores en el volumen globular resultaron ser menos reposados e introspectivos y más tendientes a la impulsividad, a ser expresivos y entusiastas. Los resultados obtenidos confirman la vinculación de los aspectos psicológicos con esta enfermedad.

Estudio sobre el niño desnutrido: VII El volumen sanguíneo y el del plasma en el preescolar desnutrido / Studies in malnourished children: Blood and plasma volumes in malmourished preschool child

Se presenta el estudio del volumen sangíneo y del plasma de 70 niños desnutridos. Se hace una comparación con los valores reportados para el niño sano, encontrando que los desnutridos presentan un aumento de ambos volúmenes (sanguíneo y del plasma), expresados éstos en cc por kilo de peso corporal. Esto es, a mayor desnutrición mayor volumen sanguíneo por kilo de peso. En virtud de los hallazgos histológicos en el hígado de los niños desnutridos y de los trabajos de Himsworth, se presenta como hipótesis de trabajo la posibilidad de que una de las causas que produce el aumento del volumen del plasma se deba a la presencia del factor vasopresor que se origina en las células hepáticas en su sufrimiento

Volúmenes sanguíneos / Blood volumes

Se revisan los métodos para determinar los volúmenes sanguíneos y se demuestra que los trazadores radiactivos han reemplazado a los no radiactivos. Se explica el principio del dilución y la determinación del volumen globular con radiocromato de sodio (51 Cr) y glóbulos rojos lavados del volumen plasmàtico con albúmina sérica humana marcada con iodo radiactivo (125 I), 2 de los métodos recomendados por el Comité Internacional de Estandarización de Hematologia en 1986. Se discute la validez del uso de la relación del hematocrito corporal y el hematocrito venoso para el cálculo del volumen sanguíneo total, y se comprueba que en sujetos normales y policetémicos es posible utilizarla, no así en pacientes con esplenomegalia, anemia y disproteinemia, debido al error considerable que se introduce en el cálculo de este parámetro. Se analizan los valores normales de los volúmenes sangúineos, la forma màs adecuada de expresarlos y las variaciones fisiológicas que pueden sufrir debido al clima, el ejercicio físico y el embarazo. Se considera la utilidad clínica de la medición de los volúmenes sanguíneos para la hematologìa y varias enfermedades no hematològicas

Evoluçäo ecográfica do perímetro abdominal de fetos submetidos à transfusäo intra-uterina / Echographic evolution of abdominal perimeter of foetuses undergoing intrauterine transfusion

Avaliou-se ecograficamente o perímetro abdominal de três fetos submetidos a cinco transfusöes intra-útero, por doença hemolítica perinatal. Foi feita correlaçäo da reduçäo do perímetro abdominal com modificaçöes no padräo da cardiotocografia, portanto, da oxigenaçäo fetal. Foi verificado que fetos näo hidrópicos apresentam ritmo regular de reduçäo do perímetro abdominal e que a cardiotocografia passa de näo reativa à reativa quando a reduçäo do perímetro abdominal é maior que 20%. Na visäo dos autores a medida seriada do perímetro abdominal é um bom método de avaliar o ritmo de absorçäo do sangue injetado na cavidade peritoneal de fetos transfundidos

Análisis de métodos de estimación del volumen sanguineo circulante / Analysis of the method of whole blood volume estimation

La estimación del volumen sanguíneo circulante puede efectuarse por varios métodos que se basan en la afinidad de substancias conocidas y cuantificables (plomo, cromo y fosfato radioactivos) con los eritrocitos o yodo radioactivo y colorantes con el plasma sanguíneo. Estas estimaciones del volumen sanguíneo circulante son complejas por el hecho de que el porcentaje de eritrocitos y plasma de las muestras venosas o arteriales es mayor que el porcentaje de células y plasma en el volumen sanguíneo circulante total. Bajo estas circunstancias, el volumen obtenido debe procesarse con adecuadas correcciones que tratan de aproximar los cálculos obtenidos a la individualidad de cada paciente. El presente análisis compara los métodos de estimación de volumen sanguíneo circulante más comúnmente utilizados en la práctica clínica con predicciones basadas sobre varios índices fisiológicos materiales

Factor de corrección simplificado para el cálculo de los volúmenes ventriculares por angiografía / Simplified correction factor in the calculation of ventricular volumes during angiography

Para la medición de los volúmenes cardíacos a partir de la silueta ventriculográfica, es necesario un factor de calibración (fc) para corregir la distorsión y amplificación debida a la divergencia de los rayos X. En el pasado, varios procedimientos ha sido descritos para la obtención de éste fc, cuya determinación es a menudo engorrosa y tardada, ya que requieren de la planimetría o del uso de una rejilla calibrada. En el presente trabajo describimos un método para calcular el fc: después de la ventriculografía izquierda, filmada en posición oblicua ederecha anterior, filmamos una esfera metálica de diámetro conocido, a las mismas incidencias y distancia del corazón al tubo o intensificador de imagen del aparato de rayos X. Encontramos una buena correlación entre los volúmenes ventriculares determinados con los procedimientos de la esfera, de la planimetría de una rejilla y el de la medición de los ejes de la elipsoide respectivamente (p<0.01). Despues de discutir estos tres procedimientos, recomendamos el de la esfera, ya que con ello se evita el uso de la rejilla, la práctica de la planimetría y se calcula fácilmente el fc