RESUMO
【Objective】 To summarize the clinical features, serological features, blood transfusion protocols and treatment of 3 cases of passenger lymphocyte syndrome(PLS) after ABO-incompatibility liver and renal transplantation in our hospital, in order to provide guidance for comprehensive clinical understanding and recognition of this disease, especially early recognition and treatment. 【Methods】 By collecting the basic information of the patients and the time of cross-matching incompatibility of homologous blood after transplantation, observing the skin yellow staining, detecting hemoglobin value and other hemolysis indexes, and blood group serological detection results before and after transfusion, the diagnosis and analysis were performed. The diagnosis and treatment effect of PLS were analyzed by collecting the clinical outcome information after immunization and blood transfusion. 【Results】 Three cases of ABO-incompatible liver transplantation showed decreased hemoglobin and hemolysis, incompatible cross-matching of homologous blood, and anti-A and anti-B IgG antibodies were confirmed by serological test. After treatment such as immunosuppression and plasma exchange, blood transfusion was effective, hemolysis was improved, and antibodies gradually disappeared. 【Conclusion】 ABO blood group antibody screening, unexpected antibody screening and direct antiglobulin test(DAT)should be performed regularly for ABO-incompatible liver and renal transplantation cases, in order to detect the PLS early. A series of laboratory tests related to PLS should be performed in time to diagnose and adjust the treatment plan, including transfusion strategy, when homologous cross-matching is incompatible.
RESUMO
Objective To summarize the effect of the timing of lung transplantation and related treatment measures on clinical prognosis of patients with paraquat poisoning. Methods Clinical data of a patient with paraquat poisoning undergoing bilateral lung transplantation were retrospectively analyzed. Clinical manifestations, auxiliary examination, diagnosis and treatment of this patient were summarized and analyzed. Results A 17-year-old adolescent was admitted to hospital due to nausea, vomiting, cough and systemic fatigue after oral intake of 20-30 mL of 25% paraquat. After symptomatic support treatment, the oxygen saturation was not improved, and pulmonary fibrosis continued to progress. Therefore, sequential bilateral lung transplantation was performed under extracorporeal membrane oxygenation (ECMO). After postoperative rehabilitation and active prevention and treatment for postoperative complications, the patient was discharged at postoperative 50 d. Conclusions The timing of lung transplantation after paraquat poisoning may be selected when the liver and kidney function start to recover. Active and targeted prevention of potential pathogen infection in perioperative period and early rehabilitation training contribute to improving clinical prognosis of lung transplant recipients.
RESUMO
【Objective】 To investigate the clinical characteristics and diagnosis and treatment of passenger lymphocyte syndrome (PLS) in patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT). 【Methods】 A total of 489 patients who underwent allo-HSCT in Suzhou Hongci Hematology Hospital were retrospectively enrolled. The clinical process, diagnosis and treatment measures and prognosis of four patients complicated with PLS after transplantation were analyzed. 【Results】 Among the 489 patients, 4 were diagnosed with PLS. The blood types of donor/recipient ABO were all secondary incompatible (The blood type of donors were O and the recipients were A or B). The overall incidence of PLS in allo-HSCT was 0.82%(4/489)and 2.2%(4/179)in transplants with donor/recipient secondary incompatible ABO-blood types. PLS occured in 6-13 days after donor stem cell infusion. Clinical manifestations were dizziness and fatigue, low back pain, jaundice, deepening urine, rapid decrease in hemoglobin on laboratory tests, elevated indirect bilirubin and lactate dehydrogenase, positive urobilinogen, positive direct anti-human globulin test (DAT), and anti-A or anti-B antibodies against recipient red blood cells were detected in plasma. After the treatment of O-type washed red blood cells, methylprednisolone, gamma globulin, rituximab and other treatments, the hemolysis was improved. All patients achieved engraftment of neutrophil and platelet. Red blood cell transfusion was halted in 3 weeks. 【Conclusion】 PLS is a rare complication of allo-HSCT, which mainly occurs in allo-HSCT patients with secondary incompatibility of ABO blood group of donor/recipient. The clinical prognosis is good after properly treatment.
RESUMO
【Objective】 To explore the laboratory monitoring procedure and its clinical significance in patients with passenger lymphocyte syndrome after liver transplantation. 【Methods】 The Hb and bilirubin levels were monitored in one AB blood type patient post-liver transplantation. The ABO blood group type, unexpected antibody screening test, direct anti-globulin test and acid elution test were performed respectively in blood samples of the patient to identify the serum antibodies and erythrocyte membrane sensitized antibodies. 【Results】 The patent’s Hb level showed a decreasing trend on the day 11 post-operation, reaching the lowest level of 62 g/L on day 17, and his serum bilirubin increased. The patient’s ABO blood type was determined as AB while anti-B antibody was detected in the patient’s serum. The direct anti-globulin test was weakly positive, while the unexpected antibody screening test was negative. Anti-B antibody was detected in the elution and the patient’s serum. The patient′s serum was incompatible with type AB and type B erythrocytes in the cross-matching test, while it was compatible with type A and type O erythrocytes. 【Conclusion】 Through monitoring serum anti-A, anti-B and direct anti-human globulin test, the patients with passenger lymphocyte syndrome after liver transplantation can be early diagnosed and the prognosis can be improved.
RESUMO
Objectives To investigate the sanitary condition of the secondary water supply for passenger trains in the administration area, to evaluate the influencing factors of the secondary water supply system for passenger trains, and to put forward suggestions for improving the water quality of the secondary water supply for passenger trains. Methods The water quality of secondary water supply of 48 trains of 24 pairs of CRH type passenger trains and 160 trains of 10 pairs of type 22 passenger trains and 30 pairs of type 25 passenger trains in Lanzhou Railway Bureau in 2019 was analyzed and compared. Results The qualification rate of 208 samples tested was 73.08%. The qualification rate of secondary water supply quality of type 22 and 25 passenger trains was 62.50% and 66.67%, respectively, and the difference was not statistically significant（χ2=0.23 ，P＞0.05）. The qualification rate of secondary water supply of CRH passenger train was 97.92%, which was statistically significantly different compared with that of type 22 and 25 passenger trains（χ2=18.40, 18.15, P2=0.056, 0.054, 0.056, 0.22, 0, and 0.22, P>0.05). The total number of bacterial colonies, total coliform, turbidity and iron in the secondary water supply of type 22 and 25 passenger trains did not meet the standard, while only one water sample for the secondary water supply of CRH passenger trains did not meet the standard. Conclusion The quality of secondary water supply of CRH passenger train is obviously better than that of type 22 and 25 passenger trains. Changing the position of defecation port and water injection pipe of type 22 and 25 passenger trains, selecting non direct train defecation collection system, or adding appropriate amount of chlorine disinfectant into the water supply hose can significantly improve the qualification rate of bacteriological indexes of secondary water supply of passenger trains.
RESUMO
【Objective】 To analyze the causes and treatments for the incompatible crossmatching between a patient, who underwent the minor ABO mismatches lung transplantation, and the blood donor with ABO-compatible blood. 【Methods】 A patient, who underwent the minor ABO mismatches (donor group O; recipient group A) lung transplantation developed a continuous decrease in Hb for 13 days after surgery, The blood sample of the patient presented major crossmatching incompatibility with the blood donors and the causes of it were analyzed by the recipient′s blood type reviewing, direct antiglobulin test, antibody screening and erythrocyte elution. 【Results】 The patient’s serum reacted with A1 erythrocyte reagent with agglutination strength at ±, and enhanced to 1+ at 4℃ after 10 min incubation.Antibodies were not detected by 10-cell panel and the effects of unexpected antibodies were excluded.The results of direct antiglobulin test and elution test were positive, and eluted anti-A antibody was detected.Combined with the patient′s continuous decline in Hb and elevated total bilirubin, passenger lymphocyte syndrome (PLS) was clinically diagnosed.After the transfusion of 6 U of O-type washed RBCs, the symptoms of anemia were improved and no adverse reactions occurred. 【Conclusion】 PLS may occur after an ABO mismatched solid organ transplantation.Most of the hemolytic symptoms are not obvious and easy to ignore, therefore clinical indicators of direct antiglobulin test results, Hb and total bilirubin should be continuously monitored after transplantation for early detection and timely treatment of PLS to avoid major adverse consequences.
RESUMO
Objective:To explore the prevalence of passenger lymphocyte syndrome(PLS) after liver transplantation, minimize the result bias caused by previous multicenter confounding factors, make up for the lack of statistical analysis of PLS and provide reference for a diagnosis and treatment of PLS after liver transplantation.Methods:We reviewed liver transplants performed in our center from 2018 to 2019, searching for cases with minor ABO incompatibility or bidirectional ABO incompatibility. Diagnostic criteria for PLS: laboratory confirmation included biochemical identifiers of hemolysis, positivity of the direct antiglobul in test(DAT), donor attributed anti-recipient antibody in recipient's sera, and exclusion of other causes of decreased HGB(i.e. postoperative infection, acute rejection & surgical blood loss). A total of 666 liver transplants were performed. Among 52 patients with minor ABO incompatibility or bidirectional ABO incompatibility, 10 cases developed PLS(19.23%)and 42 cases did not(80.77%). Statistical comparisons between patients with and without PLS were performed using the chi-square test and Fisher's exact test.Results:There were no statistically significant differences in PLS group subjects in terms of sex, age, blood group, type of incompatibility, type of immunosuppressants and postoperative outcome. There was statistically significant correlation between postoperative blood transfusion and PLS( P< 0.05), and donor blood group B cohort demonstrated a higher risk of PLS than donor blood group A and O cohorts( P< 0.05). Conclusions:PLS is one of the causes for postoperative anemia in liver transplantation, and donor blood group B graft is a risk factor for PLS.
RESUMO
PURPOSE@#After car accident, motorcycle accident ranks as the second leading cause of traffic fatality in Iran. This study aimed to compare the severity and clinical presentations between drivers and passengers under the same injury circumstance.@*METHODS@#This study was conducted in the trauma center of Shiraz, Iran in 2017. Data on demographics, triage level, blood pressure, respiratory rate, Glasgow coma scale (GCS), injured body region, injury severity score (ISS), revised trauma score (RTS), and result of accident were compared between pairs of drivers and passengers. The agreement of any type of injury between drivers and passengers evaluated by Kappa test.@*RESULTS@#This study included 143 matched pairs of drivers and passengers. Most of the pairs (84.5%) did not use helmet and 77.2% of the riders do not have driving license. ISS was significantly higher in drivers than passengers. In the unmatched pairs, drivers and passengers showed no difference in sustaining injuries in the face, head & neck, chest and soft tissue, but drivers were found more likely to suffer from injuries in the abdomen, extremities, pelvis and spine than passengers. Once one part of the matched pair suffered injury in the head & neck, face, chest, abdomen, extremities and soft tissue & skin injury, the probability that the other part had an injury in the same region was 50%, 9%, 13%, 7%, 22% and 34% respectively. Kappa value for these body regions was 0.006, 0.009, -0.006, 0.068, 0.063 and 0.001, respectively, which was significant in abdomen and extremities.@*CONCLUSION@#Although drivers had higher level of injury severity and some different injury distributions, we recommend equal treatment to drivers and passengers. We also recommend related authorities to develop policies on helmet use, driving license and third-party insurance.
RESUMO
@#Child restraint system (CRS) can protect children in the event of crash and reduce the severity of injuries. As such, it is crucial to understand the prevalence of CRS usage and knowledge attributes on CRS usage among drivers. This study aims to assessdrivers’ knowledge on CRS usage.A semi-structured questionnaire was developed and pilot tested to verify its validity and reliability. The questionnaireaddressesdrivers’ knowledge about CRS currently available in the Malaysian market, the types of restraints used and views on fitting restraints to passenger vehicles. Seventy four percentfrom 500 respondents cited that they are usingor theyhave used CRS,64% knowabout CRS and its function, and 43% areawareof ISOFIX. In short, majority of the respondents are aware of CRS use and functions. Awareness and education program should berigorously introduced to public towards the implementation of the CRS law.
Assuntos
Sistemas de Proteção para CriançasRESUMO
Objective To discuss the safety of Rh-positive patients receiving kidney grafts from Rh-negative cadaver donor. Methods On November 29 th 2013, two Rh-positive patients received renal transplantation with kidney grafts from Rh-negative cadaver donor at the Department of Urinary Surgery of Xijing Hospital,the Fourth Military Medical University. The clinical data of the two patients were analyzed retrospectively and the relevant literatures were reviewed. Results The two patients underwent renal transplantation successfully and no hyperacute rejection or acute rejection occured after the surgery.The two patients were followed up for 12 months.The kidney grafts survived well and the patients had no obvious discomfort.Conclusions Through enhanced immunosuppression before operation,sufficient perfusion and close postoperative monitoring,it is safe for Rh-positive patients receiving kidney grafts from Rh-negative cadaver donor.
RESUMO
Objective A kidney transplantation patient who was diagnosed with autoimmune hemolytic anemia (AIHA) caused by passenger lymphocyte syndrome (PLS) was reviewed.Method A male kidney transplantation patient aged 31 was admitted due to severe anemia.Direct antiglobulin test (DAT) was positive and reticulocyte was elevated significantly,and PLS was diagnosed.He was treated with blood transfusion,glucocorticoid and intravenous immunoglobulin,and recovered at last.Result PLS is a rare but important cause of AIHA after kidney transplantation,often occurs in blood type A patient who received a kidney from a blood type O donor.Final diagnosis depends on the detection of anti-erythrocyte antibody in recipient serum.Conclusion PLS should be considered when anemia with unknown reasons occurred in kidney transplantation patients.
RESUMO
Limitations due to lack of appropriate available donors for liver transplantation necessitates the use of ABO-mismatched donors. Transplantation of ABO-mismatched solid organs is sometimes associated with the development of immune hemolytic anemia, which is caused by production of antibodies by the donor B lymphocytes in a primary or secondary immune response against the recipient's red blood cell antigens. This condition is referred to as Passenger Lymphocyte Syndrome (PLS). PLS is more frequent in heart and lung transplants than in liver and kidney transplants with incidence of PLS in liver transplantation at 30~40%. When present, PLS typically manifests 1~3 weeks after transplantation, and subsides within 3 months after symptoms are first detected. In most patients, PLS is self-limiting and exhibits mild symptoms, but in some cases PLS can be life-threatening. We report a case of immune hemolytic anemia after an ABO-mismatched liver transplantation involving a blood group O donor and a blood group A recipient, and successful treatment of the resulting PLS symptoms by transfusion of gamma-irradiated group O Red Blood Cells (RBCs) accompanied by administration of 60 mg/day of methylprednisolone for 1 week.
Assuntos
Humanos , Anemia Hemolítica , Anticorpos , Linfócitos B , Eritrócitos , Coração , Incidência , Rim , Fígado , Transplante de Fígado , Pulmão , Linfócitos , Metilprednisolona , Doadores de Tecidos , TransplantesRESUMO
Seat belts and air bags are all designed according to adult, so which used by children will only increase their injury. Children who sitting in the front row do not use any restraint devices have the highest risk in the car accident,but who sat in the back with the appropriate child restraint devices only have the low risk. Education for families and parents that is basics of implementing legislation and promoting child restraint devices, but which need to integrate other method or means of effective intervention is possible. Legislation is one of the most powerful tool to prevent child passenger injury, but how to implement and enforce these laws are more important in developing countries.
RESUMO
Objective To observe the expression of survivin and Aurora B in human pancreatic cancer BXPC3 cells after the treatment of sulindac and to explore the potential mechanism. Methods MTr assay was used to determine the effect of sulindac on the proliferation of the BXPC3 cells. RT-PCR was used to detect the expression of mRNA level of survivin and Aurora B, western blot was used to detect protein expression of survivin and Aurora B Thr-232. Cell cycle and apoptosis were detected by flow eytometry (FCM). Results The BXPC3 cells were inhibited by sulindac in a dose and time-dependent manner; the expression of mRNA of survivin and Aurora B were both significantly decreased from 1.5644 and 0.6554 to 0. 4372 and 0.1132 (P< 0.01), the expression of survivin protein and the phosphorylation of Aurora B Thr-232 were also decreased from 1.2735 and 0.4680 to 0.2126 and 0.2546 (P<0.01); the proportion of cells in the G0/G1 phase was increased from (56.65±1.93)% to (70.58±3.21)% (P<0.01). Conclusions Sulindac had inhibitory effects on the growth of BXPC3 cells, the possible mechanism was via decreasing the expression of survivin which depressed the activity of Aurora B, then the CPC was influenced. The most of the cells were blocked in the G0/G1 phase, and the cells' mitosis was inhibited.
RESUMO
PURPOSE: These days, airline traffic is so developed that the globe has become much smaller and interest in fear of passenger-flight crashes is increasing. Using the opportunity offered by the Kimhae airline disaster, the author studied the relation of the injury mechanism & the seat-position to the injury severity in order to provide helpful information for use in other situations. METHODS: The author performed a retrospective analysis and compared survivors (37 persons) with deaths (129 persons) in the crash of Chinese passenger-flight B767-200 approaching Kimhae airport on April 15, 2002. RESULTS: Most of the survivors were seated in the rear of the airplane while most of those who died were in the front. Thus, a definite correlation exists between seat position in the aircraft and the injury severity. The deceleration force generated during a flight crash is sufficient to induce fatal injury. CONCLUSION: Most flight crashes are due to CFIT (controlled flight into terrain) accidents which are caused by the pilot being insensible to safety. This time, it was also the case. The author wishes it not to be the case next time.
Assuntos
Humanos , Aeronaves , Aeroportos , Povo Asiático , Desaceleração , Desastres , Estudos Retrospectivos , SobreviventesRESUMO
Transplantation of ABO-nmatched solid organs has been associated with the development of immune hemolysis due to donor-erived antibodies produced by passenger lymphocytes in the graft, called "Passenger Lymphocyte Syndrome". In a liver transplantation, about 40% of patients at risk has detectable donor-erived antibodies and hemolytic anemia occurs in 29% of patients. It is characterized by hemoglobinemia, a rapid fall in hemoglobin, hyperbilirubinemia, and an excessive red cell transfusion requirement occurring 1 to 3 weeks after the transplantation. These clinical findings are accompanied by the laboratory findings of a positive direct antiglobulin test and the detection of unexpected antibodies in the patients' red cell eluate and serum. Both the hemolytic anemia and serology resolve over the course of weeks to months. To the best of our knowledge, this is the first case of hemolytic anemia due to passenger lymphocyte syndrome after ABO-nmatched liver transplantation in Korea.