Analysis of Granulocyte Transfusions in Patients with Infections and Neutropenia: A Single Center Experience / 대한수혈학회지

BACKGROUND: Granulocyte transfusion therapy has been used as supportive care for patients with prolonged neutropenia after intensive chemotherapy or peripheral blood stem cell transplantation (PBSCT). Here, we investigated clinical factors of granulocyte transfusion therapy for neutropenic patients with infection to evaluate its efficacy and safety. METHODS: A retrospective analysis of 25 neutropenic patients treated with 99 granulocyte collection and granulocyte transfusion therapy from October 2011 to April 2016 at the National Cancer Center was conducted. Two groups, a count recovery group with a cut off of >1,000/µL and a no recovery group were compared and symptoms related with granulocyte transfusion were analyzed. RESULTS: Granulocyte collection and transfusions were performed in 99 procedures. After granulocyte transfusion therapy, 21 patients (84%) showed count recovery, whereas 4 patients (16%) had no response. Significant differences in pre-absolute neutrophil count (29/µL vs. 0/µL, P=0.048), duration of neutropenia before granulocyte transfusion (11 days vs. 26 days, P=0.011), and total number of granulocyte transfusion (2 times vs. 11 times, P=0.049) were observed between groups. Temporary symptoms related granulocyte transfusion were observed in seven patients (28%); however, all patients showed clinical improvement. The median of the single transfusion volume was 220 mL (200 to 397 mL) and the mean total granulocyte content was 4.92×10¹⁰. CONCLUSION: Granulocyte transfusion therapy is safe and effective for patient with life threatening neutropenia and infection, also considerable for early onset trial for granulocyte transfusion.

Three times spontaneous remission of severe aplastic anemia following granulocyte transfusion from related donors: a case report and literature review / 中国医学科学杂志(英文版)

Aplastic anemia (AA) is a bone marrow failure disease caused by abnormal activation of T lymphocytes, resulting in the apoptosis of hematopoietic cells and bone marrow failure. Currently, hematopoietic stem cell transplantation (HSCT), immunosuppressive - therapy (IST), and supportive care (e.g. transfusion adjuvant therapy, hematopoietic growth factors, and prevention of infection) are the main treatments of AA. Granulocyte transfusion has recently been accepted as an useful adjuvant therapy of HSCT and intensive IST. This article reported a severe AA patient who failed to respond to IST, but achieved spontaneous remission three times after granulocyte transfusions from related donors. Such cases have rarely been reported. Existence of human leukocyte antigen (HLA) cross between the patient and his relatives may influence the T cell-mediated immunity, which might explain this patient's recovery.

Granulocyte transfusion in children.

We describe a single institution experience with the use of granulocyte transfusion in children. This is a retrospective analysis of 45 collections of granulocyte units obtained by apheresis after priming with dexamethasone, infused into 17 children with severe neutropenic infections. Ten children survived the acute infection. Granulocyte transfusion is a useful adjunct to antimicrobials and growth factors in post chemotherapy neutropenic sepsis and is highly effective in children with chronic granulomatous disease and life threatening infections.

Abortamento habitual III - Trombofilias e fatores imunológicos / Habitual abortion III - Thrombophilia and imunologic factors

A associação dos anticorpos antifosfolípides, em particular o anticorpo anticardiolipina e o anticoagulante lúpico, com o abortamento habitual, bem como a eficácia do tratamento com a associação de heparina e ácido acetilsalicílico em baixa dose durante a gravidez estão respaldadas em fortes evidências clínicas. A participação e a eficácia do tratamento de outras trombofilias, tais como o fator V de Leiden, resistância à proteína C ativada, mutação do gene da protrombina e deficiência de proteína S, embora sugerida em alguns estudos, ainda não estão claramente estabelecidas. Não existe até o momento indicações de que alterações aloimunes possam ser causa de abortamento habitual. O tratamento empírico dessas alterações com imunoglobulina endovenosa ou transfusão de linfócitos paternos não tem melhorado os resultados obstétricos das mulheres com perdas recorrentes.

The association of antiphopholipid antibodies, specially the anticardiolipin antibody and lupus anticoagulant, with habitual abortion, as well as the efficacy of the treatment with heparin and low-dose aspirin during pregnancy are based in strong clinical evidence. The role and efficacy of the treatment of other thrombophilias, such as factor V Leiden, resistance to activated C protein, mutation of prothrombin gene and deficiency of protein S, althrough suggested in some studies, are not clearly established. There is no evidence, so far, that aloimmune alterations can be cause of habitual abortion. The empirical treatment of these alterations with IV immunoglobulin of paternal leukocyte transfusion have not improved obstetrical results in women with recurrent miscarriage.

Construction of hu-PBL/SCID chimeras and development of EBV-related lymphomas / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To construct hu-PBL/SCID chimeras and to investigate the development of lymphoma and oncogenicity of the Epstein-Barr virus (EBV).</p><p><b>METHODS</b>Human peripheral blood lymphocytes (PBLs) were isolated from healthy adult donors and transplanted intraperitoneally into severe combined immunodeficient (SCID) mice. Mice with hu-PBL engraftment from healthy EBV seronegative donors were injected intraperitoneally with EBV-containing supernatant from suspension culture of B95-8 cell line (active infection), whereas mice receiving lymphocytes from healthy EBV seropositive donors were not re-infected with B95-8 derived EBV (latent infection). Pathological examination and molecular analysis were performed on experimental animals and induced neoplasms.</p><p><b>RESULTS</b>In the early stage of this experiment, 12 mice died of acute graft-versus-host disease, mortality was 34.3% (12/35 mice) with an average life span of 17.5 days. In 19 survival hu-PBL/SCID chimeric recipients from 12 healthy donors, tumor incidence was 84.2% (16/19 mice). The average survival time of tumor-bearing mice was 65.5 days. EBV-related neoplasms in SCID mice were nodular tumors with aggressive and fatal features. Histological morphology of tumors exhibited diffuse large cell lymphomas. Immunohistochemistry revealed that LCA (CD45) and L26 (CD20) were positive, but both PS1 (CD3) and UCHL-1 (CD45RO) were negative, and EBV products ZEBRA, LMP1, and EBNA2 were expressed in a small number of tumor cells. EB virus particles were seen in the nuclei of some tumor cells by electron microscopy, and EBV DNA could be amplified in the tumor tissues by PCR. In situ hybridization indicated that the nuclei of tumor cells contained human-specific Alu sequence.</p><p><b>CONCLUSIONS</b>EBV-induced tumors were human B-cell malignant lymphomas. We obtained direct causative evidence dealing with EBV-associated tumor deriving from normal human cells.</p>

A Case of Disseminated Trichosporon beigelii Infection Treated with the Combination of Amphotericin B and Fluconazole / 대한임상미생물학회지

Trichosporon beigelii is often resistant to the fungicidal effect of amphotericin B and can cause fatal disseminated infections in immunocompromised patients. We report a case of a disseminated T. beigelii infection with a favorable outcome in a patient with acute erythroleukemia and neutropenia. The patient presented a persistent fever, multiple erythematous skin lesions, and pulmonary infiltrates. T. beigelii was isolated from blood cultures in four days and also from cultures of abdominal skin lesion, sputum, and stool. The isolate was resistant to amphotericin B (MIC, 2 microgram/mL), and the respective fluconazole and itraconazole MICs were 4 and 1 microgram/mL. The patient was successfully treated with fluconazole plus amphotericin B in combination with granulocyte colony stimulating factor and leukocyte transfusion. This case shows the importance of early diagnosis and treatment with combination of amphotericin B and fluconazole as a prognostic factor of disseminated T. beigelii infections.

Component therapy.

The dramatic advances that have taken place in recent years in the care of sick and premature infants also have been matched by a similar increase in the use of blood transfusion therapy. Haematological features indicate that a newborn has a blood volume of 85-125 ml/kg the foetal haemoglobin is 60-85% and average Hb in full term infant is 18 gm/dl. By 2-3 months it falls to 11-12 g/dl the main cause of anemia are iron poor diet, weaning diets recurrent or chronic infections and hemolytic episodes in malarious areas. The red cells transfusions are usually top up transfusions, exchange transfusions, partial exchange transfusions. Top up- are for investigational losses and correction of mild degrees of anemias, upto to 5-15 ml/kg. They comprise 90% of all neonatal transfusions and are used in low birth babies in special care units for a maximum of 9-10 episodes. The walk in donor programs once popular are not much in vogue. The threshold for transfusion is 8-10 g/dl Hb for upto 5 weeks. Exchange transfusions are done for correction of anemia, removal of bilirubin, removal of antibodies and replacement of red cells. Ideally plasma reduced red cells that are not older than 5 days are used. It is prepared by removal of 120 ml of standard whole blood donation. The advantage of fresh cells is that hyperkalemia is avoided and good post transfusion survival acceptable red cell oxygen affinity. However it has to be screened for sickle cell disease and G6PD deficiency. Indications for exchange transfusion are kernicterus, neonatal hemolysis, G6PD deficiency, ARDS, neonatal sepsis, DIC and neonatal isoimmune thrombocytopaenia. Complications include over transfusion, perforation of major vessels, hypocalcaemia, citrate toxicity, hypothermia, hypoglycaemia, thrombocytopenia, necrotizing enterocolitis, GVHD, bacterial, viral infections. Partial exchange transfusions are done for symptomatic anemia, where Hb<10 g/dl, it is indicated in polycythemia and hyperviscosity syndromes. Exchange volume = Blood volume x (observed Hct-Desired HCt) divided observed Hct. Points to consider-there is weak expression of ABO antigens so particular care while grouping. Transfusing volumes should be 2-5 ml/kg/hour in paediatric bags of 50-100 ml with infusion devices. Platelet transfusion are indicated in neonatal throbocytopaenia, thrombocytopaenia due to sepsis, DIC, bacterial pathogens, CMV, TORCHS, Obstetric conditions such as pre eclampsia, intrauterine death abruption placenta birth injury hypoxia schock neonatal iso immune thrombocytopaenia and maternal ITP. Administration 1 RDE/pack per 2.5 kg single dose of fresh platelets less than 24hrs which contains 55 x 10(9) cells. This also contributes fresh plasma so is useful for coagulation defects also, though there is a risk of CMV and GVHD due to leucocyte contamination. Granulocyte concentrate; Gravity leucopheresis-1:8 ratio of 60 ml of 6% HES made to stand for 1hr.

Granulocyte transfusions from G-CSF- and dexamethasone-stimulated healthy donors for treatment of patients with severe neutropenia-related infections / 대한내과학회지

BACKGROUND: Granulocyte transfusions have been used to treat severe, progressive infections in neutropenic patients who fail to respond to antimicrobial agents. Although corticosteroid or granulocyte colony-stimulating factor (G-CSF) were previously used separately to increase leukocyte counts in healthy donors, increasingly G-CSF and corticosteroids are used together, requiring the need to establish the efficacy of this mobilizing regime. METHODS: This prospective study evaluated the safety and efficacy of granulocyte transfusion therapy from donors stimulated with a combination of G-CSF and dexamethasone, in 27 patients with severe neutropenia-related infections. To mobilize granulocytes, healthy volunteer donors received G-CSF, 5 micro gram/kg subcutaneously 12-14 hr before leukapheresis, and dexamethasone, 3 mg/m2 intravenously 15 min before leukapheresis. RESULTS: Donor neutrophil counts were 5,723/micro L (range: 1,500~36,420) at baseline, 22,104/micro L (range: 9,700~41,300) before the injection of dexamethasone, 23,946/micro L (range: 10,900~42,100) immediately before leukapheresis, and 19,913/micro L (range: 9,100~36,300) after leukapheresis. Ninety-two leukapheresis procedures were performed with a mean yield of 7.88 10(10) granulocytes (range: 2.2~17.9 10(10)). The mobilizing agents were well tolerated in the donors. Of the patients, 16 (59.3%) showed favorable responses, whereas 11 (40.7%) had unfavorable responses. Adverse reactions to the therapy were arrhythmia in two patients (7.4%) and pulmonary edema in one patient (3.7%). Favorable responses were seen in 83.3, 76.9, and 45.5% of the patients from whom fungal, Gram-negative, and Gram-positive organisms were isolated, respectively. CONCLUSION: This study suggests that the combination of G-CSF and dexamethasone is an effective, well-tolerated regimen for mobilizing granulocytes from healthy donors, and that granulocyte transfusion therapy is useful for neutropenic patients, especially those with fungal or Gram-negative infections that are resistant to appropriate antimicrobial agents.

The change of peripheral white blood cell count and the transfusion of white blood cells for treating leucopenia in patients with burn sepsis

101 patients with burn sepsis including 22 patients, having peripheral white blood cell count of < 3.109/l treated in the National Institute of Burn, had received 23 units of white blood cells in transfusion. Results showed a decrease of white blood cell count in 58.4% of burn sepsis patients, and an increase in 21.8%. The peripheral white blood cell count was related closely to the germ of sepsis, the state of infections shock and the mortality. The monitoring of white blood cell count has had good impact on early diagnosis and a prognostic significance. The transfusion of white blood cells increases the white blood cell count and promotes its restoration processes

Pre-sensitive reaction in severe burn patients with white blood cell transfusion

The pre-sensitive reaction state of 10 severe burn patients after transfusion of 1-3 units of neutrophile granulocyte was investigated. After 3 weeks, almost patients had < 20% positive reaction and only 1/10 of patients had 30% positive reaction. They had received 3 units of neutrophile granulocyte

Transfusión de granulocitos en pacientes neutropénicos febriles / Granulocyte transfusion in febrile neutropenic patients

Desde 1996 a la fecha hemos transfundido con granulocitos a 20 pacientes con 21 episodios de neutropenia febril con criterios de extrema gravedad. 14 episodios correspondieron a sepsis con germen conocido y 7 neutropenia febril sin germen aislado. Los pacientes recibieron un promedio de 3.7 aféresis, con 2.17(potencia 10) granulocitos por cada una. Los donantes fueron seleccionados entre familiares directos con estudios rutinarios para la donaci¢n de sangre, los que fueron condicionados con factor estimulante de colonias granulocíticas previa al procedimiento aferético. 15 pacientes sobrevivieron al episodio neutropénico con resolución de cuadro infeccioso. Las reacciones adversas transfucionales en los receptores fueron leves y no hubo complicaciones clínicas en los donantes. Las transfusiones de granulocitos parecen ser efectivas en pacientes con neutropenia febril sin respuesta a antibióticos

Transfusion de granulócitos en enfermos neutropénicos / Granulocytes transfusion for neutropenic patients

Existe un renovado interés en el uso de trafusiones de granulocitos con el objetivo de ofrecer un mejor soporte a enfermos con neutropenia severa y prolongada.Ello se debe a los avances en la metodología de la movilización y coleta, lo que ha pertido la obtención de produtos con mayor número y función de neutrófilos comparados a los obtenidos en la década del 70. En esta revisión se discute la experiencia referidas en la literatura en las pasadas tres décadas, los progesos en la selección de donantes, y el uso de factores estimulantes de colonias y de separadores celulares. Comentaos también los efectos adversos, enfatizamos sus indicaciones actuales, y nuestra propia experencia en la utilización de transfusiones granulócitas. Es de esperar que los progresos realizados en esta área justifiquen tener en cuenta a las transfusiones de granulocitos en el tratamiento del paciente con neutropenia severa, y que ofrezcan documentación que permita no reiterar las decepciones experimentadas en los últimos veinte años.

Guía nacional para uso apropiado de sangre y hemocomponentes / National guide for appropaite use use of blood and hemocomponents

Contiene una guía nacional para uso apropiado de sangre y hemocomponentes para implementar en los Banco de sangre del todo el país

Laparoscopy-assisted Billroth I Gastrectomy Compared with Open Gastrectomy

PURPOSE: To compare laparoscopy-assisted Billroth I gastrectomy (LABIG) including standard lymph node dissection for patients with early gastric cancer was compared with open gastrectomy as a treatment method. METHODS: A prospective nonrandomized study was performed of early gastric cancer patients at Ewha Womans University Mok-Dong hospital from July 1999 to May 2001. Twenty patients (Group L) underwent LABIG including standard lymph node dissection. The control group (Group O) comprised 14 patients with conventional open radical subtotal gastrectomy and Billroth I anastomosis. RESULTS: In group L, pathologic reports revealed 18 early gastric cancers (stage IA 17 cases, IB 1 case), and 2 pm cancers (stage IB 1 case, stage II 1 case). In group O, there were 13 early gastric cancers (stage IA 12 cases, IB 1 case), and 1 pm cancer (stage IB). Significant differences (p<0.05) were present between group L and O in regards to mean operation time (277.5 vs 215.0 minutes), proximal margin (4.8 vs 7.0 cm), distal margin (4.4 vs 3.9 cm), number of harvested lymph nodes (25.6 vs 37.9), frequencies for pain control (7.2 vs 11.0 times), wound size (7.6 vs 20.0 cm) and postoperative hospital stay (13.7 vs 21.9 days). There were no differences in blood loss, transfusion, leukocyte count, time to diet, serum protein, or weight loss. Complications were seen in 2 cases in group L (enterocutaneous fistula, gastric atony), and 2 cases in group O (gastric atony, marginal ulcer with bleeding). CONCLUSION: LABIG with standard lymph node dissections is a safe and useful technique for the treatment of early gastric cancer with improved postoperative recovery as compared to open conventional gastrectomy.

La importancia de aprender a vivir saludablemente / The importance of learning to live healthily

La salud es un derecho de todo ser humano,el centinela debe ser motivado a buscar y utilizar los medios que posibilitan la satisfacción de las necesidades más elementales y optar por mejorar las condiciones,explicar el concepto del proceso salud-enfermedad,explicar el soldado la existencia de microbios que producen las diferentes enfermedades,explicar el origen de las enfermedades infecciosas.

La transfusión de sangre y los componentes sanguíneos / Blood transfusion and blood components

El artículo ofrece una descripción de los aspectos más importantes a tener en cuanta en los procesamientos de las transfusiones sanguíneas y brinda un resumen de las características de la sangre total y de los hemoderivados utilizados con mayor frecuencia

Clinical Efficacy of Intravenous Immunoglobulin for the Prevention of Recurrent Spontaneous Abortion / 대한산부인과학회잡지

The aim of this study was to evaluate the efficacy of intravenous immunoglobulin treatment for recurrent spontaneous abortion. Immunologic causes in either alloimmune or autoimmune type have been suggested for more than 80% of these patients. Various immunotherapy including paternal leukocyte transfusion has been used, but there is controversy on its efficacy and side-effects. The proposed immunomodulatory mechanism of intravenous immunoglobulin includes passive transfer of blocking or anti-idiotype antibody, blockade of Fc receptors, enhancement of supressor T-cell function, down regulation of B cell function. In this study, we used intravenous immunoglobulin for the prevention of spontaneous abortion. Five patients with a history of two or more spontaneous abortions were enrolled in this study. Other etiologic factors such as anatomical, chromosomal, hormonal factors were excluded. Three of them were positive for anti-cardiolipin antibody (ACA). When the pregnancy was diagnosed at about five weeks of gestation, 30 g intravenous immunoglobulin was administered and continued up to 28 weeks with three weeks. Ongoing pregnancy beyond 20 weeks was considered successful. Four among five patients (80%) was successful in maintaining pregnancy now ongoing 20, 31, 33, 39 weeks. One patient with ACA positive had abartion due to anembryonic pregnancy. No adverse reaction was observed during the treatment. From these preliminary data, it is suggested that intravenous immunoglobulin treatment may be effective in maintaining pregnancy in patients with unexplained recurrent spontaneous abortion, Further studies are needed to clarify the its immunomodulatory mechanism and establish a more simplified protocol limiting the use at certain critical period of time.