[Clinical aspects of packed red cell transfusion. Lessons learned from Jehovah's Witnesses?]. / Klinische Aspekte der Therapie mit Erythrozyten. "Lessons learned" von den Zeugen Jehovahs?

With the decreased risk of homologous blood transfusions, the costs of blood products have become increasingly important for hospitals with major surgical procedures and oncologic treatment. It is well established from clinical physiology that a hemoglobin concentration (cHb) lower than 6.21 mmol/l (10 g/dl) is enough to serve the oxygen demand of the tissues, but transfusion of erythrocytes is still liberally carried out. Data obtained from Jehovah's Witnesses, who categorically refuse blood transfusions, demonstrate that they have an outcome similar to patients who are transfused. The lessons we have learned from Jehovah's Witnesses should result in an emotionless discussion, and a reduction in transfusion requirements.

[Quality of whole blood as a result of storage and preparation (inline-leukocyte depletion). Evidence for autologous predeposit]. / Die Qualität von Vollblut in Abhängigkeit von Herstellungsverfahren (Leukozytendepletion) und Lagerungsdauer. Bedeutung für die operationsvorbereitende Eigenblutspende.

AIM OF THE STUDY: Investigation of various laboratory parameters in stored whole blood, with respect to duration of storage and kind of product. METHODS: Whole blood was donated by 12 healthy volunteers using CPDA1 stabilisator. Six units were filtered with the Leukotrap A1-System (PALL Comp., Dreieich, Germany) for leukocyte depletion. The twelve units were stored for 49 days. Several hematological, biochemical and coagulatory parameters were analysed during storage. RESULTS: There was an adequate reduction of lycocytes by filtration (< 3 x 10(6) white cells per unit). ATP decreased during storage to 45% of initial value at the 49th day, without any influence of the kind of preparation. The course of other parameters such as lactate and free haemoglobin (increase), PH-value (decrease), antithrombin III (decrease), prothrombin, protein C, thrombin-antithrombin-complex, alpha-2-Anti-plasmin (decrease or indifferent) did not show any influence of the kind of preparation. Coagulation factors V and VIII decreased in both preparations, which was significantly less pronounced in whole blood with leukocyte depletion. In contrast parameters of activated coagulation such as D-Dimere and fibrinmonomeric did not change during storage after leukocyte reduction but increased at the end of storage time in CPDA1-blood. CONCLUSIONS: Several parameters indicating quality of stored blood were constant in whole blood independent of the kind of preparation during a storage of 49 days. This is in contrast to the main part of specific scientific communications. A beneficial influence of leukocyte depletion was observed for some coagulation parameters whereas increasing characteristics of activated coagulation in CPDA1-stored whole blood at the end of storage time had to be observed. The preparation of whole CPDA1-blood is recommended for autologous predonation, if storage time does not exceed 30 days. Storage time of > 40 days seems to be possible for autologous whole blood after filtration for leucocyte depletion.

[Therapy of acute necrotizing pancreatitis. Results of a current survey]. / Therapie der akuten nekrotisierenden Pankreatitis. Ergebnis einer aktuellen Umfrage.

In order to ascertain the current clinical concepts in treating acute necrotizing pancreatitis (ANP), an inquiry was made covering 28 anesthesiologic, medical and surgical departments. Problems of particular concern were antibiotics, indication for mandatory ventilation, estimation of ERCP and needle biopsy, methods of treating intestinal stasis, criteria for surgical intervention, estimation of hemofiltration and estimation of mortality and hospital stay in survivors. Twenty-three affiliations participated in the study. Opinions varied significantly concerning antibiotic treatment, value of ERCP and needle biopsy, treatment of intestinal stasis and estimation of clinical course and outcome. Most participants were in agreement regarding the management of mechanical ventilation, nutritional support and surgical intervention. Eleven participants did not prefer a special medical discipline for the treatment of ANP but stressed the importance of efficient teamwork.

[Erythropoietin therapy during frequent autologous blood donations. Dose-finding study]. / Erythropoetintherapie während häufiger Blutspenden. Eine Dosisfindungsstudie.

Avoidance of homologous blood products and patients' demand for preoperative autologous blood donation programs are increasing. As many of these patients are older, with a compromised cardiovascular system and a slow response of the erythropoietic system when anemia occurs, the feasibility and benefit of autologous blood donation is often limited. Augmentation of preoperative blood donation by therapy with recombinant human erythropoietin (rHuEPO) has been described in animal models and in patients. METHODS. In a multicenter, controlled, randomized trial, 49 patients scheduled for orthopaedic or vascular surgery received 0 (control group, n = 9), 200 (n = 10), 300 (n = 11), 400 (n = 10) or 500 (n = 9) U/kg rHuEPO (Erypo, Cilag, Sulzbach, distributor Fresenius, Oberursel, Germany) subcutaneously twice a week for 3 weeks while every week 450 ml blood was collected. Iron sulphate 100 mg was prescribed orally twice a day. Patients were ineligible if they had uncontrolled hypertension, recent myocardial infarction, haematological disorders or a history of seizures. Blood donation had to be cancelled if the haematocrit was below 30%. RESULTS. There was a significant (ANOVA) drop of the haematocrit value only in the control group, and end-point values for haematocrit and haemoglobin were significantly elevated in the 400 and 500 U/kg groups compared with the control group (Table 9). DISCUSSION. The erythropoietic stimulus of phlebotomy for autologous blood donations is often not efficient enough to guarantee a constant haematocrit. Lowering of the preoperative haematocrit jeopardizes the aim of avoidance of homologous blood transfusions. rHuEPO increased the efficiency of autologous blood collections, as predonation haematocrit values could be preserved in the high-dosage groups. As a consequence, homologous transfusions could be avoided. However, there were broad interindividual differences in the erythropoietic response, possibly due to limitations in iron availability. Adverse effects of rHuEPO therapy, such as hypertension, thrombosis or neurologic disorders, are mostly reported in patients with terminal kidney failure. No such disturbances were observed in the present study. CONCLUSION. rHuEPO ameliorates the preoperative decrease of haemoglobin and haematocrit values due to autologous blood donations in a dose-related fashion. The individually adjusted dosage of rHuEPO and iron supplementation merits further investigation.