Table 3 - uploaded by Cafer Zorkun
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Maternal and fetal chimerism Maternal chimerism (Mother to child transfer of cells) Fetal chimerism (Fetus to mother transfer of cells)
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Potent antiplatelet and antithrombotic agents have significantly reduced mortality in the setting of acute coronary syndromes and percutaneous coronary intervention. However these agents are associated with increased bleeding which is in turn associated with adverse clinical outcomes. In many centers, transfusion is often used to correct for blood...
Citations
... 14,15 Without leukoreduction microchimerism may occur which may have potential adverse long-term consequences. 20,21 Therefore, the shortand long-term risks and benefits of unrefrigerated young whole blood in patients requiring massive transfusion in a civilian setting remain uncertain; an adequately powered randomized controlled trial is needed before unrefrigerated young whole blood can be recommended for massive transfusion in a civilian setting. 4,22,23 Three ongoing randomized controlled trials on effects of fresh or young blood versus aged blood (>2-3 weeks) may also inform us about the advantages of fresh or young whole blood transfusion for patients requiring transfusion in nonemergent situations in a civilian setting (ClinicalTrials.gov ...
Warm fresh whole blood has been advocated for critical bleeding in the military setting. This study assessed whether unrefrigerated young whole blood transfusion, from donation to transfusion less than 24 hours, could reduce mortality of patients with critical bleeding in a civilian setting.
A linked data cohort study was conducted on a total of 353 consecutive patients requiring massive transfusion, defined as 10 units or more of red blood cells or whole blood transfusion within 24 hours, in a quaternary health care center in Australia.
Of the 353 patients with massive blood transfusion in the study, 77 received unrefrigerated young whole blood transfusion (mean, 4.0 units; interquartile range, 2-6). The diagnosis, severity of acute illness, age, sex, and ABO blood group were not significantly different between the patients who received unrefrigerated young whole blood and those who did not. Unrefrigerated young whole blood transfusions were associated with a slightly improved coagulation profile (lowest fibrinogen concentrations 1.7g/L vs. 1.4g/L, p=0.006; worst international normalization ratio, 2.4 vs. 2.8, p=0.05) but did not reduce the total utilization of allogeneic blood products and subsequent use of recombinant Factor VIIa (27% vs. 22%, p=0.358). Thirty-day mortality and 8-year survival after hospital discharge (hazard ratio, 1.05; 95% confidence interval, 0.41-2.65; p=0.93) were also not different after the use of unrefrigerated young whole blood transfusion.
Unrefrigerated young whole blood transfusion was not associated with a reduced mortality of patients requiring massive transfusion in a civilian setting when other blood products were readily available.
Blood transfusions are sometimes necessary after a high loss of blood due to injury or surgery. Some people need regular transfusions due to medical conditions such as haemophilia or cancer. Studies have suggested that extracellular DNA present in the extracellular milieu of transfused blood products has biological actions that are capable of activating the innate immune systems and potentially contribute to some adverse reactions in transfusion. Extracellular mitochondrial DNA encompassed in extracellular DNA has also been found in blood products. From the present work, it becomes increasingly clear that extracellular DNA is far from being biologically inert in blood products. It has been demonstrated to be present in eligible blood products and thus can be transfused to blood recipients. Although the presence of extracellular DNA in human plasma was initially detected in 1948, some aspects have not been fully elucidated. In this review, we summarize the potential origins, clearance mechanisms, relevant structures, and potential role of extracellular DNA in the innate immune responses and its relationship with individual adverse reactions in transfusion.
Dr. Gibson has received consulting fees and research support from Bayer, Johnson and Johnson, and Janssen; and has received research support from Portola.
Cardiogenic shock (CS) describes the physiologic state in which reduced cardiac output and resultant tissue hypoxia occur in the presence of adequate intravascular volume. Among patients hospitalized with myocardial infarction (MI), CS is the foremost cause of death. Women are more susceptible to CS than men in the setting of ST segment increase MI. Introduction of early revascularization strategies and mechanical ventricular support have seen a decrease in short-term mortality from CS. However, the prognosis following CS remains poor. This article examines the prevalence, causes, pathophysiology, and therapeutic options for CS among women.
Microchimerism has been studied in the context of a variety of diseases which include autoimmune diseases (such as systemic sclerosis, rheumatoid arthritis, systemic lupus erythematosus and autoimmune thyroid diseases), cancer (e.g., of the cervix, thyroid gland, lung, breast), tissue repair, transplantation and transfusion. It may become relevant in the context of cell-based non-invasive prenatal diagnosis. But how to safely identify individual microchimeric cells? This is a nontrivial question, for which a solution has recently been suggested.
Bleeding has recently been identified as a major adverse outcome in patients with acute coronary syndromes. In this review, the importance of the association of bleeding with mortality and strategies to reduce bleeding with percutaneous coronary intervention are discussed.
Nine trials have shown an association of bleeding with mortality. The influence of major bleeding is at least equivalent to the effect of a myocardial infarction. In order to reduce bleeding, individualized risk assessment should be performed and attention paid to choice of access, antithrombotic, dose of antithrombotic, avoidance of crossing over from one antithrombotic to another, smaller sheaths and early removal as well as choice of P2Y12 inhibitor.
Individualizing treatment and strategies to reduce both ischemic events and bleeding will improve patient outcomes.
Bivalirudin is a direct thrombin inhibitor with several pharmacological advantages over heparin. It has been studied extensively in non-ST elevation acute 60 coronary syndromes (NSTE-ACS) and in percutaneous coronary intervention. Bivalirudin has also recently been investigated in patients with ST-elevation myocardial infarction (STEMI) treated with primary angioplasty and stenting. More than 27,000 patients were randomized in these trials.
To provide an overview of the pharmacological properties of bivalirudin and its efficacy and safety profile in patients across the spectrum of acute coronary syndromes (ACS).
All published, peer-reviewed clinical trials were reviewed and as relevant were included.
Bivalirudin with provisional IIb/IIIa antagonists provides consistent results across the full spectrum of ACS, with similar or non-inferior protection from ischemic events and significantly reduces bleeding complications compared with heparin and IIb/IIIa antagonists. In STEMI, mortality at 30 days and 1 year is significantly reduced. The unique pharmacokinetic profile of bivalirudin allows for simultaneous reductions in both ischemic and hemorrhagic events and makes it an appropriate alternative to heparin.
