To study whether the administration of recombinant human erythropoietin increases the amount of autologous blood that can be collected before surgery, we conducted a randomized, controlled trial of erythropoietin in 47 adults scheduled for elective orthopedic procedures. The patients received either erythropoietin (600 units per kilogram of body weight) or placebo intravenously twice a week for 21 days, during which time up to 6 units of blood was collected. Patients were excluded from donation when their hematocrit values were less than 34 percent. All patients received iron sulfate (325 mg orally three times daily). The mean number of units collected per patient (+/- SE) was 5.4 +/- 0.2 for the erythropoietin group and 4.1 +/- 0.2 for the placebo group. The mean red-cell volume donated by the patients who received erythropoietin was 41 percent greater than that donated by the patients who received placebo (961 vs. 683 ml, P less than 0.05). Only 1 of the 23 patients treated with erythropoietin was unable to donate greater than or equal to 4 units (4 percent) as compared with 7 of the 24 patients who received placebo (29 percent). No adverse effects were attributed to erythropoietin. We conclude that recombinant human erythropoietin increases the ability of patients about to undergo elective surgery to donate autologous blood.
Summary:Treatment of autoimmune disease with bone marrow transplantation (BMT) is under investigation. A few reports of patients undergoing allogeneic BMT for malignant conditions observed the resolution of psoriasis after BMT, with minimal late morbidity. We describe a patient with chronic myelogenous leukemia (CML) whose psoriasis resolved completely after allogeneic BMT. However, the patient's course was complicated by extensive chronic graft-versus-host disease (GVHD), recurrent serious infections, poor performance status and quality of life, and severe disability. The patient died 887 days post transplant due to infectious complications. The potential benefits and risks of treatment of autoimmune diseases with allogeneic BMT are discussed. Bone Marrow Transplantation (2000) 26, 1239-1241. Keywords: autoimmunity; psoriasis; bone marrow transplantation Psoriasis is one of the most common dermatologic diseases, affecting more than six million people in the United States and up to 2% of the world's population. 1 Psoriasis is a chronic inflammatory disease exhibiting a wide spectrum of clinical signs ranging from variable skin manifestations to debilitating arthritis. Disease affecting younger patients is generally more severe and recurrent. Treatment strategies include the use of a combination of emollients, corticosteroids, vitamin-D analogues, cyclosporine, tar preparations, dithranol, PUVA and retinoids.Psoriasis is an immune-mediated disease. Activated CD4 + and CD8 + lymphocytes infiltrate the dermis and epidermis, resulting in hyperkeratosis, parakeratosis, epidermal acanthosis and elongation of rete ridges, and vascular dilatation. oid compartment and infusion of allogeneic bone marrow is a treatment strategy which may have curative potential. Indeed, in animal models, allogeneic (and autologous) BMT has been shown to favorably alter the course of certain immune-mediated diseases. 3 Also, several clinical case reports demonstrated durable resolution of psoriasis after allogeneic BMT performed for concurrent malignant conditions. 4-8 These reports did not observe significant late procedure-related morbidity.In this report, we describe a patient with long-standing, extensive psoriasis poorly responsive to conventional treatments which resolved completely through 2.4 years of follow-up after an allogeneic BMT, performed for the diagnosis of CML. This case report demonstrates that long-term remission of immune-mediated diseases can occur with allogeneic BMT, but also illustrates the potentially serious risks associated with the application of this treatment strategy to patients with autoimmune diseases. Case reportA 55-year-old woman underwent allogeneic BMT in 1996, 4 months following a diagnosis of CML. The bone marrow donor was her healthy HLA matched brother. The patient also had a history of long-standing severe erythrodermic psoriasis for 33 years, which manifested as typical, well demarcated erythematous scaling plaques, symmetrically distributed over the elbows, knees, trunk and buttocks. During the ...
This study was designed to evaluate the potential in vitro use of heparinase to eliminate functionally active heparin prior to performing whole blood (WB) prothrombin time (PT) and activated partial thromboplastin time (APTT) assays. A total of 250 U/kg of heparin for cardiopulmonary bypass (CPB) was administered to 30 cardiac surgical patients in three consecutive, divided doses (20, 80, and 150 U/kg) at 15-min intervals. Blood specimens were obtained prior to heparin administration (baseline) and 10 min after each heparin dose. After collection, blood specimens were fractionated into three aliquots of which the first was used for determination of heparin concentration. After gentle mixing, WB PT and APTT measurements were performed for heparinase (Aliquot 2)- and nonheparinase (Aliquot 3)-treated blood. With consecutive heparin doses of 20 and 80 U/kg, WB PT increased from a baseline of 12.3 +/- 0.1 s to 13.3 +/- 0.2 and 18.5 +/- 1.3 s, while WB APTT increased from a baseline of 28.3 +/- 1.1 s to 89.5 +/- 5.4 after the initial heparin dose (20 U/kg). When compared to baseline (no heparin) results, small, progressive increases in heparinase-treated WB PT (0.7 +/- 0.1, 1.5 +/- 0.1, 2.1 +/- 0.1 s) and APTT (2.3 +/- 0.3, 5.7 +/- 0.4, 9.5 +/- 0.5 s) were seen with increasing heparin concentration (0.23, 1.58, and 3.95 U/mL, respectively). Heparinase was highly effective in eliminating the anticoagulant effects of even large amounts of heparin in plasma from cardiac surgical patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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