Granulocyte transfusion in leukopenic children by simplified leukapheresis of related donors

Abstract

In this prospective, randomised, double-blind study, we investigated the effect of epidural anaesthesia and an antifibrinolytic agent, Aprotinin (500,000 KIU in bolus before surgery and 500,000 KIU h-1 in drip form during surgery), on intra and postoperative blood loss and transfusion requirements in total hip arthroplasty. Sixty patients were allocated randomly to four groups (A: epidural + general anesthesia + Aprotinin, B: epidural + general anesthesia + placebo (equal volume), C: general anaesthesia + Aprotinin, D: general anaesthesia + placebo). Postoperative analgesia: epidural analgesia in groups A and B, systemic analgesia with opiates in groups C and D. Blood loss during surgery was monitored and salvaged with the Compact-A Dideco, and postoperative blood loss with the BT 797 Recovery Dideco for the first 24 hours. Perioperative blood loss, frequency and quantity of transfusions were significantly higher in group D (p < 0.0001). Total blood loss was reduced by 31.3% by epidural anaesthesia, 20.4% by Aprotinin and 51.4% using a combination of the two techiniques.

A Systematic Review and Meta-Analysis of the Use of Antifibrinolytic Agents in Total Hip Arthroplasty

“…A total of 22 studies involved bleeding analysis (9-10-11-12-13-14-15-16-17-18-19-20-21, 27-28-29-30-31-32-33-34, 36). There were 21 studies that involved transfusion analysis (9, 12-13-14-15, 17-18-19-20-21-22-23-24-25-26-27-28, 34-35-36), and 25 studies involved VTE analysis (9, 10, 12-13-14-15, 17-18-19-20-21-22-23-24-25-26-27-28-29-30-31-32, 34-35-36). A total of 2,131 patients were enrolled in randomis...…”

“…A total of 2,131 patients were enrolled in randomised controlled trials, 1,131 patients received antifibrinolytic agents, and 990 patients received a placebo or no intervention. In total 18 studies involved TXA (9-10-11-12-13-14-15-16-17-18-19-20-21-22-23-24-25-26), 9 studies involved aprotinin (27-28-29-30-31-32-33-34-35), and 2 studies involved EACA (27, 36). The number of patients included in these randomised controlled trials ranged from 17 to 352.…”

Aprotinin and epsilon aminocaproic acid are effective in reducing blood loss after primary total hip arthroplasty – a prospective randomized double‐blind placebo‐controlled study

“…Administration of aprotinin in revision arthroplasty, spinal and other major orthopedic surgery has been shown to be effective in reducing bleeding and transfusion requirements [3–7]. Its use in primary total hip arthroplasty (THA) is less conclusive with differing reports in the literature supporting [8–10] and refuting [11–14] claims that it is effective in reducing blood loss and transfusion requirements.…”

Regional Versus General Anesthesia for Hip Surgery in Older Patients: Does the Choice Affect Patient Outcome?

“…Administration of a regional anesthetic is one way of intentionally decreasing a patient's blood pressure. When aprotinin is administered to patients receiving a hypotensive epidural anesthetic, blood loss is further reduced 12 …”