Clin Lab
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Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion related morbidity and mortality. TRALI is suggested to be a "two hit" event. The "first hit" is the underlying condition of the patient which results in sequestration and priming of neutrophils in the pulmonary compartment. ⋯ Although it could be speculated that all of these factors may be involved in the onset of TRALI, only one pre-clinical study shows an association between the aged erythrocyte and the onset of TRALI. The suggested mechanism is a decrease in the chemokine scavenging function of the erythrocyte by reduction of the Duffy antigen expression resulting in an increase in lung injury. Further research is needed to elucidate possible mechanisms of onset of TRALI by aged blood products.
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Comparative Study Controlled Clinical Trial
Correlation between rotation thrombelastometry ROTEM analysis and standard haemostatic parameters during liver transplantation.
The determination of the correlations between simultaneously performed rotation thrombelastometry ROTEM analysis and standard haemostatic analysis during liver transplantations is indispensable for performing an adequate perioperative haemostatic monitoring. ⋯ The correlations found in the present study suggest to perform the haemoststic liver transplantation monitoring through a parallel systematic analysis of both standard and rotation thrombelastometry parameters and confirm the ROTEM method as preferable and highly informative.
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Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by tissue injury mediated by inflammatory mechanisms. Nonetheless, several acute-phase proteins may remain normal or are decreased. We explore the association of diverse biomarkers with selected clinical features, disease activity, and organ damage in SLE. ⋯ In patients with SLE, acute-phase proteins behave differently depending on the kind of organ damage evaluated. Serum complement proteins remained as the most reliable laboratory markers for nephritis, while CRP was determined the best in patients with arthritis. The muted CRP response seen in SLE patients with active nephritis could have important pathogenic implications.
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Many children receive one or more units of red blood cell (RBC) preparations during their paediatric intensive care unit (PICU) admission depending on their underlying disease course. Physicians often justify RBC transfusions in critically ill children when anaemia is present because of the assumption that by increasing the haemoglobin level the delivery of oxygen (DO2) to peripheral tissues is improved so that ultimately the oxygen utilization (VO2) can be improved. ⋯ The TRIPICU study has clearly shown that it is safe to refrain from transfusing stable critically ill children unless their Hb has dropped below 7 g/dL (4.3 mmol/L) as increasing data emphasizes that the common practice of transfusing critically ill children is not free from causing harm as shown by increased morbidity and mortality. This narrative review summarizes the current literature and discusses possible pathophysiological mechanisms.
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Comparative Study Clinical Trial
Comparison of serum cardiac specific biomarker release after non-cardiac thoracic surgery.
The detection of postoperative myocardial infarction can be difficult in patients after lung surgery. The aim of this study was to verify the clinical significance of elevated Troponin I (cTnI), N-terminal pro-natriuretic peptide (NT-pro-BNP), lactate dehydrogenase (LDH), creatine kinase (CK), and CK-MB in the perioperative course. ⋯ Despite the excellent sensitivity of troponin I for detection of acute myocardial infarction the fact remains that troponin I elevations were common after intrapericardial procedures and pneumonectomies. Thus, to differentiate between cardiac ischemia provoked chest pain and wound pain related to thoracotomy remains most difficult. Patients with only marginally elevated cTnI concentrations after intrapericardial resections or pneumonectomy should remain in the intensive care unit and should be followed-up carefully by cardiologists.