Transfus Apher Sci
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Thrombotic thrombocytopenic purpura is a rare and severe disease that manifests as a thrombotic microangiopathy with severe thrombocytopenia and variable multiorgan failure. The disease relies on a severe deficiency in a disintegrin and metalloprotease with thrombospondin type-1 repeats, 13th member (ADAMTS13), the von Willebrand factor (vWF) cleaving protease which can be either inherited (congenital TTP) or immune-mediated (iTTP). In iTTP, the therapeutic strategy has long relied on therapeutic plasma exchange alone which still represents the only way to deliver large amounts of ADAMTS13 without risking fluid overload. ⋯ Moreover, the impressive results of the anti-vWF nanobody caplacizumab in phase 2 and 3 studies have recently prompted its approval by health authorities for the initial treatment of the disease. The increasing use of these highly effective targeted therapies should translate in a reduced need for therapeutic plasma exchange and an improvement in the prognosis of the disease. Nevertheless, and until the development of a recombinant ADAMTS13, this cornerstone therapy remains irreplaceable.
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Early administration of blood products following severe trauma is pivotal for establishing hemostasis and achieving successful outcomes. Platelet transfusions, in particular, provide rapid control of hemostasis and help to restore platelet dysfunction induced by trauma. In the U. ⋯ Issues with room temperature storage of platelets, including an increased risk of bacterial growth and a decline in platelet hemostatic function, have led to a resurgence in interest in cold-stored platelets for therapeutic transfusion. This review presents the current state of cold-stored platelets and cold-stored whole blood as treatment for actively bleeding patients. Usage of cold stored platelets in alternative areas, such as in the field of regenerative medicine, is also discussed.
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Review Case Reports
Intravenous immunoglobulin as an adjunct therapy in persisting heparin-induced thrombocytopenia.
Heparin induced thrombocytopenia (HIT) is a serious adverse drug reaction caused by transient antibodies against platelet factor 4 (PF4)/heparin complexes, resulting in platelet activation and potentially fatal arterial and/or venous thrombosis. Most cases of HIT respond to cessation of heparin and administration of an alternative non-heparin anticoagulant, but there are cases of persisting HIT, defined as thrombocytopenia due to platelet activation/consumption for greater than seven days despite standard therapy. These patients remain at high risk for thrombotic events, which may result in limb-loss and mortality. ⋯ Platelet activation with and without addition of IVIg (levels equivalent to those reached in a patient after treatment with 2 gm/Kg) was evaluated in the PF4-dependent P-selectin expression assay (PEA). A significantly decreased platelet activation was demonstrated after the addition of IVIg to both patient samples, which correlated well with the rapid clinical response that each patient experienced. Thus, our study supports the use of IVIg as an adjunct therapy for persisting HIT.
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Artificial Intelligence (AI) reflects the intelligence exhibited by machines and software. It is a highly desirable academic field of many current fields of studies. Leading AI researchers describe the field as "the study and design of intelligent agents". ⋯ Complementing human intelligence with machine intelligence could have an exponentially high impact on continual progress in many fields of pediatrics. However how long before we could see the real impact still remains the big question. The most pertinent question that remains to be answered therefore, is can AI effectively and accurately predict properties of newer DDR strategies? The goal of this article is to review the use of AI method for cellular therapy and regenerative medicine and emphasize its potential to further the progress in these fields of medicine.
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Crystalloid infusion is widely employed in patient care for volume replacement and resuscitation. In the United States the crystalloid of choice is often normal saline. Surgeons and anesthesiologists have long preferred buffered solutions such as Ringer's Lactate and Plasma-Lyte A. ⋯ Its only disadvantage is a higher cost. Additional studies of the safety of normal saline for virtually all current clinical uses are needed. It seems likely that normal saline will eventually be abandoned in favor of safer, more physiologic crystalloid solutions in the coming years.