【体外膜肺ECMO精品课件】 Blood and Immunomodulation--Can we improve clinical outcomes by leukoreduction, washing and shorter red cell storage.pptVIP

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2018-03-14 发布于天津
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【体外膜肺ECMO精品课件】 Blood and Immunomodulation--Can we improve clinical outcomes by leukoreduction, washing and shorter red cell storage.ppt

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Blood and Immunomodulation--Can we improve clinical outcomes by leukoreduction, washing and shorter red cell storage?;Outline of Lecture ;n=1,436;(Transplantation 35: 320 (1983);Lancet 1982 Sep 18;2(8299):662;Meta-Analysis: Association of Cancer Recurrence Transfusion;≥;Transfusion 47: 573-581(2007) ;Limitations of the Existing Trial of ULR--Transfusion 42:1114 (2002);Transfusion 50: 2738 (December 2010);Transfusion 50: 2738 (December 2010);Proven Benefits of Leukoreduction;Cost Savings with Leukoreduction;Estimated deaths potentially averted in surgical patients by leukoreduced transfusions ;Number to treat to save one life (NNT);Immunomodulation and Leukoreduction;Evidence that immunologic mechanisms underlie the clinical evidence;“Bad” Th1 processes antagonized by allogeneic transfusion ;“Good” Th1 processes antagonized by allogeneic transfusion;So what about the supernatant of stored blood components?;*;*;BMC Blood Disorders 4: 6 (2004);Modeling of Survival in Adult Acute Leukemia Patients 50 years old (n=41) Employing the Cox Proportional Hazard Technique;;Leukemia 22: 631-635 (2008);Transfus Med 2001 Feb;11(1):45-7;A Randomized Trial of Washed Transfusions Pediatr Crit Care Med 3:290-9 (2012) To compare the cytokine response in children undergoing open heart surgery with cardiopulmonary bypass randomized to either: Unwashed group: irradiated, pre-storage leukoreduced RBC and platelet transfusions Washed group: washed, irradiated, pre-storage leukoreduced RBC and platelet transfusions ;p=0.03;Distribution of IL-6 levels (pg/ml) at 6 hours post-op;None in Washed Group 90 mg/L (0/61) p=0.006 by Fisher’s exact vs. Unwashed Group;Eight in Unwashed Group 90 mg/L (8/61);Table 4. Clinical Outcome data;Mean storage duration of oldest red cell transfused = 20 ± 2 days (95% C.I.) Median storage duration of oldest red cell transfused = 21 days (range 7-38) 5% received FFP or platelet transfusions Mean dose = 86 ± 18 ml/kg Median Dose = 56 ml