血浆置换及血小板输注治疗特发性血小板减少性紫癜疗效观察

摘要 目的：探究血浆置换及血小板输注治疗特发性血小板减少性紫癜疗效。方法：选择2016年2月至2019年1月于我院接受治疗的60例特发性血小板减少性紫癜患者为研究对象,按照其选择治疗方式的差异将其分为血小板输注组（20例）及血浆置换（Plasma exchange,PE）组（40例）,对比两组患者治疗有效率、治疗前后血细胞计数变化情况以及治疗中各类不良反应发生情况。结果：血小板输注组患者治疗显效数10例,有效数6例,总有效率80.00 %,PE组患者治疗显效数27例,有效数12例,治疗总有效率97.50 %,PE组治疗总有效率高于血小板输注组（P<0.05）。与治疗前比较,PE组患者的PLT、RBC计数和Hb水平出现了明显的升高,WBC计数出现明显的下降（P<0.05）,血小板输注组PLT、RBC计数和Hb水平也出现明显升高,WBC计数水平出现下降（P<0.05）,但组间比较显示治疗后PE组患者上述指标均优于血小板输注组（P<0.05）。血小板输注组患者不良反应总发生人数为4人,不良反应总发生率为20.00 %,PE组总不良反应发生人数3人,不良反应总发生率为7.50 %,PE组不良反应总发生率明显低于血小板输注组（P<0.05）。结论：血血浆置换及血小板输注治疗均对特发性血小板减少性紫癜具有较好的治疗效果,能够显著改善患者血细胞计数异常情况,但血浆置换治疗安全性更高。     

自身免疫性溶血性贫血(AIHA)患者的不同输血方法与效果

目的:探讨不同输血方法治疗自身免疫性溶血性贫血(autoimmune hemolytic anemia,AIHA)的效果。方法:2017年1月-2018年12月选择在本院血液科诊治的64例自身免疫性溶血性贫血患儿,根据输血方法的不同分为观察组与对照组,各32例。观察组给予洗涤红细胞输注治疗,对照组给予非洗涤红细胞(悬浮红细胞)输注治疗,记录两组输血效果。结果:治疗后4 w观察组的总有效率显著高于对照组(100.0%vs.87.5%,P0.05)。两组治疗后4 w的红细胞计数与血红蛋白都显著高于治疗前,且观察组显著高于对照组(P0.05)。观察组的吸氧、机械通气、住院时间都显著少于对照组(P0.05)。观察组治疗过程的过敏反应、发热反应、紫癜等不良反应发生率显著低于对照组(3.1%vs. 21.9%,P0.05)。结论:洗涤红细胞输注治疗自身免疫性溶血性贫血患儿能促进机体红细胞计数与血红蛋白恢复正常,减少不良反应的发生,提高治疗效果与促进患儿康复。     

191例成分输血不良反应的调查分析

目的:探讨成分输血不良反应的发生情况和原因,并总结其预防和处理措施。方法:回顾性分析2014年1月～2017年12月在海南省人民医院输注成分血的65300例病人的临床资料和输血不良反应回报单,统计后者的相关状况,并分析导致不良反应的原因,总结预防和处理措施。结果:65300例输注成分血的患者中,191例患者发生输血不良反应,总发生率为0.29%,以过敏反应(53.4%)和发热性非溶血性输血反应(34.0%)为主,其它占12.6%。血液成分输注发生不良反应以单采血小板最高(0.46%),其次为冰冻血浆(0.35%),红细胞悬液和冷沉淀分别为(0.21%)和(0.17%)。与红细胞悬液相比,冰冻血浆输血不良反应的发生率明显增高(P0.01);与红细胞悬液和冰冻血浆相比,单采血小板输血不良反应发生率明显增高(P0.01)。此外,随着输血次数的增加,输血不良反应的发生率明显升高(P0.01)。结论:近年来,海南省人民医院因成分输血所致不良反应大部分源于过敏反应及发热性非溶血性输血反应,其中发生率最高的是单采血小板输血不良反应。临床医务人员需仔细把控输血指征,选择合适的血液成分,认真执行输血操作规程,以降低输血反应,保障输血安全。     

肺结核患者血细胞结果特点分析

目的:为肺结核的诊断及观察预后提出新的思路。方法:对新住院肺结核患者的血常规标本400份及以上患者出院前血常规标本400份,使用MEK-6318K血细胞分析仪检测分析。结果:新住院400例肺结核患者中血小板计数>300×109/L的92例,占23%。92例血小板计数升高的患者中,除9例贫血患者外,83例患者中红细胞计数和血红蛋白量都不低于参考值,但红细胞计数和血红蛋白量呈现不一致性,即针对血红蛋白量而红细胞计数偏高,体现出小红细胞少量增多,这种情况在83例中所占比例为86%。出院前400例肺结核患者血小板计数>300×109/L的5例,占1.2%。结论:由于肺结核患者大多数伴有营养不良,导致造血系统功能障碍,导致小红细胞少量增多,增多的小红细胞被血细胞分析仪计数到血小板计数里,导致血小板计数偏高。这个指标在肺结核诊断中意义很大,为肺结核的诊断探索出新的思路。     

血液病患者单采血小板输注疗效的影响因素分析

目的:探讨影响血液病患者血小板输注疗效的因素,为提高血液病患者的临床疗效提供参考依据。方法:选择2013年1月至2015年12月海南省人民医院收治的156例输注单采血小板的血液病患者为研究对象,所有患者单次输入血小板12U(血小板数≥2.5×1011个),观察输注后血小板计数纠正增加指数(CCI),分析病种、脾大、发热、年龄、性别对血小板输注疗效的影响。结果:血小板输注总有效率为71.0%。再生障碍性贫血(AA)者血小板输注有效率为65.9%、特发性血小板减少性紫癜(ITP)为65.7%,急性白血病(AL)为77.7%,骨髓增生异常综合征(MDS)为71.9%,不同病种之间血小板输注有效率比较差异无统计学意义(P0.05)。发热感染者血小板输注有效率为69.9%,明显低于无发热感染者(77.6%,P0.05);脾不大者有效率为74.9%,明显高于脾大者(52.86%,P0.05);男性、女性有效率分别为76.5%、75.8%,60周岁者与芏60周岁者有效率分别为72.0%、77.3%,差异均无统计学意义(P0.05)。随着血小板输注次数的升高,血小板输注无效的发生率也显著升高。结论:发热及脾大是影响血液病患者血小板输注疗效的不利因素。     

静脉注射用免疫球蛋白在免疫血液病中的应用及作用机制

<正>最近发表了一些描述静脉注射用免疫球蛋白(IVIg)对提高免疫性血小板减少性紫癜(ITP)的血小板计数作用的报告。这一作用见于儿童和成人的急慢性ITP以及免疫性中性粒细胞减少症。血小板计数或中性粒细胞计数的升高可能是暂时的,通过这样治疗,某些病人显然获得长期的好处。毒性是最小的,其作用机制部分表明与网状内皮细胞Fc受体的封闭有关。 历史:1950年报告过1例血小板减少症病人,其对输注新鲜冰冻血浆(FFP)有效。血小板计数升高。这个作用被归因于血小板输注。几位研究者采用30ml/kgF     

不同比例新鲜冰冻血浆对大量输血患者凝血功能的影响

目的:探讨不同比例输注新鲜冰冻血浆对大量输血患者凝血功能的影响。方法:回顾性分析本院2018年1月至2018年12月收治的123例大量输血患者的临床资料,依据所输注新鲜冰冻血浆与红细胞比例不同,将其分为低比例组(1:3)、中比例组(1:2)、高比例组(1:1),比较三组患者输血前后凝血功能、血小板计数及电解质变化。结果:输血后,三组患者FIB较输血前明显降低,而PT、APTT较输血前显著升高(P0.05),高比例组PT和APTT明显低于中比例组和低比例组,FIB、血小板均高于中比例组和低比例组(P0.05),电解质水平优于低比例组和中比例组(P0.05)。结论:在大量输血时,提高血浆与红细胞比例有利于改善大量输血患者凝血功能障碍,减少电解质紊乱。     

苯肼致小鼠溶血性贫血模型的建立

目的:应用苯肼致小鼠发生溶血性贫血,建立急性溶血性贫血模型,筛选苯肼致小鼠贫血最佳浓度和红细胞移植的最佳时机。方法:30只C57BL/6小鼠随机分为6组,经腹腔注射不同浓度的苯肼溶液,于注射前和注射后第1、3、5、7、9天采集小鼠外周血进行检测,记录相关指标的变化,比较各组之间的差异,筛选出最佳溶血效果的给药浓度和红细胞移植治疗介入的时机。结果:注射苯肼溶液可使C57BL/6小鼠短期内产生明显的急性溶血性贫血症状,皮肤黏膜颜色苍白;外周血红细胞数量、血红蛋白含量、红细胞压积降低;随着苯肼溶液浓度的增加,小鼠体重显著减轻,存活率下降。结果表明,苯肼注射小鼠致贫血的最佳作用浓度为1.2mg/10g体重,小鼠贫血状态可维持7d。结论:建立了小鼠溶血性贫血模型,此模型可应用于红细胞输注效果的评价。     

静脉铁剂治疗严重产后贫血优于注输红细胞

为比较静脉铁剂与注输红细胞治疗严重产后贫血的效果,本研究选取于我院出现严重产后贫血的患者32例。随机分为铁剂治疗组(A)与红细胞悬液治疗组(B)。检查记录患者疲乏量表的自我评价、血液学检查及不良反应。研究表明,通过患者疲乏量表的自我评价显示干预后自基线至12周时间段内研究对象的体力疲乏评价无显著性改变(-0.64(95%CI:-3.25;2.11,p=0.63)),二者在改善患者自我感觉疲乏程度方面无显著性差异;在血液学检查中,干预开始时输注红细胞悬液能够暂时性地提高血红蛋白水平,但自第3周起始静脉给予铁剂组患者的血红蛋白水平显著增高,具有统计学意义(p0.05),网织红细胞计数与网红内血红蛋白量(CHr)的变化趋势基本一致,尤其是第1周内使用静脉铁剂研究对象的含量显著高于输注红细胞悬液的患者,具有统计学意义(p0.05)。本研究表明,对于治疗严重产后贫血,静脉铁剂优于输注红细胞悬液,值得在临床上推广使用。     

血浆置换方法在儿童毒蛇咬伤中的临床意义

目的探讨血浆置换治疗儿童毒蛇咬伤的临床疗效。方法对16例毒蛇咬伤患儿给予局部切开排毒、封闭、抗蛇毒血清和支持保护治疗,在此基础上进行血浆置换,观察比较血浆置换前后的凝血酶原时间、凝血酶时间、凝血活酶时间、纤维蛋白原、D-二聚体、谷丙转氨酶、尿素、肌酐、白细胞及血小板计数的情况。结果血浆置换前,患儿局部伤口红肿、渗血、患肢明显肿胀,具有刺痛或麻木感,D-二聚体明显升高,凝血酶原时间明显延长,出现凝血障碍与肝肾功能异常。血浆置换后,患儿伤口结痂,患肢肿胀消退,无刺痛或麻木感,凝血酶原时间、凝血酶时间、凝血活酶时间、D-二聚体、谷丙转氨酶、尿素、肌酐、白细胞计数均低于治疗前,Fbg、血小板计数高于治疗前,差异有统计学意义(P0.05)。临床治愈率为93.75%(15/16)。结论血浆置换是治疗儿童毒蛇咬伤的有效方法,能有效改善患儿的凝血功能及肝肾功能,具有临床推广价值。     

Image processing for automated erythrocyte classification.

Digital image processing and pattern recognition techniques were applied to determine the feasibility of a natural n-space subgrouping of normal and abnormal peripheral blood erythrocytes into well separated categories. The data consisted of 325 digitized red cells from 11 different cell classes. The analysis resulted in five features: (a) size, (b) roundness, (c) spicularity, (d) eccentricity and (e) central gray level distribution. These features separated the data into six distinct condensed subgroups of red cells. Each subgroup consisted of morphologically similar cells: (a) macrocytes, (b) normocytes, (c) schistocytes, acanthocytes and burr cells, (d) microcytes and spherocytes, (e) elliptocytes, sickle cells and pencil forms and (f) target cells. The concept of a quantitative "red cell differential" was introduced, utilizing these subgroup definitions to establish subpopulations of red cells, with quantifiable indices for the diagnosis of anemia, at the specimen level.     

Identification, purification and reconstitution of thiamin metabolizing enzymes in human red blood cells.

Thiamin and its mono- (TMP), di- (TDP) and triphosphate (TTP) were assayed in adult human whole blood using high-performance liquid chromatography (HPLC). TDP and TTP were detected in red blood cells (RBC), but not in plasma. After incubation with 20 microM thiamin and 5 mM glucose for 2 h, the TDP and TTP contents of RBC increased from 111 to 222 and 0.6 to 2.2 nmol/l of packed RBC, respectively, suggesting enzymatic conversion of thiamin to TDP and then to TTP. Thiamin pyrophosphokinase (TPK, EC 2.7.6.2) had not been isolated before from human materials, nor had cytosolic adenylate kinase (AK1, EC 2.7.4.3) in human RBC been demonstrated to catalyze the phosphorylation of TDP to TTP, although AK1 from pig and chicken skeletal muscle possess TTP-synthesizing activity. TPK and AK1 in a human RBC lysate were therefore purified by a series of the conventional techniques. The specific activity of the purified TPK, which was obtained as a single protein, was 720 nmol TDP formed/mg protein per h at 37 degrees C. A partially purified AK1 preparation catalyzed the formation of TTP from TDP (specific activity, 170 nmol/mg protein per h at 37 degrees C) in addition to its proper reaction to form ATP from ADP. After incubation of the purified TPK and AK1 with 20 microM thiamin in the presence of ATP, ADP and Mg2+ at 37 degrees C for 48 h, the amounts of TDP and TTP synthesized were 465 and 54.0 pmol/250 microliters reaction mixture, respectively. Neither TDP nor TTP was formed when TPK was omitted from the reaction mixture and an omission of AK1 resulted in the formation of TDP alone. These results indicate that thiamin is converted to TDP by TPK and, subsequently, to TTP by AK1 in human RBC.     

Evidence for in vivo synthesis of thiamin triphosphate by cytosolic adenylate kinase in chicken skeletal muscle

We showed previously that cytosolic adenylate kinase (AK1) purified from pig skeletal muscle catalyzes in vitro formation of thiamin triphosphate (TTP) from thiamin diphosphate (TDP) and ADP in addition to ATP formation from ADP [Shikata, H. et al. (1989) Biochem. Int. 18, 933-942]. To obtain evidence for in vivo synthesis of TTP by AK1, changes in TTP content and AK1 activity were determined in chicken skeletal muscle during development after hatching. Thiamin phosphate metabolism in chicken skeletal muscle was also studied. i) An extremely high TTP content, 81% of total thiamin (thiamin plus thiamin phosphates), was detected in the white (fast-twitch) muscle of adult normal chicken (5th to 9th month) compared with a relatively high TTP content of 31% in the red (slow-tonic) muscle. Since approximately equivalent amounts of total thiamin were present in the two types of muscle, the ratio of TTP to TDP was high (5.0) in the white muscle and low (0.41) in the red muscle. ii) Rabbit anti-chicken AK1 antiserum against the purified chicken cytosolic AK1 preparation was obtained. Both AK1 activity and TTP-synthesizing activity in crude cytosol fraction of adult chicken white muscle were inhibited in parallel by the antiserum. iii) In the white muscle of normal chicken, the TTP content and AK1 activity responsible for forming either ATP or TTP were increased in a parallel manner up to day 16 after hatching, after which both remained constant. In the red muscle, on the other hand, both the TTP content and the AK1 activity were low in comparison with those in the white muscle, and were almost constant after hatching.(ABSTRACT TRUNCATED AT 250 WORDS)     

Insulin increases tristetraprolin and decreases VEGF gene expression in mouse 3T3-L1 adipocytes

Objectives: Tristetraprolin (TTP) family proteins (TTP/ZFP36; ZFP36L1, ZFP36L2, ZFP36L3) destabilize adenylate uridylate‐rich element‐containing mRNAs encoding cytokines, such as tumor necrosis factor (TNF) and vascular endothelial growth factor (VEGF). Little is known about the expression and insulin regulation of TTP and related genes in adipocytes. We analyzed the relative abundance of TTP family mRNAs in 3T3‐L1 adipocytes compared to RAW264.7 macrophages and investigated insulin effects on the expression of 43 genes in 3T3‐L1 adipocytes. Methods and Procedures: Insulin was added to mouse 3T3‐L1 adipocytes. Relative abundance of mRNA levels was determined by quantitative real‐time PCR. TTP and ZFP36L1 proteins were detected by immunoblotting. Results: Zfp36l1 and Zfp36l2 genes were expressed at eight‐ to tenfold higher than Ttp in adipocytes. Zfp36l3 mRNA was detected at ～1% of Ttp mRNA levels in adipocytes and its low level expression was confirmed in RAW cells. Insulin at 10 and 100 nmol/l increased Ttp mRNA levels by five‐ to sevenfold, but decreased those of Zfp36l3 by 40% in adipocytes after a 30‐min treatment. Immunoblotting showed that insulin induced TTP but did not affect ZFP36L1 protein levels in adipocytes. Insulin decreased mRNA levels of Vegf and a number of other genes in adipocytes. Discussion: Insulin induced Ttp mRNA and protein expression and decreased Vegf mRNA levels in adipocytes. Zfp36l3 mRNA was detected, for the first time, in cells other than mouse placenta and extraembryonic tissues. This study established a basis for the investigation of TTP and VEGF genes in the regulation of obesity and suggested that Vegf mRNA may be a target of TTP in fat cells.     

血培养阳性报警时间联合降钙素原、中性粒细胞/淋巴细胞比值对大肠埃希菌血流感染患者死亡风险的预测价值

摘要 目的：探讨血培养阳性报警时间（TTP）联合降钙素原（PCT）、中性粒细胞/淋巴细胞比值（NLR）对大肠埃希菌血流感染（BSI）患者死亡风险的预测价值。方法：选取2020年1月～2022年6月我院收治的223例大肠埃希菌BSI患者,根据入院后28 d内是否死亡分为死亡组和存活组。收集患者临床资料和血培养TTP,检测PCT、NLR。采用多因素Logistic回归分析大肠埃希菌BSI患者死亡的影响因素。采用受试者工作特征（ROC）曲线分析TTP、PCT、NLR对大肠埃希菌BSI患者死亡风险的预测价值。结果：223例大肠埃希菌BSI患者入院后28 d内死亡率为30.04％（67/223）。死亡组TTP短于存活组,PCT、NLR高于存活组（P均＜0.001）。多因素Logistic回归分析显示,年龄增加、入住重症监护病房（ICU）、气管插管/切开、PCT升高、NLR升高为大肠埃希菌BSI患者死亡的独立危险因素,TTP延长为独立保护因素（P＜0.05）。ROC曲线分析显示,TTP、PCT、NLR联合预测大肠埃希菌BSI患者死亡的曲线下面积大于各指标单独预测。结论：TTP缩短和PCT、NLR升高与大肠埃希菌BSI患者死亡风险增加相关,TTP、PCT、NLR联合预测大肠埃希菌BSI患者死亡风险的价值较高。     

Tocopherol Transfer Protein Sensitizes Prostate Cancer Cells to Vitamin E

Prostate cancer is a major cause of mortality in men in developed countries. It has been reported that the naturally occurring antioxidant α-tocopherol (vitamin E) attenuates prostate cancer cell proliferation in cultured cells and mouse models. We hypothesized that overexpression of the tocopherol transfer protein (TTP), a vitamin E-binding protein that regulates tocopherol status, will sensitize prostate cancer cells to the anti-proliferative actions of the vitamin. To test this notion, we manipulated the expression levels of TTP in cultured prostate cells (LNCaP, PC3, DU145, and RWPE-1) using overexpression and knockdown approaches. Treatment of cells with tocopherol caused a time- and dose-dependent inhibition of cell proliferation. Overexpression of TTP dramatically sensitized the cells to the apoptotic effects of α-tocopherol, whereas reduction (“knockdown”) of TTP expression resulted in resistance to the vitamin. TTP levels also augmented the inhibitory effects of vitamin E on proliferation in semi-solid medium. The sensitizing effects of TTP were paralleled by changes in the intracellular accumulation of a fluorescent analog of vitamin E and by a reduction in intracellular levels of reactive oxygen species and were not observed when a naturally occurring, ligand binding-defective mutant of TTP was used. We conclude that TTP sensitizes prostate cancer cells to the anti-proliferative effects of vitamin E and that this activity stems from the ability of protein to increase the intracellular accumulation of the antioxidant. These observations support the notion that individual changes in the expression level or activity of TTP may determine the responsiveness of prostate cancer patients to intervention strategies that utilize vitamin E.     

Direct Antiglobulin Reaction in ABO-Haemolytic Disease of the Newborn

The minimum number of IgG anti-A (or anti-B) molecules detectable on A or B red cells by the antiglobulin reaction was found to be the same—that is, about 150 molecules per red cell—with newborn as with adult cells. Furthermore, the ratio of anti-IgG bound to IgG anti-A (or anti-B) molecules was the same whether the anti-A (or anti-B) molecules were present on newborn or on adult cells and was similar to that found for anti-IgG bound to IgG anti-Rh.In 15 infants (11 group A, 4 group B) with haemolytic disease of the newborn due to ABO-incompatibility the amount of anti-A or anti-B on the red cells ranged from 0·25 to 3·5 μg antibody per ml red cells, corresponding to 90-1,320 antibody molecules per cell; only five infants had more than 0·55 μg antibody per ml of red cells. These amounts are far smaller than those found in most moderate or severe cases of Rh-haemolytic disease.It is concluded that the weak direct antiglobulin reactions observed in ABO-haemolytic disease are due simply to the fact that the number of anti-A (or anti-B) molecules on the infant''s red cells is at the lower limit of sensitivity of the test. Since ABO-haemolytic disease can be quite a severe process it seems probable that IgG anti-A and anti-B molecules are more effective than anti-Rh molecules in bringing about red cell destruction.     

Clinical Problems: Quantitation of Transplacental Haemorrhage

On four occasions over a period of four years samples of adult blood to which known amounts of fetal blood had been added were distributed to 8-12 different laboratories taking part in clinical trials organized by an M.R.C. Working Party. Estimates were made of the proportion of fetal: adult red cells in the samples after preparing films by the acid-elution method. When the proportion of fetal: adult red cells was less than about 1:10,000, the highest and lowest estimates were separated by a factor of about 10. However, when the number of cells present was between about 1:100 and 1:1,000, most results were between half and twice the true number of cells present.It is pointed out that since fetal red cells are approximately 30% larger than adult red cells, and since only about 90% of fetal cells stain darkly in the acid-elution method, estimates of the proportion of darkly-staining cells in a film underestimate the volume of fetal red cells present by about one-third. A simple formula is proposed which corrects for this factor and which gives an estimate of the total volume of fetal red cells present, deduced from the ratio of fetal: adult red cells and assuming a maternal red cell volume at term of 1,800 ml.A method of screening blood films is suggested which, firstly, endeavours to standardize the density of adult red cells on films, and, secondly, takes into account the Poisson distribution. Thus limits are set for the number of fetal red cells which can be seen in scanning a given number of adult cells before the suspicion is aroused that a transplacental haemorrhage exceeding a certain amount is present.It is emphasized that the density of adult red cells on blood films varies very widely, and unless the cell density and the size of the low-power field are defined the practice of deducing the extent of transplacental haemorrhage from the number of fetal red cells seen per low-power field may lead to large errors.     

Artifactual contractions triggered by field stimulation of cardiomyocytes.

Although cell shortening in patch-clamped cells (current-clamp mode) is triggered by an ordinary action potential, the trigger mechanism in field-stimulated cells is not so obvious. The contraction characteristics of the two methods differ, and we, therefore, examined the triggering sequence in field-stimulated cells. Isolated rat cardiomyocytes were plated on laminin-coated coverslips that were mounted on an inverted light microscope and superfused with HEPES-Tyrode buffer (pH 7.4; 37 degrees C). The cells were stimulated to contract either by a 0.5-ms current injection (CC cells) through high-resistance electrodes or a 5-ms biphasic field-stimulation pulse (FS cells), and drugs were added to block sarcolemmal proteins involved in excitation-contraction coupling. Time to peak contraction (TTP) was significantly longer in FS cells and was not affected by the polarity or the length of the stimulus pulse. Tetrodotoxin (TTX; 20 microM) blocked cell shortening in CC cells but not in FS cells. Ni(2+) (5 mM) blocked cell shortening in FS cells, whereas KB-R7943 (KB; 5 microM) had no effect either on cell shortening or TTP. In FS cells, nifedipine (Nif; 100 microM) and Cd(2+) (300 microM) reduced fractional shortening by 34 and 63%, respectively, but only Cd(2+) affected TTP (reduced by 48%). A combination of Nif and KB reduced cell shortening by 50%, whereas a combination of Cd(2+) and KB almost abolished cell shortening. We conclude that field stimulation per se prolongs TTP and that cell shortening in FS cells is not dependent on Na(+) current but is triggered by a combination of L-type Ca(2+) current and reverse mode Na(+)/Ca(2+) exchange.     

Where does blood go? Prospective observational study of red cell transfusion in north England

ObjectiveTo collect population based information on transfusion of red blood cells.DesignProspective observational study over 28 days.SettingHospital blood banks in the north of England (population 2.9 million).ParticipantsAll patients who received a red cell transfusion during the study period. Data completed by hospital blood bank staff.ResultsThe destination of 9848 units was recorded (97% of expected blood use). In total 9774 units were transfused: 5047 (51.6%) units were given to medical patients, 3982 (40.7%) to surgical patients, and 612 (6.3%) to obstetric and gynaecology patients. Nearly half (49.3%) of all blood is given to female recipients, and the mean age of recipients of individual units was 62.7 years. The most common surgical indications for transfusion were total hip replacement (4.6% of all blood transfused) and coronary artery bypass grafting (4.1%). Haematological disorders accounted for 15.5% of use. Overall use was 4274 units per 100 000 population per year.ConclusionIn the north east of England more than half of red cell units are transfused for medical indications. Demand for red cell transfusion increases with age. With anticipated changes in the age structure of the population the demand for blood will increase by 4.9% by 2008.

What is already known on this topic

There have been no systematic population based surveys on use of red cells in the United KingdomStudies in France and the United States have shown that more than half of transfused red cells go to surgical patients

What this study adds

In the north of England over half of red cells are given for medical indicationsRates of red cell transfusion rise steeply with advancing ageSmall increases in the number of elderly people will have large effects on demand