losartan-potassium and Cyanosis

Preoperative autologous blood donation with recombinant human erythropoietin (rHuEPO) is effective in adults. However, there are problems concerning the blood access, cost, and blood storage in children. The purpose of this study was to evaluate the efficacy of administering a single dose of rHuEPO without blood donation in children undergoing pediatric cardiac surgery.. Eighty-two children (72 with noncyanotic heart disease, and 10 with cyanotic heart disease) whose hematocrit values were less than 45% were included in this prospective, nonrandomized study. The children were divided into 3 groups: group E0 (n = 20) was not treated with rHuEPO and iron sulfate; group E2 (n = 27) was treated with 200 IU/kg of rHuEPO and 2 mg/kg of iron sulfate; and group E4 (n = 35) was treated with 400 IU/kg of rHuEPO and 4 mg/kg of iron sulfate. Administration of rHuEPO was performed subcutaneously 7 days before the operation. The hematological and iron parameters were measured perioperatively.. A lower proportion of children treated with rHuEPO (group E2, 14.8%; group E4, 22.9%) than children without rHuEPO (group E0, 40.0%) were exposed to RBC transfusions; however, there was no significance. The elevations of the hematocrit levels were 0.7% in group E0, 1.3% in group E2, and 1.9% in group E4. The elevation of the hematocrit was greater in patients with anemia (hematocrit < or =37%).. Although the effectiveness for avoiding transfusion was not clear, the administration of a single dose of rHuEPO without autologous blood donations had an effect by increasing hematocrit levels.

Topics: Blood Chemical Analysis; Cardiac Surgical Procedures; Child; Child, Preschool; Confidence Intervals; Cyanosis; Dose-Response Relationship, Drug; Erythropoietin; Female; Follow-Up Studies; Heart Defects, Congenital; Hematocrit; Humans; Injections, Subcutaneous; Male; Postoperative Period; Preoperative Care; Probability; Prospective Studies; Recombinant Proteins; Treatment Outcome

Fetal hemoglobin (HbF) synthesis in children with congenital cyanotic heart disease was compared that in normal children. Children with hypoxemia had higher levels of hemoglobin, total HbF, and HbF synthesis. In these children there was also an inverse correlation between HbF synthesis and oxygen content, as well as between HbF synthesis and hemoglobin concentration. Thus hypoxemia increases HbF synthesis.

Topics: Child; Child, Preschool; Cyanosis; Erythropoietin; Fetal Hemoglobin; Heart Defects, Congenital; Humans; Hypoxia; Infant

Haematological features of 64 patients suffering from non operable cyanotic congenital heart disease (CCHD) treated with hydroxyurea (HU) were compared with those of 43 patients suffering from the same disorder who had not yet received this drug. Patients with subclinical renal dysfunction were excluded by measuring plasma creatinine levels. MCV and HbF were higher among patients receiving HU, the increase in MCV being cumulative with HU dosage but the rise in HbF dose independent. HbF response to HU was found to be due to the coordinated increase in F-cell and F-reticulocyte production rather than to a selective survival of F-cells. Absence of a relationship between plasma erythropoietin and HbF levels excluded a dominant role of the former in increasing F-cell production and results determined after doubling the HU dosage or immediately after initiating therapy suggested genetic differences to be responsible for the individual variations in Hb F response. No irreversible toxic effects or malignancies were noted in this series of patients. HU was administered for a relatively long period of time, the mean duration of treatment exceeding 5 years, while the study also included patients below the age of 10 years.

Topics: Adolescent; Adult; Child; Cyanosis; Erythroid Precursor Cells; Erythropoietin; Female; Fetal Hemoglobin; Globins; Heart Defects, Congenital; Hematocrit; Humans; Hydroxyurea; Kidney Function Tests; Male; Middle Aged; Oxygen; Polymorphism, Restriction Fragment Length; Retrospective Studies

We hypothesized that children with cyanotic congenital heart disease and moderate hypoxemia, as a result of erythrocytosis, and adequate iron stores would have low serum erythropoietin titers, low tissue oxygen delivery, and normal red cell 2,3-diphosphoglycerate (DPG) concentrations. We assessed hemoglobin levels, aortic oxygen saturation, iron stores, red cell 2,3-DPG, oxygen consumption, and systemic O2 transport in 19 hypoxemic patients, aged 3 months to 8 years. Low erythropoietin titers (less than 30 mU/dl) were found in 14 patients. Patients with high erythropoietin titers had lower Pao2 (36 +/- 7 vs 49 +/- 7 mm Hg, p less than 0.01), lower aortic saturation (68 +/- 12 vs 81 +/- 9%, p less than 0.01), and higher red cell 2,3-DPG (2.47 +/- 0.34 vs 3.23 +/- 0.73 mumol/ml, p less than 0.01). Aortic oxygen saturation higher than 80% was associated with a low erythropoietin titer and a hemoglobin level below that associated with hyperviscosity. The relationship between aortic oxygen saturation and hemoglobin concentration was strong (r = 0.77). These data suggest that for children less than 8 years of age, adequate compensation for moderate hypoxemia can occur with moderate increases in hemoglobin levels.

Topics: 2,3-Diphosphoglycerate; Child; Child, Preschool; Cyanosis; Diphosphoglyceric Acids; Erythropoietin; Female; Heart Defects, Congenital; Hemoglobins; Humans; Hypoxia; Infant; Iron; Male; Oxygen; Oxygen Consumption; Polycythemia

Serum immunoreactive erythropoietin (siEp) was measured in 27 cyanotic and 21 acyanotic children with congenital heart disease, age 4 months to 10 years. The geometric mean value was 9 mIU/mL for each group with 95% range from 3 to 26 mIU/mL and 4 to 22 mIU/mL for the cyanotic and acyanotic subjects, respectively. The levels are similar to those found in normal adults using the same assay system. Three cyanotic subjects showed increased siEp values. One was anemic relative to his hypoxemia, and the other two showed signs of increasing hypoxia. There was a significant negative correlation between siEp and arterial oxygen content. However, siEp did not correlate significantly with hemoglobin, hematocrit, PaO2, or SaO2. Despite normal siEp levels, the cyanotic children showed compensatory erythropoiesis with significantly elevated hemoglobin and hematocrit levels, which did correlate inversely with PaO2 and SaO2. Arterial oxygen content was also significantly higher in the cyanotic subjects (p less than 0.02). The cyanotic children seemed to display the same pattern as observed in man and animals exposed to prolonged hypobaric hypoxia, where after an initial rise in erythropoietin values the levels fall to normal, while increased erythropoiesis is sustained.

Topics: Arteries; Child; Child, Preschool; Cyanosis; Erythropoietin; Heart Defects, Congenital; Hematocrit; Hemoglobins; Humans; Infant; Oxygen; Partial Pressure; Radioimmunoassay

Topics: Adolescent; Adult; Animals; Blood; Child; Child, Preschool; Cyanosis; Erythropoietin; Heart Defects, Congenital; Humans; Hypoxia; In Vitro Techniques; Infant; Infant, Newborn; Polycythemia; Rats; Umbilical Cord