losartan-potassium and Cytomegalovirus-Infections

In the United States in 1991, 290,000 or 7.1% of the 4,110,907 live births were premature infants; 53,299 or 1.3% were infants with birth weights of less than 1500 grams. Many if not all of these very low birth weight infants will require red blood cell transfusions for one of several reasons. These include exchange transfusions for hyperbilirubinemia, but most often transfusions are simple small volume transfusion also called 'topper' transfusions. Most of these small volume transfusions are given for iatrogenic blood loss or 'bleeding into the laboratory.' Studies have demonstrated that the sicker the infant, the more blood sampling is needed and the greater the exposure to red blood cell (RBC), platelet and plasma products. Simple RBC transfusions may also be given for specific clinical indications or to maintain a predetermined hemoglobin concentration. This manuscript will review the criteria for RBC transfusion in neonates and selection of product as regards anticoagulant and specialized processing. In addition, the results of recombinant erythropoietin (r-EPO) clinical trials in neonates will be discussed.

Topics: Blood; Blood Donors; Blood Transfusion; Bloodletting; Cytomegalovirus Infections; Erythrocyte Transfusion; Erythrocyte Volume; Erythropoietin; Failure to Thrive; Graft vs Host Disease; Hematocrit; Humans; Infant, Low Birth Weight; Infant, Newborn; Jaundice, Neonatal; Oxygen; Recombinant Proteins; Transfusion Reaction

Topics: Age Factors; Blood Transfusion; Blood Volume; Bloodletting; Cell Separation; Child; Child, Preschool; Cytomegalovirus Infections; Erythropoietin; Graft vs Host Disease; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Leukocytes

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Anemia; Antiviral Agents; Clinical Trials as Topic; Cytomegalovirus Infections; Erythropoietin; Ganciclovir; Humans; Zidovudine

Approximately 10% of patients receiving recombinant human erythropoietin (rHuEPO) do not respond to the treatment. We evaluated parvovirus B19 (B19) and cytomegalovirus (CMV) infections and antierythropoietin (anti-EPO) antibodies as potential causes of anemia in dialyzed patients, hyporesponsive to rHuEPO.. Data from 120 dialyzed patients, receiving rHuEPO alfa, were collected: demographic characteristics, rHuEPO dose, duration of rHuEPO treatment and time on dialysis, etiology of chronic kidney disease and transfusion history. Serology and PCR were performed to address B19 and CMV infection status. An ELISA was developed to detect anti-EPO antibodies.. rHuEPO resistance correlated with high ferritin levels (p = 0.001) and short time on dialysis (p = 0.012). B19 DNA was found in 10 (8.3%) dialyzed patients and CMV DNA was detected in 33 (27.5%). There was no significant correlation between B19 infection and anemia,while a tendency of correlation between active CMV infection and hemoglobin levels or hematocrit value (p= 0.069 and p= 0.070, respectively) has been observed. Anti-EPO antibodies were not detected in any patient.. B19 infection is a rare complication in dialyzed patients and should be investigated after exclusion of other common causes, while CMV infection is rather common. The role of CMV infection in the hyporesponsiveness in dialyzed patients should be further evaluated in other studies. Our data suggest that anti-EPO antibodies are not involved in rHuEPO resistance in this population.

Topics: Adult; Aged; Antibodies, Neutralizing; Antiviral Agents; Case-Control Studies; Cytomegalovirus Infections; Drug Resistance, Viral; Epoetin Alfa; Erythema Infectiosum; Erythropoietin; Female; Humans; Male; Middle Aged; Parvovirus B19, Human; Recombinant Proteins; Red-Cell Aplasia, Pure; Renal Dialysis

Cytomegalovirus (CMV)-seropositive patients with ESRD may have more CD4(+) T cells lacking the co-stimulatory molecule CD28 (CD4(+)CD28null) than CMV-seronegative patients. Increased numbers of CD28null T cells associates with epoetin nonresponsiveness in patients with ESRD, but whether expansion of CD4+CD28null T cells in CMV-seropositive patients associates with demand for epoetin is unknown. In a cohort of 129 stable patients with ESRD, CMV seropositivity significantly associated with a lower hemoglobin level in predialysis patients (12.5 versus 11.5 g/dl; P < 0.02). CMV seropositivity did not associate with average hemoglobin level in hemodialysis patients, but CMV-seropositive patients required significantly more epoetin (median 12,000 versus 6300 U/wk; P = 0.02). Multivariate linear regression analysis identified CMV seropositivity as the only variable significantly associated with hemoglobin levels in predialysis patients and epoetin dosages in hemodialysis patients. In CMV-seropositive hemodialysis patients, the number of circulating CD4(+)CD28null T cells positively correlated with epoetin dosage. These CD4(+)CD28null T cells were proinflammatory; they were capable of producing large amounts of IFN-gamma and TNF-alpha. In conclusion, expansion of CD4(+)CD28null T cells in CMV-seropositive patients with ESRD associates with increased demand for epoetin.

Topics: Adult; Aged; Antibodies, Viral; CD28 Antigens; CD4-Positive T-Lymphocytes; Cohort Studies; Cytomegalovirus; Cytomegalovirus Infections; Darbepoetin alfa; Dose-Response Relationship, Drug; Erythropoietin; Female; Hemoglobins; Humans; Interferon-gamma; Kidney Failure, Chronic; Male; Middle Aged; Recombinant Proteins; Renal Dialysis; T-Lymphocyte Subsets; Tumor Necrosis Factor-alpha

Topics: Anemia; C-Reactive Protein; Coronary Artery Disease; Cytomegalovirus Infections; Erythropoietin; Heart Failure; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Middle Aged; Treatment Outcome

Vascular access failure is the main cause of morbidity in hemodialysis. Venous stenosis and subsequent thrombosis, as the result of intimal hyperplasia, is the major cause of vascular access failure. Intimal hyperplasia of the arteriovenous fistula (AVF) closely resembles the main histopathologic feature of atherosclerosis. In addition to the classic atherogenic risk factors, recently, cytomegalovirus (CMV) infection and parathyroid hormone (PTH) have been suggested as a potential cause of vascular disease.. In the present study, we evaluated the relationship between AVF dysfunction and mean plasma PTH, cholesterolemia, high titer anti-CMV immunoglobulin G (IgG) (>250 U/mL), hematocrit, and mean erythropoietin (EPO) dose in 36 cases and 51 controls matched for age, time on dialysis, and type of AVF.. A higher percentage of patients with AVF failure had a smoking habit and presented high anti-CMV IgG titer. Patients with AVF failure had significantly higher mean plasma PTH, whereas the groups did not differ for mean cholesterolemia and hematocrit. Mean EPO dose was slightly, but significantly, higher in the AVF failure group. Multiple logistic regression revealed that smoking, EPO dose, elevated mean plasma PTH and high titer anti-CMV antibodies, significantly increased the risk of AVF dysfunction.. Our data suggest that hyperparathyroidism, smoking habits, CMV infection and EPO, independently of the hematocrit achieved, represent independent risk factors for hemodialysis access thrombosis.

Topics: Aged; Arteriovenous Shunt, Surgical; Cytomegalovirus Infections; Erythropoietin; Female; Graft Occlusion, Vascular; Hematocrit; Humans; Hyperparathyroidism; Incidence; Kidney Failure, Chronic; Male; Middle Aged; Parathyroid Hormone; Renal Dialysis; Risk Factors; Smoking; Thrombosis

We studied 24 recipients of autologous bone marrow transplantation (ABMT) or allogeneic BMT (BMT) to determine whether impaired erythropoietin (Epo) response to anemia could delay full erythropoietic recovery. Observed Epo levels were compared with predicted levels based on the relationship between Epo and hematocrit in 125 control subjects. Circulating Epo levels were normal during conditioning and the early posttransplant period. Between days 21 and 180, Epo levels remained normal in ABMT patients but were inappropriately low for the degree of anemia in BMT patients. Median time to full erythropoietic engraftment was longer in BMT than in ABMT recipients. Circulating Epo returned to appropriate levels after day 180, except in patients with active cytomegalovirus infection. We conclude that impaired Epo response to anemia can contribute to delayed erythropoietic recovery after allogenic BMT. Renal toxicity of ciclosporin, interaction between host and donor marrow, and cytomegalovirus infection might play a role. This study could support the use of recombinant human Epo to accelerate erythropoietic engraftment after BMT.

Topics: Adolescent; Adult; Anemia; Bone Marrow Transplantation; Child; Child, Preschool; Cytomegalovirus Infections; Erythropoietin; Female; Graft Survival; Graft vs Host Disease; Hematocrit; Hematologic Diseases; Humans; Male; Middle Aged; Transplantation, Autologous; Transplantation, Homologous