losartan-potassium and Virus-Diseases

I have reviewed areas of development in the use of blood and blood products, placing emphasis on the complications of transfusion, particularly transmission of infection. Alloimmunization in relation to transfusion of red cells and platelets has been covered and suggestions for reducing this problem assessed. The potential methods of avoiding the infective complications have been discussed including the screening of blood for infective agents, the virucidal treatment of blood products during the manufacturing process and white cell depletion. The use of recombinant DNA technology to produce coagulation factors offers the possibility of further reducing infective risks. An area of clinical promise is the use of haematopoietic growth factors to treat bone marrow failure, either congenital or acquired, such as the myelosuppressive effects of cancer chemotherapy, and reduce reliance on blood products. The aim of the chapter is to encourage the rational use of a limited resource by considering the risks inherent in transfusion and alternative strategies. In doing this it is important to audit current and future practice, and it is suggested that reference is made to the suggestions of Hume (1989) for quality assessment and assurance in paediatric transfusion medicine.

Topics: Acquired Immunodeficiency Syndrome; Blood Coagulation Factors; Blood Group Antigens; Blood Platelets; Blood Specimen Collection; Blood Transfusion; Blood Transfusion, Intrauterine; Child; Child, Preschool; Colony-Stimulating Factors; Erythrocyte Transfusion; Erythropoietin; Female; Fetal Blood; Fetal Diseases; Hemoglobinopathies; Humans; Immunization; Immunization, Passive; Incidence; Infant; Neoplasm Recurrence, Local; Platelet Transfusion; Pregnancy; Pregnancy Complications, Hematologic; Prenatal Diagnosis; Thrombocytopenia; Transfusion Reaction; Virus Diseases

To calculate the absolute risk reduction of transfusion-related adverse events, the number of patients needed to treat, and cost to avoid one transfusion-related adverse event by using erythropoietin in critically ill patients. Number needed to treat with sensitivity analysis.. Teaching hospital.. Hypothetical cohort of critically ill patients who were candidates to receive erythropoietin.. Using vs. not using erythropoietin to reduce the need for packed red blood cell transfusions.. We used published estimates of known transfusion risks: transfusion-related acute lung injury, transfusion-related errors, hepatitis B and C, human immunodeficiency virus, human T-cell lymphotropic virus, and bacterial contamination, stratified by severity. Based on the estimated risk and frequency of transfusions with and without erythropoietin, we calculated the absolute risk reduction of transfusion-related adverse events, the number needed to treat, and cost to avoid one transfusion-related adverse event by using erythropoietin. The estimated incidence of transfusion-related adverse event was 318 permillion units transfused for all transfusion-related adverse events, 58 per million for serious transfusion-related adverse events, and 21 per million for likely fatal transfusion-related adverse events. The routine use of erythropoietin resulted in an absolute risk reduction of 191 per million for all transfusion-related adverse events, 35 per million for serious transfusion-related adverse events, and 12 per million for likely fatal transfusion-related adverse events. The number needed to treat was 5,246 to avoid one transfusion-related adverse event, 28,785 to avoid a serious transfusion-related adverse event, and 81,000 for a likely fatal transfusion-related adverse event. The total cost was $4,700,000 to avoid one transfusion-related adverse event, $25,600,000 to avoid one serious transfusion-related adverse event, and $71,800,000 to avoid a likely fatal transfusion-related adverse event. The magnitude of these results withstood extensive sensitivity analysis.. From the perspective of avoidance of adverse events, erythropoietin does not appear to be an efficient use of limited resources for routine use in critically ill patients.

Topics: Bacterial Infections; Blood Group Incompatibility; Blood Transfusion; Cost-Benefit Analysis; Critical Illness; Erythropoietin; Health Care Costs; Humans; Incidence; Medical Errors; Morbidity; Pharmacoepidemiology; Recombinant Proteins; Risk; Transfusion Reaction; United States; Virus Diseases

Coronary artery bypass graft (CABG) surgery accounts for a substantial portion of all allogeneic units of blood transfused. Drugs and autologous blood donation (ABD) are alternative or adjunctive methods for reducing complications and costs induced by allogeneic blood transfusions. Recombinant human erythropoietin (epoetin) has the potential to decrease perioperative need for allogeneic blood during CABG, but its high cost calls for a careful economic evaluation before it can be recommended for widespread use.. A decision tree was used to compare a hypothetical strategy of no epoetin with one in which epoetin was utilized to control blood transfusion needs in CABG; each strategy was tested with and without ABD. The impact of these strategies on both the quality-adjusted life years (QALYs) and costs ($US) was calculated.. Using epoetin alone and with ABD, respectively, avoided the transfusion of 0.61 and 1.35 units of allogeneic blood per patient and saved 0.000086 and 0.000146 QALYs per patient. This made cost-effectiveness (CE) higher than $7 million and $5 million for each QALY saved, respectively. ABD alone cost more than $1 million per QALY saved. If the risk of bacterial infections following allogeneic transfusions was included in the model, epoetin alone cost $6288 per QALY saved, while ABD, both alone and with epoetin, saved money.. On the basis of the existing evidence, neither of the blood-saving strategies modeled was a cost-effective means of avoiding the deleterious health effects of perioperative blood transfusions in CABG. However, if allogeneic blood-related infections were to be considered, both ABD and epoetin would be acceptable interventions.

Topics: Aged; Blood Loss, Surgical; Blood Transfusion; Blood Transfusion, Autologous; Computer Simulation; Coronary Artery Bypass; Cost-Benefit Analysis; Decision Trees; Drug Costs; Erythropoietin; Feasibility Studies; Health Care Costs; Humans; Male; Models, Theoretical; Preoperative Care; Recombinant Proteins; Safety; Transfusion Reaction; Virus Diseases

Topics: Blood Transfusion, Autologous; Erythropoiesis; Erythropoietin; Female; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Recombinant Proteins; Virus Diseases

To define the hematologic changes during a mild viral infection, 93 infants were immunized with live attenuated measles virus and studied prospectively at 0, 4, 9, 14, 21, and 30 days. Hemoglobin concentration decreased significantly by days 9 and 14. The decrease was greater than 1.0 g/dL in 8.6% and greater than 0.6 in 24.3% of the infants. Of the nonanemic infants, 22% became anemic. Serum iron and percentage saturation of transferrin decreased, whereas serum ferritin increased significantly. Mean cell volume, iron-binding capacity, protoporphyrin, and haptoglobin did not show changes. Reticulocyte index and erythropoietin increased significantly at 30 days. Leukocyte counts, Zetacrit, and C-reactive protein did not help to predict the hemoglobin decrease. These results suggest that a mild viral infection in infants induces a significant decrease in hemoglobin that may persist for 14 to 30 days and may be difficult to distinguish from iron deficiency.

Topics: Anemia; Erythrocyte Indices; Erythropoietin; Ferritins; Hemoglobins; Humans; Infant; Iron; Leukocyte Count; Measles Vaccine; Reticulocytes; Transferrin; Vaccines, Attenuated; Virus Diseases

Erythropoiesis in CBA mice was studied in Rauscher leukemia virus infected mice using the incorporation of 59Fe into spleen, bone marrow and peripheral blood. Beginning at day 4 an increased uptake into the spleen and a decrease in the bone marrow and the peripheral blood was observed. The increased uptake by the spleen was also found in plethoric mice. The erythropoietin responsive compartment was also enlarged in the spleen of these mice. The The dose-response-curve for erythropoietin was altered 4 days after infection, there was a higher background level of 59Fe incorporation and the response to low doses was better in infected animals. The reticulocytopenia which is usually seen in these mice, was overcome by administration of high doses of erythropoietin. It is concluded that the Rauscher virus acts in a similar manner to erythropoietin, but the erythropoiesis induced is ineffective since the cells do not mature. This maturation deficiency is influenced by administration of exogenous erythropoietin.

Topics: Animals; Bone Marrow Cells; Cell Count; Dose-Response Relationship, Drug; Erythropoietin; Female; Iron Radioisotopes; Mice; Mice, Inbred CBA; Rauscher Virus; Spleen; Time Factors; Virus Diseases

Topics: Animals; Blood Cell Count; Erythrocytes; Erythropoiesis; Erythropoietin; Female; Friend murine leukemia virus; Hematocrit; Hemoglobinometry; Iron; Iron Isotopes; Maternal-Fetal Exchange; Mice; Polycythemia; Pregnancy; Rauscher Virus; Spleen; Splenectomy; Virus Cultivation; Virus Diseases