The Experts below are selected from a list of 303 Experts worldwide ranked by ideXlab platform
M J Pushchak - One of the best experts on this subject based on the ideXlab platform.
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Umbilical artery regression: a rare complication of intravascular fetal Transfusion.
Obstetrics and gynecology, 1999Co-Authors: J F Smith, K D Warner, M Bergmann, M J PushchakAbstract:Intravascular fetal Transfusion is an important therapeutic advance but is associated with several complications. Regression of an umbilical artery associated with Transfusion is rare. A case of red blood cell alloimmunization managed by serial Transfusions was complicated by functional loss of an umbilical artery during pregnancy. Refractory fetal bradycardia occurred during the last Transfusion procedure, requiring emergency preterm cesarean delivery. Coagulative necrosis, thrombosis, and focal calcification of one umbilical artery was confirmed after delivery. Umbilical artery regression associated with Transfusion therapy is rare and may complicate subsequent fetal Transfusions.
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Umbilical artery regression: a rare complication of intravascular fetal Transfusion.
Obstetrics & Gynecology, 1999Co-Authors: J F Smith, K D Warner, M Bergmann, M J PushchakAbstract:Abstract Background: Intravascular fetal Transfusion is an important therapeutic advance but is associated with several complications. Regression of an umbilical artery associated with Transfusion is rare. Case: A case of red blood cell alloimmunization managed by serial Transfusions was complicated by functional loss of an umbilical artery during pregnancy. Refractory fetal bradycardia occurred during the last Transfusion procedure, requiring emergency preterm cesarean delivery. Coagulative necrosis, thrombosis, and focal calcification of one umbilical artery was confirmed after delivery. Conclusion: Umbilical artery regression associated with Transfusion therapy is rare and may complicate subsequent fetal Transfusions.
J F Smith - One of the best experts on this subject based on the ideXlab platform.
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Umbilical artery regression: a rare complication of intravascular fetal Transfusion.
Obstetrics and gynecology, 1999Co-Authors: J F Smith, K D Warner, M Bergmann, M J PushchakAbstract:Intravascular fetal Transfusion is an important therapeutic advance but is associated with several complications. Regression of an umbilical artery associated with Transfusion is rare. A case of red blood cell alloimmunization managed by serial Transfusions was complicated by functional loss of an umbilical artery during pregnancy. Refractory fetal bradycardia occurred during the last Transfusion procedure, requiring emergency preterm cesarean delivery. Coagulative necrosis, thrombosis, and focal calcification of one umbilical artery was confirmed after delivery. Umbilical artery regression associated with Transfusion therapy is rare and may complicate subsequent fetal Transfusions.
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Umbilical artery regression: a rare complication of intravascular fetal Transfusion.
Obstetrics & Gynecology, 1999Co-Authors: J F Smith, K D Warner, M Bergmann, M J PushchakAbstract:Abstract Background: Intravascular fetal Transfusion is an important therapeutic advance but is associated with several complications. Regression of an umbilical artery associated with Transfusion is rare. Case: A case of red blood cell alloimmunization managed by serial Transfusions was complicated by functional loss of an umbilical artery during pregnancy. Refractory fetal bradycardia occurred during the last Transfusion procedure, requiring emergency preterm cesarean delivery. Coagulative necrosis, thrombosis, and focal calcification of one umbilical artery was confirmed after delivery. Conclusion: Umbilical artery regression associated with Transfusion therapy is rare and may complicate subsequent fetal Transfusions.
John A. Widness - One of the best experts on this subject based on the ideXlab platform.
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Predictive factors and practice trends in red blood cell Transfusions for very-low-birth-weight infants
Pediatric Research, 2016Co-Authors: Osayame A. Ekhaguere, Frank H. Morriss, Edward F. Bell, Nadkarni Prakash, John A. WidnessAbstract:Background: Red blood cell (RBC) Transfusions in very-low-birth-weight (VLBW) infants, while common, carry risk. Our objective was to determine clinical predictors of and trends in RBC Transfusions among VLBW infants. Methods: RBC Transfusion practice and its clinical predictors in 1,750 VLBW (≤1,500 g) infants were analyzed in a single-center cohort across sequential epochs: 2000–2004 (Epoch 1), 2005–2009 (Epoch 2), and 2010–2013 (Epoch 3). Results: Overall, 1,168 (67%) infants received ≥1 Transfusions. The adjusted likelihood of ≥1 Transfusions decreased for each 1-g/dl increment in initial hemoglobin concentration following birth, for females, and for each 100-g increment in birth weight. The adjusted likelihood of ≥1 Transfusions increased with infants receiving mechanical ventilation, with increasing length of hospital stay, necrotizing enterocolitis, and nonlethal congenital anomalies requiring surgery. The adjusted mean (SEM) number of Transfusions per patient was decreased in Epoch 3, compared with Epoch 1 and Epoch 2. For an initial hemoglobin of ≥16.5 g/dl, the predicted probability of being transfused was ≤50%. Conclusion: Adjusted RBC Transfusions declined and female sex conferred an unexplained protection over the study period. Modest increases in initial hemoglobin by placentofetal Transfusion at delivery may reduce the need for RBC Transfusion.
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randomized trial of liberal versus restrictive guidelines for red blood cell Transfusion in preterm infants
Pediatrics, 2005Co-Authors: Edward F. Bell, John A. Widness, Ronald G Strauss, Larry T Mahoney, Donald M Mock, Victoria J Seward, Gretchen A Cress, Karen J Johnson, Irma J Kromer, Bridget M ZimmermanAbstract:Objective. Although many centers have introduced more restrictive Transfusion policies for preterm infants in recent years, the benefits and adverse consequences of allowing lower hematocrit levels have not been systematically evaluated. The objective of this study was to determine if restrictive guidelines for red blood cell (RBC) Transfusions for preterm infants can reduce the number of Transfusions without adverse consequences. Design, Setting, and Patients. We enrolled 100 hospitalized preterm infants with birth weights of 500 to 1300 g into a randomized clinical trial comparing 2 levels of hematocrit threshold for RBC Transfusion. Intervention. The infants were assigned randomly to either the liberal- or the restrictive-Transfusion group. For each group, Transfusions were given only when the hematocrit level fell below the assigned value. In each group, the Transfusion threshold levels decreased with improving clinical status. Main Outcome Measures. We recorded the number of Transfusions, the number of donor exposures, and various clinical and physiologic outcomes. Results. Infants in the liberal-Transfusion group received more RBC Transfusions (5.2 ± 4.5 [mean ± SD] vs 3.3 ± 2.9 in the restrictive-Transfusion group). However, the number of donors to whom the infants were exposed was not significantly different (2.8 ± 2.5 vs 2.2 ± 2.0). There was no difference between the groups in the percentage of infants who avoided Transfusions altogether (12% in the liberal-Transfusion group versus 10% in the restrictive-Transfusion group). Infants in the restrictive-Transfusion group were more likely to have intraparenchymal brain hemorrhage or periventricular leukomalacia, and they had more frequent episodes of apnea, including both mild and severe episodes. Conclusions. Although both Transfusion programs were well tolerated, our finding of more frequent major adverse neurologic events in the restrictive RBC-Transfusion group suggests that the practice of restrictive Transfusions may be harmful to preterm infants.
Samuel J Durham - One of the best experts on this subject based on the ideXlab platform.
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effect of blood Transfusion on long term survival after cardiac operation
The Annals of Thoracic Surgery, 2002Co-Authors: Milo Engoren, Robert H Habib, Anoar Zacharias, Thomas A Schwann, Christopher J Riordan, Samuel J DurhamAbstract:Abstract Background . Blood Transfusions have been linked to increased morbidity and mortality. Bleeding during and after cardiac operations and the hemodilution effects of cardiopulmonary bypass commonly result in blood Transfusions. Because we could not find any studies evaluating the effects of Transfusion on long-term survival after cardiac operation, we sought to determine these effects. Methods . We studied 1,915 patients who underwent first-time isolated coronary artery bypass operations between July 6, 1994 and December 31, 1997 at our institution. Patients with Transfusions were compared with those who had not been transfused. Long-term survival data were obtained from the United States Social Security Death Index. Groups were compared by Cox proportional hazard models, Kaplan-Meier survival plots, and hazard functions. Results . Six hundred forty-nine of 1,915 study patients (34%) received a Transfusion during their hospitalization. Transfused patients were older, smaller, and more likely to be female, and had more comorbidity. Transfused patients also had twice the 5-year mortality (15% vs 7%) of nontransfused patients. After correction for comorbidities and other factors, Transfusion was still associated with a 70% increase in mortality (risk ratio=1.7; 95% confidence interval=1.4 to 2.0; p = 0.001). By multivariate analysis, Transfusion, peripheral vascular disease, chronic obstructive pulmonary disease, New York Heart Association functional class IV, and age were significant predictors of long-term mortality. Conclusions . We found that blood Transfusions during or after coronary artery bypass operations were associated with increased long-term mortality.
Andrea Nadel - One of the best experts on this subject based on the ideXlab platform.
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platelet Transfusions during coronary artery bypass graft surgery are associated with serious adverse outcomes
Transfusion, 2004Co-Authors: Bruce D Spiess, Jane C K Fitch, David Royston, John M Murkin, Simon C Body, W. Dietrich, Jerrold H Levy, Andrea NadelAbstract:BACKGROUND: Platelet (PLT) Transfusions are administered in cardiac surgery to prevent or treat bleeding, despite appreciation of the risks of blood component Transfusion. The current analysis investigates the hypothesis that PLT Transfusion is associated with adverse outcomes associated with coronary artery bypass graft surgery (CABG). STUDY DESIGN AND METHODS: Data originally collected during double-blind placebo-controlled phase III trials for licensure of Trasylol (aprotinin injection) were retrospectively analyzed. Adverse outcome data of patients (n = 1720) that received, and did not receive, perioperative PLT Transfusion were compared. Logistic regression analysis was used to assess the association of perioperative adverse events with PLT Transfusion. Propensity scoring analysis was used to verify results of the logistic regression. RESULTS: Patients receiving PLTs were more likely to have prolonged hospital stays, longer surgeries, more bleeding, re-operation for bleeding, and more RBC Transfusions, and less likely to have full-dose aprotinin administration. Adverse events were statistically more frequent in patients that received one or more PLT Transfusion. Logistic regression analysis showed that PLT Transfusion was associated with infection, vasopressor use, respiratory medication use, stroke, and death. Propensity scoring analysis confirmed the risk of PLT Transfusion. CONCLUSIONS: PLT Transfusion in the perioperative period of CABG was associated with increased risk for serious adverse events. PLT Transfusion may be a surrogate marker for sicker patients and have no causal role in the outcomes observed. However, a direct contribution to outcomes remains possible.
