National comparative audit of blood use in elective primary unilateral total hip replacement surgery in the UK.

Introduction: Blood is a scarce and expensive product. Although it may be life-saving, in recent years there has been an increased emphasis on the potential hazards of transfusion as well as evidence supporting the use of lower transfusion thresholds. Orthopaedic surgery accounts for some 10% of transfused red blood cells and evidence suggests that there is considerable variation in transfusion practice.

Silent myocardial ischaemia and haemoglobin concentration: a randomized controlled trial of transfusion strategy in lower limb arthroplasty.

Background And Objectives: Red cell transfusion is commonly used in orthopaedic surgery. Evidence suggests that a restrictive transfusion strategy may be safe for most patients. However, concern has been raised over the risks of anaemia in those with ischaemic cardiac disease.

Which groups of patients are transfused? A study of red cell usage in London and southeast England.

Background And Objectives: There are few published data on the use of red blood cells (RBC) by specialty in the United Kingdom. The aim of this survey was to identify major specialty users of blood to target for audit of transfusion practice with a view to minimizing inappropriate use and to support planning of blood supply needs for the future.

Materials And Methods: Data were collected retrospectively of RBC units transfused at 62 hospitals/trusts in London and southeast England between April 1997 and March 1998.

RBC T activation and hemolysis in a neonatal intensive care population: implications for transfusion practice.

Background: Reports of transfusion-associated hemolysis in infants with T-activated RBCs have led to the suggestion that infants should be screened and provided with low-titer anti-T blood components. T-activated RBCs react with the lectins Arachis hypogea and Glycine soja; variants of T (Th and Tx) and Tk also react with A. hypogea, but not G.

Blood component use in critically ill patients.

This prospective observational study was conducted to assess the current transfusion practice in critically ill patients. One thousand two hundred and forty-seven consecutive critically ill patients admitted between February 1999 and October 1999 were included in the study. Overall 666 (53%) patients were administered red cells.

Effectiveness of a protocol to improve transfusion practice in knee replacement surgery.

Background And Objectives: The available guidelines on red cell transfusion are not clearly defined and therefore have had only a modest impact on transfusion practice. The aims of this study were to assess the rate of compliance with a transfusion algorithm and its effect on transfusion practice.

Materials And Methods: A prospective observational study was carried out on 101 patients who underwent primary elective total knee replacement surgery.

Retrospective study on red cell usage in primary total knee replacement surgery.

Background And Objectives: There is wide variation in the use of red cell transfusions for the same clinical indication. The purpose of the study was to comment on preoperative and discharge haemoglobin (Hb) levels and perioperative blood loss, and to project the Hb level if transfusions were not administered.

Materials And Methods: The case notes of 187 patients who underwent primary total knee replacement were reviewed retrospectively.

C-reactive protein in patients undergoing cardiac surgery.

Among 25 patients undergoing cardiac surgery with the aid of cardiopulmonary bypass, 13 who recovered uneventfully all had normal (less than 2 mg/litre) levels of serum C-reactive protein pre-operatively. In contrast, 10 of the 12 patients who suffered from various postoperative complications, including two who died, had abnormally raised levels of C-reactive protein pre-operatively. All patients showed a major acute phase response to surgery with peak C-reactive protein levels at about 46 hours but, whereas the uncomplicated cases showed a characteristic smooth biphasic pattern of declining levels thereafter, the complicated cases all exhibited significant alterations of this pattern.

Cardiovascular response to intubation. A comparative study of thiopentone and midazolam.

The cardiovascular response evoked by tracheal intubation was observed in 20 patients undergoing elective abdominal surgery in whom anaesthesia was induced with either midazolam 0.3 mg/kg or thiopentone 4.5 mg/kg followed by pancuronium 0.

Perioperative changes in complement associated with cardiopulmonary bypass.

The total haemolytic complement (CH50), the complement components C3 and C4, the complement breakdown product C3d, alternative pathway activation and transferrin, were measured before, during and after cardiopulmonary bypass. As expected, CH50 decreased after heparinization, remained low during bypass and decreased further up to 8 h after bypass. C3 and C4 decreased significantly during bypass, continued to decrease for a further 8 h after bypass (by 35% and 40% respectively) and thereafter increased gradually up to 48 h.

Complement in CPD-stored blood.

We studied complement functions, breakdown of C3 and aggregation of immunoglobulins in whole blood stored in citrate phosphate dextrose at 4 degrees C for up to 3 weeks from 10 normal blood donors. No significant changes in total haemolytic complement (CH50) and alternative pathway haemolytic complement activity were detected. However, the complement-mediated capacity of the sera to solubilise a pre-formed immune precipitate decreased significantly at 2 and 3 weeks (p less than 0.

Coagulation inhibitor in hypothyroidism.

A patient was referred for investigation of heavy bleeding after surgery. He showed several features of hypothyroidism but no goitre. Primary autoimmune hypothyroidism was confirmed by the finding of a low serum thyroxine concentration and a high thyrotropin concentration.

Simultaneous or spontaneous occurrence of lympho- and myeloproliferative disorders: a report of four cases.

We describe four patients with mixed lympho- and myeloproliferative disorders. One patient had hairy cell leukaemia and acute myelomonocytic leukaemia, another lymphocytic lymphoma in leukaemic phase and chronic myelomonocytic leukaemia and the third patient had chronic lymphocytic leukaemia and polycythaemia rubra vera; none of these patients had received any prior therapy, and in two the diagnosis of the two malignancies was simultaneous. The fourth patient developed acute monocytic leukaemia 4 years after the diagnosis of chronic lymphocytic leukaemia after only 2 weeks of therapy with chlorambucil.

Methohexitone or etomidate for induction of dental anaesthesia.

Ninety-two patients who presented for outpatient dental extractions received methohexitone (1.5 mg . kg-1, 46 patients) or etomidate (0.

Clonazepam in the treatment of choreiform activity.

In a limited study, clonazepam, a new benzodiazepine derivative, has been found to be effective in suppressing choreiform movements in three patients with Huntington's chorea, three patients with non-familial chorea, and in one patient with senile chorea. In two patients with chorea of doubtful aetiology the response was not very satisfactory. A simple method was used to assess objectively the effect on choreiform movements.