Objective:To describe the outcomes of StageⅠtwin-to-twin transfusion syndrome among patients treated with expectant management(EM),amnioreduction(AR),or fetoscopic laser occlusion of chorioangiopagous vessels(FLOC).M...Objective:To describe the outcomes of StageⅠtwin-to-twin transfusion syndrome among patients treated with expectant management(EM),amnioreduction(AR),or fetoscopic laser occlusion of chorioangiopagous vessels(FLOC).Methods:A cohort of 89 cases was studied.Based on the initial management strategy,patients were classified into three groups:the EM,AR,and FLOC.We assessed perinatal survival to 28 days of age and categorized pregnancy outcomes as good(twin live birth at≥30.0 weeks),mixed(single fetal demise or delivery between 26.0 and 29.9 weeks),or poor(double fetal demise or delivery at<26.0 weeks).Results:26(29.2%)patients underwent EM,35(39.3%)underwent AR,and 28(31.5%)underwent FLOC therapy.Of those managed expectantly,19.2%experienced spontaneous abortion,50%progressed in stage,and 30.8%remained stable or regressed.After adjusting for potential confounders including maternal age,'null'iparity,placenta location,and recipient maximum vertical pocket,and so on,FLOC therapy and AR were associated with significantly[odds ratio(OR)=0.09]and borderline significantly(OR=0.20)reduced risks of poor pregnancy outcomes and of no survivors to 28 days of age after birth(OR=0.04 and OR=0.20,respectively)compared with EM.Conclusion:About 70%of those treated with EM progressed in stage or experienced fetal loss.Compared to EM,intervention may decrease the risk of poor pregnancy outcomes and improve the perinatal survival rate.展开更多
Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterized by headache, confusion, seizures, and cortical visual loss, as well as subcortical edema without infarction on neuroi...Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterized by headache, confusion, seizures, and cortical visual loss, as well as subcortical edema without infarction on neuroimaging. We report a 56-year-old woman who developed typical manifestations of PRES, 6 days after blood transfusion for severe anemia. Acute volume overloads by transfusion may exceed the capacity of autoregulation of perfusion pressure, possibly resulting in vasogenic edema. We propose that it is clinically important to recognize that rapid correction of anemia by blood transfusion may carry the risk of inducing PRES.展开更多
BACKGROUND: Although non-thyroidal illness syndrome(NTIS) is considered a negative prognostic factor, the alterations in free triiodothyronine(f T3) levels in trauma patients requiring massive transfusion have not bee...BACKGROUND: Although non-thyroidal illness syndrome(NTIS) is considered a negative prognostic factor, the alterations in free triiodothyronine(f T3) levels in trauma patients requiring massive transfusion have not been reported.METHODS: A prospective observational study comparing 2 groups of trauma patients was conducted. Group M comprised trauma patients requiring massive transfusions(>10 units of packed red blood cells) within 24 hours of emergency admission. Group C comprised patients with an injury severity score >9 but not requiring massive transfusions. Levels of f T3, free thyroxine(f T4), and thyroidstimulating hormone(TSH) were evaluated on admission and on days 1, 2, and 7 after admission. The clinical backgrounds and variables measured including total transfusion amounts were compared and the inter-group prognosis was evaluated. Results are presented as mean±standard deviation.RESULTS: Nineteen patients were enrolled in each group. In both groups, 32 were men, and the mean age was 50±24 years. In group C one patient died from respiratory failure. The initial f T3 levels in group M(1.95±0.37 pg/m L) were signifi cantly lower than those in group C(2.49±0.72 pg/m L; P<0.01) and remained low until 1 week after admission. Initial inter-group f T4 and TSH levels were not significantly different. TSH levels at 1 week(1.99±1.64 μIU/m L) were higher than at admission(1.48±0.5 μIU/m L) in group C(P<0.05).CONCLUSION: Typical NTIS was observed in trauma patients requiring massive transfusions. When initial resuscitation achieved circulatory stabilization, prognosis was not strongly associated with NTIS.展开更多
Iron overload in myelodysplastic syndrome (MDS) results from multiple RBC-transfusions and inappropriate increased iron absoption associated with ineffective erythropoiesis. Data from hereditary iron-loading anemias i...Iron overload in myelodysplastic syndrome (MDS) results from multiple RBC-transfusions and inappropriate increased iron absoption associated with ineffective erythropoiesis. Data from hereditary iron-loading anemias indicate long-term consequences of iron toxicity are preventable and potentially reversible by effective iron-chelation therapy (ICT). There is increasing interest in using ICT in persons with MDS because of the recent introduction of orally effective iron-chelators which are suitable for older persons, (1-4). Ideally, evidence supporting the benefit of ICT in MDS should be evidenced-based, especially data from randomized trials showing better survival and, in exceptional cases, improved heart function . Such data are lacking. Nevertheless, it is possible to rely on the extensive data from trials of ICT in persons with thalassemia and to use well-defined predictors of increased risks of life-threatening complications to identify persons with MDS most likely to benefit from iron-chelating therapy.展开更多
Feto-fetal transfusion syndrome(FFTS)severely affects monochorionic(MC)multiple pregnancies and affects 1 in 1600 pregnancies overall.The number of increasing disputed obstetrics cases in China is related to unavailab...Feto-fetal transfusion syndrome(FFTS)severely affects monochorionic(MC)multiple pregnancies and affects 1 in 1600 pregnancies overall.The number of increasing disputed obstetrics cases in China is related to unavailability of prompt diagnosis of FFTS.We present here a woman with a MC triplet pregnancy with intrauterine fetal death at 33 weeks of gestation due to FFTS.Subsequent pathological anatomy showed that the MC placenta contained vascular anastomoses,including arterio-arterial anastomosis and arterio-venous anastomosis.These anastomoses led to unidirectional blood flow with the absence of adequate compensatory counter-transfusion and bi-directional flow.When encountering such challenging conditions,medical practitioners should discreetly compare the fetuses’characteristics with features of placental blood vessels and consult morphological and pathological findings.Furthermore,they should perform ultrasound examinations,particularly focussing on fetal size differences and the maximum vertical pocket in the diagnosis of FFTS,especially in MC multiple pregnancies with abdominal symptoms.展开更多
The pathophysiology of twin-to-twin transfusion syndrome(TTTS)is complex,and its understanding has evolved along with the evolution and revolution of fetal diagnostic and therapeutic techniques.Over the last few decad...The pathophysiology of twin-to-twin transfusion syndrome(TTTS)is complex,and its understanding has evolved along with the evolution and revolution of fetal diagnostic and therapeutic techniques.Over the last few decades,several therapeutic interventions have been researched for improving the outcomes in TTTS.We present a summary of the current protocols for surveillance,diagnosis,and staging of TTTS in monochorionic pregnancies.We also describe in detail the technique for treatment of TTTS by endoscopic laser photocoagulation.展开更多
目的分析胎龄<32周极低/超低出生体重新生儿呼吸窘迫综合征(NRDS)患儿输注红细胞次数的危险因素,探讨输注红细胞次数增加的相关并发症及预测指标,为NRDS患儿提供安全、科学的输血建议。方法通过回顾性分析收集本院2016年1月—2020年1...目的分析胎龄<32周极低/超低出生体重新生儿呼吸窘迫综合征(NRDS)患儿输注红细胞次数的危险因素,探讨输注红细胞次数增加的相关并发症及预测指标,为NRDS患儿提供安全、科学的输血建议。方法通过回顾性分析收集本院2016年1月—2020年12月585名胎龄<32周极低/超低出生体重NRDS新生儿,按住院期间输红细胞次数的不同分3组[输血0次(n=97)、输血1~2次(n=253)、输血≥3次(n=235)],比较3组患儿临床资料及实验室指标,分析导致极低和超低出生体重NRDS患儿输血次数增加的危险因素。结果3组新生儿胎龄(周)(30.72±1.84 vs 29.87±1.66 vs 28.29±1.46)、出生体重(g)(1366.19±128.12 vs 1265.20±163.98 vs 1081.73±196.06)、入院时血红蛋白量(g/L)(172.37±19.98 vs 161.96±21.41 vs 154.33±24.61)、入院红细胞压积比值(%)(50.46±5.74 vs 47.69±5.55 vs 45.46±6.84)、住院时间(d)(40 vs 51 vs 68)、无创通气时间(d)(6 vs 11.01 vs 24.56)、静脉营养时间(d)(16.73 vs 22.37 vs 30.74)两两比较,均有差异(P<0.05)。输血≥3次组有创通气时间(7.66 d)明显高于输血1~2次组和输血0次组(P<0.05)。3组间败血症(1%,1/97 vs 4%,10/253 vs 9.4%,22/235)、早产儿视网膜病变(ROP)(16.5%,16/97 vs 17%,43/253 vs 46.8%,110/235)、支气管肺发育不良(BPD)(4.1%,4/97 vs 19%,48/253 vs 59.1%,139/235)发病率两两比较,均有差异(P<0.05)。输血≥3次组新生儿坏死性小肠结肠炎(NEC)发生率(26.8%,63/235)与输血0次组比较有差异(P<0.05)。多因素Logistic回归分析显示:住院时间、有创通气时间、静脉营养时间是输血≥3次的独立危险因素(OR=1.048,1.073,1.030,均为P<0.05)。受试者工作特征曲线(ROC曲线)显示住院时间、有创呼吸时间、静脉营养时间对输血≥3次的预测效果较好,其ROC曲线下面积分别为0.841、0.766、0.716,3者Cutoff值分别为>57 d、>2.75 d及>23.75 d。结论NEC、败血症、BPD、ROP是胎龄<32周极低/超低出生体重NRDS患儿输血次数增加的并发症。而住院时间、有创通气时间和静脉营养时间对输血≥3次有较好的预测价值。展开更多
基金This work was supported by grants from the National Key R&D Program of China(2016YFC1000408).
文摘Objective:To describe the outcomes of StageⅠtwin-to-twin transfusion syndrome among patients treated with expectant management(EM),amnioreduction(AR),or fetoscopic laser occlusion of chorioangiopagous vessels(FLOC).Methods:A cohort of 89 cases was studied.Based on the initial management strategy,patients were classified into three groups:the EM,AR,and FLOC.We assessed perinatal survival to 28 days of age and categorized pregnancy outcomes as good(twin live birth at≥30.0 weeks),mixed(single fetal demise or delivery between 26.0 and 29.9 weeks),or poor(double fetal demise or delivery at<26.0 weeks).Results:26(29.2%)patients underwent EM,35(39.3%)underwent AR,and 28(31.5%)underwent FLOC therapy.Of those managed expectantly,19.2%experienced spontaneous abortion,50%progressed in stage,and 30.8%remained stable or regressed.After adjusting for potential confounders including maternal age,'null'iparity,placenta location,and recipient maximum vertical pocket,and so on,FLOC therapy and AR were associated with significantly[odds ratio(OR)=0.09]and borderline significantly(OR=0.20)reduced risks of poor pregnancy outcomes and of no survivors to 28 days of age after birth(OR=0.04 and OR=0.20,respectively)compared with EM.Conclusion:About 70%of those treated with EM progressed in stage or experienced fetal loss.Compared to EM,intervention may decrease the risk of poor pregnancy outcomes and improve the perinatal survival rate.
文摘Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterized by headache, confusion, seizures, and cortical visual loss, as well as subcortical edema without infarction on neuroimaging. We report a 56-year-old woman who developed typical manifestations of PRES, 6 days after blood transfusion for severe anemia. Acute volume overloads by transfusion may exceed the capacity of autoregulation of perfusion pressure, possibly resulting in vasogenic edema. We propose that it is clinically important to recognize that rapid correction of anemia by blood transfusion may carry the risk of inducing PRES.
文摘BACKGROUND: Although non-thyroidal illness syndrome(NTIS) is considered a negative prognostic factor, the alterations in free triiodothyronine(f T3) levels in trauma patients requiring massive transfusion have not been reported.METHODS: A prospective observational study comparing 2 groups of trauma patients was conducted. Group M comprised trauma patients requiring massive transfusions(>10 units of packed red blood cells) within 24 hours of emergency admission. Group C comprised patients with an injury severity score >9 but not requiring massive transfusions. Levels of f T3, free thyroxine(f T4), and thyroidstimulating hormone(TSH) were evaluated on admission and on days 1, 2, and 7 after admission. The clinical backgrounds and variables measured including total transfusion amounts were compared and the inter-group prognosis was evaluated. Results are presented as mean±standard deviation.RESULTS: Nineteen patients were enrolled in each group. In both groups, 32 were men, and the mean age was 50±24 years. In group C one patient died from respiratory failure. The initial f T3 levels in group M(1.95±0.37 pg/m L) were signifi cantly lower than those in group C(2.49±0.72 pg/m L; P<0.01) and remained low until 1 week after admission. Initial inter-group f T4 and TSH levels were not significantly different. TSH levels at 1 week(1.99±1.64 μIU/m L) were higher than at admission(1.48±0.5 μIU/m L) in group C(P<0.05).CONCLUSION: Typical NTIS was observed in trauma patients requiring massive transfusions. When initial resuscitation achieved circulatory stabilization, prognosis was not strongly associated with NTIS.
文摘Iron overload in myelodysplastic syndrome (MDS) results from multiple RBC-transfusions and inappropriate increased iron absoption associated with ineffective erythropoiesis. Data from hereditary iron-loading anemias indicate long-term consequences of iron toxicity are preventable and potentially reversible by effective iron-chelation therapy (ICT). There is increasing interest in using ICT in persons with MDS because of the recent introduction of orally effective iron-chelators which are suitable for older persons, (1-4). Ideally, evidence supporting the benefit of ICT in MDS should be evidenced-based, especially data from randomized trials showing better survival and, in exceptional cases, improved heart function . Such data are lacking. Nevertheless, it is possible to rely on the extensive data from trials of ICT in persons with thalassemia and to use well-defined predictors of increased risks of life-threatening complications to identify persons with MDS most likely to benefit from iron-chelating therapy.
基金supported by the National Natural Science Foundation of China[grant number 81373249],[grant num-ber 81571855]Mittal Student Innovation Test Plan of Cen-tral South University[grant number MX2016447]Student Innovation Test Plan of Central South University[grant number CX2016343],[grant number YC2016714].
文摘Feto-fetal transfusion syndrome(FFTS)severely affects monochorionic(MC)multiple pregnancies and affects 1 in 1600 pregnancies overall.The number of increasing disputed obstetrics cases in China is related to unavailability of prompt diagnosis of FFTS.We present here a woman with a MC triplet pregnancy with intrauterine fetal death at 33 weeks of gestation due to FFTS.Subsequent pathological anatomy showed that the MC placenta contained vascular anastomoses,including arterio-arterial anastomosis and arterio-venous anastomosis.These anastomoses led to unidirectional blood flow with the absence of adequate compensatory counter-transfusion and bi-directional flow.When encountering such challenging conditions,medical practitioners should discreetly compare the fetuses’characteristics with features of placental blood vessels and consult morphological and pathological findings.Furthermore,they should perform ultrasound examinations,particularly focussing on fetal size differences and the maximum vertical pocket in the diagnosis of FFTS,especially in MC multiple pregnancies with abdominal symptoms.
文摘The pathophysiology of twin-to-twin transfusion syndrome(TTTS)is complex,and its understanding has evolved along with the evolution and revolution of fetal diagnostic and therapeutic techniques.Over the last few decades,several therapeutic interventions have been researched for improving the outcomes in TTTS.We present a summary of the current protocols for surveillance,diagnosis,and staging of TTTS in monochorionic pregnancies.We also describe in detail the technique for treatment of TTTS by endoscopic laser photocoagulation.
文摘目的分析胎龄<32周极低/超低出生体重新生儿呼吸窘迫综合征(NRDS)患儿输注红细胞次数的危险因素,探讨输注红细胞次数增加的相关并发症及预测指标,为NRDS患儿提供安全、科学的输血建议。方法通过回顾性分析收集本院2016年1月—2020年12月585名胎龄<32周极低/超低出生体重NRDS新生儿,按住院期间输红细胞次数的不同分3组[输血0次(n=97)、输血1~2次(n=253)、输血≥3次(n=235)],比较3组患儿临床资料及实验室指标,分析导致极低和超低出生体重NRDS患儿输血次数增加的危险因素。结果3组新生儿胎龄(周)(30.72±1.84 vs 29.87±1.66 vs 28.29±1.46)、出生体重(g)(1366.19±128.12 vs 1265.20±163.98 vs 1081.73±196.06)、入院时血红蛋白量(g/L)(172.37±19.98 vs 161.96±21.41 vs 154.33±24.61)、入院红细胞压积比值(%)(50.46±5.74 vs 47.69±5.55 vs 45.46±6.84)、住院时间(d)(40 vs 51 vs 68)、无创通气时间(d)(6 vs 11.01 vs 24.56)、静脉营养时间(d)(16.73 vs 22.37 vs 30.74)两两比较,均有差异(P<0.05)。输血≥3次组有创通气时间(7.66 d)明显高于输血1~2次组和输血0次组(P<0.05)。3组间败血症(1%,1/97 vs 4%,10/253 vs 9.4%,22/235)、早产儿视网膜病变(ROP)(16.5%,16/97 vs 17%,43/253 vs 46.8%,110/235)、支气管肺发育不良(BPD)(4.1%,4/97 vs 19%,48/253 vs 59.1%,139/235)发病率两两比较,均有差异(P<0.05)。输血≥3次组新生儿坏死性小肠结肠炎(NEC)发生率(26.8%,63/235)与输血0次组比较有差异(P<0.05)。多因素Logistic回归分析显示:住院时间、有创通气时间、静脉营养时间是输血≥3次的独立危险因素(OR=1.048,1.073,1.030,均为P<0.05)。受试者工作特征曲线(ROC曲线)显示住院时间、有创呼吸时间、静脉营养时间对输血≥3次的预测效果较好,其ROC曲线下面积分别为0.841、0.766、0.716,3者Cutoff值分别为>57 d、>2.75 d及>23.75 d。结论NEC、败血症、BPD、ROP是胎龄<32周极低/超低出生体重NRDS患儿输血次数增加的并发症。而住院时间、有创通气时间和静脉营养时间对输血≥3次有较好的预测价值。
