Document Detail


Exchange transfusion therapy and its effects on real-time microcirculation in pediatric sickle cell anemia patients: an intravital microscopy study.
MedLine Citation:
PMID:  22278200     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Periodic blood exchange transfusion is a treatment modality commonly used to manage pediatric sickle cell anemia at the University of California Davis Medical Center. The goal of exchange transfusion therapy is to ameliorate vasoocclusion and improve tissue perfusion by removing sickled red blood cells and introducing normal red blood cells. Using computer-assisted intravital microscopy, pretransfusion and posttransfusion microvascular characteristics were analyzed. In this study, the bulbar conjunctiva exhibited a "blanched" avascular appearance in all 6 pediatric sickle cell anemia patients before transfusion, indicative of tissue hypoperfusion and ischemia. Immediately after transfusion, substantial improvement in vascularization and tissue perfusion resulted, reflected by the enhanced appearance of capillaries and arterioles. In addition, a decrease in red cell velocity was observed. These observations provide evidence that exchange transfusion therapy is beneficial in ameliorating vasoocclusion and improving tissue perfusion. However, with the paradoxical posttransfusion decrease in red cell velocity presumably due to induced hyperviscosity from the large transfusion volume, blood flow is still impaired. This decreased velocity may thwart efforts to improve oxygen delivery through transfusion and may, to some extent, promote vasoocclusion instead. This paradoxical result warrants further investigation on the effects of transfusion volume and viscosity in the exchange transfusion process.
Authors:
Anthony T W Cheung; Joshua W Miller; Maricel G Miguelino; Wilson J To; Jiajing Li; Xin Lin; Peter C Chen; Sandra L Samarron; Ted Wun; Theodore Zwerdling; Ralph Green
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of pediatric hematology/oncology     Volume:  34     ISSN:  1536-3678     ISO Abbreviation:  J. Pediatr. Hematol. Oncol.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-23     Completed Date:  2012-05-15     Revised Date:  2014-09-18    
Medline Journal Info:
Nlm Unique ID:  9505928     Medline TA:  J Pediatr Hematol Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  169-74     Citation Subset:  IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Anemia, Sickle Cell / blood*,  therapy*
Child
Child, Preschool
Exchange Transfusion, Whole Blood*
Humans
Longitudinal Studies
Microcirculation*
Microscopy, Video*
Prognosis
Grant Support
ID/Acronym/Agency:
R01 HL083276/HL/NHLBI NIH HHS; R01 HL083276-04/HL/NHLBI NIH HHS; R01 HL83276/HL/NHLBI NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Congenital Pancreatoblastoma: Report of an Atypical Case and Review of the Literature.
Next Document:  Antithymocyte Globulin and Cyclosporine in Children With Aplastic Anemia: A Developing Country Expe...