Miscellaneous

Abstract

Summary This study in 9 healthy human volunteers is the first prospective randomized trial to compare the ability of stored autologous red blood cells (RBCs) with fresh autologous RBCs to reverse the cognitive deficit induced by acute isovolemic anemia.

Summary This interesting pilot study sought to address the question of whether post-surgery anemia decreases exercise performance in patients undergoing total hip arthroplasty and shed light on how lower postoperative hemoglobin levels may affect patients’ ability to participate in rehabilitation programs. Performance was evaluated using a bicycle ergometer exercise test with cardiovascular fitness as the primary outcome. In an experimental group, the investigators used autologous blood collected preoperatively to return postoperative hemoglobin (Hb) levels to pre-surgery admission values.

Summary Part of SABM’s mission is to ‘promote education and training to achieve change.’ Accordingly, this study by Aberegg and colleagues may be of interest to readers as it may help shed light on the “research-practice gap.” These investigators found that, based on equivalent evidence, physicians were more likely to abandon a harmful therapy than to adopt a beneficial one. Two clinical case vignettes were prepared presenting results of hypothetical randomized controlled trials (RCTs) evaluating treatments. Each vignette had a “harmful” and a “beneficial” version.

Summary The multiple and complex hemostatic changes in liver disease means these patients can experience both bleeding and thrombotic complications. In this article Senzolo et al present a comprehensive discussion of the developing understanding of the derangements that take place in the hemostatic system with liver failure, a system that is normally in a delicate balance between coagulation and anticoagulation. They report that recent research suggests that these prothrombotic and antithrombotic processes are affected in parallel.

Summary Mathew and colleagues present their institution’s approach to managing requests for “off-label” use of recombinant factor VIIa (rVIIa). Given the drug’s considerable cost, the growing number of randomized controlled trials beginning to define both its benefits and limitations, and the fact that it is not without risks, more institutions are looking to formulate protocols for its use.

Summary This issue of Hematology/Oncology Clinics of North America with guest editor Jerrold Levy MD (preface) contains the proceedings of the Inflammation, Hemostasis and Blood Conservation Strategies forum, a meeting of a multidisciplinary group of physicians and scientists convened at Emory University in September 2005.

Summary Liu and colleagues describe their identification of bacterial enzymes capable of removing A and B antigens from the surface of red blood cells (RBCs), thus making possible the conversion of blood group A, B and AB RBCs into group O. The authors describe the work of Goldstein 25 years ago using enzymes from green coffee beans to convert type B RBCs into type O. However, type A antigens have been more difficult to remove. Liu et al identified two previously unknown enzyme families with high efficiency and specificity for removal of both A and B antigens.

Summary A recent review of 16 clinical studies concluded that bovine thrombin is not associated with a risk of excessive bleeding in postoperative patients. Intractable surgical bleeding is rare, is often underreported, and associated with poor outcomes; it carries a huge clinical and financial burden. Although randomized controlled trials (RCTs) are needed to determine the safety of bovine thrombin, a large number of subjects must be recruited, which makes such a study almost impossible.

Abstract

CONTEXT:

The erythropoiesis-stimulating agents (ESAs) erythropoietin and darbepoetin are licensed to treat chemotherapy-associated anemia in patients with nonmyeloid malignancies. Although systematic overviews of trials have identified venous thromboembolism (VTE) risks, none have identified mortality risks with ESAs.

OBJECTIVE:

To evaluate VTE and mortality rates associated with ESA administration for the treatment of anemia among patients with cancer.

DATA SOURCES: