La transfusion à domicile ? Une alternative à l'hôpital de jour Idri, S.; Catoni, M.P.; Si Ali, H. ...
Transfusion clinique et biologique : journal de la Société française de transfusion sanguine,
1996, 1996-1-00, Letnik:
3, Številka:
4
Journal Article
Recenzirano
Pour répondre aux besoins transfusionnels des services d'Hospitalisation à Domicile (HAD), une structure a été créée en 1991 dans le Service d'Hémobiologie-Transfusion de l'hôpital Beaujon. Le but de ...cette structure a été d'éviter des déplacements pénibles aux patients qui recevaient pour la plupart des soins palliatifs. Ceci a imposé une organisation rigoureuse entre médecin prescripteur, hémobiologiste et personnels de soin. Des critères d'exclusion ont été respectés (éloignement géographique, état clinique décompensé, absence de coopération famille/malade). Durant les quatre années d'activité, 1 662 séances transfusionnelles ont été réalisées chez 757 patients dont 80 % étaient porteurs d'affections hématologiques, 10 % de tumeurs solides et 10 % de patients atteints de SIDA. 5 548 produits sanguins labiles ont été transfusés (2 104 concentrés globulaires, 3 152 concentrés de plaquettes standards et 292 concentrés de plaquettes d'aphérèse). Il a été observé 31 incidents bénins, soit une prévalence de 0,56 %.
La médiocre conification des actes a freiné le développement de cette activité. Une centralisation des demandes avec coordination des hémobiologistes au sein de la région parisienne devrait permettre de répondre en toute sécurité aux nombreuses demandes.
In response to the needs of the Home Medical Services a project was set up in the Hemobiology Transfusion Service of Beaujon Hospital. The objective of this project was to avoid the difficult transfer of patients who were receiving for the most part palliative treatment. This required strict organization between consultants, haemobiologist physicians and healthcare personnel. The exclusion criteria have been respected (geographical distance, state of the non-compensated clinic, absence of family/patient co-operation).
During the last 4 years of activity, 1,662 transfusions have been carried out on 757 patients, of which 80% had hematological affections, 10% solid tumours and 10% AIDS affections. 5,548 blood components have been transfused (2,104 red cell concentrates, 3,152 pooled platelet concentrates and 292 apheresis platelet concentrates). Thirty-one minor incidents were observed representing a prevalence of 0.56%.
The poor codification of cases has slowed down the development of this project. The centralization of requests with coordination by the haemobiologist physicians within the Paris region should allow a guaranteed response to the numerous requests.
Extracorporeal photochemotherapy (ECP) consists of collection of mononuclear cells, their irradiation with UV-A light in the presence of a photoactivable molecule--8-methoxy-psoralen (8-MOP) being ...the most widely used--and their reinjection into a patient. Two technical approaches have been developed. The photopheresis procedure involves four steps: (i) 8-MOP is given to the patient orally, 2 h before collection of white blood cells; (ii) a discontinuous flow cell separator (UVAR, Therakos, West Chester, PA, U.S.A.) is used for cell collection. The final product (740 mL) has a hematocrit of 4.5 +/- 1.7%); (iii) irradiation, performed with the same UVAR apparatus, begins before all the cells are collected, and lasts for 180 min after collection; and (iv) after irradiation, the buffy-coat is reinjected into the patient. We developed a technique summarized as follows: (i) mononuclear cell collection is performed using the Spectra (Cobe, Denver, CO, U.S.A.) cell separator, which provides a highly enriched mononuclear cell concentrate (always > 90% purity), in a small volume < 150 mL, subsequently adjusted to 300 mL for irradiation. Hematocrit of the final product is always < 2%. (ii) Soluble 8-MOP is added to the mononuclear cell concentrate at a final concentration of 200 ng/mL. (iii) Mononuclear cell concentrate is transferred in an EVA plastic bag (Macopharma, Tourcoing, France) to ensure an efficient irradiation with a UV irradiator (Vilber Lourmat, Marne-la-Vallée, France). (iv) After irradiation at 2 J/cm2 (time < 20 min), the cells are reinfused into the patient. Experimental and clinical data suggest that ECP has potential applications in the treatment of connective tissue disorders, such as systemic sclerosis and rheumatoid arthritis. Although encouraging data have been obtained, further clinical trials are warranted to establish the role of this therapy in these indications.
Transfusion at home? An alternative to the day hospital Idri, S; Catoni, M P; Si Ali, H ...
Transfusion clinique et biologique : journal de la Société française de transfusion sanguine,
01/1996, Letnik:
3, Številka:
4
Journal Article
In order to determine the characteristics and the course of diseases treated with long-term plasmapheresis (e.g., more than 25 plasma exchanges), we retrospectively studied 850 patients who underwent ...plasmapheresis. Long-term plasma exchange was prescribed to 38 patients who failed to respond to conventional therapy; cryoglobulinemias, peripheral neuropathies and monoclonal gammopathies were their most frequent underlying diseases. Improvement was noted in 65.8% cases. Only minor side effects were observed and the risk/benefit ratio for such therapy was excellent.
