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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three years after splenectomy, a middle-aged woman had two separate episodes of fulminant bacterial sepsis. She recovered each time with prompt and appropriate treatment. Her immunologic system was examined and found to be normal with respect to antibody formation against diphtheria and tetanus toxoid, granulocyte killing of staphylococci and serum opsonizing activity. Granulocytes, bursa-equivalent (B) and thymus-dependent (T) lymphocytes and serum immunoglobulins were quantitatively normal. She produced antibody against subcutaneously injected polyvalent pneumococcal vaccine. She demonstrated cutaneous anergy. The literature on this syndrome was reviewed in an attempt to ascertain why hyposplenic patients are subject of fulminant bacterial, chiefly pneumococcal, sepsis. The probably explanation is the delayed production of antibodies against the phagocytic-resistant capsule of certain bacteria which the host had not previously encountered. The incidence of this syndrome appears to be on the order of 0.5 to 1.0%/year for splenectomized older children and adults. As the syndrome is seen chiefly in splenectomized or othewise hyposplenic patients, a causal relationship seems to exist.
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PMID:The syndrome of post-splenectomy fulminant sepsis. Case report and review of the literature. 2 19

The prognosis for patients with AML is improving, but mortality due to bleeding and infection remains significant. HLA compatibility has been the cornerstone of matching for prophylactic platelet transfusion; while HLA matched platelets are often of benefit, we have observed that HLA matching does not reliably predict transfusion responses. The platelet migration inhibition assay is, however, consistently predictive. The matching problem may be circumvented by the use of frozen autologous platelets, which circulate and function hemostatically. In the granulocytopenic patient with de novo fever (frequently due to bacterial sepsis), the immediate empiric use of broad spectrum antibiotics is mandatory. If the marrow begins to recover from chemotherapy shortly after the onset of infection, such that the peripheral granulocyte count will approach normal within 10 days, the likelihood of survival from an episode of septicemia after antibiosis now approaches 80%. If the marrow does not recover shortly, however, the likelihood of survival with antibiosis alone is poor. In this setting, survival is improved if patients are given granulocyte transfusions in addition to antibiotics. Patients who receive chemotherapy in a laminar air-flow room (LAFR) experience fewer severe infections than do patients in a conventional ward. However, most patients who are unresponsive to initial chemotherapy remain so in spite of protection from infection. Thus, the available results do not suggest that the LAFR is likely to improve appreciably the rate or duration of remission. Using malignant lymphoma as a model, we have found that cryopreserved autologous marrow infusions can hasten hematopoietic recovery in man after high-dose chemotherapy, and earlier reconstitution may be of clinical benefit to the patient; techniques are at hand that might permit the application of this concept to AML.
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PMID:Recent developments in the supportive therapy of acute myelogenous leukemia. 2 27

Granulocyte transfusion is becoming widely used in the treatment of infections in granulocytopenic patients. Several techniques are available for granulocyte collection. Some involve centrifugation of the whole blood and one removes granulocytes from whole blood by reversible adhesion to nylon fibers. The risks to the donor from leukapheresis do not appear to be greater than from whole blood donation. Granulocytes collected by centrifuge techniques function normally in vitro and have normal intravascular recovery and disappearance following transfusion. Granulocytes collected by filtration leukapheresis function almost normally in vitro but have a reduced intravascular recovery and abnormal kinetics as they leave the circulation. The role of leukocyte typing and compatibility testing for granulocyte transfusion is controversial. When the recipient has circulating antibody against donor leukocytes, transfused leukocytes do not circulate or migrate to sites of infection but are sequestered in the liver and spleen. Clinical studies have not defined whether patients benefit equally well clinically from transfusion of compatible or incompatible granulocytes. Initial reports of clinical trials of granulocyte transfusion were promising. However, similar patients who did not receive granulocytes were not studied. Most subsequent controlled trials showed a clear benefit from granulocyte transfusion while others did not. Differences in antibiotic therapy, chemotherapy, use of laminar flow rooms, and grouping of patients make it difficult to compare these clinical trials. Some, but not all, infected granulocytopenic patients benefit from transfusion. Granulocyte transfusions improve survival of granulocytopenic patients with gram negative sepsis and prolonged bone marrow aplasia. Studies are now attempting to identify other patients who should receive granulocytes, the optimum dose and schedule of transfusions, the optimum time to begin transfusion, and the value, if any, of prophylactic transfusions.
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PMID:Leukapheresis and granulocyte transfusion. 3 51

16 adult patients with granulocytopenia and septicemia resistant to antibiotics received 42 granulocyte transfusions. The granulocytes were obtained from healthy donors with a blood cell separator by continuous flow centrifugation. Adding hydroxyethyl-starch an average of 1.8 X 10(10) leukocytes with 69% granulocytes were harvested in 3.5 hours. A small leukocyte increment after the transfusion was seen in half of the recipients. No correlation could be found between fever lysis and survival of the infection, which occurred in half of the cases too. A granulocyte transfusion is indicated in patients, who have granulocytopenia, sepsis and no evidence of bone marrow recovery.
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PMID:[Clinical results with granulocyte transfusion (author's transl)]. 8 50

A prospective study of 45 granulocyte transfusions in children using continuous flow centrifugation is reported. During 13 episodes of proven or presumed infection, only two children failed to show a favorable response to granulocyte transfusion. The neutropenic child shows a significantly increased absolute granulocyte count one hour after transfusion. The granulocyte counts at one hour after transfusion are inversely proportional to the child's size. A child with chronic granulomatous disease who had documented Nocardia asteroides sepsis and pneumonia exhibited complete recovery following granulocyte transfusion. Dramatic responses to the nonrandom use of granulocyte transfusion have been observed in children with major gram-negative bacterial infections. Endorsement of granulocyte transfusion for instances of presumed, but unproven, infection in the neutropenic child will require randomization to control the variables of antibiotic therapy and bone marrow remission.
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PMID:Granulocyte transfusion therapy in children. 26 30

We prospectively randomized 27 granulocytopenic patients who experienced a total of 30 episodes of gram-negative septicemia. The control group received an appropriate antibiotic regimen alone, whereas the "transfusion" group received infusions of granulocytes in addition to the antibiotics. Five of 14 controls survived, and 12 of 16 in the transfusion group survived, and 12 of 16 in the transfusion group survived (P less than 0.04). An important factor in the outcome of treatment was the recovery of bone-marrow function (return of peripheral granulocyte count greater than or equal to 1000 per microliter). Eighty-three per cent (five of six) of the control group and all (four of four) of the transfusion group with recovery of granulocyte levels survived the episode of sepsis. In contrast, none of the eight control patients, as compared to 67 per cent (eight of 12) of the transfusion group, survived persistent granulocytopenia (P less than 0.005). Granulocyte transfusions appear to complement appropriate antibiotic treatment of gram-negative-septicemia due to granulocytopenia.
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PMID:Successful granulocyte transfusion therapy for gram-negative septicemia. A prospectively randomized controlled study. 32 Apr 76

Rats made transiently neutropenic by intra-arterial administration of vinblastine (3 mg/kg) and infected with E. coli (6.02+/-0.45 X 10(8), per animal) have a mortality rate of 90% within 48 h post infection. Multiple transfusions of large numbers of granulocytes (harvested from Deca-Durabolin treated donor rats) protected the neutropenic animals from sepsis. Out of a group of 11 rats, 10 recovered completely after repeated granulocyte transfusions.
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PMID:Granulocyte transfusions in recovery of neutropenic rats from induced E. coli toxicemia. 32 70

The effect of granulocyte transfusions on the course of infection in patients under treatment for acute leukemia was evaluated by comparing 19 febrile episodes in 15 patients receiving antibiotics alone with 18 febrile episodes in 13 patients receiving antibiotics in combination with granulocyte transfusions from ABO-matched donors. Both groups had a similar age, sex distribution and duration of disease prior to the febrile episode. About two-thirds of the patients in both groups had acute myeloblastic leukemia. 94% of the patients in the transfused group and 74% of the control group survived the febrile episode. In patients with positive blood cultures all transfused patients survived as compared to only 57% in the control group (p=0.05). In patients with persistent bone marrow failure 92% of the transfused patients survived as compared to 73% in the control group. Granulocyte transfusions had no effect on the outcome of febrile episodes in patients with negative blood cultures or early recovery of marrow function. These data appear to support the contention that granulocyte transfusions are beneficial in patients with blood culture-proved sepsis with persistent neutropenia.
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PMID:Granulocyte transfusion therapy: a clinical trial in patients with acute leukemia and sepsis. 34 23

Treatment with type-specific IgG antibody to Pseudomonas aeruginosa significantly increased rates of survival after experimental induction of pseudomonas pneumonia in leukopenic dogs. Longer survival times were correlated with higher titers of circulating antibody in serum; however, no animals treated with antibody alone were long-term survivors. Subsequent development of sepsis or the recovery of Pseudomonas from infected lung tissue was not altered by treatment with antibody. Therapy with granulocyte transfusions plus gentamicin was associated with a 27% rate of long-term survival. Passive immunization with IgG (reciprocal mean hemagglutination titer, 52) in addition to granulocyte transfusions and treatment with gentamicin resulted in a rate of long-term survival of 67% (P less than 0.05). Dogs that died while receiving this combination therapy still had a survival time significantly longer than those of controls or animals treated only with granulocytes and antibiotic.
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PMID:Experimental pneumonia due to Pseudomonas aeruginosa in leukopenic dogs: prolongation of survival by combined treatment with passive antibody to Pseudomonas and granulocyte transfusions. 40 42

Ten severely burned (greater than 50% BSA) pediatric and young adult patients developed 19 episodes of clinical sepsis of four or more days duration. During eight of the 19 septic episodes the patients received granulocyte transfusions (median, four; range, two to seven). Risk variables, types and prevalence of infections, mainly Pseudomonas aeruginosa and antibiotic regimens were similar for all the septic episodes studied. All eight episodes (100%) resolved in the transfused group while eight of 11 (72%) episodes resolved in the nontransfused group. Patients survived four episodes of ecthyma gangrenosum when granulocyte transfusions were used and the single episode in which they were not used was fatal. Granulocyte transfusions may be helpful in severely burned patients with sepsis.
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PMID:Granulocyte transfusions for patients with severe thermal burns. 41 32


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