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Bruenger F.,Heart and Diabetes Center North Rhine Westphalia | Kizner L.,Heart and Diabetes Center North Rhine Westphalia | Weile J.,Institute for Laboratory and Transfusion Medicine | Morshuis M.,Heart and Diabetes Center North Rhine Westphalia | Gummert J.F.,Heart and Diabetes Center North Rhine Westphalia
International Journal of Artificial Organs

Purpose: A new hemoadsorption device intended as adjunctive treatment for patients with elevated cytokine levels in the setting of SIRS and sepsis has shown promising results. We report on the beneficial application of the device in a patient with cardiogenic septic shock receiving combined extracorporeal life support with rECMO, LVAD, and CVVH despite his highly septic condition. Methods: A 39-year-old patient presented with fulminant ARDS and cardiogenic septic shock. A veno-arterial ECMO was implanted for circulatory support. During the course of illness, the patient developed acute renal failure in addition to his chronic renal insufficiency, making initiation of CVVH necessary. Due to a complete cardiac arrest in both ventricles, a left ventricular assist device (LVAD) in combination with right ECMO (rECMO) was implanted despite manifest septic conditions. In the post-operative course IL-6 levels and vasopressor dosages increased drastically. A CytoSorb hemoadsorption device was therefore installed in the CVVH circuit and 3 sessions were run during the following 4 days. Results: During CytoSorb treatment, inflammatory markers IL-6, procalcitonin, and C-reactive protein decreased concomitant with significantly reduced vasopressor support. No adverse device-related side effects were documented during or after the treatment sessions. Conclusions: This is the first clinical case report of a highly septic patient treated with the combined use of LVAD, rECMO, CVVH, and CytoSorb. The combination was practical, technically feasible, and beneficial for the patient. This combination represents a reasonable approach to improve survival in patients with multiple organ dysfunction necessitating several organ supportive techniques. © 2015 Wichtig Publishing. Source

Juhl D.,University of Lubeck | Ozdemir M.,University of Lubeck | Dreier J.,Institute for Laboratory and Transfusion Medicine | Gorg S.,University of Lubeck | Hennig H.,University of Lubeck
Vox Sanguinis

Background and Objectives: To assess the relevance of Parvovirus B19 (B19V) DNA at low to intermediate concentrations in blood donors for the recipients of their blood components. Material and Methods: We studied recipients of B19V DNA-positive blood components [red blood cell concentrates (RBCs), pooled platelet concentrates and fresh frozen plasma]. This included archived pretransfusion samples as well as follow-up samples investigated by ELISA or NAT and genome sequence analysis. Results: In 132 out of 424 recipients, we could detect no anti-B19V IgG before transfusion. In 67 out of 132 sero-negative recipients, a follow-up sample was available. Sixty-five of these received blood components from donors with <104 IU B19V DNA/ml plasma and had no evidence of transfusion-transmitted (TT)-B19V infection. Homology in genome sequences in donor and recipient provided evidence for a TT-B19V infection in two recipients. Both patients received RBC containing 3·4 × 106 and 1·8 × 104 IU B19V DNA/ml plasma, respectively. The anti-B19V IgG titres in the donors were 2 and 76 IU/ml plasma, respectively. The antibodies in the second donor were directed against capsid proteins and are thus considered as potential neutralizing antibodies. Conclusions: TT-B19V infections through blood components with low (<104 IU/ml plasma) B19V DNA concentrations did not occur in our study. One of the TT-B19V infections occurred from RBC with intermediate B19V DNA concentration despite the presence of potential neutralizing antibodies in the donor, but its clinical significance was low. © 2015 International Society of Blood Transfusion. Source

Koster A.,Institute of Anaesthesiology | Amin-Parsa M.,Heart and Diabetes Center North Rhine Westphalia | Kaufmann M.,Heart and Diabetes Center North Rhine Westphalia | Meyer-Jark T.,Institute of Anaesthesiology | And 6 more authors.
Annals of Thoracic Surgery

After on-pump coronary artery bypass graft surgery, a patient had acute heparin-induced thrombocytopenia with thoracic arterial and venous thrombus formations. Complex emergency surgery with cardiopulmonary bypass and deep hypothermic circulatory arrest using bivalirudin anticoagulation was performed. © 2013 The Society of Thoracic Surgeons. Source

Weile J.,Institute for Laboratory and Transfusion Medicine | Eickmeyer H.,Heart and Diabetes Center North Rhine Westphalia | Dreier J.,Institute for Laboratory and Transfusion Medicine | Liebke M.,Heart and Diabetes Center North Rhine Westphalia | And 6 more authors.
International Journal of Medical Microbiology

We report the first documented case of a Mycobacterium tuberculosis transmission by an orthotopic heart transplantation from the donor to the recipient. Mycobacterium tuberculosis positive blood culture showed systemic prevalence of the Mycobacteria, however, prophylactic therapy was able to prevent a clinical manifestation of tuberculosis in the recipient. © 2013 Elsevier GmbH. Source

Beck J.,University of Gottingen | Oellerich M.,University of Gottingen | Schulz U.,Heart and Diabetes Center | Schauerte V.,Clinic for Nephrology and Transplantation Center | And 10 more authors.
Transplantation Proceedings

Background In solid organ transplantation, sensitive real-time biomarkers to assess the graft health are desirable to enable early intervention, for example, to avoid full-blown rejections. During rejection, high amounts of graft-derived cell-free DNA (GcfDNA) are shed into the blood stream. The quantification of this GcfDNA in allotransplantation is considered to fulfill this need, because it can be measured with great precision and at reasonable cost. Patients and Methods Patients from 2 ongoing studies in kidney (KTx) and heart (HTx) transplantation were monitored blinded on a scheduled basis, by means of a published universal droplet digital polymerase chain reaction to quantify the GcfDNA. Results Immediately after engraftment, GcfDNA reaches high values (>5% of total cfDNA), with a rapid decrease to values of <0.5% within 1 week. Living-related KTx recipients show lower initial values, reflecting the absence of preservation injury. Episodes of rejection in KTx and HTx are accompanied by a significant increase of GcfDNA (>5-fold) above values in patients without complications, occurring earlier than clinical or biochemical hints to rejection. One case of rejection, which became clinically suspect after 1 year and was proven with biopsy, showed a significant 10-fold increase 3 months earlier. Conclusions The quantification of GcfDNA has the potential to detect rejection episodes at early stages, when other means of diagnosis are not effective. The method's noninvasiveness enables the monitoring recipients at intervals that are desired to catch rejections at early actionable stages to prevent full-blown rejection. This biomarker will be particularly valuable in regimens to minimize immunosuppression. © 2015 by Elsevier Inc. All rights reserved. Source

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