Download

Acute renal failure from hemolytic transfusion reactions






Advertisement
/ 13 []
Download Presentation
Comments
pekelo
From:
|  
(525) |   (0) |   (0)
Views: 177 | Added: 18-02-2012
Rate Presentation: 1 0
Description:
Acute renal failure from hemolytic transfusion reactions. Brad Weaver, MD 9/25/07. Acute hemolytic transfusion reaction. ABO incompatability is the major cause of death from transfusion
Acute renal failure from hemolytic transfusion reactions

An Image/Link below is provided (as is) to

Download Policy: Content on the Website is provided to you AS IS for your information and personal use only and may not be sold or licensed nor shared on other sites. SlideServe reserves the right to change this policy at anytime. While downloading, If for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.











- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -




Slide 1

Acute renal failure from hemolytic transfusion reactions

Brad Weaver, MD

9/25/07

Slide 2

Acute hemolytic transfusion reaction

  • ABO incompatability is the major cause of death from transfusion

  • 125 deaths reported to FDA due to ABO incompatable transfusion from 1976 to 1985. Sazama et al. Transfusion 1990 Sep;30(7):583-90.

  • IgM anti-A and anti-B fix complement  rapid intravascular hemolysis

    • Acute renal failure from ATN

    • DIC

    • Shock

    • Hyperkalemia

  • Renal failure can be caused by direct toxicity of hemoglobin and by renal ischemia from shock

Slide 3

Hemoglobinuria

Alpha-Beta dimers MW 34,000 -- small enough to be filtered by glomerulus

Slide 4

Proposed mechanisms of renal injury

1. Obstruction of tubules with heme pigment casts

2. Oxidative damage to proximal tubule by released free iron

Low FENa characteristic

Slide 6

Prevention of ARF

  • Volume repletion

  • Alkalinization of urine

  • Mannitol diuresis

Slide 7

Alkalinization of urine and mannitol

  • Hemoglobin less likely to precipitate with Tamm-Horsfall protein in alkaline urine

  • Alkalinization stabilizes reactive iron species

  • Mannitol acts as an osmotic diuretic, dilates renal vasculature, and is an antioxidant

Slide 8

A retrospective seriesBrown et al. J Trauma 56(6) 2004

  • Series of 382 patients with serum CK concentration >5000 U/L, 154 (40 percent) were treated with bicarbonate and mannitol

  • No statistically significant difference in the incidence of:

    • renal failure as defined by Cr >2.0 (22 versus 18 percent)

    • dialysis (7 versus 6 percent)

    • death (15 versus 18 percent)

Slide 11

A case reportAmyot et al. Intensive Care Med. 25. 1999

  • A 30yo man with myoglobin-induced renal failure was treated with CVVH for 33h

  • Blood flow 150 mL/min, ultrafiltration rate 2 to 3L/h

  • Serum myoglobin (MW 17,000) concentration decreased from 92,000 ug/L to 28,600 ug/L after 18h

  • Required HD for 25 days and eventually recovered normal renal function

Slide 13

Preventing hemolysis – recombinant complement receptor 1 Yazdanbakhsh et al. Blood 101 (12) 2003

  • Complement receptor 1 (CR1) – transmembrane protein that inhibits C3 and C5 convertases and cofactor for serum protease 1

  • Mouse study: recombinant soluble form of CR1 inhibited complement activation in mice with pre-existing anti-A transfused with human group A RBCs

  • RBC survival increased by 50%


Copyright © 2014 SlideServe. All rights reserved | Powered By DigitalOfficePro