The risk:benefit of autotransfusion--comparison to banked blood in a canine model

Recent enthusiasm for intraoperative autotransfusion has overshadowed critical assessment of its potential risks. In this study, adult mongrel dogs underwent controlled intraperitoneal hemorrhage of twice their estimated blood volume over a 4-hour period. The blood was replaced by an equal volume of banked blood (Group I, n = 5), or collected and reinfused via the Sorenson System (Group II, n = 6), or the Haemonetics Cell Washing Device (Group III, n = 6). Acid citrate dextrose was the local anticoagulant for Groups I and II, and heparin for Group III. Pulmonary capillary wedge pressure and cardiac output were maintained at baseline values with crystalloid infusion. Core temperature, pO2, and systemic pH remained normal throughout the 4 hours of evaluation. Red blood cell recovery was efficient in all animals, and the 2,3 DPG levels remained normal in the autotransfused dogs. Thrombocytopenia, however, developed uniformly and was more pronounced after autotransfusion. Platelet numbers decreased nearly 45% in the Sorenson as well as Haemonetics animals. Additionally, platelet dysfunction occurred after one blood volume exchange as evidenced by prolonged bleeding times and loss of the secondary wave on Sonoclot profiles. Coagulation studies revealed progressive consumptive coagulopathy and fibrinolysis in autotransfused dogs. The P.T., P.T.T., and T.T. lengthened, and levels of factors II, V, VIII, and fibrinogen fell. Autotransfusion clearly eliminates the infectious and incompatibility problems of banked homologous blood. Despite advances in technique, however, consumptive coagulopathy, fibrinolysis, and platelet dysfunction occur.(ABSTRACT TRUNCATED AT 250 WORDS)

Enhancement of blood pressure response to dopamine by angiotensin II

The interaction of dopamine and angiotensin II (AII) on blood pressure and heart rate was studied in rats. The influence of reserpine pretreatment and vagotomy was also studied. Inbred rats anesthetized with urethane received intravenous (i.v.) doses of 50, 100, 200, or 400 micron g (per 100 g body weight) of dopamine HCI, before and after a single i.v. dose of 0.025 micron g of AII. The same doses of dopamine were tested in vagotomized rats and in rats pretreated with reserpine. The effect of dopamine alone on blood pressure was biphasic, since 16 of 38 rats showed an early fall followed by a later rise. The early fall decreased significantly with the dose and was absent with the highest dose tested (400 micron g). The late rise was observed in all experiments, and it increased significantly with the dose. Parallel to hypotension, a decrease of heart rate was observed, but both phenomena appeared not to be linked by a sauce-effect relationship. Vagotomy prevented both hypotension and bradycardia induced by dopamine. Angiotensin II inhibited the early fall and increased the late rise of blood pressure induced by dopamine but had no effect on the bradycardia. Reserpine retreatment prevented the hypotensive and enhanced the hypertensive response to dopamine, and in this situation dopamine induced cardiac arrhythmia. The interaction between dopamine and AII is inhibited by pretreatment with reserpine. The early hypotensive phase and bradycardia caused by dopamine appeared to be the consequence of a vagal reflex.

Partial trisomy-5p

Two sibs with partial trisomy-5p are reported. Their father is the carrier of a balanced translocation 46,XY,t(4q+;5p-). Twelve cases of partial trisomy-5p--including our two patients--have been reported. The most common abnormalities found were mental retardation, short stature, dolichocephaly, prominent nasal bridge, prognathism, seizures, hypotonia, ear abnormalities, increased ulnar loops on the fingertips, and cryptorchidism in affected males.

X/XYq - mosaicism and mixed gonadal dysgenesis

A non-fluorescent Y chromosome was observed in a phenotypic male with 45,X/46,XYq-mosaicism and mixed gonadal dysgenesis. Q-banding of the father's chromosomes showed a normally fluorescent Y. Measurements of the Y chromosomes in the father and the patient showed a significant difference in length. Evidence for translocation of the Y fluorescent segment to another chromosome was lacking in the present case.

Trisomy iop

A stillborn male fetus having a trisomy of the short arm of chromosome No 10 is described. The father is a carrier of the reciprocal translocation 46XY,t(10;21) (10pter leads to 10p11::21p11 leads to 21qter). The clinical picture included growth retardation, bilateral cleft lip and palate, micrognathia, short neck, microphalus and bilateral clubbed feet. The long bones were markedly thinned with spontaneous fractures. Autopsy findings included pulmonary hypoplasia and renal dysplasia. Previous reports of trisomy 10 and trisomy of the short arm of chromosome 10 are discussed.