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A lower requirement for blood transfusion (up to 20% compared to control individuals) is reported in 29 studies of chemotherapy erectile dysfunction questions and answers buy 100mg caverta free shipping, with four studies being randomised and double-blind impotence statistics generic 100mg caverta mastercard. The quality of life was examined in 35 studies erectile dysfunction trimix buy 100mg caverta with mastercard, of which three were randomised and double-blind. No randomised, double-blind study of the transfusion requirements and quality of life has been performed for patients receiving radiotherapy. A randomised study is necessary to be able to make definitive conclusions about the quality of life, blood conservation and cost efficacy by erythropoietin, with a similar Hb as a target value in both arms of the study group. Chemotherapy treated cancer patients with anaemia had an increased risk of mortality of Level 1 10%, and a decreased long-term survival. Only 6% of the patients who previously required transfusions became independent of transfusions. The limitations of this study compared to the study by Zeng are that the Shao study was smaller in size and measured response rate instead of survival. C Bessho 1997, Shao 1998, Zeng 2006 124 Blood Transfusion Guideline, 2011 Recommendation 4. Due to the limited number of prospective studies for the indication for blood transfusion in sickle cell disease, some of the recommendations have been formulated based on expert opinion (evidence level 4). The indications for blood transfusion will be discussed consecutively in acute situations (4. Blood transfusions for anaemia are only indicated in the case of symptomatic anaemia (see also paragraph 4. An acute deterioration of the anaemia in sickle cell disease can be due to a number of factors other than blood loss: acute aplastic crisis, acute sequestration in the liver and/or the spleen, or due to a haemolytic crisis. Threatened anaemia due to aplastic crisis An aplastic crisis is usually caused by a Parvo virus B19 infection. The parvo virus inhibits haematopoiesis, which due to the short circulation time of erythrocytes in patients with sickle cell disease, results in a threatened anaemia with noticeable reticulopaenia. A large Blood Transfusion Guideline, 2011 125 125 observational study revealed that more than 75% of children with sickle cell disease and a Parvo B19 infection require a transfusion (Smith-Whitley 2004). Threatened anaemia due to acute liver and/or spleen sequestration Acute liver and/or spleen sequestration usually occurs in early childhood and is a rapidly developing and potentially fatal complication. In these cases the blood is withdrawn from the circulation, which results in acute severe anaemia, hypovolaemia and rapid progressive splenomegaly. Transfusions are recommended in symptomatic cases of acute sequestration and it should be taken into consideration that a portion of the erythrocytes will return to the circulation after sequestration, which can cause a rapid increase in Hb with associated hyperviscosity (Ohene-Frempong 2001, Josephson 2007, Wahl 2009). Acute blood transfusion can be indicated in order to treat or prevent cardiac decompensation (Wanko 2005). There is no specific Hb trigger for administering a blood transfusion, but patients should not be Level 3 transfused at an Hb over 6. C Alexy 2006 D Josephson 2007, Wahl 2009 An urgent blood transfusion is indicated in symptomatic cases of acute liver or spleen sequestration in sickle cell patients. This transfusion should take into consideration the fact that a portion of the erythrocytes return to the Level 4 circulation after sequestration and can cause hyperviscosity. D Ohene-Frempong 2001, Josephson 2007 Acute aplastic crisis, defined as acute anaemia in a sickle cell patient without elevated numbers of reticulocytes, is an indication for transfusion. A large observational Level 3 study revealed that more than 75% of children with sickle cell disease and a Parvo B19 infection require a transfusion. Blood transfusions are indicated in patients with sickle cell disease if cardiac or respiratory symptoms develop as a result of anaemia. When giving a blood transfusion to patients with sickle cell disease, one must ensure that the Hb remains < 6. The pathogenesis is complex, with inflammation, hypoxia, vaso-occlusion, fatty emboli and hypoventilation playing a role. Several non-controlled studies have shown a rapid clinical improvement after transfusion (Mallouh 1988, Emre 1995). A recent Cochrane review concluded that no studies could be found that were of sufficient quality to answer the question whether blood transfusions aid in the treatment of acute chest syndrome (Alhasihimi 2010). Level 2 B Mallouh 1988, Emre 1995 Despite the lack of randomised studies, exchange transfusions are recommended for severe hypoxaemia (pO2 < 60 mmHg in adults and pO2 Level 4 < 70 mmHg in children), the aim being to achieve an HbS% < 30%.

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