Analyses of adverse events during apheresis with focus on substitution fluids. The Swedish registryRut Norda1, Ulla Axdorph2, Claes-Göran Axelsson3, Gösta Berlin4, Svante Jonsson5, Gunilla Kumlien6, Jan Kurkus7, Bernd Stegmayr8, Björn Wikström91. Dept. of Clin. Imm. & Transfusion Medicine, Uppsala; 2. Dept. of Clin Imm. & Transfusion Medicine, Solna; 3. Dept. of Transfusion Medicine, Örebro; 4. Dept. of Transfusion Medicine, Linköping; 5. Dept. of Nephrology & Transplantation, Malmö;
6. Dept. of Transfusion Medicine, Karolinska, Huddinge; 7. Dept. of Nephrology, Lund; 8. Dept. of Nephrology, Umeå; 9. Dept. of Nephrology, Uppsala. The AEs below represent data from 2000-2001. Only symptoms and signs are reported here - Grade 1, n=40; Grade 2 and 3 n=96. AEs w i t h s u b s t i t u t i o n f l u i d a l b u m i n v e r s u s p
•There is a decrease in reported adverse events grade II/III over the years. •In parallel there is a decrease in procedures performed for diagnoses more vulnerable for AEs.
•When using albumin as substitution fluid hypotension is more frequent while urticaria and
shivering are more common AEs using plasma. This will be further analyzed. AEs with substitution of albumin vrs plasma + albumin Various diagnoses and i n c i d e n c e Adverse events grade 2/3 procedures) (symptoms and signs) Guillain-Barre Goodpasture Tx-rejection Myasthenia gravis Vasculitis Wegeners Severe sepsis Material: Data from 1996-2001 has Hyperviscosity Percentage of all Hypercholesterolemi Urticaria Hypotension Shivering
not been included since the transition to
computerization has led to a delay in the
Number of p r o c e d u r e s r e l a t e diagnoses with Adverse Events a b o v e a v e r a g e AEs with use of liquid stored plasma (LSP) + albumin v e r s u s f r e s h f r o z e n p l a s m a ( F F P ) + a l b u m i Guillain-Barr Goodpasture . procedures Tx-rejection Hypotension Tingling AE grade II/III (signs and symptoms only) in 8 apheresis units. The total number (n) of TPE procedures 1996-2001 at each unit are given. Number of procedures related to d i a g n o s e s Grade of AE in relation to substitution fluids Unit F: n=1731 with Adverse Events below average Unit C: n=1040 Unit H: n=1982 Unit E: n=1683 Unit B: n=384 Myasthenia Unit A: n=271 Vasculitis Unit G: n=1809 Wegeners Septic shock Unit D: n=1299 Hyperviscosity No. procedures Hypercholesterolemia alb 3.5-5% LSP+alb A d v e r s e e v e n t s , % Substitution fluids
AE grade 3/III: treatment required and procedure stopped
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formerly the Center for Biosecurity of UPMC Nerve Agents Background 1984.4 Toward the end of that war, the Iraqi military reportedly Nerve agents are a class of chemicals grouped together based on deployed a cocktail of chemical weapons—possibly including their common mechanism of action, which is interruption of GB, GA, and VX—against its own Kurdish population living vital nerve t