Liver resection, or hepatectomy, is a major abdominal surgery performed most often for the removal of malignant tumors of the liver, either primary or metastatic. It is often associated with significant blood loss and therefore, with blood transfusions. While transfusions are common, there is incomplete knowledge of their effects on clinical outcomes. Furthermore, both current practices and best practices in perioperative blood management, including blood product administration, are not well defined. This manuscript-based thesis will examine the clinical impact, current practices, and appropriate use of perioperative red blood cell transfusions for patients undergoing liver resection.

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Malaria was identified as one of the first infectious diseases recognised to spread through blood transfusion. Although transfusion acquired malaria is rare, nevertheless it can be lethal if it not diagnosed or treated immediately. It is a continuous challenge for the blood services to identify and exclude asymptomatic malaria infected donors, while minimising the exclusion of uninfected donors. The diagnostic tests in current use present certain limitations which include the use of inherently antigenically variable vaccine candidate proteins that have limited sensitivity against all human malaria species. Additionally, the blood transfusion services also require alternative methods for test and reagents that may be critical to the blood supply. There is therefore a scientific and an operational requirement to use alternative strategies to develop sensitive tests to all the species of malaria. In this study, we have used immunoproteomic approach to define conserved immunogenic malaria proteins. A total of 17 target P. falciparum proteins have been identified using cohorts of malaria immune sera from adults living in endemic areas, as well as by control sera from Europeans, who have never been exposed to malaria. The identified blood stage target antigens were cloned and expressed as recombinant proteins in a suitable bacterial system. In total, 15 target proteins have been expressed with 13 of them have been successfully purified. An ELISA-based system was developed, and the antigenicity of nine target antigens were evaluated using both non-malaria and malaria sera. Single antigen testing gave overall sensitivity of 50 - 84 %, with specificity consistently over 90%. Antigens such as Alpha tubulin and 26s protease showed promising immunogenicity, while Nucleosome assembly protein achieved 100% specificity. Further development of multiple antigens in an ELISA test will be required for continued evaluation of these antigens and the humoral immune response in malaria in general.

A dissertation submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg, in fulfilment of requirements for the degree of Master of Medicine (Surgery) Johannesburg 1993. / During the period June 1985-December 1989, 77 patients were accumulated for the autotransfusion trial, 21 of which were control patients. These patients were managed at three institutions namely Hillbrow (64), Coronation (1) and Shongwe (12) Hospitals. Of these 77 patients, 65 were involved in penetrating or blunt injuries, and 12 were ruptured ectopic pregnancies. The ages of all patients ranged from 16 yrs to 65 yrs. The patients were divided into four groups: 1 banked blood only (controls), 21 2 autotransfused blood only, 27 3 combined banked and autotransfusion, 17 4 ruptured ectopic pregnancies, 12. Investigated were the effects of autotransfused or banked blood volumes on the following parameters: 1 White cell counts: admission and post-transfusion day 1 2 Platelet counts: post-transfusion days :1. and 2 3 Haemoglobin: admission and post-transfusiondays 1 and 2 4 prothrombin indeex: post-trancfusidoanys 1, 2, and 3 5 Partial thromboplast times: post-transfusion days 1 and 2 6 Fibrinogen Degradation products: post-transfusion day 1 7 Haptoglobin levels: post-transfusion day 1 8 Haemopexin levels: post-transfusion day 1 9 Fibrinogen levels: post-transfusion days 1 and 2 Four salvage techniques were utilised. Complications were analysed for each transfusion group. Autotransfusion of salvaged blood from haemotihoxaces and haemoperitoneums is safe, efficaoious, and cost effective, provided that certain guidelines are followed.

Lau Fung Yi. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (p. 107-130). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Background and Aim: Preterm infants frequently receive blood transfusion (BT) during their stay in the neonatal unit. The aim of this study was to measure the effect of BT on cerebral and gut blood flow and oxygenation in preterm infants in relation to postnatal age. Another aim of the study was also to investigate the influence of measured pre-transfusion RCV on gut perfusion in preterm infants receiving first blood transfusion for clinical indication using NIRS and Doppler ultrasound scan. Methods: Preterm infants admitted to neonatal unit were recruited to three postnatal age groups: 1 to 7 days (group 1; n=20), 8 to 28 days (group 2; n=21) & ≥29 days of life (group 3; n=18). Pre and post-BT Anterior Cerebral artery (ACA) Time Averaged Mean Velocity (TAMV) and Superior Vena Cava (SVC) flow were measured to assess cerebral blood flow. Pre and post-BT Superior mesenteric artery (SMA) peak systolic velocity was measured to assess gut or splanchnic blood flow. Cerebral and gut Tissue Haemoglobin Index (THI), Oxygenation Index (TOI) were measured from 15-20 minutes before to 15-20 minutes post-BT using NIRS. Cerebral and gut fractional tissue oxygen extraction (FTOE) was calculated from the TOI and saturation of oxygen (SaO2). Vital parameters and blood pressure (BP) were also measured continuously from overhead monitors. Pretransfusion red cell volume (RCV) was measured by fetal haemoglobin (HbF) dilution method and compared with the cerebral and gut perfusion and oxygenation changes following blood transfusion. The cerebral and gut perfusion and oxygenation were also measured over a three hour period in 12 control infants not receiving blood transfusion. Results: There were 71 infants included in the study; of them 59 were study infants receiving blood transfusion and 12 were control infants. Amongst the vital parameters, mean BP increased significantly, and there was no significant change in heart rate (HR), respiratory rate (RR) or SaO2 following BT. Pre-transfusion ACA TAMV was higher in Group 2 and 3 compared to Group 1 (p < 0.001) which remained significant after multivariate analysis (p < 0.05). Pretransfusion ACA TAMV decreased significantly (p≤0.04) in all 3 postnatal age groups; pre-transfusion SVC flow decreased significantly in Group 1 (p=0.03) and Group 3 (p < 0.001) following transfusion. Pre-transfusion cTOI was significantly lower in Group 3 compared to Group 1 (p=0.02) which remained significant after multivariate analysis (p < 0.011). The cTHI (p < 0.001) and cTOI (p < 0.05) increased significantly post-transfusion in all three postnatal age groups. PDA had no effect on these measurements. Pre-transfusion SMA PSV increased with postnatal age (group 3 vs. group 1: p < 0.01; CI 0.6 to 0.1), proportion of feeds (> 50% feeds: 0.91±0.4 vs. < 50% feeds: 0.71±0.4 m/sec, p < 0.01); and decreased with presence of PDA (closed PDA: 0.94±0.4 vs. open PDA: 0.68±0.3 m/sec, p=0.006, CI 0.07 to 0.45); but remained unaltered following transfusion. The pre-transfusion sTOI varied with postnatal age (Group 2:44.6 vs. Group1: 36.7%; p=0.03, CI -0.6 to -15.2) on univariate analysis but was not significantly different on multivariate analysis; pre-transfusion sTOI was not influenced by feeds or presence of PDA. The sTHI and sTOI increased (p < 0.01) and sFTOE decreased (p < 0.01) significantly following transfusion in all postnatal age groups.

Diss. (sammanfattning) Umeå : Umeå universitet, 2006. / Härtill 4 uppsatser.

Inaug.-Diss.--Giessen. / Vita.

Thesis (M.Sc. (Public Health))--Mahidol University, 1984.

Thesis (doctoral)--Universiteit van Amsterdam.