Œdèmes aigus pulmonaires de surcharge post-transfusionnels

A review of the safety profile, antioxidant, anti-inflammatory, and bronchorelaxant activities of Waltheria indica Linn (Malvaceae): A potential antiasthmatic phytomedicine

Introduction

Waltheria indica Linn (Malvaceae) is a widely distributed plant in West Africa. It is commonly used in Burkina Faso to treat inflammation-related diseases, including asthma. Previous reviews have focused on the ethnobotanical, traditional uses, phytochemistry, and pharmacological properties of Waltheria indica. This report aims to compile the biological and pharmacological activities that highlight the anti-asthmatic properties of Waltheria indica L. (W. indica).

Method

Electronic databases, such as PubMed, Scopus, Hinari, SciFinder, Google Scholar, and ScienceDirect, were used to gather data on Watheria indica. Data on the toxicological, anti-inflammatory, antioxidant, and bronchorelaxant effects of W. indica were collected.

Results

Twenty-three studies describing the biological and pharmacological activities relevant to assessing the anti-asthmatic properties of W. indica were found. Nine articles investigated the anti-inflammatory effects, and three manuscripts were found to have bronchorelaxant activity. Five publications reported the antioxidant activity of the plant extracts. Research on the extracts revealed a tolerable safety profile in rats and mice with an LD50 ranging from 300 to 5000 mg/kg body weight, depending on the parts of the plant used. Phenolic compounds, particularly flavonoids, alkaloids, and saponins, were found to be responsible for the activities involved in the assessment of anti-asthmatic properties.

Conclusion

The results of this review suggest that W. indica could be a valuable resource for the treatment of asthma and other respiratory diseases. However, further chemical and pharmacological investigations are needed to understand its mechanism of action in treating asthma.

Acte transfusionnel, 18 ans pour une nouvelle instruction : la maturité

The DGS/DHOS/Afssaps circular No. 03/582 of December 15, 2003 has regulated the performance of the transfusion act since 2003. The French Society for Vigilance and Transfusion Therapy (SFVTT) requested the revision of this text from the Directorate General for Health (DGS) in November 2018. Indeed, the new requirements in terms of transfusion safety of the Public Health Code, the National Agency for the Safety of Medicines and Health Products, the High Authority for health, and the desire to deploy patient blood management have have caused practices to evolve. Following the agreement of the DGS, an SFVTT working group was set up, with the objective of redrafting the guidelines. This approach led to the publication of the new instruction No. DGS/PP4/DGOS/PF2/2021/230 of November 16, 2021 relating to the performance of the transfusion act , 18 years after that of the first circular.

Transfusion-associated circulatory overload: A survey among Dutch intensive care fellows

OBJECTIVES

Transfusion-associated circulatory overload (TACO) is a severe pulmonary transfusion reaction and leading cause of transfusion-related morbidity and mortality in Europe. TACO is of particular importance in critically ill patients, since they often receive blood transfusions and have multiple risk factors for TACO. This study investigates transfusion practices in patients at risk of developing TACO, and furthermore knowledge concerning risk factors, diagnoses and treatment strategies among Dutch intensive care unit (ICU) fellows.

MATERIAL AND METHODS

An unannounced paper-based survey was conducted among Dutch ICU fellows during an educational conference. The survey consisted of 16 multiple and open choice questions.

RESULTS

Of all 65 Dutch ICU fellows 56.8% completed the survey; of respondents 88.9% identified the correct constellation of symptoms for TACO. In total, 29.7% of the respondents are aware they are obligated to report TACO cases to the blood bank. Major risk factors for TACO that respondents identified were reduced left ventricular function, infusion volume and infusion rate. In a non-emergency setting, 45.9% of fellows start red blood cell transfusion with 2 units or more. Transfusion rates exceeded national guidelines in 15.4% of fictitious cases. TACO is treated with furosemide by 94.5% of the fellows, however goals of the therapy varied greatly.

CONCLUSION

Dutch ICU fellows are knowledgeable of TACO symptoms, risk factors and treatment, however knowledge on reporting and transfusion practice in the setting of at risk patients for TACO should be improved.

[Respiratory complications after transfusion]

Respiratory complications of blood transfusion have several possible causes. Transfusion-Associated Circulatory Overload (TACO) is often the first mentioned. Transfusion-Related Acute Lung Injury (TRALI), better defined since the consensus conference of Toronto in 2004, is rarely mentioned. French incidence is low. Non-hemolytic febrile reactions, allergies, infections and pulmonary embolism are also reported. The objective of this work was to determine the statistical importance of the different respiratory complications of blood transfusion. This work was conducted retrospectively on transfusion accidents in six health centers in Champagne-Ardenne, reported to Hemovigilance between 2000 and 2009 and having respiratory symptoms. The analysis of data was conducted by an expert committee. Eighty-three cases of respiratory complications are found (316,864 blood products). We have counted 26 TACO, 12 TRALI (only 6 cases were identified in the original investigation of Hemovigilance), 18 non-hemolytic febrile reactions, 16 cases of allergies, 5 transfusions transmitted bacterial infections and 2 pulmonary embolisms. Six new TRALI were diagnosed previously labeled TACO for 2 of them, allergy and infection in 2 other cases and diagnosis considered unknown for the last 2. Our study found an incidence of TRALI 2 times higher than that reported previously. Interpretation of the data by a multidisciplinary committee amended 20% of diagnoses. This study shows the imperfections of our system for reporting accidents of blood transfusion when a single observer analyses the medical records.