Diabetes mellitus is the commonest endocrine disease in all populations and all age groups. It is a syndrome of disturbed intermediary metabolism caused by inadequate insulin secretion or impaired insulin action, or both. Anemia is a common accompaniment of diabetes, particularly in those with albuminuria justifying tubulointestitial injury or reduced renal function. There are other additional factors present in diabetes, which may contribute to the development of an increased risk of anemia. Cord blood, because of its rich mix of fetal and adult hemoglobin, high platelet and WBC counts, hypo-antigenic nature, altered metabolic profile and high affinity for oxygen, may be an ideal choice for cases of diabetes with severe anemia necessitating blood transfusion. This article presents my team's experience with 78 units of placental umbilical cord whole blood (from 1 April 1999 to April 2005), collected after lower uterine cesarean section (LUCS) from consenting mothers (56 ml-138, ml mean 82 ml +/- 5.6 ml SD, median 84 ml, mean packed cell volume 49.7 +/- 4.2 SD, mean percent hemoglobin concentration 16.6 g/dl +/- 1.5 g/dl SD) and transfused to diabetes patients with microalbuminuria and severe anemia necessitating transfusion. After collection, the blood was transfused, in most cases immediately after completion of the essential norms of transfusion. In rare cases, it was kept in the refrigerator and transfused within 72 hours of collection to a suitable recipient. For inclusion in this study, the patient's percent plasma hemoglobin had to be 8 g/dl or less (the pretransfusion hemoglobin in this series varied from 5.2 g/dl to 7.8 g/dl) in the background of type two diabetes (fasting sugar 200 mg or more), along with features of microalbuminuria (albumin excretion 30-299 mg/g creatinine). This study included 39 informed consenting patients (22 males + 17 females, aged 48-74 yrs, mean 59.6 yrs). The patients were randomized into two groups: Group A (control cases N = 15, males = 8 and females = 7) and Group B (study group N = 24, males = 14 and females = 10). In Group A the rise of hemoglobin (Hgb) after two units of adult blood transfusion was 1.5 to 1.8 g/dl, as seen after a 72-hour blood sample assessment. The rise of Hgb as noted after 72 hours of two units of freshly collected cord blood transfusion was .6 g/dl to 1.5 g/dl. Each patient received two of four units of freshly collected cord blood transfusion (two units at a time), depending on availability and compatibility. Microalbuminuria was assessed in both groups after one month of treatment with transfusion and other identical support. The mean result was 152 +/- 18 m SD of albumin per gram of creatinine excreted through 24-hour urine (pre-transfusion mean excretion was 189 +/- 16 mg) in Group A and 103 +/- 16 mg SD of albumin excretion per gram of creatinine in 24-hour excretion of urine in Group B (pretransfusion mean excretion was 193 +/- 21 mg). Univariate analysis using Fisher's exact test was performed for the results of Groups A and B. The difference between Group A and B values and its comparison with the pre-transfusion microalbuminuria appeared to be statistically significant (p < less than .003). We have not encountered any clinical, immunological or non-immunological reaction so far in either group. Fetomaternal cell traffic has been implicated as the cause of scleroderma in mothers delivering male babies. In the present series, we did not see any such rare and unusual complication due to neonatal blood transfusion in the adult system in Group B patients in the six years from the initiation of the study.

译文

糖尿病是所有人群和所有年龄组中最常见的内分泌疾病。它是由胰岛素分泌不足或胰岛素作用受损或两者同时引起的中间代谢紊乱综合征。贫血是糖尿病的常见伴随,尤其是在那些蛋白尿证明肾小管损伤或肾功能降低的患者中。糖尿病中还有其他其他因素,可能会导致贫血风险增加。脐带血由于其丰富的胎儿和成人血红蛋白,高血小板和WBC计数,低抗原性,改变的代谢特征和对氧气的高亲和力,可能是糖尿病严重贫血需要输血的理想选择。本文介绍了我的团队对78单位胎盘脐带全血 (从1999年4月1日到2005年4月) 的经验,这些血液是在下子宫剖宫产 (LUCS) 后从同意的母亲 (56毫升-138,ml平均82毫升/-5.6毫升SD,中位数84毫升,平均包装细胞体积49.7 +/- 4.2 SD,平均血红蛋白浓度百分比16.6g/dl +/- 1.5g/dl SD),并被输血给患有微量白蛋白尿和需要输血的严重贫血的糖尿病患者。收集后,在大多数情况下,在完成基本输血规范后立即输血。在极少数情况下,将其保存在冰箱中,并在收集后72小时内输注给合适的接收者。为了纳入这项研究,在2型糖尿病 (空腹血糖200毫克或更多) 的背景下,患者的血浆血红蛋白百分比必须为8g/dl或更少 (本系列中的输血前血红蛋白从5.2g/dl到7.8g/dl不等),以及微量白蛋白尿 (白蛋白排泄30-299 mg/g肌酐) 的特征。这项研究包括39名知情同意的患者 (22名男性17名女性,年龄48-74岁,平均59.6岁)。将患者随机分为两组: A组 (对照组N = 15,男性 = 8,女性 = 7) 和B组 (研究组N = 24,男性 = 14,女性 = 10)。在A组中,两个单位的成人输血后血红蛋白 (Hgb) 的升高1.5为1.8g/dl,如在72小时的血液样本评估后所见。在两单位新鲜收集的脐带血输血72小时后,Hgb的升高为0.6g/dl至1.5g/dl。根据可用性和兼容性,每位患者接受四个单位的新鲜脐带血输血中的两个 (一次两个单位)。在接受输血和其他相同支持治疗一个月后,两组均评估了微量白蛋白尿。A组的平均结果是每克通过24小时尿液排泄的肌酐中白蛋白152 +/- 18 m SD (输血前平均排泄为189 +/- 16 mg),每克肌酐中白蛋白排泄103 +/- 16 mg SD在24小时排泄中B组的尿液 (输血前平均排泄为193 +/- 21 mg)。对A组和B组的结果进行了使用Fisher精确检验的单变量分析。A组和B组之间的差异及其与输血前微量白蛋白尿的比较似乎具有统计学意义 (p <小于.003)。到目前为止,我们在任何一组中都没有遇到任何临床,免疫学或非免疫学反应。胎儿的细胞流量被认为是分娩男婴的母亲中硬皮病的原因。在本系列研究中,在研究开始后的六年中,由于B组患者的成人系统中新生儿输血,我们没有发现任何这种罕见和异常的并发症。

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