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Lubenow, Norbert, Docent
Publications (10 of 51) Show all publications
Mogensen, S., Lubenow, N., Nilsson, P., Engquist, H., Knutson, F., Enblad, P., . . . Frykholm, P. (2017). An evaluation of the mixed pediatric unit for blood loss replacement in pediatric craniofacial surgery. Pediatric Anaesthesia, 27(7), 711-717
Open this publication in new window or tab >>An evaluation of the mixed pediatric unit for blood loss replacement in pediatric craniofacial surgery
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2017 (English)In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 27, no 7, p. 711-717Article in journal (Refereed) Published
Abstract [en]

Background: Surgical correction for craniosynostosis is often associated with significant perioperative hemorrhage. We implemented a transfusion strategy with a strict protocol including transfusion triggers, frequent assessment of coagulation tests, and the use of a novel transfusion unit, the mixed pediatric unit. Aim: The aim of the study was to evaluate if the applied transfusion strategy could reduce total blood loss and number of blood donors. Methods: Children <1 year old admitted for craniosynostosis surgery were included for the study. On the day before surgery, an adult red blood cell unit was mixed with plasma and split into two mixed pediatric units-one intended for intraoperative use and the other saved for the postoperative period. A series of blood samples were obtained for standard coagulation parameters as well as thromboelastography to evaluate potential coagulopathy. Estimated blood loss, the number of additional standard packed red cell units opened in the first 24 h after surgery, the volume of fluid administered, and the total transfusion volumes were compared to a historical control group with similar age and characteristics. Results: Nineteen infants were included in the study group, and were compared to 21 historical controls. There was a significant reduction of intraoperative transfusion volume. Twelve patients were transfused postoperatively, but in 8 of these additional exposure to packed red cell donor blood was avoided by using the saved mixed pediatric unit. In the historical controls, a total of 10 packed red cell units were used in nine patients postoperatively. No additional transfusions of plasma, platelets, fibrinogen, or tranexamic acid were needed in either group, and the coagulation parameters including thromboelastography remained within their respective normal ranges in the study group. Conclusion: For craniofacial surgery in infants, moderate perioperative blood loss and avoidance of coagulopathy is possible when a multifactorial approach is implemented. In this setting, intraoperative, but not total perioperative blood loss was reduced with the studied protocol. The study indicates that there may be a role for mixed pediatric units to reduce exposure to multiple donors although the reduction in total donor exposure was not significant.

Keywords
craniosynostosis, blood loss, surgical, postoperative hemorrhage, blood transfusion, blood coagulation tests, thromboelastography, infants
National Category
Anesthesiology and Intensive Care Pediatrics
Identifiers
urn:nbn:se:uu:diva-330012 (URN)10.1111/pan.13140 (DOI)000405081500007 ()28436074 (PubMedID)
Available from: 2017-10-11 Created: 2017-10-11 Last updated: 2017-10-11Bibliographically approved
Strandberg, G., Sellberg, F., Sommar, P., Ronaghi, M., Lubenow, N., Knutson, F. & Berglund, D. (2017). Standardizing the freeze-thaw preparation of growth factors from platelet lysate. Transfusion, 57(4), 1058-1065
Open this publication in new window or tab >>Standardizing the freeze-thaw preparation of growth factors from platelet lysate
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2017 (English)In: Transfusion, ISSN 0041-1132, E-ISSN 1537-2995, Vol. 57, no 4, p. 1058-1065Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Over the past decades, the focus on the regenerative properties of platelets (PLTs) has intensified and many PLT-derived growth factors are readily used in medical settings. A general lack of standardization in the preparation of these growth factors remains, however, and this study therefore examines the dynamics of growth factors throughout the freeze-thaw procedure.

STUDY DESIGN AND METHODS: Plateletpheresis (PA) and PLT-poor plasma (PPP) samples were collected from 10 healthy donors. PA was lysed to produce PLT lysate (PL) for 1, 3, 5, 10, and 30 freeze-thaw cycles. The resulting growth factor and cytokine concentrations from PPP, PA, and PL of different cycles were analyzed and compared using enzyme-linked immunosorbent assay and multiplex bead assays.

RESULTS: PL produced by the freeze-thaw procedure resulted in approximately four-to 10-fold enrichment of transforming growth factor-b1, epidermal growth factor, PLT-derived growth factor (PDGF)-AB/BB, PLT factor-4, and fibroblast growth factor-2. The increase in concentrations plateaued at Cycles 3 and 5 and in some cases declined with further cycles. The concentrations of insulin-like growth factor-1, hepatocyte growth factor, vascular endothelial growth factor, and bone morphogenetic protein-2 in PL were essentially comparable to those in PPP.

CONCLUSION: Using the freeze-thaw method, optimal preparation of PL with regard to the concentration of growth factors was achieved at Cycles 3 to 5. Based on our findings, the clinical significance of using a greater number of cycles is likely limited.

Place, publisher, year, edition, pages
WILEY, 2017
National Category
Hematology
Identifiers
urn:nbn:se:uu:diva-328740 (URN)10.1111/trf.13998 (DOI)000402864500029 ()28182293 (PubMedID)
Available from: 2017-08-30 Created: 2017-08-30 Last updated: 2017-08-30Bibliographically approved
Greiser, A., Winter, T., Mahfoud, H., Kallner, A., Ittermann, T., Masuch, A., . . . Petersmann, A. (2017). The 99th percentile and imprecision of point-of-care cardiac troponin I in comparison to central laboratory tests in a large reference population. Clinical Biochemistry, 50(18), 1198-1202
Open this publication in new window or tab >>The 99th percentile and imprecision of point-of-care cardiac troponin I in comparison to central laboratory tests in a large reference population
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2017 (English)In: Clinical Biochemistry, ISSN 0009-9120, E-ISSN 1873-2933, Vol. 50, no 18, p. 1198-1202Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Determination of cardiac troponin (cTn) is central in the emergency department (ED) for the diagnosis of myocardial infarction. In view of adverse effects of long waiting time on patient outcome, implementation of point-of-care-testing (POCT) is suggested if the turn-around-time is longer than 60min. The present study aimed to determine the 99th percentile and imprecision of two POCT in a healthy population measuring cTnI and cTnT and compare these analytical characteristics against three central laboratory test (CLT) for cTnI.

DESIGN & METHODS: CTnI and cTnT were determined in parallel by means of the AQT90 FLEX analyzer in about 2250 plasma samples from individuals with known health status. Results were compared to previously determined performance data of three CLT.

RESULTS: The 99th percentile of cTnI in the POCT was determined at 19ng/L, the lowest concentration with an imprecision of 10% was reached at 22ng/L while an imprecision of 20% was reached at 13ng/L. Age, sex, or physical activity did not affect the 99th percentile of cTnI. Compared to CLT the AQT90 cTnI POCT the analytical performance was equivalent. The cTnT POCT could not be assessed due a considerable number of high values and an inadequate imprecision profile.

CONCLUSION: While the cTnI POCT showed analytical performance comparable to CLT, the results of the cTnT assay on the same device did not suffice to determine a reliable 99th percentile. The present evaluation supports the usage of the cTnI POCT, but application of the cTnT POCT needs further evaluation.

Keywords
99th reference percentile, AQT90, Analytical performance, Cardiac troponin I and T, Point-of-care
National Category
Clinical Laboratory Medicine
Identifiers
urn:nbn:se:uu:diva-343469 (URN)10.1016/j.clinbiochem.2017.08.006 (DOI)000415987300036 ()28803961 (PubMedID)
Available from: 2018-02-27 Created: 2018-02-27 Last updated: 2018-02-27Bibliographically approved
Strandberg, G., Lipcsey, M., Eriksson, M. B., Lubenow, N. & Larsson, A. (2016). Analysis of Thromboelastography, PT, APTT and Fibrinogen in Intraosseous and Venous Samples: An Experimental Study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 24, Article ID 131.
Open this publication in new window or tab >>Analysis of Thromboelastography, PT, APTT and Fibrinogen in Intraosseous and Venous Samples: An Experimental Study
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2016 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 24, article id 131Article in journal (Refereed) Published
Abstract [en]

Background:Laboratory analysis of coagulation is often important in emergencies. If vascular access is challenging,intraosseous catheterization may be necessary for treatment. We studied the analysis of coagulation parameters inintraosseous aspirate during stable conditions and after major haemorrhage in a porcine model.Methods:Ten anesthetized pigs received central venous and intraosseous catheters and samples were taken foranalysis of thromboelastography (TEG), prothrombin time (PT), activated partial thromboplastin time (APTT) andfibrinogen concentration. Analyses were repeated after removal of 50 % of the calculated blood volume andresuscitation with crystalloid. Intraosseous and venous values were compared.Results:Bleeding and resuscitation resulted in haemodilution and hypotension. Median TEG reaction time wasshorter in intraosseous than in venous samples before (1.6 vs 4.6 min) and after (1.6 vs 4.7 min) haemodilution.Median maximal amplitude was smaller in intraosseous samples at baseline (68.3 vs 76.4 mm). No major differenceswere demonstrated for the other TEG parameters. The intraosseous samples often coagulated in vitro, makinganalysis of PT, APTT and fibrinogen difficult. After haemodilution, TEG maximal amplitude andα-angle, andfibrinogen concentration, were decreased and PT increased.Discussion:The intraosseous samples were clinically hypercoagulable and the TEG demonstrated a shortenedreaction time. The reason for this may hypothetically be found in the composition of the IO aspirate or in thesampling technique. After 50 % haemorrhage and haemodilution, a clinically relevant decrease in fibrinogenconcentration and a lower TEG maximal amplitude were observed.Conclusions:Although the sample is small, these data indicate that intraosseous samples are hypercoagulable,which may limit their usefulness for coagulation studies. Major haemodilution only moderately affected the studied parameters.

Keywords
Blood coagulation; Haemorrhage; Infusions; Intraosseous; Thrombelastography
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-306587 (URN)10.1186/s13049-016-0318-0 (DOI)000386860300001 ()
Available from: 2016-10-29 Created: 2016-10-29 Last updated: 2017-11-29Bibliographically approved
Sellberg, F., Berglund, E., Ronaghi, M., Strandberg, G., Löf, H., Sommar, P., . . . Berglund, D. (2016). Composition of growth factors and cytokines in lysates obtained from fresh versus stored pathogen-inactivated platelet units. Transfusion and apheresis science, 55(3), 333-337
Open this publication in new window or tab >>Composition of growth factors and cytokines in lysates obtained from fresh versus stored pathogen-inactivated platelet units
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2016 (English)In: Transfusion and apheresis science, ISSN 1473-0502, E-ISSN 1878-1683, Vol. 55, no 3, p. 333-337Article in journal (Refereed) Published
Abstract [en]

Background: Platelet lysate is a readily available source of growth factors, and other mediators, which has been used in a variety of clinical applications. However, the product remains poorly standardized and the present investigation evaluates the composition of platelet lysate obtained from either fresh or stored pathogen-inactivated platelet units.

Materials and Methods: Platelet pooled units (n = 10) were obtained from healthy blood donors and tested according to standard procedures. All units were pathogen inactivated using amotosalen hydrochloride and UVA exposure. Platelet lysate was subsequently produced at two separate time-points, either from fresh platelet units or after 5 days of storage, by repeated freeze-thaw cycles. The following mediators were determined at each time point: EGF, FGF-2, VEGF, IGF-1, PDGF-AB/BB, BMP-2, PF4, TGF-beta isoform 1, IL-1(i, IL-2, IL-6, IL-10, IL-12p70, 1L-17A, TNF-alpha, and IFN-gamma.

Results: The concentration of growth factors and cytokines was affected by time in storage. Notably, TGF-beta, PDGF-AB/BB, and PF4 showed an increase of 27.2% (p < 0.0001), 29.5% (p = 0.04) and 8.2% (p = 0.0004), respectively. A decrease was seen in the levels of IGF-1 and FGF-2 with 22% (p = 0.041) and 11% (p = 0.01), respectively. Cytokines were present only in very low concentrations and all other growth factors remained stable with time in storage.

Conclusion: The composition of mediators in platelet lysate obtained from pathogen inactivated platelet units differs when produced from fresh and stored platelet units, respectively. This underscores the need for further standardization and optimization of this important product, which potentially may influence the clinical effects.

Keywords
Platelet lysate, Pathogen-inactivation, Growth factor, Cytokine
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-314425 (URN)10.1016/j.transci.2016.08.004 (DOI)000390964500014 ()
Available from: 2017-02-02 Created: 2017-02-02 Last updated: 2017-11-29Bibliographically approved
Berglund, D., Lindvall, P. & Lubenow, N. (2015). Green plasma. Transfusion, 55(2), 245-245
Open this publication in new window or tab >>Green plasma
2015 (English)In: Transfusion, ISSN 0041-1132, E-ISSN 1537-2995, Vol. 55, no 2, p. 245-245Article in journal, Editorial material (Other academic) Published
National Category
Immunology in the medical area
Identifiers
urn:nbn:se:uu:diva-249059 (URN)10.1111/trf.12741 (DOI)000349820900004 ()25683187 (PubMedID)
Available from: 2015-04-22 Created: 2015-04-10 Last updated: 2018-01-11Bibliographically approved
Sedigh, A., Nordling, S., Larsson, R., Larsson, E., Norlin, B., Lubenow, N., . . . Lorant, T. (2015). Perfusion Of Porcine Kidneys With Macromolecular Heparin Ameliorates Early Ischemia Reperfusion Injury. Transplant International, 28, 94-95
Open this publication in new window or tab >>Perfusion Of Porcine Kidneys With Macromolecular Heparin Ameliorates Early Ischemia Reperfusion Injury
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2015 (English)In: Transplant International, ISSN 0934-0874, E-ISSN 1432-2277, Vol. 28, p. 94-95Article in journal, Meeting abstract (Other academic) Published
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-281006 (URN)000367726700253 ()
Available from: 2016-04-01 Created: 2016-03-16 Last updated: 2018-05-18
Almgren, J., Lindvall, P., Englund, ., Norda, R., Lubenow, N. & Safwenberg, J. (2014). Comparison of Three Fully Automated Systems for Immunohematology with the Focus on Two Important Aspects of Capacity-Efficiency and Stress. Paper presented at AABB Annual Meeting, OCT 25-28, 2014, Philadelphia, PA. Transfusion, 54, 173A-174A
Open this publication in new window or tab >>Comparison of Three Fully Automated Systems for Immunohematology with the Focus on Two Important Aspects of Capacity-Efficiency and Stress
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2014 (English)In: Transfusion, ISSN 0041-1132, E-ISSN 1537-2995, Vol. 54, p. 173A-174AArticle in journal, Meeting abstract (Other academic) Published
National Category
Hematology
Identifiers
urn:nbn:se:uu:diva-249094 (URN)000349965300387 ()
Conference
AABB Annual Meeting, OCT 25-28, 2014, Philadelphia, PA
Available from: 2015-04-10 Created: 2015-04-10 Last updated: 2017-12-04Bibliographically approved
Hron, G., Knutson, F., Thiele, T., Althaus, K., Busemann, C., Friesecke, S., . . . Lubenow, N. (2013). Alternative diagnosis to heparin-induced thrombocytopenia in two critically ill patients despite a positive PF4/heparin-antibody test. Upsala Journal of Medical Sciences, 118(4), 279-284
Open this publication in new window or tab >>Alternative diagnosis to heparin-induced thrombocytopenia in two critically ill patients despite a positive PF4/heparin-antibody test
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2013 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 118, no 4, p. 279-284Article in journal (Refereed) Published
Abstract [en]

Thrombocytopenia can cause diagnostic challenges in patients who have received heparin. Heparin-induced thrombocytopenia (HIT) is often considered in the differential diagnosis, and a positive screening can be mistaken as confirmation of the disorder. We present two patients who both received low-molecular-weight heparin for several days. In the first patient, clinical judgment rejected the suspicion of HIT despite a positive screening assay, and treatment for the alternative diagnosis of post-transfusion purpura was correctly initiated. In the second patient, the inaccurate diagnosis HIT was pursued due to a positive screening assay, while the alternative diagnosis of drug-dependent thrombocytopenia caused by piperacillin/tazobactam was rejected. This resulted in re-exposure to piperacillin/tazobactam which caused a second episode of severe thrombocytopenia. A positive screening assay for platelet factor 4/heparin-antibody should be verified by a functional assay, especially in patients with low pretest probability for HIT.

Keywords
Drug-induced thrombocytopenia, heparin-induced thrombocytopenia, HIT, piperacillin-induced thrombocytopenia, post-transfusions purpura, PTP
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-210569 (URN)10.3109/03009734.2013.838811 (DOI)000325527300012 ()
Available from: 2013-11-13 Created: 2013-11-11 Last updated: 2017-12-06Bibliographically approved
Norda, R. A., Abedi, M., Ekermo, B., Grandin, B., Holthuis, N., Konar, J., . . . Knutson, F. (2013). An Evaluation Of The Blood Donor Health Questionnaire (Dhq) In Sweden 2012. Paper presented at Special Issue: Abstracts of the 23rd Regional Congress of the International Society of Blood Transfusion, Amsterdam, The Netherlands, June 2-5, 2013. Vox Sanguinis, 105(S1), 17-17
Open this publication in new window or tab >>An Evaluation Of The Blood Donor Health Questionnaire (Dhq) In Sweden 2012
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2013 (English)In: Vox Sanguinis, ISSN 0042-9007, E-ISSN 1423-0410, Vol. 105, no S1, p. 17-17Article in journal, Meeting abstract (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-203000 (URN)000319228100045 ()
Conference
Special Issue: Abstracts of the 23rd Regional Congress of the International Society of Blood Transfusion, Amsterdam, The Netherlands, June 2-5, 2013
Available from: 2013-07-02 Created: 2013-07-01 Last updated: 2017-12-06Bibliographically approved
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