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Sample records for multiple blood transfusions

  1. Association of Prehospital Shock Index and Trauma Bay Uncrossmatched Red Blood Cell Transfusion With Multiple Transfusion.

    PubMed

    Day, Darcy L; Anzelon, Kathleen M; Conde, Franscisco A

    2016-01-01

    Early resuscitation of bleeding trauma patients with multiple blood products improves outcome, yet transfusion initiation is not standardized. Shock index (heart rate/systolic blood pressure) and trauma bay uncrossmatched red blood cell (RBC) transfusion were evaluated for association with multiple transfusions, defined as 6 or more RBCs during the first 6 hrs of hospital presentation. A prehospital shock index of 1 was significantly associated with multiple transfusions (p = .02). Subjects receiving uncrossmatched RBCs required more RBCs during the first 6 hrs (10.3 units, p < .01). Consideration of these simple variables may help trauma nurses anticipate the potentially bleeding patient. PMID:26953537

  2. Reducing donor exposure in preterm infants requiring multiple blood transfusions.

    PubMed Central

    Wood, A.; Wilson, N.; Skacel, P.; Thomas, R.; Tidmarsh, E.; Yale, C.; de Silva, M.

    1995-01-01

    Preterm infants frequently require multiple blood transfusions. Traditionally, 'fresh' (less than seven days old) blood has been used but this often results in transfusions from multiple donors. To reduce donor exposure the policy for top-up transfusions was changed. A unit of blood under five days old with additional satellite packs was ordered for each infant and used up to its expiry date, allowing up to eight transfusions from a single donation to be given. The mean (SD) number of transfusions per infant in 43 infants transfused according to previous policy and in 29 transfused according to the new policy was similar at 5.6 (4.0) and 5.3 (3.1), respectively. However, donor exposure fell following the change in policy from 4.9 (3.5) to only 2.0 (0.9). Only one infant was exposed to more than three donors compared with 24 infants in the control group. Plasma potassium concentrations were not significantly different following transfusion of blood stored for up to 33 days. This simple change in policy has reduced donor exposure in infants requiring multiple top-up transfusions. PMID:7743280

  3. Blood Transfusion and Donation - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Blood Transfusion and Donation URL of this page: https://medlineplus.gov/languages/bloodtransfusionanddonation.html Other topics A-Z A B ...

  4. Blood Transfusion and Donation - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Blood Transfusion and Donation URL ... this page: https://www.nlm.nih.gov/medlineplus/languages/bloodtransfusionanddonation.html Other topics A-Z A B ...

  5. Blood transfusions

    MedlinePlus

    ... are many reasons you may need a blood transfusion: After knee or hip replacement surgery, or other ... your body cannot make enough blood A blood transfusion is a safe and common procedure during which ...

  6. Blood Transfusions

    MedlinePlus

    ... might be the red blood cells, platelets or plasma . Rarely is whole blood (red cells, plasma, platelets, and white cells) used for a transfusion. ... of other blood components, such as platelets and plasma , may take less time. After the transfusion, you ...

  7. Possible Risks of Blood Transfusions

    MedlinePlus

    ... transfusions are done Possible risks of blood transfusions Alternatives to blood transfusions Donating blood Blood donation by cancer survivors To ... Topic How blood transfusions are done Next Topic Alternatives to blood transfusions Possible risks of blood transfusions Although blood transfusions ...

  8. Problems of multiple transfusions.

    PubMed

    GARDNER, F H

    1958-02-01

    The use of blood infusion in large amounts is increasing sharply. Increased knowledge of blood group antigens has alerted physicians to the possible hazards of hemolytic reactions to subgroups that must be eliminated by proper cross-matching techniques. Multiple transfusions of preserved blood often defeat their purpose in control of bleeding, for thrombocytopenia is enhanced. Careful selection of blood or preparations of plasma concentrates offer increased protection to the recipient.Plastic bag equipment increases the yield of viable platelets and keeps blood in usable condition for longer periods of storage. The use of multiple transfusions has complicated the selection of preserved blood to control pigment metabolism. PMID:13500210

  9. Blood transfusions

    MedlinePlus

    ... homologous blood donation. Many communities have a blood bank at which any healthy person can donate blood. ... to arrange with your hospital or local blood bank before your surgery to have directed donor blood. ...

  10. Blood Transfusion and Donation

    MedlinePlus

    ... the blood transfusion. To keep blood safe, blood banks carefully screen donated blood. The risk of catching ... or more times before the surgery. A blood bank will store your blood for your use. NIH: ...

  11. Blood Transfusion

    MedlinePlus

    ... made by the kidneys that stimulates red cell production {{ Immunoglobulins, antibodies made by plasma cells in response ... used for chemotherapy cause temporarily impaired blood cell production in the marrow and depressed immune system functions. ...

  12. Blood transfusion in obstetrics.

    PubMed

    Nigam, A; Prakash, A; Saxena, P

    2013-01-01

    Transfusion of blood and blood components is a common practice in obstetric wards but it is not without risk. The incidence of transfusion reactions varies from 4 in every hundred transfusions for non-haemolytic reactions to one in every 40,000 for haemolytic transfusion reactions. The physiological basis of blood transfusion is outlined in this article. Most of the donated blood is processed into components: packed red cells (PRBCs), platelets, and fresh frozen plasma (FFP) or cryoprecipitate. Various alternatives to blood transfusion exist and include autotransfusion, pre-autologous blood storage, use of oxygen carrying blood substitutes and intraoperative cell salvage. Despite the risks associated with transfusions, obstetricians are frequently too aggressive in transfusing blood and blood products to their patients. Acute blood loss in obstetrics is usually due to placenta praevia, postpartum blood loss and surgery related. An early involvement of a consultant obstetrician, anaesthetist, haematologist and the blood bank is essential. There are no established criteria for initiating red cell transfusions and the decision is purely based on clinical and haematological parameters, which have been discussed along with the general principles of blood transfusion in obstetrics and some practical guidelines. PMID:24899337

  13. Types of Blood Transfusions

    MedlinePlus

    ... especially in the joints (knees, ankles, and elbows). Plasma Transfusions Plasma is the liquid part of your blood. It's ... or a severe infection, you may need a plasma transfusion. Rate This Content: NEXT >> Updated: January 30, ...

  14. Blood transfusion: friend or foe.

    PubMed

    Katz, Elizabeth A

    2009-01-01

    The effectiveness of transfusions is often compromised by adverse reactions. Common transfusion reactions (hemolytic transfusion reactions, transfusion-related acute lung injury, transfusion-associated circulatory overload, transfusion-related immunomodulation) are reviewed, including pathogenesis, clinical and laboratory manifestations, and treatment. In addition, artificial blood substitutes are discussed as a way to mitigate the risk of transfusion-related morbidity and mortality. PMID:19411873

  15. Blood Transfusion (For Parents)

    MedlinePlus

    ... help to clot the blood and control bleeding. Plasma , the pale yellow liquid part of whole blood. ... patients with bleeding problems, transfusions with platelets or plasma can help to control or prevent bleeding complications. ...

  16. Alternatives to blood transfusion.

    PubMed

    Spahn, Donat R; Goodnough, Lawrence T

    2013-05-25

    The use of alternatives to allogeneic blood continues to rest on the principles that blood transfusions have inherent risks, associated costs, and affect the blood inventory available for health-care delivery. Increasing evidence exists of a fall in the use of blood because of associated costs and adverse outcomes, and suggests that the challenge for the use of alternatives to blood components will similarly be driven by costs and patient outcomes. Additionally, the risk-benefit profiles of alternatives to blood transfusion such as autologous blood procurement, erythropoiesis-stimulating agents, and haemostatic agents are under investigation. Nevertheless, the inherent risks of blood, along with the continued rise in blood costs are likely to favour the continued development and use of alternatives to blood transfusion. We summarise the current roles of alternatives to blood in the management of medical and surgical anaemias. PMID:23706802

  17. [Syphilis and blood transfusion].

    PubMed

    Serrano, J

    1991-06-01

    Along 17 years (1973-1989), syphilis screening has been performed on 146,355 blood units in the author's blood bank. A total number of 143 positive results (confirmed by MHA-TP) was registered, which means an incidence of 0.097%. Of the total number of blood units, 31,529 came from professional donors, 51 of them (0.16%) being positive, while of the 114,826 blood units from voluntary donors 92 were positive (0.08%). With respect to voluntary donations, the highest incidence of positive reactions was found between 1980 and 1982, but this period registered also the highest number of blood units studied. Along this 17 year period 8 patients have received blood products with positive syphilis test. They were transfused on urgent request with fresh blood or platelet concentrates, the transfusion being performed before knowing the results of the screening for syphilis. No special measures were taken in 2 such cases, who died shortly after the transfusion on account of their disease. Two other were treated with penicillin at the time of transfusion. The remaining four patients received preventive penicillin. Even taking into account that positive screening tests are uncommon amongst blood donors, and that only under special circumstances the patients receiving contaminated blood may develop the illness, it seems advisable for every blood bank to perform the screening for syphilis on every blood donation. PMID:1948541

  18. Blood Transfusion and Donation

    MedlinePlus

    ... that form clots to control bleeding Plasma - the liquid part of the blood that helps clotting. You may need it if you have been badly burned, have liver failure or a severe infection. Most blood transfusions go very smoothly. Some infectious agents, such as ...

  19. [Ethics and blood transfusion].

    PubMed

    Tissot, J-D; Garraud, O; Danic, B; Cabaud, J-J; Lefrère, J-J

    2013-09-01

    Blood donation is an act of solidarity. Most often, this act is done on a volunteer basis and, depending on countries and circumstances, is not remunerated. The increase in need, the always-greater number of deferral criteria, the safety issues and the changes in the structures of our societies are among the many subjects for ethical debates. Taking these into account, the actors of the transfusion must analyze certain parameters: the value of a donation, the meaning of volunteering, the appropriateness of remunerating the act of giving a part of one's self, no longer as a donation or an expression of altruism and solidarity, but as a commercial act regimented by economic laws. PMID:23916572

  20. [Alternatives to allogenous blood transfusion].

    PubMed

    Cernea, Daniela; Vlădoianu, Alice; Stoica, Maria; Novac, M; Berteanu, Cristina

    2009-01-01

    Blood transfusion is usually meant to lower morbidity and mortality rates. Allogenous blood transfusion implies certain risks that can be avoided by autologous blood transfusions techniques including: preoperatory autologous blood donation, acute normovolemic hemodilution, intraoperatory and postoperatory blood salvage. Preoperatory blood donation and acute normovolemic hemodilution are used for planned interventions with an estimated blood loss higher than 20% of blood volume. These methods imply Erythropoietin and iron treatment. Intraoperatory and postoperatory blood salvage is performed by personnel trained in blood donation, handling and storage. Autologous blood transfusions are used for certain surgical procedures that commonly require transfusions: orthopedic surgery, radical prostatectomy, cardiovascular surgery, organ transplantation. An alternative to allogenous blood transfusion is the use of artificial oxygen transporters: human or animal hemoglobin solutions or pefluorocarbonate solutions. These solutions do not require cross reactions, do not carry diseases and are generally well tolerated and easily stored in the operating room, ambulance and other transport means. They have however a slight degree of toxicity. PMID:21495338

  1. [Economic environment and blood transfusion].

    PubMed

    Durand-Zaleski, I

    2015-08-01

    The increasing pressure on healthcare resources affects blood donation and transfusion. We attempted a survey of the efficiency of different strategies, actual or proposed to improve the management of blood products. We found an important disconnect between the cost effectiveness ratio of strategies and their uptake by policy makers. In other words, the least efficient strategies are those which increase transfusion safety by increasing the number of biological markers and are those preferred by health authorities in developed countries. Other more efficient strategies are more slowly implemented and included a systematic use of transfusion guidelines, reducing blood losses or increasing pre operative blood levels in elective surgeries. PMID:26096190

  2. What Is a Blood Transfusion?

    MedlinePlus

    ... cells, white blood cells, platelets (PLATE-lets), and plasma. Blood is transfused either as whole blood (with all its parts) or, more often, as individual parts. Blood Types Every person has one of the following blood types: A, B, AB, ...

  3. Alternatives to Blood Transfusion

    MedlinePlus

    ... in cancer patients undergoing laparoscopic colorectal resection: risk factors and impact on survival. Tech Coloproctol. 2013 Oct;17(5):549-554. Hay SN, Scanga L, Brecher ME. Life, death, and the risk of transfusion: a university hospital experience. Transfusion . 2006;46(9):1491-1493. ...

  4. The hazards of blood transfusion in historical perspective

    PubMed Central

    Klein, Harvey G.

    2008-01-01

    The beginning of the modern era of blood transfusion coincided with World War II and the resultant need for massive blood replacement. Soon thereafter, the hazards of transfusion, particularly hepatitis and hemolytic transfusion reactions, became increasingly evident. The past half century has seen the near eradication of transfusion-associated hepatitis as well as the emergence of multiple new pathogens, most notably HIV. Specific donor screening assays and other interventions have minimized, but not eliminated, infectious disease transmission. Other transfusion hazards persist, including human error resulting in the inadvertent transfusion of incompatible blood, acute and delayed transfusion reactions, transfusion-related acute lung injury (TRALI), transfusion-associated graft-versus-host disease (TA-GVHD), and transfusion-induced immunomodulation. These infectious and noninfectious hazards are reviewed briefly in the context of their historical evolution. PMID:18809775

  5. [Organ transplantation and blood transfusion].

    PubMed

    Matignon, M; Bonnefoy, F; Lang, P; Grimbert, P

    2011-04-01

    Pretransplant blood transfusion remains a controversial subject and its history can summarize the last 40 years of transplantation. Until 1971, transfusions were widely used in patients awaiting transplantation, especially due to the anemia induced by the chronic renal dysfunction. Then, a noxious effect of preformed anti-HLA antibodies on renal grafts survival was reported and pretransplant transfusions were stopped. Between 1972 and 1977, improvement of renal graft survival in patients who received pretransplant transfusions was noted. Therefore, from 1978 on, a systematic policy of pretransplant transfusions was adopted by almost all centres of transplantation. During the eighties, it was again abandoned for several reasons: absence of graft survival improvement in patients treated by cyclosporine, HLA immunization leading to an increased incidence of acute graft rejection, risk of viral diseases transmission and human recombinant erythropoietin development. The lack of improvement in graft survival for ten years has been leading the transplant community to look for antigen-specific immunosuppressive strategies to achieve transplantation tolerance. Donor-specific transfusion may have clinical benefits, as long-term grafts survival improvement, through modulation of the recipient's cellular immune system and has been recently reconsidered, especially before living donor transplantation. The immunological mechanisms inducing a tolerance-gaining effect of transfusions are still misunderstood, but the recent discovery of immunomodulatory effects of the apoptotic cells present in cellular products could enlighten our comprehension of pretransplant transfusions benefits and could help to develop specific tolerance induction strategies in solid organ transplantation. PMID:21398160

  6. Blood transfusion practices in sepsis

    PubMed Central

    Murthy, TVSP

    2014-01-01

    Sepsis is a clinical syndrome characterised by systemic inflammation due to infection. There is a spectrum with severity ranging from sepsis to severe sepsis and septic shock. Even with optimal treatment, mortality due to severe sepsis or septic shock is significant and poses a challenge to management. Antibiotics, source control, resuscitation with fluids, vasopressor and inotropic agents are the main-stay of treatment for septic shock. These may be supplemented with transfusion of red blood cells and or blood products, in the case of anaemia to sustain sufficient oxygen delivery[1] or to manage associated haematological issues. Transfusion in sepsis has always been a debatable issue, especially in relation to choice of the fluid and the role of blood or blood product transfusion. PMID:25535429

  7. Immunological complications of blood transfusions.

    PubMed

    Brand, Anneke

    2016-01-01

    Most adverse blood transfusion (BT) events are immune-mediated and in the majority of severe reactions antibodies can be identified as causal factors. Alloimmunization not only causes symptomatic reactions, transfused cells can also be (silently) destroyed. Immunization by BT can contribute to hemolytic disease of the newborn as well as to allograft rejection after transplantation. Reversely, pregnancy and transplantation may evoke immunity hampering transfusion therapy. Besides causing mortality and morbidity, alloimmunization has a huge economic impact. Transfusion reactions prolong hospital stay, require diagnostic tests and complex donor selection procedures and create the need for typed donor registries. In the 1970s, Opeltz and colleagues described that pre-transplantation BT impaired rejection of renal transplants. Leukocytes were essential for this immunosuppressive BT effect that raised concern about negative effects on cancer growth and resistance against infections. Studies on the mechanism were however preliminary abandoned when calcineurin inhibitors for prevention of graft rejection became available and since all blood products underwent leukoreduction in most countries as precautionary measure against transmission of variant Creutzfeldt-Jacob disease. Whether current leukoreduced BT are immunosuppressive and for which patients or circumstances this may contribute to worse outcome, is unknown. The last decades of the previous century, leukoreduction of cellular blood products for leukemia patients significantly reduced the incidence of immunological platelet transfusion refractoriness. The first decade of this century the avoidance of plasma- and platelet-products from females, that may contain donor-derived leukocyte antibodies, decreased transfusion related acute lung injury (TRALI) by more than 30%. These were major achievements. Challenge for the near future is to further reduce alloimmunization in particular against red blood cells (RBC) as a

  8. Blood transfusion economics in Greece.

    PubMed

    Kyriopoulos, J E; Michail-Merianou, V; Gitona, M

    1995-01-01

    This paper describes the organizational structure and the economic impact of blood donation and transfusion in Greece and discusses some alternative aspects of its financing and its costing policy. The cost of blood transfusion is rising in Greece and amounts to nearly 15 billion drachmas per year due to the constant increase in demand and consequently, the price of each unit of blood. The production and distribution of blood on national scale involves meeting the demand for 500.000 units. Blood is mostly given by the friends and relatives of patients (55%) and by voluntary blood donation (30%). Approximately 50% of the blood produced is used in surgery, 20% for cases of beta-thalassaemia, 10% for emergencies and 20% for internal medicine cases. The blood transfusion system is totally funded by the state budget and the value to users is free of charge. The way in which blood is collected and processed differs from one geographical area to another and the unit cost depends on the size of the department concerned, ranging from 60-150 $. The need to control costs and restrain expenditure, in conjunction with guarantees of sufficiency and quality, makes it essential that measures should be taken to introduce economies of scale and encourage competition among blood providers, for increased production, components preparation and rational usage of blood. The introduction of a costing policy becomes necessary in this effort to achieve cost-containment techniques. PMID:8581182

  9. Blood Transfusions (For Teens)

    MedlinePlus

    ... re needed. Blood also collects waste products, like carbon dioxide, and takes them to the organs responsible for ... carry oxygen to the body's tissues and remove carbon dioxide. Red blood cells make up about 40%–45% ...

  10. [Blood transfusion and advertising].

    PubMed

    Mathez, P; Chapuis, S

    2006-09-01

    The Red-Cross and Red-Crescent International Museum has been owning from 1995 a collection (series) of 12,000 posters coming from the International Federation of the Red-Cross and Red-Crescent National Societies. These posters are dedicated to the prevention of diseases and health promotion. Blood donation is featured everywhere in this package. While the interpretation of the whole set is underway, this article presents some of these topics based on the display of some ten posters. PMID:16965926

  11. Perioperative blood transfusions in orthopaedic surgery.

    PubMed

    Ponnusamy, Karthikeyan E; Kim, Thomas J; Khanuja, Harpal S

    2014-11-01

    Blood transfusion after orthopaedic surgery accounts for 10% of all packed red blood-cell transfusions, but use varies substantially across hospitals and surgeons. Transfusions can cause systemic complications, including allergic reactions, transfusion-related acute lung injury, transfusion-associated circulatory overload, graft-versus-host disease, and infections. Tranexamic acid is a new cost-effective blood management tool to reduce blood loss and decrease the risk of transfusion after total joint arthroplasty. Current clinical evidence does not justify transfusions for a hemoglobin level of >8 g/dL in the absence of symptoms. Studies have also supported the use of this trigger in patients with a history or risk of cardiovascular disease. PMID:25378512

  12. [Safer and more appropriate blood transfusion therapy].

    PubMed

    Handa, Makoto

    2015-10-01

    The risks associated with transfusion with blood components have been greatly reduced due to the implementation of innovative strategies for donor selection and testing, as well as safety measures such as universal prestorage leukocyte reduction. However, a variety of residual or unsolved risks, such as severe acute reaction of transfusion-related acute lung injury, transfusion-associated circulatory overload and transfusion-transmitted infections, remain. Patients with hematological disorders are at high risk, since they receive therapeutic interventions frequently requiring transfusion. Thereby, balancing risk and benefit for patients, hematologists should prescribe blood components through evidence-based decision-making, minimize unnecessary transfusions and then conduct safe and error-free transfusion with a standard procedure involving the transfusion process at the bedside. PMID:26458457

  13. Adverse events related to blood transfusion

    PubMed Central

    Sahu, Sandeep; Hemlata; Verma, Anupam

    2014-01-01

    The acute blood transfusion reactions are responsible for causing most serious adverse events. Awareness about various clinical features of acute and delayed transfusion reactions with an ability to assess the serious reactions on time can lead to a better prognosis. Evidence-based medicine has changed today's scenario of clinical practice to decrease adverse transfusion reactions. New evidence-based algorithms of transfusion and improved haemovigilance lead to avoidance of unnecessary transfusions perioperatively. The recognition of adverse events under anaesthesia is always challenging. The unnecessary blood transfusions can be avoided with better blood conservation techniques during surgery and with anaesthesia techniques that reduce blood loss. Better and newer blood screening methods have decreased the infectious complications to almost negligible levels. With universal leukoreduction of red blood cells (RBCs), selection of potential donors such as use of male donors only plasma and restriction of RBC storage, most of the non-infectious complications can be avoided. PMID:25535415

  14. Operative blood transfusion quality improvement audit

    PubMed Central

    Al Sohaibani, Mazen; Al Malki, Assaf; Pogaku, Venumadhav; Al Dossary, Saad; Al Bernawi, Hanan

    2014-01-01

    Context: To determine how current anesthesia team handless the identification of surgical anaesthetized patient (right patient). And the check of blood unit before collecting and immediately before blood administration (right blood) in operating rooms where nurses have minimal duties and responsibility to handle blood for transfusion in anaesthetized patients. Aims: To elicit the degree of anesthesia staff compliance with new policies and procedures for anaesthetized surgical patient the blood transfusion administration. Settings and Design: Setting: A large tertiary care reference and teaching hospital. Design: A prospective quality improvement. Elaboration on steps for administration of transfusion from policies and procedures to anaesthetized patients; and analysis of the audit forms for conducted transfusions. Subjects and Methods: An audit form was used to get key performance indicators (KPIs) observed in all procedures involve blood transfusion and was ticked as item was met, partially met, not met or not applicable. Statistical Analysis Used: Descriptive statistics as number and percentage Microsoft excel 2003. Central quality improvement committee presented the results in number percentage and graphs. Results: The degree of compliance in performing the phases of blood transfusion by anesthesia staff reached high percentage which let us feel certain that the quality is assured that the internal policy and procedures (IPP) are followed in the great majority of all types of red cells and other blood products transfusion from the start of requesting the blood or blood product to the prescript of checking the patient in the immediate post-transfusion period. Conclusions: Specific problem area of giving blood transfusion to anaesthetized patient was checking KPI concerning the phases of blood transfusion was audited and assured the investigators of high quality performance in procedures of transfusion. PMID:25886107

  15. [Blood transfusion: the challenges for tomorrow?].

    PubMed

    Folléa, Gilles; Garraud, Olivier; Tiberghien, Pierre

    2015-02-01

    As any therapeutic means, blood transfusion requires regular evaluation, particularly for its indications, effectiveness and risks. The availability of randomized clinical trials, the evolution of the quality of blood components, and the economic constraints shared by all countries, all lead to rethink both transfusion therapy as a whole and the organization of the transfusion chain from donor to recipient. The main tools available to improve transfusion and the transfusion chain management are the following: programs of patient blood management (PBM) to optimize the use of blood products with a patient centred approach, blood supply management tools to improve the effectiveness and efficiency of the transfusion chain, donor management tools to adapt donor collections to the patients' needs in compliance with safety requirements for patients and donors, and coordination of these activities. A better understanding of these tools and their implementation will certainly be major challenges for transfusion medicine in the near future. Integrating these evolutions in regulations through the revision of the European Directives on blood and blood components (the review process is expected to be launched in 2015) should enroll them in the long term, for the benefit of patients, donors and all other stakeholders involved in the transfusion chain. PMID:25578549

  16. Red blood cell transfusion in newborn infants.

    PubMed

    Whyte, Robin K; Jefferies, Ann L

    2014-04-01

    Red blood cell transfusion is an important and frequent component of neonatal intensive care. The present position statement addresses the methods and indications for red blood cell transfusion of the newborn, based on a review of the current literature. The most frequent indications for blood transfusion in the newborn are the acute treatment of perinatal hemorrhagic shock and the recurrent correction of anemia of prematurity. Perinatal hemorrhagic shock requires immediate treatment with large quantities of red blood cells; the effects of massive transfusion on other blood components must be considered. Some guidelines are now available from clinical trials investigating transfusion in anemia of prematurity; however, considerable uncertainty remains. There is weak evidence that cognitive impairment may be more severe at follow-up in extremely low birth weight infants transfused at lower hemoglobin thresholds; therefore, these thresholds should be maintained by transfusion therapy. Although the risks of transfusion have declined considerably in recent years, they can be minimized further by carefully restricting neonatal blood sampling. PMID:24855419

  17. Blood transfusion costs: a multicenter study.

    PubMed

    Forbes, J M; Anderson, M D; Anderson, G F; Bleecker, G C; Rossi, E C; Moss, G S

    1991-05-01

    The cost of delivering a unit of blood (whole blood or red cells) to a hospitalized patient was examined in 19 United States teaching hospitals. The average hospital acquisition cost was calculated by using the prices charged by regional blood centers for blood products. To this cost was added an estimate of costs incurred by hospitals for handling, testing, and administering blood. Across study sites, the average hospital cost per unit transfused was $155 and the average charge to the patient was $219. Acquisition cost, the price that hospitals pay for blood, was 37 percent of the total cost to the hospital; the other 63 percent of the hospital cost included costs for blood bank handling (13%), laboratory tests (43%), and blood administration (7%). Significant variations in blood transfusion cost were found within our sample. Most of the variability can be attributed to geographic location of the blood supply source, type of red cell product transfused, prices charged by blood transfusion services, and the frequency of laboratory tests. The results of this transfusion cost study may be helpful in determining the costs of health care delivery, especially when blood transfusions are indicated. PMID:2020994

  18. Blood Donation and Transfusion: A Primer for Health Educators.

    ERIC Educational Resources Information Center

    Felts, W. Michael; Glascoff, Mary A.

    1991-01-01

    Presents a primer for health educators about blood donation and transfusion, examining the nature of human blood, the background of blood transfusion, blood donation criteria, risks related to homologous blood transfusion, directed blood donation, potential alternatives to homologous transfusion, and resources for education on the subject. (SM)

  19. Lichenoid Variant of Chronic Cutaneous Graft Versus Host Reaction Post Blood Transfusion: A Rare Event Post Blood Transfusion

    PubMed Central

    Ramakrishnaiah, Pushpa Kodipalya; Lakshman, Archana; Aradhya, Sacchidanand Sarvajnamurthy; Veerabhadrappa, Nataraja Holavanahally

    2015-01-01

    Chronic graft versus host disease (GVHD) is a less frequently seen disease that occurs post solid organ or bone marrow transplantation. Chronic GVHD occurring post blood transfusion is an even more uncommon disease. It can present either as a lichenoid disease or as a sclerodermatous disease involving multiple systems. In this article, we report a case of chronic graft versus host reaction occurring in skin secondary to blood transfusion. PMID:26538747

  20. [Single-donor protocol: Transfusion practices and multiple transfusion risk factors in neonatal intensive care unit].

    PubMed

    Dollat, C; Pierron, C; Keslick, A; Billoir, E; François, A; Jarreau, P-H

    2016-09-01

    In France since 2002, the single-donor transfusion protocol, using four pediatric units from the same adult donor's packed red blood cells (PRBCs) in multiply transfused newborns, is recommended in preterm neonates to reduce the risks of infection and alloimmunization. This protocol is controversial, however, because it causes the transfusion of stored blood, which could have adverse consequences. Before the new recommendations of the French Haute Autorité de santé (National authority for health) in 2015, we conducted a national practice survey in 63 neonatal intensive care units (NICU) and a retrospective study of the characteristics of 103 children transfused within our unit, to better target beneficiaries. The practice survey showed that 30 % of French NICUs no longer used the protocol in 2014, due to logistical or financial problems, or concerns about the transfusion of stored blood. The practices were heterogeneous. Few NICUs used a written protocol. In our NICU, the use of single-donor protocol involved the use of units stored for more than 20 days in half of the cases beginning with the third unit used. Six-term newborns were mainly transfused once, which does not seem to warrant the single-donor transfusion protocol. The use of this protocol caused the loss of 50 % of the manufactured units, which go unused. In multivariate analysis, two factors were predictive of multiple transfusion within our population of 95 premature neonates undergoing transfusion: low-term and a high Clinical Risk Index for Babies (CRIB) score. The risk of multiple transfusions would be reduced by about 15 % for each additional week of gestation and approximately 16 % per point within the CRIB score. These variables integrated into a statistical model predict the risk of multiplying transfusions. According to the ROC curve, a calculated risk higher than 50 % is the appropriate cut-off value to transfuse with the single-donor transfusion protocol. This would limit its

  1. Emerging risks and outcomes of blood transfusion in surgery.

    PubMed

    Shander, Aryeh

    2004-01-01

    Prior to 1900, blood transfusions were fraught with danger and often caused more complications than the underlying disease. Discovery of the ABO compatibility system in the early twentieth century opened the modern era of blood transfusion, yet ABO incompatibility-as a result of clerical error-remains a significant threat to the recipient today. The risk of disease transmission now includes new and emerging agents, such as Trepanosoma cruzii and West Nile Virus (WNV), as well as other existing pathogens. Transfusion-related immunomodulation (TRIM) presents a further risk to recipient patients. Confounding these problems are shortages of safe blood and the accelerated rise in the cost of blood due to increased testing. Outcome data on transfusion therapy have not always been favorable, particularly in the areas of postoperative infection, systemic inflammatory response syndrome (SIRS), multiple organ failure (MOF), and mortality. Such data have generated extensive efforts to determine association versus underlying cause of post-transfusion complications. In addition, unprecedented global initiatives to minimize the use of allogeneic blood are on the way. Options may include, but are not limited to, the use of "blood substitutes," although validation of such products is still required. In the meantime, blood product conservation techniques should become part of routine transfusion medicine. PMID:14872432

  2. Why an alternative to blood transfusion?

    PubMed

    Shander, Aryeh; Goodnough, Lawrence Tim

    2009-04-01

    Allogeneic blood transfusions have been associated with several risks and complications and with worse outcomes in a substantial number of patient populations and clinical scenarios. Allogeneic blood is costly and difficult to procure, transport, and store. Global and local shortages are imminent. Alternatives to transfusion provide many advantages, and their use is likely to improve outcomes as safer and more effective agents are developed. PMID:19341908

  3. Quality of transfusion products in blood banking.

    PubMed

    Franchini, Massimo; Capuzzo, Enrico; Turdo, Rosalia; Glingani, Claudia

    2014-03-01

    The primary goal in transfusion medicine and cellular therapies is to promote high standards of quality and produce ever safer and more efficacious products. The establishment of a transfusion service quality management system, which includes several organizational structures, responsibilities, policies, processes, procedures, and resources, is now mandatory and widely regulated worldwide. In this review, we summarize the current knowledge on the quality system in transfusion medicine as applied to the production of blood components, including red blood cells, platelets, and fresh frozen plasma. PMID:24474089

  4. [Blood transfusion and supply chain management safety].

    PubMed

    Quaranta, Jean-François; Caldani, Cyril; Cabaud, Jean-Jacques; Chavarin, Patricia; Rochette-Eribon, Sandrine

    2015-02-01

    The level of safety attained in blood transfusion now makes this a discipline better managed care activities. This was achieved both by scientific advances and policy decisions regulating and supervising the activity, as well as by the quality system, which we recall that affects the entire organizational structure, responsibilities, procedures, processes and resources in place to achieve quality management. So, an effective quality system provides a framework within which activities are established, performed in a quality-focused way and continuously monitored to improve outcomes. This system quality has to irrigate all the actors of the transfusion, just as much the establishments of blood transfusion than the health establishments. PMID:25578550

  5. Adverse blood transfusion outcomes: establishing causation.

    PubMed

    Isbister, James P; Shander, Aryeh; Spahn, Donat R; Erhard, Jochen; Farmer, Shannon L; Hofmann, Axel

    2011-04-01

    The transfusion of allogeneic red blood cells (RBCs) and other blood components is ingrained in modern medical practice. The rationale for administering transfusions is based on key assumptions that efficacy is established and risks are acceptable and minimized. Despite the cliché that, "the blood supply is safer than ever," data about risks and lack of efficacy of RBC transfusions in several clinical settings have steadily accumulated. Frequentist statisticians and clinicians demand evidence from randomized clinical trials (RCTs); however, causation for the recognized serious hazards of allogeneic transfusion has never been established in this manner. On the other hand, the preponderance of evidence implicating RBC transfusions in adverse clinical outcomes related to immunomodulation and the storage lesion comes from observational studies, and a broad and critical analysis to evaluate causation is overdue. It is suggested in several circumstances that this cannot wait for the design, execution, and conduct of rigorous RCTs. We begin by examining the nature and definition of causation with relevant examples from transfusion medicine. Deductive deterministic methods may be applied to most of the well-accepted and understood serious hazards of transfusion, with modified Koch's postulates being fulfilled in most circumstances. On the other hand, when several possible interacting risk factors exist and RBC transfusions are associated with adverse clinical outcomes, establishing causation requires inferential probabilistic methodology. In the latter circumstances, the case for RBC transfusions being causal for adverse clinical outcomes can be strengthened by applying modified Bradford Hill criteria to the plethora of existing observational studies. This being the case, a greater precautionary approach to RBC transfusion is necessary and equipoise that justifying RCTs may become problematic. PMID:21345639

  6. [Immunoreaction and blood transfusion--chairmen's introductory remarks].

    PubMed

    Kawabe, Tsutomu; Matsushita, Tadashi

    2013-05-01

    Although blood transfusion is an extremely important therapeutic procedure that usually proceeds without complications, there are some risks associated with donated blood. Investigations into the causes of transfusion reactions and their prevention are important issues for transfusion therapy. In addition to nucleic acid amplification testing (NAT) for infectious diseases and the irradiation of blood to prevent post-transfusion GVHD, prestorage leukocyte reduction and diversion of the first part of the donation of blood were recently introduced into transfusion therapy. This symposium, entitled "Immunoreaction and blood transfusion", reviewed the immune responses associated with blood transfusion, which is probably the most frequent medical procedure performed in allogeneic organ transplantation, with four themes provided by the four featured invited speakers: transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), high-dose intravenous immunoglobulin therapy for chronic inflammatory demyelinating polyradiculoneuropathy, transfusion-transmitted infectious disease surveillance, and transfusion-related immunomodulation. PMID:23947177

  7. Profiles of blood and blood component transfusion recipients in Zimbabwe

    PubMed Central

    Mafirakureva, Nyashadzaishe; Khoza, Star; Hassall, Oliver; Faragher, Brian E.; Kajja, Isaac; Mvere, David A.; Emmanuel, Jean C.; Postma, Maarten J.; van Hulst, Marinus

    2015-01-01

    Background There are limited published data on the characteristics of blood transfusion recipients in sub-Saharan Africa. This study describes the demographic characteristics of blood transfusion recipients and patterns of blood and blood component use in Zimbabwe. Materials and methods Data on the characteristics of the blood transfusion recipients (age, sex, blood group), blood components received (type, quantity), discharge diagnoses and outcomes following transfusion (discharge status, duration of stay in hospital), were retrospectively collected from four major hospitals for the period from January 1, 2012 to December 31, 2012. Diagnoses were grouped into broad categories according to the disease headings of the International Classification of Diseases (ICD-10). Surgical procedures were grouped into broad categories according to organ system using ICD-9. Results Most of the 1,793 transfusion recipients studied were female (63.2%) and in the reproductive age group, i.e. 15–49 years (65.3%). The median age of the recipients was 33 years (range, 0–93). The majority of these recipients (n=1,642; 91.6%) received a red blood cell transfusion. The majority of the patients were diagnosed with conditions related to pregnancy and childbirth (22.3%), and diseases of blood and blood-forming organs (17.7%). The median time spent in hospital was 8 days (range, 0–214) and in-hospital mortality was 15.4%. Discussion Our sample of blood transfusion recipients were fairly young and most of them received red blood cell transfusions. The majority of patients in the reproductive age group received blood transfusions for pregnancy and childbirth-related diagnoses. PMID:26192782

  8. Transfusion and blood donation in comic strips.

    PubMed

    Lefrère, Jean-Jacques; Danic, Bruno

    2013-07-01

    The representation of blood transfusion and donation of blood in the comic strip has never been studied. The comic strip, which is a relatively recent art, emerged in the 19th century before becoming a mass medium during the 20th century. We have sought, by calling on collectors and using the resources of Internet, comic strips devoted, wholly or in part, to the themes of transfusion and blood donation. We present some of them here in chronologic order, indicating the title, country of origin, year of publication, and names of authors. The theme of the superhero using transfusion to transmit his virtues or his powers is repeated throughout the 20th century in North American comic strips. More recently, comic strips have been conceived from the outset with a promotional aim. They perpetuate positive images and are directed toward a young readership, wielding humor to reduce the fear of venipuncture. Few comic strips denounce the abuse of the commercialization of products derived from the human body. The image of transfusion and blood donation given by the comic strips is not to be underestimated because their readership is primarily children, some of whom will become blood donors. Furthermore, if some readers are transfused during their lives, the impact of a memory more or less conscious of these childhood readings may resurface, both in hopes and in fears. PMID:23643789

  9. Why People with Cancer Might Need Blood Transfusions

    MedlinePlus

    ... saved articles window. My Saved Articles » My ACS » Blood Transfusion and Donation + - Text Size Download Printable Version [PDF] » TOPICS Document ... Possible risks of blood transfusions Alternatives to blood transfusions Donating blood Blood donation by cancer survivors To learn more References Previous ...

  10. Toward a patient-based paradigm for blood transfusion

    PubMed Central

    Farrugia, Albert; Vamvakas, Eleftherios

    2014-01-01

    The current “manufacturing paradigm” of transfusion practice has detached transfusion from the clinical environment. As an example, fresh whole blood in large-volume hemorrhage may be superior to whole blood reconstituted from multiple components. Multicomponent apheresis can overcome logistical difficulties in matching patient needs with fresh component availability and can deliver the benefits of fresh whole blood. Because of the different transfusion needs of patients in emerging economies and the vulnerability of these blood systems to emerging infections, fresh whole blood and multicomponent apheresis can better meet patient needs when compared with transplants of the “manufacturing paradigm”. We propose that patient blood management, along with panels of repeat, paid, accredited apheresis and fresh whole-blood donors can be used in emerging economies to support decentralized blood services. This alternative transfusion–medicine paradigm could eventually also be adopted by established economies to focus transfusion medicine on local patient needs and to alleviate the problem of the aging volunteer donor base. PMID:24520208

  11. Blood transfusion before radiation for malignancies

    SciTech Connect

    Hunt, T.K. )

    1989-10-27

    This editorial discusses the situation of administering blood to patients prior to radiotherapy in an attempt to increase tissue/tumor oxygen tension. The author believes that since the rate at which tumor cells consume oxygen is highly variable, the aim of achieving high cellular oxygen tension may be met better by maintaining a high blood perfusion rate. Blood volume can be maintained without relying on transfusion, and safer alternatives are available.

  12. Autologous Blood Transfusion in Sports: Emerging Biomarkers.

    PubMed

    Salamin, Olivier; De Angelis, Sara; Tissot, Jean-Daniel; Saugy, Martial; Leuenberger, Nicolas

    2016-07-01

    Despite being prohibited by the World Anti-Doping Agency, blood doping through erythropoietin injection or blood transfusion is frequently used by athletes to increase oxygen delivery to muscles and enhance performance. In contrast with allogeneic blood transfusion and erythropoietic stimulants, there is presently no direct method of detection for autologous blood transfusion (ABT) doping. Blood reinfusion is currently monitored with individual follow-up of hematological variables via the athlete biological passport, which requires further improvement. Microdosage is undetectable, and suspicious profiles in athletes are often attributed to exposure to altitude, heat stress, or illness. Additional indirect biomarkers may increase the sensitivity and specificity of the longitudinal approach. The emergence of "-omics" strategies provides new opportunities to discover biomarkers for the indirect detection of ABT. With the development of direct quantitative methods, transcriptomics based on microRNA or messenger RNA expression is a promising approach. Because blood donation and blood reinfusion alter iron metabolism, quantification of proteins involved in metal metabolism, such as hepcidin, may be applied in an "ironomics" strategy to improve the detection of ABT. As red blood cell (RBC) storage triggers changes in membrane proteins, proteomic methods have the potential to identify the presence of stored RBCs in blood. Alternatively, urine matrix can be used for the quantification of the plasticizer di(2-ethyhexyl)phthalate and its metabolites that originate from blood storage bags, suggesting recent blood transfusion, and have an important degree of sensitivity and specificity. This review proposes that various indirect biomarkers should be applied in combination with mathematical approaches for longitudinal monitoring aimed at improving ABT detection. PMID:27260108

  13. Perioperative Red Blood Cell Transfusion: What We Do Not Know

    PubMed Central

    Lei, Chong; Xiong, Li-Ze

    2015-01-01

    Objective: Blood transfusion saves lives but may also increase the risk of injury. The objective of this review was to evaluate the possible adverse effects related to transfusion of red blood cell (RBC) concentrates stored for prolonged periods. Data Sources: The data used in this review were mainly from PubMed articles published in English up to February 2015. Study Selection: Clinical and basic research articles were selected according to their relevance to this topic. Results: The ex vivo changes to RBC that occur during storage are collectively called storage lesion. It is still inconclusive if transfusion of RBC with storage lesion has clinical relevance. Multiple ongoing prospective randomized controlled trials are aimed to clarify this clinical issue. It was observed that the adverse events related to stored RBC transfusion were prominent in certain patient populations, including trauma, critical care, pediatric, and cardiac surgery patients, which leads to the investigation of underlying mechanisms. It is demonstrated that free hemoglobin toxicity, decreasing of nitric oxide bioavailability, and free iron-induced increasing of inflammation may play an important role in this process. Conclusion: It is still unclear whether transfusion of older RBC has adverse effects, and if so, which factors determine such clinical effects. However, considering the magnitude of transfusion and the widespread medical significance, potential preventive strategies should be considered, especially for the susceptible recipients. PMID:26315088

  14. Blood doping: the flip side of transfusion and transfusion alternatives.

    PubMed

    Cacic, Daniel Limi; Hervig, Tor; Seghatchian, Jerard

    2013-08-01

    Blood doping in sports has been a hot topic of present. Longitudinal follow up of hematological parameters in different endurance sports, during the 1990s and early 2000s, has provided considerable suspicions about extensive blood manipulation, with performance enhancing effects. Recent doping revelations in the media also prove that blood doping is not an anticipated myth but it is, in fact, real. Erythropoiesis stimulating agents and autologous blood transfusions are used in synergy with substantial effect on the maximum oxygen uptake and delivery to muscles. Whilst both methods of blood manipulation represent a potential health hazard, in the context of an elevated hematocrit, nevertheless despite a number of suspicious deaths amongst athletes, this has not yet been fully documented. A reliable test for detection of recombinant human erythropoietin was implemented in 2000, but this is probably circumvented by microdose regimens. The Athlete's Biological Passport represents the progeny of the idea of an indirect approach based on long term monitoring of hematological parameters, thus making it possible to detect autologous blood doping and erythropoietin use after the substance is excreted. Nevertheless with advances in anti-doping measures it is possible that the levels of excretion of substances used can be masked. Clearly more sensitive and specific diagnostic tools and research/development in these areas of major concern are warranted, which, combined with changes in the athlete's attitude, will help in reaching the vision of fair play. PMID:23791798

  15. Precautions and Adverse Reactions during Blood Transfusion

    MedlinePlus

    ... the transfused blood after it is collected. In addition to an increase in temperature, the person has chills and sometimes headache or back pain. Sometimes the person also has symptoms of an allergic reaction such as itching or a rash. Usually, acetaminophen ...

  16. Clinical Response and Transfusion Reactions of Sheep Subjected to Single Homologous Blood Transfusion

    PubMed Central

    Sousa, Rejane Santos; Minervino, Antonio Humberto Hamad; Araújo, Carolina Akiko Sato Cabral; Rodrigues, Frederico Augusto Mazzocca Lopes; Oliveira, Francisco Leonardo Costa; Zaminhan, Janaina Larissa Rodrigues; Moreira, Thiago Rocha; Sousa, Isadora Karolina Freitas; Ortolani, Enrico Lippi; Barrêto Júnior, Raimundo Alves

    2014-01-01

    Studies in relation to blood conservation and responses to transfusion are scarce for ruminants. We evaluated the clinical manifestations of sheep that received a single homologous transfusion of whole blood, focusing on transfusion reactions. Eighteen adult sheep were subjected to a single phlebotomy to withdraw 40% of the total blood volume, which was placed into CPDA-1 bags and then divided into G0, animals that received fresh blood, and G15 and G35, animals that received blood stored for 15 or 35 days, respectively. Clinical observations were recorded throughout the transfusion, whereas heart rate, respiratory rate, and rectal temperature were assessed at the following times: 24 hours after phlebotomy and before transfusion; 30 minutes, six, twelve, 24, 48, 72, and 96 hours and eight and 16 days after transfusion. All groups presented transfusion reactions, among which hyperthermia was the most frequent (50% of animals). Tachycardia occurred most frequently in the G35 animals (50% of them). During transfusion G35 animals presented more clinical manifestation (P < 0.05). Transfusion of fresh or stored total blood improved the blood volume, but transfusion reactions occurred, demonstrating that a single transfusion of fresh or stored blood can cause inflammatory and febrile nonhemolytic transfusion reactions in sheep. PMID:25544959

  17. Photodynamic decontamination of blood for transfusion

    NASA Astrophysics Data System (ADS)

    Ben-Hur, Ehud; Margolis-Nunno, H.; Gottlieb, P.; Lustigman, S.; Horowitz, Bernard

    1995-01-01

    Currently transfused cellular components of blood are not available in a sterile form and carry a small risk of transmitting viral and parasite diseases. Using phthalocyanines and red light, lipid enveloped viruses, e.g., HIV-1, can be inactivated in red blood cell concentrates (RBCC). Under conditions leading to virus sterilization the blood borne parasites Trypanosoma cruzi (Chagas disease) and Plasmodium falciparum (malaria) could be eliminated to undetectable levels (> 4 log10 kill). RBC damage during treatment could be avoided by increasing the light fluence rate to 80 mW/cm2, and by including the free radical scavenger glutathione and the vitamin E derivative Trolox during light exposure. Similar sterilization of platelet concentrates was achieved with the psoralen derivative AMT and UVA light. Platelet damage due to PUVA treatment was avoided by including the plant flavonoid rutin during irradiation. It is concluded that elimination of the risk of transmitting pathogens during blood transfusion is feasible with photochemical treatments.

  18. Blood transfusion safety: a new philosophy.

    PubMed

    Franklin, I M

    2012-12-01

    Blood transfusion safety has had a chequered history, and there are current and future challenges. Internationally, there is no clear consensus for many aspects of the provision of safe blood, although pan-national legislation does provide a baseline framework in the European Union. Costs are rising, and new safety measures can appear expensive, especially when tested against some other medical interventions, such as cancer treatment and vaccination programmes. In this article, it is proposed that a comprehensive approach is taken to the issue of blood transfusion safety that considers all aspects of the process rather than considering only new measures. The need for an agreed level of safety for specified and unknown risks is also suggested. The importance of providing care and support for those inadvertently injured as a result of transfusion problems is also made. Given that the current blood safety decision process often uses a utilitarian principle for decision making--through the calculation of Quality Adjusted Life Years--an alternative philosophy is proposed. A social contract for blood safety, based on the principles of 'justice as fairness' developed by John Rawls, is recommended as a means of providing an agreed level of safety, containing costs and providing support for any adverse outcomes. PMID:23171300

  19. Effect of blood transfusions on canine renal allograft survival

    SciTech Connect

    van der Linden, C.J.; Buurman, W.A.; Vegt, P.A.; Greep, J.M.; Jeekel, J.

    1982-04-01

    In this study significantly prolonged canine renal allograft survival has been demonstrated after transfusion of 100 ml of third-party whole blood given peroperatively. Peroperative transfusions of third-party leukocyte-free blood or pure lymphocyte cell suspensions did not influence graft survival. Furthermore, no improvement in graft survival has been found after a peroperative transfusion of irradiated whole blood (2500 rad). These data suggest that delayed graft rejection after blood transfusions can only be expected after the administration of whole blood. The role of competent lymphocytes in whole blood is questionable, since a transfusion or irradiated whole blood in combination with nonirradiated lymphocytes did not lead to prolonged graft survival. Immunosuppression of the recipient directly after transfusion seems to be essential to induce the beneficial effect of blood transfusions. This has been demonstrated for a transfusion of whole blood 14 days before transplantation. A single transfusion of 100 ml of whole blood 14 days before transplantation could effectively prolong graft survival if immunosuppression with azathioprine and prednisone was started on the day of transfusion. No improvement in graft survival has been found with such a transfusion if preoperative immunosuppression has been omitted.

  20. Management of patients who refuse blood transfusion

    PubMed Central

    Chand, N Kiran; Subramanya, H Bala; Rao, G Venkateswara

    2014-01-01

    A small group of people belonging to a certain religion, called Jehovah's witness do not accept blood transfusion or blood products, based on biblical readings. When such group of people are in need of health care, their faith and belief is an obstacle for their proper treatment, and poses legal, ethical and medical challenges for attending health care provider. Due to the rapid growth in the membership of this group worldwide, physicians attending hospitals should be prepared to manage such patients. Appropriate management of such patients entails understanding of ethical and legal issues involved, providing meticulous medical management, use of prohaemostatic agents, essential interventions and techniques to reduce blood loss and hence, reduce the risk of subsequent need for blood transfusion. An extensive literature search was performed using search engines such as Google scholar, PubMed, MEDLINE, science journals and textbooks using keywords like ‘Jehovah's witness’, ‘blood haemodilution’, ‘blood salvage’ and ‘blood substitutes’. PMID:25535432

  1. Red blood cell transfusion in pediatric patients with severe chronic anemia: how slow is necessary?

    PubMed

    Agrawal, Anurag K; Hsu, Edmund; Quirolo, Keith; Neumayr, Lynne D; Flori, Heidi R

    2012-03-01

    Historic practice recommends slow transfusion for children with chronic anemia and hemoglobin less than 5.0 g/dl due to the theoretical risk of transfusion-associated circulatory overload (TACO). In our pediatric intensive care unit (PICU), we have been utilizing a more liberal transfusion practice in patients without underlying cardiopulmonary disease, and a faster transfusion rate appears safe in this population. Rate of transfusion must be based on multiple factors including convenience, timeliness of procedures and transport to an appropriate care facility, risk of alloimmunization and wastage of blood, stress for the family, and need for PICU monitoring. PMID:21793178

  2. Precautions surrounding blood transfusion in autoimmune haemolytic anaemias are overestimated

    PubMed Central

    Yürek, Salih; Mayer, Beate; Almahallawi, Mohammed; Pruss, Axel; Salama, Abdulgabar

    2015-01-01

    Background It is very evident that many precautions are taken regarding transfusion of red blood cells in patients with autoimmune haemolytic anaemia. Frequently, considerable efforts are made to examine the indication and serological compatibility prior to transfusion in such patients. However, at times, this may unnecessarily jeopardize patients who urgently require a red blood cell transfusion. Materials and methods Thirty-six patients with warm-type autoimmune haemolytic anaemia were included in this study. All patients had reactive serum autoantibodies and required blood transfusion. Standard serological assays were employed for the detection and characterization of antibodies to red blood cells. Results A positive direct antiglobulin test was observed in all 36 patients, in addition to detectable antibodies in both the eluate and serum. Significant alloantibodies were detected in the serum samples of three patients (anti-c, anti-JKa, and anti-E). In 32 patients, red blood cell transfusion was administered with no significant haemolytic transfusion reactions due to auto- and/or allo-antibodies. Due to overestimation of positive cross-matches three patients received no transfusion or delayed transfusion and died, and one patient died due to unrecognised blood loss and anaemia which was attributed to an ineffective red blood cell transfusion. Discussion Many of the reported recommendations regarding transfusion of red blood cells in autoimmune haemolytic anaemia are highly questionable, and positive serological cross-matches should not result in a delay or refusal of necessary blood transfusions. PMID:26192772

  3. [Methologic contribution to blood transfusion materials surveillance].

    PubMed

    Roussel, P; Pujol-Rey, A; Arzur, C

    2001-08-01

    To reduce seriousness and frequency of iatrogenic risk implies prevention policies and efficient operational systems for vigilance. This risk management implies definition of precise organizations and procedures able to locate and to notify quickly undesirable events. This is the case about single use medical devices (SUMD) used in blood transfusion. This article is a contribution to the organisation of the implemented material vigilance in blood transfusion, collectively carried out with actors concerned (users, manufacturers, National Commission for Material Vigilance). It presents a lot of tools and methods to favour practices harmonization, as well as preventive a curative (specifications before purchase, main part of the quality contract between customer and supplier; internal control plan; index for medical device used in transfusion; illustrated glossaries for three main families of medical devices; index about symptomatic events; definitions of seriousness levels with their operational consequences; methods to manage a single use medical device judged as defective; tool for the review of incidents according to reference and batch). Then, the management of incidents about SUMD is presented within a material vigilance system integrated into the quality system of the institution, for user as for manufacturer. This is done in a chronological order with successively description of the incident, the assessment of the impact, the management of the associated risk, the periodical review of incidents and management of matters in dispute. PMID:11642028

  4. [Necessity of a 24-hour system of blood transfusion testing].

    PubMed

    Kishimoto, Yuji

    2003-01-01

    The preventive effects of a 24-hour system of blood transfusion testing on mistyping of transfused blood was examined. Blood transfusion tests have been performed by blood transfusion technologists during working hours and by physicians at other times. In March 2000, we introduced a system in which technologists perform blood transfusion tests after working hours. Technologists of the Blood Transfusion Unit and Central Clinical Laboratory perform the test jointly, and column agglutination technology was introduced as the test method. A computer system setup exclusively for the testing was also introduced to perform computer cross-matching. Since transfusion error is likely to occur during emergency blood transfusion, a manual was established to prioritize safety. After introduction of the system, mistyping that may have been caused by inaccurate blood test results markedly decreased, confirming the usefulness of this system for prevention of mistyping. In addition, transfusion errors also decreased in wards and the improved system increased the safety of the entire medical care system. The frequency of mistyping was about 1% when physicians performed blood typing, showing the importance of clinical technologists for blood transfusion tests. PMID:12652691

  5. Effect of blood transfusions on canine renal allograft survival

    SciTech Connect

    Van Der Linden, C.J.; Buurman, W.A.; Vegt, P.A.; Greep, J.M.; Jeekel, J.

    1982-04-01

    In this study significantly prolonged canine renal allograft survival has been demonstrated after transfusion of 100 ml of third-party whole blood given peroperatively. Peroperative transfusions of third-party leukocyte-free blood or pure lymphocyte cell suspensions did not influence graft survival. Futhermore, no improvement in graft survival has been found after a peroperative transfuson of irradiated whole blood (2500 rad). These data suggest that delayed graft rejection after blood transfusions can only be expected after the administration of whole blood. The role of competent lymphocytes in whole blood is questionable, since a transfusion of irradiated whole blood in combination with nonirradiated lymphocytes did not lead to prolonged graft survival. Immunosuppression of the recipient directly after transfusion seems to be essential to induce the beneficial effect of blood transfusions. This has been demonstrated for a transfusion of whole blood 14 days before transplantation. A single transfusion of 100 ml of whole blood 14 days before transplantation could effectively prolong graft survival if immunosuppression with azathioprine and prednisone was started on the day of transfusion. No improvement in graft survival has been found with such a transfusion if preoperative immunosuppression has been omitted.

  6. Blood transfusion: patient identification and empowerment.

    PubMed

    Stout, Lynn; Joseph, Sundari

    Positive patient identification is pivotal to several steps of the transfusion process; it is integral to ensuring that the correct blood is given to the correct patient. If patient misidentification occurs, this has potentially fatal consequences for patients. Historically patient involvement in healthcare has focused on clinical decision making, where the patient, having been provided with medical information, is encouraged to become involved in the decisions related to their individualised treatment. This article explores the aspects of patient contribution to patient safety relating to positive patient identification in transfusion. When involving patients in their care, however, clinicians must recognise the diversity of patients and the capacity of the patient to be involved. It must not be assumed that all patients will be willing or indeed able to participate. Additionally, clinicians' attitudes to patient involvement in patient safety can determine whether cultural change is successful. PMID:26878405

  7. Economic impact of blood transfusions: balancing cost and benefits.

    PubMed

    Oge, Tufan; Kilic, Cemil Hakan; Kilic, Gokhan Sami

    2014-02-01

    Blood transfusions may be lifesaving, but they inherit their own risks. Risk of transfusion to benefit is a delicate balance. In addition, blood product transfusions purchases are one of the largest line items among the hospital and laboratory charges. In this review, we aimed to discuss the transfusion strategies and share our transfusion protocol as well as the steps for hospitals to build-up a blood management program while all these factors weight in. Moreover, we evaluate the financial burden to the health care system. PMID:25610294

  8. What Are the Risks of a Blood Transfusion?

    MedlinePlus

    ... the transfusion can safely be restarted. Viruses and Infectious Diseases Some infectious agents, such as HIV, can survive in blood and infect the person receiving the blood transfusion. To keep blood safe, blood ... Creutzfeldt-Jakob disease (vCJD). This disease is the human version of ...

  9. Reducing noninfectious risks of blood transfusion.

    PubMed

    Gilliss, Brian M; Looney, Mark R; Gropper, Michael A

    2011-09-01

    As screening for transfusion-associated infections has improved, noninfectious complications of transfusion now cause the majority of morbidity and mortality associated with transfusion in the United States. For example, transfusion-related acute lung injury, transfusion-associated circulatory overload, and hemolytic transfusion-reactions are the first, second, and third leading causes of death from transfusion, respectively. These complications and others are reviewed, and several controversial methods for prevention of noninfectious complications of transfusion are discussed, including universal leukoreduction of erythrocyte units, use of male-only plasma, and restriction of erythrocyte storage age. PMID:21792054

  10. [Hepatitis E virus: Blood transfusion implications].

    PubMed

    Gallian, P; Piquet, Y; Assal, A; Djoudi, R; Chiaroni, J; Izopet, J; Tiberghien, P

    2014-11-01

    Hepatitis E virus (HEV) is a non-enveloped RNA virus transmitted by the fecal-oral route. Autochthonous hepatitis E occurring in developed countries is caused by genotypes 3 and 4 and is a zoonotic infection. Humans are infected mostly after ingestion of undercooked meat from infected animals. Most HEV 3 and 4 infections are clinically inapparent. However, genotype 3 (HEV 3) can lead to chronic hepatitis in immuno-compromised patients such as organ-transplant recipients and patients with haematological malignancies. In Europe, HEV 3 is implicated in transfusion-transmitted HEV infection. In France, as observed in several European countries, prevalence of HEV RNA and specific IgG antibodies are high indicating that viral circulation is important. The systematic HEV NAT screening of blood donations used for preparation of solvent detergent plasma indicate that 1 to 2218 donation is infected by HEV RNA. The need or implementation's impacts of safety measures to prevent HEV transmission by blood transfusion are under reflexion by French's health authorities. The HEV NAT screening is the only available tool of prevention. Alternative strategies are under investigation including individual or mini pool NAT testing all or part of blood donations. PMID:25267201

  11. A review of the application of autologous blood transfusion.

    PubMed

    Zhou, J

    2016-01-01

    Autologous blood transfusion (ABT) has been gradually attracting more attention due to the increasingly prominent problem of blood transfusion safety and blood shortage in recent years. With the rapid development of blood conservation techniques, blood component separation technology, blood transfusion medicine and a constant increase in clinical needs, ABT technology has been expanded and innovated to a large degree. In this study, the development of preoperative autologous blood donation (PABD), acute normovolemic hemodilution (ANH), intraoperative and postoperative autotransfusion, and other new technologies and theories are reviewed and existing questions are analyzed. Challenges and applications are also discussed in order to provide reference for peers. PMID:27533770

  12. A review of the application of autologous blood transfusion

    PubMed Central

    Zhou, J.

    2016-01-01

    Autologous blood transfusion (ABT) has been gradually attracting more attention due to the increasingly prominent problem of blood transfusion safety and blood shortage in recent years. With the rapid development of blood conservation techniques, blood component separation technology, blood transfusion medicine and a constant increase in clinical needs, ABT technology has been expanded and innovated to a large degree. In this study, the development of preoperative autologous blood donation (PABD), acute normovolemic hemodilution (ANH), intraoperative and postoperative autotransfusion, and other new technologies and theories are reviewed and existing questions are analyzed. Challenges and applications are also discussed in order to provide reference for peers. PMID:27533770

  13. Total quality management in blood transfusion.

    PubMed

    Smit-Sibinga, C T

    2000-01-01

    Quality management is an ongoing development resulting in consistency products and services and ever increasing customer satisfaction. The ultimum is Total Quality Management. Quality systems and quality management in transfusion medicine have gained considerable attention since the outbreak of the AIDS epidemic. Where product orientation has long been applied through quality control, Good Manufacturing Practice (GMP) principles were introduced, shifting the developments in the direction of process orientation. Globally, and particularly in the more industrialised world people and system orientation has come along with the introduction of the ISO9001 concept. Harmonisation and a degree of uniformity are needed to implement a universally applicable Quality System and related Quality Management. Where the American Association of Blood Banks (AABB) is the professional organisation with the most extensive experience in quality systems in blood transfusion, the European Union and the Council of Europe now are in the process to design a quality system and management applicable to a larger variety of countries, based on a hybrid of current GMP and ISO9001 principles. The International Federation of Red Cross and Red Crescent Societies has developed a more universally to implement Quality Manual, with a pilot project in Honduras. It is recommendable to harmonise the various designs and bring the approaches under one common denominator. PMID:10938970

  14. Severe Childhood Anaemia and Blood Transfusion in a Nigerian Secondary Level Facility.

    PubMed

    Ogunlesi, Tinuade; Fetuga, Bolanle; Olowonyo, Michael; Adekoya, Adesola; Adetola, Oluseyi; Ajetunmobi, Adebimpe

    2016-04-01

    This study aimed to describe the pattern and immediate outcome of severe childhood anaemia requiring blood transfusion at a secondary level of care in Nigeria. A cross-sectional survey of children hospitalized in a secondary health facility in Ogun State, Nigeria, with packed cell volume <20% and who received blood transfusion was done. Of the 253 children admitted between March 2013 and June 2014, 79 (31.2%) had severe anaemia and were transfused with blood. Two-thirds had multiple transfusions. Higher rates of blood transfusion were obtained among underweight children. Fever (98.7%), hypoglycaemia (65.8%) and tender liver (54.4%) were the leading co-morbidities. The case fatality rate was 21.5%. Respiratory distress, convulsions and altered sensorium were significantly associated with mortality. In conclusion, severe anaemia was associated with major morbidities and mortality at the secondary level of paediatric care in Nigeria. PMID:26637271

  15. Blood banking and transfusion medicine for the apheresis medicine practitioner.

    PubMed

    Jeffus, Susanne; Wehrli, Gay

    2012-01-01

    This article provides a concise overview of blood banking and transfusion medicine (BBTM) for the therapeutic apheresis medicine practitioner. It addresses the complete pathway from blood donor qualification to blood collection, to processing and storing blood components, to patient testing, to ordering blood components for therapeutic apheresis (TA) procedures, to preparing the component for transfusion, and finally to transfusion. The nurses, technologists, and physicians orchestrate these activities in concert to best serve patients undergoing TA procedures. Enhancing knowledge of these processes may improve the quality of patient care and the utilization of blood products. PMID:22532095

  16. Retroviral infections transmitted by blood transfusion.

    PubMed Central

    Sandler, S. G.; Fang, C.; Williams, A.

    1990-01-01

    Modifications in donor screening and the introduction of laboratory testing of donated blood for anti-HIV-1 and anti-HTLV-I have resulted in a significant reduction in the risks of retroviral infections from blood transfusion. Presently, the American Red Cross detects an average of eight carriers of human immunodeficiency virus, type 1 (HIV-1) per 100,000 otherwise acceptable blood donors (0.008 percent), compared with an average of 35 per 100,000 (0.035 percent) when testing for HIV-1 antibodies began in 1985. Surveillance studies in the United States indicate a small likelihood that HIV-2 carriers will pass current screening procedures and be accepted as blood donors. Even if an HIV-2-infected person were to be accepted as a blood donor, there is a 42-92 percent likelihood that this person's blood would be detected as infective for HIV-2 and excluded because of serological cross-reactions that occur in the EIA for HIV-1 antibodies. During 1989, which was the first year that donated blood was routinely tested for antibodies to human T-lymphotropic virus, type I (HTLV-I) in the United States, approximately nine in 100,000 donors (0.009 percent) were confirmed positive for antibodies to HTLV-I, and their donated blood was excluded. Subsequent testing has revealed that a significant number of these persons whose sera was reactive by the HTLV-I EIA were, in fact, infected by HTLV-II. Epidemiological studies of human retroviral infections (HIV-1, HIV-2, HTLV-I, and HTLV-II) continue to provide important data and direction for improving criteria for qualifying blood donors. PMID:1981409

  17. Problems and Approaches for Blood Transfusion in the Developing Countries.

    PubMed

    Roberts, David J; Field, Stephen; Delaney, Meghan; Bates, Imelda

    2016-04-01

    A safe supply of blood and the knowledge, skill, and resources for the appropriate use of blood are essential for medical services. Many problems are faced in the development of transfusion services in low- or medium-income countries (LMICs). Unfortunately, in many countries, providing safe blood is made more difficult by a lack of blood donors and the high frequency of transfusion-transmissible infections. The problems are compounded by the frequent need for urgent life-saving transfusions. This article examines the problems in supply, safety, and use of blood and how they are being addressed in LMICs, predominantly focusing on sub-Saharan Africa. PMID:27040966

  18. Blood transfusion after total shoulder arthroplasty: Which patients are at high risk?

    PubMed Central

    Kandil, Abdurrahman; Griffin, Justin W.; Novicoff, Wendy M.; Brockmeier, Stephen F.

    2016-01-01

    Purpose: There are multiple reported risk factors and a wide range of reported blood transfusion rates for total shoulder arthroplasty (TSA). There are no evidence-based guidelines for blood transfusions in TSA patients. Materials and Methods: We utilized the Nationwide Inpatient Sample to analyze 51,191 patients undergoing TSA between 1998 and 2011. The purpose was to describe the incidence and identify the preoperative factors that are independently associated with blood transfusion after TSA. In addition, we studied the association of blood transfusions with certain variables such as length of stay (LOS), total charges, and payer status. Results: The blood transfusion rate in our study was 6.1%. There was no difference in the rate of blood transfusions over the study period (P < 0.001). In our logistic regression model, significant associations were found with increased age (odds ratio [OR] =1.03), white race (OR = 1.05), higher Charlson-Deyo score (OR = 1.12), presence of ischemic heart disease (OR = 1.24), blood loss anemia (OR = 1.65), female gender (OR = 1.94), presence of coagulation disorders (OR = 2.25), and presence of deficiency anemia (OR = 3.5). Patients receiving a blood transfusion had higher total charges, a longer hospital LOS, and were more likely to be Medicare payers (P < 0.001). Conclusions: Our study found five clinically significant risk factors for blood transfusions for TSA: female gender, ischemic heart disease, deficiency anemia, coagulation disorder, and blood loss anemia. Patients with these risk factors should be considered higher risk for requiring a blood transfusion after TSA and counseled appropriately. Level of Evidence: Level II, retrospective cohort study, prognostic study. PMID:27186059

  19. [Screening for viral genomes in blood transfusion].

    PubMed

    Coste, J

    2000-06-01

    Despite sustained improvement of donor selection and serologic screening assays, there still remains a small but significant transfusion risk for each of the major viral agents (hepatitis B virus [HBV], hepatitis C virus [HCV], human immunodeficiency virus [HIV] and human T-cell leukemia virus [HTLV]). The risk is due to the failure of the screening tests to detect all the infected blood donations and in particular those which are recently infected in the pre-seroconversion window phase of infection, and the asymptomatic immunosilent chronic carriers who never develop antibodies. Another source of risk relates to variant strains of known viruses that are not detected by the current assays. The last potential risk involves the failure to detect infected blood samples because of inaccurate performances of the test process. In order to reduce this residual risk, the French health authorities requested the progressive introduction of nucleic acid technology (NAT) in blood screening so as to be generalised to all blood centres in the course of year 2000. Multicentric studies are underway to identify the most suitable techniques for the French network. PMID:10919218

  20. Reduction of exposure to blood donors in preterm infants submitted to red blood cell transfusions using pediatric satellite packs

    PubMed Central

    Uezima, Cristina Lika; Barreto, Ariane Moreira; Guinsburg, Ruth; Chiba, Akemi Kuroda; Bordin, José Orlando; Barros, Melca Maria O.; dos Santos, Amélia Miyashiro N.

    2013-01-01

    OBJECTIVE: In preterm newborn infants transfused with erythrocytes stored up to 28 days, to compare the reduction of blood donor exposure in two groups of infants classified according to birth weight. METHODS: A prospective study was conducted with preterm infants with birth weight <1000g (Group 1) and 1000-1499g (Group 2), born between April, 2008 and December, 2009. Neonates submitted to exchange transfusions, emergency erythrocyte transfusion, or those who died in the first 24 hours of life were excluded. Transfusions were indicated according to the local guideline using pediatric transfusion satellite bags. Demographic and clinical data, besides number of transfusions and donors were assessed. . Logistic regression analysis was performed to determine factors associated with multiple transfusions. RESULTS: 30 and 48 neonates were included in Groups 1 and 2, respectively. The percentage of newborns with more than one erythrocyte transfusion (90 versus 11%), the median number of transfusions (3 versus 1) and the median of blood donors (2 versus 1) were higher in Group 1 (p<0.001), compared to Group 2. Among those with multiple transfusions, 14 (82%) and one (50%) presented 50% reduction in the number of blood donors, respectively in Groups 1 and 2. Factors associated with multiple transfusions were: birth weight <1000g (OR 11.91; 95%CI 2.14-66.27) and presence of arterial umbilical catheter (OR 8.59; 95%CI 1.94-38.13), adjusted for confounders. CONCLUSIONS: The efficacy of pediatrics satellites bags on blood donor reduction was higher in preterm infants with birth weight <1000g. PMID:24142309

  1. Blood transfusion in obstetrics: the pregnant women's point of view.

    PubMed

    Abu-Salem, A N; Qublan, H S

    2009-04-01

    The objective of this study was to determine the views and compliance of a group of pregnant women regarding obstetric-related blood transfusion. In this prospective questionnaire-based analysis, a total of 300 pregnant women who attended the antenatal care clinic were included. The mean age and gestational age of patients were 31.6 years and 27.4 weeks, respectively. All demographic and questionnaire data were recorded and analysed. A total of 41% of participants were aware of the possible need for blood transfusion in pregnancy and 88% of all women would accept blood transfusion when necessary. The remaining 12% would refuse blood transfusion, even if it was life-saving, because of the fear of blood transfusion complications. It is concluded that counselling and a management plan should be scheduled for pregnancy, and management protocols should be developed for women who refuse blood transfusion. Transfusion alternatives should be discussed with women who will not accept the allogenic blood transfusion. PMID:19358029

  2. Association between transfusion of whole blood and recurrence of cancer.

    PubMed Central

    Blumberg, N; Heal, J M; Murphy, P; Agarwal, M M; Chuang, C

    1986-01-01

    Transfusion affects the immune response to renal transplantation and may be associated with recurrence of various human neoplasms. Data from patients with colonic, rectal, cervical, and prostate tumours showed an association between transfusion of any amount of whole blood or larger amounts of red blood cells at the time of surgery and later recurrence of cancer. Recipients of one unit of whole blood had a significantly higher incidence of recurrence (45%) than recipients of a single unit of red cells (12%) (p = 0.03). Recipients of two units of whole blood also had a higher rate of recurrence (52%) than those receiving two units of red cells (23%) (p = 0.03). Recipients of any amount of whole blood had similar recurrence rates (38-52%). Recipients of four or more units of red blood cells had a higher rate of recurrence (55%) than those receiving three or fewer units of red blood cells (20%) (p = 0.005). Mortality due to cancer in patients receiving three or fewer units of red blood cells (2%) was similar to that in patients who did not have transfusions (7%) and significantly lower than that observed in patients receiving three or fewer units of whole blood (20%) (p = 0.003). A proportional hazards risk analysis showed that transfusion of any whole blood or more than three units of red blood cells was significantly associated with earlier recurrence and death due to cancer. These data support an association between transfusion and recurrence of cancer. They also suggest that some factor present in greater amounts in whole blood, such as plasma, may contribute to the increased risk of recurrence in patients who have undergone transfusion. Until the questions raised by retrospective studies of cancer recurrence and transfusion can be answered by prospective interventional trials with washed red blood cells, red blood cells should be transfused to patients with cancer in preference to whole blood when clinically feasible. PMID:3092902

  3. Bacteriological Safety of Blood Collected for Transfusion at University of Gondar Hospital Blood Bank, Northwest Ethiopia

    PubMed Central

    Shiferaw, Yitayal

    2013-01-01

    Background. Transfusion associated bacterial infection has remained more frequent with a sever risk of morbidity and mortality. This study assessed the bacteriological safety of blood collected for transfusion. Method. A cross-sectional study was conducted at University of Gondar hospital blood bank from December 2011 to June 2012. Bacterial isolation, identification, and antimicrobial susceptibility tests were done as per the standard procedure. Chi-square test and P value were used to assess associations between risk factors and the bacterial isolation rate. Results. Twenty-one (15.33%) blood units were found contaminated with bacteria, and 95.24% contamination was due to external sources. The commonly isolated bacteria were Staphylococcus aureus, Coagulase negative Staphylococci, Escherichia coli, Klebsiella species, Streptococci species, Enterobacter species, and Citrobacter species. All of the bacteria isolated were 100% sensitive to Gentamicin, Chloramphenicol, Amoxicillin, and Doxycycline. Multiple antimicrobial resistances were observed in 66.7% of the isolates. Not using glove by phlebotomist, touching disinfected phlebotomy site and double puncture at the same hand or both hands of a donor were found to be risk factors for bacterial contamination. Conclusion. Bacterial contamination of blood to be transfused is a common problem in the hospital. So attention should be given to activities performed at the blood bank for safe transfusion practices. PMID:23864956

  4. Feeding during Blood Transfusions and the Association with Necrotizing Enterocolitis.

    PubMed

    Doty, Megan; Wade, Christine; Farr, Julie; Gomezcoello, Vanessa Celleri; Martin, Gregory; Nasr, Tala

    2016-07-01

    Objective The aim of this study was to determine whether very low-birth-weight (VLBW) infants who had feedings withheld during all blood transfusions had a lower incidence of necrotizing enterocolitis (NEC) compared with infants who were fed during transfusions. Study Design A retrospective chart review over a 3-year period in a level-3 neonatal intensive care unit was conducted. A total of 108 inborn VLBW infants (weight range: 500-1,500 g) who had received a transfusion before 36 weeks were reviewed. Diagnosis of NEC (≥ Bell stage II), demographics, feeds, transfusions, outcomes, and variables associated with NEC were collected. Results The percentage of NEC cases was lower in infants who had feeds withheld during transfusions: 5/64 (7.8%) compared with 16/116 (13.8%) infants who were fed during transfusions. While potentially clinically important (6% absolute difference), this difference was not statistically significant (p = 0.33 by two-tailed Fisher exact test). Conclusions No significant decrease in the incidence of NEC was found when feeds were withheld during blood transfusions. Holding feeds during transfusions is not without consequences such as the need for intravenous access, additional fluids, and the disruption of optimum nutrition. Further studies are needed to establish the relationship between blood transfusions, feeds, and NEC. PMID:27031053

  5. Appropriateness of allogeneic red blood cell transfusion: the international consensus conference on transfusion outcomes.

    PubMed

    Shander, Aryeh; Fink, Arlene; Javidroozi, Mazyar; Erhard, Jochen; Farmer, Shannon L; Corwin, Howard; Goodnough, Lawrence Tim; Hofmann, Axel; Isbister, James; Ozawa, Sherri; Spahn, Donat R

    2011-07-01

    An international multidisciplinary panel of 15 experts reviewed 494 published articles and used the RAND/UCLA Appropriateness Method to determine the appropriateness of allogeneic red blood cell (RBC) transfusion based on its expected impact on outcomes of stable nonbleeding patients in 450 typical inpatient medical, surgical, or trauma scenarios. Panelists rated allogeneic RBC transfusion as appropriate in 53 of the scenarios (11.8%), inappropriate in 267 (59.3%), and uncertain in 130 (28.9%). Red blood cell transfusion was most often rated appropriate (81%) in scenarios featuring patients with hemoglobin (Hb) level 7.9 g/dL or less, associated comorbidities, and age older than 65 years. Red blood cell transfusion was rated inappropriate in all scenarios featuring patients with Hb level 10 g/dL or more and in 71.3% of scenarios featuring patients with Hb level 8 to 9.9 g/dL. Conversely, no scenario with patient's Hb level of 8 g/dL or more was rated as appropriate. Nearly one third of all scenarios were rated uncertain, indicating the need for more research. The observation that allogeneic RBC transfusions were rated as either inappropriate or uncertain in most scenarios in this study supports a more judicious transfusion strategy. In addition, the large number of scenarios in which RBC transfusions were rated as uncertain can serve as a road map to identify areas in need of further investigation. PMID:21498040

  6. Blood transfusion: implications of treating a Jehovah's Witness patient.

    PubMed

    Effa-Heap, Gladys

    Jehovah's Witnesses believe that an individual's life is contained within blood, and that accepting transfusion of blood and blood products is sinful. The administration of blood to a Jehovah's Witness who has refused to accept transfusion may lead to criminal or civil proceedings. From an ethical viewpoint, if a rational adult who has been fully apprised of the consequences of not receiving this treatment persists in a refusal, the decision should be respected. Medical and nursing staff faced with such a problem should explore fully with the patient any transfusion alternatives that the patient might find acceptable, such as cell salvage, volume expanders, antifibrinolytics and pharmaceutical options, such as erythropoietin. This article examines the legal and consent issues around blood transfusion in Jehovah's Witness patients and their implications for medical and surgical management. PMID:19223803

  7. The annual cost of blood transfusions in the UK.

    PubMed

    Varney, S J; Guest, J F

    2003-08-01

    This study estimated the annual UK cost of blood transfusions in 2000/2001, updating a study we performed in 1994/1995. The analysis was based on published data, information from interviews with National Health Service (NHS) personnel and a structured questionnaire for blood donors. The annual cost of provision and transfusion of blood products increased by 256% in real terms, to pounds 898 million in 2000/2001, whereas the number of whole-blood donations increased by 2% to 2.8 million. The number of apheresis donations decreased by 52% to 70 000. Total blood product units issued to hospitals in 2000/2001 increased by 17% and were used in an estimated 1.7 million transfusions. The estimated NHS cost for an adult transfusion was pounds 635 for red blood cells, pounds 378 for fresh frozen plasma, pounds 347 for platelets and pounds 834 for cryoprecipitate. Blood donors incurred an annual direct cost of pounds 8.1 million and 3.1 million hours of used leisure time. There was also an indirect cost of pounds 7.2 million arising from lost productivity. The large increases since 1994/1995 reflect a real increase in expenditure by the blood transfusion services, partly due to the introduction of leucodepletion, greater hospital resource use due to more transfusions being undertaken and under-recording of hospital activity in 1994/1995. PMID:12880391

  8. A Prospective Study on Red Blood Cell Transfusion Related Hyperkalemia in Critically Ill Patients

    PubMed Central

    Raza, Shahzad; Ali Baig, Mahadi; Chang, Christopher; Dabas, Ridhima; Akhtar, Mallika; Khan, Areej; Nemani, Krishna; Alani, Rahima; Majumder, Omran; Gazizova, Natalya; Biswas, Shaluk; Patel, Priyeshkumar; Al-Hilli, Jaffar A.; Shad, Yasar; Berger, Barbara J.; Zaman, Mohammad

    2015-01-01

    -two patients (77.5%) that were transfused stored blood (for more than 12 days) had increased serum K+; eight (17.7%) patients received blood that was stored for less than 12 days. In both univariate (P = 0.02) and multivariate (P = 0.04) analysis, findings showed that among all factors, transfusion of stored blood was the only factor that affected serum potassium levels (95% CI: 0.32 - 0.91). No difference was found between central and peripheral intravenous access (P = 0.12), acidosis (P = 0.12), ARF (P = 0.6), ESRD (P = 0.5), and multiple transfusions (P = 0.09). One subject developed a sustained cardiac arrest after developing severe hyperkalemia (K+ = 9.0) following transfusion of seven units of PRBCs. Multivariate logistic regression showed linear correlation between duration of stored blood and serum K+ (R2 = 0.889). Conclusion This study assesses factors that affect K+ in patients admitted to MICU. Results from the study show that rise in serum K+ level is more pronounced in patients who receive stored blood (> 12 days). Future studies should focus on the use of altered storage solution, inclusion of potassium absorption filters during transfusion and cautious use of blood warmer in patients requiring massive blood transfusions. PMID:25883703

  9. Blood banking and transfusion medicine for the nephrologist.

    PubMed

    Wehrli, Gay

    2012-01-01

    Therapeutic Apheresis Medicine Services work closely with Blood Banking and Transfusion Medicine Services (BBTMS). The BBTMS performs patient testing and provides blood components for patients undergoing therapeutic apheresis procedures. This article will provide an overview of blood component descriptions, patient testing, and blood component options and preparations for therapeutic apheresis procedures. PMID:22276991

  10. Filtration characteristics of the polyester fiber micropore blood transfusion filter.

    PubMed

    Risberg, B I; Hurley, M J; Miller, E; deJongh, D S; Litwin, M S

    1979-06-01

    The filtration characteristics of a new polyester fiber (Fenwal II) micropore blood transfusion filter were investigated. Filtration of stored human whole blood and packed cells resulted in return of screen filtration pressure (SFP) of the blood to normal. Increased filter weights verified removal of large amounts of debris and microaggregates from the blood. Filtration of large quantities of blood accomplished at very high flow rates did not adversely affect the composition of the filtered blood. We conclude that the polyester fiber (Fenwal II) micropore blood transfusion filter is effective in removing microaggregates from stored whole blood and packed cells. It has a high volume capacity, allows rapid flow, and is reliable during pressure transfusion. PMID:451646

  11. Fresh whole blood transfusion capability for Special Operations Forces.

    PubMed

    Beckett, Andrew; Callum, Jeannie; da Luz, Luis Teodoro; Schmid, Joanne; Funk, Christopher; Glassberg, Elon; Tien, Homer

    2015-06-01

    Fresh whole blood (FWB) transfusion is an option for providing volume and oxygen carrying capacity to bleeding Special Operations soldiers who are injured in an austere environment and who are far from a regular blood bank. Retrospective data from recent conflicts in Iraq and Afghanistan show an association between the use of FWB and survival. We reviewed the literature to document the issues surrounding FWB transfusion to Special Operations soldiers in the austere environment and surveyed the literature regarding best practice guidelines for and patient outcomes after FWB transfusions. Most literature regarding FWB transfusion is retrospective or historical. There is limited prospective evidence currently to change transfusion practice in tertiary care facilities, but FWB remains an option in the austere setting. PMID:26100776

  12. Fresh whole blood transfusion capability for Special Operations Forces

    PubMed Central

    Beckett, Maj Andrew; Callum, Jeannie; da Luz, Luis Teodoro; Schmid, Joanne; Funk, Christopher; Glassberg, Col Elon; Tien, Col Homer

    2015-01-01

    Summary Fresh whole blood (FWB) transfusion is an option for providing volume and oxygen carrying capacity to bleeding Special Operations soldiers who are injured in an austere environment and who are far from a regular blood bank. Retrospective data from recent conflicts in Iraq and Afghanistan show an association between the use of FWB and survival. We reviewed the literature to document the issues surrounding FWB transfusion to Special Operations soldiers in the austere environment and surveyed the literature regarding best practice guidelines for and patient outcomes after FWB transfusions. Most literature regarding FWB transfusion is retrospective or historical. There is limited prospective evidence currently to change transfusion practice in tertiary care facilities, but FWB remains an option in the austere setting. PMID:26100776

  13. Blood transfusion risks and alternative strategies in pediatric patients.

    PubMed

    Lavoie, Josée

    2011-01-01

    Although the safety of the blood supply has been greatly improved, there still remain both infectious and noninfectious risks to the patient. The incidence of noninfectious transfusion reactions is greater than that of infectious complications. Furthermore, the mortality associated with noninfectious risks is significantly higher. In fact, noninfectious risks account for 87-100% of fatal complications of transfusions. It is concerning to note that the majority of pediatric reports relate to human error such as overtransfusion and lack of knowledge of special requirements in the neonatal age group. The second most frequent category is acute transfusion reactions, majority of which are allergic in nature. It is estimated that the incidence of adverse outcome is 18:100,000 red blood cells issued for children aged less than 18 years and 37:100,000 for infants. The comparable adult incidence is 13:100,000. In order to decrease the risks associated with transfusion of blood products, various blood-conservation strategies can be utilized. Modalities such as acute normovolemic hemodilution, hypervolemic hemodilution, deliberate hypotension, antifibrinolytics, intraoperative blood salvage, and autologous blood donation are discussed and the pediatric literature is reviewed. A discussion of transfusion triggers, and algorithms as well as current research into alternatives to blood transfusions concludes this review. PMID:21155923

  14. Jehovah's Witnesses and autonomy: honouring the refusal of blood transfusions.

    PubMed

    Bock, Gregory L

    2012-11-01

    This paper explores the scriptural and theological reasons given by Jehovah's Witnesses (JWs) to refuse blood transfusions. Julian Savulescu and Richard W Momeyer argue that informed consent should be based on rational beliefs and that the refusal of blood transfusions by JWs is irrational, but after examining the reasons given by JWs, I challenge the claim that JW beliefs are irrational. I also question whether we should give up the traditional notion of informed consent. PMID:22790086

  15. West Nile Virus in Europe and Safety of Blood Transfusion

    PubMed Central

    Pisani, Giulio; Cristiano, Karen; Pupella, Simonetta; Liumbruno, Giancarlo Maria

    2016-01-01

    Summary West Nile virus (WNV) has become an increasing issue in the transfusion setting since 2002, when it was firstly shown in the USA that it can be transmitted through blood transfusion. Since then, several precautionary measures have been introduced in Europe in order to reduce the possible risk of transmission via transfusion/solid organ transplantation. In addition, the epidemiological surveillance has been tightened and the network for communication of human WNV cases strengthened. This review will focus on WNV circulation and the safety of blood in Europe. PMID:27403087

  16. [New viral risks in blood transfusion by 2016].

    PubMed

    Pozzetto, B; Garraud, O

    2016-02-01

    Viral safety remains a major concern in transfusion of blood products. Over years, the control measures applied to blood products were made more and more sophisticated; however, the number of infectious agents, and notably of viruses, that can be transmitted by transfusion is increasing continuously. The aim of this review paper is to actualize that published in the same journal by the same authors in 2011 with more details on some of actual vs virtual viral threats that were identified recently in the field of blood transfusion. The main subjects that are covered successively concern the transmission via transfusion of hepatitis E virus, the frequency of transfusion transmitted arboviruses, transfusion at the time of the Ebola epidemics in West Africa, the debated role of Marseillevirus (giant viruses infecting amoebae and suspected to infect human blood latently), and, finally, the recent report of the identification in blood donors of a new member of the Flaviviridae family. The addition of these new viral risks to those already identified-partially controlled or not-pleads for the urgent need to move forward to considering inactivation of infectious agents in blood products. PMID:26781857

  17. Limiting excessive postoperative blood transfusion after cardiac procedures. A review.

    PubMed Central

    Ferraris, V A; Ferraris, S P

    1995-01-01

    Analysis of blood product use after cardiac operations reveals that a few patients (< or = 20%) consume the majority of blood products (> 80%). The risk factors that predispose a minority of patients to excessive blood use include patient-related factors, transfusion practices, drug-related causes, and procedure-related factors. Multivariate studies suggest that patient age and red blood cell volume are independent patient-related variables that predict excessive blood product transfusion after cardiac procedures. Other factors include preoperative aspirin ingestion, type of operation, over- or underutilization of heparin during cardiopulmonary bypass, failure to correct hypothermia after cardiopulmonary bypass, and physician overtransfusion. A survey of the currently available blood conservation techniques reveals 5 that stand out as reliable methods: 1) high-dose aprotinin therapy, 2) preoperative erythropoietin therapy when time permits adequate dosage before operation, 3) hemodilution by harvest of whole blood immediately before cardiopulmonary bypass, 4) autologous predonation of blood, and 5) salvage of oxygenator blood after cardiopulmonary bypass. Other methods, such as the use of epsilon-aminocaproic acid or desmopressin, cell saving devices, reinfusion of shed mediastinal blood, and hemofiltration have been reported to be less reliable and may even be harmful in some high-risk patients. Consideration of the available data allows formulation of a 4-pronged plan for limiting excessive blood transfusion after surgery: 1) recognize the causes of excessive transfusion, including the importance of red blood cell volume, type of procedure being performed, preoperative aspirin ingestion, etc.; 2) establish a quality management program, including a survey of transfusion practices that emphasizes physician education and availability of real-time laboratory testing to guide transfusion therapy; 3) adopt a multimodal approach using institution-proven techniques; and

  18. Blood transfusion therapy for traumatic cardiopulmonary arrest

    PubMed Central

    Moriwaki, Yoshihiro; Sugiyama, Mitsugi; Tahara, Yoshio; Iwashita, Masayuki; Kosuge, Takayuki; Toyoda, Hiroshi; Arata, Shinju; Suzuki, Noriyuki

    2013-01-01

    Background: Blood transfusion therapy (BTT), which represents transplantation of living cells, poses several risks. Although BTT is necessary for trauma victims with hemorrhagic shock, it may be futile for patients with blunt traumatic cardiopulmonary arrest (BT-CPA). Materials and Methods: We retrospectively examined the medical records of consecutive patients with T-CPA. The study period was divided into two periods: The first from 1995-1998, when we used packed red cells (PRC) regardless of the return of spontaneous circulation (ROSC), and the second from 1999-2004, when we did not use PRC before ROSC. The rates of ROSC, admission to the ICU, and survival-to-discharge were compared between these two periods. Results: We studied the records of 464 patients with BT-CPA (175 in the first period and 289 in the second period). Although the rates of ROSC and admission to the ICU were statistically higher in the first period, there was no statistical difference in the rate of survival-to-discharge between these two periods. In the first period, the rate of ROSC was statistically higher in the non-BTT group than the BTT group. However, for cases in which ROSC was performed and was successful, there were no statistical differences in the rate of admission and survival-to-discharge between the first and second group, and between the BTT and non-BTT group. Conclusion: Our retrospective consecutive study shows the possibility that BTT before ROSC for BT-CPA and a treatment strategy that includes this treatment improves the success rate of ROSC, but not the survival rate. BTT is thought to be futile as a treatment for BT-CPA before ROSC. PMID:23493056

  19. Ensemble Learning Approaches to Predicting Complications of Blood Transfusion

    PubMed Central

    Murphree, Dennis; Ngufor, Che; Upadhyaya, Sudhindra; Madde, Nagesh; Clifford, Leanne; Kor, Daryl J.; Pathak, Jyotishman

    2016-01-01

    Of the 21 million blood components transfused in the United States during 2011, approximately 1 in 414 resulted in complication [1]. Two complications in particular, transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), are especially concerning. These two alone accounted for 62% of reported transfusion-related fatalities in 2013 [2]. We have previously developed a set of machine learning base models for predicting the likelihood of these adverse reactions, with a goal towards better informing the clinician prior to a transfusion decision. Here we describe recent work incorporating ensemble learning approaches to predicting TACO/TRALI. In particular we describe combining base models via majority voting, stacking of model sets with varying diversity, as well as a resampling/boosting combination algorithm called RUSBoost. We find that while the performance of many models is very good, the ensemble models do not yield significantly better performance in terms of AUC. PMID:26737958

  20. Ensemble learning approaches to predicting complications of blood transfusion.

    PubMed

    Murphree, Dennis; Ngufor, Che; Upadhyaya, Sudhindra; Madde, Nagesh; Clifford, Leanne; Kor, Daryl J; Pathak, Jyotishman

    2015-08-01

    Of the 21 million blood components transfused in the United States during 2011, approximately 1 in 414 resulted in complication [1]. Two complications in particular, transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), are especially concerning. These two alone accounted for 62% of reported transfusion-related fatalities in 2013 [2]. We have previously developed a set of machine learning base models for predicting the likelihood of these adverse reactions, with a goal towards better informing the clinician prior to a transfusion decision. Here we describe recent work incorporating ensemble learning approaches to predicting TACO/TRALI. In particular we describe combining base models via majority voting, stacking of model sets with varying diversity, as well as a resampling/boosting combination algorithm called RUSBoost. We find that while the performance of many models is very good, the ensemble models do not yield significantly better performance in terms of AUC. PMID:26737958

  1. [Blood transfusion in emergency settings: French military health service experience].

    PubMed

    Sailliol, A; Ausset, S; Peytel, E

    2010-12-01

    Blood transfusion is required in a number of emergency settings and the French military health service (FMHS) has issued specific guidelines for the treatment of war casualties. These guidelines take into account European standards and laws, NATO standards, and also public sentiment regarding transfusion. These guidelines reflect a determination to control the process and to avoid the improvisation frequently associated with wartime transfusion. The evolution in warfare (terrorism and bombing more frequent than gunshot) and the wide use of body armor have deeply changed the clinical presentation of war injuries. These now involve the extremities in 80% of cases, with extensive tissue damage and heavy blood loss. The FMHS recommends that war casualties with hemorrhagic shock be brought quickly to a medical treatment facility (MTF) after first-line treatment applied through buddy aid or by medics. In the MTF, before an early Medevac, a damage control surgery will be performed, with resuscitation using freeze-dried plasma, red blood cells and fresh whole blood. The French military blood bank is responsible for blood product supply, training and medical advice regarding transfusion therapy during wartime, as well as hemovigilance. All transfusion therapy practices are periodically assessed but research on whole blood pathogen reduction is being conducted in order to reduce the residual infectious risk associated with this product. PMID:21051268

  2. Red Blood Cell Transfusion and Transfusion Alternatives in Traumatic Brain Injury.

    PubMed

    Kramer, Andreas H; Le Roux, Peter

    2012-02-01

    OPINION STATEMENT: Anemia develops in about 50% of patients hospitalized with traumatic brain injury (TBI) and is recognized as a cause of secondary brain injury. This review examines the effects of anemia and transfusion on TBI patients through a literature search to identify original research on anemia and transfusion in TBI, the effects of transfusion on brain physiology, and the role of erythropoietin or hemoglobin-based blood substitutes (HBBSs). However, the amount of high-quality, prospective data available to help make decisions about when TBI patients should be transfused is very small. Randomized transfusion trials have involved far too few TBI patients to reach definitive conclusions. Thus, it is hardly surprising that there is widespread practice variation. In our opinion, a hemoglobin transfusion threshold of 7 g/dL cannot yet be considered safe for TBI patients admitted to hospital, and in particular to the ICU, as it is for other critically ill patients. Red blood cell transfusions often have immediate, seemingly beneficial effects on cerebral physiology, but the magnitude of this effect may depend in part upon how long the cells have been stored before administration. In light of existing physiological data, we generally aim to keep hemoglobin concentrations greater than 9 g/dL during the first several days after TBI. In part, the decision is based on the patient's risk of or development of secondary ischemia or brain injury. An increasing number of centers use multimodal neurologic monitoring, which may help to individualize transfusion goals based on the degree of cerebral hypoxia or metabolic distress. When available, brain tissue oxygen tension values less than 15-20 mm Hg or a lactate:pyruvate ratio greater than 30-40 would influence us to use more aggressive hemoglobin correction (e.g., a transfusion threshold of 10 g/dL). Clinicians can attempt to reduce transfusion requirements by limiting phlebotomy, minimizing hemodilution, and

  3. A successful transfusion in a tamandua (Tamandua tetradactyla) using both whole blood and blood replacement products.

    PubMed

    Raines, Janis A; Storms, Timothy

    2015-03-01

    A 10-yr-old tamandua (Tamandua tetradactyla) presented with severe lethargy and ataxia. Severe anemia (9% hematocrit) was diagnosed and ultimately resolved with the administration of a whole blood transfusion from conspecific and additional blood replacement products (Oxyglobin). This is the first described use of a whole blood transfusion in an edentate. PMID:25831593

  4. Association of postoperative furosemide use with a reduced blood transfusion rate in sagittal craniosynostosis surgery.

    PubMed

    Harroud, Adil; Weil, Alexander G; Turgeon, Jean; Mercier, Claude; Crevier, Louis

    2016-01-01

    OBJECT A major challenge in sagittal craniosynostosis surgery is the high transfusion rate (50%-100%) related to blood loss in small pediatric patients. Several approaches have been proposed to prevent packed red blood cell (PRBC) transfusion, including endoscopic surgery, erythropoietin ortranexamic acid administration, and preoperative hemodilution. The authors hypothesized that a significant proportion of postoperative anemia observed in pediatric patients is actually dilutional. Consequently, since 2005, at CHU Sainte-Justine, furosemide has been administered to correct the volemic status and prevent PRBC transfusion. The purpose of this study was to evaluate the impact of postoperative furosemide administration on PRBC transfusion rates. METHODS This was a retrospective study of 96 consecutive patients with sagittal synostosis who underwent surgery at CHU Sainte-Justine between January 2000 and May 2012. The mean age at surgery was 4.9 ± 1.5 months (range 2.8-8.7 months). Patients who had surgery before 2005 constituted the control group. Those who had surgery in 2005 or 2006 were considered part of an implementation phase because furosemide administration was not routine. Patients who had surgery after 2006 were part of the experimental (or furosemide) group. Transfusion rates among the 3 groups were compared. The impact of furosemide administration on transfusion requirement was also measured while accounting for other variables of interest in a multiple logistic regression model. RESULTS The total transfusion rate was significantly reduced in the furosemide group compared with the control group (31.3% vs 62.5%, respectively; p = 0.009), mirroring the decrease in the postoperative transfusion rate between the groups (18.3% vs 50.0%, respectively; p = 0.003). The postoperative transfusion threshold remained similar throughout the study (mean hemoglobin 56.0 g/dl vs 60.9 g/dl for control and furosemide groups, respectively; p = 0.085). The proportion of

  5. Practical recommendations for patient blood management and the reduction of perioperative transfusion in joint replacement surgery.

    PubMed

    Bruce, Warwick; Campbell, David; Daly, David; Isbister, James

    2013-04-01

    Data from the Australian Better Safer Transfusion programme show that about one-third of patients undergoing hip or knee arthroplasty receive perioperative blood transfusions, placing them at increased risk for adverse clinical outcomes. Other concerns associated with allogeneic blood transfusion include the quality of stored red cell concentrates, the cost of provision of blood and the predicted local demographics, which mean that fewer donors will need to support a greater number of recipients. In view of the multiple challenges associated with allogeneic blood transfusion and its provision, we developed practical management recommendations for perioperative bleeding in joint replacement surgery, based on available evidence and expert consensus opinion, that aim to promote a new, responsible approach to transfusion management. Key recommendations are as follows. Patients' medical health, including haemoglobin and iron levels, needs to be evaluated and optimized preoperatively. Anticoagulant and antiplatelet therapy should be stopped if possible, unless indicated for secondary cardiovascular prevention or coronary stent patency, in which case careful consideration is required. If substantial blood loss is anticipated, intraoperative management with antifibrinolytic agents is recommended for bleeding prophylaxis. Normothermia should be maintained. Pharmacological and non-pharmacological measures are recommended for post-operative thromboprophylaxis. A blood management programme should be instituted for haemodynamically stable patients. PMID:23116065

  6. Cell salvage for minimising perioperative allogeneic blood transfusion

    PubMed Central

    Carless, Paul A; Henry, David A; Moxey, Annette J; O’Connell, Dianne; Brown, Tamara; Fergusson, Dean A

    2014-01-01

    Background Concerns regarding the safety of transfused blood have prompted reconsideration of the use of allogeneic (from an unrelated donor) red blood cell (RBC) transfusion, and a range of techniques to minimise transfusion requirements. Objectives To examine the evidence for the efficacy of cell salvage in reducing allogeneic blood transfusion and the evidence for any effect on clinical outcomes. Search methods We identified studies by searching CENTRAL (The Cochrane Library 2009, Issue 2), MEDLINE (1950 to June 2009), EMBASE (1980 to June 2009), the internet (to August 2009) and bibliographies of published articles. Selection criteria Randomised controlled trials with a concurrent control group in which adult patients, scheduled for non-urgent surgery, were randomised to cell salvage (autotransfusion) or to a control group who did not receive the intervention. Data collection and analysis Data were independently extracted and the risk of bias assessed. Relative risks (RR) and weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated. Data were pooled using a random-effects model. The primary outcomes were the number of patients exposed to allogeneic red cell transfusion and the amount of blood transfused. Other clinical outcomes are detailed in the review. Main results A total of 75 trials were included. Overall, the use of cell salvage reduced the rate of exposure to allogeneic RBC transfusion by a relative 38% (RR 0.62; 95% CI 0.55 to 0.70). The absolute reduction in risk (ARR) of receiving an allogeneic RBC transfusion was 21% (95% CI 15% to 26%). In orthopaedic procedures the RR of exposure to RBC transfusion was 0.46 (95% CI 0.37 to 0.57) compared to 0.77 (95% CI 0.69 to 0.86) for cardiac procedures. The use of cell salvage resulted in an average saving of 0.68 units of allogeneic RBC per patient (WMD −0.68; 95% CI −0.88 to −0.49). Cell salvage did not appear to impact adversely on clinical outcomes. Authors’ conclusions

  7. Transfusion Associated Graft Versus Host Disease Following Whole Blood Transfusion from an Unrelated Donor in an Immunocompetent Patient

    PubMed Central

    Patel, Ketan K.; Ranjan, Rajiv R.; Shah, Apurva P.

    2010-01-01

    Graft-versus-host disease (GVHD) is a well-known complication of allogeneic bone marrow transplantation. Transfusion associated graft-versus-host disease (TA-GVHD) is much less common and nearly uniformly fatal complication of blood transfusion. The risk factors underlying the development of TA- GVHD are incompletely defined, but it is commonly seen in individuals with congenital or acquired immunodeficiency, transfusions from blood relatives, intrauterine transfusions and HLA-matched platelet transfusions. Diagnosis of TA-GVHD may be difficult at a time due to rarity in occurrence and overlapping clinical features with various infections and drug reactions. We describe a case of transfusion-associated GVHD that occurred after transfusion of whole blood from unrelated donor in an immunocompetent patient. PMID:21886390

  8. The quest for an Indian blood law as of blood transfusion services regulatory framework

    PubMed Central

    Pal, Ranabir; Kar, Sumit; Zaman, Forhad Akhtar; Pal, Shrayan

    2011-01-01

    Background: Blood transfusion services are a vital part of the national health delivery system. The responsibility for ensuring a continuous supply of blood rests with health administrators, who need to galvanize entire communities towards regular and non-remunerated blood donation. Objective: The present study aimed to examine the prevailing global regulations and practices related to blood transfusion and press the case for a dedicated blood law in India. Materials and Methods: We attempted a comprehensive, annotated assembly of published studies on blood transfusion services in India. Data Abstraction and Synthesis: Laws related to blood transfusion services exist in India as a part of the Drugs and Cosmetics Law. In the developed world, most blood donors are unpaid volunteers who give blood for a community supply. In order to augment safe blood transfusion services in India, we have to develop operational legal guidelines on recruitment and retention of voluntary blood donors to direct related organizations for this imperative activity. Conclusion: Several factors, such as political will and a professional and ethical approach can help in formulating a common vision, building trust, by providing optimum information towards a social movement for the rational blood transfusion services. We have to come together for a dedicated blood law in order to improve the quality of blood transfusion services in India. PMID:21897599

  9. Neonatal transfusion models to determine the impact of using fresh red blood cells on inventory and exposure

    PubMed Central

    Quinn, Kerry; Quinn, Maureen; Moreno, Christina; Soundar, Esther; Teruya, Jun; Hui, Shiu-Ki

    2015-01-01

    Background Data on age of blood and its impact on donor exposure and inventory in the paediatric setting are lacking. The standard of practice of reserving a specific red blood cell (RBC) unit for neonates who may require repeat transfusions is unique to the paediatric setting. Requiring transfusion of fresher RBC units may increase the exposure of neonates to multiple units and negatively affect the supply of fresh RBC. We constructed a transfusion model based on a 6 months of retrospective neonatal transfusion data at our institution. Materials and methods All neonates (≤4 months old) at Texas Children’s Hospital who received a RBC transfusion from June to November 2011 were included and RBC transfusion data were compiled. The age of blood at the time of each RBC transfusion was recorded. These data were reviewed to calculate exposure and inventory impact if each transfusion had been restricted to RBC either ≤7 or ≤14 days old at transfusion. Results A total of 216 neonates received 938 RBC transfusions. Of these, 393 (42%) were fresh RBC (≤14 days old), even without a required age guideline. Requiring fresh (≤14 days) RBC for all transfusions in this period would have resulted in 70 additional fresh units and one or more additional exposures in 44 patients. Requiring fresher (≤7 days old) RBC would have resulted in an additional 147 units and. one or more additional exposures in 54 patients. Discussion The more conservative model of fresh (≤7 days old) RBC would greatly increase fresh RBC inventory requirements, and 25% of transfused neonates would require additional RBC exposure. Based on retrospective data and the two transfusion models, it can be concluded that requiring RBC ≤14 days old for neonatal transfusion would best balance the use of fresher RBC with the smallest increase in patient exposure (20%) and minimum impact on the RBC inventory. PMID:26192783

  10. Red blood cell transfusion strategies and Maximum surgical blood ordering schedule

    PubMed Central

    Iyer, Shivakumar S; Shah, Jignesh

    2014-01-01

    Blood transfusion is one of the practices that is in vogue because it expands blood volume and purportedly improves the oxygen carrying capacity. Despite this supposed physiological benefit, paradoxically, both anaemia and transfusion are independently associated with organ injury and increased morbidity. Historically, transfusion was used to maintain blood haemoglobin concentration above 10 g/dL and a haematocrit above 30%. There is now a greater emphasis on interventions to reduce the use of transfusion as it is a scarce and expensive resource with many serious adverse effects. Institutional maximum surgical blood ordering schedule algorithm developed with data analysis and consensus of surgeons, anaesthesiologists and blood banks can reduce the overuse of blood. A PubMed search was performed with search words/combination of words ‘erythrocyte transfusion, adverse effects, economics, mortality, therapy, therapeutic use and utilisation’. Search yielded a total of 1541 articles that were screened for clinical relevance for the purpose of this review. PMID:25535420

  11. Blood Transfusion Strategies for Hemostatic Resuscitation in Massive Trauma.

    PubMed

    McGrath, Caroline

    2016-03-01

    Massive transfusion practices were transformed during the 1970s without solid evidence supporting the use of component therapy. A manual literature search was performed for all references to the lethal triad, acute or early coagulopathy of trauma, fresh whole blood, and component transfusion therapy in massive trauma, and damage control resuscitation. Data from recent wars suggest traditional component therapy causes a nonhemostatic resuscitation worsening the propagation of the lethal triad hastening death. These same studies also indicate the advantage of fresh whole blood over component therapy even when administered in a 1:1:1 replacement ratio. PMID:26897426

  12. Anemia and red blood cell transfusion in neurocritical care

    PubMed Central

    Kramer, Andreas H; Zygun, David A

    2009-01-01

    Introduction Anemia is one of the most common medical complications to be encountered in critically ill patients. Based on the results of clinical trials, transfusion practices across the world have generally become more restrictive. However, because reduced oxygen delivery contributes to 'secondary' cerebral injury, anemia may not be as well tolerated among neurocritical care patients. Methods The first portion of this paper is a narrative review of the physiologic implications of anemia, hemodilution, and transfusion in the setting of brain-injury and stroke. The second portion is a systematic review to identify studies assessing the association between anemia or the use of red blood cell transfusions and relevant clinical outcomes in various neurocritical care populations. Results There have been no randomized controlled trials that have adequately assessed optimal transfusion thresholds specifically among brain-injured patients. The importance of ischemia and the implications of anemia are not necessarily the same for all neurocritical care conditions. Nevertheless, there exists an extensive body of experimental work, as well as human observational and physiologic studies, which have advanced knowledge in this area and provide some guidance to clinicians. Lower hemoglobin concentrations are consistently associated with worse physiologic parameters and clinical outcomes; however, this relationship may not be altered by more aggressive use of red blood cell transfusions. Conclusions Although hemoglobin concentrations as low as 7 g/dl are well tolerated in most critical care patients, such a severe degree of anemia could be harmful in brain-injured patients. Randomized controlled trials of different transfusion thresholds, specifically in neurocritical care settings, are required. The impact of the duration of blood storage on the neurologic implications of transfusion also requires further investigation. PMID:19519893

  13. [Acute lung injury as a consequence of blood transfusion].

    PubMed

    Rodríguez-Moyado, Héctor

    2011-01-01

    Acute lung injury (ALI) has been recognized as a consequence of blood transfusion (BT) since 1978; the Food and Drug Administration, has classified it as the third BT mortality issue, in 2004, and in first place related with ALI. It can be mainly detected as: Acute respiratory distress syndrome (ARDS), transfusion associated circulatory overload (TACO) and transfusion related acute lung injury (TRALI). The clinical onset is: severe dyspnea, bilateral lung infiltration and low oxygen saturation. In USA, ARDS has an incidence of three to 22.4 cases/100 000 inhabitants, with 58.3 % mortality. TACO and TRALI are less frequent; they have been reported according to the number of transfusions: one in 1275 to 6000 for TRALI and one in 356 transfusions for TACO. Mortality is reported from two to 20 % in TRALI and 20 % in TACO. Antileukocyte antibodies in blood donors plasma, caused TRALI in 89 % of cases; also it has been found antigen specificity against leukocyte blood receptor in 59 %. The UCI patients who received a BT have ALI as a complication in 40 % of cases. The capillary pulmonary endothelia is the target of leukocyte antibodies and also plasma biologic modifiers of the stored plasma, most probable like a Sanarelli-Shwar-tzman phenomenon. PMID:21838994

  14. Transfusion Practices Committee of a public blood bank network in Minas Gerais, Brazil

    PubMed Central

    de Carvalho, Ricardo Vilas Freire; Brener, Stela; Ferreira, Angela Melgaço; do Valle, Marcele Cunha Ribeiro; Moraes-Souza, Helio

    2012-01-01

    Objective This study aimed to verify the performance of blood transfusion committees in transfusion services linked to the public blood bank network of the state of Minas Gerais. Methods A cross-sectional observational study was conducted between 2007 and 2008 using questionnaires and proficiency tests to evaluate the reporting and investigation of transfusion reactions comparing transfusion services with and without transfusion committees in the public transfusion services of the state of Minas Gerais. Results Nineteen of Hemominas own transfusion services and 207 that contracted the services of the foundation located in 178 municipalities were visited between 2007 and 2008. Established transfusion committees were present in 63.4% of the services visited. Transfusion incidents were reported by 53 (36.8%) transfusion services with transfusion committees and by eight (9.6%) without transfusion committees (p < 0.001) with 543 (97.5%) and 14 (2.5%) notifications, respectively. Of the reported transfusion incidents, 40 (75.5%) transfusion services with transfusion committees and only two (25%) of those without transfusion committees investigated the causes. Conclusion The incidence of notification and investigation of the causes of transfusion reactions was higher in transfusion services where a transfusion committee was present. Despite these results, the performance of these committees was found to be incipient and a better organization and more effective operation are required. PMID:23323064

  15. Legal and ethical issues in safe blood transfusion

    PubMed Central

    Chandrashekar, Shivaram; Kantharaj, Ambuja

    2014-01-01

    Legal issues play a vital role in providing a framework for the Indian blood transfusion service (BTS), while ethical issues pave the way for quality. Despite licensing of all blood banks, failure to revamp the Drugs and Cosmetic Act (D and C Act) is impeding quality. Newer techniques like chemiluminescence or nucleic acid testing (NAT) find no mention in the D and C Act. Specialised products like pooled platelet concentrates or modified whole blood, therapeutic procedures like erythropheresis, plasma exchange, stem cell collection and processing technologies like leukoreduction and irradiation are not a part of the D and C Act. A highly fragmented BTS comprising of over 2500 blood banks, coupled with a slow and tedious process of dual licensing (state and centre) is a hindrance to smooth functioning of blood banks. Small size of blood banks compromises blood safety. New blood banks are opened in India by hospitals to meet requirements of insurance providers or by medical colleges as this a Medical Council of India (MCI) requirement. Hospital based blood banks opt for replacement donation as they are barred by law from holding camps. Demand for fresh blood, lack of components, and lack of guidelines for safe transfusion leads to continued abuse of blood. Differential pricing of blood components is difficult to explain scientifically or ethically. Accreditation of blood banks along with establishment of regional testing centres could pave the way to blood safety. National Aids Control Organisation (NACO) and National Blood Transfusion Council (NBTC) deserve a more proactive role in the licensing process. The Food and Drug Administration (FDA) needs to clarify that procedures or tests meant for enhancement of blood safety are not illegal. PMID:25535417

  16. Transfusion transmitted infections – A retrospective analysis from the National Blood Transfusion Service in Eritrea

    PubMed Central

    Fessehaye, Nahom; Naik, Durgadas; Fessehaye, Tesfay

    2011-01-01

    Background The emergence of transfusion transmitted infection (TTI) especially HIV/AIDS has created a huge obstacle in ensuring blood safety. To assess the situation in Eritrea, we carried out a retrospective study of 29,501 blood donors for the prevalence of TTI's i.e. HIV, HBV, HCV and Syphilis. Methods The study population included all donors who donated blood from January 2006 to November 2009. The data was collected from the National Blood Transfusion Services (NTBS) of Eritrea and includes category of donor and result for TTI markers. Results A total of 29,501 units of blood were collected from 23,385(79%) voluntary blood donors and the rest 6,116(21%) units were collected from family replacement donors. The over all prevalence of TTI's were 3.8% with 3.5% in voluntary blood donors and 5.1% in family replacement donors. The sero-prevalence for TTI markers were 0.18% HIV, 2.58% HBV, 0.57% HCV and 0.49% Syphilis. Conclusion In conclusion, even if the TTI prevalence rate among Eritrean blood donors is low, ensuring blood safety has a long way to go. PMID:22145069

  17. The evolution of perioperative transfusion testing and blood ordering.

    PubMed

    White, Marissa J; Hazard, Sprague W; Frank, Steven M; Boyd, Joan S; Wick, Elizabeth C; Ness, Paul M; Tobian, Aaron A R

    2015-06-01

    The evolution of modern anesthesia and surgical practices has been accompanied by enhanced supportive procedures in blood banking and transfusion medicine. There is increased focus on the preparation and the use of blood components including, but not limited to, preventing unnecessary type and screen/crossmatch orders, decreasing the time required to provide compatible red blood cells (RBCs), and reducing the waste of limited blood and personnel resources. The aim of this review is to help the anesthesiologist and surgical staff identify patients at highest risk for surgical bleeding. In addition, this review examines how anesthesia and transfusion medicine can efficiently and safely allocate blood components for surgical patients who require transfusions. The following databases were searched: PubMed, EMBASE, Google Scholar, and the Cochrane Library from January 1970 through March 2014. Subsequent reference searches of retrieved articles were also assessed. Several innovations have drastically changed the procedures by which blood is ordered, inventoried, and the speed in which blood is delivered for patient care. Before entering an operating room, patient blood management provides guidance to clinicians about when and how to treat preoperative anemia and intra- and postoperative strategies to limit the patient's exposure to blood components. Timely updates of the recommendations for blood orders (maximum surgical blood ordering schedule) have enhanced preoperative decision making regarding the appropriateness of the type and screen versus the type and crossmatch order. The updated maximum surgical blood ordering schedule reflects modern practices, such as laparoscopy, improved surgical techniques, and use of hemostatic agents resulting in a more streamlined process for ordering and obtaining RBCs. The electronic (computer) crossmatch and electronic remote blood issue have also dramatically reduced the amount of time required to obtain crossmatch-compatible RBCs

  18. Alternatives to standard blood transfusion: availability and promise.

    PubMed

    Prowse, C V

    1999-12-01

    Largely due to concerns over safety, a wide variety of alternatives to the conventional blood bank products of red cells, platelet concentrates, plasma and fractionated plasma products are under development. This review attempts to survey the alternative therapies that are being developed, whether they provide viable solutions and what impact they might have on transfusion practice. PMID:10583882

  19. Blood Transfusion in Children With Cancer

    ERIC Educational Resources Information Center

    Thompson, Elizabeth; Simone, Joseph

    1977-01-01

    Progress has been made in the separation of the various components of whole blood, methods of storage, and efficient use of blood components, permitting better management of blood quality in children undergoing chemotherapy and radiotherapy in the treatment of cancer. (MB)

  20. Alternative Blood Products and Clinical Needs in Transfusion Medicine

    PubMed Central

    Whitsett, Carolyn; Vaglio, Stefania; Grazzini, Giuliano

    2012-01-01

    The primary focus of national blood programs is the provision of a safe and adequate blood supply. This goal is dependent on regular voluntary donations and a regulatory infrastructure that establishes and enforces standards for blood safety. Progress in ex vivo expansion of blood cells from cell sources including peripheral blood, cord blood, induced pluripotent stem cells, and human embryonic stem cell lines will likely make alternative transfusion products available for clinical use in the near future. Initially, alloimmunized patients and individuals with rare blood types are most likely to benefit from alternative products. However, in developed nations voluntary blood donations are projected to be inadequate in the future as blood usage by individuals 60 years and older increases. In developing nations economic and political challenges may impede progress in attaining self-sufficiency. Under these circumstances, ex vivo generated red cells may be needed to supplement the general blood supply. PMID:22567025

  1. Revisiting blood transfusion preparedness: experience from the Bam earthquake response.

    PubMed

    Abolghasemi, Hassan; Radfar, Mohammad H; Tabatabaee, Morteza; Hosseini-Divkolayee, Nasim S; Burkle, Frederick M

    2008-01-01

    Blood transfusion plays a critical role in the provision of medical care for disasters due to man-made and natural hazards. Although the short-term increase in blood donations following national disasters is well-documented, some aspects of blood transfusion during disasters remain under study. The 2003 earthquake in Bam, Iran resulted in the death of >29,000 people and injured 23,000. In total, 108,985 blood units were donated, but only 21,347 units (23%) actually were distributed to hospitals around the country. Kerman Province, the site of the disaster, received 1,231 (1.3%) of the donated units in the first four days after the disaster. The Bam experience revealed crucial missteps in the development of a post-event strategy for blood product management, and led to the development of a detailed disaster preparedness and response plan that addresses issues of donation, distribution, communication, transportation, and coordination. The current plan requires the Iranian Blood Transfusion Organization to convene a disaster task force immediately as the main coordinator of all disaster preparedness and response activities. PMID:19189607

  2. Blood Transfusions and Organ/Tissue Transplants

    MedlinePlus

    ... supply is now among the safest in the world: All blood donors are prescreened for HIV risk factors. Blood donations are required to be tested both for presence of antibodies to HIV and for HIV ribonucleic acid (RNA). RNA testing detects HIV at an earlier stage ...

  3. Factors associated with knowledge of the nursing staff at a teaching hospital on blood transfusion 1

    PubMed Central

    Tavares, Jordânia Lumênia; Barichello, Elizabeth; Mattia, Ana Lúcia De; Barbosa, Maria Helena

    2015-01-01

    Abstract Objective: to determine whether there is an association between knowledge of the nursing professionals about blood transfusion and the variables related to the professional aspects. Method: this is an observational, cross-sectional and quantitative study, carried out at a large general teaching hospital. The sample consisted of 209 nursing professionals, obtained by simple random sampling. For data collection, a checklist was used. In the univariate analysis, descriptive statistics and central trend and dispersion measures were used. In the bivariate analysis, Student's t-Test, analysis of variance and Pearson's correlation were used. To determine the predictors, multiple linear regression was applied. The Institutional Review Board (Opinion number 2434) approved the study. Results: the overall average knowledge score was 52.66%; in the Pre-transfusion Step, it corresponded to 53.38%; in the Transfusion Step 51.25% and, in the Post-transfusion Step, 62.68%. The factors related to knowledge were professional category and received training and/or guidance to accomplish the transfusion process (p<0.01). Conclusion: this study showed the influence of training and guidance on the knowledge and provided a diagnosis to identify the professionals' difficulties regarding the transfusion process. PMID:26444160

  4. Acquired immunodeficiency syndrome associated with blood-product transfusions

    SciTech Connect

    Jett, J.R.; Kuritsky, J.N.; Katzmann, J.A.; Homburger, H.A.

    1983-11-01

    A 53-year-old white man had fever, malaise, and dyspnea on exertion. His chest roentgenogram was normal, but pulmonary function tests showed impaired diffusion capacity and a gallium scan showed marked uptake in the lungs. Results of an open-lung biopsy documented Pneumocystis carinii pneumonia. Immunologic test results were consistent with the acquired immunodeficiency syndrome. The patient denied having homosexual contact or using intravenous drugs. Twenty-nine months before the diagnosis of pneumocystis pneumonia was made, the patient had had 16 transfusions of whole blood, platelets, and fresh-frozen plasma during coronary artery bypass surgery at another medical center. This patient is not a member of any currently recognized high-risk group and is believed to have contracted the acquired immunodeficiency syndrome from blood and blood-product transfusions.

  5. Transfusion reaction in a case with the rare Bombay blood group.

    PubMed

    Shahshahani, Hayedeh Javadzadeh; Vahidfar, Mohamad Reza; Khodaie, Seyed Ali

    2013-01-01

    Bombay phenotype is extremely rare in Caucasian with an incidence of 1 in 250,000. When individuals with the Bombay phenotype need blood transfusion, they can receive only autologous blood or blood from another Bombay blood group. Transfusing blood group O red cells to them can cause a fatal hemolytic transfusion reaction. In this study, we report a case with the rare Bombay blood group that was misdiagnosed as the O blood group and developed a hemolytic transfusion reaction. This highlights the importance of both forward and reverse typing in ABO blood grouping and standard cross-matching and performing standard pretransfusion laboratory tests in hospital blood banks. PMID:23559776

  6. Effect of Tranexamic Acid on Blood Loss and Blood Transfusion Reduction after Total Knee Arthroplasty

    PubMed Central

    Seol, Young-Jun; Seon, Jong-Keun; Lee, Seung-Hun; Jin, Cheng; Prakash, Jatin; Park, Yong-Jin

    2016-01-01

    Purpose Total knee arthroplasty (TKA) accompanies the risk of bleeding and need for transfusion. There are several methods to reduce postoperative blood loss and blood transfusion. One such method is using tranexamic acid during TKA. The purpose of this study was to confirm whether tranexamic acid reduces postoperative blood loss and blood transfusion after TKA. Materials and Methods A total of 100 TKA patients were included in the study. The tranexamic acid group consisted of 50 patients who received an intravenous injection of tranexamic acid. The control included 50 patients who received a placebo injection. The amounts of drainage, postoperative hemoglobin, and transfusion were compared between the groups. Results The mean amount of drainage was lower in the tranexamic acid group (580.6±355.0 mL) than the control group (886.0±375.5 mL). There was a reduction in the transfusion rate in the tranexamic acid group (48%) compared with the control group (64%). The hemoglobin level was higher in the tranexamic acid group than in the control group at 24 hours postoperatively. The mean units of transfusion were smaller in the tranexamic acid group (0.76 units) than in the control group (1.28 units). Conclusions Our data suggest that intravenous injection of tranexamic acid decreases the total blood loss and transfusion after TKA. PMID:27595071

  7. Hepcidin as a new biomarker for detecting autologous blood transfusion.

    PubMed

    Leuenberger, Nicolas; Barras, Laura; Nicoli, Raul; Robinson, Neil; Baume, Norbert; Lion, Niels; Barelli, Stefano; Tissot, Jean-Daniel; Saugy, Martial

    2016-05-01

    Autologous blood transfusion (ABT) is an efficient way to increase sport performance. It is also the most challenging doping method to detect. At present, individual follow-up of haematological variables via the athlete biological passport (ABP) is used to detect it. Quantification of a novel hepatic peptide called hepcidin may be a new alternative to detect ABT. In this prospective clinical trial, healthy subjects received a saline injection for the control phase, after which they donated blood that was stored and then transfused 36 days later. The impact of ABT on hepcidin as well as haematological parameters, iron metabolism, and inflammation markers was investigated. Blood transfusion had a particularly marked effect on hepcidin concentrations compared to the other biomarkers, which included haematological variables. Hepcidin concentrations increased significantly: 12 hr and 1 day after blood reinfusion, these concentrations rose by seven- and fourfold, respectively. No significant change was observed in the control phase. Hepcidin quantification is a cost-effective strategy that could be used in an "ironomics" strategy to improve the detection of ABT. Am. J. Hematol. 91:467-472, 2016. © 2016 Wiley Periodicals, Inc. PMID:26822428

  8. [Case of Rh (-) patient's right lobectomy of the liver with massive hemorrhage evading allogeneic blood transfusion by hemodilutional autologous blood transfusion].

    PubMed

    Nishimura, Masayuki; Takada, Norikazu; Hashiba, Eiji; Kimura, Futoshi; Kitayama, Masatou; Hashimoto, Hiroshi

    2014-01-01

    A 44-year-old man (ASA-PS 1) underwent right lobectomy of the liver under total intravenous anesthesia with propofol, remifentanil, ketamine and rocuronium. In order to evade allogeneic blood transfusion, 1,200 g of the patient's blood was taken and hemodilution was induced for autologous blood transfusion (HAT) after the induction of anesthesia. As intraoperative blood loss amounted to about 4,000 g, Hb level decreased from 13.6 to 6.2 g x dl(-1). However, as intraoperative hemodynamics was relatively stable with crystalloidal and colloidal transfusion with no ischemic change on ECG and no metabolic acidosis, autologous blood transfusion was withheld. After returning the autologous blood, Hb increased to 9.8 g x dl(-1). Any postoperative complications related to the low Hb level were not recognized. HAT is a useful method to evade or at least decrease the amount of allogeneic blood transfusion by anesthesiologists. PMID:24558939

  9. Hyperkalemia after irradiation of packed red blood cells: Possible effects with intravascular fetal transfusion

    SciTech Connect

    Thorp, J.A.; Plapp, F.V.; Cohen, G.R.; Yeast, J.D.; O'Kell, R.T.; Stephenson, S. )

    1990-08-01

    Plasma potassium, calcium, and albumin concentrations in irradiated blood, and in fetal blood before and after transfusion, were measured. Dangerously high plasma potassium levels were observed in some units of irradiated packed red blood cells (range, 13.9 to 66.5 mEq/L; mean, 44.7 mEq/L) and could be one possible explanation for the high incidence of fetal arrhythmia associated with fetal intravascular transfusion. There are many factors operative in the preparation of irradiated packed red blood cells that may predispose to high potassium levels: the age of the red blood cells, the number of procedures used to concentrate the blood, the duration of time elapsed from concentration, the duration of time elapsed from irradiation, and the hematocrit. Use of fresh blood, avoidance of multiple packing procedures, limiting the hematocrit in the donor unit to less than or equal to 80%, and minimizing the time between concentration, irradiation and transfusion may minimize the potassium levels, and therefore making an additional washing procedure unnecessary.

  10. Management of anaemia and blood transfusion in critical care - implementing national guidelines in ICU.

    PubMed

    Watson, Sethina; Kendrick, Kate

    2014-01-01

    Anaemia in intensive care is common, with approximately 50% of patients receiving a red cell transfusion. Recognised complications from transfusion include 'transfusion associated lung injury', infection, and organ failure progression. Most cohort studies show a positive relationship between red cell transfusion and adverse outcomes. In 2012, the British Committee for Standards in Haematology issued guidelines for red cell (RBC) transfusion in critical care. They recommend a haemoglobin transfusion trigger of below 70 g/dL unless the patient is bleeding, has acute sepsis, neurological injury, or an acute coronary syndrome. RBC transfusions in a single intensive care unit (ICU) were prospectively assessed for compliance with national guidance. Each transfusion was categorised with a traffic light system: red for inappropriate, green for appropriate, and amber for those that were not clearly appropriate or inappropriate. The quality improvement project began with a clinical effectiveness audit of doctors' knowledge of critical care transfusion thresholds. Two quality improvement interventions were used: 1) a local blood transfusion guideline was produced and posters were placed in the ICU 2) this guidance was attached to the transfusion prescriptions. Data was collected after each intervention. A total of 30 random adult RBC transfusions were analysed between August 2013 and February 2014. Despite good results from the effectiveness audit an assessment of RBC transfusions demonstrated room for improvement. Prior to introduction of the guideline intervention, a total of two transfusions were green, one red and seven amber. Following both interventions there were seven green transfusions and three amber. No transfusions were classed as inappropriate. According to additional trust based ICU transfusion records, there was approximately a 50% reduction (41 to 18 RBC transfusions) in overall blood transfusions following the first intervention in October 2013. Simple

  11. [The 2013 Seville Consensus Document on alternatives to allogenic blood transfusion. An update on the Seville Document].

    PubMed

    Leal-Noval, S R; Muñoz, M; Asuero, M; Contreras, E; García-Erce, J A; Llau, J V; Moral, V; Páramo, J A; Quintana, M; Basora, M; Bautista-Paloma, F J; Bisbe, E; Bóveda, J L; Castillo-Muñoz, A; Colomina, M J; Fernández, C; Fernández-Mondéjar, E; Ferrándiz, C; García de Lorenzo, A; Gomar, C; Gómez-Luque, A; Izuel, M; Jiménez-Yuste, V; López-Briz, E; López-Fernández, M L; Martín-Conde, J A; Montoro-Ronsano, B; Paniagua, C; Romero-Garrido, J A; Ruiz, J C; Salinas-Argente, R; Sánchez, C; Torrabadella, P; Arellano, V; Candela, A; Fernández, J A; Fernández-Hinojosa, E; Puppo, A

    2013-05-01

    Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: "Does this particular AABT reduce the transfusion rate or not?" All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology. PMID:23415109

  12. [The 2013 Seville Consensus Document on alternatives to allogenic blood transfusion. An update on the Seville Document].

    PubMed

    Leal-Noval, S R; Muñoz, M; Asuero, M; Contreras, E; García-Erce, J A; Llau, J V; Moral, V; Páramo, J A; Quintana, M; Basora, M; Bautista-Paloma, F J; Bisbe, E; Bóveda, J L; Castillo-Muñoz, A; Colomina, M J; Fernández, C; Fernández-Mondéjar, E; Ferrándiz, C; García de Lorenzo, A; Gomar, C; Gómez-Luque, A; Izuel, M; Jiménez-Yuste, V; López-Briz, E; López-Fernández, M L; Martín-Conde, J A; Montoro-Ronsano, B; Paniagua, C; Romero-Garrido, J A; Ruiz, J C; Salinas-Argente, R; Sánchez, C; Torrabadella, P; Arellano, V; Candela, A; Fernández, J A; Fernández-Hinojosa, E; Puppo, A

    2013-05-01

    Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: « Does this particular AABT reduce the transfusion rate or not?» All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology. PMID:23507335

  13. Informed consent for blood transfusion: what do medicine residents tell? What do patients understand?

    PubMed

    Friedman, Mark; Arja, Wajih; Batra, Rashmi; Daniel, Sugganth; Hoehn, Daniela; Paniz, Alberto Mondolfi; Selegean, Sorin; Slova, Denisa; Srivastava, Swati; Vergara, Norge

    2012-10-01

    Blood transfusion is a common intervention in the hospital setting, and its benefits may not be clear but it has associated risks. Despite this, transfusion consent may not be obtained satisfactorily. We assessed transfusion consent effectiveness by comparing information given by residents with information understood by patients who receive transfusions. Medicine department residents who obtained consent were surveyed via telephone in conjunction with bedside surveys of adult inpatients who received transfusions. A total of 43 patient and 34 resident surveys were completed. Deficiencies in the transfusion consent process were noted. Discussed transfusion benefits (such as wound healing) were not always true benefits whereas some important risks (such as transfusion-related acute lung injury) were infrequently conferred. Risks were more often reported as "not discussed" than benefits. Only a few participants were aware of the hospital's Transfusion Health Guide, which provides information on transfusion benefits, risks, and alternatives. PMID:23010711

  14. Blood product transfusion: does location make a difference?

    PubMed

    Palmieri, Tina L; Sen, Soman; Falwell, Katrina; Greenhalgh, David G

    2011-01-01

    Early blood product administration during acute blood loss may improve outcomes, yet blood product transfusion for anemia of critical illness has been associated with increased mortality. After major burn injury, patients have two sources of anemia: massive acute blood loss during excision and insidious losses in the intensive care unit (ICU). The purpose of this study was to assess the relationship between the administration of fresh frozen plasma (FFP), platelets, and cryoprecipitate and outcomes in children with major burn injury. This was a retrospective review of children admitted with >20% TBSA burn from 2006 to 2009. Parameters measured included demographics, injury characteristics, operations, blood product transfusions, and outcomes. A total of 143 children received a mean of 3342 ± 283 ml blood. Nonsurvivors had larger burns (62.1 ± 4.6% vs 41.0 ± 1.5% TBSA, P < .001) and received similar amounts of packed red blood cells (PRBCs) during hospitalization (12.8 ± 2.4 units vs 10.9 ± 1.0 units, P = .5) than survivors. Nonsurvivors received more total units of FFP during hospitalization than survivors (8.0 ± 1.7 units vs 3.1 ± 0.4 units, P < .0001) because of the FFP units transfused in the ICU (5.5 ± 1.2 units vs 1.1 ± 0.2 units, P < .0001). The overall FFP:PRBC transfusion ratio in survivors was 1:4, whereas mean FFP:PRBC volume ratio in nonsurvivors was 3:4 (P < .0001). Nonsurvivors received more platelets (3.4 ± 1.0 units vs 0.50 ± 0.1 units, P < .001) and cryoprecipitate (1.9 ± 0.9 units vs 0.3 ± 0.1 units, P < .001) than survivors, both in the operating room and in the ICU. Blood product use in children with severe burns is associated with increased mortality. Appropriate use of blood products may need to be different in the operating room (massive acute hemorrhage) vs the ICU (ongoing red cell senescence). PMID:21107270

  15. [Liability for hepatitis after blood transfusion (author's transl)].

    PubMed

    Fiedler, H; Hackethal, B

    1980-01-01

    1) Only a very limited amount of all cases of so-called "post-transfusion-hepatitis" (pth) is really due to infectivity of the transfused blood. Regardless of the mostly unknown true source of the infection, the occurrence of "pth" for itself does not qualify the recipient and/or his illness-insurance company for a legitimate action for damages against the blood bank under current West Germany Federal Law. 2) All West German blood banks are obliged by Federal Law to insure themselves against strictly defined damage claims. Their damage-insurance companies are not entitled to pay compensations to the illness-insurance companies of any victim of "pth" without meticulous investigation of the exact circumstances if expenses exceeding the legally defined limitations are included in the premium of damage-insurance charged to the blood banks. 3)Since nearly all inhabitants of West Germany are legally or voluntarily insured against illness, compensations paid by damage-insurance companies to illness-insurance companies are no appropriate means for any cost containment of the latter: The blood banks have no other choice than to calculate the additional premium costs into the costs of the blood units to be debitted to the illness-insurance companies. PMID:7467874

  16. Bioethics and religious bodies: refusal of blood transfusions in Germany.

    PubMed

    Rajtar, Małgorzata

    2013-12-01

    The refusal of medical treatment is a recurrent topic in bioethical debates and Jehovah's Witnesses often constitute an exemplary case in this regard. The refusal of a potentially life-saving blood transfusion is a controversial choice that challenges the basic medical principle of acting in patients' best interests and often leads physicians to adopt paternalistic attitudes toward patients who refuse transfusion. However, neither existing bioethical nor historical and social sciences scholarship sufficiently addresses experiences of rank-and-file Witnesses in their dealings with the health care system. This article draws on results of a nine-month (2010, 2011-2012) ethnographic research on the relationship between religious, legal, ethical, and emotional issues emerging from the refusal of blood transfusions by Jehovah's Witnesses in Germany (mainly in Berlin). It shows how bioethical challenges are solved in practice by some German physicians and what they perceive to be the main goal of biomedicine: promoting the health or broadly understood well-being of patients. I argue that two different understandings of the concept of autonomy are at work here: autonomy based on reason and autonomy based on choice. The first is privileged by German physicians in line with a Kantian philosophical tradition and constitutional law; the second, paradoxically, is utilized by Jehovah's Witnesses in their version of the Anglo-Saxon Millian approach. PMID:23538204

  17. [Establishment of a blood transfusion center at Kabul (Afghanistan)].

    PubMed

    Dupire, B; Abawi, A K; Ganteaume, C; Lam, T; Truze, P; Martet, G

    1999-01-01

    Recent events concerning blood transfusion (BT) have led to the number of BT being drastically reduced and to more rigorous checking of blood donations before their use for transfusion. Very few developing countries have been able to set up BT organizations that are both self-sufficient and capable of ensuring a high quality of blood testing. A central blood bank (CBB) was set up in Kabul (Afghanistan) during the 1980s. From 1992 onwards, its activities were curtailed due to the political turmoil, lack of funds and the fact that no blood collection policy was being implemented. A partnership between a development aid agency (Avicen), French public institutions and the local authorities has resulted in the rebirth of this CBB by the injection of financial resources and technical and scientific expertise. An independent committee of BT specialists was responsible for assessing the scientific validity and ethical acceptability of the project. In 1996, the objectives of the project, which had been in operation for one year, were achieved as far as the renovation of the laboratories was concerned. Work has focused mostly on setting up a proper cold chain and on training laboratory technicians in standard biological methods for testing blood from donors (blood group, HIV screening, Ag Hbs, HCV and syphilis). However, due to the shortage of blood donors, it has been difficult to set up a minimum blood bank stock. The results of the first biological tests carried out on the blood of the first 1,281 donors have made it possible to define an appropriate, detailed policy for preventing and controlling the main risks of infection from BT, involving routine testing for HIV, Ag HBs and HCV (0.3% prevalence). BT is a major component of any health care system and it must be reconstructed. The measures proposed here are long-term and require the ongoing participation of all those involved in this project including the local authorities and sources of financial support. PMID

  18. Interventions to reduce wrong blood in tube errors in transfusion: a systematic review.

    PubMed

    Cottrell, Susan; Watson, Douglas; Eyre, Toby A; Brunskill, Susan J; Dorée, Carolyn; Murphy, Michael F

    2013-10-01

    This systematic review addresses the issue of wrong blood in tube (WBIT). The objective was to identify interventions that have been implemented and the effectiveness of these interventions to reduce WBIT incidence in red blood cell transfusion. Eligible articles were identified through a comprehensive search of The Cochrane Library, MEDLINE, EMBASE, Cinahl, BNID, and the Transfusion Evidence Library to April 2013. Initial search criteria were wide including primary intervention or observational studies, case reports, expert opinion, and guidelines. There was no restriction by study type, language, or status. Publications before 1995, reviews or reports of a secondary nature, studies of sampling errors outwith transfusion, and articles involving animals were excluded. The primary outcome was a reduction in errors. Study characteristics, outcomes measured, and methodological quality were extracted by 2 authors independently. The principal method of analysis was descriptive. A total of 12,703 references were initially identified. Preliminary secondary screening by 2 reviewers reduced articles for detailed screening to 128 articles. Eleven articles were eventually identified as eligible, resulting in 9 independent studies being included in the review. The overall finding was that all the identified interventions reduced WBIT incidence. Five studies measured the effect of a single intervention, for example, changes to blood sample labeling, weekly feedback, handwritten transfusion requests, and an electronic transfusion system. Four studies reported multiple interventions including education, second check of ID at sampling, and confirmatory sampling. It was not clear which intervention was the most effective. Sustainability of the effectiveness of interventions was also unclear. Targeted interventions, either single or multiple, can lead to a reduction in WBIT; but the sustainability of effectiveness is uncertain. Data on the pre- and postimplementation of

  19. Risk Factors for the Postoperative Transfusion of Allogeneic Blood in Orthopedics Patients With Intraoperative Blood Salvage

    PubMed Central

    Tang, Jia-Hua; Lyu, Yi; Cheng, Li-Ming; Li, Ying-Chuan; Gou, Da-Ming

    2016-01-01

    Abstract The purpose of this study is to explore the risk factors affecting the postoperative transfusion of allogeneic blood in patients undergoing orthopedics surgery with intraoperative blood salvage (IBS). A retrospective study of 279 patients undergoing orthopedic surgeries with IBS from May 2013 to May 2015 was enrolled. The binary logistic regression was used to find out the risk factors associated with postoperative transfusion of allogeneic blood in orthopedics patients with IBS, and then receiver operating characteristic (ROC) curve was drawn to determine the optimal threshold of the regression model. Single factor analysis showed that age, American Society of Anesthesiologists (ASA) grade, preoperative hemoglobin, operation time, received autologous blood, the laying time of autologous blood, bleeding volume, and postoperative drainage volume had significant effects on postoperative allogeneic blood transfusion. In binary logistic regression analysis, the independent factors predicting orthopedic patients with IBS need to transfuse allogeneic blood after surgeries were age (odds ratio [OR] = 0.415, P = 0.006), ASA grade (OR = 2.393, P = 0.035), preoperative hemoglobin (OR = 0.532, P = 0.022), and postoperative drainage volume (OR = 4.279, P = 0.000). The area under ROC curve was 0.79 and the predicted accuracy rate of the model was 81.58%. After operation, the orthopedic patients with IBS still have a high allogeneic blood transfusion rate, and IBS is not a perfect blood protection method. The logistic regression model of our study provides a reliable prediction for postoperative transfusion of allogeneic blood in orthopedic patients with IBS, which have a certain reference value. PMID:26937919

  20. Reducing Non-Infectious Risks of Blood Transfusion

    PubMed Central

    Gilliss, Brian M.; Looney, Mark R.; Gropper, Michael A.

    2011-01-01

    Summary As screening for transfusion-associated infections has improved, non-infectious complications of transfusion now cause the majority of morbidity and mortality associated with transfusion in the United States. For example, transfusion-related acute lung injury, transfusion-associated circulatory overload, and hemolytic transfusion-reactions are the first, second, and third leading causes of death from transfusion respectively. These complications and others are reviewed here and several controversial methods for prevention of non-infectious complications of transfusion are discussed; universal leukoreduction of red cell units, use of male-only plasma, and restriction of red cell storage age. PMID:21792054

  1. The hospital cost (fiscal year 1991/1992) of a simple perioperative allogeneic red blood cell transfusion during elective surgery at Duke University.

    PubMed

    Lubarsky, D A; Hahn, C; Bennett, D H; Smith, L R; Bredehoeft, S J; Klein, H G; Reves, J G

    1994-10-01

    We sought to determine the actual cost to Duke University Medical Center of a perioperative red blood cell transfusion. A recent audit at Duke University Medical Center determined the base average direct and indirect hospital costs for providing a unit of red blood cells. The Transfusion Service's base cost for providing an allogeneic unit of red blood cells was $113.58. To obtain the actual hospital cost of transfusing a unit of red blood cells in the perioperative period, associated costs were calculated and added to the Transfusion Service's base cost. These associated costs included compatibility tests on multiple units per each unit transfused in the perioperative period, performing ABO and Rh typing and antibody screening on samples from patients who were not subsequently transfused, compatibility tests on units not issued, handling costs of units issued but not used, physically administering the blood, and the cost of the recipient contracting an infectious disease or developing a transfusion reaction. These associated costs increased the cost of transfusing an allogeneic unit of red blood cells in the perioperative period to $151.20. Perhaps the techniques described in the study can be used to quantify cost/benefit ratios associated with future changes in transfusion practice. PMID:7943767

  2. Acute hemolytic transfusion reactions due to multiple alloantibodies including anti-E, anti-c and anti-Jkb.

    PubMed

    Park, Tae Sung; Kim, Ki Uk; Jeong, Woo Jin; Kim, Hyung Hoi; Chang, Chulhun L; Chung, Joo Seop; Cho, Goon Jae; Lee, Eun Yup; Son, Han Chul

    2003-12-01

    We report a case of two consecutive episodes of acute hemolytic transfusion reactions (HTRs) due to multiple alloantibodies in a 34-yr-old man who suffered from avascular necrosis of left femoral head. He received five units of packed red blood cells (RBCs) during surgery. Then the transfusion of packed RBCs was required nine days after the surgery because of the unexplained drop in hemoglobin level. The transfusion of the first two units resulted in fever and brown-colored urine, but he received the transfusion of another packed RBCs the next day. He experienced even more severe symptoms during the transfusion of the first unit. We performed antibody screening test, and it showed positive results. Multiple alloantibodies including anti-E, anti-c and anti-Jkb were detected by antibody identification study. Acute HTRs due to multiple alloantibodies were diagnosed, and the supportive cares were done for 6 days. We suggest the antibody screening test should be included in the panel of pretransfusion tests for safer transfusion, and it is particularly mandatory for the patients with multiple transfusions, pregnant women, and preoperative patients. PMID:14676451

  3. Impact of antigenic exposures and role of molecular blood grouping in enhancing transfusion safety in chronically transfused thalassemics

    PubMed Central

    Makroo, Raj Nath; Agrawal, Soma; Bhatia, Aakanksha; Chowdhry, Mohit; Thakur, Uday Kumar

    2016-01-01

    Background: Red cell alloimmunization is an acknowledged complication of blood transfusion. Current transfusion practices for thalassemia do not cater to this risk. Serological phenotyping is usually not reliable in these cases unless performed before the first transfusion. Under such circumstances, molecular blood grouping is an effective alternative. Aim: To perform molecular blood group genotyping in chronically transfused thalassemia patients and assess the risk of antigenic exposure and incidence of alloimmunization with current transfusion protocols. Materials and Methods: Molecular blood group genotyping was performed for 47 chronically transfused thalassemia patients. Their 1-year transfusion records were retrieved to assess the antigenic exposure and the frequency thereof. Results: Of 47 patients, 6 were already alloimmunized (3 with anti-E and 3 with anti-K) and were receiving the corresponding antigen negative units. We observed that random selection of ABO and Rh D matched units resulted in 57.7% ±8.26% chance of Rh and Kell phenotype matching also. Forty-four patients had received one or more antigenic exposures at least once. The 6 already alloimmunized patients were further exposed to antigens other than the ones they were immunized to. During the study period, only one patient developed an alloantibody, anti-E with exposure to antigens C (92%) and/or E (32%) at each transfusion. Conclusion: Several factors apart from mere antigen exposure may influence the development of alloimmunization as most of our patients received antigenic exposures but not alloimmunized. Our data provide an impetus for future large-scale studies to understand the development of alloimmunization in such patients. PMID:27605852

  4. Effect of perioperative blood transfusion on clinical outcomes in hepatic surgery for cancer.

    PubMed

    Dionigi, Gianlorenzo; Boni, Luigi; Rovera, Francesca; Rausei, Stefano; Cuffari, Salvatore; Cantone, Giovanni; Bacuzzi, Alessandro; Dionigi, Renzo

    2009-08-28

    Allogeneic blood transfusion during liver resection for malignancies has been associated with an increased incidence of different types of complications: infectious complications, tumor recurrence, decreased survival. Even if there is clear evidence of transfusion-induced immunosuppression, it is difficult to demonstrate that transfusion is the only determinant factor that decisively affects the outcome. In any case there are several motivations to reduce the practice of blood transfusion. The advantages and drawbacks of different transfusion alternatives are reviewed here, emphasizing that surgeons and anesthetists who practice in centers with a high volume of liver resections, should be familiar with all the possible alternatives. PMID:19705491

  5. Minimizing blood loss and the need for transfusions in very premature infants

    PubMed Central

    Lemyre, Brigitte; Sample, Megan; Lacaze-Masmonteil, Thierry

    2015-01-01

    Reducing blood loss and the need for blood transfusions in extremely preterm infants is part of effective care. Delayed cord clamping is well supported by the evidence and is recommended for infants who do not immediately require resuscitation. Cord milking may be an alternative to delayed cord clamping; however, more research is needed to support its use. In view of concerns regarding the increased risk for cognitive delay, clinicians should avoid using hemoglobin transfusion thresholds lower than those tested in clinical trials. Higher transfusion volumes (15 mL/kg to 20 mL/kg) may decrease exposure to multiple donors. Erythropoietin is not recommended for routine use due to concerns about retinopathy of prematurity. Elemental iron supplementation (2 mg/kg/day to 3 mg/kg/day once full oral feeds are achieved) is recommended to prevent later iron deficiency anemia. Noninvasive monitoring (eg, for carbon dioxide, bilirubin) and point-of-care testing reduce the need for blood sampling. Clinicians should strive to order the minimal amount of blood sampling required for safe patient care, and cluster samplings to avoid unnecessary skin breaks. PMID:26744559

  6. Blood transfusion requirement for gastric cancer surgery: reasonable preparation for transfusion in the comprehensive health insurance system.

    PubMed

    Hoya, Yoshiyuki; Takahashi, Tomoko; Saitoh, Ryouta; Anan, Tadashi; Sasaki, Toshiyuki; Inagaki, Takuya; Yamazaki, Satoshi; Yamashita, Makoto; Yanaga, Katsuhiko

    2008-06-01

    We investigated the necessity of preparation for blood transfusion in gastric cancer surgery to save costs for blood typing, antibody screening, cross-matching, and disposal of the blood product. The subjects of the study were 52 patients who underwent gastric cancer surgery at our department between 2000 and 2004. The requirement for blood transfusion during surgery was investigated in terms of patient characteristics, hemoglobin before surgery, and performance status as well as treatment regimen. Furthermore, economic effects were investigated when typing and screening (T&S) were performed instead of typing and cross-matching (T&X). Of 9 patients who received blood transfusion, 8 had gastric cancer of stage IIIB or higher, or underwent combined resection. Blood transfusion was not used in surgery for patients with early gastric cancer. The volumes of blood prepared, lost, and disposed of in 28 patients who underwent T&X were 831.3+/-249.4, 219.3+/-228.5 and 600+/-333.1 ml, respectively, whereas the blood loss in 24 patients who underwent T&S was 161.1+/-95.6 ml; this difference had a major economic effect. The practice of T&S for patients undergoing gastric surgery in the absence of combined resection for early gastric cancer seems to be a safe and cost-effective practice that abrogates disposal of blood in hospital management. PMID:18555758

  7. Tranexamic acid reduces the blood loss and blood transfusion requirements following peri-acetabular osteotomy.

    PubMed

    Wassilew, G I; Perka, C; Janz, V; Krämer, M; Renner, L

    2015-12-01

    We have investigated the effect of using tranexamic acid (TXA) during peri-acetabular osteotomy (PAO) on peri-operative blood loss and blood transfusion requirements. In addition we analysed whether the use of TXA was associated with an increased risk of venous thromboembolism (VTE) following this procedure. A consecutive series of 96 PAOs, performed by a single surgeon, were reviewed. A total of 48 patients received TXA and 48 did not. The TXA group received a continuous infusion of TXA at a rate of 10 mg/kg/h. The primary outcome measure was the requirement for blood transfusion. Secondary outcomes included total blood loss, the decrease in the level of haemoglobin in the blood, the length of hospital stay, and the complications of this treatment. The mean rate of transfusion was significantly lower in the TXA group (62.5% vs 12.5%, p < 0.001). The mean blood loss was also significantly reduced in the TXA group (1.9 L (standard deviation (SD) 0.9) vs 1.5 L (SD 0.7), p < 0.01). No post-operative episodes of VTE were identified in either group. The use of TXA reduced the blood loss and the rate of transfusion after PAO significantly, without adverse effects such as an increased rate of VTE. PMID:26637672

  8. [Universal implementation of pathogen inactivation in labile blood products is a major step towards transfusion safety].

    PubMed

    Cazenave, Jean-Pierre

    2010-12-01

    Transfusion of labile blood products (red cell concentrates, platelet concentrates and plasma) is vital in the absence of alternatives. Patients and doctors have always feared infections transmitted by blood, blood components and blood-derived drugs. It is potentially dangerous to delay implementation of pathogen inactivation in labile blood products pending a perfect process. Universal implementation of pathogen inactivation in labile blood products is a major step towards transfusion safety. PMID:22043595

  9. Awareness and performance of blood transfusion standards in operating rooms of Shiraz hospitals in 2012

    PubMed Central

    Robati, R; Mirahmadi Nejad, E

    2015-01-01

    Background Assuring safety and survival of blood in vitro depends on anti-coagulation substances, blood bag characteristics, storage conditions, and transport of blood. Besides, careful selection and screening of donors as well as blood tests can minimize the transmission risk of blood-transmissible pathogens and optimize blood health. The aim of this study was to assay the level of knowledge and practices among anesthesia technicians on blood transfusion standards. Materials and Methods This descriptive cross-sectional study was performed among 85 anesthesia technicians Shiraz, Iran throughout 2012 who were examined by census using blood transfusion questionnaires and checklists. The data were analyzed using SPSS 16 software. Results The obtained findings indicated that 32.44% of the technicians have corrected knowledge of blood transfusion standards; nevertheless, 73.84% have corrected performance. Conclusions The technicians mostly performed based on their habit and experience. However, their knowledge about blood transfusion and blood bag storage was low. PMID:26131349

  10. [Transfusion policy in trauma involving massive blood loss].

    PubMed

    Saltzherr, Teun Peter; Christiaans, Sarah C; Henny, C Pieter; Levi, Marcel M; Goslings, J Carel

    2011-01-01

    Severe haemorrhage is a significant cause of death in trauma patients. In the case of massive blood loss a combination of coagulation defects, acidosis and hypothermia arise, which are accompanied by high morbidity and mortality rates unless properly corrected. Research in wounded military showed that a high ratio of fresh frozen plasma to packed red blood cells (FFP:PRBC) seemed to have a positive effect on survival. These studies do not provide a definition of the ideal ratio FFP:PRBC; the ratio in which a positive effect is seen varies from 1:1 to 1:3. Unnecessary FFP transfusions in trauma patients without imminent severe haemorrhage increase the risk of complications such as multi-organ failure and acute respiratory distress syndrome. Additional research is required into the accuracy of diagnosis of acute coagulation disorders. PMID:21291576

  11. Maternal and Perinatal Outcome of Life Threatening Obstetrical Complications Requiring Multiple Transfusions

    PubMed Central

    Khatuja, Ritu; Radhakrishnan, Gita; Radhika, AG; Juneja, Atul; Singh, Bharat

    2015-01-01

    Introduction Obstetrical haemorrhage is the direct cause of maternal mortality, which can be prevented by timely recognition followed by quick and adequate treatment. Aim To evaluate maternal and perinatal outcome of life threatening obstetric complications requiring multiple transfusions. Materials and Methods It is an observational study conducted on 112 antenatal and postnatal women admitted in a tertiary level hospital, requiring blood and blood products transfusion of >1.5 liters in 24 hours, over a period of 15 months (Aug 2011 to Oct 2012). The demographic and obstetrical profile, amount transfused, mode of delivery, duration of hospital stay, maternal and neonatal morbidity and mortality was evaluated. Statistical Analysis Statistical analysis of the data was performed using chi-squared test. Results There were 95 women who presented in antepartum period and 17 in the postpartum. Multigravidas comprised of 70 women, 81 had unsupervised pregnancies and 33 women presented in shock. At admission, 76 peripartum women had severe anaemia and 62 had coagulopathy. Obstetrical hysterectomy was done for 33 women and total 17 women expired. Haemorrhage was the most common indication for transfusion. The mean blood transfusion and volume replacement in 24 hours was 4.2 units & 2.25 liters respectively. The mean hospital stay was 10-15 days. Intra-uterine death at the time of admission was present in 40 women and 72 had live births. After birth, 21 babies required neonatal intensive care, of which 6 expired. Conclusion Antenatal care is important to prevent complications though pregnancy is always unpredictable. Patients’ condition at admission is single most important factor often influencing the maternal and perinatal outcome. PMID:26673661

  12. Perioperative management of anemia: limits of blood transfusion and alternatives to it.

    PubMed

    Kumar, Ajay

    2009-11-01

    Perioperative anemia is associated with excess morbidity and mortality. Transfusion of allogeneic blood has been a longstanding strategy for managing perioperative anemia, but the blood supply is insufficient to meet transfusion needs, and complications such as infection, renal injury, and acute lung injury are fairly common. Further, data suggest that mortality and length of stay are worsened with liberal use of transfusion. Medical alternatives to transfusion include iron supplementation and erythropoiesis-stimulating agents (ESAs). Though ESAs reduce the need for perioperative blood transfusion compared with placebo, they are associated with an increased risk of thrombotic events in surgical patients. Cleveland Clinic has been developing a blood management program aimed at reducing allogeneic blood exposure for greater patient safety; the program has achieved some reduction in blood utilization in its first 7 months. PMID:19880828

  13. Red Blood Cell Transfusion Strategies in Adult and Pediatric Patients with Malignancy.

    PubMed

    Roubinian, Nareg; Carson, Jeffrey L

    2016-06-01

    Anemia in patients with malignancy is common as a consequence of their disease and treatment. Substantial progress has been made in the management of anemia with red blood cell transfusion in acute conditions, such as bleeding and infection, through the performance of large clinical trials. These trials suggest that transfusion at lower hemoglobin thresholds (restrictive transfusion ∼7-8 g/dL) is safe and in some cases superior to higher transfusion thresholds (liberal transfusion ∼9-10 g/dL). However, additional studies are needed in patients with malignancy to understand best practice in relation to quality of life as well as clinical outcomes. PMID:27112994

  14. Evaluation of Blood Transfusions in Anemic Children in Effia Nkwanta Regional Hospital, Sekondi-Takoradi, Ghana.

    PubMed

    Orish, Verner N; Ilechie, Alex; Combey, Theophilus; Onyeabor, Onyekachi S; Okorie, Chuku; Sanyaolu, Adekunle O

    2016-03-01

    Blood transfusion is a common practice in sub-Saharan Africa as a way of correcting anemia in children with mild and severe sicknesses. This study evaluated this practice in a secondary health-care institution in Ghana. A retrospective study was done over a 3-year period from January 2010 to December 2012. Medical records of children admitted, successfully treated, and discharged from the hospital were collected and analyzed. Data were analyzed using Epi Info version 7. Transfusions were more among male children (89, 63.1%) than female children (52, 36.9%). The highest number of blood transfusions were carried out on children in the age range 0-1 year (66, 46.8%). The majority of the blood transfusions were done on children with hemoglobin concentration level of 5 g/dL and below. Children with malaria parasitemia (83, 58.9%) had more transfusions than children without malaria parasitemia (58, 41.1%). Fever alone (43, 30.5%) and fever with gastrointestinal symptoms (33, 23.4%) were the predominant symptoms among children who had blood transfusions. In conclusion, younger children received more transfusions than older children. Also, male children received more blood transfusions than female children. Malaria was observed as a major contributory factor to the requirement for blood transfusions among the children. PMID:26787159

  15. Anaphylactic reaction after autologous blood transfusion: A case report and review of the literature

    PubMed Central

    Kumar, Shailendra; Goyal, Keshav; Dubey, Surya; Bindra, Ashish; Kedia, Shweta

    2015-01-01

    Autologous blood transfusion as a cause of intraoperative anaphylaxis is very rare. We encountered one such life-threatening event in a 72-year-old patient undergoing laminectomy and pedicle screw fixation. The probable cause identified was the floseal mixed autologous blood transfusion. Review of literature has been done, and measures to avoid such an event in the future are discussed. PMID:25972952

  16. Anaphylactic reaction after autologous blood transfusion: A case report and review of the literature.

    PubMed

    Kumar, Shailendra; Goyal, Keshav; Dubey, Surya; Bindra, Ashish; Kedia, Shweta

    2015-01-01

    Autologous blood transfusion as a cause of intraoperative anaphylaxis is very rare. We encountered one such life-threatening event in a 72-year-old patient undergoing laminectomy and pedicle screw fixation. The probable cause identified was the floseal mixed autologous blood transfusion. Review of literature has been done, and measures to avoid such an event in the future are discussed. PMID:25972952

  17. Protocol for a national blood transfusion data warehouse from donor to recipient

    PubMed Central

    van Hoeven, Loan R; Hooftman, Babette H; Janssen, Mart P; de Bruijne, Martine C; de Vooght, Karen M K; Kemper, Peter; Koopman, Maria M W

    2016-01-01

    Introduction Blood transfusion has health-related, economical and safety implications. In order to optimise the transfusion chain, comprehensive research data are needed. The Dutch Transfusion Data warehouse (DTD) project aims to establish a data warehouse where data from donors and transfusion recipients are linked. This paper describes the design of the data warehouse, challenges and illustrative applications. Study design and methods Quantitative data on blood donors (eg, age, blood group, antibodies) and products (type of product, processing, storage time) are obtained from the national blood bank. These are linked to data on the transfusion recipients (eg, transfusions administered, patient diagnosis, surgical procedures, laboratory parameters), which are extracted from hospital electronic health records. Applications Expected scientific contributions are illustrated for 4 applications: determine risk factors, predict blood use, benchmark blood use and optimise process efficiency. For each application, examples of research questions are given and analyses planned. Conclusions The DTD project aims to build a national, continuously updated transfusion data warehouse. These data have a wide range of applications, on the donor/production side, recipient studies on blood usage and benchmarking and donor–recipient studies, which ultimately can contribute to the efficiency and safety of blood transfusion. PMID:27491665

  18. The first direct human blood transfusion: the forgotten legacy of George W. Crile.

    PubMed

    Nathoo, Narendra; Lautzenheiser, Frederick K; Barnett, Gene H

    2009-03-01

    GEORGE W. CRILE is best known as the father of physiological surgery in the United States, a pioneer surgeon, an innovator and inventor, a founding member of the American College of Surgeons, and the principal founder of the Cleveland Clinic Foundation. However, Crile's legacy of performing the first direct blood transfusion in humans has been all but forgotten, even though the results were published in the leading scientific journals of the day. Crile's lifelong interest in the treatment of surgical shock led to his interest in blood transfusion. A chance visit to the laboratory of Alexis Carrel in 1902 resulted in Crile perfecting his technique for direct blood transfusion. He subsequently modified Carrel's anastomosis technique to administer a faster transfusion, investigated the use of blood transfusions in various clinical settings, and went on to introduce the concept and technique of blood transfusion to soldiers during World War I. In this report, we trace his long-time interest in blood transfusion and document the events that led to the first successful blood transfusion performed between 2 brothers on August 6, 1906, at St. Alexis Hospital, Cleveland, OH. PMID:19240569

  19. Vascular access, fluid resuscitation, and blood transfusion in pediatric trauma.

    PubMed

    Greene, Nathaniel; Bhananker, Sanjay; Ramaiah, Ramesh

    2012-09-01

    Trauma care in the general population has largely become protocol-driven, with an emphasis on fast and efficient treatment, good team communication at all levels of care including prehospital care, initial resuscitation, intensive care, and rehabilitation. Most available literature on trauma care has focused on adults, allowing the potential to apply concepts from adult care to pediatric care. But there remain issues that will always be specific to pediatric patients that may not translate from adults. Several new devices such as intraosseous (IO) needle systems and techniques such as ultrasonography to cannulate central and peripheral veins have become available for integration into our pre-existing trauma care system for children. This review will focus specifically on the latest techniques and evidence available for establishing intravenous access, rational approaches to fluid resuscitation, and blood product transfusion in the pediatric trauma patient. PMID:23181207

  20. Continuous and noninvasive hemoglobin monitoring reduces red blood cell transfusion during neurosurgery: a prospective cohort study.

    PubMed

    Awada, Wael N; Mohmoued, Maher F; Radwan, Tarek M; Hussien, Gomaa Z; Elkady, Hany W

    2015-12-01

    Continuous, noninvasive hemoglobin (SpHb) monitoring provides clinicians with the trending of changes in hemoglobin, which has the potential to alter red blood cell transfusion decision making. The objective of this study was to evaluate the impact of SpHb monitoring on blood transfusions in high blood loss surgery. In this prospective cohort study, eligible patients scheduled for neurosurgery were enrolled into either a Control Group or an intervention group (SpHb Group). The Control Group received intraoperative hemoglobin monitoring by intermittent blood sampling when there was an estimated 15% blood loss. If the laboratory value indicated a hemoglobin level of ≤10 g/dL, a red blood cell transfusion was started and continued until the estimated blood loss was replaced and a laboratory hemoglobin value was >l0 g/dL. In the SpHb Group patients were monitored with a Radical-7 Pulse CO-Oximeter for continuous noninvasive hemoglobin values. Transfusion was started when the SpHb value fell to ≤l0 g/dL and was continued until the SpHb was ≥l0 g/dL. Blood samples were taken pre and post transfusion. Percent of patients transfused, average amount of blood transfused in those who received transfusions and the delay time from the hemoglobin reading of <10 g/dL to the start of transfusion (transfusion delay) were compared between groups. The trending ability of SpHb, and the bias and precision of SpHb compared to the laboratory hemoglobin were calculated. Compared to the Control Group, the SpHb Group had fewer units of blood transfused (1.0 vs 1.9 units for all patients; p ≤ 0.001, and 2.3 vs 3.9 units in patients receiving transfusions; p ≤ 0.0 l), fewer patients receiving >3 units (32 vs 73%; p ≤ 0.01) and a shorter time to transfusion after the need was established (9.2 ± 1.7 vs 50.2 ± 7.9 min; p ≤ 0.00 l). The absolute accuracy of SpHb was 0.0 ± 0.8 g/dL and trend accuracy yielded a coefficient of determination of 0.93. Adding SpHb monitoring to

  1. PATTERN, INDICATIONS AND REVIEW OF COMPLICATIONS OF NEONATAL BLOOD TRANSFUSION IN IBADAN, SOUTHWEST NIGERIA

    PubMed Central

    Ayede, A.I.; Akingbola, T.S.

    2011-01-01

    Background and objectives: There is a huge need for blood transfusion in the newborn particularly due to the reduced marrow activity in the neonatal period. Despite widely use of blood products in the neonatal period, there is paucity of local data on the pattern, indications and reactions to blood transfusions in Nigerian newborns. This study evaluates the blood transfusion indications and patterns in special care baby unit and C12nd of University College Hospital, Ibadan, Nigeria. Methodology: A cross sectional study was carried on the recruited newborns and structured questionnaires were used to obtain bio data, medical problems, indications for blood transfusion, type of blood products transfused and clinical signs. Urinalysis was performed out before and after the transfusion. Results: A total of 100 neonates were recruited into the study with a male: female ratio of (M: F= 1:1). The age range was 2–34 days and their weight ranged between 0.8kg to 3.6 kg with a mean weight of 1.64 kg. The main indications for transfusion were anaemia from prematurity & neonatal sepsis(NNS) 46%; (red cell replacement), NNS, Disseminated intravascular coagulation(DIC) & anaemia 24%; (partial exchange + top up + Fresh frozen plasma), neonatal jaundice(NNJ) & anaemia 14%; (whole blood), NNJ, NNS + anaemia 6%(Blood transfusion + Fresh frozen plasma), NNS + anaemia 10% (whole blood). Conclusion: Blood transfusion is still frequent in the study area and prematurity, neonatal sepsis and jaundice rank high in the indications. Transfusion reactions are rare in the evaluated neonates. PMID:25161485

  2. Regional transfusion centre preoperative autologous blood donation programme: the first two years.

    PubMed Central

    Howard, M. R.; Chapman, C. E.; Dunstan, J. A.; Mitchell, C.; Lloyd, H. L.

    1992-01-01

    OBJECTIVE--To assess the efficacy of a regional autologous blood donation programme. DESIGN--Clinical and laboratory data were collected and stored prospectively. Transfusion data were collected retrospectively from hospital blood bank records. SETTING--Northern Region Blood Transfusion Service and 14 hospitals within the Northern Regional Health Authority. SUBJECTS--505 patients referred for autologous blood donation before elective surgery. MAIN OUTCOME MEASURES--Patient eligibility, adverse events from donation, autologous blood units provided, and autologous and allogeneic blood units transfused within 10 days of operation. RESULTS--Of 505 patients referred, 354 donated at least one unit. 78 of 151 referred patients who did not donate were excluded at the autologous clinic, mostly because of anaemia or ischaemic heart disease. In 73 cases the patient, general practitioner, or hospital consultant decided against donation. 363 autologous procedures were undertaken. In 213 (59%) cases all requested units were provided. The most common reasons for incomplete provision were late referral or anaemia. Adverse events accompanied 24 of 928 donations (2.6%). Transfusion data were obtained for 357 of the 363 procedures. 281 donors were transfused; autologous blood only was given to 225, autologous and allogeneic blood was given to 52, and allogeneic blood only was given to four. 648 of 902 (72%) units of autologous blood were transfused. Complete provision of requested autologous units was followed by allogeneic transfusion in 12 of 208 procedures (5.8%). Incomplete provision was followed by allogeneic transfusion in 44 of 149 procedures (30%). CONCLUSIONS--This study shows the feasibility of a regional autologous transfusion programme. Autologous donors only infrequently received allogeneic transfusion. Patients should be appropriately selected and referred early. PMID:1493393

  3. Malaysian child infected with Plasmodium vivax via blood transfusion: a case report

    PubMed Central

    2013-01-01

    Malaria may be a serious complication of blood transfusion due to the asymptomatic persistence of parasites in some donors. This case report highlights the transfusion-transmitted malaria of Plasmodium vivax in a child diagnosed with germ cell tumour. This child had received blood transfusion from three donors and a week later started developing malaria like symptoms. Nested PCR and sequencing confirmed that one of the three donors was infected with P. vivax and this was transmitted to the 12-year-old child. To the best of the authors’ knowledge, this is the first reported transfusion-transmitted malaria case in Malaysia. PMID:24007496

  4. Use of quality rapid diagnostic testing for safe blood transfusion in resource-limited settings.

    PubMed

    Mbanya, D

    2013-05-01

    Blood safety in sub-Saharan Africa is jeopardized by multiple and diverse factors, including the predominance of high-risk family/replacement donors and the high prevalence of transfusion-transmissible infections (TTIs). Thus, stringent diagnostic strategies are vital. Western blotting is costly and technically demanding, and nucleic acid testing technologies, which have been reported to reliably reduce the rate of TTI, are not available in resource-limited settings. Therefore, there is a need for reliable and affordable testing alternatives in these settings. Rapid diagnostic testing has been widely adopted in developing countries, but, for effectiveness in blood safety, highly sensitive tests and the strict selection of low-risk blood donors are indispensable. Although the pre-serological window period remains a source of residual risk for transmission of TTIs during blood transfusion, the combination antigen-antibody rapid tests could contribute significantly to shortening the window period. Thus, despite its limitations, rapid diagnostic testing continues to contribute significantly to blood safety, as a cost-effective means of enhancing screening for TTIs and reducing their transmission in resource-limited rural settings. PMID:23464853

  5. Safety and efficacy of packed red blood cell transfusions at different doses in very low birth weight infants.

    PubMed

    Mallett, Lea H; Govande, Vinayak P; Shetty, Ashita; Beeram, Madhava R

    2016-04-01

    This double-blinded, randomized, crossover study evaluated the safety and effectiveness of 20 mL/kg aliquots of packed red blood cell (PRBC) transfusions versus 15 mL/kg aliquot transfusions in very low birth weight (VLBW) infants with anemia. The study enrolled 22 hemodynamically stable VLBW infants requiring PRBC transfusions, with a mean gestational age of 25.7 ± 2.2 weeks and birth weight of 804 ± 261 g. Each infant was randomized to receive one of two treatment sequences: 15 mL/kg followed by 20 mL/kg or 20 mL/kg followed by 15 mL/kg. The infants were monitored during and after transfusions, and the efficacy and safety of the treatments were evaluated. Infants had higher posttransfusion hemoglobin (13.2 g/dL vs 11.8 g/dL, P < 0.01) and hematocrit levels (38.6 g/dL vs 34.4 g/dL, P < 0.01) following 20 mL/kg PRBC transfusions when compared to 15 mL/kg transfusions. There were no differences in the incidence of tachypnea, hepatomegaly, edema, hypoxia, necrotizing enterocolitis, or vital sign instability between groups. In conclusion, high-volume PRBC transfusions (20 mL/kg) were associated with higher posttransfusion hemoglobin and hematocrit levels but no adverse effects. Higher-volume transfusions may reduce the need for multiple transfusions and therefore the number of donors the infant is exposed to. PMID:27034542

  6. Safety and efficacy of packed red blood cell transfusions at different doses in very low birth weight infants

    PubMed Central

    Govande, Vinayak P.; Shetty, Ashita; Beeram, Madhava R.

    2016-01-01

    This double-blinded, randomized, crossover study evaluated the safety and effectiveness of 20 mL/kg aliquots of packed red blood cell (PRBC) transfusions versus 15 mL/kg aliquot transfusions in very low birth weight (VLBW) infants with anemia. The study enrolled 22 hemodynamically stable VLBW infants requiring PRBC transfusions, with a mean gestational age of 25.7 ± 2.2 weeks and birth weight of 804 ± 261 g. Each infant was randomized to receive one of two treatment sequences: 15 mL/kg followed by 20 mL/kg or 20 mL/kg followed by 15 mL/kg. The infants were monitored during and after transfusions, and the efficacy and safety of the treatments were evaluated. Infants had higher posttransfusion hemoglobin (13.2 g/dL vs 11.8 g/dL, P < 0.01) and hematocrit levels (38.6 g/dL vs 34.4 g/dL, P < 0.01) following 20 mL/kg PRBC transfusions when compared to 15 mL/kg transfusions. There were no differences in the incidence of tachypnea, hepatomegaly, edema, hypoxia, necrotizing enterocolitis, or vital sign instability between groups. In conclusion, high-volume PRBC transfusions (20 mL/kg) were associated with higher posttransfusion hemoglobin and hematocrit levels but no adverse effects. Higher-volume transfusions may reduce the need for multiple transfusions and therefore the number of donors the infant is exposed to. PMID:27034542

  7. Predictive factors for perioperative blood transfusion in surgeries for correction of idiopathic, neuromuscular or congenital scoliosis

    PubMed Central

    Cristante, Alexandre Fogaça; Borges, Paulo Alvim; Barbosa, Angelo Roberto; Letaif, Olavo Biraghi; Marcon, Raphael Martus; de Barros-Filho, Tarcisio Eloy Pessoa

    2014-01-01

    OBJECTIVE: To evaluate the association of clinical and demographic variables in patients requiring blood transfusion during elective surgery to treat scoliosis with the aim of identifying markers predictive of the need for blood transfusion. METHODS: Based on the review of medical charts at a public university hospital, this retrospective study evaluated whether the following variables were associated with the need for red blood cell transfusion (measured by the number of packs used) during scoliosis surgery: scoliotic angle, extent of arthrodesis (number of fused levels), sex of the patient, surgery duration and type of scoliosis (neuromuscular, congenital or idiopathic). RESULTS: Of the 94 patients evaluated in a 55-month period, none required a massive blood transfusion (most patients needed less than two red blood cell packs). The number of packs was not significantly associated with sex or type of scoliosis. The extent of arthrodesis (r = 0.103), surgery duration (r = 0.144) and scoliotic angle (r = 0.004) were weakly correlated with the need for blood transfusion. Linear regression analysis showed an association between the number of spine levels submitted to arthrodesis and the volume of blood used in transfusions (p = 0.001). CONCLUSION: This study did not reveal any evidence of a significant association between the need for red blood cell transfusion and scoliotic angle, sex or surgery duration in scoliosis correction surgery. Submission of more spinal levels to arthrodesis was associated with the use of a greater number of blood packs. PMID:25518018

  8. The development and specificity of antiidiotypic antibodies in renal transplant recipients receiving single-donor blood transfusions.

    PubMed

    Phelan, D L; Rodey, G E; Anderson, C B

    1989-07-01

    Multiple pretransplant sera obtained from alloimmunized renal transplant recipients were tested for the presence of antiidiotypic-like antibodies (AB2) that inhibit donor-specific HLA antibodies in the microlymphocytotoxicity assay. Fourteen patients received repetitive single-donor blood transfusions (SDT). In this patient group, sera were collected prior to each blood transfusion and prior to transplantation. Three additional patients were studied in whom prior donor-specific HLA antibodies had been lost over a period of 6 months preceding transplantation. Donor-specific AB2-like antibodies were found in the sera of 13/14 SDT patients who did not develop HLA antibodies, and in the 3 patients who had lost donor-specific HLA antibodies. All patients had received prior random blood transfusions in the year preceding the study. Five (38%) of the SDT patients had detectable donor-specific AB2 prior to the initiation of single-donor blood transfusion, presumably related to previous blood transfusions. In the remaining six SDT patients in whom complete serum sets were available, AB2 always appeared after the first blood transfusion. The specificity of HLA antibodies inhibited by AB2 was studied, and antibodies against HLA-A, -B, -C, -DR, and DQw were all identified. Thus, there was no predilection for patients to develop AB2 against locus-specific HLA gene products. This study also confirms the apparent polymorphism of putative crossreactive idiotypes. Approximately 25% of donor-specific HLA antibodies were not inhibited by relevant AB2. This study confirms and extends previous observations that alloimmunization is associated in many patients with the development of antiidiotypic-like antibodies that are capable of inhibiting the binding and cytotoxicity of HLA alloantibodies. PMID:2473550

  9. [Prions and risks for blood transfusion: the situation in 2003].

    PubMed

    Deslys, J P

    2003-06-01

    In 2003, Prions still constitute a biological enigma and a public health concern. The risks of transmission of the so called "mad cow disease" are now under control but concerns still persist about potential secondary transmissions, notably via blood transfusion. Information obtained from diseases previously observed in animals (scrapie of sheep and goat) and in man (Kuru, Creutzfeldt-Jakob disease) demonstrate the complexity of the relations between these transmissible agents and their host. The difficulty in decontamination, the very long silent incubation period during which diagnosis is not possible and the lack of treatment are alarming elements which explain the increased perception of risk for these diseases. The development of rapid screening tests used on bovine at slaughterhouse has represented an important improvement in the development of a targeted protection against these agents. Today, technical evolutions in diagnosis let us imagine the possibility of blood detection for prions: on one hand new garanties for security may arise but on the other hand it points out the potential infectivity of blood with these agents responsible for constant fatal diseases. Precautionary security measures have to ensure an optimal ratio benefit/risk for the patient and thus, in this field, to balance the risk linked to prions with those clearly identified elsewhere. PMID:12798843

  10. Transfusion safety in francophone African countries: an analysis of strategies for the medical selection of blood donors

    PubMed Central

    Tayou, Claude Tagny; Kouao, Maxime Diané; Touré, Hamane; Gargouri, Jalel; Fazul, Ahamada Said; Ouattara, Siaka; Anani, Ludovic; Othmani, Habiba; Feteke, Lochina; Dahourou, Honorine; Mbensa, Guy Olivier; Molé, Simplice; Nébié, Yacouba; Mbangue, Madeleine; Toukam, Michel; Boulahi, Mahommed Ould; Andriambelo, Lalatiana Valisoa; Rakoto, Olivat; Baby, Mounirou; Yahaya, Rakia; Bokilo, Amelia; Senyana, Florent; Mbanya, Dora; Shiboski, Caroline; Murphy, Edward L.; Lefrère, Jean Jacques

    2013-01-01

    BACKGROUND The goal of selecting a healthy blood donor is to safeguard donors and reduce the risks of infections and immunologic complications for recipients. STUDY DESIGN AND METHODS To evaluate the blood donor selection process, a survey was conducted in 28 blood transfusion centers located in 15 francophone African countries. Data collected included availability of blood products, risk factors for infection identified among blood donor candidates, the processing of the information collected before blood collection, the review process for the medical history of blood donor candidates, and deferral criteria for donor candidates. RESULTS During the year 2009, participating transfusion centers identified 366,924 blood donor candidates. A mean of 13% (range, 0%–36%) of the donor candidates were excluded based solely on their medical status. The main risk factors for blood-borne infections were having multiple sex partners, sexual intercourse with occasional partners, and religious scarification. Most transfusion centers collected this information verbally instead of having a written questionnaire. The topics least addressed were the possible complications relating to the donation, religious scarifications, and history of sickle cell anemia and hemorrhage. Only three centers recorded the temperature of the blood donors. The deferral criteria least reported were sickle cell anemia, piercing, scarification, and tattoo. CONCLUSIONS The medical selection process was not performed systemically and thoroughly enough, given the regional epidemiologic risks. It is essential to identify the risk factors specific to francophone African countries and modify the current medical history questionnaires to develop a more effective and relevant selection process. PMID:22014098

  11. Neonatal Transfusion Practice: When do Neonates Need Red Blood Cells or Platelets?

    PubMed

    Del Vecchio, Antonio; Franco, Caterina; Petrillo, Flavia; D'Amato, Gabriele

    2016-09-01

    Based on small studies and not on statistically valid clinical trials, guidelines for neonatal transfusions remain controversial and practices vary greatly. Premature infants and critically ill neonates in the neonatal intensive care unit (NICU) often require blood transfusions and extremely preterm neonates receive at least one red blood cell transfusion during their hospital stay. Transfusions to neonates convey both benefits and risks and consequently it is imperative to establish specific guidelines to improve practice and avoid unnecessary transfusions. Appropriate and lifesaving platelet transfusion in thrombocytopenic bleeding neonates pertains to 2% of all neonates in NICUs. Inversely, 98% of platelet transfusions are given prophylactically, in the absence of bleeding, with the assumption that this reduces the risk of a serious hemorrhage. To date, no evidence base is available for assigning a platelet transfusion trigger to NICU patients. Each NICU should approve specific guidelines that best suit its local clinical practice. Therefore, whatever guidelines are chosen in deciding when to transfuse, what is most important is to adhere strictly to the guidelines adopted, thus limiting unnecessary transfusions that convey no benefits and carry both known and unknown risks. PMID:27603540

  12. Blood Transfusion Reactions in Elderly Patients Hospitalized in a Multilevel Geriatric Hospital

    PubMed Central

    Lubart, E.; Segal, R.; Tryhub, N.; Sigler, E.; Leibovitz, A.

    2014-01-01

    Background/Objectives. Blood transfusion is a critical issue for patients with chronic diseases such as heart failure, chronic kidney disease, and malignancy. However, side effects are not rare. The purpose of the study is to evaluate the frequency of adverse blood transfusion reactions in hospitalized elderly patients during a one-year period. Design/Setting/Participants. Blood transfusion reactions such as fever, chills, dyspnea, and others following blood transfusions in hospitalized geriatric patients during one-year period were examined. Results. 382 blood units (242 patients) were administered during the study period. In 40 (11%) cases, blood transfusion reactions occurred. Fever was the most common reaction in 29 cases (72%), four (10%) had shortness of breath, and 3 (8%) had vomiting and chills each. There were no lethal cases in the 24-hour period following blood transfusions. Conclusion. A relatively low rate of adverse blood transfusion reactions occurred in our geriatric patients. We may speculate that this is related to underreporting of minor symptoms due to the high percentage of demented patients in this population. PMID:24804100

  13. Blood Transfusion Requirements for Patients With Sarcomas Undergoing Combined Radio- and Chemotherapy

    PubMed Central

    Earl, Helena M.; Whitehead, Lynne; Jefferies, Sarah J.; Burnet, Neil G.

    2005-01-01

    Patients with bony and soft tissue sarcomas may require intensive treatment with chemotherapy and radiotherapy, which often leads to a fall in haemoglobin levels, requiring blood transfusion. There may be advantages in predicting which patients will require transfusion, partly because anaemia and hypoxia may worsen the response of tumours to chemotherapy and radiotherapy. Between 1997 and 2003, a total of 26 patients who received intensive treatment with curative intent were identified. Transfusions were given to maintain the haemoglobin at 10g/dl or above during chemotherapy, and at 12 g/dl or above during radiotherapy. Eighteen (69%) required a transfusion, the majority as a result of both the chemotherapy and RT criteria. There were 78 transfusion episodes, and 181 units of blood given. In the 18 patients who required transfusion, the average number of units was 10.1, but seven patients required more blood than this. The most significant factor influencing blood transfusion was choice of intensive chemotherapy. Intensive chemotherapy and presenting Hb less than 11.6 g/dl identified 13 out of 18 patients who needed transfusion. Adding a drop in haemoglobin of greater than 1.7 g/dl after one cycle of chemotherapy identified 16 out of 18 patients who required transfusion. The seven patients who had heavy transfusion requirements were identified by age 32 or less, intensive chemotherapy and a presenting Hb of 12 g/dl or less. Erythropoietin might be a useful alternative to transfusion in selected patient groups, especially those with heavy transfusion requirements. PMID:18521418

  14. Impact of red blood cell transfusion on global and regional measures of oxygenation.

    PubMed

    Roberson, Russell S; Bennett-Guerrero, Elliott

    2012-01-01

    Anemia is common in critically ill patients. Although the goal of transfusion of red blood cells is to increase oxygen-carrying capacity, there are contradictory results about whether red blood cell transfusion to treat moderate anemia (e.g., hemoglobin 7-10 g/dL) improves tissue oxygenation or changes outcomes. Whereas increasing levels of anemia eventually lead to a level of critical oxygen delivery, increased cardiac output and oxygen extraction are homeostatic mechanisms the body uses to prevent a state of dysoxia in the setting of diminished oxygen delivery due to anemia. In order for cardiac output to increase in the face of anemia, normovolemia must be maintained. Transfusion of red blood cells increases blood viscosity, which may actually decrease cardiac output (barring a state of hypovolemia prior to transfusion). Studies have generally shown that transfusion of red blood cells fails to increase oxygen uptake unless oxygen uptake/oxygen delivery dependency exists (e.g., severe anemia or strenuous exercise). Recently, near-infrared spectroscopy, which approximates the hemoglobin saturation of venous blood, has been used to investigate whether transfusion of red blood cells increases tissue oxygenation in regional tissue beds (e.g., brain, peripheral skeletal muscle). These studies have generally shown increases in near-infrared spectroscopy derived measurements of tissue oxygenation following transfusion. Studies evaluating the effect of transfusion on the microcirculation have shown that transfusion increases the functional capillary density. This article will review fundamental aspects of oxygen delivery and extraction, and the effects of red blood cell transfusion on tissue oxygenation as well as the microcirculation. PMID:22238040

  15. [Rational blood reservation for elective surgery. A prospective evaluation of blood reservation, use of transfusions and resources].

    PubMed

    Jensen, B A

    1992-03-23

    Danish and international studies have documented that preoperative blood ordering policy in elective surgery is extremely inefficient if not based on knowledge of actual transfusion frequencies and requirements. During a 12-month period, the impact of practical application of Type & Screen (T&S), and a thoroughly revised preoperative blood ordering policy in elective surgery, on crossmatch ordering, transfusion extent and safety were assessed prospectively. In addition, the effect on resource and laboratory economy was estimated, using the number of crossmatches, crossmatch to transfusion (C/T) ratio, out-dating, transfusion complications, and the proportional use of fractionated red cell products (erythrocyte concentrate and suspension) as efficiency parameters. In 86% out of 6,766 surgical procedures the recommendations were followed. A total of 1,736 patients had a preoperative cross-match of two or more units of blood and 25.1% were transfused during or within 48 hours following surgery. Only 2.4% of patients with T&S were transfused. Of the crossmatched blood 18.1% was actually transfused, and the overall crossmatch to transfusion ratio (C/T-ratio) was 5.33. In only 0.5% of operations, unexpected crossmatching and transfusions proved necessary during surgery. None of the reported transfusion complications were due to failure of the T&S procedure. During a period of increasing blood bank activities, as measured by the number of blood groupings and the blood turnover, a significant decrease in C/T-ratio and number of crossmatches was observed, corresponding to an estimated annual reduction of 11,000 crossmatches. Outdating declined from 9 to 3.2%, corresponding to savings of approximately 1,000 transfusion units annually, while the complication rate remained constant at 1.7%.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1553781

  16. A Derivation and Validation Study of an Early Blood Transfusion Needs Score for Severe Trauma Patients

    PubMed Central

    Wang, Hao; Umejiego, Johnbosco; Robinson, Richard D.; Schrader, Chet D.; Leuck, JoAnna; Barra, Michael; Buca, Stefan; Shedd, Andrew; Bui, Andrew; Zenarosa, Nestor R.

    2016-01-01

    Background There is no existing adequate blood transfusion needs determination tool that Emergency Medical Services (EMS) personnel can use for prehospital blood transfusion initiation. In this study, a simple and pragmatic prehospital blood transfusion needs scoring system was derived and validated. Methods Local trauma registry data were reviewed retrospectively from 2004 through 2013. Patients were randomly assigned to derivation and validation cohorts. Multivariate logistic regression was used to identify the independent approachable risks associated with early blood transfusion needs in the derivation cohort in which a scoring system was derived. Sensitivity, specificity, and area under the receiver operational characteristic (AUC) were calculated and compared using both the derivation and validation data. Results A total of 24,303 patients were included with 12,151 patients in the derivation and 12,152 patients in the validation cohorts. Age, penetrating injury, heart rate, systolic blood pressure, and Glasgow coma scale (GCS) were risks predictive of early blood transfusion needs. An early blood transfusion needs score was derived. A score > 5 indicated risk of early blood transfusion need with a sensitivity of 83% and a specificity of 80%. A sensitivity of 82% and a specificity of 80% were also found in the validation study and their AUC showed no statistically significant difference (AUC of the derivation = 0.87 versus AUC of the validation = 0.86, P > 0.05). Conclusions An early blood transfusion scoring system was derived and internally validated to predict severe trauma patients requiring blood transfusion during prehospital or initial emergency department resuscitation. PMID:27429680

  17. [Mobilization of Blood: Blood Transfusion Service, Blood Group Research, and Total Defence in Switzerland, 1940-1960].

    PubMed

    Germann, Pascal

    2015-01-01

    During World War II and the early Cold War period, a rapid development of the blood transfusion service and a boom in blood group research occurred in Switzerland. Unprecedented volumes of blood were stored and enormous quantities of blood group data were recorded. In the following paper I will argue that this mobilization of blood was strongly shaped by military institutions and aims. The military worked closely with the Red Cross in order to build a blood transfusion service that was supposed to guarantee a permanent readiness for war and help prepare the nation for an imagined nuclear conflict. Concurrently, geneticists, anthropologists, and physicians obtained new opportunities for scientific research in collaboration with the military and the Red Cross enabling them access to comprehensive military data and modern serological laboratories. The paper points out how this cooperation between the military and the sciences influenced and transformed the cultural meanings, the medical uses of as well as the knowledge about human blood. PMID:26902059

  18. Study of blood-transfusion services in Maharashtra and Gujarat States, India.

    PubMed

    Ramani, K V; Mavalankar, Dileep V; Govil, Dipti

    2009-04-01

    Blood-transfusion services are vital to maternal health because haemorrhage and anaemia are major causes of maternal death in South Asia. Unfortunately, due to continued governmental negligence, blood-transfusion services in India are a highly-fragmented mix of competing independent and hospital-based blood-banks, serving the needs of urban populations. This paper aims to understand the existing systems of blood-transfusion services in India focusing on Maharashtra and Gujarat states. A mix of methodologies, including literature review (including government documents), analysis of management information system data, and interviews with key officials was used. Results of analysis showed that there are many managerial challenges in blood-transfusion services, which calls for strengthening the planning and monitoring of these services. Maharashtra provides a good model for improvement. Unless this is done, access to blood in rural areas may remain poor. PMID:19489420

  19. Study of Blood-transfusion Services in Maharashtra and Gujarat States, India

    PubMed Central

    Ramani, K.V.; Govil, Dipti

    2009-01-01

    Blood-transfusion services are vital to maternal health because haemorrhage and anaemia are major causes of maternal death in South Asia. Unfortunately, due to continued governmental negligence, blood-transfusion services in India are a highly-fragmented mix of competing independent and hospital-based blood-banks, serving the needs of urban populations. This paper aims to understand the existing systems of blood-transfusion services in India focusing on Maharashtra and Gujarat states. A mix of methodologies, including literature review (including government documents), analysis of management information system data, and interviews with key officials was used. Results of analysis showed that there are many managerial challenges in blood-transfusion services, which calls for strengthening the planning and monitoring of these services. Maharashtra provides a good model for improvement. Unless this is done, access to blood in rural areas may remain poor. PMID:19489420

  20. Reduction in Red Blood Cell Transfusions Among Preterm Infants: Results of a Randomized Trial With an In-Line Blood Gas and Chemistry Monitor

    PubMed Central

    Widness, John A.; Madan, Ashima; Grindeanu, Ligia A.; Zimmerman, M. Bridget; Wong, David K.; Stevenson, David K.

    2010-01-01

    Background Critically ill, extremely premature infants develop anemia because of intensive laboratory blood testing and undergo multiple red blood cell (RBC) transfusions in the early weeks of life. To date, researchers have had only limited success in finding ways to reduce transfusions significantly in this patient population. Objective To reduce RBC transfusions for these infants by using a point-of-care bedside monitor that returns analyzed blood to the patient. Design, Setting, and Patients This was a prospective, 2-center, randomized, open, controlled, clinical trial with a 1:1 assignment of extremely low birth weight infants (weighing 500–1000 g at birth) to control or monitor groups and analysis with the intention-to-treat approach. Predefined RBC transfusion criteria were applied uniformly in the 2 groups. Interventions Clinical treatment of study subjects with an in-line, ex vivo, bedside monitor that withdraws blood through an umbilical artery catheter, analyzes blood gases and sodium, potassium, and hematocrit levels, and returns the sample to the patient. Main Outcome Measures The total volume and number of RBC transfusions during the first 2 weeks of life and the total volume of blood removed for laboratory testing. Results The trial was terminated prematurely when one center's NICU changed its standard method of laboratory testing. In the first 2 weeks of life, there was a nonsignificant 17% lower cumulative RBC transfusion volume in the monitor group (n = 46), compared with the control group (n = 47). However, data from the first week only (the period of greater catheter use) demonstrated a significant 33% lower cumulative RBC transfusion volume in the monitor group. Cumulative phlebotomy loss was ~25% less in the monitor group throughout the 2-week study period. There was no difference between groups in neonatal mortality, morbidity, and neurodevelopmental outcome rates at 18 to 24 months. This is the first randomized trial documenting that RBC

  1. Predicting red blood cell transfusion in hospitalized patients: role of hemoglobin level, comorbidities, and illness severity

    PubMed Central

    2014-01-01

    Background Randomized controlled trial evidence supports a restrictive strategy of red blood cell (RBC) transfusion, but significant variation in clinical transfusion practice persists. Patient characteristics other than hemoglobin levels may influence the decision to transfuse RBCs and explain some of this variation. Our objective was to evaluate the role of patient comorbidities and severity of illness in predicting inpatient red blood cell transfusion events. Methods We developed a predictive model of inpatient RBC transfusion using comprehensive electronic medical record (EMR) data from 21 hospitals over a four year period (2008-2011). Using a retrospective cohort study design, we modeled predictors of transfusion events within 24 hours of hospital admission and throughout the entire hospitalization. Model predictors included administrative data (age, sex, comorbid conditions, admission type, and admission diagnosis), admission hemoglobin, severity of illness, prior inpatient RBC transfusion, admission ward, and hospital. Results The study cohort included 275,874 patients who experienced 444,969 hospitalizations. The 24 hour and overall inpatient RBC transfusion rates were 7.2% and 13.9%, respectively. A predictive model for transfusion within 24 hours of hospital admission had a C-statistic of 0.928 and pseudo-R2 of 0.542; corresponding values for the model examining transfusion through the entire hospitalization were 0.872 and 0.437. Inclusion of the admission hemoglobin resulted in the greatest improvement in model performance relative to patient comorbidities and severity of illness. Conclusions Data from electronic medical records at the time of admission predicts with very high likelihood the incidence of red blood transfusion events in the first 24 hours and throughout hospitalization. Patient comorbidities and severity of illness on admission play a small role in predicting the likelihood of RBC transfusion relative to the admission hemoglobin. PMID

  2. Supra-plasma expanders: the future of treating blood loss and anemia without red cell transfusions?

    PubMed

    Tsai, Amy G; Vázquez, Beatriz Y Salazar; Hofmann, Axel; Acharya, Seetharama A; Intaglietta, Marcos

    2015-01-01

    Oxygen delivery capacity during profoundly anemic conditions depends on blood's oxygen-carrying capacity and cardiac output. Oxygen-carrying blood substitutes and blood transfusion augment oxygen-carrying capacity, but both have given rise to safety concerns, and their efficacy remains unresolved. Anemia decreases oxygen-carrying capacity and blood viscosity. Present studies show that correcting the decrease of blood viscosity by increasing plasma viscosity with newly developed plasma expanders significantly improves tissue perfusion. These new plasma expanders promote tissue perfusion, increasing oxygen delivery capacity without increasing blood oxygen-carrying capacity, thus treating the effects of anemia while avoiding the transfusion of blood. PMID:25871869

  3. Pathogen Inactivation of Platelet and Plasma Blood Components for Transfusion Using the INTERCEPT Blood System™

    PubMed Central

    Irsch, Johannes; Lin, Lily

    2011-01-01

    Summary Background The transmission of pathogens via blood transfusion is still a major threat. Expert conferences established the need for a pro-active approach and concluded that the introduction of a pathogen inactivation/reduction technology requires a thorough safety profile, a comprehensive pre-clinical and clinical development and an ongoing hemovigilance program. Material and Methods The INTERCEPT Blood System utilizes amotosalen and UVA light and enables for the treatment of platelets and plasma in the same device. Preclinical studies of pathogen inactivation and toxicology and a thorough program of clinical studies have been conducted and an active he-movigilance-program established. Results INTERCEPT shows robust efficacy of inactivation for viruses, bacteria (including spirochetes), protozoa and leukocytes as well as large safety margins. Furthermore, it integrates well into routine blood center operations. The clinical study program demonstrates the successful use for very diverse patient groups. The hemovigilance program shows safety and tolerability in routine use. Approximately 700,000 INTERCEPT-treated products have been transfused worldwide. The system is in clinical use since class III CE-mark registration in 2002. The safety and efficacy has been shown in routine use and during an epidemic. Conclusion The INTERCEPT Blood System for platelets and plasma offers enhanced safety for the patient and protection against transfusion-transmitted infections. PMID:21779203

  4. Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study

    PubMed Central

    Syahputra, Firtantyo Adi; Birowo, Ponco; Rasyid, Nur; Matondang, Faisal Abdi; Noviandrini, Endrika; Huseini, Maruto Harjanggi

    2016-01-01

    Objectives Bleeding is the most common complication of percutaneous nephrolithotomy (PCNL). Injudicious transfusion is frequently performed in current practice, even though it is not always needed. This study aimed to identify the predictive factors of blood loss in the PCNL procedure and evaluate the perioperative transfusion practice. Methods A prospective study of PCNL was randomly performed by two consultants of endo-urology at our institution. The inclusion criteria were adults with kidney pelvic stones >20 mm or stone in inferior calyx >10 mm or staghorn stone. Those with coagulopathy, under anti-coagulant treatment or open conversion were excluded. A full blood count was taken at baseline and during 12, 24, 36, 72-hours post-operatively. Factors such as stone burden, sex, body surface area, shifting of hematocrit level and amount of blood transfused were analyzed statistically using line regression to identify the predictive factors of total blood loss (TBL).   Results Eighty-five patients were enrolled in this study. Mean TBL was 560.92 ± 428.43 mL for both endo-urology surgeons. Stone burden was the most influential factor for TBL (p=0.037). Our results revealed that TBL (mL) = -153.379 + 0.229 × stone burden (mm2) + 0.203 x baseline serum hematocrit (%); thus considerably predicted the need for blood transfusion. A total of 87.1% patients did not receive perioperative transfusion, 3.5% received intra-operative transfusion, 7.1% received post-operative transfusion, 23% had both intra and post-operative transfusion, resulting in a cross-matched transfusion ratio of 7.72. Mean perioperative blood transfused was 356.00 ± 145.88 mL. PMID:27429745

  5. Blood transfusion for the treatment of acute anaemia in inflammatory bowel disease and other digestive diseases

    PubMed Central

    García-Erce, José Antonio; Gomollón, Fernando; Muñoz, Manuel

    2009-01-01

    Allogeneic blood transfusion (ABT) is frequently used as the first therapeutic option for the treatment of acute anaemia in patients with inflammatory bowel disease (IBD), especially when it developed due to gastrointestinal or perioperative blood loss, but is not risk-free. Adverse effects of ABT include, but are not limited to, acute hemolytic reaction (wrong blood or wrong patient), febrile non-hemolytic transfusional reaction, bacterial contamination, transfusion-related acute lung injury, transfusion associated circulatory overload, transfusion-related immuno-modulation, and transmission of almost all infectious diseases (bacteria, virus, protozoa and prion), which might result in increased risk of morbidity and mortality. Unfortunately, the main physiological goal of ABT, i.e. to increase oxygen consumption by the hypoxic tissues, has not been well documented. In contrast, the ABT is usually misused only to increase the haemoglobin level within a fixed protocol [mostly two by two packed red blood cell (PRC) units] independently of the patient’s tolerance to normovolemic anaemia or his clinical response to the transfusion of PRC units according to a “one-by-one” administration schedule. Evidence-based clinical guidelines may promote best transfusion practices by implementing restrictive transfusion protocols, thus reducing variability and minimizing the avoidable risks of transfusion, and the use of autologous blood and pharmacologic alternatives. In this regard, preoperative autologous blood donation (PABD) consistently diminished the frequency of ABT, although its contribution to ABT avoidance is reduced when performed under a transfusion protocol. In addition, interpretation of utility of PABD in surgical IBD patients is hampered by scarcity of published data. However, the role of autologous red blood cells as drug carriers is promising. Finally, it must be stressed that a combination of methods used within well-constructed protocols will offer better

  6. Blood transfusion for the treatment of acute anaemia in inflammatory bowel disease and other digestive diseases.

    PubMed

    García-Erce, José Antonio; Gomollón, Fernando; Muñoz, Manuel

    2009-10-01

    Allogeneic blood transfusion (ABT) is frequently used as the first therapeutic option for the treatment of acute anaemia in patients with inflammatory bowel disease (IBD), especially when it developed due to gastrointestinal or perioperative blood loss, but is not risk-free. Adverse effects of ABT include, but are not limited to, acute hemolytic reaction (wrong blood or wrong patient), febrile non-hemolytic transfusional reaction, bacterial contamination, transfusion-related acute lung injury, transfusion associated circulatory overload, transfusion-related immuno-modulation, and transmission of almost all infectious diseases (bacteria, virus, protozoa and prion), which might result in increased risk of morbidity and mortality. Unfortunately, the main physiological goal of ABT, i.e. to increase oxygen consumption by the hypoxic tissues, has not been well documented. In contrast, the ABT is usually misused only to increase the haemoglobin level within a fixed protocol [mostly two by two packed red blood cell (PRC) units] independently of the patient's tolerance to normovolemic anaemia or his clinical response to the transfusion of PRC units according to a "one-by-one" administration schedule. Evidence-based clinical guidelines may promote best transfusion practices by implementing restrictive transfusion protocols, thus reducing variability and minimizing the avoidable risks of transfusion, and the use of autologous blood and pharmacologic alternatives. In this regard, preoperative autologous blood donation (PABD) consistently diminished the frequency of ABT, although its contribution to ABT avoidance is reduced when performed under a transfusion protocol. In addition, interpretation of utility of PABD in surgical IBD patients is hampered by scarcity of published data. However, the role of autologous red blood cells as drug carriers is promising. Finally, it must be stressed that a combination of methods used within well-constructed protocols will offer better

  7. Rhesus Negative Woman Transfused With Rhesus Positive Blood: Subsequent Normal Pregnancy Without Anti D production.

    PubMed

    Maya, E T; Buntugu, K A; Pobee, F; Srofenyoh, E K

    2015-03-01

    Clinicians sometimes are confronted with the challenge of transfusing haemorrhaging Rhesus (Rh) D negative patients with Rh D positive blood to save their lives. There are concerns about alloimmunization and future haemolytic disease of the newborn in women of the reproductive age. Another fear is transfusion reaction if they receive another Rh D positive blood in future. We present a 32-year-old Rh D negative woman, who had postpartum haemorrhage in her first pregnancy and was transfused with Rh D positive blood because of unavailability of Rh D negative blood. She did not receive anti D immunoglobin but subsequently had a normal term pregnancy of an Rh positive fetus without any detectable anti D antibodies throughout the pregnancy. In life threatening situations from obstetric haemorrhage, transfusion of Rh D negative women with Rh D positive blood should be considered as the last resort. PMID:26339087

  8. Pharmacologic Strategies to Prevent Blood Loss and Transfusion in Orthotopic Liver Transplantation.

    PubMed

    Tischer, Sarah; Miller, James T

    2016-01-01

    Patients undergoing orthotopic liver transplantation are at risk of both life-threatening blood loss and thrombosis due to preexisting liver dysfunction and major intra- and postoperative coagulopathy. Traditional laboratory markers of hemostasis and coagulopathy are often inadequate to describe the alterations. Whole blood global viscoelastic tests, thromboelastography, and thromboelastometry may provide more complete pictures of the hematologic derangements and allow for more targeted therapy to prevent blood loss and massive transfusion. Antifibrinolytic medications such as aprotinin, tranexamic acid, and [Latin Small Letter Open E]-aminocaproic acid have been used successfully to reduce blood loss and the need for transfusion, although most published data are from small prospective trials or larger retrospective cohorts. Recombinant factor VIIa has not been shown to improve outcomes. Although transfusion needs have been associated with adverse outcomes, no studied medications for prevention of blood loss and transfusion have been associated with improved mortality or graft survival post-liver transplant. PMID:27254642

  9. Does tranexamic acid reduce blood transfusion cost for primary total hip arthroplasty? A case-control study.

    PubMed

    Harris, Ryan N; Moskal, Joseph T; Capps, Susan G

    2015-02-01

    Peri-operative tranexamic acid (TXA) significantly reduces the need for allogeneic blood transfusion in total hip arthroplasty (THA) and thus hospital costs are reduced. Before employing TXA in primary THA at our institution, facility costs were $286.90/THA for blood transfusion and required 0.45 man-hours/THA (transfusion rate 19.87%). After incorporating TXA, the cost for intravenous application was $123.38/THA for blood transfusion and TXA medication and 0.07 man-hours/THA (transfusion rate 4.39%) and the cost for topical application was $132.41/THA for blood transfusion and TXA and 0.14 man-hours/THA (transfusion rate 12.86%). TXA has the potential to reduce the facility cost per THA and the man-hours/THA from blood transfusions. PMID:25534861

  10. Recruitment of prospective donors: what do they expect from a homepage of a blood transfusion service?

    PubMed

    Moog, R; Fourné, K

    2007-08-01

    In times of shrinking donor population, the recruitment of donors is of utmost importance. Recruitment can be done by personal communication, advertisement/information, classical mass media (newspaper, radio, TV) or new computerized media. The aim of this study was to gain information about the donors' demands of an Internet presentation of a blood transfusion service. Between October and December 2004 inclusive, prospective donors were asked to complete a survey about the impact of Internet information for blood donors. The survey contained questions measuring demographics, education and motivation for blood donation. In addition, the survey included questions that measured Internet access, duration of online time and donors' demands for an Internet presentation of a blood transfusion service. Donors were asked to tick a box with predefined answers. In cases where no options were applied, donors were requested to specify their answers. One hundred and fourteen prospective donors (71 female, 43 male) with a median age of 25 years (range 18-57 years) completed the survey. Most donors (57.9%) were 18-30 years old. Forty-two (36.8%) of the surveyed donors were repeat donors, whereas 72 (63.2%) were first-time donors. The majority of donors were informed about blood donation from relatives or friends (70.7% repeat donors and 67.7% first-time donors). Most of them had Internet access (85.7% repeat donors and 90.3% first-time donors). Exclusive use of private access was more often reported in repeat donors (77.8%), whereas both private and professional access was more frequently used in first-time donors (32.3%). Most donors used the Internet access daily, followed by weekly and monthly use. Multiple answers were given about the importance of desired information about the topic 'blood donation'. Both first-time and repeat donors wanted to be informed about organizational details of blood donation such as opening times, eligibility criteria, donation process and the kind

  11. Prolongation of rat heart allografts by donor-specific blood transfusion treated with ultraviolet irradiation

    SciTech Connect

    Oluwole, S.F.; Iga, C.; Lau, H.; Hardy, M.A.

    1985-07-01

    The effect of donor-specific blood transfusion was compared to that of UVB-irradiated donor-specific blood transfusion on heart allograft survival in inbred rats with major histocompatibility differences. In one series ACI rats received heterotopic heart grafts from Lewis rats and 1 mL transfusion of donor-type blood at 1, 2, and 3 weeks prior to the transplantation. Fifty percent of the grafts were permanently accepted (survival greater than 200 days). Following UVB-irradiated donor-specific blood transfusion, 55% of the grafts survived indefinitely. In a mixed lymphocyte reaction ACI lymphocytes are weak responders to Lewis lymphocytes. In another series, Lewis rats received ACI hearts. Donor-specific transfusions at 1, 2, and 3 weeks prior to transplantation did not significantly alter the survival of heart allografts. Lewis lymphocytes react strongly to ACI stimulator cells in a mixed lymphocyte reaction. However, when the donor blood was UVB-irradiated prior to transfusion, the ACI allograft survival was significantly prolonged in this ACI-to-Lewis strain combination. When Lewis rats received W/F hearts following either donor-specific or UVB-irradiated donor-specific transfusions, the hearts' survival was similarly and significantly prolonged, but did not become permanent. Mixed lymphocyte reaction reveals that the stimulation index of Lewis lymphocytes against W/F lymphocytes is greater than that of ACI versus Lewis, but is less than that between Lewis responder cells against ACI stimulators.

  12. Drugs and blood transfusions: dogma- or evidence-based practice?

    PubMed

    Murdock, J; Watson, D; Dorée, C J; Blest, A; Roberts, M M; Brunskill, S J

    2009-02-01

    There is a lack of consensus on the safety of the coadministration of drugs and red blood cells (RBCs). A systematic review was undertaken to establish the evidence base for this question and assess how the evidence may be translated into present clinical day practice. Comprehensive searches of MEDLINE, EMBASE, CINAHL, the Cochrane Library and hand searching of transfusion journals, guidelines and websites identified 12 relevant papers: 11 in-vitro experiments and 1 case report. Data on incidences of haemolysis and agglutination following coadministration were extracted and analysed. Overall findings suggest that iron chelators (two papers), antimicrobials (three papers) and lower doses of opioids (three papers) are safe to coadminister with RBCs. Haemolysis was observed with higher doses of opioids (three papers). Transposition of these findings to clinical practice is limited because of the lack of clinical applicability of in-vitro experiments and diversity in how, and what, clinical outcome measures were used. Further evidence from true clinical settings would be required to inform clinical practice on the efficacy and safety of the coadministration of drugs and RBCs. PMID:19302450

  13. The history of blood transfusion prior to the 20th century--part 2.

    PubMed

    Learoyd, P

    2012-12-01

    Although there are a number of descriptions of 'blood infusion' in antiquity, it was the publication of the discovery of the circulation of blood in 1628 by William Harvey and the work of Christopher Wren and Robert Boyle in 1663 on the infusion of different materials into dogs that paved the way to the possible practical attempts at actual blood transfusion. Although these early experiments, principally by Richard Lower in England and Jean Denis in France provided valuable information regarding inter-species incompatibility and the problems of blood coagulation, it was not until the work of James Blundell in the early part of the 19th century that blood transfusion was used as a means of blood replacement. However, blood transfusion was not to become an accepted therapeutic possibility until the discovery of practical anticoagulation and the ABO blood groups at the start of the 20th century. PMID:23016954

  14. [The francophone Africa blood transfusion research network: a five-year report].

    PubMed

    Tagny, Claude Tayou; Murphy, Edward L; Lefrère, Jean-Jacques

    2014-03-01

    There has been little blood safety research in sub-Saharan Africa, often consisting of local efforts whose findings had limited impact The "Francophone Africa Transfusion Research Network" was created in May 2007 with the objective of developing common evidence-based blood safety policies that may be adapted to each country's situation. The Group's activities to date have focused mainly on obtaining epidemiological and laboratory data on blood transfusion and on suggesting blood safety strategies, particularly in the field of TTIs. To carry out such research activities, the group works closely with the National Blood Transfusion Services (NBTS), the Regional Blood Transfusion Services (RBTS), the hospital blood banks (HBB) and collection stations. For the first 5years, four research priorities were identified: (i) descriptive studies of the characteristics of francophone African blood donors and blood centers; (ii) estimation of the residual risk of transfusion-transmitted major viral infections; (iii) an analysis of blood donor deferral strategies; and (iv) a description of TTI screening strategies and an external quality assurance system (EQAS) project. During this period, seven projects have been implemented at the national level and published and five multicenter studies were conducted and published. The present review reports the main observations and recommendations from those studies that could improve blood safety statute in Africa. PMID:24360798

  15. Current issues relating to the transfusion of stored red blood cells.

    PubMed

    Zimrin, A B; Hess, J R

    2009-02-01

    The development of blood storage systems allowed donation and transfusion to be separated in time and space. This separation has permitted the regionalization of donor services with subsequent economies of scale and improvements in the quality and availability of blood products. However, the availability of storage raises the question of how long blood products can and should be stored and how long they are safe and effective. The efficacy of red blood cells was originally measured as the increment in haematocrit and safety began with typing and the effort to reduce the risk of bacterial contamination. Appreciation of a growing list of storage lesions of red blood cells has developed with our increasing understanding of red blood cell physiology and our experience with red blood cell transfusion. However, other than frank haemolysis, rare episodes of bacterial contamination and overgrowth, the reduction of oxygen-carrying capacity associated with the failure of some transfused cells to circulate, and the toxicity of lysophospholipids released from membrane breakdown, storage-induced lesions have not had obvious correlations with safety or efficacy. The safety of red blood cell storage has also been approached in retrospective epidemiologic studies of transfused patients, but the results are frequently biased by the fact that sicker patients are transfused more often and blood banks do not issue blood products in a random order. Several large prospective studies of the safety of stored red blood cells are planned. PMID:19152602

  16. Risk Factors for Alloimmunisation after red blood Cell Transfusions (R-FACT): a case cohort study

    PubMed Central

    Zwaginga, Jaap Jan; van der Bom, J G

    2012-01-01

    Introduction Individuals exposed to red blood cell alloantigens through transfusion, pregnancy or transplantation may produce antibodies against the alloantigens. Alloantibodies can pose serious clinical problems such as delayed haemolytic reactions and logistic problems, for example, to obtain timely and properly matched transfusion blood for patients in which new alloantibodies are detected. Objective The authors hypothesise that the particular clinical conditions (eg, used medication, concomitant infection, cellular immunity) during which transfusions are given may contribute to the risk of immunisation. The aim of this research was to examine the association between clinical, environmental and genetic characteristics of the recipient of erythrocyte transfusions and the risk against erythrocyte alloimmunisation during that transfusion episode. Methods and analysis Study design Incident case–cohort study. Setting Secondary care, nationwide study (within the Netherlands) including seven hospitals, from January 2005 to December 2011. Study population Consecutive red cell transfused patients at the study centres. Inclusion The study cohort comprises of consecutive red blood cell transfused patients at the study centre. Exclusion Patients with transfusions before the study period and/or pre-existing alloantibodies.Cases defined as first time alloantibody formers; Controls defined as transfused individuals matched (on number of transfusions) to cases and have not formed an alloantibody. Statistical analysis Logistic regression models will be used to assess the association between the risk to develop antibodies and potential risk factors, adjusted for other risk factors. Ethics and dissemination Approval at each local ethics regulatory committee will be obtained. Data will be coded for privacy reasons. Patients will be sent a letter and an information brochure explaining the purpose of the study. A consent form in presence of the study coordinator will be signed

  17. Anemia and red blood cell transfusion in critically ill cardiac patients

    PubMed Central

    2014-01-01

    Anemia and red blood cell (RBC) transfusion occur frequently in hospitalized patients with cardiac disease. In this narrative review, we report the epidemiology of anemia and RBC transfusion in hospitalized adults and children (excluding premature neonates) with cardiac disease, and on the outcome of anemic and transfused cardiac patients. Both anemia and RBC transfusion are common in cardiac patients, and both are associated with mortality. RBC transfusion is the only way to rapidly treat severe anemia, but is not completely safe. In addition to hemoglobin (Hb) concentration, the determinant(s) that should drive a practitioner to prescribe a RBC transfusion to cardiac patients are currently unclear. In stable acyanotic cardiac patients, Hb level above 70 g/L in children and above 70 to 80 g/L in adults appears safe. In cyanotic children, Hb level above 90 g/L appears safe. The appropriate threshold Hb level for unstable cardiac patients and for children younger than 28 days is unknown. The optimal transfusion strategy in cardiac patients is not well characterized. The threshold at which the risk of anemia outweighs the risk of transfusion is not known. More studies are needed to determine when RBC transfusion is indicated in hospitalized patients with cardiac disease. PMID:25024880

  18. Effect of total lymphoid irradiation and pretransplant blood transfusion on pancreatic islet allograft survival

    SciTech Connect

    Mendez-Picon, G.; McGeorge, M.

    1983-05-01

    Total lymphoid irradiation (TLI) has been shown to have a strong immunosuppressive effect both experimentally and clinically. Pretransplant blood transfusions have also been shown to have a strong beneficial effect in the outcome of organ transplantation. A study was made of the effect of TLI and pretransplant blood transfusions, alone and in combination, as an immunosuppressive modality in the isolated pancreatic islet transplant in the rat model. Donor rats (Fischer RT1v1) were kept on a 50% DL-ethionine supplemented diet for 4-6 weeks prior to pancreas removal. Recipient rats (Lewis RT1) were made diabetics prior to transplantation by iv injection of streptozotocin (45 mg/kg). Transfusion protocol consisted of a biweekly transfusion of 2 ml of either donor specific or third party transfusions. Total lymphoid irradiation was carried out by daily administration of 200 rads during one week prior to transplantation. Transplantation of the isolated islets was performed by intraportal injection. Syngeneic transplant of one and a half donor pancreata in each recipient reverted the diabetic condition indefinitely (greater than 100 days). Untreated allogenic grafts had a mean survival time (MST) of 5.2 days. Total lymphoid irradiation in dosages of 800, 1000, and 1200 rads, as the only immunosuppressive regimen, prolonged the MST of allografts to 15.3, 16.5, and 21.8 days, respectively (P less than .05). Pretransplant third party blood transfusion had no effect on allograft survival (MST 6.0). When donor specific blood transfusions were given, the MST was prolonged to 25.3 days (P less than .05). When TLI was administered to recipients of donor specific transfusions, the MST of the allografts did not show any statistical significant difference when compared with untreated animals. This abrogation of the beneficial effect of specific blood transfusion was observed in all dosages of TLI employed: 800 rad (MST 3.0), 1000 rad (MST 8.0), 1200 rad (MST 5.18).

  19. 2015 Proceedings of the National Heart, Lung, and Blood Institute's State of the Science in Transfusion Medicine Symposium

    PubMed Central

    Spitalnik, Steven L.; Triulzi, Darrell; Devine, Dana V.; Dzik, Walter H.; Eder, Anne F.; Gernsheimer, Terry; Josephson, Cassandra D.; Kor, Daryl J.; Luban, Naomi L. C.; Roubinian, Nareg H.; Mondoro, Traci; Welniak, Lisbeth A.; Zou, Shimian; Glynn, Simone

    2015-01-01

    On March 25-26, 2015, the National Heart, Lung, and Blood Institute sponsored a meeting on the State of the Science in Transfusion Medicine on the NIH campus in Bethesda, MD, which was attended by a diverse group of 330 registrants. The meeting's goal was to identify important research questions that could be answered in the next 5-10 years, and which would have the potential to transform the clinical practice of transfusion medicine. These questions could be addressed by basic, translational, and/or clinical research studies and were focused on four areas: the three “classical” transfusion products (i.e., red blood cells, platelets, and plasma) and blood donor issues. Prior to the meeting, four Working Groups, one for each area, prepared five major questions for discussion along with a list of 5-10 additional questions for consideration. At the meeting itself, all of these questions, and others, were discussed in Keynote lectures, small group breakout sessions, and large group sessions with open discourse involving all meeting attendees. In addition to the final lists of questions, provided herein, the meeting attendees identified multiple overarching, cross-cutting themes that addressed issues common to all four areas; the latter are also provided. It is anticipated that addressing these scientific priorities, with careful attention to the overarching themes, will inform funding priorities developed by the NIH and provide a solid research platform for transforming the future practice of transfusion medicine. PMID:26260861

  20. 2015 proceedings of the National Heart, Lung, and Blood Institute's State of the Science in Transfusion Medicine symposium.

    PubMed

    Spitalnik, Steven L; Triulzi, Darrell; Devine, Dana V; Dzik, Walter H; Eder, Anne F; Gernsheimer, Terry; Josephson, Cassandra D; Kor, Daryl J; Luban, Naomi L C; Roubinian, Nareg H; Mondoro, Traci; Welniak, Lisbeth A; Zou, Shimian; Glynn, Simone

    2015-09-01

    On March 25 and 26, 2015, the National Heart, Lung, and Blood Institute sponsored a meeting on the State of the Science in Transfusion Medicine on the National Institutes of Health (NIH) campus in Bethesda, Maryland, which was attended by a diverse group of 330 registrants. The meeting's goal was to identify important research questions that could be answered in the next 5 to 10 years and which would have the potential to transform the clinical practice of transfusion medicine. These questions could be addressed by basic, translational, and/or clinical research studies and were focused on four areas: the three "classical" transfusion products (i.e., red blood cells, platelets, and plasma) and blood donor issues. Before the meeting, four working groups, one for each area, prepared five major questions for discussion along with a list of five to 10 additional questions for consideration. At the meeting itself, all of these questions, and others, were discussed in keynote lectures, small-group breakout sessions, and large-group sessions with open discourse involving all meeting attendees. In addition to the final lists of questions, provided herein, the meeting attendees identified multiple overarching, cross-cutting themes that addressed issues common to all four areas; the latter are also provided. It is anticipated that addressing these scientific priorities, with careful attention to the overarching themes, will inform funding priorities developed by the NIH and provide a solid research platform for transforming the future practice of transfusion medicine. PMID:26260861

  1. Investigation of the current situation of massive blood transfusion in different surgical departments: a large multicenter study in China

    PubMed Central

    Sun, Yang; Jin, Zhan-Kui; Xu, Cui-Xiang; Dang, Qian-Li; Zhang, Li-Jie; Chen, Hong-Nan; Song, Yao-Jun; Yang, Jiang-Cun

    2015-01-01

    Objective: This study aims to learn about the current situation of surgical massive blood transfusion of different surgical departments in China’s Tertiary hospitals, which could provide the basis for the formulation of guidelines on massive blood transfusion. Method: A multicenter retrospective research on the application status of blood constituents during massive blood transfusion was conducted and a comparative analyses of survival and length of hospitalization in patients from different departments (trauma, cardiac surgery, obstetric conditions, or other common surgeries), were performed. Result: In China, during massive blood transfusion the ratio of the dosage of fresh frozen plasma to the dosage of red blood cell suspension reached 1:1-2, while the dosage of platelet and cryoprecipitate appeared to be very small. The risk of in-hospital death were associated with the primary disease in patients receiving massive blood transfusion (Log-Rank P = 0.000), cardiac surgery and trauma patients who received massive blood transfusion have a higher risk of death rate. Conclusions: Patients undergoing massive blood transfusion among different surgical departments have a certain difference in use of blood transfusion, mortality rate and the time of death. Our findings suggested that we should set up an independent transfusion program in cardiac surgery and trauma patients of massive blood transfusion. PMID:26309583

  2. [Blood transfusion in the Democratic Republic of Congo: efforts and challenges].

    PubMed

    Kabinda Maotela, J; Ramazani, S Y; Misingi, P; Dramaix-Wilmet, M

    2015-01-01

    The authors trace the history of blood transfusion in the Democratic Republic of Congo, as inherited through the colonial organization of the health system. The current configuration of transfusion system begins with the drafting of the national blood transfusion policy and the establishment of a national technical office within the Ministry of Health to coordinate transfusion activities and of its agents in each province. Despite countless difficulties, several positive points were noted. These involve essentially the drafting of all the necessary documents and standards and the integration of the blood safety system into the country's health system. Initially, the blood transfusion system applied a vertical approach, but with the reform of the country's health system, the performance of blood safety became transversal. In the 12 years from 2001 to 2012, it mobilized 112,882 volunteer blood donors; more than 80% of blood products were checked for safety and covered all blood needs; and 81,806 HIV infections were avoided by routine testing of blood products. During the same period, 7560 people were trained in blood transfusion. The prevalence of viral markers among donors has diminished sharply. Thus, HIV prevalence decreased from 4.7% to 2.1% between 2001 and 2012 that of hepatitis B dropped from 7.1% to 3.5% during the same period, and hepatitis C from 11.8% to 2.3% from 2004 to 2012. Despite this performance, enormous efforts are still required, for the organization of blood safety monitoring, the establishment of a safe supply of reagents and supplies, for sustaining the dynamics of voluntary associations of blood donors, and finally for providing stable funding for these blood safety activities. PMID:26742551

  3. Microfluidic Flow Chambers Using Reconstituted Blood to Model Hemostasis and Platelet Transfusion In Vitro.

    PubMed

    Van Aelst, Britt; Feys, Hendrik B; Devloo, Rosalie; Vandekerckhove, Philippe; Compernolle, Veerle

    2016-01-01

    Blood platelets prepared for transfusion gradually lose hemostatic function during storage. Platelet function can be investigated using a variety of (indirect) in vitro experiments, but none of these is as comprehensive as microfluidic flow chambers. In this protocol, the reconstitution of thrombocytopenic fresh blood with stored blood bank platelets is used to simulate platelet transfusion. Next, the reconstituted sample is perfused in microfluidic flow chambers which mimic hemostasis on exposed subendothelial matrix proteins. Effects of blood donation, transport, component separation, storage and pathogen inactivation can be measured in paired experimental designs. This allows reliable comparison of the impact every manipulation in blood component preparation has on hemostasis. Our results demonstrate the impact of temperature cycling, shear rates, platelet concentration and storage duration on platelet function. In conclusion, this protocol analyzes the function of blood bank platelets and this ultimately aids in optimization of the processing chain including phlebotomy, transport, component preparation, storage and transfusion. PMID:27023054

  4. Alternative procedures for reducing allogeneic blood transfusion in elective orthopedic surgery.

    PubMed

    Kleinert, Kathrin; Theusinger, Oliver M; Nuernberg, Johannes; Werner, Clément M L

    2010-09-01

    Perioperative blood loss is a major problem in elective orthopedic surgery. Allogeneic transfusion is the standard treatment for perioperative blood loss resulting in low postoperative hemoglobin, but it has a number of well-recognized risks, complications, and costs. Alternatives to allogeneic blood transfusion include preoperative autologous donation and intraoperative salvage with postoperative autotransfusion. Orthopedic surgeons are often unaware of the different pre- and intraoperative possibilities of reducing blood loss and leave the management of coagulation and use of blood products completely to the anesthesiologists. The goal of this review is to compare alternatives to allogeneic blood transfusion from an orthopedic and anesthesia point of view focusing on estimated costs and acceptance by both parties. PMID:21886535

  5. Alloimmunization screening after transfusion of red blood cells in a prospective study

    PubMed Central

    Alves, Vitor Mendonça; Martins, Paulo Roberto Juliano; Soares, Sheila; Araújo, Gislene; Schmidt, Luciana Cayres; Costa, Sidneia Sanches de Menezes; Langhi, Dante Mário; Moraes-Souza, Helio

    2012-01-01

    Background Several irregular red blood cell alloantibodies, produced by alloimmunization of antigens in transfusions or pregnancies, have clinical importance because they cause hemolysis in the fetus and newborn and in transfused patients. Objective a prospective analysis of patients treated by the surgical and clinical emergency services of Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro (HC/UFTM), Brazil was performed to correlate alloimmunization to clinical and epidemiological data. Methods Blood samples of 143 patients with initial negative antibody screening were collected at intervals for up to 15 months after the transfusion of packed red blood cells. Samples were submitted to irregular antibody testing and, when positive, to the identification and serial titration of alloantibodies. The Fisher Exact test and Odds Ratio were employed to compare proportions. Results Fifteen (10.49%) patients produced antibodies within six months of transfusion. However, for 60% of these individuals, the titers decreased and disappeared by 15 months after transfusion. Anti-K antibodies and alloantibodies against antigens of the Rh system were the most common; the highest titer was 1:32 (anti-K). There was an evident correlation with the number of transfusions. Conclusions Given the high incidence of clinically important red blood cell alloantibodies in patients transfused in surgical and clinical emergency services, we suggest that phenotyping and pre-transfusion compatibilization for C, c, E, e (Rh system) and K (Kell system) antigens should be extended to all patients with programmed surgeries or acute clinical events that do not need emergency transfusions. PMID:23049421

  6. Where does blood go? Prospective observational study of red cell transfusion in north England

    PubMed Central

    Wells, A W; Mounter, P J; Chapman, C E; Stainsby, D; Wallis, J P

    2002-01-01

    Objective To collect population based information on transfusion of red blood cells. Design Prospective observational study over 28 days. Setting Hospital blood banks in the north of England (population 2.9 million). Main outcome measures Indications for transfusion, number of units given, and the age and sex of transfusion recipients. Participants All patients who received a red cell transfusion during the study period. Data completed by hospital blood bank staff. Results The destination of 9848 units was recorded (97% of expected blood use). In total 9774 units were transfused: 5047 (51.6%) units were given to medical patients, 3982 (40.7%) to surgical patients, and 612 (6.3%) to obstetric and gynaecology patients. Nearly half (49.3%) of all blood is given to female recipients, and the mean age of recipients of individual units was 62.7 years. The most common surgical indications for transfusion were total hip replacement (4.6% of all blood transfused) and coronary artery bypass grafting (4.1%). Haematological disorders accounted for 15.5% of use. Overall use was 4274 units per 100 000 population per year. Conclusion In the north east of England more than half of red cell units are transfused for medical indications. Demand for red cell transfusion increases with age. With anticipated changes in the age structure of the population the demand for blood will increase by 4.9% by 2008. What is already known on this topicThere have been no systematic population based surveys on use of red cells in the United KingdomStudies in France and the United States have shown that more than half of transfused red cells go to surgical patientsWhat this study addsIn the north of England over half of red cells are given for medical indicationsRates of red cell transfusion rise steeply with advancing ageSmall increases in the number of elderly people will have large effects on demand PMID:12376439

  7. Blood transfusion in bimaxillary orthognathic operations: need for testing of type and screen.

    PubMed

    Fenner, Matthias; Kessler, Peter; Holst, Stefan; Nkenke, Emeka; Neukam, Friedrich Wilhelm; Holst, Alexandra Ioana

    2009-12-01

    We prospectively evaluated the incidence of blood transfusion in 105 consecutively treated patients (45 men and 60 women) having bimaxillary orthognathic operations, to find out whether type and screen testing are adequate in clinical practice. All patients had Le Fort I osteotomy combined with bilateral sagittal split osteotomy of the ramus. The preoperative routine was restricted to type and screen testing and verification of ABO/Rhesus (Rh) status. Autologous blood donation or routine cross-matching of allogeneic units of blood was not done. Intraoperative haemoglobin concentrations and the need for blood transfusion in patients having bimaxillary osteotomies were recorded in a prospective database. The mean duration of operation was 196 min (range 115-325). The median length of hospital stay was 8 days (range 4-16). The mean (SD) reduction in haemoglobin during operation was 34 (16)g/L in men and 32 (10)g/L in women (p=0.32). No patients had an allogeneic blood transfusion. We found that type and screen testing and verification of ABO/Rh status seems to be an adequate precaution to manage blood loss. As reflected by the low rate of transfusion in the present study, severe haemorrhage that requires transfusion of allogeneic blood has become the exception rather than the rule in bimaxillary orthognathic operations. PMID:19608311

  8. Blood Transfusion Safety in Africa: A Literature Review of Infectious Disease and Organizational Challenges

    PubMed Central

    Bloch, Evan M.; Vermeulen, Marion; Murphy, Edward

    2013-01-01

    Blood safety remains an important public health concern in Africa where lack of availability or provision of unsafe blood adversely impacts morbidity and mortality in the region. In recognition of this shortfall, the World Health Organization (WHO) established a goal of regional blood safety by 2012 through improved “organization and management, blood donor recruitment and collection, testing of donor blood as well as appropriate clinical use of blood” (Tagny et al: Transfusion. 2008;48:1256–1261; Tapko et al: Status of Blood Safety in the WHO African Region: Report of the 2006 Survey http://www.afro.who.int/en/divisions-a-programmes/dsd/health-technologies-a-laboratories.html. Brazzaville, Republic of Congo: WHO Regional Office for Africa; 2006). Although there has been substantial progress toward meeting these objectives, there are continued obstacles to both development and sustainability. In a setting where transfusion oversight is still being improved, transfusion-transmitted infections are of real concern. The high prevalence of some transfusion-transmissible agents such as hepatitis B virus and HIV in the general population means that some infected blood units escape detection by even well-performed laboratory testing, resulting in potential downstream transmission to patients. The spectrum of transfusion-transmitted infection include conventional as well as exotic pathogens, many of which are endemic to the region, thereby imparting ongoing challenges to recruitment and testing strategies. PMID:21872426

  9. Bridging channel dendritic cells induce immunity to transfused red blood cells.

    PubMed

    Calabro, Samuele; Gallman, Antonia; Gowthaman, Uthaman; Liu, Dong; Chen, Pei; Liu, Jingchun; Krishnaswamy, Jayendra Kumar; Nascimento, Manuela Sales L; Xu, Lan; Patel, Seema R; Williams, Adam; Tormey, Christopher A; Hod, Eldad A; Spitalnik, Steven L; Zimring, James C; Hendrickson, Jeanne E; Stowell, Sean R; Eisenbarth, Stephanie C

    2016-05-30

    Red blood cell (RBC) transfusion is a life-saving therapeutic tool. However, a major complication in transfusion recipients is the generation of antibodies against non-ABO alloantigens on donor RBCs, potentially resulting in hemolysis and renal failure. Long-lived antibody responses typically require CD4(+) T cell help and, in murine transfusion models, alloimmunization requires a spleen. Yet, it is not known how RBC-derived antigens are presented to naive T cells in the spleen. We sought to answer whether splenic dendritic cells (DCs) were essential for T cell priming to RBC alloantigens. Transient deletion of conventional DCs at the time of transfusion or splenic DC preactivation before RBC transfusion abrogated T and B cell responses to allogeneic RBCs, even though transfused RBCs persisted in the circulation for weeks. Although all splenic DCs phagocytosed RBCs and activated RBC-specific CD4(+) T cells in vitro, only bridging channel 33D1(+) DCs were required for alloimmunization in vivo. In contrast, deletion of XCR1(+)CD8(+) DCs did not alter the immune response to RBCs. Our work suggests that blocking the function of one DC subset during a narrow window of time during RBC transfusion could potentially prevent the detrimental immune response that occurs in patients who require lifelong RBC transfusion support. PMID:27185856

  10. Evaluating Large-scale Blood Transfusion Therapy for the Current Ebola Epidemic in Liberia

    PubMed Central

    Gutfraind, Alexander; Meyers, Lauren Ancel

    2015-01-01

    Background. To combat the 2014–2015 Ebola virus disease (EVD) epidemic in West Africa, the World Health Organization urged the rapid evaluation of convalescent whole blood (CWB) and plasma (CP) transfusion therapy. However, the feasibility and likely impacts of broad implementation of transfusions are yet unknown. Methods. We extended an Ebola virus transmission model published by the Centers for Disease Control and Prevention to include hospital-based convalescent donations and transfusions. Using recent epidemiological estimates for EVD in Liberia and assuming that convalescent transfusions reduce the case-fatality rate to 12.5% (range, 7.5%–17.5%), we projected the impacts of a countrywide ramp-up of transfusion therapy. Results. Under the 10% case-hospitalization rate estimated for Liberia in September 2014, large-scale CP therapy is expected to save 3586 lives by October 2015 (3.1% mortality reduction; 95% confidence interval [CI], .52%–4.5%). Under a higher 30% hospitalization rate, CP transfusions are expected to save 151 lives (0.9% of the total; 95% CI, .21%–11%). Conclusions. Transfusion therapy for EVD is a low-cost measure that can potentially save many lives in West Africa but will not measurably influence the prevalence. Under all scenarios considered, CP transfusions are predicted to achieve greater reductions in mortality than CWB. PMID:25635118

  11. Transfusion of stored blood impairs host defenses against Gram-negative pathogens in mice

    PubMed Central

    Prestia, Kevin; Bandyopadhyay, Sheila; Slate, Andrea; Francis, Richard O.; Francis, Kevin P.; Spitalnik, Steven L.; Fidock, David A.; Brittenham, Gary M.; Hod, Eldad A.

    2014-01-01

    BACKGROUND Although human red blood cell (RBC) units may be refrigerator stored for up to 42 days, transfusion of older RBCs acutely delivers a large bolus of iron to mononuclear phagocytes. Similarly, iron dextran circulates in plasma for hours to days and is progressively cleared by mononuclear phagocytes, which return iron to plasma. Finally, malaria infection continuously delivers iron to macrophages by intra- and extravascular hemolysis. Studies suggest that iron administration increases infectious risk. STUDY DESIGN AND METHODS To assess the effects of increased iron availability on susceptibility to infection, we infected mice with model Gram-negative intracellular or extracellular pathogens (Salmonella typhimurium or Escherichia coli, respectively), accompanied by RBC transfusion, iron dextran administration, or malarial coinfection. RESULTS In our mouse models, transfusion of older RBCs exacerbates infection with both Gram-negative pathogens. Although iron dextran exacerbates E. coli infection to a similar extent as transfusion of corresponding amounts of iron, higher iron doses are required to produce comparable effects with S. typhimurium. Coinfection of mice with Plasmodium yoelii and S. typhimurium produces overwhelming Salmonella sepsis. Finally, treating mice with antibiotics abrogates the enhancing effect on E. coli infection of both older RBC transfusion and iron dextran administration. CONCLUSIONS Transfusion of older RBCs exacerbates Gram-negative infection to a similar extent as malaria coinfection or iron dextran administration. Appropriate antibiotic therapy abrogates the effect of older RBC transfusions on infection with E. coli. Iron delivery to macrophages may be an underappreciated mechanism mediating, at least some, adverse effects of RBC transfusions. PMID:24840185

  12. The effects of perioperative blood transfusion on morbidity and mortality after esophagectomy.

    PubMed

    Fields, Ryan C; Meyers, Bryan F

    2006-02-01

    The effect of blood transfusion on outcomes in esophageal surgery remains controversial. The contrasting conclusions drawn from a number of retrospective analyses with different methodologies create a landscape that is difficult to interpret. Because of the scope of esophageal resection, the need for blood transfusion cannot be eliminated. What recommendations then, if any, can be made for the practicing surgeon? First, surgeons and anesthesiologists need to reevaluate their transfusion thresholds. The age-old practice of keeping the hemoglobin above 10 g/dL has very little evidence-based support. A multicenter, randomized, controlled clinical trial in Canada demonstrated that a restrictive strategy of blood transfusion, in which patients were transfused only for a hemoglobin level of less than 7 g/dL, was at least as effective as and possibly was superior to a liberal transfusion strategy in critically ill patients. It has also been estimated that more than 25% of patients undergoing colorectal resections may receive at least one unit of unnecessary blood. Further, the immediate reduction in the hemoglobin concentration caused by the normovolemic hemodilution associated with surgery and crystalloid fluid replacement is not associated with any increased morbidity or mortality. If these data are examined in the context of the results of Langley and Tachibana indicating that a threshold amount of blood needs to be transfused to impact outcomes, it becomes even more important to limit transfusion to only the amount that is essential. Thus, surgeons and anesthesiologists should adopt a more stringent set of requirements for blood transfusion. Second, with the proven feasibility and reduction in infectious complications associated with autologous blood-donation programs, any patient who meets the criteria discussed here should be encouraged to participate in such a program. Although the effect of autologous blood on cancer outcomes remains unclear, the other advantages

  13. Allogenic Blood Transfusion Following Total Hip Arthroplasty: Results from the Nationwide Inpatient Sample, 2000 to 2009

    PubMed Central

    Saleh, Anas; Small, Travis; Chandran Pillai, Aiswarya Lekshmi Pillai; Schiltz, Nicholas K.; Klika, Alison K.; Barsoum, Wael K.

    2014-01-01

    Background: The large-scale utilization of allogenic blood transfusion and its associated outcomes have been described in critically ill patients and those undergoing high-risk cardiac surgery but not in patients undergoing elective total hip arthroplasty. The objective of this study was to determine the trends in utilization and outcomes of allogenic blood transfusion in patients undergoing primary total hip arthroplasty in the United States from 2000 to 2009. Methods: An observational cohort of 2,087,423 patients who underwent primary total hip arthroplasty from 2000 to 2009 was identified in the Nationwide Inpatient Sample. International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes 99.03 and 99.04 were used to identify patients who received allogenic blood products during their hospital stay. Risk factors for allogenic transfusions were identified with use of multivariable logistic regression models. We used propensity score matching to estimate the adjusted association between transfusion and surgical outcomes. Results: The rate of allogenic blood transfusion increased from 11.8% in 2000 to 19.0% in 2009. Patient-related risk factors for receiving an allogenic blood transfusion include an older age, female sex, black race, and Medicaid insurance. Hospital-related risk factors include rural location, smaller size, and non-academic status. After adjusting for confounders, allogenic blood transfusion was associated with a longer hospital stay (0.58 ± 0.02 day; p < 0.001), increased costs ($1731 ± $49 [in 2009 U.S. dollars]; p < 0.001), increased rate of discharge to an inpatient facility (odds ratio, 1.28; 95% confidence interval, 1.26 to 1.31), and worse surgical and medical outcomes. In-hospital mortality was not affected by allogenic blood transfusion (odds ratio, 0.97; 95% confidence interval, 0.77 to 1.21). Conclusions: The increase in allogenic blood transfusion among total hip arthroplasty patients is concerning

  14. Decreasing the critical value of hemoglobin required for physician notification reduces the rate of blood transfusions

    PubMed Central

    Larson, Eric A; Thompson, Paul A; Anderson, Zachary K; Anderson, Keith A; Lupu, Roxana A; Tigner, Vicki; Hoffman, Wendell W

    2016-01-01

    Red blood cell transfusions have been cited as one of the most overused therapeutic interventions in the USA. Excessively aggressive transfusion practices may be driven by mandatory physician notification of critical hemoglobin values that do not generally require transfusion. We examined the effect of decreasing the critical value of hemoglobin from 8 to 7 g/dL at our institution. Along with this change, mandatory provider notification for readings between 7 and 8 g/dL was rescinded. Transfusion rates were compared retrospectively during paired 5-month periods for patients presenting in three key hemoglobin ranges (6.00–6.99, 7.00–7.99, and 8.00–8.99 g/dL). A change in transfusion practices was hypothesized in the 7–8 g/dL range, which was no longer labeled critical and for which mandated physician calls were rescinded. Transfusion rates showed a statistically significant 8% decrease (P≤0.0001) during the 5-month period post change in our transfusion practices. This decrease in the 7.00–7.99 g/dL range was significantly greater than the 2% decrease observed in either the 6–6.99 g/dL (P=0.0017) or 8–8.99 g/dL (P≤0.0001) range. Cost savings of up to $700,000/year were extrapolated from our results showing 491 fewer units of red blood cells transfused during the 5-month post change. These cost savings do not take into account the additional impact of complications associated with blood transfusions. PMID:27350757

  15. Active Hemovigilance Significantly Improves Reporting of Acute Non-infectious Adverse Reactions to Blood Transfusion.

    PubMed

    Agnihotri, Naveen; Agnihotri, Ajju

    2016-09-01

    One of the key purposes of a hemovigilance program is to improve reporting of transfusion related adverse events and subsequent data-driven improvement in blood transfusion (BT) practices. We conducted a study over 3 years to assess the impact of healthcare worker training and an active feedback programme on reporting of adverse reactions to BTs. All hospitalized patients who required a BT were included in the study. Healthcare workers involved in BT to patients were sensitized and trained in adverse reaction reporting by conducting training sessions and meetings. All the transfused patients were 'actively' monitored for any acute adverse reaction by using a uniquely coded blood issue form. A total of 18,914 blood components transfused to 5785 different patients resulted in 61 adverse reaction episodes. This incidence of 0.32 % in our study was found to be significantly higher (p < 0.005) than that reported from the same region in the past. Red blood cell units were the most frequently transfused component and thus most commonly involved in an adverse reaction (42.6 %), however apheresis platelets had the highest chance of reaction per unit transfused (0.66 %). There was no mortality associated with the BT during the study period. An active surveillance program significantly improves reporting and management of adverse reactions to BTs. PMID:27429527

  16. [Results of Training for Personnel Involved in Blood-Transfusion Testing Outside of Regular Work Hours at Saga University Hospital].

    PubMed

    Yamada, Marie; Yamada, Naotomo; Higashitani, Takanori; Ohta, Shoichiro; Sueoka, Eisaburo

    2015-11-01

    Laboratory testing prior to blood transfusion outside of regular hours in many hospitals and clinics is frequently conducted by technicians without sufficient experience in such testing work. To obtain consistent test results regardless of the degree of laboratory experience with blood transfusion testing, the number of facilities introducing automated equipment for testing prior to blood transfusion is increasing. Our hospital's blood transfusion department introduced fully automated test equipment in October of 2010 for use when blood transfusions are conducted outside of regular hours. However, excessive dependence on automated testing can lead to an inability to do manual blood typing or cross-match testing when necessitated by breakdowns in the automated test equipment, in the case of abnormal specimen reactions, or other such case. In addition, even outside of normal working hours there are more than a few instances in which transfusion must take place based on urgent communications from clinical staff, with the need for prompt and flexible timing of blood transfusion test and delivery of blood products. To address this situation, in 2010 we began training after-hours laboratory personnel in blood transfusion testing to provide practice using test tubes manually and to achieve greater understanding of blood transfusion test work (especially in cases of critical blood loss). Results of the training and difficulties in its implementation for such after-hours laboratory personnel at our hospital are presented and discussed in this paper. [Original] PMID:26995870

  17. Effect of Blood Donor Characteristics on Transfusion Outcomes: A Systematic Review and Meta-Analysis.

    PubMed

    Chassé, Michaël; McIntyre, Lauralyn; English, Shane W; Tinmouth, Alan; Knoll, Greg; Wolfe, Dianna; Wilson, Kumanan; Shehata, Nadine; Forster, Alan; van Walraven, Carl; Fergusson, Dean A

    2016-04-01

    Optimal selection of blood donors is critical for ensuring the safety of blood products. The current selection process is concerned principally with the safety of the blood donor at the time of donation and of the recipient at the time of transfusion. Recent evidence suggests that the characteristics of the donor may affect short- and long-term transfusion outcomes for the transfused recipient. We conducted a systematic review with the primary objective of assessing the association between blood donor characteristics and red blood cell (RBC) transfusion outcomes. We searched MEDLINE, EMBASE, and Cochrane Central databases and performed manual searches of top transfusion journals for all available prospective and retrospective studies. We described study characteristics, methodological quality, and risk of bias and provided study-level effect estimates and, when appropriate, pooled estimates with 95% confidence intervals using the Mantel-Haenszel or inverse variance approach. The overall quality of the evidence was graded using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. From 6121 citations identified by our literature search, 59 studies met our eligibility criteria (50 observational, 9 interventional). We identified the evaluation of association of 17 donor characteristics on RBC transfusion outcome. The risk of bias and confounding of the included studies was high. The quality of evidence was graded as very low to low for all 17 donor characteristics. Potential associations were observed for donor sex with reduced survival at 90 days and 6 months in male recipients that receive donated blood from females (hazard ratio 2.60 [1.09, 6.20] and hazard ratio 2.40 [1.10, 5.24], respectively; n = 1), Human Leukocyte Antigen - antigen D Related (HLA-DR) selected transfusions (odds ratio [OR] 0.39 [0.15, 0.99] for the risk of transplant alloimmunization, n = 9), presence of antileukocyte antibodies (OR 5.84 [1.66, 20.59] for risk

  18. Blood donors’ positivity for transfusion-transmissible infections: the Serbian Military Medical Academy experience

    PubMed Central

    Vučetić, Dušan; Kecman, Gorica; Ilić, Vesna; Balint, Bela

    2015-01-01

    Background Members of armed forces worldwide are considered to be very susceptible to sexually transmitted infections, thus falling into a high-risk group of blood donors regarding transfusion-transmissible infections. In the Serbian Military Medical Academy a significant number (44% for the period 2005–2013) of blood donations were from members of the Serbian Army. The aim of this study was to determine the significance of military blood donors for the safety of blood transfusion. Material and methods Between January 2005 and December 2013, a total of 155,479 blood donations were tested for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV) and syphilis using serological assays (enzyme immunoassays, chemiluminescent microparticle immunoassay and western blot) and molecular testing (polymerase chain reaction analysis). Results The percentage of blood donations positive for transfusion-transmissible infections in the estimated period was 0.38%, and the percentage of HBV, HCV, HIV and syphilis positive blood donations was 0.20%, 0.12%, 0.005% and 0.06%, respectively. During that period, the percentage of all transfusion-transmissible infections, and in particular of HBV and HCV, declined significantly. In contrast, the percentage of HIV and syphilis positive blood donations remained unchanged. Higher rates of positivity for transfusion-transmissible infections in blood donations from members of the Serbian Army were not found, especially after mandatory military service was abolished in 2009. Discussion The reported rate of positivity for transfusion-transmissible infections in blood donations from the Military Medical Academy was considered low. This information is of great significance for further implementation of public health measures. PMID:26057495

  19. Transfusion of older stored blood and risk of death: a meta-analysis

    PubMed Central

    Wang, Dong; Sun, Junfeng; Solomon, Steven B.; Klein, Harvey G.; Natanson, Charles

    2013-01-01

    BACKGROUND Blood for transfusion is stored for up to 42 days. Older blood develops lesions and accumulates potentially injurious substances. Some studies report increasing toxicity as blood ages. We assessed the safety of transfused older versus newer stored blood. STUDY DESIGN AND METHODS PubMed, Scopus and Embase were searched using terms new and old and red blood cell and storage through May 6, 2011 for observational and randomized controlled studies comparing outcomes using transfused blood having longer and shorter storage times. Death was the outcome of interest. RESULTS Twenty-one studies were identified, predominantly in cardiac surgery (n=6) and trauma (n=6) patients, including 409,966 patients. A test for heterogeneity of these studies’ results was not significant for mortality (I2=3.7%, p=0.41). Older blood was associated with a significantly increased risk of death [odds ratio (OR) 1.16; 95% confidence interval (CI) (1.07, 1.24)]. Using available mortality data, 97 (63, 199; 95% CI) patients need to be treated with only new blood to save one life. Subgroup analysis of these trials indicated the increased risk was not restricted to a particular type of patient, size of trial, or amount of blood transfused. CONCLUSION Based on available data, use of older stored blood is associated with a significantly increased risk of death. PMID:22188419

  20. Transfusion-Transmissible Infections among Voluntary Blood Donors at Wolaita Sodo University Teaching Referral Hospital, South Ethiopia.

    PubMed

    Bisetegen, Fithamlak Solomon; Bekele, Fanuel Belayneh; Ageru, Temesgen Anjulo; Wada, Fiseha Wadilo

    2016-01-01

    Background. Transfusion-transmissible infections, human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and syphilis are among the greatest threats to blood safety and pose a serious public health problem. Objective. To determine the magnitude of blood borne infections among blood donors at Wolaita Sodo University Teaching Referral Hospital. Methods and Materials. A cross-sectional study was conducted from 10/11/2015 up to 10/12/2015. 390 donors were consecutively included and data on donor's age, sex, blood type, and serum screening results were obtained by structured questionnaire and laboratory investigation. The collected data were entered into Epi Data version 1.4 and then exported to SPSS version 20.0 for analysis. Result. The seroprevalence of blood borne pathogens is 29.5% of which HCV, HBV, HIV, and syphilis account for 8.5%, 9.5%, 6.4%, and 7.5%, respectively. Multiple infections were observed among 2.8% of the infected individuals. In addition, age ≥ 30 has a significant association with HCV. Conclusion. Significantly higher prevalence of transfusion-transmissible infections was identified from blood donors and they remain to be the greatest threat to blood safety, so comprehensive screening of donors' blood for HIV, HBV, HCV, and syphilis using standard methods is highly recommended to ensure the safety of blood recipient. PMID:27597875

  1. Transfusion-Transmissible Infections among Voluntary Blood Donors at Wolaita Sodo University Teaching Referral Hospital, South Ethiopia

    PubMed Central

    Bekele, Fanuel Belayneh; Ageru, Temesgen Anjulo; Wada, Fiseha Wadilo

    2016-01-01

    Background. Transfusion-transmissible infections, human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and syphilis are among the greatest threats to blood safety and pose a serious public health problem. Objective. To determine the magnitude of blood borne infections among blood donors at Wolaita Sodo University Teaching Referral Hospital. Methods and Materials. A cross-sectional study was conducted from 10/11/2015 up to 10/12/2015. 390 donors were consecutively included and data on donor's age, sex, blood type, and serum screening results were obtained by structured questionnaire and laboratory investigation. The collected data were entered into Epi Data version 1.4 and then exported to SPSS version 20.0 for analysis. Result. The seroprevalence of blood borne pathogens is 29.5% of which HCV, HBV, HIV, and syphilis account for 8.5%, 9.5%, 6.4%, and 7.5%, respectively. Multiple infections were observed among 2.8% of the infected individuals. In addition, age ≥ 30 has a significant association with HCV. Conclusion. Significantly higher prevalence of transfusion-transmissible infections was identified from blood donors and they remain to be the greatest threat to blood safety, so comprehensive screening of donors' blood for HIV, HBV, HCV, and syphilis using standard methods is highly recommended to ensure the safety of blood recipient. PMID:27597875

  2. Mononucleated Blood Cell Populations Display Different Abilities To Transmit Prion Disease by the Transfusion Route

    PubMed Central

    Douet, Jean-Yves; Lacroux, Caroline; Litaise, Claire; Lugan, Séverine; Corbière, Fabien; Arnold, Mark; Simmons, Hugh; Aron, Naima; Costes, Pierrette; Tillier, Cécile; Cassard, Hervé

    2016-01-01

    ABSTRACT Previous experiments carried out in a sheep scrapie model demonstrated that the transfusion of 200 μl of prion-infected whole blood has an apparent 100% efficacy for disease transmission. These experiments also indicated that, despite the apparent low infectious titer, the intravenous administration of white blood cells (WBC) resulted in efficient disease transmission. In the study presented here, using the same transmissible spongiform encephalopathy (TSE) animal model, our aim was to determine the minimal number of white blood cells and the specific abilities of mononucleated cell populations to transmit scrapie by the transfusion route. Our results confirmed that the transfusion of 100 μl, but not 10 μl, of fresh whole blood collected in asymptomatic scrapie-infected donor sheep can transmit the disease. The data also show that the intravenous administration of 105 WBCs is sufficient to cause scrapie in recipient sheep. Cell-sorted CD45R+ (predominantly B lymphocytes), CD4+/CD8+ (T lymphocytes), and CD14+ (monocytes/macrophages) blood cell subpopulations all were shown to contain prion infectivity by bioassays in ovine PrP transgenic mice. However, while the intravenous administration of 106 CD45+ or CD4+/8+ living cells was able to transmit the disease, similar numbers of CD14+ cells failed to infect the recipients. These data support the contention that mononucleated blood cell populations display different abilities to transmit TSE by the transfusion route. They also represent an important input for the risk assessment of blood-borne prion disease transmission and for refining the target performance of leukoreduction processes that currently are applied to mitigate the transmission risk in transfusion medicine. IMPORTANCE Interindividual variant Creutzfeldt-Jakob disease (vCJD) transmission through blood and blood-derived products is considered a major public health issue in transfusion medicine. Over the last decade, TSE in sheep has emerged as a

  3. The effects of blood transfusion on renal functions in orthopaedic surgery

    PubMed Central

    Satoglu, Ismail Safa; Akcay, Serkan; Horoz, Levent; Kaya, Erol; Karakasli, Ahmet; Skiak, Eyad; Basci, Onur

    2015-01-01

    Objective: The effects of perioperative blood transfusion on renal functions have been studied in various studies. In this study, we investigated the effects of blood transfusion on postoperative kidney functions in patients who underwent orthopaedic surgeries. Method: Total 136 patients who were operated for several orthopedic pathologies between June 2013 and December 2014 were evaluated. The patients were divided into two groups according to the amounts of blood transfusion. Ninety five patients (69.8%) who were transfused less than 3 units were included in Group 1 and 41 patients (30.2%) who received 3 and more units of blood were included in Group 2. Results: There were no statistical difference between the two groups in terms of preoperative gender, hypertension, diabetes mellitus, chronical renal failure and smoking habbits (P > 0.05). No statistical differences between the groups were seen in terms of postoperative hospital stay, pulmonary and other complications as well as mortality (P > 0.05). When the two groups were compared for blood parameters showing postoperative renal and other system functions, no statistical differences were detected (P > 0.05). Conclusion: Blood transfusion does not have negative effects on postoperative BUN and creatinine levels in patients operated for orthopaedic pathologies. PMID:26430403

  4. Development of blood transfusion product pathogen reduction treatments: a review of methods, current applications and demands.

    PubMed

    Salunkhe, Vishal; van der Meer, Pieter F; de Korte, Dirk; Seghatchian, Jerard; Gutiérrez, Laura

    2015-02-01

    Transfusion-transmitted infections (TTI) have been greatly reduced in numbers due to the strict donor selection and screening procedures, i.e. the availability of technologies to test donors for endemic infections, and routine vigilance of regulatory authorities in every step of the blood supply chain (collection, processing and storage). However, safety improvement is still a matter of concern because infection zero-risk in transfusion medicine is non-existent. Alternatives are required to assure the safety of the transfusion product and to provide a substitution to systematic blood screening tests, especially in less-developed countries or at the war-field. Furthermore, the increasing mobility of the population due to traveling poses a new challenge in the endemic screening tests routinely used, because non-endemic pathogens might emerge in a specific population. Pathogen reduction treatments sum a plethora of active approaches to eliminate or reduce potential threatening pathogen load from blood transfusion products. Despite the success of pathogen reduction treatments applied to plasma products, there is still a long way to develop and deploy pathogen reduction treatments to cellular transfusion products (such as platelets, RBCs or even to whole blood) and there is divergence on its acceptance worldwide. While the use of pathogen reduction treatments in platelets is performed routinely in a fair number of European blood banks, most of these treatments are not (or just) licensed in the USA or elsewhere in the world. The development of pathogen reduction treatments for RBC and whole blood is still in its infancy and under clinical trials. In this review, we discuss the available and emerging pathogen reduction treatments and their advantages and disadvantages. Furthermore, we highlight the importance of characterizing standard transfusion products with current and emerging approaches (OMICS) and clinical outcome, and integrating this information on a database

  5. Impact of Perioperative Blood Transfusion on Postoperative Complications and Prognosis of Gastric Adenocarcinoma Patients with Different Preoperative Hemoglobin Value

    PubMed Central

    Xue, Lian; Wei-Han, Zhang; Yang, Kun; Chen, Xin-Zu; Zhang, Bo; Chen, Zhi-Xin; Chen, Jia-Ping; Zhou, Zong-Guang; Hu, Jian-Kun

    2016-01-01

    Background. The impact of perioperative blood transfusion on the prognosis of gastric adenocarcinoma patients is still controversial. The aim of this study was to elucidate the impact of perioperative blood transfusion on postoperative complications and prognosis of patients who underwent gastrectomy for gastric adenocarcinoma with different levels of preoperative hemoglobin value (POHb). Method. From 2003 to 2011, 1199 patients who underwent curative gastrectomy were retrospectively enrolled and followed up to December 2014. Clinicopathological features and survival outcomes were compared between transfused and nontransfused patients. Results. In this study, transfused patients had more postoperative complications than nontransfused ones (P = 0.002). In survival analysis, the difference was not significant between transfused and nontransfused patients with POHb between 70 and 100 g/L (P = 0.191). However, in patients with POHb >100 g/L, transfused patients had significantly worse prognosis (P < 0.001), especially in TNM III stage patients (P = 0.002). And intraoperative blood transfusion predicted poor prognosis (P = 0.001). Conclusion. Perioperative blood transfusion might lead to poor survival in gastric adenocarcinoma patients with POHb >100 g/L and transfused patients had more postoperative complications; thus it is better to refrain from unnecessary perioperative blood transfusion especially intraoperative transfusion. PMID:26819609

  6. Greater Volume of Acute Normovolemic Hemodilution May Aid in Reducing Blood Transfusions After Cardiac Surgery

    PubMed Central

    Goldberg, Joshua; Paugh, Paugh; Dickinson, Timothy A.; Fuller, John; Paone, Gaetano; Theurer, Patty F.; Shann, Kenneth G.; Sundt, Thoralf M.; Prager, Richard L.; Likosky, Donald S.

    2016-01-01

    Background Perioperative red blood cell transfusions (RBC) are associated with increased morbidity and mortality after cardiac surgery. Acute normovolemic hemodilution (ANH) is recommended to reduce perioperative transfusions; however, supporting data are limited and conflicting. We describe the relationship between ANH and RBC transfusions after cardiac surgery using a multi-center registry. Methods We analyzed 13,534 patients undergoing cardiac surgery between 2010 and 2014 at any of the 26 hospitals participating in a prospective cardiovascular perfusion database. The volume of ANH (no ANH, <400mL, 400–799mL, ≥800mL) was recorded and linked to each center’s surgical data. We report adjusted relative risks reflecting the association between the use and amount of ANH and the risk of perioperative RBC transfusion. Results were adjusted for preoperative risk factors, procedure, BSA, preoperative HCT, and center. Results ANH was used in 17% of the patients. ANH was associated with a reduction in RBC transfusions (RRadj 0.74, p <0.001). Patients having ≥800mL of ANH had the most profound reduction in RBC transfusions (RRadj 0.57, p<0.001). Platelet and plasma transfusions were also significantly lower with ANH. The ANH population had superior postoperative morbidity and mortality compared to the no ANH population. Conclusions There is a significant association between ANH and reduced perioperative RBC transfusion in cardiac surgery. Transfusion reduction is most profound with larger volumes of ANH. Our findings suggest the volume of ANH, rather than just its use, may be an important feature of a center’s blood conservation strategy. PMID:26206721

  7. Plasma and Plasma Protein Product Transfusion: A Canadian Blood Services Centre for Innovation Symposium.

    PubMed

    Zeller, Michelle P; Al-Habsi, Khalid S; Golder, Mia; Walsh, Geraldine M; Sheffield, William P

    2015-07-01

    Plasma obtained via whole blood donation processing or via apheresis technology can either be transfused directly to patients or pooled and fractionated into plasma protein products that are concentrates of 1 or more purified plasma protein. The evidence base supporting clinical efficacy in most of the indications for which plasma is transfused is weak, whereas high-quality evidence supports the efficacy of plasma protein products in at least some of the clinical settings in which they are used. Transfusable plasma utilization remains composed in part of applications that fall outside of clinical practice guidelines. Plasma contains all of the soluble coagulation factors and is frequently transfused in efforts to restore or reinforce patient hemostasis. The biochemical complexities of coagulation have in recent years been rationalized in newer cell-based models that supplement the cascade hypothesis. Efforts to normalize widely used clinical hemostasis screening test values by plasma transfusion are thought to be misplaced, but superior rapid tests have been slow to emerge. The advent of non-vitamin K-dependent oral anticoagulants has brought new challenges to clinical laboratories in plasma testing and to clinicians needing to reverse non-vitamin K-dependent oral anticoagulants urgently. Current plasma-related controversies include prophylactic plasma transfusion before invasive procedures, plasma vs prothrombin complex concentrates for urgent warfarin reversal, and the utility of increased ratios of plasma to red blood cell units transfused in massive transfusion protocols. The first recombinant plasma protein products to reach the clinic were recombinant hemophilia treatment products, and these donor-free equivalents to factors VIII and IX are now being supplemented with novel products whose circulatory half-lives have been increased by chemical modification or genetic fusion. Achieving optimal plasma utilization is an ongoing challenge in the interconnected

  8. Bleeding management in remote environment: the use of fresh whole blood transfusion and lyophilised plasma.

    PubMed

    Sicard, Bruno; Marouzé, Frédéric; Roche, Céline; Carron, Mathieu; Ausset, Sylvain; Sailliol, Anne

    2016-01-01

    To mitigate medical risks in remote environments, the authors have implemented an innovative integrated medical support solution for bleeding management on board ships since 2013. Fresh whole blood transfusion (FWBT) and lyophilised plasma were put in place to address life threatening haemorrhages in maritime operations in the Arctic and Antarctica. The authors are illustrating the bleeding risks with an actual case occurring in Antarctica prior to the implementation of these procedures. They are presenting the different steps involved in the complex process of FWBT, from blood donors' qualifications to actual transfusions. The pros and cons of blood transfusion in extreme remote environment are discussed, including the training of health care professionals, equipment requirements, legal and ethical issues, decision making in complex blood group matching, medical benefits and risks. PMID:27364172

  9. [Responsibility for prescribing and monitoring an act transfusion and safety blood transfusion].

    PubMed

    Piercecchi-Marti, M D; Tuchtan-Torrents, L; Lassale, B; Leonetti, G; Bartoli, C

    2014-11-01

    The act to transfuse is a prescription following basic rules similar to drug prescriptions. If harm happens, potentially linked with this prescription, the harm's responsibility is borne by the physician, the paramedics, the care organization but by the supplier laboratory too. The setting of good practice rules consistent with science data at the time when the act is performed, the respect of the patient's rights and the quality of supplied products will be assessed during the expertise. Under restorative responsibility, it is necessary to previously establish a direct and certain causation between the litigious act and the harm to enforce the vicarious liability. Nowadays, legal precedents grant a larger protection to more and more numerous victims, enhancing the field of the fault with the appeal to assumption of fault. At the same time, the lawmaker himself promulgated objective conditions of compensation for many categories of victims of medical risk from which transfused people are part. The law of March the 4th of 2002 went one step closer devoting a new foundation of compensation: national solidarity. PMID:25282487

  10. [2013: The Seville document on consensus on the alternatives to allogenic blood transfusion. Update to the Seville document. Spanish Societies of Anaesthesiology (SEDAR), Haematology and Haemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Haemostasis (SETH) and Blood Transfusion (SETS)].

    PubMed

    Leal-Noval, S R; Muñoz, M; Asuero, M; Contreras, E; García-Erce, J A; Llau, J V; Moral, V; Páramo, J A; Quintana, M

    2013-01-01

    As allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to TSA (AABT) have emerged, but there is a huge variability with respect to their indications and appropriate use. This variability results from the interplay of a number of factors, which include physicians specialty, knowledge and preferences, degree of anaemia, transfusion policy, and AABT availability. Since the ABBT are not harmless and may not meet costeffectiveness criteria, such avariability is unacceptable. The Spanish Societies of Anaesthesiology (SEDAR), Haematology and Haemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Haemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these six Societies have conducted a systematic review of the medical literature and developed the «2013. Seville Document of Consensus on Alternatives to Allogeneic Blood Transfusion», which only considers those AABT aimed to decrease the transfusion of packed red cells. The AABTs are defined as any pharmacological and non-pharmacological measure aimed to decrease the transfusion of of red blood cell concentrates, while preserving the patient safety. For each AABT, the main question is formulated, positively or negatively, as: «Does or does not this particular AABT reduce the transfusion rate?» All the recommendations on the use of AABTs were formulated according to the GRADE (Grades of Recommendation Assessment, Development and Evaluation) methodology. PMID:23789799

  11. Risk perception and its role in attitudes toward blood transfusion: a qualitative systematic review.

    PubMed

    Ngo, Ly Thi; Bruhn, Roberta; Custer, Brian

    2013-04-01

    Despite improvements in blood safety making transfusion a much safer clinical procedure, the general public still perceives it as risky. We systematically reviewed available literature to examine evidence regarding the reasons and causes behind this perception. Electronic databases including PubMed, Cochrane Library, and EMBASE for literature dating back to the 1980s were searched. Eligible studies collected information on blood recipients' demographics, measures of risk domains (sets of values that risks encompass), and general knowledge of blood transfusion in terms of risks and benefits. Each study was assessed for quality of data, research method, and relevant findings. A scoring system was used to subjectively rate the overall quality of each study. Each study was reviewed for its method of data collection and information abstracted on hazards and conceptual dimensions used to measure risk. Risk perception between blood transfusion and other hazards including alternatives to transfusion were compared. Fifteen studies met the inclusion criteria, all of which were conducted outside the United States, with most of the studies published more than 10 years ago and conducted by only 3 research groups. Five studies were rated as being very good, four good, five fair, and one of poor quality. The finding of the studies consistently show that objective or raw knowledge is not correlated with risk perception, but subjective or calibrated knowledge is. Thus, it is what people think they know rather than what they actually do know that influences risk perception of transfusion. Of the 3 common conceptual domains-dread, unknown risk, and benefits-blood transfusion was found to be of intermediate dread, intermediate unknown risk, and most beneficial compared with other hazards. Donated blood was found to have lower perceived risk than all other alternatives to transfusion, except for use of autologous blood. There is a lack of recent studies on allogeneic transfusion

  12. Metabolic pathways that correlate with post-transfusion circulation of stored murine red blood cells.

    PubMed

    de Wolski, Karen; Fu, Xiaoyoun; Dumont, Larry J; Roback, John D; Waterman, Hayley; Odem-Davis, Katherine; Howie, Heather L; Zimring, James C

    2016-05-01

    Transfusion of red blood cells is a very common inpatient procedure, with more than 1 in 70 people in the USA receiving a red blood cell transfusion annually. However, stored red blood cells are a non-uniform product, based upon donor-to-donor variation in red blood cell storage biology. While thousands of biological parameters change in red blood cells over storage, it has remained unclear which changes correlate with function of the red blood cells, as opposed to being co-incidental changes. In the current report, a murine model of red blood cell storage/transfusion is applied across 13 genetically distinct mouse strains and combined with high resolution metabolomics to identify metabolic changes that correlated with red blood cell circulation post storage. Oxidation in general, and peroxidation of lipids in particular, emerged as changes that correlated with extreme statistical significance, including generation of dicarboxylic acids and monohydroxy fatty acids. In addition, differences in anti-oxidant pathways known to regulate oxidative stress on lipid membranes were identified. Finally, metabolites were identified that differed at the time the blood was harvested, and predict how the red blood cells perform after storage, allowing the potential to screen donors at time of collection. Together, these findings map out a new landscape in understanding metabolic changes during red blood cell storage as they relate to red blood cell circulation. PMID:26921359

  13. Evaluation of blood donor deferral causes in the Trinidad and Tobago National Blood Transfusion Service.

    PubMed

    Charles, K S; Hughes, P; Gadd, R; Bodkyn, C J; Rodriguez, M

    2010-02-01

    The majority of blood donations in Trinidad and Tobago are made as replacement by family members or friends. National Blood Transfusion Policy was drafted in 2007 to promote voluntary, repeated donation. The objective of this study is to assess the current rate and reasons for donor deferral, and the aim is to guide the proposed donor education and recruitment programme. A retrospective study of pre-donation deferral of prospective blood donors at the National Blood Transfusion Centre, Port of Spain, Trinidad and Tobago, was conducted. Records of all pre-donation deferrals over a 12-month period were studied. As many as 11,346 pre-donation screening interviews were conducted. There were 4043 (35.6%) deferrals. The most common reasons for donor deferral were exposure to high-risk sexual activity (27.6%), low haemoglobin 22.2% and hypertension 17.5%. Other reasons such as medication, chronic medical illness, tattoos, travel history, recent pregnancy, surgery or presentation outside the accepted age limit caused 33.8% of all deferrals and the majority (34.7%) of male deferrals. Low haemoglobin (44.5%) was the most common reason among females. The rate of deferral of voluntary donors was not significantly different from that for replacement donors (31.7 vs. 35.4%, P = 0.25). This study exposed a lack of public awareness as the principal reason for an unacceptably high rate of donor deferral. Donor education about selection criteria needs to be urgently addressed as an objective of the National Policy. Monitoring and evaluation of deferral rates and reasons could be used as one indicator of the effectiveness of the Policy. PMID:19788640

  14. Use of remote blood releasing system for red cell transfusion in hospice care center

    PubMed Central

    Chan, Kwok Ying; Leung, Rock Yuk Yan; Cheung, Ka Chi; Lam, Clarence; Koo, Eleanor; Ng, Sylvia

    2016-01-01

    Objectives: It is quite common to have advanced cancer or end-stage renal disease patients for regular or even frequent blood transfusion in palliative care. However, due to geographical reason in some hospice centers, blood transfusion is sometimes difficult if blood bank is closed during non-office hour or not available. Methods: Here, we reported a new blood releasing system, that is, remote blood releasing system, that could be used safely by nursing staff alone when the blood bank was closed during the night time and holiday. Results: On-call nursing staff could collect red cells successful in these two cases. Conclusion: The new blood releasing system seems useful. However, larger sample sizes and longer period of study are required to estimate its efficacy and safety. The provision of antibody-positive red cells and platelet remained a limitation of this system. PMID:27489720

  15. Anemia and Blood Transfusion in Patients with Isolated Traumatic Brain Injury

    PubMed Central

    Al-Dorzi, Hasan M.; Al-Humaid, Waleed; Tamim, Hani M.; Haddad, Samir; Aljabbary, Ahmad; Arifi, Abdulaziz; Arabi, Yaseen M.

    2015-01-01

    Rationale. By reducing cerebral oxygen delivery, anemia may aggravate traumatic brain injury (TBI) secondary insult. This study evaluated the impact of anemia and blood transfusion on TBI outcomes. Methods. This was a retrospective cohort study of adult patients with isolated TBI at a tertiary-care intensive care unit from 1/1/2000 to 31/12/2011. Daily hemoglobin level and packed red blood cell (PRBC) transfusion were recorded. Patients with hemoglobin < 10 g/dL during ICU stay (anemic group) were compared with other patients. Results. Anemia was present on admission in two (2%) patients and developed in 48% during the first week with hemoglobin < 7 g/dL occurring in 3.0%. Anemic patients had higher admission Injury Severity Score and underwent more craniotomy (50% versus 13%, p < 0.001). Forty percent of them received PRBC transfusion (2.8 ± 1.5 units per patient, median pretransfusion hemoglobin = 8.8 g/dL). Higher hospital mortality was associated with anemia (25% versus 6% for nonanemic patients, p = 0.01) and PRBC transfusion (38% versus 9% for nontransfused patients, p = 0.003). On multivariate analysis, only PRBC transfusion independently predicted hospital mortality (odds ratio: 6.8; 95% confidence interval: 1.1–42.3). Conclusions. Anemia occurred frequently after isolated TBI, but only PRBC transfusion independently predicted mortality. PMID:26605080

  16. A comparative assessment of nursing students' cognitive knowledge of blood transfusion using lecture and simulation.

    PubMed

    Flood, Lisa S; Higbie, Julie

    2016-01-01

    Professional nurses must have the knowledge and skills to safely administer blood products and monitor for life-threatening complications. Nurse educators should ensure that student nurses also learn how to safely administer blood products; however students rarely have the opportunity to witness and manage adverse transfusion reactions. Despite the low incidence of rare adverse transfusion reactions, nursing students must be able to immediately recognize transfusion reactions, implement appropriate interventions, and communicate effectively with health care providers. To reinforce blood transfusion knowledge, practice technical skills, and promote management of adverse reactions, a human patient simulation experience was created for baccalaureate nursing students to provide application of related classroom content. Using a quasi-experimental design, students who received a related didactic lecture preceding the simulation were compared with students who did not receive the lecture. The lecture group's pre/posttest mean scores (n = 42) were significantly higher than the no lecture group's mean scores (n = 44). This simulation design included proper blood administration procedures, patient monitoring, management of transfusion reactions, and practice with interdisciplinary communication. Participation in a human patient simulation following a related didactic lecture may be useful to strengthen cognitive learning and help bridge the didactic-clinic gap. PMID:26073762

  17. Treatment-donation-stockpile dynamics in ebola convalescent blood transfusion therapy.

    PubMed

    Huo, Xi; Sun, Xiaodan; Lan, Kunquan; Wu, Jianhong

    2016-03-01

    The interim guidance issued by the World Health Organization during the West Africa 2014 Ebola outbreak provides guidelines on the use of convalescent blood from Ebola survivors for transfusion therapy. Here we develop a novel mathematical model, based on the interim guidance, to examine the nonlinear transmission-treatment-donation-stockpile dynamics during an Ebola outbreak and with a large scale use of the transfusion therapy in the population. We estimate the reduction of case fatality ratio by introducing convalescent blood transfusion as a therapy, and inform optimal treatment-donation-stockpile strategies to balance the treatment need for case fatality ratio reduction and the strategic need of maintaining a minimal blood bank stockpile for other control priorities. PMID:26721704

  18. Neonatal transfusion.

    PubMed

    Kelly, Anne M; Williamson, Lorna M

    2013-11-01

    Neonates and particularly preterm neonates are frequent recipients of large volumes of blood products relative to their size. Good quality evidence for transfusion practice in this patient group has been lacking but is now increasing. Triggers for red cell transfusion are now better defined, with on-going trials of platelet transfusions likely to yield similar evidence. Transfusion is now extremely safe, but complications such as transfusion associated acute lung injury (TRALI) and transfusion associated circulatory overload (TACO) are likely to be under recognised, particularly in the sick extremely preterm neonate with respiratory symptoms. This review summarises the rationale and current practice with regard to blood component therapy. Background data on component specifications and hazards of transfusion are provided. Indications for transfusion of specific products including red cells, platelets, and plasma are discussed, and their use is illustrated by case examples. PMID:24095206

  19. Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis

    PubMed Central

    Petersen, Marie W; Haase, Nicolai; Perner, Anders; Wetterslev, Jørn

    2015-01-01

    Objective To compare the benefit and harm of restrictive versus liberal transfusion strategies to guide red blood cell transfusions. Design Systematic review with meta-analyses and trial sequential analyses of randomised clinical trials. Data sources Cochrane central register of controlled trials, SilverPlatter Medline (1950 to date), SilverPlatter Embase (1980 to date), and Science Citation Index Expanded (1900 to present). Reference lists of identified trials and other systematic reviews were assessed, and authors and experts in transfusion were contacted to identify additional trials. Trial selection Published and unpublished randomised clinical trials that evaluated a restrictive compared with a liberal transfusion strategy in adults or children, irrespective of language, blinding procedure, publication status, or sample size. Data extraction Two authors independently screened titles and abstracts of trials identified, and relevant trials were evaluated in full text for eligibility. Two reviewers then independently extracted data on methods, interventions, outcomes, and risk of bias from included trials. random effects models were used to estimate risk ratios and mean differences with 95% confidence intervals. Results 31 trials totalling 9813 randomised patients were included. The proportion of patients receiving red blood cells (relative risk 0.54, 95% confidence interval 0.47 to 0.63, 8923 patients, 24 trials) and the number of red blood cell units transfused (mean difference −1.43, 95% confidence interval −2.01 to −0.86) were lower with the restrictive compared with liberal transfusion strategies. Restrictive compared with liberal transfusion strategies were not associated with risk of death (0.86, 0.74 to 1.01, 5707 patients, nine lower risk of bias trials), overall morbidity (0.98, 0.85 to 1.12, 4517 patients, six lower risk of bias trials), or fatal or non-fatal myocardial infarction (1.28, 0.66 to 2.49, 4730 patients, seven lower risk of bias

  20. Coagulation defects associated with massive blood transfusion: A large multicenter study

    PubMed Central

    YANG, JIANG-CUN; SUN, YANG; XU, CUI-XIANG; DANG, QIAN-LI; LI, LING; XU, YONG-GANG; SONG, YAO-JUN; YAN, HONG

    2015-01-01

    The variations in the coagulation indices of patients receiving massive blood transfusion were investigated across 20 large-scale general hospitals in China. The data of 1,601 surgical inpatients receiving massive transfusion were retrospectively collected and the trends in the platelet counts and coagulation indices prior to and at 16 different time points during packed red blood cell (pRBC; after 2–40 units of pRBC) transfusion were evaluated by linear regression analysis. Temporal variations in the means of prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT) and fibrinogen (FIB) concentration were also assessed and the theoretical estimates and actual measurements of the platelet count were compared. The results demonstrated that the platelet count decreased linearly with an increase in the number of pRBC units transfused (Y=150.460−3.041X; R2 linear=0.775). Following transfusion of 18 units of pRBC (0.3 units of pRBC transfused per kilogram of body weight), the average platelet count decreased to 71×109/l (<75×109/l). Furthermore, variations in the means of PT, INR, APTT and FIB did not demonstrate any pronounced trends and actual platelet counts were markedly higher than the theoretical estimates. In conclusion, no variations in the means of traditional coagulation indices were identified, however, the platelet count demonstrated a significant linear decrease with an increase in the number of pRBC units transfused. Furthermore, actual platelet counts were higher than theoretical estimates, indicating the requirement for close monitoring of actual platelet counts during massive pRBC transfusion. PMID:26095897

  1. Jehovah's Witness parents' refusal of blood transfusions: Ethical considerations for psychologists.

    PubMed

    Hoffman, Anna

    2016-08-01

    Psychologists in medical settings may be confronted with Jehovah's Witness parents refusing blood transfusions for their children as an ethical dilemma. The purpose of this discussion is to help psychologists provide informed, ethical consultations and support by investigating the values of the Jehovah's Witness community and the origin of the blood transfusion taboo, how medical and legal professionals have approached this dilemma, exploring relevant ethical principles and standards for psychologists, and suggestions for how to move toward a better understanding of harm with Jehovah's Witness families. PMID:25476572

  2. Transplant-associated and blood transfusion-associated tropical and parasitic infections.

    PubMed

    Machado, Clarisse Martins; Levi, José Eduardo

    2012-06-01

    Blood transfusion and transplantation may represent efficient mechanisms of spreading infectious agents to naive populations. In the developed countries, as a consequence of globalization, several factors such as international commerce, tourism, and immigration have acted as important features for the emergence or reemergence of infectious diseases previously referred to as tropical. This article reviews the relevant bacterial, protozoan and viral infections that are more frequently associated with blood transfusion and/or solid organ or marrow transplantation and may affect susceptible populations worldwide. PMID:22632636

  3. Blood Trials: Transfusions, Injections, and Experiments in Africa, 1890-1920.

    PubMed

    Sunseri, Thaddeus

    2016-07-01

    From about 1880 to 1920, a culture of medical experimentation promoted blood transfusion as a therapy for severe anemia in Europe, which was applied in German East Africa in 1892 for a case of blackwater fever, a complication of malaria afflicting mainly Europeans. This first case of blood transfusion in Africa, in which an African's blood was transfused into a German official, complicates the dominant narrative that blood transfusions in Africa came only after World War I. Medical researchers moreover experimented with blood serum therapies on human and animal subjects in Europe and Africa, injecting blood of different species, "races" and ethnicities into others to demonstrate parasite transmissibility and to discover vaccines for diseases such as malaria, sleeping sickness, and yellow fever. While research in German colonies is highlighted here, this was a transnational medical culture that crossed borders and oceans. This research is of interest as a possible early pathway for the epidemic spread of HIV and other zoonoses in Africa and the world, which biomedical researchers have identified as emerging in West-Central Africa sometime around the turn of the twentieth century. PMID:26514397

  4. Alloimmunization is associated with older age of transfused red blood cells in sickle cell disease

    PubMed Central

    Desai, Payal C.; Deal, Allison M.; Pfaff, Emily R.; Qaqish, Bahjat; Hebden, Leyna M.; Park, Yara A.; Ataga, Kenneth I.

    2016-01-01

    Red blood cell (RBC) alloimmunization is a significant clinical complication of sickle cell disease (SCD). It can lead to difficulty with cross-matching for future transfusions and may sometimes trigger life-threatening delayed hemolytic transfusion reactions. We conducted a retrospective study to explore the association of clinical complications and age of RBC with alloimmunization in patients with SCD followed at a single institution from 2005 to 2012. One hundred and sixty six patients with a total of 488 RBC transfusions were evaluated. Nineteen patients (11%) developed new alloantibodies following blood transfusions during the period of review. The median age of RBC units was 20 days (interquartile range: 14–27 days). RBC antibody formation was significantly associated with the age of RBC units (P = 0.002), with a hazard ratio of 3.5 (95% CI: 1.71–7.11) for a RBC unit that was 7 days old and 9.8 (95% CI: 2.66–35.97) for a unit that was 35 days old, 28 days after the blood transfusion. No association was observed between RBC alloimmunization and acute vaso-occlusive complications. Although increased echocardiography-derived tricuspid regurgitant jet velocity (TRV) was associated with the presence of RBC alloantibodies (P = 0.02), TRV was not significantly associated with alloimmunization when adjusted for patient age and number of transfused RBC units. Our study suggests that RBC antibody formation is significantly associated with older age of RBCs at the time of transfusion. Prospective studies in patients with SCD are required to confirm this finding. PMID:25963831

  5. Potential for Zika virus transmission through blood transfusion demonstrated during an outbreak in French Polynesia, November 2013 to February 2014.

    PubMed

    Musso, D; Nhan, T; Robin, E; Roche, C; Bierlaire, D; Zisou, K; Shan Yan, A; Cao-Lormeau, V M; Broult, J

    2014-01-01

    Since October 2013, French Polynesia has experienced the largest documented outbreak of Zika virus (ZIKAV) infection. To prevent transmission of ZIKAV by blood transfusion, specific nucleic acid testing of blood donors was implemented. From November 2013 to February 2014: 42 (3%) of 1,505 blood donors, although asymptomatic at the time of blood donation, were found positive for ZIKAV by PCR. Our results serve to alert blood safety authorities about the risk of post-transfusion Zika fever. PMID:24739982

  6. A brief history of the early years of blood transfusion at the Mayo Clinic: the first blood bank in the United States (1935).

    PubMed

    Moore, S Breanndan

    2005-07-01

    At the Mayo Clinic in 1914, Francis McGrath modified an existing aspiration-injection apparatus and adapted it for arm-to-arm blood transfusions. Separately, in 1919, both Pemberton and Sanford described in detail the Mayo Clinic experience with more than 1000 transfusions between January 1915 and January 1918. Most transfusions were by the indirect citrate method from freshly drawn blood. In 1935, John Lundy established a bank of refrigerated blood for transfusions at Mayo Clinic and reported on the activity in that and subsequent years. The functioning clinical blood bank established by Lundy at Mayo Clinic predated that of Bernard Fantus in Chicago by almost 2 years. PMID:16010654

  7. Association of Hematocrit and Red Blood Cell Transfusion with Outcomes in Infants Undergoing Norwood Operation.

    PubMed

    Gupta, Punkaj; King, Caitlin; Benjamin, Lisle; Goodhart, Timothy; Robertson, Michael J; Gossett, Jeffrey M; Pesek, Gina A; DasGupta, Rahul

    2015-08-01

    The objective of this study was to investigate the association between red blood cell (RBC) transfusion and hematocrit values with outcomes in infants undergoing Norwood operation. This study included infants ≤2 months of age who underwent Norwood operation with either a modified Blalock-Taussig shunt or a right ventricle-pulmonary artery shunt. Demographics, preoperative, operative, daily laboratory data, and postoperative variables were collected. The primary outcome measures evaluated included mortality, ICU length of stay, length of mechanical ventilation, and days to chest closure. The secondary outcome measures evaluated included lactate levels, estimated glomerular filtration rate, and inotrope score in the first 14 days after heart operation. Cox proportional hazard models were fitted to study the probability of study outcomes as a function of hematocrit values and RBC transfusions after operation. Eighty-nine patients qualified for inclusion. With a median hematocrit of 46 (IQR 44, 49), and a median RBC transfusion of 92 ml/kg (IQR 31, 384) in the first 14 days after operation, 81 (91 %) patients received RBC transfusions. A multivariable analysis adjusted for risk factors, including the age, weight, prematurity, cardiopulmonary bypass and cross-clamp time, and postoperative need for nitric oxide and dialysis, demonstrated no association between hematocrit and RBC transfusion with majority of study outcomes. This single-center study found that higher hematocrit values and increasing RBC transfusions are not associated with improved outcomes in infants undergoing Norwood operation. PMID:25773580

  8. Acute normovolemic hemodilution to avoid blood transfusion during intracranial aneurysm surgery in a patient with atypical antibodies

    PubMed Central

    Parasa, Sujay Kumar; Bidkar, Prasanna Udupi; Parida, Satyen

    2016-01-01

    Acute normovolemic haemodilution (ANH) has been used in neurosurgical operations to reduce the incidence of homologous blood transfusions. We report a case of anterior communicating artery aneurysm in a patient with atypical antibodies in the serum, who was posted for clipping of the said aneurysm, and was managed with ANH in the perioperative period in order to avoid blood transfusions. PMID:26957709

  9. Why group & save? Blood transfusion at low-risk elective caesarean section.

    PubMed

    Stock, Owen; Beckmann, Michael

    2014-06-01

    Women undergoing elective caesarean section (CS) routinely have a group and save ordered as part of their preoperative assessment, whereas women with expected vaginal birth do not. Our aim was therefore to determine the rate of blood transfusion at elective CS compared with vaginal birth in a large Australian maternity hospital. A retrospective cohort study was performed using routinely collected de-identified data of 35 477 women, over 4 years, who delivered at the Mater Mothers' Hospital, Brisbane, Australia. After excluding women with established risk factors for transfusion, the likelihood of blood transfusion following elective CS was significantly lower compared to vaginal birth (aOR 0.47 (0.29, 0.77)). PMID:24576105

  10. Adverse effects of small-volume red blood cell transfusions in the neonatal population

    PubMed Central

    2014-01-01

    Background Adverse transfusion reactions in the neonatal population are poorly understood and defined. The incidence and pattern of adverse effects due to red blood cell (RBC) transfusion are not well known, and there has been no systematic review of published adverse events. RBC transfusions continue to be linked to the development of morbidities unique to neonates, including chronic lung disease, retinopathy of prematurity, intraventricular haemorrhage and necrotising enterocolitis. Uncertainties about the exact nature of risks alongside benefits of RBC transfusion may contribute to evidence of widespread variation in neonatal RBC transfusion practice. Our review aims to describe clinical adverse effects attributed to small-volume (10–20 mL/kg) RBC transfusions and, where possible, their incidence rates in the neonatal population through the systematic identification of all relevant studies. Methods A comprehensive search of the following bibliographic databases will be performed: MEDLINE (PubMed/OVID which includes the Cochrane Library) and EMBASE (OVID). The intervention of interest is small-volume (10–20 mL/kg) RBC transfusions in the neonatal population. We will undertake a narrative synthesis of the evidence. If clinical similarity and data quantity and quality permit, we will also carry out meta-analyses on the listed outcomes. Discussion This systematic review will identify and synthesise the reported adverse effects and associations of RBC transfusions in the neonatal population. We believe that this systematic review is timely and will make a valuable contribution to highlight an existing research gap. Trial Registration PROSPERO, CRD42013005107 http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013005107 PMID:25143009

  11. Cardiopulmonary Function following Transfusion of Three Red Blood Cell Products in Elective Abdominal Aortic Aneurysmectomy

    PubMed Central

    Krausz, Michael M.; Dennis, Richard C.; Utsunomiya, Takayoshi; Grindlinger, Gene A.; Vegas, Armando M.; Churchill, W. Hallowell; Mannick, John A.; Valeri, C. Robert; Hechtman, Herbert B.

    1981-01-01

    In order to evaluate the importance of red cell O2 affinity of transfused blood on cardiac performance and adverse effects of transfusion on lung function, a prospective double-blind protocol was used in 27 patients undergoing abdominal aortic aneurysmectomy. Three types of blood were administered: packed red cells (PC), washed red cells (WC) and high 2,3 DPG red cells (2,3 DPG). An average of 4.5 units of blood was used per patient. Transfusion of 2,3 DPG blood resulted in maintenance of in vivo P50 during surgery and an increase to 31.2 torr after operation (p < 0.001). An intraoperative fall in in vivo P50 to 23.2 ± 2.0 torr was observed in patients who were transfused with PC (p < 0.001) and to 25.1 ± 2.6 torr with WC (p < 0.005). A fall in body temperature averaging 2.2 C intraoperatively was noticed in all three groups. After operation, in vitro P50 decreased in patients transfused with PC (p < 0.005) and WC (p < 0.005) while it remained unchanged in the high 2,3 DPG group. This was consistent with the decrease of red cell 2,3 DPG in the PC (p < 0.001) and WC groups (p < 0.01) and maintenance in the 2,3 DPG group. Left ventricular stroke work and volume loading Starling type myocardial performance curves were similar for the three groups. Microaggregates measured by Coulter counting and screen filtration pressure were the same for all three products in samples drawn on both sides of the 40 µm transfusion filter. There was no relationship of transfusion volumes or type of blood product to changes in lung function (physiologic shunting, dynamic compliance and pulmonary arterial pressure) in the three groups of patients. The false negative, β, error of missing a true 25% difference was less than 10%. It is concluded that 2,3 DPG enriched red cells improved oxygen availability, but that a 4.5 unit transfusion of any of the three blood products did not influence lung function or myocardial performance following aneurysmectomy. ImagesFig. 2. PMID:7294931

  12. Audit of clinical-laboratory practices in haematology and blood transfusion at Muhimbili National Hospital in Tanzania.

    PubMed

    Makubi, Abel N; Meda, Collins; Magesa, Alex; Minja, Peter; Mlalasi, Juliana; Salum, Zubeda; Kweka, Rumisha E; Rwehabura, James; Quaresh, Amrana; Magesa, Pius M; Robert, David; Makani, Julie; Kaaya, Ephata

    2012-10-01

    In Tanzania, there is paucity of data for monitoring laboratory medicine including haematology. This therefore calls for audits of practices in haematology and blood transfusion in order to provide appraise practice and devise strategies that would result in improved quality of health care services. This descriptive cross-sectional study which audited laboratory practice in haematology and blood transfusion at Muhimbili National Hospital (MNH) aimed at assessing the pre-analytical stage of laboratory investigations including laboratory request forms and handling specimen processing in the haematology laboratory and assessing the chain from donor selection, blood component processing to administration of blood during transfusion. A national standard checklist was used to audit the laboratory request forms (LRF), phlebotomists' practices on handling and assessing the from donor selection to administration 6f blood during transfusion. Both interview and observations were used. A total of 195 LRF were audited and 100% of had incomplete information such as patients' identification numbers, time sample ordered, reason for request, summary of clinical assessment and differential diagnoses. The labelling of specimens was poorly done by phlebotomists/clinicians in 82% of the specimens. Also 65% (132/202) of the blood samples delivered in the haematology laboratory did not contain the recommended volume of blood. There was no laboratory request form specific for ordering blood and there were no guidelines for indication of blood transfusion in the wards/ clinics. The blood transfusion laboratory section was not participating in external quality assessment and the hospital transfusion committee was not in operation. It is recommended that a referral hospital like MNH should have a transfusion committee to provide an active forum to facilitate communication between those involved with transfusion, monitor, coordinate and audit blood transfusion practices as per national

  13. Impact of Early Blood Transfusion After Kidney Transplantation on the Incidence of Donor-Specific Anti-HLA Antibodies.

    PubMed

    Ferrandiz, I; Congy-Jolivet, N; Del Bello, A; Debiol, B; Trébern-Launay, K; Esposito, L; Milongo, D; Dörr, G; Rostaing, L; Kamar, N

    2016-09-01

    Little is known about the impact of posttransplant blood transfusion on the sensitization of anti-HLA antibodies and the formation of donor-specific antibodies (DSAs). The aims of our study were to determine the 1-year incidence of DSAs (assessed using a solid-phase assay) and antibody-mediated rejection (AMR) in kidney transplant patients who had or had not received a blood transfusion during the first year after transplantation. Included were 390 non-HLA-sensitized patients who had received an ABO-compatible kidney transplant and had not previously or simultaneously received a nonkidney transplant. Overall, 64% of patients received a red blood cell transfusion within the first year after transplantation, most within the first month. The overall 1-year incidence of DSAs was significantly higher in patients that had undergone transfusion (7.2% vs. 0.7% in patients with no transfusion, p < 0.0001). AMR occurred more often in the transfusion group (n = 15, 6%) compared with the nontransfusion group (n = 2, 1.4%; p = 0.04). Blood transfusion was an independent predictive factor for de novo DSA formation but not for AMR. Patients who had a transfusion and developed DSAs were more often treated with cyclosporin A (n = 10, 55.5%) rather than tacrolimus (n = 45, 19.4%; p = 0.0001). In conclusion, early posttransplant blood transfusion may increase immunological risk, especially in underimmunosuppressed patients. PMID:26998676

  14. Frequency and Specificity of Red Blood Cell Alloimmunization in Chilean Transfused Patients

    PubMed Central

    Caamaño, José; Musante, Evangelina; Contreras, Margarita; Ulloa, Hernán; Reyes, Carolina; Inaipil, Verónica; Saavedra, Nicolás; Guzmán, Neftalí

    2015-01-01

    Summary Background Alloimmunization is an adverse effect of blood transfusions. In Chile, alloimmunization frequency is not established, and for this reason the aim of this study was to investigate the prevalence and specificity of red blood cell (RBC) alloantibodies in Chilean transfused subjects. Methods Records from 4,716 multi-transfused patients were analyzed. In these patients, antibody screening was carried out prior to cross-matching with a commercially available two-cell panel by the microcolum gel test, and samples with a positive screen were analyzed for the specificity of the alloantibody with a 16-cell identification panel. Results The incidence of RBC alloimmunization in transfused patients was 1.02% (48/4,716) with a higher prevalence in women (40/48). We detected 52 antibodies, the most frequent specificities identified were anti-E (30.8%), anti-K (26.9%), anti-D (7.7%), and anti-Fya (5.8%). The highest incidence of alloantibodies was observed in cancer and gastroenterology patients. Conclusion The data demonstrated a low alloimmunization frequency in Chilean transfused patients, principally associated with antibodies anti-E, anti-K, anti-D, and anti-Fya. PMID:25960709

  15. Perioperative Red Blood Cell Transfusion: Harmful or Beneficial to the Patient?

    PubMed

    Meier, Jens; Müller, Markus M; Lauscher, Patrick; Sireis, Walid; Seifried, Erhard; Zacharowski, Kai

    2012-04-01

    Although the transfusion of red blood cells (RBCs) is safer than ever regarding infections, it is still associated with several adverse reactions and therefore should only be used on the basis of evidence-based triggers. However, prevention of RBC transfusion and subsequent substitution of blood losses with acellular solutions will inevitably result in dilutional anemia. Acute dilutional anemia can be compensated by the body over a wide range of hemoglobin concentrations without a critical restriction of tissue oxygenation. On the other hand, chronic anemia is known to be a potent cause of morbidity and mortality. As a consequence, the impact of perioperative anemia on mortality is difficult to describe, because anemia, as well as the transfusion of RBCs, can influence the clinical outcome. The resulting 'Gordian knot' cannot be cut easily, and this circumstance forces clinical physicians to make a daily trade-off between transfusion-associated and anemia-associated risks. This review focuses on the physiology of oxygen transport, the hazards of acute anemia, the hazards of RBC transfusion, and the literature putting these problems into perspective. PMID:22670127

  16. Blood Loss and Transfusion After Topical Tranexamic Acid Administration in Primary Total Knee Arthroplasty.

    PubMed

    Wang, Hao; Shen, Bin; Zeng, Yi

    2015-11-01

    There has been much debate and controversy about the safety and efficacy of the topical use of tranexamic acid in primary total knee arthroplasty (TKA). The purpose of this study was to perform a meta-analysis to evaluate whether there is less blood loss and lower rates of transfusion after topical tranexamic acid administration in primary TKA. A systematic review of the electronic databases PubMed, CENTRAL, Web of Science, and Embase was undertaken. All randomized, controlled trials and prospective cohort studies evaluating the effectiveness of topical tranexamic acid during primary TKA were included. The focus of the analysis was on the outcomes of blood loss results, transfusion rate, and thromboembolic complications. Subgroup analysis was performed when possible. Of 387 studies identified, 16 comprising 1421 patients (1481 knees) were eligible for data extraction and meta-analysis. This study indicated that when compared with the control group, topical application of tranexamic acid significantly reduced total drain output (mean difference, -227.20; 95% confidence interval, -347.11 to -107.30; P<.00001), total blood loss (mean difference, -311.28; 95% confidence interval, -404.94 to -217.62; P<.00001), maximum postoperative hemoglobin decrease (mean difference, -0.73; 95% confidence interval, -0.96 to -0.50; P<.00001), and blood transfusion requirements (risk ratios, 0.33; 95% confidence interval, 0.24 to 0.43; P=.14). The authors found a statistically significant reduction in blood loss and transfusion rates when using topical tranexamic acid in primary TKA. Furthermore, the currently available evidence does not support an increased risk of deep venous thrombosis or pulmonary embolism due to tranexamic acid administration. Topical tranexamic acid was effective for reducing postoperative blood loss and transfusion requirements without increasing the prevalence of thromboembolic complications. PMID:26558665

  17. Clinicians' satisfaction with a hospital blood transfusion service: a marketing analysis of a monopoly supplier.

    PubMed Central

    Pennington, S J; McClelland, D B; Murphy, W G

    1993-01-01

    One of the objectives of the NHS reforms is to improve customer focus within the health service. In a study to assess the quality of customer service provided by the Edinburgh and South East Scotland Blood Transfusion Service a 19 item questionnaire survey of the main clinical users of the service was performed to ascertain their satisfaction, measured on a 5 point anchored scale, with important aspects of the service, including medical consultation, diagnostic services, blood and blood components or products and their delivery, and general satisfaction with the service. Of 122 clinicians in medical and surgical disciplines in five hospitals in Edinburgh, 72 (59%) replied. Fourteen (22%) indicated dissatisfaction with any aspect of the medical consultation service, owing to inadequate follow up of clinical contacts and unsatisfactory routing of incoming calls. Diagnostic services were criticised for the presentation, communication, and interpretation of results. The restricted availability of whole blood, the necessity to order platelets and plasma through the duty blood transfusion service doctor, and the use of a group and screen policy, attracted criticism from a small number of clinicians. Ten of 68 respondents expressed dissatisfaction with delivery of blood and components to the wards and theatres. The findings indicate that the clinicians served by this blood transfusion service are largely satisfied with the service. Changes are being implemented to improve reporting of laboratory results and measures taken to improve liaison with clinicians. PMID:10132458

  18. [Biobanks and blood transfusion in France: a tool for public health].

    PubMed

    Lefrère, J-J; Coudurier, N

    2009-05-01

    Donor and recipient sample biobanks are a precious tool in hemovigilance studies as well as in epidemiological and biological research, in particular with regards to safety against blood-borne agents. This paper describes the main transfusion biobanks existing in France and gives their advantages and limits. The National blood donation biobank, organized for medicolegal reasons, preserves samples of each blood donation for a 5-year period. The biobank of the Blood and Organ Transmissible Infectious Agents (BOTIA) project stocks paired donor-recipient samples with a research objective. Preserved over a long period of time, such transfusion biobanks will be useful in terms of public health, as a reflection of the biological state of a population at a given moment. PMID:19442557

  19. Fresh Whole Blood Transfusion: Military and Civilian Implications.

    PubMed

    Goforth, Carl W; Tranberg, John W; Boyer, Phillip; Silvestri, Peter J

    2016-06-01

    Uncontrolled hemorrhage and exsanguination are the leading cause of preventable death, and resuscitative therapy is a critical component for survival. In various combinations, fresh whole blood, blood components, colloids, and crystalloids have all been staples of trauma care. The use of fresh whole blood is a well-established military practice that has saved the lives of thousands of American and coalition military personnel. Civilian use of fresh whole blood is far less established owing to the wide availability of individual blood components. However, this highly tailored blood supply is vulnerable to both natural and man-made disasters. In the event of such disruption, such as a major hurricane, it may be necessary for civilian hospitals to rapidly enact a fresh whole blood program. Therefore, the aim of this article is to review the current use of blood therapy for trauma resuscitation, the US military's approach to fresh whole blood, and how maintaining a civilian capacity for fresh whole blood collection in the event of future man-made and natural disasters is key to promoting survival from trauma. PMID:27252101

  20. Red blood cell transfusion triggers in acute leukemia: a randomized pilot study

    PubMed Central

    DeZern, Amy E.; Williams, Katherine; Zahurak, Marianna; Hand, Wesley; Stephens, R. Scott; King, Karen E.; Frank, Steven M.; Ness, Paul M.

    2016-01-01

    BACKGROUND Red blood cell (RBC) transfusion thresholds have yet to be examined in large randomized trials in hematologic malignancies. This pilot study in acute leukemia uses a restrictive compared to a liberal transfusion strategy. STUDY DESIGN AND METHODS A randomized (2:1) study was conducted of restrictive (LOW) hemoglobin (Hb) trigger (7 g/dL) compared to higher (HIGH) Hb trigger (8 g/dL). The primary outcome was feasibility of conducting a larger trial. The four requirements for success required that more than 50% of the eligible patients could be consented, more than 75% of the patients randomized to the LOW arm tolerated the transfusion trigger, fewer than 15% of patients crossed over from the LOW arm to the HIGH arm, and no indication for the need to pause the study for safety concerns. Secondary outcomes included fatigue, bleeding, and RBCs and platelets transfused. RESULTS Ninety patients were consented and randomly assigned to LOW to HIGH. The four criteria for the primary objective of feasibility were met. When the number of units transfused was compared, adjusting for baseline Hb, the LOW arm was transfused on average 8.0 (95% confidence interval [CI], 6.9–9.1) units/patient while the HIGH arm received 11.7 (95% CI, 10.1–13.2) units (p = 0.0003). There was no significant difference in bleeding events or neutropenic fevers between study arms. CONCLUSION This study establishes feasibility for trial of Hb thresholds in leukemia through demonstration of success in all primary outcome metrics and a favorable safety profile. This population requires further study to evaluate the equivalence of liberal and restrictive transfusion thresholds in this unique clinical setting. PMID:27198129

  1. Preoperative platelet transfusions and perioperative red blood cell requirements in patients with thrombocytopenia undergoing noncardiac surgery

    PubMed Central

    Warner, Matthew A.; Jia, Qing; Clifford, Leanne; Wilson, Gregory; Brown, Michael J.; Hanson, Andrew C.; Schroeder, Darrell R.; Kor, Daryl J.

    2016-01-01

    BACKGROUND Perioperative hemorrhage impacts patient outcomes and health care resource utilization, yet the risks of transfusion therapies are significant. In patients with preoperative thrombocytopenia, the effects of prophylactic preoperative platelet (PLT) transfusion on perioperative bleeding complications remain uncertain. STUDY DESIGN AND METHODS This is a retrospective cohort study of noncardiac surgical patients between January 1, 2008, and December 31, 2011. Propensity-adjusted analyses were used to evaluate associations between preoperative thrombocytopenia, preoperative PLT transfusion, and the outcomes of interest, with a primary outcome of perioperative red blood cell (RBC) transfusion. RESULTS A total of 13,978 study participants were included; 860 (6.2%) had a PLT count of not more than 100 × 109/L with 71 (8.3%) receiving PLTs preoperatively. Administration of PLTs was associated with higher rates of perioperative RBC transfusion (66.2% vs. 49.1%, p 0.0065); however, in propensity-adjusted analysis there was no significant difference between groups (odds ratio [OR] [95% confidence interval {95% CI}], 1.68 [0.95–2.99]; p =0.0764]. Patients receiving PLTs had higher rates of intensive care unit (ICU) admission (OR [95% CI], 1.95 [1.10–3.46]; p =0.0224) and longer hospital lengths of stay (estimate [95% bootstrap CI], 7.2 [0.8–13.9] days; p =0.0006) in propensity-adjusted analyses. CONCLUSION Preoperative PLT transfusion did not attenuate RBC requirements in patients with thrombocytopenia undergoing noncardiac surgery. Moreover, preoperative PLT transfusion was associated with increased ICU admission rates and hospital duration. These findings suggest that more conservative management of preoperative thrombocytopenia may be warranted. PMID:26559936

  2. Storage Duration of Red Blood Cell Transfusion and Clostridium difficile Infection: A Within Person Comparison

    PubMed Central

    Rogers, Mary A. M.; Micic, Dejan; Blumberg, Neil; Young, Vincent B.; Aronoff, David M.

    2014-01-01

    Objective Randomized controlled trials demonstrated that red blood cell (RBC) transfusion elevates the risk of infection, and trials are underway to evaluate whether RBC storage affects outcomes. We previously reported that transfusion predicts Clostridium difficile infection (CDI) and, therefore, planned an investigation to examine this further using a more robust design. Design Within-person case-crossover study. Hospitalizations in which CDI developed (n = 406) were compared to hospitalizations for the same individuals in which CDI did not occur (n = 949). Transfusion volume and storage duration were assessed prior to the onset of CDI. Setting University of Michigan Health System. Patients Participants were individuals with a diagnosis of CDI from July 2009 through June 2012. Measurements and Main Results During the hospitalizations when CDI occurred, 34.7% of the patients received allogeneic RBC transfusions (mean volume, 688 ml) compared to 19.0% of patients in hospitalizations without CDI (mean volume, 180 ml). The odds of healthcare-associated CDI increased by 76% (95% CI 1.39–2.23) for every liter of RBCs transfused and was elevated in both nonsurgical (OR = 1.90) and surgical (OR = 1.86) hospitalizations. In patients who received RBC transfusions, the odds of developing CDI increased by 6% for every additional day of RBC stored and by 53% for every week of additional storage (P = 0.002). Conclusions Hospitalizations in which a patient received a greater volume of RBC transfusions were more likely to be associated with the development of CDI. RBC units stored for a longer duration were associated with the development of healthcare-associated CDI after adjustment for RBC volume. PMID:24586694

  3. Acute Lung Injury Complicating Blood Transfusion in Post-Partum Hemorrhage: Incidence and Risk Factors

    PubMed Central

    Teofili, Luciana; Bianchi, Maria; Zanfini, Bruno A.; Catarci, Stefano; Sicuranza, Rossella; Spartano, Serena; Zini, Gina; Draisci, Gaetano

    2014-01-01

    Background We retrospectively investigated the incidence and risk factors for transfusion-related acute lung injury (TRALI) among patients transfused for post-partum hemorrhage (PPH). Methods We identified a series of 71 consecutive patients with PPH requiring the urgent transfusion of three or more red blood cell (RBC) units, with or without transfusion of fresh frozen plasma (FFP) and/or platelets (PLT). Clinical records were then retrieved and examined for respiratory distress events. According to the 2004 consensus definition, cases of new-onset hypoxemia, within 6 hours after transfusion, with bilateral pulmonary changes, in the absence of cardiogenic pulmonary edema were identified as TRALI. If an alternative risk factor for acute lung injury was present, possible TRALI was diagnosed. Results Thirteen cases of TRALI and 1 case of possible TRALI were identified (overall incidence 19.7%). At univariate analysis, patients with TRALI received higher number of RBC, PLT and FFP units and had a longer postpartum hospitalization. Among the diseases occurring in pregnancy- and various pre-existing comorbidities, only gestational hypertension and pre-eclampsia, significantly increased the risk to develop TRALI (p = 0.006). At multivariate analysis including both transfusion- and patient-related risk factors, pregnancy-related, hypertensive disorders were confirmed to be the only predictors for TRALI, with an odds ratio of 27.7 ( 95% CI 1.27–604.3, p=0.034). Conclusions Patients suffering from PPH represent a high-risk population for TRALI. The patients with gestational hypertension and pre-eclampsia, not receiving anti-hypertensive therapy, have the highest risk. Therefore, a careful monitoring of these patients after transfusions is recommended. PMID:25408855

  4. The Importance of the Monitoring of Resuscitation with Blood Transfusion for Uterine Inversion in Obstetrical Hemorrhage

    PubMed Central

    Furukawa, Seishi; Sameshima, Hiroshi

    2015-01-01

    Objective. The aim of this study was to describe critical care for obstetrical hemorrhage, especially in cases of uterine inversion. Study Design. We extracted data for six patients diagnosed with uterine inversion concerning resuscitation. Results. The shock index on admission of the six patients was 1.6 or more on admission. Four of the six experienced delay in diagnosis and received inadequate fluid replacement. Five of the six experienced delay in transfer. Five of the six underwent simultaneous blood transfusion on admission, and the remaining patient experienced a delay of 30 minutes. All six patients successfully underwent uterine replacement soon after admission. One maternal death occurred due to inappropriate practices that included delay in diagnosis, delay in transfer, inadequate fluid replacement, and delayed transfusion. Two patients experiencing inappropriate practices involving delay in diagnosis, delay in transfer, and inadequate fluid replacement survived. Conclusion. If a delay in diagnosis occurs simultaneously with a delay in transfer and inadequate fluid replacement, failure in providing a prompt blood transfusion may be critical and result in maternal death. The monitoring of resuscitation with blood transfusion for uterine inversion is essential for the improvement of obstetrical care. PMID:26491450

  5. Clinical review: Canadian National Advisory Committee on Blood and Blood Products - Massive Transfusion Consensus Conference 2011: report of the panel

    PubMed Central

    2011-01-01

    In June 2011 the Canadian National Advisory Committee on Blood and Blood Products sponsored an international consensus conference on transfusion and trauma. A panel of 10 experts and two external advisors reviewed the current medical literature and information presented at the conference by invited international speakers and attendees. The Consensus Panel addressed six specific questions on the topic of blood transfusion in trauma. The questions focused on: ratio-based blood resuscitation in trauma patients; the impact of survivorship bias in current research conclusions; the value of nonplasma coagulation products; the role of protocols for delivery of urgent transfusion; the merits of traditional laboratory monitoring compared with measures of clot viscoelasticity; and opportunities for future research. Key findings include a lack of evidence to support the use of 1:1:1 blood component ratios as the standard of care, the importance of early use of tranexamic acid, the expected value of an organized response plan, and the recommendation for an integrated approach that includes antifibrinolytics, rapid release of red blood cells, and a foundation ratio of blood components adjusted by results from either traditional coagulation tests or clot viscoelasticity or both. The present report is intended to provide guidance to practitioners, hospitals, and policy-makers. PMID:22188866

  6. Perioperative Allogenenic Blood Transfusion is Associated With Worse Clinical Outcome for Patients Undergoing Gastric Carcinoma Surgery

    PubMed Central

    Li, Lihong; Zhu, Dajian; Chen, Xiaowu; Huang, Yanfeng; Ouyang, Manzhao; Zhang, Weijie

    2015-01-01

    Abstract Whether perioperative allogenic blood transfusion (ABT) has adverse effect on patients with gastric carcinoma (GC) surgery or not, that is controversial. Our study evaluated the association between ABT and some clinical outcomes of GC surgery patients. Data of relevant studies were based on PubMed, EMBASE, and the Cochrane Library search. The relative risk (RR) of 5-year survival rates, tumor recurrence, and postoperative complications were performed; subgroup analyses included district, transfusion rates, age, participants, sex, and tumor stage. The study was approved by the ethics committee of the First People's Hospital of Shunde. In total, 9189 participants from 16 studies were included in the meta-analysis. The 5-year survival rate was decreased for the GC patients with ABT (RR = 0.74, 95% confidence interval [CI] = 0.69–0.79), the risk of tumor recurrence was significantly higher for ABT patients (RR = 1.82, 95% CI = 1.32–2.51), and postoperative complications increased in ABT patients (RR = 1.36, 95% CI = 1.02–1.81), respectively; in subgroup analyses, 5-year survival rates were not associated with the transfusion rates (χ2 = 0.37, P = 0.54). Transfusion for patients undergoing GC surgery, even low transfusion rates, would reduce the 5-year survival rates, and elevated the risk of tumor recurrence and postoperative complication. PMID:26426632

  7. Postoperative blood transfusion strategy in frail, anemic elderly patients with hip fracture

    PubMed Central

    Gregersen, Merete; Borris, Lars C; Damsgaard, Else Marie

    2015-01-01

    Background and purpose Hip fracture (HF) in frail elderly patients is associated with poor physical recovery and death. There is often postoperative blood loss and the hemoglobin (Hb) threshold for red blood cell (RBC) transfusions in these patients is unknown. We investigated whether RBC transfusion strategies were associated with the degree of physical recovery or with reduced mortality after HF surgery. Patients and methods We enrolled 284 consecutive post-surgical HF patients (aged ≥ 65 years) with Hb levels < 11.3 g/dL (7 mmol/L) who had been admitted from nursing homes or sheltered housing. Allocation was stratified by residence. The patients were randomly assigned to either restrictive (Hb < 9.7 g/dL; < 6 mmol/L) or liberal (Hb < 11.3 g/dL; < 7 mmol/L) RBC transfusions given within the first 30 days postoperatively. Follow-up was at 90 days. Results No statistically significant differences were found in repeated measures of daily living activities or in 90-day mortality rate between the restrictive group (where 27% died) and the liberal group (where 21% died). Per-protocol 30-day mortality was higher with the restrictive strategy (hazard ratio (HR) = 2.4, 95% CI: 1.1–5.2; p = 0.03). The 90-day mortality rate was higher for nursing home residents in the restrictive transfusion group (36%) than for those in the liberal group (20%) (HR = 2.0, 95% CI: 1.1–3.6; p = 0.01). Interpretation According to our Hb thresholds, recovery from physical disabilities in frail elderly hip fracture patients was similar after a restrictive RBC transfusion strategy and after a liberal strategy. Implementation of a liberal RBC transfusion strategy in nursing home residents has the potential to increase survival. PMID:25586270

  8. Hospital billing for blood processing and transfusion for inpatient stays.

    PubMed

    McCue, Michael J; Nayar, Preethy

    2009-07-01

    Medicare, an important payer for hospitals, reimburses hospitals for inpatient stays using Diagnosis Related Groups (DRGs). Many private insurers also use the DRG methodology to reimburse hospitals for their services. Therefore, those blood service organizations that bill Medicare directly require an understanding of the DRG system of payment to enable them to bill Medicare correctly, and in order to be certain they are adequately reimbursed. Blood centers that do not bill Medicare directly need to understand how hospitals are reimbursed for blood and blood components as this affects a hospital's ability to pay service fees related to these products. This review presents a detailed explanation of how hospitals are reimbursed by the Centers for Medicare and Medicaid Services (CMS) for Medicare inpatient services, including blood services. PMID:19594718

  9. In-vitro stem cell derived red blood cells for transfusion: are we there yet?

    PubMed

    Kim, Hyun Ok

    2014-03-01

    To date, the use of red blood cells (RBCs) produced from stem cells in vitro has not proved practical for routine transfusion. However, the perpetual and widespread shortage of blood products, problems related to transfusion-transmitted infections, and new emerging pathogens elicit an increasing demand for artificial blood. Worldwide efforts to achieve the goal of RBC production through stem cell research have received vast attention; however, problems with large-scale production and cost effectiveness have yet to prove practical usefulness. Some progress has been made, though, as cord blood stem cells and embryonic stem cells have shown an ability to differentiate and proliferate, and induced pluripotent stem cells have been shown to be an unlimited source for RBC production. However, transfusion of stem cell-derived RBCs still presents a number of challenges to overcome. This paper will summarize an up to date account of research and advances in stem cell-derived RBCs, delineate our laboratory protocol in producing RBCs from cord blood, and introduce the technological developments and limitations to current RBC production practices. PMID:24532496

  10. In-Vitro Stem Cell Derived Red Blood Cells for Transfusion: Are We There Yet?

    PubMed Central

    2014-01-01

    To date, the use of red blood cells (RBCs) produced from stem cells in vitro has not proved practical for routine transfusion. However, the perpetual and widespread shortage of blood products, problems related to transfusion-transmitted infections, and new emerging pathogens elicit an increasing demand for artificial blood. Worldwide efforts to achieve the goal of RBC production through stem cell research have received vast attention; however, problems with large-scale production and cost effectiveness have yet to prove practical usefulness. Some progress has been made, though, as cord blood stem cells and embryonic stem cells have shown an ability to differentiate and proliferate, and induced pluripotent stem cells have been shown to be an unlimited source for RBC production. However, transfusion of stem cell-derived RBCs still presents a number of challenges to overcome. This paper will summarize an up to date account of research and advances in stem cell-derived RBCs, delineate our laboratory protocol in producing RBCs from cord blood, and introduce the technological developments and limitations to current RBC production practices. PMID:24532496

  11. Citrate metabolism in blood transfusions and its relationship due to metabolic alkalosis and respiratory acidosis

    PubMed Central

    Li, Kai; Xu, Yuan

    2015-01-01

    Metabolic alkalosis commonly results from excessive hydrochloric acid (HCl), potassium (K+) and water (H2O) loss from the stomach or through the urine. The plasma anion gap increases in non-hypoproteinemic metabolic alkalosis due to an increased negative charge equivalent on albumin and the free ionized calcium (Ca++) content of plasma decreases. The mean citrate load in all patients was 8740±7027 mg from 6937±6603 mL of transfused blood products. The citrate load was significantly higher in patients with alkalosis (9164±4870 vs. 7809±3967, P < 0.05). The estimated mean total citrate administered via blood and blood products was calculated as 43.2±34.19 mg/kilogram/day. In non-massive and frequent blood transfusions, the elevated carbon dioxide output has been shown to occur. Due to citrate metabolism causes intracellular acidosis. As a result of intracellular acidosis compensation, decompensated metabolic alkalosis + respiratory acidosis and electrolyte imbalance may develop, blood transfusions may result in certain complications. PMID:26131288

  12. Blood transfusion safety: A study of adverse reactions at the blood bank of a tertiary care center

    PubMed Central

    Negi, Gita; Gaur, Dushyant Singh; Kaur, Rajveer

    2015-01-01

    Background: An adverse transfusion reaction (ATR) is an unfavorable reaction to the transfused unit, the severity of which may be different among individuals depending upon the type of reaction and the patient's susceptibility. Transfusion reactions may be immediate or delayed type depending on the onset and immune or nonimmune type depending on the pathogenesis. A study was conducted to study the frequency of various transfusion reactions and the associated morbidity. Materials and Methods: All ATRs occurring over a period of 3 years at a tertiary care health center were studied in detail according to the institute's protocol. Results: Of 38,013 units of blood and components that had been issued, 101 (0.2%) cases had an ATR. The most common reaction was allergic - 34/101 (33.6%) followed by febrile - 26/101 (25.7%). Other reactions included transfusion-related acute lung injury in 6/101 (5.9%) cases, and immune reactions were seen in 19/101 (18.8%) cases. Conclusion: Allergic and febrile reactions are most common and least harmful, but fatal reactions can also occur, and preventive measures must be taken to avoid such reactions. PMID:26682203

  13. Guideline on the investigation and management of acute transfusion reactions. Prepared by the BCSH Blood Transfusion Task Force.

    PubMed

    Tinegate, Hazel; Birchall, Janet; Gray, Alexandra; Haggas, Richard; Massey, Edwin; Norfolk, Derek; Pinchon, Deborah; Sewell, Carrock; Wells, Angus; Allard, Shubha

    2012-10-01

    Although acute non-haemolytic febrile or allergic reactions (ATRs) are a common complication of transfusion and often result in little or no morbidity, prompt recognition and management are essential. The serious hazards of transfusion haemovigilance organisation (SHOT) receives 30-40 reports of anaphylactic reactions each year. Other serious complications of transfusion, such as acute haemolysis, bacterial contamination, transfusion-related acute lung injury (TRALI) or transfusion-associated circulatory overload (TACO) may present with similar clinical features to ATR. This guideline describes the approach to a patient developing adverse symptoms and signs related to transfusion, including initial recognition, establishing a likely cause, treatment, investigations, planning future transfusion and reporting within the hospital and to haemovigilance organisations. Key recommendations are that adrenaline should be used as first line treatment of anaphylaxis, and that transfusions should only be carried out where patients can be directly observed and where staff are trained in manging complications of transfusion, particularly anaphylaxis. Management of ATRs is not dependent on classification but should be guided by symptoms and signs. Patients who have experienced an anaphylactic reaction should be discussed with an allergist or immunologist, in keeping with UK resuscitation council guidelines. PMID:22928769

  14. Measures to decrease the risk of acquired immunodeficiency syndrome transmission by blood transfusion. Evidence of volunteer blood donor cooperation.

    PubMed

    Pindyck, J; Waldman, A; Zang, E; Oleszko, W; Lowy, M; Bianco, C

    1985-01-01

    We studied whether volunteers giving blood to the Greater New York Blood Program (GNYBP) cooperated with procedures implementing public health recommendations intended to decrease the risk of acquired immunodeficiency syndrome (AIDS) transmission by blood transfusion. Predonation medical screening was expanded to exclude donors who might be ill with AIDS. To exclude possible asymptomatic carriers of the disease, members of groups at increased risk of AIDS were asked either not to give blood or to give it for laboratory studies. A confidential questionnaire, administered to all donors after medical screening, provided the vehicle for donors to advise the GNYBP whether their donation was for laboratory studies or for patient transfusion. We found that the number of male donors decreased; AIDS-related questions in medical history led to a 2 percent increase in donor rejections; 97 percent of donors said their blood could be used for transfusions; 1.4 percent said their blood could be used for laboratory studies only; and 1.6 percent did not respond. Only units designated for transfusion were released to hospitals. People who indicated that their donation was for laboratory studies had a higher prevalence of markers for hepatitis B virus and of antibodies to cytomegalovirus. White cell counts and helper/suppressor T lymphocyte ratios were not significantly different in the two groups. We conclude that volunteer donors have cooperated with the established procedures. None of the laboratory assays identified blood units donated by individuals who, based on information about AIDS high-risk groups, designated their donation for laboratory studies. PMID:3969698

  15. [European Blood Alliance (EBA) and EuroNet TMS: what challenges for the transfusion of tomorrow?].

    PubMed

    Folléa, G; de Wit, J; Rouger, P

    2011-04-01

    The primary mission of the European Blood Alliance (EBA) is to contribute to the safety and efficiency of the supply of blood products, cells and tissues, in developing an active network of blood establishments in Europe (25 countries). Its strategic objectives are to improve performance (through working groups and projects funded by the European Union), to engage in regulatory affairs (particularly at the European Commission level) to promote best practices and to facilitate a network to collect and share knowledge and experiences. The main objective of EuroNet TMS, combining the blood scientific societies from more than 30 countries in Europe, is to update and publish regularly, intended for policymakers, a White Book on the transfusion chain from donor to patient and probable or possible changes in the coming 5 years. Since 2008, EBA and EuroNet TMS actively collaborate on the drafting of the 2nd edition to be published in 2011. The two presidents jointly drafted the final chapter outlining the major issues of transfusion for tomorrow, summarized thereafter. Transfusion will still be useful for a long time and for reasons of safety and ethics the voluntary and unpaid donations, with non-profit blood establishments, will remain, the cornerstone of the supply of blood products. This renders crucial the continuous improvement of donor management and optimal blood use. On the regulatory side, after 5 years of implementation, EU directives must be independently evaluated and the Blood Guide of the Council of Europe should gradually become a regulatory standard. Finally, if a competition should be introduced for the blood products, it should be strictly regulated to prevent any threat to the security of their supply and quality for patients. PMID:21458349

  16. Red Blood Cell Transfusions Impact Pneumonia Rates After Coronary Artery Bypass Grafting Surgery

    PubMed Central

    Likosky, Donald S.; Paone, Gaetano; Zhang, Min; Rogers, Mary A.M.; Harrington, Steven D.; Theurer, Patricia F.; DeLucia, Alphonse; Fishstrom, Astrid; Camaj, Anton; Prager, Richard L.

    2016-01-01

    Background Pneumonia, a known complication of coronary artery bypass (CABG) surgery, significantly increases a patient’s risk of morbidity and mortality. While not well characterized, red blood cell transfusions (RBC) may increase a patient’s risk of pneumonia. We describe the relationship between RBC transfusion and post-operative pneumonia after CABG surgery. Methods A total of 16,182 consecutive patients underwent isolated CABG surgery between 2011 and 2013 at one of 33 hospitals in the state of Michigan. We used multivariable logistic regression to estimate the odds of pneumonia associated with the use or number (0, 1, 2, 3, 4, 5, >6) of RBC units. We adjusted for predicted risk of mortality, pre-operative hematocrit, history of pneumonia, cardiopulmonary bypass duration and medical center. We confirmed the strength and direction of these relationships among selected clinical subgroups in a secondary analysis. Results 576 (3.6%) patients developed pneumonia and 6,451 (39.9%) received RBC transfusions. There was a significant association between any RBC transfusion and pneumonia (ORadj 3.4, p<0.001). There was a dose-response between number of units and odds of pneumonia, ptrend<0.001. Patients receiving only 2 units of RBCs had twofold (ORadj 2.1, p<0.001) increased odds of pneumonia. These findings were consistent across clinical subgroups. Conclusions We found a significant, volume-dependent association between an increasing number of RBCs and odds of pneumonia, which persisted after adjusting for pre-operative patient characteristics. Clinical teams should explore opportunities for preventing a patient’s risk of RBC transfusions, including reducing hemodilution or adopting a lower transfusion threshold in a stable patient. PMID:26209489

  17. Contribution of the Retrovirus Epidemiology Donor Study (REDS) to research on blood transfusion safety in Brazil.

    PubMed

    Loureiro, Paula; de Almeida-Neto, Cesar; Proietti, Anna Bárbara Carneiro; Capuani, Ligia; Gonçalez, Thelma Terezinha; de Oliveira, Claudia Di Lorenzo; Leão, Silvana Carneiro; Lopes, Maria Inês; Sampaio, Divaldo; Patavino, Giuseppina Maria; Ferreira, João Eduardo; Blatyta, Paula Fraiman; Lopes, Maria Esther Duarte; Mendrone-Junior, Alfredo; Salles, Nanci Alves; King, Melissa; Murphy, Edward; Busch, Michael; Custer, Brian; Sabino, Ester Cerdeira

    2014-03-01

    The Retrovirus Epidemiology Donor Study (REDS) program was established in the United States in 1989 with the purpose of increasing blood transfusion safety in the context of the HIV/AIDS and human T-lymphotropic virus epidemics. REDS and its successor, REDS-II were at first conducted in the US, then expanded in 2006 to include international partnerships with Brazil and China. In 2011, a third wave of REDS renamed the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) was launched. This seven-year research program focuses on both blood banking and transfusion medicine research in the United States of America, Brazil, China, and South Africa. The main goal of the international programs is to reduce and prevent the transmission of HIV/AIDS and other known and emerging infectious agents through transfusion, and to address research questions aimed at understanding global issues related to the availability of safe blood. This article describes the contribution of REDS-II to transfusion safety in Brazil. Articles published from 2010 to 2013 are summarized, including database analyses to characterize blood donors, deferral rates, and prevalence, incidence and residual risk of the main blood-borne infections. Specific studies were developed to understand donor motivation, the impact of the deferral questions, risk factors and molecular surveillance among HIV-positive donors, and the natural history of Chagas disease. The purpose of this review is to disseminate the acquired knowledge and briefly summarize the findings of the REDS-II studies conducted in Brazil as well as to introduce the scope of the REDS-III program that is now in progress and will continue through 2018. PMID:24790542

  18. Transfusion reaction - hemolytic

    MedlinePlus

    ... blood you receive. Most of the time, a blood transfusion between compatible groups (such as O+ to O+) does not cause a problem. Blood transfusions between incompatible groups (such as A+ to O-) cause an immune ...

  19. Variability in splanchnic tissue oxygenation during preterm red blood cell transfusion given for symptomatic anaemia may reveal a potential mechanism of transfusion-related acute gut injury

    PubMed Central

    Bailey, Sean M.; Hendricks-Muñoz, Karen D.; Mally, Pradeep V.

    2015-01-01

    Background There is increasing evidence indicating an association between red blood cell (RBC) transfusions and necrotising enterocolitis (NEC) in preterm infants, especially late-onset NEC. This phenomenon is referred to as transfusion-related acute gut injury (TRAGI). One theory as to a pathophysiological mechanism is that transfusion may result in an ischemia-reperfusion injury to intestinal tissue. We tested the hypothesis that there is significantly greater variability during transfusion in splanchnic tissue oxygen saturation (SrSO2) than in cerebral tissue oxygen saturation (CrSO2). Materials and methods This was a prospective, observational study using near-infrared spectroscopy to monitor SrSO2 and CrSO2 in preterm neonates undergoing RBC transfusion for symptomatic anaemia. Mean, standard deviation, highest and lowest SrSO2 and CrSO2 values during each transfusion were determined. The greatest difference in SrSO2 and CrSO2 during each transfusion was calculated, along with the coefficient of variation. Results We studied 37 subjects. Throughout all transfusions, the mean SrSO2 was 45.6% ±13.8 and the mean CrSO2 was 65.4% ±6.9 (p<0.001). The variability of SrSO2 was significantly greater than that of CrSO2. Averaging data from all subjects, the greatest difference in SrSO2 was 43.8% ±13.4 compared with 23.3% ±7.6 for CrSO2 (p<0.001). The mean coefficient of variation in all transfusions was 20.5% for SrSO2 and 6.0% for CrSO2 (p<0.001). Increasing post-conceptional age did not affect SrSO2 variability (R2 =0.022; p=0.379), whereas CrSO2 variability during transfusion decreased with increasing post-conceptional age (R2=0.209; p=0.004). Discussion In preterm infants, there is a large degree of tissue oxygenation variability in splanchnic tissue during RBC transfusion and this does not change with increasing maturity. We speculate that these findings, combined with lower average tissue oxygenation, may demonstrate susceptibility of the preterm gut to TRAGI

  20. DEL RBC transfusion should be avoided in particular blood recipient in East Asia due to allosensitization and ineffectiveness*

    PubMed Central

    Shao, Chao-peng; Wang, Bao-yan; Ye, Shi-hui; Zhang, Wen-li; Xu, Hua; Zhuang, Nai-bao; Wu, Xiao-ying; Xu, Heng-gui

    2012-01-01

    Previously, both primary and secondary anti-D alloimmunizations induced by “Asian type” DEL (RHD1227A allele) were observed in two incidents. We investigated how often these alloimmunization events occur. The transfusions of any D-negative patients were investigated in the First Affiliated Hospital of Xi’an Jiaotong University Medical College, China, during the entire 2009. The antigens of D, C, c, E, and e were routinely serotyped. The “Asian type” DEL variant was genotyped and the RHD heterozygote was determined through two published methods. The changes in anti-D levels were monitored by the indirect antiglobulin test (IAT) and flow cytometry. Thirty D-negative transfused patients were included in the study. We focused on 11 recipients who were transfused with packed red blood cells (RBCs) from DEL donors at least one time. Of those 11 recipients, seven were anti-D negative before transfusion and four were anti-D positive (one patient with an autoantibody). One of the seven pre-transfusion anti-D negative patients produced a primary-response anti-D after being transfused with 400 ml of DEL blood twice. All four pre-transfusion antibody positive patients were not observed hemoglobin (Hb) levels increased, as expected after transfusions. Two patients had an increase in anti-D from 1:8 to 1:64 by IAT, which was also shown by flow cytometry. None of the patients experienced an acute hemolytic episode. Our data indicated that the primary anti-D induced by DEL transfusion or the secondary anti-D elevated by DEL in a truly D-negative patient might not be unusual. We suggest that a truly D-negative childbearing-aged woman should avoid DEL transfusion to protect her from primary anti-D allosensitization. In addition, anti-D positive recipients should also avoid DEL red cell transfusion due to the delayed hemolytic transfusion reaction (DHTR). PMID:23125084

  1. Portacaths are safe for long-term regular blood transfusion in children with sickle cell anaemia.

    PubMed

    Bartram, Jack L; O'Driscoll, Sandra; Kulasekararaj, Austin G; Height, Susan E; Dick, Moira; Patel, Shailesh; Rees, David C

    2011-11-01

    Peripheral venous access in children with sickle cell anaemia (SCA) requiring regular blood transfusions can become difficult over time. Previous reports have suggested the use of totally implantable venous access devices, Portacaths (PAC) in this patient group are associated with unacceptable high rates of complications. We present our experience in seven children with SCA over a 9-year period. Seven devices were placed for a total of 9754 PAC days during the study period. The median age at insertion was 6.3 years (range 3-15 years). The rate of PAC associated infection was 0.2 per 1000 PAC days. There were no episodes of thrombosis. The median length of time in situ during the study period was 3.7 years (range 1.3-7.5 years). Our experience highlights the safe and reliable use of PAC in children with SCA requiring regular blood transfusions when venous access has become a major problem. PMID:20605863

  2. Red Kidney: Kidney Transplant From a Deceased Donor Who Received Massive Blood Transfusion During Cardiopulmonary Bypass.

    PubMed

    Bell, Richard; Hanif, Faisal; Prasad, Padmini; Ahmad, Niaz

    2016-06-01

    Here, we present a case of a deceased-donor kidney transplant. The brain-dead donor had received a massive blood transfusion during cardiopulmonary bypass, which lead to hemolysis, hemoglobinuria, acute kidney injury, and renal replacement therapy. The kidney appeared red after in situ flush. Postoperatively, the recipient developed delayed graft function. Protocol biopsy during the postoperative period revealed the widespread deposition of heme pigment in the renal tubules. Massive blood transfusion and cardiopulmonary bypass surgery are associated with hemolysis and heme pigment deposition in the renal tubules, which subsequently lead to acute kidney injury. Kidneys from such donors appear red and, while this does not preclude transplant, are likely to develop delayed graft function. PMID:26030717

  3. The infectious risks in blood transfusion as of today - A no black and white situation.

    PubMed

    Garraud, Olivier; Filho, Luiz Amorim; Laperche, Syria; Tayou-Tagny, Claude; Pozzetto, Bruno

    2016-01-01

    Transfusion has been tainted with the risk of contracting an infection - often severe - and fears about this risk are still prevailing, in sharp contrast with the actual risk in Western countries. Those actual risks are rather immunological, technical (overload) or metabolic. Meanwhile, in developing countries and particularly in Africa, transfusion transmitted infections (TTIs) are still frequent, because of both the scarcity of volunteer blood donors and resources and the high incidence and prevalence of infections. Global safety of blood components has been declared as a goal to be attained everywhere by the World Heath Organization (WHO). However, this challenge is difficult to meet because of several intricate factors, of which the emergence of infectious agents, low income and breaches in sanitation and hygiene. This review aims at encompassing the situation of TTIs in different settings and means that can be deployed to improve the situation where this can possibly be. PMID:27476017

  4. Accuracy of continuous noninvasive hemoglobin monitoring for the prediction of blood transfusions in trauma patients.

    PubMed

    Galvagno, Samuel M; Hu, Peter; Yang, Shiming; Gao, Cheng; Hanna, David; Shackelford, Stacy; Mackenzie, Colin

    2015-12-01

    Early detection of hemorrhagic shock is required to facilitate prompt coordination of blood component therapy delivery to the bedside and to expedite performance of lifesaving interventions. Standard physical findings and vital signs are difficult to measure during the acute resuscitation stage, and these measures are often inaccurate until patients deteriorate to a state of decompensated shock. The aim of this study is to examine a severely injured trauma patient population to determine whether a noninvasive SpHb monitor can predict the need for urgent blood transfusion (universal donor or additional urgent blood transfusion) during the first 12 h of trauma patient resuscitation. We hypothesize that trends in continuous SpHb, combined with easily derived patient-specific factors, can identify the immediate need for transfusion in trauma patients. Subjects were enrolled if directly admitted to the trauma center, >17 years of age, and with a shock index (heart rate/systolic blood pressure) >0.62. Upon admission, a Masimo Radical-7 co-oximeter sensor (Masimo Corporation, Irvine, CA) was applied, providing measurement of continuous non-invasive hemoglobin (SpHb) levels. Blood was drawn and hemoglobin concentration analyzed and conventional pulse oximetry photopletysmograph signals were continuously recorded. Demographic information and both prehospital and admission vital signs were collected. The primary outcome was transfusion of at least one unit of packed red blood cells within 24 h of admission. Eight regression models (C1-C8) were evaluated for the prediction of blood use by comparing area under receiver operating curve (AUROC) at different time intervals after admission. 711 subjects had continuous vital signs waveforms available, to include heart rate (HR), SpHb and SpO2 trends. When SpHb was monitored for 15 min, SpHb did not increase AUROC for prediction of transfusion. The highest ROC was recorded for model C8 (age, sex, prehospital shock index, admission

  5. [Norman Bethune (1890-1939), an involved doctor, icon of the blood transfusion history].

    PubMed

    Gentili, M E

    2016-05-01

    Norman Bethune was born in 1890, in Gravenhurst (Ontario, Canada). Thereafter a strong surgical training, he implied in thoracic surgery and fight against tuberculosis. His political opinions led him to join the Republicans in the Spanish Civil War. He played an important part in the development of blood transfusion on the battlefield. Then he joined China with communist troops and therein developed surgical units and accelerated training for health personal. He died of septicemia in 1939. PMID:26921106

  6. Red blood cell transfusion increases cerebral oxygen delivery in anemic patients with subarachnoid hemorrhage

    PubMed Central

    Dhar, Rajat; Zazulia, Allyson R; Videen, Tom O; Zipfel, Gregory J; Derdeyn, Colin P; Diringer, Michael N

    2009-01-01

    Background Anemia is common after subarachnoid hemorrhage (SAH) and may exacerbate the reduction in oxygen delivery (DO2) underlying delayed cerebral ischemia (DCI). The association between lower hemoglobin and worse outcome, including more cerebral infarcts, supports a role for red blood cell (RBC) transfusion to correct anemia. However, the cerebral response to transfusion remains uncertain, as higher hemoglobin may increase viscosity and further impair cerebral blood flow (CBF) in the setting of vasospasm. Methods Eight patients with aneurysmal SAH and hemoglobin < 10 g/dl were studied with 15O-PET before and after transfusion of 1 unit of RBCs. Paired t-tests were used to analyze the change in global and regional CBF, oxygen extraction fraction (OEF), and oxygen metabolism (CMRO2) after transfusion. DO2 was calculated from CBF and arterial oxygen content (CaO2). CBF, CMRO2 and DO2 are reported in ml/100g/min. Results Transfusion resulted in a 15% rise in hemoglobin (8.7±0.8 to 10.0±1.0 g/dl) and CaO2 (11.8±1.0 to 13.6±1.1 ml/dL, both p < 0.001). Global CBF remained stable (40.5±8.1 to 41.6±9.9), resulting in an 18% rise in DO2 from 4.8±1.1 to 5.7±1.4 (p = 0.017). This was associated with a fall in OEF from 0.49±0.11 to 0.41±0.11 (p = 0.11) and stable CMRO2. Rise in DO2 was greater (28%) in regions with oligemia (low DO2 and OEF≥0.5) at baseline, but was attenuated (10%) within territories exhibiting angiographic vasospasm, where CBF fell 7%. Conclusions Transfusion of RBCs to anemic patients with SAH resulted in a significant rise in cerebral DO2 without lowering global CBF. This was associated with reduced OEF, which may improve tolerance of vulnerable brain regions to further impairments of CBF. Further studies are needed to confirm the benefit of transfusion on DCI and balance this against potential systemic and cerebral risks. PMID:19628806

  7. Transfusion of D+ red blood cells to D- individuals in trauma situations.

    PubMed

    Tchakarov, Amanda; Hobbs, Rhonda; Bai, Yu

    2014-01-01

    To conserve D- red blood cells (RBCs), our facility developed a policy for transfusion of D+ units to D- patients, particularly in trauma situations. To our knowledge, this is the first study looking at D-mismatched RBC transfusion in trauma patients. We developed guidelines for the transfusion of D-mismatched RBCs. patients were followed by anti body screening and direct antiglobulin testing. Twenty-six patients were identified, and 57.7 percent of the cases were the result of trauma. Follow-up ranged from 7 to 455 days. The trauma cohort had a follow-up of 7 to 102 days. Overall, patients were transfused with 1 to 36 units of D-mismatched RBCs. Three patients produced alloanti-D, resulting in a 20 percent rate of antibody formation rate of 11.5 percent compared with 21.4 to 30.4 percent in previous studies. Approximately 58 percent of our study population was composed of trauma patients. Within that cohort, the formation of anti-D was 20 percent, similar to the rate seen in previous studies looking at primarily non-trauma populations. PMID:25831260

  8. Risks of packed red blood cell transfusion in patients undergoing cardiac surgery.

    PubMed

    Gerber, David R

    2012-12-01

    Packed red blood cell (PRBC) transfusion is common in patients undergoing cardiac surgery. Evidence has accumulated demonstrating that such patients can tolerate relatively low hemoglobins, and an extensive body of literature has developed demonstrating that patients undergoing such surgery who receive PRBC are at risk for several adverse outcomes including increased mortality, atrial fibrillation, and more postoperative infections, as well as numerous other complications. The PubMed database was searched for the English language literature on the topic of PRBC transfusion and outcomes in patients undergoing cardiac surgery, as well as alternatives to this intervention. Data were reviewed to assess the impact of transfusion in patients undergoing cardiac surgery on mortality, cardiac, infectious, and pulmonary, as well as a variety of miscellaneous complications. Patients receiving PRBC were consistently identified as being at higher risk for complications in all categories. The limited prospective data were consistent with the retrospective data, which comprised most of the literature. The preponderance of the literature suggests that patients undergoing cardiac surgery can tolerate lower hemoglobin/hematocrit values than traditionally appreciated. Most published data also indicate that PRBC transfusion should be reserved for patients with an identifiable clinical/physiologic indication fir this intervention, consistent with recent specialty society guidelines. PMID:22762927

  9. The three "R"s of blood transfusion in 2020; routine, reliable and robust.

    PubMed

    Abbot, Stewart

    2010-06-01

    To predict the timing and nature of future changes in the practice of blood transfusion, several factors must be considered. The historical rate of change of a scientific field can often provide a rough guide to the rate of future progress. To improve the accuracy of these predictions, historical rates must be adjusted to take into account the decelerating effects of technological or methodological barriers to progress, together with the potentially accelerating effects of transformative technology breakthroughs and unmet needs in the field that act as drivers for change. The cumulative impact of unpredictable and, often, limited availability of traditional blood donors, increasingly elderly populations, the potential for storage-associated adverse events, and increasingly prevalent transfusion-transmittable diseases is likely to provide significant drive to develop transformational alternatives to current transfusion practices. Considering the current stage of development of stem cell-based therapeutics and the rates of change in clinically compatible bioreactors and cell sorting systems, it is reasonable to believe that stem cell-based ex vivo manufacture of blood components will become routine, robust, and reliable within the next decade. PMID:20513559

  10. Blood transfusion and the anaesthetist: management of massive haemorrhage

    PubMed Central

    Thomas, D; Wee, M; Clyburn, P; Walker, I; Brohi, K; Collins, P; Doughty, H; Isaac, J; Mahoney, PF; Shewry, L

    2010-01-01

    Hospitals must have a major haemorrhage protocol in place and this should include clinical, laboratory and logistic responses. Immediate control of obvious bleeding is of paramount importance (pressure, tourniquet, haemostatic dressings). The major haemorrhage protocol must be mobilised immediately when a massive haemorrhage situation is declared. A fibrinogen < 1 g.l−1 or a prothrombin time (PT) and activated partial thromboplastin time (aPTT) of > 1.5 times normal represents established haemostatic failure and is predictive of microvascular bleeding. Early infusion of fresh frozen plasma (FFP; 15 ml.kg−1) should be used to prevent this occurring if a senior clinician anticipates a massive haemorrhage. Established coagulopathy will require more than 15 ml.kg−1 of FFP to correct. The most effective way to achieve fibrinogen replacement rapidly is by giving fibrinogen concentrate or cryoprecipitate if fibrinogen is unavailable. 1:1:1 red cell:FFP:platelet regimens, as used by the military, are reserved for the most severely traumatised patients. A minimum target platelet count of 75 × 109.l−1 is appropriate in this clinical situation. Group-specific blood can be issued without performing an antibody screen because patients will have minimal circulating antibodies. O negative blood should only be used if blood is needed immediately. In hospitals where the need to treat massive haemorrhage is frequent, the use of locally developed shock packs may be helpful. Standard venous thromboprophylaxis should be commenced as soon as possible after haemostasis has been secured as patients develop a prothrombotic state following massive haemorrhage. PMID:20963925

  11. A study on confidential unit exclusion at Shiraz Blood Transfusion Center, Iran

    PubMed Central

    Kasraian, Leila; Karimi, Mohammad Hossein

    2016-01-01

    Background: Confidential unit exclusion (CUE) system has been designed to enhance transfusion safety as an extra additive approach. Aims: This study was designed to survey demographic characteristics, prevalence of serologic markers, and reasons of opting CUE. Materials and Methods: The cross-sectional study was performed at Shiraz Blood Transfusion Center (Southern Iran). CUE is used for all individuals who refer for blood donation, and donors can choose their blood not to be used if they have any doubt about their blood suitability for transfusion. The prevalence rate of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) was compared between the blood donors who opted into and out of CUE. Then, the donors were contacted to give another blood sample and the reasons of deferral. Researchers also determined whether their reasons were logical or not. Data were analyzed using comparison of proportions in MedCalc software 7. Results: Out of all the donors, 2365 ones (2.3%) opted for CUE. CUE was more frequent among men, singles, donors with low education levels, between 18 and 25 years old, and with history of previous donation (P < 0.05). The prevalence rate of HCV was higher among the donors who opted for CUE (P < 0.05), but it was not the case regarding HBV and HIV (P>0.05). Furthermore, 91.5% of the donors had opted for CUE by mistake and only 8% had chosen CUE logically. Conclusion: It is necessary to review the process of CUE, make some changes both in procedure and design, and then survey its effectiveness in blood safety. PMID:27605850

  12. The challenges of meeting the blood transfusion requirements in Sub-Saharan Africa: the need for the development of alternatives to allogenic blood.

    PubMed

    Osaro, Erhabor; Charles, Adias Teddy

    2011-01-01

    As a resource, allogenic blood has never been more in demand than it is today. Escalating elective surgery, shortages arising from a fall in supply, a lack of national blood transfusion services, policies, appropriate infrastructure, trained personnel, and financial resources to support the running of a voluntary nonremunerated donor transfusion service, and old and emerging threats of transfusion-transmitted infection, have all conspired to ensure that allogenic blood remains very much a vital but limited asset to healthcare delivery particularly in Sub-Saharan Africa. This is further aggravated by the predominance of family replacement and commercially remunerated blood donors, rather than regular benevolent, nonremunerated donors who give blood out of altruism. The demand for blood transfusion is high in Sub-Saharan Africa because of the high prevalence of anemia especially due to malaria and pregnancy-related complications. All stakeholders in blood transfusion have a significant challenge to apply the best available evidenced-based medical practices to the world-class management of this precious product in a bid to using blood more appropriately. Physicians in Sub-Saharan Africa must always keep in mind that the first and foremost strategy to avoid transfusion of allogenic blood is their thorough understanding of the pathophysiologic mechanisms involved in anemia and coagulopathy, and their thoughtful adherence to the evidenced-based good practices used in the developed world in a bid to potentially reduce the likelihood of allogenic blood transfusion in many patient groups. There is an urgent need to develop innovative ways to recruit and retain voluntary low-risk blood donors. Concerns about adverse effects of allogenic blood transfusion should prompt a review of transfusion practices and justify the need to search for transfusion alternatives to decrease or avoid the use of allogenic blood. These strategies should include the correction of anemia using

  13. Prehospital blood product transfusion by U.S. army MEDEVAC during combat operations in Afghanistan: a process improvement initiative.

    PubMed

    Malsby, Robert F; Quesada, Jose; Powell-Dunford, Nicole; Kinoshita, Ren; Kurtz, John; Gehlen, William; Adams, Colleen; Martin, Dustin; Shackelford, Stacy

    2013-07-01

    U.S. Army flight medics performed a process improvement initiative of 15 blood product transfusions on select Category A (Urgent) helicopter evacuation casualties meeting approved clinical indications for transfusion. These transfusions were initiated from point of injury locations aboard MEDEVAC aircraft originating from one of two locations in southern Afghanistan. All flight medics executing the transfusions were qualified through a standardized and approved program of instruction, which included day and night skills validation, and a 90% or higher written examination score. There was no adverse reaction or out-of-standard blood product temperature despite hazardous conditions and elevated cabin temperatures. All casualties within a 10-minute flight time who met clinical indications were transfused. Utilization of a standard operating procedure with strict handling and administration parameters, a rigorous training and qualification program, an elaborate cold chain system, and redundant documentation of blood product units ensured that flight medic initiated transfusions were safe and effective. Research study is needed to refine the indications for prehospital blood transfusion and to determine the effect on outcomes in severely injured trauma patients. PMID:23820353

  14. [Concentrated red blood cells transfusion in Yaoundé, Cameroon: what quality?].

    PubMed

    Mbanya, D; Nouthe, B; Tayou Tagny, C; Moudourou, S; Ngogang, J

    2007-11-01

    As part of a quality assurance process in the transfusion service of a hospital blood bank of Yaoundé, Cameroon, a selection of units of red cell concentrates (RCC) were evaluated for volume, haemoglobin, and haematocrit levels as well as blood cell content. Blood samples were all collected into standard double blood bags containing an anticoagulant, citrate-phosphate-dextrose and adenine. During a three-month period, 35 bags intended for the preparation of the RCC were analysed. After relevant screening for transfusion transmissible infections ,and ABO and rhesus (RH1) blood grouping, the bags were centrifuged to obtain RCC. The resultant red cell bags were weighed and the volumes estimated. Full blood counts were performed on samples of the RCC using an electronic particle counter (DIANA 5, HYCEL Diagnostics, Reims, France). The results obtained showed that, based on ISO 9001: 2000 norms, there were 57, 66 and 80% of RCC respectively with volumes, hemoglobin levels as well as hematocrit that were in conformity with the norms. When the data was analysed based on the Algerian norms, 83, 66 and 95% respectively conformed. The significance of these findings and the need for establishing local norms for quality assurance in our community are discussed. PMID:18295526

  15. Red blood cell alloimmunization is influenced by the delay between Toll-like receptor agonist injection and transfusion

    PubMed Central

    Elayeb, Rahma; Tamagne, Marie; Bierling, Philippe; Noizat-Pirenne, France; Vingert, Benoît

    2016-01-01

    Murine models of red blood cell transfusion show that inflammation associated with viruses or methylated DNA promotes red blood cell alloimmunization. In vaccination studies, the intensity of antigen-specific responses depends on the delay between antigen and adjuvant administration, with a short delay limiting immune responses. In mouse models of alloimmunization, the delay between the injection of Toll-like receptor agonists and transfusion is usually short. In this study, we hypothesized that the timing of Toll-like receptor 3 agonist administration affects red blood cell alloimmunization. Poly(I:C), a Toll-like receptor 3 agonist, was administered to B10BR mice at various time points before the transfusion of HEL-expressing red blood cells. For each time point, we measured the activation of splenic HEL-presenting dendritic cells, HEL-specific CD4+ T cells and anti-HEL antibodies in serum. The phenotype of activated immune cells depended on the delay between transfusion and Toll-like receptor-dependent inflammation. The production of anti-HEL antibodies was highest when transfusion occurred 7 days after agonist injection. The proportion of HEL-presenting CD8α+ dendritic cells producing interleukin-12 was highest in mice injected with poly(I:C) 3 days before transfusion. Although the number of early-induced HEL-specific CD4+ T cells was similar between groups, a high proportion of these cells expressed CD134, CD40 and CD44 in mice injected with poly(I:C) 7 days before transfusion. This study clearly shows that the delay between transfusion and Toll-like receptor-induced inflammation influences the immune response to transfused red blood cells. PMID:26430173

  16. Proactive Risk Assessment of Blood Transfusion Process, in Pediatric Emergency, Using the Health Care Failure Mode and Effects Analysis (HFMEA)

    PubMed Central

    Dehnavieh, Reza; Ebrahimipour, Hossein; Molavi-Taleghani, Yasamin; Vafaee-Najar, Ali; Hekmat, Somayeh Noori; Esmailzdeh, Hamid

    2015-01-01

    Introduction: Pediatric emergency has been considered as a high risk area, and blood transfusion is known as a unique clinical measure, therefore this study was conducted with the purpose of assessing the proactive risk assessment of blood transfusion process in Pediatric Emergency of Qaem education- treatment center in Mashhad, by the Healthcare Failure Mode and Effects Analysis (HFMEA) methodology. Methodology: This cross-sectional study analyzed the failure mode and effects of blood transfusion process by a mixture of quantitative-qualitative method. The proactive HFMEA was used to identify and analyze the potential failures of the process. The information of the items in HFMEA forms was collected after obtaining a consensus of experts’ panel views via the interview and focus group discussion sessions. Results: The Number of 77 failure modes were identified for 24 sub-processes enlisted in 8 processes of blood transfusion. Totally 13 failure modes were identified as non-acceptable risk (a hazard score above 8) in the blood transfusion process and were transferred to the decision tree. Root causes of high risk modes were discussed in cause-effect meetings and were classified based on the UK national health system (NHS) approved classifications model. Action types were classified in the form of acceptance (11.6%), control (74.2%) and elimination (14.2%). Recommendations were placed in 7 categories using TRIZ (“Theory of Inventive Problem Solving.”) Conclusion: The re-engineering process for the required changes, standardizing and updating the blood transfusion procedure, root cause analysis of blood transfusion catastrophic events, patient identification bracelet, training classes and educational pamphlets for raising awareness of personnel, and monthly gathering of transfusion medicine committee have all been considered as executive strategies in work agenda in pediatric emergency. PMID:25560332

  17. Organizational impact of governmental audit of blood transfusion services in Norway: A qualitative study.

    PubMed

    Åsprang, Aud Frøysa; Frich, Jan C; Braut, Geir Sverre

    2015-10-01

    Little is known about the organizational impact of supervisory activities in blood banks. We did a study with the aim to explore health professional's experiences with the external audit of blood transfusion services in Norway. The audit and supervision brought attention to deficiencies in systems and practices, and had been a catalyst for quality improvement. We identify facilitators and barriers to change. While audits can bring attention to known deficiencies, and trigger improvement processes which previously have not been prioritized, involvement of senior management is important to secure change across departments. PMID:25935295

  18. Blood Transfusion Practice before and after Implementation of Type and Screen Protocol in Emergency Department of a University Affiliated Hospital in Iran

    PubMed Central

    Alavi-Moghaddam, Mostafa; Bardeh, Mahmoud; Alimohammadi, Hossein; Emami, Habib; Hosseini-Zijoud, Seyed-Mostafa

    2014-01-01

    Background. Blood transfusion is the cornerstone of therapy for many serious and common diseases. This study was performed to assess blood transfusion practice before and after implementation of type and screen protocol in emergency department of a university affiliated hospital in Iran, 2012-2013. Methods. An audit was studied before and after the implementation of type and screen protocol. The number of blood transfusions, time interval between blood order and transfusion, cross-match to transfusion ratio (C/T ratio), and transfusion index (TI) were checked. C/T ratio was used as a measure of the efficiency of blood ordering practice. We compared our results before and after implementation of type and screen protocol. Results. In present study after implementation of type and screen protocol, the time interval between requesting blood transfusion and transfusion of blood has decreased significantly (P < 0.001). The number of blood transfusions required by actual patients increased significantly from 1/2 to 2 (P < 0.001). The average cross-match to transfusion (C/T) ratio got near 1.13 from 1.41 and TI got near 0.91 from 0.58 (P < 0.001). Conclusion. The implementation of T&S protocol has been proven to be safe, efficient, and beneficial to the transfusion practice of our hospital from the current study. PMID:25254117

  19. Forum for debate: Safety of allogeneic blood transfusion alternatives in the surgical/critically ill patient.

    PubMed

    Muñoz Gómez, M; Bisbe Vives, E; Basora Macaya, M; García Erce, J A; Gómez Luque, A; Leal-Noval, S R; Colomina, M J; Comin Colet, J; Contreras Barbeta, E; Cuenca Espiérrez, J; Garcia de Lorenzo Y Mateos, A; Gomollón García, F; Izuel Ramí, M; Moral García, M V; Montoro Ronsano, J B; Páramo Fernández, J A; Pereira Saavedra, A; Quintana Diaz, M; Remacha Sevilla, Á; Salinas Argente, R; Sánchez Pérez, C; Tirado Anglés, G; Torrabadella de Reinoso, P

    2015-12-01

    In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. The Multidisciplinary Autotransfusion Study Group and the Anemia Working Group España convened a multidisciplinary panel of 23 experts belonging to different healthcare areas in a forum for debate to: 1) analyze the different safety alerts referred to certain transfusion alternatives; 2) study the background leading to such alternatives, the evidence supporting them, and their consequences for everyday clinical practice, and 3) issue a weighted statement on the safety of each questioned transfusion alternative, according to its clinical use. The members of the forum maintained telematics contact for the exchange of information and the distribution of tasks, and a joint meeting was held where the conclusions on each of the items examined were presented and discussed. A first version of the document was drafted, and subjected to 4 rounds of review and updating until consensus was reached (unanimously in most cases). We present the final version of the document, approved by all panel members, and hope it will be useful for our colleagues. PMID:26183121

  20. Emergency whole-blood use in the field: a simplified protocol for collection and transfusion.

    PubMed

    Strandenes, Geir; De Pasquale, Marc; Cap, Andrew P; Hervig, Tor A; Kristoffersen, Einar K; Hickey, Matthew; Cordova, Christopher; Berseus, Olle; Eliassen, Håkon S; Fisher, Logan; Williams, Steve; Spinella, Philip C

    2014-05-01

    Military experience and recent in vitro laboratory data provide a biological rationale for whole-blood use in the treatment of exsanguinating hemorrhage and have renewed interest in the reintroduction of fresh whole blood and cold-stored whole blood to patient care in austere environments. There is scant evidence to support, in a field environment, that a whole blood-based resuscitation strategy is superior to a crystalloid/colloid approach even when augmented by a limited number of red blood cell (RBC) and plasma units. Recent retrospective evidence suggests that, in this setting, resuscitation with a full compliment of RBCs, plasma, and platelets may offer an advantage, especially under conditions where evacuation is delayed. No current evacuation system, military or civilian, is capable of providing RBC, plasma, and platelet units in a prehospital environment, especially in austere settings. As a result, for the vast minority of casualties, in austere settings, with life-threatening hemorrhage, it is appropriate to consider a whole blood-based resuscitation approach to provide a balanced response to altered hemostasis and oxygen debt, with the goal of reducing the risk of death from hemorrhagic shock. To optimize the successful use of fresh whole blood/cold-stored whole blood in combat field environments, proper planning and frequent training to maximize efficiency and safety will be required. Combat medics will need proper protocol-based guidance and education if whole-blood collection and transfusion are to be successfully and safely performed in austere environments. In this article, we present the Norwegian Naval Special Operation Commando unit-specific remote damage control resuscitation protocol, which includes field collection and transfusion of whole blood. This protocol can serve as a template for others to use and adjust for their own military or civilian unit-specific needs and capabilities for care in austere environments. PMID:24365879

  1. Clinical, haematological and biochemical responses of sheep undergoing autologous blood transfusion

    PubMed Central

    2012-01-01

    Background This study aimed to evaluate the clinical, haematological and biochemical responses to autologous blood transfusion and the feasibility of this practice in sheep. Thus, we used eight male, 8 months old sheep, weighing on average 30 kg, from which 15 mL/kg of whole blood was collected and stored in CPDA-1 bags. Blood samples were refrigerated for 8 days and subsequently re-infused. The clinical, haematological and biochemical parameters were evaluated before blood collection and reinfusion, after 10 minutes of collection and reinfusion, after 3, 6, 12, 24, 48, 96 and 192 hours after collection and reinfusion. Results With respect to clinical parameters, we observed a decrease in heart rate after 24, 48 and 196 hours from reinfusion compared to basal values (p < 0.05). Haematological variables including globular volume and erythrocyte counts showed a significant decrease (p < 0.01) at all time points after collection and increased (p < 0.01) at all time points after reinfusion. There was a significant increase in total protein and calcium at all time points after reinfusion (p < 0.05). Conclusion Autologous transfusion in sheep slightly altered the physiological, biochemical and haematological responses of sheep, indicating that the technique proposed is safe and can be applied in the clinical practice of this species. The 8 d period was not sufficient for complete recovery of the haematological parameters after blood collection. PMID:22607611

  2. Assessing the Residual Risk for Transfusion-Transmitted Infections in the Philippine Blood Supply

    PubMed Central

    Lam, Hilton Y.; Belizario, Vicente Y.; Juban, Noel R.; Alejandria, Marissa M.; Castillo-Carandang, Nina; Arcellana-Nuqui, Elizabeth; Mirasol, Ma. Angelina; Cordero, Cynthia P.; Sison, Olivia T.; Rivera, Adovich S.

    2014-01-01

    Due to a USAID-funded study on blood banks, a national policy was instituted in 1994 that set standards for Philippine blood services, promoted voluntary donation, and led to a ban on commercial blood banks. In this follow-up study, we assess the safety of the supply by determining the residual risk for transfusion-transmitted infections (syphilis, hepatitis B and C, HIV). We also identified unsafe facility practices and generated policy recommendations. A 1992 study found that transfusion-ready blood was not safe using the LQAS method (P > 0.05). We found that the 2012 residual risk became 0 to 0.9 percent attributable to the national policy. We noted poor to fair adherence to this policy. We identified unsafe practices such as use of rapid tests and lack of random blood retesting. Training and use of regional networks may improve safety. Despite improvement in safety, facilities complain of funding and logistical issues regarding compliance with the policy. PMID:25191145

  3. Role of National Accreditation Board of Hospitals and Healthcare Providers (NABH) core indicators monitoring in quality and safety of blood transfusion

    PubMed Central

    Gupta, Anshu; Gupta, Chhavi

    2016-01-01

    Context: Certain quality indicators are mandatory in the maintenance and improvement of quality in blood transfusion. Monitoring of such indicators should be done regularly and deficiencies are to be corrected for effective blood transfusion services. Aims: To study the usefulness of monitoring of the National Accreditation Board for Hospitals and Healthcare Providers (NABH) core indicators in blood transfusion and in the maintenance of hemovigilance. Settings and Design: Hemovigilance is a quality process to improve quality and increase the safety of blood transfusion. It covers and surveys all activities of the blood transfusion chain from donors to recipients. Core indicators’ monitoring is a part of the hemovigilance process. Materials and Methods: A 2-year retrospective study was conducted in a blood storage unit of a NABH accredited tertiary care hospital of a metropolitan city. Four NABH core indicators in blood transfusion were observed and monitored by the clinical and blood storage unit staff of different levels. Results: It was observed that there was an improvement in quality by core indicators monitoring with decreased wastage of blood and blood components, decreased average turnaround time for issue of blood and blood components, and lesser number of transfusion reactions. Conclusion: This study demonstrated that monitoring of NABH core indicators results in the enhancement of quality and safety in blood transfusion services, reducing the incidence of transfusion reactions. PMID:27011668

  4. Perioperative blood transfusions and survival in patients with non-small cell lung cancer: a retrospective study

    PubMed Central

    2013-01-01

    Background Perioperative blood transfusions have been associated with poor clinical outcomes in the context of oncological surgery. Current literature is inconclusive whether blood transfusions are linked to shorter recurrence free and overall survival after lung cancer surgery. We hypothesize that blood transfusions in patients undergoing surgery for non-small cell lung cancer are associated with poor oncological survival. Methods After IRB approval, perioperative data from 636 patients who underwent lung cancer surgery was collected. Patients were evaluated for time to tumor recurrence and overall survival. Results 60 patients were transfused and 576 subjects were not. Patients who received transfusion were more likely to have more advanced disease (p = 0.018), and preoperative low hemoglobin concentrations (p < 0.0001) compared to non-transfused patients. In the multivariable Cox regression analysis, blood transfusion was associated with a significant reduction in recurrence free survival (p = 0.025), HR: 1.55 (95% CI: 1.06-2.27) and overall survival (p = 0.0002) HR: 2.04 (95% CI: 1.41-2.97). However, analysis after propensity score matching between the two groups revealed that the effect of blood transfusion was significant for reduction in overall survival (p = 0.0356), HR: 1.838 (95% CI: 1.04-3.22) but not for recurrence free survival (p = 0.1460), HR: 1.493 (95% CI: 0.87-2.56). Conclusions Perioperative administration of red blood cells appears be associated with a decreased overall survival but not recurrence free survival after lung cancer surgery. Our study has the limitations of a retrospective review. Hence, our results should be confirmed by a prospective randomized control trial. PMID:24228905

  5. Massive transfusion and massive transfusion protocol

    PubMed Central

    Patil, Vijaya; Shetmahajan, Madhavi

    2014-01-01

    Haemorrhage remains a major cause of potentially preventable deaths. Rapid transfusion of large volumes of blood products is required in patients with haemorrhagic shock which may lead to a unique set of complications. Recently, protocol based management of these patients using massive transfusion protocol have shown improved outcomes. This section discusses in detail both management and complications of massive blood transfusion. PMID:25535421

  6. Revival of the Ugandan Blood Transfusion System 1989: an example of international cooperation.

    PubMed

    Watson-Williams, E J; Kataaha, P K

    1990-01-01

    10 yr of civil war in Uganda had destroyed the Blood Transfusion Service when the government came to power in 1986. AIDS had become recognized as a problem of severe proportion. In 1987, the E.E.C. pledged to rehabilitate the central blood bank. This paper describes the first year of operation from December 1988. Over 5000 units of blood, largely from volunteer donors, were delivered to 19 hospitals. The overall incidence of HIV-1 seropositivity was 14.6% and Hepatitis B surface antigen was 5.5%. The cost was 21.5 ECU (US $25) for each unit of HIV negative, H.B.s.Ag. negative, blood. PMID:10171166

  7. From mad cows to sensible blood transfusion: the risk of prion transmission by labile blood components in the United Kingdom and in France.

    PubMed

    Lefrère, Jean-Jacques; Hewitt, Patricia

    2009-04-01

    Transfusion transmission of the prion, the agent of variant Creutzfeldt-Jakob disease (vCJD), is now established. Subjects infected through food may transmit the disease through blood donations. The two nations most affected to date by this threat are the United Kingdom (UK) and France. The first transfusion cases have been observed in the UK over the past 5 years. In France, a few individuals who developed vCJD had a history of blood donation, leading to a risk of transmission to recipients, some of whom could be incubating the disease. In the absence of a large-scale screening test, it is impossible to establish the prevalence of infection in the blood donor population and transfused patients. This lack of a test also prevents specific screening of blood donations. Thus, prevention of transfusion transmission essentially relies at present on deferral of "at-risk" individuals. Because prions are present in both white blood cells and plasma, leukoreduction is probably insufficient to totally eliminate the transfusion risk. In the absence of a screening test for blood donations, recently developed prion-specific filters could be a solution. Furthermore, while the dietary spread of vCJD seems efficiently controlled, uncertainty remains as to the extent of the spread of prions through blood transfusion and other secondary routes. PMID:19170997

  8. Upper airway oedema following autologous blood transfusion from a wound drainage system.

    PubMed

    Woda, R; Tetzlaff, J E

    1992-03-01

    We report a case of a 70-yr-old white woman who underwent a revision of a total hip arthroplasty under general anaesthesia. The intraoperative course was stable without any complications and the estimated blood loss was 2500 ml. The patient received an autologous transfusion of blood from a wound drainage system in the recovery room. The transfusion was followed immediately by marked respiratory distress and upper airway oedema. She required emergency tracheal intubation and mechanical pulmonary ventilation. A coagulopathy also developed which was treated and resolved within 12 hr of the capillary leak phenomenon. The trachea was extubated on the first postoperative day and she had an uneventful course until discharge from the hospital two days later. We discuss the possible, aetiology of such a reaction to autologous blood including complement and platelet activation. It is suggested that reinfusion of nonwashed shed blood from a wound drainage system may present a hazard even though the fluid was autologous in origin. PMID:1551163

  9. A Simple “Blood-Saving Bundle” Reduces Diagnostic Blood Loss and the Transfusion Rate in Mechanically Ventilated Patients

    PubMed Central

    Riessen, Reimer; Behmenburg, Melanie; Blumenstock, Gunnar; Guenon, Doris; Enkel, Sigrid; Schäfer, Richard; Haap, Michael

    2015-01-01

    Introduction Aim of this study was to reduce blood loss caused by diagnostic blood sampling and to minimize the development of anemia in a high-risk group of mechanically ventilated medical intensive care patients. We therefore implemented a “blood-saving bundle” (BSB) combining a closed-loop arterial blood sampling system, smaller sampling tubes, reduced frequency of blood drawings, and reduced sample numbers. Methods The study included all patients from our medical ICU who were ventilated for more than 72 hours. Exclusion criteria were: acute or chronic anemia on admission, bleeding episode(s) during the ICU stay, or end-of-life therapy. The BSB was introduced in 2009 with training and educational support. Patients treated in 2008, before the introduction of the BSB, served as a control group (n = 41, 617 observation days), and were compared with patients treated in 2010 after the introduction of the BSB (BSB group, n = 50, 559 observation days). Primary endpoints were blood loss per day, and development of anemia. Secondary endpoints were numbers of blood transfusions, number of days on mechanical ventilation, and length of the ICU stay. Results Mean blood loss per ICU day was decreased from 43.3 ml (95% CI: 41.2 to 45.3 ml) in the controls to 15.0 ml (14.3 to 15.7 ml) in the BSB group (P < 0.001). The introduction of a closed-loop arterial blood sampling system was the major contributor to this effect. Mean hemoglobin concentrations showed no significant differences in both groups during the ICU stay. Hemoglobin values <9 g/dl, however, were recorded in 21.2% of observation days in the controls versus 15.4% in the BSB group (P = 0.01). Units of transfused red blood cells per 100 observation days decreased from 7 to 2.3 (P < 0.001). The mean number of ventilation days was 7.1 days (6.1 to 8.3 days) in the controls and 7.5 days (6.6 to 8.5 days) in the BSB group (P = NS). In total, patients in the BSB group stayed in ICU for a mean of 9.9 days (8.6 to 11

  10. Proof of principle for transfusion of in vitro–generated red blood cells

    PubMed Central

    Giarratana, Marie-Catherine; Rouard, Hélène; Dumont, Agnès; Kiger, Laurent; Safeukui, Innocent; Le Pennec, Pierre-Yves; François, Sabine; Trugnan, Germain; Peyrard, Thierry; Marie, Tiffany; Jolly, Séverine; Hebert, Nicolas; Mazurier, Christelle; Mario, Nathalie; Harmand, Laurence; Lapillonne, Hélène; Devaux, Jean-Yves

    2011-01-01

    In vitro RBC production from stem cells could represent an alternative to classic transfusion products. Until now the clinical feasibility of this concept has not been demonstrated. We addressed the question of the capacity of cultured RBCs (cRBCs) to survive in humans. By using a culture protocol permitting erythroid differentiation from peripheral CD34+ HSC, we generated a homogeneous population of cRBC functional in terms of their deformability, enzyme content, capacity of their hemoglobin to fix/release oxygen, and expression of blood group antigens. We then demonstrated in the nonobese diabetes/severe combined immunodeficiency mouse that cRBC encountered in vivo the conditions necessary for their complete maturation. These data provided the rationale for injecting into one human a homogeneous sample of 1010 cRBCs generated under good manufacturing practice conditions and labeled with 51Cr. The level of these cells in the circulation 26 days after injection was between 41% and 63%, which compares favorably with the reported half-life of 28 ± 2 days for native RBCs. Their survival in vivo testifies globally to their quality and functionality. These data establish the proof of principle for transfusion of in vitro–generated RBCs and path the way toward new developments in transfusion medicine. This study is registered at http://www.clinicaltrials.gov as NCT0929266. PMID:21885599

  11. Antioxidant metabolism during blood storage and its relationship to post-transfusion red cell survival

    SciTech Connect

    Lachant, N.A.; Noble, N.A.; Myrhe, B.A.; Tanaka, K.R.

    1984-10-01

    The status of the erythrocyte antioxidant defense system and its relationship to post-transfusion red cell survival were determined in erythrocytes stored for 35 or 42 days in CPD-A1 anticoagulant with a saline-adenine-glucose additive. As storage progressed, there was a significant increase in incubated Heinz body formation (P less than .001) and a significant decrease in reduced glutathione (GSH) stability (P less than .001). Stimulated pentose phosphate shunt activity also declined during storage (P less than .06), while unstimulated shunt activity remained unchanged. The increase in Heinz body formation was associated with decreased GSH stability (r . -.77, P less than .001), which in turn was associated with the decline in stimulated pentose shunt activity (r . .67, P less than .001). The changes in Heinz body formation (r . -.85), GSH stability (r . .83), and stimulated pentose shunt activity (r . .54) were all significantly (P less than .001) related to the decline in adenosine triphosphate (ATP) content of the erythrocyte. Red cell survival 24 hours after transfusion was significantly related to the GSH stability (r . .80, P less than .001) and to the ATP concentration (r . .76, P less than .005) on the day of transfusion. Thus, dysfunction of the erythrocyte antioxidant defense system occurs during blood storage and appears to be related, in part, to ATP depletion. The ability to maintain a normal reduced glutathione concentration during oxidant stress appears to be an important determinant of red cell survival in the peritransfusion period.

  12. Non Infectious Complications Related to Blood Transfusion: An 11 year Retrospective Analysis in a Tertiary Care Hospital.

    PubMed

    Philip, J; Pawar, A; Chatterjee, T; Mallhi, R S; Biswas, A K; Dimri, U

    2016-09-01

    In India transmission of transfusion transmissible infections (TTI) has shown a relative decrease as a result of mandatory screening of donated blood for TTI's. However, reducing the incidence of non infectious complications poses a major challenge, mainly due to the fact that a number of adverse reactions go unreported. Blood transfusion reaction, can be categorized based on the time interval between transfusion of blood products and the presentation of adverse reactions as acute i.e. those presenting during or within 24 h and as delayed i.e. those presenting anytime after 24 h. Transfusion reactions can further be classified as immune and non immune or infectious and non infectious based on the pathophysiology. In this retrospective study which was undertaken with an aim to determine the type and frequency of non infectious complications due to transfusion of blood and blood products recorded the incidence of febrile non hemolytic transfusion reactions (FNHTR) 51.40 %, allergic reactions 40.14 %, non immune hemolytic reactions 4.22 %, hypothermia 2.81 %, anaphylaxis 0.70 % and iron overload 0.70 %. FNHTR which was found to be the most common complication in this study can certainly be minimized, if not completely eliminated by adopting a policy of universal leucodepletion, the implementation of which solely depends on the financial and infrastructure resources available. This study also reiterates the importance of hemovigilance as a tool to improve the safety of blood transfusion. PMID:27429521

  13. Restrictive vs Liberal Blood Transfusion for Acute Upper Gastrointestinal Bleeding: Rationale and Protocol for a Cluster Randomized Feasibility Trial

    PubMed Central

    Jairath, Vipul; Kahan, Brennan C.; Gray, Alasdair; Doré, Caroline J.; Mora, Ana; Dyer, Claire; Stokes, Elizabeth A.; Llewelyn, Charlotte; Bailey, Adam A.; Dallal, Helen; Everett, Simon M.; James, Martin W.; Stanley, Adrian J.; Church, Nicholas; Darwent, Melanie; Greenaway, John; Le Jeune, Ivan; Reckless, Ian; Campbell, Helen E.; Meredith, Sarah; Palmer, Kelvin R.; Logan, Richard F.A.; Travis, Simon P.L.; Walsh, Timothy S.; Murphy, Michael F.

    2013-01-01

    Acute upper gastrointestinal bleeding (AUGIB) is the commonest reason for hospitalization with hemorrhage in the UK and the leading indication for transfusion of red blood cells (RBCs). Observational studies suggest an association between more liberal RBC transfusion and adverse patient outcomes, and a recent randomised trial reported increased further bleeding and mortality with a liberal transfusion policy. TRIGGER (Transfusion in Gastrointestinal Bleeding) is a pragmatic, cluster randomized trial which aims to evaluate the feasibility and safety of implementing a restrictive versus liberal RBC transfusion policy in adult patients admitted with AUGIB. The trial will take place in 6 UK hospitals, and each centre will be randomly allocated to a transfusion policy. Clinicians throughout each hospital will manage all eligible patients according to the transfusion policy for the 6-month trial recruitment period. In the restrictive centers, patients become eligible for RBC transfusion when their hemoglobin is < 8 g/dL. In the liberal centers patients become eligible for transfusion once their hemoglobin is < 10 g/dL. All clinicians will have the discretion to transfuse outside of the policy but will be asked to document the reasons for doing so. Feasibility outcome measures include protocol adherence, recruitment rate, and evidence of selection bias. Clinical outcome measures include further bleeding, mortality, thromboembolic events, and infections. Quality of life will be measured using the EuroQol EQ-5D at day 28, and the costs associated with hospitalization for AUGIB in the UK will be estimated. Consent will be sought from participants or their representatives according to patient capacity for use of routine hospital data and day 28 follow up. The study has ethical approval for conduct in England and Scotland. Results will be analysed according to a pre-defined statistical analysis plan and disseminated in peer reviewed publications to relevant stakeholders. The

  14. Blood transfusion in sickle cell disease leading to posterior reversible encephalopathy syndrome (PRES).

    PubMed

    Raj, Shashi; Killinger, James; Overby, Philip

    2013-10-01

    Children with sickle cell disease have a very high risk of lifelong neurologic morbidity and mortality. Cerebrovascular accidents are a known complication in children with sickle cell disease. Posterior reversible encephalopathy syndrome is a constellation of acute neurologic findings increasingly recognized in pediatric critical care population with evidence of vasogenic edema on brain imaging possibly due to cerebral vascular endothelial cell dysfunction. This report, for the first time, describes a young adult with sickle cell disease who developed posterior reversible encephalopathy syndrome following blood transfusion. PMID:22899796

  15. Knowledge acquisition environment for the design of a decision support system: application in blood transfusion.

    PubMed Central

    Achour, S. L.; Dojat, M.; Rieux, C.; Bierling, P.; Lepage, E.

    1999-01-01

    Blood transfusion is a medical domain where decision support systems (DSSs) could be very helpful to the physicians but must easily and continuously be maintained. We have developed a knowledge acquisition tool that allows the construction and the maintenance of such a system by the domain expert. The methodology used could be applied to another highly evolutive medical domain. In this paper, we detail our knowledge acquisition tool, its use and the final DSS obtained, which is fully integrated into our hospital information network. Images Figure 5 PMID:10566346

  16. Major surgery in an osteosarcoma patient refusing blood transfusion: case report

    PubMed Central

    2010-01-01

    We describe an unusual case of osteosarcoma in a Jehovah's Witness patient who underwent chemotherapy and major surgery without the need for blood transfusion. This 16-year-old girl presented with osteosarcoma of the right proximal tibia requiring proximal tibia resection, followed by endoprosthesis replacement. She was successfully treated with neoadjuvant chemotherapy and surgery with the support of haematinics, granulocyte colony-stimulating factor, recombinant erythropoietin and intraoperative normovolaemic haemodilution. This case illustrates the importance of maintaining effective, open communication and exploring acceptable therapeutic alternative in the management of these patients, whilst still respecting their beliefs. PMID:21059231

  17. Performance Assessment of Internal Quality Control (IQC) Products in Blood Transfusion Compatibility Testing in China

    PubMed Central

    Li, Jing-Jing; Gao, Qi; Liu, Zhi-Dong; Kang, Qiong-Hua; Hou, Yi-Jun; Zhang, Luo-Chuan; Hu, Xiao-Mei; Li, Jie; Zhang, Juan

    2015-01-01

    Internal quality control (IQC) is a critical component of laboratory quality management, and IQC products can determine the reliability of testing results. In China, given the fact that most blood transfusion compatibility laboratories do not employ IQC products or do so minimally, there is a lack of uniform and standardized IQC methods. To explore the reliability of IQC products and methods, we studied 697 results from IQC samples in our laboratory from 2012 to 2014. The results showed that the sensitivity and specificity of the IQCs in anti-B testing were 100% and 99.7%, respectively. The sensitivity and specificity of the IQCs in forward blood typing, anti-A testing, irregular antibody screening, and cross-matching were all 100%. The reliability analysis indicated that 97% of anti-B testing results were at a 99% confidence level, and 99.9% of forward blood typing, anti-A testing, irregular antibody screening, and cross-matching results were at a 99% confidence level. Therefore, our IQC products and methods are highly sensitive, specific, and reliable. Our study paves the way for the establishment of a uniform and standardized IQC method for pre-transfusion compatibility testing in China and other parts of the world. PMID:26488582

  18. [Blood transfusion audit methodology: the auditors, reference systems and audit guidelines].

    PubMed

    Chevrolle, F; Hadzlik, E; Arnold, J; Hergon, E

    2000-12-01

    The audit has become an essential aspect of the blood transfusion sector, and is a management tool that should be used judiciously. The main types of audit that can be envisaged in blood transfusion are the following: operational audit concerning a predetermined activity; systems quality audit; competence audit, combining the operational audit on a specific activity with quality management, e.g., laboratory accreditation; audit of the environmental management system; and social audit involving the organization of an activity and the management of human resources. However, the main type of audit considered in this article is the conformity audit, which in this context does not refer to internal control but to conformity with an internal guideline issued by the French National Blood Service. All audits are carried out on the basis of a predescribed method (contained in ISO 10 011). The audit is a system of investigation, evaluation and measurement, and also a means of continuous assessment and therefore improvement. The audit is based on set guidelines, but in fact consists of determining the difference between the directions given and what has actually been done. Auditing requires operational rigor and integrity, and has now become a profession in its own right. PMID:11204842

  19. Scotblood 2015: Improving and delivering blood products, novel cellular therapies, and celebrating patients and donor engagement within transfusion services.

    PubMed

    Colligan, David; McGowan, Neil; Seghatchian, Jerard

    2016-08-01

    Blood Transfusion Services are striving to continually improve the efficacy and quality of their blood products whilst also simultaneously diversifying into novel cellular products. For this to be successful the relationships between the various arms of the organisation must be strong and interlinked. As new technologies impact on the products that blood transfusion services supply it should be noted that the interaction between the service and its donor base is also affected by advancing technologies. Social media has fundamentally altered the way in which the public can access information and news, as such blood services must engage and interact appropriately with these new forms of media. As a reflection of these challenges the Scotblood 2015 programme was focussed on service and product improvement, donor engagement and people centred transfusion. This commentary comprises summaries of the presentations, based in part on the abstracts provided by the speakers. PMID:27524267

  20. Clinical effects of blood donor characteristics in transfusion recipients: protocol of a framework to study the blood donor–recipient continuum

    PubMed Central

    Chassé, Michaël; McIntyre, Lauralyn; Tinmouth, Alan; Acker, Jason; English, Shane W; Knoll, Greg; Forster, Alan; Shehata, Nadine; Wilson, Kumanan; van Walraven, Carl; Ducharme, Robin; Fergusson, Dean A

    2015-01-01

    Introduction When used appropriately, transfusion of red blood cells (RBCs) is a necessary life-saving therapy. However, RBC transfusions have been associated with negative outcomes such as infection and organ damage. Seeking explanations for the beneficial and deleterious effects of RBC transfusions is necessary to ensure the safe and optimal use of this precious resource. This study will create a framework to analyse the influence of blood donor characteristics on recipient outcomes. Methods and analysis We will conduct a multisite, longitudinal cohort study using blood donor data routinely collected by Canadian Blood Services, and recipient data from health administrative databases. Our project will include a thorough validation of primary data, the linkage of various databases into one large longitudinal database, an in-depth epidemiological analysis and a careful interpretation and dissemination of the results to assist the decision-making process of clinicians, researchers and policymakers in transfusion medicine. Our primary donor characteristic will be age of blood donors and our secondary donor characteristics will be donor–recipient blood group compatibility and blood donor sex. Our primary recipient outcome will be a statistically appropriate survival analysis post-RBC transfusion up to a maximum of 8 years. Our secondary recipient outcomes will include 1-year, 2-year and 5-year mortality; hospital and intensive care unit length of stay; rehospitalisation; new cancer and cancer recurrence rate; infection rate; new occurrence of myocardial infarctions and need for haemodialysis. Ethics and dissemination Our results will help determine whether we need to tailor transfusion based on donor characteristics, and perhaps this will improve patient outcome. Our results will be customised to target the different stakeholders involved with blood transfusions and will include presentations, peer-reviewed publications and the use of the dissemination network of

  1. [Calculation of the allowable blood loss before transfusion with a programmable pocket calculator].

    PubMed

    Lorentz, A; Gasteiger, P; Osswald, P M

    1987-06-01

    Introduction. The amount of blood loss during surgery that requires transfusion is frequently estimated with a linear formula (1) using blood volume--calculated on a volume per weight basis--, preoperative hemoglobin concentration, and an established minimum hemoglobin concentration. This formula, however, underestimates allowable pretransfusion blood loss, because it implies that all blood lost contains the initial hemoglobin concentration. In addition, hemodilution by infusion therapy prior to surgery is usually not taken into consideration. Methods. In order to estimate allowable pretransfusion blood loss more accurately and conveniently, a program was developed for a programmable pocket computer. This program calculates (number of equation in parenthesis): blood volume (2a, 2b) expansion of blood volume prior to surgery (3) hemodilution prior to surgery (4) allowable blood loss during isovolemic hemodilution (5). The applicability of the program to the situation during orthopedic operations was tested in a study in which allowable pretransfusion blood loss was estimated for one group of patients and was calculated with the computer program for another group of patients. Eighty patients undergoing major orthopedic surgery were studied. After preoperative evaluation the attending anesthetist established a minimum hemoglobin concentration and the type of cardiocirculatory monitoring to be used. Patients were divided at random into two groups: for one group blood volume was estimated on a volume per weight basis and allowable blood loss was calculated using equation (1); for the second group allowable blood loss was calculated with the computer program. During the evaluation of the data the computer calculations were also carrier out for group 1.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3631499

  2. Chronic hepatitis E virus infection after living donor liver transplantation via blood transfusion: a case report.

    PubMed

    Kurihara, Takeshi; Yoshizumi, Tomoharu; Itoh, Shinji; Harimoto, Norifumi; Harada, Noboru; Ikegami, Toru; Inagaki, Yuki; Oshiro, Yukio; Ohkohchi, Nobuhiro; Okamoto, Hiroaki; Maehara, Yoshihiko

    2016-12-01

    Although it occurs worldwide, hepatitis E virus (HEV) infection in developed countries is generally foodborne. HEV infection is subclinical in most individuals. Although fulminant liver failure may occur, progression to chronic hepatitis is rare. This study describes a 41-year-old man with liver cirrhosis caused by non-alcoholic steatohepatitis and hepatocellular carcinoma within the Milan criteria. His liver function was classified as Child-Pugh grade C. Living donor liver transplantation (LDLT) was performed, and he was discharged from the hospital on postoperative day (POD) 22. However, his alanine aminotransferase concentration began to increase on POD 60 and HEV infection was detected on POD 81. Retrospective assessments of stored blood samples showed that this patient became positive for HEV RNA on POD 3. The liver donor was negative for anti-HEV antibodies and HEV RNA. However, the platelet concentrate transfused into the liver recipient the day after LDLT was positive for HEV RNA. The patient remained positive for HEV infection for 10 months. Treatment with 800 mg/day ribavirin for 20 weeks reduced HEV RNA to an undetectable level. In conclusion, this report describes a patient infected with HEV through a blood transfusion after LDLT, who progressed to chronic hepatitis probably due to his immunosuppressed state and was treated well with ribavirin therapy. PMID:27059470

  3. Association between Perioperative Blood Transfusion and Oncologic Outcomes after Curative Surgery for Renal Cell Carcinoma

    PubMed Central

    Park, Yong Hyun; Kim, Yong-June; Kang, Seok Ho; Kim, Hyeon Hoe; Byun, Seok-Soo; Lee, Ji Youl; Hong, Sung-Hoo

    2016-01-01

    Purpose: We aimed to elucidate the association between perioperative blood transfusion (PBT) and the prognosis of patients undergoing curative surgery for renal cell carcinoma (RCC). Methods: In all, 3,832 patients with RCC who had undergone curative surgery were included in this study from a multicenter database. PBT was defined as the transfusion of packed red blood cells within seven days before surgery, during surgery, or within the postoperative hospitalization period. The association of PBT with oncologic outcomes was evaluated using univariate and multivariate Cox regression analyses, and regression adjustment with propensity score matching. Results: Overall, 11.7% (447/3,832) of patients received PBT. Patients receiving PBT were significantly older at diagnosis, and had lower BMI, higher comorbidities, worse ECOG performance status, and more initial symptoms. Moreover, higher pathologic TNM stage, larger mass size, higher nuclear grade, more sarcomatoid differentiation, and more tumor necrosis were all observed more frequently in patients who received PBT. In univariate analysis, relapse-free survival, cancer-specific survival, and overall survival rates were worse in patients who received PBT; however, these factors became insignificant in the matched pairs after propensity score matching. On multivariate Cox regression analysis and regression adjustment with propensity score matching, significant prognostic effects of PBT on disease relapse, cancer-specific mortality, and all-cause mortality were not observed. Conclusions: This multicenter database analysis demonstrates no significant prognostic association between PBT and oncologic outcomes in patients with RCC. PMID:27313787

  4. Disease-related effects of perioperative blood transfusions associated with sup 125 I seed implantation for prostate carcinoma

    SciTech Connect

    Petersen, J.P.; Schellhammer, P.F.; el-Mahdi, A.M. )

    1990-08-01

    In some retrospective studies perioperative transfusions during oncologic surgery have been shown to decrease the time interval between surgery and local and/or distant recurrence of cancer. This study examines the disease-related effect, if any, of perioperative blood transfusions among 108 patients with localized carcinoma of the prostate treated by radioactive iodine-125 seed implantation of the prostate and lymphadenectomy. When all subjects were analyzed, there was no statistical difference of local and distant failure between the transfused and nontransfused groups. Patients with well-differentiated tumors had statistically fewer local recurrences (0% vs 22%, p = 0.036) if they were transfused perioperatively. However, the difference in distant metastases (0% vs 11%) was not statistically significant (p = 0.21). In contrast, patients with moderately and poorly differentiated disease receiving transfusions had more local recurrences and metastases, though this was not statistically significant. Our data suggest that there is no obvious evidence that perioperative blood transfusions have an adverse effect on local recurrence or distant metastases for iodine-125 seed implantation of carcinoma of the prostate.

  5. Anemia During Sequential Induction Chemotherapy and Chemoradiation for Head and Neck Cancer: The Impact of Blood Transfusion on Treatment Outcome

    SciTech Connect

    Bhide, Shreerang A.; Ahmed, Merina; Rengarajan, Vijayan; Powell, Ceri; Miah, Aisha; Newbold, Kate; Nutting, Christopher M.; Harrington, Kevin J.

    2009-02-01

    Purpose: Sequential treatment (chemotherapy followed by concomitant chemoradiation; CCRT) is increasingly being used for radical treatment of squamous cell cancer of the head and neck (SCCHN), which results in increased myelosuppression. In this study, we review the incidence of anemia and the effect of a policy of hemoglobin (Hb) maintenance by blood transfusion on disease outcomes in these patients. Methods and Materials: Retrospective review of the records of patients with SCCHN treated with sequential CCRT formed the basis of this study. The incidence of anemia and statistics on blood transfusion were documented. For the purpose of outcome analyses, patients were divided into four categories by (1) transfusion status, (2) nadir Hb concentration, (3) number of transfusion episodes, and (4) number of units of blood transfused (NOUT). Data on 3-year locoregional control (LRC), relapse-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) were analyzed. Results: One hundred and sixty-nine patients were identified. The median follow-up was 23.6 months. The RFS (52% vs. 41%, p = 0.03), DSS (71% vs. 66%, p = 0.02), and OS (58% vs. 42% p = 0.005) were significantly better for patients who did not have a transfusion vs. those who did. The LRC, RFS, DSS, and OS were also significantly better for patients with nadir Hb level >12 vs. <12 g/dL and NOUT 1-4 vs. >4. Conclusion: Our study seems to suggest that blood transfusion during radical treatment for SCCHN might be detrimental. Further research should be undertaken into the complex interactions among tumor hypoxia, anemia, and the treatment of anemia before making treatment recommendations.

  6. Iron-restricted erythropoiesis and risk of red blood cell transfusion in the intensive care unit: a prospective observational study.

    PubMed

    Litton, E; Xiao, J; Allen, C T; Ho, K M

    2015-09-01

    Intravenous (IV) iron can decrease transfusion requirements in selected patients with low, normal and moderately elevated ferritin. Whether the syndrome of iron-restricted erythropoiesis (IRE), diagnosed by iron studies, identifies critically ill patients at risk for subsequent red blood cell (RBC) transfusion, and hence, provides a simple method to determine response to IV iron therapy, is uncertain. We aimed to describe the characteristics of patients with IRE on admission to intensive care and determine the optimal variables to identify patients at risk of RBC transfusion who may benefit from early administration of IV iron. The study included 201 consecutive ICU admissions from a single 23-bed combined medical/surgical ICU. The prevalence of IRE on admission to ICU, defined according to ferritin <300 µg/l and transferrin saturation <20%, was 26.2% (95% CI 19.9 to 32.4). The proportion of patients with IRE subsequently receiving RBC transfusion was significantly lower than the proportion of patients without IRE receiving RBC transfusion (absolute mean difference 18.9% [95% CI 4.7 to 33.1, P <0.001]). IRE was not independently associated with risk of transfusion on multivariate analysis, however, a prognostic model with three risk factors (RBC transfusion prior to ICU admission, Hb <100 g/l and ICU length of stay >3 days), had good discrimination and calibration for predicting transfusion (receiver operator curve area under the curve 0.87 [95% CI 0.79 to 0.94, P=0.88], Hosmer-Lemeshow 6.21; P=0.1). Excluding iron overload and using simple prognostic criteria to identify patients at high risk of RBC transfusion may be a preferable strategy for identifying critically ill patients who may benefit from IV iron. PMID:26310412

  7. The National Heart, Lung, and Blood Institute Recipient Epidemiology and Donor Evaluation Study (REDS-III): A research program striving to improve blood donor and transfusion recipient outcomes

    PubMed Central

    Kleinman, Steven; Busch, Michael P; Murphy, Edward L; Shan, Hua; Ness, Paul; Glynn, Simone A.

    2014-01-01

    Background The Recipient Epidemiology and Donor Evaluation Study -III (REDS-III) is a 7-year multicenter transfusion safety research initiative launched in 2011 by the National Heart, Lung, and Blood Institute. Study design The domestic component involves 4 blood centers, 12 hospitals, a data coordinating center, and a central laboratory. The international component consists of distinct programs in Brazil, China, and South Africa which involve US and in-country investigators. Results REDS-III is using two major methods to address key research priorities in blood banking/transfusion medicine. First, there will be numerous analyses of large “core” databases; the international programs have each constructed a donor/donation database while the domestic program has established a detailed research database that links data from blood donors and their donations, the components made from these donations, and data extracts from the electronic medical records of the recipients of these components. Secondly, there are more than 25 focused research protocols involving transfusion recipients, blood donors, or both that are either in progress or scheduled to begin within the next 3 years. Areas of study include transfusion epidemiology and blood utilization; transfusion outcomes; non-infectious transfusion risks; HIV-related safety issues (particularly in the international programs); emerging infectious agents; blood component quality; donor health and safety; and other donor issues. Conclusions It is intended that REDS-III serve as an impetus for more widespread recipient and linked donor-recipient research in the US as well as to help assure a safe and available blood supply in the US and in international locations. PMID:24188564

  8. A retrospective analysis of massive blood transfusion and post-operative complications in patients undergoing supra-major orthopaedic oncosurgeries

    PubMed Central

    Gupta, Ankit; Kulkarni, Atul

    2016-01-01

    Background and Aims: Anaesthetic management of patients undergoing supra-major orthopaedic oncosurgeries is challenging. We wanted to evaluate the effects of pre-operative co-morbid conditions, intraoperative blood loss and transfusion, haemodynamic instability on post-operative complications and hospital outcomes in patients after such surgeries. Methods: We collected data from the patient files, anaesthesia records and the electronic medical records about pre-operative morbidities, intraoperative management, complications, blood loss, fluid therapy and blood products transfused. We also collected data on post-operative complications, intensive care unit (ICU) and hospital length of stay (LOS) and status at discharge. Data were summarised using percentages for categorical data and mean and median for continuous data. Results: The mean blood loss was 4567.44 ml (range 1200–16,000 ml); 95% of all patients received blood transfusion. Twenty patients needed massive blood transfusion. Fresh frozen plasma was needed in 17 patients while 1 patient needed single donor platelets. Haemodynamic instability was present in 38 patients, of which 8 needed continuous vasopressor infusion. Nineteen patients were ventilated post-operatively. Coagulopathy occurred in 22 patients while thrombocytopaenia was seen in 6 patients. The median ICU LOS was 3 (1–6) days, and median hospital stay was 17 (6–53) days. All patients were discharged alive. Conclusion: Supra-major orthopaedic oncosurgeries are associated with massive intraoperative blood loss and transfusion. Common complications include anaemia, coagulopathy and hyperbilirubinaemia and prolonged ICU stay. Meticulous care, anticipating the complications with timely treatment can lead to excellent outcomes. PMID:27141111

  9. Role of transfused red blood cells for shock and coagulopathy within remote damage control resuscitation.

    PubMed

    Spinella, Philip C; Doctor, Allan

    2014-05-01

    The philosophy of damage control resuscitation (DCR) and remote damage control resuscitation (RDCR) can be summarized by stating that the goal is to prevent death from hemorrhagic shock by "staying out of trouble instead of getting out of trouble." In other words, it is preferred to arrest the progression of shock, rather than also having to reverse this condition after significant tissue damage and organ injury cascades are established. Moreover, to prevent death from exsanguination, a balanced approach to the treatment of both shock and coagulopathy is required. This was military doctrine during World War II, but seemed to be forgotten during the last half of the 20th century. Damage control resuscitation and RDCR have revitalized the approach, but there is still more to learn about the most effective and safe resuscitative strategies to simultaneously treat shock and hemorrhage. Current data suggest that our preconceived notions regarding the efficacy of standard issue red blood cells (RBCs) during the hours after transfusion may be false. Standard issue RBCs may not increase oxygen delivery and may in fact decrease it by disturbing control of regional blood flow distribution (impaired nitric oxide processing) and failing to release oxygen, even when perfusing hypoxic tissue (abnormal oxygen affinity). Standard issue RBCs may assist with hemostasis but appear to have competing effects on thrombin generation and platelet function. If standard issue or RBCs of increased storage age are not optimal, then are there alternatives that will allow for an efficacious and safe treatment of shock while also supporting hemostasis? Studies are required to determine if fresh RBCs less than 7 to 10 days provide an outcome advantage. A resurgence in the study of whole blood stored at 4°C for up to 10 days also holds promise. Two randomized controlled trials in humans have indicated that following transfusion with either whole blood stored at 4°C or platelets stored at 4

  10. Restrictive blood transfusion strategies and associated infection in orthopedic patients: a meta-analysis of 8 randomized controlled trials

    PubMed Central

    Teng, Zhaowei; Zhu, Yun; Liu, Yugang; Wei, Guojun; Wang, Shuangneng; Du, Shaoliang; Zhang, Xiguang

    2015-01-01

    This study sought to evaluate whether restrictive blood transfusion strategies are associated with a risk of infection in orthopedic patients by conducting a meta-analysis of randomized controlled trials (RCTs). RCTs with restrictive versus liberal red blood cell (RBC) transfusion strategies were identified by searching Medline, Embase, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews from their inception to December 2014. Eight RCTs with infections as outcomes were included in the final analysis. According to the Jadad scale, all studies were considered to be of high quality. The pooled risk ratio [RR] for the association between transfusion strategy and infection was 0.65 (95% CI, 0.47–0.91; p = 0.012), and the number of patients needed to treat to avoid an infection using a restrictive transfusion strategy was 62. No heterogeneity was observed. The sensitivity analysis indicated unstable results, and no significant publication bias was observed. This meta-analysis of RCTs demonstrates that restrictive transfusion strategies in orthopedic patients result in a significant reduction in infections compared with more liberal strategies. PMID:26306601

  11. Induction and prevention of virus-associated malignant lymphoma by serial transmission of EBV-related virus from cynomolgus by blood transfusion in rabbits.

    PubMed

    Koirala, Tirtha Raj; Hayashi, Kazuhiko; Jin, Zaishun; Onoda, Sachiyo; Tanaka, Takehiro; Oda, Wakako; Ichimura, Koichi; Ohara, Nobuya; Oka, Takashi; Yamada, Masao; Yoshino, Tadashi

    2004-04-01

    Epstein-Barr virus (EBV)-related herpesvirus (Si-IIA-EBV) was serially transmitted for 3 passages from rabbit to rabbit of the opposite sex by blood transfusion, which subsequently induced virus-associated rabbit lymphomas. The virus could be transmitted by transfusion with 15-20 ml of whole blood (7/7) or irradiated blood (1/6) from the EBV-related virus-infected rabbits, but there was no transmission with transfusion of cell-free plasma (0/6) from the infected rabbits. Passive anti-EBV-VCA IgG (x 20 approximately x 10) titers decreased during the first 1-2 weeks in the transfused rabbits. The virus-transmitted rabbits showed a gradual increase in antibody titers ranging from peak titers of x 640 to x 2560 after 3 weeks of transfusion. The recipient origin of malignant lymphoma that developed in the first rabbit transfused by infected blood was confirmed by chromosomal analysis. This rabbit model thus shows that EBV-related herpesvirus is serially transmissible by blood transfusion and that transmission can not be completely prevented by irradiation of blood, but removal of blood cells is the best way to prevent transmission of EBV-related virus. Therefore, this animal model provides a convenient in vivo system for studies of the prevention and therapy of transfusion-related transmission of EBV and EBV-associated lymphoproliferative diseases in immunocompromised human beings. PMID:15255507

  12. Association of haematocrit and red blood cell transfusion with outcomes in infants with shunt-dependent pulmonary blood flow and univentricular physiology

    PubMed Central

    Dasgupta, Rahul; Parsons, Andrew; McClelland, Sarenthia; Morgan, Elizabeth; Robertson, Michael J.; Noel, Tommy R.; Schmitz, Michael L.; Rettiganti, Mallikarjuna; Gupta, Punkaj

    2015-01-01

    Background The aim of this study was to investigate the association between red blood cell (RBC) transfusion and haematocrit values with outcomes in infants with univentricular physiology undergoing surgery for a modified Blalock-Taussig shunt. Material and methods This study included infants ≤ 2 months of age who underwent modified Blalock-Taussig shunt surgery at the Arkansas Children’s Hospital (2006–2012). Infants undergoing a Norwood operation or Damus-Kaye-Stansel operation with modified Blalock-Taussig shunt were excluded. Demographics, pre-operative, operative, daily laboratory data, and post-operative variables were collected. We studied the association between haematocrit and blood transfusion with a composite clinical outcome. Multivariable logistic regression models were fitted to study the probability of study outcomes as a function of haematocrit values and RBC transfusions after operation. Results Seventy-three patients qualified for inclusion. All study patients received blood transfusion within the first 48 hours after heart surgery. The median haematocrit was 44.3 (interquartile range [IQR] 42.5–46.2), and the median volume of RBC transfused was 28 mL/kg (IQR, 10–125) in the first 14 days after surgery. The overall in-hospital mortality rate was 13.6% (10 patients). A multivariable analysis adjusted for risk factors, including weight, prematurity, cardiopulmonary bypass and postoperative need for nitric oxide and dialysis, revealed no association between haematocrit values and RBC transfusion with the composite clinical outcome. Discussion We did not find an association between higher haematocrit values and increasing RBC transfusions with improved outcomes in infants with shunt-dependent pulmonary blood flow and univentricular physiology. The power of our study was small, which prevents any strong statement on this lack of association. Future multi-centre, randomised controlled trials are needed to investigate this topic in further

  13. Impact of a blood management protocol on transfusion rates and outcomes following total hip and knee arthroplasty.

    PubMed

    Frew, N; Alexander, D; Hood, J; Acornley, A

    2016-07-01

    Introduction Preoperative anaemia remains undertreated in the UK despite advice from national agencies to implement blood conservation measures. A local retrospective audit of 717 primary hip/knee replacements in 2008-2009 revealed 25% of patients were anaemic preoperatively. These patients experienced significantly increased transfusion requirements and length of stay. We report the results of a simple and pragmatic blood management protocol in a district general hospital. Methods Since 2010 patients at our institution who are found to be anaemic when listed for hip/knee replacement have been offered iron supplementation and/or erythropoietin depending on haemoglobin and ferritin levels. In this study, postoperative blood transfusions, length of stay and readmissions were assessed retrospectively for all patients undergoing elective primary hip/knee replacement in 2014 and compared with the baseline findings. Results During the 12-month study period, 406 patients were eligible for inclusion and none were excluded. Eighty-nine patients (22%) were anaemic preoperatively and sixty-five received treatment. The transfusion rate fell from the baseline levels of 23.0% and 6.7% to 4.3% and 0.5% for hip and knee replacements respectively (p<0.001). The median length of stay reduced from 6 to 3 days (p<0.001) for both hip and knee replacements. The rate for readmissions within 90 days fell from 13.5% to 8.9% (p<0.05). Conclusions Preoperative anaemia is common in patients listed for hip/knee replacement and it is associated strongly with increased blood transfusion. The introduction of a blood management protocol has led to significant reductions in transfusion and length of stay, sustained over a four-year period. This suggests that improved patient outcomes, conservation of blood stocks and cost savings can be achieved. PMID:27055406

  14. Treatment of presumptive idiopathic immune-mediated anemia in a Holstein heifer, using blood transfusions and corticotherapy

    PubMed Central

    Lallemand, Michaël; Fecteau, Gilles; Desnoyer, Michel; Francoz, David; Gaucher, Marie-Lou

    2006-01-01

    Abstract An idiopathic immune-mediated anemia was diagnosed in a 1-year-old Holstein heifer. The diagnostic procedures, blood transfusions, use of an immunosuppressive dosage of dexamethasone, and favorable outcome are described, and idiopathic immune-mediated anemia in mammals is briefly reviewed. PMID:16898112

  15. [The effect of in vitro X-irradiated blood transfusions on the morphostructure of immunocompetent organs and their nerve elements].

    PubMed

    Iulish, E I

    1991-01-01

    A study was made of changes that occur in the rat thymus, spleen, lymph nodes, their nerve elements, and spinal ganglia under the effect of the in vitro X-irradiated blood transfusions. Parallelism was noted in the activation of the immunocompetent organ morphostructures, the rate of reactive alterations in nerve elements, and the improvement of the immunity indices. PMID:1887004

  16. Modified laparoscopic splenectomy and azygoportal disconnection combined with cell salvage is feasible and might reduce the need for blood transfusion

    PubMed Central

    Jiang, Guo-Qing; Bai, Dou-Sheng; Chen, Ping; Qian, Jian-Jun; Jin, Sheng-Jie; Yao, Jie; Wang, Xiao-Dong

    2014-01-01

    AIM: To investigate perioperative outcomes in patients undergoing modified laparoscopic splenectomy and azygoportal disconnection (MLSD) with intraoperative autologous cell salvage. METHODS: We retrospectively evaluated outcomes in 79 patients admitted to the Clinical Medical College of Yangzhou University with cirrhosis, portal hypertensive bleeding and secondary hypersplenism who underwent MLSD without (n = 46) or with intraoperative cell salvage and autologous blood transfusion, including splenic blood and operative hemorrhage (n = 33), between February 2012 and January 2014. Their intraoperative and postoperative variables were compared. These variables mainly included: operation time; estimated intraoperative blood loss; volume of allogeneic blood transfused; visual analog scale for pain on the first postoperative day; time to first oral intake; initial passage of flatus and off-bed activity; perioperative hemoglobin (Hb) concentration; and red blood cell concentration. RESULTS: There were no significant differences between the groups in terms of duration of surgery, estimated intraoperative blood loss and overall perioperative complication rate. In those receiving salvaged autologous blood, Hb concentration increased by an average of 11.2 ± 4.8 g/L (P < 0.05) from preoperative levels by the first postoperative day, but it had fallen by 9.8 ± 6.45 g/L (P < 0.05) in the group in which cell salvage was not used. Preoperative Hb was similar in the two groups (P > 0.05), but Hb on the first postoperative day was significantly higher in the autologous blood transfusion group (118.5 ± 15.8 g/L vs 102.7 ± 15.6 g/L, P < 0.05). The autologous blood transfusion group experienced significantly fewer postoperative days of temperature > 38.0 °C (P < 0.05). CONCLUSION: Intraoperative cell salvage during MLSD is feasible and safe and may become the gold standard for liver cirrhosis with portal hypertensive bleeding and hypersplenism. PMID:25561811

  17. Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 Ratio and Mortality in Patients With Severe Trauma

    PubMed Central

    Holcomb, John B.; Tilley, Barbara C.; Baraniuk, Sarah; Fox, Erin E.; Wade, Charles E.; Podbielski, Jeanette M.; del Junco, Deborah J.; Brasel, Karen J.; Bulger, Eileen M.; Callcut, Rachael A.; Cohen, Mitchell Jay; Cotton, Bryan A.; Fabian, Timothy C.; Inaba, Kenji; Kerby, Jeffrey D.; Muskat, Peter; O’Keeffe, Terence; Rizoli, Sandro; Robinson, Bryce R. H.; Scalea, Thomas M.; Schreiber, Martin A.; Stein, Deborah M.; Weinberg, Jordan A.; Callum, Jeannie L.; Hess, John R.; Matijevic, Nena; Miller, Christopher N.; Pittet, Jean-Francois; Hoyt, David B.; Pearson, Gail D.; Leroux, Brian; van Belle, Gerald

    2015-01-01

    platelets (12 U vs 6 U, P < .001) and similar amounts of red blood cells (9 U) over the first 24 hours, no differences between the 2 groups were found for the 23 prespecified complications, including acute respiratory distress syndrome, multiple organ failure, venous thromboembolism, sepsis, and transfusion-related complications. CONCLUSIONS AND RELEVANCE Among patients with severe trauma and major bleeding, early administration of plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio did not result in significant differences in mortality at 24 hours or at 30 days. However, more patients in the 1:1:1 group achieved hemostasis and fewer experienced death due to exsanguination by 24 hours. Even though there was an increased use of plasma and platelets transfused in the 1:1:1 group, no other safety differences were identified between the 2 groups. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01545232 PMID:25647203

  18. The clinical effects of red blood cell transfusions: an overview of the randomized controlled trials evidence base.

    PubMed

    Wilkinson, Kirstin L; Brunskill, Susan J; Dorée, Carolyn; Hopewell, Sally; Stanworth, Simon; Murphy, Mike F; Hyde, Chris

    2011-04-01

    No up-to-date overview of randomized controlled trials (RCTs) in red blood cell (RBC) transfusion exists. This systematic review examines the quantity and quality of the evidence for the clinical effects of RBC transfusion. One hundred forty-two eligible RCTs were identified through searches of The Cochrane Library (issue 4, 2009), MEDLINE (1950 to November 2009), EMBASE (1974 to November 2009), and other relevant sources. After data extraction and methodological quality assessment, trials were grouped by clinical specialty and type of RBC transfusion. Data analysis was predominantly descriptive. The 142 RCTs covered 11 specialties and 10 types of RBC transfusion. The number of included patients varied widely across the RCTs (median, 57; IQ range, 27-167). Most trials were single center comparing 2 parallel study arms. Overall, the reporting of methodological assessment was poor, although it improved markedly from 2001. Clinical areas with few trials are highlighted. Comparison with a study of RBC use in clinical practice highlighted a lack of correlation between the size of the evidence base for a given clinical specialty and the proportion of total RBC use by that clinical specialty. The gaps in the evidence base and the poor methodology of trials particularly in the past do not provide a strong evidence base for the use of RBC transfusions, but they indicate important targets for future research. PMID:21345644

  19. Perioperative Blood Transfusion as a Significant Predictor of Biochemical Recurrence and Survival after Radical Prostatectomy in Patients with Prostate Cancer

    PubMed Central

    Kim, Jung Kwon; Kim, Hyung Suk; Park, Juhyun; Jeong, Chang Wook; Ku, Ja Hyeon; Kim, Hyun Hoe; Kwak, Cheol

    2016-01-01

    Purpose There have been conflicting reports regarding the association of perioperative blood transfusion (PBT) with oncologic outcomes including recurrence rates and survival outcomes in prostate cancer. We aimed to evaluate whether perioperative blood transfusion (PBT) affects biochemical recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS) following radical prostatectomy (RP) for patients with prostate cancer. Materials and Methods A total of 2,713 patients who underwent RP for clinically localized prostate cancer between 1993 and 2014 were retrospectively analyzed. We performed a comparative analysis based on receipt of transfusion (PBT group vs. no-PBT group) and transfusion type (autologous PBT vs. allogeneic PBT). Univariate and multivariate Cox-proportional hazard regression analysis were performed to evaluate variables associated with BRFS, CSS, and OS. The Kaplan-Meier method was used to calculate survival estimates for BRFS, CSS, and OS, and log-rank test was used to conduct comparisons between the groups. Results The number of patients who received PBT was 440 (16.5%). Among these patients, 350 (79.5%) received allogeneic transfusion and the other 90 (20.5%) received autologous transfusion. In a multivariate analysis, allogeneic PBT was found to be statistically significant predictors of BRFS, CSS, and OS; conversely, autologous PBT was not. The Kaplan-Meier survival analysis showed significantly decreased 5-year BRFS (79.2% vs. 70.1%, log-rank, p = 0.001), CSS (98.5% vs. 96.7%, log-rank, p = 0.012), and OS (95.5% vs. 90.6%, log-rank, p < 0.001) in the allogeneic PBT group compared to the no-allogeneic PBT group. In the autologous PBT group, however, none of these were statistically significant compared to the no-autologous PBT group. Conclusions We found that allogeneic PBT was significantly associated with decreased BRFS, CSS, and OS. This provides further support for the immunomodulation hypothesis for allogeneic

  20. Outcome of Exchange Blood Transfusions Done for Neonatal Jaundice in Abakaliki, South Eastern Nigeria

    PubMed Central

    Ibekwe, Roland C.; Ibekwe, MaryAnn U.; Muoneke, Vivian U.

    2012-01-01

    Background: Neonatal jaundice (NNJ) is a major cause of morbidity and mortality among neonates in Nigeria and exchange blood transfusion (EBT) is a common modality of its treatment in Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki. This communication aims to audit this service. Materials and Methods: A 3-year retrospective review of the case files of all neonates that had EBT for NNJ at the new born special care unit of EBSUTH. Result: Two hundred and thirty seven (17.25%) out of 1374 neonatal admissions had NNJ. EBT was performed for 40 (16.9%) of them. The commonest indications for EBT were low birth weight/prematurity, ABO blood group incompatibility, sepsis and glucose 6 phosphate deficiencies. The mean serum bilirubin at which EBT was done was 28.3 mg/dl. The EBT was uneventful in 36 cases while in four (10%) cases there were reported adverse events. Seven neonates (17.5%) died after the procedure and documented causes of death include bilirubin encephalopathy, respiratory failure, and septic shock and disseminated intravascular coagulopathy. Conclusion: There is high rate of EBT use in the management of severe neonatal hyperbilirubinemia with significant morbidity and mortality in this study site. There is need to review the contribution of factors such as late presentation in the hospital to this and proffer solutions to it. PMID:24027683

  1. Autologous Umbilical Cord Blood Transfusion in Very Young Children With Type 1 Diabetes

    PubMed Central

    Haller, Michael J.; Wasserfall, Clive H.; McGrail, Kieran M.; Cintron, Miriam; Brusko, Todd M.; Wingard, John R.; Kelly, Susan S.; Shuster, Jonathan J.; Atkinson, Mark A.; Schatz, Desmond A.

    2009-01-01

    OBJECTIVE Interest continues to grow regarding the therapeutic potential for umbilical cord blood therapies to modulate autoimmune disease. We conducted an open-label phase I study using autologous umbilical cord blood infusion to ameliorate type 1 diabetes. RESEARCH DESIGN AND METHODS Fifteen patients diagnosed with type 1 diabetes and for whom autologous umbilical cord blood was stored underwent a single intravenous infusion of autologous cells and completed 1 year of postinfusion follow-up. Intensive insulin regimens were used to optimize glycemic control. Metabolic and immunologic assessments were performed before infusion and at established time periods thereafter. RESULTS Median (interquartile range [IQR]) age at infusion was 5.25 (3.1–7.3) years, with a median postdiagnosis time to infusion of 17.7 (10.9–26.5) weeks. No infusion-related adverse events were observed. Metabolic indexes 1 year postinfusion were peak C-peptide median 0.50 ng/ml (IQR 0.26–1.30), P = 0.002; A1C 7.0% (IQR 6.5–7.7), P = 0.97; and insulin dose 0.67 units · kg−1 · day−1 (IQR 0.55–0.77), P = 0.009. One year postinfusion, no changes were observed in autoantibody titers, regulatory T-cell numbers, CD4-to-CD8 ratio, or other T-cell phenotypes. CONCLUSIONS Autologous umbilical cord blood transfusion in children with type 1 diabetes is safe but has yet to demonstrate efficacy in preserving C-peptide. Larger randomized studies as well as 2-year postinfusion follow-up of this cohort are needed to determine whether autologous cord blood–based approaches can be used to slow the decline of endogenous insulin production in children with type 1 diabetes. PMID:19875605

  2. Impacts and concerns for vCJD in blood transfusion: current status.

    PubMed

    MacGregor, I R; Prowse, C V

    2004-06-01

    The impact of vCJD upon blood transfusion practice hinges on its lymphoreticular involvement. B lymphocytes play a key supporting role for the capture and replication of infectivity by follicular dendritic cells of the lymphoid tissue in animal models of transmissible spongiform encephalopathies (TSE) and tonsils, spleen and appendix in man can harbour vCJD infectivity, a situation not seen with the other human TSEs. Leucodepletion of blood donations in the UK was implemented to reduce possible vCJD transmission and preliminary data suggests that white cell associated infectivity will be effectively removed although plasma infectivity will not. Blood screening assays are under development but none yet are ready for application. The conformation dependant immunoassay, based on differences in secondary and tertiary structure between normal and TSE-associated abnormal prion protein, has a sensitivity now approaching the best bioassay. Even so further development is needed to detect the fg/ml levels likely in the event that vCJD blood does contain abnormal prion, which is as yet unproven. Surrogate assays, such as for erythroid associated factor, may provide additional means of identifying donors harbouring vCJD. Validation of clearance of TSEs from pooled plasma products consistently demonstrates effective removal of the agents in downscaled systems and studies comparing vCJD, BSE and scrapie agents yield similar results. Many approaches to therapy are under investigation, in cell culture and animal models, targeted to normal or abnormal prion metabolism, including chemical and immunological interventions. Efficacy of quinacrine/chlorpromazine and pentosan polysulphate in a clinical setting, and agents yet to be used, will be more accurately known following recent agreement of clinical drug evaluation protocols. PMID:15354867

  3. Factors Associated with Repeat Blood Donation at the Northern Zone Blood Transfusion Centre in Tanzania

    PubMed Central

    Mauka, Wilhellmuss I.; Mahande, Michael J.; Msuya, Sia E.; Philemon, Rune N.

    2015-01-01

    Background and Objective. The aim of this study was to determine factors associated with repeat blood donation. Methods. This was a cross-sectional study carried out among blood donors aged 18–65 years in northern Tanzania. The questionnaire was administered among 454 participants through the phone. Results. Of the 454 participants, the proportion of repeat donation was 63.9%. In the backward logistic regression analysis, the significant predictors were living in Arusha which had lower odds of repeat donation compared to those living in Kilimanjaro. Knowledge of time interval between donations increased odds of repeating donations. High intention increased odds of repeat donation compared to low intention. Altruistic score had minor effect on increasing odds of repeating donation. Conclusion. Repeat blood donation is affected by proximity of donating site, awareness of the blood donation interval, intention to donate, and experience on previous donation. We recommend continuous education concerning blood donors and donation among health workers and society as a whole; this will create awareness on motivational factors for repeat donations. PMID:26783496

  4. The IgE-dependent pathway in allergic transfusion reactions: involvement of donor blood allergens other than plasma proteins.

    PubMed

    Matsuyama, Nobuki; Yasui, Kazuta; Amakishi, Etsuko; Hayashi, Tomoya; Kuroishi, Ayumu; Ishii, Hiroyuki; Matsukura, Harumichi; Tani, Yoshihiko; Furuta, Rika A; Hirayama, Fumiya

    2015-07-01

    On transfusion, several plasma proteins can cause anaphylaxis in patients deficient in the corresponding plasma proteins. However, little is known about other allergens, which are encountered much more infrequently. Although it has been speculated that an allergen-independent pathway underlying allergic transfusion reactions (ATRs) is elicited by biological response modifiers accumulated in blood components during storage, the exact mechanisms remain unresolved. Furthermore, it is difficult even to determine whether ATRs are induced via allergen-dependent or allergen-independent pathways. To distinguish these two pathways in ATR cases, we established a basophil activation test, in which the basophil-activating ability of supernatants of residual transfused blood of ATR cases to whole blood basophils was assessed in the presence or absence of dasatinib, an inhibitor of IgE-mediated basophil activation. Three of 37 supernatants from the platelet concentrates with ATRs activated panel blood basophils in the absence, but not in the presence, of dasatinib. The basophil activation was inhibited by treatment of anti-fish collagen I MoAb in one case, suggesting that the involvement of fish allergens may have been present in donor plasma. We concluded that unknown non-plasma proteins, some of which had epitopes similar to fish antigens, in blood component may be involved in ATRs via an allergen/IgE-dependent pathway. PMID:25840771

  5. Total knee arthroplasty: indication of blood transfusion according to hematimetric variation and clinical symptoms of hypoperfusion☆☆☆

    PubMed Central

    Tavares Cardozo, Rodrigo; Fidelis de Souza Junior, Edison; Campoli Alves, Wagner; Barbi Filho, Flávio

    2014-01-01

    Objective To analyze the relationship between hematimetric variation and the presence of clinical symptoms of hypoperfusion for indicating blood transfusion in patients undergoing total knee arthroplasty. Methods A retrospective analysis was conducted on data gathered from the medical files of 55 patients with a diagnosis of gonarthrosis, who underwent total knee arthroplasty at a hospital orthopedics and traumatology service between February 2011 and December 2012. The patients studied presented unilateral joint degeneration and fitted into the indications for surgical treatment. All the patients underwent a preoperative cardiological evaluation, presenting a pattern of ASA I–III and absence of blood dyscrasia, and preoperative hemoglobin measurements were made. However, no minimum hematimetric value was established for the surgical treatment; there were only clinical criteria for blood perfusion. Results Among the 55 patients, 35 were female and 20 were male, and the mean age was 68 years. Six patients underwent homologous blood transfusion, because of their clinical condition of tissue hypoperfusion, persistent hypotension, loss of consciousness, sweating and coercible vomiting. They presented postoperative hemoglobin of 7.5–8.8 g/dL. Conclusion For patients with falls in hemoglobin counts greater than 20% and values lower than 9 g/dL after the surgery, there is a possible need for blood transfusion, which should only be indicated when accompanied by major symptoms of tissue hypoperfusion. PMID:26229853

  6. Transfusion associated circulatory overload.

    PubMed

    Agnihotri, Naveen; Agnihotri, Ajju

    2014-06-01

    Transfusion associated circulatory overload (TACO) is an established, but grossly under diagnosed and underreported complication of blood transfusion. We present the case of a 46-year-old diabetic and hypertensive patient admitted to our hospital for recurrent episodes of urinary retention. Over initial 3 days of the admission, the patient received multiple units of packed red blood cells (RBC) and fresh frozen plasma, uneventfully. However, the patient developed signs and symptoms suggestive of TACO with only small amount of the 4(th) unit of RBC. The patient had to be shifted to the Intensive Care Unit for further management of this complication. Etiology of TACO is more complex than a mere circulatory overload and is still not completely understood. TACO leads to a prolonged hospital stay and morbidity in the patients developing this complication. TACO thus needs to be suspected in patients at risk for this complication. PMID:24987240

  7. Quantification of Transfusion Recipients at Risk of Receiving Hepatitis B Virus-Contaminated Blood Components: A Korean Study.

    PubMed

    Lee, Kunsei; Kim, Hyeongsu; Chang, Sounghoon; Hur, Mina; Kim, Vitna; Jeong, Hyoseon; Seo, Dong Hee; Lee, SangWon; Kim, Eun Jung; Shin, Eunyoung; Kim, Young Tack

    2016-09-01

    Although there are lots of studies about the risk for the hepatitis B virus infection such as the residual risk for donated blood, there is no research on the risk of HBV infection, from the viewpoint of recipients in Korea. Using the data about HBsAg status of donated blood in 2008 and 2009, the distribution of blood components from the claim data of health insurance in 2009, the distribution of HBsAg and HBsAb of recipients, and some assumptions, we quantified the number of recipients in Korea that might be expected to receive HBV-contaminated blood components, as a proxy index for HBV infection by transfusion in 2009. Of the 376,211 recipients, the number who might be expected to receive blood components with HBV in 2009 was 23.2 (95 % CI 13.6, 36.8) in the basic model, 43.2 (95 % CI 25.4, 68.7) in extended model I, 55.2 (95 % CI 32.5, 87.7) in extended model II and 101.6 (95 % CI 59.8, 161.4) in extended model III. The number of HBV-positive samples per 100,000 transfused units was 0.6 in the basic model (95 % CI 0.3, 0.9), 1.1 in extended model I (95 % CI 0.6, 1.8), 1.4 in extended model II (95 % CI 0.8, 2.2), and 2.6 in extended model III (95 % CI 1.5, 4.1). This study showed that a few recipients might receive HBV-contaminated blood component by transfusion. These results could be used as a scientific evidence for health policy on HBV transfusion infection. PMID:27429524

  8. Pre-Trauma Center Red Blood Cell Transfusion Is Associated with Improved Early Outcomes in Air Medical Trauma Patients

    PubMed Central

    Brown, Joshua B; Sperry, Jason L; Fombona, Anisleidy; Billiar, Timothy R; Peitzman, Andrew B; Guyette, Francis X

    2015-01-01

    Background Hemorrhage is the leading cause of survivable death in trauma. Resuscitation strategies including early red blood cell (RBC) transfusion have reduced this. Pre-trauma center (PTC) RBC transfusion is growing and preliminary evidence suggests improved outcomes. The study objective was to evaluate the association of PTC RBC transfusion with outcomes in air medical trauma patients. Study Design Retrospective cohort study of trauma patients transported by helicopter to a level-I trauma center, 2007—2012. Patients receiving PTC RBC transfusion were matched to control patients (receiving no PTC RBC transfusion during transport) in a 1:2 ratio using a propensity-score based on prehospital variables. Conditional logistic regression and mixed-effects linear regression were used to determine the association of PTC RBC transfusion with outcomes. Subgroup analysis was performed for scene transport patients. Results Two-hundred forty treatment patients were matched to 480 control patients receiving no PTC RBC transfusion. PTC RBC transfusion was associated with increased odds of 24-hour survival (adjusted odds ratio [AOR] 4.92; 95%CI 1.51, 16.04, p=0.01), lower odds of shock (AOR 0.28; 95%CI 0.09, 0.85, p=0.03), and lower 24-hour RBC requirement (Coef −3.6 RBC units; 95%CI −7.0, −0.2, p=0.04). Among matched scene patients, PTC RBC was also associated with increased odds of 24-hour survival (AOR 6.31; 95%CI 1.88, 21.14, p<0.01), lower odds of shock (AOR 0.24; 95%CI 0.07, 0.80, p=0.02), and lower 24-hour RBC requirement (Coef −4.5 RBC units; 95%CI −8.3, −0.7, p=0.02). Conclusions PTC RBC was associated with an increased probability of 24-hour survival, decreased risk of shock, and lower 24-hour RBC requirement. PTC RBC appears beneficial in severely injured air medical trauma patients and prospective study is warranted as PTC RBC transfusion becomes more readily available. PMID:25840537

  9. Therapeutic options to minimize allogeneic blood transfusions and their adverse effects in cardiac surgery: A systematic review

    PubMed Central

    dos Santos, Antônio Alceu; da Silva, José Pedro; da Silva, Luciana da Fonseca; de Sousa, Alexandre Gonçalves; Piotto, Raquel Ferrari; Baumgratz, José Francisco

    2014-01-01

    Introdution Allogeneic blood is an exhaustible therapeutic resource. New evidence indicates that blood consumption is excessive and that donations have decreased, resulting in reduced blood supplies worldwide. Blood transfusions are associated with increased morbidity and mortality, as well as higher hospital costs. This makes it necessary to seek out new treatment options. Such options exist but are still virtually unknown and are rarely utilized. Objective To gather and describe in a systematic, objective, and practical way all clinical and surgical strategies as effective therapeutic options to minimize or avoid allogeneic blood transfusions and their adverse effects in surgical cardiac patients. Methods A bibliographic search was conducted using the MeSH term “Blood Transfusion” and the terms “Cardiac Surgery” and “Blood Management.” Studies with titles not directly related to this research or that did not contain information related to it in their abstracts as well as older studies reporting on the same strategies were not included. Results Treating anemia and thrombocytopenia, suspending anticoagulants and antiplatelet agents, reducing routine phlebotomies, utilizing less traumatic surgical techniques with moderate hypothermia and hypotension, meticulous hemostasis, use of topical and systemic hemostatic agents, acute normovolemic hemodilution, cell salvage, anemia tolerance (supplementary oxygen and normothermia), as well as various other therapeutic options have proved to be effective strategies for reducing allogeneic blood transfusions. Conclusion There are a number of clinical and surgical strategies that can be used to optimize erythrocyte mass and coagulation status, minimize blood loss, and improve anemia tolerance. In order to decrease the consumption of blood components, diminish morbidity and mortality, and reduce hospital costs, these treatment strategies should be incorporated into medical practice worldwide. PMID:25714216

  10. Cognitive functions in adults with β-thalassemia major: before and after blood transfusion and comparison with healthy controls.

    PubMed

    Raz, Sivan; Koren, Ariel; Dan, Orrie; Levin, Carina

    2016-07-01

    While β-thalassemia major (β-TM)-related physiological complications have been well established, less is known about implications for neuropsychological and cognitive function. The few existing studies have focused almost exclusively on children. We evaluated cognitive function in adult β-TM patients compared to healthy controls (study 1) and in β-TM patients before and after blood transfusion (study 2). Performance intelligence quotient (IQ) was evaluated with four subtests from the Wechsler Adult Intelligence Scale (WAIS-III). Attention functions were evaluated using the online continuous performance test (OCPT). The results of study 1 revealed poorer performance of β-TM patients on three of the four intelligence subtests, with significantly lower total performance IQ scores compared with controls. The percentage of participants with abnormal performance IQ (<85) was almost five times higher in the β-TM group (58%) than in the control group (12%). In study 2, significant differences were found in OCPT performance as a function of blood transfusion. Before transfusion, patients had higher rates of omission and commission errors, slower response times (RTs), and lower RT consistency than after transfusion. As β-TM patients' life expectancy is increasing, assessment and treatment of neurocognitive functions should become an integral part of appropriate follow-up to improve patients' quality of life. PMID:27447535

  11. Infusion pumps and red blood cell damage in transfusion therapy: an integrative revision of the academic literature 1

    PubMed Central

    Wilson, Ana Maria Miranda Martins; Peterlini, Maria Angélica Sorgini; Pedreira, Mavilde da Luz Gonçalves

    2016-01-01

    ABSTRACT Objectives: to obtain information from scientific literature concerning infusion pumps used in administering erythrocyte (red blood cells) and to evaluate the implications in the practical use of this equipment by nurses when conducting transfusions. Method: an integrative revision of the following scientific databases: Pubmed/Medline, Scopus, the Virtual Library for Health, SciELO, Web of Science and Cochrane. The following descriptors were used: "infusion pumps", "blood transfusion", "transfused erythrocyte" and "hemolyis". There were no restrictions on the scope of the initial data and it was finalized in December 2014. 17 articles were identified in accordance with the inclusion and exclusion criteria. Results: all of the publications included in the studies were experimental in vitro and covered the use of infusion pumps in transfusion therapy. A summary of the data was presented in a synoptic chart and an analysis of it generated the following categories: cellular damage and the infusion mechanism. Conclusion: infusion pumps can be harmful to erythrocytes based on the infusion mechanism that is used, as the linear peristaltic pump is more likely to cause hemolysis. Cellular damage is related to the plasmatic liberation of markers that largely dominate free hemoglobin and potassium. We reiterate the need for further research and technological investments to guide the development of protocols that promote safe practices and that can contribute to future clinical studies. PMID:27533272

  12. Does the preoperative administration of tranexamic acid reduce perioperative blood loss and transfusion requirements after head neck cancer surgery? A randomized, controlled trial

    PubMed Central

    Das, Anjan; Chattopadhyay, Surajit; Mandal, Debabrata; Chhaule, Subinay; Mitra, Tapobrata; Mukherjee, Anindya; Mandal, Subrata Kumar; Chattopadhyay, Sandip

    2015-01-01

    Background: Head and neck cancer (HNC) surgery is associated with high intraoperative blood loss which may require urgent blood transfusion. Many strategies have been recommended to decrease the need for allogenic transfusion. Use of perioperative tranexamic acid (TA) has a promising role. Aims: This study was to evaluate the effectiveness of single preoperative bolus dose of TA on blood loss prevention and red blood cell transfusion in patients undergoing HNC surgery. Study Design: A prospective, double-blind, and randomized controlled study. Materials and Methods: From 2007 July to 2010 January; 80 patients, aged (35–55), of American Society of Anesthesiologists II-III scheduled for unilateral HNC surgeries were randomly received either TA (Group T) in a dose of 20 mg/kg diluted to 25 cc with normal saline or an equivalent volume of normal saline (Group C) in a tertiary care hospital. Hemoglobin (Hb) concentration, platelet count, packed cell volume, fibrinogen level, D-dimer level were measured pre- and post-operatively. Results: Saline (C) Group required more blood, colloid, crystalloid for blood loss. In Group T, 32 patients did not require transfusion of any blood products compared to five patients in Group C (P < 0.0001) and only eight units of blood was transfused in Group T, whereas a total of 42 units of blood was transfused in Group C. Even after numerous transfusions, Hb% after 6 h and 24 h in Group C were significantly low in comparison with Group T (P < 0.05). Conclusion: Thus, TA significantly reduces blood loss and chances of colloid, blood, and crystalloid transfusion caused by HNC surgery. PMID:26712979

  13. Delirium Outcomes in a Randomized Trial of Blood Transfusion Thresholds Among Hospitalized Older Patients with Hip Fracture

    PubMed Central

    Gruber-Baldini, Ann L; Marcantonio, Edward; Orwig, Denise; Magaziner, Jay; Terrin, Michael; Barr, Erik; Brown, Jessica Pelletier; Paris, Barbara; Zagorin, Aleksandra; Roffey, Darren M.; Zakriya, Khwaja; Blute, Mary-Rita; Hebel, J. Richard; Carson, Jeffrey L.

    2013-01-01

    Objectives To determine if a higher blood transfusion threshold would prevent new or worsening delirium symptoms in the hospital after hip fracture surgery. Design Ancillary study to a randomized clinical trial. Setting Thirteen hospitals in United States and Canada. Participants One-hundred-thirty-nine hospitalized hip fracture patients, age ≥50, with cardiovascular disease or risk factors, and hemoglobin<10 g/dL within 3 days of surgery, recruited in an ancillary study of “Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair (FOCUS) trial.” Intervention Treatment groups: 1) Liberal: received one unit of packed red blood cells and as much blood as needed to maintain hemoglobin >10 g/dL; 2) Restrictive: received transfusions if developed symptoms of anemia or hemoglobin fell below 8 g/dL. Measurements Delirium assessments performed pre-randomization and up to three times post-randomization. Primary outcome: Severity of delirium using Memorial Delirium Assessment Scale (MDAS) scale. Secondary outcome: presence or absence of delirium defined by Confusion Assessment Method Diagnostic Algorithm (CAM). Results Mean age was 81.5 (SD=9.1). Liberal group received a median 2 units and Restrictive group 0 units of blood. Hemoglobin concentration on day 1 post randomization was 1.4 g/dL higher in the Liberal group. Treatment groups did not significantly differ at any time point or over time on either MDAS delirium severity (p=0.28) or CAM delirium presence (p=0.83). Conclusion Blood transfusion to maintain hemoglobin >10 g/dL alone is unlikely to influence delirium severity or rate in postoperative hip fracture patients with hemoglobin concentration <10 g/dL. Trial Registration ClinicalTrials.gov identifier: NCT00071032 http://clinicaltrials.gov/ct2/show/NCT00071032 PMID:23898894

  14. Targeting Continuing Medical Education on Decision Makers: Who Decides to Transfuse Blood?

    ERIC Educational Resources Information Center

    Goodnough, Lawrence T.; And Others

    1992-01-01

    Staff communication patterns were observed during 13 open-heart surgeries to identify the transfusion decision makers. It was determined that targeting decision makers for continuing medical education would improve the quality of transfusion practice and increase the efficiency of continuing education. (SK)

  15. Trend of transfusion transmitted infections frequency in blood donors: provide a road map for its prevention and control

    PubMed Central

    2012-01-01

    Background Transfusion transmitted infections create significant burden on health care system. Donor selection is of paramount importance because infected individuals serve as an asymptomatic reservoir and a potential source of transmission. Methods A retrospective study was carried out in healthy blood donors in the Lady Reading Hospital Peshawar, Pakistan over a period of three and a half years i.e., from January 2008 to June 2011, to determine the prevalence of HBV, HCV, HIV and syphilis in order to provide information for relevant polices. Results Out of 1,27,828 sample of blood donors, recorded mean prevalence for HBs Ag, anti-HCV, anti-HIV and syphilis was 2.68%, 2.46%, 0.06% and 0.43%, respectively, with an increasing trend in frequencies of transfusion transmitted infections (TTIs). Conclusions This study reflects that blood transfusion is one of the leading risk factor of spread of the TTIs, which showed the need and importance of the mandatory screening of these infectious markers in blood donations. PMID:22293125

  16. Cancer patients' willingness to pay for blood transfusions at home: results from a contingent valuation study in a French cancer network.

    PubMed

    Havet, Nathalie; Morelle, Magali; Remonnay, Raphaël; Carrere, Marie-Odile

    2012-06-01

    Home blood transfusion may be an interesting alternative to hospital transfusion, especially when given with curative or palliative intent or for terminal care in advanced-stage cancer patients. However, there is limited information about patients' attitude toward this type of care. The purpose of this study was to measure French cancer patients' willingness to pay (WTP) for home blood transfusion and to analyze determinants of their choice. A contingent valuation survey was administered to 139 patients receiving transfusions in the framework of a regional home care network or in the hospital outpatient department. Participation was high (90%). Most patients (65%) had received home care, including 43% blood transfusions. Just under half of the patients gave a zero WTP, among which we identified 8 protest bidders. The median WTP for home blood transfusion was 26.5 per patient. In multivariate analysis, long home-hospital distance, poor quality of life, and previous experience of home care were identified as important factors in determining how much more patients would be willing to pay for transfusion at home. These results demonstrate the benefits of developing domiciliary services to improve patient well-being, notably for the weakest among them. The significant impact of previous home care experience on WTP is probably related to the strong involvement of physicians from the blood center and to their active contribution to a high-level homecare network. Some of our findings could be useful for policy decision-making regarding home care. PMID:21660563

  17. Blood - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Blood URL of this page: https://www.nlm.nih.gov/medlineplus/languages/blood.html Other topics A-Z A B ...

  18. Application of DNA-based forensic analysis for the detection of homologous transfusion of whole blood and of red blood cell concentrates in doping control.

    PubMed

    Stampella, Alessandra; Di Marco, Sabrina; Pirri, Daniela; de la Torre, Xavier; Botrè, Francesco; Donati, Francesco

    2016-08-01

    In this work we present the application of a method for the identification of homologous blood transfusions using forensic genetic techniques based on DNA typing. Ex vivo mixtures of human blood samples - either whole blood or red blood cell concentrates - simulating homologous blood transfusions at different percentages of the donor were typed for a panel of 16 highly variable DNA short tandem repeats (STR). Tested samples included also mixtures, which gave false-negative results if assayed by the reference flow cytofluorimetric method, which is based on the recognition of target antigens located on the membrane of the red blood cell. The recognition of triplets and quadruplets at various loci gave information of the presence of cells belonging to different individuals, as it is the case for homologous blood transfusions. Specificity and sensitivity of the method were assessed in the validation study. The method proved to be unequivocally specific since it was able to recognize all single profiles of each individual, clearly discriminating them from mixtures. Sensitivity resulted as a consequence of the percentage of the donor aliquot in the total volume of the mixture. Although the source of DNA in a blood sample is represented only by nucleated white blood cells, the same procedure resulted effective also in detecting mixtures of red blood cell concentrates (RBCC) from leukodepletion procedure: DNA of the donor from the residual white blood cells resulted still detectable, even if with an expected loss of sensitivity. The proposed approach may contribute to reduce the risk of false-negative results, which may occur using the reference cytofluorimetric method. PMID:27175858

  19. Intraoperative transfusion practices in Europe

    PubMed Central

    Meier, J.; Filipescu, D.; Kozek-Langenecker, S.; Llau Pitarch, J.; Mallett, S.; Martus, P.; Matot, I.

    2016-01-01

    Background. Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl−1 and increased to 9.8 (1.8) g dl−1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusion. Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7–9 g dl−1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold. Clinical trial registration. NCT 01604083. PMID:26787795

  20. Anti-Platelet Therapy is Associated With Decreased Transfusion-Associated Risk of Lung Dysfunction, Multiple Organ Failure, and Mortality in Trauma Patients

    PubMed Central

    Harr, Jeffrey N.; Moore, Ernest E.; Johnson, Jeffrey; Chin, Theresa L.; Wohlauer, Max V.; Maier, Ronald; Cuschieri, Joseph; Sperry, Jason; Banerjee, Anirban; Silliman, Christopher C.; Sauaia, Angela

    2012-01-01

    Objective To determine whether pre-hospital anti-platelet therapy (APT) was associated with reduced incidence of acute lung dysfunction, multiple organ failure (MOF), and mortality in blunt trauma patients. Design Secondary analysis of a cohort enrolled in the NIGMS Trauma Glue Grant database. Setting Multicenter study including 9 US level-1 trauma centers. Patients A total of 839 severely injured blunt trauma patients at risk for MOF (age >45 years, base deficit > 6 mEq/L or systolic blood pressure < 90 mmHg, who received a blood transfusion). Severe/isolated head injuries were excluded. Measurements and Main Results Primary outcomes were lung dysfunction (defined as grades 2–3 by the Denver MOF score), MOF (Denver MOF score>3), and mortality. Patients were documented as on APT if taking acetylsalicylic acid, clopidogrel, and/or ticlopidine. Fifteen percent were taking APT prior to injury. Median injury severity score (ISS) was 30 (interquartile range, IQR: 22–51), mean age 61 ± 0.4 years and median red blood cells (RBC) volume transfused was 1700 ml (IQR: 800–3150ml). Overall, 63% developed lung dysfunction, 19% had MOF, and 21% died. After adjustment for age, gender, comorbidities, blood products, crystalloid/12hrs, presence of any head injury, ISS, and 12hrs base deficit >8 mEq/L, 12 hrs RBC transfusion was associated with a significantly smaller risk of lung dysfunction and MOF among the group receiving APT compared to those not receiving it (lung dysfunction p=0.0116, MOF p=0.0291). In addition, APT had a smaller risk (albeit not significant, p=0.06) of death for patients receiving RBC compared to those not on APT after adjustment for confounders, Conclusions Pre-injury APT therapy is associated with a decreased risk of lung dysfunction, MOF, and possibly mortality in high-risk blunt trauma patients who received blood transfusions. These findings suggest platelets have a role in organ dysfunction development and have potential therapeutic implications

  1. [The beneficial role of blood transfusion and preganancy in the survival of renal allografts].

    PubMed

    Buy-Quang, D; Soulillou, J P; Fontenaille, C; Guimbretière, J; Guenel, J

    1977-11-12

    This analysis involves 93 cases of transplants of non-related cadaver kidneys. The result was better (p = 0.02 at 1 year) in recipients transfused before the graft (73 cases) than in those who had not been trasfused (20 cases). However, this latter group had a shorter average period of haemodialysis (p = 0.05 than the first. The benefits of pre-immunisation appear from 1 to 2 transfusions or 1 pregnancy onwards (p = 0.02 at 1 year). Subjects transfused during the 6 months prior to the transplant had a graft which was functional more often than those who had been more than 6 months before the operation (p = 0.01 at 6 months). These results would be in favour of routine small quantity transfusions, approximately every six months in patients undergoing haemodialysis and on a waiting list for transplantation. PMID:341078

  2. Malaria and blood transfusion: major issues of blood safety in malaria-endemic countries and strategies for mitigating the risk of Plasmodium parasites.

    PubMed

    Abdullah, Saleh; Karunamoorthi, Kaliyaperumal

    2016-01-01

    Malaria inflicts humankind over centuries, and it remains as a major threat to both clinical medicine and public health worldwide. Though hemotherapy is a life-sustaining modality, it continues to be a possible source of disease transmission. Hence, hemovigilance is a matter of grave concern in the malaria-prone third-world countries. In order to pursue an effective research on hemovigilance, a comprehensive search has been conducted by using the premier academic-scientific databases, WHO documents, and English-language search engines. One hundred two appropriate articles were chosen for data extraction, with a particular reference to emerging pathogens transmitted through blood transfusion, specifically malaria. Blood donation screening is done through microscopic examination and immunological assays to improve the safety of blood products by detection major blood-borne pathogens, viz., HIV, HBV, HCV, syphilis, and malarial parasites. Transfusion therapy significantly dwindles the preventable morbidity and mortality attributed to various illnesses and diseases, particularly AIDS, tuberculosis, and malaria. Examination of thick and thin blood smears are performed to detect positivity and to identify the Plasmodium species, respectively. However, all of these existing diagnostic tools have their own limitations in terms of sensitivity, specificity, cost-effectiveness, and lack of resources and skilled personnel. Globally, despite the mandate need of screening blood and its components according to the blood-establishment protocols, it is seldom practiced in the low-income/poverty-stricken settings. In addition, each and every single phase of transfusion chain carries sizable inherent risks from donors to recipients. Interestingly, opportunities also lie ahead to enhance the safety of blood-supply chain and patients. It can be achieved through sustainable blood-management strategies like (1) appropriate usage of precise diagnostic tools/techniques, (2) promoting

  3. Fate in humans of the plasticizer, DI (2-ethylhexyl) phthalate, arising from transfusion of platelets stored in vinyl plastic bags. [plasticizer migration into human blood from vinyl plastic bags during transfusion

    NASA Technical Reports Server (NTRS)

    Rubin, R. J.; Schiffer, C. A.

    1975-01-01

    Platelet concentrates were shown to contain 18-38 mg/100 ml of a phthalate plasticizer (DEHP) which arose by migration from the vinyl plastic packs in which the plateletes were prepared and stored. Transfusion of these platelets into 6 adult patients with leukemia resulted in peak blood plasma levels of DEHP ranging from 0.34 - 0.83 mg/100 ml. The blood levels fell mono-exponentially with a mean rate of 2.83 percent per minute and a half-life of 28.0 minutes. Urine was assayed by a method that would measure unchanged DEHP as well as all phthalic acid-containing metabolities. In two patients, at most 60 and 90% of the infused dose, respectively, was excreted in the urine collected for 24 hours post-transfusion. These estimates, however, could be high due to the simultaneous excretion of DEHP remaining from previous transfusions or arising from uncontrolled environmental exposures.

  4. Transfusion medicine

    SciTech Connect

    Murawski, K.; Peetoom, F.

    1986-01-01

    These proceedings contain 24 selections, including papers presented at the conference of American Red Cross held in May 1985, on the Subject of transfusion medicine. Some of the titles are: Fluosol/sup R/-DA in Radiation Therapy; Expression of Cloned Human Factor VIII and the Molecular Basis of Gene Defects that Cause Hemophilia; DNA-Probing Assay in the Detection of Hepatitis B Virus Genome in Human Peripheral Blood Cells; and Monoclonal Antibodies: Convergence of Technology and Application.

  5. Error management in blood establishments: results of eight years of experience (2003–2010) at the Croatian Institute of Transfusion Medicine

    PubMed Central

    Vuk, Tomislav; Barišić, Marijan; Očić, Tihomir; Mihaljević, Ivanka; Šarlija, Dorotea; Jukić, Irena

    2012-01-01

    Background. Continuous and efficient error management, including procedures from error detection to their resolution and prevention, is an important part of quality management in blood establishments. At the Croatian Institute of Transfusion Medicine (CITM), error management has been systematically performed since 2003. Materials and methods. Data derived from error management at the CITM during an 8-year period (2003–2010) formed the basis of this study. Throughout the study period, errors were reported to the Department of Quality Assurance. In addition to surveys and the necessary corrective activities, errors were analysed and classified according to the Medical Event Reporting System for Transfusion Medicine (MERS-TM). Results. During the study period, a total of 2,068 errors were recorded, including 1,778 (86.0%) in blood bank activities and 290 (14.0%) in blood transfusion services. As many as 1,744 (84.3%) errors were detected before issue of the product or service. Among the 324 errors identified upon release from the CITM, 163 (50.3%) errors were detected by customers and reported as complaints. In only five cases was an error detected after blood product transfusion however without any harmful consequences for the patients. All errors were, therefore, evaluated as “near miss” and “no harm” events. Fifty-two (2.5%) errors were evaluated as high-risk events. With regards to blood bank activities, the highest proportion of errors occurred in the processes of labelling (27.1%) and blood collection (23.7%). With regards to blood transfusion services, errors related to blood product issuing prevailed (24.5%). Conclusion. This study shows that comprehensive management of errors, including near miss errors, can generate data on the functioning of transfusion services, which is a precondition for implementation of efficient corrective and preventive actions that will ensure further improvement of the quality and safety of transfusion treatment. PMID

  6. Perioperative Allogeneic Blood Transfusion Is Associated With Surgical Site Infection After Abdominoperineal Resection-a Space for the Implementation of Patient Blood Management Strategies.

    PubMed

    Kaneko, Kensuke; Kawai, Kazushige; Tsuno, Nelson H; Ishihara, Soichiro; Yamaguchi, Hironori; Sunami, Eiji; Watanabe, Toshiaki

    2015-05-01

    Allogeneic blood transfusion (ABT) has been reported as a major risk factor for surgical site infection (SSI) in patients undergoing colorectal surgery. However, the association of ABT with SSI in patients undergoing abdominoperineal resection (APR) and total pelvic exenteration (TPE) still remains to be evaluated. Here, we aim to elucidate this association. The medical records of all patients undergoing APR and TPE at our institution in the period between January 2000 and December 2012 were reviewed. Patients without SSI (no SSI group) were compared with patients who developed SSI (SSI group), in terms of clinicopathologic features, including ABT. In addition, data for 262 patients who underwent transabdominal rectal resection at our institution in the same period were also enrolled, and their data on differential leukocyte counts were evaluated. Multivariate analysis showed that intraoperative transfusion was an independent predictive factor for SSI after APR and TPE (P = 0.004). In addition, the first-operative day lymphocyte count of patients undergoing APR, TPE, and transabdominal rectal resection was significantly higher in nontransfusion patients compared with transfusion ones (P = 0.026). ABT in the perioperative period of APR and TPE may have an important immunomodulatory effect, leading to an increased incidence of SSI. This fact should be carefully considered, and efforts to avoid allogeneic blood exposure while still achieving adequate patient blood management would be very important for patients undergoing APR and TPE as well. PMID:26011197

  7. Perioperative Allogeneic Blood Transfusion Is Associated With Surgical Site Infection After Abdominoperineal Resection—a Space for the Implementation of Patient Blood Management Strategies

    PubMed Central

    Kaneko, Kensuke; Kawai, Kazushige; Tsuno, Nelson H.; Ishihara, Soichiro; Yamaguchi, Hironori; Sunami, Eiji; Watanabe, Toshiaki

    2015-01-01

    Allogeneic blood transfusion (ABT) has been reported as a major risk factor for surgical site infection (SSI) in patients undergoing colorectal surgery. However, the association of ABT with SSI in patients undergoing abdominoperineal resection (APR) and total pelvic exenteration (TPE) still remains to be evaluated. Here, we aim to elucidate this association. The medical records of all patients undergoing APR and TPE at our institution in the period between January 2000 and December 2012 were reviewed. Patients without SSI (no SSI group) were compared with patients who developed SSI (SSI group), in terms of clinicopathologic features, including ABT. In addition, data for 262 patients who underwent transabdominal rectal resection at our institution in the same period were also enrolled, and their data on differential leukocyte counts were evaluated. Multivariate analysis showed that intraoperative transfusion was an independent predictive factor for SSI after APR and TPE (P = 0.004). In addition, the first–operative day lymphocyte count of patients undergoing APR, TPE, and transabdominal rectal resection was significantly higher in nontransfusion patients compared with transfusion ones (P = 0.026). ABT in the perioperative period of APR and TPE may have an important immunomodulatory effect, leading to an increased incidence of SSI. This fact should be carefully considered, and efforts to avoid allogeneic blood exposure while still achieving adequate patient blood management would be very important for patients undergoing APR and TPE as well. PMID:26011197

  8. Antibodies to Leptospira among blood donors in higher-risk areas of Australia: possible implications for transfusion safety

    PubMed Central

    Faddy, Helen; Seed, Clive; Lau, Colleen; Racloz, Vanessa; Flower, Robert; Smythe, Lee; Burns, Mary-Anne; Dohnt, Michael; Craig, Scott; Harley, Robert; Weinstein, Philip

    2015-01-01

    Background Leptospirosis is one of the most common bacterial zoonoses worldwide, and clinical manifestations range from asymptomatic infection to acute febrile illness, multi-organ failure and death. Asymptomatic, acute bacteraemia in a blood donor provides a potential for transfusion-transmission, although only a single such case from India has been recorded. Human leptospirosis is uncommon in developed countries; however, the state of Queensland in Australia has one of the highest rates among developed countries, especially after increased rainfall. This study examined the prevalence of antibodies to Leptospira spp. in blood donors residing in higher-risk areas of Australia, to evaluate the appropriateness of current blood safety guidelines. Materials and methods Plasma samples collected from blood donors residing in higher-risk areas of Australia during 2009 and 2011 were included in the study. All samples were tested for the presence of antibodies to 22 leptospiral serovars using the microscopic agglutination test. Result No sample had antibody titres suggestive of a current or recent infection, however, seven samples (1.44%, 95% CI: 0.38–2.50%) had titres suggestive of a past infection. Discussion This study provides data that may support the appropriateness of current relevant donor selection policies in Australia. Given that the risk profile for leptospirosis is expanding and that the infection is likely to become more prevalent with climate change, this disease may become more of a concern for transfusion safety in the future. PMID:24960651

  9. Prophylactic use of tranexamic acid combined with thrombelastogram guided coagulation management may reduce blood loss and allogeneic transfusion in pediatric hemispherectomy: case series.

    PubMed

    Xiao, Wei; Fu, Wenya; Wang, Tianlong; Zhao, Lei

    2016-09-01

    Hemispherectomy is an established surgical procedure to treat medically refractory epilepsy caused by diffuse hemispheric diseases. The most common complication of hemispherectomy is intraoperative bleeding. Perioperative allogeneic blood transfusion increases mortality and morbidity in pediatric patients. Etiologies of massive blood loss during hemispherectomy include intraoperative diffuse vascular damage, antileptic drugs induced coagulation dysfunction, hyperfibrinolysis and dilutional coagulopathy. Great efforts should be made to minimize the need of blood transfusion. We present a series of three cases undergoing pediatric hemispherectomy, where a new algorithm was employed to manage coagulation. This new algorithm was mainly based on timely thrombelastogram analyses guided clotting factors supplement and continuous administration of tranexamic acid. In our cases, the amount of blood loss and subsequent allogeneic blood transfusion seemed to be less than literature reported. PMID:27555151

  10. Ethical issues in transfusion medicine.

    PubMed

    Elhence, Priti

    2006-01-01

    The practice of transfusion medicine involves a number of ethical issues because blood comes from human beings and is a precious resource with a limited shelf life. In 1980 the International Society of Blood Transfusion endorsed its first formal code of ethics, which was adopted by the World Health Organisation and the League of Red Crescent Societies. A revised code of ethics for donation and transfusion was endorsed in 2000. Blood donation as a gift, donor confidentiality, donor notification and donor consent, consent for transfusion, the right to refuse blood transfusion, the right to be informed if harmed, and ethical principles for establishments, are discussed in the international and Indian contexts. PMID:17223681

  11. Anemia, Blood Transfusion Requirements and Mortality Risk in Human Immunodeficiency Virus-Infected Adults Requiring Acute Medical Admission to Hospital in South Africa

    PubMed Central

    Kerkhoff, Andrew D.; Lawn, Stephen D.; Schutz, Charlotte; Burton, Rosie; Boulle, Andrew; Cobelens, Frank J.; Meintjes, Graeme

    2015-01-01

    Background. Morbidity and mortality remain high among hospitalized patients infected with human immunodeficiency virus (HIV) in sub-Saharan Africa despite widespread availability of antiretroviral therapy. Severe anemia is likely one important driver, and some evidence suggests that blood transfusions may accelerate HIV progression and paradoxically increase short-term mortality. We investigated the relationship between anemia, blood transfusions, and mortality in a South African district hospital. Methods. Unselected consecutive HIV-infected adults requiring acute medical admission to a Cape Town township district hospital were recruited. Admission hemoglobin concentrations were used to classify anemia severity according to World Health Organization/AIDS Clinical Trials Group criteria. Vital status was determined at 90 days, and Cox regression analyses were used to determine independent predictors of mortality. Results. Of 585 HIV-infected patients enrolled, 578 (98.8%) were included in the analysis. Anemia was detected in 84.8% of patients and was severe (hemoglobin, 6.5–7.9 g/dL) or life-threatening (hemoglobin, <6.5 g/dL) in 17.3% and 13.3%, respectively. Within 90 days of the date of admission, 13.5% (n = 78) patients received at least 1 blood transfusion with red cell concentrate and 77 (13.3%) patients died. In univariable analysis, baseline hemoglobin and receipt of blood transfusion were associated with increased mortality risk. However, in multivariable analysis, neither hemoglobin nor receipt of a blood transfusion were independently associated with greater mortality risk. Acquired immune deficiency syndrome-defining illnesses other than tuberculosis and impaired renal function independently predicted mortality. Conclusions. Newly admitted HIV-infected adults had a high prevalence of severe or life-threatening anemia and blood transfusions were frequently required. However, after adjustment for confounders, blood transfusions did not confer an

  12. Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

    PubMed Central

    Brown, Joshua B.; Cohen, Mitchell J.; Minei, Joseph P.; Maier, Ronald V.; West, Michaela A.; Billiar, Timothy R.; Peitzman, Andrew B.; Moore, Ernest E.; Cuschieri, Joseph; Sperry, Jason L.; Inflammation, The

    2014-01-01

    Objective To evaluate the association of pretrauma center (PTC) red blood cell (RBC) transfusion with outcomes in severely injured patients. Background Hemorrhage remains a major driver of mortality. Little evidence exists supporting PTC interventions to mitigate this. Methods Blunt injured patients in shock arriving at a trauma center within 2 hours of injury were included from the Glue Grant database. Subjects were dichotomized by PTC RBC transfusion. Outcomes included 24-hour mortality, 30-day mortality, and trauma-induced coagulopathy [(TIC), admission international normalized ratio >1.5]. Cox regression and logistic regression determined the association of PTC RBC transfusion with outcomes. To address baseline differences, propensity score matching was used. Results Of 1415 subjects, 50 received PTC RBC transfusion. Demographics and injury severity score were similar. The PTC RBC group received 1.3 units of RBCs (median), and 52% were scene transports. PTC RBC transfusion was associated with a 95% reduction in odds of 24-hour mortality [odds ratio (OR) = 0.05; 95% confidence interval (CI), 0.01–0.48; P < 0.01], 64% reduction in the risk of 30-day mortality [hazard ratio = 0.36; 95% CI, 0.15–0.83; P = 0.02], and 88% reduction in odds of TIC (OR = 0.12; 95% CI, 0.02–0.79; P = 0.03). The matched cohort included 113 subjects (31% PTC RBC group). Baseline characteristics were similar. PTC RBC transfusion was associated with a 98% reduction in odds of 24-hour mortality (OR = 0.02; 95% CI, 0.01–0.69; P = 0.04), 88% reduction in the risk of 30-day mortality (hazard ratio = 0.12; 95% CI, 0.03–0.61; P = 0.01), and 99% reduction in odds of TIC (OR = 0.01; 95% CI, 0.01–0.95; P = 0.05). Conclusions PTC RBC administration was associated with a lower risk of 24-hour mortality, 30-day mortality, and TIC in severely injured patients with blunt trauma, warranting further prospective study. PMID:24670858

  13. Exjade® (deferasirox, ICL670) in the treatment of chronic iron overload associated with blood transfusion

    PubMed Central

    Cappellini, Maria Domenica

    2007-01-01

    Although blood transfusions are important for patients with anemia, chronic transfusions inevitably lead to iron overload as humans cannot actively remove excess iron. The cumulative effects of iron overload lead to significant morbidity and mortality, if untreated. Although the current reference standard iron chelator deferoxamine has been used clinically for over four decades, its effectiveness is limited by a demanding therapeutic regimen that leads to poor compliance. Deferasirox (Exjade®, ICL670, Novartis Pharma AG, Basel, Switzerland) is a once-daily, oral iron chelator approved for the treatment of transfusional iron overload in adult and pediatric patients. The efficacy and safety of deferasirox have been established in a comprehensive clinical development program involving patients with various transfusion-dependent anemias. Deferasirox has a dose-dependent effect on iron burden, and is as efficacious as deferoxamine at comparable therapeutic doses. Deferasirox therapy can be tailored to a patient’s needs, as response is related to both dose and iron intake. Since deferasirox has a long half-life and is present in the plasma for 24 hours with once-daily dosing, it is unique in providing constant chelation coverage with a single dose. The availability of this convenient, effective, and well tolerated therapy represents a significant advance in the management of transfusional iron overload. PMID:18360637

  14. The Medical Event Reporting System for Transfusion Medicine: will it help get the right blood to the right patient?

    PubMed

    Kaplan, Harold S; Callum, Jeannie L; Rabin Fastman, Barbara; Merkley, Lisa L

    2002-04-01

    The Medical Event Reporting System for Transfusion Medicine (MERS-TM) collects, classifies, and analyzes events that potentially could compromise the safety of transfused blood to facilitate system improvement. This system is designed to collect data on near misses as well as actual events. Near-miss events are a valuable source of data because they occur more frequently than, but share many characteristics and causes of, actual events. Further, although most current reporting efforts describe only what has occurred with little attention to what caused the event, MERS-TM includes a standardized method of causal analysis. The standardization provided by MERS allows users to compare their experience with that of other organizations, which speeds learning across the entire transfusion medicine community. Important features of the MERS-TM system are that it is able to capture threats, hazards, near misses, injuries, and deaths; characterizes failures and recoveries systematically; identifies and provides causal codes for the entire range of system defects including technical, organizational, cultural, and human factors; raises staff awareness about error management; is easily integrated with existing quality assurance programs; has a consistent and straightforward classification method; enables compliance with mandatory Food and Drug Administration reporting and accreditation requirements; has features to deal with a high volume of reports; supplies Web-based training, data entry, and analysis; and provides comparative benchmarks from comparable institutions. PMID:11941572

  15. Tranexamic acid reduces blood loss and need of blood transfusion in total knee arthroplasty: A prospective, randomized, double-blind study in Indian population

    PubMed Central

    Shinde, Abhishek; Sobti, Anshul; Maniar, Shriji; Mishra, Amit; Gite, Raju; Shetty, Vivek

    2015-01-01

    Introduction: For quite a few years, tranexamic acid (TEA) has been used during total knee arthroplasty (TKA) to reduce blood loss. However, no consensus exits regarding its timing and doses. Materials and Methods: We conducted a prospective, randomized double-blinded study of 56 patients in the Indian population undergoing TKA from 2011 to 2012. A dose of 10 mg/kg body weight of TEA (three doses) was given in one group and normal saline was administered in the other. Results: The mean blood loss in the TEA unilateral group was 295 mL ± 218 mL and in the placebo group was 482 mL ± 186 mL (P < 0.005). In the bilateral TEA group, the mean blood loss was 596 mL ± 235 mL and in the placebo group was 1349 mL ± 41 mL (P < 0.005). Conclusion: The number of patients requiring blood transfusion reduced substantially. There was no increase in the risk of deep vein thrombosis (DVT) and pulmonary embolism. TEA reduces intraoperative and postoperative blood loss and thus reduces the need of allogenic blood transfusion. PMID:26420938

  16. Effect of induced hypotensive anaesthesia vs isovolaemic haemodilution on blood loss and transfusion requirements in orthognathic surgery: a prospective, single-blinded, randomized, controlled clinical study.

    PubMed

    Ervens, J; Marks, C; Hechler, M; Plath, T; Hansen, D; Hoffmeister, B

    2010-12-01

    Induced hypotensive anaesthesia and isovolaemic haemodilution are well-established blood-sparing techniques in major surgery. This prospective study compared them for blood loss, transfusion requirements, and surgical field quality during standardized orthognathic operations. In a surgeon-blinded trial, 60 healthy patients requiring either Le Fort I osteotomy or bimaxillary surgery were randomly allocated to receive normotensive anaesthesia, induced hypotensive anaesthesia, or induced hypotensive anaesthesia combined with isovolaemic haemodilution. Blood loss and haemoglobin level were measured intraoperatively and calculated on postoperative day 3. The surgeons rated surgical field quality. Mean blood loss was 1021.63, 392.38 (p<0.05) and 1191.65ml in the normotensive, hypotensive and haemodilution groups, respectively. Mean haemoglobin level immediately after surgery was 9.3, 10.3, and 7.4g/dl (p<0.05), respectively. No hypotensive group patients received transfusions; four normotensive group patients required allogenic transfusions; seven haemodilution group patients needed autogenous retransfusions (p<0.05). Surgical field quality was significantly better in the hypotensive than in the normotensive (p<0.05) or haemodilution (p<0.05) groups. In orthognathic surgery, hypotensive anaesthesia significantly reduces blood loss and transfusion requirements and minimizes allogenic transfusions risks. Induced hypotensive anaesthesia combined with isovolaemic haemodilution has no additional blood-sparing effects but impairs surgical field quality. PMID:20961738

  17. Transfusion of fresher vs older red blood cells in hospitalized patients: a systematic review and meta-analysis.

    PubMed

    Alexander, Paul E; Barty, Rebecca; Fei, Yutong; Vandvik, Per Olav; Pai, Menaka; Siemieniuk, Reed A C; Heddle, Nancy M; Blumberg, Neil; McLeod, Shelley L; Liu, Jianping; Eikelboom, John W; Guyatt, Gordon H

    2016-01-28

    The impact of transfusing fresher vs older red blood cells (RBCs) on patient-important outcomes remains controversial. Two recently published large trials have provided new evidence. We summarized results of randomized trials evaluating the impact of the age of transfused RBCs. We searched MEDLINE, EMBASE, CINAHL, the Cochrane Database for Systematic Reviews, and Cochrane CENTRAL for randomized controlled trials enrolling patients who were transfused fresher vs older RBCs and reported outcomes of death, adverse events, and infection. Independently and in duplicate, reviewers determined eligibility, risk of bias, and abstracted data. We conducted random effects meta-analyses and rated certainty (quality or confidence) of evidence using the GRADE approach. Of 12 trials that enrolled 5229 participants, 6 compared fresher RBCs with older RBCs and 6 compared fresher RBCs with current standard practice. There was little or no impact of fresher vs older RBCs on mortality (relative risk [RR], 1.04; 95% confidence interval [CI], 0.94-1.14; P = .45; I(2) = 0%, moderate certainty evidence) or on adverse events (RR, 1.02; 95% CI, 0.91-1.14; P = .74; I(2) = 0%, low certainty evidence). Fresher RBCs appeared to increase the risk of nosocomial infection (RR, 1.09; 95% CI, 1.00-1.18; P = .04; I(2) = 0%, risk difference 4.3%, low certainty evidence). Current evidence provides moderate certainty that use of fresher RBCs does not influence mortality, and low certainty that it does not influence adverse events but could possibly increase infection rates. The existing evidence provides no support for changing practices toward fresher RBC transfusion. PMID:26626995

  18. Transfusion of Red Blood Cells Is Associated With Improved Central Venous Oxygen Saturation But Not Mortality in Septic Shock Patients

    PubMed Central

    Sadaka, Farid; Trottier, Steven; Tannehill, David; Donnelly, Paige L; Griffin, Mia T; Bunaye, Zerihun; O’Brien, Jacklyn; Korobey, Matthew; Lakshmanan, Rekha

    2014-01-01

    Background Although the optimum hemoglobin (H) concentration for patients with septic shock (SS) has not been specifically investigated, current guidelines suggest that H of 7 - 9 g/dL, compared with 10 - 12 g/dL, was not associated with increased mortality in critically ill adults. This contrasts with early goal-directed resuscitation protocols that use a target hematocrit of 30% in patients with low central venous oxygen saturation (ScvO2) during the first 6 hours of resuscitation of SS. Methods Data elements were prospectively collected on all patients with SS patients (lactic acid (LA) > 4 mmol/L, or hypotension). Out of a total of 396 SS patients, 46 patients received red blood cell (RBC) transfusion for ScvO2 < 70% (RBC group). We then matched 71 SS patients that did not receive RBC transfusion (NRBC group) on the following goals (G): LA obtained within 6 hours (G1), antibiotics given within 3 hours (G2), 20 mL/kg fluid bolus followed by vasopressors (VP) if needed to keep mean arterial pressure > 65 mm Hg (G3), central venous pressure > 8 mm Hg within 6 hours (G4) and ScvO2 > 70% within 6 hours (G5). Results In the RBC group, after one unit of RBC transfusion, ScvO2 improved from average of 63% (± 12%) to 68% (± 10%) (P = 0.02). Sixteen patients required another unit of RBC, and this resulted in increase of ScvO2 to 78% (± 11%) (P < 0.01). The RBC and NRBC groups were matched on sequential organ failure assessment (SOFA) scores and all five goals. There was no difference in mortality between the two groups: 41% vs. 39.4% (OR: 0.8, 95% CI: 0.4 - 1.7, P = 0.6). Conclusions In our study, transfusion of RBC was not associated with decreased mortality in SS patients. PMID:25247015

  19. Prevalence of p24 antigen among a cohort of HIV antibody negative blood donors in Sokoto, North Western Nigeria - the question of safety of blood transfusion in Nigeria

    PubMed Central

    Osaro, Erhabor; Mohammed, Ndakotsu; Zama, Isaac; Yakubu, Abdulrahaman; Dorcas, Ikhuenbor; Festus, Aghedo; Kwaifa, Ibrahim; Sani, Ibrahim

    2014-01-01

    Introduction Blood transfusions remain a substantial source of HIV in SSA particularly among children and pregnant women. Aims and objectives: This aim of this retrospective study was to investigate the prevalence of p24 antigen among HIV antibody seronegative blood donors in Sokoto, North West Nigeria. Methods A total of 15,061 HIV antibody negative blood donors with mean age and age range (29.2 ± 8.18 and 18-50 years) were screened for p24 antigen between January 2010 to July 2013 using the Diapro Diagnostic immunoassay kit for P24 antigen (King Hawk Pharmaceuticals Beijing China). Results The overall prevalence of p24 antigen among the HIV antibody negative donors sample was 5.84%. The yearly prevalence was 9.79, 8.12, 2.7 and 2.84% respectively in 2010, 2011, 2012 and 2013. Of the total number of blood donor tested, 14,968 (99.38%) were males while 93 (0.62%) were females. The prevalence of P24 antigen was significantly higher among male blood donors 873 (5.8%) compared to females 7(0.05%), (p= 0.001). P24 positivity was significantly higher among blood group O blood donors compared to A, B and AB donors (494 (3.29%) compared to 184 (1.89%), 196 (1.30%) and 6 (0.04%)) respectively, p = 0.001). The prevalence of P24 antigen was significantly higher among Rhesus positive blood donors compared to Rhesus negative (807 (5.36%) versus 73 (0.48%), p =0.001). Conclusion Blood transfusion in Nigeria is associated with increased risk of HIV transmission. There is the urgent need to optimize the screening of blood donors in Nigeria by the inclusion of p24 antigen testing into the blood donor screening menu. The Nigerian government urgently need to adopt the WHO blood safety strategies to reduce the risk of transmission of HIV through blood transfusion. PMID:25419301

  20. Far Forward Anesthesia and Massive Blood Transfusion: Two Cases Revealing the Challenge of Damage Control Resuscitation in an Austere Environment.

    PubMed

    Gaskin, David; Kroll, Nicholas A; Ochs, Alyson A; Schreiber, Martin A; Pandalai, Prakash K

    2015-10-01

    Since the beginning of Operation Enduring Freedom and Operation Iraqi Freedom, the US military has treated more than 51,000 casualties and sustained more than 6,600 deaths. The past decade of conflict has solidified major advances in the use of blood component therapy and the liberal use of fresh whole blood during damage control resuscitation. This resuscitation strategy, combined with far forward damage control surgery, rapid aeromedical evacuation, and major improvements in critical care air transportation and personal protective equipment has led to a 90% to 92% survival rate in US casualties. We describe 2 cases treated by a Forward Surgical Team serving in Afghanistan during Operation Enduring Freedom in 2014. Both patients suffered severe trauma and required massive blood transfusion and damage control surgery. In describing these 2 cases, we wish to share our experience with damage control, resuscitation in an austere environment, as well as advocate for the critical role of the Certified Registered Nurse Anesthetist in advancing the knowledge and execution of this lifesaving strategy in both military and civilian trauma centers. In addition, we suggest alternatives to the current transfusion strategy, which will mitigate limitations currently encountered. PMID:26638455

  1. Refusal of Medical Blood Transfusions Among Jehovah's Witnesses: Emotion Regulation of the Dissonance of Saving and Sacrificing Life.

    PubMed

    Ringnes, Hege Kristin; Hegstad, Harald

    2016-10-01

    This study focuses on the requirement of JWs to refuse medical blood transfusions. We identified a life-death cognitive dissonance among JWs, with the opposing cognitions of being willing to sacrifice life by religious standards, while being unwilling to do so. Using a theory that connects cognitive dissonance with the need to regulate difficult emotions to analyze our qualitative data material, we identified two sets of dissonance reduction strategies among the JWs. Set 1 was tied to the individual-group: selective focus on eternal life, a non-blood support and control system, and increased individualization of treatment choices. Set 2 was in the religion versus medicine intersection: denial of risk combined with optimism, perception of blood as dangerous, and use of medical language to underscore religious doctrine. PMID:27094707

  2. Evaluation of a new tablet formulation of deferasirox to reduce chronic iron overload after long-term blood transfusions.

    PubMed

    Chalmers, Anna W; Shammo, Jamile M

    2016-01-01

    Transfusion-dependent anemia is a common feature in a wide array of hematological disorders, including thalassemia, sickle cell disease, aplastic anemia, myelofibrosis, and myelo-dysplastic syndromes. In the absence of a physiological mechanism to excrete excess iron, chronic transfusions ultimately cause iron overload. Without correction, iron overload can lead to end-organ damage, resulting in cardiac, hepatic, and endocrine dysfunction/failure. Iron chelating agents are utilized to reduce iron overload, as they form a complex with iron, leading to its clearance. Iron chelation has been proven to decrease organ dysfunction and improve survival in certain transfusion-dependent anemias, such as β-thalassemia. Several chelating agents have been approved by the United States Food and Drug Administration for the treatment of iron overload, including deferoxamine, deferiprone, and deferasirox. A variety of factors have to be considered when choosing an iron chelator, including dosing schedule, route of administration, tolerability, and side effect profile. Deferasirox is an orally administered iron chelator with proven efficacy and safety in multiple hematological disorders. There are two formulations of deferasirox, a tablet for suspension, and a new tablet form. This paper is intended to provide an overview of iron overload, with a focus on deferasirox, and its recently approved formulation Jadenu(®) for the reduction of transfusional iron overload in hematological disorders. PMID:26929633

  3. Evaluation of a new tablet formulation of deferasirox to reduce chronic iron overload after long-term blood transfusions

    PubMed Central

    Chalmers, Anna W; Shammo, Jamile M

    2016-01-01

    Transfusion-dependent anemia is a common feature in a wide array of hematological disorders, including thalassemia, sickle cell disease, aplastic anemia, myelofibrosis, and myelo-dysplastic syndromes. In the absence of a physiological mechanism to excrete excess iron, chronic transfusions ultimately cause iron overload. Without correction, iron overload can lead to end-organ damage, resulting in cardiac, hepatic, and endocrine dysfunction/failure. Iron chelating agents are utilized to reduce iron overload, as they form a complex with iron, leading to its clearance. Iron chelation has been proven to decrease organ dysfunction and improve survival in certain transfusion-dependent anemias, such as β-thalassemia. Several chelating agents have been approved by the United States Food and Drug Administration for the treatment of iron overload, including deferoxamine, deferiprone, and deferasirox. A variety of factors have to be considered when choosing an iron chelator, including dosing schedule, route of administration, tolerability, and side effect profile. Deferasirox is an orally administered iron chelator with proven efficacy and safety in multiple hematological disorders. There are two formulations of deferasirox, a tablet for suspension, and a new tablet form. This paper is intended to provide an overview of iron overload, with a focus on deferasirox, and its recently approved formulation Jadenu® for the reduction of transfusional iron overload in hematological disorders. PMID:26929633

  4. Transfusion requirements in septic shock (TRISS) trial - comparing the effects and safety of liberal versus restrictive red blood cell transfusion in septic shock patients in the ICU: protocol for a randomised controlled trial

    PubMed Central

    2013-01-01

    Background Transfusion of red blood cells (RBC) is recommended in septic shock and the majority of these patients receive RBC transfusion in the intensive care unit (ICU). However, benefit and harm of RBCs have not been established in this group of high-risk patients. Methods/Design The Transfusion Requirements in Septic Shock (TRISS) trial is a multicenter trial with assessor-blinded outcome assessment, randomising 1,000 patients with septic shock in 30 Scandinavian ICUs to receive transfusion with pre-storage leuko-depleted RBC suspended in saline-adenine-glucose and mannitol (SAGM) at haemoglobin level (Hb) of 7 g/dl or 9 g/dl, stratified by the presence of haematological malignancy and centre. The primary outcome measure is 90-day mortality. Secondary outcome measures are organ failure, ischaemic events, severe adverse reactions (SARs: anaphylactic reaction, acute haemolytic reaction and transfusion-related circulatory overload, and acute lung injury) and mortality at 28 days, 6 months and 1 year. The sample size will enable us to detect a 9% absolute difference in 90-day mortality assuming a 45% event rate with a type 1 error rate of 5% and power of 80%. An interim analysis will be performed after 500 patients, and the Data Monitoring and Safety Committee will recommend the trial be stopped if a group difference in 90-day mortality with P ≤0.001 is present at this point. Discussion The TRISS trial may bridge the gap between clinical practice and the lack of efficacy and safety data on RBC transfusion in septic shock patients. The effect of restrictive versus liberal RBC transfusion strategy on mortality, organ failure, ischaemic events and SARs will be evaluated. Trial registration ClinicalTrials.gov: NCT01485315. Registration date 30 November 2011. First patient was randomised 3 December 2011. PMID:23702006

  5. Normative evaluation of blood banks in the Brazilian Amazon region in respect to the prevention of transfusion-transmitted malaria

    PubMed Central

    Freitas, Daniel Roberto Coradi; Duarte, Elisabeth Carmen

    2014-01-01

    Objective To evaluate blood banks in the Brazilian Amazon region with regard to structure and procedures directed toward the prevention of transfusion-transmitted malaria (TTM). Methods This was a normative evaluation based on the Brazilian National Health Surveillance Agency (ANVISA) Resolution RDC No. 153/2004. Ten blood banks were included in the study and classified as ‘adequate’ (≥80 points), ‘partially adequate’ (from 50 to 80 points), or ‘inadequate’ (<50 points). The following components were evaluated: ‘donor education’ (5 points), ‘clinical screening’ (40 points), ‘laboratory screening’ (40 points) and ‘hemovigilance’ (15 points). Results The overall median score was 49.8 (minimum = 16; maximum = 78). Five blood banks were classified as ‘inadequate’ and five as ‘partially adequate’. The median clinical screening score was 26 (minimum = 16; maximum = 32). The median laboratory screening score was 20 (minimum = 0; maximum = 32). Eight blood banks performed laboratory tests for malaria; six tested all donations. Seven used thick smears, but only one performed this procedure in accordance with Ministry of Health requirements. One service had a Program of External Quality Evaluation for malaria testing. With regard to hemovigilance, two institutions reported having procedures to detect cases of transfusion-transmitted malaria. Conclusion Malaria is neglected as a blood–borne disease in the blood banks of the Brazilian Amazon region. None of the institutions were classified as ‘adequate’ in the overall classification or with regard to clinical screening and laboratory screening. Blood bank professionals, the Ministry of Health and Health Surveillance service managers need to pay more attention to this matter so that the safety procedures required by law are complied with. PMID:25453648

  6. Association between Perioperative Blood Transfusions and Clinical Outcomes in Patients Undergoing Bladder Cancer Surgery: A Systematic Review and Meta-Analysis Study.

    PubMed

    Cata, Juan P; Lasala, Javier; Pratt, Greg; Feng, Lei; Shah, Jay B

    2016-01-01

    Background. Perioperative blood transfusions are associated with poor survival in patients with solid tumors including bladder cancer. Objective. To investigate the impact of perioperative blood transfusions on oncological outcomes after radical cystectomy. Design. Systematic review and meta-analysis. Setting and Participants. Adult patients who underwent radical cystectomy for bladder cancer. Intervention. Packed red blood cells transfusion during or after radical cystectomy for bladder cancer. Outcome Measurements and Statistical Analysis. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). We calculated the pooled hazard ratio (HR) estimates and 95% confidence intervals by random and fixed effects models. Results and Limitation. Eight, seven, and five studies were included in the OS, CSS, and RFS analysis, respectively. Blood transfusions were associated with 27%, 29%, and 12% reduction in OS, CSS, and RFS, respectively. A sensitivity analysis supported the association. This study has several limitations; however the main problem is that it included only retrospective studies. Conclusions. Perioperative BT may be associated with reduced RFS, CSS, and OS in patients undergoing RC for BC. A randomized controlled study is needed to determine the causality between the administration of blood transfusions and bladder cancer recurrence. PMID:26942040

  7. Blood Sugar - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Blood Sugar URL of this page: https://medlineplus.gov/languages/bloodsugar.html Other topics A-Z A B ...

  8. Blood Disorders - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Blood Disorders URL of this page: https://medlineplus.gov/languages/blooddisorders.html Other topics A-Z A B ...

  9. Blood Thinners - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Blood Thinners URL of this page: https://medlineplus.gov/languages/bloodthinners.html Other topics A-Z A B ...

  10. Blood Thinners - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Blood Thinners URL of this page: https://www.nlm.nih.gov/medlineplus/languages/bloodthinners.html Other topics A-Z A B ...

  11. Blood Disorders - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Blood Disorders URL of this page: https://www.nlm.nih.gov/medlineplus/languages/blooddisorders.html Other topics A-Z A B ...

  12. Blood Sugar - Multiple Languages: MedlinePlus

    MedlinePlus

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Blood Sugar URL of this page: https://www.nlm.nih.gov/medlineplus/languages/bloodsugar.html Other topics A-Z A B ...

  13. Transfusion of 28 Day-Old Leukoreduced or Non-Leukoreduced Stored Red Blood Cells Induces an Inflammatory Response in Healthy Dogs

    PubMed Central

    Callan, Mary Beth; Patel, Reema T.; Rux, Ann H.; Bandyopadhyay, Sheila; Sireci, Anthony N.; O’Donnell, Patricia A.; Ruane, Therese; Sikora, Tracey; Marryott, Kimberly; Sachais, Bruce S.; Hod, Eldad A.

    2013-01-01

    BACKGROUND AND OBJECTIVES Studies in mice suggest that rapid transfusions of red blood cells (RBCs), refrigerator stored for longer durations, induce a pro-inflammatory cytokine response. Studies in human neonates confirm these findings; however, to date, adult human studies have failed to replicate these findings. We used healthy research dogs to begin to examine the factors affecting the cytokine response to transfusion. MATERIALS AND METHODS In a prospective study, healthy dogs were randomized for two autologous packed RBC transfusions after 7 (i.e. “fresh”) and 28 (“old”) days of storage, or after 28 and 7 days of storage, with or without pre-storage leukoreduction (LR). RESULTS No significant differences were observed between LR and non-LR transfusions for all circulating analytes measured following transfusion. A pro-inflammatory cytokine response, exemplified by monocyte chemoattractant protein-1, was observed 6 hours after only old RBC transfusions, irrespective of infusion rate (P<0.001). This response was accompanied by increased neutrophil counts (P<0.001) and decreased platelet counts (P<0.001). CONCLUSION In healthy dogs, old RBC transfusions induce inflammation, which is unaffected by infusion rate. PMID:23763639

  14. Parvovirus B19 Passive Transmission by Transfusion of Intercept® Blood System-Treated Platelet Concentrate

    PubMed Central

    Gowland, Peter; Fontana, Stefano; Stolz, Martin; Andina, Nicola; Niederhauser, Christoph

    2016-01-01

    Summary Background Pathogen reduction methods for blood components are effective for a large number of viruses though less against small, non-enveloped viruses such as Parvovirus B19 (B19V). This article describes the passive transmission by transfusion of two B19V-contaminated pooled platelet concentrates (PCs) which were treated with the Intercept® blood pathogen reduction system. Case Reports Two transfusion cases of B19V-contaminated Intercept-treated pooled PCs were described. Due to the analysis delay, the PCs were already transfused. The viral content of each donation was 4.87 × 1010 IU/ml in case 1and 1.46 × 108 IU/ml in case 2. B19V (52 IU/ml) was detected in the recipient of the case 1 PC, whereas no virus could be detected in the case 2 PC recipient. A B19V IgM response and a transient boost of the underlying B19V IgG immune status and was observed in recipient 1. Recipient of the case 2 PC remained B19V IgG- and IgM-negative. B19V DNA sequence and phylogenetic analysis revealed a 100% homology between donor and recipient. Conclusion This report describes passive B19V transmission by a PC with very high B19 viral load which elicited a transient boost of the B19V immunity, but not by a PC with a lower B19V content, suggesting that there is a B19 viral load threshold value at which B19V inactivation is exceeded. PMID:27403092

  15. Noninfectious serious hazards of transfusion.

    PubMed

    Hendrickson, Jeanne E; Hillyer, Christopher D

    2009-03-01

    As infectious complications from blood transfusion have decreased because of improved donor questionnaires and sophisticated infectious disease blood screening, noninfectious serious hazards of transfusion (NISHOTs) have emerged as the most common complications of transfusion. The category of NISHOTs is very broad, including everything from well-described and categorized transfusion reactions (hemolytic, febrile, septic, and allergic/urticarial/anaphylactic) to lesser known complications. These include mistransfusion, transfusion-related acute lung injury, transfusion-associated circulatory overload, posttransfusion purpura, transfusion-associated graft versus host disease, microchimerism, transfusion-related immunomodulation, alloimmunization, metabolic derangements, coagulopathic complications of massive transfusion, complications from red cell storage lesions, complications from over or undertransfusion, and iron overload. In recent years, NISHOTs have attracted more attention than ever before, both in the lay press and in the scientific community. As the list of potential complications from blood transfusion grows, investigators have focused on the morbidity and mortality of liberal versus restrictive red blood cell transfusion, as well as the potential dangers of transfusing "older" versus "younger" blood. In this article, we review NISHOTs, focusing on the most recent concerns and literature. PMID:19224780

  16. [Transfusions in geriatrics].

    PubMed

    Moulias, Sophie; Lesure, Christine

    2015-01-01

    Elderly people are Darticularlv Drone to anaemia and the need for transfusions. However, in response to the known adverse effects of red blood cell transfusions, particularly in the context of chronic anaemia, new recommendations have been issued. it is always necessary to consider this procedure on a case-by-case basis, analysing the risk-benefit ratio. PMID:25966521

  17. Management of complaints in blood establishments: thirteen years of experience at the Croatian Institute of Transfusion Medicine

    PubMed Central

    Vuk, Tomislav; Barišić, Marijan; Očić, Tihomir; Đogić, Vesna; Bingulac-Popović, Jasna; Šarlija, Dorotea; Balija, Melita; Jukić, Irena

    2012-01-01

    Background. The aim of the study is to present the results and experience in the management of complaints in a transfusion service in order to draw attention to the importance of this segment of quality management and to stimulate publication of other studies on the topic. Materials and methods. This study is based on data from the Croatian Institute of Transfusion Medicine obtained by analysis of complaints recorded during a 13-year period (1998–2010). The distribution of the types and frequencies of complaints is presented, along with the level of their justifiability and criticality. The dynamics of the complaints is analysed overall and within particular categories. In addition, corrective actions and other factors that may have influenced the trends observed are discussed. Results. During the study period, 817 complaints were received, most of which (40.9%) referred to the positive direct antiglobulin test in red cell concentrates, followed by blood product issuing and distribution (12.9%) and blood product quality (9.4%). Of the 817 complaints, 177 (21.7%) were assessed as serious and 645 (78.9%) as justified based on the testing performed. Conclusion. Data collected by systematic recording and analysis of complaints provide a basis for problem identification, implementation of corrective and preventive actions, and improvement of product and service quality, and, thereby, customer satisfaction. PMID:22507865

  18. Physiologic effects of transfusing red blood cells with high or low affinity for oxygen to passively hyperventilated, anemic baboons: systemic and cerebral oxygen extraction.

    PubMed Central

    Valeri, C R; Rorth, M; Zaroulis, C G; Jakubowski, M S; Vescera, S V

    1975-01-01

    Anemic, passively hyperventilated baboons were given preserved red blood cells either with increased or with slightly reduced affinity for oxygen to restore the red cell volume. In the high affinity group there was a 50% increase in cerebral blood flow immediately after the transfusion, but there was no significant change in the low affinity group. The cardiac output decreased slightly in the low affinity group, and increased slightly but insignificantly in the high affinity group. Two hours after transfusion the cerebral blood flow had returned to normal in the high affinity group. In both groups there was a decrease in arterial blood pH and an increase in Po2 in blood from the pulmonary artery and the jugular vein after transfusion. A 40% restoration of the 2,3 DPG level occurred within 4 hours of the transfusion of red cells with high affinity for oxygen, and this rapid increase was associated with increases in blood pH and inorganic phosphorus levels. Preserved red cells with high affinity for oxygen and low 2, 3 DPG levels significantly increased the cerebral circulation during the 2-hour posttransfusion period. These findings lend support to the recommendation that preserved red cells with normal or elevated 2,3 DPG levels be administered to patients in hemorrhagic or septic shock, and to patients subjected to extracorporeal circulation during cardiac surgery in order to lessen the demand for increased blood flow and to ensure adequate tissue oxygenation during the postoperative period. PMID:1119857

  19. Effect of Closed Suction Drain on Blood Loss and Transfusion Rates in Simultaneous Bilateral Total Knee Arthroplasty: A Prospective Randomized Study

    PubMed Central

    Shetty, Gautam M.; Gupta, Vinay; Saxena, Purvi; Singh, Nidhi

    2016-01-01

    Purpose Simultaneous bilateral total knee arthroplasty (TKA) is associated with excessive blood loss and morbidity arising from postoperative reduction in hemoglobin (Hb). The purpose of this prospective randomized study was to determine if drains have any effect on blood loss, postoperative reduction in Hb levels and transfusion rates compared to no drainage in simultaneous bilateral TKAs. Materials and Methods Two hundred and thirty patients who underwent simultaneous bilateral TKA by a single surgeon were randomly allotted to drain or no-drain group (n=115 in each group). Postoperative Hb level, blood loss volume and transfusion rate were compared between the two groups. Results The mean postoperative Hb level (p=0.38), blood loss volume (p=0.33) and transfusion rate (p=0.52) in the drain group were not significantly different compared to the no-drain group. No statistical difference was found in terms of complications, readmissions and mortality rates between the two groups. Conclusions No significant difference was observed in the two groups with respect to blood loss and blood transfusion. Non-drainage does not offer an advantage over drainage with respect to conserving blood in simultaneous bilateral TKA. PMID:27595073

  20. Effects of Leukoreduction and Premedication With Acetaminophen and Diphenhydramine in Minimizing Febrile Nonhemolytic Transfusion Reactions and Allergic Transfusion Reactions During and After Blood Product Administration: A Literature Review With Recommendations for Practice.

    PubMed

    Duran, Joana; Siddique, Sulman; Cleary, Myra

    2014-05-01

    Transfusion-related reactions cause unwanted interruptions in blood-product administration and potential complications for patients. The most common reactions are febrile nonhemolytic transfusion reactions (FNHTRs) and allergic transfusion reactions (ATRs). The presence of leukocytes in blood products has been associated with these reactions, and efficacy of leukoreduction in minimizing FNHTRs and ATRs has recently been investigated. In addition, premedication with acetaminophen and diphenhydramine is the most widely used practice in minimizing FNHTRs and ATRs, yet the benefit of this is not supported by research. The aim of this systematic literature review was to evaluate the potential benefits of both of these interventions in minimizing FNHTRs and ATRs and provide recommendations for practice. We found moderate quality evidence with strong recommendations for the practice of leukoreduction in minimizing FNHTRs but not ATRs. We did not find evidence to support the use of premedications in minimizing transfusion-related reactions, and we question the need for this practice in settings where leukoreduction is used. PMID:24794886

  1. Sero-epidemiology of transfusion-transmissible infectious diseases among blood donors in Osogbo, south-west Nigeria

    PubMed Central

    Buseri, Fiekumo Igbida; Muhibi, Musa Abidemi; Jeremiah, Zaccheaus Awortu

    2009-01-01

    Background: Transfusion-transmissible infectious agents such as hepatitis B virus (HBV), human immunodeficiency virus (HIV), hepatitis C virus (HCV) and syphilis are among the greatest threats to blood safety for transfusion recipients and pose a serious public health problem. This cross-sectional study was undertaken with the aim of determining the seroprevalence of HIV, HCV, hepatitis B surface antigen (HBsAg) and syphilis and correlates the findings with sex and age to ascertain the associations, if any, in the occurrence of the pathogens. Materials and Methods: HBsAg, antibodies to Treponema pallidum and HCV were determined using Clinotech test strips. Antibodies to HIV types 1 and 2 were screened with Determine and Immunocomb. All the reactive samples were confirmed using enzyme-linked immunosorbent assays. Antibodies to Treponema pallidum were confirmed with a Treponema pallidum haemagglutination test. Results: A total of 1,410 apparently healthy prospective blood donors aged between 18 and 64 years (mean±SD, 32.58 ± 10.24 years) who presented for blood donation at the Ladoke Akintola University of Technology Teaching Hospital Blood Bank, Osogbo were studied. The male:female ratio was 6:1. Of the prospective blood donors, 406 (28.8%) had serological evidence of infection with at least one infectious marker and 36 (2.6%) had dual infections. The overall seroprevalence of HBsAg, HIV, HCV and syphilis was found to be 18.6%, 3.1%, 6.0% and 1.1%, respectively. The highest prevalences of HBsAg, HIV, HCV and syphilis infections occurred among commercial blood donors and those aged 18 to 47 years old, the most sexually active age group. There were no significant associations between pathogens except for syphilis and HIV (p > 0.001). Conclusion: The high seroprevalence of blood-borne pathogens among prospective blood donors in Osogbo, Nigeria calls for mandatory routine screening of blood donors for HBV, HIV, HCV and syphilis. PMID:20011640

  2. The impact of HIV-associated anaemia on the incidence of red blood cell transfusion: Implications for blood services in HIV-endemic countries

    PubMed Central

    van den Berg, Karin; Murphy, Edward L.; Pretorius, Lelanie; Louw, Vernon J.

    2015-01-01

    Cytopaenias, especially anaemia, are common in the HIV-infected population. The causes of HIV related cytopaenias are multi-factorial and often overlapping. In addition, many of the drugs used in the management of HIV-positive individuals are myelosuppresive and can both cause and exacerbate anaemia. Even though blood and blood products are still the cornerstone in the management of severe cytopaenias, how HIV may affect blood utilisation is not well understood. The impact of HIV/AIDS on blood collections has been well documented. As the threat posed by HIV on the safety of the blood supply became clearer, South Africa introduced progressively more stringent donor selection criteria, based on the HIV risk profile of the donor cohort from which the blood collected. The implementation of new testing technology in 2008 which significantly improved the safety of the blood supply enabled the removal of what was perceived by many as a racially based donor risk model. However, this new technology had a significant and sustained impact on the cost of blood and blood products in South Africa. In contrast, it would appear little is known of how HIV influences the utilisation of blood and blood products. Considering the high prevalence of HIV among hospitalised patients and the significant risk for anaemia among this group, there would be an expectation that the transfusion requirements of an HIV-infected patient would be higher than that of an HIV-negative patient. However, very little published data is available on this topic which emphasises the need for further large-scale studies to evaluate the impact of HIV/AIDS on the utilisation of blood and blood products and how the large-scale roll-out of ARV programs may in future play a role in determining the country’s blood needs. PMID:25457008

  3. The Coagulative Profile of Cyanotic Children Undergoing Cardiac Surgery: The Role of Whole Blood Preoperative Thromboelastometry on Postoperative Transfusion Requirement.

    PubMed

    Vida, Vladimiro L; Spiezia, Luca; Bortolussi, Giacomo; Marchetti, Marta E; Campello, Elena; Pittarello, Demetrio; Gregori, Dario; Stellin, Giovanni; Simioni, Paolo

    2016-07-01

    The objective of this study is to evaluate the preoperative coagulation pattern and its association to postoperative blood products transfusion in children with congenital heart disease (CHD), focusing on cyanotic patients (oxygen saturation, SATO 2  < 85%). From January to August 2014, preoperative standard coagulation tests and rotational thromboelastometry assays were performed on 81 pediatric patients (<16 years old) who underwent surgery for CHD with the aid of cardiopulmonary bypass. Sixty patients (74%) were acyanotic and 21 (26%) cyanotic. Mean age at time of surgery was 7.9 months (interquartile range 2.9-43.6 months). Cyanotic patients had a significantly higher hematocrit (P < 0.001), a reduced prothrombin activity (PT) (P = 0.01) level, and a lower platelet count (P = 0.02) than acyanotic patients. An inverse linear association was found between patient's SATO2 and clot formation time (CFT) (INTEM, P = 0.001, and EXTEM, P < 0.0001). A direct linear association was found between patient's SATO2 and maximum clot firmness (MCF) (INTEM, P = 0.04, and EXTEM, P = 0.05). Preoperative cyanosis was also associated with a lower median MCF in FIBTEM (P = 0.02). Cyanotic patients required more frequent postoperative transfusions of fibrinogen (7/21 patients, 33% vs. 4/60 patients, 6.7%, P = 0.01) and fresh frozen plasma (14/21, 67% vs. 25/60, 42%, P = 0.08). Patients with a lower presurgery PT and platelet count subsequently required more fibrinogen transfusion P = 0.02 and P = 0.003, respectively); the same goes for patients with a longer CFT (INTEM, P = 0.01 and EXTEM, P = 0.03) and a reduced MCF (INTEM, P = 0.02 and FIBTEM, P = 0.01) as well. Cyanotic patients showed significant preoperative coagulation anomalies and required a higher postoperative fibrinogen supplementation. The preoperative MCF FIBTEM has become an important factor in our postoperative thromboelastometry-guided transfusion

  4. [Respiratory complications after transfusion].

    PubMed

    Bernasinski, M; Mertes, P-M; Carlier, M; Dupont, H; Girard, M; Gette, S; Just, B; Malinovsky, J-M

    2014-05-01

    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. PMID:24814817

  5. Multiple myeloma: managing a complex blood cancer.

    PubMed

    Dowling, Maura; Kelly, Mary; Meenaghan, Teresa

    2016-09-01

    This article gives a comprehensive overview of multiple myeloma (MM), a complex blood cancer involving overproduction of plasma cells. Although MM remains incurable, patients are living longer as a result of multiple treatment options. However, MM patients are also living with a higher symptom burden. The overall aims in managing MM are therefore to control disease progression, prolong survival and improve quality of life. PMID:27615537

  6. Where are the systematic reviews in transfusion medicine? A study of the transfusion evidence base.

    PubMed

    Dorée, Carolyn; Stanworth, Simon; Brunskill, Susan J; Hopewell, Sally; Hyde, Chris J; Murphy, Mike F

    2010-10-01

    Transfusion medicine has become a large and complex specialty. Although there are now systematic reviews covering many aspects of transfusion, these span a large number of clinical areas and are published across more than a hundred different medical journals, making it difficult for transfusion medicine practitioners and researchers to keep abreast of the current high-level evidence. In response to this problem, NHS Blood and Transplant's Systematic Review Initiative (SRI) has produced a comprehensive overview of systematic reviews in transfusion medicine. A systematic search (to December 2009) and screening procedure were followed by the appraisal of systematic reviews according to predefined inclusion criteria. The 340 eligible systematic reviews were mapped to 10 transfusion intervention groups and 14 topic groups within clinical medicine. Trends in the systematic review literature were examined and gaps in the literature described. The spread of systematic reviews across clinical areas was found to be very uneven, with some areas underreviewed and others with multiple systematic reviews on the same topic, making the identification of the best evidence for current transfusion practice a continuing challenge. References and links to all systematic reviews included in this overview can be freely accessed via the SRI's new online database, the Transfusion Evidence Library (www.transfusionguidelines.org). PMID:20851331

  7. Practical use of computerized hospital information systems to improve blood transfusion.

    PubMed

    Butch, S H

    1997-04-01

    Data collection can be enhanced with the use of computers. Care must be taken, however, to ensure that the data collected have a purpose and meet either the quality assessment needs or business functions of the transfusion service. Required data elements are frequently in several data repositories and must be merged to obtain needed information. Effective data collection may be hindered by several factors, including a lack of data elements in the computer systems, data retention limitations, and changes in the computer system or collection needs. Personal computers with commonly available spreadsheet and database management software are useful in preparing summarized reports. An ideal report is legibly printed on one side of a sheet of paper and includes graphs and charts that enhance data presentation and facilitate trend analysis. PMID:9124230

  8. Potassium content of irradiated packed red blood cells in different storage media: is there a need for additive solution-dependent recommendations for infant transfusion?

    PubMed

    El Kenz, H; Corazza, F; Van Der Linden, P; Chabab, S; Vandenvelde, C

    2013-10-01

    Prevention of transfusion-associated graft versus host disease (TA-GVHD) by gamma irradiation is known to induce increased K+ in supernatant of packed red blood cells (PRBCs) stored in CPDA-1 and SAGM conservative solutions. However, no data exist for PRBCs in AS-3 medium which is considered safe for neonatal transfusion. We evaluated haemolysis and K+ release from irradiated AS-3 PRBCs and compared our results with reported data for SAGM and CPDA-1 PRBCs. Our results indicate that irradiated PRBCs stored in AS-3 after more than 7 days post-irradiation should not be used in massive and/or rapidly infused transfusions in neonates and infants. PMID:23711835

  9. Cytogenetic studies in dogs after total body irradiation and allogeneic transfusion with cryopreserved blood mononuclear cells: observations in long-term chimeras

    SciTech Connect

    Carbonell, F.; Calvo, W.; Fliedner, T.M.; Kratt, E.; Gerhartz, H.; Koerbling, M.; Nothdurft, W.; Ross, W.M.

    1984-03-01

    Cytogenetic studies were performed on two dog groups after total body irradiation and allogeneic transfusion with cryopreserved blood mononuclear cells. The first group of dogs was transfused with unseparated leukocytes and suffered from graft-versus-host disease (GvHD). Cytogenetic studies demonstrated only cells of donor origin in all dogs of this group. The second group of animals was transfused with fraction 2 of a discontinuous albumin gradient. The dogs of this group did not develop GvHD, and the cytogenetic studies showed the presence of a mosaic of cells from donor and recipient origin in all of them. These results suggest that the GvHD may suppress autochthonous regeneration.

  10. Transfusion problems associated with transplantation

    SciTech Connect

    Storb, R.; Weiden, P.L.

    1981-04-01

    Researchers have reviewed the role of blood transfusions in renal and marrow graft recipients. Striking contrasts are evident: while transfusions may promote successful kidney grafting, any transfusions before initiation of the transplant conditioning regimen may jeopardize the treatment of severe aplastic anemia by marrow transplantation. Researchers have suggested guidelines for the transfusion support of transplant candidates before transplantation and for marrow graft recipients after transplantation. It is important to recognize that after conditioning for marrow transplantation, all patients will be profoundly pancytopenic for a limited period of time, and intensive transfusion support is vital to patient survival.

  11. Nonhemolytic, noninfectious transfusion reactions.

    PubMed

    Barton, J C

    1981-04-01

    The delivery of optimal transfusion therapy requires that the physician first have a thorough understanding of his patient's disease and prior transfusion history. Sometimes the need for blood product administration is more apparent than real. In the selection of necessary therapy, particular blood components, their volumes, and the timing of their administration should be carefully planned. The transfusion of whole blood, particularly as single-unit transfusions, is rarely indicated. Often forgotten, autotransfusion represents a means whereby many subjects who have repeated, unusual, or severe reactions may receive safe treatment. An appreciation of the frequency and manifestations of transfusion-related problems permits effective treatment of ongoing reactions. The prophylactic measures which should be taken against future reactions in most patients are specific, and are the responsibility of the clinician, based upon his bedside observations and laboratory studies. Problems should be discussed with either a hematologist, pathologist, or blood banking expert without hesitation. These guidelines help conserve a precious resource and assure that safe, effective, and economical transfusion therapy is available for all patients in need. PMID:6164098

  12. Comparison of acute non-haemolytic transfusion reactions in female and male patients receiving female or male blood components

    PubMed Central

    Imoto, S; Araki, N; Shimada, E; Saigo, K; Nishimura, K; Nose, Y; Bouike, Y; Hashimoto, M; Mito, H; Okazaki, H

    2007-01-01

    To study the relationship between antibodies detected in patients’ and/or donors’ sera and the clinical features of acute non-haemolytic transfusion reactions (ANHTRs), and to determine any gender-related difference. ANHTRs range from urticaria to transfusion-related acute lung injury (TRALI). Antibodies to human leukocyte antigen (HLA), granulocytes, platelets, and/or plasma proteins are implicated in some of the ANHTRs. A higher antibody positivity is expected for females than for males. A comparative study of ANHTRs for antibody positivity and their clinical features between females and males for both patients and donors is helpful for characterizing ANHTRs including TRALI more clearly, but such studies are few and outdated. Two hundred and twenty-three ANHTR cases reported by 45 hospitals between October 2000 and July 2005 were analysed. The patients and 196 donors of suspect blood products were screened for antibodies to HLA Class I, HLA Class II, granulocytes, and platelets. The patients were also screened for anti-plasma protein antibodies. The types and severity of ANHTR did not differ significantly between female and male patients. The frequency of the anti-HLA antibodies, but not that of the non-HLA antibodies, was significantly higher in females. Non-HLA antibodies were significantly associated with severe reactions in females. All the TRALI cases had predisposing risk factors for acute lung injury, and 60% of the cases showed anti-leucocyte antibodies. Although the anti-HLA antibodies were detected more frequently in females than males, no significant association of ANHTRs including TRALI with gender, not only for patients, but also for donors, could be shown in this study. PMID:18067650

  13. [Prevention of ABO-incompatible transfusion].

    PubMed

    Fujii, Yasuhiko

    2011-01-01

    "Identification error between patient and blood product" is the main cause of ABO-incompatible blood transfusion, but "Phlebotomy error" also has serious consequences. In order to prevent ABO-incompatible transfusion, it is important to establish a management system of blood transfusion in the hospital, including a hospital transfusion committee and a responsible medical doctor. In addition, in large hospitals routinely carrying out a considerable number of blood transfusions, it is important to employ specialists in blood banking. More than 50 ml of ABO-incompatible blood transfusion (major ABO mismatch) causes a severe acute hemolytic reaction. Because there is little residual plasma in leukocyte-reduced red cell concentrate (RCC-LR), acute hemolysis is not detected on minor ABO mismatch blood transfusion. In the case of emergent blood transfusion, concerning the risk of acute hemolytic reaction, type-O RCC-LR blood transfusion is safer than ABO-identical RCC-LR when the blood of the patient is tested only once. When red cell antibody screening is not performed, there is a risk of hemolysis due to incompatible blood transfusion irrespective of the ABO blood group system, including a delayed hemolytic transfusion reaction. PMID:21348250

  14. Transfusion issues in cancer patients.

    PubMed

    Federici, Augusto B; Vanelli, Chiara; Arrigoni, Luisa

    2012-04-01

    Allogeneic blood transfusion (ABT) therapy plays a major role in the case of patients with cancer. Packed red blood cells (PRBC) are given for increased oxygen-carrying capacity, platelets concentrates (PC) and fresh frozen plasma (FFP) for the cessation and prevention of bleeding due to thrombocytopenia and other defects of hemostasis associated with neoplasia. All these blood components can induce complications and/or adverse reactions in cancer patients including transfusion-associated graft versus host disease (TA-GVHD), transfusion transmitted diseases, alloimmunization to blood cell antigens, pulmonary decompensation, immunomodulation. Therefore, specific modifications such as leukocyte-reduction and irradiation of the blood components to be transfused in cancer patients should be introduced to reduce the risk of these complications. Patients undergoing hematopoietic progenitor cell (HPC) transplantation are a unique group and present complex concerns related to transfusion, including major and minor ABO incompatibility and chimeric blood cells. Therefore, transfusion for patients undergoing treatment with cellular therapies requires careful blood component selection. The process of HPC infusion itself carries many risks including DMSO toxicity and hemolytic reactions. In all areas of transfusion therapy, new advances such as pathogen inactivation and synthetic alternatives to blood components should help to increase the safety and tolerance of transfusion in cancer patients. PMID:22682136

  15. Red blood cell transfusion to treat or prevent complications in sickle cell disease: an overview of Cochrane reviews

    PubMed Central

    Estcourt, Lise J; Fortin, Patricia M; Hopewell, Sally; Trivella, Marialena

    2016-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To summarize the evidence in Cochrane reviews of the effectiveness and safety of red cell transfusions versus no transfusion, or restrictive (to increase the total haemoglobin) versus liberal (to decrease the haemoglobin S level below a specified percentage) transfusion, for treatment or prevention of complications experienced by people with SCD. PMID:27069421

  16. Survey of Blood Collection Centers and Implementation of Guidance for Prevention of Transfusion-Transmitted Zika Virus Infection - Puerto Rico, 2016.

    PubMed

    Vasquez, Amber M; Sapiano, Mathew R P; Basavaraju, Sridhar V; Kuehnert, Matthew J; Rivera-Garcia, Brenda

    2016-01-01

    Since November 2015, Puerto Rico has reported active mosquito-borne transmission of Zika virus (1). Because of the potential for Zika virus to be transmitted through transfusion of blood components, and because a high percentage of persons infected with Zika virus are asymptomatic (2), the Food and Drug Administration (FDA) recommended that blood collections cease in areas of the United States affected by active vector-borne transmission of Zika virus until laboratory screening of blood donations or pathogen reduction technology (PRT)* for treatment of blood components can be implemented (3). To inform efforts to maintain the safety and availability of the blood supply in Puerto Rico, CDC, in collaboration with the Puerto Rico Department of Health, conducted a rapid assessment of blood collection and use on the island. A total of 139,369 allogeneic red blood cell (RBC) units,(†) 45,243 platelet units, and 56,466 plasma units were collected in or imported to Puerto Rico during 2015, and 135,966 allogeneic RBC units, 13,526 therapeutic platelet units,(§) and 25,775 plasma units were transfused. Because of the potential for local Zika virus transmission in areas with a competent mosquito vector (4), other areas of the United States should develop plans to ensure local blood safety and adequacy. Blood collection organizations and public health agencies should collaborate to maintain the safety and availability of local blood supplies in accordance with FDA guidance. PMID:27078190

  17. Degeneration and atrophy of the thymus of lethally irradiated dogs, rescued by transfusion of cryopreserved autologous blood leukocytes

    SciTech Connect

    Calvo, W.; Fliedner, T.M.; Herbst, E.W.; Huegl, E.B.; Boedey, B.

    1987-12-01

    Dogs exposed to a fatal radiation dose of 12 Gy were rescued by transfusion of autologous blood leukocytes. A severe acute and long-lasting damage to the thymus was observed. The acute damage, as observed on the tenth day, consisted of a marked reduction in the number of lymphocytes, degeneration of Hassall's bodies, and hemorrhage. Long-term effects, observed several months after irradiation, were partial to total atrophy of the thymus. Regeneration, when it occurred, was limited to a few small isolated areas in which lymphopoiesis was supported by epithelial reticular cells. In contrast, the lymph nodes of all dogs had abundant cortical lymphopoiesis. The abundant hemopoiesis present in the marrow from the tenth day after irradiation until the end of the observation period should have provided sufficient circulating precursor cells to seed the thymus and regenerate the organ to the same extent as that observed in the other blood-forming organs. The impairment of lymphopoietic regeneration in the thymus seems to be due, therefore, to damage caused by irradiation on the specific stroma of the organ, which is not able to support such activity.

  18. Characterization of the cation-binding capacity of a potassium-adsorption filter used in red blood cell transfusion.

    PubMed

    Suzuki, Takao; Muto, Shigeaki; Miyata, Yukio; Maeda, Takao; Odate, Takayuki; Shimanaka, Kimio; Kusano, Eiji

    2015-06-01

    A K(+) -adsorption filter was developed to exchange K(+) in the supernatant of stored irradiated red blood cells with Na(+) . To date, however, the filter's adsorption capacity for K(+) has not been fully evaluated. Therefore, we characterized the cation-binding capacity of this filter. Artificial solutions containing various cations were continuously passed through the filter in 30 mL of sodium polystyrene sulfonate at 10 mL/min using an infusion pump at room temperature. The cation concentrations were measured before and during filtration. When a single solution containing K(+) , Li(+) , H(+) , Mg(2+) , Ca(2+) , or Al(3+) was continuously passed through the filter, the filter adsorbed K(+) and the other cations in exchange for Na(+) in direct proportion to the valence number. The order of affinity for cation adsorption to the filter was Ca(2+) >Mg(2+) >K(+) >H(+) >Li(+) . In K(+) -saturated conditions, the filter also adsorbed Na(+) . After complete adsorption of these cations on the filter, their concentration in the effluent increased in a sigmoidal manner over time. Cations that were bound to the filter were released if a second cation was passed through the filter, despite the different affinities of the two cations. The ability of the filter to bind cations, especially K(+) , should be helpful when it is used for red blood cell transfusion at the bedside. The filter may also be useful to gain a better understanding of the pharmacological properties of sodium polystyrene sulfonate. PMID:25656422

  19. Transfusion of human volunteers with older, stored red blood cells produces extravascular hemolysis and circulating non–transferrin-bound iron

    PubMed Central

    Brittenham, Gary M.; Billote, Genia B.; Francis, Richard O.; Ginzburg, Yelena Z.; Hendrickson, Jeanne E.; Jhang, Jeffrey; Schwartz, Joseph; Sharma, Shruti; Sheth, Sujit; Sireci, Anthony N.; Stephens, Hannah L.; Stotler, Brie A.; Wojczyk, Boguslaw S.; Zimring, James C.; Spitalnik, Steven L.

    2011-01-01

    Transfusions of RBCs stored for longer durations are associated with adverse effects in hospitalized patients. We prospectively studied 14 healthy human volunteers who donated standard leuko-reduced, double RBC units. One unit was autologously transfused “fresh” (3-7 days of storage), and the other “older” unit was transfused after 40 to 42 days of storage. Of the routine laboratory parameters measured at defined times surrounding transfusion, significant differences between fresh and older transfusions were only observed in iron parameters and markers of extravascular hemolysis. Compared with fresh RBCs, mean serum total bilirubin increased by 0.55 mg/dL at 4 hours after transfusion of older RBCs (P = .0003), without significant changes in haptoglobin or lactate dehydrogenase. In addition, only after the older transfusion, transferrin saturation increased progressively over 4 hours to a mean of 64%, and non–transferrin-bound iron appeared, reaching a mean of 3.2μM. The increased concentrations of non–transferrin-bound iron correlated with enhanced proliferation in vitro of a pathogenic strain of Escherichia coli (r = 0.94, P = .002). Therefore, circulating non–transferrin-bound iron derived from rapid clearance of transfused, older stored RBCs may enhance transfusion-related complications, such as infection. The trial was registered with www.clinicaltrials.gov as #NCT01319552. PMID:22021369

  20. Smart blood cell and microvesicle-based Trojan horse drug delivery: Merging expertise in blood transfusion and biomedical engineering in the field of nanomedicine.

    PubMed

    Wu, Yu-Wen; Goubran, Hadi; Seghatchian, Jerard; Burnouf, Thierry

    2016-04-01

    Therapeutic and diagnostic applications of nanomedicine are playing increasingly important roles in human health. Various types of synthetic nanoparticles, including liposomes, micelles, and other nanotherapeutic platforms and conjugates, are being engineered to encapsulate or carry drugs for treating diseases such as cancer, cardiovascular disorders, neurodegeneration, and inflammations. Nanocarriers are designed to increase the half-life of drugs, decrease their toxicity and, ideally, target pathological sites. Developing smart carriers with the capacity to deliver drugs specifically to the microenvironment of diseased cells with minimum systemic toxicity is the goal. Blood cells, and potentially also the liposome-like micro- and nano-vesicles they generate, may be regarded as ideally suited to perform such specific targeting with minimum immunogenic risks. Blood cell membranes are "decorated" with complex physiological receptors capable of targeting and communicating with other cells and tissues and delivering their content to the surrounding pathological microenvironment. Blood cells, such as erythrocytes, have been developed as permeable carriers to release drugs to diseased tissues or act as biofactory allowing enzymatic degradation of a pathological substrate. Interestingly, attempts are also being made to improve the targeting capacity of synthetic nanoparticles by "decorating" their surface with blood cell membrane receptor-like biochemical structures. Research is needed to further explore the benefits that blood cell-derived microvesicles, as a Trojan horse delivery systems, can bring to the arsenal of therapeutic micro- and nanotechnologies. This short review focuses on the therapeutic roles that red blood cells and platelets can play as smart drug-delivery systems, and highlights the benefits that blood transfusion expertise can bring to this exciting and novel biomedical engineering field. PMID:27179926

  1. Non-infectious complications of transfusion therapy.

    PubMed

    Perrotta, P L; Snyder, E L

    2001-06-01

    Blood transfusion is considered safe when the infused blood is tested using state of the art viral assays developed over the past several decades. Only rarely are known viruses like HIV and hepatitis C transmitted by transfusion when blood donors are screened using these sensitive laboratory tests. However, there are a variety of transfusion risks which still remain that cannot be entirely eliminated, many of which are non-infectious in nature. Predominantly immune-mediated complications include the rapid intravascular or slow extravascular destruction (hemolysis) of transfused red cells or extravascular removal of platelets by pre-formed antibodies carried by the transfusion recipient. Alternatively, red cells can be damaged when exposed to excessive heat or incompatible intravenous fluids before or during the transfusion. Common complications of blood transfusion that at least partly involve the immune system include febrile non-hemolytic and allergic reactions. While these are usually not life-threatening, they can hamper efforts to transfuse a patient. Other complications include circulatory overload, hypothermia and metabolic disturbances. Profound hypotensive episodes have been described in patients on angiotensin-converting enzyme (ACE) inhibitors who receive platelet transfusions through bedside leukoreduction filters. These curious reactions appear to involve dysmetabolism of the vasoactive substance bradykinin. Products contaminated by bacteria during blood collection and transfused can cause life-threatening septic reactions. A long-term complication of blood transfusion therapy unique to chronically transfused patients is iron overload. Less common - but serious - reactions more specific to blood transfusion include transfusion-associated graft-versus-host disease and transfusion-associated acute lung injury. Many of these complications of transfusion therapy can be prevented by adhering to well-established practice guidelines. In addition, individuals

  2. Twin-to-twin transfusion syndrome

    MedlinePlus

    Twin-to-twin transfusion syndrome is a rare condition that occurs only in identical twins while they are in the womb. ... Twin-to-twin transfusion syndrome (TTTS) occurs when the blood supply of 1 twin moves to the ...

  3. Transfusion-associated bacterial sepsis.

    PubMed Central

    Wagner, S J; Friedman, L I; Dodd, R Y

    1994-01-01

    The incidence of sepsis caused by transfusion of bacterially contaminated blood components is similar to or less than that of transfusion-transmitted hepatitis C virus infection, yet significantly exceeds those currently estimated for transfusion-associated human immunodeficiency and hepatitis B viruses. Outcomes are serious and may be fatal. In addition, transfusion of sterile allogenic blood can have generalized immunosuppressive effects on recipients, resulting in increased susceptibility to postoperative infection. This review examines the frequency of occurrence of transfusion-associated sepsis, the organisms implicated, and potential sources of bacteria. Approaches to minimize the frequency of sepsis are discussed, including the benefits and disadvantages of altering the storage conditions for blood. In addition, the impact of high levels of bacteria on the gross characteristics of erythrocyte and platelet concentrates is described. The potentials and limitations of current tests for detecting bacteria in blood are also discussed. PMID:7923050

  4. Prevalence and Trends of Transfusion-Transmissible Viral Infections among Blood Donors in South of Iran: An Eleven-Year Retrospective Study

    PubMed Central

    Farshadpour, Fatemeh; Taherkhani, Reza; Tajbakhsh, Saeed; Gholizadeh Tangestani, Marziyeh; Hajiani, Gholamreza; Sharifi, Nasrin; Taherkhani, Sakineh; Nejadbolkheyr, Abdolreza

    2016-01-01

    Background Blood transfusion is considered a potential risk factor for transmission of life-threatening viral infections, including HIV, HCV and HBV infections. This study was performed to find out the prevalence and trends of these infections among blood donors in Southern Iran. Methods The blood donor data recorded in twelve regional blood transfusion centers from 2004 to 2014 were analyzed in an anonymous way with respect to the results of serological screening for HBV, HCV, and HIV infections. Overall, 293454 donors were screened for viral infections. Results Most of the donors were male, married, aged between 20–40 years, educated, and regular donors. The overall seroprevalence rates of HBV, HCV and HIV were 0.15%, 0.1% and 0.004%, respectively. The highest seroprevalence was found for HBV, followed by HCV and HIV. These infections were more prevalent in male, low educated and first time donors. The highest HCV seroprevalence was observed among donors aged 20 to 40 years, while HBV seroprevalence increased with age. The seroprevalence rates of HBV and HCV from 2004 to 2014 showed significant decreasing trends from 0.460% to 0.060% (P < 0.001) and 0.329% to 0.045% (P < 0.001), respectively. Whereas HIV infection had a slight but not significant decline from 0.0173% in 2004 to 0.0028% in 2014 (P = 0.087). Conclusions The decreasing trends of transfusion-transmissible viral infections in blood donations indicate that the attempts of IBTO were successful in improving the safety of the blood supply, since the prevalence rates of viral infections have been reduced to very low levels in blood donations over the years. However, still more effective techniques such as polymerase chain reaction (PCR) are needed to guarantee blood safety. PMID:27309959

  5. The efficacy of combined use of intraarticular and intravenous tranexamic acid on reducing blood loss and transfusion rate in total knee arthroplasty.

    PubMed

    Lin, Sung-Yen; Chen, Chung-Hwan; Fu, Yin-Chih; Huang, Peng-Ju; Chang, Je-Ken; Huang, Hsuan-Ti

    2015-05-01

    The purpose of this study is to investigate the effect of preoperative intravenous (IV) and intraoperative topical administration of tranexamic acid (TXA) in total knee arthroplasty (TKA). A total of 120 patients were and randomly allocated to either topical group, combined group, or control group. The mean total blood loss was lower in the combined and topical groups (705 mL and 579 mL, respectively) in comparison with control group (949 mL, P < 0.001). There was a significant difference in transfusion rate among groups (P = 0.009). The postoperative hemoglobin drop and total drain amount were significantly less in the combined group compared to other groups. In conclusion, combining preoperative IV injection and topical administration of TXA can effectively reduce blood loss and transfusion rate. PMID:25534864

  6. Short Communication: Investigating a Chain of HIV Transmission Events Due to Homosexual Exposure and Blood Transfusion Based on a Next Generation Sequencing Method.

    PubMed

    Zhao, Qi; Zhang, Chen; Jiang, Yan; Wen, Yujie; Pan, Pinliang; Li, Yang; Zhang, Guiyun; Zhang, Lei; Qiu, Maofeng

    2015-12-01

    This study investigates a chain of HIV transmission events due to homosexual exposure and blood transfusion in China. The MiSeq platform, a next generation sequencing (NGS) system, was used to obtain genetic details of the HIV-1 env region (336 base pairs). Evolutionary analysis combined with epidemiologic evidence suggests a transmission chain from patient T3 to T2 through homosexual exposure and subsequently to T1 through blood transfusion. More importantly, a phylogenetic study suggested a likely genetic bottleneck for HIV in homosexual transmission from T3 to T2, while T1 inherited the majority of variants from T2. The result from the MiSeq platform is consistent with findings from the epidemiologic survey. The MiSeq platform is a powerful tool for tracing HIV transmissions and intrapersonal evolution. PMID:26355677

  7. [An a priori risk analysis study. Securisation of transfusion of blood product in a hospital: from the reception in the medical unit to its administration].

    PubMed

    Bertrand, E; Lévy, R; Boyeldieu, D

    2013-12-01

    Following an ABO accident after transfusion of red blood cells, an a priori risk analysis study is being performed in a hospital. The scope of this analysis covers from the reception of the blood product in the medical unit to its administration. The risk analysis enables to identify the potentially dangerous situations and the evaluation of the risks in order to propose corrective measures (precautionary or protective) and bring the system back to an acceptable risk level. The innovative concept of an a priori risk analysis in the medical field allows the extension of the analysis of this transfusion risk to other hospitals. In addition, it allows the extension of the use of this approach to other medical fields. PMID:24176607

  8. Strategies for the transfusion of subjects with complex red cell immunisation: the Bank of rare blood donors of the Region of Lombardy

    PubMed Central

    Morelati, Fernanda; Arnaboldi, Piera; Barocci, Fiorella; Bodini, Umberto; Boiani, Elisa; Bresciani, Susanna; Cambiè, Giuseppe; Cazzaniga, Giovanni; Cocco, Ernesto; Copeta, Alessandro; Crotti, Massimo; D’Agostino, Francesco; D’Agostino, Marco; Focchiatti, Valeria; Fonti, Elena; Galassi, Luigi; Gazzola, Giambattista; Gelpi, Luigi; Greppi, Noemi; Inghilleri, Giovanni Battista; Isernia, Paola; Manera, Maria Cristina; Marini, Mirella; Monti, Rosalia; Morales, Rino; Moroni, Gianalessandro; Morra, Enrica; Pau, Maria Paola; Paccapelo, Cinzia; Pagliaro, Pasqualepaolo; Prati, Daniele; Revelli, Nicoletta; Rinaldini, Claudia; Rossi, Davide; Rossi, Fabio; Salvaneschi, Laura; Sciariada, Luca; Sergiacomo, Pierluigi; Tiburzi, Alessandra; Trotti, Roberta; Turdo, Rosalia; Velati, Claudio; Villa, Maria Antonietta; Vismara, Giuseppina; Vitali, Elisabetta; Marconi, Maurizio

    2007-01-01

    Introduction Selecting units of rare blood for transfusion to patients with complex immunisation is one of the most critical processes of a Transfusion Centre. In January 2005 the ‘Rare Blood Components Bank – Reference Centre of the Region of Lombardy’ w as established with the following goals: 1) identifying regional rare blood donors; 2) creating a regional registry of rare donors; 3) organising a regional bank of liquid and frozen rare blood units; 4) setting up a regional Immunohaematology Reference Laboratory (IRL) to type donors and resolve complex cases. Methods The key elements in establishing the Bank were periodic meetings organised by the directors and representatives of the regional Departments of Transfusion Medicine and Haematology (DTMH) and the institution of three working groups (informatics, regulations, finance). Results The regional IRL was set up, the relevant operating procedures were distributed region-wide, software features were defined and later validated upon activation, and the funds assigned were allocated to various cost items. The number and characteristics of the donors to be typed were identified and 14 regional DTMHs started to send samples. Overall, 20,714 donors were typed, for a total of 258,003 typings, and 2,880 rare donors were identified. Of these, 97% were rare donors because of combinations of antigens (2,139 negative for the S antigen and 659 negative for the s antigen) and 3% (n=82) because they were negative for high-frequency antigens. In the first 2 years of activity, the IRL carried out investigations of 140 complex cases referred from other Centres and distributed 2,024 units with rare phenotypes to 142 patients. Conclusions The main goal achieved in the first 24 months from the start of the project was to set up a regional network able to meet the transfusion needs of patients with complex immunisation. PMID:19204778

  9. Intraoperative transfusion of packed red blood cells in microvascular free tissue transfer patients: assessment of 30-day morbidity using the NSQIP dataset.

    PubMed

    Kim, Bobby D; Ver Halen, Jon P; Mlodinow, Alexei S; Kim, John Y S

    2014-02-01

    Although often a life-saving therapeutic maneuver, there is minimal data available that details the effects of intraoperative packed red blood cell transfusion (IOT) after microvascular free tissue transfer. The National Surgical Quality Improvement Program database was queried to identify all patients who underwent microvascular free tissue transfer between 2006 and 2010. Multivariate logistic regression models were used to determine the association between intraoperative transfusion and outcomes. Upon bivariate and multivariate analyses, IOT was significantly associated with higher rates of overall complications (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.12-3.63), medical complications (OR, 3.35; 95% CI, 1.75-6.42), postoperative transfusion (OR, 6.02; 95% CI, 2.02-17.97), and reoperation (OR, 2.24; 95% CI, 1.24-4.04). IOT was not associated with either surgical complications or free flap loss. IOT significantly increases risk for adverse overall and medical complications. However, IOT was not associated with surgical complications or free flap loss. Transfusion practices in the operating room should be reevaluated to improve overall outcomes. PMID:24114710

  10. Characterisation of hepatitis C virus genotype among blood donors at the regional blood transfusion centre of Ouagadougou, Burkina Faso

    PubMed Central

    Zeba, Moctar Tokèda Abdoul; Sanou, Mahamoudou; Bisseye, Cyrille; Kiba, Alice; Nagalo, Bolni Marius; Djigma, Florencia Wendkuuni; Compaoré, Tegwindé Rebecca; Nebié, Yacouba Koumpingnin; Kienou, Kisito; Sagna, Tani; Pietra, Virginio; Moret, Rémy; Simporé, Jacques

    2014-01-01

    Background Hepatitis C virus (HCV) is responsible for about 900 deaths every year in Burkina Faso. In this country, serological screening for hepatitis B and C viruses is only carried out systematically among blood donors. The aim of this study was to determine the prevalence and genotypes of HCV among blood donors using reverse transcription polymerase chain reaction (PCR) and real-time PCR, respectively. Materials and methods Serum samples were screened for antibodies to HCV using an enzyme-linked immunosorbent assay (ARCHITECT-i1000SR-ABBOTT). All the reactive samples for HCV antibodies were re-tested using a second enzyme-linked immunosorbent assay (Bio-Rad, Marnes la Coquette, France) for confirmation. RNA was detected in all the reactive samples for antibodies to HCV. HCV RNA positive samples were genotyped using the HCV Real-TM Genotype kit (Sacace Biotechnologies, Italy). Results Among 2,200 blood donors, the prevalences of antibodies to HCV and viral RNA were 4.4% (95% confidence interval=3.5–5.3) and 1.5% (95% confidence interval=1.0–2.0), respectively. Among HCV RNA carriers, genotyping showed that HCV genotypes 2 and 3 were the most prevalent as they were detected in 18 (56.3%) and 5 (15.6%) individuals, respectively. HCV genotypes 1a and 4 were the least frequent among the blood donors. HCV mixed genotypes 2/3 and 2/4 were also detected among the blood donors. Conclusion The prevalence of HCV found in this study is lower than previously reported prevalences. Large-scale studies are needed to obtain a better picture of the molecular epidemiology of HCV in Burkina Faso. PMID:24599906

  11. Trends in Transfusion Transmitted Infections Among Replacement Blood Donors in Karachi, Pakistan

    PubMed Central

    Irfan, Syed Mohammad; Uddin, Jamal; Zaheer, Hasan Abbas; Sultan, Sadia; Baig, Amjad

    2013-01-01

    Objective: To determine the prevalence of Hepatitis-B, Hepatitis-C and Human Immunodeficiency infections in replacement blood donors. Materials and Methods: From January 2004 to December 2011, 108,598 apparently healthy donors donated blood at our Blood Bank. Screening was done by Microparticle Enzyme Immuno Assay (MEIA) method on Axsym System (Abbott Diagnostic, USA) and in year 2011 by Chemiluminescent Immunoassay (CIA) method on Architect i2000 (Abbott Diagnostic, USA). From 2010 onward, HIV reactive donors were advised for confirmatory tests and reported back with the results. Results: Of the 108,598 total donors, 108,393 (99.8%) were replacement donors with a mean age of 28.92 (17-55) years. Of this, only 164 (0.15%) were females. Among the replacement donors, 4,906 (4.5%) were found to be reactive for Hepatitis-B, C and Human Immunodeficiency Virus. All the reactive patients, except one, were males. HbsAg was positive in 2,068 (1.90%) and anti-HCV in 2832 (2.61%) donors, while 111 (0.10%) were positive for Human Immunodeficiency Virus. Co-infectivity was observed in 103 (0.09%) cases. The prevalence appeared to be higher in younger age group (17-30 yrs). Only 16.6% cases should be patients returned with results of the confirmatory tests for HIV and were found positive. Conclusion: Hepatitis-B and C sero-prevalence in our series of replacement donors appears high compared to most studies from neighboring countries and relatively low in comparison to earlier studies from Pakistan. Prevalence of HIV, however, appears low and turn out of HIV positive cases for confirmatory tests is low. Conflict of interest:None declared. PMID:24385780

  12. 42 CFR 493.1103 - Standard: Requirements for transfusion services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... of transfusion reactions on a continuous basis through a CLIA-certified laboratory or a laboratory... transfusion reactions. The facility must have procedures for preventing transfusion reactions and when necessary, promptly identify, investigate, and report blood and blood product transfusion reactions to...

  13. 42 CFR 493.1103 - Standard: Requirements for transfusion services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... of transfusion reactions on a continuous basis through a CLIA-certified laboratory or a laboratory... transfusion reactions. The facility must have procedures for preventing transfusion reactions and when necessary, promptly identify, investigate, and report blood and blood product transfusion reactions to...

  14. 42 CFR 493.1103 - Standard: Requirements for transfusion services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... of transfusion reactions on a continuous basis through a CLIA-certified laboratory or a laboratory... transfusion reactions. The facility must have procedures for preventing transfusion reactions and when necessary, promptly identify, investigate, and report blood and blood product transfusion reactions to...

  15. 42 CFR 493.1103 - Standard: Requirements for transfusion services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... of transfusion reactions on a continuous basis through a CLIA-certified laboratory or a laboratory... transfusion reactions. The facility must have procedures for preventing transfusion reactions and when necessary, promptly identify, investigate, and report blood and blood product transfusion reactions to...

  16. Effects of Exercise in Combination With Epoetin Alfa During High-Dose Chemotherapy and Autologous Peripheral Blood Stem Cell Transplantation for Multiple Myeloma

    PubMed Central

    Coleman, Elizabeth A.; Coon, Sharon K.; Kennedy, Robert L.; Lockhart, Kimberly D.; Stewart, Carol B.; Anaissie, Elias J.; Barlogie, Bart

    2008-01-01

    Purpose/Objectives To determine the effect of aerobic and strength resistance training and epoetin alfa (EPO) therapy on transfusions, stem cell collections, transplantation recovery, and multiple myeloma treatment response. Design Randomized clinical trial. Setting A myeloma research and therapy center in the south central United States. Sample 135 patients with multiple myeloma, 120 evaluable. Methods Random assignment to exercise or usual care groups. All patients received EPO based on an algorithm. Aerobic capacity, using the six-minute walk test, was assessed prior to induction chemotherapy, prior to stem cell mobilization, and following stem cell collection for all patients and before and after transplantation for patients continuing in the study. Data analysis included analysis of variance to compare other outcome variables by groups. Main Research Variables Number of red blood cell and platelet transfusions during transplantation, number of attempts at and total number of days of stem cell collection, time to recovery after transplantation, and response to intensive therapy for multiple myeloma. Findings Recovery and treatment response were not significantly different between groups after transplantation. The exercise group had significantly fewer red blood cell transfusions and fewer attempts at stem cell collection. Serious adverse events were similar in each group. Conclusions Exercise with prophylactic EPO therapy reduces the number of RBC transfusions and attempts at stem cell collection for patients receiving intensive treatment for multiple myeloma. Implications for Nursing Exercise is safe and has many physiologic benefits for patients receiving multiple myeloma treatment. PMID:18467280

  17. Biochemical and Cellular Changes in Leukocyte-Depleted Red Blood Cells Stored for Transfusion

    PubMed Central

    Nogueira, Diana; Rocha, Susana; Abreu, Estela; Costa, Elísio; Santos-Silva, Alice

    2015-01-01

    Summary Background To evaluate biochemical and cellular changes associated with the storage of leukocyte-depleted red blood cells (RBCs). Methods We investigated 10 leukocyte-depleted RBC units, randomly chosen from volunteer donors. Every week an aliquot was collected for laboratorial evaluation, which included complete cell blood count, glucose-6-phosphate dehydrogenase (G6PD) activity, extracellular sodium, potassium and pH, membrane-bound hemoglobin (MBH), band 3 profile, and quantification of RBC membrane proteins composition. Results We observed an increase in mean cell volume (from 91.86 ± 4.65 fl to 98.10 ± 5.80 fl, day 0 vs. day 21; p < 0.05), red cell distribution width, percentage of macrocytic RBCs, reticulocyte hemoglobin content and a decreased percentage of microcytic RBCs, mean cell volume concentration and G6PD activity. The extracellular concentration of sodium decreased, and that of potassium increased significantly over time. RBC membrane composition revealed an increase in spectrin/ankyrin ratio after 21 days (from 4.84 ± 0.99 to 5.27 ± 0.94, day 0 vs. day 21; p < 0.05). At day 35, a decrease in ankyrin (from 6.44 ± 1.70% to 5.49 ± 1.96%, day 0 vs. day 35; p < 0.05), in protein 4.1/band 3, protein 4.2/band 3, and ankyrin/band 3 ratios and in band 5 was observed. Conclusions Our data show that leukocyte-depleted RBCs present changes in the RBC morphology, membrane protein composition, enzymatic activity, and extracellular electrolyte concentration and pH. PMID:25960715

  18. Iron and transfusion medicine.

    PubMed

    Waldvogel-Abramovski, Sophie; Waeber, Gérard; Gassner, Christoph; Buser, Andreas; Frey, Beat M; Favrat, Bernard; Tissot, Jean-Daniel

    2013-11-01

    Blood bankers have focused their energy to secure blood transfusion, and only recently have studies been published on the effect of blood donation on iron metabolism. In many facilities, hemoglobin measurement is only performed just before or even during blood donation, but the determination of iron stores is largely ignored. The 2013 paradox of transfusion medicine is due to the fact that blood donation may be harmful and leads to iron deficiency with or without anemia, but for other individuals, it may be a healthy measure preventing type 2 diabetes. The purpose of this review is to discuss iron metabolism in the perspective of blood donation, notably regarding their possible genetic profiles that eventually will discriminate "good" iron absorbers from "bad" iron responders. PMID:24148756

  19. Are lower levels of red blood cell transfusion more cost-effective than liberal levels after cardiac surgery? Findings from the TITRe2 randomised controlled trial

    PubMed Central

    Stokes, E A; Wordsworth, S; Bargo, D; Pike, K; Rogers, C A; Brierley, R C M; Angelini, G D; Murphy, G J; Reeves, B C

    2016-01-01

    Objective To assess the incremental cost and cost-effectiveness of a restrictive versus a liberal red blood cell transfusion threshold after cardiac surgery. Design A within-trial cost-effectiveness analysis with a 3-month time horizon, based on a multicentre superiority randomised controlled trial from the perspective of the National Health Service (NHS) and personal social services in the UK. Setting 17 specialist cardiac surgery centres in UK NHS hospitals. Participants 2003 patients aged >16 years undergoing non-emergency cardiac surgery with a postoperative haemoglobin of <9 g/dL. Interventions Restrictive (transfuse if haemoglobin <7.5 g/dL) or liberal (transfuse if haemoglobin <9 g/dL) threshold during hospitalisation after surgery. Main outcome measures Health-related quality of life measured using the EQ-5D-3L to calculate quality-adjusted life years (QALYs). Results The total costs from surgery up to 3 months were £17 945 and £18 127 in the restrictive and liberal groups (mean difference is −£182, 95% CI −£1108 to £744). The cost difference was largely attributable to the difference in the cost of red blood cells. Mean QALYs to 3 months were 0.18 in both groups (restrictive minus liberal difference is 0.0004, 95% CI −0.0037 to 0.0045). The point estimate for the base-case cost-effectiveness analysis suggested that the restrictive group was slightly more effective and slightly less costly than the liberal group and, therefore, cost-effective. However, there is great uncertainty around these results partly due to the negligible differences in QALYs gained. Conclusions We conclude that there is no clear difference in the cost-effectiveness of restrictive and liberal thresholds for red blood cell transfusion after cardiac surgery. Trial registration number ISRCTN70923932; Results. PMID:27481621

  20. A comparison of high versus low dose recombinant human erythropoietin versus blood transfusion in the management of anaemia of prematurity in a developing country.

    PubMed

    Avent, M; Cory, B J; Galpin, J; Ballot, D E; Cooper, P A; Sherman, G; Davies, V A

    2002-08-01

    The purpose of this study was to evaluate the effectiveness of early treatment with erythropoietin (EPO) in two different treatment regimes (high vs. low dose) in comparison to the conventional treatment of packed red blood cell (PRBC) transfusions in the management of anaemia of prematurity in a country with limited resources. An open controlled trial was conducted on 93 preterm infants (7 days postnatal age, 900-1500 g birthweight). Patients were randomly assigned either to a low dose (250 IU/kg), a high dose (400 IU/kg), or a control group. EPO was administered subcutaneously three times a week and all infants received 6 mg/kg iron orally from study entry to endpoint of therapy. Haematological parameters were measured and compared. The success was defined as an absence of transfusions and a haematocrit that did not fall below 30 per cent during the time period that the infants were in the study. The three groups were statistically comparable at study entry with respect to gestational age, birthweight, Apgar scores, and haematological values. Over the period that the infants were in the study, 75 per cent of the low dose group and 71 per cent of the high dose group met the criteria for success compared with 40 per cent in the control group (p < 0.001). However, there was no significant difference in the number of transfusions when the low and high EPO dose groups (9.5 per cent) were combined and compared with the control group (26.7 per cent) p = 0.0587. It was concluded that in stable infants, 900-1500 g, where phlebotomy losses are minimized and stringent transfusion guidelines are adhered to, EPO does not significantly decrease the number of transfusions. A conservative approach in the management of anaemia of prematurity, is a viable alternative in areas with limited resources. PMID:12200985

  1. Perioperative blood transfusion affects hepatitis C virus (HCV)-specific immune responses and outcome following liver transplantation in HCV-infected patients

    PubMed Central

    Subramanian, Vijay; Bharat, Ankit; Vachharajani, Neeta; Crippin, Jeffrey; Shenoy, Surendra; Mohanakumar, Thalachallour; Chapman, William C

    2014-01-01

    Objectives:Perioperative factors can affect outcomes of liver transplantation (LT) in recipients with hepatitis C virus (HCV) infection. This study was conducted to investigate whether the immunomodulatory effects of packed red blood cells (PRBC) and platelets administered in the perioperative period might affect immune responses to HCV and thus outcomes in LT recipients. Methods:Data for a total of 257 HCV LT recipients were analysed. Data on clinical demographics including perioperative transfusion (during and within the first 24 h), serum cytokine concentration, HCV-specific interferon-γ (IFN-γ) and interleukin-17 (IL-17) producing cells, and outcomes including graft and patient survival were analysed. Results:Patient survival was higher in HCV LT recipients who did not receive transfusions (Group 1, n = 65) than in those who did (Group 2, n = 192). One-year patient survival was 95% in Group 1 and 88% in Group 2 (P = 0.02); 5-year survival was 77% in Group 1 and 66% in Group 2 (P = 0.05). Group 2 had an increased post-transplant viral load (P = 0.032) and increased incidence of advanced fibrosis at 1 year (P = 0.04). After LT, Group 2 showed increased IL-10, IL-17, IL-1β and IL-6, and decreased IFN-γ, and a significantly increased rate of IL-17 production against HCV antigen. Increasing donor age (P = 0.02), PRBC transfusion (P < 0.01) and platelets administration were associated with worse survival. Conclusions:Transfusion had a negative impact on LT recipients with HCV. The associated early increase in pro-HCV IL-17 and IL-6, with decreased IFN-γ, suggests that transfusion may be associated with the modulation of HCV-specific responses, increased fibrosis and poor transplant outcomes. PMID:23869514

  2. How often should a red blood cell administration set be changed while a patient is being transfused? A commentary and review of the literature.

    PubMed

    Blest, A; Roberts, M; Murdock, J; Watson, D; Brunskill, S

    2008-04-01

    Current recommendations vary with regard to the frequency of change of a red blood cell (RBC) administration set. A full review was undertaken to evaluate the recommendations for how often a RBC administration set should be changed while a patient is being transfused. Comprehensive searches of Medline, Embase, Cinahl, the Cochrane Library, handsearching of transfusion journals, guidelines and websites and contact with administration set manufacturers identified 32 relevant papers: 11 clinical updates; 11 guidelines; 5 manufacturer data sheets; 3 standards; 1 Department of Health report and 1 expert opinion. Recommendations varied widely across papers. There was no pattern in recommendation by paper type, date or country of origin. Recommendations were based on change of RBC administration set either after a given number of hours or number of RBC units. The recommendations varied widely and ranged from 4 to 48 h and from 'every unit' to 'several units'. The most frequent recommendations were change of RBC administration set after 12 h or 4 units. Methodological quality of the included papers is poor. There is no formal evidence base on which to support current recommendations or challenge the current British Committee for Standards in Haematology guideline. Targeted research aimed at establishing an evidence base may be warranted and would need to document other variables that can impact frequency of change, including type of filter, age of blood and duration of RBC transfusion. PMID:18399846

  3. Does autologous blood transfusion during liver transplantation for hepatocellular carcinoma increase risk of recurrence?

    PubMed Central

    Araujo, Raphael LC; Pantanali, Carlos Andrés; Haddad, Luciana; Rocha Filho, Joel Avancini; D’Albuquerque, Luiz Augusto Carneiro; Andraus, Wellington

    2016-01-01

    AIM: To analyze outcomes in patients who underwent liver transplantation (LT) for hepatocellular carcinoma (HCC) and received autologous intraoperative blood salvage (IBS). METHODS: Consecutive HCC patients who underwent LT were studied retrospectively and analyzed according to the use of IBS or not. Demographic and surgical data were collected from a departmental prospective maintained database. Statistical analyses were performed using the Fisher’s exact test and the Wilcoxon rank sum test to examine covariate differences between patients who underwent IBS and those who did not. Univariate and multivariate Cox regression models were developed to evaluate recurrence and death, and survival probabilities were estimated using the Kaplan-Meier method and compared by the log-rank test. RESULTS: Between 2002 and 2012, 158 consecutive patients who underwent LT in the same medical center and by the same surgical team were identified. Among these patients, 122 (77.2%) were in the IBS group and 36 (22.8%) in the non-IBS group. The overall survival (OS) and recurrence free survival (RFS) at 5 years were 59.7% and 83.3%, respectively. No differences in OS (P = 0.51) or RFS (P = 0.953) were detected between the IBS and non-IBS groups. On multivariate analysis for OS, degree of tumor differentiation remained as the only independent predictor. Regarding patients who received IBS, no differences were detected in OS or RFS (P = 0.055 and P = 0.512, respectively) according to the volume infused, even when outcomes at 90 d or longer were analyzed separately (P = 0.518 for both outcomes). CONCLUSION: No differences in RFS or OS were detected according to IBS use. Trials addressing this question are justified and should be designed to detect small differences in long-term outcomes. PMID:26981190

  4. Laser-Bioplasma Interaction: The Blood Type Transmutation Induced by Multiple Ultrashort Wavelength Laser Beams

    NASA Astrophysics Data System (ADS)

    Stefan, V. Alexander

    2015-11-01

    The interaction of ultrashort wavelength multi laser beams with the flowing blood thin films leads to the transmutation of the blood types A, B, and AB into O type. This is a novel mechanism of importance for the transfusion medicine. Laser radiation is in resonance with the eigen-frequency modes of the antigen proteins and forces the proteins to parametrically oscillate until they get kicked out from the surface. The stripping away of antigens is done by the scanning-multiple-lasers of a high repetition rate in the blue-purple frequency domain. The guiding-lasers are in the red-green frequency domain. The laser force, (parametric interaction with the antigen eigen-oscillation), upon the antigen protein molecule must exceed its weight. The scanning laser beam is partially reflected as long as the antigen(s) is not eliminated. The process of the protein detachment can last a few minutes. Supported by Nikola Tesla Labs., Stefan University.

  5. Deferasirox in Treating Iron Overload Caused By Blood Transfusions in Patients With Hematologic Malignancies

    ClinicalTrials.gov

    2014-12-09

    ; Noncontiguous Stage II Grade 1 Follicular Lymphoma; Noncontiguous Stage II Grade 2 Follicular Lymphoma; Noncontiguous Stage II Grade 3 Follicular Lymphoma; Noncontiguous Stage II Mantle Cell Lymphoma; Noncontiguous Stage II Marginal Zone Lymphoma; Noncontiguous Stage II Small Lymphocytic Lymphoma; Noncutaneous Extranodal Lymphoma; Peripheral T-cell Lymphoma; Previously Treated Myelodysplastic Syndromes; Primary Myelofibrosis; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Recurrent Adult Burkitt Lymphoma; Recurrent Adult Diffuse Large Cell Lymphoma; Recurrent Adult Diffuse Mixed Cell Lymphoma; Recurrent Adult Diffuse Small Cleaved Cell Lymphoma; Recurrent Adult Grade III Lymphomatoid Granulomatosis; Recurrent Adult Hodgkin Lymphoma; Recurrent Adult Immunoblastic Large Cell Lymphoma; Recurrent Adult Lymphoblastic Lymphoma; Recurrent Adult T-cell Leukemia/Lymphoma; Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma; Recurrent Grade 1 Follicular Lymphoma; Recurrent Grade 2 Follicular Lymphoma; Recurrent Grade 3 Follicular Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Marginal Zone Lymphoma; Recurrent Mycosis Fungoides/Sezary Syndrome; Recurrent Small Lymphocytic Lymphoma; Refractory Anemia; Refractory Multiple Myeloma; Secondary Acute Myeloid Leukemia; Secondary Myelofibrosis; Small Intestine Lymphoma; Splenic Marginal Zone Lymphoma; Stage I Adult Burkitt Lymphoma; Stage I Adult Diffuse Large Cell Lymphoma; Stage I Adult Diffuse Mixed Cell Lymphoma; Stage I Adult Diffuse Small Cleaved Cell Lymphoma; Stage I Adult Hodgkin Lymphoma; Stage I Adult Immunoblastic Large Cell Lymphoma; Stage I Adult Lymphoblastic Lymphoma; Stage I Adult T-cell Leukemia/Lymphoma; Stage I Cutaneous T-cell Non-Hodgkin Lymphoma; Stage I Grade 1 Follicular Lymphoma; Stage I Grade 2 Follicular Lymphoma; Stage I Grade 3 Follicular Lymphoma; Stage I Mantle Cell Lymphoma; Stage I Marginal Zone Lymphoma; Stage I Multiple Myeloma; Stage I Mycosis Fungoides/Sezary Syndrome

  6. NOTE: Arterio-venous flow between monochorionic twins determined during intra-uterine transfusion

    NASA Astrophysics Data System (ADS)

    van Gemert, Martin J. C.; van den Wijngaard, Jeroen P. H. M.; Lopriore, Enrico; Pasman, Suzanne A.; Vandenbussche, Frank P. H. A.

    2008-04-01

    Twin-twin transfusion syndrome (TTTS) is a severe complication of monozygotic (identical) twin fetuses sharing one single (monochorionic) placenta. TTTS is caused by a net inter-twin transfusion of blood through placental anastomoses, from one twin (the donor) to the other (the recipient), which link the two feto-placental circulations. Currently, the only reliable method to measure the net inter-twin transfusion clinically is when incomplete laser therapy of TTTS occurs and one of the twins becomes anemic and requires an intra-uterine transfusion of adult red blood cells. Then, differences between adult hemoglobin concentrations measured during the transfusion and at birth relate not only to the net inter-twin transfusion but also to the finite lifetime of the adult red blood cells. We have analyzed this situation, derived the differential equations of adult hemoglobin in the donor and recipient twins, given the solutions and given expressions relating the net inter-twin flow with clinically measured parameters. We have included single and multiple intra-uterine transfusions. In conclusion, because incomplete laser therapy occurs frequently, and some cases require an intra-uterine transfusion, this method may allow collecting a wealth of net inter-twin flow data from clinicians involved in laser therapy of TTTS. To aid to the widespread use of this method, we have presented the equations as clearly as possible in tables for easy use by others.

  7. Transfusion-related acute lung injury (TRALI).

    PubMed

    Roberts, George H

    2004-01-01

    Transfusion is an inevitable event in the life of many individuals. Transfusion medicine personnel attempt to provide blood products that will result in a safe and harmless transfusion. However, this is not always possible since no laboratory test gives totally accurate and reliable results all the time and testing in routine transfusion services is devoted primarily to the identification of red blood cell problems. Thus, when patients are transfused, several possible adverse effects may occur in the transfused patient even though quality testing indicates no potential problem. These adverse events include infectious complications, hemolytic reactions, anaphylaxis, urticaria, circulatory overload, transfusion-associated graft-versus-host disease, chills and fever, immunomodulation, and transfusion-related acute lung injury (TRALI). PMID:15314887

  8. Acute pain transfusion reaction.

    PubMed

    Hardwick, Jody; Osswald, Michael; Walker, Daniel

    2013-11-01

    A 34-year-old woman with a diagnosis of hemophagocytic lymphohistocytosis (HLH) received a double umbilical cord blood transplantation following a myeloablative chemotherapy preparative regimen with busulfan and cyclophosphamide. HLH is a rare, potentially fatal hematologic disorder characterized by the overactivation of histocytes and T lymphocytes, leading to organ infiltration and acute illness. On day 25 post-transplantation, the patient required a platelet transfusion for a platelet count of 6,000 per ml (normal range = 150,000-450,000 per ml). The patient's blood type prior to the cord blood transplantation was B positive and, although both umbilical cord blood donors were O positive, the patient was still B positive per blood bank testing on that day. Although the recipient of an allogenic stem cell transplantation will eventually become the blood type of the donor, the time for this process to occur varies for each person. That process must be monitored by the blood bank for the purpose of cross-matching blood products to decrease hemolysis as much as possible. The patient was premedicated with the facility's standard for platelet transfusions: acetaminophen 650 mg and diphenhydramine 25 mg about 30 minutes prior to the platelet transfusion. PMID:24161631

  9. An analysis of the influence of intra-operative blood salvage and autologous transfusion on reducing the need for allogeneic transfusion in elective infrarenal abdominal aortic aneurysm repair

    PubMed Central

    Pasternak, Janko; Nikolic, Dragan; Milosevic, Djordje; Popovic, Vladan; Markovic, Vladimir

    2014-01-01

    Background An intra-operative cell salvage machine, commonly known as a “cell saver”, aspirates, washes, and filters patient’s blood during an operation so that the blood can be returned to the patient’s circulation instead of being discarded. This procedure could significantly reduce the risks related to the use of allogeneic blood and blood products in surgery. The aim of this study was to analyse the influence of intra-operative cell salvage on reducing the need for allogeneic blood in patients with asymptomatic infrarenal abdominal aortic aneurysm undergoing elective repair of the aneurysm. Material and methods We retrospectively collected data from the clinical records of patients who underwent elective infrarenal abdominal aortic aneurysm repair. Two groups were formed: the “cell saver” group, in which intra-operative cell salvage was used, and the control group, in which a cell saver was not used. Results Thirty patients underwent abdominal aortic aneurysm repair with the use of a cell saver, while 32 underwent the same operation without cell salvage. We found a significant association between use of the cell saver and a reduced need for allogeneic blood in these patients. Operations performed with the use of a cell saver lasted, on average, less time than those performed without it. The difference between pre-operative and post-operative haemoglobin levels was significantly greater in the group of patients who underwent repair with the use of a cell saver than in the control group. Conclusion The use of a cell saver in elective abdominal aortic aneurysm repair significantly reduces the need for intra-operative use of allogeneic blood. PMID:23114525

  10. [Clinical application of blood matching with hemolytic test in vitro for transfusion treatment of crisis puerpera with acute hemolytic anemia].

    PubMed

    Yuan, Min; Tang, Cong-Hai; Gan, Wei-Wei; Wu, A-Yang; Yang, Hui-Cong; Zhang, Tian-Xin; Huang, Yan Xue; Qiu, Lu-Zhen; Chen, Hong-Pu; Lin, Feng-Li

    2014-08-01

    This study was aimed to establish the matching method of hemolytic test in vitro, and to guide the transfusion treatment for puerpera with acute hemolytic disease. The donor's erythrocytes were sensibilized by all the antibodies in plasma of patient in vitro and were added with complement, after incubation for 6.5 hours at 38 °C, the hemolysis or no hemolysis were observed. It is safe to transfuse if the hemolysis did not occur. The results showed that when the matching difficulty happened to puerpera with acute hemolytic disease, the compatible donor could be screened by hemolytic test in vitro. There were no untoward effects after transfusion of 6 U leukocyte-depleted erythrocyte suspension. The all hemoglobin, total bilirubins, indirect bilirubin, reticulocyte, D-dimex and so on were rapidly improved in patient after transfusion , showing obvious clinical efficacy of treatment. It is concluded that when the matching results can not judge accurately compatible or incompatible through the routine method of cross matching, the agglutinated and no-hemolytic erythrocytes can be screened by hemolytic test in vitro and can be transfused with good efficacy; the hemoglobin level can be promoted rapidly, and no untoward effects occur. PMID:25130835

  11. Transfusion practices and infectious risks.

    PubMed

    Shander, Aryeh; Lobel, Gregg P; Javidroozi, Mazyar

    2016-06-01

    Transfusion-transmitted infections remain among the most-feared complications of allogeneic blood transfusion. Thanks to several strategies including donor screening and deferral, blood testing and pathogen inactivation, their risks have reached all-time low levels, particularly in developed nations. Nonetheless, new and emerging infections remain a threat that is likely to exacerbate in the coming years with continued globalization and climate change. More effective strategies of pathogen inactivation and more vigilant horizon screening are hoped to abate the risk. Additionally, allogeneic transfusion has repeatedly been shown to be associated with worsening of outcomes in patients, including the documented increased risk of infections (often nosocomial) in recipients of transfusions. The underlying mechanism is likely to be related to immunosuppressive effects of allogeneic blood, iron content, and bacterial contamination. This issue is best addressed by more judicious and evidence-based use of allogeneic blood components to ensure the potential benefits outweigh the risks. PMID:26959944

  12. Rare and transient anti-D antibody response in D(-) liver transplant recipients transfused with D(+) red blood cells.

    PubMed

    Burin des Roziers, N; Ibanez, C; Samuel, D; Francoz, C; Idri, S; François, A; Mortelecque, R; Bierling, P; Pirenne, F

    2016-07-01

    A retrospective analysis was conducted on 20 D(-) liver transplant (LT) recipients transfused with D(+) RBCs perioperatively and screened for RBC antibodies between 2 and 6 months later. None developed anti-D detectable by the indirect antiglobulin test. Two patients produced weak anti-D that reacted only with papain-treated RBCs at 10 and 11 days without any sign of immune haemolysis. Antibodies became quickly undetectable. These data suggest an unusual pattern of alloimmunization in LT recipients with rapid, weak and transient antibody response and support the safety of transfusing D(+) RBCs in most of D(-) patients during LT surgery. PMID:26918570

  13. A randomized controlled trial comparing darbepoetin alfa doses in red blood cell transfusion-dependent patients with low- or intermediate-1 risk myelodysplastic syndromes.

    PubMed

    Jang, Jun Ho; Harada, Hironori; Shibayama, Hirohiko; Shimazaki, Ryutaro; Kim, Hyeoung-Joon; Sawada, Kenichi; Mitani, Kinuko

    2015-10-01

    Darbepoetin alfa (DA) is a standard treatment for anemia in lower-risk MDS. However, to date there has been no comparative study to investigate the initial dosage. We, thus, conducted a randomized controlled trial to elucidate the optimal initial dosage of DA. International Prognostic Scoring System low or intermediate-1 risk MDS patients with hemoglobin levels ≤9.0 g/dL, serum erythropoietin levels ≤500 mIU/mL, and red blood cell transfusion dependency were enrolled. Patients were randomized to receive DA either at 60, 120, or 240 μg/week for 16 weeks followed by continuous administration with dose adjustment up to 48 weeks. Of 17, 18, and 15 patients in the 60, 120, and 240 μg DA groups included in the efficacy analysis, 64.7, 44.4, and 66.7 %, respectively, achieved the primary endpoint (major or minor erythroid response), while 17.6, 16.7, and 33.3 % achieved major erythroid responses in the initial 16-week period. No clinically significant safety concerns were identified. DA reduced the transfusion requirements effectively and safely in transfusion-dependent, lower-risk MDS patients. Given the highest achievement rate of the major erythroid response in the 240 μg group and the absence of dose-dependent adverse events, 240 μg weekly is the optimal initial dosage. PMID:26323997

  14. Epidemiology of Transfusion Transmitted Infection among Patients with β-Thalassaemia Major in Pakistan

    PubMed Central

    Ahmed Kiani, Rizwan; Anwar, Muhammad; Asad, Muhammad Javaid; Abbasi, Saleem; Abbas Zaheer, Hasan

    2016-01-01

    Introduction. Transfusion Transmitted Infections (TTIs) continue to be a major risk in transfusions in many parts of the world. The transfusion-dependent β-thalassaemia patients are particularly at risk of acquiring TTIs. The current study was undertaken to estimate the prevalence of TTIs in transfusion-dependent β-thalassaemia patients. Material and Methods. A cross-sectional study of 1253 multitransfused thalassaemia major patients was conducted in five different centres of Islamabad, Rawalpindi, and Karachi. The study subjects were screened for HIV, HCV, and HBV. The screening was performed at two centres: Department of Pathology, Shaheed Zulfiqar Ali Bhutto (SZAB) Medical University, and Blood Transfusion Services, Jinnah Postgraduate Medical Centre, from July to December 2015. The confirmatory screening was performed by Chemiluminescent Immunoassay (CLIA). Results. Out of the 1253 multiple transfused patients, 317 (25.3%) were infected with TTIs. HCV was positive in 273 cases (21.7%), HBV in 38 cases (3.0%), and HIV in 6 cases (0.5%). Conclusion. HCV was the leading TTI in multitransfused thalassaemia major patients in the study. Presence of HIV in thalassaemia patients is a recent disturbing development in Pakistan. Improved regulation of blood banks including use of internationally or nationally evaluated kits will bring down the incidence of TTIs in transfusion-dependent β-thalassaemia patients. More stringent behavioral and serological pretransfusion screening of blood for TTIs must be implemented in blood banks. PMID:27559490

  15. Epidemiology of Transfusion Transmitted Infection among Patients with β-Thalassaemia Major in Pakistan.

    PubMed

    Ahmed Kiani, Rizwan; Anwar, Muhammad; Waheed, Usman; Asad, Muhammad Javaid; Abbasi, Saleem; Abbas Zaheer, Hasan

    2016-01-01

    Introduction. Transfusion Transmitted Infections (TTIs) continue to be a major risk in transfusions in many parts of the world. The transfusion-dependent β-thalassaemia patients are particularly at risk of acquiring TTIs. The current study was undertaken to estimate the prevalence of TTIs in transfusion-dependent β-thalassaemia patients. Material and Methods. A cross-sectional study of 1253 multitransfused thalassaemia major patients was conducted in five different centres of Islamabad, Rawalpindi, and Karachi. The study subjects were screened for HIV, HCV, and HBV. The screening was performed at two centres: Department of Pathology, Shaheed Zulfiqar Ali Bhutto (SZAB) Medical University, and Blood Transfusion Services, Jinnah Postgraduate Medical Centre, from July to December 2015. The confirmatory screening was performed by Chemiluminescent Immunoassay (CLIA). Results. Out of the 1253 multiple transfused patients, 317 (25.3%) were infected with TTIs. HCV was positive in 273 cases (21.7%), HBV in 38 cases (3.0%), and HIV in 6 cases (0.5%). Conclusion. HCV was the leading TTI in multitransfused thalassaemia major patients in the study. Presence of HIV in thalassaemia patients is a recent disturbing development in Pakistan. Improved regulation of blood banks including use of internationally or nationally evaluated kits will bring down the incidence of TTIs in transfusion-dependent β-thalassaemia patients. More stringent behavioral and serological pretransfusion screening of blood for TTIs must be implemented in blood banks. PMID:27559490

  16. Post-traumatic immunosuppression is reversed by anti-coagulated salvaged blood transfusion: deductions from studying immune status after knee arthroplasty

    PubMed Central

    Islam, N; Whitehouse, M; Mehendale, S; Hall, M; Tierney, J; O'Connell, E; Blom, A; Bannister,, G; Hinde, J; Ceredig, R; Bradley, B A

    2014-01-01

    Major trauma increases vulnerability to systemic infections due to poorly defined immunosuppressive mechanisms. It confers no evolutionary advantage. Our objective was to develop better biomarkers of post-traumatic immunosuppression (PTI) and to extend our observation that PTI was reversed by anti-coagulated salvaged blood transfusion, in the knowledge that others have shown that non-anti-coagulated (fibrinolysed) salvaged blood was immunosuppressive. A prospective non-randomized cohort study of patients undergoing primary total knee arthroplasty included 25 who received salvaged blood transfusions collected post-operatively into acid–citrate–dextrose anti-coagulant (ASBT cohort), and 18 non-transfused patients (NSBT cohort). Biomarkers of sterile trauma included haematological values, damage-associated molecular patterns (DAMPs), cytokines and chemokines. Salvaged blood was analysed within 1 and 6 h after commencing collection. Biomarkers were expressed as fold-changes over preoperative values. Certain biomarkers of sterile trauma were common to all 43 patients, including supranormal levels of: interleukin (IL)-6, IL-1-receptor-antagonist, IL-8, heat shock protein-70 and calgranulin-S100-A8/9. Other proinflammatory biomarkers which were subnormal in NSBT became supranormal in ASBT patients, including IL-1β, IL-2, IL-17A, interferon (IFN)-γ, tumour necrosis factor (TNF)-α and annexin-A2. Furthermore, ASBT exhibited subnormal levels of anti-inflammatory biomarkers: IL-4, IL-5, IL-10 and IL-13. Salvaged blood analyses revealed sustained high levels of IL-9, IL-10 and certain DAMPs, including calgranulin-S100-A8/9, alpha-defensin and heat shock proteins 27, 60 and 70. Active synthesis during salvaged blood collection yielded increasingly elevated levels of annexin-A2, IL-1β, Il-1-receptor-antagonist, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IFN-γ, TNF-α, transforming growth factor (TGF)-β1, monocyte chemotactic protein-1 and macrophage inflammatory

  17. Evaluation of Risk Minimisation Measures for Blood Components – Based on Reporting Rates of Transfusion-Transmitted Reactions (1997-2013)

    PubMed Central

    Funk, Markus B.; Heiden, Margarethe; Volkers, Peter; Lohmann, Annette; Keller-Stanislawski, Brigitte

    2015-01-01

    Summary Background To assess the impact of safety measures, we compared reporting rates of transfusion-related reactions before and after the implementation of six measures in 1999, 2004, 2006, 2008 and 2009. Methods Reporting rates of transfusion-transmitted bacterial infection (TTBI), viral infection (TTVI) and immune-mediated transfusion-related acute lung injury (TRALI) were calculated on the basis of confirmed annual reports and distributed blood components. Results The introduction of HCV NAT testing caused a significant reduction of HCV reporting rate from 1:0.6 to 1:83.16 million administered blood components (p < 0.0001), donor screening for antibodies to hepatitis B core antigen caused a reduction of HBV reporting rate from 1:2.90 to 1:10.70 million units (p = 0.0168). A significant reduction from 1:0.094 to 1:2.42 million fresh frozen plasma (FFP) units could also be achieved by risk minimisation TRALI measures (p < 0.0001). Implementation of pre-donation sampling did not result in a significant decrease in TTBI, whereas limitation of shelf life for platelet concentrate (PC) minimised the TTBI reporting rate from 1:0.088 to 1:0.19 million PC units (p = 0.041). For HIV NAT pool testing, no significant reduction in HIV transmission was found due to very low reporting rates (1:10 million versus 1:27 million blood components, p = 0.422). Conclusion On the basis of haemovigilance data, a significant benefit could be demonstrated for four of six implemented safety measures. PMID:26557816

  18. Red blood cells, multiple sickle cells (image)

    MedlinePlus

    ... inherited disorder in which abnormal hemoglobin (the red pigment inside red blood cells) is produced. The abnormal hemoglobin causes red blood cells to assume a sickle shape, like the ones seen in this photomicrograph.

  19. Red blood cells, multiple sickle cells (image)

    MedlinePlus

    Sickle cell anemia is an inherited disorder in which abnormal hemoglobin (the red pigment inside red blood cells) is produced. The abnormal hemoglobin causes red blood cells to assume a sickle shape, like the ones seen in this photomicrograph.

  20. Chimerism in transfusion medicine

    PubMed Central

    Brunker, Patricia AR

    2013-01-01

    Transfusion therapy is complicated by the production of alloantibodies to antigens present in the donor and lacking in the recipient through the poorly-understood but likely multi-factorial process of alloimmunization. The low prevalence of alloimmunization in transfused patients (6.1%)1 suggests that processes central to immunologic tolerance may be operating in the vast majority of transfused patients who do not produce alloantibodies. Using RhD as a prototype, evidence is reviewed that the ability to make antibodies to red blood cell (RBC) antigens may result in part from immunologic tolerance acquired in utero. These ideas are extended to other examples of maternal microchimerism (MMc) of other non-inherited maternal antigens (NIMA). An evolutionary argument is offered that multi-generational immunity supports the hypothesis that MMc may partly explain the “non-responder” phenotype in RBC alloimmunization. PMID:24196285

  1. Transfusion transmitted diseases in perioperative and intensive care settings.

    PubMed

    Das, Rekha; Hansda, Upendra

    2014-09-01

    Patients in the perioperative period and intensive care unit are commonly exposed to blood transfusion (BT). They are at increased risk of transfusion transmitted bacterial, viral and protozoal diseases. The risk of viral transmission has decreased steadily, but the risk of bacterial transmission remains same. Bacterial contamination is more in platelet concentrates than in red cells and least in plasma. The chances of sepsis, morbidity and mortality depend on the number of transfusions and underlying condition of the patient. Challenges to safe BT continue due to new emerging pathogens and various management problems. Strategies to restrict BT, optimal surgical and anaesthetic techniques to reduce blood loss and efforts to develop transfusion alternatives should be made. Literature search was performed using search words/phrases blood transfusion, transfusion, transfusion transmitted diseases, transfusion transmitted bacterial diseases, transfusion transmitted viral diseases, transfusion transmitted protozoal diseases or combinations, on PubMed and Google Scholar from 1990 to 2014. PMID:25535416

  2. Metabolomics in transfusion medicine.

    PubMed

    Nemkov, Travis; Hansen, Kirk C; Dumont, Larry J; D'Alessandro, Angelo

    2016-04-01

    Biochemical investigations on the regulatory mechanisms of red blood cell (RBC) and platelet (PLT) metabolism have fostered a century of advances in the field of transfusion medicine. Owing to these advances, storage of RBCs and PLT concentrates has become a lifesaving practice in clinical and military settings. There, however, remains room for improvement, especially with regard to the introduction of novel storage and/or rejuvenation solutions, alternative cell processing strategies (e.g., pathogen inactivation technologies), and quality testing (e.g., evaluation of novel containers with alternative plasticizers). Recent advancements in mass spectrometry-based metabolomics and systems biology, the bioinformatics integration of omics data, promise to speed up the design and testing of innovative storage strategies developed to improve the quality, safety, and effectiveness of blood products. Here we review the currently available metabolomics technologies and briefly describe the routine workflow for transfusion medicine-relevant studies. The goal is to provide transfusion medicine experts with adequate tools to navigate through the otherwise overwhelming amount of metabolomics data burgeoning in the field during the past few years. Descriptive metabolomics data have represented the first step omics researchers have taken into the field of transfusion medicine. However, to up the ante, clinical and omics experts will need to merge their expertise to investigate correlative and mechanistic relationships among metabolic variables and transfusion-relevant variables, such as 24-hour in vivo recovery for transfused RBCs. Integration with systems biology models will potentially allow for in silico prediction of metabolic phenotypes, thus streamlining the design and testing of al