Biomedical subjects

R E Domen

Publications and source records attributed to R E Domen.

At least 19 recordsLinked to original sources

PubMed1998

Adverse reactions associated with autologous blood transfusion: evaluation and incidence at a large academic hospital.

BACKGROUND: It is acknowledged that autologous blood is the safest for the patient to receive. However, it is generally not appreciated that transfusion reactions to autologous blood may occur, despite the fact that it is the patient's own blood. STUDY DESIGN AND METHODS: A retrospective review of all transfusion reactions reported to a hospital transfusion service from 1991 through 1996 was performed, and all reactions to autologous blood were further investigated. RESULTS: Reported adverse reactions to autologous blood composed 2.1 percent of all transfusion reactions investigated in the hospital, involving 0.16 percent (15/9,353) of all transfused preoperatively donated autologous red cell units and 0.027 percent (5/18,506) of all intraoperatively salvaged units. Further investigation revealed that 60 percent (12/20) of these adverse reactions were felt to be clinically important and directly attributable to the autologous blood transfusion. Adverse reactions included febrile nonhemolytic (5) and allergic (4) reactions, an acute hemolytic transfusion reaction secondary to a clerical error (1 intraoperatively salvaged unit), and other nonsignificant adverse reactions (2). Eight adverse reactions were determined these reactions to be unrelated to the autologous transfusion. CONCLUSION: Despite the fact that the blood given is the patient's own blood, transfusion reactions to autologous blood do occur. As it is for allogeneic transfusion, any suspected adverse reaction to autologous blood transfusion should be investigated.

Adolescent↗

PubMed1998

Autologous blood donation by patients who have undergone solid organ transplantation.

Autologous blood donation before elective surgery is generally believed to be a safe procedure for patients with a variety of underlying medical conditions, but the accumulation of additional data continues to define its safety in unique patient groups. Patients who have received a solid organ transplant may also undergo various elective surgical procedures after transplantation, and the question of safety of autologous blood donation for these patients is raised. In one hospital-based blood collection program, we identified 4 patients who had received solid organ transplants and subsequently made autologous blood donations for elective operations unrelated to the transplantation. Two patients had received heart transplants and 2 received liver transplants. A total of 10 autologous donations were made by these 4 patients without adverse effects or complications. A low hemoglobin concentration was the only reason for temporary deferral from autologous donation. Despite having complicated clinical situations, recipients of solid organ transplants can safely donate autologous blood and should not be automatically excluded from making such donations.

Aged↗

PubMed1998

An overview of immune hemolytic anemias.

Often patients with immune hemolytic anemias present with symptoms that are common in anemia of any cause. In the different types of immune hemolytic anemia, red blood cells are destroyed by processes mediated by antibodies. This article reviews the pathophysiology, diagnosis, and treatment of this group of diseases.

Adrenal Cortex Hormones↗

PubMed1997

Results of a survey of infectious disease testing practices by organ procurement organizations in the United States.

BACKGROUND: Information related to infectious disease testing policies and practices of organ procurement organizations in the United States does not currently exist. METHODS: A total of 63 organ procurement organizations in the United States were surveyed during May 1996. Participants responded to a detailed questionnaire concerning infectious disease tests performed for tissue and solid organ donors and policies related to the reporting and notification of positive test results. RESULTS: The response rate was 77.8%. The majority of testing is performed by hospital laboratories with an expected turnaround time of 5 hr or less by 71% of organ procurement organizations. Almost all routinely perform screening tests for human immunodeficiency virus, hepatitis C virus, cytomegalovirus, syphilis, human T lymphocyte virus I, and hepatitis B surface antigen. Other tests are performed with greater variability. Although the majority of organ procurement organizations perform confirmatory tests when screening tests are positive, 35% do not perform confirmatory testing or do so only sporadically. There are a wide range of policies concerning the subsequent reporting of positive infectious disease tests and to whom results should be reported. CONCLUSIONS: Infectious disease testing policies of organ procurement organizations, particularly for solid organs, demonstrate variability in interpretation and perceived significance of positive test results, the initiation or need for reflex and confirmatory testing, the reporting of positive results, and to whom positive test results should be reported. There is a need for a consistent national policy for appropriate infectious disease testing and reporting of results.

AIDS Serodiagnosis↗

PubMed1997

An evaluation of the need for shared blood donor deferral registries.

OBJECTIVE: This study examined the frequency with which allogeneic, volunteer blood donors who had been deferred from donation at one blood collection facility donated, or attempted to donate, at a second blood collection facility. METHODS: The blood donor computer files of two local blood collection facilities were-combined and matched donors on the donor deferral registry of each blood collection facility were identified. RESULTS: Of 26,300 donors in the hospital-based blood bank file, 6732 (25.6%) were matched to the community blood center donor file (active donor base approximately 275,000). Matched donors on the donor deferral registry at each blood collection facility numbered 427 (6.3% of total matched donors). A total of 103 evaluable donors (1.5% of total, or 24.1% of deferred, matched donors) had been deferred at one blood collection facility and then later donated, or attempted donation, at the other blood collection facility. Of these 103, 51 were allogeneic donors who had been notified of their deferral status and should not have subsequently attempted blood donation. Thirty-two donors on the donor deferral registry of one blood collection facility made donations at the second blood collection facility which entered the general blood inventory. CONCLUSION: Shared donor deferral registries may be valuable at the local or regional level to prevent deferred blood donors from donating at other blood collection facilities. Whether or not a national donor deferral registry would be efficacious remains to be proven and deserves further study.

Blood Banks↗

PubMed1996

Fellowship training programs in blood banking and transfusion medicine: results of a national survey.

This report details the results of a 1995 survey of the 40 fellowship training programs in blood banking and transfusion medicine in the United States approved by the Accreditation Council for Graduate Medical Education. Fellows primarily enter transfusion medicine training after completing a pathology residency, and are subsequently employed in an academic or university setting, or a blood donor center. Program directors indicated that either the current level, or fewer, transfusion medicine specialists will be needed in the future. The educational content of fellowship training was examined, as well as aspects of proficiency and competency in several areas. Research is an important part of most fellowship programs, and a majority of program directors felt that some formal training in clinical medicine should be a part of fellowship training in transfusion medicine. The information obtained from this survey should be helpful to both fellowship applicants and program directors in delineating important aspects of fellowship training in blood banking and transfusion medicine.

Blood Banks↗

PubMed1996

Preoperative autologous blood donation: clinical, economic, and ethical issues.

Many patients are donating their own blood before surgery to avoid blood-borne infections, often on the advice of their physicians. But autologous blood transfusion, while safer than allogeneic transfusion, is not completely risk-free. It is also expensive, its benefits are difficult to assess, and its increasing popularity raises many difficult ethical issues, such as whether the benefit of allogeneic transfusion supports its additional expense. Record-keeping, collection, and transfusion errors are occasional risks of autologous transfusions. In addition, risks associated with blood donation, from mild dizziness to precipitation of angina, should be considered when high-risk patients are referred for autologous collection. Only approximately half of autologous units collected are actually used, and the cost per quality-adjusted year of life saved may be as high as $1 million, depending on the type of surgical procedure. Although recombinant human erythropoietin can stimulate red blood cell production before autologous donation and decrease the need for transfusion, it is not clear whether this strategy, which can cost thousands of dollars per patient, will be cost-effective. Perioperative hemodilution may become an important component in efforts to reduce patient exposure to allogeneic blood, but its use remains controversial.

Blood Transfusion, Autologous↗

PubMed1995

Paid-versus-volunteer blood donation in the United States: a historical review.

Several points are clear from this historical review. Over 50 years ago the first indications that hepatitis could be transmitted from the serum or plasma of one human to another became evident. This was confirmed in human transfer experiments although the agent causing hepatitis was not known and there was no specific test for what eventually was presumed to be a virus. It soon became clear that hepatitis was a complication of blood and plasma transfusion. Over the course of 10 to 20 years (the 1950s and 1960s) the connection was made between posttransfusion hepatitis and certain high-risk donors and behaviors. Despite the availability of scientific data to support the idea that not all commercial or paid blood donors were associated with higher rates of post-transfusion hepatitis, public opinion and emotions seemed to be a major driving force behind increased government regulation of blood banking. Because there were commercial blood banks that continued to recruit, collect, and pay blood donors from low-income, skid row areas, despite the mounting evidence that such donors clearly harbored higher rates of hepatitis, all commercial blood banks were reduced to that common denominator. Clearly economic factors were also being thrown into the equation. Political and philosophical differences between the major professional organizations involved in blood procurement and recruitment were important factors favoring more government control. The public pressured politicians and government agencies for more regulation and many scientific and medical professionals requested greater regulation. By the early 1970s the die was cast for increased regulation by the federal government.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Banks↗

PubMed1995

An analysis of autologous blood donor motivational factors.

Little is known about the patient's reasons for participating in an autologous blood (AUB) collection program. We surveyed 110 AUB donors in our hospital-based collection program. Although fear of infection from an allogeneic blood transfusion was cited by 20% of AUB donors, 68.2% indicated that their physician's recommendation was a motivating factor. For 18.2% self-initiated motivation was a factor in pursuing AUB. The overwhelming majority (97.1%) stated they would donate AUB even if the risk of getting AIDS from a blood transfusion was zero. Fear of infection does not appear to be the primary reason for patients to donate AUB. Recommendation by their personal physician is an important component in the patients' decision-making process to set aside their own blood for upcoming surgery.

Attitude to Health↗

PubMed1995

The confidential unit exclusion and allogeneic blood donation. Results from supplementary questions to the Donor Center and Viral Markers surveys of the College of American Pathologists.

OBJECTIVE: The confidential unit exclusion (CUE) is a mechanism for allogeneic blood donors to confidentially indicate whether they feel their blood is safe for transfusion to others. The purpose of this national survey was to determine the extent of use of the CUE procedure and its related policies. DESIGN: Supplementary questions related to the use of the CUE were asked of those 1994 DC-C, W1-C, and W2-C College of American Pathologists survey subscribers who collect allogeneic blood for transfusion. SETTING: National survey. PARTICIPANTS: Blood collection facilities who collect allogeneic blood components. MAIN OUTCOME MEASURES: Survey responses. RESULTS: There were a total of 2966 total participants in the 1994 DC-C, W1-C, and W2-C surveys. A potential total of 444 participants indicated that they collected allogeneic blood and were eligible to participate in the CUE survey. A variety of approaches are used concerning donor deferral, reinstatement, and follow-up in the use of the CUE. Documentation and donor counseling issues also show variation. CONCLUSIONS: Different approaches and procedures have been developed by collection facilities to address issues related to the use of the CUE. More data on the efficacy and cost-effectiveness of the CUE are needed.

Blood Donors↗

PubMed1995

Infectious disease marker testing of the autologous blood donor. A case study in clinical ethics.

OBJECTIVE: The Food and Drug Administration currently requires written authorization from the patient's physician before autologous units of blood that are positive or reactive for hepatitis B surface antigen or anti-human immunodeficiency virus can be shipped from a site of collection different from the site of transfusion. Additionally, the Blood Products Advisory Committee has recommended the universal testing of all autologous units of blood. DESIGN: The case of an autologous blood donor with positive infectious disease markers is presented. The ethics of infectious disease testing of patients who preoperatively donate their own blood is discussed. RESULTS: Many ethical issues are raised by policies requiring infectious disease testing of the autologous blood donor. Blood banking and transfusion medicine specialists should examine the ethical issues raised by regulatory mandates to perform infectious disease testing of the patient who desires to make a preoperative autologous blood donation. CONCLUSION: A policy that protects the rights of the patient as well as the rights and concerns of health care professionals should be pursued.

Blood Donors↗

PubMed1995

Multiple red cell transfusions and alloimmunization. Experience with 6996 antibodies detected in a total of 159,262 patients from 1985 to 1993.

This retrospective study of red cell antibodies covered the period from 1985 to 1993. A three-cell antibody screen, 22% albumin enhancement, and a polyspecific antiglobulin reagent assay were performed. From a total of 159,262 patients in the data set, 6996 antibodies were detected among the sera of 4700 patients (2.9%). Four thousand two hundred thirty-five (60.5%) alloantibodies of potential clinical significance were found. These included anti-K1 (23.0%), -E (17.6%), -D (12.4%), -Le(a) (7.3%), -C (6.3%), -Fya (5.7%), and -c (4.4%). Cold agglutinins were found in 1119 positive antibody screens, 261 had warm autoantibodies, and 554 had high-titered, low-avidity antibodies. Three hundred seven were clinically insignificant (eg, Sda and Bga). Five hundred seventeen were too weak to identify. Most patients' sera demonstrated only one antibody (69.3%), but there was a strong linear correlation between the total number of recorded red cell transfusions and the number of antibodies found (r = .976; P < .0001). There was a higher percentage of females with antibodies than the percentage of females in the total study population (59.2% versus 43.8%, P < .0001). Two hundred nine of 554 (37.7%) high-titered, low-avidity antibodies and 349 (31.2%) of 1119 of the cold agglutinins accompanied or obscured clinically significant antibodies.

Adult↗

PubMed1994