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PubMedDate not supplied

Blood component therapy.

Blood loss in orthopaedic injuries or procedures may be substantial, and more than 23 million units of blood components are transfused each year. The most frequent components used include whole blood, packed red blood cells, platelets, plasma derivatives, leukocytes, and clotting factors. This article will discuss blood classification systems, transfusion components, administration and potential complications of transfusion therapy, and nursing implications.

ABO Blood-Group System↗
PubMed2001

Mechanisms of severe transfusion reactions.

Serious adverse effects of transfusion may be immunologically or non-immunologically mediated. Currently, bacterial contamination of blood products, particularly platelets, is one of the most significant causes of transfusion-related morbidity and mortality. Septic transfusion reactions can present with clinical symptoms similar to immune-mediated hemolytic transfusion reactions and transfusion-related acute lung injury. Extremely high fever and/or gastrointestinal symptoms, in a transfusion recipient, may be indicative of sepsis. The diagnosis is based upon culturing the same organism from both the patient and the transfused blood component. Numerous organisms have been implicated as the cause of septic transfusion reactions. Due to different storage conditions, gram negative organisms are more often isolated from red blood cell components; gram positive organisms are more often isolated from platelets. Prevention of septic transfusion reactions is primarily dependent on an adequate donor history and meticulous preparation of the donor phlebotomy site. Visual inspection of blood components prior to transfusion is also vital to preventing these reactions. Several methods of detection of bacterial contamination and inactivation of pathogens are currently under active investigation.

Bacteremia↗
PubMed2007

Pulmonary transfusion reactions.

Transfusion reactions remain a common complication of transfusion therapy; reactions affecting the lungs are some of the most serious. Several different mechanisms are responsible for pulmonary transfusion reactions, and most cause adverse effects in addition to lung injury. Fluid overload can lead to pulmonary edema, antibodies reacting with plasma proteins can cause bronchospasm and anaphylaxis, and particulate matter can produce microemboli. These reactions are well understood and usually can be prevented. Transfusions are also associated with acute lung injury and acute respiratory distress syndrome (ARDS), but their etiology is poorly understood and they remain clinically problematic. Neutrophil antibodies cause some of these serious as well as mild pulmonary reactions, but the exact role of leukocyte antibodies in pulmonary reactions remains unclear. Other blood donor, blood component, and transfusion recipient factors likely play a contributing or modulating role in pulmonary transfusion reactions, but prospective studies are needed to better understand their role.

Blood Component Transfusion↗
PubMed2000

Current viral risks of blood and blood products.

A number of viruses may be transmitted by blood transfusion, the most important of these are HIV, human T-cell lymphotrophic retrovirus (HTLV), hepatitis B virus (HBV), and hepatitis C virus (HCV). A series of overlapping safety measures are in place and are being improved and supplemented continuously. As a result, the risk of transmission of these viruses in the USA has been reduced to between one and four per million blood components transfused.

Blood Substitutes↗
PubMed1991

[Essential standards of mechanical autologous donation and transfusion].

Apparative autologous blood donation and transfusion can be performed by simple devices (Bentley ATS, Sorenson, Solcotrans) or by using cell separation and RBC-washing (Dideco, Haemonetics). Due to many problems in retransfusion of recovered whole blood, simple devices should no longer be used. By mechanical autotransfusion including cell separation and RBC-washing, an autologous RBC-concentrate of high quality is reached. Considering essential standards, mechanical autotransfusion is a safe method to reduce the risks of homologous blood transfusion.

Blood Component Removal↗
PubMed1994

Overview: diagnostic tests for viral infections transmitted by blood.

The risk of transmitting viral infections by transfusion today is quite remote. The many, sensitive, diagnostic tests in place, when applied to the blood of volunteer, unpaid (unremunerated), unpressured donors who are also carefully evaluated at the time of donation, make blood and blood component transfusions very safe. A number of sensitive laboratory tests are performed on each unit of donated blood and plasma to reduce the risk of transmission of hepatitis viruses and retroviruses from asymptomatic donors to transfusion recipients. With the tests, we hope to catch otherwise undetectable individuals who may be carrying these viruses yet appear healthy and deny risk factors for their carriage. However, the laboratory tests in use in blood banks were designed to aid in the diagnosis of patients with viral diseases. Therefore, a reactive test, even if reproducible, on a sample from a healthy blood donor is more apt to be falsely than truly positive. An ideal microbiologic test is one which is one hundred percent sensitive, i.e., it will identify every person with an infectious disease (including asymptomatic carriers). In addition, a perfect test would have one hundred percent specificity, i.e., it would not be reactive in anyone without the infectious agent. The decision point or "cutoff" for an ideal test would be above the (negative) results for all normal and uninfected samples, but below that for all (positive) infectious ones. In reality, there is an overlap between some of the results on normals and those on diseased individuals, including persons who are carrying an infectious agent. When we try to obtain maximal sensitivity, e.g., to detect all asymptomatic carriers of a virus, the assay cutoff is set very low for tests applied to blood donors; but this approach will compromise the specificity of a test. The net effect is that many normal people donating blood are said to have "abnormal" test results which, among other things, necessitates the loss of their blood and plasma. In addition, we must follow up the reactive results by enzyme linked immunoassays (EIA or ELISA) or radioimmunoassays (RIA) used to screen or preliminarily test blood from donors with supplemental or confirmatory tests to verify whether the initial test is a true positive or a false positive one. Trying to explain the significance of a false positive test for AIDS or hepatitis to a healthy donor often causes fear, concern and/or anger. Thus, the use of very sensitive tests on blood donors will increase the safety of transfusion for recipients but result in loss of some donors and discard of many blood components unnecessarily. Despite the problems in applying sensitive tests to asymptomatic individuals who are not patients, the assays in place in blood banks have, nonetheless, resulted in remarkably small risks of virus transmission by transfusions. Currently, the risk of HCV infection following a transfusion is about 1 in 3,300 per unit transfused. This is an enormous improvement compared to the risks of what was called non-A, non-B hepatitis in the 1970s and 1980s before the use of the test for antibodies to HCV. For HTLV-1 (and, potentially, HTLV-II) the risk of transfusion transmission is about 1 in 50,000 per unit of screened blood. Using blood which is anti-HIV-1/2 non-reactive, the risk is about 1 in 225,000 units of transmitting HIV. The risk of transfusion associated AIDS is thus quite remote in 1993. For hepatitis B virus, only about 1 in 200,000 units of blood transmit this virus now. In sum, only about 3 units of blood per 10,000 of those collected from acceptable, volunteer donors are currently likely to transmit a serious or fatal transfusion-transmitted viral infection. In contrast, in America, about 6 out of every 1,000 patients hospitalized will die from an accidental or preventable cause other than the underlying disease for which he/she was hospitalized. (ABSTRACT TRUNCATED)

Acquired Immunodeficiency Syndrome↗
PubMed1993

Single dose aprotinin in routine cardiac surgery.

Evidence exists that the serine protease inhibitor, aprotinin, when used in high dosage, can reduce the bleeding associated with cardiopulmonary bypass. This high dosage is particularly effective in patients at increased risk for bleeding. Less convincing information is available for regimens that use a lower dose and its place in routine cardiac surgery has not been fully resolved. Some studies have shown significant benefit from a single dose added to the cardio-pulmonary bypass prime and we re-examined this alternative. In a randomized, prospective, double-blinded study, we compared this single dose method with placebo in a low risk adults undergoing a first procedure. Benefit was considered established if a significant reduction in blood loss or the use of transfused blood products was seen. We found a significant reduction in red cell transfusion but no improvement in blood loss or blood component transfusion in the treated group. This included patients maintained on aspirin as well as those not receiving aspirin. Aspirin significantly increased blood loss in both control and treatment groups and the usage of blood products in the treatment group. Aprotinin in this low, single dosage was not confirmed as an effective means of improving hemostasis following CPB in routine cardiac surgery.

Adult↗
PubMed1994

[Indications of the different components of blood and outcome of transfusion practices in postpartum hemorrhage].

Despite a high incidence of mortality associated with post-partum haemorrhage, indications for transfusion of blood and its components in obstetrics remain ill defined. Transfusion is often massive if needed. Transfusion management depends upon appreciation of blood loss, with systematic research of associated disseminated intravascular coagulopathy (DIC) or other preexisting coagulation disorders. If DIC is ruled out, the classic rules of volemic substitution apply, besides certain qualitative characteristics intrinsic to the blood components or products used. Treatment of DIC calls for fresh frozen safely screened plasma, fibrinogen or platelets concentrates. Indications for autologous transfusion are very limited in these circumstances.

Blood Coagulation Disorders↗
PubMed2001

Transfusion triggers for blood components.

Whereas there are general guidelines for acceptable transfusion therapy, optimal transfusion therapy has not been determined for most clinical settings. Recent research has focused on controlled studies of red cell transfusion in specific clinical settings. Better determinations of oxygen delivery and consumption are needed to guide clinicians in determining whether transfusion is justified for patients during the perioperative period, those with coronary artery disease, and those in intensive care units. For sickle cell disease, the role of transfusion for acute complications can be life saving; however, the role of chronic transfusion regimens awaits further research into efficacy. Finally, whereas criteria for the prophylactic transfusion of platelets in hematologic diseases are well described, relatively little information is available on the value of platelet transfusion where the absolute count is less than 100,000 but greater than 50,000. The value of fresh frozen plasma components, both standard and sterilized, also requires elucidation.

Blood Component Transfusion↗
PubMed1992

Use of platelets and other transfusion products in patients with malignancy.

The need for blood components for oncology patients is small compared with the need for patients with hematologic malignancies. Appropriate use of blood components is necessary, not only medically, but also because of limited supply and availability. Agreement on when to use components is extremely important. In fact, at the time of this writing, the Transfusion Practices Committee of the AABB is conducting an extensive survey on the use of platelets in the oncology and hematology cancer patients (Questionnaire on Institutional Policy on Platelet Transfusion Practice for Hematology/Oncology Patients). The results will, it is hoped, provide a consensus on the proper times and counts that require prophylactic use of components for these patients. Since these patients use the vast majority of components (see Table 15), their proper use is imperative to maintaining an adequate platelet and frozen plasma supply. Transfusion support in cancer patients is vital for their survival. Platelets, in particular, are necessary to prevent serious bleeding. However, refractoriness to platelet transfusions can develop. It must be appreciated that refractoriness is not a general problem and need not require the expensiveness of a universal decision for handling all platelet transfusions in the same manner. Total refractoriness probably occurs in 15 to 20% of patients frequently transfused. In patients in whom frequent platelet transfusion is anticipated, that is, bone marrow transplantation, the development of platelet refractoriness may be reduced by using SDPC and administering them through leukocyte filters. Patients who become refractory to either random or SDPC can either be cross-matched for single-donor platelets that are compatible or can be given HLA-A,B matched platelets. Certainly, the success of platelet transfusion in leukemic patients cannot be denied, since only a small number of these patients now die because of bleeding due to platelet refractoriness. Most of the serious bleeding still seen is associated with sepsis. The risks from transfusion must always be considered. Fortunately, with increased monitoring of the blood supply, they have been reduced. As with any therapeutic regimen, these risks must be weighed against the benefit the patient may gain. Transfusion should always be used prudently.

Blood Component Transfusion↗
PubMed1994

Blood component therapy and changing transfusion triggers.

Transfusion trigger points and appropriate blood component therapy must be continuously evaluated by the anesthesia team during a surgical procedure. This article examines the composition of homologous blood, the storage of blood products, and transfusion reactions. Additionally, the incidence of transfusion transmitted infections is explored. Finally, a review of the current recommendations for transfusions in the clinical setting is provided.

Anesthesia↗
PubMed2005

[Transfusions in the Copenhagen Hospital Corporation, 2000-2002].

INTRODUCTION: Blood usage in Denmark is among the highest in the Western world. It has been postulated that this is due to a more liberal transfusion policy, especially in the eastern part of the country. MATERIALS AND METHODS: All transfusions of blood components in the five hospitals in the Copenhagen Hospital Corporation (H:S) in the period 2000-2002 were analysed. RESULTS: The percentage of transfused patients in H:S equals that of other Danish hospitals of similar size and specialisation and is in accordance with published results from abroad. The number of transfused SAG M per transfused patient is highest at the University Hospital of Copenhagen, Rigshospitalet (RH), among all hospitals in Denmark. This is a result of the demographics of the patients treated and the highly specialised treatments performed there. Of acutely multitransfused patients at RH, 36% survive. There is no correlation between the number of transfused units and the survival rate. Of patients with a haemoglobin 7.0 mmol/L at discharge, RH has one of the lowest percentages of all hospitals in Denmark, reflecting its restrictive transfusion policy. DISCUSSION: This study shows no evidence of a more liberal transfusion policy in H:S as compared to other Danish hospitals of similar size and specialisation.

Blood Component Transfusion↗
PubMed1998

Neonatal blood component therapy.

Blood transfusion therapy plays an important role in the care and management of ill newborns, yet the indications for blood product administration remain controversial. The article reviews basic definitions, indications for blood product transfusion, and risks and difficulties involved in transfusion therapy. Descriptions, indications, ABO/Rh compatibility, shelf life, necessary equipment, dose, rate, and general considerations for various blood product components are included.

Blood Component Transfusion↗
PubMed2004

Transfusion-related acute lung injury caused by two donors with anti-human leucocyte antigen class II antibodies: a look-back investigation.

Transfusion-related acute lung injury (TRALI) is considered as one of the most important complications of blood transfusion. Previous look-back investigations have revealed unrecognized cases. We report two cases of TRALI in brief and the outcomes of transfusion in the recipients of previous components from the implicated donors. This look-back investigation was a retrospective case-note study assessing whether there were any untoward events associated with the previous transfusions. 18 patients were identified as having received a blood component transfusion from one of the two donors with anti-human leucocyte antigen (HLA) antibodies to antigens occurring frequently in the local population. One of the five patients receiving a unit of fresh frozen plasma had an evidence of TRALI, which was not diagnosed at the time. A second patient, who had been HLA typed and who carried a full match of antigens for the antibody specificities of the plasma received, had no evidence of a reaction. There were no documented reactions in 13 recipients of red cells in optimal additive (OA) solution. Cases of TRALI may go unrecognized. Not all patients with antibody/antigen concordance will develop clinical signs. Red cells in OA solution from donors with anti-HLA antibodies appear to have a low risk of causing clinically evident lung damage.

Adult↗
PubMed2007

Acetaminophen and diphenhydramine premedication for allergic and febrile nonhemolytic transfusion reactions: good prophylaxis or bad practice?

Febrile nonhemolytic and allergic reactions are the most common transfusion reactions, but usually do not cause significant morbidity. In an attempt to prevent these reactions, US physicians prescribe acetaminophen or diphenhydramine premedication before more than 50% of blood component transfusions. Acetaminophen and diphenhydramine are effective therapies for fever and allergy, respectively, so their use in transfusion has some biologic rationale. However, these medications also have potential toxicity, particularly in ill patients, and in the studies performed to date, they have failed to prevent transfusion reactions. Whether the benefits of routine prophylaxis with acetaminophen and diphenhydramine outweigh their risks and cost requires reexamination, particularly in light of the low reaction rates reported at many institutions even when premedication is not prescribed.

Acetaminophen↗