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PubMed1993

[Blood transfusion in anemic patients. When and how?].

The functional red cells infused must breathe and circulate. The effectiveness of transfusion depends on different factors in patients (lack of antibodies or hypersplenism) and on the way the blood has been preserved. The transfusion-related risks may be immediate (immunological conflicts between erythrocytes or leucocytes) or delayed (alloimmunization induced by transfusion, transmission of or viral or parasitic diseases). The current preventive measures are highly efficient, provided all "safety catches" are respected, including selection of donors on immunological and serological grounds, and choice of the red cell concentrate most appropriate to the clinical situation and the transfusional future of the patient. All patients on chronic transfusion must be under long-term surveillance, with search for antibodies and serological profile. The decision to transfuse blood rests on the levels of erythrocyte constants and on clinical tolerance to anaemia, taking into account the compensatory mechanisms. Several formulas are available to calculate the red cell volume to be transfused in relation to haemoglobin values. The advances achieved in blood perfusion are such that anaemic patients nowadays are both less and better transfused.

Anemia↗
PubMed1993

Platelet alloantigens and transfusion.

Platelet transfusion therapy became to be largely used in the last 20 years. This development was related to the progress of plastic bags and of blood cell separators. In parallel the platelet immunology has moved from serological techniques to molecular biology. The biochemical characterization of platelet antigen and the genetic basis of the polymorphism was discovered in the last years. The platelet RNA PCR amplification and specific oligonucleotide typing are now accessible to several laboratories. Five major human platelet antigen (HPA) systems are completely characterized. HPA-1 (PLA, Zw) localized on platelet glycoprotein GPIIIa correspond to a single amino acid substitution (leu<==> Pro 33). HPA-2 (Ko, Sib) present on GPIb is due to a Thre<==>Met substitution in 145. HPA-3 formerly Bak, Lek correspond to a polymorphism in 843 (Ile<==>ser) on GPIIb. HPA-4 (Pen, Yuk) as HPA1 is on GPIIIa but in a different location (Arg<==>Gln 143). HPA-5 (Br, He, Zav) and HPA-6 (Ca, Tu) are on GPIa and GPIIIa respectively. The major progress made in the field of platelet immunology has not yet been largely applied to the clinical situation of platelet transfusion. We can hope that it could help in the future to a better platelet-transfusion compatibility and consequently an improved clinical efficacy of platelet transfusion.

Blood Component Transfusion↗
PubMedDate not supplied

Guidelines for administering blood and blood components.

The Serious Hazards of Transfusion (SHOT) scheme has revealed that many patients have received incorrect blood or blood component. This article reports new national guidelines for ordering, administering and managing blood, blood components and blood transfusion.

Blood Banks↗
PubMed2005

[Bacterial detection leading to pathogen inactivation].

Bacterial contamination of blood components remains the highest infectious risk in blood transfusion, the risk is particularly high when it affects platelet concentrates (PC). In France, the residual risk of transfusion reaction due to bacterial contamination of PC has been decreasing slowly since 1994 but for all severity 1 case occurs with about 25,000 distributed PC and one death occurs with 200,000 distributed units. This reduction of the risk may be due to the measures which were implemented during the last 10 years in order to prevent contamination during donation. Improving strategies for reducing the risks of bacterial contamination is one of the priorities of the French National Blood Transfusion Service (l'Etablissement Français du sang - EFS). The main target remains PC. Bacterial detection or pathogens inactivation are now available and are able to reduce (for detection) or prevent (for inactivation) the occurrence of reaction due to bacterial contamination of PC. Up to now, the choice is in favour of bacterial detection. A national study was carried out in seven regional EFS at the end of 2004. It aims at confirming the feasibility of a systematic bacterial screening of PC before their delivery. The first conclusions show that this screening can be implemented with acceptable modifications in term of platelets availability. We can expect in a next future that new pathogens reduction technique and/or new detection systems will be available, certainly more efficient to prevent reaction due to bacterial contamination. Implementation of actual detection methods is probably a temporary solution.

Bacteriological Techniques↗
PubMed1993

[Blood replacement in elective surgery: results of the Sanguis Study].

The aim of the Sanguis study, a project sponsored by the European Community, is to assess the use of blood and blood components including the use of programs for autologous blood transfusion in 43 hospitals in 10 European countries. The study was inaugurated by Prof. G. Sirchia, Milan, who formed a study group of experts from 10 countries. The study group defined the study design, identified the centers, and followed the progress of the project. From October 1990 until September 1991 data were collected in the 43 hospitals from patients undergoing one of six elective surgical procedures. The results obtained from interim analysis (70% of expected data) of patients with total hip replacement revealed differences in the frequency of homologous blood transfusion between hospitals and also regional differences between different countries. There was great variation in the use of alternative programs for reduction or even avoidance of homologous blood transfusion between hospitals. For total hip replacement, the calculated probability to receive homologous blood varied between 0 and 100% in different hospitals. This observational study will provide a data base concerning the transfusion practice in 6 elective surgical procedures in 10 European countries. According to the findings of this study, recommendations for improving the transfusion practice shall be elaborated and indications for alternative programs identified. In a subsequent study (Sanguis 2), these recommendations are to be validated.

Aged↗
PubMed2004

Clopidogrel and bleeding in patients undergoing elective coronary artery bypass grafting.

OBJECTIVE: In an effort to minimize transfusions in patients undergoing elective coronary artery bypass grafting operations after recent clopidogrel exposure, we studied laboratory tests predictive of platelet dysfunction and used a strict algorithm-driven treatment of bleeding. METHODS: Forty-five patients receiving clopidogrel within 6 days of the operation and 45 control subjects were studied. Prothrombin time, activated partial thromboplastin time, platelet count, and platelet function test results were measured before heparinization, after protamine administration, and then every 2 hours. No transfusions were administered unless a patient met both laboratory and clinical criteria. RESULTS: Algorithm-driven treatment of bleeding significantly reduced the mean units of all blood components transfused by about one third, as shown by comparison with current control and historical data. Compared with current control subjects, clopidogrel recipients required significantly more transfusions of platelets (9.0 +/- 1.7 vs 1.2 +/- 0.5 U; P <.0001) and packed red blood cells (4.3 +/- 0.6 vs 2.3 +/- 0.5 U; P =.01) and required longer periods of controlled ventilation (12.4 +/- 1.3 vs 8.6 +/- 0.8 hours; P =.02). Preoperative platelet dysfunction before heparin administration for cardiopulmonary bypass, as measured by using adenosine diphosphate aggregometry (response <40%), predicted all but 1 case of severe coagulopathy requiring multiple transfusions (16.6 +/- 2.8 U of platelets and 5.8 +/- 1.0 U of packed red blood cells). CONCLUSIONS: A strict transfusion algorithm can reduce the transfusion requirement for all blood components. Preheparin testing of platelet function with adenosine diphosphate aggregometry can identify patients at highest risk for perioperative bleeding and transfusions and might further reduce the perioperative transfusion requirement.

Algorithms↗
PubMed1992

[The effect of blood transfusion on immunological response in mice].

Recent clinical and experimental studies have suggested that blood transfusion decreased immunological responsiveness. In order to investigate this mechanism, we performed following studies. In vivo experiments, we investigated the effect of blood transfusion on tumor growth and survival rate in mice, and added the comparative studies about the timing of blood transfusion and blood cell component transfusion. In vitro experiments, we studied on the responses of CTL and NK activity by the experimental model of postoperative blood transfusion. These experiments led to the following results: 1) Accelerated tumor growth and reduced survival rate were observed in allogeneic transfused mice. 2) These effects were seen independently of the timing of blood transfusion. 3) A transfusion of lymphocytes was capable of inducing this effect of blood transfusion. 4) Blood transfusion induced both suppression of anti-tumor CTL, TNP-CTL and NK activity. 5) The suppression of CTL was mediated by suppressor cells. From these results, it was suggested that allogenic blood transfusion induced immunosuppression in mice independently of its timing.

Animals↗
PubMed1999

Impact of innovations on transfusion medicine.

The final decade of the last century of the second millennium ad has seen dramatic changes in all aspects of science and health care. In transfusion medicine, the blood supply is the safest it has ever been. Newer refinements and innovations are continuously being researched and implemented to achieve and further enhance safety. Advances in blood conservation, pharmacologic manipulation, engineered blood derivatives, and recombinant growth factors can now provide safer and more effective alternatives to blood transfusions for many patients. This overview highlights selective innovations in transfusion medicine and emphasizes some significant advances that have occurred in blood donor screening, blood component collections and therapy, and laboratory testing. Newer technologies are anticipated that will further enhance the safety of blood and transfusions and potentially augment annually the blood supply on a worldwide basis.

Blood Component Transfusion↗
PubMed1996

Blood utilization in adult patients undergoing extracorporeal membrane oxygenated therapy.

BACKGROUND: The impact of extracorporeal membrane oxygenation (ECMO), performed on adult patients, on the blood transfusion service of a tertiary-care hospital was assessed. The quantity and pattern of blood component utilization by these patients were compared to those in a previous evaluation of neonatal patients receiving similar treatment. STUDY DESIGN AND METHODS: The records of blood component transfusion to 74 adult patients, treated with ECMO within a 6-year period, were reviewed. This information was correlated with the clinical indication for ECMO and duration of ECMO treatment. In addition, daily use of components for these patients was studied to ascertain whether the blood requirements were predictable and uniform. RESULTS: Over 15,000 units of blood components, with platelet concentrates making up the largest portion, were transfused to these patients while they were undergoing ECMO. The duration of ECMO varied from less than 1 day to 53 days. However, the length of treatment could not uniformly be correlated with blood utilization or with survival. Daily blood transfusion needs often could not be anticipated, which meant that the transfusion service frequently had to respond to urgent requests for transfusion support. The provision of platelet concentrates proved to be the most difficult part of the maintenance of this program. CONCLUSION: Whereas ECMO treatment of neonatal patients has a relatively minor impact on a transfusion service, the same is not true for a program that uses this form of treatment for adults as well.

Adult↗
PubMed1999

[Assessment of the acquisition, use and needs of plasma derivatives in Asturias (1990-1995)].

PURPOSE: To estimate the effectiveness of the Asturias transfusion network in achieving self-sufficiency in plasma, derivatives, blood and blood components in the period from 1990 to 1995. MATERIAL AND METHODS: A retrospective study of the indicators of blood donation, production, management and transfusion of fresh frozen plasma and of the clinical usage of plasma derivatives in 1990 and 1995 was carried out. RESULTS: In 1990, 26.1% of the plasma and derivatives used were produced in Asturias (108% of the plasma transfused and 15.9% of that equivalent to the plasma derivatives). On the other hand, an estimated 112.4% of the plasma needed was used (FFP, 153%; plasma derivatives, 108.7%). In 1995, 32.2% of all the plasma and derivatives used were produced here (118% of the FFP transfused and 27.2% of the equivalent to the plasma derivatives used). The usage of the plasma necessary for clinical supplies was estimated in 149.0% of the needs (FFP, 138.9%; plasma derivatives, 149.6%). The volume of plasma-equivalent used in both years was higher for albumin than for factor VII. CONCLUSIONS: The Consulting Commission of the Blood Centre, with the participation of the Services of Pharmacy, has to establish a programme aimed to monitor all the aspects related with the use of plasma and to evaluate the degree of accomplishment of the obligation of attaining self-sufficiency in plasma.

Blood Component Transfusion↗
PubMed2003

[Reports of transfusion incidents: experiences from the first year of hemovigilance in the region of the former ZWN (South West Netherlands) blood bank in Rotterdam].

OBJECTIVE: Itemize blood transfusion incidents in the South-West Netherlands region (about 3.5 million inhabitants), where a regional reporting system for transfusion incidents was introduced in January 2001. DESIGN: Prospective, descriptive. METHOD: In the period 1 January 2001-31 December 2001, 22 hospitals voluntarily reported transfusion incidents in patients to the blood bank. All incidents were anonymously recorded in a standardised report and registered in 14 categories. RESULTS: A total of 119 transfusion incidents were reported and categorised as: incorrect blood component transfused (n = 8), mild fever 1-2 degrees C (n = 14), non-haemolytic fever > 2 degrees C (n = 36), acute haemolytic transfusion reactions (n = 3). delayed haemolytic transfusion reactions (n = 18), allergic reactions (n = 11), bacterial contamination (n = 3), transfusion-related acute lung injury (n = 1), near accidents (n = 6) and product recalls (n = 19). There were no reports in the categories anaphylactic shock, post-transfusion purpura, transfusion-acquired viral infection, and transfusion-related graft versus host disease. In the same year of haemovigilance, the blood bank issued a total of 158,000 blood products. A complication rate of 1:700 blood products was calculated. It is estimated that 53% of all incidents were reported. CONCLUSION: Despite all of the safety measures taken, severe adverse events still occurred. A well-run system for haemovigilance can contribute to the knowledge of transfusion incidents. The safety and quality of blood transfusions can be improved if this knowledge is incorporated into ongoing education about blood transfusions and in the prevention and treatment of transfusion reactions.

Blood Banks↗