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PubMed1994

Utilization and sources of blood components in Taiwan.

A three-year survey program, sponsored by the Department of Health, Taiwan R.O.C., was conducted from 1990 to 1992 to investigate blood utilization and blood sources in Taiwanese hospitals. The survey covered the period from January 1989 to December 1991. The hospitals surveyed included nine to 12 medical centers, 40 to 48 regional hospitals, 148 to 163 community hospitals, and 363 to 451 specialty hospitals. Their respective response rates for three consecutive years were 75.0%, 87.9% and 84.1%. Approximately 86% (for 1988) to 98% (for 1991) of all units transfused in Taiwan were surveyed (unit of blood = 250 ml). Utilization of various blood components, ie, red blood cell (RBC) components, frozen plasma (FP), cryoprecipitate (CRYO) and platelets (PLT), showed a trend of continuous increase. In 1991, 12 medical centers and 48 regional hospitals consumed 81.4% of the RBC components, including whole blood (WB) and packed red blood cells (PRBC), while the remaining 18.6% was consumed by 138 community hospitals and 282 specialty hospitals. The average blood utilization of medical centers was 37,383 units of RBC components, 30,949 units of FP, 6,990 units of CRYO, and 21,353 units of PLT per hospital. Utilization of RBC components was 7,191 units per regional hospital, 1,012 units per community hospital, and 148 units per specialty hospital. In 1991, almost all other components consumed in Taiwan, namely FP, CRYO and PLT, were utilized by medical centers and regional hospitals. WB and PRBC sources showed a drastic decline in paid donation, a modest decrease in hospital blood drawn from voluntary donors and an increasing role of the BLood Donation Association (BDA) in volunteer blood donation.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Component Transfusion↗
PubMed2001

Bacterial contamination of blood components.

Despite considerable advances in the safety of blood components, transfusion associated bacterial infection (TABI) remains an unresolved problem. As yet there are no perfect preventative, screening and/or detection methodologies for eliminating contaminated units. Until a practical, rapid, cost-effective and logistically acceptable test becomes available, we should be satisfied with the choice of various limited solutions that at least partially improve the bacterial safety of blood components. It is also necessary to establish standardised guidelines and agreed upon systematic procedures for the recognition and reporting of the laboratory and clinical evaluation of adverse reactions in recipients of contaminated blood components.

Bacteremia↗
PubMed1991

[Analysis of the frequency of blood transfusion in surgery].

For the period from 1985 to 1987 were analysed the blood transfusions, which were carried out in seven surgical wards, within the scope of a study for quality assurance. 7.6% of the patients, treated in surgical ward and 5.4% of the patients, treated in traumatological ward, were given blood transfusion. The average was 3.6 transfusional units per treated patient. The biggest differences were to be remarked at cases of breast cancer and at thyroid gland surgery. The average transfusion frequency at breast cancer was 16% with a difference between 5 and 63%. In thyroid gland surgery the average transfusion frequency was 11%, differing between 1 and 54%. At these operation groups the blood transfusion were usually given once. Transfusional reactions, costs and responsibility towards the donor demand a turning away from scientifically non-established transfusion habits. The components concept by Lundsgaard should serve as an orientation.

Blood Component Transfusion↗
PubMedDate not supplied

Transfusion-associated graft-versus-host disease and the irradiation of blood components.

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare but lethal disorder caused when viable donor lymphocytes engraft and proliferate in a susceptible transfusion recipient. Patients with immune deficiency disorders, hematologic malignancies and bone marrow transplants are at risk to TA-GVHD, as are premature newborns and transfusion recipients who are HLA heterozygous for an HLA-haplotype that is shared with an HLA homozygous donor. Irradiation of blood components with 2500 cGy will inactivate donor lymphocytes and prevent TA-GVHD. Platelets and granulocytes are not functionally impaired by this radiation dose, but red cells sustain detectable damage. Red cell units irradiated and stored for 42 days have significantly higher supernatant recovery of chromium-51 labeled cells is sub-optimal. Based on these data, the maximum permissible storage time for irradiated red cells has been reduced to 28 days.

Graft vs Host Disease↗
PubMed1999

The effect of unmodified or prestorage white cell-reduced allogeneic red cell transfusions on the immune responsiveness in orthopedic surgery patients.

BACKGROUND: The immunomodulatory effects of allogeneic blood transfusions have been attributed to the white cells (WBCs) present in the cellular blood components transfused to patients. STUDY DESIGN AND METHODS: The effect of the transfusion of allogeneic red cells (RBCs) or allogeneic prestorage WBC-reduced RBCs (WBC-reduced RBCs) on host immune responsiveness was evaluated by measuring the lymphocyte subsets and the in-vitro cytokine production in response to phytohemagglutinin stimulation of WBCs of orthopedic surgery patients. Forty-seven patients undergoing hip replacement surgery were randomly assigned to receive allogeneic RBCs (n = 17) or WBC-reduced RBCs (n = 14; 99.95% WBC removal). Sixteen patients were not transfused. Patient blood samples taken before surgery and on Days 1 and 4 after surgery were tested for complete blood count, lymphocyte subset analysis, and measurement of cytokine levels. RESULTS: After surgery, the lymphocyte count was significantly decreased in patients transfused with > or = 3 units of allogeneic RBCs (2.0 +/- 0.5 vs. 1.3 +/- 0.3 x 10(9)/L; p = 0.017), but not in patients transfused with > or = 3 units of WBC-reduced RBCs (2.0 +/- 0.9 vs. 1.7 +/- 0.8 x 10(9)/L). Compared with preoperative levels, on Day 4 after surgery, patients transfused with > or = 3 units of allogeneic RBCs also had a decrease in the number of natural killer cells (0.07 +/- 0.05 vs. 0.04 +/- 0.03 x 10(9)/L; p = 0.018). Postoperatively, interleukin-2 was decreased in one patient who received WBC-reduced RBCs compared with that in four patients transfused with allogeneic RBCs (p = 0.32), and eight untransfused patients (p = 0.01). On Day 4, about 70 percent of patients transfused with allogeneic RBCs showed a 20-percent decrease in the interferon gamma level. CONCLUSION: Taken together, these data support the hypothesis that transfusion of > or = 3 units of allogeneic RBCs is associated with early postoperative lymphopenia in otherwise healthy individuals undergoing surgery. These findings were not observed in those individuals transfused with RBCs that had undergone prestorage WBC reduction.

Adult↗
PubMed1982

Febrile transfusion reaction: what blood component should be given next?

Reports of febrile, nonhemolytic transfusion reactions (FNHTR) occurring at hospitals served by a regional blood center supplying 99,658 units of blood during 1980 were analyzed to determine if leukocyte-poor red blood cells prepared by the inverted centrifugation technique (LP RBCs) were adequate to prevent subsequent reactions. FNHTR occurred following 0.5% of units transfused. The records of transfusions given to patients who had a FNHTR were reviewed in a subgroup of hospitals. Of 253 such patients, 161 received subsequent transfusions, 140 received red cells or LP RBCs without a reaction. The remaining 21 had a second reaction following transfusion of packed red cells. 12 of the 21 received further red cell transfusions. Only one experienced a third febrile reaction after receiving LP RBCs. We conclude that LP RBCs are adequate to prevent recurrence of FNHTR and question the need for costly saline-washed, leukocyte-poor red blood cells for this purpose.

Blood Grouping and Crossmatching↗
PubMed1994

Blood usage review in a Belgian university hospital.

The appropriate use of whole blood, packed red cells (PRC), fresh-frozen plasma (FFP) and platelets was evaluated. The indications, effectiveness and complications of transfusion were determined on the basis of existing criteria described in the literature and prevailing practices in the hospital. A retrospective review of medical records demonstrated that the administration of PRC was unnecessary in 15% of the cases and that the use of FFP was not indicated in 67% of the patients. The result of PRC transfusion was inadequate in 4% of the cases. Haemolysis and circulatory overload occurred in 2% and 4% of the patients, respectively. Major hazards such as Acquired Immunodeficiency Syndrome (AIDS) and hepatitis were not observed. In order to improve the appropriate use of blood components, transfusion guidelines were proposed to all medical departments.

Blood Transfusion↗
PubMed1997

[Implementation of a continuous quality improvement program in transfusion medicine].

The transfusion safety is one of the themes of National Quality Assurance Programme 1995/1996 (National Agency for the Promotion of Medical Evaluation-ANDEM/Direction des Hôpitaux (National Hospital Authority)). The Quality Assurance Programme (QAP) in transfusion medicine of our University Hospital has been selected. The QAP is a prospective and normative programme, in which all the actors of the transfusion process are involved. The goals are: i) to assure the quality and the safety of the blood products delivered all along the chain leading to blood or blood components transfusion; ii) the guarantee of the exhaustiveness and the quality of information about the transfusion process that are used to mark out blood products; iii) the standardization of the different steps and the creation of "tools" in order to control the application of written procedures.

Blood Transfusion↗
PubMed1998

Update on leucocyte depletion of blood components by filtration.

It has long been recognized that allogenic leucocytes from donor blood are responsible for serious untoward effects in some transfused patients such as alloimmunization, febrile reactions, platelet refractoriness, transfusion associated acute lung injury, immunosuppression as well as transmission or reactivation of viruses such as CMV, HTLV or EBV. Leucocytes are also known to accelerate the rate of storage lesion. The optimal method to remove leucocytes from blood components has been shown to be filtration. However, many variables exist in the properties of leuco-depletion filters (material, composition, surface charge, mechanisms of leucocyte entrapment), the blood components to be filtered (composition, age), and the filtration method (pre- or post-storage, priming and rinsing, temperature, flow rate). In this paper principles of filtration and subsequent logistic consequences will be discussed. It is recommended to carefully select a filter for a specific blood component and to perform leuco-depletion procedures under controlled conditions according to validated methods meeting Good Manufacturing Practice (GMP) and Good Laboratory Practice (GLP).

Blood Component Transfusion↗
PubMed1994

[LEVEL 1--a new blood warming device].

Hypothermia of less than 35 degrees C, which frequently occurs in connection with massive blood transfusion, is a serious problem in many patients, in particular in those with polytrauma. The restoration of normal body temperature is very important and requires the use of a rapidly-acting, efficient and safe blood warmer, which is able to work effectively at high flow-rates. The LEVEL 1 (Technologies, Rockland, MA) is such a new blood warmer and works as a heat-exchanger via an aluminium column. This system is highly effective. Six hundred ml of sodium chloride 0.9% are warmed from 4 to 35 degrees C within one minute. This device is quickly operational and has a low priming volume. The LEVEL 1 is the only device currently available which is able to warm blood sufficiently during a very rapid blood transfusion.

Blood Component Transfusion↗
PubMed1993

[Transfusion-induced virus infections: how great is the risk?].

The risk of infection by blood transfusions contaminated with the human immunodeficiency virus (HIV) and/or the hepatitis C virus (HCV) was dramatically reduced after the introduction of blood donor screening using specific and sensitive 2nd- or 3rd-generation enzyme immunoassays for virus antibody detection. In addition, donors selection provides the greatest safety. The strategy for safe blood supply includes medical examination and self-exclusion of donors. For example, in German blood donors, the current detection rate of HIV is between 1.36 and 1.82 confirmed positive results per 100,000 blood donations. For hepatitis C the rate of anti-HCV-positive donors is between 0.27 and 0.49%. The overall risk of HIV infection ranges from 1 in 500,000 to 1 in 3 million and that of a transfusion-associated HCV infection from 1 in 20,000 to 1 in 40,000 per transfused blood unit. From the observed virus load among German blood donors, the transfusion-associated mortality was calculated to be 1 in 260,000 per transfused blood unit. Implications are discussed resulting from this low risk of HIV and/or HCV infection by blood transfusions.

Blood Component Transfusion↗
PubMed2004

[French training program for medical students in transfusion medicine. Transfusion Medicine Teachers' College].

In France, transfusion medicine training program has been updated. A national committee of professors in transfusion medicine propose a series of 13 items which represent the minimum knowledge that general practitioners should possess. This overview of transfusion medicine is far below the level that specialists should reach and they will need an additional specialized training. Several French universities have set up their own training program which is quite similar to the work of the committee of professors. The following recommendations are not strict guidelines but is a common basis which will be improved in 2005 according to new evidence based transfusion medicine.

Accidents, Occupational↗
PubMed1992

Blood products.

Modern transfusion therapy offers the seriously ill patient an array of blood products, designed to improve oxygen delivery, maintain intravascular volume, suppress infection, and induce hemostasis. Depending on the patient's clinical circumstance, the choice of product may need to incorporate consideration of the state of intravascular volume, history of prior transfusion reactions, the possible existence of serum antibodies directed against the relevant blood component, and the risk of transmission of infectious disease, as well as the relative cost of the blood product chosen. Fortunately, the contemporary blood bank has acquired considerable expertise in preparing safe products and in providing sound guidance for the clinician in their proper use.

Blood Component Transfusion↗