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PubMed1986

Haematological, immunological and endocrinological aspects of chronic high frequency blood sampling in rats with replacement by fresh or preserved donor blood.

Haematological, immunological and endocrinological aspects of blood transfusions with either freshly collected or preserved donor blood were investigated in chronically cannulated unrestrained rats. Three anticoagulant preservatives were tested: citrate, citrate-dextrose and citrate-phosphate-dextrose-adenine (CPDA-1). Prolactin was used as an indicator of stress in endocrine studies. The repeated collection of 4 ml blood at 2-week intervals did not affect normal blood composition. Whole blood of rats could be stored in citrate, citrate-dextrose or CPDA-1 for 8, 22 or 35 days, respectively. Blood transfusions with fresh or preserved donor blood of F1 (R X U) rats did not affect normal blood composition nor did it induce immunological responses in F1 rats. Frequent blood sampling for several hours at highest rates of 1 sample/min did not affect prolactin secretion when blood volume reduction was replaced by blood transfusions with fresh donor blood. However, compensation with preserved blood affected prolactin secretion significantly. Blood transfusions did not affect health, behaviour, cyclicity or pseudopregnancy. The application of blood transfusion in chronically cannulated rats appeared to be quite simple. Its advantages are the possibility of following individual secretion patterns of blood-bound substances, the repeated use of animals and the reduction of the number of animals.

Animals↗
PubMed2000

Molecular heterogeneity in complete cytogenetic responders after interferon-alpha therapy for chronic myelogenous leukemia: low levels of minimal residual disease are associated with continuing remission. German CML Study Group and the UK MRC CML Study Group.

A substantial minority of patients with chronic myelogenous leukemia (CML) achieve a complete response (CR) to treatment with interferon-alpha (IFN), defined as the disappearance of Philadelphia chromosome-positive metaphases. Currently it is unclear how long IFN treatment should be continued for such patients. We used a competitive reverse transcriptase-polymerase chain reaction (RT-PCR) to quantify levels of BCR-ABL transcripts in 297 peripheral blood specimens collected from 54 patients who had achieved CR with IFN. The median duration of observation was 1.9 years (range, 0.3-11.0 years). Total ABL transcripts were quantified as internal control and results were expressed as the ratio BCR-ABL/ABL. All 54 patients had molecular evidence of residual disease, although 3 patients were intermittently PCR negative. The median BCR-ABL/ABL ratio at the time of maximal response for each patient was 0.045% (range, 0%-3. 6%). During the period of observation 14 patients relapsed, 11 cytogenetically to chronic phase disease and 3 directly to blastic phase. The median ratio of BCR-ABL/ABL at maximal response was significantly higher in patients who relapsed than in those who remained in CR (0.49% versus 0.021%, P < 0.0001). Our findings show that the level of residual disease falls with time in complete responders to IFN, but molecular evidence of disease is rarely if ever eliminated. The actual level of minimal residual disease correlates with the probability of relapse. We suggest that for patients who reach CR, IFN should be continued at least until relatively low levels of residual leukemia are achieved. (Blood. 2000;95:62-66)

Adolescent↗
PubMed1997

[Cost savings with autotransfusion in connection with coronary surgery].

The main purpose of this study was to estimate the costs and savings related to a consistent autotransfusion programme. More than 8,000,000 ml of autologous blood or blood-containing fluid were collected from 3,637 consecutive patients undergoing coronary artery bypass and returned to the patients during and after the operation. Economic analyses revealed a price of NOK 13 million (approximately 2 million USD) for this amount of autologous blood, or NOK 3,500 (600 USD) per patient. In the present series the need for bank blood or blood products was modest, since 69 patients (1.9%) received packed red cells, with or without plasma, 76 patients (2.1%) were given plasma transfusions only, and 11 patients (0.3%) received platelets. Thus, 95.7% of the patients were not exposed to any homologous blood products during the stay in hospital. Absence of morbidity related to the low homologous blood transfusion rate was assumed to save costs substantially, although this saving was difficult to calculate in terms of currency. Post-operative complications were few, and the total in-hospital mortality rate was 0.4%.

Adult↗
PubMed2005

The cost of blood: multidisciplinary consensus conference for a standard methodology.

Prior attempts to account for the cost of blood have varied in economic perspective, methodology, and scope and may have underestimated both direct and indirect costs associated with transfusions. To devise a comprehensive and standardized methodology for the United States that will improve upon existing estimates, a panel of experts in blood banking and transfusion medicine was assembled and participated in consensus deliberations using modified Delphi methods. As a first step, a process-flow model that describes all the major steps involved in collecting, processing, and transfusing blood such as donor recruitment and follow-up of transfusion sequelae was constructed. Next, interdependencies were outlined and detailed cost elements within each step were itemized. The relative importance of each element was rated. Personnel, screening for infectious agents, information systems, laboratory evaluations, management of transfusion reactions, and equipment were ranked as the most important factors to capture but, in an effort to be all-inclusive, even minor elements were included. This consensus model is broad-based and should serve societal, provider, and payer perspectives for future cost studies. Recognizing the limitations of process-flow models, the next iteration will use an activity-based approach to more fully account for the cost of blood than present estimates.

Blood Banks↗
PubMedDate not supplied

Study of red cell aggregation in pulsatile flow from ultrasonic Doppler power measurements.

Human red cell aggregability and disaggregability represent important hemorheological parameters of blood. Several techniques have been proposed to evaluate the tendency of red cells to form aggregates and to disrupt in the presence of shear stress. One of the most recent approaches is based on the characterization of the intensity of ultrasonic scattered signals. A pulsatile flow loop model is used in the present study to demonstrate the potential applicability of Doppler ultrasound to detect and characterize the hemodynamic behavior of red cell aggregates. Porcine whole blood specimens collected from 20 different pigs were circulated in the flow model (tube diameter of 0.476 cm) at different mean velocities and pulsation rates. At a pulsation of 70 beats/min for mean velocities of 13 cm/sec and 63 cm/sec, no cyclic variation of the Doppler power was observed, suggesting the absence of rouleaux build-up and rouleaux disruption. At a pulsation of 20 beats/min and mean velocities of 11 cm/sec and 38 cm/sec, statistically significant cyclic variations (p < 0.01) were measured. It is suggested that aggregate size enlargement, rouleaux orientation with the flow field and the effect of shear stress on rouleaux disruption are possible causes for the observed cyclic variation of the Doppler power within the flow cycle at a pulsation of 20 beats/min. A discussion of the potential application of this technique for in vivo study in large vessels is given.

Animals↗
PubMed1994

The impact of autologous blood ordering and blood procurement practices on allogeneic blood exposure in elective orthopedic surgery patients.

The contribution of autologous blood ordering and blood procurement practices on subsequent allogeneic blood exposure in elective orthopedic surgery must be understood to address the role of aggressive autologous blood procurement in blood conservation strategies. The authors examined the relationship between autologous blood ordering, blood collection, and subsequent allogeneic blood transfusion in orthopedic surgical patients. Of 263 consecutive autologous blood donors reviewed, 179 (68%) successfully donated the number of units requested (blood ordering cohort). Of these, 17 (9.5%) received allogenic blood. Of 84 patients unable to donate the units requested, 23 (27%) received allogeneic blood (blood procurement cohort). Allogeneic blood exposure in the blood ordering cohort occurred at the same prevalence for patients asked to donate < or = 3 units or > or = 4 units (10[6.8%] of 146 patients and 7[6%] of 116 patients, respectively). In contrast, only 3 (2%) of 146 patients asked to donate < or = 3 units received allogeneic blood in the blood procurement cohort, compared with 20 (17%) of 116 patients asked to donate > or = 4 units (P < .01). The greatest prevalence of allogeneic blood exposure occurred in 13 (35%) of 37 anemic (hematocrit level 39% at first donation) patients in the blood procurement cohort who could not donate > or = 4 units as requested. The study indicated that both blood ordering and blood procurement practices in autologous blood donation programs are important factors in blood conservation efforts to minimize allogeneic blood exposure.

Adult↗
PubMed1976

Preparation and storage of platelet concentrates. II. Storage variables influencing platelet viability and function.

Factors affecting the viability and function of stored platelet concentrates have been investigated in a blood component programme. It was found that platelets could be maintained for up to 72 h without bacterial contamination under the following conditions: (1) surgical skin preparation at venipuncture site; (2) blood collection in CPD or ACD anticoagulant in a closed bag system; (3) centrifugation of PRP at 3000 g for 20 min; (4) storage in Fenwal PL-146, Cutter CL-2383, or McGaw plastic bags; (5) resuspension of the platelet pellet in 70 ml residual plasma; (6) storage at 22+/-2 degrees C; and (7) constant gentle mixing throughout storage. Platelet viability as determined by recovery and survival is largely maintained, as is platelet function measured by template bleeding time. Both viability and function of concentrated platelets stored at 4 degrees C are severely compromised.

Aspirin↗
PubMed1991

Progressive platelet activation with storage: evidence for shortened survival of activated platelets after transfusion.

Platelets are known to become activated during storage, but it is unclear whether such activation affects recovery or survival after platelet concentrate (PC) transfusion. With the use of flow cytometry to determine the percentage of platelets expressing the alpha-granule membrane protein 140 (GMP-140), a known adhesive ligand appearing on the platelet surface after activation, several studies were conducted. These investigations evaluated 1) the occurrence of significant platelet activation over time in PCs (n = 46) stored under standard blood bank conditions; 2) the correlation between platelet activation and platelet recovery in normal subjects after PC storage (n = 12), as assessed by the recovery of Indium-labeled platelets; and 3) the recovery of activated and unactivated platelets in thrombocytopenic cancer patients transfused with standard PCs (n = 11). It was determined 1) that an increasing duration of storage of PC was associated with increasing platelet activation as measured by the percentage of platelets expressing GMP-140, progressing from a mean of 4 +/- 2 percent (SD) on the day of collection to a mean of 25 +/- 8 percent by 5 days of storage: 2) that, in normal subjects, posttransfusion recovery of autologous platelets stored for 2 to 4 days and then labeled with In111 was inversely correlated with the percentage of activated platelets in the transfused PC (r = -0.55, p = 0.05); and 3) that, when thrombocytopenic patients were transfused with standard PCs, the recovery of the activated platelets in the transfused PCs averaged only 38 +/- 15 percent of the number predicted by the absolute platelet increment.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Monoclonal↗
PubMedDate not supplied

A survey of autologous blood collection and transfusion in Japan in 1997.

BACKGROUND: In spite of the fact that autologous blood is safest for a patient to receive, it is not generally appreciated that adverse reactions during donation and transfusion may occur. This study was conducted to assess the state and the risk of autologous blood transfusion in Japan in 1997. STUDY DESIGN AND METHODS: Results of a nation-wide questionnaire-based survey are presented. The questionnaire assessed the number of autologous blood donations, donation procedures, and the adverse reactions associated with donation, preservation, recombination erythropoietin administration and transfusion. RESULTS: Between November 1996 and October 1997, 10,697,000 ml (or 53,485 units, 200 ml = 1 unit) prestorage blood donation were made by 14,200 patients (averages; 1.9 donations/patient, 753 ml/patient, 398 ml/donation). Of these, 87% were transfused to the patients and the remainder were discarded. Using hemodilution and blood salvage intra- or postoperatively some 2,540,000 ml of blood was collected and > 70% of patient-donors received such blood. Adverse reactions were observed with 1.6% (428/26,905) of donations including 6 angina and 2 asthma attacks. There were 63 (0.2%) problems with 28,705 donations and 117 (0.5%) errors/problems reported for 24,929 units transfused; the most frequent problems were clotting on the units and breakage of the bags during storage. Hypotension using hemodilution (3.7%), coagulation (0.9%) or bacterial contamination (0.4%) using salvage were often observed. A 10-20 ml volume of autologous fresh-frozen plasma was transfused to the wrong recipient. CONCLUSION: Autologous blood transfusion accounts for at least 1.1% (2.8% estimated) of the red cell supply in Japan. Errors and adverse reactions are not infrequent in autologous blood programmes. By introducing systematic safety policies, we will be able to make autologous blood transfusion safer.

Adolescent↗
PubMed1993

[Intraoperative autotransfusion. Reinfusion of erythrocytes in total hip arthroplasty reduces the need for blood from banks].

We have tested a cell-saver system, which collects, washes, concentrates and filtrates red blood cells before autotransfusion. The study consisted of 35 consecutive patients who had a total hip arthroplasty (THA), 18 using the cell-saver and 17 not using it. There was no significant difference in the peroperative bleeding, or in the total blood loss. The median blood loss was 1950 ml (925-6337 ml) in the cell-saver group and 2350 ml (1260-4440 ml) in the control group. The need for homologous transfusion was significantly higher in the control group compared to the cell-saver group, median 500 vs 250 ml of sag-M blood. This difference is of the same magnitude as the amount of autotransfused red blood cells suspended in saline water, median 398 ml. In the cell-saver group nine patients did not need any homologous transfusions at all, whereas in the control group only one did not need any transfusion.

Adult↗
PubMed1996

Stability of therapeutic drug measurement in specimens collected in VACUTAINER plastic blood-collection tubes.

Recently Becton-Dickinson marketed a plastic serum-separator tube that uses the same serum-separator gel as the glass tubes. We studied the stability of therapeutic drugs stored in plastic tubes by comparing it with the stability of drugs stored in glass serum-separator tubes and plain red-top glass tubes. We observed no absorption of caffeine, primidone, N-acetylprocainamide, procainamide, theophylline, tobramycin, ethosuximide, acetaminophen, amikacin, valproic acid, methotrexate, salicylate, and cyclosporine in either plastic or glass serum-separator tubes. On the other hand, concentrations of lidocaine, quinidine, phenobarbital, and phenytoin were reduced after storing in both plastic and glass serum-separator tubes, especially with prolonged storage and small sample volume. The reduction in concentrations were due to slow absorption of those drugs by serum-separator gel.

Blood Specimen Collection↗
PubMed1994

In vitro characteristics of 'undercollected' units of whole blood in CP2D-A.

Blood donation volumes less than 350 ml are classified as 'undercollected' at the NSW Red Cross Blood Transfusion Service (BTS) and are discarded. This study evaluated the in vitro characteristics during storage of both undercollected units and units of acceptable volume. Thirty-two units of whole blood were each collected into 63 ml of CP2D-A, with blood volumes ranging from 180 to 456 ml. The units were stored between 4 and 6 degrees C for 35 days and in vitro measurements were performed weekly. Biochemical parameters measured included ATP, extracellular pH, total haemoglobin, haematocrit, mean cell volume, plasma sodium and potassium, plasma haemoglobin, 2,3-DPG and lactate levels. All parameters were within the BTS acceptable quality control limits for whole blood. Thus, it appears feasible to transfuse undercollected units with volumes between 180 and 350 ml. However, routine transfusion of undercollected homologous units is undesirable. In contrast, it may be preferable to transfuse an autologous unit, even if it was undercollected. The performance of in vivo survival studies would provide confirmatory data on this proposition.

2,3-Diphosphoglycerate↗
PubMed2001

[Preoperative autologous blood donation in elderly patients with cardiovascular surgery].

BACKGROUND: During the cardiovascular surgeries in elderly people, only a few cases can avoid the homologous blood transfusion, because of their preoperative anemic tendency and low hemopoietic abilities. We examined the capability to avoid the homologous blood transfusion in over 75 year old patients by the preoperative autologous blood collection. Sixty-six patients underwent scheduled cardiovascular surgery between January 1996 and December 1999. The groups were divided into three categories of preoperatively collected autologous blood amounts: high-amount (800-1,200 ml), medium-amount (200-800 ml), and low-amount (0 ml). Each group was divided into two subgroups in according to the use of cardiopulmonary bypass (CPB). There were no differences among the each group in age, body weight, or preoperative and postoperative day-7 hematocrit values. RESULTS: Only 21.2% of patients could donate the expected blood amounts preoperatively. Mean volume was 641 ml. In groups used CPB, no patient was transfused homologous blood in high-amount group. On the contrary, 100% patients were donated in medium and low amount groups. In groups operated without CPB, homologous blood transfusion was required 14.3% in high-amount group, 25.0% in medium-amount group, and 83.3% in low-amount group. CONCLUSION: It seems that predonation of more than 800 ml may be sufficient to avoid the homologous blood transfusion in using CPB operation and more than 400 ml in non using CPB operation.

Aged↗
PubMed2005

Frequency of isolation and antimicrobial susceptibility of bacteria isolated from bloodstream infections at Children's Medical Center, Tehran, Iran, 1996-2000.

Antimicrobial susceptibility patterns of major bloodstream pathogens from Iran provide essential information regarding the selection of antibiotic therapy for patients with bloodstream infections (BSIs) living in Iran. Unfortunately, data regarding the isolation frequency and antimicrobial susceptibility patterns of endemic BSI pathogens are scarce in Iran. To shed some light on the susceptibility patterns of BSI pathogens endemic to Tehran, Iran, we investigated the antimicrobial susceptibility patterns of 2248 bloodstream isolates from patients in Children's Medical Center (CMC) Hospital in Tehran between January 1996 and December 2000. Microbiology reports of 24600 blood specimens collected from inpatients in CMC Hospital were retrospectively reviewed. Specimen culture, bacterial identification and disk diffusion susceptibility testing were performed according to National Committee for Clinical Laboratory Standards guidelines. Overall, Gram-positive bacteria comprised 72% (1627/2248) of recovered isolates and Gram-negative bacteria comprised 28% (621/2248). Coagulase-negative staphylococci (CoNS) comprised 48.4% of all isolates, followed by Staphylococcus aureus (16.7%) and Klebsiella spp. (8.5%). Among the 621 Gram-negative organisms, Klebsiella spp. (31%) were the most frequently isolated, followed by Escherichia coli (21%) and Pseudomonas aeruginosa (17%). The rates of oxacillin resistance for S. aureus and CoNS isolates were similar (60% versus 61%); however, the rate of S. aureus vancomycin resistance was almost twice that of CoNS resistance (21% versus 11%). Over 55% of S. pneumoniae were resistant to penicillin and co-trimoxazole. Although all isolates of enterococci were susceptible to vancomycin, only 21% were susceptible to gentamicin. Among Gram-negative isolates, amikacin was shown to be very effective, with susceptibility rates of 84%. The susceptibility of Klebsiella spp. to ampicillin and co-trimoxazole was 1% and 39%, respectively. The susceptibility of Klebsiella spp., E. coli and Enterobacter spp. to ceftriaxone was 47%, 86% and 67%, respectively. There were notable differences in the order of the five most common organisms isolated from blood cultures, which can help set priorities for focused control efforts. Our findings highlight the importance of a nationwide surveillance programme to monitor the trends in isolation frequency of bacteria and their antimicrobial resistance patterns throughout Iran.

Bacteremia↗
PubMed2006

Thirty-day typing and screening for patients undergoing elective surgery: experience at a large cancer center.

BACKGROUND: Preoperative testing in patients scheduled to undergo surgery often includes determining the ABO group and Rh type and screening for atypical alloantibodies in blood samples. AABB recommends obtaining blood samples within 3 days of transfusion. This was extended to 30 days to minimize the number of phlebotomies, avoid delays in providing blood during surgery, and decrease the laboratory workload. This study was conducted to show that extending the expiration date of the preoperative blood sample for blood typing and screening to 30 days will serve our purpose and provide better patient care. STUDY DESIGN AND METHODS: Data were collected for all patients undergoing elective surgery with perioperative blood samples submitted to our blood bank over 31 months. Each patient completed a questionnaire to determine whether his or her samples qualified for a 30-day preoperative clot. The questionnaires were validated upon preoperative screening. A transfusion medicine physician made the final determination regarding whether the samples qualified for 30-day typing and screening. These blood samples were used for cross-matching to find compatible blood during surgery. RESULTS: A total of 12,310 preoperative blood samples were received with a request for typing and screening, 4,370 (35.5%) of which qualified for a 30-day expiration date. No significant problems were encountered with these blood samples. CONCLUSION: Extension of the preoperative clot expiration date from 3 to 30 days has improved service to our patients and their physicians and indirectly reduced the laboratory workload.

ABO Blood-Group System↗
PubMed1979

Clinical use of blood, blood components and blood products.

The goal of modern transfusion therapy is to provide appropriate replacement therapy with blood components as opposed to whole blood for patients with specific hematologic deficiencies. A prerequisite of component therapy is, therefore, correct identification of the deficiency. Appropriate use of components avoids many of the hazards associated with the use of whole blood, and at the same time makes maximal use of this valuable resource. Blood components separated from whole blood soon after collection and appropriately stored can, in combination, provide all the factors present in fresh whole blood. Red cell concentrates prepared from multiple packs have a hematocrit of approximately 70%. They may be stored for up to 3 weeks at 4 degrees C and are recommended for most situations requiring red cell transfusions. Platelet concentrates, which can be stored for up to 72 hours at 22 degrees C, may be used for thrombocytopenic patients. Fresh frozen plasma, stored plasma, cryoprecipitated factor VIII, factor VIII concentrate and factor IX complex concentrate are available for the proper treatment of patients with hemorrhagic disorders due to coagulation factor deficiencies. Similarly, albumin and immune serum globulin are available for their oncotic and antibody properties respectively. Thus, the availability and appropriate use of the various blood products allows not only optimal transfusion therapy for each patient, but also fuller utilization of national blood resources.

Albumins↗
PubMed1979

Blood kinetics and in vivo chemotaxis of transfused neutrophils: effect of colllection method, donor corticosteroid treatment, and short-term storage.

To evaluate effect of collection technique and short-term storage on in vivo cell function, neutrophils were collected from 53 normal subjects by phlebotomy (PB), intermittent flow centrifugation (IFC), or filtration leukopheresis (FL), stored 0 or 1 day, labeled with 32P-diisopropylfluorophosphate, reinfused into the donor, and blood kinetics and/or skin chamber accumulation of labeled cells measured. The blood kinetics of unstored PB and IFC cells were similar; the kinetics of unstored FL cells were markedly abnormal. The percent of infused neutrophils localizing to the skin chamber was 0.1, 0.06, and 0.006 for unstored PB, IFC, and FL cells, respectively. One-day storage substantially decreased chamber accumulation of infused neutrophils. Donor steroid pretreatment had no effect on chamber results. Thus, in vivo chemotactic ability of IFC neutrophils is slightly impaired, whereas that of FL cells is severely impaired. One-day storage of either cell concentrate causes further cell damage.

Adrenal Cortex Hormones↗
PubMed2005

Composition of the blood sampled from surgical drainage after joint arthroplasty: quality of return.

BACKGROUND: The quality of blood obtained with a device for postoperative blood drainage and autotransfusion (Bellovac-ABT, Astra Tech AB) was investigated in 50 patients who underwent total hip replacement (THR) or total knee replacement (TKR) surgeries. STUDY DESIGN AND METHODS: The Bellovac-ABT drainage set was inserted and blood collection began after skin closure (THR) or 15 minutes after tourniquet deflation (TKR). A collecting bag stayed in place for less than 6 hours. The product was then returned after sedimentation and discard of supernatant, without anticoagulants. RESULTS: Blood returned with the Bellovac-ABT had optimal hemoglobin levels and red blood cell (RBC) counts; the low platelet count reduced the risk of disseminated intravascular coagulation. Inertia of materials maintained acceptable values of C-reactive protein, whereas cytokines and complement split products rose rapidly. Higher concentrations of adenosine triphosphate and 2,3-diphosphoglycerate than in circulating blood suggested a normal RBC metabolism. No adverse reactions were observed in any participants. CONCLUSION: Because of its simplicity and safety, the Bellovac-ABT autologous blood transfusion system is recommended in THR or TKR without joint infection or malignancy.

Adult↗