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PubMed2004

Infectious and immunologic consequences of blood transfusion.

Blood transfusions remain common practice in the critical care and surgical settings. Transfusions carry significant risks, including risks for transmission of infectious agents and immune suppression. Transmission of bacterial infections, although rare, is the most common adverse event with transfusion. The risk for transmission of viral infections has decreased over time, clearly because tests are becoming more sensitive in detecting certain viral infections such as hepatitis B, hepatitis C, and HIV. Several immunomodulatory effects are thought to be related to transfusions, and these can result in cancer recurrence, mortality, and postoperative infections. Numerous studies have been performed to examine the role of leukoreduction in decreasing these transfusion-related complications but results remain contradictory. We review the infectious risks associated with blood transfusion and the most recent data on its immunologic effects, specifically on cancer recurrence, mortality, and postoperative infections in surgical patients. We also review the use of leukoreduction in blood transfusion and its role in preventing transfusion-transmitted infections and immunomodulatory complications.

Blood Transfusion↗
PubMed1984

[Immunologic selection of renal transplant donors and recipients: blood transfusions].

Blood transfusions clearly improve the prognosis of cadaver kidney transplantation. The percentage of graft survival at one year is increased, about + 25%. Preoperative transfusions are effective, whereas peroperative transfusions are ineffective. The following technique seems to be good. Each patient should first receive 5 blood transfusions over a short time lapse, and then one unit of blood from time to time, two times per year for example. The blood must be less than three days old and must contain leucocytes. Transfusions induce, in a few hemodialysed patients, an anti-HLA immunisation. It is thus necessary to choose a donor with a negative cross-match. Transfusions induce in many patients a better tolerance for kidney transplant. This tolerance is perhaps immunologically specific. Blood transfusions are also useful for the selection of related donors HLA semi identical with recipients. The recipient is transfused several times with donor's blood. Transplantation is only performed when the cross-match remains negative and then leads to a high percentage of success.

Antibody Formation↗
PubMed1992

Induction of a subpopulation of suppressor cells by a single blood transfusion.

Blood transfusion induces immunosuppression by a mechanism which is probably multifactorial and, in large part, obscure. In this study cellular immune suppression was examined in patients with end-stage renal disease (ESRD) following a single blood transfusion (BT). OKT8+ cells proliferated within four hours, their count increasing significantly, and reached their peak after four days. Since OKT4+ cells tended to decrease, the OKT4/OKT8 ratio declined significantly from the fourth day. Evidence in support of the above results is offered in studies on ability of concanavalin A reagent (ConA)-activated T cells to form autorosettes with human red blood cells (RBC); these T cells have been shown to function as suppressor effector cells. Autorosetting cells (RFC) proliferated in a similar pattern to OKT8+ cells. Moreover, the percentage of rise at one and two weeks of OKT8+ and RFC correlated directly, suggesting that the proliferating OKT8+ cells are in large part a subset of suppressor cells. Functional studies were performed to establish the suppressor activity of T cells before and at various times after blood transfusion. A significant increase in T cell ConA-induced suppressor activity was found one week after BT, peaking at two weeks following BT. Monocytes increased significantly from day 4 following BT, but prostaglandin E2 (PGE2) started to rise immediately, peaking at day 4. PGE2 might induce suppression by induction of suppressor cells or by direct suppression of interleukin-2. Both monocytes and suppressor cells respond immediately, but they probably induce suppression most effectively four days or more after BT.

Adult↗
PubMedDate not supplied

Immunologic effects of blood transfusion.

Blood transfusion is associated with numerous clinical phenomena attributable to immune suppression. Homologous blood transfusion is associated with declines in lymphocyte numbers and inhibition of lymphocyte function. In dialysis patients this immune suppression is accompanied by prolongation of survival of subsequently transplanted allografts. For patients undergoing surgical procedures, the receipt of homologous blood increases the risk of postoperative infectious complications. Patients with malignancies have significantly increased recurrence and mortality rates when removal of their tumor is accompanied by the administration of blood. The clinical course of Crohn's disease may be beneficially influenced by transfusion at the time of resection of diseased bowel. Women suffering recurrent abortion may carry to term following transfusion of spouse leukocytes. Experimental studies, in addition to replicating the clinical studies, have documented that transfusion inhibits wound healing. Blood transfusion, the oldest form of transplantation, causes profound and prolonged alterations in immune function which result in clinical phenomena which can be either beneficial or detrimental to the recipient.

Animals↗
PubMed2004

Almonte's great train disaster: Shaping nurses' roles and the civilian use of blood transfusion.

Blood transfusion was initially a small-scale, labour-intensive therapy administered by physicians. Through the first decades of the 20th century, transfusion comprised a "last resort" measure used and tested primarily in the context of war. Media accounts of the Almonte train disaster on the night of 27 December 1942 linked survival to the newly established blood bank located 42 km east in Ottawa, Ontario. This event did not constitute a "first time" occurrence or a "great discovery" in the history of blood. But it did illustrate in a very visible and public manner that blood transfusion technology was now readily available for use in general hospitals and civilian populations. Canada had an infrastructure for the collection, processing, storage, and transportation of blood products, and for the recruitment of blood donors by the mid-1940s. As the need for blood declined toward the end of World War II, transfusion became a technology in need of application. The extension of transfusion to civilian populations, however, would require a ready source of labour-increased numbers of health care workers who were available continuously with the necessary knowledge and skills to assume the responsibility. Nurses were well situated for this technological role by a convergence of scientific, economic, labour, gender, professional, and educational influences that both facilitated and constrained blood transfusion as a nursing competency. This paper examines how the expanded use of one medical technology shaped related roles for nurses. Transfusion ultimately influenced nurses' work and the composition of the workforce as the first medical act "delegated" to nurses in Ontario (1947), setting a precedent for the delegation of further technologies over the next four decades.

Blood Transfusion↗
PubMed1984

[The legal basis of blood transfusion].

Blood transfusion is a procedure in which it is incumbent on the attendant doctor to undertake appropriate enlightenment of the patient, obtain the patient's consent, define the precise indications and perform the task with technical proficiency. The doctor undertaking blood transfusion must be acquainted with the legal basis for these responsibilities and be aware of the legal aspects which free him from these obligations in exceptional cases. Since the urgency of transfusion varies from case to case the following classification is proposed: normal cases, special cases and emergency cases. In view of the lack of legal guiding principles, the "3-stage cross-match test" in saline and albumin milieu, as well as in the Coombs test is recommended, in accordance with the provisions existing in Switzerland, the Federal Republic of Germany and in France. The procedure to be used in emergency cases is discussed. Moreover, advice is given in the event of fatal complications on the basis of a discussion of the causative factors and legal consequences involved in 21 cases which came to autopsy by order of the coroner.

Blood Group Antigens↗
PubMedDate not supplied

Blood transfusion.

Blood transfusion is a potentially dangerous treatment in which adverse reactions are rare but can be fatal. This article introduces recently published national guidelines for the care of recipients of a blood transfusion (BCSH 1999) and focuses in particular on the responsibilities of nurses and midwives.

Blood Grouping and Crossmatching↗
PubMed1993

Computerized continuous quality improvement methods used to optimize blood transfusions.

Blood transfusion, although common, is not without risk and expense. Recently there has been a national focus on both overtransfusion and undertransfusion. To provide the best quality of patient care, there must be a balance between both over and undertransfusion. We used a computer system to minimize overtransfusion by prompting physicians when orders that did not meet accepted criteria were made. Continuous quality improvement methods were used to optimize blood transfusions. We also evaluated undertransfusions by assessing patients who did not receive a red cell transfusion when the Hemoglobin or Hematocrit showed it was clearly indicated. Using our computerized alerting system we are able to promptly notify physicians when such conditions exist. Results of the blood ordering show that overtransfusions of red cells have been minimized. Reductions in both mean Hematocrit and the standard deviation have occurred as predicted by continuous quality improvement theory. Assessment of undertransfusions showed that it was a minimal problem, but one that can be easily addressed with our laboratory alerting system.

Blood Transfusion↗
PubMed1976

Ascorbic acid levels in stored blood and in patients undergoing surgery after blood transfusion.

Blood was obtained from 11 healthy voluteers, mixed with two standard types of anticoagulant used in blood transfusion centres and stored for 21-28 days at 4 degrees C. Leucocyte ascorbic acid (LAA) fell to deficient levels after 7 days in all cases. There were no corresponding changes in plasma ascorbic acid (PAA) levels. LAA and PAA were measured before, during and after surgery in 5 control patients who underwent definitive operations for benign peptic ulceration and in 4 patients under-going surgery for bleeding peptic ulceration. The average amount of blood administered to the latter group was 10 units. There was a fall in LAA and PAA in both groups of patients after operation. This fall had returned to normal by 7 days in the controls, but the LAA remained at a deficient level at 7 days in the patients who had bled. Deficient ascorbic acid in stored blood may contribute to low leucocyte ascorbic acid levels in patients after blood transfusion and may contribute to the increased complication rate when surgery is undertaken in these patients.

Adult↗
PubMed1999

Blood transfusion.

Blood transfusion became a relatively safe and practicable procedure following the discovery in 1900 of blood groups and the realization early in the first World War that citrate was a safe and effective anticoagulant. Transfusion may elicit the formation of antibodies in the recipient due to "foreign" antigens on the donor's red cells, white cells, or platelets. Application of the methods of molecular biology has characterized the antigens concerned and the genes that determine them. The concept of transfusing whole blood to remedy a deficiency of any constituent, for example, platelets, has been superseded by the idea of transfusing only that component of blood which is needed. Many viruses, for example, hepatitis viruses and human immunodeficiency viruses, can be transmitted by transfusion. The high degree of success in preventing their transmission is a scientific triumph.

Blood Transfusion↗
PubMed2005

Effect of substituting allogenic blood transfusion with autologous blood transfusion on outcomes after radical oesophagectomy for cancer.

BACKGROUND: The oncologic benefit of avoiding allogenic blood transfusion in oesophageal cancer resection has not been studied. METHODS: The medical records of 68 patients (Auto group) who underwent a potentially curative oesophageal cancer resection without allogenic blood transfusion from 1996 to 1999 receiving 800 g of autologous blood donated preoperatively, and 97 patients (Allo group) who underwent the same operation with allogenic blood transfusion from 1990 to 1995 were compared. RESULTS: There were no differences in age, gender, stage of disease, number of retrieved nodes, or perioperative hemoglobin concentration between the two groups. The survival of the 45 patients with nodal involvement in the Auto group was better than that of the 59 patients in the Allo group (p=0.0435), and the survival of the 35 patients with T3 or T4 lesions in the Auto group was better than that of the 61 patients in the Allo group (p=0.0408). According to logistic regression analysis, allogenic blood transfusion correlated with tumour recurrence in patients with either nodal involvement or a T3-4 lesion. The natural killer cell activity remained higher in the Auto group than in the Allo group (p<0.05). CONCLUSION: Avoidance of allogenic blood transfusion favorably effected the survival of patients with oesophageal cancer at risk for recurrence.

Aged↗
PubMed1987

Determination of antiidiotypic antibodies to anti-HLA IgG following blood transfusions.

Blood transfusions (BT) administered prior to renal allograft transplantation are known to enhance allograft survival. One proposed mechanism for this effect is through the induction of antiidiotypic antibodies that modify the immune response to subsequently presented graft antigens. In an attempt to determine if antiidiotypic antibodies are generated post-BT, we studied sera from post-BT patients for the presence of antiidiotypic antibodies to anti-HLA class I IgG (i.e., anti-anti-HLA). Anti-HLA antiidiotypes were demonstrated by idiotype-specific inhibition of an enzyme immunoassay (EIA) for anti-HLA antibodies. Using this inhibition technique, test sera from 8 of 16 post-BT patients showed significant inhibition of the anti-HLA target sera (P less than 0.05). Sera from normal individuals showed no inhibition of the target sera, and test sera did not inhibit other antigen-antibody systems. Protein A absorption of test sera eliminated the inhibitory effect, suggesting that the antiidiotypic activity was limited to the IgG fraction of the sera. The EIA binding activity of F(ab')2 fragments of anti-HLA IgG was suppressed by sera from patients post-BT but not by sera from normal volunteers. Studies of serially obtained sera from a post-BT patient showed that anti-HLA antiidiotype levels fluctuate with time and transfusion status. These studies demonstrate that anti-HLA antiidiotypic antibodies are generated post-BT. Their importance in mediating the known allograft-enhancing effect of pretransplant BT remains to be clarified.

Antibodies, Anti-Idiotypic↗
PubMed1999

Knowledge acquisition environment for the design of a decision support system: application in blood transfusion.

Blood transfusion is a medical domain where decision support systems (DSSs) could be very helpful to the physicians but must easily and continuously be maintained. We have developed a knowledge acquisition tool that allows the construction and the maintenance of such a system by the domain expert. The methodology used could be applied to another highly evolutive medical domain. In this paper, we detail our knowledge acquisition tool, its use and the final DSS obtained, which is fully integrated into our hospital information network.

Artificial Intelligence↗
PubMed2000

[The transfusion and blood transfusion in pediatric patients with palatoplasty]

OBJECTIVE: To study whether the pediatric patients with palatoplasty needs blood transfusion and the rational combination of transfusion during operation,in order to provide a basis for the management of clinical anesthesia and postoperative recovery in children.METHODS:20 subjects without blood transfusion were selected,the combination of transfusion during the operation was 5% glucose solution,sodium lactate ringers solution,gelofusine.The intraoperative and postoperative circulation, hemoglobulin, hematocrit were compared with the preoperative data.RESULTS:Both the intraoperative and the postoperative circulation of all subjects were steady, having no significant difference from the data base(P>0.05), the values of hemoglobulin and hematocrit descended,but were in the normal limit(P>0.05).CONCLUSION: During palatoplasty in pediatric patients, if transfusion was apporpriate, steady circulation can be substained without boold transfusion,which saved the blood, and avoided the side effects of blood transfusion.

Journal Article↗
PubMed2001

[The use of the autologous blood transfusion to the respiratory surgery: autologous blood transfusion or no-blood transfusion surgery?].

We could report the effect of the autologous blood transfusion to the lobectomy, by comparison with no-blood transfusion group and MAP-red cell concentrate transfused group (MAP group). Autologous blood which was stored three days before an operation and preserved at 4 degrees C kept 89.9 +/- 11.7% of the number of erythrocyte and 59.6 +/- 23.4% of platelet. Autologous blood transfusion group and MAP group showed significantly more than no-blood transfusion group on the number of erythrocyte at the time of discharge. These facts suggest that the autologous blood has an ability of coagulation. We concluded that on lobectomy autologous blood transfusion was better than MAP-red cell concentrate transfusion in point of protection from disease transmission and better than no-blood transfusion in point of post-operative recovery.

Aged↗
PubMed2004

Enhanced angiogenesis following allogeneic blood transfusion.

Blood transfusions are associated with recurrence of solid cancers. Angiogenesis is essential for cancer growth. Our aim was to determine for the first time in a prospective cohort study the effect of prestorage allogeneic leucodepleted SAGM (saline, adenine, glucose, mannitol) red cell transfusion on angiogenic factor levels and in vitro angiogenesis. Forty pretransfusion adult hospital inpatients were selected consecutively. Serum vascular endothelial growth factor (VEGF) and endostatin were measured in each patient before and after prestorage allogeneic leucodepleted SAGM red cell transfusion. All samples were exposed to an in vitro endothelial cell proliferation assay and 10 sample groups were also exposed to an in vitro whole angiogenesis assay. The median number of units transfused was 2 (minimum-maximum, 2-4). Twenty-nine (73%) patients had a rise in VEGF, with an overall increase of 118 pg/ml (quartiles -5, 306; P < 0.01). Twenty-eight (70%) patients had a decrease in endostatin, with an overall reduction of 1.2 ng/ml (quartiles 4.0, 0.0; P = 0.017). There was an overall 33% increase in endothelial cell proliferation (P < 0.01) and a 9.4% increase in in vitro whole assay angiogenesis (P < 0.01). Prestorage allogeneic leucodepleted SAGM red cell transfusions are associated with a favourable angiogenic factor imbalance and an elevation in in vitro angiogenesis.

Adult↗
PubMed1993

[Current focus: blood transfusion. Risks and problems in blood transfusion].

Blood transfusion became the subject of major interest because of a possible HIV-infection. It should not been forgotten, however, that HIV-infection is not the only of a wide variety of risks. The leading complication is still the hemolytic transfusion reaction, followed by transmission of hepatitis or other viral or bacterial germs. Less striking side effects, like an immunomodulation or a graft-versus-host reaction, should also been included into the therapeutical considerations. One possibility to avoid risks, is the use of autologous blood. The most important requirement, however, remains to operate with a minimal blood loss.

Blood Donors↗