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PubMed1998

Detection of a novel DNA virus (TTV) in blood donors and blood products.

BACKGROUND: A newly discovered DNA virus, transfusion-transmitted virus (TTV), has been implicated as a cause of post-transfusion hepatitis. We investigated the frequency of TTV viraemia in UK blood donors, and the extent to which TTV contaminates blood products such as factor VIII and IX clotting factors. We also investigated the possible aetiological role of TTV in cryptogenic fulminant hepatic failure (FHF). METHODS: We extracted DNA from plasma of blood donors and patients with FHF, and from blood products (factor VIII and IX clotting-factor concentrates, immunoglobulin preparations). We detected TTV by PCR using primers from a conserved region in the TTV genome. FINDINGS: TTV viraemia was detected in 19 (1.9%) of 1000 non-remunerated regular blood donors. Infection occurred more frequently in older donors (mean age 53 years), compared with the age prolife of donors infected with hepatitis C virus and other parenterally-transmitted viruses. TTV contamination was found in ten (56%) of 18 batches of factor VIII and IX concentrate manufactured from such non-remunerated donors, and in seven (44%) of 16 batches of commercially available products. Whereas solvent or detergent treatment had little effect on the detection of TTV in factor VIII and IX by PCR, this virucidal step seemed to inactivate TTV infectivity. TTV infection was detected in four (19%) of 21 patients with FHF; in three cases, infection was detected at the onset of disease and could thus not be excluded from its aetiology. INTERPRETATION: TTV viraemia is frequent in the blood-donor population, and transmission of TTV through transfusion of blood components may have occurred extensively. Clinical assessment of infected donors and recipients of blood and blood products, and assessment of TTV's aetiological role in hepatic and extra-hepatic disease, are urgently needed.

Adult↗
PubMed1998

Blood transfusion.

This Clinical Update considers issues relating to transfusion of blood components--erythrocytes, platelets and plasma products--obtained from human donors.

Blood Component Transfusion↗
PubMedDate not supplied

The impact of red cell substitutes on the blood service in Japan.

The total number of blood donors in 1994 was 6.6 millions, and 200 ml whole blood donation occupied 41.8% of all donations, whereas 400 ml and apheresis donations occupied 35.6%, 22.5% of all donations respectively. From the donated blood, about 8.35 million bags of blood components were prepared and were used for blood transfusion. Besides used as blood components, 720,000 L source plasma was used to produce plasma derivatives, and therefore Japan has achieved self-sufficiency in Factor VIII by donated blood. Blood transfusion has become quite safer but there are still risks of acquiring transfusion-associated GVHD(TA-GVHD) or infecting with HIV from blood in window period. To avoid adverse reactions of blood transfusion, the strategies for reducing homologous blood transfusion has been promoting. The use of red cell substitutes will be an option of using non-human derived substitutes toward "zero" adverse reaction of transfusion, and when red cell substitutes are accepted in Japan, they will be applied as the substitution to allogeneic blood transfusion below 1200 ml hemorrhage. They will also be applied as an alternation to and/or combination with allogeneic and autologous blood transfusion and the use of erythropoietin.

Blood Banks↗
PubMed2001

Transfusion of blood components and postoperative infection in patients undergoing cardiac surgery.

OBJECTIVE: To investigate the influence of blood derivatives on the acquisition of severe postoperative infection (SPI) in patients undergoing heart surgery. SETTING: The postoperative ICUs of a tertiary-level university hospital. DESIGN: A cohort study. METHODS: During a 4-year period, 738 patients, classified as patients with SPIs and patients without SPIs (non-SPI patients), were included in the study. We studied the influence of 36 variables on the development of SPI in general and individually for pneumonia, mediastinitis, and/or septicemia. The influence of the blood derivatives on infections was assessed for RBC concentrates, RBC and plasma, and RBC and platelets. RESULTS: Seventy patients (9.4%) were classified as having SPIs, and 668 (90.6%) were classified as not having SPIs. After multivariate analysis, the variables associated with SPI (incidence, 9.4%) were reintubation, sternal dehiscence, mechanical ventilation (MV) for > or = 48 h, reintervention, neurologic dysfunction, transfusion of > or = 4 U RBCs, and systemic arterial hypotension. The variables associated with nosocomial pneumonia (incidence, 5.9%) were reintubation, MV for > or = 48 h, neurologic dysfunction, transfusion of > or = 4 U blood components, and arterial hypotension. The variables associated with mediastinitis (incidence, 2.3%) were reintervention and sternal dehiscence, and those associated with sepsis (incidence, 1.6%) were reintubation, time of bypass > or = 110 min, and MV for > or = 48 h. The mortality rate (patients with SPI, 52.8%; non-SPI patients, 8.2%; p < 0.001) and mean (+/- SD) length of stay in the ICU (patients with SPI, 15.8 +/- 12.9 days; non-SPI patients, 4.5 +/- 4.4 days; p < 0.001) were greater for the infected patients. The transfused patients also had a greater mortality rate (13.3% vs 8.9%, respectively; p < 0.001) and a longer mean stay in the ICU (6.1 +/- 7.2 days vs 3.7 +/- 2.8 days, respectively; p < 0.01) than those not transfused. CONCLUSION: The administration of blood derivatives, mainly RBCs, was associated in a dose-dependent manner with the development of SPIs, primarily nosocomial pneumonia.

Aged↗
PubMed1999

[Evaluation of the supplies, usage, and necessity of blood components in Asturias (1990-1995)].

PURPOSE: To assess the effectiveness of the transfusion network in Asturias regarding the autosufficiency in the production of haemoderivatives and their usage, as well as the components of the transfusion procedure in the period 1990-1995. MATERIAL AND METHODS: The procedure data and the results of donation, production and management and transfusion of blood components were analysed in a retrospective fashion. RESULTS: The overall production of haemoderivatives in the years analysed, 1990 and 1995, was, respectively, 55.8% and 64% of the overall usage. These figures correspond to 113% and 138% when applied to blood components for transfusion, and 15.9% and 27% with regard to plasma derivatives. On the other hand, it was estimated that 113% of the necessary haemoderivatives were transfused, respectively, in 1990 and 1995, corresponding to 121% and 112% for blood components, and 108% and 149%, respectively, for plasma derivatives. CONCLUSION: The Consultive Committee of the Community Blood Centres must establish a quality assurance programme for blood transfusion in order to monitor all the different steps of the transfusion procedure and to evaluate the accomplishment of the legal norms tending to achieve auto-sufficiency in blood derivatives.

Blood Component Transfusion↗
PubMed1992

Leukocyte-reduced blood components in transfusion medicine. Current indications and prospects for the future.

Transfusion medicine is a rapidly evolving specialty, and efforts are ongoing to improve the safety and quality of blood component therapy. Leukocytes are known to be the cause of numerous adverse effects of transfusion therapy, and their removal from red cells and platelet components may be desirable in a variety of clinical settings. The various complications of transfusion that can be attributed to contaminating leukocytes and the benefits of leukocyte depletion are addressed in this article. Laboratory as well as clinical data are summarized.

Bacterial Infections↗
PubMedDate not supplied

Evaluation of a volumetric intravenous fluid infusion pump for transfusion of blood components containing red cells.

A method was devised to evaluate the suitability of an infusion pump for transfusing components containing red cells. With simulated transfusions of units of whole blood tested before or after the expiration date there was no increase in the plasma hemoglobin level in pumped blood compared with blood that was put through a standard blood transfusion set. With outdated units of red cells there was an increased level of plasma hemoglobin after pumping. The increases were greatest at maximum pump rates, but were not statistically or clinically significant. The authors' evaluation indicates that this pump causes minimal damage to the red cells, although care should be exercised when rapidly transfusing red cells with high hematocrit values.

Blood Transfusion↗
PubMedDate not supplied

Transfusion in the newborn.

Transfusion, either with whole blood or blood components is frequently needed in the neonatal intensive care. Certain aspects are very important to consider. Citrated blood is preferred to heparinized blood. Transfusion must be rational, either with whole blood or blood components. Whole blood is only indicated for repletion of blood volume, exchange transfusion and certain cases in which no blood component needed is available. To improve oxygen carrying capacity, to stop bleeding due to coagulation defect, thrombocytopenic bleeding due to depressed platelets production and to counter gram negative septicemia, blood component is indicated to obtain optimal effects with minimal side effects.

Blood Component Transfusion↗
PubMed2003

Barcode technology: its role in increasing the safety of blood transfusion.

BACKGROUND: Incorrect blood component transfusion is the most frequent serious incident associated with transfusion. Errors responsible for these incidents frequently involve patient misidentification. STUDY DESIGN AND METHODS: This study evaluated a barcode patient identification system involving hand-held computers for blood sample collection for compatibility testing and the administration of blood. Audit of practice was carried out before and after its introduction. RESULTS: The baseline audit revealed poor practice, particularly in patient identification. Significant improvements were found in the procedure for the administration of blood following the introduction of barcode patient identification, including an improvement from 11.8 to 100 percent in the correct verbal identification of patients (p </= 0.001). Similar significant improvements were found in matching verbally stated identification details with details on patient identification wristbands, in correct patient identification before the collection of blood samples, and in the proportion of correctly labeled samples. Staff found the barcode identification system easy to operate and preferred it to standard procedures. CONCLUSIONS: A barcode patient identification system was found to simplify the clinical transfusion process and improve practice. These results provide support for further work on the development of such systems for transfusion and for other hospital procedures requiring patient identification.

Blood Transfusion↗
PubMed1997

[Pilot study of the characteristics of transfused patients and utilized labile blood products].

The aim of this study was to describe blood recipients and blood components transfused during the first 24 hours in 13 French hospitals. We included all blood recipients who had not had any blood transfusion within the past six months. Recipients were screened for red cell alloantibodies, the alanine aminotransferase activity and specific viral markers (hepatitis B and C, Human Immunodeficiency Virus). Eligible patients represented 47% of the all transfused. Among the 371 patients included, 57% were males and 71% were transfused in a surgical unit. Alloantibodies, non specific and specific viral markers were detected in 3%, 19% and 2% respectively. Among the patients included, 42 received 172 autologous units. In total, 1056 allogeneic units (an average of 3 units per patient) were transfused; blood products were leucocyte-depleted (49%) or leucocyte-poor (20%); 54% of red cell units were matched for antigens Rh and Kell. Neoplasms were the most frequently reported disease for which patients were transfused. This study provides baseline blood transfusion information on recipients and blood utilization for a specific period in French hospitals. Following this study, a national study will allow the clarification of the characteristics, for instance the surgical procedures requiring transfusion.

Adolescent↗
PubMed1999

Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports.

OBJECTIVE: To receive and collate reports of death or major complications of transfusion of blood or components. DESIGN: Haematologists were invited confidentially to report deaths and major complications after blood transfusion during October 1996 to September 1998. SETTING: Hospitals in United Kingdom and Ireland. SUBJECTS: Patients who died or experienced serious complications, as defined below, associated with transfusion of red cells, platelets, fresh frozen plasma, or cryoprecipitate. MAIN OUTCOME MEASURES: Death, "wrong" blood transfused to patient, acute and delayed transfusion reactions, transfusion related acute lung injury, transfusion associated graft versus host disease, post-transfusion purpura, and infection transmitted by transfusion. Circumstances relating to these cases and relative frequency of complications. RESULTS: Over 24 months, 366 cases were reported, of which 191 (52%) were "wrong blood to patient" episodes. Analysis of these revealed multiple errors of identification, often beginning when blood was collected from the blood bank. There were 22 deaths from all causes, including three from ABO incompatibility. There were 12 infections: four bacterial (one fatal), seven viral, and one fatal case of malaria. During the second 12 months, 164/424 hospitals (39%) submitted a "nil to report" return. CONCLUSIONS: Transfusion is now extremely safe, but vigilance is needed to ensure correct identification of blood and patient. Staff education should include awareness of ABO incompatibility and bacterial contamination as causes of life threatening reactions to blood.

Blood Component Transfusion↗