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PubMed1991

Prevalence of hepatitis C in transfusion dependent thalassaemics & haemophilics.

Seventy thalassaemics (B = 37, EB = 33) and 20 haemophilics (A = 18, B = 1, C = 1) were tested for antibodies to hepatitis C virus (anti-HCV) and markers for hepatitis B virus (HBV). The seropositivity for anti-HCV in thalassaemics and haemophilics was 14.3 and 25 per cent respectively. The subjects who were sero-positive to anti-HCV had had additional exposure to HBV. Anti-HCV positivity was not related to the age of the subject nor the number of units of blood and blood components transfused. Screening of blood donors for anti-HCV, apart from HBV, may minimise the hazards of post transfusion hepatitis in high risk recipients like transfusion dependent thalassaemics and haemophilics.

Hemophilia A↗
PubMed2002

Intraoperative use of platelet-plasmapheresis in vascular surgery.

STUDY OBJECTIVE: To determine, in a pilot study, whether pheresis of plasma and platelets before surgical blood loss, with reinfusion of the autologous plasma and platelets after completion of the aortic reconstruction, will result in decreased bleeding and decreased transfusion of allogenic blood components in patients undergoing elective aortic reconstruction. DESIGN: Randomized study. SETTING: University medical center. INTERVENTIONS: Patients were randomized to perioperative (acute) platelet plasmapheresis (APP group) versus conventional blood component therapy (control group). In the APP group, blood was withdrawn after induction of anesthesia, to sequester approximately 300 mL of platelet rich plasma (PRP); platelet poor plasma (PPP) and red blood cells (RBC) were sequestered as well. An autotransfusion device was used to collect and re-infuse autologous RBC during the course of the operation in both groups. After completion of the aortic reconstruction, autologous PRP and PPP were re-infused in the APP group. Blood loss, volume of blood component transfusions, and preoperative and postoperative hemoglobin (Hb), hematocrit (Hct), platelet, international normalized ratio (INR), and activated partial thromboplastin time (aPTT) were recorded. MEASUREMENTS AND MAIN RESULTS: There was no difference between groups in demographics, preoperative laboratory values, or surgical procedures, although more patients were treated for aneurysms (73% vs. 60%) and fewer for occlusive disease (20% vs. 40%) in the control versus APP group. Also, there were no differences between the control and APP groups in duration of operation, blood loss, volume of colloid infused, or volume of allogenic RBC and plasma transfused. Patients in the APP group received a greater volume of crystalloid solution (9.1 +/- 3.4 L vs. 6.8 +/- 3.0 L; p = 0.002), but fewer units of allogenic platelets than the control group (0.7 +/- 1.0 units vs. 0.2 +/- 0.4 units; p < 0.04). There were no differences in postoperative Hb, Hct, INR, aPTT, or fibrinogen. The platelet count was lower in the APP group than in the control group (123 +/- 40 x 10(3)/mm(3) vs. 182 +/- 51 x 10(3)/mm(3); p = 0.004). CONCLUSIONS: Perioperative platelet plasmapheresis led to fewer allogenic platelet transfusions in patients undergoing elective aortic reconstruction. However, there was no decrease in blood loss and no reduction in transfusion of allogenic RBC or plasma. Perioperative platelet plasmapheresis is not recommended for routine use in elective aortic reconstruction.

Aged↗
PubMed1997

Transfusion requirements are correlated with the degree of proteolysis of von Willebrand factor during orthotopic liver transplantation.

During orthotopic liver transplantation (OLT) excessive bleeding is the main cause of death and graft failure. The acute bleeding tendency that accompanies OLT, particularly during the anhepatic period and after reperfusion of the graft, is due to the depletion or functional abnormalities of several hemostasis components caused by the enhanced activity of enzymes such as plasmin, trypsin and leukocyte proteases. We surmised that enhanced proteolysis might also cause abnormalities of von Willebrand factor (vWF), and that these abnormalities are implicated in the bleeding tendency that develops during OLT. Therefore, the pattern of vWF proteolysis was studied with 16 patients with chronic liver disease, in serial blood samples obtained before OLT, during the anhepatic stage, after graft reperfusion and at the end of the surgical procedure. vWF became markedly degraded during the anhepatic and reperfusion stages, as shown by the partial loss of high molecular weight multimers, the relative decrease of the intact 225 kD subunit and the increase of the native proteolytic fragments of 176 and 140 kD. Novel proteolytic fragments also became detectable. Using monoclonal antibody epitope mapping, it could be demonstrated that some of the proteolytic fragments corresponded in apparent molecular mass to those produced in vitro by incubating purified vWF with plasmin or elastase, but other fragments could not be attributed to these proteases. During the anhepatic and reperfusion stages there was a significant correlation between the degree of vWF degradation and the total amount of blood components transfused to replace blood losses. To evaluate whether or not vWF degradation could be controlled by the administration of a broad-spectrum protease inhibitor such as aprotinin, 5 patients were given a bolus dose of 500,000 U before surgery followed by 100,000 U/h during surgery, 5 were given a 2,000,000 U bolus followed by 500,000 U/h, and no aprotinin was given to the remaining 6 patients. There were no differences in the patterns or degrees of vWF degradation between patients treated with aprotinin or not. In conclusion, there is a marked degradation of a key hemostasis protein during OLT. These alterations may be of clinical significance, because they are correlated with the transfusion requirements.

Adult↗
PubMed1998

The role of flow cytometry in improving biocompatibility in transfusion medicine.

In transfusion medicine, blood and blood components, donors and patients are increasingly confronted with biomaterials. The need to understand the response of human blood to contact with these artificial surfaces has led to multiple studies on the biocompatibility of biomaterials. Up to this time, these investigations have predominantly been performed using physical, immunological and biochemical methods. Many of these approaches are useful in investigating the multiple factors involved in blood-biomaterial interactions. However, they always reflect the overall behaviour of whole cellular populations in local or systemic reactions. The application of multiparameter flow cytometry, on the other hand, provides insight into antigenic expression and changes at the single-cell level. Therefore, the technique of flow cytometry represents a new and powerful way of analysing and improving the biocompatibility of these materials in blood-contacting applications in this field.

Blood Component Transfusion↗
PubMed2006

[Complications, adverse events and errors in medical treatment with the emphasis on transfusion treatment with blood components].

Adverse events and errors are relatively frequent in patients treatment and occur in all medical departments. In most cases they do not cause medical complications and they are seldom the cause of serious reactions and patients morbidity or mortality. Although adverse events and errors are almost always brought about by individual persons, their cause in the majority of cases is inadequate organization or bad working conditions. The frequency and serious consequences of errors and adverse events were not recognized until to the recent past and they were not analyzed enough mostly due to subjective or organizational reasons. The patient has to be informed about the error that has caused damage or harmed him. The decrease of harm done by errors and adverse reactions and their prevention can be achieved only by an organizational change with the introduction of quality management, specifically risk management, and the acceptance of the culture of quality and open dialogue by all. The errors that have already been made should be used for the improvement of health service and the patient's benefit. Full truth and genuine sincerity are the prerequisites for the protection against legal proceedings.

Blood Component Transfusion↗
PubMed1993

Economic impact of inappropriate blood transfusions in coronary artery bypass graft surgery.

PURPOSE: In addition to historically important issues of blood inventory and blood safety, the costs of blood transfusion are anticipated to have an increasingly important impact on transfusion practices. To address this, we analyzed costs of blood support given to patients undergoing coronary artery bypass graft (CABG) surgery, along with costs of blood components whose transfusions were identified to be unnecessary. PATIENTS AND METHODS: Blood components transfused as part of a previously reported national, multicenter audit of 30 adult patients each at 18 institutions undergoing primary, elective CABG surgery were reviewed. RESULTS: The range of blood purchase costs among institutions was broad, varying over two-fold. The range of red cell units transfused varied over 10-fold, and the range of total components transfused varied over 40-fold. The number of blood components transfused unnecessarily represented 27% of all blood units transfused, ranging from 7% to 43% among institutions. Inappropriate transfusions accounted for 47%, 32%, and 15% of all platelet, plasma, and red cell units transfused. The mean institutional cost for all blood components transfused per patient was $397 +/- $244. The cost per patient of components transfused inappropriately was 24% of this, or $96 +/- $89 (mean +/- SD). CONCLUSION: These costs could be reduced with practice guidelines and quality improvement programs aimed at reducing the number of inappropriate transfusions.

Adult↗
PubMed2004

The Quebec hemovigilance system: description and results from the first two years.

Following federal and provincial reviews of the blood system, the Canadian province of Quebec passed a series of legislative and administrative measures to improve blood safety, including the establishment of a hemovigilance system, and made infrastructure and human resource investments to support their implementation. The Quebec hemovigilance system was inspired by the French system using similar data elements and case definitions, grading of severity and determination of likelihood of association with transfusion for adverse transfusion events (ATE). The Quebec system also monitors transfusion incidents without adverse consequences such as "incorrect blood component transfused" (IBCT) and near-miss events. Accurate rate estimates are possible through the collection of denominator data on the number of blood products transfused. This paper describes the Quebec hemovigilance system and reports on ATE (including IBCT but excluding near-miss events) associated with blood components notified in 2000 and 2001, the first two years of implementation. The Quebec hemovigilance system is voluntary, but hospital participation in 2000 and 2001 represented 80% and 82% of transfused products, respectively. Notified ATE (including IBCT) increased 78% between 2000 and 2001 primarily because of better reporting of minor adverse reactions. In 2001, the overall ATE rate was 3.5 per 1000 blood components transfused. Despite an overall increase in reported ATE, rates for some serious ATE decreased in the second year, including ABO-incompatible transfusions, acute hemolytic reactions and bacterial contamination.

Blood Banks↗
PubMed2006

Post-transfusion purpura: a challenging diagnosis.

BACKGROUND: Post-transfusion purpura is a rare syndrome characterized by severe thrombocytopenia and bleeding caused by alloimunization to human platelet specific antigens following a blood component transfusion. The suggested incidence is 1:50,000-100,000 transfusions, most often occurring in multiparous women. The diagnosis is not easy because these patients, who are often critically ill or post-surgery, have alternative explanations for thrombocytopenia such as infection, drugs, etc. OBJECTIVES: To describe patients with initially misdiagnosed PTP and to emphasize the diagnostic pitfalls of this disorder. PATIENTS AND RESULTS: During a period of 11 years we diagnosed six patients with PTP, four women and two men. The incidence of PTP was approximately 1:24,000 blood components transfused. We present the detailed clinical course of three of the six patients in whom the diagnosis was particularly challenging. The patients were initially misdiagnosed as having heparin-induced thrombocytopenia, systemic lupus erythematosus complicated by autoimmune thrombocytopenia, and disseminated intravascular coagulation. A history of recent blood transfusion raised the suspicion of PTP and the diagnosis was confirmed by appropriate laboratory workup. CONCLUSIONS: PTP seems to be more frequent than previously described. The diagnosis should be considered in the evaluation of life-threatening thrombocytopenia in both men and women with a recent history of blood transfusion.

Aged↗
PubMed1989

Exposure of patients to human immunodeficiency virus through the transfusion of blood components that test antibody-negative.

The risk of transmission of the human immunodeficiency virus to recipients of blood transfusions exists chiefly during the period between the time a donor is infected and the time he or she has a positive blood test for HIV antibodies. Estimating the chance that blood will be donated during this period is an effective way to define the risk of HIV infection from transfusion. Using this approach, and employing data from over 17 million American Red Cross blood donations, we estimate that during 1987 the most likely number of units of blood infected with undetected HIV that were transfused was 131 (range, 67 to 227). For a patient, the odds of contracting HIV infection were 1:153,000 per unit transfused. A patient who received the average transfusion (5.4 units) had odds of 1:28,000. The risk has been decreasing by more than 30 percent a year. We estimate that donor-recruitment practices plus careful education and screening are eliminating 49 of every 50 donors likely to be HIV-positive and that testing is 92 to 97 percent effective, for a combined effectiveness of 99.9 percent. The risk of undetected infectious units can probably be further reduced by transfusing fewer units and units from fewer donors, recruiting more women and fewer men as new donors, and encouraging more frequent donations from donors who have been tested repeatedly.

AIDS Serodiagnosis↗
PubMed2003

Automated collection of blood components: their storage and transfusion.

The performance of an automated device, the Gambro TRIMA, was evaluated for component production, and an in vivo assessment of the platelets was carried out. Red cell concentrates (RCCs), platelets and plasma were collected and stored according to standard blood bank procedures and evaluated for quality by in vitro measurements. Additionally, single-donor platelets (n=10) were transfused to thrombocytopenic patients after 5 days of storage. Platelet counts were measured after 1 h and the corrected count increment (CCI) was calculated. No significant changes were seen before or after procedure in donor haemoglobin, haematocrit, coagulation factors or platelet count. Return-line samples showed no increase in the level of plasma haemoglobin. Plasma haemoglobin and potassium increased following RBC storage, but there was no change in the red cell number. Platelet aggregation decreased from 52 to 11% (adenosine diphosphate) and the Kunicki morphology score dropped from 379 to 174. Little change was seen in the hypotonic shock response (69-63%) or in the percentage of CD62 expression (4.8-19.8) over time. The CCI averaged 28+/-26 x 10(3) microL(-1) in 10 patients 1 h after transfusion. The TRIMA machine collects RCCs, platelets and plasma in a variety of combinations in one session. For autologous collection, two units of RCC plus platelets can be collected at one time, reducing administrative and testing costs. The platelets have good in vivo recovery, as shown by the CCI values. An added advantage is that the TRIMA machine can be used in hospitals to generate components in times of shortage without the need for a component's laboratory.

Automation↗
PubMed2004

Infectious risks associated with the transfusion of blood components and pathogen inactivation in Japan.

Even after the implementation of the nucleic acid amplification testing (NAT) system, there remains a residual risk of viral transmission through blood transfusion because of the limited sensitivity of the reagents used and the pooling strategy of the current NAT system. From the calculation using NAT yield and the length of the window period, we presume that we will obtain 0.75 donations for human immunodeficiency virus and 0.58 donations for hepatitis C virus annually that are individual donation-NAT positive but 50-individual pool-NAT negative, figures that are comparable with those in other developed countries. The number of donations potentially positive for the hepatitis B virus genome is, however, considerably high in Japan and is estimated to be more than 100 annually, which is the sum of the donors in the minipool-NAT window period and the chronic carriers with a low viral load. The incidence of bacterial sepsis after transfusion is relatively low in Japan. This incidence is possibly attributable to the short shelf lives of platelet concentrate and red blood cell component, which are 3 and 21 days, respectively. In Japan, the implementation of a new technology to screen out or abrogate infectious agents in blood components is necessary while considering the balance between benefits and possible new risks or costs.

Bacterial Infections↗
PubMed1993

Collection and transfusion of blood and blood components in the United States, 1989.

To probe recent trends in transfusion practice and their effect on the adequacy of the national blood resource, transfusions and collections in the United States in 1989 were studied, by using data shared by the American Association of Blood Banks, the American Red Cross, and the Council of Community Blood Centers, together with results from a sample survey of the 3600 hospitals that were not members of the national organizations. Statistical methods were used to estimate national activities. The total US supply of blood in 1989 was 14,229,000 units, an increase of 1.2 percent over the supply in 1987. Red cell transfusions were 12,059,000 units. A total of 3,159,000 patients underwent transfusion with whole blood and/or red cells (mean, 3.8 units/patient). Preoperative autologous deposits of 655,000 units by 310,000 patients represented an increase of 65 percent over the level in 1987. However, only 356,000 units (54%) were transfused to the patients who preoperatively deposited them; of the remainder, 13,000 units were crossed over for transfusion to other patients, while 286,000 units were never used. Directed donations, 350,000 units, were provided for 130,000 intended recipients, but only 97,000 units (28%) were transfused to their intended recipients; of the balance, 59,000 units (17%) were crossed over and 194,000 units (55%) were never transfused. Total platelet transfusions were equivalent to 7,258,000 units in 1989, for an increase of 13.7 percent over totals in 1987.

Blood Component Transfusion↗