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PubMed2001

Transfusing methylene blue-photoinactivated plasma instead of FFP is associated with an increased demand for plasma and cryoprecipitate.

BACKGROUND: Photodynamic virus inactivation of plasma with methylene blue significantly decreases the recovery of fibrinogen and coagulation factors V and VIII. Because an adequate supply of fibrinogen is essential for the therapeutic efficacy of transfused plasma in many clinical settings, it was plausible that transfusing photoinactivated plasma (PIP) instead of FFP would result in an increased demand for plasma and cryoprecipitate. STUDY DESIGN AND METHODS: The study involved a retrospective analysis of the use of plasma at a university hospital (Barcelona, Spain) over three 1-year periods: one before the implementation of PIP therapy and two after. Blood components transfused to plasma recipients were listed by broad diagnostic categories based on the Diagnosis-Related Group classification. RESULTS: During the period under study, 2,967 patients were given plasma in this hospital. They received 27,434 units of plasma, 1,660 of cryoprecipitate, 10,079 of platelets, and 24,607 of packed RBCs. Patients undergoing surgical procedures accounted for 74 percent of all transfused plasma. In 71 percent of patient admissions, packed RBCs were transfused in addition to plasma. Diagnostic categories with the greatest requirement for plasma were cardiac valve surgery, liver transplant, wounds and traumatic injuries, and bowel surgery. The use of PIP was associated with a 56-percent increase in the aggregated demand for plasma, whereas the transfusion of non-virus-inactivated cryoprecipitate increased twofold the first year and threefold the second year. The growth in the use of plasma took place in all the diagnostic categories. In those categories that include patients with liver disease, a partial substitution of PIP for cryoprecipitate was observed during the second year after PIP therapy implementation. CONCLUSION: The use of PIP was associated with a marked increase in the demand for plasma and cryoprecipitate, which probably was due to the low hemostatic quality of the new component. It is possible that such an increase overrode the potential health benefits derived from transfusing virus-inactivated plasma.

Aged↗
PubMed1988

Post-tonsillectomy and adenoidectomy hemorrhage.

This is a retrospective review of 6842 tonsillectomies and adenoidectomies performed over a seven-year period at the Montreal Children's Hospital. The total incidence of postoperative bleeding was 2.5%. The incidence of primary post-tonsillectomy hemorrhage was 1.0%, with 78% of these children having developed bleeding within 12 hours of surgery. The overall incidence of secondary post-tonsillectomy hemorrhage was 1.2%. Twenty-nine percent of children with primary hemorrhage required a second general anesthetic, and 40% required blood component transfusion. Eight percent of children with secondary hemorrhage required a second general anesthetic and 24% received transfusions. Based on these findings, primary and secondary hemorrhage can be classified further into major and minor. The criteria for a major post-tonsillectomy hemorrhage are: requirements of a general anesthetic to control and repair the bleeding, or blood loss that is sufficient to require blood component transfusion therapy. The relevance of these findings with regard to outpatient adenotonsillectomies is discussed.

Adenoidectomy↗
PubMed1992

[Clinical and serologic studies in 34 patients with post-transfusion purpura].

Posttransfusion purpura (PTP) is a rare transfusion reaction characterized by a severe bleeding tendency and thrombocytopenia which occurs approximately 1 week after transfusion of platelet-containing blood components in patients previously immunized against platelet alloantigens. 34 cases of PTP were studied. Our patients were all female with a mean age of 60.8 years (35-78 years, n = 32). The inciting blood components were whole blood (4) or red cell concentrates (28). The interval between transfusion and onset of purpura ranged from 2 to 14 days with a clear maximum at 7 and 8 days. In 11 of 13 patients (85%) transfusion was accompanied by febrile, nonhemolytic transfusion reactions. Hemorrhagic symptoms lasted 9.4 days (3-37 days, n = 16). The mean minimal platelet count was 7.1 x 10(3)/microliters [(0-28) x 10(3)/microliters, n = 29]. The platelet count rose to over 50 x 10(3)/microliters after 13.9 days (2-61 days, n = 26), over 100 x 10(3)/microliters after 17.0 days (3-75 days, n = 22). In 1 patient, PTP led to death due to intracranial hemorrhage. 22 patients were treated with corticosteroids, 20 patients with intravenous immunoglobulins (IVIG), 17 of these patients received both. Therapy with IVIG was successful in 14 of 19 patients, whereas platelet transfusions (n = 18) were not able to evaluate the platelet count. Serological analysis showed that antibodies against the HPA-1a antigen either alone (18), in combination with HLA antibodies (12) or with anti-HPA-5b (1) were responsible in 91.2%, while antibodies against other platelet antigens were rarely implicated. In elution experiments HPA-1a antibodies could be eluted from the autologous HPA-1a-negative platelets. We suppose that these antibodies had a pseudo-specificity and were involved in the destruction of the patients' own platelets.

Adult↗
PubMed1987

Monocyte-macrophage (M-M) functions in asymptomatic hemophiliacs and supertransfused thalassemics.

Patients suffering from acquired immune deficiency syndrome (AIDS) succumb to opportunistic infections due to a generalized failure of their cell-mediated immune defenses. The monocyte-macrophage (M-M) system plays an important role in host defense against viruses, protozoa, mycobacteria, and tumours, all potentially involved in the terminal stages of AIDS. We studied M-M functions in 55 asymptomatic hemophiliacs, 20 supertransfused thalassemics, and 9 von Willebrand's syndrome patients over a period of 17 months to establish the part played by chronic repeated blood component transfusions on the macrophage defense system. We found a significant impairment of chemotaxis in 24 out of 55 hemophiliacs, 13 out of 20 thalassemics, and 4 out of 9 von Willebrand's patients. In contrast, Candida pseudotropicalis killing was markedly increased in all 3 patient groups, while Candida phagocytosis was most significantly diminished in thalassemics. Fc-receptor-dependent erythrophagocytosis showed wide variations in all patients, with a significant decrease only in thalassemics. Phorbol ester-activated nitroblue tetrazolium (NBT) reduction to formazan was normal in most cases, but background spontaneous NBT was often much higher than in the controls. Monocyte adhesion to plastic appeared impaired in hemophiliacs and von Willebrand's Syndrome patients, yet was of no statistical significance. It thus appears that continuous, repeated blood component transfusions cause an alteration of M-M functions. This may be either due to chronic, recurrent antigenic stimulation by foreign proteins transfused, or oncogenic and known immune suppressive viruses, like cytomegalovirus, Epstein-Barr virus, hepatitis, and human T cell lymphotropic virus III. This in turn may increase susceptibility to AIDS.

Adolescent↗
PubMed1993

Blood component supplementation during massive transfusion of AS-1 red cells in trauma patients.

Coagulation component transfusions in trauma patients given more than 10 units of AS-1 red cells during the first 24 hours after injury were studied. Serial coagulation tests were obtained to direct component therapy. Coagulopathy developed in more than 70% of patients. Patients with blunt or penetrating trauma had similar coagulation abnormalities during massive transfusions. More than 40% of patients with either exsanguinating hemorrhage from penetrating trauma or blunt trauma with associated brain injuries had abnormal coagulation tests on admission. In contrast, patients with blunt trauma, but without brain injury, did not have coagulopathy on admission. Patients received an average of 25 units (range, 10-77) of AS-1 red cells and were exposed to an average of 80 (range, 11-252) donors. Exsanguination and brain injuries primarily caused death in 57%. Abnormal coagulation tests will be frequent and profound during a massive transfusion with AS-1 red cells. Serial coagulation testing is recommended.

Adolescent↗
PubMed2004

The rationale for pathogen-inactivation treatment of blood components.

Blood transfusion provides an ideal portal of entry for microorganisms. Although current residual risks of microbial infection by transfusion are extremely low in the developed world, the requirements for even safer blood are paradoxically increasing. Such requirements are partly a legacy of the tragic transmissions of human immunodeficiency virus (HIV) by blood early in the acquired immunodeficiency syndrome pandemic and are legally expressed in consumer protection laws imposing strict product liability. Enhanced safety is called for, not only for recognized agents (especially bacteria, which cause most current transfusion-transmissible infections [TTIs]and have only recently been addressed) but also for potential future "emerging" TTIs. These possibilities are not merely theoretical. TTIs of HIV-1, HIV-2, hepatitis B virus vaccine escape mutants, human herpesvirus 8, West Nile fever virus, and variant Creutzfeld-Jakob disease amply demonstrate the continual emergence of such threats. For recognized agents, the possibilities of test errors, misreporting, process-control failures, and false-negative results (although rare with modern automation) remain. In principle, an all-embracing, pan-effective microbe-inactivation procedure offers a potential solution to blood safety concerns. Such procedures may also allow the removal of several existing antimicrobial interventions. However, blood services remain to be convinced that the various prerequisites for safe and effective pathogen inactivation have been met. Not the least of these prerequisites is that all blood components can be inactivated to provide a single streamlined alternative blood safety strategy. Furthermore, the huge potential value of effective pathogen-inactivation systems for developing countries should not be forgotten once such systems are perfected.

Bacterial Infections↗
PubMed1991

Impact of whole blood usage in massive transfusion.

A retrospective survey comparing blood and component usage during thoracoabdominal aortic reconstruction between patients receiving whole blood vs packed red cells was conducted. Volume of salvaged blood, usage of homologous blood components, and total homologous exposures were compared between eight patients who received only packed red blood cells and four patients who received whole blood for replacement of surgical losses, using a chi-square test for comparison. All variables demonstrated a decline among patients who received whole blood. The declines in homologous blood and plasma usage were statistically significant (P less than .05). The decline in platelet usage did not reach statistical significance. The decline in total homologous exposures approached statistical significance (P less than .1). The data suggest that use of whole blood for expected massive transfusion may reduce total blood-component requirements and total homologous exposures.

Aorta↗
PubMed1996

A survey of red cell use in 45 hospitals in central Ontario, Canada.

BACKGROUND: The purpose of this survey was to establish baseline information on blood component use in relation to patient diagnoses, procedures, and demographics and to identify patterns of blood use that may be used for blood program planning and transfusion audits. STUDY DESIGN AND METHODS: A cross-sectional survey of the transfusion of blood components in teaching and nonteaching hospitals in central Ontario between September 1991 and August 1992 was carried out. Coders of hospital medical records routinely record demographics, procedures, diagnoses, and other relevant information. A protocol was created by which medical records coders could add the components transfused to the discharge abstract for this study. Red cell use is reported here. RESULTS: Of the 61 hospitals invited to participate, from which 547,279 patients were discharged during the 12-month period of the study, 45 (74%) agreed to participate. Information was collected on 439,373 discharged patients. Of these, 26,611 (6.1%) received at least 1 unit of red cells. Of a total of 101,116 red cell units transfused, more than 74 percent were used in patients discharged with neoplasms, gastrointestinal diseases, circulatory system diseases, and trauma. High-transfusion-use procedures included operations and procedures on the digestive and cardiovascular systems, diagnostic and therapeutic procedures, musculoskeletal system, and hemic or lymphatic system procedures. CONCLUSION: This survey provides baseline blood transfusion information for a specific period that can help determine the need for hospital audits and maximum surgical blood-order schedule guideline reviews. This information is relevant to current recommendations to reduce patient's exposure to blood components. These transfusion data will assist in blood program planning based on known disease trends, demographics, and population changes.

Cross-Sectional Studies↗
PubMed1996

[The organization of the donation of autologous blood and its components in cardiac surgery].

The article analyzes an experience with the organization of autodonation of blood and its components in surgical treatment of 305 patients with congenital and acquired defects and ischemic heart disease. Methods of plasmacytapheresis and cryopreservation used at the terms from 3 days to 12 months before operation allowed storage of the autologous components of blood in 41.2% of the patients having indications for autodonation. In 29.1% of the observations the autotransfusion media were reserved under the outpatient clinic conditions which resulted in shorter terms of treatment at the hospital. The number of unfavorable reactions during the donation in patients did not exceed analogous parameters in regular donors. Autohemotransfusions 3-5 times reduced the volume of transfusions of the allogenic blood components and they were completely avoided in 20.1% of the patients.

Adolescent↗
PubMed2006

End-to-end electronic control of the hospital transfusion process to increase the safety of blood transfusion: strengths and weaknesses.

BACKGROUND: Incorrect blood component transfused is a frequent serious incident associated with transfusion and often involves misidentification of the patient and/or the unit of blood. STUDY DESIGN AND METHODS: This study extended the evaluation of an electronic system involving bar code technology and handheld computers. Electronic control of collection of blood from blood refrigerators was incorporated into a previously described process for blood sample collection and blood administration. Practice was evaluated before and after its introduction in cardiac surgery. RESULTS: The baseline audits revealed poor practice. Significant improvements were found following the introduction of the electronic system, including from 8 percent to 100 percent in checking that the blood group and unit number on the blood pack matched the compatibility label and the pack was in date (p < or = 0.0001). Similar significant improvements were found in blood sample collection, the collection of blood from blood refrigerators, and the documentation of transfusion. Staff found the system easy to operate and preferred it to standard procedures. CONCLUSIONS: A bar code patient identification system improved transfusion practice, although areas for improvement were identified. These results provide support for further work on the development of such systems for both transfusion and other procedures requiring patient identification.

Blood Group Incompatibility↗
PubMed1991

Leukocyte-poor blood components: issues and indications.

Leukocyte-poor blood components (LPBC) have now become part of the armamentarium of available transfusable blood components. Indications for the use of LPBC vary in accordance with the underlying clinical condition, as well as the intended objectives of the transfusion therapy. Technological advances have made it possible to prepare LPBC using rather simple procedures. However, any manipulation of blood components and the additional use of filters, washing, rinsing solutions, etc. inevitably result in additional costs to the patient, the health-care institution, or third-party payers. Requests for LPBC involve the preparation of RBC or platelets, leuko-depleted by at least one log. Transfusion of LPBC must be done in a logical fashion that meets the needs of the patient. Currently, LPBC is indicated for patients with a history of nonhemolytic febrile transfusion reactions to delay alloimmunization to HLA antigens and avoidance of cytomegalovirus (CMV) infection.

Blood Component Removal↗
PubMed2005

The use of a World Health Organization Transfusion Basic Information Sheet to evaluate transfusion practice in Croatia.

BACKGROUND AND OBJECTIVES: To assess the feasibility of using the World Health Organization (WHO) Transfusion Basic Information Sheet as a bedside tool for data collection and assessing transfusion practice. MATERIALS AND METHODS: A prospective 6-month audit of all transfusion episodes using the tool. RESULTS: Eight hundred and twenty-two forms were completed, capturing data on 59.7% of transfusion episodes. Completion of data fields was > 80%, except for the clinician's transfusion targets that were documented in only 58.5% of cases. Twenty per cent of patients received single red cell unit transfusions. CONCLUSIONS: The Basic Information Sheet can be incorporated into bedside clinical practice. We have identified the need to encourage clinicians to determine and document their transfusion targets before prescribing blood components.

Blood Component Transfusion↗