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Peripheral blood flow and systolic blood pressure (strain-gauge plethysmograph), blood volume (Evans blue) and whole blood viscosity (cone-plate viscometer) have been measured in 66 premature and full-term infants 6 to 144h of age. Blood flow and blood volume were moderately decreased in the infants with respiratory distress. Highly significant (P less than 0.001) correlations were found between blood flow and blood volume (r = 0.77), blood pressure and blood volume (r = 0.50), peripheral resistance and blood volume (r = -0.44), blood flow and blood pressure (r = 0.50), blood flow and peripheral resistance (r = -0.67), peripheral resistance and blood viscosity (r = 0.45), and blood viscosity and haematocrit (r = 0.86). There was no correlation between peripheral blood flow and blood viscosity. However, at given blood volume, peripheral blood flow decreased with increasing blood viscosity. These results indicate that in newborn infants peripheral blood flow, blood pressure and peripheral resistance are influenced by blood volume, but also depend on blood viscosity.
The Food and Drug Administration (FDA) is amending the biologics regulations to require that blood establishments (including plasma establishments) prepare and follow written procedures for appropriate action when it is determined that Whole Blood, blood components (including recovered plasma), Source Plasma and Source Leukocytes at increased risk for transmitting human immunodeficiency virus (HIV) infection have been collected. This final rule requires that when a donor who previously donated blood is tested on a later donation in accordance with the regulations and tests repeatedly reactive for antibody to HIV, the blood establishment shall perform more specific testing using a licensed test, if available, and notify consignees who received Whole Blood, blood components, Source Plasma or Source Leukocytes from prior collections so that appropriate action is taken. Blood establishments and consignees are required to quarantine previously collected Whole Blood, blood components, Source Plasma and Source Leukocytes from such donors, and if appropriate, notify transfusion recipients. The Health Care Financing Administration (HCFA) is also issuing a final rule, published elsewhere in this Federal Register, which requires all transfusion services subject to HCFA's conditions of Medicare participation for hospitals to notify transfusion recipients who have received Whole Blood or blood components from a donor whose subsequent donation test results are positive for antibody to HIV (hereinafter referred to as HCFA's final rule). FDA is requiring transfusion services that do not participate in Medicare and are, therefore, not subject to HCFA's final rule, to take steps to notify transfusion recipients. FDA is taking this action to help ensure the continued safety of the blood supply, and to help ensure that information is provided to consignees of Whole Blood, blood components, Source Plasma and Source Leukocytes and to recipients of Whole Blood and blood components from a donor whose subsequent donation tests positive for antibody to HIV.
In a simplified method for measurement of cerebral blood flow using one 123I-IMP SPECT scan and one point arterial blood sampling (Autoradiography method), input function is obtained by calibrating a standard input function by one point arterial blood sampling. A purpose of this study is validation of calibration by one point venous blood sampling as a substitute for one point arterial blood sampling. After intravenous infusion of 123I-IMP, frequent arterial and venous blood sampling were simultaneously performed on 12 patients of CNS disease without any heart and lung disease and 5 normal volunteers. The radioactivity ratio of venous whole blood which obtained from cutaneous cubital vein to arterial whole blood were 0.76 +/- 0.08, 0.80 +/- 0.05, 0.81 +/- 0.06, 0.83 +/- 0.11 at 10, 20, 30, 50 min after 123I-IMP infusion, respectively. The venous blood radioactivities were always 20% lower than those of arterial blood radioactivity during 50 min. However, the ratio which obtained from cutaneous dorsal hand vein to artery were 0.93 +/- 0.02, 0.94 +/- 0.05, 0.98 +/- 0.04, 0.98 +/- 0.03, at 10, 20, 30, 50 min after 123I-IMP infusion, respectively. The venous blood radioactivity was consistent with artery. These indicate that arterio-venous difference of radioactivity in a peripheral cutaneous vein like a dorsal hand vein is minimal due to arteriovenous shunt in palm. Therefore, a substitution by blood sampling from cutaneous dorsal hand vein for artery will be possible. Optimized time for venous blood sampling evaluated by error analysis was 20 min after 123I-IMP infusion, which is 10 min later than that of arterial blood sampling.
We have analyzed the relationship between blood lost and blood transfusions given to 498 consecutive patients undergoing primary elective coronary artery bypass graft operations at 18 institutions. Seventy-nine percent of blood and 59 percent of patients were transfused only on the day of the operation. Patients who received none, 1 or 2 units of blood were not different when analyzed for blood transfusion risk factors except for the percentage of patients who were female. We identified 91 patients who received transfusion inappropriately, using a clinical indicator that analyzed blood losses for each patient. Forty-nine percent of all patients transfused could have avoided exposure to homologous blood if the equivalent of 4 units of the blood in erythrocyte volume had been provided for blood transfusion needs; if blood determined to have been transfused inappropriately had not been given, 95 percent of all patients would have received four or fewer erythrocyte units. We conclude that physician education and quality assurance programs need to be coupled with innovative blood conservation efforts that provide the equivalent of 4 units of homologous blood to minimize blood transfusions in this setting.
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BACKGROUND: There are no reports in the transfusion medicine literature that describe adverse reactions and donor arm injuries after whole-blood donation based on solicited information. STUDY DESIGN AND METHODS: The present study solicited adverse reaction and donor arm injury information from 1000 randomly selected whole-blood donors approximately 3 weeks after the whole-blood donation. Two 16-gauge phlebotomy needles in use were also compared. RESULTS: Thirty-six percent of the donors had one or more adverse effects (AEs). The most common systemic AEs were fatigue (7.8%), vasovagal symptoms (5.3%), and nausea and vomiting (1.1%). The most common arm findings were bruise (22.7%), arm soreness (10.0%), and hematoma (1.7%). Men were half as likely as women to have an AE (23% AE vs. 48% AE, p < 0.0001). Repeat blood donors had fewer AEs than first-time blood donors (36% AE vs. 47% AE, p < 0.007), and African-American donors had numbers of AEs similar to those of Caucasian donors (31% AE vs. 38% AE, p = 0.30). The two phlebotomy needles did not differ in causing blood donor AEs. CONCLUSION: AEs after donation and complaints may be more common than previously thought. The postdonation interview is a good tool for defining the blood donor's experience. It can also be used to evaluate and potentially improve blood donor safety and comfort.
Prevalence of anti C100-3 and HBsAg in donor blood collected at the Hiroshima Red Cross Blood Center during the period of Aug., 1990 to July, 1991 was studied in three groups--total received blood units (187,532 units) without any adjustment, blood units after adjustment by excluding repeat donations of blood units by the same donors (142,160 units), and blood units of first time donors (28,596 units). The results of the study is summarized as follows. 1) There was no significant difference in the prevalence of anti C100-3 between the group comprising the total collected units, and the group after the adjustment. This result suggests that repeat donors do not necessarily belong to any fixed age group. 2) The prevalence of HBsAg is significantly higher in the first time donor group than in the other two groups. In both the total blood units group and the group after the adjustment, prevalence of HBsAg among older age groups was as low as that of younger age groups. This is presumably because of the introduction of selective exclusion of HBsAg positive subjects from donors since 1980. When data from blood donors are used for the epidemiological studies of viral infection among healthy subjects, it is important to know the characteristics of such donor subjects and whether or not they are pre-screened for the viral markers in question.
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A prospective analysis of 300 consecutively collected homologous blood (HB) units from a regional blood center and an analysis of 188 consecutively collected autologous blood (AB) units from a community hospital was conducted. Analysis of the red blood cell (RBC) mass content of these blood units revealed that HB contained 13 percent more RBC than AB: 200 +/- 1.1 vs 177.1 +/- 1.1 mL, (m +/- SE), respectively (p less than 0.05). Of 174 AB units eligible for crossover by AABB criteria for RBC mass (greater than or equal to 154 mL), 35 (20%) were below the 95 percent confidence interval range for RBC mass of HB units collected; mean RBC mass of 300 HB units was 12 percent greater than that of 174 AB units (200.1 +/- 1.1 vs 178.9 +/- 0.9 mL, p less than 0.001) and 20 percent greater than that of the 35 AB units outside the 95 percent confidence interval (200.1 +/- 1.1 vs 161.2 +/- 0.5 mL, p less than 0.001). These findings indicate that an evaluation of the issues of AB crossover for HB transfusion should include a risk/benefit analysis of AB units with lower RBC mass. These findings also indicate that the proposed changes in AABB standards regarding directed donation (DD) should consider the reduced benefits of DD units with lower RBC mass in a risk/benefit analysis of this practice, and support retention of homologous donor standards for directed donors.
Exchange of blood units between transfusion services and blood depots, using EDP systems requires standardisation of unit identification and bar-codes. The ISBT Working Party on Data Processing defined recommendations for blood-unit identification by Codabar. Our group (German Society of Transfusion Medicine and Immunohematology, Section Data Processing and Standardization) extended and adapted these standards to the German blood bank settings. This paper describes the basic definitions and standards. A complete outline will be published in the next future.
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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.
BACKGROUND/AIM: The ultrasonic transit time is currently the best method for measuring the blood flow rate in the extracorporeal hemodialysis circuit. The purpose of this study was to analyze the differences between blood flow as indicated by the hemodialysis blood roller pump (prescribed blood flow) and by an ultrasonic flowmeter (delivered blood flow). METHODS: The ultrasonic blood flow was measured in 20 patients on chronic hemodialysis who were dialyzed through an arteriovenous fistula. During each dialysis session the ultrasonic blood flow was measured at three different blood roller pump flow rates (300, 350, and 400 ml/min). In order to analyze the influence of inflow and outflow pressures on blood flow, this study was conducted during nine consecutive dialysis sessions during which needles of different sizes were used. RESULTS: The ultrasonic flow was always lower than indicated by the blood roller pump: 265+/-12, 304+/-15, and 341+/- 19 ml/min for blood roller pump flow rates of 300, 350, and 400 ml/min, respectively (variability: -11.6, -13.1, and -14.8%, respectively). An univariate regression analysis showed that the reduction in flow recorded ultrasonically correlated with both venous blood line pressure (r = -0.2679, p<0.001) and negative arterial blood line pressure (r = 0. 6773, p<0.001). By multivariate analysis, only the arterial blood line pressure has a predictive value. When all measurements were grouped by arterial blood line pressure ranges, the variability between ultrasonic blood flow and blood roller pump flow was found to be similar in those groups with the same arterial blood line pressure, regardless of the blood roller pump flow rate. CONCLUSIONS: The blood flow indicated by the dialysis blood roller pump is always greater than the delivered blood flow, and this difference is in turn conditioned by the negative pressure induced by the blood roller pump in the arterial blood line.
Differential counts of normal and leukemic cells separated from human peripheral blood were compared using three different separation media a) Verografin, b) Verografin-Ficoll, c) Isopaque-Ficoll (Lymphoprep), density 1.077 g/ml. In the separation the solution of Verografin (SPOFA) or Verografin-Ficoll yields analogous cell counts to Isopaque-Ficoll solution. The separation of leukemic cells is similar on all three separation media with considerable packing of some cells of the myeloid line. The blood cells separated from peripheral blood of normal donors on three various separation media correlate also in T and B lymphocyte counts, as demonstrated by the results of E and EAC rosette tests.