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Biomedical subjects

L Stehling

Publications and source records attributed to L Stehling.

At least 19 recordsLinked to original sources
PubMed1998

Nationwide survey of home transfusion practices.

BACKGROUND: Limited information exists on home transfusion practices. STUDY DESIGN AND METHODS: In 1995, a survey requesting data for 1994 was sent to 1273 American Association of Blood Banks (AABB) institutional members and 113 non-AABB home health care agencies that provide out-of-hospital transfusions. RESULTS: Of 943 respondents, 102 provide blood to a home transfusion program, 37 provide blood and run a home transfusion program, and 13 run a home transfusion program only, for a total of 152 (16%) with some involvement in home blood transfusions. Most of the 50 respondents with a home transfusion program are licensed by their state and accredited by the Joint Commission on Accreditation of Healthcare Organizations. All respondents have written policies for home transfusion, and 90 percent require a signed informed-consent document before initiating transfusions in the home. Most have policies requiring that there be a second adult and a telephone in the home, that the home be deemed safe for transfusion, that the patient's physician be readily available, and that the patient have had prior transfusions. The most common component issued by the blood providers was red cells, followed by platelets. White cell-reduced components were always provided by 36 percent of respondents. The most common patient diagnosis was cancer. Home transfusions were provided primarily by registered nurses. Only 14 percent of respondents indicated that the medical director of the blood bank is responsible for approving a patient for home transfusion. A posttransfusion visit is performed by 46 percent of respondents. CONCLUSION: Although most facilities have policies for the administration of home transfusions, there remains marked heterogeneity among blood providers and transfusionists regarding home transfusion practices.

Adult↗
PubMed1998

Practice parameter for the use of red blood cell transfusions: developed by the Red Blood Cell Administration Practice Guideline Development Task Force of the College of American Pathologists.

A practice parameter has been developed to assist physicians in the therapeutic use of red blood cell transfusions. The developers of this parameter used the best available information from the medical literature, as well as clinical experience and the extensive reality testing required by the College of American Pathologists for approval. In acute anemia, a fall in hemoglobin values below 6 g/dL or a rapid blood volume loss of more than 30% to 40% requires red blood cell transfusions in most patients. However, tissue oxygenation provides a better indication of physiologic need in situations where invasive monitoring provides this information. When these data are not available, heart rate and blood pressure measurements and the nature of bleeding (active, controlled, uncontrolled) supplement the hemoglobin value in guiding the transfusion decision. In sickle cell disease and thalassemias, red blood cells are transfused to prevent acute or chronic complications. Red blood cell transfusions are used in chronic anemias unresponsive to pharmacologic agents based on the patient's symptoms. Guidelines must be altered for neonates who require an increase in hematocrit to above 0.30 to 0.35 when respiratory distress is present. Indications for red blood cell transfusion for the pregnant or postpartum patient are similar to those for the nonpregnant patient. Risks of transfusion, particularly transmissible disease and incompatibility, remain but have been reduced. Thus, red blood cell transfusion continues to be a powerful therapeutic tool when used judiciously and carries less risk than in the recent past.

Adult↗
PubMed1994

Preoperative autologous donation: surgery clinic staff knowledge/attitudes. Preoperative Autologous Blood Donation Study Group.

Preoperative autologous blood donation (PABD) is both under- and overused. Although the decision to order PABD lies with the surgeon, it is quite likely that other surgery clinic personnel influence patient acceptance and enrollment into PABD programs. Accordingly, we measured knowledge, attitudes, and the referral practice of clinic personnel pertaining to PABD. We administered a questionnaire to 102 nurses and 33 clerks working in surgery clinics at three university medical centers--one center in an area with a high incidence of AIDS and two centers in areas of low incidence of AIDS. Knowledge of PABD was poor when assessed by six questions. Only 6% each of nurses and clerks answered all questions correctly; 55% of nurses and 54% clerks missed three or more of the six questions. Surprisingly, no differences (P > .05) in knowledge deficits were noted when personnel from high and low AIDS areas were compared--indicating an overall need for education about PABD. In general, attitudes about PABD were positive, as most respondents (63%) gave favorable answers. Clinic personnel from the high AIDS area had even more favorable attitudes (P = .02). Because of these favorable attitudes, it seems likely that educational programs dealing with PABD would be readily accepted by clinic personnel. Greater knowledge should enhance the effectiveness of clinic staff in identifying, counseling, and referring eligible patients for this service.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Controversies in transfusion medicine. Perioperative hemodilution: pro.

Hemodilution can obviate the need for allogeneic transfusion in some patients. However, it is only one component of a comprehensive blood conservation program and should be combined with other techniques whenever possible. While most often employed in teenagers and healthy young adults, ANH has been used in small children, the elderly, and patients of all ages who are undergoing cardiac surgery. Extreme caution should be exercised if ANH is used in patients with coronary artery disease or aortic stenosis who are undergoing noncardiac surgery, because their normal compensatory mechanisms are impaired. What usually is a safe and relatively simple procedure can become a disaster if employed in inappropriately selected patients. Careful hemodynamic monitoring and maintenance of normovolemia are critical.

Adolescent↗
PubMed1994

Guidelines for blood utilization review.

Hospitals are required by accrediting agencies to perform blood utilization review. Specific areas that must be addressed are the ordering, distribution, handling, dispensing, and administration of blood components. Monitoring the effects of transfusion on patients is also required. The format of the review process and the criteria for appropriate blood utilization must be developed by each institution. This article provides examples of areas that can be reviewed and procedures that may be used. However, the suggested laboratory values must not be interpreted as defining indications or criteria for transfusion. Each transfusion committee, or its equivalent, is responsible for developing its own institutional blood utilization procedures and audit criteria. Review and approval by the medical staff prior to implementation are essential. The procedures must also be reviewed and revised on a regular basis.

Blood Transfusion↗
PubMed1994

The red blood cell transfusion trigger. Physiology and clinical studies.

The need for red blood cell transfusion is determined by the etiology, chronicity, and severity of anemia, the patient's ability to compensate for decreased oxygen carrying capacity, and tissue oxygen requirements. The compensatory mechanisms invoked by acute blood loss differ from the physiologic adaptations to chronic anemia. Factors such as myocardial depression and inadequate ventilation can also decrease oxygen delivery, but their occurrence cannot be reliably predicted, particularly in surgical patients. A margin of safety is therefore necessary to prevent inadequate oxygen delivery and potential morbidity and mortality in anemic patients. Appropriate use of pharmacologic agents can obviate the need for red blood cell administration in some chronically anemic patients. There is no single red blood cell transfusion trigger. The entire clinical picture not just the hemoglobin, must be considered in each patient.

Anemia↗
PubMed1991

Indications for perioperative blood transfusion in 1990.

Rational transfusion practices are determined by clinical evaluation and utilization of appropriate laboratory tests. While the trend toward more conservative transfusion practices is laudable, blood transfusions should not be withheld because of fear of transfusion-transmitted disease. The blood supply is safer than ever before and advances in monitoring and laboratory testing are facilitating scientific approaches to blood administration.

Blood Transfusion↗
PubMed1991

Autologous blood salvage procedures.

Autologous transfusion is not a luxury. Some states have passed legislation mandating that surgical patients be informed of the alternatives to homologous blood administration as well as the risks and benefits of transfusion. Technological advances have made autologous blood salvage in surgery, the postoperative period, and certain trauma situations a safe and relatively inexpensive procedure. While there is minimal data documenting the quality of blood which is administered without processing, extensive clinical experience attests to the safety of the procedure. Ample clinical and laboratory data support the safety of reinfusing processed blood.

Animals↗
PubMed1990

Surgeons' knowledge, attitude, and use of preoperative autologous blood donation.

Before a comprehensive educational program on preoperative autologous blood donation was begun, 118 surgeons from three different areas of the country were tested to assess their baseline knowledge and attitude about this practice. Test results were correlated with the percentage of eligible patients that the surgeons actually referred for preoperative donation during a period of observation. The purpose of this preliminary effort was to identify areas in the educational program that required emphasis. Overall, the surgeons' attitude toward preoperative donation was quite favorable, but their depth of knowledge varied. Misunderstandings may have led to diminished use of this service (eg, about 50% didn't realize that many patients with medical conditions or low hematocrits are permitted to donate). However, it is not clear that simply bolstering surgeons' knowledge will increase their appropriate use of preoperative donation. When all 118 surgeons were studied, their knowledge and attitude were unrelated to the percentage of eligible patients referred. However, when 44 surgeons who managed the largest number of eligible patients were analyzed separately, their use of preoperative donation was directly correlated with their knowledge and attitude. The local awareness of AIDS also significantly influenced the use of this service. It is proposed that knowledge of preoperative donation may be important for inducing surgeons to begin referring patients for this service. Once a pattern of successful participation is established, referral seems to increase with the acquisition of working knowledge.

Blood Transfusion, Autologous↗
PubMed1990

Autologous transfusion.

Autologous transfusion is but one component of the comprehensive blood conservation program. It is often appropriate to employ more than one method of autologous transfusion. In addition, use of pharmacological measures to decrease blood loss, meticulous attention to surgical hemostasis, acceptance of lower hemoglobin levels during the perioperative period, and seeking the advice of transfusion medicine experts in assessing the need for administration of blood components are also important. Finally, the risks of homologous blood transfusion should not overshadow the life-saving benefits of transfusion.

Blood Transfusion, Autologous↗
PubMed1988

Predeposit autologous blood donation.

Predeposit autologous donation for elective surgical procedures during which there is a potential requirement for transfusion is medically proven as safe and efficacious but significantly underutilized. The primary advantages are avoidance of transfusion-transmitted disease and alloimmunization. Appropriate donor selection is essential. In general, there are no age or weight limits for donors. The incidence of adverse reactions is no greater in properly selected autologous donors than in homologous donors. Administration of oral ferrous sulfate allows many patients to meet all of their perioperative transfusion requirements. The blood is usually stored in the liquid state, but can be frozen. The mere availability of autologous blood is not an indication for its reinfusion. The criteria for transfusion are similar to those for homologous blood. However, a more liberal interpretation may be appropriate in some clinical situations. The issue of disposition of predonated blood which is not transfused to donor-patients remains unresolved. In some areas all units are discarded. In others, the blood can be administered to other patients if the donor met all the criteria for homologous donors and the blood tested negative for infectious disease markers.

Blood Donors↗
PubMed1987

Comparison of bleeding times performed on the arm and the leg.

The standardized bleeding time (SBT) is used to assess hemostatic function in patients suspected of having coagulation disorders. Because injury to the arm or the presence of intravascular cannulae often preclude the determination of SBTs on the upper extremity, the authors compared the SBT on the arm with the bleeding time on the leg to ascertain the efficacy of the lower extremity for this test. Thirty healthy volunteers were enrolled in the study. Bleeding times were performed on the forearm and on the medial aspect of the calf. The subjects then ingested 650 mg of aspirin, and the tests were repeated two hours later on the contralateral extremities. The mean preaspirin SBT (5.6 +/- 1.7 minutes did not differ significantly from the mean bleeding time on the leg (5.8 +/- 2.3 minutes) (P greater than 0.50), nor was there a significant difference between the mean postaspirin bleeding time on the arm (10.2 +/- 4.3 minutes) and that on the leg (9.9 +/- 3.7 minutes) (P greater than 0.50). On the basis of this study, the authors conclude that the arm and leg are equally reliable sites for determining bleeding times in normal persons and are equally sensitive for detection of aspirin-induced prolongation of bleeding.

Adult↗