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PubMed1990

[Blood transfusion complications based on data from a provincial blood transfusion station].

It is concluded that the outcome of hemotransfusion complication is influenced by the clinical state of the patients during incompatible transfusion, the amount of the transfused medium as well as the treatment carried out after development of acute renal failure. Constant alertness during transfusion as well as wider use of blood antigen-typed for Rh-Hr system antigens are of major importance for the prophylaxis of blood transfusion complications.

Blood Grouping and Crossmatching↗

PubMed1985

[Current problems of blood transfusion. Responsibility of the physician in transfusion].

The physician's responsibility regarding the indication and induction of blood transfusion, the request for fresh whole blood and the decision for the degree of urgency are outlined. The risk of hemolytic transfusion reaction, one of many transfusion hazards, is calculated on the basis of the results obtained from a 7-year antibody screening program in blood recipients. Measures for the prevention of hemolytic transfusion-reactions are discussed.

Antibody Specificity↗

PubMed1994

[Blood transfusion in surgical gynecology. Strategies for preventing homologous blood transfusion].

A statistical evaluation of homologous blood transfusions is imperative in any gynecological surgical department, to be able to define the transfusion-associated risk of the individual interventions. On the basis of our own statistical data and reports in the literature, strategies for limiting the use of homologous blood are discussed. So far, experience with autologous blood transfusion in surgical gynecology is limited, and clinical studies are needed to better define its role. In special cases, the use of erythropoietin and gonadotropin-releasing hormone (GnRH) analogues extends the possibilities for reducing homologous blood transfusion.

Adult↗

PubMed1996

[Autologous blood transfusion in the Federal Republic of Germany--results of a questionnaire in 1993. 2. The use of autologous transfusion in the old and new federation].

In 1993, we conducted a postal survey to assess the use of autologous blood transfusion (ABT) in the Federal Republic of Germany after reunification. The results of this survey have already been reported in a previous paper, but without differentiation between the "old" and "new" states (former West Germany and former German Democratic Republic, respectively). In the present study, the data of our 1993 survey were further analysed to see if there were differences in the use of ABT between the "old" and "new" states. METHODS. The study is based on data of a 1993 postal survey of German hospitals. Details concerning the performance of the survey have been reported in a previous paper. Briefly, questionnaires were mailed to the anaesthesia departments of 400 randomly selected hospitals in the "old" states and 284 hospitals in the "new" states of the Federal Republic of Germany. The questionnaires contained 36 questions related to general information on the hospital and the use of ABT; 305 completed questionnaires were returned from the "old" states and 197 from the "new" states, response rates of 76% and 69%, respectively. For the present investigation, the responses of the hospitals of the "old" and "new" states were analysed separately. Frequency distributions of categorical variables were analysed by the chi-square test. Because of multiple testing, statistical significance was attained only at the 0.05% level (P < or = 0.0005). RESULTS. There were no significant differences between the "old" and "new" states with respect to hospital size by number of beds, percentage of general and specialised hospitals, and percentage of operations requiring blood transfusion. In both the "old" and "new" states, 9% of the responding hospitals maintained a hospital-based transfusion service, while the other depended on regional blood banks. Preoperative autologous blood donation (PABD) was performed at least "rarely" in 85% and 71% (P = 0.0001), and "mostly" in 20% and 10% (P = 0.0014) of the hospitals in the "old" and "new" states, respectively. Uniformly, the principal uses of PABD were for orthopaedic and cardiac surgery. In 62% and 27% (P < 0.0001) of those hospitals that reported performing PABD, the autologous blood service was run by the anaesthesia department. Preoperative plasmapheresis was performed in 14% and 8% (P = 0.008), and isovolaemic haemodilution in 82% and 56% (P < 0.0001) of the hospitals in the "old" and "new" states, respectively. Automated autotransfusion devices (cell savers) were available in 38% and 19% (P < 0.0001) of the hospitals, respectively. Simple collection devices for perioperative blood salvage were used in 17% and 15% (P = 0.24) of the hospitals in the "old" and "new" states, respectively. CONCLUSION. We conclude that ABT is more widely used in the "old" than the "new" states of the Federal Republic of Germany. ABT is regarded as a desirable alternative to homologous blood transfusion, and in the interest of equal standards of medical care throughout the nation, the use of ABT should be further promoted, especially in the "new" states of the Federal Republic of Germany.

Blood Transfusion, Autologous↗

PubMed2003

Reduction of blood transfusion rates in unilateral total knee arthroplasty by the introduction of a simple blood transfusion protocol.

We prospectively studied blood transfusion practices within a single institution before and after the introduction of a blood transfusion protocol in consecutive patients undergoing unilateral total knee arthroplasty. Data were collected on 393 patients (group I) prior to and 295 patients (group II) after the introduction of the protocol. Following the introduction of the protocol, patients with preoperative haemoglobin of less than 11 g/dl were cross-matched prior to surgery. The criterion for postoperative transfusion was postoperative haemoglobin of less than 8.5 g/dl or a symptomatic patient with haemoglobin of greater than 8.5 g/dl. This change in practice reduced the transfusion rates from 31% in group I to 11.9% in group II. It reduced the non-utilisation of blood from 64 to 1%. There were no adverse outcomes related to the introduction of the protocol.

Aged↗

PubMed2000

[Platelet transfusion and allergic transfusion reactions: experiences at Lille Hospital over a four year period].

Among the immediate transfusion reactions caused by the utilization of blood products, those suggesting immuno-allergic mechanisms posed problems for frequency, gravity, laboratory diagnosis and safety. We report here the Lille Hospital's experience over a four-year period concerning these manifestations after platelet concentrate transfusion. Eight hundred and fifty-two immediate transfusion reactions have been declared, of which 230 were allergic, which appeared in 181 patients (27%). Among the most frequent clinical signs, rash was often described (158 cases: 68.7%); less frequent were respiratory problems such as dyspnea (34 cases: 14.8%) and hypotensive reactions (18 cases: 7.8%). Seven patients presented severe reactions (3%). Twenty percent of them presented multiple allergic reactions and in 43.2%, the recurrence was more serious than the initial problem in spite of preventive medication; the use of washed blood components was necessary. The age of platelet concentrates does not appear to play a part in provoking these events (67% of platelet concentrates had been collected within four days). These allergic transfusion reactions posed problems for those who prescribe medication, because they are frequent, sometimes serious, can recur and at present, the proposed medication prevention is not always efficient.

Adolescent↗

PubMed2005

Transfusion-transmitted infections inmulti-transfused patients in Honduras.

BACKGROUND: Monitoring infectivity markers in multi-transfused patients is an important indicator of the efficiency and quality of testing in blood centers. This study is part of a regional initiative to bring both national and regional attention to the problem of hepatitis C, compare the threat of HCV to that of HBV and HIV; assess the risks for viral infection of using different blood products and implementing different transfusion practices, and contribute to a better understanding of the state of blood safety in the region. STUDY DESIGN AND METHODS: A cross sectional study was conducted from September 2002 to August 2003 and included multi-transfused patients from eight private, public and Social Security hospitals from Tegucigalpa and San Pedro Sula, Honduras. A survey was completed for each patient which included demographic and clinical data. Patients were tested for HBsAg, anti-HBc, anti-HIV and anti-HCV Effects of the exposure to blood products, to whole blood; to lyophilized factor VIII in patients living with hemophilia on the prevalence of HBV, HCV and HIV infection were evaluated. RESULTS: Five hundred and two patients were enrolled in the study; 11% were positive for HBsAg; 27% for anti-HBc; 7% for HCV and 1% for HIV One point six percent of hemophilia patients were positive for HBsAg; 38% were positive for anti-HBc and 26.9% for HCV A dose effect between the exposure to blood products and prevalence of HCV was found (p < 0.05). It was not possible to show a dose effect between the exposure to blood products and prevalence of either HBV or HIV in any of the subpopulations studied. CONCLUSIONS: The transfusion of blood products seems to be the main factor for HCV seropositivity in the subpopulation of patients studied. Additional work is needed to elucidate the risk factors associated with HBV infection in Honduras.

Adult↗

PubMed1988

[Transfusion hepatitis. Occurrence and comparison of risks of blood transfusion and surgery].

The incidence of hepatitis (B and non-A, non-B) was determined in a prospective multicentre study of 1100 hospital patients during 12 months without or after surgery and with or without transfusion. The incidence was 3.6% (4 of 111 patients) after surgery and transfusion, and 0.5% (5 of 989) without transfusion - with or without surgery. The incidence of hepatitis B was significantly higher in the transfused group, while non-A, non-B hepatitis had the same incidence in all three groups. Hepatitis was clinically manifest in only three of the nine patients. The remaining six silent ones were uncovered by a careful prospective follow-up plan. Thus the incidence of hepatitis in this study was higher than has been reported in retrospective series. However, the absolute number of cases is small and the confidence limits thus rather wide: the incidence of non-A, non-B hepatitis must be interpreted with caution.

Adolescent↗

PubMed1981

Delayed serum sickness-like transfusion reactions in a multiply transfused patient.

The clinical features and progress of a patient with a fatal myeloproliferative disease are reported. Her care required frequent transfusions of red cell products and components. These transfusions were followed, after varying intervals, by fever, arthralgia, myalgia, headache and pericarditis. These reactions could be avoided by transfusing plasma-free products, and were ameliorated by systemic steroids. This patient, then, is the first reported case of delayed, serum sickness-like transfusion reactions. During the course of her illness she was demonstrated to have antibodies to immunoglobulins. The role of these antibodies, if any, is uncertain.

Anemia↗

PubMed1997

Does transfusion practice affect mortality in critically ill patients? Transfusion Requirements in Critical Care (TRICC) Investigators and the Canadian Critical Care Trials Group.

In 4,470 critically ill patients, we examined the impact of transfusion practice on mortality rates. As compared with survivors, patients who died in intensive care units (ICU) had lower hemoglobin values (95 +/- 26 versus 104 +/- 23 g/L, p < 0.0001) and were transfused red cells more frequently (42.6% versus 28.0%, p < 0.0001). In patients with cardiac disease, there was a trend toward an increased mortality when hemoglobin values were < 95 g/L (55% versus 42%, p = 0.09) as compared with anemic patients with other diagnoses. Patients with anemia, a high APACHE II score (> 20), and a cardiac diagnosis had a significantly lower mortality rate when given 1 to 3 or 4 to 6 units of allogeneic red cells (55% [no transfusions] versus 35% [1 to 3 units] or 32% [4 to 6 units], respectively, p = 0.01). Adjusted odds ratio (OR) predicting survival were 0.61 (95% CI; 0.37 to 1.00, p = 0.026) after 1 to 3 units and 0.49 (95% CI; 0.23 to 1.03, p = 0.03) after 4 to 6 units compared with nontransfused anemic patients. In the subgroup with cardiac disease, increasing hemoglobin values in anemic patients was associated with improved survival (OR = 0.80 for each 10 g/L increase, p = 0.012). We conclude that anemia increases the risk of death in critically ill patients with cardiac disease. Blood transfusions appear to decrease this risk.

APACHE↗

PubMed2006

Toward rational fresh frozen plasma transfusion: The effect of plasma transfusion on coagulation test results.

Numerous published guidelines encourage appropriate use of fresh frozen plasma (FFP). However, adherence is documented as poor. Therefore, we sought to determine the laboratory effect of FFP administration to patients with an international normalized ratio (INR) less than 1.6 (prothrombin time < 1.6 times normal). We found minimally prolonged INRs decreased with treatment of the underlying disease alone. Adding FFP to the treatment failed to change the decrease in INR over time. In addition, we observed that the change in the INR per unit of FFP transfused can be predicted by the pretransfusion INR (INR change = 0.37 [pretransfusion INR] - 0.47; r2 = 0.82). With an observed analytic variation of 3.2%, a significant amount of change in the INR following FFP transfusion is expected at an INR of more than 1.7. Indeed, only 50% of patients with an INR of 1.7 showed a significant change in INR with FFP transfusion. Therefore, transfusion for patients not meeting current FFP guidelines does not reliably reduce the INR and exposes patients to unnecessary risk.

Blood Banks↗

PubMed1993

Also with a restrictive transfusion policy, screening with second-generation anti-hepatitis C virus enzyme-linked immunosorbent assay would have reduced post-transfusion hepatitis C after open-heart surgery.

The incidence of post-transfusion hepatitis non-A, non-B (PTH-NANB) was prospectively assessed among open-heart surgery patients from the southeast region of Sweden before the introduction of antihepatitis C virus (HCV) blood donor screening. Blood samples for alanine aminotransferase analysis were drawn before and 2, 3, and 4 months after transfusion. Surgery was performed in four centres. Of 190 transfused and followed-up patients 2 (1.1%) contracted PTH-NANB, both operated on at the centre with significantly fewer transfusions than the other centres. One patient had antibodies to HCV detected by first-generation (C100-3) and later by second-generation anti-HCV enzyme-linked immunosorbent assay (ELISA-2) and by positive second-generation recombinant immunoblot assay (4-RIBA). The other patient, although negative by first-generation anti-HCV ELISA, was positive by second-generation ELISA and by 4-RIBA. Both patients were hepatitis C-viremic by polymerase chain reaction (PCR). All the six donors implicated in the two hepatitis cases were first-generation anti-HCV-negative, but two, one for each patient, were positive by second-generation anti-HCV ELISA. This finding was confirmed by positive 4-RIBA in only 1 donor, the other being 'indeterminate'. However, in both donors hepatitis C viremia was found by PCR. This study shows that the second-generation anti-HCV ELISA will further reduce the risk for PTH-NANB/C and draws attention to the problem of evaluation of confirmatory tests.

Adolescent↗

PubMedDate not supplied

Autologous blood transfusion: evaluation of an alternative strategy in reducing exposure to allogeneic blood transfusion.

The perceived risk of transfusion-transmitted disease led to the rejuvenation of autologous blood transfusion (ABT). ABT, a process in which the blood donor and recipient are the same, is increasingly becoming an integral component of the elective surgical protocol in many institutions. Various methods of ABT are being utilized. These include: preoperative blood donation, in which the patient donates blood prior to surgery and the blood is stored for an expected need during or after surgery; acute normovolemic hemodilution, in which blood is collected immediately prior to surgery and replaced with cell free fluids and then returned to the patient upon need; intraoperative blood salvage in which blood is collected from the surgical field and is reinfused after being washed and finally, postoperative blood salvage in which collected shed blood from surgical drains is reinfused to the patient. Although ABT is known to reduce the risk of allogeneic blood transfusion, it is not risk free and should be evaluated in relation to the patient's clinical picture. The combination of various methods of ABT in addition to the proper utilization of blood may consequently lead to the elimination of patients' exposure to allogeneic blood transfusion in many surgical procedures.

Blood Preservation↗

PubMed2006

Recombinant human erythropoietin and blood transfusion in low-birth weight preterm infants under restrictive transfusion guidelines.

OBJECTIVE: To compare the number and volume of red blood cell transfusions (RBCTs) in very low birth weight infants under restrictive red blood cell transfusion guidelines with and without erythropoietin administration. METHODS: In a controlled clinical trial conducted at the neonatal intensive care unit of Alzahra Hospital, Isfahan, Iran, between April 2002 to April 2004, 60 premature infants with gestational age up to 34 weeks, birth weight up to 1500 g, and postnatal age between 8 and 14 days were included. The newborns were randomized into 2 groups: Group 1 received 3 doses of 400 IU/kg erythropoietin per week for 6 weeks, and Group 2 received no treatment aside from their conventional medications. RESULTS: The 2 groups did not differ significantly with respect to their mean gestational age, birth weight and hematocrit at the study entry. Fewer transfusions were administered to those receiving erythropoietin (26.7% versus 50%, p=0.03), but there was no statistically significant difference between groups with respect to volume of transfusion. Compared with the placebo group, the infants receiving erythropoietin had a higher mean hematocrit (34% +/- 4.3 versus 29% +/- 5.9, p<0.001) and absolute reticulocyte count (57 +/- 19 versus 10 +/- 4.8 x 106, p<0.001) at the end of the study. We found no significant difference in the incidence of thrombocytopenia and leukopenia between the 2 groups. CONCLUSION: We conclude that when the restrictive RBCT guidelines were followed, treatment with erythropoietin can be useful in reduction of the number of RBCTs.

Erythrocyte Transfusion↗

PubMed1990

[Compatibility problems in transfusion. Special reference to the delayed hemolytic transfusion reaction].

During 1988, our laboratory (The National Blood Group Reference Laboratory) detected clinically significant alloantibodies (excluding anti-D and anti-C + D) in samples from 72 patients from 24 different hospitals, transfusing about 40,000 units of red cells in this period of time. The simultaneous presence of autoantibodies complicated the serological diagnosis in a number of cases. Two patients had suffered acute haemolytic transfusion reactions due to antibodies not being discovered in the pretransfusion testing (anti-c and anti-Fya). 13 showed serological evidence of delayed haemolytic transfusion reaction not noted in the local hospital. We believe that delayed haemolytic transfusion reaction is seldom recognized. We stress the importance of quality control programmes in blood group serology.

Autoantibodies↗

PubMed1984

Neonatal exchange transfusions complicated by transfusion-induced malaria.

Two neonates who became infected with Plasmodium vivax subsequent to exchange transfusion are described. This complication of neonatal exchange transfusion is unusual in that only two other similar cases have been reported to the Centers for Disease Control. Although malaria is an unusual complication, it should be kept in mind when considering the differential diagnoses of fever following neonatal exchange transfusion. The risk of transfusion-induced malaria may be increasing due to the influx of immigrants from areas endemic for malaria. Careful blood donor selection and blood donor education may minimize this risk.

Diagnosis, Differential↗

PubMed1984

A delayed hemolytic transfusion reaction after partial exchange transfusion for sickle cell disease in pregnancy: a case report and review of the literature.

A delayed hemolytic transfusion reaction that occurred after a prophylactic partial exchange transfusion for sickle-cell disease in pregnancy is described. The clinical presentation and laboratory findings of delayed transfusion reactions are discussed, with special emphasis on problems associated in the sickle-cell disease patient. Suggestions on how to minimize the risk of transfusion reactions in the pregnant sickle-cell disease patient are given.

Adult↗

PubMed1994

Transfusion medicine teaching for harmonisation of blood transfusion practice in Europe.

However intended, European integration is approaching, with more or less binding procedures, for many aspects of our countries' political life. 'Transfusional integration' will require intensive efforts, by all professionals working in blood transfusion all over Europe, to understand that progresses of any kind in one nation's Transfusion Medicine will not be completely effective unless they will be shared by all the rest of European nations. Recognition and harmonisation of teaching criteria and training procedures are essential. The birth and the rapid growth of the European School of Transfusion Medicine (ESTM) is a clear witness of the profound need for increasing harmonisation of the teaching of Transfusion Medicine within Europe.

Blood Transfusion↗