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PubMed1997

[Blood components: indication and notice of transfusion].

The total number of blood donors in 1996 was 6 millions, and the number of 200 ml whole blood donors was 2.16 million(35.7%), whereas the numbers of 400 ml and apheresis donors were 2.66 million(44.1%), and 1.22 million(20.2%) respectively. From the donated blood, about 18.78 million units(1u: equivalent to 200 ml WB derived) of blood components were prepared and used for blood transfusion. Currently, whole blood is separated and prepared into MAP red cell concentrates and FFP, and all platelet concentrates are prepared from apheresis donations. In 1996, MAP red cell concentrates occupied 30.5% of all blood supply for transfusion, whereas FFP occupied 27.7% and PC occupied 40.2%.

Blood Component Removal↗
PubMed2005

Circulation and distribution of 111-In-oxine-labeled autologous baboon platelet aggregates and buffy coat.

BACKGROUND: Although it is known that RBC concentrates may contain buffy coat and platelet concentrates may contain platelet aggregates, the circulation and distribution of these materials in the blood products have never been reported. STUDY DESIGN AND METHODS: Baboon platelets were labeled with 111-In-oxine, aggregated with ADP and autotransfused without a filter. Baboon buffy coat was stored at 4 degrees C, labeled with 111-In-oxine and autotransfused without a filter. The circulation of the radiolabeled platelets and buffy coat was measured and the distribution of the buffy coat and platelet aggregates was measured by external scanning of the baboon using a gamma camera. The effects of the infusion of aggregated platelets, buffy coat, and gelatin on the plasma fibronectin level also were evaluated. RESULTS: The 111-In-oxine labeled platelet aggregates were initially sequestered in the lungs and released into the peripheral blood during the next 3h, during which time the cell associated radioactivity increased by about 25%. Following the autotransfusion of 111-In-oxine labeled buffy coat, the 111-In-oxine radioactivity over the lungs increased, but decreased during the 60-min post-transfusion period as the radioactivity over the liver increased. Cell-associated radioactivity increased by about 10% over the 3-h post-transfusion period. Fibronectin levels decreased by 3% following the autotransfusion of platelet aggregates, by 10% after the autotransfusion of buffy coat and by 50% after the infusion of gelatin. CONCLUSIONS: 111-In-oxine radioactivity in the platelet aggregates and buffy coat was initially sequestered in the lungs, and 10-25% of the 111-In-oxine cell-associated radioactivity was released into the circulation during the 24-h post-transfusion period.

Animals↗
PubMed2001

Granulocyte transfusion: a review.

Neutrophils are the body's main defence against invasion by bacteria and fungi and, below a level of 1 x 10(9)/l, there is a direct relationship between their circulating number and the risk of systemic infection. Despite advances in supportive care, such as improved broad-spectrum antibiotics and the haemopoietic growth factors, neutropenia following myelosuppressive chemotherapy for malignant disease remains the most important cause of treatment-related morbidity and mortality and its most important dose-limiting toxicity. Although there is clear theoretical, experimental and anecdotal clinical evidence supporting the use of transfused granulocytes to prevent and treat infection in neutropenia, early attempts at exploiting this clinically were unsuccessful, mainly because of difficulties in collecting a sufficient number of cells. Improvements in the technology of collection, including the use of red cell sedimenting agents, glucocorticoids and, more recently, granulocyte-colony-stimulating factor, now allow granulocyte doses within the therapeutic range to be routinely collected. Preliminary evidence suggests clinical efficacy. However, well-designed trials with clinically relevant end-points will be required before granulocyte transfusion can become part of routine clinical practice.

Blood Component Transfusion↗
PubMed1992

Erythrocyte apheresis as a method for autologous blood transfusion--a case study in a patient with Vel-antibodies.

A 60-year old man was suffering from angina and a percutaneous transluminal coronary angioplasty (PTCA) had to be done. In the preoperative screening procedure antibodies anti-Vel were identified. The patients blood group is 0, rr. The prevalence of the blood group 0, rr, Vel(-) is 1:60,000. Compatible blood groups were not found in the patients family. The only alternative method to give this patient his necessary units of blood was an autologous transfusion procedure, however, because of the patients clinical condition it was necessary to use an erythrocyte apheresis procedure without changing his blood volume. We performed erythrocyte apheresis, using the Fenwal CS-3000. 920 ml blood was collected, Ht 0.67 l/l, enough for three units packed cells compared with random donor blood. The erythrocyte apheresis procedure was performed without any problem. The PTCA was done without complications and transfusions. The units of blood are stored in liquid nitrogen in the central laboratory of blood transfusion, Amsterdam.

Angioplasty, Balloon, Coronary↗
PubMed1983

Do preoperative laboratory tests predict blood transfusion needs in cardiac operations?

We retrospectively compared preoperative prothrombin (PT), partial thromboplastin (PTT), dilute whole blood clot lysis and bleeding times, fibrinogen level, and platelet count with subsequent blood component administration in 92 patients who had undergone cardiac operations with cardiopulmonary bypass (CPB). Abnormal results for one or more tests were found in 34% of 71 adults and 81% of 21 children and teenagers. The patients with abnormal test(s) received no more whole blood and packed red cell units, platelets, or plasma than those with normal tests in either age group. No individual or multiple test abnormalities predicted excess blood component transfusion, even when low-grade abnormalities were excluded. The high rate of abnormal tests in patients less than 20 years of age was not due to polycythemia and may indicate a need for age-specific reference ranges. Baseline PT, PTT, and platelet count may aid in the evaluation of the potential for subsequent development of coagulopathy, but we conclude that further preoperative testing may be reserved for infants, polycythemic individuals, or others in whom history or drug use suggests potential bleeding problems.

Adolescent↗
PubMed1998

Inactivation of viruses, bacteria, protozoa, and leukocytes in platelet concentrates.

Despite the increased safety of blood achieved through continued improvements in donor testing, concern remains about the safety of blood components. Transfusion of cellular components has been implicated in transmission of viral, bacterial, and protozoan diseases. While it is commonly recognized that hepatitis B virus (HBV), hepatitis C virus (HCV), cytomegalovirus (CMV), and the retroviruses, such as human immunodeficiency virus (HIV) and the human lymphotrophic viruses (HTLV) can be transmitted through cellular components, other pathogens are emerging as potentially significant transfusion-associated infectious agents. For example, transmission of protozoan infections due to trypanosomes and babesia have been reported. In addition to viral and protozoal infectious agents, bacterial contamination of platelet concentrates continues to be reported; and may be an under reported transfusion complication. More importantly, new infectious agents may periodically enter the donor population before they can be definitively identified and tested for to maintain consistent safety of the blood supply. The paradigm for this possibility is the HIV pandemic which erupted in 1979. During the past decade a number of methods to inactivate infectious pathogens in blood components, including platelets, have been developed. This technology is now entering the clinical trial phase.

Animals↗
PubMed2005

Risk management in transfusion after the HIV blood contamination crisis in France: the impact of the precautionary principle.

The importance of the precautionary principle in public health was highlighted in France after the HIV contamination of blood products used for transfusion. However, the definition of this principle, its objectives, the way in which it should be applied, and its consequences had not been considered previously. The question as to whether the application of the precautionary principle is appropriate remains unanswered. The aim of this study was to analyze the interpretations of the application of the precautionary principle to determine its consequences in terms of risk management and patient rights. This was accomplished by interviewing persons involved in transfusion medicine. We conducted 33 interviews and describe the issues enunciated for and against the application of the precautionary principle. The precautionary principle concept was confusing to the respondents. A major issue emerging from the interviews was that the precautionary principle was perceived more as a means of protecting the decision maker than as a means of protecting the patient. Taken to its extreme, the use of the precautionary principle could prejudice sound medical decision making. However, it was felt that it also can lead to the introduction of measures that update and gradually reduce risks associated with transfusion.

Blood Component Transfusion↗
PubMed1992

Lipid peroxidation in stored red cells.

Lipid peroxidation is initiated by the production of oxygen-free radicals; it is increased in a wide variety of diseases, including various hemolytic anemias, and in hemoglobin disorders. Increased lipid peroxidation occurs in red cells in the presence of reactive iron species and some heme moieties. In this study, greatly reduced concentrations of malondialdehyde, an indicator of lipid peroxidation, were observed in stored blood upon the addition of both deferoxamine mesylate and diethylenetriaminepentaacetic acid (p less than 0.001). The antioxidant glutathione was much less effective (p less than 0.01 or less than 0.05, depending on incubation time). On the other hand, the addition of dimercaptosuccinic acid and ascorbic acid both significantly increased malondialdehyde production over controls (p less than 0.001 and p less than 0.05, respectively). Ascorbic acid, in the presence of deferoxamine mesylate, added no red cell protection over that of deferoxamine mesylate alone. The addition of metal chelators and, possibly, certain antioxidants to stored blood may be effective in increasing the viability and longevity of transfused red cells.

Blood Component Transfusion↗
PubMed2005

Combination of acute preoperative plateletpheresis, cell salvage, and aprotinin minimizes blood loss and requirement during cardiac surgery.

Acute preoperative plateletpheresis (APP), cell salvage (CS) technique, and the use of aprotinin have been individually reported to be effective in reducing blood loss and blood component transfusion while improving hematological profiles in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). In this prospective randomized clinical study, the efficacy of these combined approaches on reducing blood loss and transfusion requirements was evaluated. Seventy patients undergoing primary coronary artery bypass grafting (CABG) were randomly divided into four groups: a control group (group I, n = 10) did not receive any of the previously mentioned approaches. An APP and CS group (group II, n = 20) experienced APP in which preoperative platelet-rich plasma was collected and reinfused after reversal of heparin, along with the cell salvage technique throughout surgery. The third group (group III, n = 22) received aprotinin in which 5,000,000 KIU Trasylol was applied during surgery, and a combination group (group IV, n = 18) was treated with all three approaches, i.e., APP, CS, and aprotinin. Compared with group I (896+/-278 mL), the postoperative total blood loss was significantly reduced in groups II, III, and IV (468+/-136, 388+/-122, 202+/-81 mL, respectively, p < 0.05). The requirements of packed red blood cells in the three approached groups (153+/-63, 105+/-178, 0+/-0 mL, respectively) also were reduced when compared with group I (343+/-118 mL, p < 0.05). In group I, six patients (6/10) received fresh-frozen plasma and three patients (3/10) received platelet transfusion, whereas no patients in the other three groups required fresh-frozen plasma and platelet. In conclusion, both plateletpheresis concomitant with cell salvage and aprotinin contribute to the improvement of postoperative hemostasis, and the combination of these two approaches could minimize postoperative blood loss and requirement.

Acute Disease↗
PubMed1992

Epidemiology of AIDS in females with hemophilia and other chronic bleeding disorders in the United States: comparisons with males with chronic bleeding disorders and AIDS and with nonhemophilic female blood-transfusion recipients with AIDS.

From January 1, 1981 through June 30, 1990, 32 females with chronic bleeding disorders were diagnosed with acquired immunodeficiency syndrome (AIDS) in the United States. Most (81.3%) were white and greater than or equal to 30 years of age, with a median age of 37.5 years. Eighteen (56.3%) had von Willebrand's disease. Pneumocystis carinii pneumonia was reported for 16 (50%). None had Kaposi sarcoma. The median survival time was 10.8 months, with a cumulative probability of survival at 1 year of 47.3% and at 2 years of 27.6%. We compared the demographic data and survival times of these females with those of males with a chronic bleeding disorder and AIDS, and with those of nonhemophilic females with AIDS whose exposure to the human immunodeficiency virus (HIV) was through receipt of blood transfusions, blood components, or tissue. The principal demographic difference was age distribution. The females with chronic bleeding disorders tended to be younger than the transfused, nonhemophilic females, but older than the males. The survival time from AIDS diagnosis to death for the females with chronic bleeding disorders did not differ statistically from that of the other two groups, although older nonhemophilic females whose exposure was transfusion may progress more rapidly to AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Transfusion support in acute leukemias.

Patients with acute myeloid leukemia and acute lymphocytic leukemia receive significant numbers of blood products for hematologic support during periods of disease and treatment related cytopenias. These patients may be at increased risk for complications associated with transfusion. This article reviews the indications for platelet and red blood cell transfusion, as well as the incidence and strategies for prevention of the immunohematologic and infectious sequelae arising in the setting of multiple blood component transfusions.

Acute Disease↗
PubMed2004

Anemia in the critically ill.

The anemia of critical illness is a distinct clinical entity with characteristics similar to that of chronic disease anemia. Several solutions to the processes of anemia, such as blunted erythropoietin production and erythropoietin response and abnormalities in iron metabolism have been developed. The transfusion of RBCs provides immediate correction of low hemoglobin levels, which may be of value in patients with life-threatening anemia. Avoidance of RBC and blood component transfusion, however, is becoming increasingly important as data of adverse clinical outcomes in critically ill patients become clearer. Although the optimal hemoglobin in critically ill patients is not determined, this organ system has a generous reserve. Short-term compensated anemia is tolerated well, while exogenous erythropoietin allows patients to achieve higher hemoglobin concentrations without exposure to transfused blood/blood components. A recent randomized trial enrolled over 1300 critically ill patients to receive either 40,000 units of exogenous erythropoietin or placebo. These authors found that patients randomized to erythropoietin received significantly less allogeneic RBC transfusions and had significantly greater increases in hemoglobin. Although no differences were found between groups in gross clinical outcomes (ie, death, renal failure, myocardial infarction), this study did not have the power to identify small differences in outcomes. This and other studies of exogenous erythropoietin therapy in critically ill patients clearly demonstrate that the bone marrow in many of these patients will respond to the administration of erythropoietin despite their illness, suggesting a blunted production of erythropoietin rather than a blunted response to erythropoietin. Exogenous erythropoietin therefore represents a therapeutic option for treating anemia in critical illness. Acute events in medicine and surgery often lead to many patients becoming anemic. Solutions to this process of anemia should be focused on preventing such events. Anemia after surgery represents an area for prevention. Blood conservation strategies can be performed with adequate results. Monk et al randomized 79 patients undergoing radical prostatectomy to preoperative autologous donation (PAD), preoperative exogenous erythropoietin therapy plus ANH immediately following induction of general anesthesia, and ANH alone. This study concluded that all three techniques resulted in similar hemostasis outcomes (eg, bleeding and transfusion rates), but ANH alone was the least expensive, and ANH plus exogenous erythropoietin and ANH alone resulted in a higher ICU hematocrit compared with PAD. Regardless of these prophylactic strategies, patients still become anemic after surgery or during critical illness. This acute event anemia usually is treated with RBC transfusion; however, autologous blood recovery (cell salvage systems) has been shown to be effective in patients with acute bleeding-related anemia, and this may reduce patients' exposure to allogeneic blood in these patients. There are no universally accepted treatment guidelines for managing anemia, and practice differs between clinicians, hospitals, regions, and countries. Transfusion medicine is evolving and incorporating many new pharmacological agents into the armamentarium of anemia and bleeding therapy. Accumulating evidence suggests that anemia in critically ill patients is common and correlated with poor outcomes. The management of anemia can improve outcomes; however, the optimal management of anemia is not performed universally. New approaches, continued research, and an understanding of anemia may result in more consistent and improved outcomes for critically ill patients.

Anemia↗
PubMed1992

[Reduction of leukocytes and loss of erythrocytes in production of erythrocyte concentrates using the "top and bottom" principle, a comparison between the equipment combinations Biopack-U/Biotrans Separator and Optipac/Optipress].

Using four different centrifugation methods, we compared the combinations of top and bottom bags and blood component separators made by Biotrans and Baxter. Compared with the cell counts of the donated blood, there remained 25% of the leukocytes and 88% of the red blood cells in the red cell preparations following application of the Biotrans system; the respective values for the Baxter system were 20% leukocytes and 85% red cells. The results were not influenced by the centrifugation method used. Thus, febrile nonhemolytic transfusion reactions and immunization against leukocyte antigens can be avoided by neither system.

Blood Component Removal↗