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PubMed1995

Retrograde transmission of Proteus mirabilis during platelet transfusion and the use of arbitrarily primed polymerase chain reaction for bacteria typing in suspected cases of transfusion transmission of infection.

BACKGROUND: When bacteria are found, after a platelet transfusion, in the recipient's blood as well as in the platelet concentrate (PC), a causal relationship is normally suspected, with the PC as the causative agent. The other alternative, that the patient has bacteremia and contaminated the PC, is less well documented in the literature. CASE REPORT: Arbitrarily primed polymerase chain reaction (AP-PCR) was used for testing strains of Proteus mirabilis isolated from a patient's blood before and after a platelet transfusion and from the PC. Because of a febrile reaction after a platelet transfusion, bacterial culture was performed on the PC used, showing growth of P. mirabilis. The same species was found in the patient's blood after the transfusion. Posttransfusion sepsis caused by a contaminated PC was suspected, and anti-sepsis treatment was given to the recipient. Later, it became apparent that the patient had had bacteremia before the transfusion and that P. mirabilis was one of the species in the isolate. With AP-PCR, the identity of the three P. mirabilis isolates could be distinguished. CONCLUSION: AP-PCR is a useful technique for distinguishing the identity of bacterial isolates from patients and blood components. A patient with bacteremia can contaminate a PC in conjunction with a platelet transfusion. With AP-PCR, the PC could be ruled out as the cause of the posttransfusion sepsis.

Base Sequence↗
PubMed2001

Platelet transfusion refractoriness associated with HPA-1a (Pl(A1)) alloantibody without coexistent HLA antibodies successfully treated with antigen-negative platelet transfusions.

BACKGROUND: Alloimmune-mediated refractoriness to platelet transfusion is most commonly due to antibody to HLA antigens in multiply transfused or multiparous patients. Published reports of poor transfusion response due to antibodies to platelet-specific antigens are rare and often confounded by the presence of coexistent antibodies against HLA antigens. CASE REPORT: A case is presented of a multiparous woman with acute myelogenous leukemia whose sole cause of transfusion refractoriness was antibody to platelet antigen HPA-1a. She responded dramatically to HPA-1a-negative platelet transfusion. CONCLUSION: This case provides strong serologic and clinical evidence that platelet transfusion refractoriness may result from antibodies to platelet-specific antigens.

Antigens, Human Platelet↗
PubMed2001

A reduction in type and screen: preoperative prediction of RBC transfusions in surgery procedures with intermediate transfusion risks.

In many patients, a 'type and screen' procedure is routinely performed before surgery. However, most patients are not transfused after all. Can we predict, which surgical patients will and will not be transfused, to reduce the number of these investigations? We studied 1482 consecutive surgical patients with intermediate risk for transfusion. Multivariate logistic regression modelling and the area under the Receiver Operating Characteristic curve (ROC area) were used to quantify how well age, gender, surgical procedure, emergency or elective surgery and anaesthetic technique predicted transfusion, and whether the preoperative haemoglobin concentration had added predictive value. Gender, age > or =70 yr, and type of surgery were independent predictors of transfusion, with a ROC area of 0.75 (95% CI: 0.72-0.79). Validating this model with an easily used prediction rule in a second patient population yielded a ROC area of 0.70 (95% CI: 0.63-0.77). With this rule type and screen could correctly be withheld in 35% of these patients. In the remaining 65% of the patients, a further reduction in type and screen investigations of 15% could be achieved using the preoperative haemoglobin concentration. Using a simple prediction rule, preoperative type and screen investigations in patients who have to undergo surgery procedures with intermediate transfusion risk can be avoided in about 50%. This may reduce patient burden and hospital costs (on average: 3 million US$ per 100 000 procedures).

Adolescent↗
PubMed2002

Can hospital transfusion committees change transfusion practice?

Blood and blood products are commonly over-used in hospital practice. We investigated whether the introduction of a red-cell transfusion trigger (haemoglobin <8 g dL(-1)) influenced transfusion practice in surgery. Coronary artery bypass grafts (CABGs, n=400), total hip replacements (n=107), colectomies (n=85) and transurethral prostatectomies (TURPs, n=158) were reviewed over two periods of six months, before and after the introduction of the policy by the local hospital transfusion committee. After introduction of the policy, the proportion of patients transfused fell from 57% to 45% with CABGs (P=0.02) and from 52% to 26% with hip replacements (P=0.006); for colectomies and TURPs there was no change. Hospital stay did not increase in any of the groups. In the second period, haemoglobin concentration on discharge was lower after total hip replacement, by a mean (95% CI) of 0.7 (0.3-1.2) g dL(-1) (P=0.002) and after colectomy, by a mean of 0.6 (0.1-1.1) g dL(-1) (P=0.03). Although other factors cannot be excluded, we suggest that the reductions in red-cell transfusion were in large part attributable to the new transfusion policy.

Arthroplasty, Replacement, Hip↗
PubMed2004

Transfusion-related acute lung injury resulting from designated blood transfusion between mother and child: a report of two cases.

Transfusion-related acute lung injury (TRALI) is an underdiagnosed serious complication of blood transfusion characterized by the rapid onset of respiratory distress, hypoxia, and noncardiogenic pulmonary edema during or soon after blood transfusion. The presence of anti-HLA and/or antigranulocyte antibodies in the plasma of donors is implicated in the pathogenesis of TRALI. We report 2 cases of TRALI that were caused by designated blood transfusion between mothers and their daughters; one in a 4-month-old girl who received designated packed RBCs donated by her mother and the second in a 78-year-old mother who received blood from her daughter. In both cases, examination of mother's serum revealed panel-reactive cytotoxic HLA antibodies. It is most likely that the mothers were sensitized from earlier pregnancy and produced HLA antibodies against the daughters' paternally derived HLA antigens. Designated blood transfusion between multiparous mothers and children might add an additional transfusion-related risk owing to the higher likelihood of the HLA antibody-antigen specificity between mother and child.

Adult↗
PubMed2000

[Comparative effects of autologous blood transfusion and isovolemic colloids transfusion on hemorrhagic shock: measurement of NO production and tissue oxygen pressure].

Effects of autologous blood transfusion and isovolemic colloids transfusion on hemorrhagic shock model in rats were investigated. The hemorrhagic shock model in rats was prepared by rapid exsanguination and the blood pressure was kept at 40 mmHg for 30 min. As a marker of hemodynamic change, the blood gas analysis was performed, and the tissue oxygen pressure of the liver and the spleen was also measured. Furthermore, we analyzed the changes in NO production in the liver and the spleen of the hemorrhagic shock model. By hemorrhagic shock, Ht, HCO3-, base excess, and PaO2 levels decreased, and liver NO level, but not spleen NO, increased rapidly. However, the liver PtO2 did not show any changes during hemorrhagic shock, although the spleen PtO2 tended to decrease. These changes seen at the hemorrhagic shock were equally restored after the treatment with either autologous blood transfusion or isovolemic colloids transfusion. These results indicate that either autologous blood transfusion or isovolemic colloids transfusion can be useful for the therapy of severe hemorrhagic shock, and the NO production in the liver can participate in the maintenance of homeostasis under hemorrhagic shock.

Animals↗
PubMed1992

[Creation of a planned autologous transfusion unit in a hospital distinct from a transfusion center].

Autologous blood predonation now widely used for programmed surgery has been recently regulated by a law from january 9 1992. It establishes that the procedure must be performed under the responsibility of an accredited blood transfusion center. This work discloses that the establishment of an autotransfusion unit in a hospital endowed with an active surgical program is feasible, the major objective being improvement of the quality of life of elderly patients with invalidating diseases. We report the one year experience of a collaboration between the Braine-l'Alleud-Waterloo hospital and the Red Cross Erasme-Brabant Wallon blood transfusion center. Eighty patients enrolled in programmed surgery consisting mostly in orthopedic surgery have given 187 units of packed red blood cells and fresh frozen plasma. Sixty two patients (83%) were transfused solely with autologous blood. Tolerance was excellent as only 4 slight malaise episodes were observed. Our study also indicates that programmed predonation should be proposed mainly to patients for whom the prescribed blood is effectively transfused. Creation of such autotransfusion units in hospitals distinct from a blood transfusion center is feasible with the deep collaboration between physicians in charge of the patients, the hospital laboratory and the blood transfusion center.

Adult↗
PubMed2005

[Transfusion-related acute lung injury (TRALI): emerging or main transfusion hazard?].

Transfusion-Related Acute Lung Injury or TRALI is one of the most frequent severe transfusion reactions ( one third of Non Hemolytic Febrile Transfusion Reactions). It presents as a generally mild form of acute respiratory distress syndrome occurring 1 to 2 hours after transfusion of a plasma-containing blood component. This transfusion reaction appears, most of the time, in patients with focal inflammation and is of good prognosis when adequately diagnosed and treated. TRALI prevention rests on donor selection for plasma donation, hemovigilance system effectiveness and restrictive transfusion strategy.

Humans↗
PubMed1985

Platelet transfusion therapy in acute leukemia: lack of effect of splenomegaly on transfusion requirements and risk of hemorrhage.

Platelet transfusions are an important supportive measure during treatment for acute nonlymphocytic leukemia (ANLL). The presence of splenomegaly may produce decreased posttransfusion platelet increments leading some to recommend an increased dose of platelets per transfusion in this situation. Forty-nine newly diagnosed patients with ANLL were evaluated during 1980 and 1981, and 24% had palpable splenomegaly. Although treated with usual doses of platelets per transfusion, there was no detectable statistical increase in transfusion requirement or incidence of hemorrhage in patients with splenomegaly. Experimental evidence indicates that the splenic platelet pool enlarges with splenomegaly, but the life span of circulating platelets is not significantly changed. Furthermore, the splenic platelet pool is in dynamic equilibrium with the circulating platelet pool thus allowing these platelets to participate in hemostasis. Although posttransfusion increment in platelet count may be less, it appears that platelet transfusion therapy need not be altered solely because of splenomegaly.

Acute Disease↗
PubMed1987

Enhanced growth of artificial tumor metastases following blood transfusion: the effect of erythrocytes, leukocytes and plasma transfusion.

Clinical and experimental investigations have shown that allogeneic blood transfusions may modulate the growth of tumors. Dependent on the tumor model used in animal studies, the effects observed ranged from inhibition to stimulation of tumor growth. We have demonstrated previously that allogeneic blood transfusions gave rise to enhanced growth of a transplantable sarcoma (LS 175) in BN rats. In the experiments reported here the effect of transfusion of different allogeneic blood constituents on the growth of artificial LS 175 lung metastases was investigated. Erythrocytes and leukocytes were found to promote tumor growth to a similar degree as whole blood transfusions, plasma transfusions had no effect.

Animals↗
PubMed1997

[Analysis of transfusion incident reports filed at 15 blood transfusion centers and health facilities during 17 months. Groupe Receveurs de laSFTS].

The principal result of the development of hemovigilance since 1994 has been the declaration of undesirable effects likely to be due to transfusions of labile blood products. Using the 1,694 cases of undesirable effects registered, it seemed worthwhile to us to analyze the distribution of the signs noticed, their frequency and the types of blood products responsible. This analysis allowed us to observe that the majority of reactions were shivery-feverish (47%) or allergic (24%). Most of them are linked to platelet concentrate transfusions especially simple donor platelets (with a frequency of ten reactions for thousand apheresis platelet concentrates transfused). In this study the frequency of undesirable effects reported is 2 per 1,000 apheresis platelet concentrate transfusions. Further investigations are necessary to determine the physiological mechanisms of these reactions and to estimate the degree to which transfusions are responsible for their occurrence.

Adult↗
PubMed2002

Meta-analysis of randomized controlled trials investigating the risk of postoperative infection in association with white blood cell-containing allogeneic blood transfusion: the effects of the type of transfused red blood cell product and surgical setting.

Previous meta-analyses of the randomized controlled trials (RCTs) investigating the association of perioperative allogeneic blood transfusion (ABT) with postoperative bacterial infection included studies transfusing either autologous or white blood cell (WBC)-reduced allogeneic red blood cells (RBCs) or whole blood to the control arm, and they were unable to investigate the type of RBC product administered as an explanation for the disagreements among the studies. The availability of additional RCTs has permitted investigation of this hypothesis in a meta-analysis restricted to RCTs transfusing WBC-reduced allogeneic RBCs or whole blood to the control arm. In this analysis, across 5 RCTs comparing recipients of non-WBC-reduced versus WBC-reduced allogeneic RBCs, there was no difference (P > .25) in the risk of postoperative infection between recipients of buffy-coat-reduced versus WBC-reduced allogeneic RBCs filtered before storage (summary odds ratio [OR] = 1.19; 95% confidence interval [CI], 0.87-1.63). In contrast, across 3 RCTs, there was an increased (P < .05) risk of postoperative infection in recipients of non-buffy-coat-reduced allogeneic RBCs, or whole blood, as compared with recipients of WBC-reduced allogeneic RBCs, or whole blood, filtered before or after storage (summary OR = 1.77; 95% CI, 1.02-3.09). Moreover, across 3 RCTs that enrolled patients undergoing open-heart surgery, there was an increased (P < .05) risk of postoperative infection in recipients of buffy-coat-reduced (compared with WBC-reduced) allogeneic RBCs (summary OR = 1.39; 95% CI, 1.08-1.80), but the findings of 5 RCTs that enrolled patients having abdominal surgery could not be combined because of extreme variation in the results of the studies. RCTs conducted in the setting of open-heart surgery or transfusing non-buffy-coat-reduced RBCs or whole blood to the treatment arm had administered various RBC products to the control arm, however, and thus the medical heterogeneity of the studies precludes any conclusion about an immunomodulatory (TRIM) effect of ABT mediated by non-buffy-coat-reduced RBC products. To determine whether such a deleterious immunomodulatory effect of ABT exists, additional RCTs transfusing non-buffy-coat-reduced RBCs to the treatment arm should be conducted.

Blood Transfusion↗
PubMed1994

Informed consent for blood transfusion as a transfusion medicine educational intervention.

The aim here was to determine the effectiveness of a transfusion medicine educational intervention in a medicine core clerkship program. Third-year medical students enrolled in their medicine core clerkship rotations at tertiary care hospitals affiliated with our institution underwent a two-part educational intervention that incorporated a transfusion medicine curriculum within the context of the medicolegal, ethical and educational elements of informed consent. Part one was a 1-h didactic session on standards of practice for red blood cell transfusion. Part two was a 90-min multidisciplinary workshop on informed consent. The effectiveness of the educational intervention was analysed by an objective structured clinical evaluation. The student group receiving the educational intervention scored significantly higher than in the comparison group (65.8 +/- 9.2 vs. 54.1 +/- 10.56, P < 0.001). When student scores were used to determine changes in student response patterns over time, the largest change occurred in identifying possible other options to allogeneic blood transfusion. These results suggest that a transfusion medicine curriculum using an informed consent model can be used effectively as an educational intervention in a medicine core clerkship programme.

Blood Transfusion↗
PubMed1996

Leukocyte reduction of red cells when transfusing patients with autoimmune hemolytic anemia: a strategy to decrease the incidence of confounding transfusion reactions.

Autoimmune hemolytic anemia (AIHA) presents a difficult challenge to clinicians and blood bankers alike. Autoantibodies in the serum significantly complicate serologic evaluation, and necessitate performing procedures such as adsorptions to eliminate the possibility of underlying alloantibodies. In many instances the blood that is issued may be phenotypically similar but remains crossmatch incompatible, generating a considerable degree of anxiety among the clinical staff who are responsible for transfusing the patient. We report a case of warm autoimmune hemolytic anemia (WAIHA) in which the transfusion of red cells was complicated by a febrile transfusion reaction. Evaluation of the reaction resulted in a significant delay in transfusion therapy. Subsequent administration of leukocyte-poor red cells resulted in uneventful transfusions with a good therapeutic response. Retrospective analysis of the pretransfusion sample demonstrated significant levels of anti-neutrophil antibodies. This case resulted in the establishment of our policy to administer all red cell transfusions to patients with autoantibodies (warm or cold) as leukocyte- poor red cells.

Journal Article↗
PubMed1998

Erythropoietin to minimize perioperative blood transfusion: a systematic review of randomized trials. The International Study of Peri-operative Transfusion (ISPOT) Investigators.

Our aim was to perform a systematic review to determine the efficacy and side-effects of erythropoietin, given with or without autologous predonation, to patients undergoing orthopaedic or cardiac surgery. A number of studies have been done to determine whether erythropoietin minimizes exposure to perioperative allogeneic red cell transfusion. A systematic review of all randomized trials will provide the best estimate of the efficacy and side-effects of erythropoietin therapy. All randomized trials of erythropoietin in cardiac or orthopaedic surgery that reported the proportion of patients receiving perioperative allogeneic transfusion were included. The efficacy of erythropoietin was evaluated in subgroups of patients depending upon the route of administration, dose of erythropoietin, the type of control and the methodological quality of the study report. The odds ratio for the proportion of patients transfused with allogeneic blood in studies of erythropoietin to augment autologous donation was 0.42 (95% confidence limits 0.28-0.62; P < 0.0001) for orthopaedic surgery and 0.25 (95% CI 0.08-0.82; P = 0.02) for cardiac surgery. The odds ratio for erythropoietin alone was 0.36 (95% CI 0.24-0.56; P = 0.0001) in orthopaedic surgery and 0.25 (95% CI 0.06-1.04; P < 0.06) in cardiac surgery. The route of administration, dose of erythropoietin, type of control and methodological quality of the study report had no statistically significant effect upon the odds ratios. Although there was no convincing evidence that erythropoietin used alone increased the frequency of thrombotic complications, some studies found an excess of events in erythropoietin-treated patients, and the number of patients studied was relatively small. Erythropoietin, when given alone or to augment autologous donation, decreased exposure to perioperative allogeneic transfusion in orthopaedic and cardiac surgery. Further studies are required to definitively establish the safety of erythropoietin alone, to determine the optimal dose of perioperative erythropoietin, and to compare its efficacy and cost-effectiveness with other methods of minimizing perioperative transfusion.

Blood Transfusion↗
PubMed2000

Immunologic changes after transfusion of autologous or allogeneic buffy coat-poor versus WBC-reduced blood transfusions in patients undergoing arthroplasty. II. Activation of T cells, macrophages, and cell-mediated lympholysis.

BACKGROUND: To estimate the impact of RBC preparations on the status of postoperative immune activation, the soluble cytokine receptors of TNFalpha (sTNF-R) and IL-2 (sIL-2R), as well as neopterin and cell-mediated lympholysis (CML), were measured. STUDY DESIGN AND METHODS: Patients undergoing strictly standardized anesthesiologic management for elective orthopedic surgery were enrolled in a prospective study. The perioperative course (Days 0, 3, 7, and 10) of sTNF-R, sIL-2R, neopterin, and CML was compared after random assignment to allogeneic buffy coat-reduced (Group 2, n = 8) or WBC-reduced (Group 3, n = 11) RBC transfusion regimen. Recipients of autologous buffy coat-reduced RBC transfusions (Group 1, n = 15) served as controls. Patients receiving intraoperatively and postoperatively salvaged blood only (n = 10) were separately analyzed as Group 4. RESULTS: In Group 1, a short-lasting increase in soluble cytokine receptors, a diminished cytolytic response (Day 0 vs. Day 7: sTNF-R, p = 0.0001; sIL-2R, p = 0.0004; CML, p = 0. 0238), and an elevation of neopterin (Day 0 vs. Day 3: p = 0.0064) were observed. In contrast, in allogeneically transfused patients, sTNF-R (Group 2, p = 0.0469: Group 3, p = 0.0039), sIL-2R (Group 3, p = 0.002) and neopterin (Group 3, p = 0.0164) increased further from baseline to Day 10 (Day 0 vs. Day 10), and this increase was accompanied by a diminished cytolytic response (Day 0 vs. Day 10: Group 2, p = 0.05; Group 3, p = 0.0076). Patients in Group 4 showed a short-lasting increase in sIL-2R (Day 0 vs. Day 3: p = 0.0078), neopterin (Day 0 vs. Day 3: p = 0.0156) and sTNF-R (Day 0 vs. Day 7: p = 0.0781). CONCLUSION: Allogeneic transfusions seem to prolong the postoperative status of immune activation, even when WBC-filtered RBCs are used for the transfusion regimen.

Arthroplasty↗
PubMed2005

Intravenous immunoglobulin given to lymphoma patients with recurrent haemolytic transfusion reactions after transfusion of compatible blood.

Accelerated destruction of red cells after transfusion of compatible blood has been reported in both sickle cell disease (SCD) and non-SCD patients. We report three patients with lymphoma, all of whom had recurrent haemolytic transfusion reactions after receiving compatible red cell units. The direct antiglobulin test (DAT) was negative and there were no detectable red cell alloantibodies in either pre-transfusion or post-transfusion samples. As there was no evidence of red cell antibody-mediated haemolysis and response to oral steroids, a trial of intravenous immunoglobulin (IVIg) was given. Immediate cessation of haemolysis with sustained haemoglobin level was achieved in all cases. The response to IVIg in these cases suggests that IVIg should be tried when recurrent non-antibody mediated haemolytic transfusion reactions occur in patients with a lymphoid malignancy.

Aged↗