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[Providing of polytraumatized persons with blood transfusion, blood derivatives and infusion solutions].

The therapy by blood transfusion, blood plasma and infusion solutions, duration and dosage are individual for each patient and dependent on the previous state of health of a patient, size of injure, degree of bleeding, expressed shock and disturbed general state. For taking care of the polytraumatized persons and especially for taking care of the parenhematozic organs and gastrointestinal bleedings greater quantities of blood are required. We assessed the seriousness of shock and hypovolemia on the basis of the clinical picture, decreased arterial pressure, haemogram, hematocrytes and diuresis. On assessing hypovolemia we used the size of opening and depth of wound, as well as the size of extremity. In treatment of polytraumas there is need for harmonious cooperation of surgeons, orthopedists, transfusiologists, röntgenologists etc. Traumatism is an important and difficult problem of the society and health care; it requires imperatively better organization of the first aid service, medical care on the spot of injury, then, in transport, greater and better organized traumatological and transfuzion service, training and scientific research.

Blood Transfusion

Increased pulmonary arteriovenous shunting in humans following blood transfusion. Relation to screen filtration pressure of transfused blood and prevention by Dacron wool (Swank) filtration.

Transfusion through standard filters to dogs of stored blood containing microaggregates results in an increase in pulmonary arteriovenous shunting (Qs/Qt) and a decreased diffusion capacity of the lung for O2. These effects are due to microemboli that pass the filters and are prevented by use of Dacron wool (Swank) micropore transfusion filters. It was the purpose of this study to determine whether alterations in pulmonary shunting occur in humans following transfusions of stored blood through standard transfusion filters. In eight patients transfused over 20% of blood volumes through standard filters, Qs/Qt and alveolar-arterial O2 tension differences increased significantly. These changes did not occur in patients transfused comparable amounts of blood through Dacron wool (Swank) filters or in patients transfused less than 20% of blood volumes. A direct correlation was found between the absolute percent change in Qs/Qt and the quantity of microaggregates passing the filter and present in the transfused blood. It is concluded that removal from stored blood of microaggregates by administration of the blood through effective micropore transfusion filters prevents an increase in Qs/Qt caused by administration of such material.

Adult

Ascorbic acid levels in stored blood and in patients undergoing surgery after blood transfusion.

Blood was obtained from 11 healthy voluteers, mixed with two standard types of anticoagulant used in blood transfusion centres and stored for 21-28 days at 4 degrees C. Leucocyte ascorbic acid (LAA) fell to deficient levels after 7 days in all cases. There were no corresponding changes in plasma ascorbic acid (PAA) levels. LAA and PAA were measured before, during and after surgery in 5 control patients who underwent definitive operations for benign peptic ulceration and in 4 patients under-going surgery for bleeding peptic ulceration. The average amount of blood administered to the latter group was 10 units. There was a fall in LAA and PAA in both groups of patients after operation. This fall had returned to normal by 7 days in the controls, but the LAA remained at a deficient level at 7 days in the patients who had bled. Deficient ascorbic acid in stored blood may contribute to low leucocyte ascorbic acid levels in patients after blood transfusion and may contribute to the increased complication rate when surgery is undertaken in these patients.

Adult

Toxoplasmosis transmitted by blood transfusions.

Blood from humans collected into heparin or citrate was inoculated with toxoplasma organisms. After storage at 4 C up to 28 days, samples were injected into the ear veins of rabbits. The test rabbits developed toxoplasmosis. Similar results were obtained by transfusing rabbits with blood obtained from rabbits subcutaneously injected with toxoplasma organisms.

Animals

Autologous blood transfusion.

Autologous blood transfusion is a procedure in which blood is removed from a donor and returned to his circulation at some later time. Autologous transfusion can be performed in three ways: (1) preoperative blood collection, storage, and retransfusion during surgery; (2) immediate preoperative phlebotomy with subsequent artificial hemodilution and later return of the phlebotomized blood; and (3) intraoperative blood salvage and retransfusion. All three methods of autologous transfusion offer a potentially superior method of blood transfusion which eliminates many of the problems and complications associated with the banking and administration of homologous donor blood.

Blood Specimen Collection

Autologous blood transfusion.

Autologous blood transfusion is a procedure in which blood is removed from a donor and returned to his circulation at some later time. Autologous transfusion can be performed in three ways: (1) preoperative blood collection, storage, and retransfusion during surgery; (2) immediate preoperative phlebotomy with subsequent artificial hemodilution and later return of the phlebotomized blood; and (3) intraoperative blood salvage and retransfusion. All three methods of autologous transfusion offer a potentially superior method of blood transfusion which eliminates many of the problems and complications associated with the banking and administration of homologous donor blood.

Blood Preservation

HCV and blood transfusion.

Posttransfusion hepatitis remains a threat to transfusion therapy. Testing for increased ALT levels has been used in an attempt to reduce this risk. Presence of the infectious agent, hepatitis C virus (HCV), appears to be a much more sensitive criterion. Stored serum samples from transfusion blood as well as recipients of transfusion were tested by ELISA, RIBA and PCR for the presence of HCV. The results show that RIBA and PCR are about equally sensitive and are able to detect HCV positivity in many sera that might have been otherwise transfused. Routine screening for the presence of virus will dramatically reduce the danger of hepatitis infection to transfusion patients.

Blotting, Western