Transfusion-related acute lung injury (TRALI): A Canadian blood services research and development symposium

Since the first description of transfusion-related acute lung injury (TRALI) more than 2 decades ago, we have only recently begun to learn how this disorder may occur and how to prevent it. Scientists from around the world have made great strides in identifying the possible causes of this condition. Blood banks and transfusion services have risen to the challenges of prevention. Recent introduction of restricting most plasma products to those obtained from male donors only has greatly reduced the incidence of TRALI worldwide. Scientists have recently identified the gene and protein for the human neutrophil antigen-3a associated with most mortality due to TRALI, and this presents an opportunity for a screening assay to prevent future TRALI-associated deaths. Finally, animal models of TRALI have provided insight into the possible mechanisms of this disorder and can be used to explore potential treatment modalities.

Blood still kills: six strategies to further reduce allogeneic blood transfusion-related mortality

After reviewing the relative frequency of the causes of allogeneic blood transfusion-related mortality in the United States today, we present 6 possible strategies for further reducing such transfusion-related mortality. These are (1) avoidance of unnecessary transfusions through the use of evidence-based transfusion guidelines, to reduce potentially fatal (infectious as well as noninfectious) transfusion complications; (2) reduction in the risk of transfusion-related acute lung injury in recipients of platelet transfusions through the use of single-donor platelets collected from male donors, or female donors without a history of pregnancy or who have been shown not to have white blood cell (WBC) antibodies; (3) prevention of hemolytic transfusion reactions through the augmentation of patient identification procedures by the addition of information technologies, as well as through the prevention of additional red blood cell alloantibody formation in patients who are likely to need multiple transfusions in the future; (4) avoidance of pooled blood products (such as pooled whole blood-derived platelets) to reduce the risk of transmission of emerging transfusion-transmitted infections (TTIs) and the residual risk from known TTIs (especially transfusion-associated sepsis [TAS]); (5) WBC reduction of cellular blood components administered in cardiac surgery to prevent the poorly understood increased mortality seen in cardiac surgery patients in association with the receipt of non-WBC-reduced (compared with WBC-reduced) transfusion; and (6) pathogen reduction of platelet and plasma components to prevent the transfusion transmission of most emerging, potentially fatal TTIs and the residual risk of known TTIs (especially TAS).

Progress in blood transfusion services in Kenya from the 1980's: a review

BACKGROUND

Provision of safe and adequate supplies of blood is dependent on a well organised blood transfusion service with dedicated well-trained manpower and resources for the service.

OBJECTIVE

To provide an overview of the evolution of blood transfusion services in Kenya, from the 1980s to date.

DATA SOURCES

Various Government of Kenya publications and websites on blood transfusion related issues. Publications and websites of stakeholders including donors and other partners as well.

PERSONAL EXPERIENCE

The author has been in national blood transfusion administration for over five years.

DATA SELECTION

Data related to blood transfusion in Kenya on websites and publication were scrutinised.

DATA EXTRACTION

All selected articles were read.

DATA SYNTHESIS

All the collected data together with the author's experience were used for this publication.

CONCLUSION

As part of the effort by the Ministry of Health to reform the health sector, there was need to reorganise departments and divisions within the Ministry. The reorganisation of the blood transfusion service was one such consideration and it was hoped that following this change, there would be better, safer and more efficient provision of blood for transfusion service snation wide. This article documents the evolution of blood transfusion services from the early 1980s to date.

Approach to Clinical Trial Considering Medical Ethics and Efficacy for HbV, Liposome Encapsulated Hemoglobin Vesicle

Since around 1985, a liposome encapsulated hemoglobin vesicle (HbV) has been developed in Waseda University as an artificial red cell. Subsequently, in 1995, Terumo Co. produced a prototype of HbV for clinical trial, the so-called Neo Red Cell. We tested this in preclinical study and believed firmly that infusion of the HbV could substitute for ordinary blood transfucion. Subsequently, further improvement was done on the HbV by investigators of Waseda and Keio University supported by a grant of Health & Welfare Ministry, Japan, and recent physicochemical properties of the HbV are evaluated, mostly applicable for clinical trial.

[Trends in blood transfusion indications]

Blood components prescription has been greatly modified in the recent years. From 1986 to 2002, the consciousness rising of diseases transmission by blood transfusion led to a reduction of their indications, and for accepted indications, to establish specific thresholds and choice of components in order to reduce donor exposure as much as possible. Since 2003 and more significantly since 2006, we observed a constant increase (3 to 5%/year) of their use. Improvement of blood transfusion safety by many measures taken from collection to delivery including expansion of pathogen reduction technology to cellular blood components, population ageing (as the proportion of transfused people increases exponentially with age) and evidence of under-transfusion risks are the main key factors for such an evolution of practices.

Proceedings of a Consensus Conference: pathogen inactivation-making decisions about new technologies

Significant progress has been made in reducing the risk of pathogen transmission to transfusion recipients. Nonetheless, there remains a continuing risk of transmission of viruses, bacteria, protozoa, and prions to recipients. These include many of the viruses for which specific screening tests exist as well as pathogens for which testing is currently not being done, including various species of bacteria, babesiosis, variant Creutzfeld-Jacob disease, hepatitis A virus, human herpes virus 8, chikungunya virus, Chagas disease, and malaria. Pathogen inactivation (PI) technologies potentially provide an additional way to protect the blood supply from emerging agents and also provide additional protection against both known and as-yet-unidentified agents. However, the impact of PI on product quality and recipient safety remains to be determined. The purpose of this consensus conference was to bring together international experts in an effort to consider the following issues with respect to PI: implementation criteria; licensing requirements; blood service and clinical issues; risk management issues; cost-benefit impact; and research requirements. These proceedings are provided to make available to the transfusion medicine community the considerable amount of important information presented at this consensus conference.

Bloodless cardiac surgery: not just possible, but preferable

Blood transfusions after cardiac surgery are very common, and the rates are highly variable among institutions. Transfusion carries the risk of infectious and noninfectious hazards and is often clinically unnecessary. This article discusses the history of bloodless cardiac surgery, the hazards of transfusion, the benefits of reducing or eliminating transfusion, and strategies to conserve blood. It also provides a list of resources for those who are interested in learning more about bloodless care.

Changing trends in surgical outcomes after major hepatobiliary resection for hilar cholangiocarcinoma: a single-center experience over 25 years

BACKGROUND/PURPOSE

Hepatobiliary resection (HBR) for hilar cholangiocarcinoma (HCCa) remains a technically demanding procedure and is still associated with significant rates of morbidity and mortality. The aim of this study was to characterize changes in surgical outcomes following major HBR for HCCa at a single center over a 25-year period.

METHODS

Between 1980 and 2004, 126 patients undergoing preoperative biliary drainage, portal vein embolization, and major HBR were enrolled in this study. The patients were divided into two groups according to the chronological treatment period; i.e., patients who underwent surgery during the initial 20-year period (1980-1999; early group [EG]) and those who underwent surgery during the most recent 5-year period (2000-2004; late group [LG]). Clinicopathological variables were compared retrospectively between the two groups.

RESULTS

The mortality rate improved from 7.9% in the EG to 0% in the LG, but this difference did not reach the level of statistical significance (P = 0.058). The overall survival rate at 1, 3, and 5 years was 82.4%, 43.9%, and 35.2%, respectively. The overall survival rate was similar in the two groups (P = 0.153). Morbidity was documented in 57.1% of all the patients, and was comparable in the two groups (P = 0.471), but the rate of major morbidity was significantly higher in the EG (P = 0.031). Red blood cell and fresh frozen plasma transfusion requirements were significantly reduced in the LG, both in regard to the number of patients and the amount of blood product administered. The mean length of postoperative hospital stay was significantly reduced, from 74.4 + -56.3 days in the EG to 29.0 + -11.8 days in the LG (P < 0.001). Sixty-nine patients (54.8%) had stage III or IV disease (according to the General rules for surgical and pathological studies on cancer of the biliary tract of the Japanese Society of Biliary Surgery), and 55 patients (43.7%) showed positive surgical margins. There were no differences between the two groups in terms of surgical margins or pathological staging.

CONCLUSIONS

Improvements were documented in rates of major morbidity, length of hospital stay, and the mortality rate in the LG when compared with the EG. The overall survival rate was similar in the two groups. Blood transfusion requirements were significantly reduced in the LG when compared with the EG. However, the high proportion of patients with positive surgical margins remains a significant problem.

[Evaluation of the professional practices of physicians in transfusion technology and medicine]

The evaluation of the professional practices (EPP) is obligatory for all the physicians since July 1, 2005 for a first five-year period. It represents one of the components of the continuous medical training (CMT). The French Society of Blood Transfusion and National Institute of Blood Transfusion are the promoters of the EPP in transfusion technology and medicine. Initially, the programs of EPP will be conceived and controlled by experts and will relate to their basic activities. During a five years cycle, the physician taking part in a program must validate a specific action and take part in a rolling programme. At the end of the programme, the physician will receive a certificate issued by National Institute of Blood Transfusion and will have to submit it to a committee placed under the responsibility of the regional physicians' committee.

Bleeding duodenal ulcer in patients admitted to Erbil city hospital, Iraq: 1996-2004

The frequency of bleeding duodenal ulcer was assessed in patients admitted with upper gastrointestinal bleeding to Erbil City hospital from the Emergency Department during 1996-2004. Of 740 such patients, 556 (75.1%) were diagnosed with bleeding duodenal ulcer: 312 (56.1%) were managed conservatively while 238 (42.8%) underwent surgery. Overall mortality over the 9 years was 4.7%. Over the 3 consecutive 3-year periods, mortality fell from 7.1% in the first 3 years to 2.2% in the final 3 years. Overall mortality among the 238 patients treated surgically was 8.4%. This fell from 13.3% in 1996-98 to 3.1% in 2002-04. Mortality in the conservatively managed patients was 1.9%.

[Future technological evolutions in blood donation qualification]

In the past decades, blood donation screening contributed significantly to blood safety improvement, thanks to the increasing performances of serological and nucleic acid testing (NAT) assays, as well as the evolution of automated systems technology. The rapid pace of NAT development can be clearly seen to extend into the future. NAT for additional viruses as well as the use of new automated systems for individual donation or smaller mini-pool testing, with multiplex assays, is currently debated. However, few added benefit is expected for blood safety from such developments, while cost-effectiveness appears to be poor. The next step in laboratory automation will probably be the implementation of robotic pre- and post-analytical procedures. In this article we review the potential future evolutions of screening technologies in blood qualification platforms, particularly those derived from nanobiotechnologies. DNA microarrays, Lab-On-Chips, biosensors and nanoparticles (quantum dots) will probably play a major role in the coming decade.

[Marketing in the world of blood donation]

Public and non-profit organizations have long debated how marketing concepts and management styles apply to their sector of activity as they are largely derived from principles of consumerism and economic decision-making proper to the private sector. The arrival of marketing in the world of blood donation is no exception. The purpose of this article is to illustrate concretely how marketing techniques can contribute in achieving the objectives of a blood donation program: a marketing model that is adapted to the realities of blood donation in Quebec. Although types of marketing are as varied as the fields they are used in, the major marketing activities of this program fall under positioning, operational or relationship marketing. The process is presented in the form of a cycle that includes four major phases containing all marketing functions, that is, raising public awareness, acquiring a clientele, client retention and loyalty building, and establishing the relationship. Finally, the information and effective management of information are at the heart of the marketing process. In fact, research, understanding our customers and their expectations, and measuring our performance are essential for the success of any marketing initiative.

Trends in morbidity and mortality after hepatic resection for hepatocellular carcinoma: an institute's experience with 625 patients

BACKGROUND

Despite recent developments in surgery and patient management during the perioperative period, critical complications still developed in a few patients who had hepatic resection for hepatocellular carcinoma (HCC).

STUDY DESIGN

Six hundred twenty-five consecutive patients who had hepatic resection for HCC were reviewed and operative morbidity and mortality rates assessed.

RESULTS

There were progressive decreases in the surgical blood loss and the rate of blood transfusion (p = 0.0001). Occurrence of ascites and other complications dramatically decreased in the study series (p = 0.0001). Hospital death rate and incidence of postoperative liver failure also decreased from 2.5%, 1.9% (1985 to 1990), 4.4%, 3.2% (1991 to 1996) to 1.9%, 1.4% (1997 to 2002), respectively. Using multiple logistic regression, independent risk factors associated with postoperative complications were found to be the period of operation (odds ratio [OR] = 0.408; p < 0.0001) and alanine aminotransferase > or = 70 IU/L (OR = 2.020; p = 0.0009) over the entire period of this study (1985 to 2002), or the platelet count of < 100 x 10(3)/mm(3) (OR = 4.654; p = 0.0072) and the presence of blood transfusion during operation (OR = 8.249; p = 0.0230) in 1997 to 2002.

CONCLUSIONS

In this series, there has been a decline in surgical blood loss and rate of blood transfusion and in the number of patients with major complications. These results are largely attributable to the adequate selection of surgical candidate and factors aimed at reducing surgical blood loss.

[Present condition and problems of the blood transfusion system in Yamanashi Prefecture]

In order to investigate the condition and problems of transfusion inspection in Yamanashi Prefecture, a "transfusion operating questionnaire" was carried out. The questionnaire was sent to 30 top hospitals that use many blood components, and we received a reply from 28 hospitals. The blood-transfusion system was unified in 25 hospitals (89.3%). The blood-transfusion therapy commission added 1 hospital with the same function, and it was established in 24 hospitals (85.7%). However, the blood-transfusion therapy commission was only held 6 times or more per year in only 9 hospitals (37.5%). Although doctors responsible for transfusion were appointed in 20 hospitals (71.4%), only 1 hospital appointed full-time doctors. A full-time medical technologist responsible for transfusion was only available in 5 hospitals (17.9%). The activity of the Yamanashi Prefecture joint blood-transfusion therapy commission founded in 2005 is indispensable for the promotion of "safe and proper" blood-transfusion therapy.

Can we safely restrict transfusion in trauma patients?

PURPOSE OF REVIEW

Transfusion of red blood cells in the trauma patient can be lifesaving. The question is how much and when? It is important to weigh the risks and benefits of red blood cell transfusions, as well alternatives to transfusion as these products are not benign.

RECENT FINDINGS

We explore the evidence, and provide the rationale for current and future red blood cell transfusion strategies within a framework of prehospital and hospital care of the trauma patient. We also describe how red blood cell transfusion trends are changing in trauma, discuss alternatives to red blood cell transfusion and present evidence from randomized controlled trials that support a lower transfusion trigger.

SUMMARY

Optimal transfusion practice and use of alternatives in trauma is a rapidly expanding and important area of research. Strong clinical evidence derived by future randomized controlled trials in the area of transfusion triggers as well as transfusion alternatives is required to determine their roles in clinical practice.