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Weiskopf RB, Glassberg E, Guinn NR, James MFM, Ness PM, Pusateri AE. The need for an artificial oxygen carrier for disasters and pandemics, including COVID-19. Transfusion 2020; 60:3039-3045. [PMID: 32978804 PMCID: PMC7537157 DOI: 10.1111/trf.16122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 01/29/2023]
Affiliation(s)
| | - Elon Glassberg
- The Israel Defense Force Medical Corps, Ramat Gan, Israel.,Departments of Surgery, Bar-Ilan University Faculty of Medicine, Safed, Israel, and The Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Nicole R Guinn
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael F M James
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Paul M Ness
- Transfusion Medicine Division, Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
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Zumberg M, Gorlin J, Griffiths EA, Schwartz G, Fletcher BS, Walsh K, Dao KH, Vansandt A, Lynn M, Shander A. A case study of 10 patients administered HBOC-201 in high doses over a prolonged period: outcomes during severe anemia when transfusion is not an option. Transfusion 2020; 60:932-939. [PMID: 32358832 DOI: 10.1111/trf.15778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/26/2020] [Accepted: 02/25/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Hemoglobin-Based Oxygen Carriers (HBOCs) can act as an "oxygen bridge" in acute severe anemia when transfusion is indicated, but not possible. We present data on 10 Expanded Access (EA) patients treated with high cumulative doses of Hemopure (HBOC-201), to assess the ability of HBOC-201 to safely treat life threatening anemia in situations where high volumes of product were administered over an extended period of time. STUDY DESIGN AND METHODS Inclusion in this study required that the patient receive at least 10 units of HBOC-201 between 2014 and 2017 under the FDA-sanctioned EA program. Depending on a patient's geographical location, treatment with HBOC-201 was obtained through either a single patient emergency Investigational New Drug (IND) application, or an intermediate size population IND. Of the 41 patients who were treated during this period, 10 patients received 10 or more units of the product. Data were obtained from medical records. RESULTS Treatments with HBOC-201 started within 24 hours of signing consent and were administered at an average rate of 1.99 (SD 0.17) units per day over a mean of 8.2 days (SD 2.9), during which patients received on average 16.2 units (SD 5.7 units) of HBOC-201. The median pre-treatment nadir corpuscular hemoglobin (Hb) concentration was 3.3 (SD 0.9) g/dL and post-treatment Hemoglobin was 7.3 (SD 1.7) g/dL. Common side effects included methemoglobinemia, gastrointestinal symptoms, and hypertension. However, no product-related serious adverse events (SAEs) were noted. All patients survived. CONCLUSIONS Administration of HBOC-201 over an extended period is a feasible and safe oxygen bridge for severely anemic patients who cannot be transfused with RBC.
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Affiliation(s)
- Marc Zumberg
- Division of Hematology/Oncology, University of Florida Shands Cancer Hospital, Gainesville, Florida, USA
| | - Jed Gorlin
- Transfusion Service, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elizabeth A Griffiths
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | | | - Bradley S Fletcher
- Division of Hematology and Oncology, University of Florida Shands Cancer Hospital, Gainesville, Florida, USA
| | - Katherine Walsh
- Division of Hematology, The Ohio State University Comprehensive Cancer Center Columbus, Columbus, Ohio, USA
| | - Kim-Hien Dao
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Amanda Vansandt
- Department of Pathology, Oregon Health & Science University Portland, Portland, Oregon, USA
| | - Mauricio Lynn
- Ryder Trauma Center, Jackson Memorial Hospital, University of Miami Medical School, Miami, Florida, USA
| | - Aryeh Shander
- Department of Anesthesiology, Critical Care Medicine, Pain Management and Hyperbaric Medicine, Team Health Research Institute, Englewood Medical Center, Englewood, New Jersey, USA
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3
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Reassessment of the Need for an Oxygen Carrier for the Treatment of Traumatic Hemorrhage When Blood is not an Option. Shock 2019; 52:55-59. [DOI: 10.1097/shk.0000000000001417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Hemoglobin-based Oxygen Carriers (HBOC)—What the Next Generation Holds: When Red Blood Cells are not an Option. Shock 2019; 52:4-6. [DOI: 10.1097/shk.0000000000001421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Association Between Transfusion of RBCs and Subsequent Development of Delirium in Critically Ill Children. Pediatr Crit Care Med 2018; 19:925-929. [PMID: 30059476 PMCID: PMC6170711 DOI: 10.1097/pcc.0000000000001675] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To determine the temporal relationship between the transfusion of RBCs and the subsequent development of delirium in a cohort of critically ill children. DESIGN Nested retrospective cohort study within prospective cohort study. SETTING Urban academic tertiary care PICU. PATIENTS All consecutive admissions from September 2014 through August 2015. INTERVENTIONS Children were screened twice daily for delirium during their PICU admission. MEASUREMENTS AND MAIN RESULTS Among 1,547 independent admissions screened for delirium, 166 (10.7%) were transfused RBCs. Children who were transfused RBCs were more than twice as likely to be delirious during their admission compared with children who were never transfused, after controlling for known predictors of delirium development (adjusted odds ratio, 2.16; 95% CI, 1.38-3.37; p = 0.001). Among transfused children, a temporal relationship was observed between receipt of RBCs and the subsequent development of delirium. For each additional 10 mL/kg of RBCs transfused, the recipients were 90% more likely to develop delirium or coma in the 72 hours following the transfusion, after controlling for confounders (adjusted odds ratio, 1.90; 95% CI, 1.14-3.17; p = 0.01). Anemia (represented by nadir hemoglobin prior to transfusion) was not associated with delirium development. CONCLUSIONS In this cohort of critically ill children, there is an independent association between the receipt of an RBC transfusion and the subsequent development of delirium. Further prospective studies are warranted to replicate this finding and investigate possible pathophysiologic mechanisms for this association.
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Allonen J, Nieminen MS, Hiippala S, Sinisalo J. Relation of Use of Red Blood Cell Transfusion After Acute Coronary Syndrome to Long-Term Mortality. Am J Cardiol 2018; 121:1496-1504. [PMID: 29631802 DOI: 10.1016/j.amjcard.2018.02.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/17/2018] [Accepted: 02/26/2018] [Indexed: 01/28/2023]
Abstract
Registry studies have associated red blood cell (RBC) transfusion with increased in-hospital mortality in patients with acute coronary syndrome (ACS). The impact on long-term mortality after 1-year follow-up remains unknown. Consecutive patients with ACS (n = 2,009) of a prospective Genetic Predisposition of Coronary Artery Disease cohort were followed for a median of 8.6 years (95% confidence interval [CI] 8.59 to 8.69). After discharge, 1,937 (96%) patients survived for over 30 days. Of those survivors, a subgroup of previously transfusion-naïve patients 85/1,937 (4.4%) who had received at least 1 RBC transfusion during hospitalization were compared with 1,278/1,937 patients (66.0%) who had not received any transfusion either during the hospitalization or the entire follow-up. Unadjusted long-term mortality was significantly higher in the patients transfused with RBC compared with their counterparts not transfused with RBC (58.8% vs 20.3%, p <0.001). The results remained significant for hazard ratio (HR) 1.91, 95% CI 1.39 to 2.63, p <0.001, after multivariate Cox proportional hazards model analysis and were similar after 1-year landmark analysis (HR 1.90, 95% CI 1.34 to 2.70, p <0.001). The higher all-cause mortality was largely explained by cancer mortality (15.3% vs 4.1%, p <0.001) and cardiovascular mortality (34.1% vs 12.1%, p <0.001). After 1:1 propensity score matching (n = 65 vs 65), the association of RBC transfusion with worse survival remained significant (HR 2.70, 95% CI 1.48 to 4.95, p = 0.001). Inverse probability weighted Cox analyses turned out similar results (HR 2.07, 95% CI 1.38 to 3.11, p <0.001). In conclusion, the strong association of need for RBC transfusion with increased mortality continued for patients with ACS even after a 1-year follow-up.
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Guinn NR, Cooter ML, Villalpando C, Weiskopf RB. Severe anemia associated with increased risk of death and myocardial ischemia in patients declining blood transfusion. Transfusion 2018; 58:2290-2296. [DOI: 10.1111/trf.14768] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/05/2018] [Accepted: 04/10/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Nicole R. Guinn
- Department of Anesthesiology; Duke University Medical Center; Durham North Carolina
| | - Mary L. Cooter
- Department of Anesthesiology; Duke University Medical Center; Durham North Carolina
| | - Claudia Villalpando
- Department of Anesthesiology; Garfield Medical Center; Monterey Park California
| | - Richard B. Weiskopf
- Department of Anesthesiology; University of California; San Francisco California
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Soril LJJ, Noseworthy TW, Dowsett LE, Memedovich K, Holitzki HM, Lorenzetti DL, Stelfox HT, Zygun DA, Clement FM. Behaviour modification interventions to optimise red blood cell transfusion practices: a systematic review and meta-analysis. BMJ Open 2018; 8:e019912. [PMID: 29776919 PMCID: PMC5961610 DOI: 10.1136/bmjopen-2017-019912] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To assess the impact of behaviour modification interventions to promote restrictive red blood cell (RBC) transfusion practices. DESIGN Systematic review and meta-analysis. SETTING, PARTICIPANTS, INTERVENTIONS Seven electronic databases were searched to January 2018. Published randomised controlled trials (RCTs) or non-randomised studies examining an intervention to modify healthcare providers' RBC transfusion practice in any healthcare setting were included. PRIMARY AND SECONDARY OUTCOMES The primary outcome was the proportion of patients transfused. Secondary outcomes included the proportion of inappropriate transfusions, RBC units transfused per patient, in-hospital mortality, length of stay (LOS), pretransfusion haemoglobin and healthcare costs. Meta-analysis was conducted using a random-effects model and meta-regression was performed in cases of heterogeneity. Publication bias was assessed by Begg's funnel plot. RESULTS Eighty-four low to moderate quality studies were included: 3 were RCTs and 81 were non-randomised studies. Thirty-one studies evaluated a single intervention, 44 examined a multimodal intervention. The comparator in all studies was standard of care or historical control. In 33 non-randomised studies, use of an intervention was associated with reduced odds of transfusion (OR 0.63 (95% CI 0.56 to 0.71)), odds of inappropriate transfusion (OR 0.46 (95% CI 0.36 to 0.59)), RBC units/patient weighted mean difference (WMD: -0.50 units (95% CI -0.85 to -0.16)), LOS (WMD: -1.14 days (95% CI -2.12 to -0.16)) and pretransfusion haemoglobin (-0.28 g/dL (95% CI -0.48 to -0.08)). There was no difference in odds of mortality (OR 0.90 (95% CI 0.80 to 1.02)). Protocol/algorithm and multimodal interventions were associated with the greatest decreases in the primary outcome. There was high heterogeneity among estimates and evidence for publication bias. CONCLUSIONS The literature examining the impact of interventions on RBC transfusions is extensive, although most studies are non-randomised. Despite this, pooled analysis of 33 studies revealed improvement in the primary outcome. Future work needs to shift from asking, 'does it work?' to 'what works best and at what cost?' PROSPERO REGISTRATION NUMBER CRD42015024757.
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Affiliation(s)
- Lesley J J Soril
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Thomas W Noseworthy
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Laura E Dowsett
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Katherine Memedovich
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Hannah M Holitzki
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Diane L Lorenzetti
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
| | - Henry Thomas Stelfox
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - David A Zygun
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Critical Care Medicine, Alberta Health Services and Faculty of Medicine and Dentistry, University of Alberta, Calgary, Alberta, Canada
| | - Fiona M Clement
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, The University of Calgary, Calgary, Alberta, Canada
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Davis JM, El-Haj N, Shah NN, Schwartz G, Block M, Wall J, Tidswell M, DiNino E. Use of the blood substitute HBOC-201 in critically ill patients during sickle crisis: a three-case series. Transfusion 2017; 58:132-137. [DOI: 10.1111/trf.14386] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Jonathan M. Davis
- Baystate Medical Center, Tufts University School of Medicine; Springfield Massachusetts
| | - Nura El-Haj
- Baystate Medical Center, Tufts University School of Medicine; Springfield Massachusetts
| | - Nimish N. Shah
- Tufts University School of Medicine; Boston Massachusetts
| | - Garry Schwartz
- Levine Cancer Institute, Carolinas Healthcare System; Charlotte North Carolina
| | - Margaret Block
- CHI Health/Creighton University and Methodist Health System; Omaha Nebraska
| | - James Wall
- Levine Cancer Institute, Carolinas Healthcare System; Charlotte North Carolina
| | - Mark Tidswell
- Baystate Medical Center, Tufts University School of Medicine; Springfield Massachusetts
| | - Ernest DiNino
- Baystate Medical Center, Tufts University School of Medicine; Springfield Massachusetts
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10
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Gomez MF, Aljure O, Ciancio G, Lynn M. Hemoglobin-Based Oxygen Carrier Rescues Double-Transplant Patient From Life-Threatening Anemia. Am J Transplant 2017; 17:1941-1944. [PMID: 28188676 DOI: 10.1111/ajt.14226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 01/25/2017] [Accepted: 01/31/2017] [Indexed: 01/25/2023]
Abstract
This case describes a 46-year-old male recipient of a kidney-pancreas transplant who is Jehovah's Witness. Early in the postoperative period, he was found to have splenic vein thrombosis requiring heparin infusion. Two days later, he developed severe symptomatic anemia (hemoglobin <6 g/dL). Standard medical therapy for bloodless surgical patients with severe anemia was instituted. Nevertheless, the patient's hemoglobin concentration continued to decline to critical levels (2 g/dL). Because he was Jehovah's Witness, transfusion of allogeneic blood products was not an option, prompting use of a hemoglobin-based oxygen carrier (HBOC). After approval by the U.S. Food and Drug Administration and the local institutional review board, 12 U of HBOC-201 were transfused over a period of 8 days. Two weeks later, the patient's hemoglobin levels had increased to 6.8 g/dL. The patient's overall clinical condition improved, and he was discharged home. This case describes the first use of HBOC transfusion in a double solid organ transplant patient. HBOC may represent a viable option in patients with severe symptomatic anemia when allogeneic blood transfusion is not an option.
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Affiliation(s)
- M F Gomez
- Ryder Trauma Center, Division of Trauma and Surgical Critical Care, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, FL
| | - O Aljure
- DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Jackson Memorial Hospital, Miami, FL
| | - G Ciancio
- Miami Transplant Institute, Kidney Transplant, Clinical Surgery and Urology, University of Miami Miller School of Medicine, Jackson Health System, Miami, FL
| | - M Lynn
- Division of Trauma and Surgical Critical Care, Bloodless Surgery Center, Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL
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11
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van der Zanden V, Beishuizen SJ, Swart LM, de Rooij SE, van Munster BC. The Effect of Treatment of Anemia with Blood Transfusion on Delirium: A Systematic Review. J Am Geriatr Soc 2017; 65:728-737. [PMID: 28205243 DOI: 10.1111/jgs.14564] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Treating the precipitating factors of delirium is the mainstay of the prevention and treatment of delirium. We aim to investigate the role of anemia and blood transfusion within the multicomponent prevention and treatment strategy of delirium. DESIGN Systematic review. SETTING We included cohort studies or Randomized Controlled Trials (RCTs) that considered blood transfusion as treatment for delirium or risk factor, and had delirium as outcome. PARTICIPANTS Hospitalized patients above 55 years old. MEASUREMENTS We searched MEDLINE from 1946 through November 2014. Quality assessment and data extraction were performed systematically. RESULTS We included 23 studies (n = 29,471). The majority of the studies (n = 22) had a limited quality and for one study quality was uncertain. Two studies evaluated the association between transfusion strategy and postoperative delirium and found no association. Twenty-one studies investigated blood transfusion as a risk factor for delirium. In four of the 21 studies it could be assumed that delirium occurred after transfusion. One of these studies stated that transfusion was a significant risk factor for subsequent delirium (odds ratio (OR) = 3.68, 95% confidence interval (CI) = 1.32-10.94). The other three studies found no association between transfusion and delirium. In the remaining 17 studies, it was not clear whether delirium occurred before or after transfusion, so no conclusion could be drawn on the role of transfusion in delirium development. CONCLUSION The majority of the included studies was not suited to answer the research question properly as the time course of the beginning of delirium as to transfusion was lacking. Our review shows that there is no good quality evidence available for blood transfusion to be a risk factor for delirium or to be a preventive or treatment option.
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Affiliation(s)
- Vera van der Zanden
- Geriatrics Section, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sara J Beishuizen
- Geriatrics Section, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieke M Swart
- Geriatrics Section, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sophia E de Rooij
- Geriatrics Section, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara C van Munster
- Department of Internal Medicine, University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands.,Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands
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Low-dose erythropoietin treatment is not associated with clinical benefits in severely anaemic Jehovah's Witnesses: a plea for a change. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 16:53-62. [PMID: 27893353 DOI: 10.2450/2016.0085-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/19/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND Jehovah's Witnesses who refuse blood transfusion have high mortality. Erythropoietin (EPO) has been used as an alternative to blood transfusion. The optimal dosing of EPO in anaemic Jehovah's Witnesses is unknown. The aim of our study was to evaluate the clinical benefits of treatment with a low dose (<600 IU/kg/week) of epoietin beta (EPO-β). MATERIALS AND METHODS This was an observational study, retrospectively considering a 10-year period during which 3,529 adult Jehovah's Witnesses with a total of 10,786 hospital admissions were identified from databases of four major public hospitals in New Zealand. Patients with severe symptomatic anaemia (haemoglobin <80 g/L) who were unable to tolerate physical activity were included in the study. Patients treated without EPO were assigned to the conventional therapy group and those treated with EPO to the EPO treatment group. RESULTS Ninety-one Jehovah's Witnesses met the eligibility criteria. Propensity score matching yielded a total of 57 patients. Patients treated with conventional therapy and those treated with EPO had similar durations of severe anaemia (average difference 6.25 days, 95% confidence interval [CI]: -3.77-16.27 days; p=0.221). The mortality rate among Jehovah's Witnesses treated with conventional therapy was 4.68 per year (95% CI: 2.23-9.82), while that in those treated with EPO was 2.77 per year (95% CI: 0.89-8.60). Treatment with EPO was associated with a mortality ratio of 0.59 (95% CI: 0.1-2.6; p=0.236). Both groups of patients had similar in-hospital survival (p=0.703). DISCUSSION Treatment with low-dose EPO-β was not associated with either shorter duration of severe anaemia or a reduction in mortality.
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Weiskopf RB, Beliaev AM, Shander A, Guinn NR, Cap AP, Ness PM, Silverman TA. Addressing the unmet need of life-threatening anemia with hemoglobin-based oxygen carriers. Transfusion 2016; 57:207-214. [PMID: 27859328 DOI: 10.1111/trf.13923] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/22/2016] [Accepted: 10/02/2016] [Indexed: 01/02/2023]
Affiliation(s)
| | - Andrei M Beliaev
- Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
| | - Aryeh Shander
- Department of Anesthesiology, Center for Blood Conservation, Duke University Medical Center, Durham, North Carolina
| | - Nicole R Guinn
- Department of Anesthesiology, Critical Care Medicine, Pain Management and Hyperbaric Medicine, Englewood Hospital & Medical Center, Englewood, New Jersey.,Medicine & Surgery, Icahn School of Medicine Mount Sinai, New York, New York
| | - Andrew P Cap
- US Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas
| | - Paul M Ness
- Pathology, Medicine, Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
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15
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Prick BW, Duvekot JJ, van der Moer PE, van Gemund N, van der Salm PCM, Jansen AJG, van Rhenen DJ, Mol BW, Uyl-de Groot CA. Cost-effectiveness of red blood cell transfusion vs. non-intervention in women with acute anaemia after postpartum haemorrhage. Vox Sang 2014; 107:381-8. [DOI: 10.1111/vox.12181] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 06/28/2014] [Accepted: 06/29/2014] [Indexed: 01/28/2023]
Affiliation(s)
- B. W. Prick
- Department of Obstetrics and Gynaecology; Erasmus MC; Rotterdam the Netherlands
- Department of Obstetrics and Gynaecology; Maasstad Hospital; Rotterdam the Netherlands
| | - J. J. Duvekot
- Department of Obstetrics and Gynaecology; Erasmus MC; Rotterdam the Netherlands
| | - P. E. van der Moer
- Department of Obstetrics and Gynaecology; Maasstad Hospital; Rotterdam the Netherlands
| | - N. van Gemund
- Department of Obstetrics and Gynaecology; Sint Franciscus Gasthuis; Rotterdam the Netherlands
| | - P. C. M. van der Salm
- Department of Obstetrics and Gynaecology; Meander Medical Centre; Amersfoort the Netherlands
| | - A. J. G. Jansen
- Department of Internal Medicine; Erasmus Medical Centre; Rotterdam the Netherlands
- Sanquin Blood Supply Foundation; Rotterdam the Netherlands
| | | | - B. W. Mol
- School of Pediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
| | - C. A. Uyl-de Groot
- Institute for Medical Technology Assessment; Erasmus University; Rotterdam the Netherlands
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16
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Abstract
The current “manufacturing paradigm” of transfusion practice has detached transfusion from the clinical environment. As an example, fresh whole blood in large-volume hemorrhage may be superior to whole blood reconstituted from multiple components. Multicomponent apheresis can overcome logistical difficulties in matching patient needs with fresh component availability and can deliver the benefits of fresh whole blood. Because of the different transfusion needs of patients in emerging economies and the vulnerability of these blood systems to emerging infections, fresh whole blood and multicomponent apheresis can better meet patient needs when compared with transplants of the “manufacturing paradigm”. We propose that patient blood management, along with panels of repeat, paid, accredited apheresis and fresh whole-blood donors can be used in emerging economies to support decentralized blood services. This alternative transfusion–medicine paradigm could eventually also be adopted by established economies to focus transfusion medicine on local patient needs and to alleviate the problem of the aging volunteer donor base.
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Affiliation(s)
- Albert Farrugia
- College of Medicine, Biology and Environment, Australian National University, Acton, ACT, Australia ; Centre for Orthopaedic Research, Department of Surgery, Faculty of Medicine and Surgery, University of Western Australia, Perth, WA, Australia
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Chinbuah MA, Adjuik M, Cobelens F, Koram KA, Abbey M, Gyapong M, Kager PA, Gyapong JO. Impact of treating young children with antimalarials with or without antibiotics on morbidity: a cluster-randomized controlled trial in Ghana. Int Health 2013; 5:228-35. [DOI: 10.1093/inthealth/iht021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Kacker S, Frick KD, Tobian AA. Establishing a framework: economic evaluations in transfusion medicine, Part 2. Transfusion 2013; 53:1634-6. [DOI: 10.1111/trf.12187] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 02/20/2013] [Indexed: 11/28/2022]
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High-risk anaemic Jehovah's Witness patients should be managed in the intensive care unit. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 11:330-2. [PMID: 23522897 DOI: 10.2450/2013.0043-13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Beliaev AM, Marshall RJ, Smith W, Windsor JA. Treatment monitoring and mortality risk adjustment in anaemic Jehovah's Witnesses. ANZ J Surg 2012; 83:161-4. [DOI: 10.1111/j.1445-2197.2012.06228.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Andrei M. Beliaev
- Department of General Surgery; Auckland City Hospital; Auckland; New Zealand
| | - Roger J. Marshall
- Department of Epidemiology and Statistics; University of Auckland; Auckland; New Zealand
| | - Warren Smith
- Department of Cardiology; Auckland City Hospital; Auckland; New Zealand
| | - John A. Windsor
- Department of Surgery; University of Auckland; Auckland; New Zealand
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Park JJ, Lang CC, Manson L, Brackenbury ET. Aortic valve replacement in a Jehovah's Witness: a case of multi-disciplinary clinical management for bloodless surgery. BMJ Case Rep 2012; 2012:bcr.12.2011.5403. [PMID: 22665474 DOI: 10.1136/bcr.12.2011.5403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 81-year-old female Jehovah's Witness (JW) patient with severe aortic stenosis required aortic valve replacement (AVR). However, the patient's religious beliefs precluded the use of primary blood components. Since the definitive treatment of AVR required bloodless open heart surgery, careful peri-operative plans were set forth by a multi-disciplinary team involving the cardiothoracic surgeon, haematologist and anaesthetist. The patient went on to successfully recover postoperatively. This case highlights: 1) The importance of carefully navigating through the most recent clinical and ethical protocol involved in the surgical management of JW's. 2) The importance of preparing individually tailored pre, intra and postoperative plans that are delivered through a multi-disciplinary clinical team to ensure the best and safest possible outcomes.
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Affiliation(s)
- John Jungpa Park
- University of Edinburgh Medical School, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK.
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