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Pagano MB, Stanworth SJ, Valentine S, Metcalf R, Wood EM, Pavenski K, Cholette J, So-Osman C, Carson JL. The 2023 AABB international guidelines for red blood cell transfusions: What is new? Transfusion 2024; 64:727-732. [PMID: 38380850 DOI: 10.1111/trf.17764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Affiliation(s)
- Monica B Pagano
- Transfusion Medicine, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- AABB Clinical Transfusion Practice Committee, Bethesda, Maryland, USA
| | - Simon J Stanworth
- Department of Haematology, Oxford University Hospitals NHS Trust; NHSBT, Oxford, UK
- Radcliffe Department of Medicine, Department of Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
| | - Stacey Valentine
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ryan Metcalf
- AABB Clinical Transfusion Practice Committee, Bethesda, Maryland, USA
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Erica M Wood
- Department of Haematology, Monash Health, Melbourne, Victoria, Australia
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- International Society of Blood Transfusion, Amsterdam, Netherlands
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology, University of Toronto and St Michael's Hospital-Unity Health Toronto, Toronto, Ontario, Canada
- International Collaboration for Transfusion Medicine Guidelines, British Columbia, Canada
| | - Jill Cholette
- Department of Pediatrics, University of Rochester, Golisano Children's Hospital, Rochester, New York, USA
| | - Cynthia So-Osman
- Department of Unit Transfusion Medicine (UTG), Sanquin Blood Bank, Amsterdam, the Netherlands
- Department Hematology, Erasmus Medical Center, Rotterdam, the Netherlands
- European Haematology Association, Transfusion-Specialized Working Group
| | - Jeffrey L Carson
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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The Association of Preoperative Hematocrit and Transfusion with Mortality in Patients Undergoing Elective Non-cardiac Surgery. World J Surg 2017; 42:1939-1948. [DOI: 10.1007/s00268-017-4359-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Manzini PM, Dall'Omo AM, D'Antico S, Valfrè A, Pendry K, Wikman A, Fischer D, Borg-Aquilina D, Laspina S, van Pampus ECM, van Kraaij M, Bruun MT, Georgsen J, Grant-Casey J, Babra PS, Murphy MF, Folléa G, Aranko K. Patient blood management knowledge and practice among clinicians from seven European university hospitals: a multicentre survey. Vox Sang 2017; 113:60-71. [DOI: 10.1111/vox.12599] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 01/28/2023]
Affiliation(s)
- P. M. Manzini
- Banca del Sangue e del Plasma; Città della Salute e della Scienza di Torino; Torino Italy
| | - A. M. Dall'Omo
- Banca del Sangue e del Plasma; Città della Salute e della Scienza di Torino; Torino Italy
| | - S. D'Antico
- Banca del Sangue e del Plasma; Città della Salute e della Scienza di Torino; Torino Italy
| | - A. Valfrè
- Banca del Sangue e del Plasma; Città della Salute e della Scienza di Torino; Torino Italy
| | - K. Pendry
- Department of Transfusion; Central Manchester University Hospitals NHS Foundation Trust; Manchester UK
| | - A. Wikman
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | - D. Fischer
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy; University Hospital Frankfurt; Frankfurt Germany
| | - D. Borg-Aquilina
- Hospital Blood Bank; Mater Dei University Hospital; Msida Malta
| | - S. Laspina
- Hospital Blood Bank; Mater Dei University Hospital; Msida Malta
| | - E. C. M. van Pampus
- Laboratory of Medical Immunology; Radboud University Medical Center; Nijmegen The Netherlands
| | - M. van Kraaij
- Laboratory of Medical Immunology; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Transfusion Medicine and Donor Affairs; Sanquin Blood bank; Amsterdam The Netherlands
| | - M. T. Bruun
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | - J. Georgsen
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | | | - P. S. Babra
- Oxford Blood Centre; NHS Blood & Transplant; Oxford UK
| | - M. F. Murphy
- Oxford Blood Centre; NHS Blood & Transplant; Oxford UK
| | - G. Folléa
- French Blood Establishment; Saint Denis France
| | - K. Aranko
- European Blood Alliance; Amsterdam The Netherlands
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Affiliation(s)
- Jeffrey L Carson
- From the Department of Medicine, Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ ( J.L.C.); the Division of Transfusion Medicine, Department of Pathology, University of Pittsburgh, Pittsburgh (D.J.T.); and the Department of Pathology, Division of Transfusion Medicine, Johns Hopkins University School of Medicine, Baltimore (P.M.N.)
| | - Darrell J Triulzi
- From the Department of Medicine, Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ ( J.L.C.); the Division of Transfusion Medicine, Department of Pathology, University of Pittsburgh, Pittsburgh (D.J.T.); and the Department of Pathology, Division of Transfusion Medicine, Johns Hopkins University School of Medicine, Baltimore (P.M.N.)
| | - Paul M Ness
- From the Department of Medicine, Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ ( J.L.C.); the Division of Transfusion Medicine, Department of Pathology, University of Pittsburgh, Pittsburgh (D.J.T.); and the Department of Pathology, Division of Transfusion Medicine, Johns Hopkins University School of Medicine, Baltimore (P.M.N.)
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Abstract
The hematocrit (Hct) determines the oxygen carrying capacity of blood, but also increases blood viscosity and thus flow resistance. From this dual role the concept of an optimum Hct for tissue oxygenation has been derived. Viscometric studies using the ratio Hct/blood viscosity at high shear rate showed an optimum Hct of 50-60% for red blood cell (RBC) suspensions in plasma. For the perfusion of an artificial microvascular network with 5-70μm channels the optimum Hct was 60-70% for high driving pressures. With lower shear rates or driving pressures the optimum Hct shifted towards lower values. In healthy, well trained athletes an increase of the Hct to supra-normal levels can increase exercise performance. These data with healthy individuals suggest that the optimum Hct for oxygen transport may be higher than the physiological range (35-40% in women, 39-50% in men). This is in contrast to clinical observations. Large clinical studies have repeatedly shown that a correction of anemia in a variety of disorders such as chronic kidney disease, heart failure, coronary syndrome, oncology, acute gastrointestinal bleeding, critical care, or surgery have better clinical outcomes when restrictive transfusion strategies are applied. Actual guidelines, therefore, recommend a transfusion threshold of 7-8 g/dL hemoglobin (Hct 20-24%) in stable, hospitalized patients. The discrepancy between the optimum Hct in health and disease may be due to factors such as decreased perfusion pressures (low cardiac output, vascular stenoses, change in vascular tone), endothelial cell dysfunction, leukocyte adhesion and others.
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Meurrens J, Steiner T, Ponette J, Janssen HA, Ramaekers M, Wehrlin JP, Vandekerckhove P, Deldicque L. Effect of Repeated Whole Blood Donations on Aerobic Capacity and Hemoglobin Mass in Moderately Trained Male Subjects: A Randomized Controlled Trial. SPORTS MEDICINE-OPEN 2016; 2:43. [PMID: 27873242 PMCID: PMC5118378 DOI: 10.1186/s40798-016-0067-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 11/04/2016] [Indexed: 01/08/2023]
Abstract
Background The aims of the present study were to investigate the impact of three whole blood donations on endurance capacity and hematological parameters and to determine the duration to fully recover initial endurance capacity and hematological parameters after each donation. Methods Twenty-four moderately trained subjects were randomly divided in a donation (n = 16) and a placebo (n = 8) group. Each of the three donations was interspersed by 3 months, and the recovery of endurance capacity and hematological parameters was monitored up to 1 month after donation. Results Maximal power output, peak oxygen consumption, and hemoglobin mass decreased (p < 0.001) up to 4 weeks after a single blood donation with a maximal decrease of 4, 10, and 7%, respectively. Hematocrit, hemoglobin concentration, ferritin, and red blood cell count (RBC), all key hematological parameters for oxygen transport, were lowered by a single donation (p < 0.001) and cumulatively further affected by the repetition of the donations (p < 0.001). The maximal decrease after a blood donation was 11% for hematocrit, 10% for hemoglobin concentration, 50% for ferritin, and 12% for RBC (p < 0.001). Maximal power output cumulatively increased in the placebo group as the maximal exercise tests were repeated (p < 0.001), which indicates positive training adaptations. This increase in maximal power output over the whole duration of the study was not observed in the donation group. Conclusions Maximal, but not submaximal, endurance capacity was altered after blood donation in moderately trained people and the expected increase in capacity after multiple maximal exercise tests was not present when repeating whole blood donations. Electronic supplementary material The online version of this article (doi:10.1186/s40798-016-0067-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julie Meurrens
- Exercise Physiology Research Group, Department of Kinesiology, KU Leuven, Leuven, Belgium.,Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Thomas Steiner
- Section for Elite Sport, Swiss Federal Institute of Sports, Magglingen, Switzerland
| | - Jonathan Ponette
- Exercise Physiology Research Group, Department of Kinesiology, KU Leuven, Leuven, Belgium
| | - Hans Antonius Janssen
- Exercise Physiology Research Group, Department of Kinesiology, KU Leuven, Leuven, Belgium
| | - Monique Ramaekers
- Exercise Physiology Research Group, Department of Kinesiology, KU Leuven, Leuven, Belgium
| | - Jon Peter Wehrlin
- Section for Elite Sport, Swiss Federal Institute of Sports, Magglingen, Switzerland
| | - Philippe Vandekerckhove
- Belgian Red Cross-Flanders, Mechelen, Belgium.,Faculty of Medicine, University of Ghent, Ghent, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Louise Deldicque
- Exercise Physiology Research Group, Department of Kinesiology, KU Leuven, Leuven, Belgium. .,Institute of Neuroscience, Université catholique de Louvain, 1, Place Pierre de Coubertin box L08.10.01, 1348, Louvain-la-Neuve, Belgium.
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Folléa G. Gestion du sang du patient et pour le patient. Transfus Clin Biol 2016; 23:175-184. [DOI: 10.1016/j.tracli.2016.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/22/2016] [Indexed: 12/28/2022]
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Tobian AA, Heddle NM, Wiegmann TL, Carson JL. Red blood cell transfusion: 2016 clinical practice guidelines from AABB. Transfusion 2016; 56:2627-2630. [DOI: 10.1111/trf.13735] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/09/2016] [Indexed: 01/28/2023]
Affiliation(s)
- Aaron A.R. Tobian
- Department of Pathology; Johns Hopkins University; Baltimore Maryland
| | - Nancy M. Heddle
- Department of Medicine; McMaster University; Hamilton Ontario Canada
| | | | - Jeffrey L. Carson
- Division of General Internal Medicine; Rutgers Robert Wood Johnson Medical School; New Brunswick New Jersey
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Folléa G. Rethinking blood components and patients: Patient blood management. Possible ways for development in France. Presse Med 2016; 45:e273-80. [DOI: 10.1016/j.lpm.2016.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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