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Liu X, Ma Z, Wang H, Zhang X, Li S, Zhang M, An J, Luo Z. Effectiveness and Safety of High-Dose Tranexamic Acid in Adolescent Idiopathic Scoliosis Surgery: A Meta-Analysis and Systematic Review. World Neurosurg 2024; 191:39-48. [PMID: 39111654 DOI: 10.1016/j.wneu.2024.07.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 07/29/2024] [Indexed: 09/02/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis of randomized controlled trials and retrospective controlled studies aims to evaluate the efficacy and safety of high-dose tranexamic acid (TXA) in spinal correction surgery for adolescent idiopathic scoliosis patients. METHODS In March 2024, a comprehensive search was conducted in PubMed, Web of Science, Embase, and Cochrane databases to identify randomized controlled trials and retrospective controlled studies comparing the effects of high-dose TXA on blood loss and transfusion requirements during spinal correction surgery. RESULTS This meta-analysis included 10 studies encompassing a total of 741 patients. The pooled results indicated that the use of high-dose TXA significantly reduced intraoperative blood loss [weighted mean difference (WMD) = -519.83, 95% CI (-724.74, -314.92), P < 0.00001], transfusion rate [RR = 0.28, 95% CI (0.17, 0.45), P < 0.00001], total blood loss [WMD = -891.09, 95% CI (-1623.92, -158.26), P = 0.02], and postoperative blood loss [WMD = -105.91, 95% CI (-141.29, -70.52), P < 0.00001]. There was no significant difference in operative time [WMD = -18.96, 95% CI (-40.20, 2.28), P = 0.08] and blood loss per segment [WMD = -50.51, 95% CI (-102.19, 1.17), P = 0.06]. Both groups had a comparable incidence of thromboembolic events. CONCLUSIONS Our meta-analysis suggests that the use of high-dose TXA reduces intraoperative blood loss, transfusion rate, total blood loss, and postoperative blood loss in spinal correction surgery for adolescent idiopathic scoliosis patients. However, there were no significant differences in operative time and blood loss per segment.
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Affiliation(s)
- Xin Liu
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China; Key Laboratory of Bone and Joint Disease Research of Gansu Provincial, Lanzhou, China
| | - Zhong Ma
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China; Key Laboratory of Bone and Joint Disease Research of Gansu Provincial, Lanzhou, China
| | - Hao Wang
- Gansu University of Chinese Medicine, Lanzhou, China
| | - Xianxu Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China; Key Laboratory of Bone and Joint Disease Research of Gansu Provincial, Lanzhou, China
| | - Shicheng Li
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China; Key Laboratory of Bone and Joint Disease Research of Gansu Provincial, Lanzhou, China
| | - Mingtao Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China; Key Laboratory of Bone and Joint Disease Research of Gansu Provincial, Lanzhou, China
| | - Jiangdong An
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhiqiang Luo
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, China.
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2
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Husk KE, Wang R, Rogers RG, Harvie HS. Is Preoperative Type and Screen High-value Care? A Cost-effectiveness Analysis of Performing Preoperative Type and Screen Prior to Urogynecological Surgery. Int Urogynecol J 2024; 35:781-791. [PMID: 38240801 DOI: 10.1007/s00192-023-05696-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/07/2023] [Indexed: 05/01/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Routine preoperative type and screen (T&S) is often ordered prior to urogynecological surgery but is rarely used. We aimed to assess the cost effectiveness of routine preoperative T&S and determine transfusion and transfusion reaction rates that make universal preoperative T&S cost effective. METHODS A decision tree model from the health care sector perspective compared costs (2020 US dollars) and effectiveness (quality-adjusted life-years, QALYs) of universal preoperative T&S (cross-matched blood) vs no T&S (O negative blood). Our primary outcome was the incremental cost-effectiveness ratio (ICER). Input parameters included transfusion rates, transfusion reaction incidence, transfusion reaction severity rates, and costs of management. The base case included a transfusion probability of 1.26%; a transfusion reaction probability of 0.0013% with or 0.4% without T&S; and with a transfusion reaction, a 50% probability of inpatient management and 0.0042 annual disutility. Costs were estimated from Medicare national reimbursement schedules. The time horizon was surgery/admission. We assumed a willingness-to-pay threshold of $150,000/QALY. One- and two-way sensitivity analyses were performed. RESULTS The base case and one-way sensitivity analyses demonstrated that routine preoperative T&S is not cost effective, with an ICER of $63,721,632/QALY. The optimal strategy did not change when base case cost, transfusion probability, or transfusion reaction disutility were varied. Threshold analysis revealed that if transfusion reaction probability without T&S is >12%, routine T&S becomes cost effective. Scenarios identified as cost effective in the threshold and sensitivity analyses fell outside reported rates for urogynecological surgery. CONCLUSIONS Within broad ranges, preoperative T&S is not cost effective, which supports re-evaluating routine T&S prior to urogynecological surgery.
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Affiliation(s)
- Katherine E Husk
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, 12208, USA.
| | - Rui Wang
- Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT, 06106, USA
| | - Rebecca G Rogers
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, 12208, USA
| | - Heidi S Harvie
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, 19104, USA
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Sakaeva DD. Anemia and iron deficiency in cancer patients: the role of intravenous iron supplements (a literature review). JOURNAL OF MODERN ONCOLOGY 2023. [DOI: 10.26442/18151434.2022.4.202018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Anemia in patients with malignancies is a common disorder that has a markedly negative impact on quality of life and overall prognosis. The pathogenesis of anemia is complex and multifactorial, depending on the type and stage of malignancy, nutritional status, renal function, age and gender, cytostatic drug, dose, and chemotherapeutic regimen, with iron deficiency often being the main and potentially treatable factor for anemia. In cancer patients, it can be caused by various concomitant mechanisms, including bleeding (e.g., in malignant gastrointestinal tumors or after surgery), malnutrition, medication, and hepcidin-induced iron sequestration in macrophages, with subsequent iron-deficient erythropoiesis. The variety of clinical manifestations of anemia makes it challenging to establish universal criteria to develop optimal treatments. Current therapy for anemia in malignant tumors includes replacement therapy with an iron supplement, erythropoiesis-stimulating agents (erythropoietins), and blood transfusions. However, blood transfusions should be minimized due to the high risks and costs. Therapy with an iron supplement is an effective approach to correcting the iron deficiency. It can increase the efficacy of erythropoiesis-stimulating drugs and reduce the need for blood transfusions. Published guidelines suggest the wide use of intravenous iron supplements. This article discusses possible approaches to treating iron deficiency in cancer patients in various clinical settings. We build on current guidelines and emphasize the need for further research in this area.
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4
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Guamba E, Cevallos A. Recent advances on the development of a universal blood type. BIONATURA 2022. [DOI: 10.21931/rb/2022.07.01.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Blood transfusion is the most common form of tissue transplant, and correct blood type matching is decisive for the success of this procedure. However, the availability of different blood types depends on each population, leading to a shortage of blood units from uncommon types. Then, it represents a problem for patients who need a blood transfusion because the supply for their blood type is scarce. Fortunately, researchers have been developing different techniques to engineer universal red blood cells (RBC) that could be transplanted to any human being independent of its blood type. This paper details the main features of blood transfusion and red blood cells maintenance and the two more recent procedures used to produce universal RBCs, the Enzymatically Converted Group O (ECO) and the antigen masking methods.
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Affiliation(s)
- Esteban Guamba
- Yachay Tech University, School of Biological Sciences and engineering, Hda. San José s/n y Proyecto Yachay, 100119, Urcuquí, Ecuador
| | - Alejandra Cevallos
- Yachay Tech University, School of Biological Sciences and engineering, Hda. San José s/n y Proyecto Yachay, 100119, Urcuquí, Ecuador
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Eisler L, Chihuri S, Lenke LG, Sun LS, Faraoni D, Li G. Development of a preoperative risk score predicting allogeneic red blood cell transfusion in children undergoing spinal fusion. Transfusion 2022; 62:100-115. [PMID: 34761400 PMCID: PMC8758528 DOI: 10.1111/trf.16722] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Children undergoing spinal fusion often receive blood products. The goal of this study was to develop a preoperative score to help physicians identify those who are at risk of allogeneic red blood cell (RBC) transfusion. STUDY DESIGN AND METHODS This retrospective study of children undergoing spinal fusion in the ACS-NSQIP Pediatric database (2016-2019) aimed at identifying risk factors associated with allogeneic RBC transfusion. Univariable logistic regression and multivariable logistic regression were performed using preoperative patient characteristics and aided in the creation of a simplified scoring system. RESULTS Out of 13,929 total patients, 2990 (21.5%) were transfused. We created a risk score based on 10 independent predictors of transfusion: age, sex, race, weight < 3rd percentile, American Society of Anesthesiologists physical status classification, cardiac risk factors, hematologic disease, preoperative anemia, deformity type, and number of spinal levels to be fused. Patients in both the training and testing cohorts were assigned a score ranging from 0 (lowest risk) to 21 (highest risk). The developed transfusion risk score showed 77% accuracy in distinguishing patients who did not receive a transfusion during or soon after surgery (AUROC 0.7736 [95% CI, 0.7619-0.7852]) in the training cohort and 77% accuracy (AUROC 0.7732 [95% CI, 0.7554-0.7910]) in the testing cohort. DISCUSSION Our score, based on routinely available preoperative data, accurately estimates the risk of allogeneic RBC transfusion in pediatric patients undergoing spinal fusion. Future studies will inform whether patient blood management interventions targeted to high-risk patients can help reduce the need for transfusion and improve outcomes.
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Affiliation(s)
- Lisa Eisler
- Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Stanford Chihuri
- Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Lawrence G. Lenke
- Orthopedic Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - Lena S. Sun
- Anesthesiology and Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY
| | - David Faraoni
- Anesthesiology, Perioperative and Pain Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Guohua Li
- Anesthesiology and Epidemiology, Columbia University College of Physicians and Surgeons, New York, NY
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Musumari PM, Mbikayi SM, Srithanaviboonchai K, Techasrivichien T, Tangmunkongvorakul A, Tshilolo L. Symptoms of acute transfusion reactions at a general referral hospital in Kinshasa, Democratic Republic of Congo: a cross-sectional study. BMJ Open 2021; 11:e045081. [PMID: 34290061 PMCID: PMC8296776 DOI: 10.1136/bmjopen-2020-045081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Blood transfusion is a life-saving procedure and is also associated with a range of risks including the occurrence of symptoms of acute transfusion reactions (ATRs). Very few studies in sub-Saharan Africa have reported on ATRs. The present study addresses this gap in the literature by documenting the prevalence of and factors associated with ATRs in the Democratic Republic of Congo (DRC). DESIGN This is a cross-sectional descriptive and analytical study using blood bank data from a general referral hospital. SETTING Centre Hospitalier Mère-Enfant (CHME) Monkole, a general referral hospital in Kinshasa, DRC. PARTICIPANTS General population who have received blood transfusion in CHME Monkole between 2014 and 2019. RESULTS The data set included a total of 7166 patients; 3153 (44%) men and 4013 (56%) women. The overall prevalence of symptoms of ATRs was 2.6%; the lowest prevalence was in 2017 (2.34%) and highest in 2018 (2.95%) and 2019 (2.94%). The documented symptoms included 74 (39.6%) cases of dyspnoea/respiratory distress, 60 (32.1%) cases of fever, 36 (19.2%) cases of pruritus/urticaria and 17 (9.1%) cases of vomiting. None of the studied factors was associated with symptoms of ATRs. CONCLUSION Symptoms of ATRs were not uncommon in the studied population. Dyspnoea and respiratory distress, fever and pruritus/urticaria were the most common symptoms of ATRs. This study highlights the need for a clinical and biological surveillance to detect, prevent and manage ATRs in the context of the DRC.
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Affiliation(s)
- Patou Masika Musumari
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- Chiang Mai University Research Institute for Health Sciences, Chiang Mai, Thailand
| | - Samclide Mutindu Mbikayi
- Department of Hematology, Centre Hospitalier Mère-Enfant Monkole, Kinshasa, Democratic Republic of Congo
| | - Kriengkrai Srithanaviboonchai
- Chiang Mai University Research Institute for Health Sciences, Chiang Mai, Thailand
- Department of Community Medicine, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand
| | - Teeranee Techasrivichien
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-Epidemiology, Kyoto, Japan
| | | | - Léon Tshilolo
- Department of Hematology, Centre Hospitalier Mère-Enfant Monkole, Kinshasa, Democratic Republic of Congo
- Centre de Formation et Appui Sanitaire (CEFA), Kinshasa, Democratic Republic of Congo
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7
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Koepsell S. Complications of Transfusion. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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8
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Sousa RS, Minervino AHH, Oliveira FLC, Araújo CASC, Rodrigues FAML, Zaminhan JLR, Vale RG, Tavares MD, Mori CS, de Paula VV, Ortolani EL, Barrêto Júnior RA. Impact of blood storage duration on hematologic, blood gas, biochemical, and oxidative stress variables in sheep undergoing allogeneic blood transfusions. Vet Clin Pathol 2020; 49:545-556. [PMID: 33277948 DOI: 10.1111/vcp.12917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hemotherapy in ruminants is limited to whole blood transfusions, sometimes with stored blood for up to 42 days, but little attention has been given to the effect of blood storage times and recipient responses after transfusions. OBJECTIVES We aimed to evaluate the hematologic and serum biochemical effects after allogeneic blood transfusion with either fresh or stored blood in sheep. We also sought to examine hematologic and biochemical analyte changes in the store blood. METHODS Eighteen sheep underwent a single phlebotomy to remove 40% of their blood volume. The sheep were divided into three experimental groups, G0, G15, and G35, which included six animals, each receiving 20 mL/kg of either fresh blood or blood stored in citrate, phosphate, dextrose, and adenine (CPDA-1) bags for 15 and 35 days, respectively. Biochemical, hematologic, coagulation, blood gas, lipid peroxidation, and oxidative stress test evaluations were performed using the blood samples gathered at T0 (before transfusion), 30 minutes (T30m), 6, 12, 24, 48, 72, and 96 hours (T6h-T96h), 8 days (T8d), and 16 days (T16d) after transfusions. RESULTS Sheep exhibited increases in packed cell volumes, red blood cell counts, and total hemoglobin concentrations at T30m (P < .05). G35 animals had greater plasma hemoglobin concentrations at T12h and decreased blood pH values at T6h, characterized by slight metabolic acidemia. Regarding oxidative stress, G35 animals had decreased catalase activities from T0 at T30m, T6h, T12h, and T24h, indicating that hemolysis had occurred, which was supported by concomitant increases in bilirubin. CONCLUSIONS Sheep transfused with 35-day stored blood exhibited greater hematologic, blood gas, biochemical, and oxidative alterations; however, anemic animals without comorbidities effectively reversed those alterations.
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Affiliation(s)
- Rejane S Sousa
- Federal University of the South and Southeast of Pará (Unifesspa), Xinguara, Brazil.,Federal Rural University of the Semi-Arid Zone, Mossoró, Brazil
| | - Antonio H H Minervino
- Laboratory of Animal Health, LARSANA, Federal University of Western Pará, UFOPA. Rua Vera Paz S/N, SaléSantarém, Brazil
| | | | | | | | | | - Rodolfo G Vale
- School of Veterinary Medicine and Animal Science, University of São Paulo, Cidade Universitária, São Paulo, Brazil
| | - Marcondes D Tavares
- School of Veterinary Medicine and Animal Science, University of São Paulo, Cidade Universitária, São Paulo, Brazil
| | - Clara S Mori
- Federal University of the South and Southeast of Pará (Unifesspa), Xinguara, Brazil
| | - Valéria V de Paula
- Federal University of the South and Southeast of Pará (Unifesspa), Xinguara, Brazil
| | - Enrico L Ortolani
- Federal University of the South and Southeast of Pará (Unifesspa), Xinguara, Brazil
| | - Raimundo A Barrêto Júnior
- School of Veterinary Medicine and Animal Science, University of São Paulo, Cidade Universitária, São Paulo, Brazil
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The Effects of Pre-Storage Leukoreduction on the Conservation of Bovine Whole Blood in Plastic Bags. BIOLOGY 2020; 9:biology9120444. [PMID: 33291543 PMCID: PMC7761855 DOI: 10.3390/biology9120444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 11/17/2022]
Abstract
Simple Summary Blood transfusion is a life-saving veterinary therapeutic procedure. While fractionated blood components are used in humans, whole blood is most commonly used in animals, especially for farm animals. Whole blood contains white blood cells that can cause a transfusion reaction in animals. Here, we proposed that using a blood bag with leukocyte filtration is sufficient for blood conservation under field conditions and thus can be an option for transfusion medicine in the case of farm animals. The filtered bag was efficient in removing white cells from cattle whole blood and could be used under field conditions. Blood stored after white blood cells were removed showed less acidic load. Further experimental studies are required to prove that blood without white cells results in a decrease in transfusion reactions in cattle. Abstract Leukoreduction (LR) is a technique that consists of reducing the number of leukocytes in whole blood or blood components that can contribute to decreasing storage lesions and the occurrence of post-transfusion complications. We propose that using a blood bag with pre-storage leukocyte filtration is sufficient for blood conservation under field conditions. Ten healthy Nelore cows were used. Whole blood was sampled from each animal and stored at 2 to 6 °C in CPD/SAG-M (citrate phosphate dextrose bag with a saline, adenine, glucose, mannitol satellite bag) triple bags (Control) and in CPD/SAG-M quadruple bags with a leukocyte filter (Filter). At baseline and after 7, 14, 21, 28, 35, and 42 days (D0, D7, D14, D21, D28, D35, and D42, respectively), complete hematological, blood gas, and biochemical evaluations were determined. The filtered bag removed 99.3% of white blood cells from cattle blood, and the entire filtration process was performed in the field. There was a reduction in the number of red blood cells (RBCs) in both groups from D14 onward, with a decrease of 19.7% and 17.1% at D42 for the Control and Filter bags, respectively. The hemoglobin (Hb) concentration had variation in both groups. Potassium, pO2, pCO2, and sO2 increased, and sodium, bicarbonate, and pH decreased during storage. The filtered bag was efficient in removing white cells from cattle whole blood and could be used under field conditions. Blood stored after LR showed differences (p < 0.05) in blood gas analysis towards a better quality of stored blood (e.g., higher pH, lower pCO2, higher sO2). Further experimental studies are required to prove that blood without white cells results in a decrease in transfusion reactions in cattle.
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10
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McQuinn ER, Smith SA, Viall AK, Wang C, LeVine DN. Neutrophil extracellular traps in stored canine red blood cell units. J Vet Intern Med 2020; 34:1894-1902. [PMID: 32881076 PMCID: PMC7517510 DOI: 10.1111/jvim.15876] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/18/2020] [Accepted: 08/05/2020] [Indexed: 12/21/2022] Open
Abstract
Background Neutrophil extracellular traps (NETs), webs of DNA and citrullinated histones extruded from activated neutrophils cause transfusion‐related acute lung injury. Supernatants of stored red blood cell (RBC) units might promote NETosis in neutrophils from the units or from transfusion recipients. Hypotheses (1) NETs form during storage of canine RBC, (2) leukoreduction (LR) before storage of RBC reduces NETosis, and (3) supernatant from stored, nonleukoreduced (NLR) RBC units induces NETosis in healthy canine neutrophils modeling transfusion recipients. Animals Six healthy purpose‐bred research dogs were utilized for blood donation. Methods Prospective controlled study. RBC units were collected from each dog, aseptically divided into 2 equal subunits, 1 of which was leukoreduced, and stored for 42 days. Stored units were sampled biweekly for quantification of NET markers citrullinated histone H3 (Western blot) and cell‐free DNA (cfDNA) (DNA dye binding). Unit supernatants were applied ex vivo to canine neutrophils and extracellular DNA release representing NETosis was assessed. Results Markers of NETs increased during RBC storage (cfDNA P < .0001 and citrullinated H3 P = .0002) and were higher in NLR than LR units (day 42 LR cfDNA 0.34 ± 0.82 ng/mL vs day 42 NLR 1361.07 ± 741.00 ng/mL, P < .0001; day 42 LR citrullinated H3 0.19 ± 0.13 AU vs NLR 0.57 ± 0.34 AU, P = .007). Isolated neutrophils did not form NETs when exposed to stored canine RBC supernatant. Conclusions and Clinical Importance NETosis occurs in stored canine NLR RBC units, and is attenuated by LR before storage. NETs might be mediators of transfusion reactions.
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Affiliation(s)
- Erin R McQuinn
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, USA
| | - Stephanie A Smith
- Department of Biochemistry, College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Austin K Viall
- Department of Veterinary Pathology, Iowa State University, Ames, Iowa, USA
| | - Chong Wang
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, Iowa, USA
| | - Dana N LeVine
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, USA
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11
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Ebrahimisadr P, Bakhshandeh Z, Majidiani H. Red cell alloantibodies in beta-thalassaemia major patients' blood referring to the regional blood transfusion center of Tehran, Iran. ACTA ACUST UNITED AC 2020; 11:129-133. [PMID: 33842283 PMCID: PMC8022230 DOI: 10.34172/bi.2021.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/25/2020] [Accepted: 04/04/2020] [Indexed: 11/24/2022]
Abstract
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Introduction: Thalassemia is associated with a genetic decline in the rate of synthesis of one or more types of natural hemoglobin polypeptide chains. One of the major complications in thalassemia patients is alloimmunization, which is antibody production by the patient against transfused red blood cells (RBCs). These RBCs are unknown by the recipient and the formed antibodies against them are called alloantibodies. This study aimed to evaluate the frequency of alloantibodies against RBCs in beta-thalassemia patients referred to Tehran Regional Blood Transfusion Center. Methods: In this study, antibody screening tests (Dia-cell I, II, and III) were performed on 184 thalassemia patients. An identification test by the Dia panel consisting of 11 different O RBCs groups to examine sera with Dia cells (I, II, or III) was performed. Results: In our study, males and females patients comprised 66 (35.87%) and 118 (64.13%), respectively, of whom 116 (63%) had alloimmunization. In addition, 68 thalassemia subjects (37%) lacked alloantibodies. Among 184 patients with beta-thalassemia major, anti-K (Kell system), anti-D, and anti-E (Rhesus system) had the most abundant alloantibody variants with an incidence of 24 (13%), 11 (5.98%), and 10 (5.4%), respectively. Conclusion: Before RBC transfusion, regular RBC antigen phenotypes, as well as problem-solving of alloantibody production by receiving compatible blood for Kell and RH subgroups, are suggested for all cases of transfusion-derived thalassemia.
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Affiliation(s)
- Parisa Ebrahimisadr
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Zahra Bakhshandeh
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Hamidreza Majidiani
- Departments of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Raitt J, Curry N, Lewis P, Dearman J, Poole K, Surendra Kumar D. Developing clinical performance indicators for pre‐hospital blood transfusion: The Thames Valley Air Ambulance approach. Transfus Med 2020; 30:134-140. [DOI: 10.1111/tme.12668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/23/2022]
Affiliation(s)
- James Raitt
- Thames Valley Air Ambulance, Stokenchurch Oxfordshire UK
| | - Nicola Curry
- Oxford Haemophilia & Thrombosis Centre, Department of Haematology, Oxford University Hospitals NHS TrustChurchill Hospital Oxford UK
- Blood Theme, Oxford Centre for HaematologyNIHR BRC Oxford UK
| | - Pip Lewis
- Registrar in Emergency Medicine, Defence Deanery UK
| | - James Dearman
- Registrar in Pre‐Hospital Emergency Medicine Thames Valley Air Ambulance Oxfordshire UK
| | - Kurtis Poole
- Research and Audit Lead, Thames Valley Air Ambulance Oxfordshire UK
| | - Dhushy Surendra Kumar
- Anaesthesia and Pre‐Hospital Emergency Medicine, University Hospitals Coventry and Warwickshire NHS Trust
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13
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Jackson Chornenki NL, James TE, Barty R, Liu Y, Rochwerg B, Heddle NM, Siegal DM. Blood loss from laboratory testing, anemia, and red blood cell transfusion in the intensive care unit: a retrospective study. Transfusion 2019; 60:256-261. [DOI: 10.1111/trf.15649] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/08/2019] [Accepted: 11/22/2019] [Indexed: 02/04/2023]
Affiliation(s)
| | - Tyler E. James
- Department of Medicine McMaster University Hamilton Ontario Canada
| | - Rebecca Barty
- Department of Medicine McMaster University Hamilton Ontario Canada
- McMaster Centre for Transfusion Research McMaster University Hamilton Ontario Canada
| | - Yang Liu
- Department of Medicine McMaster University Hamilton Ontario Canada
- McMaster Centre for Transfusion Research McMaster University Hamilton Ontario Canada
| | - Bram Rochwerg
- Department of Medicine McMaster University Hamilton Ontario Canada
- Department of Health Research Methods Evidence and Impact at McMaster Hamilton Ontario Canada
| | - Nancy M. Heddle
- Department of Medicine McMaster University Hamilton Ontario Canada
- McMaster Centre for Transfusion Research McMaster University Hamilton Ontario Canada
| | - Deborah M. Siegal
- Department of Medicine McMaster University Hamilton Ontario Canada
- Population Health Research Institute McMaster University Hamilton Ontario Canada
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14
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Will ND, Kor DJ, Frank RD, Passe MA, Weister TJ, Zielinski MD, Warner MA. Initial Postoperative Hemoglobin Values and Clinical Outcomes in Transfused Patients Undergoing Noncardiac Surgery. Anesth Analg 2019; 129:819-829. [PMID: 31425225 DOI: 10.1213/ane.0000000000004287] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Intraoperative red blood cell (RBC) transfusion is common, yet transfusion strategies remain controversial as pretransfusion hemoglobin triggers are difficult to utilize during acute bleeding. Alternatively, postoperative hemoglobin values may provide useful information regarding transfusion practices, though optimal targets remain undefined. METHODS This is a single-center observational cohort study of adults receiving allogeneic RBCs during noncardiac surgery from 2010 through 2014. Multivariable regression analyses adjusting for patient illness, laboratory derangements, and surgical features were used to assess relationships between initial postoperative hemoglobin values and a primary outcome of hospital-free days. RESULTS A total of 8060 patients were included. Those with initial postoperative hemoglobin <7.5 or ≥11.5 g/dL had decreased hospital-free days [mean (95% confidence interval [CI]), -1.45 (-2.50 to -0.41) and -0.83 (-1.42 to -0.24), respectively] compared to a reference range of 9.5-10.4 g/dL (overall P value .003). For those with hemoglobin <7.5 g/dL, the odds (95% CI) for secondary outcomes included acute kidney injury (AKI) 1.43 (1.03-1.99), mortality 2.10 (1.18-3.74), and cerebral ischemia 3.12 (1.08-9.01). The odds for postoperative mechanical ventilation with hemoglobin ≥11.5 g/dL were 1.33 (1.07-1.65). Secondary outcome associations were not significant after multiple comparisons adjustment (Bonferroni P < .0056). CONCLUSIONS In transfused patients, postoperative hemoglobin values between 7.5 and 11.5 g/dL were associated with superior outcomes compared to more extreme values. This range may represent a target for intraoperative transfusions, particularly during active bleeding when pretransfusion hemoglobin thresholds may be impractical or inaccurate. Given similar outcomes within this range, targeting hemoglobin at the lower aspect may be preferable, though prospective validation is warranted.
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Affiliation(s)
- Nicholas D Will
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daryl J Kor
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ryan D Frank
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Melissa A Passe
- Anesthesia Clinical Research Unit, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Timothy J Weister
- Anesthesia Clinical Research Unit, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Martin D Zielinski
- Division of Trauma, Critical Care, and General Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew A Warner
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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15
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Hilleary LA, Wratten C, Siva S, Hilleary J, Martin JM. Intratumoural renal cell carcinoma haemorrhage following stereotactic radiotherapy: a case report. BMC Cancer 2019; 19:671. [PMID: 31286870 PMCID: PMC6615206 DOI: 10.1186/s12885-019-5899-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 07/02/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Stereotactic radiotherapy is an emerging treatment option for patients with inoperable renal cell carcinoma (RCC). Haemorrhage has not previously been reported to occur as a result of Stereotactic Body Radiotherapy (SBRT) to the kidney for primary RCC. We report an acute haemorrhage in a patient who received only one of three planned fractions of SBRT as part of a clinical trial. CASE PRESENTATION A 74 year old female had a left renal mass under observation for 4 years, during which time she was imaged repeatedly using ultrasound and CT scans. There has been no evidence of metastases, and the lesion has demonstrated a steady pattern of growth over the 4-year period. Fine needle aspiration histologically confirmed RCC. Following a multidisciplinary review, the patient was recommended for SBRT as she was not considered a surgical candidate. Treatment was planned for an ablative 42Gray (Gy) to be delivered in 3 fractions at 14Gy/fraction as part of a clinical trial. Our patient presented to the emergency department (ED) suffering left flank pain, fever and vomiting within 3 h of the first fraction of SBRT. CT showed the mass to have markedly increased in size, measuring 8.7 × 8.1 × 7.0 cm, from 6.5 × 5.4 × 5.6 cm. It was reported as an internal haemorrhage into the malignancy. The patient was admitted for analgesia, anti-pyretics, and transfusion of 2 units of packed red blood cells. The patient recovered without any further intervention but radiotherapy was discontinued. The patient was alive and free from disease progression two years after the aborted treatment. CONCLUSION Such events, though rare, are potentially serious, and therefore clinicians should be aware of such treatment related complications.
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Affiliation(s)
- Liam A Hilleary
- Calvary Mater Hospital, Locked Mail Bag 7 Hunter Region Mail Centre, Newcastle, New South Wales, 2310, Australia.
| | - Christopher Wratten
- Calvary Mater Hospital, Locked Mail Bag 7 Hunter Region Mail Centre, Newcastle, New South Wales, 2310, Australia.,University of Newcastle School of Medicine and Public Health, University Drive, Callaghan, New South Wales, 2308, Australia
| | - Shankar Siva
- Peter MacCallum Cancer Centre, Locked Bag 5m A'Beckett St, Melbourne, Victoria, 8006, Australia
| | - Jenna Hilleary
- Calvary Mater Hospital, Locked Mail Bag 7 Hunter Region Mail Centre, Newcastle, New South Wales, 2310, Australia
| | - Jarad M Martin
- Calvary Mater Hospital, Locked Mail Bag 7 Hunter Region Mail Centre, Newcastle, New South Wales, 2310, Australia.,University of Newcastle School of Medicine and Public Health, University Drive, Callaghan, New South Wales, 2308, Australia
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16
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Simpson JD, Hopkins A, Amil A, Ross B, Enjeti AK. Transfusion-associated circulatory overload in ambulatory patients. Vox Sang 2019; 114:216-222. [PMID: 30734301 DOI: 10.1111/vox.12753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/28/2018] [Accepted: 12/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Transfusion-associated circulatory overload is a leading cause of transfusion-related adverse events. The frequency and risks for transfusion-associated circulatory overload in ambulatory haematology patients are not known. MATERIALS AND METHODS A retrospective cohort analysis of ambulatory patients transfused in a tertiary haematology centre, using medical records and an electronic transfusion database, was undertaken between January and December 2014. Variables studied included age, gender, diagnosis, heart failure, kidney disease and details of transfusions. Transfusion-associated circulatory overload was defined according to proposed International Society of Blood Transfusion criteria. Patients with clinical evidence of hypervolaemia, not meeting the TACO definition and/or who were prescribed otherwise unscheduled diuretic agent, were collectively deemed to be at 'risk of clinically significant hypervolaemia' (ROCSH). RESULTS In the study period, 93 ambulatory patients (male = 49, female = 44, mean age = 75·89 ± 11·37 years) attended 715 transfusion encounters, totalling 1536 packed red cell units. No cases of TACO occurred whilst 'ROCSH' events occurred in 57/715 (8%) of transfusion encounters. In a univariate model, age was significantly associated with 'ROCSH', odds ratio = 1·05 (P = 0·017 95%, CI 1·01-1·09) and no factors were significant on multivariate analysis. CONCLUSIONS Transfusion-associated circulatory overload occurs infrequently haematology patients receiving ambulatory blood transfusions. To our knowledge, this is the first study to report on occurrence and risk factors for circulatory overload in ambulatory transfusions. This study provides vital baseline data for future prospective studies on this important aspect of haemovigilance.
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Affiliation(s)
- Jock D Simpson
- Haematology Department, Calvary Mater Newcastle, Waratah, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Adam Hopkins
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Adilah Amil
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Bryony Ross
- Haematology Department, Calvary Mater Newcastle, Waratah, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,NSW Health Pathology - Hunter, New Lambton Heights, NSW, Australia
| | - Anoop K Enjeti
- Haematology Department, Calvary Mater Newcastle, Waratah, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,NSW Health Pathology - Hunter, New Lambton Heights, NSW, Australia.,Hunter Medical Research Institute, New Lambton, NSW, Australia.,Hunter Cancer Research Alliance, Callaghan, NSW, Australia
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17
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Furuta Y, Nakamura Y, Tokida M, Ichikawa K, Ohsawa T, Ohkubo M, Ohsaka A. Pre-operative autologous blood donation and transfusion-related adverse reactions: A 14-year experience at a university hospital. Transfus Apher Sci 2018; 57:651-655. [PMID: 30078740 DOI: 10.1016/j.transci.2018.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/11/2018] [Accepted: 07/25/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to determine the rate of adverse reactions to pre-operative autologous blood donation (PAD) transfusion in a single institution over a 14-year period. STUDY DESIGN AND METHODS Between January 2003 and December 2016, we investigated adverse reactions to PAD transfusion and compared them with those to allogeneic blood transfusion in Juntendo University Hospital. Adverse reactions were categorized according to the definition proposed by the International Society of Blood Transfusion (ISBT) Working Party on Haemovigilance. RESULTS A total of 178,014 blood components were transfused during the study period, of which PAD transfusions were 13,653 (8%), whereas allogeneic blood transfusions were 164,361 (92%). The number and rate of adverse reactions to PAD transfusion were 16 and 0.1%, whereas those of allogeneic blood transfusion were 1075 and 0.7%, respectively. The rate of adverse reactions to allogeneic blood transfusions excluding platelet transfusion was 0.3%, being significant (p < 0.01) against PAD transfusion. Among 16 adverse reactions to PAD transfusion, the most common was febrile non-hemolytic transfusion reaction (FNHTR) at 12 (75%), followed by allergic reaction at 4 (25%). The severity of adverse reactions to PAD transfusion was Grade 1 (non-severe) in all cases. With regard to blood component types, 16 adverse reactions involved: 12 cases of whole blood PAD, 2 of frozen PAD, and 2 of autologous fresh-frozen plasma. CONCLUSIONS Non-severe adverse reactions were observed on PAD transfusion at a rate of 0.1% at our institution.
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Affiliation(s)
- Yoshiaki Furuta
- Department of Transfusion Service, Juntendo University Hospital, Tokyo, Japan.
| | - Yuki Nakamura
- Department of Transfusion Service, Juntendo University Hospital, Tokyo, Japan.
| | - Miho Tokida
- Department of Transfusion Service, Juntendo University Hospital, Tokyo, Japan.
| | - Kayoko Ichikawa
- Department of Transfusion Service, Juntendo University Hospital, Tokyo, Japan.
| | - Toshiya Ohsawa
- Department of Transfusion Service, Juntendo University Hospital, Tokyo, Japan.
| | - Mitsuo Ohkubo
- Department of Transfusion Service, Juntendo University Urayasu Hospital, Chiba, Japan; Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Akimichi Ohsaka
- Department of Transfusion Service, Juntendo University Hospital, Tokyo, Japan; Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University Graduate School of Medicine, Tokyo, Japan.
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18
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Vörös E, Piety NZ, Strachan BC, Lu M, Shevkoplyas SS. Centrifugation-free washing: A novel approach for removing immunoglobulin A from stored red blood cells. Am J Hematol 2018; 93:518-526. [PMID: 29285804 DOI: 10.1002/ajh.25026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/20/2017] [Accepted: 12/26/2017] [Indexed: 01/28/2023]
Abstract
Washed red blood cells (RBCs) are indicated for immunoglobulin A (IgA) deficient recipients. Centrifugation-based cell processors commonly used by hospital blood banks cannot consistently reduce IgA below the recommended levels, hence double washing is frequently required. Here, we describe a prototype of a simple, portable, disposable system capable of washing stored RBCs without centrifugation, while reducing IgA below 0.05 mg/dL in a single run. Samples from RBC units (n = 8, leukoreduced, 4-6 weeks storage duration) were diluted with normal saline to a hematocrit of 10%, and then washed using either the prototype washing system, or via conventional centrifugation. The efficiency of the two washing methods was quantified and compared by measuring several key in vitro quality metrics. The prototype of the washing system was able to process stored RBCs at a rate of 300 mL/hour, producing a suspension of washed RBCs with 43 ± 3% hematocrit and 86 ± 7% cell recovery. Overall, the two washing methods performed similarly for most measured parameters, lowering the concentration of free hemoglobin by >4-fold and total free protein by >10-fold. Importantly, the new washing system reduced the IgA level to 0.02 ± 0.01 mg/mL, a concentration 5-fold lower than that produced by conventional centrifugation. This proof-of-concept study showed that centrifugation may be unnecessary for washing stored RBCs. A simple, disposable, centrifugation-free washing system could be particularly useful in smaller medical facilities and resource limited settings that may lack access to centrifugation-based cell processors.
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Affiliation(s)
- Eszter Vörös
- Department of Biomedical Engineering; University of Houston; Houston Texas 77204
| | - Nathaniel Z. Piety
- Department of Biomedical Engineering; University of Houston; Houston Texas 77204
| | - Briony C. Strachan
- Department of Biomedical Engineering; University of Houston; Houston Texas 77204
| | - Madeleine Lu
- Department of Biomedical Engineering; University of Houston; Houston Texas 77204
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19
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Management of Children With β-Thalassemia Intermedia: Overview, Recent Advances, and Treatment Challenges. J Pediatr Hematol Oncol 2018; 40:253-268. [PMID: 29629992 DOI: 10.1097/mph.0000000000001148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Our knowledge of the various clinical morbidities that thalassemia intermedia (TI) patients endure has substantially increased over the past decade. It is mandatory to grasp a solid understanding of disease-specific complications in order to tailor management. The optimal course of management for TI patients has been hard to identify, and several controversies remain with regard to the best treatment plan. Although advances in TI are moving at a fast pace, many complications remain with no treatment guidelines. Studies that expand our understanding of the mechanisms and risk factors, as well as clinical trials evaluating the roles of available treatments, will help establish management guidelines that improve patient care. Novel therapeutic modalities are now emerging. This article focuses on the management of children with β-TI. We present various clinical morbidities and their association with the underlying disease pathophysiology and risk factors. All therapeutic options, recent advances, and treatment challenges were reviewed.
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20
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Mazzeffi MA, See JM, Williams B, Richards J, Zimmerman D, Galvagno S, Fontaine M, Tanaka K. Five-year trends in perioperative red blood cell transfusion from index cases in five surgical specialties: 2011 to 2015. Transfusion 2018. [PMID: 29542136 DOI: 10.1111/trf.14559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Red blood cell (RBC) transfusion can be life-saving; however, the risks of RBC transfusion have been increasingly recognized, and current guidelines recommend restrictive transfusion in most patients. We hypothesized that RBC transfusions are decreasing in surgical patients. STUDY DESIGN AND METHODS A retrospective review of the National Surgical Quality Improvement Program database was performed from 2011 to 2015. Index cases in five surgical specialties were studied: neurosurgery, thoracic surgery, gynecologic surgery, orthopedic surgery, and vascular surgery. Patient characteristics, preoperative laboratory values, and surgery details were compared between years. The study's primary outcome was perioperative RBC transfusion, which was compared over the 5-year period for each specialty. Secondary outcomes were myocardial infarction and renal failure after surgery. In addition, trends in RBC transfusion between low-risk and high-risk patients and between emergency and elective surgery were examined. RESULTS RBC transfusion decreased in all surgical specialties except for thoracic and gynecologic surgery. RBC transfusion decreased substantially in orthopedic surgery, falling from 22.4% in 2011 to 6.3% in 2015 (p ≤ 0.0001). High-risk patients had greater reductions in the receipt of RBC transfusion than low-risk patients, and there were no increases in myocardial infarction or renal failure after surgery in any specialty. CONCLUSION RBC transfusion appears to be decreasing across multiple surgical specialties, with no apparent increase in myocardial infarctions or renal failure. This likely represents an important improvement in patient care. Continued efforts are needed to develop patient blood management programs and further reduce RBC transfusion.
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Affiliation(s)
- Michael A Mazzeffi
- Departments of Anesthesiology and Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - John M See
- Departments of Anesthesiology and Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Brittney Williams
- Departments of Anesthesiology and Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Justin Richards
- Departments of Anesthesiology and Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Darin Zimmerman
- Departments of Anesthesiology and Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Samuel Galvagno
- Departments of Anesthesiology and Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Magali Fontaine
- Departments of Anesthesiology and Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kenichi Tanaka
- Departments of Anesthesiology and Pathology, University of Maryland School of Medicine, Baltimore, Maryland
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21
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Jones AR, Frazier SK. Consequences of Transfusing Blood Components in Patients With Trauma: A Conceptual Model. Crit Care Nurse 2017; 37:18-30. [PMID: 28365647 DOI: 10.4037/ccn2017965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Transfusion of blood components is often required in resuscitation of patients with major trauma. Packed red blood cells and platelets break down and undergo chemical changes during storage (known as the storage lesion) that lead to an inflammatory response once the blood components are transfused to patients. Although some evidence supports a detrimental association between transfusion and a patient's outcome, the mechanisms connecting transfusion of stored components to outcomes remain unclear. The purpose of this review is to provide critical care nurses with a conceptual model to facilitate understanding of the relationship between the storage lesion and patients' outcomes after trauma; outcomes related to trauma, hemorrhage, and blood component transfusion are grouped according to those occurring in the short-term (≤30 days) and the long-term (>30 days). Complete understanding of these clinical implications is critical for practitioners in evaluating and treating patients given transfusions after traumatic injury.
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Affiliation(s)
- Allison R Jones
- Allison R. Jones is an assistant professor, Department of Acute, Chronic, and Continuing Care, School of Nursing, University of Alabama, Birmingham, Alabama. She has a clinical background in emergency and trauma nursing. In research, she focuses on the consequences of blood component storage and transfusion, with particular interest in transfusion after trauma. .,Susan K. Frazier is the director of the PhD program, a codirector of the RICH Heart Program, and an associate professor, College of Nursing, University of Kentucky, Lexington, Kentucky. Her research focuses on cardiopulmonary interactions in a variety of critically ill patients, including patients with acute heart failure, acute decompensated heart failure, acute respiratory distress syndrome, chronic obstructive pulmonary disease, and multiple trauma.
| | - Susan K Frazier
- Allison R. Jones is an assistant professor, Department of Acute, Chronic, and Continuing Care, School of Nursing, University of Alabama, Birmingham, Alabama. She has a clinical background in emergency and trauma nursing. In research, she focuses on the consequences of blood component storage and transfusion, with particular interest in transfusion after trauma.,Susan K. Frazier is the director of the PhD program, a codirector of the RICH Heart Program, and an associate professor, College of Nursing, University of Kentucky, Lexington, Kentucky. Her research focuses on cardiopulmonary interactions in a variety of critically ill patients, including patients with acute heart failure, acute decompensated heart failure, acute respiratory distress syndrome, chronic obstructive pulmonary disease, and multiple trauma
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22
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Chen DP, Wen YH, Lu JJ, Tseng CP, Chen WL, Chang SW. Human platelet antigens are associated with febrile non-hemolytic transfusion reactions. Clin Chim Acta 2017; 474:120-123. [PMID: 28919492 DOI: 10.1016/j.cca.2017.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/09/2017] [Accepted: 09/13/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Febrile non-hemolytic transfusion reaction (FNHTR) is the most common type of transfusion reactions, and it could be reduced by transfusing patients with leukocyte-poor blood products. However, FNHTR still occur in certain patients transfused with leukocyte-poor red blood cell (LPR) products. It is examined whether human platelet antigen (HPA) could be a potential membrane antigen that plays a role in FNHTR. METHODS A total of 120 inpatient subjects who transfused with LPR (60 in FNHTR group, 60 in control group) were typed for HPA-2, HPA-3, and HPA-15 using sequence specific primer-polymerase chain reaction (SSP-PCR) and electrophoresis. RESULTS HPA-2 unmatched rate between donors and patients in FNHTR group was 18%, and only 3% unmatched rate was observed in control group (p=0.0082). FNHTR group was further classified according to the imputability. There was a significant difference (p=0.0041) between FNHTR (probable imputability, infection) group and control group, and more significant difference (p=0.0008) was seen between FNHTR (probable imputability, febrile neutropenia) group and control group. CONCLUSIONS Those results indicated that HPA-2 might play roles on inducing FNHTR in patients suffering from infectious diseases and febrile neutropenia. HPA-2 genotyping between donors and recipients might be worth integrating in pre-transfusion testing to increase transfusion safety.
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Affiliation(s)
- Ding-Ping Chen
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan.
| | - Ying-Hao Wen
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Jang-Jih Lu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Ping Tseng
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Ling Chen
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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23
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Lee SW, Kumar Gn K, Kim TK. Unplanned readmissions after primary total knee arthroplasty in Korean patients: Rate, causes, and risk factors. Knee 2017; 24:670-674. [PMID: 28325552 DOI: 10.1016/j.knee.2016.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 05/09/2016] [Accepted: 05/24/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unplanned hospital readmissions are indicators of the quality and performance of a health care system, but data on early readmission after primary total knee arthroplasty (TKA) in the Asian population are limited. The purpose of this study was to determine the causes, risk factors, and rate of unplanned readmission after primary TKA at a single institution in Korea. METHODS We analyzed all primary TKAs from 2004 to 2013 using the data from our institutional electronic database. A total of 4596 TKAs were performed on 3049 patients. All unplanned readmissions within 30 and 90days of discharge were identified, categorized into arthroplasty-related, medical, and other orthopedic causes. RESULTS The overall unplanned readmission rate was 1.9% (n=59) within 30days and 3.3% (n=101) within 90days, and both the 30 and 90day readmission rates remained stable over the entire study period. The majority of readmissions involved arthroplasty-related causes; the most common cause being wound problems, accounting for 22% (13/59) within 30days and 24% (24/101) within 90days. Age (P=0.029) and hypertension (P=0.021) were identified as risk factors for unplanned readmissions after TKA. CONCLUSION This study demonstrates that unplanned readmissions after TKA are not infrequent in Korean patients and has identified wound complication as the most frequent cause of unplanned readmissions. Optimized care systems should be established to minimize unplanned readmissions, particularly for patients with high risk factors.
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Affiliation(s)
- Seon Woo Lee
- Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kiran Kumar Gn
- Department of Orthopaedic Surgery, Apollo BGS Hospital Mysore, Karnataka, India
| | - Tae Kyun Kim
- Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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24
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Michelet D, Julien-Marsollier F, Hilly J, Diallo T, Vidal C, Dahmani S. Predictive factors of intraoperative cell salvage during pediatric scoliosis surgery. Cell saver during scoliosis surgery in children. Anaesth Crit Care Pain Med 2017; 37:141-146. [PMID: 28546128 DOI: 10.1016/j.accpm.2017.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/17/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Blood-saving strategy during spinal surgery in children often includes recombinant erythropoietin (rEPO) and antifibrinolytic therapapy (AFT). The aim of this study was to investigate the efficacy of intraoperative blood salvage in decreasing homologous blood transfusion. MATERIAL AND METHODS Using the prospective data from patients operated during a one year period for scoliosis correction, we calculate the predictable hematocrit at day postoperative 1 without the use of blood salvage and compare it to the target hematocrit transfusion according to patient's status. Predictors analyzed were: age, weight, surgical indication, Cobb's angle, ASA status, preoperative hemoglobin, number of level fused, sacral fusion and thoracoplasty. Statistical analyses were performed using a classification tree analysis. RESULTS This study included 147 patients. Blood salvage was estimated avoiding homologous blood transfusion in 17 patients. Predictors of the efficacy of blood salvage were: neuromuscular indications, number of level fused and BMI. Blood salvage was found totally ineffective in: patients with no neuromuscular diseases with either: surgeries interesting<13 levels fused or surgeries interesting>13 levels with a preoperative BMI ≥ 21. In all other cases, blood salvage can decrease homologous transfusion. The model exhibited 97% of accurate for the prediction if the inefficacy of blood salvage. The AUCROC of the model was 0.93 [95% confidence interval 0.9 to 0.99] and the overall validation was 60.1% of explained variability. CONCLUSION The present study indicates that blood salvage is ineffective under certain circumstances. More studies are mandatory to confirm these results.
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Affiliation(s)
- Daphné Michelet
- Department of anaesthesia and Intensive care, Robert-Debré University Hospital, 75019 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75019 Paris, France; DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France
| | - Florence Julien-Marsollier
- Department of anaesthesia and Intensive care, Robert-Debré University Hospital, 75019 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75019 Paris, France; DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France
| | - Julie Hilly
- Department of anaesthesia and Intensive care, Robert-Debré University Hospital, 75019 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75019 Paris, France; DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France
| | - Thierno Diallo
- Department of anaesthesia and Intensive care, Robert-Debré University Hospital, 75019 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75019 Paris, France; DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France
| | - Christophe Vidal
- Department of pediatric orthopedic surgery, Robert-Debré University Hospital, 75000 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75019 Paris, France; DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France
| | - Souhayl Dahmani
- Department of anaesthesia and Intensive care, Robert-Debré University Hospital, 75019 Paris, France; Paris Diderot University (Paris VII), PRES Paris Sorbonne Cité, 75019 Paris, France; DHU PROTECT, Inserm U1141, Robert-Debré University Hospital, 75019 Paris, France.
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Soares JM, Queiroz AGV, Queiroz VKPD, Falbo AR, Silva MN, Couceiro TCDM, Lima LC. [Anesthesiologists' knowledge about packed red blood cells transfusion in surgical patients]. Rev Bras Anestesiol 2016; 67:584-591. [PMID: 27745700 DOI: 10.1016/j.bjan.2016.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 09/13/2016] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Blood is an important resource in several lifesaving interventions, such as anemia correction and improvement of oxygen transport capacity. Despite advances, packed red blood cell (PRBC) transfusion still involves risks. The aim of this study was to describe the knowledge of anesthesiologists about the indications, adverse effects, and alternatives to red blood cell transfusion intraoperatively. METHOD Cross-sectional study using a questionnaire containing multiple choice questions and clinical cases related to relevant factors on the decision whether to perform PRBC transfusion, its adverse effects, hemoglobin triggers, preventive measures, and blood conservation strategies. The questionnaire was filled without the presence of the investigator. Likert scale was used and the average rank of responses was calculated. The Epi Info 7 software was used for data analysis. RESULTS 79% of the institution's anesthesiologists answered the questionnaire; 100% identified the main adverse effects related to blood transfusion. When asked about the factors that influence the transfusion decision, hemoglobin level had the highest agreement (MR=4.46) followed by heart disease (MR=4.26); hematocrit (MR=4.34); age (RM=4.1) and microcirculation evaluation (MR=4.22). Respondents (82.3%) identified levels of Hb=6g.dL-1 as a trigger to transfuse healthy patient. Regarding blood conservation strategies, hypervolemic hemodilution (MR=2.81) and decided by drugs (MR=2.95) were the least reported. CONCLUSION We identify a good understanding of anesthesiologists about PRBC transfusion; however, there is a need for refresher courses on the subject.
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Affiliation(s)
- Joyce Mendes Soares
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brasil
| | | | | | - Ana Rodrigues Falbo
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brasil
| | - Marcelo Neves Silva
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brasil
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Complications of Transfusion. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Philip J, Biswas AK, Hiregoudar S, Kushwaha N. Red blood cell alloimmunization in multitransfused patients in a tertiary care center in Western India. Lab Med 2016; 45:324-30. [PMID: 25316664 DOI: 10.1309/lmucv97yuwqkahu4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To investigate the seroprevalence and specificity of red blood cell (RBC) antibodies in multitransfused patients, in whom the risk of alloimmunization is especially high. METHODS We conducted a retrospective study on blood specimens from 200 multitransfused patients. We evaluated all specimens for alloimmunization using various immunohematological tests via the column agglutination technique. RESULTS The overall prevalence of RBC alloantibodies was 5.5%. Of the 11 specific types of alloantibodies identified, most (72.7%) belonged to the Rh blood group system, followed by the S, M, and Lewis blood group systems (9.1% each). CONCLUSION Most alloantibodies were of the Rh blood group specificity. To improve the quality of blood supplied, especially to patients with thalassemia, we recommend that Rh phenotyped, cross-match-compatible blood should be issued to prevent complications such as acute and delayed hemolytic reactions.
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Affiliation(s)
- Joseph Philip
- Department of Immunohematology and Blood Transfusion, Armed Forces Medical College, Pune, Maharashtra, India
| | - Amit Kumar Biswas
- Department of Immunohematology and Blood Transfusion, Armed Forces Medical College, Pune, Maharashtra, India
| | - Sumathi Hiregoudar
- Department of Immunohematology and Blood Transfusion, Armed Forces Medical College, Pune, Maharashtra, India
| | - Neerja Kushwaha
- Department of Immunohematology and Blood Transfusion, Armed Forces Medical College, Pune, Maharashtra, India
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Hofbauer N, Windberger U, Schwendenwein I, Tichy A, Eberspächer E. Evaluation of canine red blood cell quality after processing with an automated cell salvage device. J Vet Emerg Crit Care (San Antonio) 2016; 26:373-83. [DOI: 10.1111/vec.12472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 09/29/2014] [Accepted: 10/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Nina Hofbauer
- Department of Anesthesiology and Perioperative Intensive Care; University of Veterinary Medicine; Vienna Austria
| | - Ursula Windberger
- Decentralized Biomedical Facilities of the Medical University of Vienna; Vienna Austria
| | - Ilse Schwendenwein
- Department of Pathobiology, Central Laboratory; University of Veterinary Medicine; Vienna Austria
| | - Alexander Tichy
- Department of Biomedical Sciences; University of Veterinary Medicine; Vienna Austria
| | - Eva Eberspächer
- Department of Anesthesiology and Perioperative Intensive Care; University of Veterinary Medicine; Vienna Austria
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Mazzeffi M, Greenwood J, Tanaka K, Menaker J, Rector R, Herr D, Kon Z, Lee J, Griffith B, Rajagopal K, Pham S. Bleeding, Transfusion, and Mortality on Extracorporeal Life Support: ECLS Working Group on Thrombosis and Hemostasis. Ann Thorac Surg 2016; 101:682-9. [DOI: 10.1016/j.athoracsur.2015.07.046] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/06/2015] [Accepted: 07/20/2015] [Indexed: 10/22/2022]
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Abstract
We have attempted to reduce blood use during the perioperative period to avoid complications associated with blood transfusions in pediatric patients undergoing open-heart surgery. We retrospectively reviewed clinical data of patients who underwent open-heart surgery (age < 15 years, body weight ≤ 30 kg) from January 2012 to October 2013. Our strategy to reduce transfusion volume included: (1) shortening the length of cardiopulmonary bypass (CPB) circuit, and adding red blood cells (RBC) to CPB circuit priming solution when preoperative hematocrit was ≤30%; (2) routine modified ultrafiltration in all patients; and (3) restricting RBC transfusions during postoperative period, given when hematocrit was ≤25%. In total, 349 cases were enrolled. The median age of patients was 7 months (1 day-168 months), and body weight was 7 kg (2.3-30 kg). We did not use blood products in 81 (23.2%) cases and did not add RBCs to CPB priming solution in 119 (34.1%) cases. Patients who did not require a transfusion showed a shorter intensive care unit (ICU) stays (0.97 ± 0.5 days) than patients who required a transfusion (4.1 ± 5.5 days, p = 0.003). Larger volume transfusion correlated with longer intubation durations, ICU and hospital stays, higher peak C-reactive protein levels, and an increased blood urea nitrogen/creatinine ratio. No significant problems were observed in patients with relatively lower hematocrit levels. Our strategy to reduce transfusion volume resulted in shorter ventilator support, ICU stay, hospitalization, reduced inflammatory reaction, and less kidney insult during the postoperative course in pediatric patients.
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Dupuis C, Michelet D, Hilly J, Diallo T, Vidal C, Delivet H, Nivoche Y, Mazda K, Dahmani S. Predictive factors for homologous transfusion during paediatric scoliosis surgery. Anaesth Crit Care Pain Med 2015; 34:327-32. [DOI: 10.1016/j.accpm.2015.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 04/10/2015] [Indexed: 02/02/2023]
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Burnouf T, Chou ML, Goubran H, Cognasse F, Garraud O, Seghatchian J. An overview of the role of microparticles/microvesicles in blood components: Are they clinically beneficial or harmful? Transfus Apher Sci 2015; 53:137-45. [PMID: 26596959 DOI: 10.1016/j.transci.2015.10.010] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Blood cells and tissues generate heterogeneous populations of cell-derived vesicles, ranging from approximately 50 nm to 1 µm in diameter. Under normal physiological conditions and as an essential part of an energy-dependent natural process, microparticles (MPs) are continuously shed into the circulation from membranes of all viable cells such as megakaryocytes, platelets, red blood cells, white blood cells and endothelial cells. MP shedding can also be triggered by pathological activation of inflammatory processes and activation of coagulation or complement systems, or even by shear stress in the circulation. Structurally, MPs have a bilayered phospholipid structure exposing coagulant-active phosphatidylserine and expressing various membrane receptors, and they serve as cell-to-cell shuttles for bioactive molecules such as lipids, growth factors, microRNAs, and mitochondria. It was established that ex vivo processing of blood into its components, involving centrifugation, processing by various apheresis procedures, leucoreduction, pathogen reduction, and finally storage in different media and different types of blood bags, can impact MP generation and content. This is mostly due to exposure of the collected blood to anticoagulant/storage media and due to shear stresses or activation, contact with artificial surfaces, or exposure to various leucocyte-removal filters and pathogen-reduction treatments. Such artificially generated MPs, which are added to the original pool of MPs collected from the donor, may exhibit specific functional characteristics, as MPs are not an inert element of blood components. Not surprisingly, MPs' roles and functionality are therefore increasingly seen to be fully relevant to the field of transfusion medicine, and as a parameter of blood safety that must be considered in haemovigilance programmes. Continual advancements in assessment methods of MPs and storage lesions are gradually leading to a better understanding of the impacts of blood collection on MP generation, while clinical research should clarify links of MPs with transfusion reactions and certain clinical disorders. Harmonization and consensus in sampling protocols, sample handling and processing, and assessment methods are needed to achieve consensual interpretations. This review focuses on the role of MPs as an essential laboratory tool and as a most effective player in transfusion science and medicine and in health and disease.
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Affiliation(s)
- Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.
| | - Ming-Li Chou
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hadi Goubran
- Saskatoon Cancer Centre, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Fabrice Cognasse
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France; GIMAP-EA3064, Université de Lyon, Saint Etienne, France
| | - Olivier Garraud
- Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France; Institut National de Transfusion Sanguine (INTS), Paris, France
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety, Audit/Inspection and DDR Strategy, London, UK.
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Aapro M, Moebus V, Nitz U, O'Shaughnessy J, Pronzato P, Untch M, Tomita D, Bohac C, Leyland-Jones B. Safety and efficacy outcomes with erythropoiesis-stimulating agents in patients with breast cancer: a meta-analysis. Ann Oncol 2015; 26:688-695. [DOI: 10.1093/annonc/mdu579] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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The use of an extracorporeal membrane oxygenation anticoagulation laboratory protocol is associated with decreased blood product use, decreased hemorrhagic complications, and increased circuit life. Pediatr Crit Care Med 2015; 16:66-74. [PMID: 25319630 DOI: 10.1097/pcc.0000000000000278] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine if a comprehensive extracorporeal membrane oxygenation anticoagulation monitoring protocol results in fewer hemorrhagic complications, reduced blood product usage, and increased circuit life. DESIGN In September 2011, we augmented our standard extracorporeal membrane oxygenation laboratory protocol to include anti-factor Xa assays, thromboelastography, and antithrombin measurements. We performed a retrospective chart review to determine outcomes for patients placed on extracorporeal membrane oxygenation prior to and after the initiation of our anticoagulation laboratory protocol. SETTING Tertiary care, academic children's hospital. PATIENTS All patients who were placed on extracorporeal membrane oxygenation at our institution from January 1, 2007, to September 30, 2013. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 261 extracorporeal membrane oxygenation runs before the initiation of the protocol and 105 extracorporeal membrane oxygenation runs after the initiation of the protocol. There were no major changes to our extracorporeal membrane oxygenation circuit or changes to our transfusion threshold during the study period. The indication for extracorporeal membrane oxygenation, age, and severity of illness of the patients were similar before and after protocol initiation. Median blood product usage for packed RBCs, fresh frozen plasma, platelets, and cryoprecipitate decreased significantly after protocol initiation. The occurrence of cannula site bleeding decreased from 22% to 12% (p = 0.04), and surgical site bleeding decreased from 38% to 25% (p = 0.02). Median extracorporeal membrane oxygenation circuit life increased from 3.6 to 4.3 days (p = 0.02). A trend toward increased patient survival was noted, but it did not reach statistical significance. CONCLUSIONS We demonstrate an association between an extracorporeal membrane oxygenation anticoagulation laboratory protocol using anti-factor Xa assays, thromboelastography, and antithrombin measurements and a decrease in blood product transfusion, a decrease in hemorrhagic complications, and an increase in circuit life. To our knowledge, this is the first study to demonstrate clinical benefit associated with the use of these laboratory values for patients on extracorporeal membrane oxygenation.
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Taher AT, Radwan A, Viprakasit V. When to consider transfusion therapy for patients with non-transfusion-dependent thalassaemia. Vox Sang 2015; 108:1-10. [PMID: 25286743 PMCID: PMC4302976 DOI: 10.1111/vox.12201] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 07/17/2014] [Accepted: 08/05/2014] [Indexed: 01/19/2023]
Abstract
Non-transfusion-dependent thalassaemia (NTDT) refers to all thalassaemia disease phenotypes that do not require regular blood transfusions for survival. Thalassaemia disorders were traditionally concentrated along the tropical belt stretching from sub-Saharan Africa through the Mediterranean region and the Middle East to South and South-East Asia, but global migration has led to increased incidence in North America and Northern Europe. Transfusionists may be familiar with β-thalassaemia major because of the lifelong transfusions needed by these patients. Although patients with NTDT do not require regular transfusions for survival, they may require transfusions in some instances such as pregnancy, infection or growth failure. The complications associated with NTDT can be severe if not properly managed, and many are directly related to chronic anaemia. Awareness of NTDT is important, and this review will outline the factors that should be taken into consideration when deciding whether to initiate and properly plan for transfusion therapy in these patients in terms of transfusion interval and duration of treatment.
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Affiliation(s)
- A T Taher
- American University of Beirut, Beirut, Lebanon
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36
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Abstract
The last 20 years have seen many advances in transfusion therapy and safety. Blood products are biological products engendering complex interactions with the immune system. Prestorage leukoreduction results in a reduced risk of febrile reactions, CMV transmission, and immune modulation, proving to be safer for patients than non-leuko reduced products. Simple patient identification issues and clerical error continue to be the primary causes of ABO-incompatible transfusions. Rigorous donor screening as well as serologic and nucleic acid testing for transfusion transmitted infection have brought the blood supply to a very safe level, although transmission of these agents continues to be a problem in underdeveloped countries. Emerging infectious diseases, beyond current laboratory detection capabilities, combined with global travel, pose unknown imminent risks everywhere. We also briefly discuss the current risks of transfusion-transmitted infections. We review currently available hemostatic blood products, their compositions, and their clinical indications; we mention product modifications currently in development; and we touch upon the hemostatic properties and drawbacks of whole blood, which is currently gaining popularity as an alternative to split blood products. We conclude with an in-depth overview of the risks associated with transfusion, including incompatibility, hemolytic transfusion reactions, transfusion-associated circulatory overload (TACO), and transfusion-related acute lung injury (TRALI).
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Affiliation(s)
| | - Patrick Schoettker
- Department of Anesthesiology, University Hospital of Lausanne, Lausanne, Switzerland
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Menis M, Forshee RA, Anderson SA, McKean S, Gondalia R, Warnock R, Johnson C, Mintz PD, Worrall CM, Kelman JA, Izurieta HS. Febrile non-haemolytic transfusion reaction occurrence and potential risk factors among the U.S. elderly transfused in the inpatient setting, as recorded in Medicare databases during 2011-2012. Vox Sang 2014; 108:251-61. [DOI: 10.1111/vox.12215] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/25/2014] [Accepted: 09/30/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. Menis
- Food and Drug Administration; Silver Spring MD USA
| | | | | | | | | | | | | | - P. D. Mintz
- Food and Drug Administration; Silver Spring MD USA
| | - C. M. Worrall
- Centers for Medicare & Medicaid Services; Baltimore MD USA
| | - J. A. Kelman
- Centers for Medicare & Medicaid Services; Baltimore MD USA
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Clinical response and transfusion reactions of sheep subjected to single homologous blood transfusion. ScientificWorldJournal 2014; 2014:734397. [PMID: 25544959 PMCID: PMC4269081 DOI: 10.1155/2014/734397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 09/14/2014] [Indexed: 01/22/2023] Open
Abstract
Studies in relation to blood conservation and responses to transfusion are scarce for ruminants. We evaluated the clinical manifestations of sheep that received a single homologous transfusion of whole blood, focusing on transfusion reactions. Eighteen adult sheep were subjected to a single phlebotomy to withdraw 40% of the total blood volume, which was placed into CPDA-1 bags and then divided into G0, animals that received fresh blood, and G15 and G35, animals that received blood stored for 15 or 35 days, respectively. Clinical observations were recorded throughout the transfusion, whereas heart rate, respiratory rate, and rectal temperature were assessed at the following times: 24 hours after phlebotomy and before transfusion; 30 minutes, six, twelve, 24, 48, 72, and 96 hours and eight and 16 days after transfusion. All groups presented transfusion reactions, among which hyperthermia was the most frequent (50% of animals). Tachycardia occurred most frequently in the G35 animals (50% of them). During transfusion G35 animals presented more clinical manifestation (P < 0.05). Transfusion of fresh or stored total blood improved the blood volume, but transfusion reactions occurred, demonstrating that a single transfusion of fresh or stored blood can cause inflammatory and febrile nonhemolytic transfusion reactions in sheep.
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Elhence P, Solanki A, Verma A. Red blood cell antibodies in thalassemia patients in northern India: risk factors and literature review. Indian J Hematol Blood Transfus 2014; 30:301-8. [PMID: 25435732 PMCID: PMC4243402 DOI: 10.1007/s12288-013-0311-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 12/17/2013] [Indexed: 01/28/2023] Open
Abstract
Study of the factors responsible for red cell alloimmunization can help in adopting appropriate strategy to minimize alloimmunization. However data for thalassemia patients from our region is limited. Therefore, a study was conducted to find out the frequency and the factors associated with red cell allo and autoimmunization in thalassemia patients at our center so as to enable us to take appropriate action to reduce alloimmunization. Clinical, demographic, allo and autoantibody and transfusion records of 280 thalassemia patients at our hospital were studied. Patients with and without alloantibodies were compared to find significant differences for age, gender, race, age at start of regular transfusions and splenectomy. Red cell antigen frequencies in thalassemia patients and published antigen frequencies in blood donors from the same center were compared to look antigen differences as a risk factor for alloimmunization. Twenty four thalassemia patients (8.6 %) developed 28 clinically significant alloantibodies. 18 (65 %) of the alloantibodies were of Rh system. The three most common antibodies detected was anti E (11, 39.3 %) followed by anti K (6, 21.4 %) and anti c (10.8 %). Five (1.8 %) of the 280 patients developed autoantibodies. Patient age was found to be significantly higher in alloimmunized patients than in non alloimmunized patients. Red cell antigen frequencies between blood donor and recipient populations were found to be homogenous for most of the relevant RBC antigens. The frequency of red cell alloimmunization in thalassemia patients from our center is moderate. In this setting of red cell phenotype concordant donor-recipient population requirement of extended phenotype matched transfusions may not be cost effective.
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Affiliation(s)
- Priti Elhence
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 India
| | - Archana Solanki
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 India
| | - Anupam Verma
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014 India
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Harvey AR, Basavaraju SV, Chung KW, Kuehnert MJ. Transfusion-related adverse reactions reported to the National Healthcare Safety Network Hemovigilance Module, United States, 2010 to 2012. Transfusion 2014; 55:709-18. [PMID: 25371300 DOI: 10.1111/trf.12918] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND In 2010, health care facilities in the United States began voluntary enrollment in the National Healthcare Safety Network (NHSN) Hemovigilance Module. Participants report transfusion practices; red blood cell, platelet (PLT), plasma, and cryoprecipitate units transfused; and transfusion-related adverse reactions and process errors to the Centers for Disease Control and Prevention through a secure, Internet-accessible surveillance application available to transfusing facilities. STUDY DESIGN AND METHODS Facilities submitting at least 1 month of transfused components data and adverse reactions from January 1, 2010, to December 31, 2012, were included in this analysis. Adverse reaction rates for transfused components, stratified by component type and collection and modification methods, were calculated. RESULTS In 2010 to 2012, a total of 77 facilities reported 5136 adverse reactions among 2,144,723 components transfused (239.5/100,000). Allergic (46.8%) and febrile nonhemolytic (36.1%) reactions were most frequent; 7.2% of all reactions were severe or life-threatening and 0.1% were fatal. PLT transfusions (421.7/100,000) had the highest adverse reaction rate. CONCLUSION Adverse transfusion reaction rates from the NHSN Hemovigilance Module in the United States are comparable to early hemovigilance reporting from other countries. Although severe reactions are infrequent, the numbers of transfusion reactions in US hospitals suggest that interventions to prevent these reactions are important for patient safety. Further investigation is needed to understand the apparent increased risk of reactions from apheresis-derived blood components. Comprehensive evaluation, including data validation, is important to continued refinement of the module.
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Affiliation(s)
- Alexis R Harvey
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sridhar V Basavaraju
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Koo-Whang Chung
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew J Kuehnert
- Office of Blood, Organ and Other Tissue Safety, Division of Healthcare Quality Promotion, National Center for Emerging, Zoonotic, and Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
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Farrell C, Hayes SC, Wire M, Zhang J. Population pharmacokinetic/pharmacodynamic modelling of eltrombopag in healthy volunteers and subjects with chronic liver disease. Br J Clin Pharmacol 2014; 77:532-44. [PMID: 24117976 DOI: 10.1111/bcp.12244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 01/17/2013] [Indexed: 12/29/2022] Open
Abstract
AIMS To characterize the pharmacokinetics (PK)/pharmacodynamics (PD) of eltrombopag in chronic liver disease (CLD). METHODS The PK/PD model was developed using data from 79 CLD patients using nonlinear mixed-effects modelling. RESULTS The PK of eltrombopag were described by a two-compartment model with dual sequential first-order absorption. Gender, race and severity of CLD were predictors of the apparent clearance of eltrombopag. The PD of eltrombopag in CLD were adequately described by a four-compartment lifespan model, in which eltrombopag stimulated platelet precursor production rate. East Asian CLD patients were less sensitive to the stimulatory effect of eltrombopag. Following a daily dose regimen of 50 mg eltrombopag, the time to achieve peak platelet counts was longer for the CLD population compared with patients who had immune thrombocytopenic purpura, but was comparable to patients with hepatitis C. Likewise, it took a longer time for platelet counts to rebound back to baseline once eltrombopag treatment was discontinued. CONCLUSIONS The time course of the platelet response in CLD was different from that in immune thrombocytopenic purpura but comparable to that in hepatitis C.
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Affiliation(s)
- Colm Farrell
- ICON Development Solutions, Marlow, Buckinghamshire, UK
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Menis M, Forshee RA, Anderson SA, McKean S, Gondalia R, Warnock R, Johnson C, Mintz PD, Worrall CM, Kelman JA, Izurieta HS. Posttransfusion purpura occurrence and potential risk factors among the inpatient US elderly, as recorded in large Medicare databases during 2011 through 2012. Transfusion 2014; 55:284-95. [DOI: 10.1111/trf.12782] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 05/28/2014] [Accepted: 06/01/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Mikhail Menis
- Food and Drug Administration; Silver Spring Maryland
| | | | | | | | | | | | | | - Paul D. Mintz
- Food and Drug Administration; Silver Spring Maryland
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Sandler SG, Eder AF, Goldman M, Winters JL. The entity of immunoglobulin A-related anaphylactic transfusion reactions is not evidence based. Transfusion 2014; 55:199-204. [PMID: 25066014 DOI: 10.1111/trf.12796] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/16/2014] [Accepted: 05/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
- S Gerald Sandler
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Washington, DC
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Cappell KA, Shreay S, Cao Z, Varker HV, Paoli CJ, Gitlin M. Red blood cell (RBC) transfusion rates among US chronic dialysis patients during changes to Medicare end-stage renal disease (ESRD) reimbursement systems and erythropoiesis stimulating agent (ESA) labels. BMC Nephrol 2014; 15:116. [PMID: 25015348 PMCID: PMC4112651 DOI: 10.1186/1471-2369-15-116] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 06/30/2014] [Indexed: 11/28/2022] Open
Abstract
Background Several major ESRD-related regulatory and reimbursement changes were introduced in the United States in 2011. In several large, national datasets, these changes have been associated with decreases in erythropoiesis stimulating agent (ESA) utilization and hemoglobin concentrations in the ESRD population, as well as an increase in the use of red blood cell (RBC) transfusions in this population. Our objective was to examine the use of RBC transfusion before and after the regulatory and reimbursement changes implemented in 2011 in a prevalent population of chronic dialysis patients in a large national claims database. Methods Patients in the Truven Health MarketScan Commercial and Medicare Databases with evidence of chronic dialysis were selected for the study. The proportion of chronic dialysis patients who received any RBC transfusion and RBC transfusion event rates per 100 patient-months were calculated in each month from January 1, 2007 to March 31, 2012. The results were analyzed overall and stratified by primary health insurance payer (commercial payer or Medicare). Results Overall, the percent of chronic dialysis patients with RBC transfusion and RBC transfusion event rates per 100 patient-months increased between January 2007 and March 2012. When stratified by primary health insurance payer, it appears that the increase was driven by the primary Medicare insurance population. While the percent of patients with RBC transfusion and RBC transfusion event rates did not increase in the commercially insured population between 2007 and 2012 they did increase in the primary Medicare insurance population; the majority of the increase occurred in 2011 during the same time frame as the ESRD-related regulatory and reimbursement changes. Conclusions The regulatory and reimbursement changes implemented in 2011 may have contributed to an increase in the use of RBC transfusions in chronic dialysis patients in the MarketScan dataset who were covered by Medicare plus Medicare supplemental insurance.
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Affiliation(s)
- Katherine A Cappell
- Truven Health Analytics, 777 East Eisenhower Parkway, Ann Arbor, MI 48108, USA.
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Transfusion practices in a neonatal intensive care unit in a city in Brazil. Rev Bras Hematol Hemoter 2014; 36:245-9. [PMID: 25031162 PMCID: PMC4207911 DOI: 10.1016/j.bjhh.2014.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 03/24/2014] [Indexed: 01/30/2023] Open
Abstract
Objective Newborn infants are the most heavily transfused population inside intensive care units. The hemoglobin level used to indicate the need of transfusions is not well established. The aim of this study was to evaluate transfusional practices in newborns in the neonatal intensive care units of one specific city. Methods Red blood cell transfusion practices of all transfused newborns in all five of the neonatal intensive care units of the city were analyzed. Data are reported as descriptive statistics, including numbers and percentages and means and standard deviation. Univariate analysis, followed by stepwise logistic regression was performed in respect to transfusional data and outcomes. Results A total of 949 patients were admitted to the intensive care units during the 12-month study period with 20.9% receiving at least one transfusion, most (62.4%) of whom received more than one transfusion. The mean number of transfusions per infant was 2.7 ± 2.16; in the liberal transfusion group the mean number was 1.59 ± 1.63 and in the restrictive group it was 1.08 ± 1.51. The mean hemoglobin and hematocrit levels were 9.0 g/dL (±1.4 g/dL) and 27.4% (±4.3%), respectively. The most common indications for blood transfusions were sepsis and prematurity. Conclusion This study shows that the characteristics and the transfusion practices for newborns admitted in the neonatal intensive care units of Juiz de Fora are similar to recent pubications. There was no significant reduction in the number of transfusions per child in the restrictive group compared to the liberal group. Restrictive transfusions are an independent risk factor for peri-intraventricular hemorrhages and death.
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Reim D, Kim YW, Nam BH, Kim MJ, Yook JH, Park YK, Roh SH, Yu WS, Bae JM. FAIRY: a randomized controlled patient-blind phase III study to compare the efficacy and safety of intravenous ferric carboxymaltose (Ferinject®) to placebo in patients with acute isovolemic anemia after gastrectomy - study protocol for a randomized controlled trial. Trials 2014; 15:111. [PMID: 24708660 PMCID: PMC3992134 DOI: 10.1186/1745-6215-15-111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/04/2014] [Indexed: 12/21/2022] Open
Abstract
Background Isovolemic anemia (decrease in hemoglobin concentration with normal or even increased blood volume) after gastric cancer surgery may negatively influence short- and long-term outcomes. Therefore correction of isovolemic postoperative anemia is supposed to be beneficial. This prospective randomized placebo-controlled multicenter trial is designed to evaluate the efficacy of ferric carboxymaltose administration with the primary end point of successful hemoglobin level increase by 2 g/dl at 12 weeks after randomization. Methods and design Gastric cancer patients after oncologic resection and postoperative hemoglobin level ≥ 7 g/dl to <10 g/dl at postoperative days 5 to 7 will be eligible for trial inclusion. After randomization, 450 patients (225 per group) are going to be subjected either to administration of ferric carboxymaltose (treatment group) or normal (0.9%) saline (placebo group). Patients will be blinded to the intervention. Patients will undergo evaluation for hemoglobin level, hematology and quality of life assessment 3 and 12 weeks after randomization. Discussion Correction of isovolemic postoperative anemia in gastric cancer patients after oncologic resection is considered to be beneficial. Administration of ferric carboxymaltose is considered to be superior to placebo for anemia correction without the possible risks of red blood cell transfusion. Further, improved quality of life for patients with quick recovery of hemoglobin levels is expected. Trial registration NCT01725789 (international: http://www.clinicaltrials.gov) and NCCCTS-12-644 (NCC, Korea).
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Affiliation(s)
| | - Young-Woo Kim
- Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang-si, Gyeonggi-do 411-769, Republic of Korea.
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Menis M, Anderson SA, Forshee RA, McKean S, Johnson C, Warnock R, Gondalia R, Mintz PD, Holness L, Worrall CM, Kelman JA, Izurieta HS. Transfusion-related acute lung injury and potential risk factors among the inpatient US elderly as recorded in Medicare claims data, during 2007 through 2011. Transfusion 2014; 54:2182-93. [PMID: 24673344 DOI: 10.1111/trf.12626] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/17/2014] [Accepted: 01/23/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is a serious complication leading to pulmonary edema and respiratory failure. This study's objective was to assess TRALI occurrence and potential risk factors among inpatient US elderly Medicare beneficiaries, ages 65 and older, during 2007 through 2011. STUDY DESIGN AND METHODS This retrospective claims-based study utilized large Medicare administrative databases. Transfusions were identified by recorded procedure and revenue center codes. TRALI was ascertained via ICD-9-CM diagnosis code. The study evaluated TRALI rates among the inpatient elderly overall and by calendar year, age, sex, race, blood components, and units transfused. Logistic regression analyses were used to assess potential risk factors. RESULTS Of 11,378,264 inpatient transfusion stays for elderly Medicare beneficiaries, 2556 had a recorded TRALI diagnosis code, an overall rate of 22.46 per 100,000 stays. TRALI rates were higher for platelet (PLT)- and plasma-containing transfusions and increased by year and number of units transfused (p < 0.0001). Significantly higher odds of TRALI were also found for persons ages 65 to 79 years versus more than 79 years (OR, 1.19; 95% confidence interval CI, 1.09-1.29), females versus males (OR, 1.26; 95% CI, 1.16-1.38), white versus nonwhite (OR, 1.43; 95% CI, 1.27-1.66), and with 6-month histories of postinflammatory pulmonary fibrosis (OR, 1.89; 95% CI, 1.52-2.20), tobacco use (OR, 1.16; 95% CI, 1.00-1.26), and other diseases. CONCLUSION Our study among the elderly suggests TRALI to be a severe event and identifies a substantially increased TRALI occurrence with greater number of units and with PLT- or plasma-containing transfusions. The study also suggests importance of underlying health conditions, prior recipient alloimmunization, and nonimmune mechanism in TRALI development among the elderly.
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Alloimmunization to Red Cells and the Association of Alloantibodies Formation with Splenectomy Among Transfusion-Dependent β-Thalassemia Major/HbE Patients. Indian J Clin Biochem 2014; 30:198-203. [PMID: 25883429 DOI: 10.1007/s12291-014-0424-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 01/26/2014] [Indexed: 01/19/2023]
Abstract
Severe hemolytic anemia in β-thalassemia major and β-thalassemias/HbE (β-TM) patients requires giving blood transfusions. Chronic blood transfusions lead to iron overload consequence with organs damage and risk of alloantibody-formation. This study evaluates the prevalence of red cell alloimmunization and estimates the risk of alloantibody-formation in chronic transfusion-dependent β-TM patients. This cross sectional study was conducted on 143 β-TM patients receiving regular transfusions. We tried to determine the frequency, types and factors influencing red cell alloimmunization in these transfusion-dependent β-TM patients. Median age of 25 (17.5 %) alloantibody-formation β-TM patients was 19.0 years (inter quartile 15.5-24.0 years). The alloantibodies were Anti-Rh (E) (13.1 %), Anti-Rh (D) (0.7 %). Thirty-four patients (23.8 %) of the sample had splenectomies of which 10 (29.4 %) had alloantibody-formation. The interval from first transfusion to antibody development varied from 1.5 to 14 years. Alloantibody-formation correlated with splenectomy and splenectomy correlated with number of transfusion (p < 0.005). In multiple logistic regression used to estimate the risk of alloantibodies formation with splenectomy; OR and 95 % CI were 2.88 (1.07-7.80), p = 0.037 after adjusting for other co-variates. The rate of red cell alloimmunization was 17.5 % and splenectomy associated with increased alloantibody-formation in these transfusion-dependent β-TM patients.
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Karim F, Moiz B, Shamsuddin N, Naz S, Khurshid M. Root cause analysis of non-infectious transfusion complications and the lessons learnt. Transfus Apher Sci 2014; 50:111-7. [DOI: 10.1016/j.transci.2013.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/27/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
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Kilic A, Whitman GJR. Blood transfusions in cardiac surgery: indications, risks, and conservation strategies. Ann Thorac Surg 2013; 97:726-34. [PMID: 24359936 DOI: 10.1016/j.athoracsur.2013.08.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/31/2013] [Accepted: 08/07/2013] [Indexed: 10/25/2022]
Abstract
Although red blood cell (RBC) transfusions are frequently used in cardiac operations, an increasing amount of data has demonstrated deleterious consequences. Consequently, the appropriate use of this limited resource is unclear. In this review, we discuss the relationship between anemia and the outcomes of cardiac surgical procedures, the risks associated with RBC transfusion, and the impact of blood transfusions on mortality and morbidity after cardiac operations. The review concludes with a discussion of randomized trials comparing restrictive versus liberal transfusion strategies and a consideration of blood conservation techniques.
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Affiliation(s)
- Arman Kilic
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Glenn J R Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
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