Blood still kills: six strategies to further reduce allogeneic blood transfusion-related mortality.
ABSTRACT After reviewing the relative frequency of the causes of allogeneic blood transfusion-related mortality in the United States today, we present 6 possible strategies for further reducing such transfusion-related mortality. These are (1) avoidance of unnecessary transfusions through the use of evidence-based transfusion guidelines, to reduce potentially fatal (infectious as well as noninfectious) transfusion complications; (2) reduction in the risk of transfusion-related acute lung injury in recipients of platelet transfusions through the use of single-donor platelets collected from male donors, or female donors without a history of pregnancy or who have been shown not to have white blood cell (WBC) antibodies; (3) prevention of hemolytic transfusion reactions through the augmentation of patient identification procedures by the addition of information technologies, as well as through the prevention of additional red blood cell alloantibody formation in patients who are likely to need multiple transfusions in the future; (4) avoidance of pooled blood products (such as pooled whole blood-derived platelets) to reduce the risk of transmission of emerging transfusion-transmitted infections (TTIs) and the residual risk from known TTIs (especially transfusion-associated sepsis [TAS]); (5) WBC reduction of cellular blood components administered in cardiac surgery to prevent the poorly understood increased mortality seen in cardiac surgery patients in association with the receipt of non-WBC-reduced (compared with WBC-reduced) transfusion; and (6) pathogen reduction of platelet and plasma components to prevent the transfusion transmission of most emerging, potentially fatal TTIs and the residual risk of known TTIs (especially TAS).
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ABSTRACT: The Intercept Blood System(TM) (Cerus) is used to inactivate pathogens in platelet concentrates (PC). The aim of this study was to elucidate the extent to which the Intercept treatment modifies the functional properties of platelets.
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ABSTRACT: Postoperative bleeding after cardiac reoperations is among the most complicating problems, both for the physicians and for the patients. Many modalities have been used to decrease its adverse effects and the need for blood products administration. In a randomized double-blinded clinical trial of redo cardiac valve surgery in adult, the effect of active recombinant factor VII (rFVIIa) on postoperative bleeding was compared with placebo. Chest tube drainage was used for comparison of bleeding between the two groups. Two groups of 18 patients undergoing redo valve surgeries were treated and compared regarding chest tube drainage, need for blood products, prothrombin time (PT), partial thromboplastin time (PTT), hemoglobin and hematocrit, platelet count, and international normalized ratio (INR) in first 24 hours after surgery. Bleeding was assessed at 3rd, 12th, and 24th hour after operation. In rFVIIa group, 40 µg/kg of AryoSeven was administered before end of surgery and same volume of normal saline was administered as placebo in the control group. Study groups showed no difference regarding baseline variables. Three patients in rFVIIa group (16.67%) and 13 in placebo group (72.23%) received blood products (P < 0.01). Chest tube blood drainage at 24th hour after operation was 315 ± 177 mL in rFVIIa group and 557 ± 168 mL in control group (P = 0.03). At third and 12th hour after operation, the difference was not statistically significant (P = 0.71 and P = 0.22, respectively). Postoperative ICU stay was not different; while extubation was longer in the placebo group (352 ± 57 vs. 287 ± 46 minutes; P = 0.003). Our study demonstrated the efficacy of rFVIIa in controlling postoperative bleeding in redo cardiac valve surgeries regarding subsequent blood loss and transfusion requirement; however, outcome results remains to be defined.02/2015; 5(1). DOI:10.5812/aapm.22846
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ABSTRACT: Previous studies have indicated that medical trainees receive inadequate instruction in transfusion medicine and that this translates into insufficient transfusion knowledge throughout medical practice. We undertook to assess transfusion knowledge among internal medicine trainees in a single institution using a standardized oral examination case. A case of an adult with clear requirement for red blood cell transfusion was created. The case was reviewed by content experts and pilot tested on hematology trainees in their fifth postgraduate training year. The case was administered to internal medicine trainees in their first to fourth postgraduate years as part of a larger examination that is mandatory for all internal medicine trainees in our center. Scores on the transfusion case were assessed for each examinee. Seventy-three residents participated in the examination and completed the transfusion objective structured clinical examination (OSCE) case. The mean score on this case was 6.6 of 10 with 31.5% of examinees failing this case. Scores did not differ as a function of increasing years of training. This study again indicated that transfusion knowledge is poor among internal medicine trainees and that this does not improve with increasing number of years of training. Innovative strategies for transfusion education are urgently needed and should be rigorously assessed for efficacy.Transfusion 12/2013; 54(6). DOI:10.1111/trf.12508 · 3.57 Impact Factor