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ABSTRACT: Haemophilia is a complex disease to manage. Home-based management of haemophilia has placed greater responsibility for disease management on individuals with haemophilia, heightening the individual's need for knowledge, particularly among individuals with severe haemophilia. The aim of this study was to identify and understand the knowledge needs and gaps of Canadian men with severe haemophilia from the perspectives of health care providers. A qualitative approach was undertaken. Data were collected using semi-structured focus groups and interviews with health care providers from Haemophilia Treatment Centres (HTCs) across Canada; data were analysed using thematic analysis. Three focus groups and two interviews were conducted; 13 individuals participated in this study. Health care providers identified the following areas of knowledge required by men with severe haemophilia: disease pathology, causes and consequences of bleeds, bleed prevention, recognition, treatment, how and when to access support, activity selection and risk reduction, benefits of exercise, genetic inheritance patterns, impact on career selection, travel and ageing. Knowledge gaps and challenges to knowledge provision were highlighted. In addition, providers emphasized the influences of timing, rapport and context on readiness to receive and assimilate information and recommended tailoring education to the individual and creating a developmental curriculum and knowledge assessment tool. Provision and uptake of disease knowledge is essential to patient self-management. To effectively receive, retain and assimilate information, individuals with severe haemophilia require the right information, from the right source, at the right time. Education should be tailored to the needs of the individual, provided throughout the lifespan.
Haemophilia 04/2013; · 2.60 Impact Factor
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Haemophilia 01/2013; · 2.60 Impact Factor
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ABSTRACT: Red blood cell concentrates (RCCs) are the major blood component transfused to patients. There is a great variability in patient response, depending on both the patient's blood volume and haemoglobin content in the RCC. Standardisation of transfusion practice is needed to improve the prediction of patient outcome.
We hypothesise that labelling of RCCs with haemoglobin content will add possibilities for the standardisation of transfusion practice.
Data from multiple international transfusion services regarding haemoglobin content and weight or volume of RCC were collected and analysed. Results: We demonstrate a strong and highly significant correlation between haemoglobin content with both weight and volume of the RCCs. A linear regression model was used to assess these relationships, and it demonstrates how haemoglobin content can be estimated for different cell production processes.
We recommend the use of weight or volume of the RCCs as the basis of estimating haemoglobin in the RCC and postulate that this can be used in future studies to explore the effects of a haemoglobin dose-based transfusion system. As the weight - and sometimes the volume - of the blood bag is easily accessible, in contrast to direct haemoglobin measurements from each individual unit, this method is feasible and simple.
Transfusion Medicine 12/2010; 21(3):145-9. · 1.14 Impact Factor
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ABSTRACT: Red blood cell concentrates (RBCs) are the major blood component transfused. Although the haemoglobin content is variable, the transfusion dose is prescribed as units of red cell concentrates. Thus, by chance, large volume patients may receive a low haemoglobin dose and low volume patients may be transfused with haemoglobin-rich RBCs. The aim of this study was to evaluate whether the haemoglobin increment (grams per litre) in the patient can be predicted from the haemoglobin dose (in grams) transfused, with and without correction for estimated blood volume. If this is true, it may be possible to achieve the predicted transfusion outcome by selecting RBCs for each patient.
Haemodynamically stable patients scheduled for day treatment with transfusion of RBCs were recorded. A total of 52 transfusions episodes, 27 for women and 25 for men, were recorded. Blood volumes were estimated, haemoglobin content in the RBCs was measured before transfusion, and pre- and post-transfusion haemoglobin concentrations were obtained.
The haemoglobin content of the RBCs prepared for transfusion showed a wide range, varying from 38.7 g/unit to 69.0 g/unit. There were statistically significant correlations between haemoglobin concentration in the RBCs and haemoglobin increment in patients.
Post-transfusion increment in circulating haemoglobin can be predicted from the haemoglobin content of transfused cells, but knowledge of the patient's blood volume improves the accuracy of prediction. It may be feasible to select the high haemoglobin content RBC for patients with largest blood volume and vice versa.
Vox Sanguinis 03/2010; 99(1):71-6. · 2.86 Impact Factor
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ABSTRACT: Transfusion of a bacterially contaminated blood product can have serious consequences. We undertook an electronic survey of representative Canadian hospitals to determine current clinical and laboratory practices for investigating such reactions, prior to the development of national guidelines. There was considerable variability in symptoms and signs that would trigger investigation of possible contamination. The most frequent laboratory investigations performed were aerobic blood cultures of recipients and the residual component. If there is no residual product in the component bag, 36% of respondents would use a segment to perform testing. Guidelines could be helpful in improving and standardizing these practices.
Vox Sanguinis 03/2009; 96(2):157-9. · 2.86 Impact Factor
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ABSTRACT: Light transmission aggregometry (LTA) is commonly performed to assess individuals for bleeding disorders.
The goal was to evaluate the incidence and spectrum of platelet function abnormalities in a prospective cohort of individuals referred for bleeding disorder assessments after exclusion of thrombocytopenia and von Willebrand disease.
Subjects were healthy controls and patients from a prospective cohort of individuals referred for bleeding disorder assessments after exclusion of thrombocytopenia and von Willebrand disease. LTA was performed by standardized methods using platelet-rich plasma adjusted to 250x10(9) platelets L(-1). Maximal aggregation data were analyzed to determine the likelihood of detecting a platelet function disorder by LTA, and the sensitivity and specificity of LTA for platelet disorders.
The incidence of false positive LTA among subjects excluded of having bleeding disorders was similar to healthy controls. Abnormal LTA was more common in subjects with bleeding disorders and the likelihood of a bleeding disorder was significantly increased (odds ratio 32) when maximal aggregation was reduced with two or more agonists. Receiver operator curve analyses indicated that LTA had high specificity and moderate sensitivity for detecting inherited defects in platelet function and that the LTA agonists 1.25 microg mL(-1) collagen, 6 microM epinephrine, 1.6 mM arachidonic acid and 1.0 microM thromboxane analogue U44619 detected most inherited disorders with abnormal LTA.
LTA is valuable for detecting platelet function abnormalities among individuals referred for bleeding problems, particularly when the test indicates abnormal responses to multiple agonists.
Journal of Thrombosis and Haemostasis 02/2009; 7(4):676-84. · 5.73 Impact Factor
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N M Heddle
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ABSTRACT: Some of the basic principles behind evidence-based medicine have been known for many years; however, the concept and approach to integrating evidenced-based decision making into clinical practice on a day-to-day basis has only evolved over the past 15 years. This paper focuses on five important steps in evidence-based decision making: (1) the importance of a well-defined question; (2) ways to effectively search the scientific literature; (3) the process of critical appraisal for an article about therapy; (4) the role of clinical expertise, patient values, clinical circumstances and society's expectations in the decision-making process; and (5) continuous quality improvement of the process.
Vox Sanguinis 11/2006; 91(3):214-20. · 2.86 Impact Factor
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ABSTRACT: Advantages to storing whole blood-derived platelets (PLTs) as a pool for 7 days would include operational efficiencies and facilitation of bacterial testing and pathogen inactivation. The in vitro quality of pre-storage pooled PLTs stored for up to 7 days was assessed.
Leukoreduced PLTs were pooled before storage (5 units/pool) and stored for either 5 or 7 days. Samples were collected at the time of pooling and either on Day 5 (n=16-29) or on Day 7 (n=4-30) and tested for biochemical and activation markers and morphology and/or shape change. Control PLTs were stored individually for 5 or 7 days and then tested as indicated above.
The mean PLT counts (x10(9)/L) were similar: control PLTs, 1344 (464 SD); and prestorage pooled PLTs, 1327 (220 SD; p=0.93). On Day 5, the pH value was significantly lower (p<or=0.0001) for the prestorage pooled PLTs. Lactate and partial pressure of O2 (pO2) were significantly higher (p<or=0.003). On Day 7 of storage, significant differences were noted with pH, pCO2, and hypotonic shock all being lower with the prestorage pooled product, whereas pO2, lactate, and morphology scores were higher (p values all <0.03). Although significant differences were found, the magnitude of the difference would not be expected to impact on transfusion outcomes.
These results suggest that prestorage pooled PLTs can be stored for up to 7 days; however, studies are needed to ensure that the clinical benefit of PLTs stored as a pool is not inferior to those stored individually.
Transfusion 06/2005; 45(6):904-10. · 3.22 Impact Factor
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ABSTRACT: Prestorage pooling of whole blood-derived platelets (PLTs) would simplify bacterial detection. This study evaluated the in vivo effect of the prestorage pooling of PLTs stored for up to 5 days, by assessing the corrected count increment (CCI) 18 to 24 hours after transfusion of the product.
A randomized block noninferiority design was used. Eligible patients had chemotherapy-induced thrombocytopenia and were considered likely to need at least six PLT transfusions. For every block of two transfusion events, one consisted of PLTs stored individually and then pooled before transfusion, and the other was a product pooled before storage. The primary outcome was categorized as a successful (>4.5) or unsuccessful (<or=4.5) 18- to 24-hour posttransfusion CCI analyzed with a matched pair score test. A mixed-effect linear model estimated the mean difference in CCI between the two types of storage.
Twenty-three eligible patients received a total of 189 PLT transfusions. The median number of PLT transfusions was 7 (range, 0-27). Eighty-five complete transfusion pairs were used in the primary analysis. The proportions of transfusions leading to a CCI of greater than 4.5 was identical for both routine and PLTs pooled before storage (45/85=52.9%; relative risk, 1.00; lower limit of the one-sided 95% confidence interval [CI], 0.83). The estimate of the mean difference in CCI between pooled and routine storage (pooled-routine) was -0.45 (95% CI, -2.23 to 1.33; p=0.63).
These results provide evidence that storage of PLTs as a pool for up to 5 days results in posttransfusion CCIs that are not inferior to PLTs stored individually.
Transfusion 06/2005; 45(6):896-903. · 3.22 Impact Factor
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ABSTRACT: BACKGROUND: Advantages to storing whole blood–derived platelets (PLTs) as a pool for 7 days would include operational efficiencies and facilitation of bacterial testing and pathogen inactivation. The in vitro quality of pre-storage pooled PLTs stored for up to 7 days was assessed.STUDY DESIGN AND METHODS: Leukoreduced PLTs were pooled before storage (5 units/pool) and stored for either 5 or 7 days. Samples were collected at the time of pooling and either on Day 5 (n = 16-29) or on Day 7 (n = 4-30) and tested for biochemical and activation markers and morphology and/or shape change. Control PLTs were stored individually for 5 or 7 days and then tested as indicated above.RESULTS: The mean PLT counts (×109/L) were similar: control PLTs, 1344 (464 SD); and prestorage pooled PLTs, 1327 (220 SD; p = 0.93). On Day 5, the pH value was significantly lower (p ≤ 0.0001) for the prestorage pooled PLTs. Lactate and partial pressure of O2 (pO2) were significantly higher (p ≤ 0.003). On Day 7 of storage, significant differences were noted with pH, pCO2, and hypotonic shock all being lower with the prestorage pooled product, whereas pO2, lactate, and morphology scores were higher (p values all < 0.03). Although significant differences were found, the magnitude of the difference would not be expected to impact on transfusion outcomes.CONCLUSION: These results suggest that prestorage pooled PLTs can be stored for up to 7 days; however, studies are needed to ensure that the clinical benefit of PLTs stored as a pool is not inferior to those stored individually.
Transfusion 05/2005; 45(6):904 - 910. · 3.22 Impact Factor
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ABSTRACT: BACKGROUND: Prestorage pooling of whole blood–derived platelets (PLTs) would simplify bacterial detection. This study evaluated the in vivo effect of the prestorage pooling of PLTs stored for up to 5 days, by assessing the corrected count increment (CCI) 18 to 24 hours after transfusion of the product.STUDY DESIGN AND METHODS: A randomized block noninferiority design was used. Eligible patients had chemotherapy-induced thrombocytopenia and were considered likely to need at least six PLT transfusions. For every block of two transfusion events, one consisted of PLTs stored individually and then pooled before transfusion, and the other was a product pooled before storage. The primary outcome was categorized as a successful (>4.5) or unsuccessful (≤4.5) 18- to 24-hour posttransfusion CCI analyzed with a matched pair score test. A mixed-effect linear model estimated the mean difference in CCI between the two types of storage.RESULTS: Twenty-three eligible patients received a total of 189 PLT transfusions. The median number of PLT transfusions was 7 (range, 0-27). Eighty-five complete transfusion pairs were used in the primary analysis. The proportions of transfusions leading to a CCI of greater than 4.5 was identical for both routine and PLTs pooled before storage (45/85 = 52.9%; relative risk, 1.00; lower limit of the one-sided 95% confidence interval [CI], 0.83). The estimate of the mean difference in CCI between pooled and routine storage (pooled − routine) was −0.45 (95% CI, −2.23 to 1.33; p = 0.63).CONCLUSION: These results provide evidence that storage of PLTs as a pool for up to 5 days results in posttransfusion CCIs that are not inferior to PLTs stored individually.
Transfusion 05/2005; 45(6):896 - 903. · 3.22 Impact Factor
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ABSTRACT: A number of methodologic challenges arise in the analysis of bleeding data from clinical trials of PLT transfusion triggers. It is important to understand the assumptions and role of the various methods of analysis to interpret published trials and to design future studies appropriately.
The methods of analysis used for testing the effectiveness and safety of transfusion strategies are reviewed from several recent PLT transfusion trigger trials. The underlying assumptions of these methods are discussed, as well as the clinical interpretations of the resulting summary statistics. Four methods of analysis were applied to data from a large PLT transfusion trigger study to illustrate the differences in the interpretations that can arise from various approaches.
PLT transfusion trigger trials of patients with leukemia have based their primary analyses on 1) simple dichotomous classifications of whether or not at least 1 day of clinically important bleeding was experienced; 2) the time to the first day of clinically important bleeding; and 3) the proportion of days at risk with clinically important bleeding. Recurrent event methods provide a robust alternative approach to the analysis of this kind of data and should be considered if interest is in capturing the overall burden of bleeding over time. These four methods differ in the extent to which they utilize information on the number of days with bleeding and the temporal variation in bleeding patterns. Inferences drawn regarding the relative safety and efficacy of different transfusion triggers can vary depending on the method of analysis.
To rigorously design and analyze future PLT transfusion studies based on bleeding outcomes, it is important to have a clear understanding of the interpretation of the different ways of analyzing bleeding outcomes. The analysis strategy should be selected based on the clinical question being addressed.
Transfusion 09/2004; 44(8):1135-42. · 3.22 Impact Factor
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N M Heddle
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ABSTRACT: Most febrile nonhemolytic transfusion reactions (FNHTR) to platelets are caused by cytokines that accumulate in the product during storage. There have been numerous studies that have demonstrated high concentrations of leukocyte- and platelet-derived cytokines in stored platelet products. The mechanism of cytokine accumulation is not understood; however, recent studies have suggested that leukocyte apoptosis and/or monocyte activation during the manufacturing process may play a role. Additional support of cytokines as a cause of FNHTR is provided by a recently published randomized controlled trial that shows that removal of the supernatant plasma from platelets before transfusion significantly lowers the frequency of reactions and eliminates most of the severe reactions associated with platelet transfusions. Although cytokines appear to play a major role in causing platelet reactions, there is little evidence to support their role in causing erythrocyte reactions. Hence, it appears that most febrile nonhemolytic transfusion reactions to erythrocytes are probably the result of an incompatibility between leukocytes in the erythrocyte product and antibodies in the recipient's plasma. Recent studies have confirmed that the concentrations of proinflammatory cytokines in a wide variety of stored erythrocyte products are low. Also, there is no clinical evidence to suggest that the small quantities of cytokines present in stored erythrocyte products contribute to acute reactions to these products when transfused.
Current Opinion in Hematology 12/1999; 6(6):420-6. · 4.52 Impact Factor
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ABSTRACT: Recent data suggest that most reactions to platelets are caused by white cell (WBC)-derived cytokines that accumulate in the plasma portion of the component during storage. On the basis of this theory, the effectiveness of two interventions to prevent reactions, poststorage WBC reduction and plasma depletion, were compared.
A multiple crossover design was used, in which platelet components for transfusion to a patient randomly were WBC reduced after storage, or the plasma supernatant was removed. Adults >17 years of age, with a hematologic disease requiring platelet transfusion support, were eligible for the study. Patients were assessed for signs and symptoms characteristic of a reaction during, immediately after, and 1 hour after transfusion. Reactions were graded as mild, moderate, or severe. Interleukin 6 levels were also measured in the transfused platelet components.
There were 380 analyzable platelet transfusions to 30 patients. The frequency of reactions was 25.8 percent (48/186) in the transfusions of poststorage WBC-reduced platelets and 17.0 percent (33/194) in the transfusions of plasma-depleted platelets (p<0.008). The severity of the reaction was graded by the patient. Severe reactions occurred more frequently in connection with poststorage WBC-reduced platelets than with plasma-depleted platelets: 33.4 percent (16/48) versus 18.2 percent (6/33), respectively (p = 0.048). Regression analysis identified interleukin 6 as the most significant of the evaluated factors in its correlation with the risk of reaction.
Plasma removal is more effective than poststorage WBC reduction in preventing reactions, especially severe reactions to platelets.
Transfusion 03/1999; 39(3):231-8. · 3.22 Impact Factor
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ABSTRACT: There is debate in the literature about the frequency and importance of delayed transfusion reactions. This uncertainty could reflect the endpoints used (clinical or serological) and the type of study (typically retrospective or case series). In this report we describe a prospective investigation to determine the frequency of alloimmunization post transfusion and whether the alloantibody production is a laboratory event or has clinical relevance. A total of 2490 patients were transfused 11,218 red cell concentrates. One or more blood samples were collected within 7 d post transfusion and screened for serological evidence of alloimmunization. If any antibody was detected the patient's post-transfusion sample was screened for biochemical evidence of haemolysis and the patient's chart reviewed for documentation of clinical signs of a transfusion reaction. Post transfusion alloimmunization occurred in 2.6% of the patients (95% CI 2.1-3.6%), who had no detectable alloantibody in pre-transfusion testing. For those 86 patients (3.5%) with alloantibodies detectable pretransfusion, 8.9% (95% CI 3.6-17.4%) developed additional aloantibodies. The most common alloantibodies detected were anti-Jka, anti-E and anti-K. Despite the high frequency of serological evidence of delayed transfusion reactions, only one patient (0.05%) had clinical evidence of a delayed haemolytic transfusion reaction (95% CI 0.0-0.27%). Serological evidence of a delayed transfusion reaction is common; however, these reactions rarely cause clinical symptoms.
British Journal of Haematology 01/1996; 91(4):1000-5. · 4.94 Impact Factor
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N M Heddle
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ABSTRACT: Although febrile nonhemolytic transfusion reactions to erythrocytes and platelets are not life threatening, the clinical symptoms associated with them cause discomfort for the patient, result in the use of premedicative drugs, and utilize nursing and laboratory resources. For many years it was assumed that febrile nonhemolytic transfusion reactions were caused by an interaction between leukocyte antibody in the patient's plasma and leukocytes present in the transfused product. Thus prevention has focused on the removal of leukocytes from the blood product by centrifugation or filtration just prior to transfusion. Recent data suggest that most febrile nonhemolytic transfusion reactions to platelets do not involve an immune-mediated event but are caused by the accumulation of biologic response modifiers in the platelet product during storage. Potential biologic response modifiers that have been investigated include histamine, lipids, complement fragments, and cytokines. The concentrations of these substances have been shown to increase in erythrocytes or platelet products or both during storage, and there is some clinical evidence that supports an association between elevated cytokine levels and the risk of reaction. If biologic response modifiers play a major role in febrile nonhemolytic transfusion reactions to platelets, then interventions to prevent these reactions should focus on ways to stop production of these substances or on mechanisms to remove these substances from the platelet product before transfusion. Possible interventions include prestorage leukoreduction, plasma removal from the platelet product before transfusion, and reduction of the platelet storage period to 3 days. Clinical studies to identify the most effective approach for preventing febrile nonhemolytic transfusion reactions have not yet been reported.
Current Opinion in Hematology 12/1995; 2(6):478-83. · 4.52 Impact Factor
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ABSTRACT: Typically the serological diagnosis of alloimmune haemolytic disease of the newborn (HDN) includes a positive direct antiglobulin test on the infant's red cells, and the presence of an IgG red cell alloantibody in both maternal and cord sera. HDN with a negative direct antiglobulin test has been reported with anti-A and anti-B, but not with other red-cell alloantibodies. In this report we describe four examples of HDN in infants whose red cells had a negative direct antiglobulin test. The first case was diagnosed retrospectively when the infant was admitted to hospital aged 3 weeks with severe anaemia and cardiac failure, and subsequently died. Maternal and infant sera were both shown to contain anti-C: however, the direct antiglobulin test on the infant's red cells was negative. Approximately 1 year later the mother of this infant gave birth to triplets: soon after birth one of the triplets required an exchange transfusion, one had hyperbilirubinaemia, and the third was unaffected. Anti-C and anti-e were detectable in the maternal serum at this time. The most probable Rh genotypes of the two affected infants were R1R2 (CDe/cDE), while the Rh genotype of the unaffected infant was R2R2 (cDE/cDE). Anti-c was implicated as causing HDN in a fourth infant (from a different family) who was a hydropic stillborn. The direct antiglobulin test on fetal blood was negative and other causes of non-immune hydrops were excluded. These four infants provide evidence that the direct antiglobulin test may be negative in some severely affected and even fatal cases of HDN.
Transfusion Medicine 07/1995; 5(2):113-6. · 1.14 Impact Factor
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Blood 03/1995; 85(3):603-6. · 9.90 Impact Factor
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ABSTRACT: Patients undergoing induction chemotherapy for acute leukaemia often become refractory to platelet transfusions. Increased clearance of transfused platelets due to alloimmune destruction has been identified as one of the primary mechanisms contributing to this refractory state. We performed a double-blind randomized trial to determine whether the administration of anti-D to Rh-positive individuals could prevent the refractory state and improve post-transfusion platelet response. Rh-positive patients with acute leukaemia undergoing induction chemotherapy and requiring platelet transfusions were allocated to weekly intravenous anti-D (20 micrograms/kg) or placebo. Platelets and red cell concentrates were administered according to standardized transfusion guidelines. Outcome measures included platelet transfusion utilization, red cell utilization, platelet recovery 18-24 h post-infusion, and the percentage of patients refractory to platelet transfusion. There were 43 patients studied: 21 received anti-D and 22 saline placebo. The mean number of platelet concentrates required per day of observation was 0.59 (SD 0.22) in the anti-D group and 0.61 (SD 0.22) in the placebo group, P = 0.86. No difference was detected between groups in terms of platelet recovery post-infusion, refractoriness to platelet transfusion or frequency of infection (P = 0.97). Red cell concentrate utilization was significantly increased in the anti-D group compared to the placebo group, 0.58 units per day versus 0.37 units per day respectively, P = 0.005. We conclude that the use of anti-D did not improve post-transfusion platelet response in Rh positive patients with acute leukaemia, but did result in an increased need for red cell transfusion.
British Journal of Haematology 02/1995; 89(1):163-8. · 4.94 Impact Factor
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ABSTRACT: A considerable literature has accumulated over the past decade indicating that leukocytes present in allogeneic cellular blood components, intended for transfusion, are associated with adverse effects to the recipient. These include the development of febrile transfusion reactions, graft-versus-host disease, alloimmunization to leukocyte antigens, and the immunomodulatory effects that might influence the prognosis of patients with a malignancy. Moreover, it has become evident that such leukocytes may be the vector of infectious agents such as CMV, HTLV-I/II, and EBV as well as other viruses. An interesting development that has occurred coincidentally in transfusion medicine is that agencies responsible for the provision of blood products are being designated manufacturers of biologicals. The trend among manufacturers of biologicals is to try to produce pure products to provide for the specific therapeutic need of patients. Thus, with the realization that allogeneic leukocytes and their products may have adverse biologic activities, there is increasing pressure from various sources for the reduction of the leukocyte content in allogeneic blood components to minimize the occurrence of their adverse effects. Although the threshold leukocyte number below which these effects might no longer occur is still to be determined, a 2 to 3 log10 leukocyte reduction, provided by the currently available commercial leukocyte filters, has been shown to reduce the frequency of many of such reactions. On the other hand, the immunosuppressive effects produced by the infusion of allogeneic leukocytes might be beneficial for some patients, ie, for the maintenance of kidney allografts, in possibly reducing the relapse rate in patients with inflammatory bowel diseases, and in ameliorating recurrent spontaneous abortion. Moreover, therapeutic granulocyte transfusions may be of benefit in certain well-defined categories of patients infected with bacteria, yeast, and/or fungi. These include neonates with bacterial sepsis associated with bone marrow failure as well as severely neutropenic leukemic patients with an infection unresponsive to appropriate and specific antibiotic therapy. Many of the results obtained with the use of leukocyte depletion filters are tantalizing, but the actual clinical benefit of leukodepletion has not been established in most instances, because much of the available data are retrospective or from uncontrolled clinical trials. Moreover, issues of cost-effectiveness and quality control have not been considered adequately. Properly designed prospective clinical trials are essential to provide data with which to answer such questions and also to help define the optimal conditions required for the preparation of blood components ultimately destined for clinical use. Only with the availability of such data can sound decisions be made about the clinical value of leukodepletion.
Blood 10/1994; 84(6):1703-21. · 9.90 Impact Factor
