Science topic

Blood Transfusion - Science topic

The introduction of whole blood or blood component directly into the blood stream. (Dorland, 27th ed)
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On screening If MNS blood grouping is incompatible, can the blood go forward for blood transfusion?
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It depends on the immunological statute of the recipient.
1. If the recipient is immunized against MNS antigens (mainly MNS3 and MNS4), anti-MNS3 and anti-MNS4 are clinically significant, they cause post-transfusion haemolytic reactions and haemolytic disease of the fetus/new born. So, in this situation the RBC’s units selected must be negative for these antigens and must show negative reaction when tested with recipient serum
2. If the recipient is not immunized, it's not necessary to select compatible RBC’s units for MNS antigens
3. Except for sickle anaemia patients which are at a high risk of immunization. It’s really recommended to select compatible RBC’s units for the RH, KEL, Duffy, KIDD and MNS antigens for these patients even if they are not immunized.
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Though on emergency the blood transfusion is proven medically, the genetic factors like DNA, RNA etc cannot be the same. How come the body accepts or manage or else whether the transferred blood is rejected or destroyed or excreted. Is there any evidence?
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Human RBCs are un-nucleated ( No nucleus ) and follows the Human blood group system i.c. ABO, Rh, kell Duffy ..etc . So RBCs can be transfuse without DNA matching . Nucleated cells of the body fallow HLA cell typing . If human RBCs are nucleated, blood transfusion is as complicated as organ transplant ( kidney , liver , etc )
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Blood Substitutes for Paediatric use, to avoid Blood Transfusions
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The two major types of blood substitutes are volume expanders (Saline, Alba (DSC) ,Albuked.,albumin IV,Albuminar (DSC), Albuminex, Albutein, dextran and Flexbumin.)
that are used to replace lost plasma volume, and oxygen therapeutics, which are agents designed to replace oxygen normally carried by hemoglobin in red blood cells.
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With the limited human activities under COVID-19, blood donation is also affected. In endemic places with high prevalence of COVID-19, what criteria should be set for eligible blood donor?
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Have a look at this useful RG link.
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considering the blood transfusion reactions , what would be the recommendation for the safe rate to start PRBC transfusion during hemodialysis ? our current practice is to be given in 30 min to 1hour and in first 15 min 50ml /hour.
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Watch for 5 minutes for transfusion adverse effect , than you can transfuse as fast as required for maintained the critical parameters
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With high ferritin and high LDH we assume that there is significant hemolysis with some Covid-19 + patients. Is there any research whether blood transfusion is helpful in some cases? .
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I fallowing
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Can SARS-CoV-2, the virus that causes COVID-19, be transmitted by blood transfusion?
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Have a look at the following RG link.
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1.5 yr (m) baby with low Hb,MCV,MCH,MCHC and raised RDW-CV, Serum Iron ,TIBC, Plateletes and mildly raiseed TLC.
No hx of blood transfusion ,LFTs not done yet.
My query is If Serum Iron level is high so TIBC should be low and vice versa . In what circumstances will both Serum Iron and TIBC will be high ?
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The result of blood indexes shows micocytic and hypochromic anaemia feature of iron deficiency, that means serum iron should be lower, but if patient on iron supplement could increase serum iron and saturated: unsaturated iron ratio.
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Could SARS-CoV-2 be transmitted by blood transfusion?
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Certainly
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Looking at the fact that the COVID 19 is a novel pathogen and scientists across the world are yet to fully understand the virus, the question of whether this novel virus would affect the current blood transfusion processes or protocols cannot be ignored. Please any ideas on how this virus could affect blood transfusion protocols?
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The Essential Role of Patient Blood Management in a Pandemic
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I have a dataset containing 130patients who underwent surgery. I was determining the effect of intraop blood transfusion on post-op respiratory complications and NIV use.
ROC for transfusion Vs none has AUC of 0.67.
I would like to know what should be the sample size to improve this ROC and how to figure it out on SPSS.
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Dear Kammar,
As per my little understanding, the term ROC stands for Receiver Operating Characteristic. ROC curves were first employed in the study of discriminator systems for the detection of radio signals in the presence of noise in the 1940s, following the attack on Pearl Harbor.
ROC curves are frequently used to show in a graphical way the connection/trade-off between clinical sensitivity and specificity for every possible cut-off for a test or a combination of tests. In addition, the area under the ROC curve gives an idea about the benefit of using the test(s) in question. 
ROC curves are used in clinical biochemistry to choose the most appropriate cut-off for a test. The best cut-off has the highest true positive rate together with the lowest false positive rate.  
As the area under an ROC curve is a measure of the usefulness of a test in general, where a greater area means a more useful test, the areas under ROC curves are used to compare the usefulness of tests.
Now ROC curves are frequently used to show the connection between clinical sensitivity and specificity for every possible cut-off for a test or a combination of tests. In addition, the area under the ROC curve gives an idea about the benefit of using the test(s) in question.
Hope the followings help you to chalk out your problems to determine or calculate the sample size in a very brilliant way.
Please find the manual "Sample size determination" as an attached file.
Happy researching..
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Fluid therapy and blood transfusion is quite a challenge during lung transplantation. Too much fluid results in pulmonary edema and too little causes hemodynamic instability, what is your protocol?
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I am unaware of any benefits of intravenous fluids. There is no evidence that they increase cardiac output or tissue perfusion. They only transiently elevate blood pressure by altering the diastolic turbulence that generates the lateral force that is measured as blood pressure. They confer only harmful effects. 100 years ago George Washington Crile demonstrated that crystalloids rapidly depart the vasculature and are transported by lymph drainage to the bowel, which swells like a sausage and presses on the underside of the diaphragm and undermines breathing. Such fluid accumulation can dangerously disrupt bowel repairs. Intravenous fluids disrupt the glycocalyx that coats the inner walls of blood vessels. Excessive IV fluids aggravate atelectasis, undermine gas exchange, inhibit coagulation, and exaggerate surgical blood loss. Before needle technology enabled intravenous access in the 1930's, thousands of major surgical procedures were accomplished with remarkable safety without the benefit of intravenous fluids or blood transfusions. Intravenous access required a "cutdown" procedure that was beyond the scope of most anesthesia practice.
With regard to blood transfusion, its necessity is largely exaggerated. I once had a 28 y.o. pregnant patient who tore her uterine artery and suffered massive internal bleeding. This was in Hilo, Hawaii, where there was no blood bank at the time. Only three units of blood were available, and they were scheduled for other patients and could not be cross-matched for this patient. She received those units plus lots of intravenous fluids, which lowered her hemoglobin level to around 2g/dL. The baby was stillborn and a hysterectomy was necessary to control blood loss. Amazingly, she survived without organ damage.
Red cell mass regulates blood turbulence. Excessive red cell mass due to polycythemia vera, excessive transfusion with packed red cells, or excessive erythropoietin treatment can reduce blood turbulence below a threshold and cause spontaneous onset of disseminated intravascular coagulation (DIC). Inadequate red cell mass allows excessive blood turbulence that can paralyze coagulation, as sometimes occurs in severe anemia secondary to renal failure and inadequate erythropoietin production.
Whole blood is preferable to packed red cells, because it includes plasma that maintains normal red cell mass. Care must be taken to maintain red cell mass within normal range if packed red cells are administered.
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The volume of domestic animal (such as cattle, goats, sheep, dogs, etc) raring or handling is high in Northern Nigeria, as such I suppose Brucellosis could be endemic and yet, there is no system or policy in place for screening Brucella in donors before transfusing Blood. Does it mean we do not consider infection with Brucella sp. of any significant in public health?
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Thank you Styles for that comment. Perhaps the story of Brucellosis and blood donors may be different in an endemic area. It may be rewarding to find out.
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I want to know the effect of transfusing blood of different haemoglobin genotype to a patient.
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It will have no adverse effect but any hemoglobin variant will be diluted if the donor is wild type. If the donor carries a variant and the recipient is wild type, wou will find small percentages of the variant in the recepient.
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Transfusion related acute lung injury (TRALI) is a major cause of transfusion related death. Within 6-72 hours of transfusions of whole blood, packed red cells, fresh frozen plasma or platelets TRALI can develop. What could the measure/measures that might help in preventing the development of TRALI?
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Thanks Emmanuel Ifeanyi Obeagu, Dharmesh Chandra Sharma, Gayle Haider for your remarkable comments.
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What do you think are the symptoms that require blood transfusion during cardiopulmonary bypass?
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The programs that are most progressive don't transfuse due to any single number. They look for signs of inadequate oxygen delivery based upon current metabolic needs. So, Venous Saturation, VeCO2 (an indication of metabolic rate, and if anaerobic metabolism is starting to occur it will rise in relation to VO2), lactate increasing (or already above 2 mmol/L), DO2index, DO2i/VeCO2 ratio, and other parameters/comparisons/ratios. At high Cardiac Outputs with low metabolic requirements, I've seen patients doing well with a Hemoglobin below 6 gm/dL. I've also seen those that struggle even with Hemoglobin at 10. Back in the 1970's, we used to give blood and see the venous saturation pop upwards, which we thought justified that transfusion. We didn't understand that 2, 3 DPG stores were depleted in that transfused blood, so the oxy-hemoglobin curve was severely shifted to the left. Although that transfused blood was picking up oxygen, it was not releasing it normally at the tissue level. The Venous Saturation increased NOT due to increased satisfaction of meeting O2 demand, but, due to O2 not readily leaving the Hb molecule. It's more involved than one single number...
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Hello, Im going exposure platelets to Aspergillus fumigatus conidia. In this step, I want provide a suspension of platelets then transfer to culture media plates but my problem is that i dont know what kind of plates is necessary for plateles culture ? whether it is essential to polyester plates for adhering them?
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Dear Bahare,
Platelets are "pieces" of megakaryocytes and have no nucleous. So, it is impossible to cultivate them.
Regards,
Nelder Gontijo
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some cancer are graded no be non accessible and few times asymptomatic ,the cell be be metastasizing in blood and ,this person may be volunteer donor ,can these cells be incidentally transfuse leading to cancer in others ?
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Foe cancer (solid tumour) to spread, definitely it is at stage 3 and above and never found in an asyptomatic individuals. Certainly, tumour cells metastasize through the blood and lymphatic systems and there is possibility to transfuse them, but ask me, I will tell the two instances put together are nothing but theoretical. In clinical practice, a malignant growth upto that stage will never leave an individual healthwisely free to be settled for transfusion and thus can never be symptomless.
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Today i received a hemoglobin electrophoresis report. Patient was suspected to have Hb E trait / disease. Report: HbA 94.4%, HbE 3.2%, HbA2 is 2.4%. At the end comment says- "there is an abnormal band of HbE zone found ,but not amounting to E trait. Advise repeat test 6 months later."
The patient (female, 34 year) has long history of anemia and blood transfusion. Recently received 2 units. The patient belongs to a community from south east Asia where Hb E is highly prevalent.
So what is the current status of the patient?
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This is no HbE trait. It is either another variant moving like HbE in this method or an artefact or the patient has been transfused with HbE containing blood.
Please refer to http://globin.cse.psu.edu/ for more information - very helpful resource.
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With multiple Red cells transfusions in extreme preterm babies with AOP, Do we still need to give iron supplements? Do we need to measure Ferrritin level?
Is there a reference values of plasma ferritin witth GA? at what level We have  not to administer Fe supplements
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ferritin dosing isn't a good newborn parameter
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I have read that the lifetime of neutrophils is normally quite short, 3-5 days in vivo. On the other hand, whole blood can be stored for a much longer time, around 30-35 days.
My question is: What happens to neutrophils in whole blood for transfusion that was stored for more than 5 days?
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Unfortunately leukoreduction is not practiced universally and still recipients are exposed to febrile, immunologic reaction and exposed to increased risk of disease transmission. It should be a mandatory practice all over the world. Lekocytes are lysed and some are filtered out but still can induce this type of reactions.
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Can we use umbilical cord blood for transfusion purposes in human? If somebody has any experiences, please share. It would be nice if somebody could share some studies related to it. Thanks!
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I am doing that . Go through my articles
1. Dharmesh Chandra Sharma*, Nidhi Agrawal, Jyoti Bindal, Poonam Woike, A. S. Tomar, Anita Arya. A Study of 120 Umbilical Cord Whole Blood Transfusions in 77 Patients with Different Clinical Conditions. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) Volume 16, Issue 4 Ver. IV (April. 2017), PP 05-12 DOI: 10.9790/0853-1604040512
and thesis on cord blood transfusion
RANSFUSION OF PLACENTAL UMBILICAL CORD WHOLE BLOOD (RICH IN STEM CELLS) IN TRANSFUSION DEPENDENT PATIENTS AND TO ASSESS ITS OUTCOME
  • September 2016
  • DOI:
  • 10.13140/RG.2.2.33994.98245/1
  • Thesis for: MS ( Obstetrics & Gynecology )
  • Advisor: Jyoti Bindal D.C. Sharma
  • Project:
  • Whole cord blood Transfusion in transfusion dependent patients, Malignancies , degenerative diseases and Geriatric Patients
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Researches claimed that this blood is more efficient for medical use than blood collected from donors. Patients with rare blood types will benefit the most.
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The term "Artificial blood" is a misnomers and can't be prepared in laboratory. There is a limitation of stem cells culture in vitro and component in whole blood is much more complex.
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I wonder about the risks of using an immortalised adult erythroid line (BEL-A) as a source of functional RBCs for human transfusion. Even if RBCs are “terminal cells” there may be some risks of “transfusing” an “immortalised phenotype”.
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Dear Siva,
I completely agree with you!
Kind regards. Pedro.
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We know that until these days most blood transfusions are common in the form of offline.
Is there a way for online blood transfusion and what points should be observed to design it?
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I Think your , your question is incomplete and not clearly stated
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Please, someone should help recommend to me a good but cheap journal on haematology and Blood transfusion Medicine.
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Transfusion is the best journal on Transfusion Medicine.
I concurr with the rest upon Blood. I would also recommend British Journal of Hematology. Good luck!
You can also look up at the Internet Qxread by QxMD: https://www.readbyqxmd.com/
You can select the journals and receive a free copy of the abstracts you are interested every week.
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I would strongly appreciate your comments on the legal / medical status of Jehovah´s Witnesses in the process of providing health care in your country. I use Witnesses as an example of patients with specific requirements (rejection of blood transfusions, etc.), but of course, there are other special requests of patients such as rejection of compulsory vaccinations, birthing plans and so on. Are there any special guides for medical staff or special legal regulation of such cases in your country? Thank you in advance for your help and recommendations.
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In my country Nigerian, the most notable thing amongst Jehovah's witnesses, is the refusal of the transfusion of blood or blood products.
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I'd like to know if I take some blood (1-2 ml) from a rat and then transfuse it to another rat (from the same stain) , what about the results ---- Will the rejection reaction occur? If so, what should I do to avoid or relief it?
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If the blood is not blood group-compatible (in particular for red blood cells) you are at high risk to induce immunological reactions in the transfused (immunocompetent) rats with generation of alloantibodies. There is in my opinion not much you can do to avoid this if using immunocompetent rats of different blood groups.
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Umbilical cord blood is usually thrown away in developing countries barring few exceptions where it is stored as a source for future stem cell. There is huge scarcity of blood and blood product in India and other developing countries. Therefore, use of umbilical cord blood for transfusion process can be of some potential help!
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Yes certainly, I am doing that .
On this topic we have publications & MD thesis
link are as fallows
1. Cord Blood is a geriatric medicine: A preliminary Observation
  • November 2017
  • DOI: 10.13140/RG.2.2.11543.88484
  • Conference: Transmedcon 2017 At: LucknowAffiliation: G R Medical College , Gwalior
  • 📷Dharmesh Chandra Sharma,📷Anita Arya2
2. Dharmesh Chandra Sharma*, Nidhi Agrawal, Jyoti Bindal, Poonam Woike, A. S. Tomar, Anita Arya. A Study of 120 Umbilical Cord Whole Blood Transfusions in 77 Patients with Different Clinical Conditions. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) Volume 16, Issue 4 Ver. IV (April. 2017), PP 05-12 DOI: 10.9790/0853-1604040512
3.
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If you were in a hospital and need blood transfusion, would you choose the transfusion service that uses traditional system of holding stocks of blood, or just-in-time system? What does this tell you about JIT in other organization?
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I think it depends largely on the situation of the patient at the time of transfusion.
The categories of patients we see in our facility are essentially transfusion dependent for their disease and in some instances may have to take emergent transfusions in places that are far removed from their place of primary care, e.g. during vacations.
We therefore rely more on the traditional pre-grouping and crossmatching to ensure that any new clinically significant antibod(ies) that might have formed are not missed.
The JIT protocol is probably more ideal for previously antibody screen negative individuals, with no prior history of transfusion(s) or pregnancy.
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This is with reference to a patient suffering from low hemoglobin (as low as 4-5) for over a decade. With blood transfusion or medication (including some injections etc.), the hemoglobin rises slowly to 7-8-9 but then again has a tendency to fall back. What could be the reason?
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In case of anemia, a logic route must be started:
1. What are the age and sex of the patient?
2. Is this anemia regenerative (increased reticulocytes count) or hypo-regenerative (decreased reticulocytes count)?
3. What are the morphological features of anemia? Normo-, macro (megalo)-, microcytic? Normo-, hypochromic?
4. What are the biochemical parameters associated with? (haptoglobin, LDH, bilirubin)
5. Iron balance? B12 and folate?
6. It is possible to postulate (or exclude) a chronic disorder? (Tumor, inflammation, infection; autoimmune diseases)
7. Are the other cellular lines involved? (cytopenia; dysplasia)
Based on the above results, a bone marrow aspiration could be performed, to check (in primis) for an erythroblastopenic situation (Diamond-Blackfan anemia if case of paediatric patient; tymoma; idiopathic pure red cells aplasia and other in case of adult patient).
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What are the best markers for evaluating the immunological effects of massive allogenic blood transfusion?
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To assess cumulative immunological effects of massive transfusion, you may quantity IgG levels among massive transfusion recipients and a control group, within the population.  A comparison of the data generated may be helpful in your research. Thanks 
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Person who has Vitiligo is permanent deferral for donation or can donate blood for the use of blood transfusion in needy patients .
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Thanks Jyoti
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Prehospital activation of MTP could lead to earlier transfusion and hence earlier and more efficient hemostatic resuscitation. But identification of the patients in need for MT is challenging and wrong indications can lead to many problems.
In your local institution, do you use prehospital activation of MTP ?
What is your exerience/feeling about it ?
What criteria do you use ?
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Ciao Stefano !!! Come stai ? Fa lontano ! Did you envoy working with DWB in Pakistan ? You're back to Bxl now. Maybe we'll meet again with Laura and the guys from Antwerpen ! Maybe also we could work together on prehospital identification of trauma patients in need for MTP ? I will start in 2018 in RCT, maybe St Pierre could be part of it !? Thanks for your answer. Blood products waste is very problematic. Late identification of trauma in need for MTP is problematic as well. It makes all this very challenging for us, especially in the prehospital setting...
Take care
Martin
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I am preparing neocytes concentrates by  conventional method i.e. centrifugation and separation method 
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Many a thanks sir.
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WHO recommends universal leukoreduction for the blood components. Is there any valid indication of Granulocytes transfusion. 
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Thanks 
Muttuswamy Sivakumaran & Anita for valuable feed 
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Dharmesh Chandra Sharma, Sunita Rai, Sudha Iyengar, Bharat Jain, Satya Sao,  Ajay Gaur, Rahul Sapra Efficacy of Whole Blood Reconstituted (WBR) in Exchange Transfusion (ET) in Hemolytic Sisease of New Born (HDN) – A study of 110 Cases.Open Journal of Blood Diseases, 2013;   3(1): 15-20.  DOI: 10.4236/ojbd.2013.31004,
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To,
Linda Hoyland
Though there is risk of donor exposure, we are doing this practice in routine . one can add human albumin  in plasma to increase the albumin sites. As we are doing the exchange transfusion, will Human albumin serve the purpose of plasma. Is human albumin is isotonic solution . My article on this subject is 
Dharmesh Chandra Sharma, et al  Efficacy of Whole Blood Reconstituted (WBR) in Exchange Transfusion (ET) in Hemolytic Sisease of New Born (HDN) – A study of 110 Cases.Open Journal of Blood Diseases, 2013;   3(1): 15-20.  DOI: 10.4236/ojbd.2013.31004,
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Multiple splenic infarct in beta thalassemia major patient of 15 yrs age ?
On regular transfusion, no HLA matched donor available, no iron overload.
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Very interesting indeed. Thank you for the update.
Best wishes
Siva
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I am working on haemoparasites of village chickens in Nigeria, blood samples were collected for the same but for two diagnostic study 1, as thin smear on slides for microscopy and on FTA cards for DNA extraction however, I wished to first gather my samples before proceeding for the molecular detection in reference laboratory abroad. I wished to know for how long can my samples remain safe?
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Dear Jallailudeen.you can preserve your sample at (-20) for long time.
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Endocrinologist
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I think there's no any records for your mentioned case, in addition to that blood transfusion doesn't developes any hormonal stimulation for male or female. Otherwise the pregnant woman shouldn't get a full maturated male because of blood exchange with her fetus
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Is there a significant difference in the risk of HIT in patients on LMWH thromboprophylaxis when compared to those on UFH ?
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One study in 2010 found HIT was reported in 1/272 patients in the LMWH group (0.4%, 95% CI 0.1 to 2.4) and in 4/289 in the UFH arm (1.4%, 95% CI 0.4 to 3.6). Lubenow, et al. Blood. 2010 Mar 4;115(9):1797-803.
In earlier work  by Levine et al  HIT was seen in 2/170 in the LMWH group (1.2%, 95% CI 0.2 to 3.8) and 10/192 in the UFH group (5.2%, 95% CI 2.7 to 9.1).Ann Intern Med. 1991 Apr 1;114(7):545-51.
Relative risk for HIT with LMWH compared with UFH  risk ratio (RR) 0.24, 95% CI 0.07 to 0.82; P = 0.02 in post surgical population meta analysis of those trials. Cochrane Database Syst Rev. 2012 Sep 12;(9) PMID: 22972111
In my experience the I see closer the Lubenow numbers for incidence (even lower in general internal medicine population). Seems clear risk for HIT is 3x or more with UFH than LMWH. We use LMWH as our standard and use UFH for those with high bleed risk ( UFH shorter half life & more fully reversible with protamine) or poor renal function (CrCl <15 ml/min, UFH cleared extra-renally, primarily).
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Needs Blood substitutes for Packed red blood cells and platelet concentrates
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Thank you 
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Back in 2004, i read a research paper that was investigating the possibility of using RBCs from pigs for blood transfusion to humans.... How far are we in research in making this possible? Tried to search, could not find anything useful.
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 Ape-to-human, pig-to-human blood donations: Could xenotransfusions work? an interesting article worth a read. please see the link added below
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When a sickle cell anaemic patient needs blood transfusion, I want to know if there is an advantage in transfusing them with blood of Hb genotype  AA over that of Hb genotype AS.
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Transfusing sickle cell patients with donor blood with a normal Hb (ie HBAA) is ABSOLUTELY essential. Some people who are HbAS (sickle trait) can be accepted as blood donors, but if their blood is transfused to a HbSS person, especially during sickle crisis or anaesthetic, the transfused cells would also sickle and contribute to the already existing problem.
If a transfusion is needed, please ensure you inform the supplying blood bank of the sickle problem. They will then select HbAA donors for transfusion.
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People loose blood in accidents , the amount needed for resuscitation is still hazy for acute blood loss..Is there a formulae or developed index to decide amount to be requested from Blood Bank for transfusion?
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Systolic blood pressure is the best indicator in the prehospital care environment.   In-hospitable blood pressure and HCT are good indicators. If you don't use a ratio of 1:1:1 red cells, plasma, platelets, monitoring pt, ptt and platelets will help prevent dilutional coagulopathy.  You can add more sophisticated testing but they take time, and in the face of acute blood loss, simple is better. You might also consider reinfusing any blood collected from the chest.  
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Cardiac & Hepatic Iron overload are prevalent and understandable in transfusion-dependent SCD patients. however, it has been observed and reported by many recent cases about iron overload among non-transfusion dependent SCD patients; is there any studies or hypotheses about the justification of this overload?
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from a pratical point of vue, yes we've to actively look for  iron surcharge in HbSS people : many have aditional alpha talassemia deletions, causing microcytosis  - micro and anemia byitself may increase the iron absortion; even if they aren't transfusion dependent, they are transfusioned sometimes; at least in western countries diets trend to have high iron content; some still have poor muscle mass (and muscle can "harbour" a lot of iron); some of them will have heterozigoty for haemochromatosis; and the role of free iron from intravascular hemolysys as described
all that together make iron surcharge a serious issue, not so much for pediatrics, but for the adult group, which longevity is improving
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I am looking at blood transfusion transmissible diseases and any possible way of avoiding them.
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currently, blood banks in malaria endemic areas do not screen blood for plasmodium parasites because of logistical constraints. Plus, there is no strong evidence supporting the fact that Malaria is actually a serious TTI. Rapid diagnostic kits are also available but are not highly  sensitive to all plasmodium species. The baseline is that prevention of malaria transmission through blood products is more of a policy issue  than its practicability.
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As in the majority of the hospitals, we use a blood management program. We use postsurgery blood recovery system in some situations: low presurgery Hb level, tranexamic acid contraindication..., but, if the surgeon practices an intraarticular infiltration of local anesthetic, within a fast recovery system, we won't be able to use it, . What is more important in your opinion, faster recovery or lower possibility of blood transfusion?
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It is indeed a difficult question.
One option is collecting retransfusion blood for 4-6 hours, and then changing to introduction of local anesthetic solutions. If you you spinal or general anesthesia the first hours are already covered by pain relief.
Kindest regards,
Robert Slappendel
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Can anybody please provide references on safe use or practice in repetitive transfusions of fresh (frozen plasma)? What are the cases where such procedures are most often used?
Tnx!
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Thank you all for your answers! There are very few reports regarding multiple/repetitive transfusions of plasma, namely over longer time periods. If anyone has a reference or experience in this matter, it would be very welcome.
Tnx!
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if i want to measure some microRNAs from the plasma of a transfusion dependant patient, what is the minimum period after the last blood transfusion in order to take a representative blood sample
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Hello Noha,
I think it is also important to know the miRNa signature in the source blood as well.
Our concept of miRNA and its role in diseases took a major turn when we found that alien miRNAs can also survive in our system. If you have the time kindly read the attached manuscript. It will interest you.
Warm regards,
Venk
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when a patient receives frequent transfusions (every 4-6 weeks)
how long do his CBC and hemoglobin electrophoresis take to return to baseline or to reach a plateau
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As Ricardo is saying,  Hb and red cells counts reach a final value about 30-60 minutes, and then it depends on the clinical situation of the patient. As for platelets and white blood cells, there are no changes in final values.
Best regards,
Nilo
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The FDA and our federal health authority among many others have recently asked for a four weeks deferral period for blood donors coming back from regions infested by the vector and the virus.
However, since infections may be asymptomatic in blood donors, how is it guaranteed that infected donors do not harbour the virus in third spaces and in danger of a long lasting viraemia?
Do you have any specific thoughts regarding this topic?
Thank you very much in advance! 
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My dear friends. I think that high commited blood transfusion specialists like ourselves are actually paying attention very carefully and closely about the insurgence of this quite unknown virus. There is no doubt that it is very important, particularly for pregnant women, and for them, all attention must be driven from authorities in order to avoid new cases. But most importantly, if we do not fight the real culprit, the mosquito, we will certainly lose not only this battle, but the whole war. Unfortunately, this I haven´t seen not only in my country, but in several places.  This is a great forum for discussion. Regards
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In blood transfusion program to avoid platelet microparticles contaminations to FFP, I need the ideal flow cytometry protocol to detect  PMP?
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HI Hasnaa,
Gregory's links are indeed much appropriate. PMP detection iand more generally EV(extra-cellular vesicles) analysis and counting is actually a hot topic. For your and general information, 3 major scientific societies (i.e. ISAC, ISEV and ISTH) have recently expressed their willing to collaborate for improving the field together. This was announced at CYTO 2015 (june 2015 in Glasgow, UK) and will surely be again actively discussed and setup at ISEV 2016 (Rotterdam, NL, 4-8 May 2016), ISTH SSC (Montpellier, F, May 25-28, 2016) and CYTO 2016 (Seattle, June 2016). 
My suggestion is to look for two special issues on Microvesicles just coming out i) in TRASCI (Transfusion & Apheresis Science) as well as ii) In Press in Cytometry A,(papers also available as doi.)
I point mines to you (also listed in my RG page) to give the website links to the journals and help you find the many very interesting contributions around, in each special issue. If you do not find focused enough information, do not hesitate to come back again and re-focus your question. .
Best regards. Philippe
Journal: Cytometry Part A
Article title: "Standardized counting of circulating Platelet Microparticles using currently available flow cytometers and scatter-based triggering: Forward or Side Scatter?"       DOI: 10.1002/cyto.a.22685
Article title: Tips and tricks for flow cytometry-based analysis and counting of microparticles.
Article reference: TRASCI1912
Journal title: Transfusion and Apheresis Science
 First author: Dr. Philippe Poncelet
Accepted manuscript (unedited version) available online: 27-OCT-2015
DOI information: 10.1016/j.transci.2015.10.008
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45 yrs male with a BMI of 50,Diabetic for 8years presented with severe malena for 3days.On admission his Hb was 8gr/dl bl sugar was 200mgs,dyslipedimia other Biochemical parameters were normal XRay chest, ECG, Echcardio were normal. Upper Gi endoscopy was normal, scope could not be negotiated in to the 3rd part.U/S scan howed only Fatty Liver. CECT with angio was done revealed lipomatous filling defects in the above mentioned areas. Pt was resuscitated with Blood transfusions and control of Bl sugar.But slow oozing continued even though pt became stable.
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This is an interesting and difficult problem.
Firstly, recurrence of bleeding implies treatment.
Secondly, medical treatment will, most probably, not be durably sufficient.
Thirdly, endoscopic localization of the lesion is compulsory. I would start with capsule to have a good over-view. In case of a clear-cut result, i.e. a bleeding and/or ulcerated lesion, its elective destruction seems to be the best way. Access to this lesion will probably be possible with a colonoscope which is largely available with numerous usable  devices. 
Fourthly, in case of an ulcerated lipoma, endoscopic treatment is not so easy. As a matter of fact, hot snaring is difficult (high impedance) and dangerous (thin wall). In case of an intermediate or pseudo-pedonculated shape (frequent because ulceration is, usually, the consequence of invaginations) and a normal elasticity under forceps, I would suggest to put a plastic snare, then cut a macro-biopsy with manual setting, high power, pure section, high manual tension on the wire by the endoscopist himself. The remaining of lipoma will be digested after necrosis of its base. If pathology is not perfectly benign (very improbable) : surgery.
In case of multiple lipoma, without certainty of bleeding location, I would treat the largest snarable by the same way and follow.
In the absence of any snarable, probably responsible lipoma, a surgical, sub-mucosal resection will probably be relatively easy, precisely because of the flatness of the lipoma.
Finally, if the problem fails to be solved, I would wait until a new bleeding and perform urgently endoscopy with colono or enteroscope with tatooing. Injection should be large  (1 ml, eliminate any air in the syringe) to allow dye to be visible on the peritoneal side.
Then, elective surgery will treat the responsible lipoma with resection-anastomosis if jejunal or en-coin resection if duodenal.
The probability of 2 lesions bleeding simultaneously is almost 0. In case of recurrence on another lipoma (improbable) the same algorithm can be applied.
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Umbilical Cord Blood HSCs (UCB-HSCs) has become one of the most widely stored blood cells, in view of probable future need? Can someone, who is working on this, suggest the success rate of UCB-HSC transfusion? How many people have been cured from this till date? 
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You can also see the journal of Mymensingh Medical Journal via ICMJE i.e.www.icmje.org of 2013.
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How can one manage fever in adult with still disease and during a blood transfusion? The fever was not present at the beginning of the transfusion.
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Not of my expertise. Sorry.
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Is there any evidence that blood transfusion increase the risk of GVHD in patients post hematopoietic stem cell transplantation?
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Transfusion-associated GVHD is seen in patients who receive RBC transfusion and they develop skin rash and pancytopenia. In those patients the bone marrow gets hit and it is almost always fatal, and steroids do not work. However, in GVHD after allogeneic HSCT the hematopoiesis in the bone marrow is from the donor; so, it does not get hit by the GVHD process. We use steroids and they are usually effective. Attached you find a retrospective study about the relationship between RBC transfusion and GVHD from the BMT group at Emory University which is quite interesting, it was presented at ASH last December.
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For our research on blood transfusion and the micro-circulation, we are seeking to borrow or purchase used InSpectra StO2 Monitor (650) and the Aimago Laser-Doppler Imager (Easy LDI). We will be glad as well to receive the instruments for collaborative research from interested researchers.
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Irina & Josef, many thanks for the tip.
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Natural blood has problems of shelf life and infections such as HIV , Hbs Ag.
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There are no available blood constituent. It is prudent to use allogenous blood alternatives such as iron, hemostatic drugs, topical agents, intraoperative blood salvage, autologous predeposit.
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1. Yes, or no?  2. If yes, how many percentage of platelet components? 3. Name of the solution? 4. Are there any solution-associated problems?
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Dear Hitoshi,
1. Yes we use PAS for all platelet concentrates (both apheresis and buffy-caot derived). We use Intersol in a ratio of 39% plasma / 61% Intersol. This ratio comes from the Intercept PI technique specification (32-47% plasma; whereas 100% plasma is feasible, it poses other operational constraints - longer procedure basically).
2. 100% of platelet components. For apheresis we use 500 mL Intersol bags with automatic addition of Intersol on Trimas. For Buffy coat platelets, we use 280 mL Intersol bags, automatically added on the Orbisac machine during pooling of BC.
3. The transition from 100% plasma to 39% plasma /61% Intersol for paltelet storage has been associated in Switzerland with a significant decrease of transfusion reactions:
Whereas the document compares pre- and post Intercept (pathogen inactivation technique) introduction, the main difference for non-infectious transfusion reactions comes from the use of additive solution instead of 100% plasma.
Regards
Niels
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Platelet pockets intended for transfusion are stored at room temperature. Is there any risk of protein degradation that could affect their role?
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Dear Hadjkacem Basma,
if I understand your question correctly, you want to know why platelet units cannot be stored in a refrigerator at 4°C. The answer is quite simple: The platelets loose their function. A couple of explanations for this can be found in literature, however, a simple test can show this phenomenon: Just store a bag of platelets at 4°C overnight, and look at swirling prior to and after storage: The swirling will be gone. So will platelet function (you could do aggregation tests before and after storage).
Some mechanisms are explained in this recent publication.
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Hi,
this is somewhat of a hot topic. 75 y.o. male, BMI 27, comes in for a STEMI with cardiac arrest, primary PCI of prox LAD (2 overlapping DES, radial approach) in 3-VD, ICU, LV EF 25%.
On day 5 he undergoes completion of revascularization with 2 DCBs in the Circ, and 1 DES in the RCA (radial approach).
Hemoglobin begins with 14.5 g/dl on admission and then drops progressively to 12, 10, and then, after the second PCI to 7.5 g/dl, without signs of overt bleeding except for an already known hemorragic gastritis.
Patient currently suffers heart failure.
Should I go for blood transfusion now, or not?
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Thank you, I believe your considerations are absolutely competent and I would advise the same. Besides, recently a new paper went out (JACC) saying that in case of acute MI blood transfusion is not harmful as previously thought (it could be of some benefit). This is just a retrospective study, but strong as regards statistical methods. Please take your time for a rapid scanning here: http://www.medscape.com/viewarticle/830202
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I would like to know whether PBM is a topic in your country. If yes, then which professions are the key drivers of the PBM project? Do you have results from these PBM Projects? Are they safe? Are they effective? What are clinical outcomes?
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We are also very interested in PBM here in Northern Ireland. Our multidiscliplinary Regional Transfusion Committee conducted several large regional audits over the last 8 years to show considerable deficiencies in the appropriateness of blood transfusion and the treatment of anaemia before transfusion was necessary. Guidelines with better definition of transfusion thresholds were generated and accepted and implemented by all hospitals. Our Department of Health in conjunction with the Regional Transfusion Committee also released guidance on the managment of anaemic adult patients before surgery. Regional blood use is down by over 27% and we have a red cell transfusion index of less than 28 units per 1000 of the population.  
We believe the high quality audits accurately identified the scale of problems with common themes and allowed clear recommendations to be generated to allow front line haemovigilance staff address the issues.  
Audits and guidelines can be found at http://nitransfusion.com/index.html
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The association of necrotizing enterocolitis (NEC) and blood transfusion is suggested by several case series and observational studies. The few RCTs dealt with this matter so far have not confirmed such association. Nonetheless, many colleagues like to err on the conservative side, i.e. to stop feeding altogether upon blood transfusion. Do you support this approach in your practice?
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OUR INCIDENCE OF NEC VERY LOW, AND OVER MANY YEARS OF EXPERIENCE I HAVE SEEN FEW CASES OF PRETERM INFANTS DEVELOPED NEC AFTER BLOOD TRANSFUSION AND THEY WERE ON FEEDS.
WE DON'T HAVE GUIDLINE TO STOP FEEDING DURING TRANSFUSION, BUT MY PRACITCE NOT TO FEED AT LEAST DURING TRANSFUSION AND MAY FEW HOURS AFTER. (THIS PERSONAL PRACTICE WITHOUT CLEAR EVIDENCE YET WHAT TO DO!) 
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Hemoglobin measurement in healthy volunteer blood donors is mandatory before whole blood donation in a great number of countries. However, the current invasive methods are not very reliable. Has anyone broad experience with the non-invasive techniques in daily use?
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Dear Markus,
I send the data (unpublished) of an our study which compare two non invasive devices: Pronto 7 (Masino), NBM 200 (Orsense) with HemoCue 301 (in use) and LH 750 Coulter (gold standard).. We have tested 412 donors (262 men and 159 women) on september 2011) and 465  (286 men and 179 women) on november 2011. the data from Pearson correlation are: HemoCue vs Coulter: 0.83 in both series, Pronto 7 vs Coulter: 0.69, NBM vs Coulter: 0.57. But Pronto 7 under value the Hb and it determine the deferral of 35% donors (vs 20% for NBM 200 and 6% for HemoCue). Moreover non invasive system are very appreciated from donors and thus in our institution if the value of Hb from NBM is different (1.5-2.0 gr/dL) vs the previous values from Coulter (data available on line), then we use HemoCue 301 and we conside this value for donation or not.
On 2013  we have verified this approch and we have a good result.
I send you the results of this control. 
Refernces.
Gayat E, Aualgnier J, Matthieu E, et al.: Non-Invasive Measurement of Hemoglobin: Assessment of Two Different Point-of-Care Technologies:  PLoS ONE 7(1): e30065, doi: 10.1371/journal.pone.0030065
[1] Hahn RG, Li Y, Zdolsek J: Non-invasive monitoring of blood haemoglobin for analisys of fluid volume kinetics. Acta Anaesthesiol Scand, 2010; 54: 1233-1240
[1]Macknet MR, Allard M, Applegate RL, 2nd, Rook J: The accuracy of non invasive and continuous totale hemoglobin measurement by pulse CO-Oximetry in human subjects undergoing hemodiluition. Anesth Analg, 2010; 111: 1424-1426
Baart AM, de Kort WL, Atsma F, et al.: Development and validation of a prediction model for low hemoglobin deferral in a large cohort of whole blood donors, Transfusion.2012 Apr 23. doi: 10.1111/j.1537-2995.2012.03655.x. [Epub ahead of print]
Dobao Gonzales ML, Brito D, Abreu M, Maia S: Measurement of a pre-donation hemoglobin with a non-invasive methodology, Abstracts of the 32nd International Congress of the International Society of Blood Transfusion in joint cooperation with the 10th Congress of AMMTAC, Vox Sanguinis, 103, supplement 1, july 2012: P-071
[1]Gavalaki M, Kalfa E, Myriokefalitaki H, et al.: Evaluation of a non invasive pre donation hemoglobulin screeining, Abstracts of the 32nd International Congress of the International Society of Blood Transfusion in joint cooperation with the 10th Congress of AMMTAC, Vox Sanguinis, 103, supplement 1, july 2012: P-117
[1]Pinto M, Barjas-Castro ML, Nascimento S, et al.:The new noninvasive occlusion spectroscopy hemoglobin measurement method: a reliable and easy anemia screening test for blood donors. Transfusion. 2012 Jul 15. doi: 10.1111/j.1537-2995.2012.03784.x. [Epub ahead of print]
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Do you follow blood conservation/transfusion guidelines in perioperative care in cardiac surgery? If so, do you use known international/regional guidelines or an institutional protocol?
What are important points in the development and/or implementation of an efficient protocol for blood conservation/transfusion?
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Why not?
Make another three possible and simple questions:
one) who can justify the "unversal" transfusion of the "two units pack" of red cell concentrates?
two) who can justify that a patients admitted at the surgical waiting list during months could come anemic to the operation room?
three) who can justify to do not use autologous blood? why do not recover intra or post surgical bleeding and reinfuse after wash it?
Please, do not ask if we follow, ask youself why you do not follow the blood management guidelines?
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In central Europe, West-Nile-Virus (WNV) infections are endemic in small regions and only seasonal small outbreaks occur outside these regions. Therefore, WNV infection risk for blood donors is difficult to assess. One can test all donors by WNV PCR, but that is extremely costly and far more than 99% will be tested negative. However, in the U.S. with their high prevalence of WNV, the WNV PCR has proven cost effective. Alternatively, European blood transfusion centers defer blood donors travelling through "WNV regions" for 4 weeks. What is the strategy, you and your Institution prefers?
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The details of the UK Blood Transfusion Service strategy for management of West Nile Virus can be found here:
Regards,
Anna
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Phlebotomy or bloodletting has been the mainstay of therapy for the polycythemia vera (PV) disease process for a long time. The object is to remove excess cellular elements, mainly red blood cells, to improve the circulation of blood by lowering the blood viscosity. (these words were cited from http://emedicine.medscape.com/article/205114-treatment).
After red blood cells were removed from patients with PV, could they be used for blood transfusion (without any infectious diseases)?
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in Germany, P vera is an exclusion criterion for blood donation because it is part of the chronic myeloproliferative syndromes. Patients are not allowed to donate allogeneic blood. However, a sole genetic abnormality/difference is not considered a contraindication as long as there are no disease symptoms. This allows asymptomatic hemochromatosis carriers to donate allogeneic blood, while patients with P. vera or patients suffering from hemochromatosis complications are deferred.
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Who proposes a transfusion trigger for packed red blood cell concentrates (RBC) in your country? The medical association? Specific medical specialities like anaesthesiologists, surgeons, transfusion medicine specialists, etc.? What is the scientific basis (e.g. publications, clinical study results, etc.) for this trigger? Is it mandatory to follow this recommendation? Who controls this? Is there any penalty for not adhering to the proposed trigger?
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In Australia,we have started to follow/implement the new guidelines published recently which include some recommendations where sufficient evidence was available and practice points in abscence of enough evidence. You could find the details in
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A Thalassemia patient is chronic and transfusion dependent, and as a result, they have iron overload in their bodies. I have read many journals concerning SOD activity and this iron overload. However, some researchers found it will increase SOD, and the others say decreased. I read their explanation, but it's not enough to get deep explanation based on a biochemical reason. Any answers will be appreciated.
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Thanks, but what I mean is about SOD (SuperOxide Dismutase), an antioxidant enzyme.
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Patient, 55 years old, diaphragm hernia operation.
Cirrhosis is detected intraoperatively (no clinical manifestations). This patient doesn't show history of viral infection of the liver or the use of toxic substances.
The only laboratory parameter which was without normal range: prothrombin 28% with INR 2.36, in postoperative period.
The patient shows no signs of active bleeding, the response to administration of vitamin K (10mg) was minor (TP 40% after 6 hours).
What it is your opinion about indication to transfuse FFP in this case to correct prothrombin complex?
It would be sufficient reserves liver cells that respond to the vitamin K?
Thank you in advance for your help.
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Of course!
There is a decrease of several coagulation factors, but also an umpaired anticoagulation proteins realease and cleavage!, and a fbrinolysis disbalance, with a trend to hyperfibrinolisis and disfibrinogenemia!
Unnecessary plasma transfusion (with citrate as anticoagulant) could modify this fragil balance
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In Spain, since 2005, "severe hypertension" is a "definitive exclusion criteria". But, which is the rational severe hypertension definition? Must we accept them? And when must we reject them?
It is well known that donors under HTA treatment can have severe hypotension reaction after whole blood donation and the incidence of hypotension transfusion reactions in patients transfused with plasma from HTA donors is well known.
Thank you very much for your help, comments and experiences.
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After 48 hours hours of debate, actually there are more questions open!
First) Is it a patient diagnosed of HTA and under especific treatment sane or unsane? If he is unsane or unhealthy, can be allogenic donors?
At EEUU yes, but at some european countries Not!
Second) Which are the normal or safe, minimun or maximun, levels of HTA to donate? There is no clear evidence. Most of them are simple expert oppinions
Third) Is it dangerous donate blood with elevated or decreased arterial Tension level? Probably it is no dangerous donate high or low levels, if those are the normal patient´s level. Also, probably, blood donation could be benefit to same HTA patients.
Four) What happens with the residual drug levels still present in the blood components? Must we have some concern?
Thanks again
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I'm seeking to carry out a survey in my home country and would prefer a validated questionnaire. I've seen a couple mentioned in papers but am unable to find them electronically. Thanks for your help.
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Hi Anique,
Here is the translated Italy Questionnaire that we print for every Donor of Blood and Components. I added, in the last part of the document a survey questionnaire to understand problems or trigger points for a blood donor candidate. I agree with Torsten and Markus that you have to give a look DOMAINE group and EBA but I am sure that the questionnaire adopted in Italy is perfectly aligned, as well as German Blood Donor Questionnaire, with European Community standard guidelines updated continuously.
I hope it was helpful for You.
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I think that in intrauterine life, if we introduce antigens at the time of development of immune system, the body will consider them as self antigens and will not produce antibodies later in life as happens in case of AB blood group. If it is possible,we can save many lives that are wasted due to ABO incompatibility.
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I do not believe that this will work (unless done through molecular genetics procedure) and even if it were it were, this would also diminish the donor supply during this transition period (as we are creating universal recipients). Simply introducing the antigen in embryonic life will cause the babies to be born with the antibodies instead, and the reason that this is not is the fact that when babies are born they have to prior exposure to the antigens, However they start to build them up as early as 3 months of age.
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We have a mutant line of mice in which the homozygous mutant pups die around P7 from hemolytic anemia (the mutated protein is important in red blood cells). We'd like to study the mutant gene/protein's function in the brain, and for this we need to get the pups to survive a few weeks longer. We'd like to try blood transfusions (from mom to pup) but I can't find much info out there about doing this in mice.
Specifically, my questions are:
1. Do you need to wash/purify mom's blood before injecting it into the pup?
2. Should I collect blood into an anticoagulant? If so, which one won't affect the recipient pup?
3. Is blood-typing necessary in mice?
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As long as your work has nothing to do with coagulation, use any one you like. Sodium citrate is easy and cheapest. I have used sodium citrate and worked well.
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Four cases of transmission of variant CJD in humans from transfused blood components have been reported. Recent investigations have demonstrated the utility of prion-filter and bi-functional (prion+leukocyte) filter with reduction of 3 to 4 log infectivity titer. I am inquiring whether any country or region blood service is considering the adoption of any prion-reduction filter for the prevention of transmission of vCJD. Furthermore, if not, the reason why not, cost, lacking evidence of effectiveness, or concerns for safety?
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Hi Hitoshi
Yes the UK has considered implementing a prion filtration system for blood transfusions. Below I have posted one link to a surveillance trial (there are other interesting articles and papers which can easily be found online if you are interested in reading more) http://www.nhsbt.nhs.uk/clinicaltrialsunit/current-trials/prion-filter-pms/
Best
Daryl
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ASH’s Chosing Wisely first recommendation advises against liberal transfusion of RBCs:
"Transfusion of the smallest effective dose of RBCs is recommended because, compared with restrictive strategies, liberal transfusion does not improve patient outcomes.
Therefore, liberal transfusion generates costs and exposes patients to potential harms from transfusion without likelihood of benefit."
Consistent with this recommendation, ASH panel further advise that clinicians avoid administering 2 units of RBCs if 1 unit is sufficient and that appropriate weight-based dosing of RBCs be used in children.
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Don’t administer packed red blood cells (PRBCs) in a young healthy patient without ongoing blood loss and hemoglobin of ≥ 6 g/dL unless symptomatic or hemodynamically unstable.
The hemoglobin transfusion threshold used in multiple studies has varied from 6.0 to 10.0 g/dL. The optimal hemoglobin/hematocrit criterion for transfusion remains controversial in several clinical settings. Nevertheless, compared with higher hemoglobin thresholds, a lower hemoglobin threshold is associated with fewer red blood cell units transfused without adverse associations with mortality, cardiac morbidity, functional recovery or length of hospital stay. Hospital mortality remains lower in patients randomized to a lower hemoglobin threshold for transfusion versus those randomized to a higher hemoglobin threshold. The decision to transfuse should be based on a combination of both clinical and hemodynamic parameters.
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Is there any formula or tables to predict the amount of plasma that can be removed using volume, hematocrit and the centrifugation settings? I give you an example, I'd like to know in advance how much plasma I can remove after centrifugating a 600 cc whole blood bag with 7% hematocrit during 15 minutes at 200g(rcf) at room temperature.
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You can predict that when you centrifuge whole blood with anticoagulant (e.g. sodium citrate) at about 500-3000 x g for 15 min at 20-24°C, you will get about 40-45% (= 40-45% hematocrit) as red blood cells (bottom layer), and therefore 60-55% (upper layer) as plasma. There will be a small intermediate phase that is called buffy coat that contains platelets and white blood cells. As the g force or the time of centrifugation increases, there will be less platelets and WBC in the plasma phase. The hematocrit is usually 40-45% (not 7%), so from 600 ml of whole blood you can expect to get 600 x 55-60% = 330-360 ml of plasma.
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