- Abdulqadir J. Nashwan added an answer:10What's the pathophysiology behind iron overload among non-transfusion dependent sickle cell patients?
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?
Many thanks Dr. Torioni .. very helpfulFollowing
- Philippe Poncelet added an answer:2How to optomize the protocol of detection of platelet microparticles by flow cytometry?
In blood transfusion program to avoid platelet microparticles contaminations to FFP, I need the ideal flow cytometry protocol to detect PMP?
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.2015.10.008Following
- Sergio Torloni added an answer:1What is the way in a Hospital Laboratory to refresh the blood subscription after the process?
In small volumes prefer to study and take small volume blood, and throw away the reductant. In must be in mind that the blood series like eritrosit 120 days has to be cleared from the vessel the old cells in also the other cell types of blood have to be gone away.
I am not sure what you are asking? What is a "blood subscription"?
Blood can be frozen with Glycerol for upt 10 or more years, but there is a loss everytime you freeze or thaw. After thawing the blood is good for 24 hours only. Cell morphology will be really distorded but once in circulation it will "autocorrect" and perform normally.
- Jainudeen K. A. Jameel added an answer:12What would be your approach to a patient with upper GI bleed due to multiple lipomas in the 3rd ,4th part of duodenum and proximal jejunum?
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.Difficult situation! I would wait as patient is currently stable. I have seen Octreoride/ propranolol help in preventing a re-bleed in such a situation by reducing gut venous back-pressure, even when there is no portal hypertension (purely anecdotal). Not aware of any studies supporting this, happy to be educated if there are any...Following
- Pradipesh Chakrabarty added an answer:3What are the success stories of umbilical cord blood HSC transfusion?
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?
You can also see the journal of Mymensingh Medical Journal via ICMJE i.e.www.icmje.org of 2013.Following
- Asaad abd allah added an answer:3How do you transfuse blood in mice?
From what I was reading, the procedure involves euthanizing the donor mouse and collecting blood (Intracardiac) in a heparinized tube and giving the blood via tail vein within the hour. Does anyone have experience with this and possibly have a precise protocol in your lab or your institution on specific steps?
- Giuliano Grazzini added an answer:2Is anyone familiar with the use of Umbilical Cord Blood (UCB) for transfusion?
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!
And also this one:
Allogeneic cord blood red cells for transfusion.
Bianchi M, Landini A, Giannatonio C, Papacci P, d'Onofrio G, Zini G.
Transfus Med Rev. 2012 Jan;26(1):90-1; author reply 91-2. doi: 10.1016/j.tmrv.2011.06.002. Epub 2011 Aug 9. No abstract available.
- Kailash C. Agarwal added an answer:1Does anyone have experience with still disease and febrile non-hemolytic reaction?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.
Not of my expertise. Sorry.Following
- Mojtaba Akhtari added an answer:6Does blood transfusion increase the risk of GVHD in patients who are post hematopoietic stem cell transplantation?
Is there any evidence that blood transfusion increase the risk of GVHD in patients post hematopoietic stem cell transplantation?
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.Following
- Gregory Barshtein added an answer:3Can anybody advise us or provide us with the InSpectra StO2 Monitor (650) and/ or the Aimago Laser-Doppler Imager (Easy LDI)?
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.
Irina & Josef, many thanks for the tip.Following
- Terry S. Singeltary added an answer:12Does any country or region consider the introduction of prion filter or bi-functional (prion and leukocyte) filter for blood transfusion?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?
Wednesday, July 23, 2014
After the storm? UK blood safety and the risk of variant Creutzfeldt-Jakob Disease
22. SaBTO’s decision not to recommend the adoption of prion filtration, taken alongside the other evidence that we have gathered during this inquiry, in our view signals a change from what was a genuinely precautionary approach to vCJD risk reduction in the late 1990s to a far more relaxed approach today. Much of the uncertainty surrounding prions, their potential modes of transmission and the possible rate of undetected infection and disease remains: recent evidence that subclinical prevalence could be as high as one in 2,000 people would suggest that a precautionary approach is now more warranted than ever. (Paragraph 94)
23. Our fear is that the Government’s current attitude is driven less by the available scientific evidence than it is by optimism: a hope that the storm has now passed and that vCJD is no longer the threat to public health that it once was. In the current economic environment, this attitude is not surprising. However, it is not justified. For all we know, the storm may well be ongoing. We conclude this report by recommending that the Government take a more precautionary approach to both vCJD risk mitigation and blood safety more generally, in order to safeguard against future infections. We suggest that it begin by assessing the key risks, known and unknown, that the UK blood supply currently faces and might face in the future, so that it can identify and fill relevant knowledge gaps and support the development of appropriate risk reduction measures and technologies. The Government should initiate this work immediately and we ask that it provide us with an update on its progress well before the dissolution of Parliament. (Paragraph 95)
56After the storm? UK blood safety and the risk of variant Creutzfeldt-Jakob Disease EMBARGOED ADVANCE COPY Not to be published in full, or in part, in any form before 00.01am on Thursday 24 July 2014 Formal Minutes Wednesday 16 July 2014
Friday, October 11, 2013
Removal of exogenous prion infectivity in leukoreduced red blood cells unit by a specific filter designed for human transfusion
Thursday, January 22, 2015
Transmission properties of atypical Creutzfeldt-Jakob disease: a clue to disease etiology?
MAD COW DISEASE nvCJD TEXAS CASE NOT LINKED TO EUROPEAN TRAVEL CDC ***
Sunday, November 23, 2014
*** Confirmed Variant Creutzfeldt-Jakob Disease (variant CJD) Case in Texas in June 2014 confirmed as USA case NOT European ***
the patient had resided in Kuwait, Russia and Lebanon. The completed investigation did not support the patient's having had extended travel to European countries, including the United Kingdom, or travel to Saudi Arabia. The specific overseas country where this patient’s infection occurred is less clear largely because the investigation did not definitely link him to a country where other known vCJD cases likely had been infected.
Sunday, December 14, 2014
*** ALERT new variant Creutzfeldt Jakob Disease nvCJD or vCJD, sporadic CJD strains, TSE prion aka Mad Cow Disease United States of America Update December 14, 2014 Report ***
kindest regards, terryFollowing
- Steingrimur Stefansson added an answer:7What are the blood substitutes available for transfusion?
Natural blood has problems of shelf life and infections such as HIV , Hbs Ag.
Also, Jehovah's Witnesses do not understand hematology and biochemistry.
All of the proteins and cells in your blood have a finite lifetime. After a period, they are absorbed by the liver or kidneys, cleaved to their individual components and recycled.
This happens in all of us, every day
Blood transfusion have nothing to do with consumption of human flesh.
Blood transfusions administered to trauma victims are not designed to keep them well fed on human flesh, they are done to keep them alive by replacing their lost blood.
If you are a vampire, then yes, blood is a consumable. But for the rest of us, blood transfusions are procedures that have saved many more lives than prayers.Following
- Niels Lion added an answer:7Do you use a platelet additive solution for platelets?
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?
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.
- Mehran Ghasemzadeh added an answer:7Why are platelet pockets stored at room temperature (20-25°C)?
Platelet pockets intended for transfusion are stored at room temperature. Is there any risk of protein degradation that could affect their role?
AS main problem, cold storage of platelets leads to clustering of alpha subunits of glycoprotein Ib (GPIbalpha)) on the platelet surface, its Desialylation that accelerating platelet clearance as well as increased rate of apoptosis.
- Khalid A. Altirkawi added an answer:14Do you subscribe to the practice of withholding feeding in preterm infants when they receive a blood transfusion?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?
Two recently published studies are probably of interest in this discussion.
1- Packed red blood cell transfusion is not associated with increased risk of necrotizing enterocolitis in premature infants. by R Sharma, D F Kraemer, R M Torrazza, V Mai, J Neu, J J Shuster, M L Hudak.
2- Red Blood Cell Transfusion Is Not Associated with Necrotizing Enterocolitis: A Review of Consecutive Transfusions in a Tertiary Neonatal Intensive Care Unit. by Matthew B. Wallenstein, Yassar H. Arain, Krista L. Birnie, Jennifer Andrews, Jonathan P. Palma, William E. Benitz, Valerie Y. Chock.
- 13Blood transfusion in acute MI with multivessel disease the right course for patient?
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?
A tu disposición!Following
- 4What is your experience with Patient Blood Management (PBM) programs in your country?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?
Thank you very much for sharing the Northern Ireland experience with us. From the view of hemotherapy, the most important benefit of improvements in management of preoperative anemia and perioperative patient care is the increase in overall patient safety
I think, you made an important point by adding high quality audits, which in our hands also help to increase the quality of hemotherapy.
- Mahdi Najafi added an answer:8Do you follow blood management guidelines in your daily practice?
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?
Recently a conference was held in our hospital and experts from different disciplines discussed on challenging aspects of coagulation control and transfusion. We had a panel on prerequisites of an appropriate protocol for our hospital. We came to agreement on some topics:
1. To determine time interval from discontinuing anticoagulants and surgery
2. To rely more on TEG results for bleeding control
3. To agree on fibrinogen indications and dosage
4. To measure heparin level (Anti X) in bleeding patients
5. To agree on the indications, route of use and dosage of vitamin K in patients on warfarin who are candidates for emergent surgery
To agree on the critical Hb level for transfusion in different situations.
However, to be honest there is a deep valley between knowledge and practice.Following
- 6Does anyone have experience with non-invasive Hb measurement in blood donors?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?
Thank you very much for sharing your very important data.
- 4How do you deal with the West-Nile-Virus (WNV) threat in Europe re. blood donors?
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?
Thank you very much. Most useful.
- Bahri Abayli added an answer:33What are the indications for transfusion of fresh frozen plasma in a cirrhotic patient?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.
I AM AGRE, ONLY İF BLEEDİNG AND DICFollowing
- Sultan Salah added an answer:39Can diabetic people donate blood?Blood is an all-important life saving component that any person can voluntarily donate and for which demand is steep. However, conflicting reports and suggestions by the medical fraternity indicate that willing diabetics are often deprived of the privilege of blood donation. Please clarify this point.
There is a certainty that the Type 1 DM patients are excluded from donating blood even though they are keen to donate, as regards to the type 2 DM they can donate subject to they full fill the criteria (for instance additional co-morbidities like CV diseases,high blood pressure,metabolic syndrome etc.,) set forth by the respective health authorities of the countries, nowadays there is stringent guidelines in place for most of the countries and is readily available for the donors in the official web site of the federal health authorities.
I suppose that i have added a point to the discussion.Following
- 40Could red blood cells, which were removed from patients with Polycythemia vera, be used for blood transfusion (without any infectious diseases)?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)?Dear José,
Your answer perfectly summarizes the strategy.
- 4What is the scientific background in your country for the proposed transfusion trigger for RBC?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?Dear Romi,
Thanks a lot.
This is helpful. You are quite advanced "down under" also in PBM - congratulations!
- Farooq Wani added an answer:3Does SOD decrease or increase in Thalassemic patients?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.SOD activity will increase to fight increased oxidative stress inside the cellsFollowing
- 23Can hypertension patients donate allogenic blood?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.Thanks
At Europe, we ussualy do not accept new donors older than 60, but veterans can continue donating after 65 y/o till 70.
They are not oldies now, only mature!Following
- Michele Schiavulli added an answer:11Does anyone have a validated 'Knowledge, Attitudes and Practices (KAP) survey on blood donations?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.Sorry, here is the questionnaire attachment....Following
- Valencia Nkambule added an answer:1Can we create universal ABO recipients like AB blood group by introducing antigens in individuals in intrauterine life?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.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.Following
- 15Why do all we still transfuse two Red Blood Cells Concentrates each time?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.Hi Ivo!
Actually at my hospital we are serving, except in case of active bleeding, the unit one by one. Also, one today and tomorrow "maybe" the second one, after reevaluation!
Also, after review all the "transfusion order" and "hemoglobin level", I try to phone to each prescritor. I had small service presentation in the most important consume service: "treat the patient, not the figure!
Also, in the hemogram study we are treating to add a message like: We recommend the anemia study, or give iron, etc; plus, we recommend the apply of restrictive transfusion criteria: one by one, ajusted to clinical situation and acording cardiovascular risk factors!
We have reduced more than 30%the red cell concentrates in three years. Also we have save more than half millon of euros last years!
But the problem are the own hematologist! My main "enemy" is my own new boss!!
We must fight every day again pre 1988 NIH Conference attitudes!!
I hope to see at Oporto (NATA Meeting)Following
About Blood Transfusion
The introduction of whole blood or blood component directly into the blood stream. (Dorland, 27th ed)