Red Cell Transfusion

Abstract

Department of Anesthesiology; University of Alabama at Birmingham; Jefferson Tower; Birmingham, Alabama;sergio.gregoretti@ccc.uab.eduRed Cell Transfusion: A Practical Guide. Edited by Marion E. Reid and Sandra J. Nance. Totowa, Humana Press, 1998. Pages: 227. Price:$99.50.This monograph, apparently the first one of a new series entitled “Contemporary Hematology,” seeks to provide a concise, up-to-date overview of current issues associated with the collection, selection, and transfusion of erythrocytes. The material is organized in 14 chapters with 21 contributors, all (with one exception) pathologists laboratory medicine specialists, or both. The practical aspects of blood collection, donor screening, autologous and directed donations, blood administration, and the immunologic principles of transfusion medicine are discussed in five chapters. These chapters are somewhat scattered through the book, and a better arrangement of sequence would have helped the reader. For instance, donor-related issues are contained in chapter 1, whereas an expanded discussion regarding directed donations is found in chapter 10. The chapter concerning blood group antigen and antibodies is relegated at the end of the book, whereas germane immunologic topics are presented in chapter 3.Five chapters are dedicated to erythrocyte transfusion in recipients with special needs. The topics include transfusion in autoimmune hemolytic anemias, in the immunocompromised patient, in solid organ transplantation, and in neonates, and long-term transfusion therapy.The final chapters deal with massive transfusion, the transfusion “trigger,” and transfusion reactions. One chapter also deals with the laboratory aspects of hematopoietic stem cell transfusion, i.e., collection, processing, purification, and storage of the stem cells. This chapter seems out of place in a monograph dedicated to erythrocyte transfusion. Actually, in several instances, steps are taken to remove erythrocytes from the stem cell preparation.The chapters are well written and to the point. Occasionally, however, for the sake of conciseness the quality of presentation suffers, such as when all the complications of massive transfusion are squeezed into a three-page summary in chapter 9. Inaccuracies and questionable statements are few. An increase in hemoglobin concentration by erythropoietin administration decreases but does not “enhance” resting cardiac index in patients with end-stage renal disease (p. 171). Few would agree that the placement of a pulmonary artery catheter is beneficial in treating a patient with an acute hemolytic transfusion reaction (p. 191). Repetitions, despite the multiauthorship, are minor. For instance, transfusion problems in the immunoglobulin (Ig) A-deficient patient are addressed on pages 83 and 198; as to whether the transfusion criteria for autologous blood should be more liberal then for allogeneic blood is discussed on pages 153 and 169. Stylistic lapses are very rare ("the presence of fever can result in an unnecessary work-up for infection, which can result in the patient's being cultured and treated…," page 203). In three chapters (1, 10, and 11) the word autogeneic is used instead of “autologous” to refer to the patient's blood. Because this word was new to me, I looked it up in several medical dictionaries and could not find the word in any. Although allogeneic (i.e., genetically dissimilar, although belonging to individuals of the same species) has legitimately replaced the word donor to qualify the origin of the blood, I see no need for a new word, in this case an etymological nonsense, to replace the perfectly appropriate word autologous (i.e., derived from the same individual). The references are up to date and well chosen, a notable exception being the key reference to citrate toxicity during massive transfusion (p. 144).This monograph, with its emphasis on blood bank issues and the laboratory aspects of transfusion medicine, is mainly written for pathologists and hematologists/oncologists. The practicing anesthesiologist will be better off in searching for answers to clinical questions elsewhere. In this respect, the American Society of Anesthesiologists booklet Questions and Answers about Transfusion Practices can be an excellent starting point. Finally, this monograph may find tough competition as a reference source in transfusion medicine, as in the intention of its editors, because very recently new editions of two major textbooks in this field have been released Clinical Practice of Transfusion Medicine, second edition (Petz DL, Swisher SN, Kleinman S, Spence RK, Strauss RG: Churchill Livingstone, 1966) and Principles of Transfusion Medicine, second edition, (Rossi EC, Simon TL, Moss GS: Williams & Wilkins, 1966). Instead of a book focused exclusively on erythrocyte transfusion, for just $50 more one can purchase an equally up-to-date textbook that discusses the whole spectrum of transfusion medicine.Sergio Gregoretti, M.D.Department of Anesthesiology; University of Alabama at Birmingham; Jefferson Tower; Birmingham, Alabama;sergio.gregoretti@ccc.uab.edu