Average Transfusion Requirement Research Articles

Optimal anticoagulation strategy for left ventricular assist device patients undergoing thoracentesis: a retrospective study

Abstract Background Left ventricular assist devices (LVADs) are associated with thromboembolic risks necessitating anticoagulation, yet balancing these risks with bleeding concerns remains challenging. Current practice involves warfarin with a target INR of 2-3 alongside anti-platelet therapy. However, consensus on anticoagulation management is lacking, particularly during sub-therapeutic INR or procedural settings. Common strategies include bridging anticoagulation with heparin or enoxaparin, temporary cessation of anticoagulation during the procedure or uninterrupted anticoagulation. Purpose To evaluate and compare the incidence of bleeding and thromboembolic events in LVAD patients undergoing thoracentesis, with a focus on determining the optimal anticoagulation strategy during procedures. Methods Retrospective data was collected over one year from LVAD patients undergoing thoracentesis at a large academic center. Patients were categorized into ‘bridge’ (received intravenous heparin for bridging during thoracentesis) and ‘no-bridge’ (did not receive bridging anticoagulation) groups. Warfarin was paused before procedure and resumed after procedure in both groups. Baseline characteristics, including age, sex, race, BMI, LVAD type, and INTERMACS profile, were recorded. Primary outcomes were major bleeding and thromboembolic events within 30 days of warfarin cessation. Statistical analysis used t-test/Wilcoxon for continuous variables and Chi-square/Fisher exact test for categorical variables. A p-value <0.05 was considered significant. Results During the study, twenty LVAD patients underwent thirty-two thoracenteses (nineteen bridge, thirteen no-bridge). The demographics were similar among the two groups. Warfarin was held for an average of 5.5 ± 4.6 days before and resumed 4.1 ± 4.6 days after the procedure in the bridge group and 3.8± 3.2 days before and 1.7 ± 2.5 days after in the no-bridge group. Major bleeding occurred in 73.7% of bridge group cases versus 30.8% of no-bridge group cases (p=0.059). 63.2% of bridge group patients had a bloody pleural effusion on thoracentesis compared to 46.2% of no-bridge group patients (p value= 0.34). Average transfusion requirements were 2.8 units and 2 units in the bridge and the no-bridge groups respectively (p=0.658). Thromboembolic events included a 10.5% ischemic CVA rate in the bridge group, with none in the no-bridge group. No other arterial thromboembolic events, pump thrombosis or DVT/PE were observed in either group. Conclusion In LVAD patients undergoing thoracentesis, a non-bridging strategy does not appear to elevate the risk of thrombosis compared to a bridging approach. Moreover, the incidence of bleeding, while not statistically significant, trended higher in the bridging group.

The Commands Trial: A Phase 3 Study of the Efficacy and Safety of Luspatercept Versus Epoetin Alfa for the Treatment of Anemia Due to IPSS-R Very Low-, Low-, or Intermediate-Risk MDS in Erythropoiesis Stimulating Agent-Naive Patients Who Require RBC Transfusions

The Commands Trial: A Phase 3 Study of the Efficacy and Safety of Luspatercept Versus Epoetin Alfa for the Treatment of Anemia Due to IPSS-R Very Low-, Low-, or Intermediate-Risk MDS in Erythropoiesis Stimulating Agent-Naive Patients Who Require RBC Transfusions

Hepatic Resection in Kurdistan Center for Gastroenterology and Hepatology: A Single Center Experience

Background and objectives:Liver resection has become definitive management for several benign and malignant conditions. The aim of the study is to review the short-term outcome of hepatic resection, including extent of resection, the original pathology, blood loss, blood transfusion, morbidity and mortality. Methods: This is a case series study included 25 patients underwent hepatic resection to treat benign conditions or to potentially eradicate malignant conditions between 1stJanuary 2016 to 31st August 2017 in three hospitals belongs to Kurdistan Center for Gastroenterology and Hepatology. Data regarding socio-demographics and short term outcome, including extent of resection, blood loss, blood transfusion, morbidity and mortality were collected and analyzed. Results: The total number of patients that underwent hepatic resection was 25. There were 5 male, 20 female. Age ranged between 5-77 years with mean age of 45.8 years. The indications for resection were malignant disease in (44%) and benign diseases in (56%).The mean estimated blood loss was 904.0 ± 597.7 .The mean blood transfusion was 800 ml packed red blood cell. The postoperative recovery was smooth in (64%) and complicated in (36%). The mortality rate was (4%). Conclusions: hepatic resections can be done with acceptable early postoperative outcomes despite limited resources and low volume set-up, morbidity, mortality, estimated blood loss and average transfusion requirement was high which can be further minimized with better meticulous surgical technique and use of novel energy devices

The use of whole blood during cardiopulmonary bypass in neonates reduces donor exposures and costs

Improvised Explosive Devices (IED) are the primary wounding mechanism for casualties in Operation Enduring Freedom. Patients can sustain devastating traumatic amputations, which are unlike injuries seen in the civilian trauma sector. This is a database analysis of the largest patient registry of multiple traumatic amputations.The Joint Theater Trauma Registry was queried for patients with a traumatic amputation from 2009 to 2012. Data obtained included the Injury Severity Score (ISS), Glasgow Coma Score (GCS), blood products, transfer from theatre, and complications including DVT, PE, infection (Acinetobacter and fungal), acute renal failure, and rhabdomyolysis. Comparisons were made between number of major amputations (1–4) and specific outcomes using χ2 and Pearson’s rank test, and multivariable logistic regression was performed for 30-day survival. Significance was considered with p < 0.05.We identified 720 military personnel with at least one traumatic amputation: 494 single, 191 double, 32 triple, and 3 quad amputees. Average age was 24.3 years (18–46), median ISS 24 (9–66), and GCS 15 (3–15). Tranexamic acid (TXA) was administered in 164 patients (23%) and tourniquets were used in 575 (80%). Both TXA and tourniquet use increased with increasing number of amputations (p < 0.001). Average transfusion requirements (in units) were packed red blood cells (PRBC) 18.6 (0–142), fresh frozen plasma (FFP) 17.3 (0–128), platelets 3.6 (0–26), and cryoprecipitate 5.6 (0–130). Transfusion of all blood products increased with the number of amputations (p < 0.001). All complications tested increased with the number of amputations except Acinetobacter infection, coagulopathy, and compartment syndrome. Transfer to higher acuity facilities was achieved in 676 patients (94%).Traumatic amputations from blast injuries require significant blood product transfusion, which increases with the number of amputations. Most complications also increase with the number of amputations. Despite high injury severity, 94% of traumatic amputation patients who are alive upon admission to a role II/III facility will survive to transfer to facilities with higher acuity care.

Patients with multiple traumatic amputations: An analysis of operation enduring freedom joint theatre trauma registry data

IntroductionImprovised Explosive Devices (IED) are the primary wounding mechanism for casualties in Operation Enduring Freedom. Patients can sustain devastating traumatic amputations, which are unlike injuries seen in the civilian trauma sector. This is a database analysis of the largest patient registry of multiple traumatic amputations. MethodsThe Joint Theater Trauma Registry was queried for patients with a traumatic amputation from 2009 to 2012. Data obtained included the Injury Severity Score (ISS), Glasgow Coma Score (GCS), blood products, transfer from theatre, and complications including DVT, PE, infection (Acinetobacter and fungal), acute renal failure, and rhabdomyolysis. Comparisons were made between number of major amputations (1–4) and specific outcomes using χ2 and Pearson’s rank test, and multivariable logistic regression was performed for 30-day survival. Significance was considered with p<0.05. ResultsWe identified 720 military personnel with at least one traumatic amputation: 494 single, 191 double, 32 triple, and 3 quad amputees. Average age was 24.3 years (18–46), median ISS 24 (9–66), and GCS 15 (3–15). Tranexamic acid (TXA) was administered in 164 patients (23%) and tourniquets were used in 575 (80%). Both TXA and tourniquet use increased with increasing number of amputations (p<0.001). Average transfusion requirements (in units) were packed red blood cells (PRBC) 18.6 (0–142), fresh frozen plasma (FFP) 17.3 (0–128), platelets 3.6 (0–26), and cryoprecipitate 5.6 (0–130). Transfusion of all blood products increased with the number of amputations (p<0.001). All complications tested increased with the number of amputations except Acinetobacter infection, coagulopathy, and compartment syndrome. Transfer to higher acuity facilities was achieved in 676 patients (94%). ConclusionTraumatic amputations from blast injuries require significant blood product transfusion, which increases with the number of amputations. Most complications also increase with the number of amputations. Despite high injury severity, 94% of traumatic amputation patients who are alive upon admission to a role II/III facility will survive to transfer to facilities with higher acuity care.

Outcomes of Lumbopelvic Fixation in the Treatment of Complex Sacral Fractures Using Minimally Invasive Surgical Techniques

Introduction Complex sacral fractures with vertical and anterior pelvic ring instability treated with traditional fixation methods are associated with high rates of failure and poor clinical outcomes. Supplemental lumbopelvic fixation(LPF) has been utilized for additional stability to help with fracture union. The purpose of this study was to determine if minimally invasive LPF provides reliable fracture stability and acceptable complication rates in complex sacral fractures. Methods Twenty-eight patients were retrospectively chosen from a pool of 105 at our level 1 trauma center (2008–2014) who had undergone LPF. Patients underwent posterior sacroiliac fixation, with or without anterior fixation, followed by minimally invasive LPF. Main outcomes were return to the operating room (OR) for instrumentation revision secondary to loss of correction or failure of fixation, return to the OR for treatment of infection, radiographic evaluation to assess for loss of reduction. ISS score, transfusion requirements, length of hospital stay, postoperative day at mobilization, and mortality were also evaluated. Results Three patients returned to the OR for infection (11%). One patient required revision surgery for instrumentation malposition and neurologic deficit (3.5%). No patients required return to the OR for revision due to failure of instrumentation or loss of correction. The average length of surgery was 3.9 hours and estimated blood loss was 192 mL. The average transfusion requirement was 2.2 units of packed red blood cells and the majority of patients were mobilized at postoperative day 4. There were no mortalities. Conclusion This is currently the largest series of high energy complex sacral fractures treated with minimally invasive LPF. The results demonstrate reliable maintenance of reduction with a low complication rate.

Profil clinico-biologique et immunohématologique des patients atteints de β-thalassémie en Tunisie : à propos de 26 cas

Aim of the studyTo study the clinical and biological profile of β-thalassemic patients in our region, reflecting the quality of their care. Patients and methodsA retrospective study (2010–2011) on 26 β-thalassemic patients followed in the pediatrics service at CHU Farhat Hached Sousse, Tunisia. Epidemiological, clinical and biological data were collected from medical records and transfusion files of patients. The transfusion protocol adopted was to maintain a hemoglobin level>10g/dL by regular transfusions every 3–4 weeks. Iron chelation therapy, in order to maintain serum ferritin<1500ng/mL, was introduced when serum ferritin exceeded 800–1000ng/mL. ResultsThe mean age of patients at diagnosis was 15 months. The clinical impact of anemia had resulted in failure to thrive in 54% of patients and facial dysmorphism in 23%. The average transfusion requirement was estimated at 311.02mL/kg/year with 6 cases of hyperconsumption. The immunohaematological monitoring showed the appearance of anti-RBC alloimmunization in one patient and 4 cases of autoimmunization. Poor adherence of chelation therapy was 62% and causing 5 cases of cardiac complications, 4 cases of liver injury and 14 cases of endocrine complications. ConclusionImproving the therapeutic care of β-thalassemic children requires better monitoring of transfusion recovery and improved adherence to chelation therapy.

Time of Day Effect on Surgical Complications Following Liver Transplantation

Purpose: Liver transplantation (LT) start time can be dictated by several factors and there is growing concern that it may contribute to complications. This study reviewed the relationship between developing surgical complications following liver transplant and time of starting surgery. Methods: We conducted retrospective analysis of our center's liver transplant records from 1995 to October 2008 and extracted start, end and total operation times. We collected data on donor and recipient characterstics: Age, Gender, indication for LT, MELD score at LT, Donor age, Donation after Cardiac Death (DCD) or Donation after Neurologic Death (DN), and Cold Ischemic Time (CIT). We categorized surgical start time in to eight 3-hour categories (starting 12:00AM - 3:00AM as first category). Type and number of surgical complications, number of transfusions and duration of surgery were also entered for analysis. Patients with multiple organ transplantation were excluded from the analysis. For patients who underwent re-transplantation, only their first LT operation was included for analysis. Results: A total of 551 LT operations were included for this study. The median recipient age was 51 years, 67% were males and 84.4% Caucasians. The median pre-LT MELD score was 23. DCD accounted for 6.4% of transplants and the mean CIT for our group was 9.2 hours. The mean duration of the LT procedure was 9.18 hours. Average transfusion requirements were 8.62 units of packed red blood cells and 10.78 units of FFP. Among 551 LT operations there was 247 surgical, medical, and/or non-transplant surgical complications. We found no significant difference in the rate of LT-related surgical complications when analyzed by operation start time. In fact, the rate of occurrence of relevant surgical complications was almost the same across all 3-hour categories of start time. Conclusion: Our study indicates no relation between operation start time and rate of relevant surgical complications following LT. This study is limited by its retrospective nature. A structured prospective study to collect variables to clearly define the relation or no relation between surgical start time and complications is needed.

Acquired haemophilia A as a blood transfusion emergency.

Acquired haemophilia is a rare autoimmune disorder caused by autoantibodies directed in the majority of the cases against clotting factor VIII. This disorder is characterised by the sudden onset of bleeding that not rarely may be life-threatening and need transfusion support. Most reports on this condition describe the need for blood transfusions during the acute, haemorrhagic phase, but the number of transfused red cell units is often unknown. In the last 5 years, 14 patients with acquired haemophilia A were identified in the transfusion and haemophilia centres of Verona and Castelfranco Veneto. The transfusion support for these 14 patients was analyzed in this retrospective survey. The 14 patients required a total of 183 red cell units. The average transfusion requirement was 13 red cells units/patient, with a range from 0 to 38 units. Eleven of the 14 patients studied needed strong transfusion support to enable any further management of the haemorrhages, as well as for eradication treatment of the autoantibodies to factor VIII. A relevant part of the management of haemorrhagic symptoms as well as the first choice for any further treatment (bleeding or the cure of the underlying disease) is transfusion of red blood cells.

Selective Management of Isolated and Nonisolated Grade IV Renal Injuries

We reviewed all grade IV renal injuries to report outcomes, and determined if operative and selective nonoperative management can lead to high salvage rates. We also determined if management and outcome differ significantly between cases of isolated grade IV renal injuries and those with associated multiorgan injuries. We retrospectively reviewed the records of 153 grade IV renal injuries from a 25-year period. We divided these into isolated grade IV renal injuries (43) and those with associated nonrenal injuries (110), and analyzed both groups on the basis of type of renal injury, operative vs nonoperative management, operative nephrectomy rate and renal salvage rate. Salvage was defined as 25% or greater overall renal function (50% or greater function of the injured kidney). Of the 153 patients 103 were treated operatively and 50 nonoperatively with an overall salvage rate of 84%. Penetrating trauma accounted for 87 injuries and blunt trauma 66, while 52% (79 of 153) involved a renal vascular injury. The grade IV renal injuries with concurrent associated injuries requiring operative exploration were repaired at exploration with a 15% nephrectomy rate and an 83% salvage rate. Of the 43 patients with isolated injuries 18 (42%) underwent operative exploration with an average transfusion requirement of 8.5 units packed red blood cells. Two patients (11%) required nephrectomy, 1 kidney was nonfunctional postoperatively and 2 minor complications were identified. The remaining 25 (58%) isolated grade IV renal injuries were managed nonoperatively, with only 12 patients requiring transfusion (average 2.6 units) and a renal salvage rate of 88%. None of the 50 nonoperative cases (isolated or nonisolated renal injuries) required delayed nephrectomy. Six cases demonstrated nonfunctioning kidneys and 4 incurred minor complications. Management of grade IV renal injuries is complex and demanding if renal salvage is to be achieved. Selective operative vs nonoperative management is based on the presence of associated nonrenal injuries, the hemodynamic stability of the patient, the degree of renal staging and the skill of the surgeon. Isolated grade IV renal injuries represent a unique situation to treat the patient based solely on the extent of the renal injury, thus nonoperative management is used more frequently. Persistent bleeding represents the main indication for renal exploration and reconstruction. In all cases of severe renal injury nonoperative management should only occur after complete renal staging in hemodynamically stable patients.

Early Experience With Activated Recombinant Factor VII for Intractable Hemorrhage After Cardiovascular Surgery

Intractable hemorrhage after complex cardiovascular operations is a serious and potentially lethal complication. We report our experience with the use of activated recombinant factor VIIa (rFVIIa) as rescue therapy for patients with refractory postoperative hemorrhage. From April 2002 through December 2003, 9 patients received rFVIIa for intractable hemorrhage after cardiovascular surgery. Patients underwent aortic surgery (2), coronary artery bypass graft surgery (4), double valve operations (2), and mitral valve replacement (1). Four of these procedures were reoperations. Intraoperative aprotinin was used in all patients. All patients underwent standard heparinization (300 IU/kg) before cardiopulmonary bypass and reversal with protamine. Five patients underwent reexploration for mediastinal hemorrhage before treatment; 2 were reexplored twice. The average transfusion requirement before rFVIIa administration was 9 U of blood, 7 U of plasma, 22 U of platelets, and 19 U of cryoprecipitate. rFVIIa was administered as an intravenous bolus at 68 to 120 mug/kg. Mean time of administration from the first operation was 10.9 +/- 7.2 hours. At the time of activated rFVIIa administration, chest tube drainage averaged 640 mL/h. In all patients, chest tube drainage was dramatically reduced to less than 100 mL/h within 5 hours after drug delivery. None of the patients required reexploration after treatment. There were no postoperative neurologic or cardiovascular complications. When used as rescue therapy for intractable hemorrhage after cardiovascular surgery, rFVIIa may be effective in promoting hemostasis, preventing reexploration, and reducing transfusion requirements.

Perioperative morbidity in bilateral one-stage total knee replacements.

A retrospective review was done on 501 patients who had bilateral sequential one-stage total knee replacements from September 1995 to April 2000 to evaluate perioperative (inhospital) morbidity. One thousand two knee replacements were done with the patients receiving regional anesthesia, on 286 women and 215 men with an average age of 66 years. The average transfusion requirement was 2.8 units of blood per patient. There were no deaths, myocardial infarctions, or cerebrovascular accidents. The mean length of hospital stay was 7.2 days. One hundred forty-four perioperative complications were observed in 109 patients (21.8%). These complications included 27 arrhythmias (5%), one congestive heart failure (0.2%), 65 lower extremity deep venous thromboses (13%), 14 fat emboli (3%), and two pulmonary emboli (0.4%). Other major complications were pneumonia (1%), acute renal failure (0.4%), ileus (2%), and mental status changes (2%). Wound complications included two deep infections (0.4%), three hematomas (0.6%), and five delayed wound healings (0.9%). According to the current study the perioperative morbidity and mortality is acceptable if the procedure is used for selected patients. Patients with significant comorbidities should have a staged bilateral total knee replacement.

Laparoscopic Cholecystectomy in Cirrhotic Patients

Background/Aims: Laparoscopic cholecystectomy has become the procedure of choice for symptomatic cholelithiasis. A study to evaluate the benefits and risks of laparoscopic cholecystectomy in cirrhotic patients was performed. Methods: Between January 1994 and December 2000, 1,100 laparoscopic cholecystectomies for symptomatic gallbladder diseases were performed. There were 24 cirrhotic patients (group A) and 72 age- and sex-matched controls (group B). All patients had well-compensated cirrhosis (Child’s class A or B). Results: There was no operative mortality in either group and the postoperative complication rates were 20.8 and 9.72% in groups A and B, respectively (p < 0.000001). Operative time in group A was 89.16 vs. 68.41 min in group B (p < 0.000001). The estimated intraoperative blood loss in group A was 106.25 vs. 37.08 ml in group B (p < 0.000001). The average transfusion requirement was 0.155 and 0.0 units in groups A and B, respectively (p < 0.025). The hospital stay in groups A and B was 4.7 and 3.61 days, respectively (p < 0.0500). Conclusion: Laparoscopic cholecystectomy in patients with compensated cirrhosis is safe and should be the treatment of choice for these patients. Laparotomy should be applied only if the surgeon considers the operation inadequate to be continued laparoscopically.

Spinal Instrumentation for Duchenne's Muscular Dystrophy: Experience of Hypotensive Anaesthesia to Minimise Blood Loss

Nineteen patients with Duchenne's muscular dystrophy underwent segmental spinal instrumentation and posterior fusion between 1989 and 1994. The indication for surgery was loss of the ability to walk and development of scoliosis with sitting discomfort. Preoperative assessment included evaluation of pulmonary function. Average age at operation was 12.5 years. Instrumentation and fusion extended from upper thoracic levels to L-5 or the sacrum. A Hartshill rectangle was used in all cases, with banked allograft bone. Severe intraoperative blood loss was avoided by use of hypotensive anaesthesia. Peroperatively, systolic blood pressure was maintained between 75 and 85 mm Hg. Average blood loss was 1,246 ml (range, 400-3,100) or 30% of estimated total blood volume. Average transfusion requirements were 3 units of packed cells. Postoperative analgesia was provided by infusion via an epidural catheter. There were no postoperative wound or chest infections. Three patients required catheterisation for urinary retention. Postoperatively patients were fitted with a Neofract jacket to allow early mobilisation and discharge. Mean postoperative length of stay was 16 days. Posterior spinal fusion by using the Hartshill rectangle provided good correction and fixation. Hypotensive anaesthesia permitted surgery to be performed rapidly in a relatively dry field and avoided the complications of severe intraoperative blood loss and massive transfusion.

DIAGNOSTIC LAPAROSCOPY AS AN ADJUNCT TO SELECTIVE CONSERVATIVE MANAGEMENT OF SOLID ORGAN INJURIES AFTER BLUNT ABDOMINAL TRAUMA

To investigate the efficacy of diagnostic laparoscopy (DL) as an adjunct in patient selection for conservative management of solid organ injuries (SOI) following blunt abdominal trauma, 15 patients with injuries documented by computed tomographic (CT) scanning were prospectively evaluated. Diagnostic laparoscopy was performed in an attempt to characterize SOI, to evaluate the abdomen for associated occult injuries, and to select patients for conservative management or laparotomy. The 15 patients had CT evidence of 17 SOIs (nine spleen, eight liver), and DL allowed adequate visualization of 15 of the 17 injuries. Occult hollow viscus injury was discovered in 2 of 15 patients (one colon, one small bowel) and required laparotomy. In the remaining 13 patients, DL revealed ongoing hemorrhage in four patients and poor visualization in one patient that prompted laparotomy (four splenorrhaphy, one hepatorrhaphy). Conservative management was employed in the treatment of eight patients with findings of minor injury or adequate hemostasis on DL. The average transfusion requirement in this group was 1.8 U. No patient failed conservative management. There were no complications attributable to DL. These data demonstrate that DL may become an effective adjunct in patient selection for conservative management of SOI following blunt abdominal trauma.

Endoscopic Nd:YAG laser treatment of severe radiation injury of the lower gastrointestinal tract: long-term follow-up

We report a series of patients with severe radiation injury treated with endoscopic laser photocoagulation. Eight patients with recurrent lower gastrointestinal bleeding secondary to procosigmoiditis were treated with endoscopic Nd:YAG laser therapy. Patients were followed for an average of 21.7 months after the first laser treatment. Average transfusion requirements and hospital admissions per patient-month were 0.93 and 0.27, respectively, in the prelaser period and 0.18 and 0.06, respectively, in the entire period following the first laser treatment. A total of 26 laser treatments were performed. There were three major (prolonged ileus) and one minor (pain) complication. We conclude that endoscopic Nd:YAG laser photocoagulation is a safe, effective, and lasting treatment in severe, symptomatic radiation injury of the lower gastrointestinal tract.

Transfusion of Predonated Autologous Blood in Elective Cardiac Surgery

Despite blood conservation techniques, the average transfusion requirement in patients undergoing elective cardiac surgical procedures remains 1 to 3 units. We studied the efficacy of predonated autologous blood in decreasing homologous transfusion in two matched groups of 58 patients each. Group 1 received homologous blood perioperatively, and Group 2 was transfused with predonated autologous blood. An average of 1.97 units was predonated in Group 2 over 18 days. This resulted in a decline in whole blood hemoglobin concentration of 2.2 gm/dl. No complications resulted from phlebotomy in this ambulatory population consisting predominantly of patients with coronary artery disease. Transfusion of an average of 1.7 units of autologous blood in Group 2 reduced the volume of homologous transfusion by 46% compared with Group 1 ( p < .01). In Group 1, 38% of patients required no homologous transfusion compared with 64% in Group 2 ( p < .02). There were no complications related to autologous blood transfusion. Total transfusion requirement was related to the length of cardiopulmonary bypass. We conclude that autologous predonation is a simple, safe, and cost-effective method of reducing homologous transfusion and thereby decreasing the risk of transfusion-related reactions and infections.

Endoscopic injection sclerosis (EIS) of esophageal varices

A technique for injection of sclerosing agents into esophageal varices using a fiberoptic endoscope in conscious but sedated patients was evaluated. With a flexible needle of our own design, 82 such procedures were performed in 22 patients over a period of 17 months. A solution of 0.5% sodium tetradecyl sulfate, 50% glucose, and 3.5 units of bovine thrombin per ml was used. None of the patients were surgical candidates and all presented with variceal hemorrhage. The complication rate was 2.4% (two of 82 procedures). Prior to beginning injection sclerosis the 22 patients had sustained an average of 3.8 episodes of hemorrhage and the average transfusion requirement was 25.7 units per patient. After instituting therapy the number of episodes of hemorrhage averaged 1.3 per patient with a mean transfusion requirement of 7.3 units.

Blood transfusion requirements before and after bilateral nephrectomy in patients undergoing chronic hemodialysis.

Abstract. Blood transfusion requirements have been calculated in 6 patients undergoing chronic hemodialysis before and after bilateral nephrectomy. Following nephrectomy the monthly average transfusion requirement per patient increased from 379 + 135 to 673+202 ml (+S.D.) (p&lt;0.03) and average Hb decreased from 7.7+0.4 to 6.9+0.5 g/100 ml (p&lt; 0.03). Furthermore transfusion requirements were calculated in 10 nephrectomized and 15 non‐nephrectomized patients. The monthly transfusion requirement averaged 404+181 ml per patient in the nephrectomized against 14+22 in the non‐nephrectomized group (p&lt;0.01). Hb averaged 5.3+0.7 g/100 ml in the nephrectomized against 6.7+1.2 in the non‐nephrectomized group (p&lt;0.01). No significant difference in age, body weight, length of observation period, average predialytic serum creatinine, average predialytic BP or duration of antibiotic therapy was found in the two groups. Seven of 9 multitransfused patients developed lymphocytotoxic antibodies. It is concluded that severely atrophic kidneys exert a significant, although limited, erythropoietic stimulating function and that nephrectomy should not be performed as a routine in patients on chronic dialysis awaiting renal transplantation.