Transfusion Risk Of Infection Research Articles

Hepatitis E risks: pigs or blood-that is the question.

Infection with hepatitis E virus (HEV) Genotype 3 is recognized as a food-borne zoonosis in developed countries where it usually causes a mild self-limited acute hepatitis. It may cause a persistent infection in the immunosuppressed human that can progress to cirrhosis. To protect the patient from transfusion-acquired HEV infection, steps have been taken in the United Kingdom to provide for at-risk patients only components from donors screened for HEV viremia. This strategy does not protect from dietary exposure and calls into question estimation of relative risk between blood transfusion and diet. Using data on HEV viremia, component exposure, residual plasma volume, and resulting transmission, the dose of virus administered and subsequent transmission rates were determined and used to populate a model that can infer the relationship between blood and dietary exposure. The annual attack rate of a population, defined as seroconversion, provides an estimate of the risk of receiving a component containing HEV from a viremic donor. The lowest viral dose that resulted in infection was 2 × 104 IUs and 55% of components containing this dose transmitted infection. The transfusion risk of infection only exceeds the annual dietary risk when more than 13 individual donor components are transfused. For many solid organ transplant patients dietary exposure far exceeds the risk of transfusion from unscreened donors. It is only in the immunosuppressed patient requiring extensive blood component support that transfusion risk dominates. This understanding should inform policy decisions on HEV RNA screening of blood donations.

Immunological complications of blood transfusion

SUMMARYIn the developed world, most of the reported complications of transfusion have an immunological basis. Although the media and the public are worried about the infectious risks of transfusion, hemovigilance reports show that antigen–antibody reactions are responsible for the vast majority of acute and delayed transfusion reactions. Among the immediate complications of transfusion, the most common and serious are intravascular hemolytic transfusion reactions because of ABO incompatibility caused by giving the wrong blood to a patient (e.g. group A blood to a group O recipient). Fortunately, the vast majority of ABO‐incompatible transfusions do not lead to major morbidity or mortality. Another important cause of severe immediate transfusion reactions is transfusion‐related acute lung injury (TRALI), caused by white cell antibodies in donor plasma. The most common, although not severe, acute tansfusion reactions are urticaria and febrile, nonhemolytic, mostly preventable by leukodepletion and leukoreduction. Delayed transfusion reactions are: (i) hemolytic, caused by anamestic responses to red cell antigens, causing hemolysis days after the transfusion; (ii) post‐transfusion purpura, caused by an anmnestic response to platelet antigens; (iii) graft‐versus‐host disease, caused by engrafted donor lymphocyte reacting against the recipient; and (iv) immunological refractoriness to platelet transfusions, caused mostly by human leukocyte antigen antibodies destroying transfused platelets. The diagnosis of most of these complications can now be made by immunohematologists, with the aid of specialist reference laboratories, thus enabling prompt therapy as required.

Safe Handling and Administration of Blood Components: Review of Practical Concepts

The more advanced we become, the more evident are the infectious and noninfectious risks of the blood supply. Infectious risks are somewhat straightforward and are addressed by implementing stricter donor criteria and testing. The noninfectious risks, however, are more complicated. Each step in the transfusion process, beginning with the physician who orders a transfusion to the actual transfusion of the component, is subject to adverse outcomes and increases the noninfectious risks of transfusion. The challenges to provide the safest blood possible with zero risk have resulted in the implementation of stringent standards from both the American Association of Blood Banks and the Joint Commission on Accreditation of Healthcare Organizations. A series of case scenarios serve as the basis for discussion of the risks, which affect the safety and administration of blood components, inherent in the transfusion process. Journals, textbooks, Internet. The transfusion process is a complex multistep process with inherent risks. Infectious risks of transfusion are being adequately addressed such that the noninfectious risks of transfusion are becoming much more evident. Patient safety can be compromised if each step of the transfusion process is not completed according to established policies and procedures at each individual institution.

The Infectious Risks of Transfusion: State of the Art

Transfusion Alternatives in Transfusion MedicineVolume 5, Issue s2 p. 11-12 The Infectious Risks of Transfusion: State of the Art Michael P. Busch MD, PhD, Michael P. Busch MD, PhD Blood Systems, Blood Centers OF THE Pacific, AND University OF California, San FranciscoSearch for more papers by this author Michael P. Busch MD, PhD, Michael P. Busch MD, PhD Blood Systems, Blood Centers OF THE Pacific, AND University OF California, San FranciscoSearch for more papers by this author First published: 28 February 2008 https://doi.org/10.1111/j.1778-428X.2003.tb00310.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume5, Issues2June 2003Pages 11-12 RelatedInformation

Multimodal blood sparing concepts.

Infectious risks of transfusion, but also cost and resource efficiency considerations have triggered continuing efforts to reduce blood transfusion. Despite different national consensus guidelines, several American and European multicenter studies demonstrated a substantial variability in perioperative transfusion practice [1] [2] [3] [4] [5]. Even in a selected patient population at low risk for transfusion therapy, Stover et al demonstrated that the percentage of patients transfused and the median number of units transfused per patient varied considerably between institutions [3]. Evaluating blood products use in more than 40 teaching hospitals from 10 European countries, the SANGUIS study demonstrated that transfusion rates depend more on physicians than on type of procedure, patient population or hospital [4]. A recent study involving teaching and non-teaching hospitals found similar results [5]. Reasons for the large variability in transfusion practice remain elusive, but clinicians' practice and attitude may be entrenched and slow to change [6]. Application of a standardised multidisciplinary transfusion strategy might reduce the use of allogeneic blood transfusion in major surgical patients.

Transfusion medicine in obstetrics and gynecology.

Obstetricians and Gynecologists care for many patients with conditions potentially requiring blood transfusions. Cesarean section and hysterectomy are the two surgeries performed most frequently and both have the potential for blood loss requiring transfusion. Other examples include postpartum hemorrhage, placenta previa, and ruptured ectopic pregnancy. Obstetricians and gynecologists need to become knowledgeable about the ever-changing aspects of blood transfusion and apply it in their clinical practice. This review intends to update obstetricians and gynecologists and other health care professionals about the basic as well as the latest technologies of blood transfusion. The different types of blood components are discussed including their preparation, indications, risks, and benefits. The complications of blood transfusion and their management are reviewed, including infections, noninfectious, and immunological etiologies. HIV and hepatitis are explored, these being the most serious infectious risks of transfusion. Autologous blood transfusion, an underutilized option, is examined. Hemodilution and intraoperative blood salvage, other techniques for using the patient's own blood, are discussed. Finally, synthetic agents such as erythropoietin, granulocyte colony-stimulating factors, factors, desmopressin acetate, gonadotropin-releasing hormone agonists, and new products are introduced as potential replacements to blood transfusion in the future.

Rational Use Of Blood And Blood Components

The basis for appropriate use of blood and tissue homographs is founded on an understanding of the risks, benefits, and alternatives to their use. In this article, the issues that need to be considered when the clinician obtains informed consent are discussed. Infectious risks of transfusion and tissue homographs are reviewed in historical context. Various types of transfusion reactions, their frequency, cause, and treatment are detailed. Lastly, current guidelines for the appropriate use of blood components and alternatives to homologous transfusion are reviewed.