Large Number Of Blood Transfusions Research Articles

Comparison of ELISA and NAT techniques among blood donors

Large number of blood transfusions are carried out globally to save countless lives, but unsafe practices risks the recipient of transfusion transmittable infections ((TTI’S). TTI’s can be reduced by improving donor selection, donor awareness regarding TTI and implementing sensitive screening tests. In India, it is mandatory to test each donated unit of blood for markers of HIVI and II, HBV, HCV, malaria and syphilis. Currently, in India all the blood donations are screened for various infectious markers using ELISA or rapid methods. TTIs can be responsible for causing considerable burden on the health status and economy of the country. Hence there is need to introduce better methods for testing blood units. Even after being seronegative the blood transfusions are still at risk of transmitting infections. In order to reduce the residual risk sensitive screening tests are needed and as a result NAT has been considered. In India NAT testing is not mandatory but many private blood banks and hospitals and state Governments of few states have started implementing NAT for blood safety. It increases the possibility of identifying the infection in window period and thus reducing the residual risk of TTIs. NAT is highly sensitive and specific for viral nucleic acids and is based on amplification of targeted regions of RNA and DNA and thus is the technique of choice. By early detection than serology, the window period of HIV, HBV and HCV infections narrows. But the issue of higher cost accounts for its limited use especially in developing countries. The present study is designed to understand the role of NAT in detecting the risk acquiring TTIs as compared to conventional methods currently in use for detection of HBV, HCV and HIV infections amongst blood donors.

836 Audit of Neonatal Blood Transfusions

Introduction: Blood transfusions are very common on a neonatal unit. Patients often need a large number of blood transfusions but each may be as little as 8mls. To reduce donor exposure and wastage of blood each standard unit is split into 6 parts or a Pedipack which may be all or partly allocated to 1 infant. Our guideline was developed in 2007 and a prospective audit showed good compliance with no unnecessary donor exposure, but wastage due to inappropriate allocation of a full pedipack. Aims: This was a retrospective re-audit of all babies who had received a blood transfusion to ensure continued compliance with the protocol and to monitor donor exposure and the wastage of blood units. Results: Babies received between 1 and 17 blood transfusions. For babies ≤28 weeks gestation who did not receive pedipacks as per protocol they were exposed to up to 6 unnecessary donors. For babies >28 weeks 15% were allocated an inappropriate full pedipack resulting in wastage. Conclusions: There was very poor adherence to the protocol resulting in unnecessary exposure to multiple donors and excessive wastage. This was felt to be due to poor compliance with the guideline, poor communication between the neonatal unit and blood bank staff and an increase in the need for blood transfusions resulting in a lack of availability of full pedipacks. Recommendations: To provide teaching sessions for all staff. To improve communication between the neonatal unit and blood transfusion. To re-audit to ensure that improvements have occurred.

The Role of Erythropoietin Therapy in the Critically Ill

Critically ill patients receive an extraordinarily large number of blood transfusions. Between 40% and 50% of all patients admitted to intensive care units (ICUs) receive at least one allogeneic red blood cell (RBC) unit and average close to 5 U of RBCs during their ICU admission. RBC transfusion is not risk-free, and there is little evidence that "routine" transfusion of stored allogeneic RBCs is beneficial to critically ill patients. It is clear that most critically ill patients can tolerate hemoglobin levels as low as 7 g/dL, and therefore, a more conservative approach to RBC transfusion is warranted. Anemia of critical illness is a distinct clinical entity characterized by blunted erythropoietin (EPO) production and abnormalities in iron metabolism identical to what is commonly referred to as anemia of chronic disease. As such, the bone marrow in many of these patients responds to the administration of exogenous EPO, in spite of their underlying critical illness. The efficacy of perioperative recombinant human erythropoietin (rHuEPO) has been demonstrated in a variety of elective surgical settings. Similarly, in critically ill patients, rHuEPO therapy will also stimulate erythropoiesis. In randomized placebo-controlled trials, therapy with rHuEPO resulted in a significant reduction in allogeneic RBC transfusions. Strategies to increase the production of RBCs are complementary to other approaches to reduce blood loss in the ICU and decrease the transfusion threshold in the management of all critically ill patients.

Variability of the Iron Specific Magnetic Susceptibility of Spleen Tissue in β-Thalassemia and β-Thalassemia/Hb E Patients.

Patients with β-Thalassemia major are transfusion dependent and become iron loaded owing to the large number of blood transfusions they receive. Patients with β-Thalassemia/Hb E become iron loaded even in the absence of regular blood transfusions because of increased erythropoeisis and stimulated dietary iron absorption. In both cases, iron accumulates in tissues such as the liver, spleen, and heart in the form of insoluble iron(III) oxyhydroxide nanoparticles found in ferritin and hemosiderin. The body iron burden is usually estimated by measurement of the liver iron concentration (LIC). Non-invasive techniques for measuring LIC often exploit the large magnetic susceptibility of tissue iron, taken to be 1600 x 10−9 m3/kgFe at body temperature. The current study examined spleen tissue samples from Australian β-Thalassemia major patients (n = 7) who had undergone chelation and transfusion therapy and Thai β-Thalassemia/Hemoglobin E disease patients (n = 11) who had received very few transfusions and no chelation therapy. Magnetometry measurements of the iron specific magnetic susceptibility of the spleen tissue samples ranged from 800 x 10−9 m3/kgFe to 1800 x 10−9 m3/kgFe. The mean iron specific magnetic susceptibility for the β-Thal major spleen tissue was approximately 25% lower than that for the β-Thal/Hb E samples (p = 0.007 Student's t test). To investigate the underlying cause of this variability the physico-chemical properties of the tissue iron deposits were probed using cryogenic 57Fe Mössbauer spectroscopy. Spectra recorded at 78K showed that the β-Thal major tissues contained iron with a greater fraction in the form of a more crystalline chemical species of iron oxyhydroxide than the β-Thal/Hb E tissues (p =0.01 Wilcoxon-Mann-Whitney test). Significant correlations (Spearman rank correlation tests) were identified between the iron specific magnetic susceptibility measured at body temperature and the Mössbauer spectral parameters recorded at both 5 K (p = 0.02) and at 78 K (p = 0.03). This relationship between the iron specific magnetic susceptibility and the chemical speciation of iron oxyhydroxide tissue deposits implies that the magnetic behaviour of tissue iron deposits is determined by the physical and chemical nature of the iron deposits. Variability in the iron specific magnetic susceptibility of tissues could impact on the precision of non-invasive techniques of tissue iron measurement based on magnetic susceptibility measurements.

Management of massive lower gastrointestinal bleeding: should there be surgical intervention without initial endoscopy and radiological evidence of the source of bleeding?

We report two case histories of patients with massive rectal blood loss. Endoscopic and radiological investigations could not identify the source of bleeding at admission. Initially, both patients recovered without surgical intervention, receiving a large number of blood transfusions only. Extensive subsequent radiological analysis showed that the bleeding was due to a pathological part of the proximal jejunum in one case and of the colon transversum in the other. Although immediate surgical intervention was not needed at presentation, both patients underwent resection of a part of the bowel some time thereafter. Surgery was performed after hemodynamic stabilization in the first case. However, in the second case, emergency surgical intervention was needed due to persistent bleeding 4 days after admission. Both patients are still doing well half a year after this massive gastrointestinal (GI) hemorrhage. Aside from a small area of chronic inflammation and fibrosis of the jejunum in one patient, histopathological evaluation of the surgical resection specimens revealed no specific cause for these massive gastrointestinal bleedings. We discuss the general approach of gastrointestinal hemorrhage and the several (dis)advantages of the various imaging techniques and the order in which they should be used.

Anemia and blood transfusion in the critically ill patient: role of erythropoietin

Critically ill patients receive an extraordinarily large number of blood transfusions. Between 40% and 50% of all patients admitted to intensive care units receive at least 1 red blood cell (RBC) unit during their stay, and the average is close to 5 RBC units. RBC transfusion is not risk free. There is little evidence that 'routine' transfusion of stored allogeneic RBCs is beneficial to critically ill patients. The efficacy of perioperative recombinant human erythropoietin (rHuEPO) has been demonstrated in a variety of elective surgical settings. Similarly, in critically ill patients with multiple organ failure, rHuEPO therapy will also stimulate erythropoiesis. In a randomized, placebo-controlled trial, therapy with rHuEPO resulted in a significant reduction in RBC transfusions. Despite receiving fewer RBC transfusions, patients in the rHuEPO group had a significantly greater increase in hematocrit. Strategies to increase the production of RBCs are complementary to other approaches to reduce blood loss in the intensive care unit, and they decrease the transfusion threshold in the management of all critically ill patients.

Transfusion practice in the critically ill.

Anemia in the critically ill patient population is common. This anemia of critical illness is a distinct clinical entity characterized by blunted erythropoietin production and abnormalities in iron metabolism identical to what is commonly referred to as the anemia of chronic disease. As a result of this anemia, critically ill patients receive an extraordinarily large number of blood transfusions. Between 40% and 50% of all patients admitted to intensive care units receive at least one red blood cell unit, and the average is close to five red blood cell units during their intensive care unit stay. There is little evidence that "routine" transfusion of stored allogeneic red blood cells is beneficial for critically ill patients. Most critically ill patients can tolerate hemoglobin levels as low as 7 mg/dL, so a more conservative approach to red blood cell transfusion is warranted. Practice strategies should be directed toward a reduction of blood loss (phlebotomy) and a decrease in the transfusion threshold in critically ill patients.

RBC Transfusion in the ICU: Is There a Reason?

To evaluate RBC transfusion practice in the ICU. Retrospective chart review. Multidisciplinary ICU in a tertiary care center. All patients admitted to the ICU with a length of stay of greater than 1 week. A total of 23% of all patients admitted to the ICU had a length of stay of greater than 1 week (19.6 +/- 1.6 days). Of these patients, 85% received blood transfusions (9.5 +/- 0.8 U per patient). These transfusions were not solely a function of acute blood loss. Patients were transfused a constant 2 to 3 U/wk. Patients receiving blood transfusions were phlebotomized on average 61 to 70 mL per day. Phlebotomy accounted for 49% of the variation in amount of RBCs transfused. No indication for blood transfusion was identified for 29% of transfusion events. A low hematocrit (< 25%) was the only identifiable indication in an additional 19% of events. Almost one third of all RBCs transfused were without a clear transfusion indication. The long-term ICU population receive a large number of blood transfusions. Phlebotomy contributes significantly to these transfusions. There is no clear indication for a large number of the blood transfusions given. Many blood transfusions appear to be administered because of an arbitrary "transfusion trigger" rather than a physiologic need for blood. Blood conservation and adherence to transfusion guidelines could significantly reduce RBC transfusion in the ICU.

Factors Affecting Long‐Chain Polyunsaturated Fatty Acid Composition of Plasma Choline Phosphoglycerides in Preterm Infants

SummaryLong‐chain polyunsaturated fatty acid (LCPUFA) composition of choline phosphoglycerides was measured in the plasma of 22 preterm infants at birth and at expected date of delivery (EDD). In a subgroup of 10 infants, data were also collected at regular intervals between birth and EDD. Levels at birth showed a positive correlation between arachidonic acid (AA) and birth weight, p&lt;0.01, and between docosahexaenoic acid (DHA) and gestational age, p&lt;0.01. Percentage compositions of both AA and DHA fell rapidly between preterm birth and expected date of delivery, at a time when they would remain high in utero. For AA, the mean value fell from 16.52 to 7.18%, and for DHA from 4.49 to 2.63%. Levels of DHA fell less in babies fed breast milk than in those fed formula milk, p&lt;0.05, and levels of AA fell less in those requiring a large number of blood transfusions, p&lt;0.05. The level of DHA fell more in those infants with intrauterine growth retardation, p&lt;0.05. Although these nutrients share common metabolic pathways for their synthesis, they appear to be affected by different factors in both the fetus and the preterm infant. Low levels at this time may adversely affect brain and retinal development.

Factors affecting long-chain polyunsaturated fatty acid composition of plasma choline phosphoglycerides in preterm infants.

Long-chain polyunsaturated fatty acid (LCPUFA) composition of choline phosphoglycerides was measured in the plasma of 22 preterm infants at birth and at expected date of delivery (EDD). In a subgroup of 10 infants, data were also collected at regular intervals between birth and EDD. Levels at birth showed a positive correlation between arachidonic acid (AA) and birth weight, p less than 0.01, and between docosahexaenoic acid (DHA) and gestational age, p less than 0.01. Percentage compositions of both AA and DHA fell rapidly between preterm birth and expected date of delivery, at a time when they would remain high in utero. For AA, the mean value fell from 16.52 to 7.18%, and for DHA from 4.49 to 2.63%. Levels of DHA fell less in babies fed breast milk than in those fed formula milk, p less than 0.05, and levels of AA fell less in those requiring a large number of blood transfusions, p less than 0.05. The level of DHA fell more in those infants with intrauterine growth retardation, p less than 0.05. Although these nutrients share common metabolic pathways for their synthesis, they appear to be affected by different factors in both the fetus and the preterm infant. Low levels at this time may adversely affect brain and retinal development.

Left ventricular filling and emptying patterns in anemia due to beta thalassemia. A computer-assisted echocardiographic study.

Patterns of left ventricular (LV) filling and emptying were studied in 17 patients with chronic anemia due to beta thalassemia and in 8 normal subjects. M-mode echocardiograms were recorded in each patient and digitization and computer analysis of the tracings provided data relating to the systolic and diastolic performance of the LV. LV diameter was increased. The rate, pattern and time relationships of LV systolic emptying were normal or increased in patients with thalassemia especially in those with thalassemia major requiring a large number of blood transfusions. Peak LV filling rate and the time course of early diastolic ventricular filling were also normal or increased in most patients but an abnormality of diastole was present in 3; this may have been due to abnormal early diastolic relaxation or to right-sided overload altering the LV filling pattern.

Syphilis infection through blood transfusions

The issue of hematogenous infection with syphilis is of considerable interest given the large number of blood transfusions that have been carried out recently for various medical indications.