Need For Donor Blood Research Articles

Comparison of Washing Efficiency and Recovery of Blood Cells Between Centrifugation, Coarse Filtration and Microfiltration Techniques to Prepare Autologous Blood for Transfusion.

PurposeCell salvage is the process by which blood lost in surgery is collected and washed or filtered to produce autologous blood for re-transfusion to the patient. Cell salvage aims to reduce the need for donor blood. Centrifugal cell salvage washing technique is a preferred medical treatment in order to retain lost red blood cells (RBCs) without contaminants. Although this technology very efficiently collects and washes shed blood, it is costly and often impractical or unavailable, especially in middle- or low-income countries. This study assessed two innovative filter devices as an alternative to centrifugal cell salvage technology: a coarse collection filter device (Hemafuse) and a microfiltration device (HemoClear). In contrast to centrifugal technology, both filter devices do not require electricity, nor costly equipment and extensive training. We compared the effectiveness of these filtration technologies to remove plasma constituents and recover and concentrate the cellular components with centrifugal technology (autoLog® device).MethodsWhole blood was processed with each technology according to the device manufacturer’s instructions. Before and after processing, the blood products were analyzed for supernatant solutes and cellular composition.ResultsThe centrifugal technology confirmed its efficacy to remove potentially harmful solutes and capture red blood cells. The microfiltration technology (HemoClear) reached comparable levels of removal of solutes, with a potential advantage over centrifugal technology in the ability to also recover platelets. The coarse filtration technology (Hemafuse) had no washing capacity but, like the microfiltration technology, has the advantage of recovering platelets.ConclusionInnovative filtration devices represent an alternative to centrifugal technology in the preparation of autologous blood for reinfusion. The HemoClear technology for the first time enables the recovery of washed platelets and red blood cells. Clinical trials will have to be performed to investigate the clinical value of this new autologous blood product.

Development of Hematopoietic Stem Cells in the Early Mammalian Embryo.

Hematopoietic stem cells (HSCs) were the first stem cells discovered in humans. A. A. Maximov proposed an idea of blood stem cells that was confirmed later by McCulloch and Till experimentally. HSCs were the first type of stem cells to be used in clinics and ever since are being continually used. Indeed, a single HSC transplanted intravenously is capable of giving rise to all types of blood cells. In recent decades, human and animal HSC origin, development, hierarchy, and gene signature have been extensively investigated. Due to the constant need for donor blood and HSCs suitable for therapeutic transplants, the experimental possibility of obtaining HSCs in vitro by directed differentiation of pluripotent stem cells (PSCs) has been considered in recent years. However, despite all efforts, it is not yet possible to reproduce in vitro the ontogenesis of HSCs and obtain cells capable of long-term maintenance of hematopoiesis. The study of hematopoiesis in embryonic development facilitates the establishment and improvement of protocols for deriving blood cells from PCSs and allows a better understanding of the pathogenesis of various types of proliferative blood diseases, anemia, and immunodeficiency. This review focuses on the development of hematopoiesis in mammalian ontogenesis.

Пухлинний тромбоз нижньої порожнистої вени та правого передсердя у хворих на нирково-клітинний рак: 25-річний досвід хірурґічного лікування

Aim. To improve the results of surgical treatment of tumor thrombosis of the inferior vena cava and right atrium in patients with renal cell carcinoma. Materials and Methods. The results of clinical examination, laboratory, instrumental, intraoperative observations and morphological studies were analyzed in 83 patients with renal cell carcinoma, complicated with tumor venous thrombosis, who were hospitalized to the vascular surgery department of Lviv regional clinical hospital for the period from 1993 to 2018. For a comparative analysis, all patients were divided into two groups: the first, main, group included 61 patients (39 men and 20 women, mean age 58,1±2,7 years old; two children, 5 and 9 years old) with renal cell carcinoma, complicated with tumor thrombosis of inferior vena cava and right atrium. The second, control, group included 22 patients (19 men and 3 women, mean age 58,3±4,3 years old) with renal cell carcinoma and renal vein invasion. Thepatients’ examination included laboratory and instrumental methods: ultrasound; computer or magnetic resonance imaging with intravenous contrast enhancement of the abdominal and chest cavity;excretory urography; echo-cardiography; veno-cavagraphy according to indications. Kaplan-Meier method was used to evaluate the long-term survival of patients with renal cell carcinoma, complicated with tumor venous thrombosis. Results and Discussions. Surgical treatment included radical nephrectomy in combination with thrombectomy from the inferior vena cava and right atrium. The using of Cell-Saver system has significantly reduced the need for donor blood. Despite the significant volume and trauma of surgical interventions in patients of the first group, the risk of most postoperative complications did not predominate in eithergroup. Survival indicators were evaluated among 76 patients with renal cell carcinoma, complicated with venous invasion - in 55 patients of the first and 21 patients of the second group. The median follow-up was 53,2 months. The median survival rate for patients in the first group was 33,3 months; for patients in the second group - 118,2 months. The cumulative 2-, 5-, and 10-year survival rates for patients in the second group (80,0%, 59,1%, 52,5%) were significantly higher compared to the first group (57,8%, 38,5%, 23,4%) (p 0,2). Regarding the level of the tumor thrombus of the inferior vena cava, there was no significant difference in survival as well (p>0,29). Conclusions. A detailed preoperative assessment of the prevalence of neoprocess, the improvement of surgical procedure, an effective prevention of thromboembolic and hemorrhagic complications allow providing acceptable long-term survival rates of patients with renal cell carcinoma with venous invasion.

Efficiency Improvement of Blood Supply Chain System Using Taguchi Method and Dynamic Simulation

The management of blood is a problem of specific concern for the human race. Even though there are technological developments in the field of substitutes for blood products, the need for donor blood and its derived products will always exist. Blood is not an ordinary commodity. The supply of donor blood is fairly irregular and the demand for blood products is at least as stochastic. Matching supply and demand in an efficient manner is not straightforward. Blood products are also perishable, which complicates things even further. Shortages lead to high costs for society, since they can cause increase mortality rates. The goal of this paper is applying dynamic simulation and Taguchi method to design a robust blood supply chain system to improve the blood supply chain efficiency. The National Blood Center (NBC) in Iran has been selected as the case of study. To do the Taguchi method, four main controllable factors that are arrival rate of donors, maximum inventory level, minimum inventory level and blood delivery policy and one noise factor which is demand variable have been chosen. Based on final result, to achieve a robust blood supply chain, all main factors should be located at the high level except for factor B. This means that arrival rate of donors, maximum inventory level and blood delivery policy should be equaled to 300, 1000 and LIFO, in case, the minimum inventory level should be equaled to 70 respectively to optimize the efficiency of the blood supply chain based on the patient safety.

Transfusion for trauma: civilian lessons from the battlefield?

Transfusion for trauma: civilian lessons from the battlefield?

A rat model of cardiopulmonary bypass with cardioplegic arrest and hemodynamic assessment by conductance catheter technique

Cardiopulmonary bypass (CPB) is known to induce systemic inflammation and cardiac dysfunction associated with a significant morbidity. Aim of the study was to develop an in vivo model of rat CPB with hypothermic cardiac arrest and the use of cardioplegia. The CPB circuit consisted of a venous reservoir, membrane oxygenator, heat exchanger, and roller pump. CPB was instituted in adult male Wistar rats (400-500 g) for 60 min at a flow rate of 120 ml x kg(-1) x min(-1), including 15 min cooling to 32 degrees C, 30 min cardiac arrest with the use of cold crystalloid cardioplegia after aortic cross clamping, and 15 min of reperfusion and rewarming to 37 degrees C. Arterial blood pressure (MAP) and heart rate (HR) were monitored, arterial blood samples were analyzed. Left ventricular (LV) function parameters were assessed by intraventricular conductance catheter. Important technical aspects are: ventilation is required during partial bypass; anticoagulation should be performed immediately prior to CPB to reduce blood loss; active suction on venous drainage allows higher pump flows; and the small priming volume of the extracorporeal circuit (8 ml) avoids the need for donor blood. MAP remained stable prior to and during CPB.MAP and HR were significantly decreased 60 min after weaning from bypass. Hct was significantly lowered after hemodilution, but remained stable during CPB and 60 min after weaning from bypass. BE and pH remained stable throughout the experiment.Without inotropic support diastolic and systolic LV function parameters were impaired after 30 min of cardioplegic arrest followed by 15 min of reperfusion. Myocardial TNF-alpha mRNA levels were slightly increased (1.28-fold, p = 0.71), and IL-6 mRNA was significantly increased in the cardioplegia group (90.3-fold, p = 0.001). Both IL-6 and TNF-alpha plasma levels were significantly elevated in the cardioplegia group (TNF-alpha: 4.6-fold increase,p < 0.05; IL-6: 426.8-fold increase, p < 0.001). We have developed a rat CPB with mild hypothermic cardioplegic arrest. This rodent model is suitable to study clinically relevant problems related to CPB,myocardial protection and systemic inflammation.

A novel rat model of cardiopulmonary bypass with blood cardioplegic arrest, no need for donor blood and precise hemodynamic assessment by conductance catheter technique

A novel rat model of cardiopulmonary bypass with blood cardioplegic arrest, no need for donor blood and precise hemodynamic assessment by conductance catheter technique

Artificial O2 Carriers: Status in 2005

Donor blood is a limited resource and its transfusion is associated with significant adverse effects. Therefore, alternatives have been searched, the ultimate being artificial oxygen (O2) carriers. There are two main groups of artificial O2 carriers: hemoglobin based and perfluorocarbon emulsions. The hemoglobin molecule in hemoglobin based artificial O2 carriers needs to be stabilized to prevent dissociation of the alpha2beta2-hemoglobin tetramer into alphabeta-dimers in order to prolong intravascular retention and to eliminate nephrotoxicity. Other modifications serve to decrease O2 affinity in order to improve O2 off-loading to tissues. In addition, polyethylene glycol may be surface conjugated to increase molecular size. Finally, certain products are polymerized to increase the hemoglobin concentration at physiologic colloid oncotic pressure. Perfluorocarbons are carbon-fluorine compounds characterized by a high gas dissolving capacity for O2 and CO2 and chemical and biologic inertness. Perfluorocarbons are not miscible with water and therefore need to be brought into emulsion for intravenous application. Development, product specification, physiologic effects, efficacy to decrease the need for donor blood in surgery and side effects of the following products are described: Diaspirin cross-linked hemoglobin (HemAssist), human recombinant hemoglobin (rHb1.1 and rHb2.0), polymerized bovine hemoglobin-based O2 carrier (HBOC-201), human polymerized hemoglobin (PolyHeme), hemoglobin raffimer (Hemolink), maleimide-activated polyethylene glycol-modified hemoglobin (MP4) and perflubron emulsion (Oxygent). In addition, enzyme cross-linked poly-hemoglobin, hemoglobin containing vesicles (nano-dimension artificial red blood cells) and an allosteric modifier (RSR13) are discussed. The most advanced products are in clinical phase III trials but no product has achieved market approval yet in the US, Europe or Canada.

Reduction of bacterial contamination during mechanical autotransfusion by uv irradiation--initial results

To investigate the effects of UV-radiation of autologous blood on bacteria and red blood cells when using intraoperative sampling of autologous blood using a cell separator--an established method for reducing the need for donor blood during surgery--which is reported to have a bacterial contamination rate of 5-75%, due mainly to coagulase-negative staphylococci (CNS). Cell-separator blood was diluted to a haematocrit level permitting transmission of 1% of the UV-radiation used in this study (lambda 254 nm, coat thickness 1 mm). CNS samples were irradiated for 2, 4, 10, 20 and 30 seconds. Free haemoglobin and methaemoglobin levels were measured, and erythrocytes examined microscopically at the end of the procedure. Blood samples had to be diluted to a haematocrit of 1% to permit transmission of 1% of the UV light. The optimal irradiation duration was 4 seconds, when bacteria were completely eliminated. Longer irradiation durations were associated with increasing levels of free haemoglobin and methaemoglobin, the levels of which at 4 seconds exposure were 12.5 mg/L and 15.5%, respectively. It is possible to prevent CNS contamination of cell-separator blood by irradiation with UV light. Prior to clinical application, however, the method will need to be modified to minimize side effects and increase its decontamination efficacy.

Blood conservation in small adults undergoing valve surgery

Objectives: A substantial reduction in transfusion requirements for cardiac surgical procedures has been reported. Many of these reports have been described in patients undergoing coronary artery bypass grafting. Patients suffering from rheumatic heart disease in India are usually small and also anemic. This study was conducted to assess blood conservation methods for cardiac valve surgery in this subset of patients. Design: This was a prospective, randomized study. Setting: The study was performed in a New Delhi tertiary care hospital, and the patients were referred from the northern states of India. Participants: One hundred fifty consecutive patients undergoing elective valve surgery using cardiopulmonary bypass were included. The mean age was 27.7 years and mean weight was 45.2 kg. Interventions: The patients were divided into three groups of 50 each. Group 1 received autologous fresh blood donated before bypass, and both a cell saver and membrane oxygenator were used. The oxygenator contents at the end of perfusion were processed by cell saver. Group 2 patients were reinfused with autologous blood only, and group 3 was a control group. In groups 2 and 3, the blood that remained in the oxygenator at the conclusion of cardiopulmonary bypass was reinfused. A hematocrit of less than 25% was considered an indication for transfusion in the postoperative period. Measurements and Main Results: The mean preoperative hematocrit was 35.5%. A mean of 361.1 mL of autologous blood was collected from group 1 and 303.0 mL from group 2. Group 1 required 15 units of bank blood, group 2, 90 units ( p < 0.001), and group 3, 102 units ( p < 0.001). Seventyeight percent of group 1 patients did not receive any donor blood. There was no significant difference in chest tube drainage among the three groups. Conclusions: In this unique group of patients whose mean body weight was only 45 kg, autologous blood alone did not decrease blood bank requirements but when combined with a cell saver and membrane oxygenator greatly reduced the need for donor blood.

Serine protease inhibition prevents both cellular and humoral responses to cardiopulmonary bypass.

Serine proteases are ubiquitous and are fundamentally responsible for many of the control processes in plasma. Hemostasis and inflammation have the same evolutionary origins and developed as host-defense mechanisms. This article highlights this development and defines the role of serine proteases in the complex inflammation and coagulation cascades that have evolved to maintain homeostasis. Generation of the serine protease thrombin plays a pivotal role in the regulation of many functions and is able to initiate activation and release of a number of humoral mediators involved in the inflammatory and hemostatic systems. Control processes are required to limit coagulation and inflammation to sites of injury, and a number of these have at their center inhibitors of serine proteases (SERPIN). A vast number of inhibitors are found throughout nature. In addition to these naturally occurring SERPINs, a number of others are available for administration to both animals and humans. Of these, aprotinin is a complex polypeptide; there are other chlormethyl ketones and small synthetic agents that also act as potent SERPINs. A second group of compounds are not protein inhibitors but have a broad spectrum of inhibition, e.g., a gabexate mesylate (FOY) and nefamostat (FUTHAN). The profound actions of aprotinin, FUTHAN, and FOY to inhibit bleeding and prevent the need for donor blood are well known. The potential role of these agents, particularly aprotinin, to reduce the inflammatory effects of cardiac and other kinds of surgery is considered. The data on SERPINs actions to reduce neutrophil-induced tissue injury are reviewed, with particular reference to the inflammatory events that occur during surgery with cardiopulmonary bypass.

Systemic blood activation with open and closed venous reservoirs

In 20 patients undergoing coronary artery bypass grafting, we studied prospectively systemic blood activation, blood loss, and the need for donor blood when using an extracorporeal circuit equipped at random with one of two different venous reservoirs. In 10 patients we used an open venous reservoir system (ORS) consisting of a hard shell venous reservoir with an integral cardiotomy filter, and in 10 patients we used a closed reservoir system consisting of a collapsible venous reservoir and separate cardiotomy reservoir. Concentrations of complement 3a, elastase, thromboxane B2, and fibrin degradation products showed a biphasic course, especially in ORS patients. During bypass, we observed a first peak of levels of complement 3a, thromboxane B2, fibrin degradation products, and elastase, which was higher in ORS patients than in patients with the closed system, because their blood continuously contacted the foreign materials of the filter and air in the open reservoir, which was avoided in the closed reservoir. Intensive blood-foreign material contact also caused the highest (p < 0.05) hemolysis in ORS patients. The larger amount of hemolytic products in ORS patients theoretically resulted in a temporary decrease in capacity of their Kupffer cells to clear endotoxin released after aortic declamping. This theory might explain the significantly (p < 0.01) higher second peak of activated products after declamping that was observed in ORS patients. Due to increased blood activation, the largest (p < 0.001) amount of shed blood loss, greatest (p < 0.05) need for colloid-crystalloid infusion, and largest (not significant) need for donor blood were found in ORS patients (0.8 +/- 0.4 versus 0.2 +/- 0.2 units of packed cells).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood donor behaviour in Greece: Implications for health policy

Blood donation behaviour was studied in 809 residents of the Greater Athens area to identify socio-economic and attitudinal factors and level of knowledge about blood donation related to donor behaviour. The sample was randomly selected and consisted of men and women aged 18–65, the legally defined age for donation. According to stepwise regression analysis, blood donation (40.8% of the study population) was found to be correlated with gender, place of birth, occupation and knowledge about donation. Donors were more likely to be men than women; students and military recruits than professionals and scientists; and those with higher knowledge scores regarding donation. In our factor analysis of the social attitudes related to blood donation, three factors emerged as important regarding donation: health-related incentives for the donor, structural incentives (organization of blood donation education and management of facilities) and the creation of social and economic incentives. With respect to the affective measures those who expressed feelings of guilt when presented with hypothetical, emotionally charged situations dramatizing the need for donor blood were more likely to be donors. The results of the data are discussed within a larger socio-cultural context and suggestions for health policy are made.

Autologous Blood Transfusions in Children and Young Adults with Low Body Weight Undergoing Spinal Surgery

The perioperative course of 118 patients weighing less than 45.5 kg (100.1 pounds) who participated in a predeposited autologous blood program from 1979-1984 is reviewed. Average age was 13 years 11 months (range 6 years 4 months to 20 years 4 months) and the average weight, 41 kg (range 30-45.4 kg). All underwent spinal surgery, 96% for scoliosis. The program involved preoperative donation of blood that was stored and subsequently retransfused to replace operative blood losses. Patients donated an average of 811 ml (range 208-1,320 ml) blood. Operation and hospitalization were completed by 63% without receiving any homologous blood, and the need for donor blood was reduced in the remaining 37%. Preoperative blood donation and retransfusion led to no significant complications. We describe an autologous blood transfusion program and show that autotransfusion is a safe and preferred method of blood replacement for children and young adults with low body weight undergoing elective surgery.

Preoperative haemodilution.

In preoperative haemodilution, blood is withdrawn before surgery while normovolaemia is maintained by infusion of cell free fluid. A surgical bleeding then entails a smaller loss of red cells. Reinfusion of the saved blood maintains normovolaemia, raises hematocrit and decreases the need for donor blood. Dilutional anaemia may endanger the oxygenation of the tissues. Tissue oxygenation can be upheld by an augmented and redistributed cardiac output and by a raised oxygen extraction. These compensatory mechanisms are less efficient in the presence of vascular stenosis, in particular in the myocardium which relies virtually exclusively on coronary vasodilatation. Major contraindications to preoperative haemodilution are, apart from coronary insufficiency, ventricular failure and valvular disease. Deleterious increases in cardiac oxygen consumption and/or heart rate may result from e.g. hypovolaemia, arterial desaturation and painful stimuli. The haemodilution procedure requires knowledge and vigilance in all involved personnel and gives best results if combined with other blood saving measures, like blood predeposit and intraoperative red blood cell salvage.

Improving autologous blood harvest: recovery of red cells from sponges and suction.

The efficacy of red cell salvage was assessed under circumstances which simulated blood loss managed with sponges or suction. Expired banked blood was equally divided and processed by either suction, or absorbing the blood on a sponge followed by rinsing the sponge in saline. These two techniques were used to harvest washed, centrifuged erythrocytes. The volume, haematocrit and free haemoglobin concentration of the banked blood and the processed units were measured, and smears from all units were examined microscopically. The red cell mass was calculated as the product of the volume and haematocrit. The red cell mass recovered by suction and from sponges averaged 93% and 87% respectively. Blood lost in sponges can be recovered and used to increase the available autologous blood, thereby reducing the need for donor blood.