Reduction In Donor Exposure Research Articles

Dedicated donor unit transfusions reduces donor exposure in pediatric surgery patients.

BACKGROUND:Many strategies have been explored to reduce multiple donor exposures in neonates such as use of restrictive transfusion protocols, limiting iatrogenic blood loss, use of recombinant erythropoietin and single donor programs.METHOD:In our study we assessed the feasibility of dedicating single donor units with reserving all the components from the same donor for the specified neonates/infants undergoing surgery and estimating reduction of donor exposure. Fifty neonates undergoing surgery were included in the prospective study group and the transfusion details were compared with 50 retrospective cases with same inclusion criteria.RESULTS:An intra-operative blood loss of >13 ml/Kg was significantly associated with transfusion (P <0.05) which was most frequently administered in the intra-operative period. Donor exposure rate of overall transfusion was 1.15 in the study group as compared to 4.03 in the retrospective control group. In study group Donor Exposure Rate (DER): Transfusion Rate (TR) ratio was 1:1.5 and Transfusion per Donor Unit (TPDU) of 1.5, means that one donor unit contributed to 1.5 transfusions in each patient and contributed to 50% reduction in donor exposure in each patient as compared to retrospective control group.CONCLUSION:Our study showed that by practicing dedicated donor unit transfusion policy, for neonates undergoing surgery we could significantly reduce the donor exposure.

G214(P) Reducing transfusion donor exposure in preterm babies: good communication is vital

BackgroundPreterm infants frequently require multiple blood transfusions. Splitting adult units into 6–8 satellite packs has been universally adopted by neonatal units to reduce donor exposure. Our NICU guideline is to...

Reduction in donor exposure with use of reconstituted blood in craniofacial patients – an alternative explanation

Reduction in donor exposure with use of reconstituted blood in craniofacial patients – an alternative explanation

Automated red cell collection – quality and value

Automated red cell collection was initially used largely for therapeutic purposes. New technology has rendered the procedure safer for donors and easier for machine operators. Optimal additive solution can be automatically added and the red cells filtered to provide a leucodepleted product. Two units of red cells may be collected during a single procedure from individuals who have a high enough red cell mass, whilst a single unit of red cells plus platelets or plasma can be collected from smaller donors. In vitro studies suggested that red cells collected by automated methods would be of better quality than those collected by gravity. This was not confirmed in vivo, but red cells collected by automated methods have the major advantage of consistency in terms of haemoglobin content, volume and haematocrit, compared with red cells collected by gravity. This standardised product is of particular value for transfusion dependent patients as the patient's haemoglobin can be maintained within narrow limits. The use of a double dose red cell product for transfusion to a single patient also confers benefit in terms of reduction in donor exposure.

Cost effective use of satellite packs in neonates: importance of birth weight

<b>Background:</b> Blood banks split an adult packed red cell bag (usually 250 ml) into 30 ml bags, making a total of eight neonatal “satellite” packs per donor. These packs are then “allocated”/“committed” to be used to serially transfuse a newborn. <b>Aim:</b> To study transfusion requirements of premature infants in relation to their birth weight and thereby attempt to rationalise the method of dispensing satellite blood packs. <b>Method:</b> Data on the distribution of neonatal transfusions with respect to weight were obtained retrospectively from unit A (51 infants, 168 transfusions) and unit B (46 infants, 151 transfusions). These data were used to model the effect of different policies on donor exposure and number of unused packs. <b>Results:</b> Infants weighing less than 1000 g at birth have significantly higher transfusion requirements than those weighing1000 g or more (p = 0.001 (unit A), p = 0.004 (unit B)). Our model predicted a significant reduction in donor exposure if eight packs/infant were allocated to those weighing &lt; 1000 g, and a significant cut in the number of unused packs if four satellite packs/infant were allocated to those weighing ⩾ 1000 g. <b>Conclusions:</b> It would be safer and cost effective to allocate eight packs/infant to those with birth weights &lt; 1000 g and four packs/infant to those with birth weights ⩾ 1000 g.

Donor exposure rate to transfusion ratio: a better discriminator of improvement in neonatal transfusion practice.

This study identifies the benefit of using donor exposure rate (DER) to transfusion rate (TR) ratio as a discriminative index for assessing improvement in practice pattern in multiple-transfused neonates. It provides a methodology to demonstrate reduction in donor exposure that is not evident from the use of DER alone. Two time points, one 12-month period (1996-1997) before and one 12-month period (1999-2000) following the introduction of a paedipack system, were reviewed. Blood issued and wasted was quantified. The 1994 BSCH guidelines to define transfusion were used for both time periods, and recombinant erythropoietin (EPO) was not used. Following implementation of paedipack system, 186 donor units were made into satellite bags and kept for 35 days. A dramatic decrease in DER : TR ratio was noted for 79 transfused infants. The DER : TR ratio was 1 : 1 before and 1 : 3.2 after introduction of paedipacks, giving a 70.5% reduction in donor exposure risk. This was not evident from the use of DER alone, which remained the same (2.4) in the historical and study groups. High transfusions per donor unit (TPDU) correlated with the reduction in DER : TR ratio. Red cell wastage per transfusion was 190 +/- 30 mL before and 24.5 +/- 10 mL after intervention.

Evidence-based use of blood products

Clinical governance requires the introduction of evidence-based practice in all areas of medicine. Variations in transfusion practice in neonatal units in the UK and USA indicate that evidence-based paediatric transfusion practice is not currently practised in many units and, as a result, children are being exposed to transfusion risks without likelihood of clinical benefit. This also places excessive demands on the transfusion services which are faced with escalating costs of providing safe blood and difficulties in recruiting suitable donors. Introduction of restrictive transfusion policies in some neonatal units has been achieved without increase in morbidity and with significant reduction in donor exposure and indicates what can be achieved once the barriers to the introduction of evidence-based transfusion practice can be broken down. Communication, education and increased resources are required in order to change current practices but, more than anything else, paediatricians must be prepared to take the initiative in examining their current practices and modifying these appropriately.

Effective use of a strategy using assigned red cell units to limit donor exposure for neonatal patients

Critically ill neonatal infants receive frequent small-volume red cell (RBC) transfusions for replacement of blood drawn for laboratory analysis or for treatment of symptomatic anemia secondary to underlying medical conditions and/or a relative bleeding diathesis. Retrospective review of transfusion practice in a hospital revealed that the donor exposure-to-transfusion ratio was 1:1.3. In an effort to limit donor exposure and decrease the risk of transfusion-transmitted disease, a sterile connection device was used for multiple small-aliquot preparations. Three neonatal infants were given part of the same RBC unit, and the assigned RBC unit was used only until it reached 14 days of age. These criteria resulted in 49-percent reduction in donor exposure for neonatal infants weighting less than 1500 g and 27-percent reduction for those weighing more than 1500 g. The donor exposure-to-transfusion ratio decreased to 1:2.5. RBC waste from syringe aliquot preparation and residual volume at Day 15 were a mean of 32 percent of the total unit volume. Of 722 transfusion occurrences, there were no reported adverse effects due to elevated potassium subsequent to transfusion of 14-day-old RBCs. This limited-donor-exposure strategy effectively meets the needs of a transfusion service and will reduce the donor exposures of neonatal infants in similar institutions.

Less intensive long-term transfusion therapy for sickle cell anemia and cerebrovascular accident

To determine the efficacy of a less intensive transfusion regimen in preventing recurrent cerebrovascular accidents and reducing transfusion requirements in patients with sickle cell anemia, we offered to 14 patients who had been undergoing aggressive transfusion therapy (sickle hemoglobin concentration kept less than 30% of total) for a mean of 9 years the option of either diminishing or stopping transfusion therapy. Thirteen patients chose to continue a modified transfusion regimen to maintain sickle hemoglobin concentration less than 60%; 10 of these patients have now been followed for 1 year or more (12 to 27 months, mean 15.5 months). There have been no recurrent neurologic events, although two patients have died of complications of hemochromatosis. All patients had a reduction in donor exposure, and there was a mean reduction in net transfusion requirement of 31.4% during the first year after modification. The greatest reduction was achieved in the single patient managed by small-volume (5 ml/kg) simple transfusion rather than partial packed cell exchange. We conclude that although long-term consequences of less aggressive transfusion therapy are unknown, the use of such a regimen may be reasonable, particularly in patients with significant transfusional hemochromatosis.

Avoiding Infection From Blood Transfusion in Neonatal Units-Reply

In Reply.— Dr Novak is correct in pointing out that technological advances have lagged, and, thus, the ideal reduction in donor exposure has not yet been approached in transfusion practices among premature infants. However, despite my sympathy for the transfusionist who has to balance the competing demands of prompt availability of blood with economy, safety, and so on, I do not think that these issues should cloud appreciation of the lower total disease rates that always follow when any given donor's blood is restricted to fewer recipients. Only in patients with a lifelong need for hundreds of transfusions can it be shown that reduction in donor exposure reaches a point of diminishing returns. The multiplicity of donors used for premature infants is based not only on the limitations in current multibag technology, but also arises because an empirically defined degree of freshness of blood is thought desirable to minimize bilirubin

Use of 'Single Donor' Factor VIII From Plasma Exchange Donation

We investigated the advantages of using "single donor" factor VIII derived from a new cyclic apheresis donation (plasma exchange donation) to treat hemophiliac children. By selecting donors with high factor VIII levels and using thaw-siphon isolation of cryoprecipitate, we achieved a mean yield of 1,360 units of factor VIII per weekly donation. The half-life, posttransfusion increments, and clinical efficacy of factor VIII in this material are comparable with those of factor VIII from other sources. A single donor has provided total support for seven months for one patient with severe hemophilia, and another for 24 months for a patient with mild hemophilia. Other patients have been supported through major surgery or CNS hemorrhage by a single donor. This approach to factor VIII replacement is hemostatically effective and can substantially decrease donor exposure for both major and minor bleeding episodes. The reduction in donor exposure should result in a reduced risk of acquiring hepatitis and perhaps the acquired immune deficiency syndrome in patients with hemophilia A.