Shortage Of Blood Supply Research Articles

Views and attitudes towards blood donation: a qualitative investigation of Indian non-donors living in England

ObjectiveTo explore the views and attitudes of Indians living in England on blood donation.BackgroundIn light of the predicted shortages in blood supply, it is vital to consider ways in which...

Mergers and acquisitions in blood banking systems: A supply chain network approach

Blood banking systems in the United States over the past decade have been faced with a volatile demand for blood, specifically, a decrease in demand for red blood cells, for a variety of reasons. This change in the blood supply chain landscape, accompanied by an increasing emphasis on cost efficiency, is a driver of Mergers & Acquisitions between blood banks. In this paper, we first present supply chain network optimization pre- and post-merger models. The models handle perishability of the life-saving product of blood, include both operational and discarding costs of waste, capture the uncertainty associated with the demand points, as well as the expected total blood supply shortage cost and the total discarding cost at demand points. They also incorporate capacities on the links. Their solution yields the optimal path and link flows plus the frequencies of activities associated with blood collection, shipment, testing and processing, storage, and distribution, and incurred total costs. We provide a cost efficiency (synergy) measure associated with a merger or acquisition in the blood banking industry, as well as measures capturing the expected supply shortage and surplus. The methodological framework and its applicability are then illustrated via a large-scale blood supply chain network example inspired by a pending merger in the real-world in both status quo and disaster scenarios.

Obstetric hemorrhage and safe blood for transfusion in Ethiopia: the challenges of bridging the gap.

Obstetric hemorrhage is a leading cause of maternal death in sub-Saharan Africa, and the shortage of blood for transfusion is a contributory factor. In Ethiopia, the National Blood Bank Service continues to be confronted with challenges in its efforts to ensure the availability of blood for health care facilities. This paper reviews the available data on the contribution of obstetric hemorrhage to maternal mortality and examines the current status of the blood supply in Ethiopia. We reviewed the published literature and data from the Ethiopian Federal Ministry of Health. To assess the status of the current blood supply, we applied the five cornerstones of a safe and effective blood donor service advocated by the World Health Organization. Our review indicates that there are insufficient national data on the prevalence of obstetric hemorrhage and the contribution of blood supply shortage to maternal death. Also, transfusion safety may be compromised by inadequate testing of donated blood and ineffective hospital transfusion policies. To overcome the shortage of blood to treat obstetric hemorrhage, the first step is to evaluate the demand and supply gap by acquiring comprehensive data on the current status of the blood supply and the prevalence of obstetric hemorrhage in Ethiopia. Subsequent steps would include the implementation of transfusion policies, the optimization of whole blood collection, ensuring quality-assured testing of donated blood, and the implementation of transfusion guidelines for the appropriate use of blood products. Strategies for long-term, viable solutions to maintain an adequate blood supply should be simultaneously developed.

Large-Scale Ex Vivo Generation of Human Red Blood Cells from Cord Blood CD34+ Cells.

The ex vivo generation of human red blood cells on a large scale from hematopoietic stem and progenitor cells has been considered as a potential method to overcome blood supply shortages. Here, we report that functional human erythrocytes can be efficiently produced from cord blood (CB) CD34+ cells using a bottle turning device culture system. Safety and efficiency studies were performed in murine and nonhuman primate (NHP) models. With the selected optimized culture conditions, one human CB CD34+ cell could be induced ex vivo to produce up to 200 million erythrocytes with a purity of 90.1% ± 6.2% and 50% ± 5.7% (mean ± SD) for CD235a+ cells and enucleated cells, respectively. The yield of erythrocytes from one CB unit (5 million CD34+ cells) could be, in theory, equivalent to 500 blood transfusion units in clinical application. Moreover, induced human erythrocytes had normal hemoglobin content and could continue to undergo terminal maturation in the murine xenotransplantation model. In NHP model, xenotransplantation of induced human erythrocytes enhanced hematological recovery and ameliorated the hypoxia situation in the primates with hemorrhagic anemia. These findings suggested that the ex vivo‐generated erythrocytes could be an alternative blood source for traditional transfusion products in the clinic. Stem Cells Translational Medicine 2017;6:1698–1709

Large-Sacle Ex Vivo Generation of Human Red Blood Cells from Cord Blood CD34+ Cells

Blood transfusion is widely used for various clinical therapies. Ex vivo production of red blood cells (RBCs) in a large-scale from hematopoietic stem cells (HSCs) has been considered as a potential way to overcome the shortage of blood supply. Here, we report that functional human RBCs can be efficiently produced by using a bottle-turning device culture system from cord blood (CB) CD34+cells.A procedure of four-stage ex vivo expansion and differentiation was developed in a modified IMDM basal medium supplemented with transferrin, insulin, folic acid, fetal bovine serum, and some other nutrients with selected cytokine combinations that contained stem cell factor (SCF), Flt-3 ligand (FL), and thrombopoietin (TPO) in stage I (days 0~5); SCF, FL, erythropoietin(EPO), interleukin 3 (IL-3), and GM-CSF in stage II (days 6~12); SCF, FL, IL-3, and EPO in stage III (days 13~18); SCF and EPO in stage IV (days 19~21). Enriched CD34+ cells were firstly cultured and expanded in 25-T flasks. After 5 day-culture, the cells were transferred to a 2-L bottle with 600 ml of medium in the bottle-turning device system. During the differentiation process, erythroid markers (CD71 and CD235a) and enucleation efficiency (LDS- percentage) of cultured cells were evaluated by flow cytometry. Erythroid progenitor cells were confirmed by clonogenic capacity by colony-forming unit (CFU) assay. Hemoglobin (HGB) content of the cells were determined quantitatively, and RT-qPCR analysis was performed to examine the expression of erythroid-specific genes and the status of proto-oncogenes. Furthermore, generated RBCs were CFSE-labeled and injected into irradiated NOD/SCID mice to monitor the viability and maturation in vivo.For stage I, the proliferation folds of CD34+ cells reached 20 ± 2.4 while CD34+ rate was maintained at 80% ± 4.3%. Subsequently, CFU assay on Day9 and Day12 showed that over 90% of the total colonies were erythroid burst-forming units (BFU-E) or erythroid colony-forming units (CFU-E), suggesting that these expanded cells were induced toward the erythroid lineage. For 21-day induction, approximate 2×108erythrocytes were produced from one CD34+cell with a purity of CD235a+ and CD71+ cells at 90% ± 6.2% and 54 % ± 7.2%, respectively. Furthermore, the results from flow cytometry of LDS-stained cells showed that 50% ± 5.7% of induced erythrocytes were enucleated. At various time points of the cell culture process, RT-qPCR analysis showed that expressions of erythroid-specific genes were normal and the proto-oncogenes (c-myc, c-myb, Bmi-1, k-ras, cyclinB, and HETRT) were not activated. From days 9 to 21, HGB contents of the cultured cells increased from 12.3 ± 1.5 pg/cell to 31.5 ± 2.4 pg/cell, which was similar to the contents of normal human RBCs (range: 27 - 33 pg/cell). In addition, the induced RBCs, after storing at 4°C for more than 4 weeks, had normal HGB content, and showed normal expression of both CD235a and CD71. In mouse studies, the CD71+ marker on the 21-day cultured cells was diminished or undetectable in CFSE+ cells 3-day after transplantation. In contrast, LDS- cells among the CFSE+ population increased to 97.1% ± 2.3% 3-day post injection, indicating that the 21-day cultured RBCs could be further enucleated and matured in vivo.Taken together, we have established a pilot-scale culture system to produce functional human RBCs ex vivo. Considering that one blood transfusion unit contains 0.8×1012RBCs, the CD34+ cells from one CB unit (80 ml with 2×106 CD34+ cells) would generate 4×1014 RBCs, which are equivalent to 500 blood transfusion units in the clinical application. DisclosuresRen:Biopharmagen Corp: Employment. Jiang:Biopharmagen Corp: Consultancy.

Study on the Causes and Governance Path of Blood Supply Shortage in China Mainland

In the past five years, the situation of blood supply shortage in China mainland was increasingly grim. The occurrence of blood supply shortage has inevitable objective reasons, but more are subjective reasons that can be avoided originally. The purpose of this paper is that through the analysis of the subjective reasons for the formation of blood supply shortage, to seek the effective way to solve the problem. Analysis shows that the main four causes of blood supply shortage are imperfect incentive mechanism, crisis of confidence, in short supply and the weak foundation. The governance path of blood supply shortages should be multi-governance dominated by the government and involved with multi-organization participation. The government should play a leading role; Blood collection and supply department should improve its service level; Medical institutions should improve the level of scientific and reasonable blood use; Nongovernmental organizations (NGOs) should play their own advantages, to participate in the propaganda and the donation work; The news media should actively participate in social public welfare publicity of blood donation; The general public should trust and support for acquisition and use of blood. For the immediate interests of the public, the relevant departments and personnel should work together and perform its own functions, only in this way the blood supply shortage problem can be effectively alleviated or thoroughly solved.

An Analysis of and Recommendations for the Peruvian Blood Collection and Transfusion System.

Peru experienced a crisis in its blood collection and supply system in the mid-2000s, as contaminated blood led to several transfusion-transmitted infections (TTI), occurring in the backdrop of extremely low voluntary donation rates and a national blood supply shortage. Thus, the Peruvian Ministry of Health (MINSA) implemented a national investigation on the safety and quality of the Peruvian blood collection/transfusion network. Every Peruvian blood bank was evaluated by MINSA from 2007-2008. These evaluations consisted of an update of the national registry of blood banks and visits to each blood bank from MINSA oversight teams. Information was collected on the condition of the blood bank personnel, equipment, supplies, and practices. Further, previously-collected blood at each blood bank was randomly selected and screened for TTI-causing pathogens. Uncovered in this investigation was a fragmented, under-equipped, and poorly-staffed blood collection and transfusion network, consisting of 241 independent blood banks and resulting in suboptimal allocation of resources. Further, blood with evidence of TTI-causing pathogens (including Hepatitis B, Hepatitis C, and syphilis) and set for transfusion was discovered at three separate blood banks as part of the random screening process. Using the successful reorganizations of national blood supply systems in other Latin American countries as examples, Peru would be well-served to form large, high-volume, regional blood collection and transfusion centers, responsible for blood collection and screening for the entire country. The small, separate blood banks would then be transformed into a network of blood transfusion centers, not responsible for blood collection. This reorganization would allow Peru to better utilize its resources, standardize the blood collection and transfusion process, and increase voluntary donation, resulting in a safer, more abundant national blood product.

AB035. Thalassemia in Vietnam

Thalassemia is a common inherited hemoglobin disorder in Vietnam. The alpha thalassemia, beta thalassemia, and HbE are popular in Vietnam but its variance depends on ethnics. The research for frequency of some ethnics almost in electrophoresis includes: Kinh (beta thalassemia carrier 1.49%, HbE 1.24%), Muong (beta thalassemia carrier 10.7%, HbE 11.7%), Tay (beta thalassemia carrier 11%, HbE 1%). In the recent years, we have conducted researches on thalassemia gene in the Northern and Southern areas of Vietnam. The two researches on beta thalassemia conducted at National Hospital of Pediatrics were Cd17 (33.8%), Cd41/42 (29.4%) following are HbE (19.1%), Cd 71/72 (7.3%), -28 (5.9%), IVS 2-625 (1.5%), IVS 1-5 (1.5%), IVS 1-1 (1.5%). In Vietnam, we have a thalassemia centre at the National Institute of Hematology and Blood Transfusion and several outpatient clinics at National Hospital of Pediatrics, Children No. 1 Hospital, Blood Transfusion and Hematology Hospital Ho Chi Minh city, Central Hue Hospital. In provincial hospitals, we have transfusion service but very variance. That the number of patients with thalassemia requires regular blood transfusion has been increasing results in big shortage of blood supply. At Department of Clinical Hematology-NHP, we provide patients with screening for HIV, HCV and HBV in every 6 months. Patients were done antibody screening test. Deferoxamine, deferiprone and deferasirox are currently used but in short supply. We are facing the difficulty that almost hospitals in Vietnam lack the drug which is unique for each type of chelation. We have to apply ferritin level to follow the chelation effective and MRI to measure iron overload in patients’ liver and heart. We are only able to provide SCT for the modest number of patients with thalassemia. In almost cases, we used sibling donor in SCT for patients with thalassemia. Regarding prevention service, we offer genetic counseling and prenatal diagnosis at three hospitals. We organized prevention program in Hoa Binh province on national budget. The most important future planning is expanding prevention program in provinces with high prevalence and after that in the all country. Our future plan is to set up more thalassemia centres in provincial and central hospitals where overload with patient’s demand. We also launch for appeal for blood and iron chelation to patients with thalassemia. In near future, use of haplo SCT to treatment thalassemia patients will be more.

슬관절과 고관절 전치환술 환자의 수혈에 영향을 미치는 병원특성 요인 분석

저출산 고령화로 헌혈인구는 감소하고, 노년층의 혈액사용량은 증가할 것으로 예상되어 혈액부족과 수혈의 안정성 문제가 대두되고 있다. 이에 본 연구에서는 만성 퇴행성관절염인 슬관절과 고관절 전치환술 환자의 수혈에 영향을 주는 요인을 분석하고자 하였다. 이를 위해 건강보험심사평가원의 2011년 환자표본자료 중 입원환자 5,370명을 대상으로 하였으며, SPSS 20 프로그램을 이용하여 로지스틱 회귀분석을 실시하였다. 독립변수로 사용된 변수는 병원특성과 환자특성으로 병원특성은 의료기관 종류, 설립구분, 기관소재지와 가동병상수를, 환자특성으로는 성, 연령, 중증도, 전신마취유무, 주 진단, 빈혈유무와 의료보험종류로 구분하였다. 분석결과, 슬관절전치환술 환자의 수혈에 유의한 영향을 미치는 변수로는 의료기관 종류, 기관소재지, 성, 연령, 중증도, 주 진단, 빈혈유무였으며, 고관절전치환술 환자의 수혈에 유의한 영향을 주는 변수로는 의료기관 종류, 기관소재지, 성, 연령, 중증도, 전신마취유무, 빈혈유무였다. 수혈현황과 영향요인을 분석한 본 연구는 비용 효과적이며, 양질의 의료를 위한 기초자료로 활용될 수 있을 것으로 기대한다. The problems related with blood supply shortage and the stability of blood transfusion are on the rise, as it is expected that the blood doners will decrease but the blood use amount for aged population will increase, owing to low birth and aged population increase. The purpose of this study is to analyze the hospital characteristics which affect patients receiving and non-receiving blood transfusion for the knee and hip total replacement arthroplasty. Data were collected from Health Insurance Review and Assessment Service's 2011 sample data, and 5,370 inpatients were abstracted from them. Logistic regression analysis was performed, using SPSS 20. Independent variables used are hospital characteristics variables and patient characteristics variables. Hospital characteristics variables are hospital type, ownership, residence and the number of usable beds, and patient characteristics variables are gender, age, severity, type of anesthesia, main diagnosis, whether or not of anemia and insurance class. At the result of this study, it was found that hospital type, region, gender, age, severity, main diagnosis and whether or not of anemia were the factors that mostly affected the blood transfusion for knee arthroplasty. And hospital type, residence, gender, age, severity, type of anesthesia and whether of not of anemia were the factors that mostly affected the blood transfusion for hip arthroplasty. In addition to that, it is expected that this research which analyzed the present state of blood transfusion and its influence factors are cost effective, and would make a good use of preliminary data for good quality of medical service.

The impact of angiogenic and adipogenic microenvironment on adipose tissue regeneration in tissue engineering chamber

By observing the adipogenic and angiogenic microenvironment impact on the morphology of newly generated tissue for exploring the key factors which inducing mature adipose tissue regeneration in tissue engineering model. 24 healthy 6 months' New Zealand rabbits were picked and put into four groups according to different microenvironment. Every group has 6 rabbits and divided as follows: no axial-blood supply fat flap(0 ml), granular fat only(0.6 ml), axial blood vessel only (0.05 ml), axial vascularized fat flap ((0.6 ml). We separated or combined adipogenic and angiogenic environment within these groups. After 8 weeks, samples were harvested for histologic observation including macroscopic observation, volume analysis and HE testing. In granular fat group, its volume decreased by (0.25 ± 0.10) ml after 8 weeks as the shortage of blood supply and finally it could be enveloped. In axial blood vessel group, its volume increased by (0. 37 ± 0. 04) ml after 8 weeks with fibrous tissue formation as shortage of adipogenic microenvironment. The no axial-blood supply fat flap group grew into(0.12 ± 0.03) ml, which can' t support large volume adipose tissue formation because of lacking independent blood supply. Only axial vascularized fat flap model could generate mature adipose tissue in large volume(3.45 ± 0.48) ml. The number of new capillary in every group was different after 8 weeks. By counting the numbers in every single view, no axial-blood supply fat flap group 15 ± 3.5)and granular fat only group(5 ± 2.5)had a significant difference with axial vascularized fat flap group 22 ± 5) respectively. Only both adipogenic or angiogenic microenvironment exist could induce mature adipose tissue in large volume in tissue engineering chamber model.

Preeclampsia serum-induced collagen I expression and intracellular calcium levels in arterial smooth muscle cells are mediated by the PLC-γ1 pathway.

In women with preeclampsia (PE), endothelial cell (EC) dysfunction can lead to altered secretion of paracrine factors that induce peripheral vasoconstriction and proteinuria. This study examined the hypothesis that PE sera may directly or indirectly, through human umbilical vein ECs (HUVECs), stimulate phospholipase C-γ1-1,4,5-trisphosphate (PLC-γ1-IP3) signaling, thereby increasing protein kinase C-α (PKC-α) activity, collagen I expression and intracellular Ca2+ concentrations ([Ca2+]i) in human umbilical artery smooth muscle cells (HUASMCs). HUASMCs and HUVECs were cocultured with normal or PE sera before PLC-γ1 silencing. Increased PLC-γ1 and IP3 receptor (IP3R) phosphorylation was observed in cocultured HUASMCs stimulated with PE sera (P<0.05). In addition, PE serum significantly increased HUASMC viability and reduced their apoptosis (P<0.05); these effects were abrogated with PLC-γ1 silencing. Compared with normal sera, PE sera increased [Ca2+]i in cocultured HUASMCs (P<0.05), which was inhibited by PLC-γ1 and IP3R silencing. Finally, PE sera-induced PKC-α activity and collagen I expression was inhibited by PLC-γ1 small interfering RNA (siRNA) (P<0.05). These results suggest that vasoactive substances in the PE serum may induce deposition in the extracellular matrix through the activation of PLC-γ1, which may in turn result in thickening and hardening of the placental vascular wall, placental blood supply shortage, fetal hypoxia–ischemia and intrauterine growth retardation or intrauterine fetal death. PE sera increased [Ca2+]i and induced PKC-α activation and collagen I expression in cocultured HUASMCs via the PLC-γ1 pathway.

Incomplete Circle of Willis and Migraine: Role for Shear‐Induced Platelet Aggregation?

Incomplete Circle of Willis and Migraine: Role for Shear‐Induced Platelet Aggregation?

The effects of information, social and financial incentives on voluntary undirected blood donations: Evidence from a field experiment in Argentina

In many low- and middle-income countries blood donations per capita are substantially lower than in advanced economies. In these countries blood supply is mostly collected through directed donations from relatives and friends to individuals needing transfusions or to replace blood used in emergencies. The World Health Organization considers this method of blood supply inefficient compared to undirected voluntary donations. To examine methods to motivate undirected voluntary donations, we ran a large-scale, natural field experiment in Argentina, testing the effectiveness of information, social and financial incentives. We find that only higher-valued financial incentives generated more donations, increasing with the value of the reward. These incentives did not create adverse selection in the safety or usability of the donated blood. We discuss the implications of our findings for researchers interested in understanding motivations for pro-social behavior and for health agencies and policymakers concerned with the current and growing shortages in blood supply in low- and middle-income countries.

WIRELESS Temperature Monitoring System for Blood Bank using Zigbee

A wireless temperature monitoring system has been designed and fabricated for the monitoring of blood bank temperature. The protection of blood is done by labeling of blood components and stored at refrigerator temperature of 4°C. Therefore, it is important to monitor the temperature of blood bank to ensure the blood is stored properly to avoid the shortage of blood supply. This study involve both hardware and software implementation. A circuitry is produced and is placed at the blood bank which involves thermistor, ZigBee as transmitter and a buzzer as alarm. The temperature data is transmitted for every one second to the base station. As for the monitoring system, it will display the temperature data as well as time that received by another ZigBee at the base station. By using LabVIEW, the monitoring system was published to the internet by creating a website which can reduce the work load without involvement of labour. The integration of both software and hardware is done, where activation of the alarm and indicators for both circuit and monitoring system happen simultaneously based on the temperature condition of the blood bank.

The Intention to Donate Blood: An Analysis of Socio-Demographic Determinants

The current trends of blood supply shortage have raised the concern about the ability to meet the blood product demand in the future. At the time of high demand for blood products especially during festive seasons, Malaysia is unable to encounter the demand. As a result, the quality of human life is affected. This has created the prerequisite to understand the scenario and recognizing the factors that may influence people’s intention to donate blood. The purpose of this survey-based study is to investigate the implication of socio-demographic factors in measuring the intention of the public to involve in a blood donation program specifically in Perlis population, Malaysia. The findings indicated that, among the socio-demographic factors, gender is predicted to have the greatest association with intention to donate blood than others. Besides, individuals who have blood donation experience in life were more desired to do again their behavior in the future than those who are not. The new discoveries generated are believed to be valuable for future research as well as in designing future blood donation program in order to encourage the participation of the public.

Detection of Intracerebral Hemorrhage and Transient Blood-Supply Shortage in Focused-Ultrasound-Induced Blood–Brain Barrier Disruption by Ultrasound Imaging

Focused ultrasound (FUS) in the presence of microbubbles can selectively open the blood–brain barrier (BBB). However, since overexcitation by FUS probably induces intracerebral hemorrhage, it is essential to develop an imaging approach for real-time detection of hemorrhage and blood-flow changes during FUS-induced BBB disruption. Here we investigated the feasibility of using ultrasound imaging to monitor the transient responses of FUS-induced BBB disruption. The BBB was disrupted with in-house-manufactured microbubbles in rats by 1-MHz FUS with a pressure of 1.1 MPa (pulse repetition frequency: 1 Hz, pulse duration: 10 ms, exposure time: 60 s) and imaged for the next 2 h. Ultrasound B-mode imaging was used to detect hyperechoic changes induced by hemorrhage and contrast-enhanced ultrasound (US) imaging was performed to analyze changes in blood flow. Hyperechoic spots appeared in B-mode images at 5 s after FUS sonication and contrast-enhanced US images simultaneously showed a region of transient blood-supply shortage in the sonicated area. Thus, the location of hyperechoic spots correlated with hemorrhagic patterns and the blood-supply-shortage region was consistent with the BBB-disrupted areas. Furthermore, we detected a transient hyperemic response in the unsonicated contralateral hemisphere brain. Our approach has potential as an immediate-feedback control tool for preventing the induction of intracerebral hemorrhage during FUS treatment.

Anesthesia Literature Review

Anesthesia Literature Review

Ex-vivo red blood cells generation: A step ahead in transfusion medicine?

Blood transfusion and especially red blood cell (RBC) transfusion is an essential therapeutic act because it might be life-saving in several situations such as massive bleeding or as prolonged quality-of-life therapies in patients with chronic anemic disorders. Although the need for blood is thereby widespread, there is however a major imbalance between demand and supply of donors, so that there is a mounting research to develop suitable surrogates for human donated blood. Functional RBCs have already been generated from a variety of cellular progenitors (i.e., somatic stem cells, human embryonic stem cells and induced pluripotent stem cells) and synthetic biomaterials. Although these types of “artificial blood” carry several advantages over donated blood, including larger supply, lower risk of blood-borne pathogens transmission, no risk of immune incompatibility using group O, RhD-negative RBCs, and extended survival of stored RBCs, their efficacy has not been extensively tested thus far in clinical trials. Therefore, while it seems premature at this point in time to conclude that ex-vivo manufacturing of blood might be the definitive solution to the current shortage of blood supply, it represents however a valuable starting point for translational research in transfusion medicine.

Transforming growth factor-β1 downregulates beating frequency and remodeling of cultured rat adult cardiomyocytes

We have observed increased levels of transforming growth factor-beta1 (TGF-beta1) in human hibernating myocardium (HM). Impaired ventricular function in HM is known to be restored to normal following revascularization implying that myocardial structure in HM is to a certain degree preserved. We have therefore tested whether TGF-beta1 can imitate features of HM by reducing the number and frequency of beating cells (chronotropism) and structural remodeling of cultured adult rat cardiomyocytes (ARC), thus saving substrate, energy, and oxygen. Parameters measured were cell size, protein synthesis, protein degradation, protein content, myofibrillogenesis, and chronotropism. ARC were stimulated for 6 days with sera from patients with coronary heart disease, as this period led to a maximum response of cells. An increase of 90% in cell surface area following such treatment was reduced to a 20% increase of the original size by TGF-beta1. Concomitantly, the rate of protein synthesis dropped from 3.6-fold to 2.4-fold, and myofibrillogenesis was reduced. TGF-beta1 downregulated both the number of contracting cells from 81% to 10% and the frequency from 52 to nine beats per minute. However, TGF-beta1 treatment did not reduce the augmentation of protein content (1.28-fold versus 1.25-fold) indicating that protein degradation was also inhibited. Similar results were obtained with serum from healthy volunteers. The effects of TGF-beta1 were reversible. We conclude that TGF-beta1 constrains protein turnover and beating activity in underperfused myocardium, thus mediating protection by adapting myocytes to shortages in blood supply.

Terrorist Attacks: Transfusion Specialists' Point of View.

The issue of mass casualties in civilian population has lately become globally relevant and prevalent. Explosions of loaded busses by suicide bombers as well as explosions in crowded public places create a great number of casualties, many of them being children and several members of same families, who are evacuated by scoop and run method to nearby hospitals. We report on potential hazards of massive blood transfusions to multi-trauma patients, simultaneously admitted to hospital. Upon admission to the emergency room (ER) ID and personal details of patients are recorded and a temporary ID badge is issued for unidentified patients. Then, a blood sample for typing and screening is taken and required blood is ordered. Primary blood supply for patients with unstable condition, who need immediate blood transfusion, is O Rh positive packed cells (for fertile females O Rh negative) until the ABO and Rh blood groups are established. In order to avoid misidentification our routine includes presence of a blood bank representative in the ER for confirming identification of patients and correct labeling of blood samples. 2 individuals must identify patients from whom samples are taken. In the operating rooms (OR) another blood bank representative (either a transfusion medicine specialist or a hematologist) matches blood types and identification numbers, maintains contact with the blood bank, conveys information to anesthesiology team and advises them on replacement therapy. 7 terrorist attacks resulted in a total of 55 patients, evacuated to 2 hospitals in Israel. 285 packed cells units were typed and cross-matched for these patients. The amount of packed cells supplied during the first 2 hours was 47% of the total blood supplied during the first 24 hours. The cross-matched/transfused ratio varied from 1.3 to 2.19 reflecting overestimation of blood requirement during mass casualty episodes. One “near-miss” was prevented in OR when two members of the same family were operated on in adjacent rooms. Units for one of these patients were misplaced. ABO incompatibility is one of the major causes of morbidity and mortality resulting from blood transfusions. Signs and symptoms are masked in an anesthesized patient. The fact that units of blood accumulate at patient's bedside upon being deleted from the blood bank inventory may be misinterpreted as a shortage of blood supply in the blood bank. There is also a potential for errors in matching units of blood to patients both in ER and OR. In the setup of mass casualties influx the blood bank personnel should be on alert for the following potential Achilles' heels: misidentification of the patient when taking a blood sample for typing and screening or misidentification of the patient who needs to receive the blood product. Reasons for these may be either one digit difference in serial temporary number of unidentified patients, being operated on simultaneously in nearby rooms, or several family members undergoing simultaneous surgery in adjacent OR. Such errors can be minimized by using a 3-digit bold number in addition to the running temporary ID and thus providing 2 identification parameters. Our data suggest that the amount of blood products ordered for such patients is excessive. Surgical teams should be aware of the possibility to have blood components kept on hold in the blood bank instead of accumulating them in ER and OR and risking misidentification and suboptimal storage conditions.