Blood Transfusion Status Research Articles

Introduction of a program for voluntary blood donations in Iran (blood transfusion status in Iran)

Background A national and well‐coordinated system is very effective for blood self sufficiency of a country; this system might be committed to follow all requirements and standards. It should manifest itself strong and well‐established in reality and practice so that all potential donors trust it and contribute. Iranian Blood Transfusion Organization (IBTO) is an example of a centralized network with 200 centers in 31 provinces which could only be decentralized in some aspects of blood donor recruitment based on the cultural and regional attributes of the people there.Methods The mission of IBTO is to provide and ensure a safe and adequate blood supply in Iran. Selection of low risk donors in pre‐donation consultation and interview sessions based on behavioral, medical and demographic factors has improved the transfusion safety even before specific lab screening tests have been conducted; Standardization of criteria for donor eligibility and exclusion, and donor screening procedures are all priorities and most importantly the collection of all blood donations just from voluntary nonremunerated (VNR) blood donors. In fact, a lot of efforts concentrated on recruitment of VNR donors and to this end the Blood Donor Recruitment and Retention Office was established. A variety of measures were made to increase the number of voluntary regular donors including technical efforts, information dissemination activities, demographic studies, campaigns, awareness raising programs, publicity, publications, commemorative ceremonies and the like.Results The annual donation index in Iran has greatly increased from 0.39 in 1974 to 25.3 in 2010–2011. Accordingly we have been witness to increasing trend of blood donation reaching about 2 million blood units in 2011, all of which obtained from voluntary non‐remunerated blood donors with the annual index of 26 per 1000 population.Conclusions It shows that every country based on its needs should establish a very effective and safe program to raise the number of its voluntary blood donors and to this end centralization of activities monitored by a headquarters and implementation of an efficient recruitment plan by which all aspects are covered and monitored: ranging from stages prior to donor selection including campaigns and activities to motivate populations to embark on donation, donor selection, screening, retention, statistical audit, continuous evaluation of donation sites, ease of access to donation centers, demographic attributes, donor reactions, to post donation era to ensure high return rate and so on so forth. All in all, availability and affordability are the issues which should be always guaranteed.

Safety and current status of blood transfusion in China

The volume of blood used for transfusion in China continues to soar as a result of the increasing amount of surgery. In Beijing, for example, the transfusion volume has increased by 161%, from 268 000 units (200 mL per unit) in 1998 to 700 000 units in 2008, of which 70% was for patients undergoing surgery.1 This transfusion volume is about half that used in the USA in 2006.2

Allo-Immunity to Erythrocytes in Relation to Blood Transfusion and Pregnancy: Cooperative Study of Allo-Immunity to Antigen Diversity in Asian Populations.

Abstract 3144Poster Board III-81 PurposeAllo-immunization to erythrocytes is an important issue with regard to blood transfusions, albeit perhaps less prominent than other possible adverse effects. Several studies including pregnant and transfused cases have been conducted in US and European counties. However, a sufficient international or interracial comparative study has not been performed yet. Asian populations contain a wide variety of genetics and circumstances. They may differ in immune responses to allo-antigens that are common among American and European populations. Because no confirmed nor detail information exists for many Asian populations, collaborative international study concerning these issues will improve blood transfusions and transplantations not only in Asia but also the world. (Method) Forty-eight institutes, including those in Japan (29), Korea (15), Hong Kong (1), Singapore (1), Malaysia (1) and Thailand (1), participated in this first cooperative study of Asian population examining allo-immunity to erythrocytes. The total number of independent cases included more than 866,000 patients. Ab screening methods adopted in these institutes included gel columns, beads columns, traditional tubes or some combination of these three. If a case was tested multiple times, we counted it as one case. Multiple antibodies detected during the study in one patient were separately analyzed. Patients with unconfirmed histories were excluded from the study. We analyzed and compared the frequencies of irregular antibodies (Abs) to erythrocyte antigens between patients of different gender, patients pregnant or not, and patients with and without previous blood transfusion. ResultsAbs were determined in 8,880 patients (male /female: 3,528 /5,482), including 1801 /2418 from Japan, 946 /1477 from Korea, 287 /688 from Malaysia, 214 /408 from Thailand, 237 /375 from Hong Kong, and 11 /15 from Singapore. Of note, anti-D Ab was more frequently detected in females (p<0.01), but varies among countries as follows; 0.6 /2.4 (male /female, %) in Japan, 1.7 /8.1 in Korea, and 8.0 /19.6 in Malaysia. It significantly increased in pregnant patients (4.8% in Japan, 35.9% in Korea, 34.0% in Malaysia), but did not increase in patients that had received blood transfusion. Other Abs including complex ones did not significantly increase in pregnant patients. Anti-D Ab was rare in other Asian counties. Anti-E Ab was 1.4 times more frequently detected in patients that had received blood transfusion. [Japan (2.4x), Thailand (3.1x) Hong Kong (1.3x) and Singapore (1.3x)]. Anti-Jka and -C Abs increased in patients that had received blood transfusion. Anti-Dia Ab increased 1.6 times more in Japan, but did not in Korea (0.5x). Anti-c+E complex Abs, increased in patients that had received blood transfusion in many Asian counties. However, other complex Abs such as Anti-Lea+Leb Abs did not. ConclusionAlthough there have been several previous reports on allo-immunity in pregnant and transfused cases, this is the first international collaborative study in allo-immunity to erythrocyte antigens in relation to gender, pregnancy and blood transfusion status in Asia. Anti-D Ab was frequently detected in pregnant female patients. Anti-E, -Jka and -C Abs were frequently detected in patients that had received blood transfusion. However, the frequency varies among Asian countries. These data will contribute to the international body of knowledge concerning allo-immunity, allowing for advancements in successful blood transfusion in Asia and the world. The number of cases might be small in the light of total Asian populations, therefore, we should continue and spread the study. DisclosuresNo relevant conflicts of interest to declare.

Chimerism in Kidneys, Livers and Hearts of Normal Women: Implications for Transplantation Studies

Tissue chimerism was recently described in transplanted organs from female donors into male recipients, by demonstration of the Y-chromosome in tissue-derived cells. It was claimed that these Y-chromosome positive cells were recipient derived. To find out whether the chimeric cells, derived from pregnancies of sons or blood transfusions, could have been present in the solid organs before transplantation, we performed the following study. In situ hybridization for the Y-chromosome was performed on the normal organs (51 kidneys, 51 livers, 69 hearts) from 75 women of the normal population, whose child and blood transfusion status were known. Chimeric cells were found in 13 kidneys, 10 livers and 4 hearts, of 23 women. There was no relation between the child status or the blood transfusion history with the presence of Y-chromosome positive cells. We have for the first time demonstrated that male cells are present in normal kidneys, livers and hearts. Theoretically, these organs could have been used for the transplantation. Therefore, our findings demonstrate that the chimeric cells thus far described in transplantation studies, are not necessarily donor derived, and could have been present in the organs before the transplantation.

Clinical studies on autologous blood transfusion

To study the present status of blood transfusion in head and neck surgery, we investigated recent cases of intraoperative transfusion in our department. In addition, we present our autologous blood transfusion cases, presently involved in an ongoing clinical trial for patients with head and neck cancer in our department which began in 1989. 1. Investigation of intraoperative blood transfusion cases There were 37 cases of intraoperative blood transfusion among 677 cases who underwent surgery under general anesthesia during the period from May, 1991 to December, 1993. We divided these 37 cases into three groups according to the amount of intraoperative blood loss: less than 600ml (10 cases), more than 600ml and less than 1200ml (11 cases), and more than 1200ml (16 cases). Average amounts of intraoperative blood transfusion in each group were 195ml, 475ml and 780ml, respectively. As we noted that most of these 37 cases received a blood transfusion of less than 800ml, the majority needing intraoperative blood transfusion during head and neck surgery are potential candidates for autologous blood transfusion. Therefore, we have promoted autologous blood transfusion for intraoperative blood transfusion in head and neck surgery. Thus, the patients undergoing intraoperative autologous blood transfusion increased to seven annually as of 1994. 2. Clinical studies on autologous blood transfusion Among 677 cases of head and neck surgery conducted during a six year period (1989-1994), we experienced ten cases of autologous blood transfusion. For the prevention of anemia due to repeated blood withdrawal, we administered an iron preparation. Patients who preoperatively showed a low value of Hb (less than 11g/ dl) received intravenous drip infusion of erythropoietin. Since some patients selected for autologous blood transfusion, who also received neo-adjuvant chemotherapy and preoperative radiotherapy, exhibited a generally chronic anemia status, an iron preparation and erythropoietin should be preoperatively administered in combination.

Blood Transfusion as a Risk Factor for Death in Stage III and IV Operative Laryngeal Cancer

To evaluate the role of a blood transfusion in a patient population with head and neck cancer that was treated with combined therapy (surgery and radiation). Retrospective, nonrandomized end point study. Univariate and multivariate analysis of 24 variables, including transfusion status. The Veterans Affairs Cooperative Study (Cooperative Studies Program 268). Patients in the surgical arm of the study (166 patients) underwent surgery and postoperative radiation therapy for advanced (stage III and IV) laryngeal cancer. Identification of variables related to patient time to death. The univariate analysis identified age, clinical N (lymph node) class, primary tumor site, number of pathologically positive lymph nodes, extracapsular spread, pretreatment screening hematocrit, hematocrit and albumin level at 1 month after treatment, intraoperative fluids and units of blood, and total units of blood as significant (P < .05). The stepwise multivariate models identified independent significance in clinical and pathologic node status, hematocrits at both screening and 1 month, extracapsular spread, albumin level at 1 month, age, and primary site. The position of each variable within the individual regression models varied. Clinical N class or pathologic node status occupied the first position of predictive significance in all models. Blood transfusion status never retained independent significance in any multivariate assessment.

関西医科大学病院における輸血の現状と問題点およびその対策について

1989年9月,厚生省は「輸血療法の適正化に関するガイドライン」を制定し,血液製剤の適正使用を強く要請している.当院で1990年に使用された血液製剤は58318単位で,うち各製剤の占める割合は赤血球製剤(CRC)15 .7%,血小板製剤(PC)35、9%,新鮮凍結血漿(FFP)48.4%であり,3年前に比べPC製剤は2.1倍,FFPは1.4倍に増加した.一方,赤血球製剤の使用量はほぼ一定であり,FFPは過剰使用と言われそいる本邦の平均33 .6%より更に高い.赤血球製剤においては適正使用の指標となるC/T比(輸血単位数に対する交差試験実施単位数の比)は1.5以下が適正とされているが,当院における各診療科別のC/T比は最低1.0から最高6.5,平均は2.4であり,特に外科系では3.6と高い.その原因として,手術用血液の過剰申し込み,未使用血液の病棟滞在日数の延長などが考えられた.これらの対策の二つとして,1990年12月よりType&Screen(T&S)とMaximum Surgical Blood Order Schedule(MSBOS)を導入した.その結果,1991年1月31日までにT&Sが実施されたのは5診療科の計24例であり,その全例で輸血を必要としなかった.また,FFPにおいては,1990年7月よりガイドラインに沿った払い出し制限を行った結果,1ヵ月間に1402単位減少したが,臨床的に特に問題は起こらなかった.今後,T&S,MSBOSの対象症例や実施数を増やし,未使用血液の早期返却などの基本的事項の徹底と共に,各種血液製剤の適正使用が望まれる.

The relationship of blood transfusion, tumor staging, and cancer recurrence

Previous research demonstrated a relationship between transfusions of whole blood, or large numbers of red cell concentrates, and later recurrence of cancers of the colon, rectum, cervix, and prostate. It is possible that the transfusion of whole blood may represent a surrogate marker for advanced or more aggressive clinical disease. The relationship of clinical or histologic tumor stage, blood transfusion status, and disease outcome was studied in detail. Patients receiving no transfusions or small numbers of red cells (less than or equal to 3 units) had uniformly better recurrence and survival experiences than patients receiving similar amounts of blood that included at least 1 unit of whole blood, regardless of the patient's clinical or histologic tumor stage. In multivariate analyses, stage was an independent predictor of outcome, and transfusion status was not a surrogate marker for stage. The effects on recurrence of stage and transfusion appear to be cumulative. These results are consistent with but do not prove the hypothesis that the transfusion of large amounts of stored plasma and cellular debris impairs the host defenses against cancer, regardless of the underlying biologic and clinical aggressiveness of the cancer.

Blood Transfusion and Other Risk Factors for Recurrence of Cancer of the Head and Neck

To determine whether perioperative blood transfusion affected the recurrence rate of squamous cell cancer of the head and neck, we performed a retrospective study of all patients with stage III and IV disease treated surgically at the University of North Carolina, Chapel Hill, between 1983 and 1986. Those who recurred were compared with those who did not in regard to 16 prognostic variables, including whether or not they had received a perioperative blood transfusion. Analyzing each variable separately, five were significantly related to recurrence. These were (1) surgical margin status, (2) stage, (3) presence of pathologically positive nodes, (4) blood transfusion status, and (5) type of treatment. However, because several of these variables were clearly interrelated, the same data were subjected to a multivariate regression analysis specifically designed to identify significant prognostic variables independent of their association with other variables. By this analysis, only margin status and the presence or absence of a blood transfusion were statistically significant predictors of recurrence.

Successful DR-incompatible cadaver kidney transplantation. Combined effect of HLA A and B matching and blood transfusion.

The purpose of this retrospective analysis of DR-incompatible cadaver renal transplantation was to evaluate the effect of HLA A and B matching and blood transfusion status on actual one-year graft survival. There were 31 2-DR, 111 1-DR, and 27 0-DR grafts at risk during the study period. First, a comparison was made between preoperative (PRE) and peroperative (PER) transfusions alone. Graft survivals were 70% vs. 92% (2 DR), 67% vs. 52% (1 DR) and 71% vs. 39% (0 DR) for the PRE and PER groups, respectively. Statistical significance was not found between the two values in each DR subgroup, although the difference approached significance in the O DR group (0.1 greater than P greater than 0.05). Matching for greater than or equal to 2 A and B antigens significantly improved graft survival in the 1 DR-matched group when compared with those matched for less than 2 antigens (76% vs. 44%, P less than 0.005). While marked differences between the greater than or equal to 2 and less than 2 A and B matched groups were observed for both the 2 DR (92% vs. 68%, P greater than 0.1) and O DR groups (59% vs. 40%, P greater than 0.3) these differences were not significant. Stratifying the data for transfusion status revealed that the positive influence of HLA A and B matching in the 1 DR group was dependent upon the presence of preoperative blood administration. Graft survival of 87% for the PRE transfused recipients of grafts matched for greater than or equal to 2 A and B antigens was significantly better (P less than 0.001) than the 42% survival observed in similarly transfused recipients of poorer matched organs. Conversely, A and B matching was not significantly beneficial in the 1 DR recipients transfused only at the time of transplant with graft survivals of 57% vs. 43% for those matched for greater than or equal to 2 or less than 2 A and B antigens, respectively (P greater than 0.3). This analysis suggests that a combined effect of both HLA A and B matching and preoperative blood transfusions may allow for highly successful first cadaver renal transplantation in the face of DR incompatibility.

"THE STATUS OF BLOOD TRANSFUSION"

To Editor: —In an editorial on status of blood transfusion (The Journal, September 29, p. 1114), discussing citrate method of blood transfusion, it is stated that the added chemical also develops anticomplementary properties in plasma, and reduces phagocytic and opsonic powers of blood. These facts would naturally argue against use of citrate method in general infections when a resistance action is sought. The corpuscles are said to become more friable—a result particularly undesirable in combating certain forms of anemia. These statements as to action of sodium citrate on blood are based on a paper by Unger (The Deleterious Effect of Sodium Citrate Employed in Blood Transfusion,The Journal, Dec. 31, 1921, p. 2107). In order to correct erroneous impression created by editorial, as if this deleterious action of sodium citrate on various constituents of blood

"THE STATUS OF BLOOD TRANSFUSION"

To the Editor: —In an editorial (The Journal, September 29, p. 114) you comment on the present status of blood transfusion. After reviewing some of the work showing the disadvantages of the citrate method of transfusion, you commend very heartily whole blood transfusion. This commendation appears to be in keeping with results of physiologic and clinical investigations, but it is difficult to understand your position with regard to direct transfusion, in which the blood is directly conveyed from the artery of the donor to the vein of the recipient. The obvious objections to blood vascular suturing in transfusion are the technical difficulties and the rather prolonged incisions necessary to expose the vessels. These objections do not obtain when a short jointed cannula, such as the Bernheim cannula, is used. In a communication in the Archives of Surgery (September, 1923, pp. 466-468) I have reported fifty-four consecutive cases, in which this