Practice Of Transfusion Medicine Research Articles

Practice Parameters for Transfusion Medicine

© In the United States, more than 23 million blood components are transfused annually. Health care resources, including those for transfusion, are increasingly constrained. The availability of voluntarily donated blood used for component preparation is becoming more limited.1 In addition, increasingly restrictive donor qualification criteria, multiple layers of required disease testing, novel postdonation component modifications, and the characteristic perishability of blood continue to add to the cost and value of blood services. Moreover, the complex process of blood transfusion, from the vein of the donor to the vein of the recipient, is problem-prone. Therefore, in addition to the inherent risks associated with a biologic resource, the use of blood is an activity of high volume, increasingly greater cost, and limited availability. Because of these issues, appropriate and prudent use of blood requires some constraints on the way blood is transfused. Reflecting a trend over the last 2 decades in all areas of medicine, scores of transfusion medicine practice parameters have been in developed in an attempt to fill this need [T1].

Transfusion Therapy: Clinical Principles and Practice.

Medical Writings: Book Notes3 October 2000Transfusion Therapy: Clinical Principles and PracticeJanice P. Dutcher, MDJanice P. Dutcher, MDOur Lady of Mercy Medical Center, New York Medical College, Bronx, New York. (Dutcher)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-133-7-200010030-00032 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Mintz PD, ed. 481 pages. Bethesda, MD: American Assoc of Blood Banks Pr; 1999. $139.00. ISBN 1563950995. Order phone 301-215-6499.Field of medicine: Hematology/oncology and transfusion medicine.Format: Hardcover book.Audience: Hematologists, oncologists, surgeons, obstetricians, and general medicine practitioners.Purpose: To provide a broad view of the clinical practice of transfusion medicine, with emphasis on clinical applications and specific clinical problems.Content: The initial sections discuss cellular blood products and the clinical problems that dictate their use, including red cell transfusion for autoimmune disease and hemoglobinopathy. Platelet and granulocyte transfusion therapy are also covered. A detailed section describes various aspects ... Author, Article, and Disclosure InformationAffiliations: Our Lady of Mercy Medical Center, New York Medical College, Bronx, New York. (Dutcher) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byHemostatic techniques to reduce blood transfusion after primary TKA: a meta-analysis and systematic review 3 October 2000Volume 133, Issue 7Page: 572KeywordsBlood banksBlood cellsBlood transfusionHematology and oncologyHemostasisPlateletsSoftware toolsSurgeonsTransfusion medicineTransplantation ePublished: 3 October 2000 Issue Published: 3 October 2000 Copyright & PermissionsCopyright © 2000 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Total quality management in non-profit secondary health care

The management of non-profit secondary health care is significantly influenced by the cost/price signals of key components within the casemix process. The total quality management (TQM) of health care requires an understanding of the nature of these costs. This paper demonstrates that the historic view of the allocation of costs in the case of joint products, such as those in transfusion manufacturing, is that they can only be solved in an arbitrary manner. In contrast, this paper describes a quality-based rationale for the allocation of joint costs to plasma, red cells and platelets, as routinely manufactured from whole blood. The key element is first to trace joint-process costs to product specification elements, rather than directly to products. By this means, final product costs become valid for cost-benefit analysis. This should significantly affect many cost-benefit decisions in the practice of transfusion medicine. It should also retrieve the current probable misallocation of secondary health care resources, estimated at approximately 200,000,000 per annum for Western Europe on the basis of historically determined cost models. Quality-driven blood product costing is shown to be central to the achievement of the TQM of secondary health care.

Transfusion Therapy: Clinical Principles and Practice

This book, as its title implies, is orientated towards the clinical practice of transfusion medicine and is therefore of primary relevance to clinicians rather than to transfusion centre and blood bank staff. It is compact and clearly laid out with numerous tabulations of very high quality, although few figures. The text is well written by no fewer than 27 experts in their respective fields, well referenced and up to date. Sections on transfusion of patients with chronic anaemias and haemolytic anaemias are well written and there are chapters that cover systematically platelet and granulocyte transfusion therapy, correction of congenital and acquired disorders of haemostasis. The other chapters deal with transfusion in surgery, trauma, stem cell and organ transplantation and fetuses and neonates. Appropriately there are good descriptions of cellular immunotherapy, the use of immunoglobulins, leucodepleted and CMV-negative blood components, transfusion-associated graft-versus-host disease and transfusion reactions. There is also a very comprehensive section on fibrin sealants. Putting this book to the test, I was surprised to find that in bone marrow transplantation patients, washed red cells were recommended where there was recipient–donor ABO mismatch — a somewhat unusual strategy, perhaps reflecting the practice of the contributor's institution. Transfusion of FFP was somewhat loosely described within the sections on acquired and congenital bleeding disorders. Inevitably a book that deals with transfusion by clinical category rather than by blood component will suffer from this kind of omission. However, these are minor points and the book is a real pleasure to read. Dr Dzik writes a section challenging our views on the need for correction of haemostatic defects prior to invasive procedures, that perhaps predictably indicates a lack of systematic study in this area. This chapter and many others are thought-provoking and point to whether further information from prospective evaluations is needed. The American Association of Blood Banks' use of electronic publishing enabled the Editor to include late items of text and references up to 10 weeks prior to the scheduled publication date. This is a book that I would recommend highly to all those with an interest in the clinical practice of transfusion medicine. It will also be of value to laboratory and nursing staff seeking information and advice on the patients they help to care for, and at a cost of $159 for non-AABB members it is reasonably priced.

The case for standardization of transfusion medicine practices in French blood banks.

Despite a decrease in collection and transfusion of blood components and technical and quality assurance improvements, adverse effects of transfusion, particularly fatalities due to ABO incompatibility, remain high. In order to evaluate the immunohaematology and blood products recipient practices in French blood banks, we have mailed a questionnaire and analysed the answers. Our study shows a great variation in practices. Most blood banks (70.6%) perform a second ABO blood grouping test for patients before they consider it as valid and keep it in their laboratory's computer system. The use of faxed requisition forms for blood products (84.0%) or immunological data (89.4%) are commonly accepted by French blood banks before preparation of orders for blood components. Nevertheless, at the time of blood product delivery, 40.4% of them required the original order documents. Completion of the transfusion follow-up form for blood components is undertaken free of charge by blood banks. When immunohaematology data of a patient are in the blood banks computer system and if a hospital department wants patient's ABO rhesus (RHI) blood group card, a duplicate of this card is frequently edited. Lastly, a committee is needed to establish, as in United Kingdom, guidelines in blood products recipients practices in French blood banks. Standard operating procedures regarding organization, documentation, techniques, etc., at the blood banks and the hospital will be written and valided for each step of the process prior to blood transfusion of a patient.

Red Cell Transfusion

Department of Anesthesiology; University of Alabama at Birmingham; Jefferson Tower; Birmingham, Alabama;sergio.gregoretti@ccc.uab.eduRed Cell Transfusion: A Practical Guide. Edited by Marion E. Reid and Sandra J. Nance. Totowa, Humana Press, 1998. Pages: 227. Price:$99.50.This monograph, apparently the first one of a new series entitled “Contemporary Hematology,” seeks to provide a concise, up-to-date overview of current issues associated with the collection, selection, and transfusion of erythrocytes. The material is organized in 14 chapters with 21 contributors, all (with one exception) pathologists laboratory medicine specialists, or both. The practical aspects of blood collection, donor screening, autologous and directed donations, blood administration, and the immunologic principles of transfusion medicine are discussed in five chapters. These chapters are somewhat scattered through the book, and a better arrangement of sequence would have helped the reader. For instance, donor-related issues are contained in chapter 1, whereas an expanded discussion regarding directed donations is found in chapter 10. The chapter concerning blood group antigen and antibodies is relegated at the end of the book, whereas germane immunologic topics are presented in chapter 3.Five chapters are dedicated to erythrocyte transfusion in recipients with special needs. The topics include transfusion in autoimmune hemolytic anemias, in the immunocompromised patient, in solid organ transplantation, and in neonates, and long-term transfusion therapy.The final chapters deal with massive transfusion, the transfusion “trigger,” and transfusion reactions. One chapter also deals with the laboratory aspects of hematopoietic stem cell transfusion, i.e., collection, processing, purification, and storage of the stem cells. This chapter seems out of place in a monograph dedicated to erythrocyte transfusion. Actually, in several instances, steps are taken to remove erythrocytes from the stem cell preparation.The chapters are well written and to the point. Occasionally, however, for the sake of conciseness the quality of presentation suffers, such as when all the complications of massive transfusion are squeezed into a three-page summary in chapter 9. Inaccuracies and questionable statements are few. An increase in hemoglobin concentration by erythropoietin administration decreases but does not “enhance” resting cardiac index in patients with end-stage renal disease (p. 171). Few would agree that the placement of a pulmonary artery catheter is beneficial in treating a patient with an acute hemolytic transfusion reaction (p. 191). Repetitions, despite the multiauthorship, are minor. For instance, transfusion problems in the immunoglobulin (Ig) A-deficient patient are addressed on pages 83 and 198; as to whether the transfusion criteria for autologous blood should be more liberal then for allogeneic blood is discussed on pages 153 and 169. Stylistic lapses are very rare ("the presence of fever can result in an unnecessary work-up for infection, which can result in the patient's being cultured and treated…," page 203). In three chapters (1, 10, and 11) the word autogeneic is used instead of “autologous” to refer to the patient's blood. Because this word was new to me, I looked it up in several medical dictionaries and could not find the word in any. Although allogeneic (i.e., genetically dissimilar, although belonging to individuals of the same species) has legitimately replaced the word donor to qualify the origin of the blood, I see no need for a new word, in this case an etymological nonsense, to replace the perfectly appropriate word autologous (i.e., derived from the same individual). The references are up to date and well chosen, a notable exception being the key reference to citrate toxicity during massive transfusion (p. 144).This monograph, with its emphasis on blood bank issues and the laboratory aspects of transfusion medicine, is mainly written for pathologists and hematologists/oncologists. The practicing anesthesiologist will be better off in searching for answers to clinical questions elsewhere. In this respect, the American Society of Anesthesiologists booklet Questions and Answers about Transfusion Practices can be an excellent starting point. Finally, this monograph may find tough competition as a reference source in transfusion medicine, as in the intention of its editors, because very recently new editions of two major textbooks in this field have been released Clinical Practice of Transfusion Medicine, second edition (Petz DL, Swisher SN, Kleinman S, Spence RK, Strauss RG: Churchill Livingstone, 1966) and Principles of Transfusion Medicine, second edition, (Rossi EC, Simon TL, Moss GS: Williams & Wilkins, 1966). Instead of a book focused exclusively on erythrocyte transfusion, for just $50 more one can purchase an equally up-to-date textbook that discusses the whole spectrum of transfusion medicine.Sergio Gregoretti, M.D.Department of Anesthesiology; University of Alabama at Birmingham; Jefferson Tower; Birmingham, Alabama;sergio.gregoretti@ccc.uab.edu

The French Hæmovigilance System

Haemovigilance was part of the reform of the French transfusion system. The haemovigilance network is now operational with approximately 4600 transfusion incidents reported annually. Immediate incidents observed within 8 days after transfusion account for 85% of the reports. A cause cannot be identified in 41% of these, usually concerning minor clinical incidents with transient fever and/or shivers. An allergic reaction is described in 31% of transfusion reactions. Immunological conflicts account for 18% and bacteria associated transfusion reactions for 6%. The importance of bacteria associated transfusion reactions, the first identified cause of death associated with transfusion is one of the findings of haemovigilance. Improvement in the haemovigilance systems aims at obtaining better descriptions of transfusion incidents, standardisation of severity and imputability assessment and definitions of denominators such as the actual number of recipients. Delayed incidents will ultimately provide a true vision of post transfusion immunisation and infection The improvement of haemovigilance now considered as part of transfusion medicine practice is a continuous process.

Frequency, Predictors, and Appropriateness of Blood Transfusion After Percutaneous Coronary Interventions

Increased awareness of the risks of blood-borne infections has recently led to profound changes in the practice of transfusion medicine. These changes include, among others, the development of guidelines by the American College of Physicians (ACP) for transfusion. Although the incidence and predictors of vascular complications of percutaneous interventions have been well defined, there are currently no data on frequency, risk factors, and appropriateness of blood transfusions. We performed a retrospective analysis of 628 consecutive percutaneous coronary revascularization procedures. Predictors of blood transfusion were identified using multivariate logistic regression analysis. Appropriateness of transfusions was determined using modified ACP guidelines. Transfusions were administered after 8.9% of interventions (56 of 628). Multivariate analysis identified age >70 years, female gender, procedure duration, coronary stenting, acute myocardial infarction, postprocedural use of heparin and intra-aortic balloon pump placement as independent predictors of blood transfusions (all p <0.05). According to the ACP guidelines, 36 of 56 patients (64%) received transfusions inappropriately. Transfusion reactions (fever) occurred in 10% of patients who received tranfusions appropriately and in 5% of patients who received tranfusions inappropriately. The estimated additional costs per procedure related to transfusions were $551 and $419, respectively. In conclusion, unnecessary transfusions were performed frequently after percutaneous coronary interventions. Application of available guidelines could reduce the number of unnecessary transfusions, thus avoiding exposure of patients to additional risks and reducing procedural costs.

Clinical Practice of Transfusion Medicine

Clinical Practice of Transfusion Medicine

Clinical Practice of Transfusion Medicine: 3rd ed. Petz LD, Swisher SN, Kleinman S, Spence RK, Strauss RG, eds.

Clinical Practice of Transfusion Medicine: 3rd ed. Petz LD, Swisher SN, Kleinman S, Spence RK, Strauss RG, eds.

Book review

Transfusion MedicineVolume 7, Issue 1 p. 71-72 Book review Clinical Practice of Transfusion Medicine, 3rd edn. Ed. by Lawrence D. Petz, Scott N. Swisher, Steven Kleinman, Richard K. Spence and Ronald G.Strauss. Churchill Livingstone, USA. 1115 pp. D. Pamphilon, D. PamphilonSearch for more papers by this author D. Pamphilon, D. PamphilonSearch for more papers by this author First published: 03 November 2003 https://doi.org/10.1046/j.1365-3148.1997.d01-4.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume7, Issue1March 1997Pages 71-72 RelatedInformation

Clinical Practice of Transfusion Medicine, 3rd Ed

Clinical Practice of Transfusion Medicine, 3rd Ed

Clinical Practice of Transfusion Medicine, 3rd Ed

Clinical Practice of Transfusion Medicine, 3rd Ed

Immunotherapy and gene transfer in the treatment of the oncology patient: role of transfusion medicine.

T HE PRACTICE of transfusion medicine and the role of the blood bank have seen considerable evolution in the last decade from supplying components predominately derived from whole blood donation, to the acquisition, processing, quality monitoring, and provision of a large range of plasma-derived acellular, and apheresis-derived cellular, components (Table 1). Indeed, many basic, preclinical, and clinical studies now support the use of these cellular components in the treatment of neoplastic (and nonneoplastic) diseases via bone marrow transplantation, adoptive immunotherapy, and gene transfer therapy. A detailed discussion of all relevant advances in these fields is beyond the scope of this review. However, data supporting the clinical utility of these therapies have increased rapidly in the past 10 years and have had a growing impact on transfusion services and blood banks. Herein, the authors review some of the key studies related to the development of these therapeutic modalities and the role of the transfusion medicine service in their provision. Bone marrow transplantation (BMT), immunotherapy, and gene transfer therapies are linked, in part, by their use of mononuclear cells of hematolymphopoietic origin. Parallels between BMT, immunotherapy, and gene transfer therapy are common, and discussion of these fields overlaps in several areas. For example, allogeneic BMT, in addition to reconstituting hematopoiesis after highdose chemotherapy, has the potential to react immunologically against the patient's leukemia cells, an antitumor effect termed graft-versusleukemia (GVL). Indeed, the induction of GVL via buffy-coat or T-cell infusions derived from the original bone marrow donor has been used to treat leukemic relapse following B M T . 1-3 This, then, is a form of cancer immunotherapy in BMT. Additionally, early work with gene transfer modalities used the insertion of a marker gene into bone marrow cells so that their progeny could be tracked and followed post-BMT. 4 A third similarity is that apheresis-derived mononuclear cell (MNC) preparations can be used for BMT (as peripheral blood stem cells), adoptive immunotherapy (as lymphokine-activated killer cells [LAK]), or in gene therapy programs (as a vehicle for a tumoricidal molecule). Thus, it is not unexpected that the transfusion medicine specialist would have a role in these three programs with a focus on cell acquisition, current good manufacturing practice (cGMP)level processing, storage, and transfusion of these products. This review provides an overview of each field, cell-processing methodologies, current clinical protocols and studies, and the role of the blood bank/transfusion medicine scientist for BMT, immunotherapy, and gene transfer therapies.

Selection of Anticoagulant-Preservatives for Canine and Feline Blood Storage

Blood or blood component transfusions have become a well recognized, lifesaving form of therapy in veterinary medicine. Blood used for small animal transfusions may be collected and prepared with a variety of anticoagulants, anticoagulant-preservatives, or additive solutions. Selection of the most appropriate of these collection or storage solutions requires a knowledge of their formulations and of the shelf-lives previously established for storage of canine or feline red blood cells. Other factors that should be considered in the selection process are based on the specific transfusion needs of a clinic and its patients, including whether the blood will be used fresh or stored, the length of storage time desired, and whether components will be prepared. New products and techniques for blood storage continue to be developed, offering exciting new possibilities for the future practice of veterinary transfusion medicine.

Monoclonal anti-D specificity and Rh D structure: criteria for selection of monoclonal anti-D reagents for routine typing of patients and donors.

The Rh blood group system is the next most important to the ABO system in terms of its clinical significance in blood transfusion. It is vital to the safe, efficient practice of transfusion medicine that Rh D phenotyping tests are selected, executed and interpreted correctly. However, the Rh D blood group antigen has been shown to be subject to many phenotypic variations, and different reagents and typing techniques vary in their ability to detect these variants. The range of D-positive phenotypes are reviewed in terms of their reactivity with monoclonal antibody reagents and their clinical significance. In view of the available evidence, it is suggested that patient typing can be safely achieved by the duplicate use of one high-avidity or two very similar IgM monoclonal anti-D reagents that detect most variants except category DVI in simple tube or microplate saline tests. Antiglobulin testing for weak D should not be carried out on patient samples. Donor typing can be safely achieved by the use of the same monoclonal, used in parallel with a polyclonal anti-D reagent that detects DVI on sensitive automated equipment.

Transfusion-Transmitted Retrovirus Infection

This article reviews the history, classification, and disease associations of the known human retroviruses and outlines their profound effects on the practice of transfusion medicine. The immunodeficiency viruses, HIV-1 and HIV-2, produce a cytolytic effect on infected lymphocytes, and are the causative agents of AIDS. In contrast are the oncoviruses, including HTLV-I and HTLV-II, which are typically lymphoproliferative and able to induce cellular transformation. Human foamy viruses, more recently recognized as a potential human neuropathogen, resemble the other retroviruses with their complex genome organization and structure.

Initial validation and quality control of platelet concentrates prepared by apheresis

Platelet concentrate (PC) prepared by apheresis is a widely used product in the practice of transfusion medicine. New machines, new protocols and/or disposables for existing machines, as well as new storage containers for the PC are being introduced with great frequency. Furthermore, additional steps such as filtration are being introduced between preparation and storage. The goal of this paper is to discuss the wide range of laboratory measurements which might be used by manufacturers of apheresis centers to validate a new procedure prior to its introduction into clinical practice. In addition, the discussion should shed light on what procedures might be used as quality control assessments by an apheresis center during the ongoing utilization of a procedure which has previously been validated. Once a PC has been prepared, it must be stored for finite period of time. A new procedure may provide a PC with a large number of platelets and few contaminating leukocytes but poor potential for storage. Therefore, any new preparative procedure must specify how long the PC may be stored and what the conditions of storage are to be. The laboratory assays to be described should be applied at the end of that storage interval.

Legal Issues in Transfusion Medicine

The threat of transmitting serious illness through infected blood used in a transfusion permeates all transfusion medicine practices. Legislatures and other agencies grapple with this problem by developing regulations to reduce infection risk and assign liability. We review some of the laws and cases that form the basis for legal actions and liability in this area.

Perioperative haemotherapy: I. Indications for blood component transfusion.

The practice of transfusion medicine has undergone substantial change over the last decade. Much of the impetus for the change has come from the isolation of human immunodeficiency virus (HIV) and the linkage of HIV transmission to blood transfusion. The purpose of this paper is to collate and review the literature relating to the indications for blood transfusion and provide recommendations for the appropriate utilization of blood products. Peer-reviewed and published studies and reviews relating to aspects of clinical blood transfusion were identified through computer searches and searching of the bibliographies of identified articles. Emphasis was placed on the literature published within the last decade and particularly in the years 1985-91. Material was chosen which was of proved clinical importance and in which findings were consistent among different investigators or different centres. Less emphasis was placed on material reporting new findings of uncertain clinical relevance or findings that were not consistent with majority reports. It is concluded that the only indication for red cell transfusion is to increase the oxygen carrying capacity of the blood and that an adjustment downwards in the haemoglobin concentration at which blood is transfused (transfusion trigger) from the traditional level of 100 g.L-1 is supported by the physiological and clinical data. Perioperative haemoglobin concentrations of 80 g.L-1 are acceptable in otherwise healthy young patients. The transfusion trigger should be adjusted upwards from this in medically compromised patients and in the elderly (greater than 60 yr). Fresh frozen plasma (FFP) is only indicated when there are documented deficiencies of coagulation factors. Platelet concentrates (PC) are indicated for the treatment of clinical coagulopathy resulting from thrombocytopaenia or platelet dysfunction. Routine or prophylactic administration of either FFP or PC after cardiopulmonary bypass or during resuscitation from haemorrhage is not indicated.