Units Of Fresh Whole Blood Research Articles

Transfusion-Associated Graft Versus Host Disease Following Hepatectomy for Hepatocellular Carcinoma. A Case Report.

A case of transfusion-associated graft versus host disease (TA-GVHD) following hepatectomy for hepatocellular carcinoma is described in a 53 year-old male patient. The intraoperative bleeding was estimated to be 1220 ml, and he was transfused with 4 units of fresh whole blood. On postoperative day (POD) 12, a fever of 38 degrees C developed, followed by a systemic erythema on POD 14, and a marked progressive leukopenia starting from POD 19. The patient died of multiple organ failure (MOF) on POD 29. Just before death, the results of skin, bone marrow, and liver biopsies had no physical evidence of GVHD. TA-GVHD was found in the HLA typing of the patient's family. This TA-GVHD case was considered to be a reduced immunity due to severe surgical stress or preoperative transcatheter arterial embolization (TAE), in view of the fact that he was transfused with fresh whole blood during the operation. TA-GVHD has frequently been reported in patients after open heart surgery, but also after hepatectomy. It is therefore necessary to take all available means to prevent it by restricting the use of blood preparations as much as possible, and if hetero blood transfusions are performed, blood should be irradiated prior to transfusion.

Fresh blood units contain large potent platelets that improve hemostasis after open heart operations

Twenty units of fresh whole blood were separated into fresh packed red blood cells (PC) and platelet-rich plasma (PRP) and were transfused to 40 patients immediately after coronary bypass grafting. Patients were preoperatively randomized to receive either PRP (group A, 20 patients) or PC (group B, 20 patients). Platelet number in the PRP group was greater, but not significantly greater, than in the PC group (7.5 ± 3 versus 5.9 ± 2.2 × 10 10; p = not significant). However, mean platelet volume in the PC group was significantly greater (8.75 ± 1.1 versus 6 ± 0.7 fL). Postoperatively, group A patients bled more than group B (566 ± 164 versus 327 ± 41 mL; p < 0.01) and received more red blood cell units (2.7 ± 1.2 versus 1.6 ± 0.7 U; p < 0.05) and a larger number of blood products (5.9 ± 3.7 versus 2.6 ± 1.2 U; p < 0.05). Transfusion of PRP to group A increased platelet count from 128 ± 20 to 148 ± 110 × 10 9/L; however, platelet functions did not improve. Administration of PC to group B increased platelet count from 139 ± 22 to 156 ± 23 × 10 9/L, improved platelet aggregation (with collagen from 33% ± 20% to 53% ± 23%, with epinephrine from 36% ± 24% to 51% ± 20%; p < 0.05), and corrected the prolonged bleeding time. The results suggest that the improved hemostasis observed after fresh whole blood administration is related to the large, potent platelets that remained in the PC and were not separated to the PRP during standard platelet concentrate preparation.

Is Transfusion of Fresh Plasma After Cardiac Operations Indicated?

Patients undergoing cardiac operations constitute the majority of recipients of fresh frozen plasma. In most centers the reason for transfusing fresh frozen plasma is to replace clotting factors. However, the decrease of clotting factors during cardiopulmonary bypass is not sufficient in most patients to cause abnormal bleeding. One of the major causes of nonsurgical bleeding after cardiac operations is acquired platelet dysfunction, which can be corrected by transfusion of 1 unit of fresh whole blood. Because plasmatic factors in fresh whole blood may be responsible for this improvement, a study was designated to evaluate the effect of transfusing fresh plasma on platelet function after cardiac operations. Forty patients undergoing cardiopulmonary bypass were randomized to receive either fresh plasma or the fresh packed cell fraction. Administration of packed cells increased platelet number (118 ± 8.5 to 154 ± 7.6 × 109/L, p

Is transfusion of fresh plasma after cardiac operations indicated?

Patients undergoing cardiac operations constitute the majority of recipients of fresh frozen plasma. In most centers the reason for transfusing fresh frozen plasma is to replace clotting factors. However, the decrease of clotting factors during cardiopulmonary bypass is not sufficient in most patients to cause abnormal bleeding. One of the major causes of nonsurgical bleeding after cardiac operations is acquired platelet dysfunction, which can be corrected by transfusion of 1 unit of fresh whole blood. Because plasmatic factors in fresh whole blood may be responsible for this improvement, a study was designated to evaluate the effect of transfusing fresh plasma on platelet function after cardiac operations. Forty patients undergoing cardiopulmonary bypass were randomized to receive either fresh plasma or the fresh packed cell fraction. Administration of packed cells increased platelet number (118 +/- 8.5 to 154 +/- 7.6 x 10(9)/L, p less than 0.05), shortened bleeding time (7.57 +/- 0.4 to 4.0 +/- 0.3 minutes, p less than 0.05), and improved platelet aggregation in response to collagen and epinephrine (32% +/- 4.7% to 50% +/- 5.6% and 37% +/- 5.8% to 50% +/- 5.8%, respectively, p less than 0.05). Fresh plasma, however, neither increased platelet number nor improved bleeding time or platelet aggregation. Each group later received the remainder of the blood unit, with similar results. The results suggest that improvement of platelet function in patients receiving fresh whole blood after cardiac operations is not related to plasmatic factors. Therefore the massive use of fresh frozen plasma in patients after cardiopulmonary bypass should be reconsidered.

Transfusion of fresh whole blood stored (4° C) for short period fails to improve platelet aggregation on extracellular matrix and clinical hemostasis after cardiopulmonary bypass

It has recently been shown that the hemostatic effect of 1 unit of fresh whole blood is equivalent to the effect of 8 to 10 platelet units. This study was designed to evaluate the effect of short periods of cold (4 degrees C) storage on the hemostatic effect of fresh whole blood transfusion in 36 patients immediately after cardiopulmonary bypass. Twelve patients (group A) received unrefrigerated fresh whole blood, 12 (group B) received fresh whole blood after 5 hours' storage at 4 degrees C, and 12 (group C) after 24 hours' storage at 4 degrees C. For evaluation of platelet function, a method with an extracellular matrix and an electron microscope was used. The platelet function was graded from 1 to 4, with grade 4 being normal aggregation. Postoperatively, group A patients bled less than groups B and C (267 +/- 42 versus 397 +/- 72 and 601 +/- 172 ml/24 hr, respectively, p less than 0.001) and therefore received fewer blood units (1.4 +/- 0.5 versus 2 +/- 0.9 and 3 +/- 1.4, respectively, p less than 0.01). Five patients of group A (42%) reached grade A aggregation after transfusion of unstored fresh whole blood, compared with two (17%) of group B and none (0%) of group C (p less than 0.01). Posttransfusion platelet count and mean platelet volume were not significantly different in the three groups. We conclude that storage at 4 degrees C, even for a short period of 5 hours, diminishes the hemostatic effect of fresh whole blood by decreasing platelet aggregability.

不規則抗体が検出されない溶血性輸血副作用をＲｈ因子適合血により予防しえた１症例

A 52 years old woman with ruptured esophageal varix, who had hemolytic transfusion reaction without any detectable irregular antibodies in her serum, was reported. She had history of twice blood transfusions on each caesarean operation in 1979 and 1980.She has received 10 units of fresh whole blood from 16 to 18 May in 1988. Ten days after blood transfusions, she noticed hemoglobinuria. Laboratory tests showed increase in LDH and indirect bilirubin levels with decreased haptoglobin level.The irregular antibodies were weakly detected in her serum by low ionic strength polybren method on the Autoanalyzer, but not by saline, albumin, bromelin and indirect antiglobulin method. Specificity of the antibodies were anable to be identified, and direct antiglobulin test wa negative. The blood groups of the patient were A1, ccDee. She received blood with Rh phenotype of ccdee. Ever since, she has been saved from occurrences of any hemolytic reactions. Thus delayed hemolytic transfusion reaction by anti-E+C was mostly suspected, though irregular antibodies could not be detected in her serum in March, 1989.

The Hemostatic Effect of Transfusing Fresh Whole Blood Versus Platelet Concentrates After Cardiac Operations

The major cause of nonsurgical bleeding after cardiopulmonary bypass is delayed recovery of platelet count and function. Recovery of platelet count and function was compared in 27 patients who were randomized preoperatively to receive after cardiopulmonary bypass either 1 unit of fresh whole blood (15 patients) or 10 units of platelet concentrates (12 patients). Platelet count, bleeding time, platelet aggregation (adenosine diphosphate, collagen, epinephrine, and ristocetin) and platelet thromboxane formation were abnormal after cardiopulmonary bypass in all the patients. The increase of platelet count after 1 unit of fresh whole blood (from 115 ± 32 X 109/L to 148.5 ± 36 × 109/L) was similar to that achieved by 4 units of platelets (from 140 ± 61 X 109/L to 171 ± 60 × 109/L). The increase was doubled after 10 platelet units (from 140 ± 61 × 109/L to 209 ± 55 × 109/L). Bleeding time returned to normal values after fresh whole blood or after 8 platelet units. However, platelet thromboxane formation was higher after 1 unit of fresh whole blood than after 10 platelet units (95 ± 25 versus 46 ± 35 ng/ml, p

The effect of transfusion of fresh whole blood versus platelet concentrates after cardiac operations: A scanning electron microscope study of platelet aggregation on extracellular matrix

To evaluate the effect of fresh whole blood transfusion versus platelet concentrates transfusion on platelet aggregation after cardiac operations, 24 patients were randomized to receive either one unit of fresh whole blood (12 patients) or 10 platelet units (12 patients) after cardiopulmonary bypass. Platelet aggregation on extracellular matrix, platelet count, and mean platelet volume were studied preoperatively, at termination of cardiopulmonary bypass, after protamine administration, and after the transfusion of fresh whole blood or after transfusion of each two platelet units. Extracellular matrix produced by cultured bovine corneal cells closely resembles the vascular subendothelial basal lamina, and is an ideal in vitro model in the study of platelet interaction with the subendothelium. Platelet aggregation on extracellular matrix, studied by a scanning electron microscope, was graded from 1 to 4, wherein grade 1 represents nonactivated platelets and grade 4 a mature platelet aggregate. With this grading system, the two groups were similar in preoperative values (3.3 +/- 0.9 versus 3.7 +/- 0.4) and values after cardiopulmonary bypass (1.5 +/- 1.0 in both groups). One unit of fresh whole blood restored platelet aggregation on extracellular matrix to preoperative status (3.0 +/- 1.0), whereas eight platelet units were needed for the same result (3.2 +/- 0.8). One unit of fresh whole blood increased platelet count in a manner similar to that achieved by six platelet units and increased mean platelet volume to a level higher than that achieved by 10 platelet units. These results suggest that the effect of one unit of fresh whole blood on platelet aggregation after cardiopulmonary bypass is at least equal, if not superior, to the effect of 8 to 10 platelet units.

開心術における赤血球濃厚液単独使用の有用性に関する検討 新鮮血使用例との比較

We have tried to save the blood in open-heart surgery, then concentrated the diluted blood remained in the reservoir after cardiopulmonary bypass (CPB), and transfused it to the patients through venous line. Also we have primed extracorporeal circuit with concentrated red blood cells. In this study, we compare the results of this method with it produced through transfusion and the priming of fresh whole blood and fresh frozen plasma, and investigate the effectiveness and safety in the usage of concentrated red blood cells as the priming fluid. (Material and Method) From January, 1984 to December, 1987, 84 adult patients underwent coronary artery bypass surgery. We classified them into two groups, depending on their priming fluid for extracorporeal circuit, fresh whole blood or concentrated red blood cells. In group I consisted of 41 patients, fresh whole blood was used for the priming and in group II, consisted of 43 patients, in which concentrated red blood cells were applied and the blood components remained in the reservoir after weaning from CPB were concentrated and returned to patients. In these two groups, we compare the hemodynamic functions and the hematorogical data and also evaluate the safety through the usage of concentrated red blood cells in open-heart surgery. (Results) The components and average amount of blood used in group I were 11.6±5.5 units of fresh whole blood and 8.2±5.9 units of fresh frozen plasma. In group II, they were 6.1±3.0 units of concentrated red blood cells and almost no fresh whole blood or fresh frozen plasma were required. The diluted volume of 1, 315±320ml in the CPB reservoir was concentrated to 620±275ml of blood components and transfused. The values of hemoglobin and hematocrit were significantly higher in group I than these in group II, but there were no significant differences in cardiac index, pulmonary capillary wedge pressure and stroke work index among hemodynamic functions. The incidence of post-transfusion hepatitis was 3/41(7.3%) in group I, while zero in group II. (Conclusion) Concentrated red blood cells could be applied safely as the priming fluid for CPB in open-heart-surgery, and are clearly effective in prevention of post-transfusion hepatitis. These results indicate that this method has a big advantage.

The hemostatic effect of transfusing fresh whole blood versus platelet concentrates after cardiac operations

The major cause of nonsurgical bleeding after cardiopulmonary bypass is delayed recovery of platelet count and function. Recovery of platelet count and function was compared in 27 patients who were randomized preoperatively to receive after cardiopulmonary bypass either 1 unit of fresh whole blood (15 patients) or 10 units of platelet concentrates (12 patients). Platelet count, bleeding time, platelet aggregation (adenosine diphosphate, collagen, epinephrine, and ristocetin) and platelet thromboxane formation were abnormal after cardiopulmonary bypass in all the patients. The increase of platelet count after 1 unit of fresh whole blood (from 115 +/- 32 X 10(9)/L to 148.5 +/- 36 X 10(9)/L) was similar to that achieved by 4 units of platelets (from 140 +/- 61 X 10(9)/L to 171 +/- 60 X 10(9)/L). The increase was doubled after 10 platelet units (from 140 +/- 61 X 10(9)/L to 209 +/- 55 X 10(9)/L). Bleeding time returned to normal values after fresh whole blood or after 8 platelet units. However, platelet thromboxane formation was higher after 1 unit of fresh whole blood than after 10 platelet units (95 +/- 25 versus 46 +/- 35 ng/ml, p less than 0.05), as was platelet aggregation response to collagen and epinephrine. The 24-hour blood loss was smaller in the fresh whole blood group (560 +/- 420 ml versus 770 +/- 360 ml), although the difference was not statistically significant. The results suggest that the hemostatic effect of 1 unit fresh whole blood after cardiopulmonary bypass is at least equal, if not superior, to the effect of 10 units of platelets.

Outcome of closed injuries exceeding 20-unit blood transfusion need

A series of 129 patients with closed injuries receiving more than 20 units (1 unit = 500 ml) of blood within the first 48 h of accident was analysed. The transfusion policy included type-specific crossmatched whole blood stored with citrate phosphate-adenine as the main replacement. One unit of fresh whole blood was transfused for every 5 to 6 units of stored blood. Also platelet concentrates and fresh frozen plasma were in routine use. The patients required 340 surgical procedures, on average 2.6 per patient. Thrombocytopenia with a lowest recorded platelet count of less than 100000/mm 3 occurred in 81 patients (63 per cent) of whom 18 had disseminated intravascular coagulation. This serious complication seemed to be associated with large retroperitoneal blood accumulations, the latter possibly acting as an enhancing factor. The mortality rate in the whole series was slightly lower than recorded previously in the literature. Among patients receiving 21 to 39 blood units the mortality was 25 per cent and among those receiving 40 units or more the mortality was 52 per cent.

Removal of leukocytes from whole blood and erythrocyte suspensions by filtration through cotton wool. II. Influence of filtration on biochemical parameters of erythrocytes during storage.

Abstract. Using the filtration method described earlier, leukocytes were removed from units of fresh whole blood and erythrocyte suspensions (hematocrit 50%). After filtration, the units were stored for one or two weeks.Units of whole blood and erythrocyte concentrates were stored for periods up to three weeks, the leukocytes were then removed by filtration, and the units were stored for another week.During the storage period, the following parameters were measured: pH and concentrations of ATP + ADP, 2,3‐diphosphoglycerate, hemoglobin and potassium (Hb and K+ in the cell‐free supernatant).The parameters used in the present study indicate that removal of leukocytes by filtration did not cause significant alteration to stored whole blood and erythrocyte concentrates, compared to unfiltered blood stored for the same time.

Transfusion Reaction among the Blood Recipient - A Study of 120 Cases

Context: Blood transfusion is a life saving procedure. Transfusion of one unit of blood, plasma or platelet if employed safely, well in time with proper intensive care can save many valuable lives. But due to transfusion a number of untoward reactions develop that are sometimes more serious and life threatening So the aim of this study was to find out the most frequent and life threatening reactions that develop during transfusion.Methods: In between January'2006 to December'2007 a total 120 subjects, mean aged 25.9 ±13.9 years were selected as study population in BSMMU. Those who were receiving transfusion for congenital hemolytic anemia, aplastic anemia, refractory anaemia, undiagnosed anaemia, anaemia of chronic disease, hematological malignancy, post chemotherapy, clotting factor deficiency, pre and post operatively as well as during operation. The transfusion unit was single unit to 100 unit of fresh whole blood or its component- red cell concentrate, fresh frozen plasma, platelet concentrate, cryoprecipitate.Results: There were 8 (6.66%) patients showed reactions of different types. Among them febrile reaction was 5 (62.5%), allergic reaction was 2 (25%) and 1 (12.5%) developed pulmonary congestion (Transfusion Related Acute Lung Injury), characterized by cough, shortness of breath and increase rate of respiration. No fatal reaction observed during the study period. Key words: Transfusion reaction; Febrile reaction; Allergic reaction. DOI: 10.3329/jdmc.v17i2.6585J Dhaka Med Coll. 2008; 17(2) : 67-71