Transfusion and Apheresis Science

Editorial board/Publication information

2011-12-01

Editorial

Gail Rock — 2011-12-01

We are delighted to have information from the Polish Blood Transfusion Service featured in the International Forum of this issue. Dr. Pogłód has written a very comprehensive overview of the evolution of activities in that country and the current emphasis on blood safety as represented by the use of various plasmas that have been either quarantined or subject to one of two forms of pathogen inactivation. This is followed by a summary article from Dr. Anna Ettinger from Caridian in which she reviewed the information presented at the symposium at the International Congress of Clinical Transfusiology; Polish National Transfusion Service, held in Ossa, Poland, September 24th 2010. It is indeed interesting to see the effective manner in which some countries, such as Poland, are moving forward with the initiation of programs to provide safer plasma.

Plasma in Poland: Production, use and safety

Ryszard Pogłód, Magdalena Łętowska — 2011-12-01

Blood and blood components have never been as safe as they are now. The substantial progress in safety improvement has been achieved through: more restrictive donor selection, implementation of more sensitive serological and molecular biology tests, quarantine of plasma, preparation within a closed system and quality assurance (QA) establishment in blood transfusion service.

Improving blood safety and patient outcomes with pathogen reduction technology

Raymond P. Goodrich, Anna Ettinger, Piotr M. Radziwon, Gail Rock — 2011-12-01

International Congress of Clinical Transfusiology, Polish National Transfusion Service September 24th 2010, Hotel Ossa, Ossa, Poland This symposium was a part of the International Congress of Clinical Transfusiology, which took place in September 2010 in Ossa, Poland. An overview of the Mirasol Pathogen Reduction Technology (PRT) and the results from its use in research and clinical settings were presented. Among presenters were research scientists and doctors who used PRT treated blood components in the research laboratories and routinely for the transfusion support of patients.

Scope and application of therapeutic apheresis: Experience from a tertiary care hospital in North India

2011-12-01

Abstract: Background: We present here our experience with therapeutic apheresis (TA) performed for various indications, clinical response and complications in a tertiary care center over last 10years.Study design and methods: Present study is a retrospective analysis of 492 TA procedures performed for 125 patients from January 2000 to December 2009. For each patient: age, gender, weight, clinical indication, pre-procedure hematological profile and ionized calcium levels were recorded. For every procedure following parameters were analyzed: type of venous access (central/peripheral), volume of blood and plasma processed, amount of anticoagulant used, procedure duration, blood flow rate, type of replacement fluid given, response to therapy and adverse reactions.Results: Of 492 TA procedures, 68.8% were performed for neurology, 20.8% hematology–oncology, 9.6% renal and 0.8% for rheumatology patients. Therapeutic plasma exchanges (n=464; 94.3%) and therapeutic cytapheresis (n=28; 6.7%) were performed in 113 and 12 patients, respectively. Majority of patients belonged to ASFA category I and II (n=124; 99.2%). The overall response rate was 84%, with encouraging response in TTP (100%), aHUS (81.8%) and in neurological disorders (88.4%). Adverse events were reported in 52.8% of patients in 14.83% of procedures.Conclusion: Our results of TPE in neurological disorders and in atypical hemolytic uremic syndrome are encouraging and it is a cost effective alternative to IvIg in neurological disorders. Currently, there is a need for establishment of an Indian apheresis registry to understand the scenario of TA across the country and in the expansion of appropriate and applicable indications for TA in our setting.

New approaches to in vitro diagnosis of hepatitis C infection a reason for post transfusion hepatitis: Diagnostic value of determination of hepatitis C virus core antigen

2011-12-01

Abstract: In between the dates of February 2008–March 2009, by applying to Istanbul University CTF Microbiology and Clinical Microbiology Basic Sciences Branch and Duzen laboratories, 123 cases, where HCV RNA and anti-HCV positivity are identified with molecular (real-time PCR) and serologic (ELISA) methods as a positive control group, and 48 cases where HCV RNA and anti-HCV negativity are identified as a negative control group are established. The values of sensitivity, specificity, positive and negative approximation of recently developed HCV Core Ag (Abbott Diagnostics, Germany) kit are determined successively as 94.3%, 97.9%, 99.1%, 87%, 95.3% and 88%. Although the new HCV Ag assay is clearly not sensitive enough to replace HCV NAT it may serve as a valuable tool in the HCV diagnostic algorithm as it is able to pick up a great majority of anti-HCV and HCV RNA positive samples, thus allowing a timely and less expensive serological diagnosis of an active HCV infection. This may be an advantage for labs that do not have access to PCR easily.

Experience with extracorporeal elimination therapy in myasthenia gravis

2011-12-01

Abstract: We describe our experience with plasma exchange (PE) and immunoadsorption in patients with myasthenia gravis. The group of 27 patients consists of 21 patients treated with PE and 6 patients who received immunoadsorption. PE therapy led to stabilization in 20 patients. In patients treated with immunoadsorption, therapy could be discontinued in 2 patients after 13months of therapy, and the other 4 patients were stabilized without myasthenic crises after 6–9years of therapy. Extracorporeal elimination therapy through PE or immunoadsorption is effective and sometimes life saving and is safe in the hands of an experienced team (6% complication rate).

Continuous renal replacement therapy and blood transfusions in treating patients with crush syndrome: 8 Case studies from the Wenchuan earthquake

Cui-ying Li, Jian-wen Gu, Yun-ming Li, Tao Peng, Xin-yu Gan — 2011-12-01

Abstract: Objective: We analyzed the efficacy of continuous renal replacement therapy (CRRT) combined with blood transfusion for patients with crush syndrome from an earthquake.Methods: Eight patients with crush syndrome were included. CRRT were performed in six of eight patients with crush syndrome, and transfusion was performed in all eight patients. Routine blood tests, urea nitrogen, creatinine, blood coagulation function, electrolyte levels, and serum myoglobin were determined and analyzed.Results: Two patients regained their health completely, four patients required amputation but recovered well, and two patients died. The total amount of red blood cells transfused in the eight cases was 521U (mean volume=68.25U). CRRT was performed 164 times in six patients (mean 27.33 times per person). The routine blood test results and coagulation and renal function parameters improved obviously (P<0.05) in the six surviving patients.Conclusions: Sufficient blood transfusion and early dialysis treatment effectively improved the conditions of patients with crush syndrome.

“A hematologist, a surgeon and an anesthetist meet at a meeting and start talking…”

Alberto Zanella — 2011-12-01

That is not the beginning of a joke, but the beginning of ANEMO. ANEMO is born from an idea of two physicians, a hematologist (GI) and an anesthetist (MP) who care for blood saving: they started to inform, sensitize and involve physicians and surgeons about these issues through meetings and publications.

Dr. Alberto Zanella

2011-12-01

A predictive model to reduce allogenic transfusions in primary total hip arthroplasty

2011-12-01

Abstract: An efficient Blood Conservation Program (BCP) should be considered in preparation of the surgical patient transfusion requirement. BCP should account for the association between bleeding reduction and anemia during or post surgery. In this paper, our aim was to develop a predictive model of bleeding that could help direct decision making about the strategy to reduce unnecessary transfusions. Such a strategy could guarantee an adequate peri-operative hemoglobin value, to reduce the patients’ risk and rehabilitation time.Moreover, an accurate prediction of bleeding and anemia helps to plan preventive autologous transfusion or erythropoietic stimulus, to enhance a conservative transfusion approach, reducing both costs and risks.

Acute normovolemic hemodilution

Giorgio Oriani, Marco Pavesi, Alessandro Oriani, Ilaria Bollina — 2011-12-01

Abstract: Acute normovolemic hemodilution (AHN) is a well known but poorly used “blood saving” method. The authors, based on their own experience and on the “low hematocrit” physiology, present some concepts on AHN and a clinical experience to demonstrate the usefulness and affordability of this method. Consequently we offer several tools concerning both the realization of AHN and the safe use of such dilution, suggesting simple and exciting methods to determine if, when and how to apply this blood saving system.

Transrectal ultrasound-guided prostate biopsies in patients taking aspirin for cardiovascular disease: A meta-analysis

2011-12-01

Abstract: Introduction: The management of anti-platelet therapy in the peri-operative period is a source of great concern. The dilemma is between whether to stop these agents peri-operatively in order to reduce the risk of bleeding complications, or to continue them in order not to compromise the protection they afford against the risk of cardiovascular events.Materials and methods: The aim of this systematic review and meta-analysis was to understand whether continued aspirin therapy is a risk factor for bleeding complications after ultrasound-guided biopsy of the prostate. A bibliographic search covering the period from January 1990 to May 2011 was conducted in PubMed, MEDLINE and EMBASE. We also included our own series in the analysis.Results: A total of 3218 participants were included. Haematuria was statistically more frequent (P=0.001) among patients taking aspirin than in the control group with an odds ratio estimate of 1.36 [1.13;1.64]. This increased risk was, however, due to minor bleeding. The occurrence of rectal bleeding and haematospermia was not statistically increased (P=0.33 and P=0.24, respectively) in patients taking aspirin compared to in the control group with odds ratios estimate of 1.24 [0.80;1.93] and 1.52 [0.75;3.08], respectively.Discussion: There is limited information of the relationship between continued use of aspirin and haemorrhagic complications after transrectal ultrasound-guided biopsy of the prostate. This is the first comprehensive analysis on this topic.Conclusion: Continued use of aspirin does not increase the risk of overall bleeding or moderate and severe haematuria after prostatic biopsy, and thus stopping aspirin before such biopsies is unnecessary.

Integrated strategies for allogeneic blood saving in major elective surgery

2011-12-01

Abstract: Background: Large use of allogeneic red blood cell concentrates (RBCc), albeit necessary in major surgery, may influence patients’ outcome.Design and methods: We introduced an integrated strategy including patients’ evaluation and supplementation associated with autologous blood collection and saving to support major elective surgery at our hospital since 2008. After 2years of stabilization of this approach, we analyzed the results obtained in 2010 in terms of allogeneic blood usage and reduction of transfusion of stored RBCc.Results: Analyzing 2010 results we found that usage of total autologous RBCc units was increased by 2.2 folds, of “not stored” autologous RBCc units by 2.4 folds and of allogeneic RBCc unit transfusion reduced by 65%. The significant reduction in the number of transfused allogeneic RBCc units associated with the use of “fresher” blood could prevent patients’ complications due to immunomodulation and biologic/metabolic disregulation.

Massive bleeding: Are we doing our best?

Marco Marietta, Paola Pedrazzi, Massimo Girardis, Mario Luppi — 2011-12-01

Abstract: Massive bleeding accounts for more than 50% of all trauma-related deaths within the first 48h following hospital admission and it can significantly raise the mortality rate of any kind of surgery. Despite this great clinical relevance, evidence on the management of massive bleeding is surprisingly scarce, and its treatment is often based on empirical grounds. Successful treatment of massive haemorrhage depends on better understanding of the associated physiological changes as well as on good team work among the different specialists involved in the management of such a complex condition.

Pathophysiological alterations in oxygen delivery to the tissues

Giuseppe Miserocchi, Manuela Bartesaghi — 2011-12-01

Abstract: This paper reviews co-factors that impact on oxygen delivery and uptake, in the attempt to unravel the mechanisms underlying the correlation between the decrease in oxygen delivery and oxygen consumption. In sequence, the following factors are analyzed that, besides a decrease in haemoglobin concentration, impair tissue metabolism: (1) lung diffusion and perfusion limitation in oxygen transport, (2) decrease in cardiac output, (3) impairment of peripheral microvascular perfusion and (4) reduced ability of cells to extract oxygen. The contribution of the various factors is modeled aiming to present a decisional flow chart for the functional evaluation of the efficiency of the oxygen transport system.

Effects of red blood cell transfusions on exercise tolerance and rehabilitation time after cardiac surgery

2011-12-01

Abstract: Transfusions in cardiac surgery are associated with an increased morbidity and mortality rate. However, no information is available with respect to the recovery process of transfused patients after discharge from the hospital. Two-hundred-seventeen patients who underwent cardiac surgery operations requiring packed red cells transfusions were studied during the rehabilitation stay. The exercise tolerance (6-min walk test) was not dependent on the number of packed red cells units transfused. Conversely, the length of stay in the rehabilitation hospital was independently associated (P=0.004) with the number of packed red cells transfused, with an increase of 0.6days per each unit transfused.

Topical hemostatic agents in surgical practice

2011-12-01

Abstract: Hemostasis is of critical importance in achieving a positive outcome in any surgical intervention. Different hemostatic methods can be employed and topical hemostatic agents are used in a wide variety of surgical settings. Procoagulation agents have different hemostatic properties and the choice of a specific one is determined by the type of surgical procedure and bleeding. Hemostatic treatments include fibrin sealants, microfibrillar collagen, gelatin hemostatic agents, oxidized regenerated cellulose and cyanoacrylates adhesives. Surgeons should be familiar with topical hemostatics to ensure an appropriate use. Our purpose is to illustrate the currently available agents, their mechanism of action and their effective applications, in order to ensure an optimal use in operating room.

Thrombotic thrombocytopenic purpura following post-ERCP pancreatitis

Yaşar Tuna, Erdem Akbal, Seyfettin Köklü — 2011-12-01

To Editor, Thrombotic thrombocytopenic purpura (TTP) is a syndrome characterized by fever, microangiopathic hemolytic anemia, thrombocytopenia, renal disease and neurologic changes. TTP constitutes a poorly understood multisystemic disease of vascular origin that may involve any organ by thrombotic occlusions of the small vessels. It may be idiopathic or secondary. There is a range of clinical conditions that trigger the onset of acute TTP.

Scotblood 2011 features advances in translational medicine, haemopoietic progenitor cells and milestones of blood banking systems

Hagop Bessos, Robin Fraser, Jerard Seghatchian — 2011-12-01

Abstract: Amongst the presentations featured at Scotblood 2011 were advances in diagnostic tests for antibodies to red blood cells, the establishment of an islet isolation laboratory, and the development of a clinical product for corneal stem cell transplantation. In addition, the conference comprised presentations on state-of-the-art in collection, storage, and clinical utility of haemopoietic progenitor cells. It also included a session on blood banking systems dedicated to an SNBTS colleague, the late Russell Graham. Finally, the keynote lecture was delivered by Prof. John Forsythe on behalf of the Safety of Blood, Tissues and Organs (SaBTO) members, while the Iain Cook Memorial Lecture was delivered by the recently retired SNBTS R&D director, Prof. Chris Prowse.

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2011-12-01