Blood donation and transfusion practices: the 1990 American Association of Blood Banks Institutional Membership Questionnaire

Requests for Directed Blood Donations

This Ethics Rounds presents a request for directed blood donation. Two parents feel helpless in the setting of their daughter's new leukemia diagnosis and want to directly help their child by providing their own blood for a transfusion. They express hesitancy about trusting the safety of a stranger's blood. Commentators assess this case in the setting of blood as a scarce community resource during a national blood shortage. Commentators review the child's best interest, future risks, and harm-benefit considerations. Commentators recognize the professional integrity, humility, and courage of the physician to admit his own lack of knowledge on the subject and to seek help rather than claim directed donation is not possible without further investigation into options. Shared ideals such as altruism, trust, equity, volunteerism, and solidarity are recognized as values relevant to sustainment of a community blood supply. Pediatric hematologists, a blood bank director, transfusion medicine specialists, and an ethicist conclude that directed donation is only justified by lower risks to the recipient in particular circumstances.

Perioperative hemodilutional autologous blood transfusion in burn surgery

It is important to avoid or minimise allogeneic blood transfusion, because of possible alloimmunisation or disease transmission. In burn cases these risks are high, and predonated autologous transfusion is not practical. Perioperative haemodilutional autologous blood transfusion is considered applicable in burn surgery. This study evaluates the effectiveness of the technique in the treatment of burns.

Monitoring transfusion practice--a computerized procedure

As the description of transfusion practice over time requires the handling of massive amounts of data, and because the majority of records have until now been paper-based, little is known about the epidemiology of blood transfusion. Furthermore, most previous studies have collected data manually from patient records or from computerized registers created solely for study purposes. We describe a procedure for monitoring transfusion practices based exclusively upon the collection of data from the existing computerized registers. During the calendar years 1997 and 1998, more than 750 000 data records were collected from the blood transfusion registers, diagnosis and procedure registers, and clinical biochemistry registers at two university hospitals. Linking of the data required a unique and consistent identification of all data records. This was made possible by the national Personal Identification Number. In this way more than 98% of all transfusions could be identified and approximately 95% (77 950) could be connected to a principal diagnosis. The described procedure creates new opportunities for studies of transfusion practices both on a large scale and in richness of detail, and we propose to establish a network where transfusion practices data are available and comparable for individual departments, hospitals, whole regions, and possibly nations.

Autologous blood transfusions

Due to enormous risks of transfusion-transmitted diseases in allogenic blood transfusions, including dreaded AIDS, there has been constant endeavour to look for a safer alternative. Autologous transfusion which is transfusion of blood/component donated by intended recipient, has proved to be a safe and viable alternative. Initially tried in 1874 in the form of blood salvage, the process has become popular since 1971 with better PVC containers and storage facilities. Due to ignorance and lack of interest the procedure in still unpopular in India. It is very useful for preventing complications of allogenic transfusion and in rare blood group or patients for whom it is difficult to find compatible blood. Since 1980s the procedure is being widely used. Maximally used category is preoperative donation. Strict protocols regarding selection, storage and labelling are essential. There has been tenfold increase in the preoperative autologous donations in many centres. Isovolemic hemodilution and blood salvage are also being used. The procedure has also been used for preteenage and paediatric ages successfully. 1 to 5 units can be collected from single donor. Now the popularity of the procedure has increased due to awareness and interest.

AUTOLOGOUS TRANSFUSION AFMC EXPERIENCE (1992-1996)

In this era of Acquired Immune Deficiency Syndrome (AIDS) and other infectious diseases - complications of homologous blood transfusion, autologous transfusion is the safest possible blood for transfusion. The present study was conducted from January 1992 to August 1996 to analyse the programme of autologous transfusion. A total of 471 pre-operative autologous collections were undertaken out of a total of 27,542 blood collections during this period. The present study shows a significant increase in autologous collections from 0.44 per cent in 1992 to 3.94 per cent till August 1996. 37.1 per cent autologous donors were from the urosurgery ward. Of the total 471 autologous blood units collected, 171 were transfused to the autologous donors (27.5%).

Immune response of immunocompromised children with malignancies to a recombinant hepatitis B vaccine

The aim of this study was to interpret the antibody response to hepatitis B vaccination following an intensified four-dose schedule in 140 cancer patients who presented at our clinic between January 1, 1993 and December 31, 1994. According to therapy status, the patients were divided into two groups: group A consisted of 76 patients undergoing chemotherapy and group B of 64 patients in complete remission and off treatment. The eligibility requirements were negative hepatitis B virus (HBV), HCV, and human immunodeficiency virus serologic markers. A total of four dose (20 micrograms per dose) of recombinant HB vaccine was administered intramuscularly in the deltoid region at 0, 1, 2, and 6 months. Blood from the vaccinated subjects was obtained at months 1, 2, 3, and 7 in order to measure anti-HBs titer levels. Protective anti-HBs titers were considered to be those > or = 10 mIU/mL. The overall seroconversion rate 1 month after the fourth dose was 57% (80/140 patients), and the seroconversion rates for groups A and B were 31.5% (24/76 patients) and 87.5% (56/64 patients), respectively. Our results indicated that immunocompromised children undergoing chemotherapy (although less responsive than children in complete remission and off treatment) still preserved their potential to produce protective titers of anti-HBs. On this basis we recommend (1) HB vaccination after diagnosis of malignancy in pediatric patients whenever a high prevalence of HB infection exists and (2) vaccination of patients of therapy and in complete remission.

Centralized transfusion service: a novel approach to the delivery of transfusion services

The development and expansion of the CTS in Pittsburgh shows the feasibility of this transfusion medicine delivery system. Few of the changes driven by health care reform both improve patient care and reduce costs. When properly implemented, a CTS achieves these objectives, benefits the community as a whole, and enhances the role of transfusion medicine specialists and the blood center in the region.

Use of Oxygent, a perfluorochemical-based oxygen carrier, as an alternative to intraoperative blood transfusion

Oxygent is a stable concentrated perfluorochemical (PFC) emulsion being developed for use as a temporary oxygen carrier. In this application, PFC emulsions can be used to augment oxygen delivery during acute blood loss and thereby provide a margin of safety during hemodilution and surgical anemia. PFCs simply dissolve oxygen in direct proportion to its partial pressure. The oxygen transported by a PFC emulsion is present in the plasma compartment and is therefore easily extracted and consumed by the tissues. Preclinical and clinical studies have demonstrated that a relatively low dose (1.35 g PFC/kg) of Oxygent can support oxygen delivery despite ongoing blood loss. Clinical safety studies in 57 healthy, conscious volunteers and in 30 anesthetized surgical patients have been completed. In these studies, there were no hemodynamic changes or vasoconstriction and cardiac output increased normally in response to hemodilution. Two transient side effects were observed, but only in the high dose (1.8 g PFC/kg) group: a 1-1.5 degrees C increase in body temperature (at 4-6 hours), and a moderate decrease in platelet count (mean nadir approximately 130,000/microL by 2-3 days) without any bleeding complications. Oxygent is presently being evaluated as an alternative to allogeneic blood transfusion in patients undergoing medium- to high-blood-loss surgical procedures.

The collection of platelets by apheresis procedures

Collection of platelets by apheresis has been a major advance in transfusion medicine. It has allowed the supply of a therapeutically beneficial component to grow with medical needs. Donors find fulfillment in more frequent donations than are possible with whole blood and know that their donation fills a special need. New technology allows leukocyte reduction in the collection of the component with or without the use of filtration. Matching for refractory patients is possible. However, platelets collected by apheresis have not been shown to be hemostatically different from platelets separated from whole blood donations, and thus, do not represent an advance in therapeutic efficacy. The use of apheresis platelets does reduce donor exposure, but this has not been shown to be a safety advance, although it seems intuitively obvious that transfusion risk is statistically reduced in some patients requiring only a few platelet transfusions. Support of patients by apheresis platelets may or may not reduce the risk of alloimmunization. Apheresis platelets from some equipment have less white blood cell contamination even in the absence of filtration, which may be an advantage. Apheresis platelets could be a major step in the ultimate customization of blood collection, in which some donors would preferentially donate red blood cells, whereas others would donate platelets or plasma depending on their blood type and ability to donate frequently, and the current medical need of their donation. Perhaps this would be the most significant advance from the medical progress initiated by Cohn almost 50 years ago.

Blood donor-, apheresis-, and transfusion-related activities: results of the 1991 American Association of Blood Banks Institutional Membership Questionnaire

Approximately 2154 regional blood centers and hospital-based blood banks and transfusion services responded to the 1991 American Association of Blood Banks Institutional Membership Questionnaire that elicited data from 1990. Information from 2144 institutions was considered valid. Questionnaire topics were donor blood collections, hemapheresis, perioperative cell salvage, component usage, and transfusion-associated diseases. Institutional members reported collecting 9.3 million units, of which 90.9 percent were for allogeneic use in the community, 6.0 percent were for autologous use, and 3.1 percent were directed donations. The percentage of directed-donor units that were crossed over for allogeneic use (51%) was greater than the percentage of units transfused to the designated patient (49%). Only 12.5 percent of institutions reported obtaining specific consent for transfusion. Of the 15.4 million transfused blood components, 8.5 million were red cells, 4.1 million were platelets, 1.8 million were fresh-frozen plasma, and 0.9 million were cryoprecipitate. There were 1263 reported cases of transfusion-associated hepatitis. Approximately 44 percent of the patients who were tested proved positive for hepatitis B surface antigen, and 80 percent of the patients who were tested proved positive for antibody to hepatitis C. The questionnaire's aggregate results can be used to assess current patterns of blood donation and transfusion activities.