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Holmberg JA, Henry SM, Burnouf T, Devine D, Marschner S, Boothby TC, Burger SR, Chou ST, Custer B, Blumberg N, Siegel DL, Spitalnik SL. National Blood Foundation 2021 Research and Development summit: Discovery, innovation, and challenges in advancing blood and biotherapies. Transfusion 2022; 62:2391-2404. [PMID: 36169155 DOI: 10.1111/trf.17092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Stephen M Henry
- Centre for Kode Technology Innovation, School of Engineering, Computer and Mathematical Sciences, Faculty of Design and Creative Technologies, Auckland University of Technology, Auckland, New Zealand
| | - Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering & International PhD Program in Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Dana Devine
- Centre for Blood Research, Canadian Blood Services, University of British Columbia, Vancouver, Canada
| | | | - Thomas C Boothby
- Department of Molecular Biology, University of Wyoming, Laramie, Wyoming, USA
| | - Scott R Burger
- Advanced Cell & Gene Therapy, LLC, Chapel Hill, North Carolina, USA
| | - Stella T Chou
- Children's Hospital of Philadelphia, Perelman School of Medicine, Divisions of Hematology and Transfusion Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian Custer
- Vitalant Research Institute and the Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Neil Blumberg
- University of Rochester Medical Center, Rochester, New York, USA
| | - Donald L Siegel
- Hospital of the University of Pennsylvania, Perelman School of Medicine, Division of Transfusion Medicine and Therapeutic Pathology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven L Spitalnik
- Department of Pathology & Cell Biology, Columbia University, New York, New York, USA
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Vamvakas EC. Transfusion-Related Immunomodulation (TRIM): From Renal Allograft Survival to Postoperative Mortality in Cardiac Surgery. Respir Med 2017. [DOI: 10.1007/978-3-319-41912-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cancino‐Faure B, Fisa R, Riera C, Girona‐Llobera E, Jimenez‐Marco T. Where doTrypanosoma cruzigo? The distribution of parasites in blood components from fractionated infected whole blood. Transfusion 2016; 56:2233-8. [DOI: 10.1111/trf.13687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Beatriz Cancino‐Faure
- Laboratori de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de FarmàciaUniversitat de BarcelonaBarcelona Catalonia, Spain
| | - Roser Fisa
- Laboratori de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de FarmàciaUniversitat de BarcelonaBarcelona Catalonia, Spain
| | - Cristina Riera
- Laboratori de Parasitologia, Departament de Biologia, Sanitat i Medi Ambient, Facultat de FarmàciaUniversitat de BarcelonaBarcelona Catalonia, Spain
| | - Enrique Girona‐Llobera
- Fundació Banc de Sang i Teixits de las Illes Balears
- IUNICS Institut Universitari d' Investigació en Ciències de la Salut, Universitat de les Illes BalearsMajorca Balearic Islands Spain
| | - Teresa Jimenez‐Marco
- Fundació Banc de Sang i Teixits de las Illes Balears
- IUNICS Institut Universitari d' Investigació en Ciències de la Salut, Universitat de les Illes BalearsMajorca Balearic Islands Spain
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Abstract
BACKGROUND Perioperative blood transfusions are associated with an increased risk of adverse postoperative outcomes through immunomodulatory effects. OBJECTIVE The purpose of this study was to identify factors associated with variation in blood transfusion use after elective colorectal resection and associated postoperative infectious complications DESIGN This was a retrospective cohort study. SETTINGS The study included elective colorectal resections in New York State from 2001 to 2013. PATIENTS The study cohort consists of 125,160 colorectal resections. Patients who were admitted nonelectively or who were admitted before the date of surgery were excluded. MAIN OUTCOME MEASURES Receipt of a perioperative allogeneic red blood cell transfusion and the secondary end points of postoperative pneumonia, surgical site infection, intra-abdominal abscess, and sepsis were measured. RESULTS The overall rate of perioperative blood transfusion for the study cohort was 13.9%. The unadjusted blood transfusion rates ranged from 2.4% to 58.7% for individual surgeons and 2.9% to 32.8% for individual hospitals. After controlling for patient-, surgeon-, and hospital-level factors in a 3-level mixed-effects multivariable model, significant variation was still present across both surgeons (p < 0.0001) and hospitals (p < 0.0001), with a 16.8-fold difference in adjusted blood transfusion rates across surgeons and a 13.2-fold difference in adjusted blood transfusion rates across hospitals. Receipt of a blood transfusion was also independently associated with pneumonia (OR = 3.23 (95% CI, 2.92-3.57)), surgical site infection (OR = 2.27 (95% CI, 2.14-2.40)), intra-abdominal abscess (OR = 2.72 (95% CI, 2.41-3.07)), and sepsis (OR = 4.51 (95% CI, 4.11-4.94)). LIMITATIONS Limitations include the retrospective design and the possibility of miscoding within administrative data. CONCLUSIONS Large surgeon- and hospital-level variations in perioperative blood transfusion use for patients undergoing colorectal resection are present despite controlling for patient-, surgeon-, and hospital-level factors. In addition, receipt of a blood transfusion was independently associated with an increased risk of postoperative infectious complications. These findings support the creation and implementation of perioperative blood transfusion protocols aimed at limiting unwarranted variation.
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Aquina CT, Blumberg N, Probst CP, Becerra AZ, Hensley BJ, Iannuzzi JC, Gonzalez MG, Deeb AP, Noyes K, Monson JRT, Fleming FJ. Significant Variation in Blood Transfusion Practice Persists following Upper GI Cancer Resection. J Gastrointest Surg 2015; 19:1927-37. [PMID: 26264360 DOI: 10.1007/s11605-015-2903-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/27/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE Perioperative blood transfusions are costly and linked to adverse clinical outcomes. We investigated the factors associated with variation in blood transfusion utilization following upper gastrointestinal cancer resection and its association with infectious complications. METHODS The Statewide Planning and Research Cooperative System was queried for elective esophagectomy, gastrectomy, and pancreatectomy for malignancy in NY State from 2001 to 2013. Bivariate and hierarchical logistic regression analyses were performed to assess the factors associated with receiving a perioperative allogeneic red blood cell transfusion. Additional multivariable analysis examined the relationship between transfusion and infectious complications. RESULTS Among 14,875 patients who underwent upper GI cancer resection, 32 % of patients received a perioperative blood transfusion. After controlling for patient, surgeon, and hospital-level factors, significant variation in transfusion rates was present across both surgeons (p < 0.0001) and hospitals (p < 0.0001). Receipt of a blood transfusion was also independently associated with wound infection (OR = 1.68, 95% CI = 1.47 and 1.91), pneumonia (OR = 1.98, 95% CI = 1.74 and 2.26), and sepsis (OR = 2.49, 95% CI = 2.11 and 2.94). CONCLUSION Significant variation in perioperative blood transfusion utilization is present at both the surgeon and hospital level. These findings are unexplained by patient-level factors and other known hospital characteristics, suggesting that variation is due to provider preferences and/or lack of standardized transfusion protocols. Implementing institutional transfusion guidelines is necessary to limit unwarranted variation and reduce infectious complication rates.
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Affiliation(s)
- Christopher T Aquina
- Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA.
| | - Neil Blumberg
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Christian P Probst
- Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Adan Z Becerra
- Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Bradley J Hensley
- Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - James C Iannuzzi
- Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Maynor G Gonzalez
- Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Andrew-Paul Deeb
- Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Katia Noyes
- Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - John R T Monson
- Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Fergal J Fleming
- Department of Surgery, Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Box SURG, 601 Elmwood Ave, Rochester, NY, 14642, USA
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Rajesh K, Harsh S, Amarjit K. Effects of Prestorage Leukoreduction on the Rate of Febrile Nonhemolytic Transfusion Reactions to Red Blood Cells in a Tertiary Care Hospital. Ann Med Health Sci Res 2015; 5:185-8. [PMID: 26097760 PMCID: PMC4455008 DOI: 10.4103/2141-9248.157498] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Febrile nonhemolytic transfusion reactions (FNHTRs) are relatively common complications associated with allogenic transfusion. White blood cells (WBCs or leukocytes) are considered to be an important cause of FNHTRs; the rate of WBC derived pro-inflammatory cytokines increase with storage due to active synthesis of cytokines by these cells. The removal of the WBCs before storage will prevent the accumulation of cytokines during storage that leads to a reduction in the number of FNHTRs. Aim: We have conducted a retrospective analysis comparing the rate of FNHTRs in prestorage leukoreduced (PrSLR) and non leukoreduced RBCs transfusion. Subjects and Methods: A retrospective review of all the transfusion reactions (TRs) reported to the department over a period of 2 years from July 2012 to June 2014 was done. Patients were stratified by the date of reaction and by component received and then divided into two groups: (1) Patients who received allogeneic PrSLR RBCs and (2) nonleukoreduced RBCs. For the PrSLR RBC units, leukoreduction was performed by using buffy coat method of component preparation by quadruple bags and integral bags containing Sepacell® Pure RC filters (Fenwal™ France). Results: 37,232 RBCs units were transfused and out of which 14149 (38% i.e. is 14149/37232) were prestorage leukoreduced (PrSLR) and 23083 (62%) were non leukoreduced. A total of 142 (0.38%) TRs were reported during that time period, of which 62 (0.17%) were classified as FNHTRs. In the nonleukoreduced group 124 TRs were reported, of which 55 were classified as FNHTRs to RBCs and the overall rate of FNHTR to RBCs was 0.24%. In pre storage leukoreduced group, 18 TRs were reported, of which 7 were classified as FNHTRs to RBCs and the overall rate of FNHTR to RBCs was 0.05% (P ≤ 0.001). This represents a significant reduction in the rate of FNHTR after institution of prestorage leukoreduction. Conclusion: The rate of FNHTRs to allogenic RBC units after the implementation of prestorage leukoreduction has decreased significantly. Cytokines and chemokines accumulating during storage of cellular blood products are responsible for residual FNHTRs.
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Affiliation(s)
- K Rajesh
- Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - S Harsh
- Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - K Amarjit
- Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Cost-effectiveness of leucoreduction for prevention of febrile non-haemolytic transfusion reactions. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 12:232-7. [PMID: 24931843 DOI: 10.2450/2014.0263-13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 09/27/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND The cost-effectiveness of universal leucoreduction of blood components remains unclear. When using leucoreduced red blood cells, the decrease in the rate of febrile non-haemolytic transfusion reactions (FNHTR) is the only proven, meaningful clinical benefit, whose relationship to costs can be calculated relatively easily. The aim of this study was to evaluate the cost-effectiveness of leucoreduction in avoiding FNHTR. MATERIALS AND METHODS Data were obtained from two large tertiary hospitals in Athens, Greece, over a 4-year period (2009-2012). The incidence of FNHTR in patients transfused with leucoreduced or non-leucodepleted red blood cells, the additional cost of leucoreduction and the cost to treat the FNHTR were estimated. The incremental cost-effectiveness ratio (ICER), which is the ratio of the change in costs to the incremental benefits of leucoreduction, was calculated. RESULTS In total, 86,032 red blood cell units were transfused. Of these, 53,409 were leucodepleted and 32,623 were non-leucoreduced. Among patients transfused with leucodepleted units, 25 cases (0.047%) met the criteria for having a FNHTR, while in patients treated with non-leucoreduced components, 134 FNHTR were observed (0.411%). The ICER of leucoreduction was € 6,916 (i.e., the cost to prevent one case of FNHTR). CONCLUSIONS Leucoreduction does not have a favourable cost-effectiveness ratio in relation to the occurrence of FNHTR. However, many factors, which could not be easily and accurately assessed, influence the long-term costs of transfusion. It is imperative to undertake a series of large, meticulously designed clinical studies across the entire spectrum of blood transfusion settings, to investigate most of the parameters involved.
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The abandoned controversy surrounding universal white blood cell reduction. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 12:143-5. [PMID: 24931838 DOI: 10.2450/2014.0009-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Vamvakas EC. Allogeneic blood transfusion and cancer recurrence: 20 years later. Transfusion 2015; 54:2149-53. [PMID: 25212422 DOI: 10.1111/trf.12689] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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The impact of two different transfusion strategies on patient immune response during major abdominal surgery: a preliminary report. J Immunol Res 2014; 2014:945829. [PMID: 24804272 PMCID: PMC3996304 DOI: 10.1155/2014/945829] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 11/17/2022] Open
Abstract
Blood transfusion is associated with well-known risks. We investigated the difference between a restrictive versus a liberal transfusion strategy on the immune response, as expressed by the production of inflammatory mediators, in patients subjected to major abdominal surgery procedures. Fifty-eight patients undergoing major abdominal surgery were randomized preoperatively to either a restrictive transfusion protocol or a liberal transfusion protocol (with transfusion if hemoglobin dropped below 7.7 g dL(-1) or 9.9 g dL(-1), respectively). In a subgroup of 20 patients randomly selected from the original allocation groups, blood was sampled for measurement of IL-6, IL-10, and TNFα. Postoperative levels of IL-10 were higher in the liberal transfusion group on the first postoperative day (49.82 ± 29.07 vs. 15.83 ± 13.22 pg mL(-1), P < 0.05). Peak postoperative IL-10 levels correlated with the units of blood transfused as well as the mean duration of storage and the storage time of the oldest unit transfused (r(2) = 0.38, P = 0.032, r(2) = 0.52, P = 0.007, and r(2) = 0.68, P<0.001, respectively). IL-10 levels were elevated in patients with a more liberal red blood cell transfusion strategy. The strength of the association between anti-inflammatory IL-10 and transfusion variables indicates that IL-10 may be an important factor in transfusion-associated immunomodulation. This trial is registered under ClinicalTrials.gov Identifier: NCT02020525.
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Bassuni WY, Blajchman MA, Al-Moshary MA. Why implement universal leukoreduction? Hematol Oncol Stem Cell Ther 2010; 1:106-23. [PMID: 20063539 DOI: 10.1016/s1658-3876(08)50042-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The improvement of transfusion medicine technology is an ongoing process primarily directed at increasing the safety of allogeneic blood component transfusions for recipients. Over the years, relatively little attention had been paid to the leukocytes present in the various blood components. The availability of leukocyte removal (leukoreduction) techniques for blood components is associated with a considerable improvement in various clinical outcomes. These include a reduction in the frequency and severity of febrile transfusion reactions, reduced cytomegalovirus transfusion-transmission risk, the reduced incidence of alloimmune platelet refractoriness, a possible reduction in the risk of transfusion-associated variant Creutzfeldt-Jakob disease transmission, as well as reducing the overall risk of both recipient mortality and organ dysfunction, particularly in cardiac surgery patients and possibly in other categories of patients. Internationally, 19 countries have implemented universal leukocyte reduction (ULR) as part of their blood safety policy. The main reason for not implementing ULR in those countries that have not appears to be primarily concerns over costs. Nonetheless, the available international experience supports the concept that ULR is a process that results in improved safety of allogeneic blood components.
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Affiliation(s)
- Wafaa Y Bassuni
- Central Laboratory and Transfusion Services, King Fahad Medical City, Riyadh, Saudi Arabia.
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Shander A, Hofmann A, Gombotz H, Theusinger OM, Spahn DR. Estimating the cost of blood: past, present, and future directions. Best Pract Res Clin Anaesthesiol 2007; 21:271-89. [PMID: 17650777 DOI: 10.1016/j.bpa.2007.01.002] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Understanding the costs associated with blood products requires sophisticated knowledge about transfusion medicine and is attracting the attention of clinical and administrative healthcare sectors worldwide. To improve outcomes, blood usage must be optimized and expenditures controlled so that resources may be channeled toward other diagnostic, therapeutic, and technological initiatives. Estimating blood costs, however, is a complex undertaking, surpassing simple supply versus demand economics. Shrinking donor availability and application of a precautionary principle to minimize transfusion risks are factors that continue to drive the cost of blood products upward. Recognizing that historical accounting attempts to determine blood costs have varied in scope, perspective, and methodology, new approaches have been initiated to identify all potential cost elements related to blood and blood product administration. Activities are also under way to tie these elements together in a comprehensive and practical model that will be applicable to all single-donor blood products without regard to practice type (e.g., academic, private, multi- or single-center clinic). These initiatives, their rationale, importance, and future directions are described.
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Affiliation(s)
- Aryeh Shander
- Department of Anesthesiology and Critical Care, New Jersey Institute for the Advancement of Bloodless Medicine and Surgery Englewood Hospital and Medical Center, 350 Engle Street, Englewood, NJ 07631, USA.
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Meiler SE. Long-term Outcome After Anesthesia and Surgery: Remarks on the Biology of a Newly Emerging Principle in Perioperative Care. ACTA ACUST UNITED AC 2006; 24:255-78. [PMID: 16927929 DOI: 10.1016/j.atc.2006.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is a strong possibility that the risk from anesthesia and surgery carries over from the immediate perioperative period to more remote time points. This extended risk seems to influence the progression, severity, and complication rate of certain chronic illnesses, such as vascular heart disease and some of the malignancies, although other disease processes might be affected as well. With the recognition that the perioperative process could be responsible for later adverse events comes the need to reassess existing patient safety models, because some of the risk could be preventable. To confront these challenges, it is necessary to understand the underlying biology of this association, and immunology should be particularly helpful in this pursuit. It will be of special importance to integrate our knowledge of the host immune response to anesthesia and surgery with the recent revelations on the role of immunity in the progression of many of the chronic diseases. Additionally, we need to examine how genetic diversity or acquired defects alter the immune response to tissue injury and infection so that we can improve risk stratification and preemptive therapies. In the meantime, we must strive to improve short- and long-term outcomes by expanding our efforts to reduce disease activity preoperatively, to control the surgical stress response and infection rate, and to use tissue-preserving surgical techniques. Long-term patient safety after anesthesia and surgery is not a specialty-by-specialty endeavor; it requires a highly collaborative, institutional, and national effort to foster innovative research and health care process improvements.
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Affiliation(s)
- Steffen E Meiler
- Program of Molecular Perioperative Medicine and Genomics, Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, 1150 15th Street, BIW 2144, Augusta, GA 30912-2700, USA.
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Abstract
BACKGROUND AND OBJECTIVES Exploitation of economies of scale is often argued in favour of blood-bank consolidation into large regional centres, despite a lack of adequate empirical support. This study was aimed at testing the economies of scale hypothesis in a sample of blood centres in the USA. MATERIALS AND METHODS An input-orientated data envelopment analysis (DEA) was used to calculate the technical efficiency scores of blood centres, and to determine whether they were operating under increasing returns to scale (IRS), constant returns to scale (CRS) or decreasing returns to scale (DRS). Correlation between the blood-centre efficiency score and the demographic and socioeconomic characteristics of the service area was further investigated. RESULTS Seventy-one blood centres were included in the analysis. The scale of operations ranged from 7270 to 275,500 red blood cell (RBC) units per year. Six (8%) centres operated under CRS, 29 (55%) under IRS, and most of their technical inefficiency was scale-independent, and 26 (37%) operated under DRS, and most of their technical inefficiency was size-related. Efficiency scores were unrelated to any demographic or socioeconomic characteristics of the blood centre service area. CONCLUSIONS Within the size range of blood centres included in this study, expanding the level of operations beyond a certain point leads to DRS.
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Affiliation(s)
- A Pereira
- Service of Hemotherapy and Hemostasis, and Blood Bank, Hospital Clínico, Barcelona, Spain
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Sime SL. Strengthening the service continuum between transfusion providers and suppliers: enhancing the blood services network. Transfusion 2005; 45:206S-23S. [PMID: 16181404 DOI: 10.1111/j.1537-2995.2005.00620.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
As the cost of health care increases, the focus on cost containment grows. The pressure to reduce costs comes at the same time the public focus is on ensuring a zero-risk blood supply. The blood supply has never been safer or more expensive. With the relative vanquishing of transfusion-transmitted diseases, noninfectious risks now exceed infectious risks. This has resulted in a call to refocus blood safety efforts on interconnected processes that link a unit of blood from its volunteer blood donor to the patient. Additional costs in the blood supply chain will create new pressures on an already taxed system that gets little additional reimbursement with each new safety initiative. Opposing interests have created a tenuous relationship between the blood supplier and the transfusion provider. This adversarial relationship does not benefit the ultimate stakeholder, the patient. It is time to create a service partnership that is built on access, cost, and quality. Initiatives must be undertaken at a local, regional, and national level. Locally, blood suppliers and transfusion providers must reevaluate policies that are focused on individual gain and reinvent policies that will reward improvements in the overall system and expand cooperative services. Regionally, both blood suppliers and transfusion providers need to consolidate services to gain cost and quality benefits without compromising the competitive nature of the industry. Nationally, the creation of a strategic plan will help ensure that a mutually beneficial relationship focused on the patient is created between the blood supplier and transfusion provider at all levels. Development of such a plan would benefit the transfusing and supplying parties by identifying areas of common interest and how each may facilitate the achievement of shared benefits.
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Affiliation(s)
- Stacy L Sime
- The Blood Center of Iowa, 431 East Locust St., Des Moines, IW 50309, USA.
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Ezidiegwu CN, Lauenstein KJ, Rosales LG, Kelly KC, Henry JB. Febrile nonhemolytic transfusion reactions. Management by premedication and cost implications in adult patients. Arch Pathol Lab Med 2005; 128:991-5. [PMID: 15335265 DOI: 10.5858/2004-128-991-fntr] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Febrile nonhemolytic transfusion reactions (FNHTRs) cause unwelcome interruptions during the course of blood product transfusions and necessitate measures to verify the nature of the reaction and to exclude certain dangerous reactions, such as hemolytic and septic phenomena. OBJECTIVE To examine transfusion medicine data to determine the clinical implications of the routine administration of antipyretic medication to adult patients before transfusion for the prevention of FNHTRs. DESIGN A retrospective review was conducted of FNHTR data during 5 years (1998-2002), and a determination was made of the cost of a transfusion complicated by an FNHTR. In addition, a comparative cost analysis was performed using our data and published data on the incidence of FNHTRs. The clinical implications of medication with respect to possible drug-induced adverse effects were assessed, as well as the potential interference with diagnosing other forms of transfusion reactions and the mitigation of the clinical effect of an FNHTR. RESULTS For nearly 120,000 U of transfused blood components, approximately 80% of which were preceded by antipyretic medication during the study period, the overall incidence of FNHTR was found to be 0.09%. Furthermore, there was no evidence of antipyretic-associated complications, nor any evidence that antipyretics prevented the recognition of other more dangerous complications of transfusions. CONCLUSION Our findings indicate that this practice provides significant advantages to the recipient of a transfusion, but does not appear to yield significant cost benefits for the health care provider.
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Affiliation(s)
- Christian N Ezidiegwu
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
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Abstract
The anemia of critical illness is a distinct clinical entity with characteristics similar to that of chronic disease anemia. Several solutions to the processes of anemia, such as blunted erythropoietin production and erythropoietin response and abnormalities in iron metabolism have been developed. The transfusion of RBCs provides immediate correction of low hemoglobin levels, which may be of value in patients with life-threatening anemia. Avoidance of RBC and blood component transfusion, however, is becoming increasingly important as data of adverse clinical outcomes in critically ill patients become clearer. Although the optimal hemoglobin in critically ill patients is not determined, this organ system has a generous reserve. Short-term compensated anemia is tolerated well, while exogenous erythropoietin allows patients to achieve higher hemoglobin concentrations without exposure to transfused blood/blood components. A recent randomized trial enrolled over 1300 critically ill patients to receive either 40,000 units of exogenous erythropoietin or placebo. These authors found that patients randomized to erythropoietin received significantly less allogeneic RBC transfusions and had significantly greater increases in hemoglobin. Although no differences were found between groups in gross clinical outcomes (ie, death, renal failure, myocardial infarction), this study did not have the power to identify small differences in outcomes. This and other studies of exogenous erythropoietin therapy in critically ill patients clearly demonstrate that the bone marrow in many of these patients will respond to the administration of erythropoietin despite their illness, suggesting a blunted production of erythropoietin rather than a blunted response to erythropoietin. Exogenous erythropoietin therefore represents a therapeutic option for treating anemia in critical illness. Acute events in medicine and surgery often lead to many patients becoming anemic. Solutions to this process of anemia should be focused on preventing such events. Anemia after surgery represents an area for prevention. Blood conservation strategies can be performed with adequate results. Monk et al randomized 79 patients undergoing radical prostatectomy to preoperative autologous donation (PAD), preoperative exogenous erythropoietin therapy plus ANH immediately following induction of general anesthesia, and ANH alone. This study concluded that all three techniques resulted in similar hemostasis outcomes (eg, bleeding and transfusion rates), but ANH alone was the least expensive, and ANH plus exogenous erythropoietin and ANH alone resulted in a higher ICU hematocrit compared with PAD. Regardless of these prophylactic strategies, patients still become anemic after surgery or during critical illness. This acute event anemia usually is treated with RBC transfusion; however, autologous blood recovery (cell salvage systems) has been shown to be effective in patients with acute bleeding-related anemia, and this may reduce patients' exposure to allogeneic blood in these patients. There are no universally accepted treatment guidelines for managing anemia, and practice differs between clinicians, hospitals, regions, and countries. Transfusion medicine is evolving and incorporating many new pharmacological agents into the armamentarium of anemia and bleeding therapy. Accumulating evidence suggests that anemia in critically ill patients is common and correlated with poor outcomes. The management of anemia can improve outcomes; however, the optimal management of anemia is not performed universally. New approaches, continued research, and an understanding of anemia may result in more consistent and improved outcomes for critically ill patients.
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Affiliation(s)
- Aryeh Shander
- Department of Anesthesiology, Critical Care Medicine, Pain Management and Hyperbaric Medicine, Englewood Hospital and Medical Center, NJ 07631, USA.
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Coursin DB, Connery LE, Weiss J. Should red cell transfusions be leukoreduced in critically ill patients? Crit Care Med 2004; 32:600-2. [PMID: 14758192 DOI: 10.1097/01.ccm.0000104924.42673.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dzik WH, Anderson JK, O'Neill EM, Assmann SF, Kalish LA, Stowell CP. A prospective, randomized clinical trial of universal WBC reduction. Transfusion 2002; 42:1114-22. [PMID: 12430666 DOI: 10.1046/j.1537-2995.2002.00182.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Recipient exposure to allogeneic donor WBCs results in transfusion complications for selected populations of recipients. Whether or not WBC reduction should be universally applied is highly controversial. STUDY DESIGN AND METHODS In a general hospital, a randomized, controlled clinical trial of conversion to universal WBC reduction was conducted. Patients (11%) with established medical indications for WBC-reduced blood were not eligible. All other patients who required transfusion were assigned at random to receive either unmodified blood components or stored WBC-reduced RBCs and platelets. Analysis for each patient was restricted to the first hospitalization. RESULTS All eligible patients (n = 2780) were enrolled. Three specified primary outcome measures were not different between the two groups: 1) in-hospital mortality (8.5% control; 9.0% WBC-reduced; OR, 0.94 [95% CI, 0.72-1.22]; p = 0.64); 2) hospital length of stay (LOS) after transfusion (median number of days, 6.4 for control and 6.3 for WBC-reduced; p = 0.21); and 3) total hospital costs (median, $19,500 for control and $19,200 for WBC-reduced, p = 0.24). Secondary outcomes (intensive care LOS, postoperative LOS, antibiotic usage, and readmission rate) were not different between the two groups. Subgroup analysis based on patient age, sex, amount of blood transfused, or category of surgical procedure showed no effect of WBC reduction. Patients who received WBC-reduced blood had a lower incidence of febrile reactions (p = 0.06). CONCLUSION A beneficial effect of conversion from selective to universal WBC reduction was not demonstrated.
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Affiliation(s)
- W H Dzik
- Blood Transfusion Service, Massachusetts General Hospital, Boston 02114, USA.
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Volkova N, Klapper E, Pepkowitz SH, Denton T, Gillaspie G, Goldfinger D. A case-control study of the impact of WBC reduction on the cost of hospital care for patients undergoing coronary artery bypass graft surgery. Transfusion 2002; 42:1123-6. [PMID: 12430667 DOI: 10.1046/j.1537-2995.2002.00180.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND WBC reduction of blood components may reduce the incidence of transfusion reactions. The cost of this intervention might be offset by a reduction in the incidence of postoperative infection, thereby reducing the length of hospital stay and thus the cost of care for patients receiving transfusion. Cedars-Sinai Medical Center provided WBC-reduced blood components to all patients for a period of 2 years, creating an opportunity to compare the incidence of postoperative infection, length of hospital stay, and total hospital costs for patients undergoing coronary artery bypass graft surgery, before, during, and after WBC reduction. STUDY DESIGN AND METHODS Data were obtained by examining hospital records of patients who received transfusion and control patients who did not receive transfusion for the years 1991 (before WBC reduction), 1992 to 1993 (during WBC reduction), and 1994 (following discontinuation of WBC reduction). Comparisons were made by use of ANOVA following log or square root transformation of the data. RESULTS Length of hospital stay for patients who received transfusion decreased over time. Mean hospital stays were 15.9, 14.1, and 12.1 days before, during, and after WBC reduction, respectively. A similar trend was seen in the patients who did not receive transfusion. There was no indication that WBC reduction functioned as an independent variable that was responsible for the observed decrease. The rate of postoperative infection stayed constant during WBC reduction and only dropped when WBC reduction was stopped. Mean hospital cost showed no significant change over time for either the transfusion group or the nontransfusion group. CONCLUSION The cost of providing a totally WBC-reduced blood supply may not be offset by immediate savings related to decreased postoperative infections, reduced length of hospital stay, and cost of hospital care.
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Affiliation(s)
- Natalia Volkova
- Division of Transfusion Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Sanders G, Coker AO, Mellor NJ, Richards K, Rushton ARA, Christie I, Hosie KB. Acute normovolaemic haemodilution in colorectal surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2002; 28:520-2. [PMID: 12217305 DOI: 10.1053/ejso.2002.1286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS Blood transfusions are often given to surgical patients. This study was designed to assess whether acute normovolaemic haemodilution (ANH) reduces exposure to allogeneic blood, affects clinical outcome and hospital stay, and is feasible in colorectal surgery. METHODS All ASA 1 and 11 patients undergoing colectomies performed between 1997 and 1999 were identified retrospectively from our colorectal cancer database to ascertain our current peri and postoperative transfusion practice. Twenty-six selected patients subsequently underwent ANH during colectomy surgery. The number of patients and units transfused were identified. RESULTS One hundred and twenty-three of 317 (39%) patients identified from our colorectal cancer database were transfused a total of 328 units (median 2, range 1-7). Of the 26 patients undergoing ANH, 4 (15%) were transfused a total of 13 units (median 3, range 2-5). The reduction in number of patients transfused was statistically significant (P=0.017). ANH increased anaesthetic time by a median of 19 min. There were no complications associated with ANH and the median hospital stay was 9 days (range 6-13). CONCLUSIONS In this pilot study of selected patients, ANH is a feasible and effective method of reducing allogeneic blood exposure in major colorectal surgery. A prospective randomised controlled trial is now urgently required.
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Affiliation(s)
- G Sanders
- Colorectal Unit, Department of Surgery, Derriford Hospital, Plymouth, UK
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Mascaretti L, Baggi L, Riva M, Proserpio P, Dassi M, Varallo F, Sciorelli G, Quarti C. Lymphocyte subsets in inline filtered packed red blood cell units: comparison between low and high spin procedures. Transfus Apher Sci 2002; 26:167-74. [PMID: 12126201 DOI: 10.1016/s1473-0502(02)00009-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Lymphocyte subsets were determined in 20 packed red blood cell units (PRC) before and after filtration (FPRC) with the Pall Leukotrap RC inline filter system; 10 units were prepared by low spin and platelet rich plasma (PRP) removal (Group A) and 10 with high spin, plasma and buffy-coat (BC) removal (Group B). Flow cytometry was employed for white blood cell (WBC) enumeration and phenotype analysis. Median WBCs in prefiltered units was 2.08 x 10(9) (Group A) vs. 0.8 x 10(9) (Group B) (p < 0.0001). Five Group A and three Group B filtered units had WBC counts above the limit of detection (LD), median values being 25.59 and 3.08 x 10(3), respectively. Whereas CD3+, CD3+CD4+ and CD3+CD8+ lymphocyte subsets were assessable in 20-40% of Group A units, inline filtration of Group B units lowered lymphocytes below the LD of the present study. Post-filtration CD19+ lymphocytes were below the LD in all the 20 units.
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Affiliation(s)
- Luca Mascaretti
- Blood Transfusion Center, Azienda Ospedaliera San Gerardo, Servizio Immunotrasfusionale, Monza, Italy.
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Ibojie J, Greiss MA, Urbaniak SJ. Limited efficacy of universal leucodepletion in reducing the incidence of febrile nonhaemolytic reactions in red cell transfusions. Transfus Med 2002; 12:181-5. [PMID: 12071874 DOI: 10.1046/j.1365-3148.2002.00370.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article demonstrates a 62% reduction in the number of febrile nonhaemolytic transfusion reactions (FNHTRs) and 50% reduction in febrile reaction rate associated with red cell transfusions following graded introduction of universal leucodepletion. Though this is a statistically significant reduction (P = 0.009), it shows limited efficacy in abrogating this complication. We also found a reduction in the proportion of cases of FNHTRs with lymphocytotoxic antibodies over the period studied from 54% in 1998, 28% in 1999 to 23% in 2000. This corresponds to a relative increase in the number of febrile reactions without human leucocyte antigen (HLA) antibodies following full implementation of universal leucodepletion, as the total number of reported reactions actually fell considerably during the period. The increase in the number of cases without HLA antibodies was directly proportional to the increase in the number of leucodepleted units used.
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Affiliation(s)
- J Ibojie
- Department of Medicine and Therapeutics, Aberdeen and North-East Scotland Blood Transfusion Service, University of Aberdeen, Foresterhill Road, Aberdeen AB25 2ZW, Scotland, UK.
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Sherman LA. Universal leukocyte reduction: state of the art and the nature of decision making. Arch Pathol Lab Med 2002; 126:220-2. [PMID: 11825125 DOI: 10.5858/2002-126-0220-ulr] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Laurence A Sherman
- Department of Pathology, Northwestern University Medical School, Chicago, IL, USA
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Muñoz Gómez M, Llau Pitarch JV, Leal Noval SR, García Erce JA, Culebras Fernández JM. Transfusión sanguínea perioperatoria en el paciente neoplásico (II). Alternativas para la reducción de los riesgos transfusionales. Cir Esp 2002. [DOI: 10.1016/s0009-739x(02)72070-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kavanagh BD, Fischer BA, Segreti EM, Wheelock JB, Boardman C, Roseff SD, Cardinale RM, Benedict SH, Goram AL. Cost analysis of erythropoietin versus blood transfusions for cervical cancer patients receiving chemoradiotherapy. Int J Radiat Oncol Biol Phys 2001; 51:435-41. [PMID: 11567818 DOI: 10.1016/s0360-3016(01)01645-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Red blood cell (RBC) transfusions or erythropoietin (EPO) can be used to evade the detrimental effects of anemia during radiotherapy, but the economic consequences of selecting either intervention are not well defined. The RBC transfusion needs during chemoradiotherapy for cervix cancer were quantified to allow comparison of RBC transfusion costs with the projected cost of EPO in this setting. METHODS AND MATERIALS For patients receiving pelvic radiotherapy, weekly cisplatin, and brachytherapy, the RBC units transfused during treatment were tallied. RBC transfusion costs per unit included the blood itself, laboratory fees, and expected value (risk multiplied by cost) of transfusion-related viral illness. EPO costs included the drug itself and supplemental RBC transfusions when hemoglobin was not adequately maintained. An EPO dosage based on reported usage in cervix cancer patients was applied. RESULTS Transfusions were given for hemoglobin <10 g/dL. Among 12 consecutive patients, 10 needed at least 1 U of RBC before or during treatment, most commonly after the fifth week. A total of 37 U was given during treatment, for an average of 3.1 U/patient. The sum total of the projected average transfusion-related costs was $990, compared with the total projected EPO-related costs of $3869. CONCLUSIONS Because no proven clinical advantage has been documented for EPO compared with RBC transfusions to maintain hemoglobin during cervix cancer treatment, for most patients, transfusions are an appropriate and appealingly less expensive option.
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Affiliation(s)
- B D Kavanagh
- Department of Radiation Oncology, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia, USA
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Ratko TA, Cummings JP, Oberman HA, Crookston KP, DeChristopher PJ, Eastlund DT, Godwin JE, Sacher RA, Yawn DH, Matuszewski KA. Evidence-based recommendations for the use of WBC-reduced cellular blood components. Transfusion 2001; 41:1310-9. [PMID: 11606834 DOI: 10.1046/j.1537-2995.2001.41101310.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- T A Ratko
- Technology Assessment Group, Clinical Practice Advancement Center, University Health System Consortium, Oak Brook, Illinois 60523-1890, USA.
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Rebulla P. Revisitation of the clinical indications for the transfusion of platelet concentrates. REVIEWS IN CLINICAL AND EXPERIMENTAL HEMATOLOGY 2001; 5:288-310; discussion 311-2. [PMID: 11703819 DOI: 10.1046/j.1468-0734.2001.00042.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Platelet transfusion is indicated when the expected benefits of increasing the number of functional platelets in the patient's circulation outweigh the potential risks generated by exposing the patient to allogeneic, manipulated and stored blood products such as platelet concentrates. Although reassuring evidence has been collected indicating that current risks associated with blood transfusion are lower than those of several voluntary and involuntary human activities, balancing benefits and risks of platelet transfusion may not be easy in a proportion of patients and in a number of conditions. To facilitate this task, guidelines have been developed, with particular attention to cancer patients. As witnessed by the most recent guidelines, over the last few years there has been a progressive, although not absolute, consensus on: (i) the routine use of platelets as a tool to prevent hemorrhage in oncohematology (the so called 'prophylactic approach') as opposed to limiting platelet transfusion to actual bleeding episodes (the so-called 'therapeutic approach') and (ii) lowering the trigger for prophylactic platelet transfusion in stable oncohematology recipients from 20 x 109 to 10 x 109 platelets/L. This has been accompanied by a reduction of platelet use per oncohematology patient of about 20%, an important outcome in view of the progressive increase of platelet demand due to more aggressive therapy in cancer patients. In selected clinical conditions, specific triggers ranging from 30 x 10(9) to 100 x 10(9) platelets/L have been recommended, with higher values when surgical procedures are required for the patient's treatment. Indications and trigger values proposed in the guidelines must be considered within the context of careful clinical evaluation of each patient, with a clear appreciation of the power of discrimination of automated platelet counters at low counts, and of the quality and local availability of platelet products for emergency.
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Affiliation(s)
- P Rebulla
- Centro Trasfusionale e di Immunologia dei Trapianti, IRCCS Ospedale Maggiore, Milano, Italy.
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Uhlmann EJ, Isgriggs E, Wallhermfechtel M, Goodnough LT. Prestorage universal WBC reduction of RBC units does not affect the incidence of transfusion reactions. Transfusion 2001; 41:997-1000. [PMID: 11493730 DOI: 10.1046/j.1537-2995.2001.41080997.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Febrile nonhemolytic transfusion reaction (FNHTR) has been identified as a pivotal reason for prestorage universal WBC reduction. A regional blood center implemented universal prestorage WBC reduction for RBCs on January 1, 2000. Whether prestorage universal WBC reduction of RBC units will affect FNHTR is not known. STUDY DESIGN AND METHODS All reports of RBC transfusion reactions at Barnes-Jewish Hospital submitted for evaluation to the blood bank, before and after the implementation of WBC reduction of RBCs, were retrospectively evaluated. RESULTS For the 36,303 allogeneic RBC transfusions administered in 1999, 85 reactions (0.23%) were reported. These reactions were classified as FNHTR in 43 cases, allergic in 13, delayed hemolytic in 19, and miscellaneous in 10. For the 31,543 non-WBC-reduced RBC transfusions performed in 1999, 78 reactions (0.25%) were reported. These reactions were classified as FNHTR in 39 cases, allergic in 13, delayed hemolytic in 19, and miscellaneous in 7. In the first half of 2000, 32 reactions (0.20%) were reported for 16,093 prestorage WBC-reduced RBC transfusions (p = 0.41). There were 13 FNHTRs and 10 allergic, 7 delayed hemolytic, and 2 miscellaneous reactions. The use of prestorage WBC-reduced RBCs did not significantly affect the rate of reactions classified as allergic (0.04% in 1999; 0.06% in 2000; p = 0.43) or as FNHTR (0.12% in 1999; 0.08% in 2000; p = 0.33). For all patients, universal WBC reduction in 2000 did not reduce the rate of FNHTR from the rate seen with selective bedside WBC reduction, the practice used in 1999 (0.12% in 1999; 0.08% in 2000; p = 0.36). CONCLUSION No significant difference was found in the incidence of transfusion reactions in patients receiving prestorage WBC-reduced RBCs and non-WBC-reduced RBCs. In addition, no difference was found in transfusion reaction rates when periods of prestorage universal WBC reduction were compared to those of selective WBC reduction.
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Affiliation(s)
- E J Uhlmann
- Department of Pathology and Immunology, Washington University, St. Louis, Missouri 63110, USA
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Brecher ME, Triulzi DJ, Assmann SF. Number of RBC units and rate of transfusionto anemic HIV-positive patients assigned to receiveWBC-reduced or non-WBC-reduced RBCs: the viral activation transfusion study experience. Transfusion 2001; 41:794-8. [PMID: 11399822 DOI: 10.1046/j.1537-2995.2001.41060794.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND It is known that the use of filtration to reduce WBCs in RBC units is associated with a 6- to 15-percent loss of RBCs. It is not known if the use of such WBC-reduced RBCs results in an increased need for RBC units or in the transfusion of more units per year to patients with anemia. STUDY DESIGN AND METHODS In the multicenter Viral Activation Transfusion Study (VATS), anemic HIV-positive patients were randomly assigned to receive either WBC-reduced or non-WBC-reduced RBCs. The number of RBC units transfused per patient and the rate of RBC use were studied. All RBC units given after the enrollment transfusion were counted, until the end of follow-up or the occurrence of bleeding (receiving >5 RBCs within 2 consecutive days). RESULTS As expected, the WBC-reduced RBC units in VATS were lighter in weight than the non-WBC-reduced units (median weight: WBC-reduced, 300 g; non-WBC-reduced, 330 g; p<0.0001). After the enrollment transfusion, 258 WBC-reduced arm patients received 1279 units of RBCs (average, 5.0 units/patient, median, 2 units) while 262 patients in the non-WBC-reduced arm received 1111 RBCs (4.2 units/patient; median, 2 units). The number of units transfused for anemia was slightly greater in the WBC-reduced arm, but the difference was not significant (p = 0.41). Similarly, the rate of RBC use was somewhat higher in the WBC-reduced arm, but the difference was not significant (p = 0.14). The median was 2.3 units per patient per year of follow-up in the WBC-reduced arm; the median in the non-WBC-reduced arm was 1.2 units. CONCLUSION This study confirms that WBC-reduced RBC units are significantly lighter in weight than non-WBC-reduced RBCs. However, in the setting of a large, randomized, blinded study of transfusion for anemia, the smaller size of the WBC-reduced RBC units had no significant effect on the number of RBC units transfused or on the rate at which RBC units were used. In this study, the frequency of blood transfusion may have had a greater relationship to the frequency of routine, scheduled appointments or transfusion orders for a specified Hb trigger than to the actual Hb content of the unit.
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Affiliation(s)
- M E Brecher
- Transfusion Medicine Service, University of North Carolina, Chapel Hill, North Carolina 27514, USA.
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Affiliation(s)
- J D Sweeney
- Department of Transfusion Medicine and Coagulation, Brown University School of Medicine, and Lifespan Academic Medical Center, Miriam Hospital, Providence, RI, USA
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Affiliation(s)
- E C Vamvakas
- Blood Bank and Transfusion Service, New York University Medical Center, New York, New York, USA.
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Affiliation(s)
- P M Ness
- Transfusion Medicine Division, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Vamvakas EC, Blajchman MA. Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction? Blood 2001; 97:1180-95. [PMID: 11222359 DOI: 10.1182/blood.v97.5.1180] [Citation(s) in RCA: 329] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E C Vamvakas
- Department of Pathology, New York University Medical Center, New York, NY 10016, USA.
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Goldfinger D, Klapper E, Pepkowitz SH, Millar SI, Heal JM, Blumberg N, Wuest D, Reich L, Mayer K. Universal WBC reduction and patient advocacy. Transfusion 2000; 40:1545-6. [PMID: 11134580 DOI: 10.1046/j.1537-2995.2000.40121545.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Goodnough LT. The case against universal WBC reduction (and for the practice of evidence-based medicine). Transfusion 2000; 40:1522-7. [PMID: 11134574 DOI: 10.1046/j.1537-2995.2000.40121522.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- L T Goodnough
- Department of Medicine, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri 63110-1093, USA.
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