Outcome predictors for maternal red blood cell alloimmunisation with anti‐K and anti‐D managed with intrauterine blood transfusion

2021 ◽  
Author(s):  
Evangelia Vlachodimitropoulou ◽  
Maciej Garbowski ◽  
Shelley Anne Solomon ◽  
Nimrah Abbasi ◽  
Gareth Seaward ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Outcome Predictors ◽  
Intrauterine Blood Transfusion

scholarly journals BLOOD TRANSFUSION IN CARDIAC SURGERY- NEED TO FOLLOW BASICS!

2020 ◽  
Vol 7 (3) ◽  
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Red Blood Cell Transfusion ◽  
Transfusion Strategy ◽  
Transfusion Threshold ◽  
Restrictive Transfusion ◽  
Conflicting Evidence ◽  
American Society

More and more data is coming in recent times about hazards of blood transfusion. In a landmark TRICC1 trial Euvolemic patients in the intensive care unit (ICU) with Hb<9 g/dl were randomized to a restrictive transfusion strategy for transfusion of PRBCs (transfused if Hb<7 g/dl to maintain Hb between 7 and 9 g/dl) or a liberal strategy (transfused if Hb<10 g/dl to maintain Hb 10-12 g/dl). Mortality was similar in both groups, indicating that liberal transfusions were not beneficial. An Updated Report by the American Society of AnaesthesiologistsTask Force on Perioperative Blood Management tells us restrictive red blood cell transfusion strategy may be safely used to reduce transfusion administration. It further states that The determination of whether hemoglobin concentrations between 6 and 10 g/dl justify or require red blood cell transfusion should be based on potential or actual on going bleeding (rate and magnitude), intravascular volume status, signs of organ ischemia, and adequacy of cardiopulmonary reserve. Should we extrapolate these guidelines in Cardiac surgery? TRACS2 trial concluded that among patients undergoing cardiac surgery, the use of a restrictive perioperative transfusion strategy compared with a more liberal strategy resulted in noninferior rates of the combined outcome of 30-day all-cause mortality and severe morbidity.They advocated use of restrictive strategy, but 5 years later, the authors 3concluded that A restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care costs. With this conflicting evidence, by which way anaesthesiologist to go?

scholarly journals A SARS-CoV-2-pandémia hatása a vérkészítmény-felhasználásra a Pécsi Tudományegyetemen

2021 ◽  
Vol 162 (43) ◽  
pp. 1717-1723
Author(s):  
Sándor Pál ◽  
Barbara Réger ◽  
Tamás Kiss ◽  
Hussain Alizadeh ◽  
András Vereczkei ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Blood Product ◽  
Patient Blood Management ◽  
Blood Products ◽  
Blood Management ◽  
Number Of Patients ◽  
Willingness To Donate ◽  
The Impact

Összefoglaló. Bevezetés: A COVID–19-világjárvány betegellátásra gyakorolt hatása hazánkban is jelentős. A vérellátást nehezítette a járványügyi intézkedések következményeként a véradási események elmaradása, a csökkent véradási hajlandóság, továbbá a nehezen megítélhető vérkészítményigény . A „Patient Blood Management” irányelveinek az orvosi gyakorlatban történő egyre szélesebb körű alkalmazása elősegíti az optimális vérkészítmény-felhasználást a transzfúziók lehetőség szerinti elkerülésével. Célkitűzés és módszer: Vizsgálatunk célja a Pécsi Tudományegyetem Klinikai Központjának Janus Pannonius Klinikai Tömbjében a vérkészítmény-felhasználás változásainak felmérése volt a 2020. év első öt hónapjában. Eredmények: A járványügyi intézkedéseket követő időszakban szignifikánsan csökkent a hospitalizált betegeknek (34,08%), a transzfúziót igénylő betegeknek (39,69%) és a felhasznált vörösvérsejt-készítményeknek (46,41%) a száma, valamint az egy betegre jutó felhasznált vörösvérsejt-koncentrátum átlaga (2,61-ről 1,97-re) is. Közel 30%-os arányban csökkent a felhasznált friss fagyasztott plazma egységeinek és a thrombocytakoncentrátumoknak a száma is. Következtetés: A szigorú korlátozások életbe léptetését követően a nehézségek ellenére sikerült elegendő mennyiségű vérkészítményt biztosítani a betegeknek. Az Országos Vérellátó Szolgálat Pécsi Regionális Vérellátó Központja munkatársainak és a klinikusok erőfeszítéseinek köszönhetően a vérkészítményigény és -kínálat között új egyensúly alakult ki, mely megfelelő ellátást biztosított a feltétlenül szükséges transzfúziók kivitelezéséhez. Orv Hetil. 2021; 162(43): 1717–1723. Summary. Introduction: The impact of COVID–19 pandemic on patient care is pronounced also in Hungary. Blood supply was hindered by the reduction of public blood donation events, the reduced willingness to donate, and the difficult predictability of blood product demand as a result of the epidemiological regulations. The wider application of Patient Blood Management guidelines in the medical practice will promote optimal blood product utilization by avoiding transfusions where possible. Objective and method: The aim of our study was to assess the changes in the usage of blood products in the first five months of 2020 at the Clinical Center of the University of Pécs, Janus Pannonius Clinical Building. Results: In the period following the epidemiological measures, we found reduction in the number of hospitalized patients (34.08%), in the number of patients requiring transfusion (39.69%) and in the number of red blood cell products used (46.41%). The number of transfused red blood cell concentrates per patient was also significantly reduced (from 2.61 to 1.97) in this period. The number of transfused fresh frozen plasma units and platelet concentrates also decreased by approximately 30%. Conclusion: After the implementation of the strict restrictions, despite the difficulties, it was possible to provide patients with sufficient blood products. Due to the efforts of both the Regional Blood Transfusion Center of Pécs of the Hungarian National Blood Transfusion Service and of the clinicians, a new balance was established between the demand and the supply of blood products, which provided adequate care for the necessary transfusions. Orv Hetil. 2021; 162(43): 1717–1723.

scholarly journals Changes in the red blood cell enzyme, carbonic anhydrase, following blood transfusion.

1981 ◽  
Vol 27 (6) ◽  
pp. 541-545
Author(s):  
Kenji Taki ◽  
Koji Murakami ◽  
Takae Kawamura ◽  
Mieko Takamura ◽  
Reiji Wakusawa
Keyword(s):  
Blood Transfusion ◽  
Carbonic Anhydrase ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Cell Enzyme

scholarly journals Infusion of Autologous Retrodifferentiated Stem Cells into Patients with Beta-Thalassemia

2006 ◽  
Vol 6 ◽  
pp. 1278-1297 ◽  
Author(s):  
Ilham Saleh Abuljadayel ◽  
Tasnim Ahsan ◽  
Huma Quereshi ◽  
Shakil Rizvi ◽  
Tamseela Ahmed ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Cell ◽  
Red Blood Cell ◽  
White Blood Cells ◽  
Fetal Hemoglobin ◽  
Beta Thalassemia ◽  
Mean Corpuscular Hemoglobin ◽  
Beta Globin ◽  
Globin Chain ◽  
Adult Hemoglobin

Beta-thalassemia is a genetic, red blood cell disorder affecting the beta-globin chain of the adult hemoglobin gene. This results in excess accumulation of unpaired alpha-chain gene products leading to reduced red blood cell life span and the development of severe anemia. Current treatment of this disease involves regular blood transfusion and adjunct chelation therapy to lower blood transfusion–induced iron overload. Fetal hemoglobin switching agents have been proposed to treat genetic blood disorders, such as sickle cell anemia and beta-thalassemia, in an effort to compensate for the dysfunctional form of the beta-globin chain in adult hemoglobin. The rationale behind this approach is to pair the excess normal alpha-globin chain with the alternative fetal gamma-chain to promote red blood cell survival and ameliorate the anemia. Reprogramming of differentiation in intact, mature, adult white blood cells in response to inclusion of monoclonal antibody CR3/43 has been described. This form of retrograde development has been termed “retrodifferentiation”, with the ability to re-express a variety of stem cell markers in a heterogeneous population of white blood cells. This form of reprogramming, or reontogeny, to a more pluripotent stem cell state ought to recapitulate early hematopoiesis and facilitate expression of a fetal and/or adult program of hemoglobin synthesis or regeneration on infusion and subsequent redifferentiation. Herein, the outcome of infusion of autologous retrodifferentiated stem cells (RSC) into 21 patients with beta-thalassemia is described. Over 6 months, Infusion of 3-h autologous RSC subjected to hematopoietic-conducive conditions into patients with beta-thalassemia reduced mean blood transfusion requirement, increased mean fetal hemoglobin synthesis, and significantly lowered mean serum ferritin. This was always accompanied by an increase in mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) in such patients. No adverse side effects in response to the infusion of autologous RSC were noted.This novel clinical procedure may profoundly modify the devastating course of many genetic disorders in an autologous setting, thus paving the way to harnessing pluripotency from differentiated cells to regenerate transiently an otherwise genetically degenerate tissue such as thalassemic blood.

An Assessment of the Differences in Erythropoiesis Between Transfused Males and Females with β Thalassaemia Major

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4045-4045
Author(s):  
Greg Hapgood ◽  
Timothy Walsh ◽  
Ronit Cukierman ◽  
Eldho Paul ◽  
Ken Cheng ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Blood Transfusion ◽  
Blood Cell ◽  
Blood Volume ◽  
Red Blood Cell ◽  
Reticulocyte Count ◽  
Thalassemia Major ◽  
P Value ◽  
Red Cell ◽  
Males And Females

Abstract Background: β thalassemia major results in ineffective erythropoiesis. Blood transfusion aims, in part, to suppress this and to limit morbidity from anaemia, bone marrow expansion and extra-medullary hemopoiesis (EMH), thereby increasing survival. According to current international guidelines, males and females are transfused equally. Aims: We sought to assess the adequacy of suppression of erythropoiesis in all 126 transfused adult (>18 years) males and females with β thalassemia major at our centre by: (1) assessing readily available pre-transfusion indices of erythropoiesis, including erythropoietin (EPO) levels; (2) determining the volume of blood transfused per kilogram (kg) and per calculated blood volume; and (3) assessing the incidence of para-spinal EMH masses based on magnetic resonance imaging (MRI). Methods: We analysed pre-transfusion (i.e., the day of transfusion) hemoglobin (Hb), reticulocyte count, red blood cell count (RCC), nucleated red blood cell (NRBC) count, EPO and ferritin levels in patients receiving stable, regular blood transfusion. Automated and manual NRBC and reticulocyte enumerations were performed. Blood volume was calculated using Nadler’s formula. MRI performed to assess cardiac function and hepatic and cardiac iron loading was reviewed for the presence of para-spinal EMH. Results: One hundred and sixteen adult patients (51 males and 65 females) provided pre-transfusion blood samples (Table 1). The 10 patients not included were either not available or declined testing. The mean pre-transfusion Hb was 98-99g/l with no difference between males or females (Table 2). Therefore, our data reflect long-standing adherence to current international transfusion recommendations. EPO levels and NRBC count (manual and automated) were significantly higher in males compared to females. RCC, reticulocyte count (manual and automated) and ferritin levels were not different between males and females. Males received less blood per kg of body weight and per calculated blood volume. The incidence of para-spinal EMH was 13% (14/110) and was significantly higher in males (11/50) compared to females (3/60)(22% versus 5%, respectively, (p = 0.01)). The incidence of splenectomy was higher in males. Conclusions: These findings confirm that erythropoiesis is not equally suppressed in males and females and that males are more prone to complications from being under-transfused with current transfusion practices. This work has major clinical implications for transfusion practices in the management of β thalassemia major. Abstract 4045. Table 1 Summary of patients included in the study Variable Overall Males Females p value Number 116 51 65 - Age (years) 39.3 ± 9.3 40.0 ± 9.6 38.8 ± 9.1 0.511 Weight (kg) 60.0 ± 11.6 64.9 ± 9.8 55.7 ± 12.4 < 0.0001 Height (cm) 159 ± 10.5 166 ± 8.3 153 ± 8.1 < 0.0001 Transfusion interval (weeks) 3.2 ± 0.6 3.2 ± 0.7 3.1 ± 0.5 0.168 No. RBC units per transfusion 3.03 ± 0.63 3.22 ± 0.76 2.89 ± 0.48 0.006 Estimated annual transfused volume (l) 13.5 (10.1-13.5) 14.0 (14.0-14.0) 14.0 (10.0-14.0) < 0.0001 Estimated annual transfused volume per kg (ml/kg) 215 (185-255) 202 (185-225) 225 (188-263) 0.028 Estimated patient blood volume (l) 3.79 ± 0.73 4.39 ± 0.50 3.32 ± 0.52 < 0.0001 Ratio of estimated annual transfused volume (l) per estimated patient blood volume (l) 3.33 (2.84-4.01) 2.98 (2.68-3.28) 3.79 (3.3-4.35) < 0.0001 Splenectomy 49.5% 61% 40% 0.031 Data are mean ± standard deviation, median (interquartile range) or percentage. Transfused volumes are calculated on the assumption that each unit contains 260ml red cells (Australia Red Cross Blood Service red cell unit mean volume = 259 ± 23ml). Nadler’s formula for total blood volume (TBV): men TBV (ml) = 604 + (367 x height3(m3)) + (32.2 x weight (kg)); women TBV = 183 + (356 x height3(m3)) + 33.1 x weight (kg)). Table 2. Laboratory indices of pre-transfusion erythropoiesis for all patients Variable Overall Male Female p value Hemoglobin (g/l) 98 ± 8.9 98 ± 9.9 99 ± 8.1 0.36 Red cell count (x 1012/l) 3.4 ± 0.35 3.45 ± 0.40 3.50 ± 0.32 0.46 Ferritin (mcg/l) 821 (604-1300) 754 (582-1139) 943 (639-1356) 0.11 Erythropoietin (mIU/ml) 58 (37-99) 72 (41-149) 52 (35-89) 0.006 Manual NRBC (number NRBC/100 WBC counted) 6 (1-54) 21 (2-98) 3 (1-28) 0.003 Automated NRBC (number NRBC/100 WBC counted) 5 (0-34) 17 (0-54) 1 (0-20) 0.014 Data are mean ± standard deviation or median (interquartile range). Disclosures No relevant conflicts of interest to declare.

scholarly journals A Comparative Study of Storage Related Haematological Changes in Whole Blood and PRBC in Blood Bank of a Tertiary Care Hospital

2020 ◽  
Vol 9 (2) ◽  
pp. 1-7
Author(s):  
Pratibha Shirvastava ◽  
Shyamoli Dutta
Keyword(s):  
Blood Transfusion ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Whole Blood ◽  
Tertiary Care ◽  
Blood Bank ◽  
Clotting Factor ◽  
Research Centre ◽  
Care Hospital ◽  
Haematological Changes

Background: Blood transfusion is very common in present era. Now day’s whole blood transfusion is common but also the blood product like red blood cell, white blood cell, platelets, clotting factor, plasma can be done .the aim of study to know the storage related changes in whole blood, packed red blood cell. Subjects and Methods: In our institution we have selected 100 voluntary blood donors sample in blood bank of Teerthankar Mahaveer medical college and research centre, Moradabad up to 12 month. Results: The store blood is Followed up to 35th days .during regular interval 1st, 7th, 14th, 21st, 28th and 35th day, in the blood there is significant change in and all other component in all sample. Conclusion: In the case of storage of blood in blood bank. As the number day of store is more the haematological changes is more significant.

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