scholarly journals Anticoagulation, bleeding and blood transfusion practices in Australasian cardiac surgical practice

2007 ◽  
Vol 35 (5) ◽  
pp. 760-768 ◽  
Author(s):  
D. J. Daly ◽  
P. S. Myles ◽  
J. A. Smith ◽  
J. L. Knight ◽  
O. Clavisi ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Teaching Hospitals ◽  
Red Cell ◽  
Transfusion Threshold ◽  
Excessive Bleeding ◽  
Factors Associated ◽  
Antifibrinolytic Therapy ◽  
Marked Variability ◽  
Clopidogrel Therapy ◽  
Red Cell Transfusion

We surveyed contemporary Australasian cardiac surgical and anaesthetic practice, focusing on antiplatelet and antifibrinolytic therapies and blood transfusion practices. The cohort included 499 sequential adult cardiac surgical patients in 12 Australasian teaching hospitals. A total of 282 (57%) patients received red cell or component transfusion. The median (IQR) red cell transfusion threshold haemogloblin levels were 66 (61-73) g/l intraoperative^ and 79 (74-85) g/l postoperatively. Many (40%) patients had aspirin within five days of surgery but this was not associated with blood loss or transfusion; 15% had Clopidogrel within seven days of surgery. In all, 30 patients (6%) required surgical re-exploration for bleeding. Factors associated with transfusion and excessive bleeding include pre-existing renal impairment, preoperative Clopidogrel therapy, and complex or emergency surgery. Despite frequent (67%) use of antifibrinolytic therapy, there was a marked variability in red cell transfusion rates between centres (range 17 to 79%, P <0.001). This suggests opportunities for improvement in implementation of guidelines and effective blood-sparing interventions. Many patients presenting for surgery receive antiplatelet and/or antifibrinolytic therapy, yet the subsequent benefits and risks remain unclear.

Developing a National Registry for Hemochromatosis

2016 ◽  
pp. 154-164
Author(s):  
Indu Singh ◽  
Janelle Guerrero ◽  
Michael J. Simmonds
Keyword(s):  
Blood Transfusion ◽  
Hereditary Hemochromatosis ◽  
National Registry ◽  
Red Cross ◽  
Blood Collection ◽  
Healthy Population ◽  
Red Cell ◽  
Blood Products ◽  
Patient Health ◽  
Red Cell Transfusion

Hereditary Hemochromatosis (HH) is a disorder where iron and ferritin concentrations in a patient's blood are much higher than normal healthy levels. The main therapeutic intervention for individuals with HH is removing 300-500 mL of blood every few months to maintain ferritin concentration within acceptable ranges. The blood collected during these venesections is usually discarded as there is a belief that blood with high levels of ferritin are not suitable for blood transfusion purposes. Australian Red Cross Blood Services voluntarily collects blood from donors for subsequent use in blood transfusion. Annually more than 700 thousand units are transfused within Australia and there is a constant need for new donors given the significant imbalance between supply and demand of blood products. Besides red cell transfusions, the Red Cross also issues donor blood for development of many other blood products essential for patient health care. The HH blood can currently be used for other blood products if not for red cell transfusion. However, there is evidence to suggest that there is no significant difference between the red cells of the normal healthy population compared to those from HH patients. Australian Red Cross has developed a mobile computer application (High Ferritin “app”) as they have started collecting blood from HH patients. Though there is little or no awareness about the existence and use of this High Ferritin app in general HH population, their doctors and nurses collecting their blood for therapeutic purposes. This chapter describes possibility of saving and utilizing the blood collected from hemochromatosis patients for therapeutic purposes. A national hemochromatosis patients registry, in collaboration with High Ferritin app (HFa) developed by Australian Red Cross Blood Services, accessible to the patients, their doctors and Red Cross Blood Collection Sservices 24 hours a day anywhere in the country can allow the patients to donate the blood collected for therapeutic purposes at any affiliated blood collection center in the country after they automatically get a message either by email or text message after their blood results have been reviewed by their doctor and they are required to go for venesection.

scholarly journals Packed red cell blood transfusion practices review in medical oncology unit in a tertiary cancer center, South India

2019 ◽  
Vol 7 (12) ◽  
pp. 4433
Author(s):  
Veerendra Angadi ◽  
Manjunath Nandennavar ◽  
Shashidhar V. Karpurmath ◽  
Roshan Jacob ◽  
Yamini Donekal
Keyword(s):  
Blood Transfusion ◽  
Cancer Patients ◽  
Intravenous Iron ◽  
Red Blood Cell Transfusion ◽  
Cancer Center ◽  
Red Cell ◽  
Retrospective Case ◽  
Case Record ◽  
Red Cell Transfusion ◽  
Oncology Unit

Background: Anaemia is a very common complication in cancer patients. Up to 60% of solid tumor patients and 70-90% of patients receiving myelosuppressive chemotherapy have anaemia. Pathophysiology of anaemia in cancer patients is multifactorial. The treatments for cancer related anaemia include Erythropoietin Stimulating Agents (ESAs), iron supplementing therapies (intravenous iron, oral iron) and blood transfusion. There are various safety concerns regarding usage of ESAs; also, their usage is less in India due to cost factor. There is scant literature regarding blood transfusion practices in patients undergoing chemotherapy.Methods: Patients diagnosed with cancer and patients receiving chemotherapy were included in the study. Retrospective case record review of cancer patients who received chemotherapy between January to March 2019 was done. Type of malignancy, presence of symptoms related to anemia and trigger for packed red cell transfusion were recorded.Results: Among 342 patients received total of 1365 cycles of chemotherapy in this time period. Mean age of patients was 46 years. 46 of the 342 patients received blood transfusion. Only 13% of the patients had symptoms of anemia like weakness and fatigue the average hemoglobin level at which transfusion was given was 6 gm/dL.Conclusions: Packed Red blood cell transfusion was usually administered at Hb <7 gm/dL. Very few patients reported anaemia related symptoms prior to transfusion. No patient received erythropoietin. Further data is needed from other tertiary cancer centres to understand the blood transfusion practices in Indian cancer patients undergoing chemotherapy.

Acute Effects of Blood Transfusion on Spermatogenesis and Pituitary Gonadal axis in Eugonadal Males with Beta Thalassemia Major (pilot study)

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1027-1027
Author(s):  
Mohamed A. Yassin ◽  
Ashraf T Soliman ◽  
Ahmed S Elawa ◽  
Hanadi Rafii El-Ayoubi ◽  
Vincenzo Desanctis
Keyword(s):  
Blood Transfusion ◽  
Research Funding ◽  
Sperm Count ◽  
Thalassemia Major ◽  
Semen Parameters ◽  
Red Cell ◽  
Acute Effects ◽  
Seminal Parameters ◽  
Igf I ◽  
Red Cell Transfusion

Abstract Abstract 1027 Objective: To evaluate semen parameters and measure serum follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T) and insulin-like growth factor-I (IGF-I) concentrations before and 7 days after packed red cell transfusion (PCTx) in young adults with thalassemia major (TM). Design: Prospective study. Setting, Patients, Interventions: We studied the effect of blood transfusion on semen parameters, the endocrine functions in 10 young adults with TM, aged from 17 to 32 years, with full pubertal development (Tanner's stage 5) (euogonadal),and capacity to ejaculate. They were regularly transfused since early childhood and underwent chelation therapy using desferrioxamine which was replaced by deferasirox for the last 4 –5 years. At the time of the study their serum ferritin levels ranged from 500 to 5922 ng/ml (mean2686 ng/ml). Basal serum concentrations of FSH, LH, T and IGF-I were evaluated before and 7 days after packed red cell transfusion (PCTx). Main Outcome Measures and Results: After PCTx significant increase of Hb from 8.7 +/− 0.86 g/dl to 11.1 +/− 0.82 g/dl was associated with increased testosterone (from 16.5 +/− 8 nmol/L to 20 +/− 8.8 nmol/L, IGF-I (from 173 +/− 46ng/ml to 214 +/− 61ng/ml) and gonadotropins' concentrations. Total sperm count increased significantly from 57.8 +/− 38.3 million/ml to 166 +/− 132 million/ml and rapid progressive sperm motility progressive motility increased from 20.6+/− 16.6 % to 79.7 +/− 67.4 %. After PCTx, LH concentrations were correlated significantly with T concentrations (r = 0.434, p < 0.001) and sperm volume and count (r = 0.439 and r = 0.376 respectively, p: 0.01). The increase of IGF-I concentration was correlated significantly with Hb level after PCTx (r = 0.535, p < 0.001) and negatively with ferritin concentration (r = −0.458, p < 0.001). Significant correlation were found between serum T concentrations and semen parameters before and after PCTx including sperm count (r = 0.658 and r = 0.73 respectively, p < 0.001)rapid progressive motility (r = 0.675 and r = 0.758 respectively p < 0.001), and the number of sperms with normal morphology (r = 0.752 and r = 0.834 respectively, p < 0.001) IGF-I levels and seminal parameters. No correlations were found between serum FSH and IGF-I concentrations and seminal parameters. Conclusion: Our study suggests that in thalassemic males blood transfusion is associated with significant acute enhancement of sperm parameters and with an increased concentrations of serum testosterone, LH, FSH and IGF-I. These “acute” effects on spermiogenesis are reached with an unknown mechanism/s and suggest a number of pathways that need further human and/or experimental studies. Disclosures: Yassin: Hamad medical corporation MRC: Employment, Research Funding. Soliman:Hamad medical corporation MRC: Employment, Research Funding. Elawa:Hamad medical corporation MRC: Employment, Research Funding.

scholarly journals Transfusion strategy for acute upper gastrointestinal bleeding

CJEM ◽  
2015 ◽  
Vol 17 (5) ◽  
pp. 582-585 ◽  
Author(s):  
James Handel ◽  
Eddy Lang
Keyword(s):  
Gastrointestinal Bleeding ◽  
Patient Outcomes ◽  
Upper Gastrointestinal Bleeding ◽  
Secondary Outcome ◽  
Red Cell ◽  
Transfusion Threshold ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Red Cell Transfusion ◽  
Hemoglobin Threshold ◽  
Upper Gastrointestinal

Clinical questionDoes a hemoglobin transfusion threshold of 70 g/L yield better patient outcomes than a threshold of 90 g/L in patients with acute upper gastrointestinal bleeding?Article chosenVillanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368(1):11-21.Study objectivesThe authors of this study measured mortality, from any cause, within the first 45 days, in patients with acute upper gastrointestinal bleeding, who were managed with a hemoglobin threshold for red cell transfusion of either 70 g/L or 90 g/L. The secondary outcome measures included rate of further bleeding and rate of adverse events.

Retrospective Review of Erythropoietin Therapy Versus Supportive Care in Newborns with Hereditary Spherocytosis (HS): Difficulties Implementing Trial Results Into Clinical Practice

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2066-2066
Author(s):  
Jacqueline F. Morrison ◽  
Ellis J. Neufeld ◽  
Rachael F. Grace
Keyword(s):  
Clinical Practice ◽  
Blood Transfusion ◽  
Prospective Study ◽  
Hereditary Spherocytosis ◽  
Common Belief ◽  
Recombinant Erythropoietin ◽  
Red Cell ◽  
Transfusion Therapy ◽  
Academic Center ◽  
Red Cell Transfusion

Abstract Abstract 2066 Background: Most newborns with HS have a family history of disease since the most common inheritance pattern is autosomal dominant. Therefore, hematologists often see these infants before their physiologic hemoglobin nadir, which is exaggerated in comparison to healthy infants and can cause a symptomatic anemia requiring red cell transfusion(s) during the first few months of life. In 2000, a small multicenter prospective study demonstrated that recombinant erythropoietin (EPO) therapy can aid infants through this nadir and prevent transfusions (Tchernia et al., Hematol J. 2000; 1(3):146–152). The goal of the present study was to evaluate the frequency of implementation and cost of EPO versus transfusion therapy in infants with HS at a pediatric academic center. Methods: After IRB approval, 59 infants with HS were identified from hematology department records and from an electronic clinic note search tool at Children's Hospital Boston. Subjects with a date of birth from July 2000 through June 2011 were included. Demographic, clinical, laboratory, and transfusion data were collected through a retrospective chart review. Statistical analysis was performed using R 2.13.1. Results: Only 9 of 59 (15%) infants with HS were treated with EPO therapy in the decade since the study by Tchernia et al. was first published. Table I shows the demographic and clinical data for EPO vs. non-EPO treated newborns. The mean age at the start of treatment was 5.3 ± SD 3.6 weeks. In our academic center of >15 clinical hematologists, two commenced EPO therapy for over half of the treated patients. Of those treated with EPO, 6 (67%) had an older sibling with HS of whom 3 (33%) were treated with EPO. The nadir hemoglobin was not different in the EPO vs. non-EPO treated groups (7.6 vs 8.1 g/dl, p=0.2). The difference in the number of transfusions needed in the first year of life in the two groups was not statistically significantly (0.9 vs 1.1, p=0.52), although 6 of the 9 EPO treated patients received a red cell transfusion prior to starting therapy. EPO was discontinued at a mean age of 23.5 weeks (12–37 weeks). The estimated cost of the average course of EPO therapy was approximately $5437 per infant (AWP plus repeated injections) versus the cost of a single blood transfusion of $1783 per infant (estimated gross charges at our center). Conclusion: Since a 2000 report of the efficacy of EPO to limit transfusions in newborns with HS, only 15% of infants at our center have been treated with EPO, despite common belief among hematologists that this is a frequent treatment modality. The decision to start EPO appeared arbitrary, based on hematologist preference and previous experiences of families. The estimated cost of EPO therapy is greater than a single outpatient red cell transfusion, and the majority of EPO treated infants also received a blood transfusion. It remains unclear whether EPO decreases the number of transfusions required in infants with HS. The lack of implementation of EPO therapy at our institution is likely due to a combination of financial and logistical challenges, in addition to individual practice customs, which often impede translation of prospective trials into clinical practice. A larger prospective study accounting for these factors could establish “best practice” for infants with HS. Disclosures: Off Label Use: Recombinant erythropoietin for anemia in infancy associated with hereditary spherocytosis.

scholarly journals The Effects of Acidosis and Hypothermia on Blood Transfusion Requirements following Factor VII Administration

2007 ◽  
Vol 35 (4) ◽  
pp. 494-497 ◽  
Author(s):  
K. Hall ◽  
P. Forrest ◽  
C. Sawyer
Keyword(s):  
Blood Transfusion ◽  
Rescue Therapy ◽  
Surgical Patients ◽  
Factor Vii ◽  
Red Cell ◽  
Recombinant Activated Factor Vii ◽  
Activated Factor Vii ◽  
Rfviia Administration ◽  
Transfusion Requirements ◽  
Red Cell Transfusion

While there is laboratory evidence that the activity of recombinant activated factor VII (rFVIIa) is reduced by the presence of acidosis and hypothermia, there is limited clinical data to support this observation. Recombinant FVIIa may be used as rescue therapy in surgical patients who have bleeding that is refractory to conventional therapy. However, these patients are also frequently acidotic and hypothermic at the time the drug is administered. In this retrospective study, the records of 38 adult surgical patients who received rFVIIa intraoperatively or within six hours postoperatively were reviewed. The requirements for red cell transfusion in the two hours following the administration of rFVIIa and the need for repeated doses of rFVIIa were recorded. The relationship between red cell transfusion and pH and temperature of the patient at the time of rFVIIa administration was assessed by multiple regression analysis. The major finding was an inverse relationship between the degree of acidosis at the time of rFVIIa administration and the requirement for either subsequent blood transfusion or repeat dosing of rFVIIa (P=0.003 and P <0.001 respectively). For patients with apH <7.2 vs. pH >7.2, the odds ratio for receiving two or more packs of red blood cells within two hours of rFVIIa administration was 15:1. This effect was not observed for hypothermia. The implication of this study is that rFVIIa may be less effective when administered to severely acidotic patients. Further studies are required to examine whether this is related to the acidosis directly, or is secondary to other intraoperative variables affecting acidosis. The clinical utility of rFVIIa in acidotic patients also requires further investigation.

Antecedents of red cell transfusion in a large contemporary obstetric cohort

2019 ◽  
Vol 47 (2) ◽  
pp. 195-199
Author(s):  
Siobhan Enright ◽  
Sonia Varadkar ◽  
Alison Demaio ◽  
Catherine Flynn ◽  
Fionnuala Ni Áinle ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Maternal Age ◽  
Maternal Obesity ◽  
Multiple Pregnancy ◽  
Surrogate Marker ◽  
Individual Characteristics ◽  
Red Cell ◽  
Blood Products ◽  
Number Of Patients ◽  
Red Cell Transfusion

Abstract Background Hemorrhage is a critical contributor to maternal morbidity but estimation of blood loss at delivery is frequently inaccurate. Due to this inaccuracy we sought to examine blood transfusion as a surrogate marker for morbidity in a large non-population based consecutive cohort. Methods A retrospective analysis of prospectively gathered data was carried out at two university institutions serving a heterogeneous urban obstetric population from January to December 2016. Data were analyzed to determine whether individual characteristics were associated with perinatal transfusion. Hematological indices and requirement for other blood products were also characterized. Results A total of 16,581 deliveries were recorded during the study and 1.7% (289/16,581) of the cohort required red cell transfusion. Those who received transfusion were more likely to be nulliparous, and to deliver <37 weeks’ or >42 weeks’ gestation. They were also more likely to have a macrosomic infant (birthweight >4 kg) and to have had a multiple pregnancy. Characteristics not associated with risk of transfusion included obesity [18% (52/289) vs. 15% (2445/16,292); P=0.18], and maternal age ≥35 years [28% (82/289) vs. 33% (5537/16,292); P=0.05]. Additional blood products were necessary in a small number of patients who received red cells. Conclusion The rate of transfusion in a contemporary Irish cohort has risen compared with previous data. Several variables associated with transfusion are consistent with older studies but importantly; maternal obesity and advanced maternal age are not associated with transfusion. These data may encourage the investment of resources in a population previously considered low-risk and, following future studies, to improve strategies aimed at limiting blood transfusion.

Expansion of Red Blood Cells for Transfusion

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. SCI-46-SCI-46
Author(s):  
Anna Rita F Migliaccio ◽  
Carolyn Whitsett ◽  
Giovanni Migliaccio
Keyword(s):  
Stem Cells ◽  
Blood Transfusion ◽  
Blood Supply ◽  
Ex Vivo ◽  
Red Cells ◽  
Blood Group Antigens ◽  
Red Cell ◽  
Erythroid Cells ◽  
Red Cell Transfusion ◽  
Safety Considerations

Abstract Abstract SCI-46 Blood transfusion, the earliest form of cell replacement therapy, has become indispensable for modern medicine making the safety and adequacy of the blood supply a national priority. The US blood supply is adequate overall because in 2006 the number of blood units collected exceed by 7.8% the number of those transfused. However, issues surrounding blood transfusion, such as sporadic shortages and potential adverse events to recipients (related to changes in red cell physiology during storage and alloimmunization in chronically transfused patients) prompted past and current efforts to develop alternative transfusion products. Recently, the culture conditions to generate erythroid cells have greatly improved making the production of a transfusion product ex-vivo a theoretically possible, although expensive, proposition. This recognition is inspiring several investigators to develop production processes for ex-vivo generation of red cell transfusion products. A proof-of-concept demonstrating that ex-vivo generated red cells protect mice from experimentally induced lethal anemia has been obtained. Alternative sources of stem cells which include human embryonic stem cells (hESC) and induced pluripotency stem cells (iPS), are being explored. Since red cells do not have a nucleus, safety considerations suggest that they may represent the first cell therapy product to be generated from hESC and iPS. In addition, discarded hematopoietic stem cells present in adult and cord blood donations may theoretically generate numbers of red cells ex-vivo sufficient for transfusion. Affordable clinical grade humanized culture media have also been developed. Possible differences in immunological and biological properties of erythroid cells from different sources are under investigation. These differences include size, levels of activity of glycolytic enzymes and carbonic anhydrase, expression of different isozymes, hemoglobin and antigenic profiles (HLA class II antigens). This last aspect is particularly important because ex-vivo expanded red cells pose the same risk for infection and incompatibility as any transfusion product but pose unique antigenic risks. Since expression of blood group antigens is susceptible to post-transcriptional modifications, the ex-vivo expansion process itself may induce antigenic variability. Therefore, even cells generated from completely matched stem cell sources may induce auto-immunity and/or appear incompatible. Regarding the identity of ex-vivo generated red cell transfusion products, a conservative approach would be to define them as “enucleated red cells”. In principle, however, ex-vivo generated erythroblasts may also serve as transfusion product. Since they undergo 4–64 further divisions and reduce iron overload, they may represent a more potent transfusion product for patients that require chronic transfusion. The clinical use of these cells, however, may involve development of specific procedures to facilitate their homing/maturation in the erythroid niches of the recipients. In summary, on the basis of these cost, logistic and safety considerations we hypothesize that the clinical application of ex-vivo expanded erythroblasts will involve in sequence, drug discovery for personalized therapy, systemic drug delivery, genotypically matched transfusion for alloimmunized patients and then transfusion in the general population. Disclosures: No relevant conflicts of interest to declare.

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