Errors in Transfusion Medicine: Scope of the Problem

1999 ◽  
Vol 123 (7) ◽  
pp. 563-565 ◽  
Author(s):  
Jeanne V. Linden
Keyword(s):  
Autologous Blood ◽  
Virus Transmission ◽  
Air Embolism ◽  
Transfusion Medicine ◽  
Transfusion Reaction ◽  
Risk Of Death ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Hemolytic Transfusion Reaction ◽  
Disease Risks

Abstract Error is ubiquitous whenever humans are involved in a process. Fortunately, most transfusion-related errors are benign. However, the risk of death due to acute hemolytic transfusion reaction rivals that of human immunodeficiency virus transmission and administration of the wrong blood or of blood to the wrong recipient has occurred at many facilities. Most blood misadministration errors are caused by failure to identify the recipient and blood unit adequately, although phlebotomy errors and blood bank errors also contribute. Many errors are multifactorial and may reflect underlying systems defects. Noncompliant specimen labels may be a cue to an increased risk of phlebotomy error. Autologous blood is not immune from error and poses infectious disease risks as well as the risk of hemolytic transfusion reaction; also, perioperatively recovered blood may pose a risk of air embolism if improperly handled.

scholarly journals Association of Selected Phenotypic Markers of Lymphocyte Activation and Differentiation with Perinatal Human Immunodeficiency Virus Transmission and Infant Infection

2005 ◽  
Vol 12 (5) ◽  
pp. 622-631 ◽  
Author(s):  
John S. Lambert ◽  
Jack Moye ◽  
Susan F. Plaeger ◽  
E. Richard Stiehm ◽  
James Bethel ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
T Cells ◽  
Hiv Transmission ◽  
Virus Transmission ◽  
Lymphocyte Activation ◽  
Phenotypic Markers ◽  
Perinatal Hiv ◽  
Hla Dr ◽  
Increased Risk ◽  
Immunodeficiency Virus

ABSTRACT This study of a subset of women and infants participating in National Institutes of Health Pediatric AIDS Clinical Trials Group protocol 185 evaluated lymphocyte phenotypic markers of immune activation and differentiation to determine their association with the likelihood of human immunodeficiency virus (HIV) transmission from the women to their infants and the potential for early identification and/or prognosis of infection in the infants. Lymphocytes from 215 human immunodeficiency virus type 1 (HIV)-infected women and 192 of their infants were analyzed by flow cytometry with an extended three-color panel of monoclonal antibodies. Women who did not transmit to their infants tended to have higher CD4+ T cells. Most notably, levels of total CD8+ T cells and CD8+ CD38+ cells made significant independent contributions to predicting the risk of mother-to-child transmission. Adjusting for HIV-1 RNA level at entry, a one percentage-point increase in these marker combinations was associated with a nine percent increase in the likelihood of maternal transmission. Total as well as naïve CD4+ T cells were significantly higher in uninfected than infected infants. Total CD8+ cells, as well as CD8+cells positive for HLA-DR+, CD45 RA+ HLA-DR+, and CD28+ HLA-DR+ were elevated in infected infants. Detailed immunophenotyping may be helpful in predicting which pregnant HIV-infected women are at increased risk of transmitting HIV to their infants. Increasing differences in lymphocyte subsets between infected and uninfected infants became apparent as early as six weeks of age. Detailed immunophenotyping may be useful in supporting the diagnosis of HIV infection in infants with perinatal HIV exposure.

scholarly journals Epidemiology of Anemia in Human Immunodeficiency Virus (HIV)-Infected Persons: Results From the Multistate Adult and Adolescent Spectrum of HIV Disease Surveillance Project

Blood ◽  
1998 ◽  
Vol 91 (1) ◽  
pp. 301-308 ◽  
Author(s):  
Patrick S. Sullivan ◽  
Debra L. Hanson ◽  
Susan Y. Chu ◽  
Jeffrey L. Jones ◽  
John W. Ward ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Disease Surveillance ◽  
Cd4 Count ◽  
Hiv Disease ◽  
Black Race ◽  
Risk Of Death ◽  
Female Sex ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Cd4 Percentage

Abstract To study the incidence of, the factors associated with, and the effect on survival of anemia in human immunodeficiency virus (HIV)-infected persons, we analyzed data from the longitudinal medical record reviews of 32,867 HIV-infected persons who received medical care from January 1990 through August 1996 in clinics, hospitals, and private medical practices in nine United States cities. We calculated the 1-year incidence of anemia (a hemoglobin level of <10 g/dL or a physician diagnosis of anemia); the adjusted odds ratios showing excess risk of anemia associated with demographic factors, prescribed therapies, and concurrent diseases; the risk of death for patients who developed anemia compared with risk for patients who did not develop anemia; and, of patients who did develop anemia, the risk of death for those who did not recover from anemia compared with the risk for those who did recover. The 1-year incidence of anemia was 36.9% for persons with one or more acquired immunodeficiency syndrome (AIDS)-defining opportunistic illnesses (clinical AIDS), 12.1% for patients with a CD4 count of less than 200 cells/μm or CD4 percentage of <14 but not clinical AIDS (immunologic AIDS), and 3.2% for persons without clinical or immunologic AIDS. Of anemia diagnoses, 22% were identified by physicians as drug related. Incidence of anemia was associated with clinical AIDS, immunologic AIDS, neutropenia, thrombocytopenia, bacterial septicemia, black race, female sex, prescription of zidovudine, fluconazole, and ganciclovir, and lack of prescription of trimethoprim-sulfamethoxazole. The increased risk of death associated with anemia differed by first CD4 count: for patients with a CD4 count of ≥200 cells/μL at the beginning of the survival analysis, the risk of death was 148% (99% confidence interval [CI], 114 to 188) greater for those who developed anemia; for patients whose first CD4 count was <200 cells/μL, the risk of death was 56% (99% CI, 43 to 71) greater for those in whom anemia developed. For persons in whom anemia developed, the risk of death was 170% (99% CI, 132 to 203) greater for persons who did not recover from anemia compared with those who did recover. Anemia is a frequent complication of HIV infection, and its incidence is associated with progression of HIV disease, prescription of certain chemotherapeutics, black race, and female sex. Anemia, particularly anemia that does not resolve, is associated with shorter survival of HIV-infected patients.

scholarly journals Drugs of Abuse and Their Impact on Viral Pathogenesis

Viruses ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2387
Author(s):  
Jason Blackard ◽  
Kenneth Sherman
Keyword(s):  
Disease Progression ◽  
Drugs Of Abuse ◽  
Virus Transmission ◽  
Viral Disease ◽  
Viral Pathogenesis ◽  
Viral Pathogens ◽  
Increased Risk ◽  
B Virus ◽  
Immunodeficiency Virus ◽  
Illicit Use

Commonly misused substances such as alcohol, cocaine, heroin, methamphetamine, and opioids suppress immune responses and may impact viral pathogenesis. In recent years, illicit use of opioids has fueled outbreaks of several viral pathogens, including the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). This review focuses on the myriad of mechanisms by which drugs of abuse impact viral replication and disease progression. Virus–drug interactions can accelerate viral disease progression and lead to increased risk of virus transmission.

scholarly journals Therapeutic closure of bronchopleural fistulas using ethanol

2021 ◽  
Vol 15 ◽  
pp. 175346662110444
Author(s):  
Osheen Abramian ◽  
Justin Rosenheck ◽  
Diana Taddeo-Kolman ◽  
Francis Bowen ◽  
Ziad Boujaoude ◽  
...  
Keyword(s):  
Autologous Blood ◽  
Bronchopleural Fistula ◽  
Early Postoperative Period ◽  
Endobronchial Ultrasound ◽  
High Morbidity ◽  
Transbronchial Needle Aspiration ◽  
Surgical Interventions ◽  
Risk Of Death ◽  
Amplatzer Device ◽  
Increased Risk

Bronchopleural fistula (BPF) leading to persistent air leak (PAL), be it a complication of pulmonary resection, radiation, or direct tumor mass effect, is associated with high morbidity, impaired quality of life, and an increased risk of death. Incidence of BPF following pneumonectomy ranges between 4.4% and 20% with mortality ranging from 27.2% to 71%. Following lobectomy, incidence ranges from 0.5% to 1.5% in reported series. BPFs are more likely to occur following right-sided pneumonectomy, while patients undergoing bi-lobectomy were more likely to suffer BPF than those undergoing single lobectomy. In addition to supportive care, including appropriate antibiotics and nutrition, management of BPF includes pleural decontamination, BPF closure, and ultimately obliteration of the pleural space. There are surgical and bronchoscopic approaches for the management of BPF. Surgical interventions are best suited for large BPFs, and those occurring in the early postoperative period. Bronchoscopic techniques may be used for smaller BPFs, or when an individual patient is no longer a surgical candidate. Published reports have described the use of polyethylene glycol, fibrin glues, autologous blood products, gel foam, silver nitrate, and stenting among other techniques. The Amplatzer device, used to close atrial septal defects has shown promise as a bronchoscopic therapy. Following their approval under the humanitarian device exemption program for treatment of prolonged air leaks, endobronchial valves have been used for BPF. No bronchoscopic technique is universally applicable, and treatment should be individualized. In this report, we describe two separate cases where we use an Olympus© 21-gauge EBUS-TBNA (endobronchial ultrasound–transbronchial needle aspiration) needle for directed submucosal injection of ethanol leading to closure of the BPF and subsequent successful resolution of PAL.

scholarly journals Epidemiology of Anemia in Human Immunodeficiency Virus (HIV)-Infected Persons: Results From the Multistate Adult and Adolescent Spectrum of HIV Disease Surveillance Project

Blood ◽  
1998 ◽  
Vol 91 (1) ◽  
pp. 301-308 ◽  
Author(s):  
Patrick S. Sullivan ◽  
Debra L. Hanson ◽  
Susan Y. Chu ◽  
Jeffrey L. Jones ◽  
John W. Ward ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Disease Surveillance ◽  
Cd4 Count ◽  
Hiv Disease ◽  
Black Race ◽  
Risk Of Death ◽  
Female Sex ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Cd4 Percentage

To study the incidence of, the factors associated with, and the effect on survival of anemia in human immunodeficiency virus (HIV)-infected persons, we analyzed data from the longitudinal medical record reviews of 32,867 HIV-infected persons who received medical care from January 1990 through August 1996 in clinics, hospitals, and private medical practices in nine United States cities. We calculated the 1-year incidence of anemia (a hemoglobin level of <10 g/dL or a physician diagnosis of anemia); the adjusted odds ratios showing excess risk of anemia associated with demographic factors, prescribed therapies, and concurrent diseases; the risk of death for patients who developed anemia compared with risk for patients who did not develop anemia; and, of patients who did develop anemia, the risk of death for those who did not recover from anemia compared with the risk for those who did recover. The 1-year incidence of anemia was 36.9% for persons with one or more acquired immunodeficiency syndrome (AIDS)-defining opportunistic illnesses (clinical AIDS), 12.1% for patients with a CD4 count of less than 200 cells/μm or CD4 percentage of <14 but not clinical AIDS (immunologic AIDS), and 3.2% for persons without clinical or immunologic AIDS. Of anemia diagnoses, 22% were identified by physicians as drug related. Incidence of anemia was associated with clinical AIDS, immunologic AIDS, neutropenia, thrombocytopenia, bacterial septicemia, black race, female sex, prescription of zidovudine, fluconazole, and ganciclovir, and lack of prescription of trimethoprim-sulfamethoxazole. The increased risk of death associated with anemia differed by first CD4 count: for patients with a CD4 count of ≥200 cells/μL at the beginning of the survival analysis, the risk of death was 148% (99% confidence interval [CI], 114 to 188) greater for those who developed anemia; for patients whose first CD4 count was <200 cells/μL, the risk of death was 56% (99% CI, 43 to 71) greater for those in whom anemia developed. For persons in whom anemia developed, the risk of death was 170% (99% CI, 132 to 203) greater for persons who did not recover from anemia compared with those who did recover. Anemia is a frequent complication of HIV infection, and its incidence is associated with progression of HIV disease, prescription of certain chemotherapeutics, black race, and female sex. Anemia, particularly anemia that does not resolve, is associated with shorter survival of HIV-infected patients.

Increased Risk of Death in Human Immunodeficiency Virus-infected Children With Pneumococcal Meningitis in South Africa, 2003–2005

2011 ◽  
Vol 30 (12) ◽  
pp. 1075-1080 ◽  
Author(s):  
Peter Nyasulu ◽  
Cheryl Cohen ◽  
Linda De Gouveia ◽  
Charles Feldman ◽  
Keith P. Klugman ◽  
...  
Keyword(s):  
South Africa ◽  
Human Immunodeficiency Virus ◽  
Pneumococcal Meningitis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Immunodeficiency Virus

scholarly journals Association of CTLA4 Gene Polymorphism with Transfusion Reaction after Infusion of Leukoreduced Blood Component

2019 ◽  
Vol 8 (11) ◽  
pp. 1961 ◽  
Author(s):  
Ying-Hao Wen ◽  
Wei-Tzu Lin ◽  
Wei-Ting Wang ◽  
Tzong-Shi Chiueh ◽  
Ding-Ping Chen
Keyword(s):  
Gene Polymorphism ◽  
Adverse Reactions ◽  
Care Center ◽  
Tertiary Care ◽  
Blood Component ◽  
Transfusion Reaction ◽  
Hematopoietic Stem ◽  
Increased Risk ◽  
Hemolytic Transfusion Reaction ◽  
Ctla4 Gene

Leukocytes and cytokines in blood units have been known to be involved in febrile non-hemolytic transfusion reaction (FNHTR), and these adverse reactions still occur while using pre-storage leukoreduced blood products. Blood transfusion is similar to transplantation because both implant allogeneic cells or organs into the recipient. CTLA4 gene polymorphism was found to be associated with graft-versus-host disease in hematopoietic stem cell transplantation. We performed a prospective cohort study at a major tertiary care center to investigate the correlation of CTLA4 gene polymorphism and transfusion reactions. Selected CTLA4 gene SNPs were genotyped and compared between patients with transfusion-associated adverse reactions (TAARs) and healthy controls. Nineteen patients and 20 healthy subjects were enrolled. There were 4 SNPs showing differences in allele frequency between patients and controls, and the frequency of “A” allele of rs4553808, “G” allele of rs62182595, “G” allele of rs16840252, and “C” allele of rs5742909 were significantly higher in patients than in controls. Moreover, these alleles also showed significantly higher risk of TAARs (OR = 2.357, 95%CI: 1.584–3.508, p = 0.02; OR = 2.357, 95%CI: 1.584–3.508, p = 0.02; OR = 2.462, 95%CI: 1.619–3.742, p = 0.008; OR = 2.357, 95%CI: 1.584–3.508, p = 0.02; OR = 2.357, 95%CI: 1.584–3.508, p = 0.02, respectively). The present study demonstrated the correlation of CTLA4 gene polymorphism and transfusion reaction, and alleles of 4 CTLA4 SNPs with an increased risk of TAARs were found. It is important to explore the potential immune regulatory mechanism affected by SNPs of costimulatory molecules, and it could predict transfusion reaction occurrence and guide preventive actions.

scholarly journals Prospective International Study of Incidence and Predictors of Immune Reconstitution Inflammatory Syndrome and Death in People Living With Human Immunodeficiency Virus and Severe Lymphopenia

2019 ◽  
Vol 71 (3) ◽  
pp. 652-660 ◽  
Author(s):  
Irini Sereti ◽  
Virginia Sheikh ◽  
Douglas Shaffer ◽  
Nittaya Phanuphak ◽  
Erin Gabriel ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
The United States ◽  
Cd4 Counts ◽  
Risk Of Death ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Inflammatory Syndrome ◽  
D Dimer

Abstract Background Patients living with human immunodeficiency virus (PLWH) with low CD4 counts are at high risk for immune reconstitution inflammatory syndrome (IRIS) and death at antiretroviral therapy (ART) initiation. Methods We investigated the clinical impact of IRIS in PLWH and CD4 counts &lt;100 cells/μL starting ART in an international, prospective study in the United States, Thailand, and Kenya. An independent review committee adjudicated IRIS events. We assessed associations between baseline biomarkers, IRIS, immune recovery at week 48, and death by week 48 with Cox models. Results We enrolled 506 participants (39.3% were women). Median age was 37 years, and CD4 count was 29 cells/μL. Within 6 months of ART, 97 (19.2%) participants developed IRIS and 31 (6.5%) died. Participants with lower hemoglobin at baseline were at higher IRIS risk (hazard ratio [HR], 1.2; P = .004). IRIS was independently associated with increased risk of death after adjustment for known risk factors (HR, 3.2; P = .031). Being female (P = .004) and having a lower body mass index (BMI; P = .003), higher white blood cell count (P = .005), and higher D-dimer levels (P = .044) were also significantly associated with increased risk of death. Decision-tree analysis identified hemoglobin &lt;8.5 g/dL as predictive of IRIS and C-reactive protein (CRP) &gt;106 μg/mL and BMI &lt;15.6 kg/m2 as predictive of death. Conclusions For PLWH with severe immunosuppression initiating ART, baseline low BMI and hemoglobin and high CRP and D-dimer levels may be clinically useful predictors of IRIS and death risk.

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