Transfusion medicine
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Transfusion medicine · Oct 2008
A questionnaire-based survey of perioperative blood conservation practice for revision hip arthroplasty in Scotland.
The aim of this study was to describe current blood conservation practice during revision hip surgery in Scotland and document practice variation. Revision hip surgery is associated with a high likelihood of blood transfusion. A decrease in the proportion of patients requiring blood transfusion has been documented, but the reasons for this are unclear. ⋯ A total of 62 of 92 (67%) surgeons and 78 of 174 (45%) anaesthetists surveyed participated in revision hip surgery. Blood conservation practice varied widely: 34 of 78 (44%) anaesthetists routinely assessed revision hip patients >or=1 week prior to surgery; 10 of 62 (16%) surgeons and 24 of 78 (31%) anaesthetists routinely used cell salvage; 7 of 78 (9%) anaesthetists and 2 of 62 (3%) surgeons routinely used tranexamic acid; and 45 of 62 (73%) surgeons use a transfusion protocol. A wide variation in the use of blood conservation strategies exists during revision hip surgery in Scotland.
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Although passive infusion of plasma-rich components containing white blood cell (WBC) antibodies are responsible for majority of the reported transfusion-related acute lung injury (TRALI) cases, the minimum volume of residual plasma, which might trigger TRALI, is not known. We report three cases of TRALI where the implicated donor component contained between 10 and 20 mL of residual plasma. Two cases were related to transfusion of red blood cells prepared in optimal additive solution, and the other was related to transfusion of pooled buffy coat platelets. ⋯ Our cases suggest that the residual plasma volume as small as 10-20 mL containing donor derived WBC antibodies may cause TRALI. The risk of TRALI remains, despite providing pooled platelets suspended in male donor plasma. The significance of multiple HLA antigen/antibody matching between donor and recipient in immune TRALI warrants further study.
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Transfusion medicine · Oct 2008
A tabletop exercise to assess a hospital emergency blood management contingency plan in a simulated acute blood shortage.
The objective was to assess both our local plan and the assumptions made in the national guidelines on how laboratories should prepare for an acute shortage of red cells. The Chief Medical Officer's National Blood Transfusion Committee for England and North Wales has issued guidance on how hospitals should prepare contingency plans to deal with a shortage of red cells for transfusion. This study has therefore assessed the practicalities of these proposals together with assessing how well local policies would deal with this situation. ⋯ The results show that application of the national guidelines on the restriction of the use of red cells during an acute blood shortage resulted in all transfusion requests for red cells being met. We also appear to have shown that the assumptions made by the national transfusion team are realistic. Carrying out a tabletop exercise is a useful method to assess local procedures for dealing with an acute reduction in the supply of red cells.