Transfusion medicine
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Transfusion medicine · Feb 2009
Controlled Clinical TrialAn individualized pre-operative blood saving protocol can increase pre-operative haemoglobin levels and reduce the need for transfusion in elective total hip or knee arthroplasty.
We have prospectively evaluated the efficacy of an individualized pre-operative blood saving protocol in elective total hip arthroplasty (THA) or total knee arthroplasty (TKA). The primary aim was to obtain a pre-operative haemoglobin (Hb) level of > or =14 g dL(-1). A reduction in requirements for allogeneic transfusion was considered the second aim. ⋯ Treatment with PAD showed a significant reduction in the pre-operative Hb levels. The rate of RBC transfusion was 18.8% compared with 31.5% of matched historic group (P < 0.001). In conclusion, all patients scheduled to undergo THA or TKA should be candidates for an individualized pre-operative blood salvage programme.
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Transfusion medicine · Dec 2008
Case Reports Clinical TrialScreening of multiparous women to avoid transfusion-related acute lung injury: a single centre experience.
The aim of this study was to investigate which approach for serological testing of multiparous donors might be feasible and effective to reduce the risk of transfusion-related acute lung injury (TRALI). TRALI is a serious adverse event of blood transfusion. Antibodies to granulocytes and human leucocyte antigens (HLAs) are frequently detected in sera of implicated donors. ⋯ We conclude from these data that, not unexpectedly, the number of previous pregnancies is not a reliable indicator for the likelihood of inducing TRALI. More importantly, screening strategies for antibodies that might induce TRALI should probably not be reduced to HLA antibody screening. This finding awaits further research.
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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.