Transfus Apher Sci
-
The number of Jehovah's Witnesses worldwide is estimated at approximately 8.6 million. As Jehovah's Witnesses refuse administration of blood and blood-derived products on religious grounds, transfusion of red blood cells is not an option. It is especially problematic when anaemia develops acutely, as in non-elective surgery, as there is no time to optimise volume of red blood cells preoperatively. ⋯ To our knowledge, the patient presented here was the oldest patient who survived anaemia of such severity to date. When deciding on red blood cells transfusion clinicians should consider patient's physiologic response to anaemia, as tolerance of anaemia is variable among patients. Even elderly patients may tolerate severe anaemia, as it has been shown in our care report.
-
Serological testing for extended RHCcEe, Kell, Kidd and Duffy blood grouping from multitransfused patients may not give correct blood grouping of the recipient. Hence molecular testing for these blood groups was compared with serological groups in a cohort of multitransfused thalassemia mjor and sickle cell anaemia patients. ⋯ Extended phenotyping in multitransfused thalassemia patients by serological technique often donot detect the exact red cell phenotype of the recipient and molecular techniques for such grouping is preferable, especially in multitransfused thalassemia patients where red cells from previous transfusions continues to be present in significant numbers whenever the testing is done.
-
In cardiac surgical patients it is a complex challenge to find the ideal balance between anticoagulation and hemostasis. Preoperative anemia and perioperative higher transfusion rates are related to increased morbidity and mortality. Patient blood management (PBM) is an evidence based patient specific individualized protocol used in the perioperative setting in order to reduce perioperative bleeding and transfusion rates and to improve patient outcomes. ⋯ This narrative review focuses on the challenges with special emphasis on PBM in the preoperative phase and intraoperative transfusion management and hemostasis in cardiac surgery patients. It is a "must" that PBM is a collaborative effort between anesthesiologists, surgeons, perfusionists, intensivists and transfusion laboratory teams. This review represents an up to date overview over "PBM in cardiac surgery patients".
-
Clinical Trial
Clearance and phenotype of extracellular vesicles after red blood cell transfusion in a human endotoxemia model.
In the critically ill, extracellular vesicles (EV) from red blood cells (RBC) have been related to adverse effects of blood transfusion. Stored RBC units contain high concentrations of RBC- EVs, thereby increasing the concentration of EVs in the circulation after transfusion. The mechanisms underlying the clearance of donor RBC-EVs after transfusion are unknown. This study investigates whether membrane markers that are associated with clearance of RBCs are also implicated in clearance of RBC-EVs in human endotoxemic recipients of a transfusion. ⋯ Besides a minor fraction of PS-exposing EVs, RBC-EVs produced during storage do not expose detectable levels of RBC membrane markers that are associated with clearance, which is in contrast to the EVs produced by the circulating RBCs.