Seminars in hematology
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Seminars in hematology · Jul 1997
ReviewAllogeneic transfusion and infection: economic and clinical implications.
An increased incidence of postoperative infection and risk of cancer recurrence in patients who have received allogeneic blood transfusions suggests that such transfusions may be associated with clinically significant immunomodulatory effects. Allogeneic transfusion increase humoral immunity and decrease cell-mediated immunity. The mechanism of allogeneic transfusion-induced immunomodulation may involve altered cytokine regulation with a shift toward a type-2 (Th2) immune response. ⋯ Multiple linear regression analyses demonstrated that the number of units of allogeneic blood transfused, rather than surgeon and type of surgery, was the most statistically significant predictor of length of stay and hospital charges. Using data reported in the literature, we estimate that the death rate from allogeneic transfusion-related postoperative infection and cancer recurrence combined (215 deaths with 1% causality to 21,500 with 100% causality) may exceed the death rate due to all other transfusion risks combined. Improved clinical outcomes may result from techniques that minimize allogeneic blood use or its immunologic effects (e.g., autologous transfusion or other blood-sparing approaches in surgery, leukodepletion of allogeneic blood, and the use of growth factors [eg, epoetin alfa]).
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Seminars in hematology · Jul 1997
Review Randomized Controlled Trial Clinical TrialPerioperative epoetin alfa increases red blood cell mass and reduces exposure to transfusions: results of randomized clinical trials.
To avoid the inherent risk of complications associated with perioperative allogeneic transfusion, preoperative autologous blood donation (PAD) is frequently employed by patients undergoing major elective surgical procedures. However, many patients are unable to donate a sufficient quantity of blood prior to surgery. Recent studies have shown that epoetin alfa (Procrit; Ortho-Biotech, Raritan, NJ) effectively increases red blood cell (RBC) mass when administered preoperatively and decreases the requirement for allogeneic transfusion. ⋯ Our study demonstrated that epoetin alfa is safe and effective in increasing RBC mass; however, iron stores considered sufficient for basal erythropoiesis may not optimally support the accelerated RBC production associated with epoetin alfa therapy. In a subsequent randomized multicenter trial, we compared weekly epoetin alfa dosing to daily dosing in patients undergoing elective major orthopedic surgery. The results of this study indicated that administering epoetin alfa on a weekly schedule for several weeks prior to surgery may be at least as effective and more convenient than perioperative daily epoetin alfa dosing.