Transfusion
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Meta Analysis
The intention-to-treat principle in clinical trials and meta-analyses of leukoreduced blood transfusions in surgical patients.
The scientific method requires that only experiments actually and correctly performed be used to draw conclusions. The intention-to-treat principle requires that all patients, even those not or improperly treated, be included. In clinical trials and meta-analyses investigating leukoreduced blood transfusions to reduce postoperative infections, the intention-to-treat principle and the scientific method have been variably applied. ⋯ When data restricted to patients receiving transfusions are analyzed, and no data absent from the actual investigations are introduced, leukoreduced transfusions substantially and significantly reduce the odds of postoperative infection by approximately 50 percent. These results demonstrate the importance of including only scientifically valid data in clinical trials and meta-analyses. The intention-to-treat principle should never lead to inclusion of data not actually derived from experimental results.
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Comparative Study Clinical Trial
Proactive administration of platelets and plasma for patients with a ruptured abdominal aortic aneurysm: evaluating a change in transfusion practice.
Continued hemorrhage remains a major contributor of mortality in massively transfused patients and those who survive have a higher platelet (PLT) count and a shorter prothrombin time and activated partial thromboplastin time (APTT) than nonsurvivors. It was considered that early substitution with PLTs and fresh-frozen plasma (FFP) would prevent development of coagulopathy and thus improve survival. ⋯ This study suggests that proactive administration of PLTs and FFP improves coagulation competence, reduces postoperative hemorrhage, and increases survival in massively bleeding rAAA patients.
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Comparative Study
In vitro quality of red blood cells (RBCs) collected by multicomponent apheresis compared to manually collected RBCs during 49 days of storage.
New technologic developments enable automated collection and preparation of red blood cells (RBCs). This study's aim was to evaluate quality of apheresis-derived RBCs (ARBCs) collected as single units along with platelets (RBC-Ps) or double units (2-RBCs) with four different apheresis systems. ⋯ ARBCs exhibited better predictability in volume and absolute RBC mass than MRBCs and demonstrated sufficient in vitro quality throughout storage, even though lower ATP preservation and higher methemoglobin formation were observed compared to MRBCs probably due to differences in glucose metabolism.
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American Red Cross surveillance data on transfusion-related acute lung injury (TRALI) fatalities were analyzed to evaluate the association with components from donors with white blood cell (WBC) antibodies and to examine the potential impact of the selective transfusion of plasma from male donors. ⋯ Plasma components linked to female donors with WBC antibodies were responsible for the majority of probable TRALI fatalities. Prudent measures to limit transfusion of WBC antibody-containing plasma components may prevent as many as six fatalities per year in the Red Cross system.
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Postchemotherapy mobilization results were reviewed in patients undergoing apheresis before planned autologous hematopoietic progenitor cell (HPC) transplantation to improve the timing of collection procedures. ⋯ In the majority of patients, the first day of apheresis occurred 11 to 13 days after the last dose of chemotherapy with a variety of different chemotherapy regimens. Administering the last dose of chemotherapy on Thursday or Friday versus Monday, Tuesday, or Wednesday was associated with a 77 percent lower incidence in the frequency of weekend apheresis collections (p < 0.001).