Transfusion
-
Multicenter Study
Red blood cell transfusion practice in elective orthopedic surgery: a multicenter cohort study.
The indications for red blood cell (RBC) transfusions remain unclear despite published guidelines. Our hypothesis was that the transfusion practice varies inside the Centre hospitalier de l'Université de Montréal (CHUM). ⋯ There was no difference among hospitals regarding the way RBC transfusions are used. Our data suggest that physicians mainly based their decision to transfuse on a single variable, the Hb concentration, with the use of a restrictive strategy. Future trials should focus on the optimal transfusion trigger to adopt in major orthopedic surgery.
-
Clinical guidelines recommend a restrictive transfusion strategy in nonhemorrhaging critically ill patients. ⋯ Between 1997 and 2007, important and sustained changes have occurred in our MICU physician transfusion practices, with overall reductions in the proportion of patients transfused, mean pretransfusion Hb level, and nadir Hb level in patients who were not transfused.
-
Pathogen reduction technologies (PRTs) may induce storage lesion in platelet (PLT) concentrates. To investigate this, buffy coat PLTs (BCPs) in PLT additive solution (AS; SSP+) with or without Mirasol PRT (CaridianBCT Biotechnologies) were assessed by quality control tests and four-color flow cytometry. ⋯ PRT treatment of BCP in AS induced a minor initial PLT loss and enhanced metabolism and PLT activation. The clinical relevance for PLT function in vivo of these findings will be investigated in a clinical trial.
-
Trypanosoma cruzi, the etiologic agent of Chagas disease, is a potential threat to transfusion recipients in the United States. The cost-effectiveness of seven testing strategies was evaluated against no testing and hierarchically in incremental analysis. Donor-specific strategies included testing donors born in endemic countries, testing all donors a specific number of times, or testing all donors every time. Component-specific strategies are based on screening platelet-containing donations. ⋯ Selective T. cruzi screening generates nearly the same effectiveness as universal screening, but at a reduced cost. Outcomes and associated costs of Chagas disease take longer to materialize than the average life expectancy of transfusion recipients.