Transfusion
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There are no current estimates of the residual risks of transmission by blood of hepatitis B virus (HBV) or hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in China. Such estimates are an essential prerequisite to monitoring and improving transfusion safety as well as supporting evidence based assessment of the value of implementing new screening interventions. ⋯ Relative to that reported for Western blood systems, the prevalence and the residual risk of HBV and HCV are high, whereas HIV is comparable. Pending a formal cost-effectiveness study for NAT, implementing improved HBsAg and combination HCV antibody-antigen assays in Shenzhen would markedly reduce the residual risk.
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Meta Analysis
Lower or higher doses for prophylactic platelet transfusions: results of a meta-analysis of randomized controlled trials.
There are conflicting data regarding the optimal platelet (PLT) dose to transfuse prophylactically to patients with thrombocytopenia. A meta-analysis has been performed to summarize the results of different randomized controlled trials (RCTs). ⋯ Few RCTs have addressed the issue of PLT dose for transfusion. It is shown that the transfusion of higher doses of PLTs is statistically associated with an increase in the transfusion interval and in the posttransfusion PLT count increment. A well-designed study of enough power is essential to establish the most effective and efficient dose for prophylactic PLT transfusions.
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Randomized Controlled Trial
Retransfusion of filtered shed blood in primary total hip and knee arthroplasty: a prospective randomized clinical trial.
Allogeneic blood transfusions are associated with a number of well-recognized risks and complications. Postoperative retransfusion of filtered shed blood is an alternative to (reduce) allogeneic blood transfusion. The objectives of this study were to evaluate the clinical efficacy of retransfusion of filtered shed blood and to evaluate the complications, in particular febrile reactions. ⋯ Postoperative retransfusion of filtered shed blood is effective for decreasing allogeneic blood transfusions after total hip and knee arthroplasty. There was no relationship between retransfusions and postoperative febrile reactions.
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Randomized Controlled Trial
Cardioprotective effects of acute normovolemic hemodilution in patients with severe aortic stenosis undergoing valve replacement.
After acute normovolemic hemodilution (ANH), improvement of the rheologic conditions may contribute to optimize tissue oxygen delivery and attenuate ischemia-reperfusion injuries. It was hypothesized that ANH would confer additional cardioprotection in patients with ventricular hypertrophy undergoing open heart surgery. ⋯ Besides conventional cardiac preservation techniques, preoperative ANH further attenuates myocardial injuries. Optimization of preischemic myocardial oxygen delivery and/or consumption and the postconditioning effects of endogenous EPO are potential mechanisms for ANH-induced cardioprotection.
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Prophylactic platelet (PLT) transfusion practices have become more conservative as studies support a threshold for transfusions at 10 x 10(9) per L. This change in practice may reduce our use of PLT transfusions. ⋯ Many prophylactic PLT transfusions were given at PLT counts higher than the recommended trigger. Although the new transfusion guidelines altered transfusion practice, only a minor change in overall PLT usage was observed. Other changes in transfusion practices, such as dose per transfusion or sampling interval, will be required before significant reduction in the costs and hazards of prophylactic PLT transfusions can be realized.