Transfusion
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Between January 1995 and November 1998, at Yale-New Haven Hospital, 25 percent of RBCs transfused were processed through prestorage or bedside leukoreduction filters, chosen on a per patient basis (selective leukoreduction [SLR]). Between January 1995 and July 1999, 30 percent of platelet concentrates (PCs) were infused through bedside leukoreduction filters. In an attempt to decrease febrile nonhemolytic transfusion reactions (FNHTR), a change was made from SLR to universal prestorage leukoreduction (UPL) for RBCs between November 1998 and December 1999 and for random donor PCs between July 1999 and January 2000. FNHTR and allergic transfusion reactions (ATR) reported from January 1995 through December 2002 were reviewed. ⋯ A significant decrease in the frequency of posttransfusion FNHTR, but not ATR, for RBCs and PCs followed introduction of 100-percent UPL. The data support the hypothesis that the practice of UPL of RBCs and PCs decreases the frequency of FNHTR and thus improves patient care over the practice of selective leukoreduction.
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Incorrect blood component transfusion is the most frequent serious incident associated with transfusion. Errors responsible for these incidents frequently involve patient misidentification. ⋯ A barcode patient identification system was found to simplify the clinical transfusion process and improve practice. These results provide support for further work on the development of such systems for transfusion and for other hospital procedures requiring patient identification.
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Meta Analysis
WBC-containing allogeneic blood transfusion and mortality: a meta-analysis of randomized controlled trials.
An association between allogeneic blood transfusion (ABT) and mortality was reported by one team of investigators from randomized controlled trials (RCTs) comparing recipients of non-WBC-reduced versus WBC-reduced RBCs in open-heart surgery. A meta-analysis was undertaken to examine whether this finding can be generalized across clinical settings and/or transfused RBC components. ⋯ An association between ABT and either short-term or long-term mortality was not detected across clinical settings and transfused RBC components, but subgroup analyses suggest that an association between WBC-containing ABT and short-term mortality may exist in open-heart surgery and in settings where WBC-reduced allogeneic RBCs filtered before storage are administered.
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Multicenter Study
Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe.
The purpose of this study was to assess current practices in blood management in elective orthopedic surgery in Europe. ⋯ Accurate assessment of preoperative Hb levels, better estimation of perioperative blood loss, efficient use of autologous blood, adherence to transfusion guidelines, and pharmacologic alternatives contribute to effective and comprehensive blood and anemia management.
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Persons with a congenital deficiency of FVIII or F IX (hemophilia A and hemophilia B, respectively) receive factor concentrate to treat or prevent bleeding. ⋯ Hemophilia patients, especially patients with severe disease, use large amounts of expensive factor concentrates to prevent and to treat bleeding episodes. Specialized hemophilia treatment centers play a key role in the care of these patients.