Transfusion
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A survey was conducted among resident physicians at nine academic medical centers to assess their perceptions of their knowledge of transfusion medicine (TM), their confidence in using various blood bank resources, and their ratings of the contribution of various learning resources to their knowledge of TM. A total of 320 residents completed the survey; nearly 90 percent were in an internal medicine, surgery, or anesthesiology residency. Respondents placed a high value on the relevance of TM to patient care, although they rated their knowledge and learning opportunities as only moderate. ⋯ Residents had the greatest confidence in using packed red cells, platelets, and fresh-frozen plasma. Surgery and anesthesiology residents generally had greater confidence in using blood bank resources than internal medicine residents. The findings of the survey can be used, along with the results of medical care evaluations of transfusion practice and opinions of education experts, to create an optimally relevant and effective curriculum for resident education in transfusion medicine.
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Case Reports
Virus-inactivated factor VIII concentrate prevents postoperative bleeding in a patient with von Willebrand's disease.
A patient with von Willebrand's disease underwent cholecystectomy after replacement therapy with a factor VIII concentrate that had been sterilized by treatment with tri(n-butyl)phosphate and Tween 80. The patient received 53 units of factor VIII per kg of body weight prior to operation. ⋯ This replacement regimen prevented excessive bleeding during surgery and supported normal hemostasis during the postoperative period. Analysis of the multimeric pattern and the functional assay of von Willebrand factor in factor VIII concentrates indicated that the procedures utilized for virus inactivation had no significant deleterious effect upon the quality of von Willebrand factor molecules.
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The authors studied retrospectively the formation of clinically significant red cell (RBC) alloantibodies in 958 HLA-typed, multiply transfused patients receiving kidney (603 patients) or liver (263 patients) transplants or plateletpheresis transfusions (92 patients). RBC alloantibodies were found in 91 (9.5%) of these patients and multiple antibodies in 35 (3.7%). Rh (D, C, c, and E) antibodies accounted for 49 percent of the total and Kell antibodies for 31 percent. ⋯ Renal transplant patients with RBC alloantibodies were somewhat more broadly HLA-alloimmunized than were those without RBC alloantibodies. Patient gender did not affect these results. The authors concluded that the immune response to RBC alloantigens is independent of HLA type but is associated with an increased level of HLA antibody formation.
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When red cells are stored as suspensions in artificial preservative solutions such as those consisting of saline, adenine, and glucose, increased hemolysis of the red cells occurs in vitro, a phenomenon that is readily prevented by the addition of mannitol. The mechanism by which mannitol prevents hemolysis is unknown. The authors have examined the possibility that mannitol prevents hemolysis by prevention of osmotic swelling of red cells that might otherwise increase their volume beyond their critical hemolytic volume. ⋯ Moreover, increasing the volume of the stored red cells acutely by osmotic means results in relatively little additional hemolysis. These findings make it appear unlikely that simple osmotic lysis is the cause of hemolysis in stored cells. Some other stabilizing effect of mannitol that may or may not be related to its osmotic effect must play a role.
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Electrocardiographic (ECG) monitoring was performed on 291 donors during apheresis. Twenty-one donors (7.2%) had clinical symptoms such as discomfort, nausea, chill, numbness, and paresthesia, and 13 of this group exhibited ECG abnormalities, such as tachycardia, bradycardia, and other abnormal wave patterns. The donors with tachycardia and slight bradycardia had no symptoms. ⋯ These changes were not associated with symptoms. Only three of these donors complained of discomfort or chest heaviness. The abnormal waves appeared more often in granulocytapheresis donors than in plateletapheresis donors.