Vox sanguinis
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Although we still do not know enough about the influence of anaemia and transfusion on outcomes for the surgical patient, it is possible to develop a general consensus about many aspects of management. A quality programme to improve consistency of practice in these consensus areas is feasible. (Table 6) This should be linked with further randomised trials to evaluate the clinical effectiveness of alternative regimes.
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The occurrence of iatrogenic cases of Creutzfeldt-Jakob disease (CJD) and the isolation of infectivity in some laboratory transmission studies in transmissible spongiform encephalopathies raises the possibility that CJD might be accidentally transmissible through blood or blood products. Epidemiological evidence, although not conclusive, does not suggest that classical CJD is transmitted through this route. However, new variant CJD (nvCJD) might pose greater risks of accidental transmission of infection and mechanisms to reduce the theoretical risk are under consideration. The theoretical risks from CJD and nvCJD must be balanced against the established therapeutic benefits of blood and blood products.
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Electronic verification of ABO compatibility (computer crossmatching) has been accepted as the crossmatching procedure for patients without clinically significant alloantibodies. Computer crossmatching offers several advantages over the immediate spin crossmatch and enables the setting up of a self service blood banking system. ⋯ Blood banking service can also be provided at satellite hospitals without stationing blood banking staff there. We have also developed a novel self service system that does not require expensive computer hardware and networking.
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Multicenter Study
Transfusion practices in primary total joint replacements in Finland.
A multicenter survey was carried out in 11 Finnish hospitals to determine the prevailing transfusion practices in orthopedic surgery. ⋯ The use of RBCs in orthopedic surgery was generous compared with reports from other European countries and the US. Each hospital's individual transfusion policy seemed to be a strong determinant of allogeneic blood use.