Vox sanguinis
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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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This review deals with the rationale for the use of hemodilution in patients not subjected to open heart surgery. The claim for an optimum of circulatory oxygen transport at 30% hematocrit has been disproved; hemodilution thus simply means acute normovolemic anemia. ⋯ Potentially serious clinical side effects have been reported. Hemodilution should therefore not be carried beyong the lower normal range for the hemoglobin or hematocrit level, i.e. 12--12.5 g% or 35--36%.