Vox sanguinis
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The National Haemovigilance Office has collected and analysed reports on errors associated with transfusion since 2000. A 3-year pilot research project in near-miss event reporting commenced in November 2002. ⋯ This study confirms that near-miss events occur far more frequently than adverse events causing harm. Collecting near-miss data is an effective means of highlighting human and system failures associated with transfusion that may otherwise go unnoticed. These data can be used to identify areas where resources need to be targeted in order to prevent future harm to patients, improving the overall safety of transfusion.
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Meta Analysis
White-blood-cell-containing allogeneic blood transfusion and postoperative infection or mortality: an updated meta-analysis.
Additional randomized controlled trials (RCTs) comparing recipients of non-white-blood-cell-(WBC)-reduced and WBC-reduced allogeneic red blood cells (RBCs) have been reported since the undertaking of previous meta-analyses of the association of allogeneic blood transfusion (ABT) with postoperative infection and/or mortality. Because no further RCTs are underway, a final meta-analysis of all available RCTs was conducted. ⋯ An association between ABT and postoperative infection or short-term mortality is not detected across all clinical settings and transfused RBC products. An association between ABT and mortality is detected in cardiac surgery, but the other associations found in subgroup analyses contradict current theories about mechanism(s) of the ABT effect.
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Randomized Controlled Trial
Rationalizing blood transfusion in cardiac surgery: preliminary findings with a red cell volume-based model.
Cardiac surgery, utilizing extracorporeal circulation, is associated with a heavy fluid load that may significantly depress haemoglobin concentration. Thus, considering haemoglobin alone may be an inaccurate method of replacing red cell volume loss. This study was designed to examine the impact on red cell transfusion of a red cell volume-based guideline. ⋯ Considering haemoglobin concentration alone may significantly overestimate the requirement for red cell transfusion in elective cardiac surgery patients.
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Despite the continuous efforts to increase the safety of blood components, red blood cell transfusions remain associated with some risks and side effects. Therefore, numerous techniques have been developed to decrease blood use, but they also carry risks and bear costs. ⋯ The development of the 'best strategy' consists of the selection of those techniques that are most appropriate to the local specific situation. It implies the establishment of a reliable system, collecting data both at the surgical team and at the medical level.
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Requirements for allogeneic blood transfusion (ABT) after total knee replacement (TKR) are still high (30-50%), and salvage of unwashed filtered postoperative shed blood (USB) may represent an alternative to ABT. We evaluated that patients are more likely to benefit of USB reinfusion after TKR. ⋯ Return of USB after TKR seems to reduce the need for ABT, especially in patients with preoperative Hb between 12 and 15 g/dl. There is little benefit of USB reinfusion for patients with preoperative Hb > 15 g/dl, whereas patients with preoperative Hb < 12 g/dl would probably benefit from the combination of USB with some other blood-saving method.