Vox sanguinis
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We identified some fatal cases where massively bleeding patients received inadequate transfusion therapy. The aim of this study was to review and evaluate the transfusion practice in acutely multitransfused patients. ⋯ An early balanced transfusion therapy is vital in massively bleeding patients, and a pro-active approach from the blood bank is warranted. We have introduced an acute transfusion package (ATP) consisting of 5 RBC, 5 FFP and 2 PC units, indicated in massively bleeding patients, securing a balanced transfusion therapy.
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Analyses of fatal transfusion reactions in the UK and USA have shown that transfusion-related acute lung injury (TRALI) is among the most common causes of fatal transfusion reactions. ⋯ By virtue of its morbidity and mortality, TRALI has become one of the most serious current complications of transfusion. To prevent further antibody-mediated cases, the evaluation of TRALI should include leucocyte antibody testing of implicated donors. However, further studies are necessary for the prevention of this serious transfusion complication.
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Patients undergoing surgery for hip fracture (HF) often receive perioperative allogeneic blood transfusions (ABT) to avoid anaemia. However, concerns about the adverse effects of ABT have prompted the review of transfusion practice and the search for a safer treatment of perioperative anaemia. ⋯ The blood-saving protocol implemented seems to reduce ABT requirements in patients with HF, and is associated with a lower postoperative morbidity. The possible mechanisms involved in these effects are discussed.
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Survival rates in patients transfused in 1993 and 2000 were compared in relation to diagnoses and surgical interventions. ⋯ The improved survival among those transfused in 2000 could not be accounted for by differences in ages or case-mix.
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The cloning of blood group genes and subsequent identification of the molecular bases of blood group polymorphisms has made it possible to predict blood group phenotypes from DNA with a reasonable degree of accuracy. The major application of this technology, which has now become the standard of care, is the determination of a fetal RHD genotype in women with anti-D, to assess whether the fetus is at risk of haemolytic disease of the fetus and newborn (HDFN). ⋯ Since the discovery of fetal DNA in maternal plasma in 1997, the technology of detecting an RHD gene in this very small quantity of fetal DNA has developed rapidly, so that non-invasive fetal D typing can now be provided as a diagnostic service for D-negative pregnant women with anti-D. Within a few years, it is probable that fetuses of all D-negative pregnant women will be tested for RHD, to establish whether the mother requires antenatal anti-D immunoglobulin prophylaxis.