Vox sanguinis
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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.
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To determine the cause of hypotensive reactions associated with platelet transfusions in coronary artery bypass surgery patients. ⋯ Preliminary findings suggest a new type of transfusion reaction associated with the use of negatively charged leukocyte reduction filters during platelet transfusions to patients on ACE inhibitors.
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Delayed haemolytic transfusion reactions (DHTRs) are seen more frequently in patients with sickle cell disease (SCD) than in other groups of patients, and are characterised by a positive direct antiglobulin test and the appearance of previously undetected red blood cell (RBC) alloantibodies in the patient's serum. Recently a syndrome of post-transfusion hyperhaemolysis has been described in children with SCD, characterised by destruction of both autologous and transfused RBCs with negative serological findings: continuation of RBC transfusion exacerbated haemolysis further. We describe a case of life-threatening post-transfusion hyperhaemolysis in an adult patient with SCD in whom severe anaemia necessitated further RBC transfusion, which was successfully performed in conjunction with intravenous immunoglobulin. This approach may be useful in the management of post-transfusion hyperhaemolysis in SCD as well as in the management of severe DHTRs.
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Randomized Controlled Trial Clinical Trial
Irradiation of fresh whole blood for prevention of transfusion-associated graft-versus-host disease does not impair platelet function and clinical hemostasis after open heart surgery.
Since our previous studies suggested that the transfusion of 1 unit fresh whole blood (FWB) after cardiopulmonary bypass (CPB) using a bubble oxygenator may provide hemostatic benefit equivalent to 8-10 units of platelet concentrates, we have routinely used FWB at the termination of CPB. Two patients who received FWB and developed transfusion-associated graft-versus-host disease (TA-GVHD) prompted us to investigate the effect of irradiation of FWB on platelet and clinical hemostasis. Twenty-four patients were randomized to receive either 1 unit FWB (12 patients), or 1 unit irradiated FWB (IrFWB, 1,500 cGy,12 patients) after CPB. ⋯ Platelet aggregation was similar after transfusion of FWB (3.0 +/- 1.0) and after IrFWB (3.2 +/- 0.8), as was the increase in platelet count. Twenty-four hours total postoperative bleeding was similar (560 +/- 420 and 523 +/- 236 ml for FWB and IrFWB, respectively). We conclude that irradiation of FWB for prevention of TA-GVHD does not impair platelet aggregating capacity, and can be used when blood is donated by the patient's next of kin.
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Letter Case Reports
HIV-1 causing AIDS and death in a seronegative individual.