Transfusion
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Red blood cell (RBC) transfusion may prolong recovery in some patients, perhaps due to changes that occur during more prolonged RBC storage. We examined the impact of RBC transfusion and the age of transfused RBC units on clinical outcomes in hematopoietic stem cell transplantation (HSCT). ⋯ The importance of RBC storage time does not appear to influence clinical outcomes in HSCT. Patients with increased RBC transfusion requirements have greater toxicity after HSCT. Whether RBC transfusion contributes to toxicity, however, remains unclear.
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Patients with severe thrombocytopenia are at risk for bleeding during insertion of central venous catheters (CVCs). Although most guidelines recommend preprocedural platelet (PLT) transfusions at a threshold of less than 50 × 10(9) /L, there is only weak evidence supporting such recommendations. ⋯ CVC placements can safely be performed in patients with PLT counts of 20 × 10(9) /L or more without preprocedural PLT transfusions.
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Randomized Controlled Trial
Stored red blood cell viability is maintained after treatment with a second-generation S-303 pathogen inactivation process.
Transfusion-transmitted infections and immunologic effects of viable residual lymphocytes remain a concern in red blood cell (RBC) transfusion. Pathogen reduction technologies for RBC components are under development to further improve transfusion safety. S-303 is a frangible anchor-linker-effector with labile alkylating activity and a robust pathogen reduction profile. This study characterized the viability of RBCs prepared with a second-generation S-303 process and stored for 35 days. ⋯ RBCs prepared using the S-303 pathogen inactivation process were physiologically and metabolically suitable for transfusion after 35 days of storage, met the FDA guidance criteria for 24-hour recovery, and did not induce antibody formation.
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In 2005, The Joint Commission set about assessing the need for performance measures associated with the provision of blood products. Through a rigorous process, seven patient blood management performance measures were created. These measures incorporated a measure requiring transfusion consent; three measures requiring the combination of a laboratory value and a rationale for transfusion of plasma, platelets, or red blood cells; a measure requiring standard documentation about a transfusion; a measure evaluating preoperative anemia screening; and a measure of preoperative type screening and antibody testing before the start of major blood loss surgery. This article describes the process of this measure development and summarizes the final measures and some of the evidence supporting the measures.
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Blood transfusion is the most common procedure performed in American hospitals, and transfusions are commonly ordered by physicians without formal training in transfusion medicine. Several transfusion medicine curricula have been proposed, including those developed through the Transfusion Medicine Academic Awards (TMAA). To our knowledge, no comprehensive study has assessed how transfusion medicine is incorporated into undergraduate medical education. ⋯ Transfusion medicine content in American undergraduate medical education is variable and the influence of the TMAA program on contemporary medical school curricula is questionable. Future efforts in this area should focus on standardizing and improving undergraduate medical education in transfusion medicine.