TRANSFUSION ISSUES

Transfusion of aged packed red blood cells results in decreased tissue oxygenation in critically injured trauma patients. J Trauma. 2009 Jul;67(1):29-32. There was a decrease in peripheral tissue oxygenation in patients receiving older red blood cells. There was no oxygenation decrease in patients receiving blood less than 21 days. This indicates that factors in stored blood may influence the peripheral vasculature and oxygen delivery.

Negative Impact of Blood Transfusion on Recurrence and Prognosis of Hepatocellular Carcinoma After Hepatic Resection. J Gastrointest Surg. 2009 Jul 7. [Epub ahead of print] Transfusion of blood products is associated with increased recurrence rate and worse survival after elective hepatic resection for patients with hepatocellular carcinoma.

Relationships among haemoglobin level, packed red cell transfusion and clinical outcomes in patients after cardiac surgery. Intensive Care Med. 2009 Jun 23. [Epub ahead of print] Low haemoglobin concentrations and transfusions in patients undergoing cardiac surgery are associated with increased morbidity and mortality. Also, anemia and transfusions are associated with poor outcome. Therefore, intra- and postoperative bleeding seem to be a risk factor in patients undergoing cardiac surgery.

Perioperative blood transfusion in combat casualties: a pilot study. J Trauma. 2009 Apr;66(4 Suppl):S150-6.Allogeneic blood transfusions in combat casualties were associated with impaired wound healing, increased perioperative infection rate, and resource utilization. In addition, the extent of blood transfusion was associated with significant differences in inflammatory chemokine and cytokine release.

Intraoperative transfusion of 1 u to 2 u packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients. J Am Coll Surg. 2009 May;208(5):931-937.e2. Epub 2009 Mar 26. Intraoperative transfusion of PRBCs increases risk for mortality and several morbidities in general surgery patients. These risks, substantial for even 1 U, remain after adjustment for transfusion propensity and numerous risk factors available in the American College of Surgeons National Surgical Quality Improvement Program. Transfusion for mildly hypovolemic or anemic patients should be discouraged in light of these risks.

Red blood cell supernatant potentiates LPS-induced proinflammatory cytokine response from peripheral blood mononuclear cells. J Interferon Cytokine Res. 2009 Jun;29(6):333-8 Packed red blood cell supernatant potentiates proinflammatory lipopolysaccharide-induced cytokine secretion from PBMCs. This response is accentuated with storage duration and partially attenuated with leukoreduction. These findings may partially explain the immune activation seen clinically after blood transfusion.

Cytomegalovirus infection in critically ill patients: a systematic review. Crit Care. 2009 May 14;13(3):R68. [Epub ahead of print] CMV infection occurs in 0-36% of critically ill patients, mostly between 4-12 days after ICU admission. Potential risk factors for CMV infection include sepsis, requirement of mechanical ventilation, and transfusions. CMV infection frequently occurs in critically ill immunocompetent patients and may be associated with poor outcomes

The association of perioperative red blood cell transfusions and decreased long-term survival after cardiac surgery. Anesth Analg. 2009 Jun;108(6):1741-6. Exposure to 1 or 2 U of RBCs was associated with a 16% increased hazard of decreased survival after cardiac surgery.

First transmission of human immunodeficiency virus Type 1 by a cellular blood product after mandatory nucleic acid screening in Germany. Transfusion. 2009 May 11. [Epub ahead of print] This case represents the first documented HIV-1 transmission by transfusion of red blood cells after mandatory introduction of HIV-1 NAT for blood screening in Germany. Low viral load and mismatches in the primer/probe region might explain the detection failure of the NAT screening assay. A certain risk remains that new virus variants contain mutations at positions critical for amplification or detection of viral genomes.

[TRALI and TACO: Diagnostic and clinical management.]. Transfus Clin Biol. 2009 May 11. [Epub ahead of print] French. Review

Red Blood Cell Supernatant Potentiates LPS-Induced Proinflammatory Cytokine Response From Peripheral Blood Mononuclear Cells . J Interferon Cytokine Res. 2009 May 14. [Epub ahead of print] Allogeneic blood transfusion has an immunomodulatory capacity on its recipients through accumulation of immunologically active substances with blood storage, and prestorage leukoreduction reduces many of these mediators

Role of storage time of red blood cells on microcirculation and tissue oxygenation in critically ill patients. Curr Opin Anaesthesiol. 2009 Apr;22(2):275-80. Large-scale prospective randomized trials are needed to explicitly clarify the role of new transfusion triggers, such as tissue oxygenation, and the impact of storage lesions of packed red blood cells on tissue oxygenation and--more important--on clinical outcomes in different patient populations.

Transfusion, not just injury severity, leads to posttrauma infection: a matched cohort study. Am Surg. 2009 Apr;75(4):307-12.Infection was most associated with transfusion of packed red blood cells (PRBCs), although transfusion of other blood products had strong collinearity with PRBCs. Transfused patients had eight times the risk of infection independent of Injury Severity Scores; this appears to be the result of PRBC transfusion. Modifying the ratio of components in transfusion protocols favoring plasma may cause less infection after injury

Blood Transfusion and Outcomes. MILWAUKEE, Wis., April 22 /PRNewswire/. An exhaustive review and analysis of the medical literature by a panel of experts at the International Consensus Conference on Transfusion and Outcomes (ICCTO) held this month in Phoenix concluded that there is little evidence to support a beneficial effect from the greatest number of transfusions currently being given to patients. The vast majority of studies show an association between red blood cell transfusions and higher rates of complications such as heart attack, stroke, lung injury, infection and kidney failure and death.

Complications and prognosis of intraoperative blood transfusion Rev Bras Anestesiol. 2008 Sep-Oct;58(5):454-61, 447-54. English, Portuguese. Hemoglobin level, and the number of packed red blood cells used were elevated when compared with studies that suggest restrictive strategies. This sample presented a high incidence of complications, especially infections, and complications. APACHE II and POSSUM scores and the number of transfusions were independent risk factors for a worse postoperative prognosis

Packed blood cells stored in AS-5 become proinflammatory during storage. Transfusion. 2009 Apr 3. [Epub ahead of print] Units of NLR PBCs stored in AS-5 become increasingly proinflammatory as a function of storage time. Leukoreduction prevents this change.

TRALI risk reduction: Donor and component management strategies. J Clin Apher. 2009 Apr 13. [Epub ahead of print]. Review

The hazards of blood transfusion. Br J Hosp Med (Lond). 2009 Jan;70(1):12-5. Review

Stored erythrocytes have less capacity than normal erythrocytes to support primary haemostasis. Thromb Haemost. 2009 Apr;101(4):720-3.Stored RBCs have less capacity than normal RBCs to support primary haemostasis by platelet aggregation in vitro, suggesting a decreased capacity of stored RBCs to bring platelets into close contact with the wall, which may contribute to sustained bleeding seen after mass transfusion.

Intraoperative use of packed red blood cell transfusion and mortality in patients undergoing abdominal or thoracoabdominal aortic aneurysm surgery. J Cardiovasc Surg (Torino). 2009 Apr 1. [Epub ahead of print] Intraoperative use of RBC transfusion in patients with acute or elective aortic aneurysm surgery is independently associated with an increased incidence of perioperative mortality.

The current infectious risks of transfusions.Surg Infect (Larchmt). 2005;6 Suppl 1:s23-31.Several infectious agents pose potential threats. The current risk of a blood transfusion is very low but the potential threat is ever present.

Noninfectious serious hazards of transfusion. Anesth Analg. 2009 Mar;108(3):759-69. Review

Transfusion-related acute lung injury: current concepts for the clinician. Anesth Analg. 2009 Mar;108(3):770-6. Review

The platelet as an immune cell-CD40 ligand and transfusion immunomodulation.. Immunol Res. 2009 Jan 29. [Epub ahead of print] Transfusion recipient biology, particularly immune function, is dramatically altered by transfusion of stored allogeneic blood

Correlations Between Neoadjuvant Treatment, Anemia, and Perioperative Complications in Patients Undergoing Esophagectomy for Cancer.J Surg Res. 2008 Jul 31. [Epub ahead of print] Overall, we determined that administration of neoadjuvant treatment to esophageal cancer patients was not associated with an increased rate of perioperative complications. Preoperative anemia did not predict worsened short-term outcomes, but increased the chances of red blood cell transfusion, which were significantly associated with higher overall complications and increased risk of surgical site infections. These data confirm previous studies that allogenic red blood cell transfusions are independent risk factors for increased morbidity and mortality and should be minimized during surgery for esophageal cancer.

Surgical treatment of sigmoid diverticulitis-analysis of predictive risk factors for postoperative infections, surgical complications, and mortality. Int J Colorectal Dis. 2009 Feb 4. [Epub ahead of print] Hinchey classification and intraoperative blood transfusion are independently associated with a worse perioperative outcome in patients undergoing surgery for sigmoid diverticular disease. While Hinchey classification cannot be influenced per se by the surgeon, outcome might be influenced by reducing the need for intraoperative blood transfusion.

Risk of Adverse Outcomes Associated With Blood Transfusion After Cardiac Surgery Depends on the Amount of Transfusion. J Surg Res. 2008 Nov 21. [Epub ahead of print] Bloodless cardiac surgery is associated with a decreased morbidity and mortality. Limiting transfusion is advisable. Transfusion of less than 5.5 units of total blood-products may not have deleterious effects on outcomes.

Transfusions in Burn Patients With/Without Comorbidities.J Burn Care Res. 2009 Jan 21. [Epub ahead of print] There was a 5-fold increase in mortality among the transfused patients with comorbidities compared with the nontransfused group

Early Packed Red Blood Cell Transfusion and Acute Respiratory Distress Syndrome after Trauma. Anesthesiology. 2009 Feb;110(2):351-360. Transfusion of packed red blood cells (PRBCs) is a risk factor for acute respiratory distress syndrome (ARDS) in trauma patients. Patients receiving more than 5 units of PRBCs had higher risk of developing ARDS. Each additional unit of PRBCs transfused conferred a 6% higher risk of ARDS Early transfusion of PRBCs is an independent predictor of ARDS in adult trauma patients. Conservative transfusion strategies that decrease PRBC exposure by even 1 unit may be warranted to reduce the risk of ARDS in injured patients.

Erythrocyte ageing in vivo and in vitro: structural aspects and implications for transfusion. Transfus Med. 2008 Dec;18(6):335-47. Review

Microparticles in stored red blood cells: an approach using flow cytometry and proteomic tools. Vox Sang. 2008 Nov;95(4):288-97. Microparticles (MPs) are small phospholipid vesicles of less than 1 microm, shed in blood flow by various cell types. These MPs are involved in several biological processes and diseases.Storage of red blood cell is associated with the generation of MPs characterized by particular proteomic profiles. These results contribute to fundamental knowledge of transfused blood products.

The effect of storage on the accumulation of oxidative biomarkers in donated packed red blood cells. J Trauma. 2009 Jan;66(1):76-81. The presence of an oxidative environment in transfused PRBC increases with storage time. This could partially explain the increased risk of developing TRALI related to the transfusion of older blood products.

Plasma from stored packed red blood cells and MHC class I antibodies cause acute lung injury in a two-event in vivo rat model. Blood. 2009 Jan 8. [Epub ahead of print]. TRALI is the result of two events with the second events consisting of the plasma from stored blood and antibodies that prime PMNs.

Perioperative Red Blood Cell Transfusion and Outcome in Stable Patients after Elective Major Vascular Surgery.Eur J Vasc Endovasc Surg. 2008 Dec 24. [Epub ahead of print]. Definitive evidence that red blood cell transfusion improves outcome after vascular surgery is lacking. In patients who underwent elective major vascular surgery, perioperative transfusion was associated with a significantly increased risk of 30-day events which was more attributable to patients with lesser degree of anaemia. Our data caution against the use of liberal transfusion in stable vascular surgery patients.

Allogeneic blood transfusion given before radiotherapy is associated with the poor clinical outcome in patients with cervical cancer. Yonsei Med J. 2008 Dec 31;49(6):993-1003.Allogeneic blood transfusions given before radiotherapy may be associated with higher incidence of distant metastases and decreased survival in patients with stage IIB cervical cancer.

The effect of erythrocyte blood transfusions on survival after surgery for hip fracture. J Trauma. 2008 Dec;65(6):1411-5 Use of allogeneic erythrocyte transfusions to patients undergoing surgical repair of hip fractures was associated with an increased risk of death. This risk started after 90 days from surgery and persisted the length of follow-up.

[Relationship between allogeneic blood transfusion, iron deficiency and nosocomial infection in patients with hip fracture.] Med Clin (Barc). 2008 Nov 15;131(17):647-52. Spanish. Lower haemoglobin and ferritin levels and allogeneic blood transfusion are associated with an increasing nosocomial infection (NI) risk in surgical hip fracture patients. Thus, in order to decrease the frequency of NI in surgical patients, the development of blood saving protocols including intravenous iron administration would be recommendable.

Loss of red cell chemokine scavenging promotes transfusion related lung inflammation. Blood. 2008 Dec 8. [Epub ahead of print]. Red cell transfusions are associated with the development of acute lung injury in the critically ill. Recent evidence suggests that storage induced alterations of the red cell collectively termed the "storage lesion" may be linked with adverse biological consequences. Reduction in erythrocyte chemokine scavenging is one functional consequence of the storage lesion by which RBC transfusion can augment existing lung inflammation.

Blood transfusion promotes cancer progression: a critical role for aged erythrocytes. Anesthesiology. 2008 Dec;109(6):989-97. In rats, transfusion of fresh blood is less harmful than transfusion of stored blood in the context of progressing malignancies. Further studies should address mediating mechanisms through which erythrocytes' storage duration can impact the rate of complications while treating malignant diseases and potentially other pathologies.

Blood transfusions, thrombosis, and mortality in hospitalized patients with cancer. Arch Intern Med. 2008 Nov 24;168(21):2377-81. Both RBC and platelet transfusions are associated with increased risks of venous and arterial thrombotic events and mortality in hospitalized patients with cancer. Further investigation is necessary to determine whether this relationship is causal.

Blood Transfusion Alters the Superior Mesenteric Artery Blood Flow Velocity Response to Feeding in Premature Infants. Am J Perinatol. 2008 Nov 19. [Epub ahead of print]. The postprandial increase in mesenteric blood flow velocity (MBFV). MBFV increased in response to feeding in the anemic but not the transfused state. The MBFV increases in response to feeding in anemic preterm infants > 1250 g. We speculate that the lack of response to feeding in the immediate posttransfusion state may contribute to the development of transfusion-associated necrotizing enterocolitis.

Iron overload following red blood cell transfusion and its impact on disease severity.

Biochim Biophys Acta. 2008 Oct 18. [Epub ahead of print] Chronic transfusion results in accumulation of excess iron that surpasses the binding capacity of the major iron transport protein, transferrin. The resulting non-transferrin bound iron (NTBI) can catalyze the production of highly reactive oxygen species (ROS) leading to significant and wide spread injury to the liver, heart, and endocrine organs as well as increases in infection. Acute transfusion of red blood cells in critically ill patients likewise has significant effects including increased mortality, prolonged hospital stays, and elevated risk of nosocomial infection. These effects appear to be more profound with increasing age of stored blood. The progressive release of free iron associated with storage time suggests that morbidity following acute transfusion, like that seen in chronic transfusion, may be due in part to elevated levels of NTBI.

[A case of transfusion-related acute lung injury associated with severe intraoperative hypoxemia]

Masui. 2008 Oct;57(10):1265-8. Japanese. Perioperative transfusion of blood components has a potential to provoke serious TRALI.

Red blood cell transfusion within the first 24 hours of admission is associated with increased mortality in the pediatric trauma population: a retrospective cohort study.

J Trauma Manag Outcomes. 2008 Oct 20;2(1):9. [Epub ahead of print] Red blood cell transfusion within the first 24 hours following admission is associated with an increase in mortality in pediatric trauma patients. The potential contribution of red blood cell transfusion as an independent predictor of hospital mortality could not be assessed from our single-institution trauma registry. A review of state-wide or national trauma databases may be necessary to obtain adequate statistical confidence.

How much residual plasma may cause TRALI?

Transfus Med. 2008 Oct;18(5):276-80. Residual plasma volume as small as 10-20 mL containing donor derived WBC antibodies may cause TRALI. The risk of TRALI remains, despite providing pooled platelets suspended in male donor plasma.

Transfusions in the less severely injured: does age of transfused blood affect outcomes?

J Trauma. 2008 Oct;65(4):794-8. In a mild to moderately injured intensive care unit patient cohort, the receipt of blood stored beyond 2 weeks was independently associated with mortality, renal failure, and pneumonia. The deleterious effect of older blood on patient outcome does not appear to be limited to the severely injured.

Transfusion-transmissible infections and transfusion-related immunomodulation.

Best Pract Res Clin Anaesthesiol. 2008 Sep;22(3):503-17. Review

Dengue hemorrhagic fever transmitted by blood transfusion.

N Engl J Med. 2008 Oct 2;359(14):1526-7. No abstract available.

Acute lung injury following blood transfusion: Expanding the definition.

Crit Care Med. 2008 Sep 26. [Epub ahead of print] The "Delayed TRALI Syndrome" is common, occurring in up to 25% of critically ill patients receiving a blood transfusion and is associated with a mortality of up to 40%. Although the delayed transfusion-related acute lung injury syndrome can develop after the transfusion of a single unit, the risk increases as the number of transfused blood products increase.

The hazards of blood transfusion in historical perspective.

Blood. 2008 Oct 1;112(7):2617-26. Review

Current management of anemia in critically ill patients: analysis of a database of 139 hospitals.

Am J Ther. 2008 Sep-Oct;15(5):423-30. Multiple factors increased the likelihood of pRBC use in ICU patients. In addition, pRBC transfusion was associated with increased length of stay. Clinicians should evaluate the risk-benefit ratio and consider interventions to limit any unnecessary pRBC use in the critically ill.

The silent risks of blood transfusion.

Curr Opin Anaesthesiol. 2008 Oct;21(5):664-668. The benefits of blood transfusion have never been conclusively demonstrated, but evidence of transfusion-related harm continues to accumulate. Given the transfusion triggers that currently predominate in clinical practice it appears that clinical outcomes could improve significantly with more widespread adoption of restrictive transfusion strategies.

Increased mortality, morbidity, and cost associated with red blood cell transfusion after cardiac surgery.

Curr Opin Anaesthesiol. 2008 Oct;21(5):669-673. The harms of RBC transfusion have potentially serious and long-term consequences for patients and are costly for health services. This evidence should shift clinicians' equipoise towards more restrictive transfusion practice. The immediate aim should be to avoid transfusing small numbers of RBC units for general malaise attributed to anaemia, a practice which appears to occur in about 50% of transfused patients. Randomized trials comparing restrictive and liberal transfusion triggers are urgently needed to compare directly the balance of benefits and harms from RBC transfusion.

Transfusion associated microchimerism: a heretofore little recognized complication following transfusion.

J Thromb Thrombolysis. 2008 Sep 3. [Epub ahead of print] Blood transfusion in the setting of acute coronary syndrome has been associated with adverse clinical outcomes including increased mortality. Transfusion associated microchimerism (TA-MC) is a newly recognized complication of blood transfusion. There is engraftment of the donor's hematopoietic stem cells in patients who then develop microchimerism. This article discusses the association of bleeding/blood transfusion with adverse outcomes and the potential role of TA-MC in clinical outcomes.

Role of anemia in traumatic brain injury.

J Am Coll Surg. 2008 Sep;207(3):398-406.. 2008 Sep;207(3):398-406.. 2008 Sep;207(3):398-406. Epub 2008 May 19. Blood transfusion is associated with significantly worse outcomes in traumatic brain injured patients. In addition, blood transfusion is a major contributing factor to worse outcomes in TBI patients who are anemic. We caution against the liberal use of blood in TBI patients.

Age of transfused blood: an independent predictor of mortality despite universal leukoreduction.

J Trauma. 2008 Aug;65(2):279-82; discussion 282-4. Although larger volumes of blood, irrespective of age, are associated with increased odds of mortality, the transfusion of blood stored beyond 2 weeks appears to potentiate this association despite a practice of universal leukoreduction. For patients who receive relatively smaller transfusion volumes, blood age appears to have no effect on mortality.

Anemia During Sequential Induction Chemotherapy and Chemoradiation for Head and Neck Cancer: The Impact of Blood Transfusion on Treatment Outcome.

Int J Radiat Oncol Biol Phys. 2008 Aug 7. [Epub ahead of print] Our study seems to suggest that blood transfusion during radical treatment for SCCHN might be detrimental. Further research should be undertaken into the complex interactions among tumor hypoxia, anemia, and the treatment of anemia before making treatment recommendations

Survival after blood transfusion.

Transfusion. 2008 Jul 30. [Epub ahead of print] Long-term survival of transfusion recipients has rarely been studied. This study examines short- and long-term mortality among transfusion recipients and reports these as absolute rates and rates relative to the general population.

Efficacy of red blood cell transfusion in the critically ill: A systematic review of the literature.

Crit Care Med. 2008 Aug 1. [Epub ahead of print] Despite the inherent limitations in the analysis of cohort studies, our analysis suggests that in adult, intensive care unit, trauma, and surgical patients, red blood cell transfusions are associated with increased morbidity and mortality and therefore, current transfusion practices may require reevaluation. The risks and benefits of red blood cell transfusion should be assessed in every patient before transfusion.

Prion diseases are efficiently transmitted by blood transfusion in sheep.

Blood. 2008 Jul 22. [Epub ahead of print] The emergence of variant Creutzfeld-Jakob disease (vCJD), following on from the bovine spongiform encephalopathy (BSE) epidemic, led to concerns about the potential risk of iatrogenic transmission of disease by blood transfusion and the introduction of costly control measures to protect blood supplies. The high transmission rates and relatively short and consistent incubation periods in clinically positive recipients suggest that infectivity titres in blood were substantial and/or that blood transfusion is an efficient method of transmission. This experiment has established the value of using sheep as a model for studying transmission of vCJD by blood products in humans.

Review: Incidence of bacterial transmission and transfusion reactions by blood components.

Clin Chem Lab Med. 2008 Apr 21. [Epub ahead of print] Review

Impact of red blood cell transfusion on clinical outcomes in patients with acute myocardial infarction.

Am J Cardiol. 2008 Jul 15;102(2):115-9. Epub 2008 May 9. RBC transfusion in patients with acute myocardial infarction and hemoglobin </=8 g/dL may be appropriate. The increased mortality observed in transfused patients with nadir hemoglobin above 8 g/dL underscores the clinical difficulty of balancing risks and benefits of RBC transfusion in the setting of acute coronary syndrome.

The direct effects of stored blood products may worsen prognosis of cancer patients; shall we transfuse or not? An explanation of the adverse oncological consequences of blood product transfusion with a testable hypothesis driven experimental research protocol.

Med Hypotheses. 2008 Jun 28. [Epub ahead of print]

Intraoperative Allogeneic Red Blood Cell Transfusion in Ampullary Cancer Outcome after Curative Pancreatoduodenectomy: A Clinical Study and Meta-Analysis.

World J Surg. 2008 Jun 27. [Epub ahead of print] The amount of intraoperative allogeneic blood transfusion (ABT) is one of the important factors that adversely influenced survival in patients with ampullary cancer after curative pancreatoduodenectomy. Healing anemia preoperatively and careful dissection to minimize intraoperative bleeding as much as possible are mandatory for reducing risk of the intraoperative ABT.

Platelets in liver transplantation: Friend or foe?

Liver Transpl. 2008 Jun 25;14(7):923-931. [Epub ahead of print]Platelet transfusions are frequently considered in liver transplant recipients to correct low platelet counts and to prevent bleeding; however, evidence-based transfusion thresholds are lacking, and the other detrimental and nonhemostatic properties of platelets are generally not weighed in this respect. First, platelets have been shown to contribute to ischemia/reperfusion (I/R) injury of the liver graft via induction of sinusoidal endothelial cell apoptosis. Second, platelet transfusion has been identified as an independent risk factor for reduced survival via mechanisms that are not completely understood yet. On the other hand, recent studies indicate that platelets are critically involved in restoration after liver injury and in liver regeneration via serotonin-mediated mechanisms. These findings make platelets both friend and foe in liver transplantation.

Outcome Analysis of Blood Product Transfusion in Trauma Patients: A Prospective, Risk-Adjusted Study.

World J Surg. 2008 Jun 24. [Epub ahead of print] There is a dose-dependent correlation between blood product transfusion and adverse outcome (increased mortality and infection) in trauma patients.

The variant Creutzfeldt-Jakob Disease. Risk, uncertainty or safety in the use of the blood and blood derivatives? Int Arch Med. 2008 Jun 23;1(1):9. [Epub ahead of print]. FREE FULL TEXT

RBC-derived vesicles during storage: ultrastructure, protein composition, oxidation, and signaling components.

Transfusion. 2008 Jun 18. [Epub ahead of print] These data indicate that the vesicles released during storage of RBCs contain lipid raft proteins and oxidized or reactive signaling components commonly associated with the senescent RBCs. Vesiculation during storage of RBCs may enable the RBC to shed altered or harmful material.

Leukodepletion of autologous whole blood has no impact on perioperative infection rate and length of hospital stay.

Transfusion. 2008 Jun 18. [Epub ahead of print] This trial provides strong evidence, from clinically relevant outcome data, that leukoreduction of AWB does not improve postoperative patient outcome and that the release of BRMs from disintegrating blood cells during storage cannot explain the immunomodulatory effect of blood transfusion.

Oncogenic and Angiogenic Growth Factors Accumulate during Routine Storage of Apheresis Platelet Concentrates.

Clin Cancer Res. 2008 Jun 15;14(12):3942-7. During storage, growth factors accumulate in the plasma, specifically platelet-derived growth factor, vascular endothelial growth factor (VEGF), transforming growth factor-beta, and fibroblast growth factor-2, which may adversely affect cancer patients. Significant amounts of growth factors are present in apheresis platelets due to the isolation procedures, and these concentrations increase over storage, which may be partially removed by washing. In addition, apheresis platelet transfusion could affect cancer treatment by binding monoclonal antibodies directed against growth factors of tumor origin.

The role of donor antibodies in the pathogenesis of transfusion-related acute lung injury: a systematic review.

Transfusion. 2008 Jun 18. [Epub ahead of print] Leukocyte antibodies were more prevalent in donors involved in TRALI cases than among randomly selected donors. These findings suggest that donor antibodies contribute to four-fifths of all TRALI cases

Transfusion-associated graft-versus-host disease. Vox Sang. 2008 Jun 9. [Epub ahead of print] Transfusion-associated graft-versus-host disease (TA-GvHD) is a rare complication of transfusion of cellular blood components producing a graft-versus-host clinical picture with concomitant bone marrow aplasia. The disease is fulminant and rapidly fatal in the majority of patients. TA-GvHD is caused by transfused blood-derived, alloreactive T lymphocytes that attack host tissue, including bone marrow with resultant bone marrow failure.

The Acellular Fraction of Stored Platelets Promotes Tumor Cell Invasion. J Surg Res. 2008 May 7. [Epub ahead of print]Components in stored platelets can promote the invasion of multiple cancer cell lines in vitro. These results indicate that factors in platelets may mediate deleterious effects associated with transfusion in cancer patients

Blood transfusion, anesthesia, surgery and risk of non-Hodgkin lymphoma in a population-based case-control study.

Int J Cancer. 2008 May 27. [Epub ahead of print] The incidence of NHL has increased dramatically since at least the 1950s, and during this timeframe there has been a major increase in the use of blood transfusions, invasive surgical procedures and anesthesia, all of which can impact immune function. History of transfusion was associated with a 26% higher risk of NHL (95% CI 0.91-1.73), and the elevated risk was specific to transfusions first given 5-29 years before the reference date (OR = 1.69; 95% CI 1.08-2.62) and transfusions given for a medical condition (OR = 2.09; 95% CI 1.03-4.26). Blood transfusions were associated with NHL risk, but appear to be a marker for underlying medical conditions.

Acute lung injury after ruptured abdominal aortic aneurysm repair: The effect of excluding donations from females from the production of fresh frozen plasma

Crit Care Med. 2008 May 19. [Epub ahead of print] The policy to exclude female donors from the production of fresh frozen plasma was associated with a decrease in the frequency of acute lung injury in patients undergoing repair of a ruptured abdominal aortic aneurysm.

HLA-DR antibodies in transfusion-related acute lung injury (TRALI): A case report.

Transfus Apher Sci. 2008 May 5. [Epub ahead of print] Case report

Immunomodulatory effects of blood transfusions: the synergic role of soluble HLA Class I free heavy-chain molecules detectable in blood components.

Transfusion. 2008 May 6. [Epub ahead of print]Over the past decades, the weight of the published literature demonstrates that blood transfusions can induce clinically significant immunosuppression in recipients. These data are comparable with those previously reported dealing with contaminant soluble molecules in allogeneic and autologous blood components, suggesting that sHLA-beta(2)fHC molecules could contribute to the immunosuppressive effects of blood transfusions.

A probable case of hepatitis B virus transfusion transmission revealed after a 13-month-long window period.

Transfusion. 2008 May 2. [Epub ahead of print] In unusual circumstances, HBV incubation time can be considerably prolonged.

Intraoperative massive transfusion decreases survival after liver transplantation.

Transplant Proc. 2008 Apr;40(3):789-91. Patients receiving over 6 red blood cell units intraoperatively displayed reduced survival

Anemia, transfusions and hospital outcomes among critically ill patients on prolonged acute mechanical ventilation: a retrospective cohort study.

Crit Care. 2008 Apr 28;12(2):R60. [Epub ahead of print] Patients on prolonged acute mechanical ventilation (PAMV) have a high likelihood of being transfused with multiple units of blood at relatively high Hb levels. Transfusions independently contribute to an increased risk of hospital death, LOS and costs. Reducing PAMV patients' exposure to blood may represent an attractive target for efforts to improve quality and efficiency of healthcare delivery to this population.

Effects of leukoreduced blood on acute lung injury after trauma: A randomized controlled trial.

Crit Care Med. 2008 Apr 21; [Epub ahead of print] Prestorage leukoreduction had no effect on the incidence or timing of lung injury or on plasma measures of systemic alveolar and endothelial inflammation in a population of trauma patients requiring transfusion. The relationship between transfusion and lung injury is not obviously explained by mechanistic pathways involving the presence of transfused leukocytes.

Platelet transfusions have a negative impact on liver transplant survival.

Liver Transpl. 2008 Apr 23;14(5):701-705 [Epub ahead of print] This retrospective study indicates that, in addition to RBC, platelet transfusions are an independent risk factor for survival after OLT. These findings have important implications for transfusion practice in liver transplant recipients.

Influence of blood transfusions and preoperative anemia on long-term survival in patients operated for non-small cell lung cancer.

Lung Cancer. 2008 Apr 18; [Epub ahead of print] RBC transfusion might exert an immunomodulatory effect on patients with early disease while in more advanced stages this effect is not apparent.

Establishing an association between a peri-operative perfusion score system (PerfSCORE) and post-operative patient morbidity/mortality during CPB cardiac surgery.

Perfusion. 2007 Sep;22(5):311-6. Cardiopulmonary bypass (CPB) time, blood transfused and PaO2 are independent risk factors of mortality. Fluid balance, blood transfusion, PaO2, PerfSCORE and CPB time are independent parameters for predicting morbidity. .

Red cell transfusion in medicine: Future challenges.

Transfus Clin Biol. 2008 Mar 21; [Epub ahead of print] Review

The proteome of red cell membranes and vesicles during storage in blood bank conditions.

Transfusion. 2008 Mar 12; [Epub ahead of print] The results of this analysis indicate that the storage-related changes in the RBC membrane are the results of disturbance and/or acceleration of physiologic processes such as cellular aging, including vesicle formation. The latter may serve to remove damaged membrane patches that would otherwise lead to accelerated RBC removal. These data provide a framework for future studies toward the development of better storage conditions and a reduction of the side effects of RBC transfusion.

Impact of age of transfused blood on cerebral oxygenation in male patients with severe traumatic brain injury.

Crit Care Med. 2008 Apr;36(4):1290-6. Transfusion of erythrocytes increased cerebral oxygenation in patients with severe traumatic brain injury, except in those transfused with erythrocytes stored >19 days.

Transfusion of fresh frozen plasma in critically ill surgical patients is associated with an increased risk of infection.

Crit Care Med. 2008 Apr;36(4):1114-8. Retrospective study.

Transfusion of packed red blood cells in patients with ischemic heart disease.

Crit Care Med. 2008 Apr;36(4):1068-74. Despite the variability in data sources and study design, with a handful of exceptions, the preponderance of data indicates that transfusion of PRBC in the population of patients with ischemic heart disease is of limited clinical utility and may carry the potential for serious adverse consequences.

New blood, old blood, or no blood?

N Engl J Med. 2008 Mar 20;358(12):1295-6. No abstract available.

Duration of red-cell storage and complications after cardiac surgery.

N Engl J Med. 2008 Mar 20;358(12):1229-39. In patients undergoing cardiac surgery, transfusion of red cells that had been stored for more than 2 weeks was associated with a significantly increased risk of postoperative complications as well as reduced short-term and long-term survival.

Transfusion-related acute lung injury.

J Intensive Care Med. 2008 Mar-Apr;23(2):109-21. Review

Occult hepatitis B virus in liver tissue of individuals without hepatic disease.

J Hepatol. 2008 Feb 13; [Epub ahead of print] Occult HBV infection was revealed in 16 of the 98 cases (16.3%). In particular, 10/16 anti-HBc positive (62.5%) versus 6/82 (7.3%) HBV-seronegative individuals were occult carriers (p<0.0001). This study revealed that about 1/6 of the Italian general population might be carriers of occult HBV infection, and this condition is significantly associated with the anti-HBc positive status

Early neurological complications after coronary artery bypass grafting and valve surgery in octogenarians.

Eur J Cardiothorac Surg. 2008 Feb 12; [Epub ahead of print] Octogenarians undergoing on-pump CABG and/or valve repair/replacement are at higher risk of neurological dysfunction, from which the majority recover fully. The adverse implications for operative mortality and morbidity, however, are profound. Blood product transfusion which has a powerful correlation with neurological complication should be reduced by rigorous haemostasis with parsimonious use of sealants when appropriate.

Storage of strain-specific rat blood limits cerebral tissue oxygen delivery during acute fluid resuscitation.

Br J Anaesth. 2008 Jan 29; [Epub ahead of print] Although resuscitation with stored blood restored cerebral oxygen delivery to baseline, fresh blood produced a greater increase in both PBr(o(2)) and rCBF. These data support the hypothesis that storage limits the ability of RBC to deliver oxygen to brain tissue.

Risk Factors for Acute Respiratory Distress Syndrome in Patients Mechanically Ventilated for Greater Than 48 Hours.

Chest. 2008 Feb 8; [Epub ahead of print] Major non-ventilator risk factors for ARDS included sepsis, low pH, elevated lactate, low albumin, transfusion of packed red blood cells, transfusion of plasma, high net fluid balance, and low respiratory compliance.

Red blood cell arginase suppresses Jurkat (T cell) proliferation by depleting arginine.

Surgery. 2008 Feb;143(2):286-91. Epub 2007 Dec 21. Jurkat T cell proliferation was impaired by PRBC in clinically relevant volumes. The mechanism influencing T cell impairment appears to result from arginine depletion by arginase. Arginine depletion by PRBC arginase may be a novel mechanism for immunosuppression after transfusion.

Body size, gender, and transfusions as determinants of outcome after coronary operations.

Ann Thorac Surg. 2008 Feb;85(2):481-6. Female gender is not a risk factor for hospital mortality or prolonged intensive care unit stay. Small body surface area in men and large body surface area in women are associated with a prolonged intensive care unit stay. Transfusions are independent risk factors for both mortality and prolonged intensive care unit stay. Fresh-frozen plasma and platelet transfusion carry a higher mortality risk (odds ratio, 12) than transfusions of packed red blood cells (odds ratio, 5).

Blood transfusion and in-hospital outcomes in anemic patients with myocardial infarction undergoing percutaneous coronary intervention.

Clin Cardiol. 2007 Oct;30(10 Suppl 2):II49-56. After adjustment for comorbidities and propensity for transfusion, blood transfusion was associated with a higher risk of in-hospital mortality (adjusted odds ratio = 2.02, 95% confidence interval 1.47-2.79, p < 0.0001). In anemic patients undergoing PCI for MI, transfusion was associated with an increased crude and adjusted rate of in-hospital mortality. A randomized controlled trial is needed to determine the value of transfusion and the ideal transfusion criteria.

Transfusion-related acute lung injury: past, present, and future.

Am J Clin Pathol. 2008 Feb;129(2):287-97. Review.

Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery.

Ann Card Anaesth. 2008 Jan-Jun;11(1):15-9. CABG patients receiving blood transfusion have significantly longer time for tracheal extubation, intensive care unit length of stay, postoperative length of stay and higher morbidity and 30-day hospital mortality. Blood transfusion was an independent predictor of increased resource utilisation, postoperative morbidity and mortality.

Case report: Transfusion-related acute lung injury (TRALI) A clear and present danger:

Can J Anaesth. 2007 Dec;54(12):1011-6. Transfusion-related acute lung injury is now the leading cause of transfusion-related fatalities. Early diagnosis of TRALI is important and these reactions should be reported to the blood transfusion service so that appropriate action can be taken to prevent future morbidity and mortality in other patients. To reduce serious transfusion reactions, inappropriate transfusions must be minimized and the decision to transfuse blood products should be taken with care.

Increased risk of infection and mortality in women after cardiac surgery related to allogeneic blood transfusion.

J Womens Health (Larchmt). 2007 Dec;16(10):1412-20. One reason for the greater mortality in women after cardiac surgery may be the increased likelihood of receiving nonleukoreduced allogeneic RBCs and platelets. Transfusion increased the risk of infection; infection, then, increased the likelihood of pulmonary dysfunction and mortality.

An overview of unresolved inherent problems associated with red cell transfusion and potential use of artificial oxygen carriers and ECO-RBC: Current status/future trends.

Transfus Apher Sci. 2007 Nov 23; [Epub ahead of print]Review

Immunological reactions secondary to blood transfusion.

Injury. 2007 Nov 27; [Epub ahead of print] Review.

Alloimmunization to red blood cell antigens affects clinical outcomes in liver transplant patients.

Liver Transpl. 2007 Nov 28;13(12):1654-1661 [Epub ahead of print] Our findings suggest that blood transfusion and immune modulation greatly affect the survival of patients after liver transplantation

Theoretically estimated risk of severe acute respiratory syndrome transmission through blood transfusion during an epidemic in Shenzhen, Guangdong, China in 2003.

Transfus Apher Sci. 2007 Nov 22; [Epub ahead of print] Although there are currently no confirmed reports of the transmission of SARS-CoV from asymptomatic individuals, recent research data indicate that transfusion-transmitted SARS-CoV is at least theoretically possible. Although the risk is low, with its rapid spread of the disease, appearance of alarmingly high infectivity and high fatality rate, public health authorities need to consider strategies for blood donor recruitment and virus inactivation during an epidemic to further ensure blood safety.

Transfusion-related acute lung injury in the critically ill: prospective nested case-control study.

Am J Respir Crit Care Med. 2007 Nov 1;176(9):886-91. Epub 2007 Jul 12. Both patient and transfusion risk factors determine the probability of ALI after transfusion. Transfusion factors represent attractive targets for the prevention of ALI.

Increased Mortality, Postoperative Morbidity, and Cost After Red Blood Cell Transfusion in Patients Having Cardiac Surgery.

Packed Red Blood Cell-Associated Arginine Depletion is Mediated by Arginase.

Monoclonal B-cell lymphocytosis in blood donors.
Br J Haematol. 2007 Oct 24; [Epub ahead of print] Monoclonal B-cell populations have been detected in the peripheral blood of apparently healthy individuals by flow cytometry. In 2005, the term monoclonal B-cell lymphocytosis (MBL) was proposed to describe these findings. MBL may be immunophenotypically similar to chronic lymphocytic leukaemia (CLL). The clinical importance of these findings with regard to transfusion medicine has not been established.

S-nitrosohemoglobin deficiency: A mechanism for loss of physiological activity in banked blood.
Proc Natl Acad Sci U S A. 2007 Oct 11; [Epub ahead of print] Our findings indicate that NO bioactivity is depleted in banked blood, impairing the vasodilatory response to hypoxia, and they suggest that SNO-Hb repletion may improve transfusion efficacy.

Anemia and Transfusions in Patients Undergoing Surgery for Cancer.
Ann Surg Oncol. 2007 Oct 18; [Epub ahead of print] This review summarizes published evidence of the consequences of anemia and blood transfusion, the effects of blood storage, the infectious and noninfectious risks of blood transfusion, and the role of blood-conservation strategies for cancer patients who undergo surgery. The optimal blood-management strategy remains to be defined by additional clinical studies. Until that evidence becomes available, the clinical utility of blood conservation should be assessed for each patient individually as a component of preoperative planning in surgical oncology.

Transfusion Alert for Patients with Curable Cancer.
World J Surg. 2007 Oct 5; [Epub ahead of print] Perioperative transfusion (POT) is a negative prognostic factor for outcome in cancer patients undergoing surgery. Our findings support the need for a clinical alert against POT throughout the course of cancer treatment, especially for curable disease; thus, POT should be carefully considered from an oncologic point of view. Appropriate strategies to minimize POT should be urgently developed.

Blood banking-induced alteration of red blood cell flow properties.
Transfusion. 2007 Sep 27; [Epub ahead of print] Red blood cell (RBC) flow properties appear to be especially sensitive to cold storage and gamma irradiation because they are impaired long before the expiration date. Because impaired RBC flow properties facilitate circulatory disorders, the potential circulatory risk of transfusion RBC with blood banking-impaired rheology should be considered.

Distinguishing between transfusion related acute lung injury and transfusion associated circulatory overload.
Curr Opin Hematol. 2007 Nov;14(6):682-7. Transfusion associated circulatory overload (TACO) and transfusion related acute lung injury (TRALI) have emerged as important causes of posttransfusion morbidity and mortality. As understanding of their pathogenesis improves, incidence, risk factors, differences, and possible preventive interventions are becoming clearer. There is no sentinel feature that distinguishes TRALI from TACO. Developing a thorough clinical profile including presenting signs and symptoms, fluid status, cardiac status including measurement of brain natriuretic peptide, and leukocyte antibody testing is the best strategy currently available to distinguish the two disorders.

Current risk for transfusion transmitted infections.
Curr Opin Hematol. 2007 Nov;14(6):671-6.The estimated risk for transfusion transmitted hepatitis viruses and retroviruses is now vanishingly small, but clinicians should be alert to the possibility of infection with emerging infectious agents, because preventive measures may not be available in all cases.

Ninety-six suspected transfusion related acute lung injury cases: Investigation findings and clinical outcome.
Hematology. 2007 Aug 3;:1 [Epub ahead of print] By applying strict clinical criteria and using sensitive techniques a white blood cell antibody mediated immunological pathophysiology can be implicated in the majority TRALI cases.

HBsAg non-reactive HBV infection in blood donors: Transmission and pathogenicity.
J Med Virol. 2007 Sep 14;79(S1):S32-S36 [Epub ahead of print] Five blood donors with occult persistent and one donor with an early window phase HBV infection were identified. They were negative in regular HBsAg screening and had low levels of HBV DNA that were probably not detectable by current mini-pool nucleic acid amplification testing.

Risk factors for the development of delayed infections following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis patients.
Spine. 2007 Sep 15;32(20):2272-7. The occurrence of a delayed infection is most likely multifactorial and is related to a positive past medical history and the use of blood transfusions.

Transfusion-associated microchimerism.
Vox Sang. 2007 Oct;93(3):188-95. Transfusion-associated microchimerism seems to be common (affecting approximately 10% of transfused injured patients), enduring (lasting years to decades) and pronounced (involving up to 5% of circulating leucocytes and multiple immunophenotypic lineages suggestive of haematopoietic engraftment). Further study of this topic may reveal important information regarding potential clinical consequences of TA-MC, as well as basic haematologic and immunologic processes.

Bloodless Cardiac Surgery is Associated With Decreased Morbidity and Mortality.
J Card Surg. 2007 Sep-Oct;22(5):373-8. Identification and management of risk factors associated with transfusion may reduce the transfusion requirement, minimize perioperative complications and improve outcomes. Bloodless cardiac surgery is associated with a decreased morbidity and mortality.

Transfusion-related immunomodulation (TRIM): An update.
Blood Rev. 2007 Sep 3; [Epub ahead of print] Review

AABB survey of transfusion-related acute lung injury policies and practices in the United States.
Transfusion. 2007 Sep;47(9):1679-85. There is wide variability in procedures and policies related to the diagnosis of and donor investigation and/or management of TRALI cases. Lack of a consensus approach may partly reflect limitations in understanding of TRALI pathogenesis. The survey suggests that increased education of transfusion medicine practitioners is needed.

Human erythrovirus B19 and blood transfusion - an update.
Transfus Med. 2007 Aug;17(4):263-78. Transmission of B19 by blood and blood products and its resistance to common viral inactivation methods raises several blood safety questions, still unanswered. The diversity of B19 strains and the ability of the virus to persist in the presence of specific antibodies raise the issue of transmissibility by transfusion not so much to immunocompetent recipients but rather to the large proportion of recipients in whom there is some degree of immunodeficiency.

Effect of Perioperative Allogeneic Red Blood Cell Transfusion on the Immune-Inflammatory Response After Colorectal Cancer Resection.
World J Surg. 2007 Aug 2; [Epub ahead of print] Perioperative allogeneic RBC transfusion enhances the inflammatory systemic response and decreased immunity in patients submitted to colorectal resection for cancer.

Effect of perioperative autologous versus allogeneic blood transfusion on the immune system in gastric cancer patients.
J Zhejiang Univ Sci B. 2007 Aug;8(8):560-5. Perioperative surgical trauma and stress have an immunosuppressive impact on gastric cancer patients. Allogeneic blood transfusion exacerbates the impaired immune response. Autologous blood transfusion might be significantly beneficial for immune-compromised patients in the perioperative period, clearly showing its superiority over allogeneic blood transfusion.

Impact of blood loss on outcome after liver resection.
Dig Surg. 2007;24(4):259-64. Epub 2007 Jul 27. Review

Transfusion Related Acute Lung Injury in the Critically Ill: Prospective Nested Case-Control Study.
Am J Respir Crit Care Med. 2007 Jul 12; [Epub ahead of print] Seventy-four out of 901 transfused patients developed ALI within 6 hours after transfusion (8%). Both patient and transfusion risk factors determine the probability of ALI after transfusion. Transfusion factors represent attractive targets for prevention of ALI.

The decreasing incidence of late posttraumatic acute respiratory distress syndrome: the potential role of lung protective ventilation and conservative transfusion practice.
J Trauma. 2007 Jul;63(1):1-7; discussion 8. The increasing use of restrictive transfusion policies and ventilation strategies that potentially limit elevations in early peak inspiratory pressures are associated with a decreased incidence of late posttraumatic ARDS.

Transfusion of blood products and nosocomial infection in surgical patients.
Curr Opin Crit Care. 2007 Aug;13(4):428-32. Transfusion of blood and blood products can be life-saving interventions. Consequences of transfusion may ultimately result in worse outcomes. More research will be required in order to identify indications and practices that optimize outcomes of surgical patients who require a blood transfusion

Verses, viruses, and the vulnerability of the blood supply in industrialized countries.
J Med Virol. 2007 Jun 27;79(8):1229-1237 [Epub ahead of print]. Despite the major technical advances against main infections, there remains a legitimate concern as to the transmission of other blood-borne infectious agents through blood transfusion. Among these agents are HBV mutants, occult HBV and HCV infections, malaria, Chagas, West Nile, dengue, and vesiviruses, bacterial infections such as Yersinia enterocolitica, and tick borne diseases such as human monocytic ehrlichiosis, human granulocytic ehrlichiosis, Rocky Mountain spotted fever, and Lyme and prion diseases such as Creutzfeldt and variant Creutzfeldt. Most of these agents are very rarely transmitted by transfusion in industrialized countries. However, an awareness of their possible transmission is essential for the control of spread of these diseases among the public by human-to-human transmission via blood transfusion

Inflammation enhances consumption and presentation of transfused RBC antigens by dendritic cells.
Blood. 2007 Jun 25; [Epub ahead of print] These data provide additional insight into the nature of transfused RBCs as an immunogen and provide a mechanism by which viral-like inflammation enhances alloimmunization to transfused RBCs.

Stored Packed Red Blood Cell Transfusion Up-regulates Inflammatory Gene Expression in Circulating Leukocytes.
Ann Surg. 2007 Jul;246(1):129-134. Packed red blood cells activate inflammatory genes in circulating leukocytes, which may be central to the pathogenesis of the adverse inflammatory responses that lead to postinjury MOF.

Storage-dependent remodeling of the red blood cell membrane is associated with increased immunoglobulin G binding, lipid raft rearrangement, and caspase activation.
Transfusion. 2007 Jul;47(7):1212-20 The remodeling of the RBC membrane during storage includes loss and oxidative cross-linking of Band 3 as well as IgG binding. This process occurs with lipid raft development and loss and is probably driven by caspase activation. Oxidative injury appears to be an important driver of RBC aging during storage.

A novel subtype of Creutzfeldt-Jakob disease characterized by a small 6 kDa PrP fragment.
Acta Neuropathol (Berl). 2007 Jun 19; [Epub ahead of print] Case report.

Red blood cell transfusion in critically ill children is independently associated with increased mortality.
Intensive Care Med. 2007 Jun 16; [Epub ahead of print] RBC transfusion in critically ill children is independently associated with increased mortality and prolonged duration of mechanical ventilation, prolonged infusion of vaso-active agents and prolonged pediatric intensive care unit stay.

Transfusion-transmitted infections.
J Transl Med. 2007 Jun 6;5(1):25 Although the risk of transfusion-transmitted infections today is lower than ever, the supply of safe blood products remains subject to contamination with known and yet to be identified human pathogens FULL TEXT

Progressive oxidation of cytoskeletal proteins and accumulation of denatured hemoglobin in stored red cells.
J Cell Mol Med. 2007 Jan-Feb;11(1):148-55. The reported data corroborate the evidence for oxidative damage in membrane proteins with emphasis to the cytoskeletal components. FULL TEXT

Red blood cell transfusions and the risk of ARDS among critically ill: a cohort study.
Crit Care. 2007 Jun 6;11(3):R63 [Epub ahead of print] After adjusting for age, baseline severity of illness, admitting diagnosis, and process of care factors, the independent relationship between pRBC transfusions and ICU-onset ARDS remained significant (adjusted odds ratio 2.80, 95% CI: 1.90-4.12, p<.0001). Development of ARDS after ICU admission is common, occurring in approximately 5% of critically ill patients. Transfusion of pRBCs is independently associated with the development of ARDS in the ICU.

Oxygenating the microcirculation: the perspective from blood transfusion and blood storage.
Vox Sang. 2007 Jul;93(1):12-8. The release of vasodilators from RBC that will alter blood flow during hypoxia, mediated by haemoglobin in the RBC that functions as an oxygen sensor, could be impaired during storage.

Nosocomial Infections after Peripheral Arterial Bypass Surgery.
World J Surg. 2007 Jun 6.Blood transfusion was a postoperative risk factor for nosocomial infection (p < .0001). Nosocomial infection was associated with a prolonged hospital stay (p < .0001).

Transfusion-related acute lung injury and leucocyte-reacting antibodies.
Vox Sang. 2007 Jul;93(1):70-7. Transfusion-related acute lung injury (TRALI) is underdiagnosed and underreported. Antibodies are involved in TRALI, although their role is very complex. The role of stored red blood cells in the development of TRALI requires further observations in comparison with a control group of patients without TRALI.

Transfusion from male-only versus female donors in critically ill recipients of high plasma volume components.
Crit Care Med. 2007 May 22; [Epub ahead of print] In critically ill recipients of high plasma volume components, gas exchange worsened significantly after transfusion of female but not male donor components.

Red blood cell (RBC) age at collection and storage influences RBC membrane-associated carbohydrates and lectin binding.
Transfusion. 2007 Jun;47(6):966-8. Changes to lectin binding during storage of RBCs suggest that significant changes occur to the carbohydrate structures at the RBC membrane. These findings provide further insight into the mechanisms of the RBC storage lesion and potential influence on RBC survival after transfusion

Frequent detection of the parvoviruses, PARV4 and PARV5, in plasma from blood donors and symptomatic individuals.
Transfusion. 2007 Jun;47(6):1054-61. Plasma pools used in the manufacture of blood- and plasma-derived medicinal products are frequently contaminated with parvovirus B19. The presence of the novel human parvovirus PARV4 and a related variant PARV5 in manufacturing plasma pools was recently demonstrated. Another recently identified parvovirus, human bocavirus (HBoV), has been identified in respiratory samples from children with lower respiratory tract disease.

Planning for pandemic influenza: effect of a pandemic on the supply and demand for blood products in the United States.
Transfusion. 2007 Jun;47(6):1071-9. Lower blood collection capacity and transfusion service support capability will reduce the availability of RBCs and especially of platelets. Plans for rationing medical care need to take the vulnerability of the blood transfusion system into account.

Toward the prevention of acute lung injury: Protocol-guided limitation of large tidal volume ventilation and inappropriate transfusion
Crit Care Med. 2007 May 15; [Epub ahead of print] Interdisciplinary intervention effectively decreased large tidal volumes and unnecessary transfusion in mechanically ventilated patients and was associated with a decreased frequency of new acute lung injury.

Association of Red Cell Transfusion with Mortality in Patients with Acute Lung Injury.
Chest. 2007 May 15; [Epub ahead of print] The transfusion of RBCs in patients with ALI was associated with increased in-hospital mortality. This risk occurred with RBC transfusion after the onset of ALI, and was greater for nonleukoreduced than for leukoreduced RBCs. Aggressive transfusion strategies in patients with established ALI should be questioned, pending further study.

Effects of fresh versus banked blood transfusions on microcirculatory hemodynamics and tissue oxygenation in the rat cremaster model.
Surgery. 2007 May;141(5):630-9. Fresh blood transfusion is more effective in relieving effects of microcirculatory hypoxia. Banked blood, in particular 2-week stored blood, has limited capacity of improving tissue oxygenation.

Bleeding and blood transfusion issues in patients with non-ST-segment elevation acute coronary syndromes.
Eur Heart J. 2007 Apr 24; [Epub ahead of print] Review.

First case of hepatitis C virus transmission by a red blood cell concentrate after introduction of nucleic acid amplification technique screening in Germany: a comparative study with various assays.
Vox Sang. 2007 May;92(4):297-301. HCV transmission can be caused by donations that escape NAT detection even when tested in an individual donation. Comparison of different assays led to results that did not necessarily reflect the expected sensitivities. The need for standard materials representing further HCV genotypes is discussed.

Effects of erythrocyte flexibility on microvascular perfusion and oxygenation during acute anemia.
Am J Physiol Heart Circ Physiol. 2007 Apr 20; [Epub ahead of print]. Responses to exchange transfusion using red blood cells (RBCs) with normal and reduced flexibility were studied in the hamster window chamber model during acute moderate isovolemic hemodilution to determine the role of RBC membrane stiffness in microvascular perfusion and tissue oxygenation

Impact of blood transfusions in patients presenting with anemia and suspected acute coronary syndrome.
Am J Cardiol. 2007 Apr 15;99(8):1119-21. Epub 2007 Feb 21. Transfusion in anemic patients admitted with suspected acute coronary syndrome/non-ST-elevation MIs led to a significant increase in 30-day recurrent MI or death (odds ratio 3.05, 95% confidence interval 1.80 to 5.17, p <0.001). The risk versus benefit of transfusion in patients presenting with an acute coronary syndrome needs careful assessment.

TGF-beta1 and TNF-alpha after red blood cell transfusion in colorectal cancer patients.
Exp Oncol. 2007 Mar;29(1):67-70. TGF-alpha and TNF-alpha are important in neoplasia development. Levels of multipotent cytokines TGF-alpha1 and TNF-alpha were elevated after red blood cell (RBC) transfusion in colorectal cancer patients

The significance of perioperative anemia in patients with resectable gastrointestinal tract tumors.
J BUON. 2004 Jul-Sep;9(3):247-53. From the surgical point of view, any effort for "bloodless surgery" should be attempted.

Transfusion of red blood cells: no impact on length of hospital stay in moderately anaemic parturients.
Acta Anaesthesiol Scand. 2007 May;51(5):565-569. The duration of admission for delivery in moderately anaemic parturients was longer than the average length of hospital stay in Finnish parturients. However, 1-2 RBC units had no impact on the length of stay, suggesting that unnecessary RBCs are transfused after delivery. Thus, transfusion practices in obstetrics are not always optimal.

Fresh frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients.
Chest. 2007 Mar 30; [Epub ahead of print] Transfusion is associated with increased risk of developing ALI/ARDS in critically ill medical patients. The risk is higher with plasma rich blood products, FFP and platelets, than with RBC transfusions.

Prognosis and postoperative lymphocyte count in patients with hepatocellular carcinoma who received intraoperative allogenic blood transfusion: A retrospective study.
Eur J Surg Oncol. 2007 Mar 30; [Epub ahead of print] Intraoperative blood transfusion results in immunosuppression in the early postoperative period, allowing for progression of residual HCC after resection. Therefore, intraoperative allogenic blood transfusion should be avoided in patients with resectable HCC, particularly in those with a large tumor.

Transfusion-related acute lung injury surveillance (2003-2005) and the potential impact of the selective use of plasma from male donors in the American Red Cross.
Transfusion. 2007 Apr;47(4):599-607. Plasma components linked to female donors with WBC antibodies were responsible for the majority of probable TRALI fatalities. Prudent measures to limit transfusion of WBC antibody-containing plasma components may prevent as many as six fatalities per year in the Red Cross system.

Effect of blood transfusion on outcome after pancreaticoduodenectomy for exocrine tumour of the pancreas.
Br J Surg. 2007 Feb 28; [Epub ahead of print] In patients with exocrine tumours of the pancreas, blood transfusion should be avoided when possible. Preoperative risk factors can identify patients who are likely to require transfusion and would therefore benefit most from blood conservation methods.

Transfusion-acquired Trypanosoma cruzi infection.
Transfusion. 2007 Mar;47(3):540-4. This is the seventh reported case of Chagas disease transmission by blood transfusion in the United States and Canada. Although this would not be expected to occur in New England, it did, and this case demonstrates the significance of the immune status of patients as it relates to transfusion-acquired infections, the impact of geographic mobility in disease transmission, and the need for a licensed screening test for Chagas disease for the US blood supply.

Association between venous thromboembolism and perioperative allogeneic transfusion.
Arch Surg. 2007 Feb;142(2):126-32. In this large observational study of patients undergoing colorectal cancer resection, perioperative allogeneic blood transfusion was associated with an increased risk of VTE in women but not in men.