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Latest news:
TRANSFUSION ISSUES
Blood transfusion from another person doubles infection risk after CABG
surgery.
BMJ. 2009 Aug 4;339:b3147. doi:
10.1136/bmj.b3147. No abstract available.
Does blood transfusion harm cardiac surgery patients?
BMC Med. 2009 Jul 31;7(1):38. [Epub
ahead of print] Allogeneic, but not autologous,
blood transfusion increased the odds of in-hospital infection 2.0-fold (95%
CI 1.6 to 2.5), in-hospital mortality 4.7-fold (95% CI 2.4 to 9.2), 30-day
readmission 1.4-fold (95% CI 1.2 to 1.6), and 30-day mortality 2.9-fold (95%
CI 1.4 to 6.0) in elective surgeries. Allogeneic transfusion was associated
with infections of the genitourinary system, respiratory tract, bloodstream,
digestive tract and skin, as well as infection with Clostridium difficile.
For each 1% increase in hospital transfusion rates, there was a 0.13%
increase in predicted infection rates. Allogeneic blood transfusion
was associated with an increased risk of infection at multiple sites,
suggesting a system-wide immune response. Hospital variation in transfusion
practices after coronary artery bypass grafting was considerable, indicating
that quality efforts may be able to influence practice and improve outcomes.
Transfusion-related acute lung injury (TRALI): a clinical review with
emphasis on the critically ill.
Br J Haematol. 2009 Aug 5. [Epub
ahead of print] Review
Fresh Frozen Plasma Is Independently Associated With a Higher Risk of
Multiple Organ Failure and Acute Respiratory Distress Syndrome.
J Trauma. 2009 Aug;67(2):221-230.
In patients who survive their initial injury, FFP was independently
associated with a greater risk of developing MOF and ARDS, whereas CRYO was
associated with a lower risk of MOF. Further investigation into the
mechanisms by which these plasma-rich component transfusions are associated
with these effects are required.
Association of Allogeneic Blood Transfusions and Long-Term Survival of
Patients with Gastric Cancer after Curative Gastrectomy.
J Gastrointest Surg. 2009 Aug 5.
[Epub ahead of print] Allogeneic blood transfusion
is an independent prognostic factor for long-term survival in gastric cancer
patients.
HAEMATOLOGICA
Pomalidomide Is Active in the Treatment of Anemia Associated With
Myelofibrosis.J
Clin Oncol. 2009 Aug 3. [Epub ahead of print]
Pomalidomide therapy at 0.5 or 2 mg/d with or
without an abbreviated course of prednisone is well tolerated in patients
with myelofibrosis and active in the treatment of anemia.
Incorporating novel agents in the treatment of myelodysplastic syndromes.
Leuk Res.
2009 Aug 3. [Epub ahead of print] Review
BLOOD MANAGEMENT
Independent Validation of a Model Predicting the Need for Packed Red Blood
Cell Transfusion at Liver Transplantation.
Transplantation. 2009 Aug
15;88(3):386-391.Our nomogram represents the first
model capable of predicting the individual risk of PRBC transfusion at OLT.
Other weekly news:
THROMBOPOIETIC AGENTS
Thrombopoietin and thrombopoietin mimetics in the treatment of
thrombocytopenia.Annu
Rev Med. 2009;60:193-206. Review
TRANSFUSION ISSUES
Prognostic impact of blood transfusion after primary angioplasty for acute
myocardial infarction: analysis from the CADILLAC (Controlled Abciximab and
Device Investigation to Lower Late Angioplasty Complications) Trial.
JACC Cardiovasc Interv. 2009 Jul;2(7):624-32.
Patients transfused versus not transfused had
significantly higher rates of 1-year mortality (23.9% vs. 3.4%), disabling
stroke (2.5% vs. 0.5%), reinfarction (7.0% vs. 2.2%), and composite major
adverse cardiac events (41.0% vs. 16.6%) (all p values < 0.01). After
multivariable adjustment for potential confounders including transfusion
propensity, RBC transfusion was independently associated with mortality at
30 days (hazards ratio: 4.71, p = 0.0005) and 1 year (hazards ratio: 3.16, p
= 0.0005). An RBC transfusion after primary PCI in AMI may be harmful,
which is consistent with the findings from other studies after PCI in the
noninfarct setting. Alternatively, RBC transfusion may be a marker of
markedly increased risk. Randomized studies are warranted to determine the
optimal threshold for RBC transfusion in patients with AMI undergoing
mechanical reperfusion therapy.
ERYTHROPOIETIC THERAPY
Erythropoietin increases reticulocyte counts and maintains hematocrit in
neonates requiring surgery.
J Pediatr Surg. 2009 Aug;44(8):1540-5.
Infants randomized to Epo increased
reticulocyte counts and hematocrits without adverse effects. Erythropoietin
administration may provide an adjunct to present care in decreasing or
eliminating erythrocyte transfusions in surgical neonates.
BLOOD MANAGEMENT
Management of bleeding and of invasive procedures in patients with platelet
disorders and/or thrombocytopenia: The SISET Guidelines.Thromb
Res. 2009 Jul 23. [Epub ahead of print] In
these guidelines, promoted by the Italian Society for Studies on Haemostasis
and Thrombosis (Società Italiana per lo Studio dell'Emostasi e della
Trombosi [SISET]), Authors offer the best available evidence to help the
physicians involved in the management of patients with disorders of platelet
count or function. Literature review and appraisal of available evidence are
discussed for different clinical settings and for different available
treatments, including platelet concentrates (PC), recombinant activated
factor VII, desmopressin, antifibrinolytics, aprotinin and local hemostatic
agents.
CELL SALVAGE
COAGULANTS
HEMODILUTION
JEHOVAH'S WITNESSES
SURGICAL
TECHNIQUES AND DIAGNOSTIC TOOLS
INTERVENTIONAL RADIOLOGY
CARDIO-THORACIC SURGERY
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GlaxoSmithKline
plc Announces Start Of Eltrombopag
Phase III Worldwide Clinical Trial In Adults With
Previously-Treated Idiopathic Thrombocytopenic Purpura.
Click here
Baxter
BioSurgery
is a division of Baxter Healthcare, which markets advanced biomaterials for
hemostasis and tissue sealing. One of the latest products launched is FloSeal,
an adjunct hemostatic agent indicated in surgical procedures other than
ophthalmic (please refer to the package insert for details on approved
indication). FloSeal is effective in the presence of anticoagulants such as
heparin, and in patients placed on cardiopulmonary bypass, which can impair
coagulation ability.
TissueLink
-
Surgeons are able to simultaneously seal and dissect liver tissue with
one, easy-to-use device. The unique technology behind TissueLink’s DS™ devices
couples radio-frequency (RF) energy with saline to seal liver and pancreatic
tissue without charring or re-bleeding. Surgeons can pre-coagulate parenchyma
and vessels prior to transection to prevent or reduce blood loss.
TissueLink’s BPS™ line of products are designed to provide a rapid hemostatic
effect in hip and knee arthroplasty. These devices have the ability to
comprehensively treat broad surface areas such as cut bone. By delivering saline
to the point of tissue contact, both product lines reduce patient exposure to
allogenic blood and reduce the need for or eliminate other blood management
techniques. TissueLink Medical — Simply Better Surgery™.(video library).
The Hemobag - Global
Blood Resources has received US FDA clearance to market its novel Hemobag and
TS3 Tubing Set products for the salvage, hemoconcentration and reinfusion of
autologous whole blood instead of red blood cells only. Saving whole blood
enable perfusionist and anesthesiologist to return concentrated platelets,
clotting factors and plasma proteins back to the patients quickly, potentially
enhancing homeostasis and reducing bleeding activity. See
the Video:
www.mybloodfirst.com
The
Dideco
CryoSeal FS System
produces concentrated Thrombin and the same amount of
Cryoprecipitate containing highly concentrated Factor VIII, Factor XIII, and
fibrinogen from a single unit of autologous or allogeneic plasma in about one
hour. The components, collected in a dual syringe system, can be used on the
surgical field to produce fibrin glue.
Z-Medica
is the developer of hemostatic agents such as QuikClot ® and
Hemosorb™, medical breakthrough products that speed the coagulation of
blood.
QuikClot has undergone rigorous testing that proved it is unsurpassed in safely
and effectively stopping blood loss, the primary cause of death from severe
bleeding injuries.
QuikClot has received FDA 510(k) clearance on September 7,
2004
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The
XII International Symposium on
Blood Substitutes(ISBS)
will be held in Parma, Italy, on August 25-28, 2009.
Informations on the symposium are available on the
web page
FDA
Public Workshop 2008
The Food
and Drug Administration (FDA), the National Heart, Lung and
Blood Institute, National Institutes of Health; and the
Department of Health and Human Service's Office of the
Secretary and Office of Public Health and Science (OS/OPHS)
co-sponsored a public workshop entitled: "Hemoglobin
Based Oxygen Carriers: Current Status and Future
Directions."
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By:
Petra Seeber and Aryeh Shander
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PeerView
in Review:
Anemia Management and Blood Conservation in the Hospital Setting
-
Restrictive Blood Transfusion Does
Not Worsen Clinical Outcome
CME/CE
David Henry,
MD
Pennsylvania Hospital
Philadelphia, Pennsylvania
- Blood Transfusion and Adverse Events
CME/CE
Patricia Ann
Ford, MD
Pennsylvania Hospital
Philadelphia, Pennsylvania
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Exogenous Erythropoietin Reduces
Blood Transfusion in Critically Ill
CME/CE
Lena
Napolitano, MD
University of Michigan Medical School
University of Michigan Health System
Ann Arbor, Michigan
- Blood Conservation Reduces Transfusion and
Associated Risks in Surgical Patients CME/CE
Aryeh
Shander, MD
Englewood Hospital Medical Center
Englewood, New Jersey
Mount Sinai School of Medicine
New York, New York
 TATM
Treatment of a Jehovah's Witness using a
transfusion-free autologous stem cell transplant protocol. Community
Oncology 2006 Dec 12; 3(12):776-81 (PDF Full Text)
Extreme intraoperative blood loss and
hemodilution in a Jehovah's Witness:
new aspects in postoperative management
A 41 year
old female Jehovah's Witness patient was admitted for elective hysterectomy (large
uterine myoma). Unexpected massive bleeding occurred during the operation.
Wer hematocrit at the preoperative visit was 37,4% . At the end of the
surgery it was 8 %! In postoperative day 2 hematocrit was 6,4%
What would you do in this
case?
Anesthesiology
1999 December; 91(6):1949-1951
Nation's blood
supply failing to meet demand. Fears emerge that new restrictions on blood
donors will add to a year of national shortages. AMNews
- Aug. 20, 2001
Emerging
infectious disease issues in blood
safety.
In recent years,
numerous infectious agents found worldwide have been identified as potential
threats to the blood supply. Several newly discovered hepatitis viruses and
agents of transmissible spongiform encephalopathies present unique challenges
in assessing possible risks they may pose to the safety of blood and plasma
products. Emerg
Infect Dis. 2001;7(3 Suppl):552-3. See also
Annu Rev Med. 2004;55:191-207. Review. And:
Lancet.
2006 Jan 21;367(9506):252-61.
BROWN UNIVERSITY - Excellent website with comprhensive informations about blood
substitutes.
This site has been developed to
provide an up-to-date, unbiased and critical review of the current medical
issues surrounding blood substitutes. Our aim is to make available, an
informative yet concise insight into the recent and current research into this
exciting field of study.
Queens Medical Centre NHS Trust, Nottingham
An online
introduction to Intra-operative Cell Salvage
for Nurses, ODPs, Perfusionists, Surgeons and Anaesthetists. This is a pilot
course,
available until September 2005
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