One year period prevalence of blood transfusion

Transfusion practice is reported to differ considerably between countries. Comparisons often rely on transfusion rates, incidence ‐ or prevalence rates. In this paper, the one‐year period prevalence rate (1‐YPPR) of transfusion of red cells (RBC) is presented. Transfusion data, demographic data and patient data were retrospectively combined to calculate sex and diagnosis specific and age standardized 1‐YPPR s of RBC transfusion for the complete population in a Danish county. During the calendar year of 2006, 4427 patients received RBC transfusion in Funen County. The crude 1‐YPPR of RBC transfusion was 9.2/1000 citizens. Most of the transfused patients had a main diagnosis of neoplasm (22% of recipients), diseases of the circulatory system (15%), the digestive system (15%), injuries (13%) and diseases of the blood (8%). Age standardization reversed the relation between sex specific 1‐YPPRs, yielding a statistically significantly higher 1‐YPPR in males (6.8/1000) vs. females (6.3/1000). The method for calculating a diagnosis specific 1‐YPPR of transfusion of RBC is presented and proposed as an option for comparison of transfusion practice with other transfusion centres. The crude and the diagnosis specific 1‐YPPR s are found to increase with age. Thus, age standardization of crude prevalence rates is necessary for meaningful comparisons between populations.     

Erythropoietin to minimize perioperative blood transfusion: a systematic review of randomized trials

Our aim was to perform a systematic review to determine the efficacy and side-effects of erythropoietin, given with or without autologous predonation, to patients undergoing orthopaedic or cardiac surgery. A number of studies have been done to determine whether erythropoietin minimizes exposure to perioperative allogeneic red cell transfusion. A systematic review of all randomized trials will provide the best estimate of the efficacy and side-effects of erythropoietin therapy. All randomized trials of erythropoietin in cardiac or orthopaedic surgery that reported the proportion of patients receiving perioperative allogeneic transfusion were included. The efficacy of erythropoietin was evaluated in subgroups of patients depending upon the route of administration, dose of erythropoietin, the type of control and the methodological quality of the study report. The odds ratio for the proportion of patients transfused with allogeneic blood in studies of erythropoietin to augment autologous donation was 0.42 (95% confidence limits 0.28–0.62; P < 0.0001) for orthopaedic surgery and 0.25 (95% CI 0.08–0.82; P = 0.02) for cardiac surgery. The odds ratio for erythropoietin alone was 0.36 (95% CI 0.24–0.56; P = 0.0001) in orthopaedic surgery and 0.25 (95% CI 0.06–1.04; P < 0.06) in cardiac surgery. The route of administration, dose of erythropoietin, type of control and methodological quality of the study report had no statistically significant effect upon the odds ratios. Although there was no convincing evidence that erythropoietin used alone increased the frequency of thrombotic complications, some studies found an excess of events in erythropoietin-treated patients, and the number of patients studied was relatively small. Erythropoeitin, when given alone or to augment autologous donation, decreased exposure to perioperative allogeneic transfusion in orthopaedic and cardiac surgery. Further studies are required to definitively establish the safety of erythropoietin alone, to determine the optimal dose of perioperative erythropoietin, and to compare its efficacy and cost-effectiveness with other methods of minimizing perioperative transfusion.     

Multifaceted role of glycosylation in transfusion medicine,platelets, and red blood cells

Glycosylation is highly prevalent, and also one of the most complex and varied posttranslational modifications. This large glycan diversity results in a wide range of biological functions. Functional diversity includes protein degradation, protein clearance, cell trafficking, cell signaling, host‐pathogen interactions, and immune defense, including both innate and acquired immunity. Glycan‐based ABO(H) antigens are critical in providing compatible products in the setting of transfusion and organ transplantation. However, evidence also suggests that ABO expression may influence cardiovascular disease, thrombosis, and hemostasis disorders, including alterations in platelet function and von Willebrand factor blood levels. Glycans also regulate immune and hemostasis function beyond ABO(H) antigens. Mutations in glycogenes (PIGA, COSMC) lead to serious blood disorders, including Tn syndrome associated with hyperagglutination, hemolysis, and thrombocytopenia. Alterations in genes responsible for sialic acids (Sia) synthesis (GNE) and UDP‐galactose (GALE) and lactosamine (LacNAc) (B4GALT1) profoundly affect circulating platelet counts. Desialylation (removal of Sia) is affected by human and pathogenic neuraminidases. This review addresses the role of glycans in transfusion medicine, hemostasis and thrombosis, and red blood cell and platelet survival.     

Nitric oxide and blood: a review

Nitric oxide (NO) was identified as a physiological mediator of vascular tone in 1987. NO produced by endothelial cells causes vasodilatation and also inhibits platelet aggregation and leucocyte adhesion. Red cells metabolize NO to nitrate but may possibly carry and release, or even produce, NO in hypoxic conditions. NO physiology may have important implications for transfusion medicine, ranging from adverse effects of haemoglobin substitutes to preservation of stored platelets and to detrimental effects of stored red cells.     

悬浮红细胞及血浆输注对大量输血手术患者凝血功能的影响

目的 观察悬浮红细胞及血浆输注对大量输血手术患者凝血功能的影响.方法 选取2018年12月至2020年5月该院大量输血手术患者63例,输注悬浮红细胞的31例患者为对照组,输注悬浮红细胞及血浆的32例患者为联合组.比较两组输注前后凝血功能指标[凝血酶原时间(PT)、纤维蛋白原(FIB)、凝血酶时间(TT)、活化部分凝血活...     

Home blood transfusion: a necessary service development

An alternative to the transfusion of blood and platelets in hospital was assessed with the aim of reducing the demand on acute services and the need for hospital admission. Patients and general practitioners [GPs] were surveyed before a home blood transfusion service was set up. The majority of GPs and patients did not support the scheme initially. After the service was set up, all patients who received home transfusion stated that this was more convenient. We feel that by avoiding unnecessary emergency admissions, which account for up to 40% of all admissions to NHS hospitals, and improving the capacity of our day unit, we are providing a better service for local patients. More widespread use of home transfusion services should be encouraged.     

输血不良反应的回顾性分析及安全用血初探

目的分析输血不良反应发生的原因,探讨减少输血不良反应的输血方式,使临床输血更安全、科学。方法对泸州市中医医院2013年1月至2014年12月发生的输血不良反应进行分析。结果 2013年1月至2014年12月在该院接受输血治疗的住院患者1 377例,共输血2 085例,共收到临床回报的非溶血性输血不良反应记录49例,发生率为2.35%,其中,过敏反应41例,占83.67%;发热反应8例,占16.33%,其他类型输血不良反应未收到回报。在49例输血不良反应病例中,红细胞悬液28例,占57.14%;血浆14例,占28.57%;红细胞悬液+血浆组5例,占12.25%;血小板1例,占2.04%;冷沉淀1例,占2.04%;洗涤红细胞未收到不良反应记录。结论该院输血不良反应以过敏反应为主,其次为发热反应;对有妊娠史和输血史的患者输血时,应增加献血员的抗体筛查检测,选择抗体筛查阴性的血液制品进行输注,应推广使用洗涤红细胞,可有效避免和降低输血不良反应的发生,使临床输血更安全、科学。     

The cost of allogeneic red blood cells – a systematic review

Summary.  Several reports suggest that the cost of RBCs may have risen over time, but there exists very little published evidence of that. The objective was to determine whether published studies documenting cost data on RBCs suggest an increase over time and to assess the quality of cost studies. We used the terms 'cost', 'allogeneic/allogenic' and 'blood' to identify cost studies between 1966 and 2002 from Medline, ISIesource and Ingenta electronic databases. Furthermore, we manually searched a number of transfusion and health economics journals for completeness. We included studies that used an established methodology and conducted an economic evaluation using primary/secondary cost data to calculate the cost of RBCs and RBC transfusion. Studies without allogeneic RBCs as comparator were excluded. Two individuals independently reviewed the studies and included studies upon reaching a consensus. Fourteen studies qualified the selection criteria and were included in the review. Ten studies were identified from Medline, two from Ingenta, one from ISIesource and one was a conference paper. Of the 14 studies reviewed, 10 had focused on RBC transfusion and four had focused on both RBCs and RBC transfusion. Ten studies were from the US, and two each from Canada and the UK, respectively. Two studies had explicit objective of cost calculation, and others had calculated costs towards fulfilling other objectives. Most of the reviewed studies were dated and of poor quality. Despite these limitations, it appears that the cost of RBCs has increased over time in the UK, Canada and the US. More studies are needed to fully assess the trend of costs over time. Future cost studies should try to follow the economic evaluation guidelines for greater research implications.     

建立输血不良反应监测体系连续对发热性非溶血性输血反应的监测与分析

目的探讨发热性非溶血性输血反应(FNHTR)的发生率及发病的相关因素。方法建立输血不良反应的监测体系,连续监测2006年1月-2014年9月本院门诊或/和住院患者FNHTR的发病情况,对确诊的280例FNHTR的临床资料进行分析。结果 1)输注血小板、红细胞、血浆及冷沉淀患者FNHTR的发生率分别为0.8‰(33/43 684)、0.42‰(156/374 343)、0.17‰(88/519 460)和0.08‰(3/38 361);2)输注悬浮红细胞与少白红细胞的FNHTR的发生率分别为0.50‰(119/240 232)vs 0.28‰(37/134 111)(P0.05);3)男性和女性FNHTR患者有输血史的比例分别为72.4%(121/167)vs 71.7%(81/113)(P0.05)。结论引起FNHTR的血液成分主要是血小板;输注少白细胞红细胞可明显降低FNHTR的发生率;输血史是FNHTR的高危因素。     

动态观察冷沉淀对大量输血患者凝血时间的影响

目的 观察输注冷沉淀对大量输血后患者出凝血时间的影响与其在临床中的应用价值.方法 对3例大量输血后有凝血异常的患者,输注冷沉淀前与输注冷沉淀后24 h内出凝血时间曲线的动态观察并进行统计学分析.结果 3例患者输注冷沉淀前后相比,患者的凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血活酶时间(APTT)均明显缩短,纤维蛋白原(FIB)含量增加.结论 冷沉淀的输注对大量输血后并发凝血异常的患者有明显的纠正效果.     

不同自体输血方式的临床效果研究

目的 探讨不同自体输血方式的有效性,促进医疗机构开展自体输血工作,保障临床输血安全.方法 采用简单随机抽样法随机选择2014年1月至2016年7月,于北京军区总医院或大连中心医院行骨科手术的88例自体输血患者作为研究对象.采用简单随机分组法,将其随机分为,术中自体红细胞回输组(n=43),储存式自体全血回输组(n=25)及储存式自体单采红细胞回输组(n=20).采用简单随机抽样法,选择同期42例于受试者收集医院行骨科手术,并且术中仅接受异体输血的患者,纳入对照组(n=42).记录并分析采血前/术前、输血后当天、输血后第4天,各组患者红细胞计数、血红蛋白(Hb)水平、血细胞比容(HCT)、血小板计数,以及患者住院天数、术中出血量、异体输血量等指标.采用统计学方法比较4组患者上述各项指标的差异.结果 ①本研究4组患者采血前/术前的红细胞计数、Hb水平、HCT、血小板计数分别比较,差异均无统计学意义(P＞0.05).②输血后当天:4组患者的红细胞计数、Hb水平、HCT分别比较,差异均无统计学意义(P＞0.05);4组患者的血小板计数比较,差异有统计学意义(F=4.157,P=0.008).其中,储存式自体全血回输组患者的血小板计数最高[(196.0±43.8)×109/L],高于术中自体红细胞回输组、对照组,并且差异均有统计学意义(P=0.004、0.009);但是,与储存式自体单采红细胞回输组比较,差异无统计学意义(P=0.653).③输血后第4天:4组患者的红细胞计数比较,差异无统计学意义(P＞0.05);4组患者的Hb水平比较,差异有统计学意义(F=3.764,P=0.013).其中,术中自体红细胞回输组的Hb水平最高[(115.6±23.8)g/L],高于储存式自体全血回输组及对照组,并且差异均有统计学意义(P=0.022、0.006);但是,与储存式自体单采红细胞回输组比较,差异无统计学意义(P=0.878).4组患者的HCT比较,差异有统计学意义(F=3.915,P=0.011).其中,储存式自体单采红细胞回输组HCT最高[(34.4=4.8)％],高于对照组,并且差异有统计学意义(P=0.012);但是,与储存式自体全血回输组及术中自体红细胞回输组分别比较,差异均无统计学意义(P=0.059、0.819).④4组患者术中出血量和异体输血量分别比较,差异均无统计学意义(P＞0.05).4组患者住院天数比较,差异有统计学意义(x2=11.990,P=0.007).其中,对照组患者的住院天数最长[14.5 d(9.5～16.0 d)],长于储存式自体全血回输组,并且差异有统计学意义(P=0.007);但是,与储存式自体单采红细胞回输注及术中自体红细胞回输组分别比较,差异均无统计学意义(P=0.09、0.944).结论 临床择期外科手术患者的自体输血方式,首选储存式自体单采红细胞回输,其次为储存式自体全血回输和术中自体红细胞回输.在不能达到自体输血要求时,可选择异体输血.临床医师需要转变观念,逐步降低异体输血率,广泛、有效地开展自体输血工作,进一步保障临床输血安全.     

Drugs and blood transfusions: dogma‐ or evidence‐based practice?

summary .  There is a lack of consensus on the safety of the coadministration of drugs and red blood cells (RBCs). A systematic review was undertaken to establish the evidence base for this question and assess how the evidence may be translated into present clinical day practice. Comprehensive searches of MEDLINE, EMBASE, CINAHL, the Cochrane Library and hand searching of transfusion journals, guidelines and websites identified 12 relevant papers: 11 in-vitro experiments and 1 case report. Data on incidences of haemolysis and agglutination following coadministration were extracted and analysed. Overall findings suggest that iron chelators (two papers), antimicrobials (three papers) and lower doses of opioids (three papers) are safe to coadminister with RBCs. Haemolysis was observed with higher doses of opioids (three papers). Transposition of these findings to clinical practice is limited because of the lack of clinical applicability of in-vitro experiments and diversity in how, and what, clinical outcome measures were used. Further evidence from true clinical settings would be required to inform clinical practice on the efficacy and safety of the coadministration of drugs and RBCs.     

A survey of blood utilization in children and adolescents in a German university hospital

There are no detailed data on blood use with regard to diagnoses of recipients during infancy, childhood and adolescence. Available information on this issue is incomplete and no longer current. We conducted a survey of blood component use in children and adolescents in an acute-care university hospital in the greater area of Nuremberg between June 1994 and September 1996. Packed red blood cells (RBCs), fresh-frozen plasmas (FFPs) and platelet (PLT) components were evaluated for the recipients discharge diagnoses. Source study files were extracted from the hospital transfusion service and the medical records department. Transfused units were listed by broad diagnostic categories and leading diagnostic groups formed from principal diagnoses of the recipients according to the International Classification of Diseases , 9th edn (ICD-9). 34.3% of 2869 RBC cell units, 35.0% of 1095 FFP units and 5.0% of 1028 PLT components were used in patients with congenital diseases, mainly cardiac defects. The disease category neoplastic diseases was next most frequently associated with blood transfusion diagnosed in recipients of 23.9% of all RBCs, 15.6% of all FFP units and in 66.4% of all PLT units. Malignant diseases and benign haematological diseases (diagnostic categories II and IV) accounted for 68.9% of all costs of blood component transfusion. These findings demonstrate the increased importance of platelet transfusion for the organization of local and regional blood donation programmes and for cost analysis exercises. The study shows that detailed information on local blood use may be obtained quickly using available data collections of transfusion services and medical record departments.     

The EASTR Study: indications for transfusion and estimates of transfusion recipient numbers in hospitals supplied by the National Blood Service

This study provides data on National Blood Service (NBS) red blood cell (RBC, n = 9142), platelet (PLT, n = 4232) and fresh frozen plasma (FFP, n = 3584) recipients independently sampled by monthly quota from 29 representative hospitals over 12 months in 2001–2002. Hospitals were stratified by size according to total yearly RBC issues. Transfusion indications were chosen from diagnostic and procedural codes, and recipients grouped into Epidemiology and Survival of Transfusion Recipients Case-mix Groups (E-CMGs). The main E-CMGs were digestive [19% of RBC recipients; including 5% gastrointestinal (GI) bleeds and 3% colorectal surgery], musculoskeletal (15%; 12% hip and knee replacement), haematology (13%) and obstetrics and gynaecology (10%). Renal failure, fractured neck of femur, cardiac artery by-pass grafting (CABG) and paediatrics, each accounted for 3–4% recipients. FFP recipients: the main E-CMGs were digestive (21% of FFP recipients; including 7% GI bleeds and 3% colorectal surgery), hepatobiliary (15%; 7% liver disease and 2% liver transplant), cardiac (12%) and paediatrics (9%) The renal, paediatrics, vascular and haematology E-CMGs each had 6–7% of recipients. PLT recipients: the main E-CMGs were haematology (27% of PLT recipients; including 9% lymphoma and 8% acute leukaemia), cardiac (17%), paediatrics (13%), hepatobiliary (10%) and digestive (9%). Back-weighting gave national estimates of 433 000 RBC, 57 500 FFP and 41 500 PLT recipients/year in England and North Wales, median age 69, 64 and 59 years, respectively. Digestive and hepatobiliary indications emerged as the top reason for transfusion in RBC and FFP recipients, and was also a frequent indication in PLT recipients.