Autologous transfusion: a community blood bank experience

Interest in the use of autotransfusion has increased greatly, as can be ascertained by looking at usage patterns and literature citations when compared to recent past years. In this paper, we discuss different autotransfusion methods, as well as the clinical experience of a community blood bank over a 3 1/2-year period with predeposited autologous transfusions for elective surgical procedures. Blood collected in Adenine-Saline (AS-1) preservatives allows up to 42 days of storage in liquid state after donation. An average of 2.4 units per donor-patient were drawn, with almost two thirds of them being reinfused during or immediately after surgery. Even though the results of cost analysis and efficiency are far from optimal, autologous transfusion remains an effective albeit expensive alternative to homologous transfusion.     

Hemolytic transfusion reaction due to anti-A

A hemolytic transfusion reaction in an A₂B patient due to anti-A₁ is described. Anti-A₁ was first detected simultaneously with the removal of transfused A₁ red blood cells. The antibody in the serum was shown to be of both the IgM and IgG class, but only IgG was demonstrated on and eluted from sensitized, transfused red blood cells. ⁵¹Cr survival studies of A₁ red blood cells demonstrated the hemolytic capability of this antibody on two occasions.     

Hemolytic transfusion reaction due to anti-IH

BACKGROUND: Anti‐IH is usually a clinically insignificant antibody that may complicate a serologic workup. However, it can occasionally cause hemolysis. We report a rare case of acute hemolysis caused by anti‐IH. CASE REPORT: A 60‐year‐old man with a long history of chronic myelomonocytic leukemia and anemia, blood group A, D+ was found to have an unidentified antibody on serologic workup. He received an A, D+ red blood cell (RBC) unit that was crossmatch compatible by immunoglobulin G indirect antiglobulin test and then experienced an acute hemolytic transfusion reaction with fever, hemoglobinuria, and acute renal failure. The antibody was later identified as an anti‐IH with a wide thermal amplitude. The transfused RBCs were later typed as A₂. The patient was subsequently typed as an A₁ individual. The patient recovered completely from the effects of this reaction and was transfused with A₁ RBCs over the next few days with no adverse effect. CONCLUSION: Anti‐IH, which is usually clinically insignificant and often found in A₁, B, and A₁B individuals, can, on rare occasions, cause acute hemolytic transfusion reactions, especially when an A₂ unit is transfused to an A₁ patient.     

Hemolytic transfusion reaction: Safeguards for practice

Most hemolytic transfusion reactions result from administration of ABO-incompatible blood. Even a small amount of incompatible blood may initiate a reaction and cause devastating consequences leading to death. Careful monitoring of the anesthetized patient is important in recognizing symptoms of a transfusion reaction so that the reaction may be promptly detected and treatment quickly initiated. Many factors contribute to blood transfusion errors resulting from the misidentification of either the patient or the blood product. Nursing has opportunities to establish policies and procedures, design nursing practices, and educate staff to help avoid blood transfusion errors.     

Adult outpatient transfusion clinic in a hospital-based blood bank

Eighty-one patients have been followed in our ambulatory transfusion clinic for a total of 176 patient visits. They received phlebotomies, plasmapheresis, and transfusions of erythrocytes and platelets. Minor reactions (febrile reactions, transient hypotension, and urticaria) occurred in only six patients. The advantages of a transfusion service conducted by blood bank professional and technical staff are numerous. The nurse/patient ratio is low enough so that the patient can receive individualized attention including virtually constant vigilance. The laboratory staff and pathologist become familiar with the therapeutic management of patients who may potentially place great stress on the laboratory. The transfusion clinic also provides an opportunity for the pathologist to gain further experience and to train others as transfusion therapists, a role which he is often asked to assume when a transfusion reaction occurs. The gain for the outpatient clinic and emergency room is that they can function more efficiently when more rooms are available for patients who have a faster turnover time.     

Hemolytic transfusion reaction following transfusion of frozen and washed autologous red cells

A case of hemolytic transfusion reaction, accompanied by hypotension and followed by transient renal failure, occurred after the transfusion of 1 unit of previously frozen autologous red cells. Subsequent investigation revealed the probable cause of the hemolysis to be inadequate deglycerolization of the unit. The cause of the associated symptoms is unknown. Possibilities include nephrotoxic effects of hemoglobin or stroma, toxic effects of glycerol, or release of vasoactive or thrombogenic substances from lysed red cells. This case of a hemolytic reaction adds to the known risks of autologous transfusion.     

Massive blood transfusion: the blood bank perspective

The pathophysiology and support of the massively transfused patient from the vantage of a blood banker is reviewed. Hypothermia, acidosis and shock must be reversed if blood component therapy is to be effective. Algorithms which employ ratios of various blood components have not proved themselves, nor are screening coagulation tests of value until they are remarkably abnormal. Thrombocytopenia, thrombocytopathy, and hypofibrinogenemia appear to be the parameters which predispose to continued bleeding and microvascular hemorrhage in these patients. A large part of the impaired hemostasis is due to a consumption coagulopathy rather than the anecdotal assumption that dilution of the hemostatic elements is to blame. Hypocalcemia, hypomagnesemia and hyperkalemia are rarely observed nor do they pose a problem for this group of individuals. The logistics of blood supply to the clinical areas are addressed by describing one system that has proved itself.     

Hemolytic transfusion reaction due to anti-Tca

BACKGROUND: Anti-Tc(a) detects a high-incidence antigen in the Cromer blood group system. Cromer system antibodies have not usually been associated with hemolytic transfusion reactions or hemolytic disease of the newborn. CASE REPORT: Anti-Tc(a) (initially identified in the patient's serum in 1982) was not detected when she was admitted to the hospital with upper gastrointestinal. bleeding. Three units of red cells were administered. The patient was discharged, but was readmitted to the hospital after her hemoglobin fell to 7.1 g per dL. Antibody detection tests remained negative and three additional units were transfused. Over the next 7 days, her hemoglobin steadily fell to 5.5 g per dL. The level of lactate dehydrogenase rose to 1257, the plasma hemoglobin rose to >16 mg per dL, and the haptoglobin decreased to <6 mg per dL. Five days after transfusion, her direct antiglobulin test was weakly reactive with complement-specific antiglobulin reagents. Eluates were nonreactive. Anti-Tc(a) was detected in her serum; no other antibodies were detected. Differential typing failed to detect any circulating Tc(a+) red cells. The antibody was strongly reactive in a monocyte monolayer assay. CONCLUSION: Although Cromer system antibodies have generally not been proven to be clinically significant in transfusion therapy, the destruction of red cells from six units of transfused Tc(a+) red cells in this patient indicates that anti-Tc(a) may have destructive potential in some patients.     

A delayed blood transfusion reaction in a border collie

Blood transfusions are undertaken in most first-opinion practices and RVNs are often required to support patients both during and after a transfusion. Knowledge of the mechanisms behind transfusion reactions and the ability to recognise them are useful to any RVN supporting such patients. Development of laboratory skills and confidence to provide patient side information to the attending VS improves clinical care and is a great asset within any Practice team.     

Transfusion reaction. An immunologic hazard of blood transfusion

Twenty-three cases of delayed hemolytic transfusion reaction (DHTR) occurring at the Mayo Clinic from 1964 through 1973 are reviewed. Nineteen patients had clinical manifestations of hemolysis, of which fever was the most frequent presenting symptom. The degree of hemolysis served as an index of morbidity. In four cases, there was oliguria, two of these patients experiencing renal shutdown. In one case, hemolysis led to a disseminated intravascular coagulation syndrome. Death occurred subsequent of DHTR in three patients. The direct antiglobulin test was positive in all but one case; this finding coincided with elevated unconjugated bilirubin in 14 cases and decreased haptoglobin levels in 15 cases. Anti-Jka antibody accounted for somewhat more than one-third of reactions and, along with anti-E, c, D, Fya, and K antibodies accounted for 91 per cent of cases.     

自体血回输导致低血压性输血反应研究进展

为减少异体输血并发症和缓解血液资源短缺,术中血液回收技术在临床应用广泛,产科也逐步开展此项技术。低血压性输血反应(HyTR)是一种较少见的输血反应,其不仅在异体输血方面有临床报道,还发生在自体输血。自2010年,英国报道术中输注回收自体血导致HyTR以来,该不良反应持续被报道,并有上升趋势。自体血回输导致HyTR应引起广泛关注。本文就近几年HyTR的研究进展进行综述,为诊断和预防此类不良反应提供参考。     

输血不良反应的研究进展

输血不良反应是指患者在输注全血或成分血过程中或输血后发生了用其原发病不能解释的、新的症状和体征。由于人类血型系统的复杂性,同型输血实际上还是异型输血,每次输血都可能作为免疫原输入而在受血者体内产生相应的不规则抗体,导致不良反应的发生;国外综合报道输血反应的发生率约为2%—10%,输血死亡率有的国家高达1%。输血相关急性肺损伤、输血相关循环超负荷以及输血相关溶血反应等是输血导致死亡的重要原因。虽然输血不良反应无法通过输血前相容检测就可以预防,但我们可以通过认识输血不良反应的性质、特点及概率,加强临床输血环节的质量控制,具备识别潜在输血不良反应症状的能力、有确定识别输血不良反应的标准和应急措施,就能有效降低输血不良反应发生率。     

A prospective audit program to determine blood component transfusion appropriateness at a large university hospital: a 5-year experience

Predetermined transfusion guidelines, pretransfusion approval, and transfusion audits are useful tools in the education of those ordering blood components, potentially resulting in the reduction of inappropriate use of blood components. Our institution requires mandatory prospective audits for a proportion (10%) of packed red blood cell unit orders and all orders for fresh frozen plasma, platelets, and cryoprecipitate. Cases where the blood bank physician recommends against a transfusion and the ordering physician concurs, or when blood components are released against blood bank's recommendation, are referred to the transfusion committee. Transfusion committee members review the medical records to determine the circumstances surrounding the transfusion request as well as patient outcomes relating to their receiving or not receiving the transfusion. We analyzed 220 transfusion episodes brought before the transfusion committee from 2001 to 2005. The most requested blood component denied or changed was fresh frozen plasma. With only a few exceptions, the denial or change of blood components had no adverse effect on the patient. Nonetheless, these interventions were deemed appropriate by the transfusion committee. In most cases, blood components released based on the demand of the ordering physician, despite the advice of the blood bank physician, were deemed as inappropriate transfusions. This study therefore suggests that prospective audits of blood component orders can help reduce inappropriate transfusions and can be a valuable educational tool for the ordering physicians as well as for residents in training.