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The Medical Clinics of North America Mar 2017Transfusion of red blood cells (RBCs) is a balance between providing benefit for patients while avoiding risks of transfusion. Randomized, controlled trials of... (Review)
Review
Transfusion of red blood cells (RBCs) is a balance between providing benefit for patients while avoiding risks of transfusion. Randomized, controlled trials of restrictive RBC transfusion practices have shown equivalent patient outcomes compared with liberal transfusion practices, and meta-analyses have shown improved in-hospital mortality, reduced cardiac events, and reduced bacterial infections. This body of level 1 evidence has led to substantial, improved blood utilization and reduction of inappropriate blood transfusions with implementation of clinical decision support via electronic medical records, along with accompanying educational initiatives.
Topics: Anemia; Blood Transfusion; Clinical Decision-Making; Humans; Meta-Analysis as Topic; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Transfusion Reaction; Virus Diseases
PubMed: 28189180
DOI: 10.1016/j.mcna.2016.09.012 -
Critical Care Clinics Jan 2017The resuscitation of traumatic hemorrhagic shock has undergone a paradigm shift in the last 20 years with the advent of damage control resuscitation (DCR). Major... (Review)
Review
The resuscitation of traumatic hemorrhagic shock has undergone a paradigm shift in the last 20 years with the advent of damage control resuscitation (DCR). Major principles of DCR include minimization of crystalloid, permissive hypotension, transfusion of a balanced ratio of blood products, and goal-directed correction of coagulopathy. In particular, plasma has replaced crystalloid as the primary means for volume expansion for traumatic hemorrhagic shock. Predicting which patient will require DCR by prompt and accurate activation of a massive transfusion protocol, however, remains a challenge.
Topics: Blood Transfusion; Fluid Therapy; Humans; Isotonic Solutions; Practice Guidelines as Topic; Resuscitation; Shock, Hemorrhagic
PubMed: 27894494
DOI: 10.1016/j.ccc.2016.08.007 -
Blood Reviews Sep 2019Patients with β-thalassemia major (BTM) require regular blood transfusions, supported by appropriate iron chelation therapy (ICT), throughout their life. β-thalassemia... (Review)
Review
Patients with β-thalassemia major (BTM) require regular blood transfusions, supported by appropriate iron chelation therapy (ICT), throughout their life. β-thalassemia is a global disease that is most highly prevalent in Southeast Asia, Africa, and Mediterranean countries. However, the global distribution of patients with β-thalassemia is changing due to population migration, and Northern European countries now have significant thalassemia populations. Globally, many patients with BTM have limited access to regular and safe blood transfusions. A lack of voluntary nonremunerated blood donors, poor awareness of thalassemia, a lack of national blood policies, and fragmented blood services contribute to a significant gap between the timely supply of, and demand for, safe blood. In many centers, there is inadequate provision of antigen testing, even for common red cell antigens such as CcEe and Kell. Policies to raise awareness and increase the use of red blood cell antigen testing and requesting of compatible blood in transfusion centers are needed to reduce alloimmunization (the development of antibodies to red blood cell antigens), which limits the effectiveness of transfusions and the potential availability of blood. Patients with BTM are also at risk of transfusion-transmitted infections unless appropriate blood screening and safety practices are in place. Hence, many patients are not transfused or are undertransfused, resulting in decreased health and quality-of-life outcomes. Hemovigilance, leukoreduction, and the ability to thoroughly investigate transfusion reactions are often lacking, especially in resource-poor countries. ICT is essential to prevent cardiac failure and other complications due to iron accumulation. Despite the availability of potentially inexpensive oral ICT, a high proportion of patients suffer complications of iron overload and die each year due to a lack of, or inadequate, ICT. Increased awareness, training, and resources are required to improve and standardize adequate blood transfusion services and ICT among the worldwide population of patients with BTM. ICT needs to be available, affordable, and correctly prescribed. Effective, safe, and affordable new treatments that reduce the blood transfusion burden in patients with β-thalassemia remain an unmet need.
Topics: Blood Transfusion; Humans; beta-Thalassemia
PubMed: 31324412
DOI: 10.1016/j.blre.2019.100588 -
Seminars in Perinatology Feb 2019Blood product transfusion capabilities are crucial for appropriate response to postpartum hemorrhage. Novel treatments are continually being sought to improve maternal... (Review)
Review
Blood product transfusion capabilities are crucial for appropriate response to postpartum hemorrhage. Novel treatments are continually being sought to improve maternal morbidity and mortality associated with massive hemorrhage.
Topics: Antifibrinolytic Agents; Blood Transfusion; Clinical Protocols; Delivery, Obstetric; Female; Humans; Postpartum Hemorrhage; Pregnancy; Tranexamic Acid
PubMed: 30527516
DOI: 10.1053/j.semperi.2018.11.008 -
Transfusion Clinique Et Biologique :... Feb 2023Many patients worldwide receive platelet components (PCs) through the transfusion of diverse types of blood components. PC transfusions are essential for the treatment... (Review)
Review
Many patients worldwide receive platelet components (PCs) through the transfusion of diverse types of blood components. PC transfusions are essential for the treatment of central thrombocytopenia of diverse causes, and such treatment is beneficial in patients at risk of severe bleeding. PC transfusions account for almost 10% of all the blood components supplied by blood services, but they are associated with about 3.25 times as many severe reactions (attributable to transfusion) than red blood cell transfusions after stringent in-process leukoreduction to less than 10 residual cells per blood component. PCs are not homogeneous, due to the considerable differences between donors. Furthermore, the modes of PC collection and preparation, the safety precautions taken to limit either the most common (allergic-type reactions and febrile non-hemolytic reactions) or the most severe (bacterial contamination, pulmonary lesions) adverse reactions, and storage and conservation methods can all result in so-called PC "storage lesions". Some storage lesions affect PC quality, with implications for patient outcome. Good transfusion practices should result in higher levels of platelet recovery and efficacy, and lower complication rates. These practices include a matching of tissue ABH antigens whenever possible, and of platelet HLA (and, to a lesser extent, HPA) antigens in immunization situations. This review provides an overview of all the available information relating to platelet transfusion, from donor and donation to bedside transfusion, and considers the impact of the measures applied to increase transfusion efficacy while improving safety and preventing transfusion inefficacy and refractoriness. It also considers alternatives to platelet component (PC) transfusion.
Topics: Humans; Adult; Platelet Transfusion; Blood Platelets; Thrombocytopenia; Blood Transfusion; Blood Component Transfusion
PubMed: 36031180
DOI: 10.1016/j.tracli.2022.08.147 -
Journal of Cardiothoracic and Vascular... Feb 2018
Review
Topics: Adult; Advisory Committees; Anesthesia, Cardiac Procedures; Blood Transfusion; Cardiac Surgical Procedures; Europe; Humans; Practice Guidelines as Topic
PubMed: 29029990
DOI: 10.1053/j.jvca.2017.06.026 -
Journal of Feline Medicine and Surgery May 2021Blood and blood products are increasingly available for practitioners to use in the management of haematological conditions, and can be lifesaving and therapeutically...
PRACTICAL RELEVANCE
Blood and blood products are increasingly available for practitioners to use in the management of haematological conditions, and can be lifesaving and therapeutically useful for patients with anaemia and/or coagulopathies. It is important for feline healthcare that donors are selected appropriately, and transfusions of blood or blood products are given to recipients that will benefit from them. Complications can occur, but can be largely avoided with careful donor management and recipient selection, understanding of blood type compatibility, and transfusion monitoring.
CLINICAL CHALLENGES
Feline blood transfusion, while potentially a lifesaving procedure, can also be detrimental to donor and recipient without precautions. Cats have naturally occurring alloantibodies to red cell antigens and severe reactions can occur with type-mismatched transfusions. Blood transfusions can also transmit infectious agents to the recipient, so donor testing is essential. Finally, donors must be in good health, and sedated as appropriate, with blood collected in a safe and sterile fashion to optimise the benefit to recipients. Transfusion reactions are possible and can be mild to severe in nature. Autologous blood transfusions and xenotransfusions may be considered in certain situations.
EVIDENCE BASE
These Guidelines have been created by a panel of authors convened by the International Society of Feline Medicine (ISFM), based on available literature. They are aimed at general practitioners to provide a practical guide to blood typing, cross-matching, and blood collection and administration.
Topics: Anemia; Animals; Blood Group Antigens; Blood Grouping and Crossmatching; Blood Transfusion; Cat Diseases; Cats; Transfusion Reaction
PubMed: 33896248
DOI: 10.1177/1098612X211007071 -
British Journal of Haematology Dec 2016
Topics: Blood Transfusion; Female; Guidelines as Topic; Humans; Infant, Newborn; Pregnancy
PubMed: 27861734
DOI: 10.1111/bjh.14233 -
Blood Transfusion = Trasfusione Del... Jul 2019
Topics: Blood Donors; Blood Preservation; Blood Transfusion; Humans; Precision Medicine; Transfusion Medicine
PubMed: 31385798
DOI: 10.2450/2018.0142-19 -
British Journal of Anaesthesia Feb 2022Transfusion support is an essential element of modern emergency healthcare. Blood services together with hospital transfusion teams are required to prepare for, and...
Transfusion support is an essential element of modern emergency healthcare. Blood services together with hospital transfusion teams are required to prepare for, and respond to, mass casualty events as part of wider healthcare emergency planning. Preparedness is a constant collaborative process that actively identifies and manages potential risks, to prevent such events becoming a 'disaster'. The aim of transfusion support during incidents is to provide sufficient and timely supply of blood components and diagnostic services, whilst maintaining support to other patients not involved in the event.
Topics: Blood Component Transfusion; Blood Transfusion; Cooperative Behavior; Disaster Planning; Emergency Medical Services; Humans; Mass Casualty Incidents; Patient Care Team
PubMed: 34503826
DOI: 10.1016/j.bja.2021.07.027