Although guidelines recommend the use of single-unit red blood cell (RBC) transfusions to minimize allogeneic blood exposure, clinical practice remains dominated by two-unit transfusions. This study assesses the potential impact of a single-unit transfusion policy on reducing RBC utilization. We performed a retrospective analysis of adult patients admitted to a tertiary care hospital who received one or two RBC units. In subjects transfused two units, the effect of one unit was estimated by dividing the change in haemoglobin by 2. The proportion of patients reaching a haemoglobin threshold of 70, 75, 80, 85 and 90 g L(-1) with a single RBC unit was estimated. Of 302 included patients, only 65 received a one-unit transfusion. Based on thresholds of > or = 90, > or = 80 and > or = 70 g L(-1), a single-unit transfusion would be sufficient in 42.0% (RRR = 0.54), 79.6% (RRR = 0.23) and 98.0% (RRR = 0.02) of cases, respectively. This corresponds to 0.21, 0.57 and 0.82 mean RBC units saved per patient. In the orthopaedic subpopulation, the mean RBC units saved are 0.53, 0.88 and 1.00 for the same haemoglobin targets. Adopting a policy of transfusing RBC in single-unit aliquots could significantly improve RBC utilization and decrease patient exposure to allogeneic blood.
This review of IVIG-induced aseptic meningitis over a 6-year period identifies a more robust estimate of incidence and risk of 0.60% and 0.067% for all patients and infusions, respectively. Given that this complication can mimic infectious meningitis and cause considerable morbidity, physicians need to be aware of this rare but important condition.
A 3-year-old girl with relapsed acute myelogenous leukemia received a transfusion of a 5-day-old single-donor volume-reduced HLA-matched platelet (PLT) unit before a CAT scan-guided drainage of pleural fluid. Within minutes of completing the transfusion, the patient, who was receiving a broad-spectrum antibiotic (meropenem), became febrile, confused, and hypotensive. Despite aggressive treatment, she died of multisystem organ failure 21 hours after transfusion. Blood and urine samples obtained from the recipient 18 hours after the transfusion, while on antibiotics, were negative for the presence of bacteria. Serratia marcescens, however, was isolated from cultures of the recipient's blood, urine, liver, and lung obtained at autopsy.Investigations were conducted at Canadian Blood Services, the PLT provider, and at the hospital. The PLT product was positive for the presence of Gram-negative bacilli, had 3.0 × 10 9 colony-forming units (CFUs) per mL of S. marcescens, and contained 194,400 EU per mL of endotoxin . Samples obtained from the plasma removed during volume reduction (performed 30 min before transfusion), the PLT filter, and saline solution attached to the PLT pack were positive for the presence of the same bacterium . Pulse-field gel electrophoresis genotyping of S. marcescens isolates from different samples showed that they had identical band patterns (Fig. 1).Several items having the same lot numbers as the items used during collection of the transfused unit, namely, plateletpheresis collection sets, vacutainer tubes, recalled and in-date apheresis PLT units, and secondary sample bags, were cultured and found to be negative for the presence of S. marcescens. Blood and urine samples provided by the donor were also negative for the presence of this bacterium, and the donor confirmed that he was not ill before or after the transfusion.Twenty-nine hours after collection, approximately 15 mL of PLTs from the implicated unit were transferred to a sample bag. This secondary bag was separated from the remaining PLTs, which were stored in a shaking incubator until they were volume-reduced and transfused. A sample of 4 mL of PLTs was taken from the sample bag and inoculated into an aerobic culture medium bottle (BPA) for testing of bacterial contamination with an automated blood culture system (BacT/ALERT, bioMérieux Canada Inc., St. Laurent, Québec, Canada). The culture was nega-Fig. 1. Genotyping of S. marcescens isolates. Genomic DNA was extracted from all of the bacterial isolates, followed by digestion with Spe I and pulse-field gel electrophoresis analysis at the Hospital for Sick Children, Toronto. Lanes M = = = = lambda ladder. Lanes 1 through 7 = = = = samples obtained during the investigation of this case: Lane 1 = = = = saline solution attached to the PLT pack; Lane 2 = = = = removed supernatant plasma; Lane 3 = = = = transfused PLT product; Lane 4 = = = = blood from the patient's central line; Lane 5 = = = = autopsy blood; Lane 6 = = = = autopsy liver; and Lane 7 = = = = autopsy left lung; Lanes 8 and...
The objective of this study was to determine if clinically important thromboembolic adverse events (TAEs) because of recombinant activated factor VII (rFVIIa) administration are being under-reported. rFVIIa is a potent haemostatic agent with a short half-life of 2.6 h that is increasingly used in 'off-label' situations. Retrospective review of 94 patients who received rFVIIa during 1 January 2003 to 30 June 2007 was carried out at a tertiary care centre. Sixty-nine patients, 32 females and 37 males, mean age 55 years (18-84 years), satisfied study criteria of off-label usage. This was a high-risk population with 33 (48%) deaths. A mean dose of 8.2 mg (2.4-19.2 mg) was administered in two average divided doses. Thirty-six potential TAEs were identified in 29 patients, and of these, 12 patients had TAEs deemed to be rFVIIa related and were identified on average 8.8 days after exposure to rFVIIa. Forty-eight (70%) physician questionnaires were completed; however, no TAEs were reported in these questionnaires or on chart review. Potential clinically significant TAEs are being under-reported by treating physicians. Until further evidence, we suggest the urgent need to develop consensus recommendations for utilization and required follow up to monitor the safety of rFVIIa and that at a minimum, all use of rFVIIa should be regulated through a gate-keeping mechanism that ensures adherence to these policies. Furthermore, prospective registries and trials are necessary to evaluate the efficacy and safety of rFVIIa in off-label settings.
Two cases of clinically significant CD36 antibodies are reported. Investigation of one case was complicated by steric inhibition of binding in the MAIPA and MACE assays with certain MoAbs. The cases demonstrate the importance of maintaining an ethnically diverse pool of rare donors and the value of international cooperation in the management of these patients.
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