Alternatives to allogeneic blood transfusions

Pape, Andreas; Häbler, O.

doi:10.1016/j.bpa.2007.02.004

Cited by 51 publications

(74 citation statements)

References 96 publications

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“…Further randomised trials are warranted to address the important issue with preoperative anaemia that significantly affects the already overstretched health budget and compromises the outcome of elective surgery especially in view of short blood supplies. A suggested treatment algorithm or management pathway of preoperative anaemia was discussed in some studies [31,32]. Furthermore, our study has a few shortcomings; first due to the relatively small number of patients studied owing to the technical difficulties to recruit the patients, which is ideally 3-4 weeks prior to surgery, it is hard to draw firm conclusions.…”

Section: Discussionmentioning

confidence: 95%

A Prospective Randomized Controlled Trial to Assess the Effect of Intravenous versus Oral Iron Therapy in the Treatment of Preoperative Anaemia

Khalafallah¹,

Al-Barzan²,

Chan³

et al. 2012

J Blood Disord Transfus

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Background: Improving preoperative anaemia is associated with a better surgical outcome. There is lack of data regarding treatment of preoperative anaemia with intravenous versus oral iron.Objective: Assessment of efficacy of oral iron sulphate versus a single intravenous iron polymaltose and subsequent effect on perceived quality of life in both treatment groups. Patients and methods:We conducted a prospective randomised controlled trial with iron therapy for the treatment of Iron Deficiency Anaemia (IDA) patients who were undergoing elective joint arthroplasty. At a single institution, we recruited 44 patients who were randomized to a single intravenous iron polymaltose infusion (16/22) versus oral daily iron sulphate (17/22). Median age was 68 years (range, 45-91) with a male to female ratio of 14:19.

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Section: Discussionmentioning

confidence: 95%

A Prospective Randomized Controlled Trial to Assess the Effect of Intravenous versus Oral Iron Therapy in the Treatment of Preoperative Anaemia

Khalafallah¹,

Al-Barzan²,

Chan³

et al. 2012

J Blood Disord Transfus

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“…In the United States alone, over 15 million units are transfused annually (159). These transfusions are often life saving (27,29,106,154) and rarely cause serious adverse events, although side effects do occur (23,37,70,71,82,105). However, most U.S. hospitals consistently report blood shortages (159), and studies predict that these shortages will worsen as the population ages (53,130,144,164).…”

mentioning

confidence: 99%

“…Disease transmission and adverse reactions from misstransfusions remain problematic even with best practices in place (30,103,129,133,161). These and other factors have led to a cost explosion in the industry (105), with the price of blood units increasing significantly in recent years (7,11,134).…”

mentioning

confidence: 99%

“…Despite these advantages, significant efforts at developing HBOCs and rHBOCs have not yet resulted in therapeutic licensure in the United States, although HBOC 201 (HemopureÔ; OPK Biotech, Boston, MA) is approved for human use in South Africa and Russia (40,72). The lack of approval of these HBOC products in the United States is primarily due to reports of adverse cardiovascular and cerebrovascular events associated with hypertension (4,18,26,40,44,55,64,65,72,74,81,88,94,105,138,143). In the case of recombinant HBOCs, additional barriers to development include globin denaturation, misfolding, and heme-orientational disorder, issues that arise during expression of recombinant heme proteins (46,108).…”

mentioning

confidence: 99%

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Development of Recombinant Hemoglobin-Based Oxygen Carriers

Varnado

Mollan

Birukou

et al. 2013

Antioxidants & Redox Signaling

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Significance: The worldwide blood shortage has generated a significant demand for alternatives to whole blood and packed red blood cells for use in transfusion therapy. One such alternative involves the use of acellular recombinant hemoglobin (Hb) as an oxygen carrier. Recent Advances: Large amounts of recombinant human Hb can be expressed and purified from transgenic Escherichia coli. The physiological suitability of this material can be enhanced using protein-engineering strategies to address specific efficacy and toxicity issues. Mutagenesis of Hb can (i) adjust dioxygen affinity over a 100-fold range, (ii) reduce nitric oxide (NO) scavenging over 30-fold without compromising dioxygen binding, (iii) slow the rate of autooxidation, (iv) slow the rate of hemin loss, (v) impede subunit dissociation, and (vi) diminish irreversible subunit denaturation. Recombinant Hb production is potentially unlimited and readily subjected to current good manufacturing practices, but may be restricted by cost. Acellular Hb-based O 2 carriers have superior shelf-life compared to red blood cells, are universally compatible, and provide an alternative for patients for whom no other alternative blood products are available or acceptable. Critical Issues: Remaining objectives include increasing Hb stability, mitigating iron-catalyzed and iron-centered oxidative reactivity, lowering the rate of hemin loss, and lowering the costs of expression and purification. Although many mutations and chemical modifications have been proposed to address these issues, the precise ensemble of mutations has not yet been identified. Future Directions: Future studies are aimed at selecting various combinations of mutations that can reduce NO scavenging, autooxidation, oxidative degradation, and denaturation without compromising O 2 delivery, and then investigating their suitability and safety in vivo. Antioxid. Redox Signal. 18, 2314-2328.

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“…34 Autologous transfusion of ICS blood has many advantages: the risk of transfusion reaction is reduced; alloimmunization and immunosuppression associated with allogeneic blood are avoided; the quality of the red cell is excellent; and ICS is available regardless of the patient's starting hematocrit. 35 When blood loss is [ 800 mL, ICS is an effective means of reducing or avoiding allogeneic transfusion. 35 The primary objection to the use of ICS in oncologic surgery is the unproven but theoretical possibility that malignant cells from the surgical field will be re-transfused into the patient and result in subsequent tumour recurrence and metastases.…”

Section: Blood Conservation and Icsmentioning

confidence: 99%

Should intraoperative cell-salvaged blood be used in patients with suspected or known malignancy?

Trudeau

Waters

Chipperfield

2012

Can J Anesth/J Can Anesth

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Should intraoperative cell-salvaged blood be used in patients with suspected or known malignancy? Les cellules sanguines épargnées en peropératoire doivent-elles être réutilisées chez des patients ayant des processus malins connus ou suspectés? Abstract Purpose Intraoperative cell salvage (ICS) is used as an alternative to allogeneic blood transfusion in an attempt to avoid or minimize the risks associated with allogeneic blood. Intraoperative cell salvage is generally avoided in surgeries where malignancy is confirmed or suspected due to concern for potential metastasis or cancer recurrence. The application of post-processing methods for ICS is hypothesized to eliminate this potential risk. The purpose of this narrative review is to examine the in vitro experimental evidence as it pertains to the removal of tumour cells from ICS blood and to review the clinical studies where ICS blood has been used in patients with malignancy. Source A search of the English literature for relevant articles published from 1973 to 2012 was undertaken using

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Alternatives to allogeneic blood transfusions

Cited by 51 publications

References 96 publications

A Prospective Randomized Controlled Trial to Assess the Effect of Intravenous versus Oral Iron Therapy in the Treatment of Preoperative Anaemia

A Prospective Randomized Controlled Trial to Assess the Effect of Intravenous versus Oral Iron Therapy in the Treatment of Preoperative Anaemia

Development of Recombinant Hemoglobin-Based Oxygen Carriers

Should intraoperative cell-salvaged blood be used in patients with suspected or known malignancy?

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