Will blood transfusion ever be safe enough?*

Klein, Harvey G.

doi:10.1046/j.1365-3148.2001.00295-2.x

Cited by 34 publications

(29 citation statements)

References 17 publications

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“…The strategies that have been used to reduce Transfusion Transmitted Infection (TTI) includes improving donors selection, testing the donated blood for specific antibodies for infectious agents, reducing exposure to allogenic blood by use of autologous transfusion and changing transfusion guidelines to use blood more conservatively. These strategies have been extremely effective [1,2], but transmission of diseases still occurs [3], primarily because of the inability of the test to detect the disease in the pre-seroconversion or "window" phase of their infection, immunologically variant viruses, nonseroconverting chronic or immuno -silent carriers and laboratory testing errors [4 ]. TTI is still a major concern to patients, physicians and policy makers who wish to see a risk-free blood supply.…”

Section: Introductionmentioning

confidence: 99%

Transfusion Transmitted Infections in Armed Forces: Prevalence and Trends

Gupta

Kumar

Basannar

et al. 2006

Medical Journal Armed Forces India

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Section: Introductionmentioning

confidence: 99%

Transfusion Transmitted Infections in Armed Forces: Prevalence and Trends

Gupta

Kumar

Basannar

et al. 2006

Medical Journal Armed Forces India

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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%

“…This situation is more troubling in less-developed countries where blood donation rates are as low as 0.4 units per thousand people compared to 85 units per thousand in the United States and blood-borne diseases are much more prevalent (159, 161a). Costly diagnostics and handling regulations, increasingly stringent donor deferral criteria, and a lack of blood donors partly explain this problem (17,51,70,161). However, other issues, including emergent pathogens and natural disasters are of concern (1,24,25,32,34,50,59,60,89,128,141,161).…”

mentioning

confidence: 99%

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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“…Two arguments against leukoreduction are that there is a loss of red cells from 4 to 19% and cost of about $35 US per unit. Given Western Society's sentiment to implement any blood policy that might improve safety, 23 we recommend universal adoption even if we are not certain of its benefits. In other parts of the world where the cost is burdensome, further studies are needed.…”

mentioning

confidence: 99%

“…Deux arguments contre la réduction leucocytaire sont qu'il y a une perte de globules rouges de 4 à 19 % et que le coût est d'environ 35 $ US par unité de sang. Étant donné le désir de l'Occident d'appliquer toute nouvelle politique pouvant améliorer la sécurité, 23 nous recommandons l'adoption universelle même si nous ne sommes pas certains de ses avantages. Ailleurs dans le monde, où le coût est prohibitif, d'autres études sont à faire.…”

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Will we ever know if leukoreduction of red blood cells should be performed?

Carson

Berlin

2004

Can J Anesth/J Can Anesth

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N this month's Journal, Fergusson and colleagues describe a meta-analysis of clinical trials that evaluated the efficacy of leukoreduction of red blood cell (RBC) transfusion. 1 The authors found that when all patients in the randomized trials were included in the meta-analysis, statistically significant benefits were not demonstrated. However, if only patients that actually received a transfusion were included in the analysis, a 40% reduction in postoperative infections was demonstrated. This report raises a number of questions. These include: 1) Do the results presented in this report add convincing evidence that leads to the conclusion that leukoreduction improves clinical outcomes? 2) Is it methodologically proper to include only patients who received transfusion in the analysis? We begin this commentary with some background information on leukoreduction and its rationale.Universal leukoreduction is performed in Canada and many European countries. It remains voluntary in the United States. Leukoreduction involves the removal of white blood cells by use of filtration and may be performed either at the time of the preparation of RBC (prestorage) or concurrent with administration of (poststorage) RBC. There is a concomitant loss of red cells from 4 to 19% associated with filtration. 2,3 During blood storage, white blood cells produce cytokines, which are involved with intracellular communication and influence development and maintenance of immunity and the inflammatory processes. Because these cytokines may interfere with immune function, 4-7 in theory, prestorage should be superior to poststorage leukoreduction, although this has not been confirmed in clinical trials.Allogeneic transfusion has been thought to alter immune function for many years. Allogeneic blood transfusion has been demonstrated to promote tumour growth in experimental animals. 8,9 Renal allograft survival was better in patients receiving allogeneic blood transfusion prior to transplant 3,10 which is consistent with a reduction in immune function. The risk of recurrent cancer has not been demonstrated in randomized control trials. 11 However, it remains very controversial whether allogeneic blood transfusion increases the risk of bacterial infection.Ten randomized clinical trials have evaluated the effects of leukoreduction. 1 Scanning the results of clinical trials displayed in the table and figures in the article by Fergusson et al. reveals significant heterogeneity in the design and results of the studies. The majority of studies were performed in patients undergoing colorectal or cardiac surgery and used prestorage leukodepletion. Buffy-coated depleted blood was the standard RBC preparation used in many studies, which may make it more difficult to demonstrate a difference, since about 75% of leukocytes are removed by this process. Most of the individual studies did not demonstrate an improvement in outcome. In two of the three studies that showed differences, the observed effects were much larger than seems biologically plausible. 12,13 O...

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Will blood transfusion ever be safe enough?*

Cited by 34 publications

References 17 publications

Transfusion Transmitted Infections in Armed Forces: Prevalence and Trends

Transfusion Transmitted Infections in Armed Forces: Prevalence and Trends

Development of Recombinant Hemoglobin-Based Oxygen Carriers

Will we ever know if leukoreduction of red blood cells should be performed?

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