Donor blood transfusions

Fig. 7. Percentage of surgical patients avoiding donor blood transfusion in the protocol-defined target population (blood loss >20 ml per kilogram body weight) from postoperative day 1 through day 21 (or hospital discharge). First bar is the Oxygenf-treated patients second bar, control group ( p<0.05 between groups). From Ref. [27], with permission.

Keipert, P.E. Conlan, M.G. Advances in perflubron emulsion development potential use during surgery and cardiopulmonary bypass to avoid donor blood transfusion and prevent tissue hypoxia. Artif Cells Blood Subst. Immob. Biotech. 1996, 24, 359. 

Levy JH, Pifarre R, Schaff HV, Horrow JC, Albus R, Spiess B, Rosengart TK, Murray J, Clark RE, Smith P. A multicenter, double-blind, placebo-controlled trial of aprotinin for reducing blood loss and the requirement for donor-blood transfusion in patients undergoing repeat coronary artery bypass grafting. Circulation 1995 92(8) 2236 4. 

Full details of this work were pubHshed (6) and the processes, or variants of them, were introduced in a number of other countries. In the United States, the pharmaceutical industry continued to provide manufacturing sites, treating plasma fractionation as a normal commercial activity. In many other countries processing was undertaken by the Red Cross or blood transfusion services that emerged following Wodd War II. In these organisations plasma fractionation was part of a larger operation to provide whole blood, blood components, and speciaUst medical services on a national basis. These different approaches resulted in the development of two distinct sectors in the plasma fractionation industry ie, a commercial or for-profit sector based on paid donors and a noncommercial or not-for-profit sector based on unpaid donors. 

During blood transfusions, immune reactions can occur that destroy the erythrocytes transfused from the donor. These reactions result from the formation of antibodies (see p. 300) directed to certain surface structures on the erythrocytes. Known as blood group antigens, these are proteins or oligosaccharides that can differ from individual to individual. More than 20 different blood group systems are now known. The ABO system and the Rh system are of particular clinical importance. 

Avends, T., and Gallango, M. L., Immunoglobulin levels in blood bank donors of a tropical country. Proc. Congr. Int. Soc. Blood Transfus. 11th, Sydney 29, 332-335 (1966). 

Figure 8.1 When a person receives blood, it is essential that the ABO blood groups are compatible. ABO Blood Group testing for blood transfusions is illustrated here. Antibodies in the serum (the clear part of blood) form clumps of red blood cells when they come in contact with red blood cells of an incompatible blood group. For example, the sera of 0 and B transfusion recipients would cause clumping of red cells from donors whose blood is type A or AB.

Hematopoietic stem cells are used to treat people whose own blood-forming cells fail because of a rare condition called aplastic anemia, or to help people who have been accidentally exposed to very high doses of irradiation. Hematopoietic stem cells are most often used as part of the treatment for certain forms of cancer. Sometimes cancer patients are given very high doses of irradiation and/or chemotherapy drugs that destroy the blood-forming stem cells in the bone marrow. Transplants with the patient s own blood stem cells that were removed before the treatment, or stem cells from a healthy donor, allow the patient to recover. The transplant process is very simple The cells in a salt solution are slowly injected into a vein just like a blood transfusion. If the blood stem cells come from a donor, then the donor and the patient must share certain inherited proteins to make sure that the donor s immune system cells will not attack the treated patient. 

The Problem You have type B+ blood and need a blood transfusion. You can use either type-0 or type-B blood and can use either a + or - RH factor. What is the probability that a person selected at random can be a donor for you ... 

Drosten, C. Weber, M. Seifried, E. Roth, W. K. Evaluation of a new PCR assay with competitive internal control sequence for blood donor screening. Transfusion 2000, 40(6), 718-724. 

Increased plasmalogen levels have not been observed. Erroneously low red cell levels can be encountered when the transmethylation process has not been completed. Breaking the ether lipid bond of the plasmalogens requires more energy than hydrolysis of the fatty acid esters. Evaluation of the plasmalogen levels should not be done after a blood transfusion. Donor erythrocytes will be present for up to 120 days following a transfusion. 

In contrast to hemodialysis that uses ultrafiltration membranes, plasma separation (also called plasmapheresis) requires microfiltration membranes with a pore size from 0.2 to 0.6 pm, in order to transmit all proteins and lipids, including LDL cholesterol (2000kDa) and retain completely platelets (2 pm diameter), red blood cells (8 pm diameter) and white blood cells. Thus, membrane plasmapheresis can yield high-quality platelet-free plasma and red cells can be either continuously returned to the donor or saved in another bag for blood transfusion. But it is important, in the case of plasma collection from donors, to minimize the membrane area, in order to reduce the cost of disposable hollow-fiber filters and to avoid the risk of hemolysis (free hemoglobin release) due to RBC damage by contact at the membrane if the pressure difference across the membrane is too high. 

Malaria is one of the world s most serious human health problems. According to the World Health Organization, more than 200 million new infections occur each year, many resulting in death [66]. The disease is caused by protozoa of the genus Plasmodium, most notably P. falciparum, which live in the intestines of female Anopheles mosquitoes. Humans are infected by bites from infected mosquitoes, by blood transfusions from infected donors, or by an expectant mother transmitting the disease to her child. Malaria is endemic in Sub-Saharan Africa, Central and South America, the Indian subcontinent and Oceania [67]. 

It is preferable but not essential to screen PBMCs from different donors to identify a donor whose cells replicate HIV efficiently and do not carry the A 32 C025 mutation. Alternatively, leukocyte enriched buffy coats may be purchased from blood transfusion centers. Mixing PBMCs from two donors results in a mixed lymphocyte reaction which can increase cellular activation and hence HIV replication. 

Iatrogenic CJD is the second most common acquired human prion disease and these cases are the result of accidental infection due to contact with prion contaminated tissues or instruments during medical procedures (Table 29.1). The mode of prion infection include surgical equipment (e.g., surgical insd uments, depth electrodes), transplantation of human tissues (comeal, dura mater), intramuscular injections with growth hormone or gonadotrophin extracted from human pituitary tissues, or blood transfusion (reviewed by Will, 2003). The most likely source of infection is from donors with subclinical sCJD, except for the tw o transfusion-related cases that have been linked to blood donors who developed vCJD several years later (reviewed by Ironside, 2006). The incubation period in these transfusion related cases was 5 to 6 years, v hich is shorter than primary vCJD infection in humans. 

Total body wash-out This technique is a modification of exchange transfusion. The circulatory system is washed out with electrolyte solutions and then refilled with donor blood whilst the patient is in a state of hypothermia (G. Klebanoff et al., 1972). 

Blood transfusion Some 90% of cases of NANB posttransfusion hepatitis are caused by hepatitis C. The risk deriving from this greatly feared transmission route could be diminished by using the anti-HCV test to screen blood donors and blood units this caused a reduction from 4.0% to 0.6% and to < 1 for every 10,000 blood units (= residual risk if a so-called serological window is present). (295, 298, 301, 386, 396)... 

Donor-specific blood transfusion in the preparation for transplantation was complicated by a higher incidence of cytomegalovirus infection in patients receiving azathioprine (56). 

Suassuna JH, Machado RD, Sampaio JC, Leite LL, Villela LH, Ruzany F, Souza ER, Moraes JR. Active cytomegalovirus infection in hemodialysis patients receiving donor-specific blood transfusions under azathioprine coverage. Transplantation 1993 56(6) 1552-4. 

Passive transfer of allo-antibodies present in donor plasma can also cause hemolytic transfusion reactions. Low-titer erythrocjde antibodies in donor blood are considered to be relatively harmless, especially when plasma-reduced or concentrated eiythrocytes are transfused in a recipient whose cells carry the relevant antigen. A comphcation of this type provoked by high-titer anti-E antibody has been described (90). Likewise, a hemolytic transfusion reaction occurred in a Kell-negative adult when anti-KeU contained in the plasma of a unit of whole blood reacted with Kell-positive cells transfused 4 weeks before (91). 

Syphihs is one of the oldest recognized infectious risks of blood transfusion, and blood donors have been routinely screened for sjq)hihs by serological tests for more than 50 years. In recent times, transfusion-transmitted syphilis has become extraordinarily rare, with only very few cases reported. The general use of refrigerated blood reduces the risk of transmission as Treponema pallidum loses its viability within a few days in whole blood stored at 4 C. 

Interactions of transfusion with transplantation can occur (200). Blood transfusions, and especially donor-specific transfusions, given before kidney transplantation have beneficial effects on graft survival the mechanism for this is not known (201-203). By contrast, pre-transplant transfusions in bone marrow recipients with aplastic anemia cause major complications, and can be responsible for graft rejection and marrow transplantation failure (204). 

Vyas GN, Perkins HA. Non-B post-transfusion hepatitis associated with hepatitis B core antibodies in donor blood. N Engl J Med 1982 306(12) 749-50. 

---