Risks blood transfusion

In 1983 the move to develop red cell substitutes intensified when it was recognized that the acquired immune deficiency syndrome (AIDS) could be transmitted by the blood-bome human immunodeficiency vims (HIV). Concern for the nation s blood supply followed. Since that time other retrovimses have been identified, efforts to screen blood not only for these agents but also for vimses that cause hepatitis have intensified, the indications for transfusion have been reevaluated, and the use of blood products has become much more efficient. More carehil screening of donors, testing of all donated units, and a general awareness in the donor population have all contributed to a decreased risk from transfusion-contracted AIDS. 

Prior to routine screening of blood products in the early 1990s, the primary route of transmission of the HCV was blood transfusions, when the risk was 0.02% per unit transfused. Since then, the risk has decreased significantly (0.001% per unit transfused).13 Today, intravenous drug users utilizing contaminated paraphernalia are responsible for most HCV transmission. Other populations at risk for acquiring HCV are listed in Table 21-1. Approximately 10% of the individuals infected with HCV have no identifiable risk factors. 

Bone marrow suppression ZDV Onset Few weeks to months Symptoms Fatigue, risk of T bacterial infections due to neutropenia anemia, neutropenia 1. Advanced HIV 2. High dose ZDV 3. Preexisting anemia or neutropenia 4. Concomitant use of bone marrow suppressants Avoid in patients with high risk for bone marrow suppression avoid other suppressing agents monitor CBC with differential at least every 3 months Switch to another NRTI D/C concomitant bone marrow suppressant, if possible for anemia Identify and treat other causes consider erythropoietin treatment or blood transfusion, if indicated for neutropenia Identify and treat other causes consider filgrastim treatment, if indicated... 

In addition to enhancing erythropoiesis, EPO treatment also improves tolerance to exercise, as well as a patient s sense of well-being. Furthermore, reducing/eliminating the necessity for blood transfusions also reduces/eliminates the associated risk of accidental transmission of blood-borne infectious agents, as well as the risk of precipitating adverse transfusion reactions in recipients. The therapeutic spotlight upon EPO has now shifted to additional (non-renal) applications (Table 10.8). 

Hepatitis B vaccine schedule consists of three injections given at time 0, 1 month after the first injection and a third injection given 6 months after the first injection. Patients at high risk are given a booster after 5 years to maintain the immunity profile. Patients receiving blood transfusions, haemophilia patients, patients with chronic liver disease, and haemodialysis patients are among the high-risk patients who should be vaccinated. 

Cell treatments are as simple and routine as a blood transfusion and as uncertain as the use of specialized cells produced in the laboratory from adult or embryonic stem cells. The history of blood transfusion suggests that it will take a lot of research and perhaps a long time to solve the mysteries of these stem cells. From the first sheep blood transfusion, it took several hundred years for physicians to learn how to transfuse blood safely. Even today, it takes constant vigilance and research to make sure a blood transfusion is safe, a lesson learned tragically in the early years of the AIDS epidemic. Blood stem cell transplants, though life-saving in some situations, can pose the risk of potentially deadly graft versus... 

Transfusion-associated graft-versus-host disease A serious residual risk of blood transfusion Higgins, M.J., Blackall, D.P. (2005). Curr Hematol Rep, 4 (6) 470-6. 

Factor VIII promotes clotting it is deficient in hemophiliacs treatment with factor VIII produced by recombinant DNA technology eliminates infection risks associated with blood transfusions. 

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. 

For many years, blood transfusion has been a therapy for children and adults with sickle cell disease. Prior to the 1980s, due to the lack of availability of blood products and the standard of care at that time, transfusion was used infrequently and generally only for catastrophic complications of this disease. During the 1980s, the risk of infection through transfusion was so high that transfusion continued to be used infrequently. When reliable testing for infectious diseases (e.g., HTV and hepatitis) in blood products became available, the use of red cell transfusion became standard of care for complications of sickle cell disease. 

The Food and Drug Administration is reported to have released a long-awaited report on the safety of diethylhexyl phthalate, but the conclusion will not end the debate on the safety of PVC health-care products. According to the report, some young children undergoing medical procedures may be exposed to harmful levels of DEHP, one of the most widely used plasticisers in PVC health-care products. The report says that infants exposed to repeated treatments can receive between five and 20 times the safe levels. The report also says that a small number of adults undergoing some types of blood transfusion and patients who receive enteral nutrition treatments could be at risk. Details are given. 

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)... 

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