Transfusion alternative

Spence RK. Perfluorocarbons in the twenty-first century clinical apphcations as transfusion alternatives. Artif Cells Blood Substit ImmobU Biotechnol 1995 23(3) 367-80. 

Artificial Oxygen Carriers (Hemoglobin-Vesicles) as a Transfusion Alternative and for Oxygen Therapeutics... 

Keywords— Blood Substitutes, Liposome, Targeted Oxygen Delivery, Nitric Oxide, Transfusion Alternative. 

Sakai H, Tsuchida E (2007) Hemoglobin-vesicles fa- a transfusion alternative and targeted oxygen delivery. J Liposome Res 17 227-235. Plock JA, Tromp AE, Contaldo C, et al (2007) Hemoglobin vesicles reduce hypoxia-related inflammation in critically ischemic hamsto-flap tissue. Crit Care Med 35 899-905. 

F. Role in therapy Epoetin alfa represents a major advance in the treatment of anemia associated with chronic renal failure. The hormone is an alternative to androgen and red blood cell transfusion therapy, which had been the mainstay of treatment. It may also provide an alternative for those patients who previously could not be treated with blood transfusions because of religious reasons. 

F. Role in therapy According to Micro-medex, treatment of severe chemotherapy-related thrombocytopenia is hmited to platelet transfusions. There is a need for an alternative, especially due to the frequent use of myeloid colony-stimulating factors (G-CSF, GM-CSF) to reduce febrile neutropenia although effective, their use increases the risk of acute and prolonged thrombocytopenia, and the need for platelet transfusions. Other cytokines, such as interleukin-1 and interleukin-6, have been investigated as a means of ameliorating chemotherapy-induced thrombocytopenia, but results have been equivocal. 

F. Role in therapy According to Micromedex, the goal of therapy with Adagen is to correct immune function by reversal of the biochemical abnormalities caused by adenosine deaminase deficiency. Adagen s role in therapy at this time would appear to be as an alternative when bone marrow transplantation is not feasible or has been unsuccessful. It may also be considered in lieu of transplantation in milder cases of adenosine deaminase deficiency. Adagen is preferable to red cell transfusions in these patients. While regular administration of Adagen can improve immune function and reduce the incidence of opportunistic infections in patients with ADA-deficient SCID, it is of no value in patients with immunodeficiency due to other causes. 

Lake, C L. "Blood, Hemostasis, Transfusion, and Alternatives in the Perioperative Period, Lippincott Williams Wilkins, Philadelphia, PA. 1995. 

Until recently, the neonate has been a black box, an eminently valued patient, yet one that is difficult to study and treat effectively. Neonatal research, in particular, is often plagued by ethical problems of invasiveness of protocols, volume of blood to be drawn, inability of the patient to speak on his/her own behalf, etc. Even simple studies that try to address neonatal outcome often pose problems in these areas, requiring volumes of blood that subsequently need to be replaced by transfusion. Because the perceived benefit to both individual patients and to society as a whole is deemed to be highly valuable, such downsides to neonatal research are often accepted as inevitable. The introduction, however, of MS analysis, utilizing low volumes of blood for multiple biomarkers, appears to be a very attractive alternative with great potential. A number of critical areas have already begun to be addressed and include such diverse entities as hypoxic-ischemic brain injury, the infant of a diabetic mother, neonatal renal function, neonatal nutrition, neonatal sepsis, and pharmaceutical development. 

When hemophilia is due to a deficiency in factor IX (FIX), it is designated hemophilia B. In the same way as hemophilia A, the alternative to treatment based on blood transfusion or plasma-derived products is the use of recombinant FIX, which was approved for commercialization in 1997 with the name of BeneFix. ... 

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. 

Habler, O.P. Kleen, M.S. Hutter, J.W. Podtschaske, A.H. Tiede, M. Kemming, G.I. Welte, M.V. Corso, C.O. Batra, S. Keipert, P.E. Faithfull, N.S. Messmer, K.F.W. Hemodilution and intravenous perflubron emulsion as an alternative to blood transfusion effects on tissue oxygenation during profound hemodilution in anesthetized dogs. Transfusion 1998, 38, 145-155. 

Qutaishat S. Autologous blood transfusion evaluation of an alternative strategy in reducing exposirre to allogeneic blood transfusion. Immunol Invest 1995 24(l-2) 435-41. 

Engert A. Recombinant human erythropoietin as an alternative to blood transfusion in cancer-related anaemia. Dis Manage Heath Outcomes 2000 8 259-72. 

Approximately 25% of all human genes occur among individuals in a population in multiple allelic forms referred to as polymorphisms. For example, the ABO locus, an important factor in blood transfusions, consists of three different alleles (alternative states of a gene) called A, B, and O. Individuals can be homozygous or heterozygous for any pair of A, B, and O alleles. The HLA family... 

Classical studies of the recessive, sex-linked disorder hemophilia provided evidence that a gene concerned with the synthesis of factor VIII must be situated on the X-chromosome. When it was discovered that a reduction in factor VIII was commonly present also in von WUlebrand s disease, with a somatic dominant inheritance, it became clear that another gene, on an autosome, must also be involved. Cross-transfusion experiments between patients suffering from hemophilia and von Willebrand s disease show-ed that hemophilic blood would stimulate factor VIII synthesis in von Willebrand s disease, but not vice versa. These data have made it possible to construct a number of alternative genetic models now being submitted to critical experimentation. 

For ACD, EPO is effective and safe, but expensive. Cost of IV iron is low compared with the cost of EPO. ince most patients are not symptomatic from this type of anemia, patients may actually feel no improvement with therapy. ymptom severity should be considered in the decision to use EPO. One study in patients with heart failure found use of erythropoietin to be highly cost-effective. Transfusion use for ACD as an alternative to EPO must take into consideration cost, convenience, and risk of complications. 

The indirect Coombs test measures free anti-RBC antibodies in serum. If fresh blood was not collected or could not be collected, an alternative is to evaluate serum if available. The indirect Coombs test is not commonly used to diagnose IMHA. However, when plasma or serum samples are saved from animals with suspected IMHA, they can be used for additional evaluation of potential reactivity with the drug or development of an assay for screening similar drugs in developmental process. More frequently, in humans, the indirect assay is used to determine whether an individual might have a reaction to a blood transfusion. 

Epoetin alfa has been used perioperatively to treat anemia and reduce the need for transfusion. Patients undergoing elective orthopedic and cardiac procedures have been treated with 150 to 300 units/kg of epoetin alfa once daily for 10 days preceding surgery, on the day of surgery, and for 4 days after surgery. As an alternative, 600 units/kg... 

Whole blood transfusions may be administered. Alternatively, erythropoietin may be given to stimulate the production of erythrocytes. 

Hemoglobin-based oxygen carriers (HBOCs) are supposed to be used as an alternative in anemic patients when erythroc)les are not available or when erythrocyte transfusion is not possible. Adverse events with HBOCs have been reported, including myocardial infarction, stroke, acute renal insufficiency. 

Anti-D immunoglobulin is used as an alternative to intravenous immunoglobulin to treat idiopathic thrombocytopenic purpura. Patients treated with anti-D immunoglobulin (WinRho ), in contrast to earlier published reports, had more adverse reactions, particularly chills and rigors, despite pretreatment with paracetamol and diphenhydramine [66 ]. Two patients needed treatment for severe anemia and one for severe hemoglobinuria. Pretreatment with glucocorticoids or the use of subcutaneous anti-D immunoglobulin may reduce transfusion-related adverse reactions. However, the... 

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