Transfusion therapy

Whole blood is seldom used ia modem blood transfusion. Blood is separated into its components. Transfusion therapy optimizes the use of the blood components, using each for a specific need. Red cell concentrates are used for patients needing oxygen transport, platelets are used for hemostasis, and plasma is used as a volume expander or a source of proteins needed for clotting of the blood. 

The discovery in 1900 of the existence of blood groups, together with improved understanding of the importance of sterile conditions, paved the way to modem blood transfusion therapy. In 1915, the feasibiUty of storage of whole blood was demonstrated. During World War I, the optimal concentration of citrate for use as an anticoagulant was determined. This anticoagulant was used until 1942, when the acid—citrate—dextrose (ACD) solution was developed. 

J. P. Dutcher, "Platelet Transfusion Therapy in Patients with Malignancy," in J. P. Dutcher, ed.. Modem Transfusion Therapy, CRC Press, Boca Raton, Ha., 1990. 

C. A. Kasparin and M. Rzasa, eds.. Transfusion Therapy M Practical Approach, AABB, Arlington, Va., 1991. 

Rh immune globulin for intravenous use may have a place in specific transfusion therapies. 

Cellular cytokines (interferons, G-CSF) and immune response modifiers originally produced from human cells, most often leukocytes, have now been replaced with recombinant products with well-defined structure/function. Futuristic advances in experimental hematology portend development of human blood cells produced from the hemopoetic stem cells. Yet for the foreseeable future, homologous blood donated by healthy, altruistic voluntary blood donors remains the principal source of safe and adequate supply of blood and blood products for transfusion therapy. 

Chronic transfusion therapy programs have been shown to be beneficial in decreasing the occurrence of stroke in children with sickle cell disease. 

Initiate chronic transfusion therapy to prevent recurrent... 

Chronic transfusion therapy is warranted to prevent serious complications from SCD, including stroke and recurrence. Especially in children, chronic transfusions have been shown to decrease stroke recurrence from approximately 50% to 10% over 3 years. Without chronic transfusions, approximately 70% of ischemic stroke patients will have another stroke. Chronic transfusion therapy also may be used to prevent vaso-occlusive pain and ACS, as well as prevent progression of... 

Several methods of transfusion maybe used, including simple transfusion, exchange transfusion, or erythrocytapheresis. The goal of chronic transfusion therapy is to maintain the HbS level at less than 30% (0.30) of total hemoglobin concentration. Transfusions usually are administered every 3 to 4 weeks depending on the HbS concentration. For secondary stroke prevention, current studies have indicated that lifelong transfusion may be required, with an increased incidence of recurrence once transfusions are stopped.6... 

Acute neurologic events, such as stroke, will require hospitalization and close monitoring. Patients should have physical and neurologic examinations every 2 hours.27 Acute treatment may include exchange transfusion or simple transfusion to maintain hemoglobin at around 10 g/dL (100 g/L or 6.2 mmol/L) and HbS concentration at less than 30%. Patients with a history of seizure may need anticonvulsants, and interventions for increased intracranial pressure should be initiated if necessary. Children with a history of stroke should be initiated on chronic transfusion therapy. Adults presenting with ischemic stroke should be considered for thrombolytic therapy if it has been less than 3 hours since the onset of symptoms.6,27... 

A.M. Mosunov and A.V. Pozdnyakov used Enterosgel for acceleration of regression of hepato-depressive syndrome in patients with severe diffuse liver pathology, and reported shortened terms of disability of these patients from 29.4 3.8 to 18.3 2.4 days [81], A.B. Kaydulov and I.V. Vasilenko observed fast reduction of toxic and abstinent events as well as improved functional state of the Uver and decreased requirement for transfusion therapy in patients with alcoholic intoxication and in patients with abstinence syndrome of moderate severity, treated with Enterosgel [82]. 

The existence of some blood cells, such as erythrocytes and platelets, with long lifespans make cell transfusion therapy practical. Cell transfusion therapy cannot be developed for short-lived cells such as neutrophils with turnover rates of less than 8 hours. Fortunately, for neutrophils, colony stimulating factors can be used to recruit the needed number in blood within 24 hours after administration of these factors. 

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. 

The richest dietary sources of total iron are organ meats (liver and kidney), egg yolk, dried legumes, com, molasses and parsley. Liver is particularly valuable because of the high absorbability of its iron. However, only about 10% of dietary iron is absorbed. Iron deficiency anemia can be treated with soluble iron(II) compounds providing 200 mg in three or four daily divided doses. Oral iron(II) sulfate is the least expensive and is in wide use. Ascorbic acid increases the absorption efficiency of iron(II) sulfate. Parenteral administration of iron is used when oral iron is ineffective. Iron-dextran, a colloid formed from iron(III) chloride and an alkali-modified dextran, is one of several preparations available which has found extensive clinical use. It contains up to 28% Fe by weight and has a structural similarity to ferritin. Transfusion therapy may also be used in severe chronic anemia or acute hemorrhage. 

Jacobson MS, Kevy SV, Grand RJ. 1977. Effects of a plasticizer leached from polyvinyl chloride on the subhuman primate A consequence of chronic transfusion therapy. J Lab CHn Med 89 1066-1079. 

Over the next several years, she had recurrent episodes of reactive airway disease. At the age of 4 years, she had a life-threatening episode of acute chest syndrome requiring admission to the intensive care unit and exchange transfusion. She was subsequently transfused with red blood cells monthly for 6 months to prevent recurrence. Two years later, she was again admitted to the intensive care unit with acute chest syndrome. During this admission, she was found to have Streptococcus pneumoniae sepsis and pneumonia. She again received RBC transfusions monthly for 6 months. Following this course of transfusion therapy, she was offered therapy with hydroxyurea, but this therapy was never instituted. 

Dutcher JP, Kendall J, Norris D, Schiffer C, Aisner J, Wiemik PH. Granulocyte transfusion therapy and... 

National Institutes of Health Consensus Conference. Platelet transfusion therapy. Transfus Med Rev 1987 1(3) 195-200. 

Kutti J, Zaroulis CG, Dinsmore RE, Reich L, Clarkson BD, Good RA. A prospective study of platelet-transfusion therapy administered to patients with acute leukemia. Transfusion 1982 22(l) 44-7. 

McCullogh J. The clinical significance of granulocyte antibodies and in vivo studies of the fate of granulocytes. In Garratty G, editor. Current Concepts in Transfusion Therapy. Arlington, VA American Association of Blood Banks, 1985 125. 

Iron therapy is not indicated, and transfusion therapy is usually unnecessary except in acute illness, in pregnancy, and with exposure to oxidant drugs, which destabilizes Hb H, causing precipitation of the somewhat insoluble protein. Genetic counseling is recommended to prospective parents who have Hb H disease. 

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