Infection risk transfusions

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. 

Rosina, F., Saracco, G., Rizzetto, M. Risk of transfusion infection with the hepatitis Delta virus. A multicenter study. New Engl. X Med. 1985 312 1488-1491... 

LindholmPF, Armen K, Ramsey G (2011) Approaches to minimize infection risk in blood banking and transfusion practice. Infect Disord Drug Targets 11 45-56... 

Infection risk On 10 April 2009, during a routine record review in connection with a subsequent blood drive, a blood bank supervisor learned of a breach in the deferral protocol for blood products collected from trainees [52 ]. Further investigation showed that the blood that had been obtained during the previous drive had been from trainees who had been immunized with yellow fever vaccine 4 days before the drive. All of those blood products had already been processed and incorporated into the inventory at the hospital s blood bank. The blood bank supervisor reviewed the blood bank s records and identified 87 units of whole blood and three units of platelet that had been obtained from the recently immunized trainees. Blood products that had been released for transfusion were tracked forward to identify the patients who had received the implicated blood products. Unused blood products were identified and destroyed. Five patients had received six blood products (three units of platelets, two units of fresh frozen plasmas, and one unit of packed erythrocytes) from six of the trainees, who had no previous history of immunization or travel consistent with... 

Infection risk A review and analysis of pathogen-inactivated blood products cited the concern of increased bleeding however, most of the world has transfused these products for a number of years without bleeding complications [28 ]. Authors argue that years of safe use internationally, combined with the reduced-risk of bacterial contamination, are reasons to adopt the technology in the United States. 

Infection risk A retrospective cohort study looked at the association of plasma transfusion with postoperative infectious complications after oesophageal resection siugery [41 ]. Plasma transfusions were associated with an increased risk of postoperative infection (OR=6.1, 95% C3=l.l-47.8 p=0.05). Interestingly, red blood cell transfusion was not associated with infectious complications. 

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. 

The most important nonpharmacologic treatment of anemia is the transfusion of red blood cells. However, because of the risk of infection, immunosuppression, and microcirculatory... 

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 patients with anemia of critical illness, parenteral iron is often utilized but is associated with a theoretical risk of infection. Routine use of epoetin alfa or RBC transfusions is not supported by clinical studies. 

Receiving a transfusion of HIV-infected blood. Since transfusion involves placing foreign blood or blood products directly into the recipient s bloodstream, the necessary conditions for HIV transmission are present. After screening of the blood supply by antibody tests began in 1985, the risk was low that the blood or blood product involved in transfusion was infected, except for hemophiliacs, who require a clotting factor extracted from the blood of many different donors. 

Albumin (human) Epoetin alfa contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases. No cases of transmission of viral diseases or Creutzfeldt-Jakob disease have ever been identified for albumin. Anemia Not intended for CRF patients who require correction of severe anemia epoetin alfa may obviate the need for maintenance transfusions but is not a substitute for emergency transfusion. Not indicated for treatment of anemia in HIV-infected patients or cancer patients due to other factors such as iron or folate deficiencies, hemolysis, or Gl bleeding, which should be managed appropriately. Hypertension Up to 80% of patients with CRF have a history of hypertension. Do not treat patients with uncontrolled hypertension monitor blood pressure adequately before initiation of therapy. Hypertensive encephalopathy and seizures have occurred in patients with CRF treated with epoetin. 

Deravirdine (Rescnptor) [Antiretroviral/NNRTI] Uses HIV Infxn Action Nonnucleoside RT inhibitor Dose 400 mg PO tid Caution [C, ] CDC recommends HIV-infected mothers not to breast-feed (transmission risk) w/ renal/hepatic impair Contra Use w/ drugs dependent on CYP3A for clearance (Table VI-8) Disp Tabs SE Fat redistribution, immune reconstitution synd, HA, fatigue, rash, T transaminases, N/V/D Interactions T Effects W/ fluoxetine T effects OF benzodiazepines, cisapride, clarithromycin, dapsone, ergotamine, indinavir, lovastatin, midazolam, nifedipine, quinidine, ritonavir, simvastatin, terfena-dine, triazolam, warfarin effects W/ antacids, barbiturates, carbamazepine, cimetidine, famotidine, lansoprazole, nizatidine, phenobarbital, phenytoin, ranitidine, rifabutin, rifampin effects OF didanosine EMS Use of benzodiazepines and CCBs should be avoided may cause a widespread rash located on upper body and arms OD May cause an extension of nl SEs symptomatic and supportive Deferasirox (Exjade) [Iron Chelator] Uses Chronic iron overload d/t transfusion in pts >2 y Action Oral iron chelator Dose Initial 20 mg/kg... 

Epoetin Alfa [Erythropoietin/ EPO] (Epogen/ Procrit) [Recombinant Human Erythropoietin] WARNING Use lowest dose possible may be associated w/1 CV, thromboembolic events /or mortality D/C if Hgb >12 g/dL Uses CRF associated anemia zidovudine Rx in HIV-infected pts, CA chemo -1- transfusions associated w/ surgery Action Induces ery-thropoiesis Dose Adul Peds. 50-150 Units/kg IV/SQ 3x/wk adjust dose q4-6wk PRN Surgery 300 Units/kg/d x 10 d before to 4 d after -I dose if Hct 36% or Hgb, T > 12 g/dL or Hgb t >1 g/dL in 2-wk pmod hold dose if Hgb >12 g/dL Caution [C, +] Contra Uncontrolled HTN Disp Inj SE HTN, HA, fatigue, fever, tach, NA Interactions None noted EMS Monitor ECG for hypokalemia (peaked T waves) t risk of CV thrombotic events OD May cause HA, dizziness, SOB and polycythemia symptomatic and supportive... 

Erythropoietin has been used successfully to offset the anemia produced by zidovudine treatment in patients with HIV infection and in the treatment of the anemia of prematurity. It can also be used to reduce the need for transfusion in high-risk patients undergoing elective, noncardiac, nonvascular surgery to accelerate erythropoiesis after phlebotomies for autologous transfusion for elective surgery or for treatment of iron overload (hemochromatosis). 

Neutropenia is a common adverse effect of the cytotoxic drugs used to treat cancer and increases the risk of serious infection in patients receiving chemotherapy. Unlike the treatment of anemia and thrombocytopenia, transfusion of neutropenic patients with granulocytes collected from donors is performed rarely and with limited success. The introduction of G-CSF in 1991 represented a milestone in the treatment of chemotherapy-induced neutropenia. This growth factor dramatically accelerates the rate of neutrophil recovery after dose-intensive myelosuppressive chemotherapy (Figure 33-5). It reduces the duration of neutropenia and usually raises the nadir count, the lowest neutrophil count seen following a cycle of chemotherapy. 

Epoetin alfa Agonist of erythropoietin receptors expressed by red cell progenitors Stimulates erythroid proliferation and differentiation, and induces the release of reticulocytes from the bone marrow Treatment of anemia, especially anemia associated with chronic renal failure, HIV infection, cancer, and prematurity prevention of the need for transfusion in patients undergoing certain types of elective surgery IV or SC administration 1-3 times per week Toxicity Hypertension, thrombotic complications, and, very rarely, pure red cell aplasia to reduce the risk of serious CV events, hemoglobin levels should be maintained < 12 g/dL... 

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