RESUMEN
The German interdisciplinary task force for clinical hemotherapy (IAKH) is an independent association of clinicians. It aims for the improvement of blood transfusion application processes, procedures and safety in the absence of a German hemovigilance system. Whereas the producers of blood products concentrate on product safety, the IAKH focuses on administrative needs such as forms and regulations associated with the administration of blood products. It provides information about coagulation disorders, autologous blood donation and cell saving as well as techniques that reduce the amount of allogeneic transfusion needs. Benefits of a membership in IAKH are electronic and individual recommendations to clinical hemotherapy issues, an exchange forum, as well as low cost participation at conventions and meetings. Just recently, a critical incident reporting system for errors in blood transfusion and hemotherapy was launched (www.iakh.de/ BeinaheFehlerErfassung/). The entries reported are analyzed, feedback and recommendations are given. Everybody in contact with the administration of blood products is asked to report errors and critical incidents.
Asunto(s)
Comités Consultivos , Transfusión Sanguínea , Hemostasis/fisiología , Análisis y Desempeño de Tareas , Productos Biológicos/uso terapéutico , Química Farmacéutica , Humanos , Comunicación Interdisciplinaria , Errores Médicos/prevención & control , Reacción a la TransfusiónRESUMEN
BACKGROUND: Several mechanisms have been proposed as possible causes of transfusion-related immunomodulation (TRIM) after allogeneic transfusion. If one of these mechanisms, the release of mediators of immunity and inflammation ("biologic response modifiers"[BRMs]) from disintegrating blood cells during storage of blood products, really causes TRIM, it should in principle also occur after autologous transfusion. As a consequence, prestorage leukoreduction of autologous blood should be able to prevent the clinical consequences of TRIM after autologous transfusion. STUDY DESIGN AND METHODS: This hypothesis was investigated in a multicenter, double-blind, randomized controlled trial. A total of 1089 patients scheduled for total hip arthroplasty and eligible for preoperative autologous blood donation were randomly assigned to receive autologous whole blood (AWB) either unmodified or leukoreduced when transfusion was indicated. RESULTS: Neither the primary study outcome, that is, the overall postoperative infection rate (17.3% vs. 17.6%, p = 0.59), nor several secondary outcomes like median length of hospital stay (14 days vs. 14 days, p = 0.17) were significantly different between groups, whether analyzed according to the intention-to-treat principle or "as treated." CONCLUSION: This trial provides strong evidence, from clinically relevant outcome data, that leukoreduction of AWB does not improve postoperative patient outcome and that the release of BRMs from disintegrating blood cells during storage cannot explain the immunomodulatory effect of blood transfusion.
Asunto(s)
Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Transfusión de Sangre Autóloga/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Procedimientos de Reducción del Leucocitos/estadística & datos numéricos , Infección de la Herida Quirúrgica/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Infección Hospitalaria/epidemiología , Infección Hospitalaria/inmunología , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infección de la Herida Quirúrgica/inmunología , Resultado del TratamientoRESUMEN
BACKGROUND: Experimental data suggest that autologous white blood cells (WBCs) might exert an immunomodulatory effect. Leukodepletion of autologous blood is considered to prevent this unwanted side effect of autologous transfusion. In some cases, however, prolonged filtration or filtration failures occur. Because such autologous units cannot simply be discarded, the interest was in the storage variables of autologous whole blood (AWB) units after prolonged filtration. STUDY DESIGN AND METHODS: AWB of patients undergoing orthopedic surgery was leukodepleted before storage or left unmodified. Filtration times, volume, WBC count, hemoglobin level, hemolysis, potassium, and ATP were determined in all units with filtration times of more than 60 minutes that had not been transfused by the time of expiry and in representative samples of units that had been filtered normally or that had not been filtered. RESULTS: In AWB filtration, the rate of prolonged filtrations or filter blockades is three to four times higher than in allogeneic whole-blood filtration. Filtration or prolonged filtration leads to a mean loss of red blood cell (RBC) mass of 7.3 or 18.2 percent, respectively. Even in units with filtration times of more than 3 hours, storage variables were not significantly different from normally filtered or unfiltered units. Filtration times showed a high intraindividual correlation. CONCLUSION: Leukodepletion of AWB results in a diminished preoperative deposit of RBCs that is pronounced in units with prolonged filtration. The quality of the latter suggests that it is not justified to discard AWB units with prolonged filtration times. Prolonged filtrations are related to patient characteristics that have yet to be defined.