Transfusion Medicine. First of Two Parts. Blood Transfusion

Abstract

No AbstractEditorial Comment: Attitudes regarding blood transfusion are changing rapidly and the authors cover some of the relevant issues. Better screening of donors has dramatically decreased the risk of transmission of viral infections, such as human immunodeficiency virus and hepatitis C. There also is increasing information that lower hemoglobin levels are acceptable in patients without cardiac disease. Leukocyte reduction blunts transfusion mediated immunosuppression but its routine performance is still controversial. It is increasingly accepted that blood transfusion is not indicated simply for volume replacement. As policies and guidelines evolve, it becomes just as important not to under transfuse as it is to avoid inappropriate transfusion. These articles provide surgeons with some of the information they need to make informed decisions about transfusion. Background A systematic review was carried out to assess the relative efficacy of antimicrobial prophylaxis for the prevention of postoperative wound infection in patients undergoing colorectal surgery.Methods MEDLINE, EMBASE, the Cochrane Trials Register and the references cited in retrieved studies were searched to identify relevant trials published between 1984 and 1995.Results Some 147 relevant trials were identified. The quality of trials has improved over the past 12 years. The results confirm that the use of antimicrobial prophylaxis is effective for the prevention of surgical wound infection after colorectal surgery. "here was no significant difference in the rate of surgical wound infections between many different regimens. However, certain regimens appear to be inadequate (e.g. metronidazole alone, doxycycline alone, piperacillin alone, oral neomycin plus erythromycin on the day before operation). A single dose administered immediately before the operation (or short-term use) is as effective as long-term postoperative antimicrobial prophylaxis (odds ratio 1 17 (95 per cent confidence interval (c.i.) 0 * 90-1 -53)). There is no convincing evidence to suggest that the new-generation cephalosporins are more effective than first-generation cephalosporins (odds ratio 1 * 07 (95 per cent c.i. 0 * 54-2 -12)).Conclusion Antibiotics selected for prophylaxis in dorectal surgery should be active against both aerobic and anaerobic bacteria. Administration should be timed to make sure that the tissue concentration of antibiotics mound the wound area is sufliiciently high when bacterial contamination occurs. Guidelines should be developed locally in order to achieve a more cost-effective use of antimicrobial prophylaxis in colorectal surgery.Editorial Comment: Another time-honored practice in surgery is the use of systemic antibiotics for operations which require bowel resection. However, this practice is well supported by clinical trials that indicate a decreased risk of infection in patients treated with prophylactic doses of appropriate antibiotics. As this literature review illustrates, it is often difficult to demonstrate differences in outcome betwee...

Blood Transfusion and In-hospital Outcomes in Anemic Patients with Myocardial Infarction Undergoing Percutaneous Coronary Intervention

“…16 Beyond these risks, blood transfusions always carry a small risk of viral transmission, bacterial contamination, or hemolytic reactions. 17 The mechanism causing some of these adverse reactions seems diffuse and systemic. Blood transfusions may cause a systemic inflammatory response, induce nonspecific immunosuppression, and may cause tissue hypoxemia by occluding microvasculature.…”

“…Some have also suggested that blood-donor antibodies can cause the recipient's neutrophils to react, leading to increased pulmonary microcirculation permeability and to acute lung injury. 17 Thus, the mechanisms underlying adverse Values presented as percentages. a Median nadir hemoglobin = 10.0 g/dL.…”

Anaemia and its functional consequences in cancer patients: current challenges in management and prospects for improving therapy

“…However, many real and perceived risks are associated with the procedure, such as infection, allergic and/or febrile reactions, and the theoretical risk of transfusion-associated immunosuppression (Ludwig and Fritz, 1998a;Goodnough et al, 1999) (Table 1). In addition, there is the inconvenience, to both clinician and patient, of administering the transfusions for only transient benefit.…”

Minorities Are Less Likely to Receive Autologous Blood Transfusion for Major Elective Orthopaedic Surgery

“…Although infrequent, allogeneic transfusions carry important medical risks, including bloodborne infections, allergic and hemolytic reactions, and transfusion-associated sepsis [2,15,16,18,36,37,41]. Transfusion of preoperatively donated autologous blood is a theoretically safer, yet more costly and logistically difficult alternative [2,18,32].…”