| Background
Safety concerns, rising
costs, and blood shortages are some of the reasons behind the move towards blood
management and promoting autologous infusion. The prevailing medical
consensus is summarized by Isbister:
Altruistically donated allogeneic
blood transfusion should only be used as therapy when there is
evidence for potential benefit, there are no alternatives, a quality product
is available and the risks are appropriately considered and balanced against
the benefits.
SAFETY
Providing safe blood for transfusion remains a challenge. Despite advances in preventing transmission of hepatitis B, hepatitis C, and AIDS/HIV, transfusion-transmitted bacterial infection remains a significant risk.
As well, many adverse events are associated with the transfusion of
allogeneic blood products:
Viral
risks such as
HIV, although extremely rare, have not totally disappeared:
UNAIDS:
Important progress seen in tackling AIDS, but epidemic continues to outpace
response (30 May
2006)
HIV/AIDS in China: from
high-risk groups to general population
China AIDS survey (1985–2005)
There
is growing evidence that human herpesvirus 8
(HHV-8), previously thought unlikely to
be transfusion-associated,
may be transmissible by blood
transfusion:
Chagas Disease
There are now multiple reported cases of transfusion-transmitted Chagas disease
(caused by the parasite caused by Trypanosoma cruzi) in the USA and
Canada, with continued calls for blood banks to screen for the T. cruzi
parasite:
vCJD
Other risks such as variant Creutzfeldt Jakob Disease (vCJD) remain worrisome.
Blood centers worldwide have instituted criteria to reject donors who may have been exposed to
vCJD. There are now four suspected cases in the United Kingdom and donors whose
blood was transfused to people who died of vCJD have been warned that they
may be carrying the disease.
-
Houston F, McCutcheon S, Goldmann W, Chong A, Foster J, Siso S, et al.
Prion diseases are efficiently transmitted by blood transfusion in
sheep. Blood. 2008 Jul 22. [Epub ahead of print] -
Britain
may 'never be rid of vCJD threat' without screening (24 Sept.
2007) - UK:
Warning on vCJD screening (24 Sept. 2007)
-
Fourth case of transfusion-associated vCJD infection in the United
Kingdom (editorial). Euro Surveill. 2007 Jan 18;12(1). -
UK Health Protection Agency:
4th case of transfusion-associated vCJD (18 Jan. 2007) -
Should we still be worried about vCJD? (10 Jan. 2007) -
UK:
24 patients
transfused with vCJD contaminated blood at substantial risk (8
Dec. 2006) -
TraQ's vCJD
clearinghouse (latest updates)
-
Special report:
BSE and
CJD (Guardian Unlimited - ongoing updates) -
Blood transfusions could transmit vCJD (27 Mar. 2006) -
3rd
transfusion-related vCJD case in UK (BBC, 9 Feb. 2006)
- UK Health
Protection Agency:
New case of vCJD associated with blood transfusion (Press
release, 9 Feb. 2006)
- vCJD
warning for blood recipients (17 Nov. 2005, BBC)
- UK national CJD
Surveillance Unit:
2004 Annual Report (7 Nov.
2005)
-
2nd
case of possible transmission of vCJD via transfusion in UK
(22 July 2004)
-
~100 UK
blood donors warned they may have vCJD (BBC, 20 July 2005)
-
Assessing the implications for blood donors if
recipients are infected with vCJD (UK DOH,
20 July 2005)
WNV
Because
West Nile Virus (WNV) can be transmitted by blood transfusion and most patients with WNV infection are likely to be asymptomatic, a blood donor screening test for WNV was implemented in July 2003.
TRALI
Transfusion-related acute lung injury (TRALI) remains a life-threatening
complication of transfusion:
Blood
Donations From Previously Pregnant Women Restricted
-
Bueter
M, Thalheimer A, Schuster F, Bock M, von Erffa C, Meyer D, Fein M.
Transfusion-related acute lung injury (TRALI) - an important, severe
transfusion-related complication. Langenbecks Arch Surg. 2006 Aug 15; [Epub
ahead of print]
-
Swanson
K, Dwyre DM, Krochmal J, Raife TJ.
Transfusion-related acute lung injury (TRALI): Current clinical and
pathophysiologic considerations. Lung 2006 May-Jun;184(3):177-85.
- Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic
factors. Blood. 2003 Jan 15;101(2):454-62.
- Transfusion-related acute lung injury (TRALI)--under-diagnosed and under-reported.
(editorial) Br J Anaesth 2003 May; 90(5):573-6.
Transfusion-associated
Immunomodulation
Transfusion-associated immunomodulation (TRIM) has been
reported since the 1970s. Evidence-based approaches suggest that an
adverse TRIM effect probably does exist, and even if the effect is small, it
represents a clinically important complication of transfusion:
Human Error
Human
errors present more of a risk than transmissible diseases as shown by the Serious
Hazards of Transfusion (SHOT) reports from the UK. Human error also
results in many recalls of blood products that were mistakenly issued from
blood suppliers.
Misidentification
leading to blood of the wrong blood group being transfused can result in
life-threatening transfusion reactions:
OTHER
FACTORS
Costs
Costs
have risen due to adoption of improved screening tests for transmissible
diseases and government-mandated patient and hospital notification requirements
for blood products identified as having increased risk for disease transmission.
While such advances improve safety, they also increase the cost of obtaining and
processing blood. See, for example:
-
Comparative
costs of blood conservation. Table 12-7 in:
- Lee LY, DeBois WJ, Krieger KH, Isom OW. Transfusion Therapy and Blood
Conservation (Chapter 12). In: Cohn LH, Edmunds LH Jr, eds. Cardiac
Surgery in the Adult. New York: McGraw-Hill, 2003:389400.
-
Crotty B.
Blood simple. (article on cost effectiveness by financial manager of
capital projects at UK National Blood Services)
Various blood conservation strategies have been used to reduce costs, e.g.,
To learn how the
Hemobag® can
reduce costs, see
Shortages
Blood shortages exist in the United States and worldwide.
In many industrialized countries 5% or less of the eligible population are blood donors.
Screening for transmissible diseases and deferral policies for vCJD designed to
improve safety have contributed to shrinking the donor pool. Blood centers are
increasingly forced to encourage blood donation with giveaways and the AABB
operates a
National Blood Exchange to help ensure blood is moved where it is needed.
-
Appeal
for more blood donor buses as NYC blood supply at dangerously low
levels (13 Aug. 2008)
-
Hospitals
delay more surgeries. Severe blood shortage continues; donations
encouraged (26 July 2008)
-
Blood
never this low, this fast (22 June 2008)
-
ARUP
Blood Services summer car giveaway
-
Blood
for oil, literally: Donors are pumping out blood to make life easier
at the gas pump (3 June 2008)
-
American
Red Cross offers chance to win car and gas money for donating
-
Blood
supply running low in Utah as donors sell plasma (10 June 2008)
- Florida:
Blood shortage puts some surgeries on hold (1 Apr. 2008)
-
Incentives draw in donors. They're costly, but necessary as blood
centers try to match supply with demand. (23 Dec. 2007)
-
Blood for military in critical shortage (19 Dec. 2007)
- More
restrictions, generational mind-set mean fewer Americans are
donating blood (22 Nov. 2007)
- Zou S, Musavi F, Notari EP 4th, Fang CT; ARCNET Research Group.
Changing age distribution of the blood donor population in the
United States. Transfusion. 2007 Nov 13; [Epub ahead of print]
- S.E.
Michigan in jeopardy from critical blood shortage (22 Aug. 2007)
-
Blood donor pool thinning (Aug. 5, 2007)
- Summer
blood shortage prompts donation plea (Aug. 7, 2007)
- Riley W, Schwei M, McCullough J.
The United States' potential blood donor pool: estimating the
prevalence of donor-exclusion factors on the pool of potential
donors. Transfusion 2007;47 (7), 1180-8.
- As summer approaches, Red Cross blood supplies reach dangerous
levels (30 May 2007)
- New rules may
shrink ranks of blood donors (10 Jan. 2007)
- CJD fears prompt
blood donor ban (BBC)
- AABB
Blood FAQ
THE HEMOBAG®
For
these reasons the global medical community has moved away from allogeneic blood
and towards autologous
infusion. When blood is required, the safest blood is almost always the patient's own autologous blood.
The Hemobag® is a medical device developed by medical professionals with years of experience in cardiac, thoracic and vascular surgery, to assist in salvaging the patient's own whole blood in the perioperative setting.
The Hemobag® makes it easy to get the benefits of concentrated hyperoncotic whole blood with the use of any extracorporeal circuit used in surgery.
With The Hemobag® patients receive their own concentrated whole blood quickly and receive less allogeneic blood with its associated risks.
The Hemobag® takes patients one step closer to blood
free surgery by making their own Autologous Whole Blood rapidly available for
infusion at the end of the procedure.
Also see
Intraoperative Autologous Blood
Salvage and The Hemobag®
The Hemobag®
- An Improved Way to Salvage Autologous Whole Blood in Surgery | Methodology | View the video | FAQs | Contact Us | |
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