Chapter 107. Transfusion Biology and Therapy (Part 10)

Alternatives to Transfusion Alternatives to allogeneic blood transfusions that avoid homologous donor exposures with attendant immunologic and infectious risks remain attractive. Autologous blood is the best option when transfusion is anticipated. However, the cost:benefit ratio of autologous transfusion remains high. No transfusion is a zerorisk event; clerical errors and bacterial contamination remain potential complications even with autologous transfusions. Additional methods of autologous transfusion in the surgical patient include preoperative hemodilution, recovery of shed blood from sterile surgical sites, and postoperative drainage collection. ...
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Chapter 107. Transfusion Biology and Therapy (Part 10) Chapter 107. Transfusion Biology and Therapy (Part 10) Alternatives to Transfusion Alternatives to allogeneic blood transfusions that avoid homologous donorexposures with attendant immunologic and infectious risks remain attractive.Autologous blood is the best option when transfusion is anticipated. However, thecost:benefit ratio of autologous transfusion remains high. No transfusion is a zero-risk event; clerical errors and bacterial contamination remain potentialcomplications even with autologous transfusions. Additional methods ofautologous transfusion in the surgical patient include preoperative hemodilution,recovery of shed blood from sterile surgical sites, and postoperative drainagecollection. Directed or designated donation from friends and family of thepotential recipient has not been safer than volunteer donor componenttransfusions. Such directed donations may in fact place the recipient at higher riskfor complications such as GVHD and alloimmunization. Granulocyte and granulocyte-macrophage colony-stimulating factor areclinically useful to hasten leukocyte recovery in patients with leukopenia related tohigh-dose chemotherapy. Erythropoietin stimulates erythrocyte production inpatients with anemia of chronic renal failure and other conditions, thus avoiding orreducing the need for transfusion. This hormone can also stimulate erythropoiesisin the autologous donor to enable additional donation. Further Readings Blajchman MA: The clinical benefits of the leukoreduction of bloodproducts. J Trauma 60:S83, 2006 Brecher ME, Hay SN: Bacterial contamination of blood components. ClinMicro Rev 18:195, 2005 [PMID: 15653826] ———et al: The Technical Manual, 15th ed. Arlington, VA, AmericanAssociation of Blood Banks, 2005 Busch MP et al: A new strategy for estimating risks of transfusiontransmitted viral infections based on rates of detection of recently infected donors.Transfusion 45:254, 2005 [PMID: 15660836] Raghavana M, Marik PE: Anemia, allogeneic blood transfusion, andimmunomodulation in the critically ill. Chest 127:295, 2005 Sheppard CA et al: Transfusion-related acute lung injury. Hematol OncolClin North Am 21:163, 2007 [PMID: 17258125] Bibliography Agre P, Cartron JP: Molecular biology of the Rh antigens. Blood 78:551,1991 [PMID: 1907207] Burthem J, Roberts DJ: The pathophysiology of variant Creutzfeldt-Jakobdisease: The hypotheses behind concerns for blood components and products. Br JHaematol 122:3, 2003 [PMID: 12823340] Carson JL et al: Mortality and morbidity in patients with very lowpostoperative hemoglobin levels who decline blood transfusion. Transfusion42:812, 2002 [PMID: 12375651] Corwin HL et al: The CRIT study: Anemia and blood transfusion in thecritically ill—Current clinical practice in the United States. Crit Care Med 32:39,2004 [PMID: 14707558] Etchson J et al: The cost effectiveness of preoperative autologous blooddonations. N Engl J Med 332:719, 1995 Fang CT et al: Detection of bacterial contamination in apheresis plateletproducts: American Red Cross experience, 2004. Transfusion 45:1845, 2005[PMID: 16371037] Hebert PC et al: A multicenter, randomized, controlled clinical trial oftransfusion requirements in critical care. N Engl J Med 340:409, 1999 [PMID:9971864] Hillyer CD et al (eds): Blood Banking and Transfusion Medicine: BasicPrinciples and Practices, 2d ed. Philadelphia, Churchill Livingstone, 2006 Kitchen AD, Chiodini PL: Malaria and blood transfusion. Vox Sang 90:77,2006 [PMID: 16430664] Leiby DA: Babesiosis and blood transfusion: Flying under the radar. VoxSang 90:157, 2006 [PMID: 16507014] Rubella P et al: A multicenter randomized study of the threshold forprophylactic platelet transfusions in adults with acute myeloid leukemia. N Engl JMed 337:1870, 1997 Slichter SJ et al: Factors affecting posttransfusion platelet increments,platelet refractoriness, and platelet transfusion intervals in thrombocytopenicpatients. Blood 1005:4106, 2005 Stubbs JA: Alternatives to blood product transfusion in the critically ill:Erythropoietin. Crit Care Med 34(Suppl 5):160, 2006 Taylor RW et al: Red blood cell transfusions and nosocomial infections incritically ill patients. Crit Care Med 34:2302, 2006 [PMID: 16849995]