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Questions and Answers
During the 1960s, what type of blood transfusion was most commonly administered?
During the 1960s, what type of blood transfusion was most commonly administered?
What type of blood therapy characterized the 1970s through the 1980s?
What type of blood therapy characterized the 1970s through the 1980s?
In the 1970s through the 1980s, which component of blood was transfused if a patient had thrombocytopenia?
In the 1970s through the 1980s, which component of blood was transfused if a patient had thrombocytopenia?
What factor led to an increase in caution during blood transfusions from the 1970s through the 1980s?
What factor led to an increase in caution during blood transfusions from the 1970s through the 1980s?
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What was the primary concern that led to increased caution in blood transfusions from the 1970s through the 1980s?
What was the primary concern that led to increased caution in blood transfusions from the 1970s through the 1980s?
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What was the primary focus of blood product safety in the 1990s through the 2000s?
What was the primary focus of blood product safety in the 1990s through the 2000s?
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What serious hazards of transfusion were the focus of safety concerns after the 1990s?
What serious hazards of transfusion were the focus of safety concerns after the 1990s?
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What term has become synonymous with modern, evidence-based transfusion medicine?
What term has become synonymous with modern, evidence-based transfusion medicine?
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What did the Society for the Advancement of Blood Management define PBM as?
What did the Society for the Advancement of Blood Management define PBM as?
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What has integration of Patient Blood Management (PBM) into clinical pathways helped reduce?
What has integration of Patient Blood Management (PBM) into clinical pathways helped reduce?
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What age group demonstrated the most improved clinical outcomes with a reduced transfusion threshold in orthopedic surgical patients?
What age group demonstrated the most improved clinical outcomes with a reduced transfusion threshold in orthopedic surgical patients?
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What has been a limitation of most Patient Blood Management (PBM) publications?
What has been a limitation of most Patient Blood Management (PBM) publications?
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Why do low- and middle-income countries struggle with transfusion-transmissible infections in blood donations?
Why do low- and middle-income countries struggle with transfusion-transmissible infections in blood donations?
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Why does the World Health Organization strongly advocate for voluntary nonremunerated blood donation?
Why does the World Health Organization strongly advocate for voluntary nonremunerated blood donation?
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What age group is eligible for screening for potential blood donation in the United States?
What age group is eligible for screening for potential blood donation in the United States?
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What is the minimum hemoglobin level required for men to be eligible for blood donation?
What is the minimum hemoglobin level required for men to be eligible for blood donation?
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Why is it important to collect plasma from AB donors during apheresis?
Why is it important to collect plasma from AB donors during apheresis?
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What is the key benefit of apheresis over whole blood donation?
What is the key benefit of apheresis over whole blood donation?
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In apheresis, which components of the blood are collected?
In apheresis, which components of the blood are collected?
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Why is apheresis particularly helpful in donors with blood type AB?
Why is apheresis particularly helpful in donors with blood type AB?
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What is the controversial deferment category for blood donation?
What is the controversial deferment category for blood donation?
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Why do some advocate for reducing the time interval between potential exposure to HIV and donation to 3 months?
Why do some advocate for reducing the time interval between potential exposure to HIV and donation to 3 months?
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Which infectious agent is NOT required to be tested for in blood products according to the FDA?
Which infectious agent is NOT required to be tested for in blood products according to the FDA?
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What is recommended for first-time donors to be tested for?
What is recommended for first-time donors to be tested for?
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Why have infectious risks become quite rare in blood transfusions?
Why have infectious risks become quite rare in blood transfusions?
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What is a major reason for the decrease in infectivity with hepatitis, HIV, West Nile virus, and Zika virus according to the text?
What is a major reason for the decrease in infectivity with hepatitis, HIV, West Nile virus, and Zika virus according to the text?
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Which technological advancement introduced in 2003 made West Nile virus infection very rare?
Which technological advancement introduced in 2003 made West Nile virus infection very rare?
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What is the primary concern regarding posttransfusion hepatitis ?
What is the primary concern regarding posttransfusion hepatitis ?
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What percentage of posttransfusion hepatitis is caused by the hepatitis C virus according to the text?
What percentage of posttransfusion hepatitis is caused by the hepatitis C virus according to the text?
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What was observed as a common sign or symptom in patients with chronic posttransfusion hepatitis C?
What was observed as a common sign or symptom in patients with chronic posttransfusion hepatitis C?
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What was the leading cause of death among 131 patients monitored for chronic posttransfusion hepatitis C?
What was the leading cause of death among 131 patients monitored for chronic posttransfusion hepatitis C?
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What condition may patients with hepatitis C and apparent recovery from acute infection go on to develop, as mentioned in the text?
What condition may patients with hepatitis C and apparent recovery from acute infection go on to develop, as mentioned in the text?
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Which condition was least commonly observed among patients with chronic posttransfusion hepatitis C?
Which condition was least commonly observed among patients with chronic posttransfusion hepatitis C?
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Which therapy may stop progression and even cure infection from certain genotypes of hepatitis C?
Which therapy may stop progression and even cure infection from certain genotypes of hepatitis C?
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Infection with the CMV virus
Infection with the CMV virus
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Why they recommend continuing to use CMV-seronegative blood for preterm and newborn infants?
Why they recommend continuing to use CMV-seronegative blood for preterm and newborn infants?
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CMV seroconversion usually occurs in subsets of patients
CMV seroconversion usually occurs in subsets of patients
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Infection with the CMV virus closely resembles
Infection with the CMV virus closely resembles
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Which group of recipients can be significantly impacted by transfusion-transmitted CMV ?
Which group of recipients can be significantly impacted by transfusion-transmitted CMV ?
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What is the primary concern of using leukocyte-reduced blood and frozen deglycerolized RBCs according to recommendations in the text?
What is the primary concern of using leukocyte-reduced blood and frozen deglycerolized RBCs according to recommendations in the text?
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Why is it not necessary to provide blood products from CMV-seronegative donors for most patients who receive blood transfusions, according to Wilhelm and associates?
Why is it not necessary to provide blood products from CMV-seronegative donors for most patients who receive blood transfusions, according to Wilhelm and associates?
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which other infectious diseases can theoretically be transmitted by blood transfusion
which other infectious diseases can theoretically be transmitted by blood transfusion
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What type of blood products are considered CMV-safe when derived from seropositive donors in the text?
What type of blood products are considered CMV-safe when derived from seropositive donors in the text?
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Zika virus infection is associated with ?
Zika virus infection is associated with ?
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What is the main concern regarding recipients at risk of cytomegalovirus (CMV) infection mentioned in the text?
What is the main concern regarding recipients at risk of cytomegalovirus (CMV) infection mentioned in the text?
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What is a common symptom associated with Zika virus infection that poses a potential threat to the blood supply?
What is a common symptom associated with Zika virus infection that poses a potential threat to the blood supply?
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What is a potential consequence of storing blood at 4°C in phosphate buffer ?
What is a potential consequence of storing blood at 4°C in phosphate buffer ?
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Why are platelet concentrates highlighted as the blood component most likely to be implicated in Transfusion-Associated Infectious Diseases ?
Why are platelet concentrates highlighted as the blood component most likely to be implicated in Transfusion-Associated Infectious Diseases ?
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What precaution do blood banks take regarding potential malaria transmission through blood transfusions?
What precaution do blood banks take regarding potential malaria transmission through blood transfusions?
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which of the following infectious agents can transmit disease through blood transfusions, but there are no available blood testing methods
which of the following infectious agents can transmit disease through blood transfusions, but there are no available blood testing methods
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Study Notes
Transfusion Medicine
- The concept of reconstituted "whole blood" was introduced in the 1990s, led by trauma hospitals and the military.
- FFP and platelets were transfused along with PRBCs, resulting in a transfusion ratio similar to that of whole blood.
Patient Blood Management (PBM)
- The term PBM was introduced in the 2010s, focusing on a patient-centered, multi-pronged approach to transfusion medicine.
- PBM aims to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss to improve patient outcomes.
- Implementation of PBM has reduced the reliance on allogenic blood product transfusions and improved clinical outcomes.
Transfusion History
- In the 1960s, most blood given was in the form of whole blood.
- In the 1970s-1980s, transfusion therapy focused on giving patients only the component of blood that was needed.
- In the 1990s-2000s, the focus shifted to balancing the risks of anemia and transfusion, with improved screening techniques and reduced infectious disease transmission.
Blood Donation and Procurement
- In the United States, donors must be at least 16 years old and weigh at least 110 pounds to be eligible for screening.
- Blood is collected either as whole blood or by apheresis, with specific components separated and returned to the donor.
- Global disparities exist in access to safe blood, with low- and middle-income countries collecting 53% of all blood donations but representing 81% of the world's population.
Transfusion-Transmissible Infections
- Donor screening aims to reduce the risk of transfusion-transmissible diseases, including HIV, hepatitis, and West Nile virus.
- Infectious risks are now rare due to improved screening methods and testing.
- The FDA requires blood products to be tested for various infectious diseases, including hepatitis B and C, HIV, and Zika virus.
Cytomegalovirus (CMV)
- CMV is a common infection that can be transmitted through blood transfusions.
- The primary concern is recipients who are at risk due to pregnancy, immaturity, or immunosuppression.
- Use of leukocyte-reduced blood, frozen deglycerolized RBCs, and screening for CMV antibody-negative donors can help prevent infection.
Zika Virus
- Zika virus is transmitted by mosquitoes and can cause Guillain-Barré syndrome and microcephaly in newborns.
- The FDA requires all blood donations to be tested for Zika virus using NAT.
Other Transfusion-Associated Infectious Diseases
- Other infectious diseases that can be transmitted through blood transfusions include Yersinia enterocolitica, syphilis, malaria, Chagas disease, and variant Creutzfeldt-Jakob disease.
Posttransfusion Hepatitis
- Viral hepatitis was a major complication of blood transfusions, with an incidence of 3-10% before 1985.
- Hepatitis C virus is the primary cause of posttransfusion hepatitis, with chronic active hepatitis and hepatocellular carcinoma possible complications.
Blood Transfusion Indications
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Blood transfusions are given to increase O2-carrying capacity, not to augment intravascular volume.
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A sole Hb value should not be the only basis for a transfusion decision; the overall patient status should be considered.
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The current PBM emphasis is on fewer or even avoidance of blood transfusions, with a focus on restrictive versus liberal transfusion strategies.### Determining Need for Subsequent Blood Transfusions
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Reassess patient's overall condition and clinical situation to determine need for additional blood transfusions
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Key factors to consider include: measurement and trend of vital signs, measurement of blood loss and anticipated blood loss, quantitation of intravenous fluids given, determination of Hb concentration, and surgical concerns
Measurement of Blood Loss
- Measuring blood loss is crucial in assessing need for initial and subsequent blood transfusions
- Standard approach combines visualization and gravimetric measurements based on weight differences between dry and blood-soaked gauze pads
- Anesthesiologists tend to overestimate blood loss by as much as 40%, while optical scanners tend to underestimate blood loss
- No "gold standard" for blood loss quantification exists
Evolution of Blood Transfusion Therapy
- 1960s: most blood given was in the form of whole blood, with fresh frozen plasma (FFP) available for coagulopathies
- 1970s-1980s: transfusion therapy focused on giving only the component of blood needed, with caution regarding administration due to concern about infectivity of blood (e.g., hepatitis and HIV)
- 1990s-2000s: improved screening techniques for HIV and other blood-borne pathogens led to a 10,000-fold decrease in blood transfusion–related infectious disease transmission
- Focus shifted to noninfectious serious hazards of transfusion, such as hemolytic transfusion reactions, TRALI, and TACO
SpHb Monitoring
- SpHb correlates within 1.0-1.5 g/dL with laboratory Hb measurements, but accuracy is not consistent
- Accuracy is affected by Hb levels, resuscitation, finger blood flow, and temperature
- Perfusion index (PI) can be helpful in assessing accuracy of SpHb value
- A PI greater than 4% to 5% can improve accuracy of SpHb
- Bupivacaine digital nerve block and warming the finger can increase PI and accuracy of SpHb
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Description
Explore the evolution and recent history of blood transfusion therapy from the 1960s to the 1980s, focusing on the transition from whole blood to specific blood components like packed red blood cells (PRBCs) and fresh frozen plasma (FFP). Learn about the developments in transfusion therapy practices during this period.
