ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.33793325046.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.33793325047.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

ISSN:0041-1132    

DOI:10.1111/j.1537-2995.1993.tb05760.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

摘要:

Although the frequency of preoperative autologous blood donation is increasing dramatically, the economic implications of its use remain largely unexplored. Decision analysis was used to calculate the cost‐ effectiveness of autologous blood donation for hip and knee replacement. Cost‐effectiveness, expressed as cost per quality‐adjusted year of life saved, was based on observed red cell use in 629 patients undergoing surgery at two tertiary‐care centers. Autologous blood donation for bilateral and revision joint replacement cost $40,000 per quality‐adjusted year of life saved at Center 1 and $241,000 at Center 2. Autologous blood donation for primary unilateral hip replacement cost $373,000 per quality‐adjusted year of life saved at Center 1 and $740,000 at Center 2. Autologous blood donation was least cost‐ effective for primary unilateral knee replacement ($1,147,000/quality‐ adjusted year of life saved at Center 1 and $1,467,000/year at Center 2). Differences between autologous blood collections and transfusion requirements explained variations among procedures in the cost‐ effectiveness of autologous blood donation. Higher transfusion rates in autologous blood donors than in nondonors accounted for the poorer cost‐ effectiveness of autologous blood donation at Center 2 than at Center 1. Autologous blood donation is not as cost‐effective as most accepted medical practices. Its cost‐effectiveness can be improved substantially by the avoidance of overcollection and overtransfus

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.33793325048.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

摘要:

The impact of heterosexual transmission of the human immunodeficiency virus (HIV) on the United States blood supply was assessed, and deferral criteria that may exclude potential donors who are at high risk for heterosexually acquired HIV infection were evaluated. Interviews were conducted with 508 HIV‐seropositive blood donors from May 1, 1988, to August 31, 1989 (Phase 1), and with 472 donors from January 1, 1990, to May 31, 1991 (Phase 2), at 20 blood centers. From Phase 1 to Phase 2, the overall HIV prevalence decreased from 0.021 to 0.018 percent (p<0.001). HIV risk factors among HIV‐1‐seropositive donors were similar during both study phases. Eleven percent of the men and 56 percent of the women reported as their only risk that they had a heterosexual partner who was at increased risk for HIV or was known to have HIV. These percentages were similar during both study periods. During Phase 2, 13 percent of the men and 17 percent of the women with heterosexual transmission risk had a positive serologic test for syphilis, hepatitis B core antibody, or hepatitis C antibody. Among HIV‐ 1‐seropositive donors reporting heterosexual risk, the median numbers of previous‐year and lifetime sex partners for men were 2 and 30, respectively; for women, those numbers were 1 and 7, respectively. Thirty‐one percent of the men and 6 percent of the women reporting heterosexual transmission risk also reported having had syphilis or gonorrhea within 3 years of donation. It is concluded that the impact of heterosexual transmission of HIV infection on transfusion safety is not worsening at this time.(ABSTRACT TRUNCATED

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.33793325049.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

摘要:

Ninety‐two hospitals in a three‐state mid‐Atlantic region were surveyed to determine their policy toward obtaining written informed consent for transfusion and to examine the content of written consent documents and the process by which consent is obtained. Of 81 hospitals responding, 50 (62%) required written informed consent. Hospitals with fewer than 200 beds were more likely to require written informed consent. The attending physicians had responsibility for obtaining consent in 28 (57%) of 49 institutions, most often on the day or evening before surgery. Twenty‐seven of 48 forms mentioned complications: hepatitis in 80 percent, human immunodeficiency virus infection in 46 percent, nonhemolytic reactions in 32 percent, and hemolysis in 25 percent. Alternatives to allogeneic transfusion were mentioned infrequently; eight hospital forms listed autologous transfusion options and only two mentioned designated donation. The reading level required to comprehend 34 consent forms submitted was grade 14.6, which has been attained by only 23 percent of the adult United States population. Although the majority of respondent institutions require written informed consent, those forms, per se, do not document that the fundamental tenets of informed choice have been applied to the decision to transfus

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.33793325050.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

摘要:

Bone marrow for transplantation is traditionally collected into tissue culture medium with heparin. A licensed electrolyte solution (Plasma‐ Lyte A [PLA]) was used as a substitute for tissue culture medium in the harvesting of 28 bone marrows, 17 autologous and 11 allogeneic, which were subsequently transplanted. Data that were analyzed from the 25 evaluable patients consisted of the numbers of cells and colony‐forming units in the transplanted marrow as well as the time to neutrophil and platelet engraftment. These results were compared with those in the 30 (26 evaluable) preceding transplanted marrows that were collected into a tissue culture medium (RPMI‐1640 [RPMI]). The autologous marrow transplant patients in both the PLA and RPMI groups reached a neutrophil count of>or = 0.5 × 109per L a mean of 19 days following transplantation. The patients who underwent transplantation with allogeneic bone marrow collected in RPMI achieved>or = 0.5 × 109per L of neutrophils an average of 20 days following transplantation, while those who received marrow collected in PLA achieved engraftment of neutrophils to that level in a mean of 21 days. Because in vitro and in vivo results with RPMI and PLA are similar in this study, further work using a licensed solution for clinical bone marrow transplantation is in

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.33793325051.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

摘要:

As the number of successful marrow transplants has increased, the lack of HLA‐identical sibling donors for 60 to 70 percent of transplant candidates has become a serious problem. Pilot studies established that marrow transplantation between phenotypically HLA‐identical, unrelated individuals can be accomplished successfully. Therefore, the National Marrow Donor Program was established to develop a large file of volunteer marrow donors and to serve as a center for the coordination of the donor search and donor‐recipient matching processes. By November 1991, 63 months after the program was established, 457,205 potential marrow donors typed for HLA‐A and ‐B antigens had agreed to be listed in the marrow donor registry. A donor search had been initiated for 8481 patients. At least one potential donor matched for at least three of the four HLA‐A and ‐B antigens was located for 99.8 percent of patients. Among the 3156 searches that were completed, 940 (29.8%) resulted in a transplant. The median time in which to locate a matched donor, complete all predonation evaluations, and obtain donor consent was 208 days. The most common diagnosis in patients who underwent transplantation was chronic myelogenous leukemia (42.0%). When this analysis was completed in November 1991, the National Marrow Donor Program was operating a national network of 99 donor centers and 53 transplant centers. The donor file was increasing rapidly, and a follow‐ up system was in place to determine the effects of donation on the donors and the outcome in the patients who underwent transplantation. This national network of donor and transplant centers exists and is now facilitating unrelated‐donor marrow transplants. The National Marrow Donor Program made it possible to locate donors for many patients in need of a transplant and helped to determine the role of unrelated‐ donor marrow transplants in the treatme

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.33793325052.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

摘要:

To evaluate the safety of cryopreserved and thawed peripheral blood stem cell (PBSC) autografts in children with active cancer, a toxicity assessment was made of 54 PBSC transfusions to 52 children (aged 1–16 years; median, 9 years). Patients were conditioned with high‐dose chemotherapy without total body irradiation. The volume of PBSCs transfused varied from 46 to 500 mL (219.6 +/− 118.4 mL, mean +/− SD), with a mean of 0.91 g per kg of dimethyl sulfoxide. Insignificant and transient toxicities included hemoglobinuria in 40 patients (74%), headache in 38 (70%), nausea in 37 (69%), and vomiting in 25 patients (46%). Significant shock developed in 8 patients (15%), but they recovered quickly, whether they had supportive therapy or not. Vomiting and hyperbilirubinemia were the only toxicities that showed a correlation with the amount of PBSCs transfused. The data suggest that transient toxicity associated with PBSC autografts is rather common in children, and close observation of patients for possible serious morbidity is r

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.33793325053.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY

摘要:

Human T‐lymphotropic virus type I and/or II (HTLV‐I/II) may be transmitted by the transfusion of blood and blood components. Several factors are critical to the efficiency of transmission. These include the number of contaminating white cells, the component volume, and the age of the component. After look‐back notification, there was an investigation of the HTLV‐I/II serostatus of three patients who had received blood from a donor now found to be positive for HTLV‐I antibodies by enzyme immunoassay and Western blot. The donor red cell unit was group O negative and cytomegalovirus antibody negative; it was washed and irradiated at 2800 cGy and aliquoted into six small‐volume transfusions for four neonatal infants. Three of the four patients were available for testing 3.5 years after their exposure. The fourth neonatal infant died on Day 11 of life. The three tested infants received 14, 14, and 44 mL of component, respectively. HTLV‐I seroconversion was documented by enzyme immunoassay and Western blot (p19, p24) and occurred only in the patient receiving 44 mL. On the basis of quality control data, it is estimated that the affected infant received 8 × 10(7) white cells in the 44‐mL aliquot. Washing and irradiation will not necessarily eliminate HTL

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1993.33793325054.x

出版商:Blackwell Science Ltd    

年代:1993

数据来源: WILEY