摘要:

The last decade has seen substantial improvements in the provision of safe ‘infection‐free’ blood for patients in many countries. This has resulted from the combined effects of better donor education, selection, testing and exclusion processes. The residual risk of infection with HBsAg attributable to laboratory error is less than 0.1/100 000 (1/750 000). The risk for HIV remains to be quantified but may approach this figure. With such low risks it will be difficult to provide statistical evidence that further improvements in the process of selection, testing or exclusion will have an impact on reducing risk from either agent. Over the same time, less progress has been made reducing risk to the recipient attributable to problems in the clinical supply process, i.e. getting the right blood, to the right person, at the right place, at the right time. Uniform definitions of terminology defining blood donation characteristics, together with the sharing of performance data are essential if we are to make national and international comparison of the risks that patients face when they receive a transfusion. Equally, the use of agreed definitions, and the sharing of data on the clinical outcomes of transfusion can provide the key to better prescribing based on evidence of actual risks and

ISSN:0958-7578    

DOI:10.1046/j.1365-3148.1996.d01-47.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Guidelines, algorithms and recommendations have been issued in the attempt to ensure appropriateness of transfusion practice, but the results are less than satisfactory, mainly due to the difficulty to turn paper procedures into actual practice. In our hospital we have tried to overcome this difficulty through the implementation of a quality assurance programme which includes giving the privilege of nonurgent blood prescription to a limited number of physicians and a computerized prospective audit of blood requests. The latter is performed through verification of the compliance of blood requests, which are designed to include a patient's laboratory and clinical data, with hospital guidelines for the proper use of blood.  In the 12 months since implementation of the computerized prospective audit the transfusion service has evaluated 7884 requests. Of these, 63.4% (n = 4998) were for red blood cells, 21.1% (n = 1664) for platelets and 15.5% (n = 1222) for fresh frozen plasma. The prospective audit showed that 96.8% and 98.1% of requests for red units and platelets were appropriate, respectively. Conversely, approximately 27% of plasma requests did not comply with guidelines, mainly because the evidence of coagulopathy was missing. However, inappropriateness of plasma requests for elective general surgery decreased from 39% at the onset of the programme to 14% in the last trimester considered. Moreover, the evaluation by retrospective audit of the proportion of patients transfused with both red blood cells and plasma in the perioperative period out of those transfused with red blood cells only, as an indicator of unwanted reconstitution of whole blood, showed that this proportion decreased from 47.6% (320/672) in the 12 months before implementation of computerized audit to 37.8% (244/646) in the following 12 months (difference = −9.8%, 95% confidence interval of the difference from −4.5% to −15.1%;P < 0.005 by χ2test). Our initial experience, together with the present system, shows that (1) the restriction of nonurgent blood prescription to a group of clinicians more educated in transfusion medicine than average clinicians practicing in a large multispecialty hospital is feasible; (2) prospective audit is a useful tool for assuring the

ISSN:0958-7578    

DOI:10.1046/j.1365-3148.1996.d01-48.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

The acquisition of a sufficient and safe supply of blood products is required to support modern medical care; in most countries this has meant a reliance on voluntary, nonremunerated blood donors. Recent reported shortages in the United States and elsewhere have highlighted the need for a method to measure and evaluate blood donor return behaviour. This paper describes a framework within which standard time‐to‐outcome methods can be used to analyse blood donor return behaviour. Survival curves and relative risk estimates derived from a proportional hazards analysis of a large administrative dataset are reported. In addition to assessing the effect of sex, age and other key donor demographic factors on the probability of a subsequent donation attempt, the analysis reveals that the relative risks are time‐dependent. This suggests that the likelihood of attempting a subsequent donation may also depend on the time since the index donation attempt. The implications for blood collection agencies and transfusion researchers of this new perspective on donor behaviour are disc

ISSN:0958-7578    

DOI:10.1046/j.1365-3148.1996.d01-46.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

A 10‐month audit of reasons for donor medical deferral at sessions was carried out in two Scottish regions of the SNBTS. Six thousand deferred donors were assessed. Although the deferred donor population mirrored the attending donor population in both regions, significantly more donors, both new and regular, were deferred in the Edinburgh and South East region, compared with the North East. The main differences in deferral were attributable to three clinical conditions (cervical carcinomain situ, other gynaecological conditions and hypertension) and to donors admitting to high‐risk behaviour. Although the staff in the deferral process — doctors, nurses and clerks — were involved in roughly equal proportions in both regions, the spectrum of medical conditions seen by each staff grouping appeared to be different in each region. The staff in the South East appeared to have made more correct decisions. Further analysis and audits are being undertaken in areas highlighted by thi

ISSN:0958-7578    

DOI:10.1046/j.1365-3148.1996.d01-50.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Antithrombin concentrate, prepared from human plasma, has been used as replacement therapy in 35 patients with acquired antithrombin deficiency. The inhibitory activity of the concentrate, measured by chromogenic assay, correlates well with the manufacturer's quoted activity. The meanin vivorecovery of the product was 0.0124 iu mL −1per iu of antithrombin (AT) concentrate administered by kilogram body weight. The recovery was similar in all diagnostic groups studied and did not vary during the course of treatment. Consumption of the antithrombin concentrate was monitored by measuring the production of thrombin–antithrombin complexes and the loss of plasma antithrombin activity. The mean concentration of thrombin–antithrombin complexes was elevated (23 ng mL −1) at the time of admission to the intensive care unit and fell progressively over the next 4 days. The mean time for the decay of half the antithrombin activity was 23 h during the first 24 h of therapy and rose to 42.1 h after day 1. The recovery and half‐life measurements are necessary to plan an appropriate dosage regimen for the administration of this antithrombin concentrate in

ISSN:0958-7578    

DOI:10.1046/j.1365-3148.1996.d01-51.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Blood group ABH antigens are associated with platelets as intrinsic determinants and extrinsically adsorbed antigens, and exist both on glycosphingolipids and on glycoproteins (GPs). We now provide direct evidence that the blood group ABH antigens are prominently associated with platelet GPIb and GPIIb. By immunoprecipitation, a murine monoclonal anti‐A antibody precipitated surface‐biotin‐labelled blood group A1platelet membrane proteins with electrophoretic characteristics identical to those of GPIb/IX and GPIIb/IIIa. By immunoblotting of SDS‐PAGE separated blood group A1platelet proteins the monoclonal anti‐A antibody bound to proteins with electrophoretic characteristics identical to those of GPIb and GPIIb. When immunoaffinity purified GPIb/IX and GPIIb/IIIa, derived from blood group O, A1and A2platelets, were employed for immunoblotting, GPIb and GPIIb only from A1platelets bound the monoclonal anti‐A antibody. By ELISA, wherein monoclonal antibodies specific for GPIb (AP1) and the GPIIb/IIIa complex (AP2) were used to capture and hold antigens from platelet lysate, human anti‐A antibodies reacted with these proteins derived from blood group A1platelets; proteins from blood group A2, O and B platelets showed no reactivity. These results indicate that blood group A antigen is associated with GPIb and GPIIb derived from blood group A1but no

ISSN:0958-7578    

DOI:10.1046/j.1365-3148.1996.d01-52.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

In 1993 the North London Blood Transfusion Centre received its first report ofYersinia enterocoliticatransmission from a unit of red cells supplied to a local hospital. The recipient was a 23‐year‐old male who was neutropenic following a third cycle of chemotherapy for treatment of acute myeloblastic leukaemia (FAB type M6) and received a 34‐day‐old red cell unit. During transfusion the patient developed septicaemia and endotoxin‐mediated shock. The transfusion was stopped immediately and broad spectrum antibiotics administered immediately on suspicion of bacteraemia from the transfused unit. This prompt action undoubtedly prevented a fatal outcome.  Y. enterocoliticawas isolated from the blood bag. Antibody was also detected in the bag and in a sample taken from the donor 39 days post‐donation. Antibody to serotype 03 was identified, the commonest serotype reported in transfusion‐transmittedY. enterocolitica. The donor reported no gastrointestinal upset or illness prior to donation.  This transfusion reaction might not have occurred had the red cells been transfused earlier in their storage period, but would not have been prevented by the exclusion of donors with a history of gastrointestinal illness as the donor was asymptomatic. Nor would it have been prevented by inspecting the blood for a change in colour, as no such change was observed.  Y. enterocoliticais a significant problem in transfusion medicine and transmission is generally associated with a high mortality rate. Hospitals should be urged to investigate bacteriologically all appropriate transfusion reactions so that the true extent of the problem in the United King

ISSN:0958-7578    

DOI:10.1046/j.1365-3148.1996.d01-53.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Atypical antibody detection in DiaMed microtubes using a low‐ionic‐strength saline (LISS) indirect antiglobulin technique (IAT) was assessed using both serum and plasma. During the first period of the study all atypical antibodies originally detected in serum were also detected in EDTA plasma with comparable reaction strengths. Two of 73 antibodies were not detected in citrated plasma.  During the second period of the study all routine antibody screens were performed in both serum and EDTA plasma. More clinically significant antibodies were detected in EDTA plasma than in serum. More false positives and non‐specific antibodies were also detected in EDTA plasma. It is concluded that EDTA plasma is a suitable medium for antibody detection using LISS IAT in DiaMed gel mic

ISSN:0958-7578    

DOI:10.1046/j.1365-3148.1996.d01-54.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

ISSN:0958-7578    

DOI:10.1046/j.1365-3148.1996.d01-517.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

ISSN:0958-7578    

DOI:10.1046/j.1365-3148.1996.d01-518.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY