An Artificial Cadaveric Leg Blood Flow System for Endoscopic Vein Harvesting Simulation.

Despite being the most common training model for endoscopic vein harvesting, cadaveric legs are limited by their absence of blood flow, resulting in a faded vascular appearance. Because the saphenous vein and the surrounding tissue seem less distinguishable, dissection of the saphenous vein and bipolar coagulation of its branches becomes increasingly inefficient and difficult. An inexpensive artificial blood flow system was developed to overcome this limitation. A cadaveric leg was thawed to a soft and yielding degree, and the saphenous vein was dissected medial and proximal to the medial malleolus. An artificial blood solution was prepared by dissolving 4% protein powder, red dye, and a contrast agent-for x-ray visualization-in saline. The solution was perfused through the saphenous vein and artery. The open ends of the vessels were temporarily clamped after the perfusion had been completed. Blood flow within the vessels was confirmed via angiography and endoscopic visualization of the leg's vessels. A bleeding effect was observed when the saphenous vein was perforated or when a vascular branch was transected. Conversely, a tight seal indicated successful bipolar coagulation of a branch, providing an objective, quantifiable assessment parameter. The artificial blood flow system helps overcome the limitations of the cadaveric leg, creating a more realistic and inexpensive model for endoscopic vein harvesting simulation training.

Artificial oxygen carriers: a current review.

Artificial oxygen carriers are not blood substitutes. They serve to carry oxygen to tissues and are either hemoglobin based or perfluorocarbon based. Driving the development of artificial oxygen carriers are concerns involving both the safety and quantity of the blood supply. No artificial oxygen carriers are currently approved for clinical use in the United States. Hemopure has been approved for use in South Africa. The companies producing Hemopure and PolyHeme, both of which are hemoglobin-based oxygen carriers, have filed a Biologic License Application in the United States. Phase III trials have been completed for Hemopure, while PolyHeme is currently undergoing phase III trials in the PolyHeme Urban Ambulance Trial. No North American trials are under way for perfluorocarbons.

Genomics and blood substitutes for 21st century Europe ("EuroBloodSubstitutes").

Blood transfusion is a medical intervention practised throughout the world. Blood is a biologically active material that can transmit diseases (e.g., HIV/AIDS and, perhaps, vCJD). People are becoming increasingly concerned about blood safety, despite improved screening and processing. Consequently, they are reluctant to donate blood or receive transfusions. Such problems can be solved by the development and incorporation into transfusion practices of so-called "blood substitutes" to replace some blood uses. The EuroBloodSubstitutes Project is funded by the European Union Framework 6 Programme to develop a technological platform for producing novel haem proteins and blood substitute components using micro-organisms (bacteria, fungi, yeast) as "cell factories." The Project will focus on bacteria (Escherichia coli), yeast (Pichia pastoris) and, longer-term, filamentous fungi (Aspergillus niger), all organisms used to synthesize commercially important products. The multi-centre Consortium consists of the Universities of (1) Nottingham (UK), (2) Essex (UK), (3) Denmark Technical (Denmark), (4) Lund (Sweden), (5) Milan (Italy), (6) Nancy (France), (7) Parma (Italy), (8) Rome "La Sapienza" (Italy), (9) Semmelweis (Hungary), together with (10) Alligator Bioscience, AB (Sweden), (11) LCC Engineering & Trading GmbH (Switzerland), (12) Scottish National Blood Transfusion Service (UK), and (13) Sanquin Bloodbank (The Netherlands). The EuroBloodSubstitutes Project will be informed by lay and professional stakeholders (e.g., clinicians, blood donors, patient groups, prescribers and policy makers). Outcomes of the Project are (1) the production of an information pack, decision aids and physician training aids, giving balanced overviews of the benefits and risks of transfusion of blood or potential substitutes, and (2) an interactive web site (http//:www.eurobloodsubstitutes.com) for information dissemination. This will improve knowledge and address misunderstandings about transfusion issues in a climate of changing patient expectations on blood safety and benefits of blood substitutes.

[The hemotransfusion therapy rendered to the wounded during antiterrorist operation].

The blood transfusion therapy volume and structure at various stages of medical care in the wounded at antiterrorist operation on Northern Caucasus in 1999-2002 are discussed. The differences in the blood transfusion therapy structure at various stages of the military operation are established. In specialized medical care the use of blood components and products reached 86.2%, while in qualified medical care this rate was 78.7%. The blood transfusion therapy volume depended on the injury's type and location.

[Health economic aspects of the use of blood and blood products]. / Gesundheitsökonomische Aspekte der Anwendung von Blut- und Plasmaprodukten.

An adequate supply of blood components for patients depends on the population's willingness to donate blood as well as on a well-organized blood donation system. In order to ensure the blood supply, a high expenditure is necessary. The article at hand describes two areas of the use of blood and blood products. First, it considers the application of factor concentrates in haemophiliacs (approximately 3000-4000 patients are regularly in need of treatment). For the German statutory health insurance, the estimated yearly expenses for factor concentrates is approx. 450 million Euros, the average costs per patient and year and per treatment center range between 40,903 and 117,597 Euros. The costs for an immune tolerance therapy (ITT) for patients with inhibitors are estimated to be between 70,300 and 3,800,000 Euros for children, depending on the length of the therapy and the degree of severity. In the second part of the article, the authors outline the status quo of the economic evaluation of cellular blood products and present the results of a German cross-sectional survey on the use of erythrocytes in orthopaedic surgery. Within the scope of this hemotherapy study, the transfusion rates vary considerably within the participating treatment centers [elective hip joint replacement (THR): 17 and 94%]. The average blood loss also differs significantly. Comparing the treatment centers, the calculated blood loss during THR shows considerable differences (median blood loss in treatment center with lowest/treatment center with highest blood loss: 883 ml/2,975 ml). The acceptance of low intraoperative hemoglobin values in the clinics is high and diverse. These differences in transfusion procedures between the treatment centers clearly show the need to take effective action in the area of quality assurance in order to make the most of the existent savings potential. Transparency of treatment processes is a necessary condition for an economic assessment and for optimal resource allocation.

[The new Blood Law and new principles of transfusion therapy].

The new Blood Law for Self-sufficiency, Stable Supply of Safe Blood Products and Other Transfusion-related Rules was enacted in July 2003. In terms of the safety of blood products, improvement of screening tests and the introduction of the viral nucleic acid amplification test to shorten the so-called window period have markedly reduced the incidence of blood-borne virus transmission, although they cannot completely protect against transfusion-associated adverse reactions. Even with increasing blood safety, there remains an iatrogenic risk of ABO-mismatched transfusions without proper management systems and standard operation procedures. Fresh frozen plasma and plasma derivatives have been and continue to be used much more in Japan compared with the international standard. As a result, the shortage of domestic blood products remains an obstacle to achieving self-sufficiency. The goal of the new law is to provide safe transfusion therapy and achieve self-sufficiency in all blood products including plasma derivatives such as albumin solutions. To reach this goal medical professionals should recognize the necessity for safe and appropriate transfusions and establish new principles for improved transfusion therapy, including standard indications, safe operation procedure guidelines, and a 24-hour management system in each hospital.

[Characteristics of the provision of hemotransfusion materials to the wounded and patients during antiterrorist operation]. / Osobennosti obespecheniia gemotransfuzionnymi sredstvami ranenykh i bol'nykh v usloviiakh antiterroristicheskoi operatsii.

The authors analyze the experience of organization of the wounded and patient provision with hemotransfusion materials to render assistance during antiterrorist operation in Republic of Dagestan and Republic of Chechnya in 1999-2001. It is shown that supply of military treatment-and-prophylactic institutions deployed in the zone of military conflict, of specialized hospitals with hemotransfusion materials was the following: with blood preparations (at the expense of centralized deliveries), with blood components (91.8%, at the expense of centralized deliveries form the district blood transfusion station). The volume of stored blood taken from emergency reserve donors in the military treatment-and-prophylactic institutions located near the zone of military actions constituted 8.2% of the total volume of blood components received.

[Infective morbidity of replacement therapy in congenital coagulation deficiencies and its effects on demand of coagulation factors]. / La morbilidad infecciosa del tratamiento sustitutivo en los déficit congénitos de coagulación y su repercusión en la demanda de los factores de coagulación.

BACKGROUND: Analysis of the infective morbidity and mortality secondary to replacement hemotherapy in the population with congenital coagulation deficiencies (CCD) and their consequences on the demand for coagulation factors. METHODS: The 46 patients with CCD diagnosed in the autonomous community (AC) of the Balearic Islands (32 with hemophilia A, 6 with hemophilia B, 4 with von Willebrand's disease 2 with factor VII, 1 with factor X, and 1 with factor XII deficiencies) were investigated for infective morbidity and use of blood products from 1982 to 1987. RESULTS: 97% of the patients had some hepatitis marker, 77% had antibodies against human immunodeficiency virus (HIV) and 17% fulfilled the criteria for the acquired immunodeficiency syndrome (AIDS). There were 7 deaths (15%). The morbidity and mortality increased with age and use of blood products. There was a 46% reduction in factor VIII use between 1982 and 1986, from a mean yearly consumption per hemophiliac patient of 33444 international units (IU) to 18080 IU. CONCLUSIONS: The study results show a high prevalence of hepatitis and HIV, an important reduction in the demand of manufactured coagulation factors and a 15% reduction in the population with CCD during the study years.

[Blood saving--what do we use instead? Fluid substitution during surgery of abdominal aortic aneurysm]. / Blodsparing--hva bruker vi i stedet? Vaeskesubstitusjon ved operasjon for abdominalt aortaaneurisme.

The use of blood components in major surgery has been reduced significantly. Full agreement exists that patients should be held normovolemic. However, the selection of blood substitutes is controversial. In the present study we analysed infusion and transfusion policy in seven major Norwegian hospitals during and following aortic surgery. The number of patients who underwent surgery for abdominal aortic aneurysm increased significantly from 1983 to 1988. The proportion of emergency operations remained unaltered. We found a significant reduction in the use of blood components. The amount of clear solutions remained unchanged. Two hospitals had chosen polygeline as the main blood substitute, six hospitals preferred dextran 70 as a combined volume substitute and prophylaxis against thrombosis. Two hospitals used albumin 4% as recommended by the blood banks, and four used autotransfusion. Both mortality and morbidity decreased during the five-year period.

[Recent circumstances in the supply and demand of various blood products in Japan, and appropriate use of blood components or plasma protein derivatives].

In Japan, as in the United States and several other advanced countries, the use of fresh frozen plasma (FFP) and albumin has increased dramatically over the past 10 years. Especially in Japan the increase has been at least tenfold, and half of this usage has been for surgery. Most reviews of albumin usage acknowledge that there is a high ratio of wastage, or use in clinical circumstances without a firm scientific basis. Recently Japan has imported an enormous volume of various plasma fraction products such as albumin, Factor VIII etc., or plasma as raw material from foreign countries, especially the United States. As a result, Japan has come to monopolized a quarter of the albumin manufactured in the world, and has therefore received much internal and external criticism from or ethical standpoint. As countermeasures against shortage of these blood products, it will be necessary for doctors to use these blood products more sparingly and to increase the yield of volunteer donor's blood, especially plasma. More red blood cell concentrate should be utilized for hemorrhage in routine surgical operations. Because whole blood transfusion is rarely used except in cases of massive bleeding that cannot be stopped immediately, exchange transfusion has been performed in the United States and European countries recently. Transfusion of FFP is appropriately used only for replacement of coagulation factor deficiencies, massive transfusion etc. in the United States. It should be particularly noted that these carry the risk of transmission of diseases such as hepatitis and possibly AIDS. Albumin is an effective oncotic agent in the treatment of acute shock and in the maintenance of intravascular volume and cardiac output. However, albumin and FFP have no demonstrable effect in the general supportive management of chronic hypoproteinemia and undernutrition.