[French training program for medical students in transfusion medicine. Transfusion Medicine Teachers' College]. / Programme en transfusion des étudiants en médecine. Collège des enseignants en transfusion sanguine.

In France, transfusion medicine training program has been updated. A national committee of professors in transfusion medicine propose a series of 13 items which represent the minimum knowledge that general practitioners should possess. This overview of transfusion medicine is far below the level that specialists should reach and they will need an additional specialized training. Several French universities have set up their own training program which is quite similar to the work of the committee of professors. The following recommendations are not strict guidelines but is a common basis which will be improved in 2005 according to new evidence based transfusion medicine.

[Transfusion-related lung injury edema]. / Oedème pulmonaire lésionnel post-transfusionnel.

INTRODUCTION: Transfusion-related acute lung injury (TRALI) is a relatively rare but potentially severe complication of blood transfusion that should be diagnosed. EXEGESIS: The origin of this complication is most often an immunological leucocyte conflict due to transfused plasma HLA antibodies. Prevention (anti-HLA antibody screening in blood donors and elimination of blood products from immunized donors) is discussed. CONCLUSION: Transfusion-related acute lung injury should be suspected in transfusion-related respiratory distress, after elimination of potential pulmonary edema due to overloading. An immunologic cause should always be searched for. Leukodepletion of blood products and harmonization in blood donor selection should prevent this rare complication.

[Labile blood products from donors immunized against the HLA system. Apropos of a case of transfusional pulmonary edema]. / Produits sanguins labiles provenant de donneurs immunisés dans le système HLA. A propos d'un cas d'oedème pulmonaire lésionnel.

A case of transfusion-related acute lung injury (TRALI) due to HLA antibodies present in one unit of packed red blood cells led us to discuss the screening of HLA antibodies for female donors having been pregnant, and the use of labile blood products.

[Evaluation of transfusion practice. Surveys for evaluating the practice of nursing care in transfusion medicine in four hospital sites]. / Evaluation de la pratique transfusionnelle. Enquêtes d'évalution de la pratique des soins infirmiers en médecine transfusionnelle dans quatre sites hospitaliers.

In four medical centers, transfusion medicine care practices were evaluated by testing the nursing staff with a list of questions. The anonymous test evaluated the knowledge and transfusion practices, and in one of them the bed-side compatibility control procedure in particular. These tests showed failures in the labeling of tubes during phlebotomy for immuno-hematologic testing, in blood product conservation in the ward, and in bed-side compatibility testing which is not always carried out fully at the bed-side. These results, showed on which topics the teaching program should emphasize so as to improve the quality of blood transfusion in the medical centers according to legal obligations.

[Programmed autologous transfusion in obstetrics. Blood samples in 100 patients in the last month of pregnancy]. / Transfusion autologue programmée en Obstétrique. 100 patientes prélevées dans le dernier mois de la grossesse.

OBJECTIVES: Evaluation (usefulness and safety) of programmed autologous transfusion in obstetrics. SITE. Blood Transfusion Centre, Hôpital Louis-Mourier, F 92700 Colombes. PATIENTS: Prospective study of 150 patients for whom blood withdrawal was planned during the last month of pregnancy. Entry criteria were either a risk of haemorrhage or persistent patient request. PROTOCOL: Two withdrawals were planned during the last month of pregnancy at the out-patient clinic at a one-week interval. The autologous units were transfused per-partum in case of haemorrhage and/or post-partum in case of anaemia. RESULTS: One hundred pregnant women entered the protocol (43 had a risk of haemorrhage). Both preplanned withdrawals were made in 60 of these patients. Per-partum transfusions were necessary in only 7 patients including 4/43 with a risk factor (9%) and 3/57 with no risk factor (5%). Post-partum transfusions were made in 22 other patients. Consequently, 117 of the 160 units collected were not used (73%). CONCLUSION: Despite good tolerance (5% incidence) due to the known problems in evaluating the risk of haemorrhage and the small percentage of patients without risk factors who were transfused per-partum, we have decided to reserve this protocol for patients with an authentically identified risk of haemorrhage (placenta praevia, cesarean section, uterine scar tissue).

[Massive fetomaternal hemorrhage and prevention of fetomaternal Rhesus incompatibility. The failure of our present system of prevention]. / Hémorragie foeto-maternelle massive et prévention de l'incompatibilité Rhésus foeto-maternelle. Une faille de l'organisation actuelle de la prévention.

We had a case where risk of rhesus D feto-maternal immunisation occurred following failure to diagnose feto-maternal haemorrhage (HFM); and it was shown up by rhesus negative mother with a rhesus positive fetus being diagnosed as having has a massive HFM only three days after delivery. Giving the mother the standard dose of Anti-D immunoglobulin without a previous test to find out how serious the HFM was showed that we do not test for this normally. So it seems to us necessary when considering prophylaxis of rhesus D immunisation to go back to first principles and carry out Kleihauer's test particularly when neonatal anaemia is found in the child.

[Programmed autologous transfusion in coronary surgery: experience with 106 patients]. / Transfusion autologue programmée en chirurgie coronarienne: expérience sur 106 patients.

Patients undergoing elective coronary bypass surgery can benefit from Preoperative Autologous Blood Donation (PAB), despite some opinions to the contrary, as a complement of intra-operative blood salvage techniques. We report herein 106 patients eligible for coronary bypass surgery included in our PAB program. We observed a very good tolerance owing to strict exclusion criteria, a close monitoring of vital signs, and as far as we are concerned, to the infusion of a macromolecular solution (Plasmion) in a 1:1 ratio, to maintain intra-vascular volume. We chose a volume replacement because the physiological adaptation to hypovolemia is altered by the beta-blocking and/or vasodilating agents which cannot be discontinued in patients with coronary heart disease. The changes in the hematological parameters are not different from those observed in other patients eligible for PAB. The postoperative hemoglobin level is satisfactory and compatible with a normal myocardial function inasmuch as the cardiopathy has been corrected. The efficiency of PAB is good since overall, 74% of the patients did not require homologous blood, this proportion rises to 84% for patients donating 3 or more units. Preoperative Autologous Blood Donation for patients with coronary heart disease implies a perfect coordination between the Blood Bank physicians and their colleagues from the Cardiology Department. Aside from its well known advantages, PAB allows a stimulation of erythropoiesis, a progressive normovolemic hemodilution perhaps beneficial to patients with coronary heart disease, and finally, a better psychological preparation to surgery.

[Tolerance and efficacy of delayed autologous transfusion in cardiovascular surgery]. / Tolérance et efficacité de la transfusion autologue différée en chirurgie cardiovasculaire.

Over a period of 18 months, 313 patients (mean age 52 years) undergoing elective cardiovascular surgery were included in the autologous transfusion program involving two different Transfusion Centres. A further 10 patients were excluded because of anaemia (haemoglobin levels less than 11 g.dl-1) (n = 3), angina pectoris less than 8 days before (n = 3), patient refusal (n = 2), pneumonia (n = 1), and severe aortic insufficiency (n = 1). A maximum of 5 ml.kg-1 of blood was obtained during the 3 to 4 weeks prior to surgery, one donation being taken a week. In one Transfusion Centre, the blood was taken without tourniquet, and without any fluid replacement. Diuretics and converting enzyme inhibitors were stopped. In the opposite, in the other Centre, blood was taken using a tourniquet, and replaced by a gelatin solution (Plasmion). All the patients were given iron. The blood units were kept by the Transfusion Centres under the same conditions as homologous blood, but in a separate circuit. The 313 patients predeposited a mean of 2.71 units of blood: 4 units where obtained in 59 patients, 3 in 113, 2 in 133 and only 1 in 8. Mean haemoglobin level on starting the program was 14.49 g.dl-1. Neither homologous red cells nor plasma was administered in 176 patients (56.23%); among the 172 patients who predeposited 3 or 4 units, 123 (71.5%) were given their own blood only. Intraoperative blood salvage was used in 189 out of 313 patients (60.4%), and intraoperative haemodilution with albumin was used in 173 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Human anti-cytomegalovirus (CMV) immunoglobulins secreted by EBV-transformed B-lymphocytes cell lines.

The in vitro production of human immunoglobulins against cytomegalovirus may have clinical potentials. The attempts to produce human monoclonal antibodies by somatic cell hybridization have been unsuccessful so far. Another approach is to establish B-lymphoblastoid cell lines secreting specific antibodies. Usually such cell lines have been initiated after enrichment of antibody producing B-cells before immortalization by Epstein-Barr virus. We investigated the possibility of establishing lines secreting antibodies neutralizing human cytomegalovirus infectivity by selecting leucocyte donors who have undergone clinical disease which resulted in natural enrichment of antibody producing cells. Two cell lines were established from a patient with a severe post-transfusional CMV syndrome and one cell line from a patient who has continuously shed CMV since renal transplantation 10 years ago. The characterization of the specific immunoglobulin production of these lines will be presented.