Risk Associated With Autologous Fresh Whole Blood Training.

Fresh whole blood (FWB) is increasingly being recognized as the ideal resuscitative fluid for hemorrhagic shock. Because of this, military units are working to establish the capability to give FWB from a walking blood bank donor in environments that are unsupported by conventional blood bank services. Therefore, many military units are performing autologous blood transfusion training. In this training, a volunteer has a unit of blood collected and then transfused back into the same donor. The authors report their experience performing an estimated 3408 autologous transfusions in training and report no instances of hemolytic transfusion reactions or other major complications. With appropriate control measures in place, autologous FWB training is low-risk training.

Maternal health in Gujarat, India: a case study.

Gujarat state of India has come a long way in improving the health indicators since independence, but progress in reducing maternal mortality has been slow and largely unmeasured or documented. This case study identified several challenges for reducing the maternal mortality ratio, including lack of the managerial capacity, shortage of skilled human resources, non-availability of blood in rural areas, and infrastructural and supply bottlenecks. The Gujarat Government has taken several initiatives to improve maternal health services, such as partnership with private obstetricians to provide delivery care to poor women, a relatively-short training of medical officers and nurses to provide emergency obstetric care (EmOC), and an improved emergency transport system. However, several challenges still remain. Recommendations are made for expanding the management capacity for maternal health, operationalization of health facilities, and ensuring EmOC on 24/7 (24 hours a day, seven days a week) basis by posting nurse-midwives and trained medical officers for skilled care, ensuring availability of blood, and improving the registration and auditing of all maternal deaths. However, all these interventions can only take place if there are substantially-increased political will and social awareness.

The ethics of blood management.

Blood transfusion practices have evolved empirically, with few or no research data supporting them. In the past several decades, fuelled by fears of infection and reports of mistakes, patients have increasingly demanded their rights to choice, both in the components given to them as well as to refuse to receive these therapies based on religious convictions. In parallel, episodic blood unavailability and growing awareness of the need to apply evidence-based methods have caused physicians to begin re-evaluating traditional practices and to focus on minimizing or eliminating unnecessary transfusions while learning and applying methods that permit reuse of the patient's autologous blood or rely on pharmacologic agents. Ethical principles of autonomy, beneficence, non-maleficence and justice provide a rational basis for decision-making when a new blood management programme is instituted. By proactively considering the ethical dilemmas posed by the juxtaposition of patient needs with clinical judgement at the outset, institutions may devise workable programmes that improve patient safety and quality outcomes.

Crossing over of autologous and directed donor blood.

There is a considerable interest in the possibility of crossing over autologous and directed donor blood to other patients. The practicality and safety of this approach depends on the possibility of disease transmission in these groups versus those of the usual homologous donors. A review of the current literature as to the incidence of infectious disease markers shows that the total number of donors studied is rather small, and the results are not too clear. Some studies maintain crossing over is strictly unacceptable; others feel it is safe. The safest approach at this time is to repeat the studies in one's own laboratory and derive the risks and statistics in the local population.

I Congreso iberoamericano de bancos de sangre y medicina transfusional. Memoria / I Iberoamerican congress of banks of blood and transfussional medicine. Memory

La presente memoria del "I Congreso Iberoamericano de Bancos de Sangre y Medicina Transfusional" es el resultado del esfuezo que realiza la Secretaría de Salud, a través del Centro Nacional de la Transfusión Sanguínea y de los Centros Estatales de la Transfusión Sanguínea, en la revisión, actualización y difusión de las acciones desarrolladas y de los conocimientos obtenidos en la captación, manejo y uso de la sangre. Esta memoria condensa, por un lado, los principales logros alcanzados por los Centros Nacional y Estatales de la Transfusión Sanguínea durante 1990 en lo tocante a captación y análisis y transfusión de sangre, y, por otro, recopila varios trabajos de investigación, relativos a la sangre y la transfusión sanguínea, agrupados bajo los siguientes temas: enfermedades infecciosas transmisibles por vía sanguínea, medicina transfusional, inmuno hematología, feresis, autotransfusión, estudios en donadores, factor VIII-hemofilia, anemias por deficiencia de hierro y enfermedad de chagas

Blood availability for the trauma patient-autotransfusion.

Recovery of intrathoracic and intraperitoneal blood and reinfusion by autotransfusion has been demonstrated to be safe and practical in selected trauma patients. Autotransfusion is ideally applicable to the trauma patient in whom replacement of six or fewer units of blood is required. In addition, autotransfusion provides readily available blood for patients with unusual blood types and for those in whom multiple transfusions may rapidly deplete available stores. The properties of an ideal autotransfusion device include rapid assembly, relatively low cost, ease of operation, in-line filtration, minimized air blood interface, simplified anticoagulation, and safety from air embolism and coagulopathies.