Management of the blood supply for a Jk(a-b-) patient with an anti-Jk3 in preparation for an urgent heart transplant: An illustrative example of a successful international cooperation.

The Kidd blood group system currently comprises two polymorphic and antithetical antigens, Jka and Jkb, and one high-prevalence antigen, Jk3. Jknull individuals do not express any of the Kidd antigens, and are at risk of developing an anti-Jk3 which is known to be dangerous and responsible for acute or delayed hemolytic transfusion reaction. We report a case of an immunized Jknull patient, who was scheduled to undergo a heart transplant. In order to organize his blood provision management, two conference calls were held between the clinical team and the different staff involved in this challenging blood supply. In light of the blood needs, the available resources, and the constraints, a mix of fresh and frozen units were used. As the supply from France was not sufficient, Finland and New Zealand provided the majority of the fresh units. We report here how this international supply chain was organized, including the difficulties that we encountered. Anticipation, communication and flexibility were essential in making this heart transplant possible without needing to transfuse incompatible units.

[Pediatric preparations of blood products]. / Les préparations pédiatriques de produits sanguins.

The transfusion in pediatrics may require specific preparations to adapt to the various characteristics from preterm neonates to big child: weight, immaturity, immune system, blood volume, long and short-term prognosis, and to meet the needs of pathologies related to the perinatal period. The knowledge of the process for preparation, conservation and administration of these particular products shall permit a transfusion in safe conditions by supporting the prescribers in a personalized blood management.

[Transfusion and sickle cell disease]. / La transfusion du drépanocytaire.

Sickle cell disease is a hereditary pathology of the haemoglobin which affects only individuals from African ancestry. The frequency of the disease increases in France. Transfusion remains a major treatment of this disease. Depending of the indication, transfusion can be a simple transfusion or an exchange transfusion. In this last case, exchange can be performed manually or automatically. The transfusion protocols have to be adapted to the polytransfused status of these patients, but also to the high incidence of alloimmunisation against red blood cells. Alloimmunisation is a consequence of the polymorphism of blood groups between sickle cell disease patients and donors of European ancestry. Axes to optimize transfusion safety in these patients have to be developed. But the first step relies on the promotion of blood donation within individuals of African ancestry.

Aprotinin, transfusions, and kidney injury in neonates and infants undergoing cardiac surgery.

BACKGROUND: A significantly increased risk of acute kidney injury (AKI) with the prophylactic use of aprotinin has been reported in adults undergoing cardiac surgery, but not in children. Blood product transfusions have also been shown to carry an independent risk of AKI. The present study assessed associations between AKI, aprotinin, and transfusions in neonates and infants undergoing cardiac surgery. METHODS: All neonates and infants undergoing surgery with cardiopulmonary bypass over a 42 month period, before and after the withdrawal of aprotinin, were included retrospectively. AKI was assessed by the Acute-Kidney-Injury-Network classifications. A propensity score was used to balance treated and untreated groups. RESULTS: Three hundred and ninety patients received aprotinin and 568 patients did not. Inverse probability of treatment weighting resulted in good balance between groups for baseline and surgical characteristics. Controls underwent surgery with smaller bypass circuits and fewer transfusions. After adjustment for the use of miniaturized circuits and for the year of surgery, no significant association between the incidence of AKI, dialysis, and aprotinin was noted. Red blood cell transfusions were associated with an increased risk of AKI and dialysis: odds ratios (ORs) 1.64 (1.12-2.41) and 2.07 (1.13-3.73), respectively; as were fresh frozen plasma transfusions, ORs 2.28 (1.68-3.09) and 3.11 (1.95-4.97), respectively. Platelet transfusions were associated with an increased risk of dialysis: OR 2.20 (1.21-4.01). CONCLUSIONS: Blood product transfusions, but not the prophylactic use of aprotinin, are significantly associated with AKI after cardiac surgery in neonates and infants.

[Evolution of indications and consumptions of fresh frozen plasma from 1997 to 2003 in a teaching Hospital]. / Evolution des indications et de la consommation du plasma frais congelé de 1997 à 2003 dans un hôpital universitaire.

OBJECTIVE: Study the evolution for 7 years of the distribution of fresh frozen plasma consumptions (FFP) according to the therapeutic indications. MATERIALS AND METHODS: Introduction in the software of the blood bank of a specific character during the distribution of all the homologous FFP allowing a selective sort of the consumptions of FFP according to their therapeutic indications. These "qualifying terms" are defined in function, not only of the French legal references (issued on 3 December 1991),--consumption coagulopathy--global or specific deficit in coagulation factor, but also according to the specificities of our health care institution (liver transplant--thrombotic microangiopathies--open heart surgery). RESULTS: During 7 years, the consumption of FFP trebled in our institution. The indications of the FFP are now mainly medical, its use in surgery dramatically decreased. The complications are not very frequent, most of them are slight allergic reactions. CONCLUSION: New therapies, molecules coming from the research, recombinant proteins or coming from the plasma fractionation will certainly modify the indications of the fresh plasma frozen in the coming years. The supervision of our practices remains essential.

[Current data on granulocytes donations]. / Données actuelles sur les prélèvements de granulocytes.

Granulocyte transfusion is uncommon but essential for some aplastic patients with major infection and those with septic granulomatosis disease and visceral aspergillosis. Compatibility between donor and recipient (ABO, D, Kell blood type, cytomegalovirus) is necessary. Stimulation by dexamethasone, before use of GCSF, permits to obtain approximately 10 x 10(9) white cells per l. Doses of heparin must be calculated to ensure an efficient hypocoagulation without any trouble for the donor immediately after his donation. Sedimentation by hydroxyethylstarch is an unavoidable element to obtain the most efficient separation of granulocytes. Most donations present an amount of white cells between 2 and 4 10 x 10(10). This enables to transfuse efficiently children and adults.

[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.