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1.
Vox Sang ; 116(2): 167-174, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32996604

RESUMO

Whole blood is the original blood preparation but disappeared from the blood bank inventories in the 1980s following the advent of component therapy. In the early 2000s, both military and civilian practice called for changes in the transfusion support for massive haemorrhage. The 'clear fluid' policy was abandoned and replaced by early balanced transfusion of platelets, plasma and red cells. Whole blood is an attractive alternative to multi-component therapy, which offers reduced hemodilution, lower donor exposure and simplified logistics. However, the potential for wider re-introduction of whole blood requires re-evaluation of haemolysins, storage conditions and shelf-life, the need for leucocyte depletion/ pathogen reduction and inventory management for blood providers. This review addresses these questions and calls for research to define the optimal whole blood product and the indications for its use.


Assuntos
Transfusão de Sangue , Humanos
2.
J Spec Oper Med ; 20(3): 97-102, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32969011

RESUMO

Based on limited published evidence, physiological principles, clinical experience, and expertise, the author group has developed a consensus statement on the potential for iatrogenic harm with rapid sequence induction (RSI) intubation and positive-pressure ventilation (PPV) on patients in hemorrhagic shock. "In hemorrhagic shock, or any low flow (central hypovolemic) state, it should be noted that RSI and PPV are likely to cause iatrogenic harm by decreasing cardiac output." The use of RSI and PPV leads to an increased burden of shock due to a decreased cardiac output (CO)2 which is one of the primary determinants of oxygen delivery (DO2). The diminishing DO2 creates a state of systemic hypoxia, the severity of which will determine the magnitude of the shock (shock dose) and a growing deficit of oxygen, referred to as oxygen debt. Rapid accumulation of critical levels of oxygen debt results in coagulopathy and organ dysfunction and failure. Spontaneous respiration induced negative intrathoracic pressure (ITP) provides the pressure differential driving venous return. PPV subsequently increases ITP and thus right atrial pressure. The loss in pressure differential directly decreases CO and DO2 with a resultant increase in systemic hypoxia. If RSI and PPV are deemed necessary, prior or parallel resuscitation with blood products is required to mitigate post intervention reduction of DO2 and the potential for inducing cardiac arrest in the critically shocked patient.


Assuntos
Choque Hemorrágico , Humanos , Consumo de Oxigênio , Respiração com Pressão Positiva/efeitos adversos , Indução e Intubação de Sequência Rápida , Ressuscitação , Choque Hemorrágico/etiologia , Choque Hemorrágico/terapia
3.
Transfusion ; 60(12): 2793-2800, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32918285

RESUMO

Civilian and military guidelines recommend balanced transfusion to patients with life-threatening bleeding. Early start of transfusion has shown improved survival. Thus, a balanced blood inventory must be available in all levels of health care to ensure early stabilization and damage control resuscitation of patients with bleeding. Whole blood has been reintroduced as a blood product for massive bleeding situations because it affords plasma, red blood cells, and platelets in a balanced ratio in a logistically advantageous way. In this article, we describe how to establish a whole blood-based blood preparedness program in a small rural hospital with limited resources. We present an implementation tool kit, which includes discussions on whole blood program strategies and the process of developing detailed procedures on donor selection, collection, storage, and transfusion management of whole blood. The importance of training and audit of the routines is highlighted, and establishment of an emergency walking blood bank is discussed. We conclude that implementation of a whole blood program is achievable in small rural hospitals and recommend that rural health care facilities at all treatment levels enable early balanced transfusion for patients with life-threatening bleeding by establishing protocols for whole blood-based preparedness.


Assuntos
Bancos de Sangue , Transfusão de Componentes Sanguíneos , Seleção do Doador , Hemorragia/terapia , Hospitais Rurais , Ressuscitação , Hemorragia/sangue , Humanos
4.
Lancet Haematol ; 7(10): e756-e764, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32628911

RESUMO

The COVID-19 pandemic has major implications for blood transfusion. There are uncertain patterns of demand, and transfusion institutions need to plan for reductions in donations and loss of crucial staff because of sickness and public health restrictions. We systematically searched for relevant studies addressing the transfusion chain-from donor, through collection and processing, to patients-to provide a synthesis of the published literature and guidance during times of potential or actual shortage. A reduction in donor numbers has largely been matched by reductions in demand for transfusion. Contingency planning includes prioritisation policies for patients in the event of predicted shortage. A range of strategies maintain ongoing equitable access to blood for transfusion during the pandemic, in addition to providing new therapies such as convalescent plasma. Sharing experience and developing expert consensus on the basis of evolving publications will help transfusion services and hospitals in countries at different stages in the pandemic.


Assuntos
Betacoronavirus , Bancos de Sangue/estatística & dados numéricos , Doadores de Sangue/provisão & distribuição , Transfusão de Sangue , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Anticorpos Antivirais/uso terapêutico , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , Preservação de Sangue , Segurança do Sangue , Transfusão de Sangue/estatística & dados numéricos , COVID-19 , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Seleção do Doador , Procedimentos Cirúrgicos Eletivos , Alocação de Recursos para a Atenção à Saúde , Política de Saúde , Necessidades e Demandas de Serviços de Saúde , Hemoglobinopatias/complicações , Hemoglobinopatias/terapia , Humanos , Imunização Passiva , Pandemias/prevenção & controle , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2
5.
Vox Sang ; 115(8): 703-711, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32281137

RESUMO

BACKGROUND: This multi-national study evaluated changes in platelet (PLT) unit distributions at 12 national or regional blood collectors over a 10-year period. METHODS: Data on the total number of PLT distributions, the collection method, that is apheresis vs whole blood-derived (WBD), the PLT unit characteristics and post-collection modifications were obtained from 12 national or regional blood collectors from 2008 through 2017. Individual WBD PLT units were converted to apheresis equivalent units (i.e. a dose of PLTs) by dividing by 4, the typical pool size; WBD units that were pooled before distribution were counted as a single dose. RESULTS: Overall at these 12 blood collectors, the total number of PLTs distributed in 2008 was 1 373 200, which rose by 10·2% to 1 513 803 in 2017. The Japanese Red Cross, which distributes only apheresis PLTs, had a 13·4% increase in the number of distributions between the years 2008 and 2017, while the other 11 blood collectors combined demonstrated a 6·8% increase in distributions between these two years. Between the years 2008 and 2017, the changes in the proportion of apheresis, platelet-rich plasma and buffy coat PLT distributions were -29·9%, -70·7% and 80·0%, respectively. CONCLUSION: The number of PLT distributions increased during the 10-year study period despite prophylactic PLT transfusion thresholds having remained fairly consistent over the last decade. Perhaps this increase is in part driven by increased administration of platelets to patients with massive haemorrhage or an increase in stem cell transplantation. The use of buffy coat PLTs is increasing at these collectors.


Assuntos
Remoção de Componentes Sanguíneos/estatística & dados numéricos , Plaquetas , Remoção de Componentes Sanguíneos/tendências , Doadores de Sangue , Humanos , Inquéritos e Questionários
6.
Transfusion ; 60(5): 1042-1049, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32187700

RESUMO

BACKGROUND: Some jurisdictions require leukoreduction of cellular blood components. The only whole blood collection set with a platelet-saving filter uses citrate-phosphate-dextrose (CPD) as storage solution. Substituting CPD with citrate-phosphate-dextrose-adenine (CPDA-1) increases shelf life from 21 to 35 days. This would simplify prehospital and rural resupply and reduce wastage. We investigated in vitro quality and hemostatic properties of CPDA-1 whole blood leukoreduced with a platelet-saving filter. STUDY DESIGN AND METHODS: CPDA-1 whole blood was leukoreduced using a platelet-saving filter and stored 35 days. EDQM requirements, hematology, metabolic parameters, thromboelastography, light transmission aggregometry, fibrinogen, factor VIII, and interleukin-6 were measured on Days 0, 1, 14, 21, and 35 and compared to non-leukoreduced blood. RESULTS: All units met EDQM requirements. Leukoreduction yielded residual white blood cell count <1 × 106 and 87% platelet recovery on Day 1. It caused reduction in thromboelastography parameters, but not aggregometry response. No hemolysis >0.8% was observed. Factor VIII was higher on Day 35 in the leukoreduced group, 37.9 (95% CI: 26.0, 49.8) versus 13.8 (9.4, 18.2) IU/dL. In both groups, aggregation was significantly reduced by Day 14. Thromboelastography showed remaining platelet activity on Day 35, MA 46.9 (42.1, 51.7) in the leukoreduced and 44.3 (39.6, 49.0) mm in the non-leukoreduced group. Fibrinogen was within reference ranges at Day 35 (>2 g/dL). Interleukin-6 was not detectable. CONCLUSION: Leukoreducing CPDA-1 whole blood with a platelet-saving filter did not compromise hemostatic properties. We encourage development of a single bag CPDA-1 whole blood collection set with in-line platelet-saving filter.


Assuntos
Adenina/química , Preservação de Sangue/métodos , Coleta de Amostras Sanguíneas/métodos , Citratos/química , Temperatura Baixa , Glucose/química , Procedimentos de Redução de Leucócitos/métodos , Fosfatos/química , Adenina/farmacologia , Sangue/efeitos dos fármacos , Plaquetas/citologia , Plaquetas/efeitos dos fármacos , Preservação de Sangue/normas , Coleta de Amostras Sanguíneas/normas , Citratos/farmacologia , Filtração/métodos , Glucose/farmacologia , Hemólise/efeitos dos fármacos , Hemostasia/efeitos dos fármacos , Humanos , Técnicas In Vitro , Procedimentos de Redução de Leucócitos/normas , Fosfatos/farmacologia , Agregação Plaquetária/efeitos dos fármacos , Contagem de Plaquetas , Controle de Qualidade , Refrigeração/métodos
7.
Blood Transfus ; 17(3): 181-190, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30747706

RESUMO

BACKGROUND: In thrombocytopenic patients better assessment of bleeding risk than that provided by platelet count alone is required. Multiplate® aggregometry and thromboelastography (TEG) could be used, but information on their role in such patients is limited. The primary aim of this study was to investigate the feasibility of Multiplate® analyses in patients with haematological malignancies. A secondary aim was to explore whether a multiple logistic regression model combining Multiplate®, TEG, clinical and laboratory variables was associated with risk of bleeding. MATERIALS AND METHODS: This was an exploratory, prospective observational study of thrombocytopenic patients with haematological malignancies. Total platelet count (TPC), white blood cell count, C-reactive protein (CRP) level, temperature and bleeding status were recorded daily. TEG and Multiplate® analyses with four agonists were performed on weekdays. RESULTS: Ten patients were enrolled into the study. The median number of days in a study period was 21. Bleeding was observed on 64 of 298 study days. TPC <20×109/L and <10×109/L occurred on 119 and 25 days, respectively. When TPC was <33×109/L, many samples showed no aggregation, regardless of bleeding status. Despite this, the odds of World Health Organization (WHO) grade 2 bleeding decreased significantly as aggregation increased and Multiplate® had a negative predictive value (NPV) of 96% and a positive predictive value (PPV) of 19% for significant bleeding. In the multiple logistic regression model collagen-activated Multiplate® aggregation, TEG angle, TEG reaction time and CRP significantly affected the odds of WHO grade 2 bleeding. The combined model had a NPV of 99% and a PPV of 19%. DISCUSSION: Our findings suggest that the markers of platelet function and haemostasis provided by Multiplate® aggregometry and TEG may add information to support prediction of bleeding, although platelet count still remains the most accessible analysis for routine testing.


Assuntos
Plaquetas/metabolismo , Neoplasias Hematológicas/sangue , Agregação Plaquetária , Tromboelastografia , Trombocitopenia/sangue , Adulto , Feminino , Hemorragia/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Testes de Função Plaquetária , Estudos Prospectivos
8.
J Trauma Acute Care Surg ; 84(6S Suppl 1): S93-S103, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29538232

RESUMO

BACKGROUND: Damage control resuscitation principles advocate the use of blood to treat traumatic hemorrhage. Hemorrhage is a leading cause of preventable death on the battlefield, but making blood components available far forward presents logistical challenges due to shelf life and storage requirements. Whole blood simplifies logistics and enables collection in the field but can cause leukocyte-related transfusion reactions. A field-adapted leukoreduction system must be fast and safe, and storage of whole blood should preserve hemostatic function. METHODS: Blood was collected using Imuflex WB-SP and leukoreduced at 0, 150, or 300 mm Hg. Additional bags were stored at 4°C for 21 days unagitated, mixed daily, agitated or head-over-heel rotated, at 22°C for 3 days, or 32°C for 2 hours. Hematology, coagulation, CD62P/CD42b, thromboelastography (TEG)/thromboelastometry (ROTEM), and Multiplate was performed. RESULTS: Filtration time was 35 ± 1, 14 ± 0, and 9 ± 0 minutes at 0, 150, and 300 mm Hg, respectively. One of 10 units at 150 mm Hg and 4 of 11 at 300 mm Hg had residual whole blood cells greater than 5.0 × 10 per unit. One of 11 at 300 mm Hg had platelet recovery of less than 80%. Hemolysis was less than 0.2%. Filtration decreased thromboelastography/thromboelastometry and Multiplate aggregation response. Stored at 4°C, α and MA/MCF moderately decreased regardless of mixing. Significant loss of aggregation response and increased CD62P expression was seen by Day 10. By Day 3, storage at 22°C caused loss of most aggregation. Two-hour storage at 32°C did not significantly affect hemostatic capacity. CONCLUSION: Forced filtration reduced leukoreduction time, but increased residual whole blood cells reduced hemostatic function. Aggregation response deteriorated early in storage, while viscoelastic assays decreased more gradually. Mixing showed no benefits. LEVEL OF EVIDENCE: Diagnostic study, level IV.


Assuntos
Coleta de Amostras Sanguíneas , Transfusão de Sangue/métodos , Hemostasia , Procedimentos de Redução de Leucócitos , Contagem de Células Sanguíneas , Preservação de Sangue/efeitos adversos , Preservação de Sangue/métodos , Coleta de Amostras Sanguíneas/efeitos adversos , Exsanguinação/terapia , Feminino , Flores , Hematócrito , Hemofiltração/métodos , Hemoglobinas/análise , Temperatura Alta/efeitos adversos , Humanos , Procedimentos de Redução de Leucócitos/métodos , Masculino , Medicina Militar/métodos , Agregação Plaquetária , Tromboelastografia
9.
Transfusion ; 57(10): 2329-2337, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28840943

RESUMO

BACKGROUND: Transfusion of group O blood to non-O recipients, or transfusion of D- blood to D+ recipients, can result in shortages of group O or D- blood, respectively. This study investigated RBC utilization patterns at hospitals around the world and explored the context and policies that guide ABO blood group and D type selection practices. STUDY DESIGN AND METHODS: This was a retrospective study on transfusion data from the 2013 calendar year. This study included a survey component that asked about hospital RBC selection and transfusion practices and a data collection component where participants submitted information on RBC unit disposition including blood group and D type of unit and recipient. Units administered to recipients of unknown ABO or D group were excluded. RESULTS: Thirty-eight hospitals in 11 countries responded to the survey, 30 of which provided specific RBC unit disposition data. Overall, 11.1% (21,235/191,397) of group O units were transfused to non-O recipients; 22.6% (8777/38,911) of group O D- RBC units were transfused to O D+ recipients, and 43.2% (16,800/38,911) of group O D- RBC units were transfused to recipients that were not group O D-. Disposition of units and hospital transfusion policy varied within and across hospitals of different sizes, with transfusion of group O D- units to non-group O D- patients ranging from 0% to 33%. CONCLUSION: A significant proportion of group O and D- RBC units were transfused to compatible, nonidentical recipients, although the frequency of this practice varied across sites.


Assuntos
Transfusão de Eritrócitos/estatística & dados numéricos , Eritrócitos/imunologia , Sistema ABO de Grupos Sanguíneos/imunologia , Incompatibilidade de Grupos Sanguíneos , Hospitais , Humanos , Estudos Retrospectivos , Sistema do Grupo Sanguíneo Rh-Hr/imunologia , Inquéritos e Questionários
10.
Lancet ; 388(10061): 2825-2836, 2016 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-27083327

RESUMO

Blood transfusion is one of the most common procedures in patients in hospital so it is imperative that clinicians are knowledgeable about appropriate blood product administration, as well as the signs, symptoms, and management of transfusion reactions. In this Review, we, an international panel, provide a synopsis of the pathophysiology, treatment, and management of each diagnostic category of transfusion reaction using evidence-based recommendations whenever available.


Assuntos
Transfusão de Sangue/métodos , Reação Transfusional/diagnóstico , Reação Transfusional/prevenção & controle , Reação Transfusional/terapia , Transfusão de Sangue/normas , Medicina Baseada em Evidências , Humanos , Reação Transfusional/fisiopatologia
11.
Transfusion ; 56(5): 1185-91, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26779698

RESUMO

BACKGROUND: Allergic transfusion reactions (ATRs) present with a broad range of symptoms probably caused by mediators released from mast cells and basophil granulocytes upon activation. Passive immunoglobulin (Ig)E sensitization may yield clinical symptoms and positive allergy tests. Unexpected findings of IgE antibodies in pooled solvent/detergent (S/D)-treated plasma (Octaplas, Octapharma) during routine analysis initiated an investigation of serum proteins. STUDY DESIGN AND METHODS: Consecutive batches of S/D-plasma transfused during September 2014 through March 2015 were investigated for IgE, IgG, IgA IgM, C3, C4, haptoglobin, anti-nuclear antibodies (ANAs), and red blood cell (RBC) antibodies. RESULTS: During the study period, 4203 S/D-plasma units were transfused. Nineteen (14 Octaplas A and five Octaplas AB) of 20 batches of S/D-plasma were included, representing 99.9% of total number of plasma units. A total of 0.4% of units and five batches reported ATRs. Concentrations of total IgE higher than expected values in adults (<120 kU/L) were observed in 18 of the 19 (95%) batches investigated (median concentration [quartiles], 161 [133-183]). Specific IgE antibodies (expected < 0.35 kilounits antigen [kUA]/L) against house dust mite (2.52 [1.01-5.09]), timothy (2.83 [2.48-3.24]), cat (1.13 [0.58-1.52]), dog (0.83 [0.50-1.05]), mugwort (0.69 [0.53-0.97]), birch (0.62 [0.28-0.92]), peanut (0.52 [0.29-075]), wheat (0.46 [0.33-0.69]), and latex (0.32 [0.21-0.53]) were also detected. IgG, IgA, IgM, C3, C4, and haptoglobin were within or below normal ranges. No RBC antibodies were observed, but 18% of batches showed low levels of ANA (anti-RNP). CONCLUSION: Specific IgE antibodies against airborne allergens, food allergens, and latex were detected in S/D-treated pooled plasma.


Assuntos
Alérgenos/imunologia , Anticorpos/análise , Imunoglobulina E/imunologia , Plasma/efeitos dos fármacos , Plasma/imunologia , Animais , Arachis/imunologia , Detergentes/farmacologia , Humanos , Imunoglobulina E/análise , Látex/imunologia , Estudos Prospectivos , Solventes/farmacologia , Triticum/imunologia
12.
J Trauma Acute Care Surg ; 78(6 Suppl 1): S31-8, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26002261

RESUMO

BACKGROUND: Formulation of a medical preparedness plan for treating severely bleeding casualties during naval deployment is a significant challenge because of territory covered during most missions. The aim of this study was to evaluate the concept of "walking blood bank" as a supportable plan for supplying safe blood and blood products. METHODS: In 2013, the Royal Norwegian Navy conducted antipiracy operations from a frigate, beginning in the Gulf of Aden and ending in the Indian Ocean. Crews were on 24-hour emergency alert in preparation for an enemy assault on the frigate. Under an approved command protocol, a "walking blood bank," using crew blood donations, was established for use on board and on missions conducted in rigid-hulled inflatable boats, during which freeze-dried plasma and leukoreduced, group O low anti-A/anti-B titer, cold-stored whole blood were stored in Golden Hour Boxes. Data demonstrating the ability to collect, store, and provide whole blood were collected to establish feasibility of implementing a whole blood-focused remote damage-control resuscitation program aboard a naval vessel. In addition, ROTEM data were collected to demonstrate feasibility of performing this analysis on a large naval vessel and to also measure hemostatic efficacy of cold-stored leukoreduced whole blood (CWB) stored during a period of 14 days. ROTEM data on CWB was compared with reconstituted whole blood. RESULTS: Drills simulating massive transfusion activation were conducted, in which 2 U of warm fresh whole blood with platelet sparing leukoreduction were produced in 40 minutes, followed by collection of two additional units at 15-minute increments. The ROTEM machine performed well during ship-rolling, as shown by the overlapping calculated and measured mechanical piston movements measured by the ROTEM device. Error messages were recorded in 4 (1.5%) of 267 tests. CWB yielded reproducible ROTEM results demonstrating preserved fibrinogen function and platelet function for at least 3.5 weeks and 2 weeks, respectively. The frequency of ROTEM tests were as follows: EXTEM (n = 88), INTEM (n = 85), FIBTEM (n = 82), and APTEM (n = 12). CWB results were grouped. Compared with Days 0 to 2, EXTEM maximum clot firmness was significantly reduced, beginning on Days 10 to 14; however, results through that date remained within reference ranges and were comparable with the EXTEM maximum clot firmness for the reconstituted whole blood samples containing Day 5 room temperature-stored platelets. CONCLUSION: A "walking blood bank" can provide a balanced transfusion product to support damage-control resuscitation/remote damage-control resuscitation aboard a frigate in the absence of conventional blood bank products. ROTEM analysis is feasible to monitor damage-control resuscitation and blood product quality. ROTEM analysis was possible in challenging operational conditions. LEVEL OF EVIDENCE: Therapeutic study, level V.


Assuntos
Bancos de Sangue , Preservação de Sangue , Medicina Militar , Choque Hemorrágico/terapia , Tromboelastografia , Coagulação Sanguínea/fisiologia , Estudos de Viabilidade , Humanos , Noruega
13.
Blood Transfus ; 12(1): 50-5, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24333065

RESUMO

BACKGROUND: In patients who have large bleeds, there is a tendency to transfuse more plasma and platelets than recommended in earlier guidelines, and accordingly many hospitals now provide "transfusion packages" with an intended red cell:platelet:plasma ratio of 1:1:1. The purpose of this study was to investigate in vitro functions of transfusion packs compared with fresh whole blood. MATERIAL AND METHODS: "Reconstituted whole blood" was prepared with the same ratio of red cells, platelets and plasma as used in local transfusion packages. The aggregation and thrombin-antithrombin complex formation responses to collagen stimulation of this reconstituted whole blood were compared with those of fresh whole blood. The storage time of red cells and platelets was varied in a systematic manner, giving nine different compositions of reconstituted whole blood that simulated transfusion packs. RESULTS: The responses varied significantly between whole blood and reconstituted whole blood -and between the reconstituted whole blood of different compositions. A significant decrease (p<0.005) in collagen-induced platelet count reduction was seen with increasing platelet and red blood cell age. Thrombin-antithrombin complex formation peaked in studies with platelets stored for 5 days. The red cells stored for the longest time induced the greatest thrombin-antithrombin complex formation. Fresh whole blood gives more consistent responses, and the aggregation response to collagen is stronger than in reconstituted whole blood. DISCUSSION: Our results indicate that in vitro responses of reconstituted whole blood vary substantially according to how long the red cells and platelets are stored for. As the responses obtained by testing whole blood are more consistent and usually stronger, the alternative use fresh whole blood in special conditions should not be excluded without further consideration.


Assuntos
Plaquetas/metabolismo , Preservação de Sangue , Colágeno/metabolismo , Eritrócitos/metabolismo , Agregação Plaquetária , Plaquetas/citologia , Eritrócitos/citologia , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Fatores de Tempo
14.
Eur Cytokine Netw ; 22(1): 52-62, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21388914

RESUMO

BACKGROUND: Platelet concentrates contain soluble mediators derived from both platelets and contaminating leukocytes. During platelet transfusion these mediators are transferred, and transfusion-induced modulation of the cytokine network may then occur, possibly contributing to transfusion reactions, immunomodulation, or affecting residual leukemic cells. In this prospective observational study, we investigate the effect of platelet transfusion on the systemic levels of platelet-derived cytokines, chemokines and interleukins in an unselected group of acute leukaemia patients with severe chemotherapy-induced cytopenia. STUDY DESIGN AND METHODS: We investigated 31 platelet transfusions involving pre-storage, white blood cell-reduced, gamma-irradiated or pathogen-inactivated, photochemically-treated platelet concentrates received by 10 unselected patients. Peripheral blood plasma samples were collected before, immediately after, one hour, and 24 hours after the transfusions. Sampling from platelet concentrates was performed immediately before transfusion. A total of 31 soluble mediators were examined. Ten healthy controls matched for age and gender were included. RESULTS: Despite heterogeneity in patients and platelet concentrates, significantly increased plasma concentrations were detected for the platelet-derived mediators, platelet-derived growth factor, ß-thromboglobulin, transforming growth factor-ß (TGF-ß), CCL5, and CXCL4, 1 hour and/or immediately after platelet transfusions. The plasma levels of vascular endothelial growth factor and soluble CD40 ligand were not altered by platelet transfusion. Certain interleukins (IL-1ß, IL-2, IL-4, IL-6, IL-9, and IL-12), as well as interferon-γ showed a minor, transient decrease in systemic plasma levels during the first hour following transfusion. CONCLUSION: Platelet transfusions modulate the systemic cytokine network in acute leukaemia patients with severe, chemotherapy-induced cytopenia.


Assuntos
Plaquetas/metabolismo , Quimiocinas/sangue , Interleucinas/sangue , Leucemia/sangue , Leucemia/tratamento farmacológico , Pancitopenia/etiologia , Transfusão de Plaquetas , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancitopenia/sangue , Transfusão de Plaquetas/efeitos adversos , Estudos Prospectivos , Adulto Jovem
15.
Blood Rev ; 25(3): 113-22, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21316823

RESUMO

Platelet transfusions are mainly used for patients with thrombocytopenia due to bone marrow failure, especially cancer patients developing severe chemotherapy-induced thrombocytopenia (e.g. patients with acute leukemia or other hematologic malignancies). A prophylactic transfusion strategy is now generally accepted in developed countries. Some clinical data, however, support the use of a therapeutic transfusion strategy at least for certain subsets of these patients. Several methodological approaches can then be used to evaluate the outcome of platelet transfusions, including peripheral blood platelet increments and bleeding assessments. Several factors will influence the efficiency of platelet transfusions; fever and ongoing hemorrhage are among the most important patient-dependent factors, but the number and quality of the transfused platelets are also important. The quality of transfused platelets can be evaluated by analyzing platelet activation, metabolism or senescence/apoptosis. Only evaluation of metabolism is included in international guidelines, but high-throughput methods for evaluation of activation and senescence/apoptosis are available and should be incorporated into routine clinical practice if future studies demonstrate that they reflect clinically relevant platelet characteristics. Finally, platelet transfusions have additional biological effects that may cause immunomodulation or altered angioregulation; at present it is not known whether these effects will influence the long-time prognosis of cancer patients. Thus, several questions with regard to the optimal use of platelet transfusions in cancer patients still need to be answered.


Assuntos
Transfusão de Plaquetas/métodos , Trombocitopenia/terapia , Humanos , Contagem de Plaquetas , Transfusão de Plaquetas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Trombocitopenia/sangue , Trombocitopenia/etiologia , Trombocitopenia/prevenção & controle
16.
Transfusion ; 50(4): 766-75, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20030789

RESUMO

BACKGROUND: Clinical effect of platelet (PLT) transfusion is monitored by measures of PLT viability (PLT recovery and survival) and functionality. In this study we evaluate and compare transfusion effect measures in patients with chemotherapy-induced thrombocytopenia due to treatment of acute leukemia. STUDY DESIGN AND METHODS: Forty transfusions (28 conventional gamma-irradiated and 12 pathogen-inactivated photochemical-treated PLT concentrates [PCs]) were investigated. PC quality was analyzed immediately before transfusion. Samples were collected from thrombocytopenic patients at 1 and 24 hours for PLT increments and thromboelastography (TEG) with assessments of bleeding score and intertransfusion interval (ITI). Data were analyzed by Spearman's correlation. Patient and PC variables influencing the effect of transfusion were analyzed by use of a mixed-effects model. RESULTS: PLT dose, storage time, and pathogen inactivation correlated with PLT recovery but not with PLT survival (including ITI), TEG, or clinical bleeding. Fever was negatively correlated with PLT survival but did not affect PLT recovery. After 1 and 24 hours, strong correlations were observed within measures of PLT viability and between PLT increment and the TEG value maximal amplitude (MA). Negative correlation was observed between late MA increment and clinical bleeding status after transfusion (r = -0.494, p = 0.008). PLT count increments did not correlate to clinical bleeding status. CONCLUSIONS: PLT dose and quality of PCs are important for optimal immediate transfusion response, whereas duration of transfusion effect is influenced mainly by patient variables. The TEG value MA correlates with PLT count increments and bleeding, thus reflecting both PLT viability and functionality.


Assuntos
Antineoplásicos/efeitos adversos , Leucemia Mieloide Aguda/tratamento farmacológico , Transfusão de Plaquetas/métodos , Trombocitopenia/induzido quimicamente , Trombocitopenia/terapia , Sistema ABO de Grupos Sanguíneos , Antineoplásicos/uso terapêutico , Plaquetas/citologia , Plaquetas/fisiologia , Superfície Corporal , Dióxido de Carbono/sangue , Sobrevivência Celular , Documentação , Feminino , Hemorragia/sangue , Hemorragia/induzido quimicamente , Hospitais Universitários , Humanos , Leucemia Mieloide Aguda/sangue , Masculino , Noruega , Oxigênio/sangue , Contagem de Plaquetas , Estudos Prospectivos
17.
Transfus Apher Sci ; 37(3): 261-8, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18036986

RESUMO

BACKGROUND: Differences in platelet counts are observed by use of automated haematology analyzers making interlaboratory comparison difficult. MATERIALS AND METHODS: Twenty-eight single-donor platelet concentrates (PCs) were collected. Platelet concentration and markers of platelet destruction were investigated during storage for 11/12 days. RESULTS: Increasing impedance-immunoplatelet ratio was observed during storage, correlating to platelet fragments, large platelets, platelet density and cell-lysis. High variability was observed for optical-immunoplatelet ratio. CONCLUSION: Immunoplatelet count or correction factor calculated by impedance-immunoplatelet ratio should be used to confirm that platelet unit meets platelet count requirements or to compare results from clinical trials. Optical platelet count is not recommended.


Assuntos
Plaquetas/citologia , Contagem de Plaquetas/métodos , Preservação Biológica , Impedância Elétrica , Humanos , Fatores de Tempo
18.
Transfusion ; 47(4): 653-65, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17381624

RESUMO

BACKGROUND: Photochemical treatment (PCT) prevents replication of pathogens in platelet concentrates (PCs) by cross-linking nucleic acids and thus affects all cells containing DNA or RNA. STUDY DESIGN AND METHODS: Fourteen double-dose single-donor PCs were divided into two study arms. The double-dose PCs were split in two identical units, PCT and conventional control PCs. Study Arm A consisted of seven PCT PCs with corresponding untreated controls, whereas Study Arm B consisted of seven PCT PCs with corresponding gamma-irradiated control. Metabolic changes and agonist-induced platelet (PLT) response were evaluated during storage for up to 12 days. RESULTS: Higher rate of PLT destruction, illustrated by reduced PLT content, increased lactate dehydrogenase levels, and higher CD61+ microparticle formation rate, were observed after PCT. Generally PCT accelerated metabolic changes in PCs and reduced agonist-induced (collagen or thrombin receptor activator peptide [TRAP]) aggregation responses. Flow cytometric analysis of CD62P and CD42b (GPIbalpha) expression showed higher spontaneous PLT activation in PCT PCs from 5 days of storage. Correspondingly, a reduced capacity for up regulation of CD62P expression and down regulation of CD42b was observed in PCT PLTs after stimulation by the agonists ADP or TRAP. CONCLUSION: Generally reduced in vitro PLT quality was observed after PCT during storage for up to 12 days, with marked reduction from 5 days of storage. Compared to conventional PCs, reduced agonist-induced aggregation and glycoprotein expression were observed after PCT during storage, corresponding to significantly higher level of spontaneous PLT activation in PCT PCs. Clinical studies of efficacy and safety of PCT PCs stored for more than 5 days are recommended.


Assuntos
Doadores de Sangue , Plaquetas/efeitos da radiação , Preservação de Sangue/métodos , Raios gama , Difosfato de Adenosina/metabolismo , Plaquetas/metabolismo , Preservação de Sangue/normas , Citocinas/metabolismo , Ativação Enzimática/efeitos da radiação , Citometria de Fluxo , Expressão Gênica/efeitos da radiação , Glicoproteínas/metabolismo , Humanos , Integrina beta3/metabolismo , L-Lactato Desidrogenase/metabolismo , Selectina-P/metabolismo , Fotoquímica/métodos , Ativação Plaquetária/efeitos da radiação , Agregação Plaquetária/efeitos da radiação , Plaquetoferese , Receptores de Trombina/metabolismo , Reprodutibilidade dos Testes , Fatores de Tempo
19.
Transfusion ; 46(5): 800-10, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16686848

RESUMO

BACKGROUND: Photochemical treatment (PCT) for pathogen reduction of platelet concentrates (PCs) affects all cells containing DNA and/or RNA. Soluble mediators, which may cause transfusion reactions, are determined by the balance between secretion and/or cell destruction and binding and/or degradation. STUDY DESIGN AND METHODS: Ten double-dose single-donor leukoreduced PCs were split in two identical units. Two study arms were created: Study Arm A consisting of five PCT PCs with corresponding untreated control PCs and Study Arm B consisting of five PCT PCs with corresponding gamma-irradiated control PCs. PCs that had added PAS-III (Intersol) were treated with amotosalen and ultraviolet A light. Corresponding controls PCs, to which PAS-II (T-sol) were added, received no treatment or were gamma-irradiated before storage. Platelet (PLT)-derived (CCL5/RANTES, CXCL4/PF4, CCL3/MIP-1alpha, transforming growth factor [TGF]-beta, CXCL8/interleukin [IL]-8, IL-1beta) as well as white blood cell (WBC)-associated (IL-6, IL-10, IL-11, IL-12, tumor necrosis factor, interferon-gamma) cytokines were investigated by enzyme-linked immunosorbent assay and cytometric bead array during storage for up to 12 days. RESULTS: Independent of previous treatment we observed that all concentrates showed low levels of WBC-associated cytokines. PLT-derived cytokines were detected at higher levels and showed significant increase during storage. Statistical analysis showed lower PLT content per unit in PCT PCs, higher levels of activation variables in PCT PCs, and higher levels and accumulation rate of CCL5, CXCL4, TGF-beta, and CXCL8 in PCT PCs. CONCLUSION: PLTs are the main source of released cytokines during storage of untreated, gamma-irradiated, and PCT PCs. PCT may affect the level of PLT-derived cytokines in PCs. No additional reduction of WBC-associated cytokines were observed after PCT in prestorage leukoreduced PCs.


Assuntos
Plaquetas , Preservação de Sangue , Citocinas/análise , Raios gama , Plaquetas/efeitos dos fármacos , Plaquetas/efeitos da radiação , Contaminação de Medicamentos/prevenção & controle , Humanos , Leucócitos/efeitos dos fármacos , Leucócitos/efeitos da radiação , Fotoquímica , Fatores de Tempo
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