...critical care review Transfusion-Related Acute Lung Injury* A Review Mark R. Looney, MD; Michael A. Gropper, MD, PhD, FCCP; and Michael A. Matthay, MD, FCCP Transfusion-related acute lung injury (TRALI) is an underreported complication of transfusion therapy, and it is the third most common cause of transfusion-associated death. TRALI is defined as noncardiogenic pulmonary edema temporally related to transfusion therapy. The diagnosis of TRALI relies on excluding other diagnoses such as sepsis, volume overload, and cardiogenic pulmonary edema. Supportive diagnostic evidence includes identifying neutrophil or human leukocyte antigen (HLA) antibodies in the donor or recipient plasma. All plasma-containing blood products have been implicated in TRALI, with the majority of cases linked to whole blood, packed RBCs, platelets, and fresh-frozen plasma. The pathogenesis of TRALI may be explained by a “two-hit” hypothesis, with the first “hit” being a predisposing inflammatory condition commonly present in the operating room or ICU. The second hit may involve the passive transfer of neutrophil or HLA antibodies from the donor or the transfusion of biologically active lipids from older, cellular blood products. Treatment is supportive, with a prognosis substantially better than most causes of clinical acute lung injury. (CHEST 2004; 126:249 –258) Key words: ARDS; lung injury; pulmonary edema; transfusion; transfusion-related acute lung injury Abbreviations: ALI acute lung injury;...
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...red blood cells (RBC) as well as other cells (Gurpreet et al., 2004). This unregulated increased destruction primarily affects premature RBC reducing their lifespan of 120 days coupled with the bone marrow unable to compensate to this destruction rate (Gurpreet et al., 2004). Clinical findings that result from this inapt immune response are usually directly related to an abnormally reduced RBC quantity and function. These include a lower haemaglobin count, a high indirect bilirubin count, a reduction in plasma levels, a low haptoglobin, a positive direct antiglobulin test (DAT) and reduced gas exchange rates among the lungs and tissues. As these clinical effects occur after a few hours or a few days before detection, not all clinically related typical features may be present complicating the AIHA diagnosis. Based on the characteristics and pathogenesis of these auto antibodies present, AIHA is classed as warm antibody haemolytic anaemia (WAIHA), cold antibody haemolytic anemia (CAIHA), drug indcuced haemolytic anemia or the rare paroxysmal cold haemoglobinuria (Lechner & Jager, 2012). Analyzing AIHA classification and pathogenesis is important when attempting to apply transfusion treatment, other therapeutic applications or providing further clinical recommendations. Although the true aetiology of the disorder in uncertain, the cause may be either primary or secondary (Lechner & Valent et al., 2008). The primary AIHA is idiopathic accounting for half of AIHA cases (Gupta...
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...INTRODUCTION Placenta previa is generally defined as the implantation of the placenta over or near the internal os of the cervix. There are four types of placenta previa; total, low-lying, partial, and marginal. The higher incidence of low-lying placenta and placenta previa is sonographically diagnosed in the second trimester and ranges from 6% to 46%. This rate, however, decreases to as low as 0.5 % at delivery (11). Despite advances in blood transfusion techniques and surgical procedures, abnormal placentation still remains a difficult challenge for obstetricians. Intrapartum maternal hemorrhage and the need for emergency cesarean section or hysterectomy related to abnormal placentation are main causes of maternal-fetal morbidity and mortality. The overall incidence of placenta previa at delivery is reported as 0.5 % in most studies (3, 5) and the risk factors for placenta previa include advanced maternal age (above 35 years), parity, smoking, and, most importantly, prior cesarean delivery. Placenta previa with prior cesarean delivery increases risk up to 1% - 4%. As the number of previous cesarean deliveries increases, the incidence of placenta previa and abnormal placentation shows a linear increase (3). Vaginal ultrasound is the most accurate method for localizing and diagnosing placenta previa, because it can provide a better resolution in the lower margin of the placenta (4, 6, 11). There is a little increase in congenital anomalies associated with placenta previa...
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...Review Article 539 Dengue Prophylactic Platelet Transfusion—Changa Kurukularatne et al When Less is More: Can We Abandon Prophylactic Platelet Transfusion in Dengue Fever? Changa Kurukularatne,1,2MD, Frederico Dimatatac,1,2MD, Diana LT Teo,3MBBS, MSc, FRCPath, David C Lye,1,2,4 MBBS, FRACP, FAMS, Yee Sin Leo,1,2,5 M.Med (Int Med), FRCP, FAMS Abstract Dengue fever (DF) has several hematological manifestations including thrombocytopenia and increased bleeding risk. Prophylactic platelet transfusion—in the absence of major bleeding—is utilized in DF with thrombocytopenia with the intention of preventing hemorrhagic complications. However, prophylactic platelet transfusion in DF is neither standardized nor supported by clinical evidence. We conclude that risks, costs and poor resource utilization associated with prophylactic platelet transfusion in DF far outweigh any potential hematological benefit, and as such, should not constitute routine clinical practice. Ann Acad Med Singapore 2011;40:539-45 Key words: Thrombocytopenia, Preventitive, Arbovirus, Bleeding, Hemorrhage Introduction Dengue fever (DF) is the most common mosquito-borne human viral illness worldwide, and has rapidly spread to reach hyper-endemic proportions in the urban tropics over the last quarter of a century.1 With an estimated 2.5 billion people at risk and a global annual incidence of 50 million cases, DF has been identified as an example of a potential international public health emergency.2...
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...rather than ruing the day’, a similar situation awaits Biopure. A solitary decision over a timely product launch would either allow them to capitalize on a market or lose the ‘war’ in the competitive field of blood transfusion substitutes. The idea of using blood substitutes as a replacement for the existing traditional methods of blood transfusion stemmed from the complications associated with the acquiring, handling and storing of whole blood. Biopure Corporation was one such company which had produced two products, Oxyglobin and Hemopure, both of which were bovine derived hemoglobin products. The advantages of these products over classic blood transfusion techniques included elimination of blood typing, cross matching and refrigeration steps, higher oxygen carrying capacity, increased shelf life of 2 years along with infectious and contamination free products as an end result. In addition, Oxyglobin was approved by the FDA. Owing to the privilege of being the sole supplier of blood substitutes in the veterinary industry, it had a huge potential to monopolize the market. The lack of competitors would generate a significant amount of revenue from which they could recover the development cost and would simultaneously allow Biopure strengthen their position in the market in case Hemopure gets approved by the FDA in the near future. Due to the aforementioned salient benefits, launching Oxyglobin seems logical and at the same time, a strategic fit from the company’s standpoint. On a...
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...This essay is based on adult case study two a 70 year old male patient called Mr James. All names have been change in this essay in order to comply with the NMC (2008). Code professional conduct on confidential. The case study highlights a number of principle, legal issues and professional value. These will be identified and some will be discuss in details. Ethics is concerned with the study of social morality and philosophical reflection of norms and practice (Burckhardt and Nathaniel 2003). These ethical issues are those based on basic and essential to social values that include respect for life, liberty and to be cared for. There will be a demonstration of understanding the theory of deontology while recognizing the importance of ethical principles in relation on the delivery of individual patient care. Informed consent will be highlighted in detail to provide validity and factors involved. A reflection will be provided to detail the understanding of how ethical theories contribute to the ethical decision making process in clinical area. Also a brief discussion will be given to show what has been gained from producing this essay. Consent can be defined as an agreement to allow something to happen based on full disclosure of facts needed to make an intelligent decision (Hazel 2002). This includes the knowledge of risks involved, benefits and consequence of refusal. Informed consent not only requires that a person be given all relevant information required...
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...Disease Receiving Blood Transfusion Therapy for at Least Five Years After Initial Stroke Taylor Kaplan University of Bridgeport Physician Assistant Institute Introduction Sickle cell disease is an inherited blood disorder that is characterized by a defect in hemoglobin. Normally, red blood cells take the form of a biconcave disk and can easily move through the vessels throughout one’s body. Sickled red blood cells however are very different; these damaged red blood cells cluster together as a result of the loss of oxygen and can no longer easily move through blood vessels in the body. This cluster creates a blockage in small arteries or capillaries and prevents the...
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...used for the treatment of chronic iron overload due to the transfusion of blood. This drug is approved for reducing the iron concentration in liver and serum ferritin levels. It is used for chronic excessive iron in liver in the patients who are 10 years and older and suffering from Non Transfusion Dependent Thalassemia syndrome in which iron and serum ferritin gets overloaded in the liver and can cause toxicity. It is also used in patient suffering from sickle cell diseases. Approval Details: This drug is manufactured by Novartis Pharmaceutical Cooperation (Oncology Department). The New Drug Application was submitted under section 505b of Federal Food, Drug and Cosmetic Act on May 30th, 2014. FDA approved the product under accelerated approval regulations 21 CFR314.510 and requested further clinical trials and well controlled studies to explain the clinical benefit of this drug. FDA also requested to submit the post marketing requirements under section 505 (o) and the promotional material. Dosage and Administration: Initial dose is 14 mg/kg for transfusion iron overdose and...
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...be more severe than problems and issues arising from a specific department which is one of the most important sections in a clinical laboratory. That department is called the transfusion service department. At times, nothing is more confounding to a laboratory scientist then the solutions to antibody detection and identification problems. Errors from this antibody detection and identification should be resolved and dealt in a organized and logic mannered and immediate effect should be implemented as fast growing of elderly and oncology population receiving supportive transfusions are increasing as time develops. Some antibodies issues can take up to hours for a solutions to be implemented, and when this occurs, pretransfusion testing will be delay and this will definitely caused many severe damages including costly hospital extensions. Antibody detection and identification testing is one of the most complicated testing ever conducted in a clinical laboratory. This is such as many areas of error and problems can occur during testing period or even during result reading and analyzing period. This study provides an example of a scenario where a resolving some of the problems encountered daily in the blood bank laboratory. A case study will be included in this study and based from the case study, this study of antibody detection and Identification testing on leukaemia patient’s sample...
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...Nelson, Janice, Shullman, Ira. (2007). Safe Handling and Administration of Blood Components. Pathology & Laboratory Medicine, 131(1), 690-694. Retrieved on October 17, 2010, from http://ezproxy.iuk.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2009579571&site=ehost-live. Seven case scenarios are reviewed by four medical doctors to assess the risks that hinder successful blood transfusions and administration of blood components (2007). The authors present scenarios of actual transfusion situations, the mistakes made that affected real patients, and the lessons for nurses and other physicians to prevent such errors in their careers. Various journals, textbooks and internet sources were used to obtain data to support their claims. In the article, the doctors explain how the transfusion process involves several steps that can compromise patient safety if not carried out according established guidelines. Sometimes stories can be the most effective way to raise awareness and educate. Incorporating this is a strength of the study. The authors present scenarios that show inappropriate blood component ordering, the importance of obtaining patient consent to transfuse, the proper way to submit a blood sample to a blood bank and issue the components, and transfusing and monitoring the patient during transfusion. The authors are effective because one can imagine being part of a transfusion that went bad and the emotions that it will bring about. The research...
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...Stokes et al. BMC Health Services Research 2011, 11:135 http://www.biomedcentral.com/1472-6963/11/135 RESEARCH ARTICLE Open Access Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients Michael E Stokes1*, Xin Ye2, Manan Shah3, Katie Mercaldi4, Matthew W Reynolds4, Marcia FT Rupnow2 and Jeffrey Hammond2 Abstract Background: Inadequate surgical hemostasis may lead to transfusion and/or other bleeding-related complications. This study examines the incidence and costs of bleeding-related complications and/or blood product transfusions occurring as a consequence of surgery in various inpatient surgical cohorts. Methods: A retrospective analysis was conducted using Premier’s Perspective™ hospital database. Patients who had an inpatient procedure within a specialty of interest (cardiac, vascular, non-cardiac thoracic, solid organ, general, reproductive organ, knee/hip replacement, or spinal surgery) during 2006-2007 were identified. For each specialty, the rate of bleeding-related complications (including bleeding event, intervention to control for bleeding, and blood product transfusions) was examined, and hospital costs and length of stay (LOS) were compared between surgeries with and without bleeding-related complications. Incremental costs and ratios of average total hospital costs for patients with bleeding-related complications vs. those without complications were estimated using ordinary...
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...Biopure Corporation: A Case Study Biopure Corporation specializes in blood substitutes for transfusion patients, both in the veterinary market and the human market. However, in 1998, Biopure faced the monumental decision of whether to begin selling Oxyglobin, a blood substitute, to the veterinary market or to wait until Hemoglobin, a blood substitute for the human market, became available for sale. Biopure’s problem was simple: should the company launch Oxyglobin before Hemoglobin is FDA-approved or wait until after Hemoglobin is approved and released into the human market. Ted Jacobs, vice president for Human Clinical Trials at Biopure Corporation, argued that Oxyglobin should be released later because Hemoglobin would not be able to be priced at such a high rate if the same product (for a different market) was charging much less. However, Andy Wright, vice president for Veterinary Products at Biopure Corporation, countered that Oxyglobin would increase the market and make people familiar with the Biopure name, thereby giving the company competitive edge in the human market. Our recommendation is to release Oxyglobin immediately rather than wait for Hemoglobin’s FDA-approval. The reasoning behind this decision follows from an analysis of both the veterinary blood substitute market and the human blood substitute market. Reasons to release Oxyglobin immediately are summarized in Exhibit A. This conclusion requires the Oxyglobin marketing team to make several subsequent decisions...
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...BLOOD DONATION SIDRA BIBI D/O FARZAND ALI MPHIL ( BIOCHEMISTRY) 2nd SEMESTER (MORNING) PMAS –UAAR Sidrabibi1126@yahoo.com Islam enjoins preserving human life and protecting it against all potential harm, affliction and hardship, and it insists on ensuring peace and security for human beings. In the Quran, Allah says, "To save one life is to save all humanity". Islamic law urges every Muslim to be in constant support of his community, and make it a legal requirement in many cases. According to a Hadith (saying by the Prophet Mohammed (Peace Be Upon Him)),"He who relieves a believer of one form of distress, in this life shall be relieved by God of a greater distress on the Day of Resurrection" and "God will help any servant of His, as long as he continues to help his brother". "A Muslim is a brother to every Muslim, he neither lets him down, nor does him injustice, nor gives him away".Therefore, if giving blood to a patient is necessary for his survival, then, according to Islam, it becomes mandatory to donate blood`, as a case of implementing a basic Islamic principle which makes it imperative to preserve human life. Two important main Islamic rules are also applicable here, namely: "Harm must be eliminated" & "Necessity overrules constraints". Further more it is in agreement with the Islamic principles of social justice.The Prophet (Peace Be Upon Him) says, "Cupping is a most useful type of medical treatment". He also says...
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...Quality of Red Blood Cells Isolated from Umbilical Cord Blood Stored at Room Temperature Mariia Zhurova, 1 John Akabutu, 2 and Jason Acker 3 ,* Author information ► Article notes ► Copyright and License information ► ------------------------------------------------- Abstract Red blood cells (RBCs) from cord blood contain fetal hemoglobin that is predominant in newborns and, therefore, may be more appropriate for neonatal transfusions than currently transfused adult RBCs. Post-collection, cord blood can be stored at room temperature for several days before it is processed for stem cells isolation, with little known about how these conditions affect currently discarded RBCs. The present study examined the effect of the duration cord blood spent at room temperature and other cord blood characteristics on cord RBC quality. RBCs were tested immediately after their isolation from cord blood using a broad panel of quality assays. No significant decrease in cord RBC quality was observed during the first 65 hours of storage at room temperature. The ratio of cord blood to anticoagulant was associated with RBC quality and needs to be optimized in future. This knowledge will assist in future development of cord RBC transfusion product. Go to: ------------------------------------------------- 1. Introduction Fetal and neonatal anemias are among the most serious complications of pregnancy and postnatal development. The causes of fetal anemia include immune haemolytic disease [1],...
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...Yvette J. Davis HM-310: Health Care Law & Government Regs. Professor Mark L. Vrooman Assignment: Case Study January 25, 2013 Due Date: No later than Week 8 Case: Mother refuses Blood, Spouse Disagrees (Perkins v. Lavin) pg. 417-418 Summary: Mother (Plaintiff Perkins) signs a form state the refusal of a blood transfusion, due to religious beliefs. Her husband who is not of the same religious beliefs, consented to a blood transfusion, which was administered. Mother files claim against the defendant for assault and battery. The claim was upheld. Although both parties have noted that the plaintiff’s husband provided his consent for the transfusion, the defendant has not argued that his consent was sufficient to overcome plaintiff’s direction that she was not to receive a transfusion. Mother submitted sufficient evidence to the trail court to establish that there was, at least a genuine issue as to whether the defendant intentionally invaded her right to be free from offensive contact. Because of the Mother’s recognition that the defendant acted to save her life, a jury may find that she is entitled to only nominal damages. 1) Should the court be the ultimate decision maker when there is a dispute over whether or not a lifesaving measure should be taken with a nonconsenting person? No I don’t agree that the court should be the ultimate decision maker when there is a dispute over whether or not a lifesaving measure should be taken with a nonconsenting...
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