Guidelines for Transfusion and Patient Blood Management, and Discuss Relevant Transfusion Related Topics
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Guidelines for Transfusions
Guidelines for Transfu- sion Prepared by: Community Transfusion Committee Lincoln, Nebraska CHAIR: Aina Silenieks, MD MEMBERS: L. Bausch, M.D. R. Burton, M.D. S. Dunder, M.D. D. Voigt, M.D. B. J. Wilson, M.D. COMMUNITY Becky Croner REPRESENTATIVES: Ellen DiSalvo Christa Engel Phyllis Ericson Kelly Gillaspie Pat Gilles Vic Grdina Jessica Henrichs Kelly Jensen Laurel McReynolds Christina Nickel Angela Novotny Kelley Thiemann Janet Wachter Jodi Wikoff Guidelines For Transfusion Community Transfusion Committee INTRODUCTION The Community Transfusion Committee is a multidisciplinary group that meets to monitor blood utilization practices, establish guidelines for transfusion and discuss relevant transfusion related topics. It is comprised of physicians from local hospitals, invited guests, and community representatives from the hospitals’ transfusion services, nursing services, perfusion services, health information management, and the Nebraska Community Blood Bank. These Guidelines for Transfusion are reviewed and revised biannually by the Community Trans- fusion Committee to ensure that the industry’s most current practices are promoted. The Guidelines are the standard by which utilization practices are evaluated. They are also de- signed to provide helpful information to assist physicians to provide appropriate blood compo- nent therapy to patients. Appendices have been added for informational purposes and are not to be used as guidance for clinical decision making. ADULT RED CELLS A. Indications 1. One of the following a. Hypovolemia and hypoxia (signs/symptoms: syncope, dyspnea, postural hypoten- sion, tachycardia, angina, or TIA) secondary to surgery, trauma, GI tract bleeding, or intravascular hemolysis, OR b. Evidence of acute loss of 15% of total blood volume or >750 mL blood loss, OR c. -
27. Clinical Indications for Cryoprecipitate And
27. CLINICAL INDICATIONS FOR CRYOPRECIPITATE AND FIBRINOGEN CONCENTRATE Cryoprecipitate is indicated in the treatment of fibrinogen deficiency or dysfibrinogenaemia.1 Fibrinogen concentrate is licenced for the treatment of acute bleeding episodes in patients with congenital fibrinogen deficiency, including afibrinogenaemia and hypofibrinogenaemia,2 and is currently funded under the National Blood Agreement. Key messages y Fibrinogen is an essential component of the coagulation system, due to its role in initial platelet aggregation and formation of a stable fibrin clot.3 y The decision to transfuse cryoprecipitate or fibrinogen concentrate to an individual patient should take into account the relative risks and benefits.3 y The routine use of cryoprecipitate or fibrinogen concentrate is not advised in medical or critically ill patients.2,4 y Cryoprecipitate or fibrinogen concentrate may be indicated in critical bleeding if fibrinogen levels are not maintained using FFP. In the setting of major obstetric haemorrhage, early administration of cryoprecipitate or fibrinogen concentrate may be necessary.3 Clinical implications y The routine use of cryoprecipitate or fibrinogen concentrate in medical or critically ill patients with coagulopathy is not advised. The underlying causes of coagulopathy should be identified; where transfusion is considered necessary, the risks and benefits should be considered for each patient. Specialist opinion is advised for the management of disseminated intravascular coagulopathy (MED-PP18, CC-PP7).2,4 y Cryoprecipitate or fibrinogen concentrate may be indicated in critical bleeding if fibrinogen levels are not maintained using FFP. In patients with critical bleeding requiring massive transfusion, suggested doses of blood components is 3-4g (CBMT-PP10)3 in adults or as per the local Massive Transfusion Protocol. -
Bioimpedance Monitoring System for Pervasive Biomedical Applications
Bioimpedance monitoring system for pervasive biomedical applications Jaime Punter Villagrasa ADVERTIMENT . La consulta d’aquesta tesi queda condicionada a l’acceptació de les següents condicions d'ús: La difusió d’aquesta tesi per mitjà del servei TDX ( www.tdx.cat ) i a través del Dipòsit Digital de la UB ( diposit.ub.edu ) ha estat autoritzada pels titulars dels drets de propietat intel·lectual únicament per a usos privats emmarcats en ac tivitats d’investigació i docència. No s’autoritza la seva reproducció amb finalitats de lucre ni la seva difusió i posada a disposici ó des d’un lloc aliè al servei TDX ni al Dipòsit Digital de la UB . No s’autoritza la presentació del seu contingut en una finestra o marc aliè a TDX o al Dipòsit Digital de la UB (framing). Aquesta reserva de drets afecta tant al resum de presentació de la tesi com als seus continguts. En la utilització o cita de parts de la tesi és obligat indicar el nom de la persona autora . ADVERTENCIA . La consulta de esta tesis queda condicionada a la aceptación de las siguientes condiciones de uso: La difusión de esta tesis por medio del servicio TDR ( www.tdx.cat ) y a través del Repositorio Digital de la UB ( diposit.ub.edu ) ha sido auto rizada por los titulares de los derechos de propiedad intelectual únicamente para usos privados enmarcados en actividades de investigación y docencia. No se autoriza su reproducción con finalidades de lucro ni su difusión y puesta a disposición desde un si tio ajeno al servicio TDR o al Repositorio Digital de la UB . -
Association Between ABO and Duffy Blood Types and Circulating Chemokines and Cytokines
Genes & Immunity (2021) 22:161–171 https://doi.org/10.1038/s41435-021-00137-5 ARTICLE Association between ABO and Duffy blood types and circulating chemokines and cytokines 1 2 3 4 5 6 Sarah C. Van Alsten ● John G. Aversa ● Loredana Santo ● M. Constanza Camargo ● Troy Kemp ● Jia Liu ● 4 7 8 Wen-Yi Huang ● Joshua Sampson ● Charles S. Rabkin Received: 11 February 2021 / Revised: 30 April 2021 / Accepted: 17 May 2021 / Published online: 8 June 2021 This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2021, corrected publication 2021 Abstract Blood group antigens are inherited traits that may play a role in immune and inflammatory processes. We investigated associations between blood groups and circulating inflammation-related molecules in 3537 non-Hispanic white participants selected from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Whole-genome scans were used to infer blood types for 12 common antigen systems based on well-characterized single-nucleotide polymorphisms. Serum levels of 96 biomarkers were measured on multiplex fluorescent bead-based panels. We estimated marker associations with blood type using weighted linear or logistic regression models adjusted for age, sex, smoking status, and principal components of p 1234567890();,: 1234567890();,: population substructure. Bonferroni correction was used to control for multiple comparisons, with two-sided values < 0.05 considered statistically significant. Among the 1152 associations tested, 10 were statistically significant. Duffy blood type was associated with levels of CXCL6/GCP2, CXCL5/ENA78, CCL11/EOTAXIN, CXCL1/GRO, CCL2/MCP1, CCL13/ MCP4, and CCL17/TARC, whereas ABO blood type was associated with levels of sVEGFR2, sVEGFR3, and sGP130. -
Cryosupernatant Plasma
Cryosupernatant Plasma APPLICABILITY: This document applies to Other Names: Cryopoor Plasma AHS, Covenant Health, and all other health Class: Human blood component care professionals involved in the transfusion of blood components and products in Alberta INTRAVENOUS OTHER Intermittent Continuous ROUTES DIRECT IV SC IM OTHER Infusion Infusion Acceptable No Yes No No No N/A Routes* * Professionals performing these restricted activities have received authorization from their regulatory college and have the knowledge and skill to perform the skill competently. DESCRIPTION OF PRODUCT: . Cryosupernatant Plasma (CSP) is prepared from slowly thawed Frozen Plasma that is centrifuged to separate the insoluble cryopreciptate from the plasma. The remaining Cryosupernatant plasma is then refrozen. The approximate volume of a unit is 273 mL . CSP has reduced levels of Factor VIII and von Willebrand Factor (vWF), and does not contain measurable amounts of Factor VIII or fibrinogen. Donors are screened and blood donations are tested for: . ABO/Rh and clinically significant antibodies . Antibodies to human immunodeficiency virus (HIV-1 and HIV-2), hepatitis C virus (HCV), human T-cell lymphotropic virus type I and II (HTLV-I/II), hepatitis B core antigen (HBcore) . Hepatitis B Surface Antigen (HBsAg) . Presence of viral RNA (HIV-1 and HCV) and viral DNA (hepatitis B virus (HBV)) . Syphilis AVAILABILITY: . Not all laboratories/transfusion services stock CSP. Product is stored frozen, and as a result requires preparation time prior to issuing. Patient blood type should be determined when possible to allow for ABO specific/compatible plasma transfusion INDICATIONS FOR USE: . Plasma exchange in patients with Thrombotic Thrombocytopenic Purpura (TTP) or Hemolytic Uremic Syndrome (HUS). -
How Do We Treat Life-Threatening Anemia in a Jehovah's Witness
HOW DO I...? How do we treat life-threatening anemia in a Jehovah’s Witness patient? Joseph A. Posluszny Jr and Lena M. Napolitano he management of Jehovah’s Witness (JW) The refusal of allogeneic human blood and blood prod- patients with anemia and bleeding presents a ucts by Jehovah’s Witness (JW) patients complicates clinical dilemma as they do not accept alloge- the treatment of life-threatening anemia. For JW neic human blood or blood product transfu- patients, when hemoglobin (Hb) levels decrease Tsions.1,2 With increased understanding of the JW patient beyond traditional transfusion thresholds (<7 g/dL), beliefs and blood product limitations, the medical com- alternative methods to allogeneic blood transfusion can munity can better prepare for optimal treatment of severe be utilized to augment erythropoiesis and restore life-threatening anemia in JW patients. endogenous Hb levels. The use of erythropoietin- Lower hemoglobin (Hb) is associated with increased stimulating agents and intravenous iron has been mortality risk in JW patients. In a study of 300 patients shown to restore red blood cell and Hb levels in JW who refused blood transfusion, for every 1 g/dL decrease patients, although these effects may be significantly in Hb below 8 g/dL, the odds of death increased 2.5-fold delayed. When JW patients have evidence of life- (Fig. 1).3 A more recent single-center update of JW threatening anemia (Hb <5 g/dL), oxygen-carrying patients (n = 293) who declined blood transfusion capacity can be supplemented with the administration reported an overall mortality rate of 8.2%, with a twofold of Hb-based oxygen carriers (HBOCs). -
Reducing the Risk of Iatrogenic Anemia and Catheter-Related Bloodstream Infections Using Closed Blood Sampling
WHITE PAPER WHITE Reducing the Risk of Iatrogenic Anemia and Catheter-Related Bloodstream Infections Using Closed Blood Sampling INTRODUCTION In the Intensive Care Unit (ICU), critically ill patients are more numerous and severely ill than ever before.1 To effectively care for these patients, clinicians rely on physiologic monitoring of blood-flow, oxygen transport, coagulation, metabolism, and organ function. This type of monitoring has made the collection of blood for testing an essential part of daily management of the critically ill patient, yet it is widely recognized that excessive phlebotomy has a deleterious effect on patient health. The result is a clinical paradox in which diligent care may contribute to iatrogenic anemia. RISKS ASSOCIATED WITH CONVENTIONAL DIAGNOSTIC BLOOD SAMPLING Iatrogenic Anemia The process of obtaining a blood sample from an indwelling central venous or arterial Use of blood sampling techniques that rely catheter requires a volume of diluted blood on discarding a volume of blood for each (2–10 mL) to be discarded or “cleared” from the catheter before a sample can be taken.2,3 sample may contribute to iatrogenic anemia, Studies have shown that patients with central which remains a prevalent issue affecting venous or arterial catheters have more blood sampling than ICU patients who don’t have the vast majority of patients in the ICU. these catheters and the total blood volume drawn from patients with arterial catheters is 44% higher than patients without arterial catheters (See Table 1).4,5 It has also been -
6.5 X 11 Double Line.P65
Cambridge University Press 978-0-521-53026-2 - The Cambridge Historical Dictionary of Disease Edited by Kenneth F. Kiple Index More information Name Index A Baillie, Matthew, 80, 113–14, 278 Abercrombie, John, 32, 178 Baillou, Guillaume de, 83, 224, 361 Abreu, Aleixo de, 336 Baker, Brenda, 333 Adams, Joseph, 140–41 Baker, George, 187 Adams, Robert, 157 Balardini, Lodovico, 243 Addison, Thomas, 22, 350 Balfour, Francis, 152 Aesculapius, 246 Balmis, Francisco Xavier, 303 Aetius of Amida, 82, 232, 248 Bancroft, Edward, 364 Afzelius, Arvid, 203 Bancroft, Joseph, 128 Ainsworth, Geoffrey C., 128–32, 132–34 Bancroft, Thomas, 87, 128 Albert, Jose, 48 Bang, Bernhard, 60 Alexander of Tralles, 135 Bannwarth, A., 203 Alibert, Jean Louis, 147, 162, 359 Bard, Samuel, 83 Ali ibn Isa, 232 Barensprung,¨ F. von, 360 Allchin, W. H., 177 Bargen, J. A., 177 Allison, A. C., 25, 300 Barker, William H., 57–58 Allison, Marvin J., 70–71, 191–92 Barthelemy,´ Eloy, 31 Alpert, S., 178 Bartlett, Elisha, 351 Altman, Roy D., 238–40 Bartoletti, Fabrizio, 103 Alzheimer, Alois, 14, 17 Barton, Alberto, 69 Ammonios, 358 Bartram, M., 328 Amos, H. L., 162 Bassereau, Leon,´ 317 Andersen, Dorothy, 84 Bateman, Thomas, 145, 162 Anderson, John, 353 Bateson, William, 141 Andral, Gabriel, 80 Battistine, T., 69 Annesley, James, 21 Baumann, Eugen, 149 Arad-Nana, 246 Beard, George, 106 Archibald, R. G., 131 Beet, E. A., 24, 25 Aretaeus the Cappadocian, 80, 82, 88, 177, 257, 324 Behring, Emil, 95–96, 325 Aristotle, 135, 248, 272, 328 Bell, Benjamin, 152 Armelagos, George, 333 Bell, J., 31 Armstrong, B. -
Therapeutic Apheresis, J Clin Apheresis 2007, 22, 104-105
Apheresis: Basic Principles, Practical Considerations and Clinical Applications Joseph Schwartz, MD Anand Padmanabhan, MD PhD Director, Transfusion Medicine Assoc Med Director/Asst Prof Columbia Univ. Medical Center BloodCenter of Wisconsin New York Presbyterian Hospital Medical College of Wisconsin Review Session, ASFA Annual meeting, Scottsdale, Arizona, June 2011 Objectives (Part 1) • Mechanism of Action • Definitions • Technology (ies) • Use • Practical Considerations • Math • Clinical applications – HPC Collection Objectives (Part 2) • Clinical applications: System/ Disease Specific Indications • ASFA Fact Sheet Apheresis •Derives from Greek, “to carry away” •A technique in which whole blood is taken and separated extracorporealy, separating the portion desired from the remaining blood. •This allows the desired portion (e.g., plasma) to be removed and the reminder returned. Apheresis- Mechanism of Action •Large-bore intravenous catheter connected to a spinning centrifuge bowl •Whole blood is drawn from donor/patient into the centrifuge bowl •The more dense elements, namely the RBC, settle to the bottom with less dense elements such as WBC and platelets overlying the RBC layer and finally, plasma at the very top. Apheresis: Principles of Separation Platelets (1040) Lymphocytes Torloni MD (1050-1061) Monocytes (1065 - 1069) Granulocyte (1087 - 1092) RBC Torloni MD Torloni MD Separate blood components is based on density with removal of the desired component Graphics owned by and courtesy of Gambro BCT Principals of Apheresis WBC Plasma Torlo RBC ni MD Torloni MD RBC WBC Plasma G Cobe Spectra Apheresis- Mechanism of Action Definitions • Plasmapheresis: plasma is separated, removed (i.e. less than 15% of total plasma volume) without the use of replacement solution • Plasma exchange (TPE): plasma is separated, removed and replaced with a replacement solution such as colloid (e.g. -
Guide to Blood Plasma Products and Their Applications – Part One
Vet Times The website for the veterinary profession https://www.vettimes.co.uk Guide to blood plasma products and their applications – part one Author : Amanda Boag, Jenny Walton Categories : Vets Date : September 26, 2011 Amanda Boag and Jenny Walton discuss indications for the use of plasma products, their production, and storage within the practice in the first of a three-part series FOLLOWING changes in legislation in 2005, veterinary blood banking and component therapy has developed rapidly within the UK. Practitioners now have easy access to canine blood and its products – notably, packed red cells and various plasma products. This series of articles will focus on indications for plasma product use, their production and storage, the administration and monitoring of plasma transfusions and will include a series of five case studies that have used plasma products. Indications for plasma component therapy Although well-defined indications exist for the use of plasma products in single or multiple coagulation deficiencies, indications for many of its other uses are empiric. Haemostatic disorders Plasma components are most commonly used to treat haemostatic disorders and are generally effective in treating both inherited and acquired conditions. Specific diagnosis enables selection of the optimum replacement product. It is important to remember that any samples drawn for diagnostic purposes (for example, measurement of clotting factor levels) must be taken either 1 / 5 before or at least 36 hours after transfusion to allow the measurement of endogenous levels. Inherited bleeding disorders Plasma components are administered to control active haemorrhage or as preoperative prophylaxis. Inherited bleeding disorders are associated with deficiency of a specific factor and the optimal product for treatment depends on which factor is lacking. -
Blood Collection and Handling Tube Additives, Tube Type Most Laboratory Tests Are Performed on Plasma, Serum, Or Whole Blood
Blood Collection and Handling Tube Additives, Tube Type Most laboratory tests are performed on plasma, serum, or whole blood. To preserve the specimen in the form required by the test, collection tubes contain additives that either prevent coagulation (for plasma and whole blood recovery), or activate coagulation (for serum recovery). Please refer to individual test requirements. Drawing Order When multiple tubes are drawn, it is important to prioritize the drawing order to prevent a Table 1. Vacutainer Order Of Draw tube additive from contaminating the next tube and altering the chemical composition of the 1. Navy Blue (metals testing) following specimen. Coagulation tests are highly susceptible to interference from 2. Blood culture bottles / SPS tubes contamination from tissue fluid and tube additives; therefore these tests are usually collected 3. Coagulation tests: first when a series of tubes are collected. Prior to collecting tests for coagulation (i.e. Blue top a. Clear top “waste” tube tube) a plain Clear top tube containing no additive must be partially filled and discarded. b. Light Blue top This “waste” tube prevents tissue thromboplastins from contaminating the Blue top tube. Blue top tubes must be allowed to fill to the line indicated on the tube, exhausting the 4. Gold top vacuum. See Table 1, “Vacutainer Order of Draw” for proper collection order of vacutainer 5. Plain Red top tubes. 6. Dark Green top (heparin) 7. Light Green top Certain blood collection techniques have been identified as possible sources of error in 8. Lavender or Pink top laboratory testing. Avoid the following sources of test error when collecting blood: 9. -
Ubc Department of Medicine 2005 Annual Report
UBC DEPARTMENT OF MEDICINE 2005 ANNUAL REPORT TABLE OF CONTENTS MESSAGE FROM DR. GRAYDON MENEILLY….….….….………………………………3 MISSION STATEMENT.……………………………………………………...……………….7 ORGANIZATION CHART.………………………………………………...………………….9 UBC DEPARTMENT OF MEDICINE COMMITTEE STRUCTURES………………..…11 UBC DEPARTMENT OF MEDICINE ADMINISTRATIVE OFFICE...………………….13 UBC DEPARTMENT OF MEDICINE COMMITTEES..………………………………….. 15 Department Heads, Associate Heads, UBC Division Heads, Educational Program Directors & Associate Directors.………………………………………… 17 Research………………………………………………………………………………………….19 Committee for Appointments, Reappointments, Promotion and Tenure.………………………. 21 Teaching Effectiveness Office.…………………………………………………………………..25 DIVISION REPORTS.…………………………………………………………………………27 Allergy & Immunology.………………………………………………………………………… 29 Cardiology.……………………………………………………………………………………….33 Critical Care Medicine.…………………………………………………………………………..45 Dermatology.……………………………………………………………………………………. 49 Endocrinology.………………………………………………………………………………….. 55 Gastroenterology.…………………………………………………………………………….…. 59 General Internal Medicine.……………………………………………………………………… 63 Geriatric Medicine.……………………………………………………………………………… 67 Hematology.…………………………………………………………………………………….. 71 Infectious Diseases.………………………………………………………………………………75 Medical Oncology.……………………………………………………………………………… 81 Nephrology.…………………………………….……………………………………………..… 87 Neurology.……………………………………….…………………………………………….... 93 Occupational Medicine…………………………………………………………………………109 Physical Medicine & Rehabilitation.…………………………………………………………...113 Respiratory