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Frequency of immediate adverse effects associated with therapeutic apheresis

TRANSFUSION 1999年第3期39卷 282-288页

作者： McLeod, BC Sniecinski, I Ciavarella, D Owen, H Price, TH Randels, MJ Smith, JW Rush Med Ctr Apheresis Unit Chicago IL 60612 USA Puget Sound Blood Ctr Seattle WA 98104 USA Univ N Carolina Hosp Transfus Med Serv Chapel Hill NC USA Orthoclin Diagnost Inc Med Affairs & Cellular Immunoassay Design Ctr Raritan NJ USA City Hope Natl Med Ctr Dept Transfus Med Duarte CA 91010 USA Coral Therapeut Braintree MA USA Oklahoma Blood Inst Oklahoma City OK USA

BACKGROUND: Therapeutic apheresis was found to be reasonably safe in prior studies using instruments that are now largely obsolete. The incidence of adverse effects with current instruments and techniques has not been assessed in a large multicenter study. STUDY DESIGN AND METHODS: A survey was conducted in 1995 using a uniform questionnaire that asked about 32 specific events but excluded transient paresthesia and mild vasovagal events. Eighteen centers returned 3429 responses concerning 125 to 500 therapeutic apheresis procedures per center. RESULTS: Two hundred forty-two adverse events were reported in 163 procedures (4.75% of all procedures;6.87% of first-time procedures and 4.28% of repeat procedures). The numbers (incidence) of selected specific events were transfusion reaction, 56 (51 in plasma exchange [PE] with plasma replacement) (1.6%);citrate-related nausea and/or vomiting, 41 (1.2%);systolic blood pressure <80 mmHg, 34 (1.0%);vasovagal nausea and/or vomiting, 17 (0.5%);parlor and/or diaphoresis, 16 (0.5%);pulse >120, 14 (0.4%);respiratory distress, 9 (0.3%);tetany or seizure, 9 (0.2%);and chills or rigors, 6 (0.2%). Rates for other specific events were less than or equal to 0.1 percent. Vasovagal phenomena were more frequent in procedures done in neurologic patients than in those done in hematology or oncology patients (p = 0.011) or renal or rheumatic patients (p = 0.038). Procedure-specific rates were red cell exchange, 8 (10.26%) of 78;PE (plasma), 89 (7.81%) of 1140;PE (no plasma), 42 (3.35%) of 1255;leukapheresis, 4 (5.71%) of 70;plateletpheresis, 0 of 18;and autologous peripheral blood progenitor cell collection, 11 (1.66%) of 664. Three deaths were reported;all were attributed to primary disease. CONCLUSION: Therapeutic apheresis procedures are relatively safe, with a 4.75-percent overall incidence of mostly reversible adverse effects. Among the most commonly performed procedures, the risk is higher for blood component exchanges, especially if al

关键词：抗凝药/副作用血库/统计学和数值数据血液成分除去法/副作用血液成分除去法/仪器和设备血液成分输血/副作用柠檬酸盐类/副作用红细胞输注/副作用低血压/流行病学低血压/病因学恶心/流行病学恶心/病因学体外光化学疗法/副作用血浆血浆置换/副作用呼吸障碍/流行病学呼吸障碍/病因学发作/流行病学发作/病因学寒战晕厥血管迷走神经性/流行病学晕厥血管迷走神经性/病因学呕吐/流行病学呕吐/病因学人类

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Evaluation of an automated system for the collection of packed RBCs, platelets, and plasma

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TRANSFUSION 2000年第10期40卷 1214-1222页

作者： Elfath, MD Whitley, P Jacobson, MS Cranfill-Hupp, K Kemp, DM McNeil, D Sawyer, S Bell-Dize, S Gorlin, JB Kevy, SV McAteer, MJ Gambro BCT Inc Lakewood CO 80215 USA Amer Red Cross Norfolk VA USA Eastern Virginia Med Sch Dept Pathol Norfolk VA 23501 USA Childrens Hosp Boston MA 02115 USA

BACKGROUND: This study evaluated the quality of WBC-reduced platelets, RBCs, and plasma collected on a new system (Trima, Gambro BCT) designed to automate the collection of all blood components. The study also evaluated donor safety and suitability of these components for transfusion. STUDY DESIGN AND METHODS: In Phase I, the quality of the components collected on the new system was evaluated by standard in vitro and in vivo testing methods. Results were compared to those from control components collected by currently approved standard methods. In Phase II, additional collections were performed to evaluate the acceptability of the new system and the safety of platelets collected. RESULTS: In vivo 24-hour RBC recovery was 76.8 +/- 3.1 percent for the test RBC units and 77.1 +/- 4.4 percent recovery for whole-blood (control) RBCs. The differences between test and control platelet results in the in vivo and in vitro assays were not clinically significant. Plasma clotting factors and fibrinogen levels met international standards. The system was well accepted by donors, and no major adverse donor reactions were reported for the 68 procedures performed. No problems were reported with transfusing the blood components collected. CONCLUSION: Blood components collected with the Trima are equivalent to currently available components, and they meet the applicable regulatory standards. This system provides consistent, standardized components with predictable yields. It provides the option of fully automating the collection of all blood components.

关键词：自动化血液成分输血/副作用血小板血样采集/方法血样采集/标准红细胞输注/副作用红细胞评价研究(主题) 血浆血小板输注/副作用成年人女(雌)性人类男(雄)性

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RBC transfusion and postoperative length of stay in the hospital or the intensive care unit among patients undergoing coronary artery bypass graft surgery: the effects of confounding factors

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TRANSFUSION 2000年第7期40卷 832-839页

作者： Vamvakas, EC Carven, JH NYU Med Ctr Sch Med Dept Pathol Blood Bank New York NY 10016 USA Massachusetts Gen Hosp Blood Transfus Serv Boston MA 02114 USA

BACKROUND: Data on the independent association between perioperative allogeneic blood transfusion (ABT) and postoperative length of stay at the hospital or in the intensive care unit (ICU) are sparse. STUDY DESIGN AND METHODS: The records of 421 consecutive patients undergoing coronary artery bypass graft (CABG) operations at the Massachusetts General Hospital were reviewed. The effect of perioperative ABT in explaining the variation in the postoperative length of stay (LOS) at the hospital or in the ICU was calculated after adjustment for the effects of 20 confounding factors that pertained to severity of illness, difficulty of operation, and risk of postoperative wound infection or pneumonia. RESULTS: Postoperative LOS averaged (mean +/- SE) 8.0 +/- 0.3 days in the hospital and 50.0 +/- 4.1 hours in the ICU. After adjustment for the effects of confounding factors, the postoperative length of hospitalization increased by 0.837 percent (95% CI, 0.249-1.425%) per RBC unit transfused (p<0.001), and the postoperative length of stay in the ICU increased by 0.873 percent (95% CI, -0.068-1.814%) per RBC unit transfused (p<0.10). CONCLUSION: Allogeneic blood transfusion was independently associated with longer postoperative stays in the hospital or the ICU, but the observed independent association is perhaps too small to be clinically relevant. This independent association may be due to a relationship between ABT and a higher incidence of septic complications of surgery, or it may reflect the function of blood transfusion as a surrogate marker for severity of illness.

关键词：冠状动脉分流术红细胞输注/副作用医院/统计学和数值数据重症监护病房/统计学和数值数据住院时间移植同种成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Massive blood transfusion exceeding 50 units of plasma poor red cells or whole blood:: the survival rate and the occurrence of leukopenia and acidosis

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INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 1999年第9期30卷 619-622页

作者： Hakala, P Hiippala, S Syrjälä, M Randell, T Univ Cent Hosp Helsinki Dept Anaesthesia FIN-00029 Helsinki Finland

The survival rate after bleeding requiring massive blood transfusions exceeding 50 units has been reported to be low or zero. There seems to be no reports of leukopenia in connection with massive blood transfusion. This retrospective study was carried out to investigate the survival rate and the occurrence of leukopenia and acidosis in patients who were transfused with more than 50 units of plasma poor red cells or whole blood. The survival rate was 16 of 23. Three of the five patients with a blood transfusion of over 100 units survived. Pure component therapy was used on 18 occasions. All patients had a leukopenia, which lasted up to five days. All patients had an acidosis. The range of the lowest pH values in patients who did not survive was from 6.77 to 7.27 and in survivors from 6.87 to 7.28. The survival rate was considerably higher than reported in previous studies. Pure component therapy appeared to be particularly suited to massive transfusion. Leukopenia was a regular phenomenon. Severe acidosis did not predict a poor outcome. (C) 1999 Elsevier Science Ltd. All rights reserved.

关键词：酸中毒/病因学输血/死亡率输血/统计学和数值数据红细胞输注/副作用红细胞输注/死亡率红细胞输注/统计学和数值数据芬兰/流行病学白细胞减少/病因学回顾性研究存活率青少年成年人老年人女(雌)性人类男(雄)性中年人

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GVHD after transfusion of stored RBC concentrates in a solution of mannitol, adenine, phosphate, citrate, glucose, and NaCl following trauma

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TRANSFUSION 2000年第3期40卷 297-301页

作者： Kita, T Nei, J Matsu, T Yoshiba, H Matsuda, T Yahagi, H Uchida, S Nakao, S Jyouhana Kousei Hosp Dept Internal Med Toyama Japan Jyouhana Kousei Hosp Dept Surg Toyama Japan Kanazawa Univ Sch Med Dept Internal Med 3 Kanazawa Ishikawa 920 Japan Japanese Red Cross Blood Ctr Res Dept Tokyo Japan

BACKGROUND: It has not previously been reported that WBC-reduced RBC preparations can cause transfusion-associated GVHD, even in an immunocompetent individual. CASE REPORT: A 74-year-old man suffered a hemorrhage from the mesentery of the transverse colon after a traffic accident. During surgery, he received 10 units of RBCs from 10 donors in a solution containing mannitol, adenine, phosphate, citrate, glucose and NaCl (MAP). MAP RBCs had been stored for 7 to 8 days before use. On the 27th day after surgery, an erythematous, pruritic rash appeared over the face, neck, and trunk, which was associated with low-grade fever and pancytopenia. Transfusion-associated GVHD was strongly suspected and was confirmed by skin biopsy. To determine the origin of lymphocytes causing GVHD, several microsatellite loci were amplified from DNA of the patient's nails and blood and from blood samples of all 10 RBC donors by using PCR. Amplified alleles derived from the patient's blood were identical to those from one of the 10 samples. CONCLUSION:These findings indicate that transfusions of MAP-RBCs can cause transfusion-associated GVHD in an elderly but immunocompetent host.