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What Is The Difference Between Blood and Chicken Soup?
What Is The Difference Between Blood and Chicken Soup?
What Is The Difference Between Blood and Chicken Soup?
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Blood CAN Cause Harm
• Infectious diseases
• Bacterial contamination
• Immunomodulation
• Unknown mechanism
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Infectious Diseases
• Infectious diseases
• Bacterial contamination
• Immunomodulation
• Unknown mechanism
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Summary of Transfusion Errors
2000-2003
0 5 10 15 20 25
No. of Cases
FFP = fresh frozen plasma. 6
Data on file, US Department of Veterans Affairs.
Patient Identification Is Critical
blood product
• If there are ANY discrepancies when blood sample and paperwork arrive at
blood bank
It is 40 times more likely that the wrong patient’s blood is in the tube
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Blood CAN Cause Harm
• Infectious diseases
• Bacterial contamination
• Immunomodulation
• Unknown mechanism
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Transfusion-Related Acute Lung Injury (TRALI)
1:100,000 transfusions1
• “2-hit" hypothesis
Recipient granulocytes are primed in vivo, then
transfused antibodies "activate" granulocytes
• Infectious diseases
• Bacterial contamination
• Immunomodulation
• Unknown mechanism
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Blood CAN Cause Harm
• Infectious diseases
• Bacterial contamination
• Immunomodulation
• Unknown mechanism
12
Blood CAN Cause Harm
• Infectious diseases
• Bacterial contamination
• Immunomodulation
• Unknown mechanism
13
Transfusion Has Deleterious Effects via
Mechanisms We Do Not Understand
Corwin HL, et al. N Engl J Med. 2007;356:1667-1669. Hébert PC, et al. Crit
Care Med. 2001;29:227-234. Raghavan M, et al. Chest. 2005;127:295-307.
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Transfusion Requirements in Critical Care (TRICC)
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TRICC, cont’d
Hb = hemoglobin.
Hébert PC, et al. N Engl J Med. 1999;340:409-417.
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Nonetheless.…
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Subsequent Studies: Transfusion Also a Risk Factor for
Patients With Cardiovascular Disease
Published in 2008
• Koch CG, et al. Duration of red-cell storage and
complications after cardiac surgery. N Engl J Med.
2008;358:1229-1239
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Cardiac Surgery Patients Also Did Worse With Transfusion
HCT = hematocrit.
Murphy GJ. et al. Circulation. 2007;116:2544-2552.
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Effects Are Long-Lasting….
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Indications for Transfusion
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Recommendations
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Recommendations
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The Decision to Transfuse Is a Clinical Judgment
That Considers
25
Thus….
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Platelet Concentrates
Mintz PD, ed. Transfusion Therapy: Clinical Principles and Practice. 2nd ed.
Bethesda, MD: American Association of Blood Banks; 2004.
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Fresh Frozen Plasma
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Alternatives to Transfusion
• Local measures
• Prohemostatic agents
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Alternatives to Transfusion
• Local measures
Tourniquet
Embolization
Fibrin glue/topical thrombin
• Prohemostatic agents
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Alternatives to Transfusion
• Local measures
• Prohemostatic agents
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Alternatives to Transfusion
• Local measures
• Prohemostatic agents
• Don’t transfuse unless you are sure that the patient really
needs it
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