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Latest news:
HAEMATOLOGICA
Efficacy
of a combination of human recombinant erythropoietin + 13-cis-retinoic acid
and dihydroxylated vitamin D3 to improve moderate to severe anaemia in
low/intermediate risk myelodysplastic syndromes. Br
J Haematol. 2008 Nov 19. [Epub ahead of print] Our combined
therapy, independent of rEPO dosage, achieved in patients with unfavourable
response predictors, a rate of anaemia improvement comparable to the best
obtained in lower risk patients by high-dose rEPO
BLOOD MANAGEMENT
An
evaluation of cyclooxygenase-1 inhibition before coronary artery surgery:
aggregometry versus patient self-reporting. Anesth
Analg. 2008 Dec;107(6):1791-7. Patients with abnormal aggregation
before intervention (<51 U) received significantly more platelet
transfusion than patients with normal aggregation (1.1 U compared to 0.3 U,
P = 0.001). Our results suggest that arachidonic acid-induced aggregation in
whole blood may be a better predictor of platelet-related coagulopathy and
platelet transfusion than the assessment of aspirin intake by patient
self-reporting.
JEHOVAH'S WITNESSES
Management
of hemorrhagic shock when blood is not an option. J
Clin Anesth. 2008 Nov 17. [Epub ahead of print] .Case report
TRANSFUSION ISSUES
Blood
transfusions, thrombosis, and mortality in hospitalized patients with
cancer. Arch
Intern Med. 2008 Nov 24;168(21):2377-81. Both
RBC and platelet transfusions are associated with increased risks of venous
and arterial thrombotic events and mortality in hospitalized patients with
cancer. Further investigation is necessary to determine whether this
relationship is causal.
Blood
Transfusion Alters the Superior Mesenteric Artery Blood Flow Velocity
Response to Feeding in Premature Infants. Am
J Perinatol. 2008 Nov 19. [Epub ahead of print]. The postprandial
increase in mesenteric blood flow velocity (MBFV). MBFV increased in
response to feeding in the anemic but not the transfused state. The MBFV
increases in response to feeding in anemic preterm infants > 1250 g. We
speculate that the lack of response to feeding in the immediate
posttransfusion state may contribute to the development of
transfusion-associated necrotizing enterocolitis.
SURGICAL
TECHNIQUES AND DIAGNOSTIC TOOLS
Significant
small-bowel lesions detected by alternative diagnostic modalities after
negative capsule endoscopy. Gastrointest
Endosc. 2008 Dec;68(6):1209-1214. Capsule
endoscopy (CE) is considered a first-line investigation for obscure GI
bleeding (OGIB) and small-bowel polyp or tumor detection. The reliability of
a negative CE in excluding gross small-bowel pathology remains unclear. New
imaging modalities, such as double-balloon enteroscopy (DBE), CT
enterography (CTE) or magnetic resonance enterography (MRE) now provide
complementary roles to CE for these indications.
COAGULANTS
The
blood sparing effect and the safety of aprotinin compared to tranexamic acid
in paediatric cardiac surgery. Eur
J Cardiothorac Surg. 2008 Nov 20. [Epub ahead of print]. Aprotinin
administration bears no additional risks compared to tranexamic acid and it
has a stronger blood sparing effect in paediatric cardiac surgery. There
were fewer rethoracotomies and less postoperative red blood cell transfusion
in patients who received aprotinin.
Other weekly news:
TRANSFUSION ISSUES
Iron overload following red blood cell transfusion and its impact on
disease severity.
Biochim
Biophys Acta.
2008 Oct 18. [Epub ahead of print] Chronic transfusion results in
accumulation of excess iron that surpasses the binding capacity of the
major iron transport protein, transferrin. The resulting non-transferrin
bound iron (NTBI) can catalyze the production of highly reactive oxygen
species (ROS) leading to significant and wide spread injury to the liver,
heart, and endocrine organs as well as increases in infection. Acute
transfusion of red blood cells in critically ill patients likewise has
significant effects including increased mortality, prolonged hospital
stays, and elevated risk of nosocomial infection. These effects appear to
be more profound with increasing age of stored blood. The progressive
release of free iron associated with storage time suggests that morbidity
following acute transfusion, like that seen in chronic transfusion, may be
due in part to elevated levels of NTBI.
COAGULANTS
Emergency reversal of antithrombotic treatment.
Intern
Emerg Med.
2008 Nov 12. [Epub ahead of print] Heparin and heparin derivatives
can be counteracted by protamine sulphate, whereas the anticoagulant
effect of vitamin K antagonists may be neutralized by administration of
vitamin K or prothrombin complex concentrates. The anti-hemostatic effect
of aspirin and other anti-platelet strategies can be corrected by the
administration of platelet concentrate or desmopressin, if needed.
Use of antifibrinolytic therapy to reduce transfusion in patients
undergoing orthopedic surgery: A systematic review of randomized trials.
Thromb
Res.
2008 Nov 11. [Epub ahead of print] Antifibrinolytic agents may
reduce bleeding and transfusion in patients undergoing THR or TKA who
receive appropriate antithrombotic prophylaxis. There is a need for a
large, adequately powered prospective study to carefully examine the
safety and efficacy of these agents.
SURGICAL TECHNIQUES
Management of upper gastrointestinal bleeding.
Curr
Gastroenterol Rep.
2008 Dec;10(6):535-42.
Effective medical and endoscopic management of ulcer hemorrhage can
significantly improve outcomes and decrease the cost of medical care by
reducing rebleeding, transfusion requirements, and the need for surgery.
HAEMATOLOGICA
Primary Myelofibrosis: Update on Definition, Pathogenesis, and
Treatment.
Annu
Rev Med.
2008 Oct 23. [Epub ahead of print] An updated review of the
pathogenesis, definition, and treatment of PMF in light of the discovery
of JAK2 and MPL mutations, as well as other recent work in the
myeloproliferative neoplasm field. Expected final online publication date
for the Annual Review of Medicine Volume 60 is January 07, 2009. Please
see http://www.annualreviews.org/catalog/pubdates.aspx for revised
estimates.
THROMBOPOIETIC AGENTS
Thrombopoietin and Thrombopoietin Mimetics in the Treatment of
Thrombocytopenia.
Annu
Rev Public Health.
2008 Oct 31. [Epub ahead of print] In 2008 two new drugs that mimic
the effect of TPO became available to treat thrombocytopenia. Romiplostim
is a TPO peptide mimetic given by subcutaneous injection that activates
the TPO receptor by binding to the distal hematopoietic receptor domain
just like TPO. Eltrombopag is a TPO nonpeptide mimetic administered orally
that activates the TPO receptor by binding to the transmembrane domain.
Both increase the platelet count in healthy humans as well as in >80%
of patients with immune thrombocytopenic purpura (ITP). Ongoing studies
should establish the incidence of these complications and determine the
efficacy of these new agents in a variety of other thrombocytopenic
conditions. Expected final online publication date for the Annual Review
of Medicine Volume 60 is January 07, 2009. Please see
http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates
Romiplostim.
Nat
Rev Drug Discov.
2008 Nov;7(11):887-8.
In August 2008, romiplostim (Nplate; Amgen), a
thrombopoietin receptor agonist, was approved by the US FDA for the
treatment of thrombocytopaenia in patients with chronic immune
thrombocytopaenic purpura who have had an insufficient response to
corticosteroids, immunoglobulins or splenectomy.
ERYTHROPOIETIC THERAPY
BLOOD SUBSTITUTES
HEMODILUTION
CARDIO-THORACIC SURGERY
CELL SALVAGE
INTERVENTIONAL RADIOLOGY
SEALANTS
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GlaxoSmithKline
plc Announces Start Of Eltrombopag
Phase III Worldwide Clinical Trial In Adults With
Previously-Treated Idiopathic Thrombocytopenic Purpura.
Click here
Baxter
BioSurgery
is a division of Baxter Healthcare, which markets advanced biomaterials for
hemostasis and tissue sealing. One of the latest products launched is FloSeal,
an adjunct hemostatic agent indicated in surgical procedures other than
ophthalmic (please refer to the package insert for details on approved
indication). FloSeal is effective in the presence of anticoagulants such as
heparin, and in patients placed on cardiopulmonary bypass, which can impair
coagulation ability.
TissueLink
-
Surgeons are able to simultaneously seal and dissect liver tissue with
one, easy-to-use device. The unique technology behind TissueLink’s DS™ devices
couples radio-frequency (RF) energy with saline to seal liver and pancreatic
tissue without charring or re-bleeding. Surgeons can pre-coagulate parenchyma
and vessels prior to transection to prevent or reduce blood loss.
TissueLink’s BPS™ line of products are designed to provide a rapid hemostatic
effect in hip and knee arthroplasty. These devices have the ability to
comprehensively treat broad surface areas such as cut bone. By delivering saline
to the point of tissue contact, both product lines reduce patient exposure to
allogenic blood and reduce the need for or eliminate other blood management
techniques. TissueLink Medical — Simply Better Surgery™.(video library).
The Hemobag - Global
Blood Resources has received US FDA clearance to market its novel Hemobag and
TS3 Tubing Set products for the salvage, hemoconcentration and reinfusion of
autologous whole blood instead of red blood cells only. Saving whole blood
enable perfusionist and anesthesiologist to return concentrated platelets,
clotting factors and plasma proteins back to the patients quickly, potentially
enhancing homeostasis and reducing bleeding activity. See
the Video:
www.mybloodfirst.com
The
Dideco
CryoSeal FS System
produces concentrated Thrombin and the same amount of
Cryoprecipitate containing highly concentrated Factor VIII, Factor XIII, and
fibrinogen from a single unit of autologous or allogeneic plasma in about one
hour. The components, collected in a dual syringe system, can be used on the
surgical field to produce fibrin glue.
Z-Medica
is the developer of hemostatic agents such as QuikClot ® and
Hemosorb™, medical breakthrough products that speed the coagulation of
blood.
QuikClot has undergone rigorous testing that proved it is unsurpassed in safely
and effectively stopping blood loss, the primary cause of death from severe
bleeding injuries.
QuikClot has received FDA 510(k) clearance on September 7,
2004
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The
XII International Symposium on
Blood Substitutes(ISBS)
will be held in Parma, Italy, on August 25-28, 2009.
Informations on the symposium are available on the
web page
FDA
Public Workshop 2008
The Food
and Drug Administration (FDA), the National Heart, Lung and
Blood Institute, National Institutes of Health; and the
Department of Health and Human Service's Office of the
Secretary and Office of Public Health and Science (OS/OPHS)
co-sponsored a public workshop entitled: "Hemoglobin
Based Oxygen Carriers: Current Status and Future
Directions."
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By:
Petra Seeber and Aryeh Shander
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PeerView
in Review:
Anemia Management and Blood Conservation in the Hospital Setting
-
Restrictive Blood Transfusion Does
Not Worsen Clinical Outcome
CME/CE
David Henry,
MD
Pennsylvania Hospital
Philadelphia, Pennsylvania
- Blood Transfusion and Adverse Events
CME/CE
Patricia Ann
Ford, MD
Pennsylvania Hospital
Philadelphia, Pennsylvania
-
Exogenous Erythropoietin Reduces
Blood Transfusion in Critically Ill
CME/CE
Lena
Napolitano, MD
University of Michigan Medical School
University of Michigan Health System
Ann Arbor, Michigan
- Blood Conservation Reduces Transfusion and
Associated Risks in Surgical Patients CME/CE
Aryeh
Shander, MD
Englewood Hospital Medical Center
Englewood, New Jersey
Mount Sinai School of Medicine
New York, New York
 TATM
Treatment of a Jehovah's Witness using a
transfusion-free autologous stem cell transplant protocol. Community
Oncology 2006 Dec 12; 3(12):776-81 (PDF Full Text)
Extreme intraoperative blood loss and
hemodilution in a Jehovah's Witness:
new aspects in postoperative management
A 41 year
old female Jehovah's Witness patient was admitted for elective hysterectomy (large
uterine myoma). Unexpected massive bleeding occurred during the operation.
Wer hematocrit at the preoperative visit was 37,4% . At the end of the
surgery it was 8 %! In postoperative day 2 hematocrit was 6,4%
What would you do in this
case?
Anesthesiology
1999 December; 91(6):1949-1951
Nation's blood
supply failing to meet demand. Fears emerge that new restrictions on blood
donors will add to a year of national shortages. AMNews
- Aug. 20, 2001
Emerging
infectious disease issues in blood
safety.
In recent years,
numerous infectious agents found worldwide have been identified as potential
threats to the blood supply. Several newly discovered hepatitis viruses and
agents of transmissible spongiform encephalopathies present unique challenges
in assessing possible risks they may pose to the safety of blood and plasma
products. Emerg
Infect Dis. 2001;7(3 Suppl):552-3. See also
Annu Rev Med. 2004;55:191-207. Review. And:
Lancet.
2006 Jan 21;367(9506):252-61.
BROWN UNIVERSITY - Excellent website with comprhensive informations about blood
substitutes.
This site has been developed to
provide an up-to-date, unbiased and critical review of the current medical
issues surrounding blood substitutes. Our aim is to make available, an
informative yet concise insight into the recent and current research into this
exciting field of study.
Queens Medical Centre NHS Trust, Nottingham
An online
introduction to Intra-operative Cell Salvage
for Nurses, ODPs, Perfusionists, Surgeons and Anaesthetists. This is a pilot
course,
available until September 2005
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