The Effects Of Normovolemic Anemia And Blood Transfusion On Cerebral Microcirculation After Severe Head Injury
2018, Intensive Care Medicine Experimental
Severe head injury often combines the effects of a contusion with an accelerationdeceleration force leading to axonal tearing, cytogenic, vasogenic edema, impaired cerebral autoregulation, and subsequent perfusion mismatch . Secondary patho-physiologic processes may ultimately result in areas of ischemia and cerebral infarct. These changes are commonly found in regions where cerebral microcirculation has been critically reduced . An additional contributor to cerebral ischemia is partial pressure of tissue oxygenation with a series of studies focussing on the relevance of cerebral oximetry . While current evidence-based practice attempts to minimise the use of allogenic blood transfusions, specifically amongst critically ill patients by establishing a restrictive transfusion threshold controversy still remains regarding the safety of these measures, specifically when facing sustained low PtiO 2 levels, during the acute phase of head injury . Studies have showed…
Fda Advisory On The Use Of Erythropoietin
The U.S. Food and Drug Administration approved revised labeling for the erythropoiesis-stimulating agents Procrit® , Epogen® , and Aranesp® .
For patients with cancer, the November 2007 Public Health Advisory makes the following points.
- ESAs may shorten your survival time or may cause your tumors to grow faster.
- ESAs should only be used to treat anemia caused by chemotherapy and not anemia from other causes in patients with cancer.
- ESAs should not be used to treat the symptoms of anemia, such as fatigue, or improve the quality of life in patients with cancer. The goal of treatment with ESAs is to avoid blood transfusions.
- Treatment with an ESA should be stopped after you complete your course of chemotherapy.
The studies that reported increased tumor growth or decreased survival with ESAs targeted a hemoglobin level that is higher than the approved level. Nevertheless, the FDA notes that no clinical data are available to determine whether there is a similar risk of shortened survival or increased tumor growth for patients with cancer who receive an ESA dose that attempts to achieve a hemoglobin level of less than 12 g/dL. This is the hemoglobin level commonly achieved in clinical practice.
The FDA recommends that cancer patients discuss this information with their physician before beginning or continuing ESA treatment.
Plasma And Cryoprecipitate Transfusion
Fresh frozen plasma , the fluid that carries blood cells, and cryoprecipitate, the portion of the plasma that contains clotting factors , may be transfused to patients whose blood has abnormal or low levels of blood-clotting proteins. Problems can develop in patients as a result of liver disease or infection. Fortunately, these conditions are uncommon in most people with blood cancers, except for people with promyelocytic leukemia, who may need transfusions to prevent or treat bleeding.
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Types Of Transfusion Reactions
When getting a blood transfusion, there are many different types of transfusion reactions that may occur. These include:
- Acute hemolytic reactions. This can happen if there’s red blood cell damage before the transfusion due to heat or an imbalance in the cells.
- Simple allergic reactions. This may happen if your blood is hypersensitive to protein in your donor’s blood.
- Anaphylactic reactions. This is similar to a simple allergic reaction but is more severe.
- Transfusion-related acute lung injury . Damage to the lungs occurs when your body reacts to your donor’s antibodies. Your immune system responds to the reaction by releasing chemical mediators that cause edema in the lungs.
- Delayed hemolytic reactions. This may happen when an antigen gets reintroduced into your blood.
- Transfusion-associated circulatory overload . This may happen when you get too much blood in the body.
- This may happen when your donor’s white blood cells produce cytokines .
- This may happen if the blood is contaminated with bacteria or bacteria waste products.
Other Surgical And Medical Patients
Limiting unnecessary RBC transfusion in other surgical patients is likewise important. The American Society of Anesthesiologists practice guidelines for peri-operative management advocates for thorough assessment of bleeding risk, diagnosis and treatment of anemia and use of pharmacologic adjuncts to decrease blood loss all techniques which will minimize the need for allogeneic RBC transfusion . Restrictive transfusion practice is evidence-based, well-tolerated, safe, and applicable for orthopedic, burn, and surgical oncology patients . There remains some question as to the adequate Hgb level for patients undergoing major vascular surgery. Data is limited. A small pilot study of 58 patients showed higher death rates and major vascular complications with lower Hgb, < 8.0 g/dL . The authors called for further trials prior to extrapolating general restrictive thresholds to these patients.
A recent consensus statement regarding post-operative anemia management after major surgery has been published, helping to clarify interventions which furnish continuity of care for surgical patients before and after discharge .
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Complications Of Blood Transfusions
Most patients who receive a transfusion don’t suffer any adverse reactions. However, it’s still possible for reactions to occur with any blood component. A reaction can occur at the time of the transfusion or not until weeks or months later.
Symptoms and side effects that may occur during or soon after transfusion include:
- A skin rash or hives
- A drop in blood pressure
- Dark or red urine
If you notice any of these changes during a transfusion, however slight, alert the nursing staff promptly. Serious complications can be prevented by recognizing a reaction early, stopping the transfusion and limiting the amount of blood given. Although rare, a hemolytic transfusion reaction can occur when transfused red cells are damaged or destroyed. This can result in a drop in blood pressure, bleeding or kidney damage that may be life-threatening.
Reactions that aren’t immediate include:
The Leukemia & Lymphoma Society® is a global leader in the fight against cancer. The LLS mission: Cure leukemia, lymphoma, Hodgkin’s disease and myeloma, and improve the quality of life of patients and their families. LLS funds lifesaving blood cancer research around the world, provides free information and support services, and is the voice for all blood cancer patients seeking access to quality, affordable, coordinated care.
White Blood Cell Transfusions
White blood cell basics
Chemotherapy can damage cells in the bone marrow, and patients getting chemo often have low white blood cell counts.
White blood cells, especially the type called neutrophils , are very important in fighting infections. When patients have low WBC counts, doctors carefully watch the number of neutrophils or the absolute neutrophil count. Neutropenia is when a persons ANC goes below 1,000/mcL. People with neutropenia are at risk for serious infections, even more so if the count stays low for more than a week.
When white blood cell transfusions are used
White blood cell transfusions are given rarely. Research does not show that giving white blood cell transfusions lowers the risk of death or infection in people with low white blood cell counts or white blood cells that are impaired.
Instead of transfusing WBCs, doctors now commonly use drugs called colony-stimulating factors or growth factors to help the body make its own. These drugs stimulate the body to make neutrophils and other types of granulocytes.
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What Happens During An Iron Infusion
An iron infusion usually takes place at a hospital or hemodialysis center. A doctor or other healthcare provider, such as a nurse, will use a needle to insert a small tube into a vein. This small tube is known as a catheter. Its usually put into a vein in your arm or hand. Then, the healthcare provider will remove the needle, leaving the catheter in your vein.
The catheter is attached to a long tube, which is connected to an IV bag of the iron. The iron has been diluted with a saline solution. This solution is either pumped into your vein or uses gravity to slowly drip down the tube and into your vein.
You may feel a slight pinch in your skin where the IV needle is inserted. There may also be some pressure at the insertion site during the procedure.
The doctor performing the procedure will give you a test dose first to ensure you dont have any adverse reactions from the iron. If you do, they will stop the procedure.
Are Blood Transfusions Safe
Some people worry that the blood they are given may be infected by disease. People who donate blood are carefully screened for infection or viruses such as hepatitis or HIV. This is to make sure the donations are as safe as possible.
All donated blood is tested in the laboratory for infection. Very rarely, there may be an infection in the blood that is not found by these tests. But the risk of being given infected blood is extremely small.
If you have any concerns about receiving a blood transfusion, talk to your doctor or specialist nurse.
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Types Of Blood Transfusions
There are three types of blood transfusions. They include:â
How Blood Transfusions Treat Anemia
The best way to treat anemia depends on the underlying condition that caused it. For example, people with anemia due to colon cancer will require treatment for their cancer.
The most common cause of anemia is iron deficiency, which people can develop for many reasons, including chronic kidney disease, inflammatory bowel disease, and chronic heart failure. Researchers limiting the use of blood transfusions for this sort of anemia.
However, doctors may use blood transfusions to manage and treat specific forms of anemia, such as:
- Sickle cell anemia: This condition affects hemoglobin and distorts the shape of red blood cells. Blood transfusions can be particularly helpful when people are in crisis. Doctors may use blood transfusions to treat pain, chest problems, or leg sores and to prevent stroke.
- Aplastic anemia: When the bone marrowdoes not make enough blood cells, blood transfusions can help prevent infection, bleeding, and fatigue.
- Thalassemia: For people with this condition, in which the body does not make enough normal hemoglobin, blood transfusions help the body keep oxygen moving through the blood.
According to the American Red Cross, who provide the United States with 40% of its blood and blood products supplies, it only takes about 810 minutes to donate a pint of whole blood.
The National Heart, Lung, and Blood Institute note that a blood transfusion usually takes to complete.
The complete process of a blood transfusion may involve more than 70 steps.
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Patients With Sepsis Or Septic Shock
Trials in critically ill patients with sepsis have also found a lack of evidence that RBC transfusion improves outcomes . The Transfusion Requirements in Septic Shock trial included over 900 patients with randomization to Hgb thresholds of 7.0 versus 9.0 g/dL . This trial also included a single-unit transfusion strategy with assessment after each unit. No differences in 90-day mortality, need for vasopressors, duration of mechanical ventilation or occurrence of ischemic events were noted. Post-hoc analysis of a subgroup of patients from the TRISS trial showed no benefit to a liberal transfusion strategy in patients with significant comorbidities such as chronic lung disease, hematologic malignancies or metastatic cancer . Recent guidelines for management of sepsis and septic shock do not recommend transfusion to maintain a specific Hgb level as first-line treatment .
Blood Transfusion During Pregnancy
A blood transfusion is a frequently performed procedure where you receive blood through an intravenous line into one of your blood vessels. Receiving a blood transfusion during pregnancy is not something most women want to think about. However, there are two conditions that may warrant a blood transfusion during pregnancy.
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Having A Blood Transfusion During Pregnancy
Most often, the transfusion required for pregnant and recently pregnant women only involves red blood cells. It is less likely platelets and plasma will be needed. In order to receive the transfusion, a small tube will be inserted into a vein in your hand or arm.
The transfusing blood will move through a drip into your body. Each bag contains approximately 1/3 of a liter of blood and takes an estimated 3 hours to fully transfuse. In some cases, this rate of transfusion can be expedited.
How Is Thalassemia Treated
The type of treatment a person receives depends on how severe the thalassemia is. The more severe the thalassemia, the less hemoglobin the body has, and the more severe the anemia may be.
One way to treat anemia is to provide the body with more red blood cells to carry oxygen. This can be done through a blood transfusion, a safe, common procedure in which you receive blood through a small plastic tube inserted into one of your blood vessels. Some people with thalassemia usually with thalassemia major need regular blood transfusions because their body makes such low amounts of hemoglobin. People with thalassemia intermedia may need blood transfusions sometimes, such as when they have an infection or an illness. People with thalassemia minor or trait usually do not need blood transfusions because they either do not have anemia or have only a mild anemia.
Many times people with thalassemia are prescribed a supplemental B vitamin, known as folic acid, to help treat anemia. Folic acid can help red blood cells develop. Treatment with folic acid is usually done in addition to other therapies.
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Blood Transfusion: What It Is For And Side Effects
Blood transfusion is a procedure in which blood is given to a person through an IV that is placed in one of the blood vessels. The time it takes for this procedure will depend on the amount of blood the person needs, it usually takes between 1 and 4 hours . Blood transfusion is a very safe treatment and although there are people who never need a transfusion in their life, it is a much more common procedure than is believed.
According to the World Health Organization, blood transfusions can save peoples lives and hence the importance of every health center having an important blood supply to provide patients if necessary . The transfusion is performed from a donor subject to another recipient, but it can also be donated to blood banks so that they store this fluid. In this FastlyHealarticle you will learn what blood transfusion is for and what its side effects are .
What Can I Expect During The Transfusion
Before your transfusion, your nurse will:
- Check your blood pressure, pulse and temperature.
- Make sure the donor blood type is a match for your blood type.
- Make sure that the supplied blood is the product ordered by your doctor and is labeled with your name.
During your transfusion, your nurse will:
- Recheck your blood pressure and pulse after 15 minutes.
- Recheck your blood pressure and pulse at the end of the transfusion.
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Anemia And Red Blood Cell Transfusion In The Adult Non
Carolyn D. Burns
Independent Patient Blood Management Physician , , USA
Abstract: Anemia is a global health issue. It is associated with a wide variety of disease states in both medical and surgical patients. Increased morbidity and mortality are notable in patients with even mild anemia. Clinicians often consider red blood cell transfusions as first-line therapy for patients with anemia to raise the hemoglobin level and increase oxygen delivery. RBC transfusion in the hemorrhaging patient can be life- or limb-saving. However, RBC transfusion may result in serious adverse events, both acute and delayed, and thus, the medical decision to transfuse in the non-bleeding, anemic patient must be carefully considered. Recent literature identifies RBC transfusion practice, in a multitude of patient populations, can be readily avoided with attention placed on proper assessment of patient symptoms, optimal diagnosis of the etiology of the anemia, and appropriate treatment thereof. This review seeks to collate the current state of the science regarding RBC transfusions in the adult non-bleeding patient. Evidence-based alternatives to transfusion will also be briefly presented.
Keywords: Anemia red blood cells transfusion
Received: 06 August 2021 Accepted: 02 September 2021 Published: 31 March 2022.
Why Is Blood Type Important
For red blood cell transfusions, it is very important that the patients blood type match the donated blood type. Otherwise, antibodies in the transfused blood may trigger a patients immune response and attack the donated blood cells. If this happens, it can make you very sick. Matching blood type is more important for red cell transfusions than it is for platelets and plasma.
Every person has one of four groups of blood: A, B, AB or O. These blood types are known as the ABO blood type. They indicate whether the patient has antigen A, antigen B, both antigen A and B or neither of these antigens.
Blood is also Rh-positive or Rh-negative. This means that the patient either has the Rh-D antigen or doesnt have it. The blood of someone with type A blood that is Rh-positive is referred to as type A-positive blood.
The transfusions that are safe for each ABO blood type are as follows:
- Type A red blood cells: Safe for people with type A or AB blood
- Type B red blood cells: Safe for people with type B or AB blood
- Type AB red blood cells: Safe for people AB blood
- Type O red blood cells: Safe for people with type A, B, AB or O blood
Safe transfusions by Rh status are as follows:
- Rh-positive red blood cells: Safe for people with Rh-positive
- Rh-negative red blood cells: Safe for people with Rh-negative or Rh-positive red blood cells
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