Time course and etiology of death in patients with severe anemia.

Background: Mortality increases as hemoglobin (Hb) levels fall. Among severely anemic patients, the clinical course, cause of death, and whether there are any warning signs before death are unknown.

Study Design And Methods: A retrospective cohort study was performed of surgical patients who refused red blood cell transfusions for religious reasons and died with a Hb concentration 6 g/dL or less.

Posttraumatic epilepsy: the endophenotypes of a human model of epileptogenesis.

Posttraumatic epilepsy is a common complication of traumatic brain injury (TBI), occurring in up to 15-20% of patients with severe brain trauma. Trauma accounts for approximately 5% of chronic epilepsy in the community. Because it is a common condition, and because of the relatively short latency period between injury and onset of chronic seizures, posttraumatic epilepsy represents a good model to test antiepileptogenic therapies.

Therapeutic plasma exchange reduces ABO titers to permit ABO-incompatible renal transplantation.

Background: Thousands of patients with chronic renal failure die yearly without a kidney transplant due to the severe shortage of donors. Therapeutic plasma exchange (TPE) is performed to permit ABO-incompatible (ABO-I) kidney transplants, but little is known about how well TPE reduces ABO antibodies or complications related to TPE in this clinical setting.

Study Design And Methods: This retrospective study evaluated 46 individuals that received TPE to permit ABO-I kidney transplant.

The critical role of plasmapheresis in ABO-incompatible renal transplantation.

Background: Thousands of patients with chronic renal failure die yearly and are unable to have a kidney transplant due to the severe shortage of donors. Therapeutic plasma exchange (TPE) is performed to remove ABO antibodies and permit ABO-incompatible (ABO-I) kidney transplants, but there is only limited research within this area and a lack of standardized protocols for TPE. This article reviews the literature to provide a historical perspective of TPE for ABO-I kidney transplantation and also provides the Johns Hopkins Hospital protocol with a focus on both titers and TPE.

Transfusion recipient epidemiology and outcomes research: possibilities for the future.

The National Heart, Lung, and Blood Institute (NHLBI) supports major research programs related to the field of transfusion medicine, which encompass blood banking, the practice of transfusion medicine itself, and cellular therapies. Specific programmatic elements have included 1) the Transfusion Medicine/Hemostasis Clinical Trials Network (TMH CTN) charged with conducting clinical trials in transfusion medicine and hemostasis; 2) the Retrovirus Epidemiology Donor Study-II (REDS-II), which includes domestic and international efforts dedicated to blood donor safety and blood availability issues; 3) the Specialized Centers of Clinically Oriented Research (SCCOR) in Transfusion Biology and Medicine that include two major projects, the Biologic and Immunologic Aspects of Transfusion Medicine Program and the Transfusion and Lung Injury Program, and 4) the Transfusion Therapy Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair (FOCUS), a Phase III clinical trial that has as its major goal to determine whether a more aggressive transfusion strategy in surgery patients with cardiovascular disease (or risk factors) is associated with improved functional recovery and decreased risk of adverse postoperative outcomes. Notably, none of these programs supports epidemiologic and clinical outcomes research focused on transfusion recipients.

Autologous serum eyedrops: literature review and implications for transfusion medicine specialists.

Persistent corneal epithelial defects (CEDs) are caused by many diseases that are usually associated with decreased production of tears or reduced corneal sensitivity. Although surgical treatments are available for severe cases, CEDs are still difficult for ophthalmologists to treat. One treatment for CEDs that is uncommonly used in the United States is autologous serum eyedrops (ASEs).

Risk factors for hepatitis C virus infection among blood donors in Beijing and implications for improving the pretesting donor screening process.

Background: The objective was to determine risk factors of hepatitis C virus (HCV) infection in blood donors in Beijing.

Study Design And Methods: A cross-sectional study was conducted in a total of 112 volunteer blood donors at Beijing Red Cross Blood Center (BRCBC) who were identified between January 2002 and December 2003 due to isolated HCV antibody reactivity at a donor screening procedure. The donors were recalled and interviewed about possible risk factor history.

N-terminal pro-brain natriuretic peptide is a useful diagnostic marker for transfusion-associated circulatory overload.

Background: Transfusion-associated circulatory overload (TACO) can be difficult to diagnose and distinguish from transfusion-related acute lung injury (TRALI), but is a relatively common complication that occurs when increases in blood volume overwhelm the cardiovascular system. Brain natriuretic peptide (BNP) has been shown to be a functional marker for TACO. N-terminal pro-brain natriuretic peptide (NT-proBNP) is another marker that could be more helpful than BNP since it has a longer half-life in circulation and is also much more stable in laboratory samples.

The clinical significance of EEG cyclic alternating pattern during coma.

To define the clinical significance of EEG "cyclic alternating pattern" (ECAP). ECAP is the periodic presence of a high-voltage slow waves alternating with low voltage irregular faster activity. This term was first described in comatose patients in 1944.

A multi-Chinese blood center study testing serologic-negative donor samples for hepatitis C virus and human immunodeficiency virus with nucleic acid testing.

Background: A multi-blood center study was conducted to evaluate a human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) multiplex nucleic acid testing (NAT) donor screening test and to determine the residual risk for HIV-1 and HCV infection.

Study Design And Methods: A commercially available HIV-1 and HCV assay (Procleix, Chiron Corp.) was used for simultaneous detection of HIV-1 RNA and HCV RNA on 89,647 unlinked donor samples.

Evaluation of a multiplex human immunodeficiency virus-1, hepatitis C virus, and hepatitis B virus nucleic acid testing assay to detect viremic blood donors in northern Thailand.

Background: Screening of blood donors with nucleic acid testing (NAT) for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) has been implemented recently in the United States. There are limited data, however, on the additional NAT yield of donors in developing countries in Asia where the prevalence of infection is higher. In addition, data on hepatitis B virus (HBV) NAT in high prevalence areas are minimal.

Oxygen therapeutics: pursuit of an alternative to the donor red blood cell.

Context: There is no true substitute for the many functions of human red blood cells, and synthetic products will not replace the need for blood donation in the foreseeable future. Hemoglobin-based oxygen carriers have many characteristics that would serve as a useful adjunct to red cells in clinical settings. Over time, these technologies have the potential to dramatically reshape the practice of transfusion medicine.

The production of red blood cell alloantibodies in mice transfused with blood from transgenic Fyb-expressing mice.

Background: A murine model would be useful to identify which immune mechanisms could be manipulated to treat or prevent red blood cell (RBC) alloimmunization in patients who become sensitized to multiple or widely expressed antigens.

Study Design And Methods: Transgenic mice (B6CBAF1/J-Tg-Fy(b)) expressing the human Fy(b) antigen of the Duffy (Fy) blood group were donors. Recipient B6CBA-F1 mice received four weekly intravenous (IV) transfusions: either 0.

Prevalence of HLA antibodies in transfused patients with and without red cell antibodies.

Background: Multiply transfused patients are at increased risk of developing red cell (RBC) antibodies, as well as antibodies to HLA. Although pretransfusion testing screens for RBC antibodies, no such testing is routinely performed for HLA antibodies. Determining which patients are more likely to make HLA antibodies may be important for patients undergoing elective surgery where platelets (PLTs) may be required.

Demographic characteristics and risks for transfusion-transmissible infection among blood donors in Xinjiang autonomous region, People's Republic of China.

Background: The recruitment and retention of voluntary, nonremunerated blood donors continues to be a challenge in China. Understanding donor demographics and donor characteristics is crucial for any blood center in developing strategies to recruit potential donors.

Study Design And Methods: The study population included all 29,784 whole blood donors from January 1 to December 31, 2003, at the Urumqi City Blood Center or one of its mobile blood collection buses.