A survey on the availability and convenience of emergency blood transfusion in mainland China / 中国输血杂志

【Objective】 To investigate the availability and convenience of emergency blood transfusion in mainland China, and develop strategies for improvement. 【Methods】 The electronic questionnaire was self-made by the research team, and pushed to physicians and technicians related to emergency blood use and supply nationwide through the WeChat group of professional organizations such as the Chinese Medical Doctor Association′s Emergency Resuscitation and Disaster Medicine Professional Committee. The data was automatically aggregated by the internet survey platform named questionnaire star, and analyzed by statistics software SPSS 21.0. 【Results】 1) General information: A total of 3 151 questionnaires were collected, of which 85% (2 678 / 3 151), from 31 provinces, municipalities or autonomous regions in mainland China were valid, and 39%(1 044/2 678), 22%(577/2 678), 39%(1 057/2 678) were from the east, middle and west region, respectively; 78%(2 099/2 678) were from tertiary hospitals, and 22%(579/2 678) secondary hospitals and below; 60%(1 607/2 678), 16%(425/2 678), and 24%(646/2 678) were from Emergency Department(EM), Intensive Care Department (ICU) and other departments respectively. The respondents with senior position titles took up 34%(906/2 678) while those with intermediate and junior position titles took up 30% (798/2 678) and 36%(974/2 678) respectively. 2) Availability : 63%(1 680/2 678) of the respondents experienced untimely and insufficient blood supply at least once during June 2017 to May 2020, of which 75% (1 256/1 680) occurred in the past year. In the past half year, 51% (381/1 057) of respondents in the western region and 34% (713/2 099) in tertiary hospitals experienced more emergency blood shortages (P<0.05). The most prone to clinical blood supply shortage were red blood cells and whole blood, platelets and other plasma components, accounting for 43% (1151/2678), 42% (1125/2678) and 15% (402/2678), respectively. 48% (1 274/2 678) respondents believed that the insufficient blood supply for emergency use " has caused a significant adverse effect on the quality of rescue", and 40% (1 081/2 678) believed that it was " a potential medical safety threat" .3)Convenience: The waiting time for emergency blood transfusionwithin 0.5 h, 1 h and 2 h accounted for 28% (741/2 678), 71%(1 903/2 678) and 90% (2 547/2 678), respectively. The waiting time of emergency blood transfusion within 0.5 h accounted for 50% (286 / 577) in central region, which was significantly higher than that in eastern or western region (P < 0.05). 67% (889/2 678) of respondents experienced blood inventory depletion, of which 30%(792/2 678) had to wait for more than 8 hours for resuming blood supply. 80% (751/1 057) of the respondents in the western region experienced inventory depletion, significantly higher than that in the central region (P<0.05). 4)The influencing factors were mainly insufficient blood donation, growth of clinical demand in blood, blood waste due to expiration and clinical irrational use, accounted for 56% (1 485/2 678), 23% (619/2 678), 7% (183/2 678) and 6% (167/2 678) respectively. 60% (633/1 057) of the respondents in the western region considered insufficient blood donation as the influencing factors, statistically higher than that in the eastern and central regions (P<0.05).5)Suggestions for improvement included more voluntary blood donation, development of blood substitutes, standardization of clinical blood use and extension of blood storage shelf life, accounted for 49% (1 326/2 678), 24% (645/2 678), 19% (499/2 678), and 8% (208/2 678), respectively. 53% (561/1 057) of the respondents in the western region suggested strengthening voluntary blood donation (P<0.05), while 26% (268/1 044), 26% (152/577), 25% (553/2099) of respondents in the eastern, central region and tertiary hospitals respectively suggested strengthening the research and development of blood substitutes (P<0.05). 56% (504/906) of respondents with senior professional titles recommended strengthening voluntary blood donation, while 26% (453/1 772) and 0.9% (164/1 772) of those with intermediate and junior technical titles recommended research and development of blood substitutes and improvement of blood storage technology, respectively(P<0.05). 【Conclusion】 The whole blood reserve can not fully meet clinical emergency needs at present stage, especially in the western region and some tertiary hospitals,, showing the necessity to adopt comprehensive measures to further improve the availability and convenience of emergency blood transfusion, including strengthening voluntary blood donation, developing blood substitutes, prompting rational clinical blood use and improving blood storage technology.

Recomendaciones basadas en la evidencia de terapia transfusional en el paciente oncológico en pediatría / Transfusion therapy evidence-based recommendations for the pediatric cancer patient

Introduction: Transfusion therapy is probably one of the most widely used therapies with poor supporting evidence, despite the long years of practical clinical use. Objective: To adapt the evidence-based recommendations on the use of blood products to the Colombian setting: red blood cells, platelets, cryoprecipitates and irradiated blood products in cancer patients under 18 years of age. Methods: Standard methodologies were followed in the development of recommendations. First, the clinical questions were addressed, and the evidence-based clinical practice guidelines were identified, graded and selected to answer the clinical questions. A systematic methodology was used to qualify, obtain and describe the relevant information to generate recommendations based on the SIGN system. The results were then presented and discussed in a group of experts to establish the practical value of the evidence and to adapt the recommendations to the Colombian environment. Results: Out of 107,441 preliminary titles, 56 studies were analyzed, and from them 3 clinical practice guidelines and 4 Cochrane systematic reviews were selected. This evidence was evaluated using AGREE II and AMSTAR. Red blood cells transfusion support is recommended using the restrictive strategy. Prophylactic platelet transfusion is the recommended indication. Cryoprecipitate is recommended when fibrinogen levels fall below 100mg/dL, and indications on irradiated blood products were established. Conclusion: This paper is an evidence-base approach on the recommendations for transfusion therapy in children with cancer.

Introducción: La terapia transfusional es quizá una de los tratamientos de mayor uso sin buen respaldo de evidencia, a pesar de muchos años de uso en la práctica clínica. Objetiuo:Adaptar recomendaciones basadas en evidencia al contexto colombiano sobre el uso de hemocomponentes: glóbulos rojos, plaquetas, crioprecipitados y hemocomponentes irradiados en el paciente oncológico menor de 18 años. Métodos: Se utilizaron metodologías estándares para el desarrollo de las recomendaciones. Primero se formularon las preguntas clínicas, se identificaron, calificaron y seleccionaron las guías de práctica clínica basadas en la evidencia que respondían las preguntas clínicas, utilizando una metodología sistemática se realizó la calificación, extracción y descripción de los aspectos relevantes para generar recomendaciones usando el sistema SIGN, luego se realizaron exposición y discusión de los resultados obtenidos con un grupo de expertos para seleccionar la utilidad de la evidencia y adaptar las recomendaciones al contexto colombiano. Resultados: De 107.441 títulos preliminares, se analizaron 56 estudios, y de estos se escogieron 3 guías de práctica clínica y 4 revisiones sistemáticas Cochrane. Se evaluó esta evidencia con AGREE II y AMSTAR. Se recomienda soporte transfusional de glóbulos rojos usando la estrategia restrictiva, la estrategia transfusional profiláctica de plaquetas es la indicación recomendada. El valor de fibrinógeno menor de 100mg/dl es el recomendado para utilizar crioprecipitados y se determinaron las indicaciones sobre hemocomponentes irradiados. Conclusiones Este trabajo representa un enfoque basado en la evidencia sobre las recomendaciones de terapia transfusional para niños con cáncer.

Hemodynamic Analysis in Patients Who Underwent Lumbar Spine Fusion Surgery without Blood Transfusion / 대한정형외과학회잡지

PURPOSE: Lumbar fusion surgery was performed on transfusion-free patients and hemodynamic changes were analyzed. MATERIALS AND METHODS: A total of 36 transfusion-free patients who had undergone lumbar fusion surgery using recombinant human erythropoietin (rHuEPO) before surgery from April 2007 to March 2014 were included in the study. Hemoglobin and hematocrit levels were measured before surgery, immediately after surgery, 12 hours after surgery, on day 1, day 2, day 3, and day 7. Changes in levels were investigated and the factors affecting the changes in hemoglobin levels were analyzed. RESULTS: Changes in hemoglobin and hematocrit were -18.11% before surgery and -22.92% on day 7, respectively, and they tended to recover from day 2 after surgery. Depending on the patient's age, gender, body mass index, blood loss, and surgery method (presence of lumbar interbody fusion), the changes in hemoglobin level did not show statistically significant differences; however, significant differences were observed in the surgical time and extent of the operation. CONCLUSION: Transfusion alternatives during lumbar spinal fusion are deemed safe methods, leading to good, postoperative hemodynamic outcomes. However, the surgical time and extent of the operation must be determined before surgery.

Knowledge, Attitude and Practice of Blood Conservation Strategies amongst Physicians’ in Tertiary Hospitals.

Aim: To assess the extent of available knowledge, as well as the attitudes and the utilization of blood conservation strategies amongst medical doctors, who are the implementers of blood transfusion and conservation in clinical practice. Study Design: A cross-sectional study. Place and Duration of Study: Clinical Departments in both Lagos State University Teaching Hospital, Lagos State and Babcock University Teaching Hospital, Ogun State between August 2013 and November 2013. Methodology: We included clinicians from various medical specialties in the study (78 from public hospital and 26 from private hospital). A pre-tested, self-administered questionnaire was devised to collect data. Data was entered and analyzed descriptively and qualitatively. Result: A total of 104 doctors participated in the study consisting of 57 males (54.80%) and 47 females (45.29%). Almost all participants had transfused blood in their practice and all participants were aware that blood transfusions have complications. Majority 80 (76.9%) had heard about blood conservation techniques, about 51 (49%) had used any of the strategies. If available, 93 (89.4%) would use any of the strategies, only 1 (1%) would not. Conclusion: There is a need for hospital transfusion committees to educate and increase the drive for utilization of blood conservation methods amongst doctors, so as to increase its practice.

A clinical study of VOLUVEN and HES used for acute hypervolemic hemodilution on Hepatectomy / 中国基层医药

Objective To explore the safety and feasibility of VOLUVEN and HES used for acute hyperv-olemic hemodilution on selective Hepatectomy .Methods 42 patients ( ASAⅠ ~Ⅱ) were randomized to the two groups(Ⅰ,VOLUVEN group;Ⅱ,HES group),20 minutes before the operation,the two groups of patients underwent AHH with VOLUVEN and HES respectively at the same quantity and speed ,and then the changes of haemodynamics , blood gas analysis ,electrolyte and coagulation indexes were detected .Results InⅠgroup,the changes of HB、HCT, PLT,central venous pressure had statistical significance before and after AHH (t=7.880,32.257,7.303,22.812,all P=0.000).InⅡgroup,the changes of HB,HCT,PLT,central venous pressure had statistical significance before and after AHH(t=5.398,14.924,11.171,5.620,all P=0.000).For inter-group,VOLUVEN has less effect than HES on central venous pressure(t=2.367,P=0.023).Conclusion Using VOLUVEN or HES can keep hemodynamics stable and improve the ischemic tolerance for AHH in liver surgery .VOLUVEN has less effect on central venous pressure.

Effects of L-Arginine on microcirculation perfusion after banked-blood transfusion in rabbits with hypovolemia / 中华麻醉学杂志

Objective To investigate the effects of L-Arginine(L-Arg) on microcirculation perfusion after banked-blood transfusion in rabbits with hypovolemia.Methods Thirty healthy male New Zealand white rabbits weighing 2.0-2.5 kg were randomly divided into 3 groups (n =10 each): groups Ⅰ-Ⅲ.Hypovolemia was induced by blood letting (20％ of blood volume) and the equal volume of banked-blood was transfused 30 min later in groups Ⅰ and Ⅲ.25％ L-Arg 300 mg/kg was injected iv 5 min before blood letting in group Ⅲ,and the equal volume of normal saline was injected in group Ⅰ.Group Ⅱ only received 25％ L-Arg 300 mg/kg.MAP,CVP and tip perfusion index (TPI) were recorded at before (T0) and after blood letting (T1),end of banked-blood transfusion (T2),1 h ( T3 ) and 2 h (T4) after banked- blood transfusion,and blood samples were taken for determination of plasma lactate and nitric oxide (NO) concentrations.Results TPI was higher at T2-T4,plasma lactate concentration lower at T1 -T4 and plasma NO concentration lower at T3,T4 in groups Ⅱ and Ⅲ than in group Ⅰ ( P ＜0.05).There was no significant difference in MAP between groups Ⅱ,Ⅲ and group Ⅰ ( P ＞ 0.05).MAP was lower at T1 in group Ⅲ than in group Ⅱ (P ＜ 0.05).There was no significant difference in CVP among the 3 groups( P ＞ 0.05).Conclusion Pretreatment with L-Arg can increase microcirculation perfusion,and has no effect on hemodynamics in rabbits with hypovolemia after banked-blood transfusion.

Testemunhas de jeová ante o uso de hemocomponentes e hemoderivados / Jehovah's Witnesses attitude towards hemocomponents and hemoderivatives

OBJETIVO: Estudar o grau de conhecimento e aceitação de hemocomponentes e hemoderivados, frescos e armazenados, pelas testemunhas de Jeová e propor ferramentas bioéticas para o enfrentamento de eventuais conflitos éticos e morais nas relações com médicos e dentistas. MÉTODOS: Aplicação de questionários a 150 testemunhas de Jeová que frequentam Salões do Reino no Distrito Federal, Brasil. Os questionários buscaram respostas a aspectos sociodemográficos relacionados à possível aceitação de hemocomponentes e hemoderivados pelos pesquisados, bem como a atitude dos profissionais de saúde ante à opção religiosa dos pacientes. RESULTADOS: Dos pesquisados: 74 por cento acreditam que usar sangue provoca mais malefícios do que benefícios à saúde (fundamentação essencialmente bíblica); 96 por cento não aceitam usar hemocomponentes, mas 76 por cento aceitam usar hemoderivados em situações específicas, demonstrando haver entendimentos particulares sobre o tema; 80 por cento se sentem moralmente ofendidos com o uso de sangue armazenado e apenas 45 por cento com sangue fresco, confirmando a interpretação religiosa de que produtos frescos são em geral mais aceitos; segundo 83 por cento dos pesquisados, seus dentistas não perguntaram a religião dos pacientes contra 71 por cento dos médicos, demonstrando pouca preocupação dos profissionais neste aspecto. CONCLUSÃO: As testemunhas de Jeová são vistas por seus "estranhos morais" (aqui, médicos e dentistas) como religiosos que simplesmente "não aceitam sangue". Todavia, diversos tratamentos sanguíneos são hoje aceitos, o que não impede, por livre convicção, a recusa no recebimento de qualquer deles. As interpretações particulares costumam ampliar o rol de proibições e de conflitos morais, já que médicos e dentistas, além de não considerar estas particularidades, também não perguntam a religião na anamnese.

OBJECTIVE: To study extent of knowledge and acceptance of hemocomponents and hemoderivatives, fresh and stored, by Jehovah's Witnesses and also propose bioethical tools for any ethical and moral conflicts identified in their relationship with physicians and dentists. METHODS: A questionnaire was used to interview 150 Jehovah's Witnesses who attend "Salões do Reino" in the Distrito Federal, Brazil. The questionnaire was directed towards information on socio-demographic aspects related to the use (or not ) of hemocomponents and hemoderivatives by those interviewed and also approach of healthcare professionals with patients of this belief. RESULTS: 74 percent believe that the use of blood causes more harm than benefits to health - refusal is essentially based on the Bible 96 percent do not support hemocomponents, but 76 percent support hemoderivatives in specific situations, showing that personal understandings do exist; 80 percent feel morally offended with use of stored blood and only 45 percent with fresh blood, confirming the religious interpretation that fresh products are in general more accepted; according to 83 percent of the interviewees dentists do not ask about patients' religion, whereas 71 percent of physicians do, showing little professional concern about this aspect. CONCLUSION: Jehovah's Witnesses are seen by their "moral outsiders" (here physicians and dentists) as the religious group that simply "does not use blood". Although, several blood treatments are nowadays permitted,. it does not deprive them from a free conviction to refuse blood treatments. Their particular understandings frequently extend the list of blood prohibitions and, consequently, the number of moral conflicts, when considering that physicians and dentists usually do not ask about a patient's religion.

Artificial oxygen carriers as a possible alternative to red cells in clinical practice: [review] / Transportadores artificiais de oxigênio como possível alternativa às células vermelhas na prática clínica: [revisão]

Fluid resuscitation is intended to eliminate microcirculatory disorders and restore adequate tissue oxygenation. The safety limits for a restrictive transfusion policy are given by patients' individual tolerance of acute normovolemic anemia. Artificial oxygen carriers based on perfluorocarbon or hemoglobin are attractive alternatives to allogenic red blood cells. There are many risks involved in allogenic blood transfusions and they include transmission of infections, delayed postoperative wound healing, transfusion reactions, immunomodulation and cancer recurrence. Regardless of whether artificial oxygen carriers are available for routine clinical use, further studies are needed in order to show the safety and efficacy of these substances for clinical practice.

Os fluidos de ressuscitação são utilizados para abolir os distúrbios microcirculatórios e restaurar a adequada oxigenação tissular. Os limites de segurança na prática da transfusão restrita são dados pela tolerância individual do paciente na anemia normovolêmica aguda. Os transportadores artificiais de oxigênio baseados no perfluorocarbono e na hemoglobina são opções atrativas para a transfusão alogênica de células vermelhas. Os riscos da transfusão sanguínea alogênica são muitos e incluem a transmissão de infecções, retardo na cicatrização pós-operatória, reações transfusionais, imunomodulação e risco de recorrência do câncer. Independentemente de os carreadores artificiais de oxigênio estarem disponíveis para o uso clínico rotineiro, mais estudos são necessários para mostrar a segurança e a eficácia dessas substâncias na prática clínica.

Importância dos carreadores de oxigênio livre de células: [revisão] / Oxygen carriers free of cells in transfusion medicine: [review]

Os procedimentos necessários para redução de efeitos adversos associados à transfusão de sangue, em especial aqueles decorrentes da transmissão de agentes infecciosos e da aloimunização leucócito-mediada têm impacto nos custos de produção de hemocomponentes. Paralelamente, as necessidades transfusionais têm aumentado globalmente, ficando evidente a necessidade de um substituto seguro e amplamente disponível para o sangue, chamado de sangue artificial ou de substituto do sangue. Visto que o seu desenvolvimento tem se concentrado na função de carrear oxigênio aos tecidos, daí utilizarmos, nesse texto, a denominação "Carreadores de oxigênio livre de células". Atualmente, dois tipos de carreadores de oxigênio livre de células têm sido testados: as soluções de hemoglobina modificadas (de origem humana ou bovina) e os perfluorocarbonos (PFCs). Entretanto, esses produtos não são isentos de efeitos adversos e um grande número de pesquisas clínicas está em andamento para testar sua eficácia e segurança. O maior conhecimento desses carreadores de oxigênio livre de células e seus mecanismos de ação permitiu que aplicações outras, até mesmo não clínicas, estivessem em teste com as novas gerações desses produtos, expandindo assim as fronteiras da medicina transfusional.

The procedures needed to reduce transfusion-associated adverse effects, especially those related to transfusion-transmitted diseases and leukocyte-mediated alloimmunization, have a great impact on the production cost of blood components. Additionally, blood transfusion has increased worldwide making the need for a safe substitute for blood evident. These products have been named artificial blood or blood substitutes. Based on the fact that their focus has been oxygen delivery to tissues, "free oxygen carrying cells" is more appropriate. Two major groups of free oxygen carring cells have been tested: modified hemoglobin solutions (bovine or human) and perfluorocarbons (PFCs). Even though not without adverse effects, extensive clinical trials are being conducted to test their safety and efficacy. The understanding of free oxygen carrying cell mechanisms has made testing of a new generation of these products for other applications possible thereby expanding transfusion medicine frontiers.

Sustitutos de la sangre / Blood substitutes

Los sustitutos de la sangre, muchos de ellos aún en desarrollo, pueden constituir en un futuro no muy lejano un importante medio terapéutico, capaz de sustituir el empleo de componentes de la sangre alogénica, lo que evadiría los riesgos que el empleo de estos entraña. Entre ellos se encuentran sustitutos de los eritrocitos, de las plaquetas y del plasma, obtenidos a partir de sangre humana, de animales transgénicos o por tecnología recombinante. En el presente trabajo se hace una breve descripción de cada uno de ellos y el estadio de desarrollo y aplicación clínica en que se encuentran. No se abordan en esta revisión los factores de crecimiento, también útiles al estimular el crecimiento y diferenciación de células hematopoyéticas.

Blood substitutes, many of them still under development, may be in a near future an important therapeutic tool capable of substituting the use of allogeneic blood components, which will avoid the risk of using them. Among these blood substitutes, there are red cell, platelet and plasma substitutes obtained from human blood, blood of transgenic animals or by recombinant technology. A brief description of each of them and of the stage of development and clinical application in which they are is made. The growth factors, which are also useful on stimulating the growth and differentiation of hematopoietic cells are not approached in this review.