Feasibility of a predeposit autologous blood donation program in colorectal cancer patients: results from a randomized clinical study.

The hematologic and transfusion data of a multicenter randomized trial investigating the effect of blood transfusions on the 5-year survival were used to study the feasibility of an autologous blood donation program in colorectal cancer patients. Three hundred and ten patients were randomized for autologous blood transfusions (predeposition of 2 units) or homologous blood transfusions, and transfusion rules were standardized. The Hb level in the patients who donated blood decreased by 20.1 +/- 1.3 g/l (mean +/- SEM) preoperatively and 4.5 +/- 1.8 g/l postoperatively, and in controls 3.7 +/- 1.1 g/l and 16.5 +/- 1.9 g/l (significantly different between the two groups, both pre- and postoperatively: p less than 0.01). Because blood loss and number of transfusions were similar in both groups, this indicated that either preoperative or postoperative erythropoiesis is stronger in patients who had donated blood. Twenty-three percent of the autologous patients and 61% of the homologous patients were exposed to homologous blood. The effectiveness of the procedure differed per tumor localization. In patients with a right-sided colon carcinoma, 22% of the control patients needed homologous blood, compared to 10% of the autologous patients. In patients with other colon carcinomas, this was 52 and 16%, respectively, and in patients with a rectal carcinoma 85 and 41%. We conclude that predeposition of 2 units of blood for colorectal cancer surgery is feasible and useful to prevent homologous blood usage in a significant number of patients with left colon carcinoma or rectal carcinoma.

Optimal hemotherapy in elective surgery.

The transfusion incidence and the crossmatch/transfusion ratio are expected to provide objective guidelines for hemotherapy in elective surgery. For those surgical procedures which rarely require hemotherapy an ABO Rh-D typing and an antibody screening test without a crossmatch were recommended as preoperative tests. For surgical procedures with a moderate to high transfusion incidence it is suggested that the number of units to be crossmatched preoperatively should be equal to the average number of units transfused for that procedure in the past. Under conditions of normovolemia and normal cardiopulmonary function initial blood loss up to two units can readily be replaced by colloid solutions. For medical reasons transfusion of packed red cells are preferred to whole blood. supply of whole blood is only needed when rapid replacement of large amounts of blood is imminent or expected. The use of a surgical blood order schedule (SBOS) is very useful to reduce excessive preoperative crossmatching. The establishment of appropriate guidelines and recommendations can lead to an increase in quality and safety of blood transfusion and substantial economic savings.

Transfusion syphilis, survival of Treponema pallidum in stored donor blood. II. Dose dependence of experimentally determined survival times.

The hypothesis that experimentally determined survival times of Treponema pallidum in stored donor blood could be related to the number of treponemes initially present in the treponeme-blood mixtures was investigated by inoculating rabbits with three graded doses of treponemes suspended in donor blood and stored at 4 degrees C for various periods of time. The storage periods up to which living treponemes could be detected in the testes of the inoculated rabbits as well as those storage periods up to which seroconversion occurred are related to the number of treponemes present in the treponeme-blood mixtures. Increasing numbers of treponemes present in the donor blood resulted in longer periods up to which positive results in both parameters were found. All available evidence suggests that the upper limit of seroconversion coincides with the upper limit of treponemal survival. Inoculation with 5 X 10(4) treponemes per ml of donor blood resulted in a treponemal survival time of 48 h, inoculation with 1.25 X 10(6) treponemes per ml in a treponemal survival time of 72 h and inoculation with 2.5 X 10(7) treponemes per ml donor blood in a survival time of 120 h.

Transfusion syphilis, survival of Treponema pallidum in donor blood. I. Report of an orientating study.

The influence of storage at 4 degrees C on the survival of Treponema pallidum in donor blood, artificially infected with treponemes of the virulent Nichols strain was studied. Rabbits were inoculated in each testis with 0.5 ml of the blood-treponeme mixture, containing 5 X 10(5) microorganisms/ml, which was stored for up to 336 h. Under these circumstances, the blood-treponeme mixture appeared to be infectious for up to 96 h of storage, based on the demonstration of T. pallidum and serological findings, using FTA-ABS, TPHA and VDRL tests. The two former tests were found to be equally sensitive in detecting incubating syphilis in the rabbits, the VDRL test was significantly slower in this respect. From the absence of orchitis as well as seroconversion in rabbits, inoculated with blood-treponeme mixtures stored for 120 h or longer periods of time, it is concluded that after 120 h of storage infectivity is lost. The presently found survival time of treponemes in blood between 96 and 120 h of storage is discussed in relation with survival times found by other investigators.

Transfusion syphilis: a case report.

An infant girl acquired syphilis after exchange transfusion with fresh whole blood in 1977 in Rotterdam. She showed typical features of early infectious syphilis three and a half months after the transfusion. The parents had no histories or clinical or serologic signs indicative of syphilis. Although the blood donor had negative serologic tests for syphilis shortly before giving the blood, later examination indicated that he must have become infected with Treponema pallidum shortly before donation of the blood used in the transfusion of the infant.

Comparison of approaches to national automation: Iran and the Netherlands.

Two styles of approach to national automation are discussed. Iran represents the approach labeled "centralistic' and the Netherlands represents the "federalistic' approach. There are obviously numerous compromises between these two extremes. None is necessarily inherently superior to any other; which one is adopted will generally depend upon local circumstances-funding patterns, national attitudes rooted in history, geographic factors and the development history of the blood-banking services.