Transfusion medicine in practice

309 Pages·2002·64.682 MB·English

by  Desmond, Michael J., Duguid, Jennifer, Goodnough, Lawrence Tim

Transfusion Medicine
in Practice
Taylor & Francis
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Transfusion Medicine
in Practice
Edited by
jennifer Duguid, MB, FRCPath
Consultant Haematologist,

Wrexham Maelor Hospital, Wrexham, UK

Lawrence Tim Goodnough, MD
Professor of Medicine, Pathology and Immunology,
Division of Laboratory Medicine, Washington
University School of Medicine, St Louis, USA
Michael J Desmond, MB, MRCP
Consultant Cardiothoracic Anaesthetist,
The Cardiothoracic Centre, Liverpool, UK
0
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Contents
Contributors vii
1. Hospital transfusion practice FrankE Boulton 1
2. Transfusion products Susan Knowles 21
3. Blood transfusion in patients requiring long-term support Aleksandar Mijovic 49
4. Transfusion support in transplantation Darrell] Triulzi, Ileana Lopez-Plaza 73
5. Blood and blood component use in cardiac surgery or 'why do cardiac surgical patients bleed?'
Robert R]effrey, Michael] Desmond 103
6. Surgical transfusion: Non-cardiac Lawrence Tim Goodnough, Terri G Monk 115
7. Major obstetric haemorrhage Simon Bricker 133
8. Paediatric and neonatal transfusions Paula HB Bolton-Maggs 151
9. Transfusion practice in resuscitation and critical illness Gary Masterson 175
10. Pharmacologic alternatives to blood Lawrence Tim Goodnough 199
11. Congenital and acquired disorders of coagulation jeanne M Lusher, Roshni Kulkarni 215
12. Therapeutic apheresis Mark E Brecher 253
13. Transfusion service management james P AuBuchon, Dafydd W Thomas 277
Index 293
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Contributors
James P AuBuchon, MD Jennifer Duguid, MB, FRCPath
Blood Bank and Transfusion Service Department of Haematology
Dartmouth-Hitchcock Medical Center Wrexham Maelor Hospital
One Medical Center Drive Croesnewydd Road
Lebanon, NH 03782 Wrexham
USA Clwyd, Lll3 7TD
UK
Paula HB Bolton-Maggs, MD, FRCP, FRCPath,
FRCPCH Lawrence Tim Goodnough, MD
Royal Liverpool Children's Hospital Division of Laboratory Medicine, Box 8118
Alder Hey Washington University School of Medicine
Eaton Road 660 South Euclid Avenue
Liverpool, Ll2 2AP StLouis, MO 63110
UK USA
Frank E Boulton, MD Robert RJeffrey, MB, FRCSEd, FETCS
National Blood Transfusion Service Aberdeen Royal Infirmary
Coxford Road Grampian University Hospital NHS Trust
Southampton, SO16 SAS Foresterhill
UK Aberdeen, AB9 2ZB
UK
Mark E Brecher, MD
Transfusion Medicine Service Susan Knowles, MB, FRCP, FRCPath
CB 7600 University of North Carolina Hospitals Epsom and St Helier NHS Trust
101 Manning Drive St Helier Hospital
Chapel Hill, NC 27514 Wrythe Lane
USA Carshalton, SMS 1AA
UK
Simon Bricker, FRCA
Department of Anaesthetics Roshni Kulkarni, MD
Countess of Chester Hospital Department of Pediatrics, Human Development
Liverpool Road and Hematology/Oncology
Chester, CH2 IUL Michigan State University College of Human
UK Medicine
MSU Subspeciality Clinics
J
Michael Desmond, MB, MRCP B-220 Clinical Center
Department of Anaesthesia Lansing, MI 48824-1313
The Cardiothoracic Centre USA
Liverpool, Ll4 3PE
UK
viii Contributors
Ileana L6pez-Plaza, MD Terri G Monk, MD
Department of Pathology Department of Anaesthesiology
University of Pittsburgh School of Medicine University of Florida
Institute for Transfusion Medicine PO Box 100154
3636 Boulevard of the Allies Gainesville, FL 36111
Pittsburgh, PA 15113 USA
USA
Dafydd W Thomas, MB, FRCA
jeanne M Lusher, MD Department of Anaesthesia and Intensive Care
Division of Hematology/Oncology Swansea NHS Trust
Children's Hospital of Michigan Morriston Hospital
3901 Beaubien Boulevard Heol Cwmrhydyceirw
Detroit, Ml48101 Swansea SA6 6PD
USA UK
Gary Masterson, MRCP, FRCA Darrell J Triulzi, MD
Intensive Therapy Unit Department of Pathology
Royal Liverpool University Hospital University of Pittsburgh School of Medicine
Prescot Street Institute for Transfusion Medicine
Liverpool, L7 BXP 3636 Boulevard of the Allies
UK Pittsburgh, PA 15113
USA
Aleksandar Mijovic PhD, MB, MRCPath
Department of Haematological Medicine
King's College Hospital
Denmark Hill
London SE5 9RS
UK
1 Hospital transfusion practice
FrankE Boulton
INTRODUCTION killed one. The same anticoagulant was used
for a haemophiliac in 1910;4 this was the last
There is no doubt that blood transfusion has
recorded use of 'phosphated blood' being
saved lives. Unfortunately, some recipients
used.
have died from transfusion - although not
Although defribrinated blood was used by
always from administrative or technical
some surgeons, adverse events were frequent
'errors'. Some early recipients were victims of
and most surgeons at this stage favoured a
trauma (including obstetric) or had required
'direct' and rapid approach to avoid clotting.
major surgery, while others had profound
In 1905, Alexis Carrel successfully transfused
'pernicious' anaemia. A few were babies with
blood from a New York surgeon to his
haemorrhagic disease.
newborn daughter who had haemorrhagic
disease5 by surgically anastomosing donor
TRANSFUSION BEFORE 1940
artery to patient vein. Crile simply used a
Clinically based transfusion practice, con­ short metal tube over which the cut ends of
ceived in the 1820s by james Blundell in the dissected-out vessels were cuffed to join
London, gestated for nearly nine decades. donor to recipient. Elsberg's similar device
Several Americans, including two Union sol­ was used for Duke's thrombocytopenic
diers in the Civil War, received human blood patient, from whom platelet function and the
in the 1850s and 1860s (others got animal value of the bleeding time was first
blood), with singular lack of success and demonstrated. A major problem was the
occasional deaths through incompatibility.12 inability to measure the amount transfused -
•
Braxton Hicks - Blundell's successor - used indeed, Duke's donor probably gave more
rather strong solutions of 'phosphate of soda' than a litre.6 An ingenious method for trans­
to prevent troublesome clotting of blood col­ fusing known volumes of unmodified blood
lected for transfusion. This worked, but few was devised by Unger, who connected lines to
patients survived - although some rallied tem­ recipient and donor via a four-way stopcock
porarily with the rather small volumes of and a saline syringe.7 These direct methods
'phosphated blood' given. Brakenridge of (not to be confused with the later 'directed'
Edinburgh was more successful with 5% methods of donor selection) had the major
phosphate (one volume to two or three disadvantage of direct contact between donor
volumes of blood) used within hours of col­ and patient, and the surgery meant that
lection for five patients diagnosed with perni­ donors could only be used once.
cious anaemia.3 Incompatibility probably Incompatibility was still problematic.