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Transfusion service management
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
James P AuBuchon, Dafydd W Thomas
A transfusion service should assess the role it expects to play in transfusion therapy. The provision of a supply of components adequate for clinical needs that are immunohematologically compatible would be included on this list as given. The further beyond these technical requirements the service is comfortable in extending its involvement in transfusion therapy, the greater assistance it offers patient care.12 Some of these opportunities are highlighted in the following sections. For some physicians, these extra-laboratory services may represent challenges to go beyond the limited role that many transfusion service medical directors have assumed in the past. However, these opportunities represent the true reasons that physicians rather than technologists alone are in charge of transfusion services; they define ways in which physicians can share their skills with patients who will benefit from them. They represent opportunities for a trained physician to pass on knowledge to one lacking as much information in this specialized field, so that patient safety and transfusion therapy are optimized.3
Concepts of Replacement Therapy: Blood Components, Blood Derivatives, and Medications
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Medications have become increasingly important as an adjunct or alternative to traditional transfusion therapy. These are usually divided into two categories: hematopoietic growth factors and agents to reduce acute blood loss.
Haematology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Most patients with HE need no therapy. As with other haemolytic anaemias, affected individuals are susceptible to hypoplastic crisis during viral infection. Human parvovirus B19, the organism responsible for erythema infectiosum, selectively invades red cell progenitors and may cause a transient arrest of red cell production. Recovery usually begins within 7–10 days after infection and is usually complete within 4–6 weeks. Those with the more severe form usually benefit from supportive transfusion therapy and splenectomy.
Acute chest syndrome of sickle cell disease: genetics, risk factors, prognosis, and management
Published in Expert Review of Hematology, 2022
Elizabeth S. Klings, Martin H. Steinberg
In our practice, adult patients hospitalized with a VOE and/or ACS are treated with incentive spirometry and venous thromboembolism prophylaxis. Patients diagnosed with ACS are often placed in an environment where they can receive a higher level of care such as an intermediate or intensive care unit. Intravenous fluids should be used judiciously (1–1.5 mL/kg ideal body weight per hour) to prevent development of acute diastolic congestive heart failure. Diastolic dysfunction is common in SCD and often can be subclinical until an excess of fluids from transfusions and intravenous hydration occurs [93]. While an infectious agent is uncommonly identified in ACS, many favor the empiric use of antibiotics to cover the atypical organisms including Mycoplasma pneumoniae and Chlamydia pneumoniae and encapsulated bacteria including Streptococcus pneumoniae and Haemophilus influenzae. Transfusions, whose use not innocuous, should be targeted to the severity and likelihood of progression of ACS [52,57]. Factors that support the use of transfusion therapy include severity of anemia, presence of thrombocytopenia, and organ failure. Stable, non-hypoxic patients with favorable hematologic and radiographic findings need not be transfused; severe progressive disease is best managed with exchange transfusion.
Variable reactivity of Rh D antigen and its serological characterization
Published in Acta Clinica Belgica, 2021
Sreelekshmi S, Shamee Shastry, Poornima Baliga B
Regarding universal screening of Rh D negative samples for weak D phenotype, Choi et al have proposed a cost-effective testing algorithm. It is based on the hypothesis that, all D- samples with a C-E- phenotype have a complete deletion of the RHD gene, hence weak D testing is not necessary [16]. Rh D typing during the antenatal period is crucial. If women with variant D phenotype are classified under Rh D positive phenotype, they may not receive Rh immunization. Lukacevic Krstic et al reported that 1.63% of anti-D immunizations occurred in women who were carriers of Rh D variants. RHD genotyping in their study revealed that 2 out of 3 women were partial D type Va, while 1 woman was a carrier of partial D type DNB [17]. Some of the serological weak D phenotypes do not form anti-D. However until and unless, the molecular testing is done, it is safer to designate and manage them as Rh D negative. A similar approach can be adopted in patients on chronic transfusion therapy. Sippert et al noted variant RH alleles in 31/48 (65%) of Sickle Cell Disease patients with Rh antibodies [18]. Fichou et al have described a major novel, variant RHD allele in Indians that can be easily identified routinely by implementing a simple genotyping assay [2].
Acute Chest Syndrome in Sickle Cell Disease: Clinical Presentation and Outcomes. The Experience of a Single Thalassemia and Sickle Cell Unit in a University Hospital
Published in Hemoglobin, 2021
Sophia Delicou, Konstantina Aggeli, Konstantinos Magganas, Dimitrios Patsourakos, Aikaterini Xydaki, John Koskinas
Transfusion therapy is the cornerstone of treatment in the acute phase. Our approach was to immediately treat with simple transfusion in cases of moderate or progressing ACS to increase Hb levels up to 10.0 g/dL and continue with exchange blood transfusions accordingly [20]. A blood transfusion may be effective both by improving oxygen-carrying capacity through an increase in the total Hb level and by the percentage of sickle-containing Hb cells, thus reducing further lung tissue sickling and ischemia. The new American Society of Hematology (ASH) recommendations suggest the use of exchange transfusion instead of simple transfusion in ACS to rapidly lower the Hb S percentage to <30.0%. For those with a more serious worsening in respiratory function (e.g., rapid increase in oxygen or ventilation demands over hours combined with chest X-ray anomalies and decreasing oxygen saturation), exchange transfusion rather than simple transfusion is required [21,22].