Aim: To determine if a significant relationship exists between bloodless medicine practices and decreased infection rates in oncology patients following hematopoietic stem cell transplantation by performing a literature review. Background: It is not uncommon for healthcare professionals to encounter Jehovah's Witnesses (JW) seeking medical treatment in the acute care hospital setting and outpatient clinics alike. However, JW's pose a unique challenge to healthcare providers. Their refusal of blood transfusions makes them a population of interest within the medical community. The refusal of blood transfusions also poses a serious challenge to successful treatment in oncology JW patients, and many hospitals will refuse to perform a procedure as complex yet beneficial as a hematopoietic stem cell transplant in this population. Methods: An extensive electronic literature search in the CINAHL Plus database was completed and included the keywords infection, blood transfusion, stem cell transplant, bloodless medicine, Jehovah's Witnesses, and transfusion reactions. The available literature was carefully examined for interventions performed and compared for ultimate results to be finalized as a written report. Significance: The results of this research can not only optimize healthcare for the population of Jehovah's Witnesses, but also assist in reduced blood transfusions and improved cost management in all patients with a cancer diagnosis. Conclusions: All studies concluded that autologous hematopoietic stem cell transplantation can be performed safely without the use of blood products. Their conclusion was based off of the data they collected following patients post-stem cell transplant. More research is needed to explore outcomes in this population as a result of blood transfusion refusal following stem cell transplantation in comparison with those who receive blood transfusion support.

The use of hemocomponents from blood group "O" in transfusions among different blood groups may lead to transfusion reactions if the anti-A and anti-B agglutinins, present in the donor s serum / plasma, show high titers scores equal to or higher than 100. The transfusion reactions most reported with antibodies of high titers are caused by platelet concentrate, due to the presence of plasma in this hemocomponent. Considering the small number of studies on the anti-A and anti-B hemolysins and the importance of these antibodies in transfusion practice, the goal of this work was to verify the frequency of these hemolysins and their association to genre and Rh factor in 500 serum samples of type "O" registered donors at the Blood Center of Cruz Alta, RS. The results showed that the frequency of donor blood group "O" considered dangerous was 11.6% (58), and non-dangerous 88.4% (442). There was a predominance between the dangerous 50% (29) to reactive anti-A hemolysin , 37.9% (22) anti-B and 12.1% (7) for agglutinins anti-A and anti-B. Sampling of donors was not homogeneous regarding sex and not the type of blood factor, prevailing men 65% (325), Rh positive. There was no correlation between antibody screening Irregulars (PAI) with regular search antibody anti-A and anti-B. Also there was no assocation betwiin the prevalence in the variables gender, blood Rh factor anti anti-A and anti-B. It was noticed that the anti-A shows reaction under great in comparison with the anti-B thus both react in 100% of cases to1/16 however, the anti-Adecreas its percentage from1/128 whereas anti-B 1/32. The age prevalence of dangerous donors for anti-A was between 33 to 46 years, anti-B from 16 to 25 years and for both antibodies between 25 and 33 years. The results of this research can be used to measure the prevalence of these hemolysins and prevent risks of incompatible transfusion events, since in transfusion practice there is greater availability of group "O" donors and these are not classified as risk-donor "O" yet. Thus, in the search for excellence in transfusion practice and, above all, effectivenessly, it is essential to standardize the Regular Antibodies Research. / O uso de hemocomponentes do grupo sanguíneo O em transfusões nãoisogrupo pode acarretar reações transfusionais, caso as aglutininas anti-A e anti-B presentes no soro/plasma do doador, apresentem títulos elevados com escore igual ou superior a 100. As reações transfusionais mais relatadas com anticorpos de altos títulos são ocasionadas por concentrado de plaquetas, devido à presença de plasma neste hemocomponente. Considerando a pequena quantidade de estudos sobre as hemolisinas anti-A e anti-B e a importância desses anticorpos na prática transfusional, o objetivo deste trabalho foi verificar a freqüência dessas hemolisinas e a associação a gênero e fator Rh em 500 amostras de soros dos doadores tipo O cadastrados no Hemocentro de Cruz Alta,RS. Os resultados mostraram que a freqüência dos doadores de sangue do grupo O considerados perigosos foi de 11,6% (58), e de não-perigosos 88,4% (442). Constatou-se uma predominância entre os perigosos, de 50% (29) reativos para hemolisina anti-A, 37,9% (22) anti-B e 12,1% (7) para aglutininas anti-A e anti-B. A amostragem dos doadores não foi homogênea quanto ao sexo e nem quanto ao tipo de fator sanguíneo, prevalecendo homens 65% (325), Rh positivo 80,4% (402). Não houve correlação entre a Pesquisa de Anticorpos Irregulares (PAI) com a Pesquisa dos Anticorpos Regulares anti-A e anti-B. Também não existiu prevalência na associação entre as variáveis gênero, fator sanguíneo Rh e anticorpo anti-A e anti-B. Percebeu-se que o anticorpo anti-A apresenta título maior de reação em comparação com o anti-B pois, ambos reagem em 100% dos casos até 1/16 porém, anti-A diminui seu percentual de reação a partir de 1/128 enquanto que anti-B em 1/32. A faixa etária de prevalência de doadores perigosos para anti-A foi entre 33 a 46 anos, anti-B entre 16 a 25 anos e para ambos anticorpos entre 25 e 33 anos. Os resultados desta pesquisa podem servir para mensurar a prevalência destas hemolisinas e prevenir riscos de episódios transfusionais incompatíveis, visto que na prática transfusional ocorre maior disponibilidade de doadores do grupo O e estes ainda não são classificados como doadores O perigosos. Assim, na busca pela prática transfusional com excelência e, sobretudo, com eficácia, torna-se imprescindível a padronização da Pesquisa de Anticorpos Regulares.

Project title: Optimalization of the regime of marker's examination of clinically important infections in blood donors Project author: Daniela Dušková, M.D. Project supervisor: prof. Vladimír Tesař, M.D., Dr.Sc., MBA, FASN The aim of this project is to contribute to the discussion about introducing the methods of molecular biology into the routine blood donor testing in the transfusions departments in the Czech Republic. The theoretical part includes a brief history and some turning points in transfusion medicine. The next part within the theoretical section is dedicated to the problems of infectious diseases concerning transfusion and the general examination processes used during the selection of blood donors. The end of the theoretical part concentrates on existing possibilities of markers' examination of clinically important infections in blood donors, including the list of processes performed in the Czech Republic, the European Union and other countries. The practical part describes this study, ie. the routine screening test of blood donors using the CMIA method (a routine method) and using RT-Real Time PCR method (a molecular biology method) for detecting infectious markers (HCV, HBV, HIV). Within this part, the principle of both methods and the process of actual examinations are described in...

L’hémolyse post transfusionnelle retardée (HPTR) est une complication potentiellement mortelle de la transfusion dans la drépanocytose. Sa fréquence est sous-estimée et aucun facteur prédictif de sa survenue n'a encore été identifié. Nous avons mené une étude observationnelle prospective monocentrique pendant 30 mois. Nous avons inclus 694 épisodes transfusionnels (ET) chez 311 patients adultes drépanocytaires, divisés en ET ponctuels (ETP = 360) et en ET chronique dans le cadre d’un programme (ETC = 334). Au cours de ce suivi, 15 HPTR ont été enregistrées, exclusivement après un ETP. L'incidence cumulative d’HPTR sur 30 mois était de 4,2 % par ETP (IC 95 % [2,6 ; 6,9]) ou 6,8 % par drépanocytaires transfusés (IC 95 % [4,2 ; 11,3]). Le taux d’incidence était de 16,4 HPTR pour 1000 ETP-Année (IC 95 % [10,1 ; 27,2]) ou 27,1 HPTR pour 1000 Personne-Année (IC 95% [16,7 ; 45,0]). Nous avons étudié 11 HPTR supplémentaires afin de construire un score prédictif. Les variables retenues étaient un antécédent d’HPTR, le nombre d’unités précédemment transfusées et l’état d’immunisation pré transfusionnelle. L’adéquation du score était excellente (Hosmer-Lemeshow = 1,40, p = 0,71), sa capacité discriminante très satisfaisante (aire sous la courbe ROC = 0,85 ; p < 0,0001), une valeur prédictive négative de 98,4 % et une valeur prédictive positive de 50,0 %. La validité interne du score, réalisée par Bootstrap, montre une très bonne performance. Nous rapportons, pour la première fois, l'incidence de l’HPTR et montrons qu’elle survient uniquement suite à un ETP. Nous décrivons également un score simple de prédiction d’une HPTR avant un ETP afin de mieux prendre en charge cette transfusion. / Delayed hemolytic transfusion reaction (DHTR) is a life-threatening complication of transfusion in sickle cell disease (SCD). The frequency of DHTR is underestimated and no predictive fac-tors for identifying patients likely to develop DHTR have yet been defined. We conducted a prospective single-center observational study over 30 months. We included 694 transfusion epi-sodes (TE) in 311 adult patients, divided into occasional TE (OTE: 360) and TE during a chronic program (CTE: 334). During follow-up, 15 cases of DHTR were recorded, exclusively after OTEs. DHTR cumulative incidence durin the 30 months was 4.2% per OTE (95% CI [2.6, 6.9]) or 66.8% per patient (95% CI [4.2, 11.3]). The incidence rate was 16.4 DHTR per 1000 OTE-Year (95% CI [10.1, 27.2]) or 27.1 DHTR per 1000 Person-Year (95% CI [16.7 ; 45.0]). We studied 11 additional DHTR cases to construct a score for predicting DHTR after OTE. Fifteen % of the 26 DHTR patients died. The variables retained in the multivariate model were history of DHTR, number of units previously transfused and immunization status before transfusion. The score adequacy was excellent (Hosmer-Lemeshow = 1.40, p = 0.71), very satisfactory dis-criminant capacity (area under ROC curve = 0.85, p <0.0001), negative-predictive value of 98.4% and a positive-predictive value of 50%. The internal validity of the score, realized by Bootstrap, shows a very good performance.We report, for the first time, the incidence of DHTR and we show that DHTR developed only in OTE. We also describe a simple score for predicting DHTR in patients undergoing occasional transfusion, to facilitate the management of blood transfusion in SCD patients.

Les transfusions de culots globulaires sont une pratique fréquente aux soins intensifs; elles sont associées à de nombreuses complications. Ce travail s'intéresse à l'une d'entre elles, celle qui occasionne le plus de décès, la surcharge volémique liée à la transfusion (Transfusion-Associated Circulatory Overload - TACO). Dans une première étude, nous avons tenté de déterminer l’impact des critères diagnostiques pris en compte dans la définition adulte du TACO dans une population de soins intensifs pédiatriques. Cette définition a été appliquée à 136 patients de soins intensifs pédiatriques durant leur séjour. Nous avons obtenu des taux d’incidence du TACO très variables (entre 1,5 et 76%) selon la manière d’interpréter les critères diagnostiques proposés. Notre seconde étude a consisté en une revue exploratoire de la littérature concernant le TACO aux soins intensifs adultes et pédiatriques, peu importe le type de produit sanguin labile transfusé. Neuf études ont rencontré nos critères d’inclusion, à savoir décrire au moins un des critères suivants : l’incidence, les facteurs de risque ou les conséquences du TACO. Huit études étaient observationnelles. Seules trois études étudiaient la population pédiatrique. Les résultats montrent une incidence cumulée de TACO plus élevée aux soins intensifs (5,5%) que dans la population générale. Les principaux facteurs de risque chez l'adulte sont liés à la balance liquidienne préexistante, aux caractéristiques de la transfusion elle-même et aux comorbidités déjà présentes chez le patient. En outre, le TACO adulte est associé à une augmentation de la durée de séjour à l'hôpital. Les études pédiatriques incluses ne rapportaient aucune donnée sur les facteurs de risque et les conséquences du TACO dans cette population. Ce travail a permis de montrer que la définition actuelle du TACO n’est pas applicable à la population des soins intensifs pédiatriques. Le TACO aux soins intensifs est peu présent dans la littérature scientifique malgré sa fréquence et les risques qu’il présente; d’autres études sont indispensables pour en améliorer sa compréhension. Nous évoquerons certaines voies de recherche qui permettraient une meilleure connaissance de cette complication potentiellement mortelle des transfusions. / Red blood cell transfusions are common practice in intensive care and lead to many adverse reactions. This research project is focused on the most frequent fatal complication: transfusion-associated circulatory overload (TACO). In our first study, we tried to determine the impact of the diagnostic criteria of the adult definition of TACO in a pediatric intensive care population. The definition was applied to 136 pediatric intensive care patients during their stay. We obtained highly variable incidence rates (from 1.5 to 76%) depending on the interpretation of the diagnostic criteria. Our second study is a scoping review of the literature about TACO in intensive care, both adult and pediatric, regardless of the type of labile blood product transfused. Nine studies met our inclusion criteria, namely, to describe at least one of the following criteria: incidence, risk factors or outcomes of TACO. Eight studies were observational. Only three studies were conducted in pediatric population. The results showed a pooled incidence of TACO which is higher (5.5%) in intensive care than in the general population. The main risk factors in the adult population were related to the positive pre-existing fluid balance, the characteristics of the transfusion itself and the patients’ preexisting comorbidities. Furthermore, the results showed an association between TACO in adult intensive care and an increased length of stay. None of the included pediatric study reported data on risk factors or outcomes. This research demonstrates that the current TACO definition is not applicable for the pediatric intensive care population. There is limited literature about TACO in intensive care despite its occurrence rate and the associated risks; other studies are therefore necessary to enhance its comprehension. We will touch on potential research pathways that would lead to a better understanding of this deadly transfusion complication.

Project title: Optimalization of the regime of marker's examination of clinically important infections in blood donors Project author: Daniela Dušková, M.D. Project supervisor: prof. Vladimír Tesař, M.D., Dr.Sc., MBA, FASN The aim of this project is to contribute to the discussion about introducing the methods of molecular biology into the routine blood donor testing in the transfusions departments in the Czech Republic. The theoretical part includes a brief history and some turning points in transfusion medicine. The next part within the theoretical section is dedicated to the problems of infectious diseases concerning transfusion and the general examination processes used during the selection of blood donors. The end of the theoretical part concentrates on existing possibilities of markers' examination of clinically important infections in blood donors, including the list of processes performed in the Czech Republic, the European Union and other countries. The practical part describes this study, ie. the routine screening test of blood donors using the CMIA method (a routine method) and using RT-Real Time PCR method (a molecular biology method) for detecting infectious markers (HCV, HBV, HIV). Within this part, the principle of both methods and the process of actual examinations are described in...