Twin to twin transfusion syndrome is a rare complication that can develop in monochorionic twin pregnancies where abnormal placental connections lead to hemodynamic imbalance between the two fetuses. The twin receiving the surplus of blood experiences polyhydramnios whereas the twin donating their blood experiences oligohydramnios. Diagnosis of this syndrome is done based off of the Quintero Staging scale, which consists of five categories of criteria ranging from non-critical diagnoses to diagnoses involving demise of one or two fetuses. The gold standard for treatment involves ablating abnormal vessel connections via a laser therapy. This therapy has shown to reduced short term and long term complications within the twins, and be most efficient at ceasing the disproportionate blood supply between the fetuses. Long term outcomes of twin to twin transfusion syndrome mainly involve neurodevelopmental impairment, but cardiovascular and renal complications can also be present. Adverse neurodevelopmental outcomes should be the ones to most closely monitor postnatally in all TTTS survivors. For recipient twin survivors, cardiovascular outcomes should be most closely watched via blood pressure monitoring and routine echocardiograms. For donor twin survivors, creatinine levels should be routinely checked in order to detect signs of chronic kidney disease in early childhood. Long term outcomes of twin to twin transfusion syndrome still need further investigating due to the difficulty of gathering information postnatally. Limitations that further increase the complexity of this research include lack of education and decreased opportunities for underserved communities to access the advanced medical care required to treat and monitor this disease. Shedding light on this disparity can lead mothers to be more aware of the signs and symptoms of this disease, leading to early detection and more positive outcomes.

Lan is a high prevalence red blood cell antigen present in the majority of the populations that belong to the Lan (Langereis) blood group system. Anti-Lan antibody is an immunoglobulin G (IgG) antibody that is known to cause delayed hemolytic transfusion reactions in adults as well as hemolytic disease in fetuses and newborns, however with variable clinical significance ranging from mild to severe. We present a 58-year-old woman with diffuse abdominal pain and a large gastric ulcer causing gastric outlet obstruction. She underwent antrectomy and Billroth I reconstruction surgery without complications. The patient's hemoglobin upon presentation was 10g/dL and dropped acutely post-operatively to 6.4 g/dL requiring blood transfusion. The patient developed acute respiratory distress within minutes of starting a packed red blood cell (pRBC) transfusion, requiring discontinuation. Laboratory testing demonstrated pan-reactivity with additional reference testing demonstrating an anti-Lan antibody. The rarity of Lan negative pRBC units is a challenge in managing such patients requiring blood transfusions. Autologous blood donation or donation by a compatible family member is another option to consider in these rare cases.

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.

Twin-to-twin transfusion syndrome (TTTS) is a complication of blood flow among fetuses sharing a single placenta. TTTS is associated with high mortality rates; however there is treatment available which significantly increases the rate of survival. The treatment procedure is although far from perfect. Limited by a narrow field of view, it is a challenging task for the surgeon to mentally visualize the vascular structures of the placenta while trying to navigate across the areas of interest. Previous research within both medical imaging and tracking technologies has been conducted but there is no perfect solution on how to solve these issues. This paper is part of a two-part project attempting to provide an application which can make the surgical procedure easier. The two parts are image stitching and real-time tracking, this paper focusing on the latter. This is done by choosing an appropriate tracking method which can provide location and orientation of a small sensor. The 3D data gathered from the sensor is processed by various transformations so that the bounding box of the camera movement can be mapped directly onto the image generated by the stitching process. The same transformations are applied to data collected from the sensor at a rate of 60 Hz, resulting in a responsive system. By comparing the x-value and y-value of a calculated point to the bounding box, this point can be converted to its corresponding pixel in the image. The system is responsive and by visually comparing the digital position in the image to its corresponding real world position it seems accurate enough, even though a few pixels misalignment will occur. / Tvillingstransfusionssyndrom (TTTS) är en komplikation av blodflöde som kan uppstå hos foster som delar placenta. TTTS associeras medhöga dödstal, emellertid finns det behandlingar som signifikant ökar chanserna för fostrens överlevnad. Behandlingsprocessen är docklångt ifrån perfekt. Begränsad av ett smalt synfält är det en utmanande uppgift för kirurgen att mentalt föreställa sig placentansvaskulärsystem samtidigt som denne försöker att navigera mellan alla intresseområden. Forskning inom både bildbehandling ochspårningsteknologier är inget främmande men det finns ännu ingen självklar lösning på dessa problem. Den här rapporten är en del av etttvåstegsprojekt vars mål är att framställa en applikation som kan underlätta behandlingen. De två delarna är image stitching ochrealtidsspårning, där den här rapporten fokuserar på det sistnämnda. Detta görs genom att välja en lämplig spårningsmetod som kan mätabåde position samt orientering av en sensor. 3D-datan från sensorn behandlas av olika matematiska transformationer så att denomskrivande rektangeln av kamerans rörelser kan placeras på bilden erhållen från stitchingprocessen. På samma sätt behandlas deninformation som hämtas från sensorn i realtid med en frekvens på 60 Hz, vilket resulterar i ett snabbreagerande system. Genom att jämförax-värde och y-värde från en beräknad punkt med den omskrivande rektangeln, kan den här punkten översättas till sin motsvarande pixel ibilden. Systemet reagerar snabbt på indata och genom att visuellt jämföra den digitala positionen i bilden mot den motsvarande positionen iden riktiga världen ger systemet ett tillfredställande resultat, även om punkten kommer att ha ett par pixlars felmarginal.

No description available.

Patients with myelodysplastic syndromes (MDS) often experience chronic anemia and long-term red blood cell transfusion dependence associated with significant burden on clinical and health-related quality of life (HRQoL) outcomes. In the MEDALIST trial (NCT02631070), luspatercept significantly reduced transfusion burden in patients with lower-risk MDS who had ring sideroblasts and were refractory to, intolerant to, or ineligible for prior treatment with erythropoiesis-stimulating agents. We evaluated the effect of luspatercept on HRQoL in patients enrolled in MEDALIST using the EORTC QLQ-C30 and the QOL-E questionnaire. Change in HRQoL was assessed every 6 weeks in patients receiving luspatercept with best supportive care (+ BSC) and placebo + BSC from baseline through week 25. No clinically meaningful within-group changes and between-group differences across all domains of the EORTC QLQ-C30 and QOL-E were observed. On one item of the QOL-E MDS-specific disturbances domain, patients treated with luspatercept reported marked improvements in their daily life owing to the reduced transfusion burden, relative to placebo. Taken together with previous reports of luspatercept + BSC reducing transfusion burden in patients from baseline through week 25 in MEDALIST, these results suggest luspatercept may offer a treatment option for patients that reduces transfusion burden while providing stability in HRQoL.

No description available.

Les pratiques transfusionnelles optimales demeurent incertaines chez les victimes de traumatismes craniocérébraux modérés ou graves. En l’absence de données probantes et en présence de divergences d’opinions parmi les experts quant aux transfusions de culots globulaires chez cette population, nous avons réalisé une revue systématique et deux études de cohortes sur le sujet. Ces 3 études avaient pour objectif de décrire les fréquences de transfusions, d’évaluer les déterminants potentiels et d’estimer l’association entre les transfusions de culots globulaires et les issues cliniques, telle la mortalité. La revue systématique a permis de synthétiser les connaissances disponibles dans les écrits scientifiques actuels relatifs aux transfusions de culots globulaires. Nous avons observé une fréquence importante des transfusions à travers les études, de l’ordre de 36 % (IC 95 % 28 à 44; 23 études) et des seuils transfusionnels variables (de 60 à 100 g/L). Peu d’études ont évalué les déterminants des transfusions. Aucune différence significative de la mortalité chez les patients transfusés comparativement à ceux non transfusés n’a pu être démontrée, mais des durées de séjour plus longues ont été observées à la suite de transfusions. L’étude de cohorte pancanadienne a permis de souligner la variabilité des pratiques transfusionnelles à travers les centres de traumatologie canadiens, avec des fréquences de transfusions par centre allant de 16 à 35 %, avec une moyenne de 28 % (IC 95 % 27 à 29 %). Nous avons pu identifier les traumatismes extracérébraux sérieux et l’anémie comme étant de potentiels déterminants majeurs des décisions transfusionnelles. Par ailleurs, nous avons pu observer une augmentation significative de l’ensemble des issues défavorables chez les patients transfusés. L’étude de cohorte provinciale, à l’aide de données plus précises quant à la temporalité de l’exposition et de la mortalité, nous a permis de caractériser l’évolution des niveaux d’hémoglobine et des pratiques transfusionnelles en cours de séjours hospitaliers à l’unité de soins intensifs. Nous avons pu observer une concentration d’hémoglobine prétransfusionnelle médiane de 81 g/L (étendue interquartile de 67 à 100). Après ajustement, les issues défavorables étaient significativement plus fréquentes chez les patients transfusés que ceux non transfusés. Une tendance non significative vers des rapports de risque plus défavorables à la suite de transfusions chez les patients présentant des niveaux d’hémoglobine plus élevés a été observée pour la majorité des issues. / Optimal red blood cell transfusion practices remain unclear for patients with moderate and severe traumatic brain injuries. Considering evidences are lacking and scientific experts have expressed divergent opinions, we conducted a systematic review and two cohort studies to evaluate red blood cell transfusion practices in this population. These three studies had for objective to describe red blood cell transfusions frequency, to evaluate potential determinants and to estimate the association between red blood cell transfusions and clinical outcomes, such as mortality. The systematic review allowed to synthetize knowledge currently available in published studies regarding red blood cell transfusion. We observed a high frequency of transfusion across studies, with 36% (95%CI 28 to 44; 23 studies) being transfused at some point during hospital stay. Reported hemoglobin thresholds varied between 60 and 100 g/L. Few studies evaluated potential determinants. No significant difference in mortality between patients who received transfusion or not was observed. However, lenght of stay were longer following transfusions. Our canadian multicenter cohort study highlighted the variability in transfusionnal practices across the country, with transfusion frequencies varying from16 to 35% (mean 28%, 95%CI 27 to 29%). We identified serious extracerebral traumas and anemia as major determinants of transfusions. We also observed an increased risk of unfavorable outcomes (mortality, complications, lenght of stay) in patients who were transfused compared to those who were not, in adjusted statistical models. Our provincial cohort study, using hospital laboratory and pathology data, allowed to characterize the evolution of hemoglobin levels over intensive care unit stay, as well as transfusion practices. We observed a median pre-transfusional hemoglobin level of 81 g/L (IQR 67 to 100). After adjustment, unfavorable outcomes were significantly more frequent in transfused patients than non transfused. We observed a non significant trend toward higher risk ratios of unfavorable outcomes after transfusions in strata of patients with higher hemoglobin levels in most models.

To reduce the risk of transfusion related complications, blood components should, according to European guidelines, contain less than 1 x 106 leukocytes per unit. To verify that these guidelines are upheld, residual leukocytes are measured in randomly selected blood components as means of quality control. At Uppsala University Hospital, the method currently used for this is flow cytometry (FCM). However, the hospital recently purchased a new instrument, ADAM rWBC2, for this purpose. The aim of this study was to verify ADAM rWBC2 as a replacement method for FCM and investigate whether the type of test tube chosen for the instrument (EDTA or micro test tube) would affect the leukocyte concentration. To conduct the study, 30 red blood cell units (RBCs), 30 platelet units (PLTs) and 30 plasma units were analyzed on both the ADAM rWBC2 instrument and with FCM. In addition to this, each RBC and PLT unit was allocated into both an EDTA tube and a micro test tube before analysis on the ADAM rWBC2 instrument. Results from both methods and tubes were compared using statistical analysis. The results from ADAM rWBC2 tended to be higher than the results from FCM, and the difference turned out to be statistically significant (p<0,001). No significant difference could be detected between the results from the different test tubes. The assessment is that ADAM rWBC2 will replace FCM for quality control of residual leukocytes in blood components. According to the results, the type of test tube used does not affect the leukocyte concentration.

Thesis (M. Tech.) -- Central University of Technology, Free State, 2008 / Blood transfusions carry a number of risks, one of which is transmitting HIV/AIDS from an infected donor. Since HIV is sexually and parenterally transmitted, the initial HIV risk management of donated blood in the early 1980‟s consisted of screening by visual assessment and completion of a lifestyle questionnaire, followed by deferral of practicing homosexual and bisexual male donors and intravenous drug addicts. The visual assessment was replaced by tests for antibodies directed against HIV, from the middle 1980‟s. In the early 1990‟s HIV was increasingly found in the black population of South Africa, particularly among black women. By 1998 0.26% of the received donations returned a positive test for HIV-1. In 1999 the South African Blood Transfusion Service (SABTS) Blood Safety Policy was introduced, including a donation HIV-risk categorization model which used the donor ethnic group, gender and donation history as indicators of the risk of exposure to HIV. The unacceptable use of the donor ethnic group as an indicator was the motivation to seek a suitable alternative donation risk categorization model which excludes the donor‟s ethnic group. The use of a more acceptable model with a high level of accuracy in predicting the risk of exposure to HIV has the potential of contributing to the reduced risk of HIV transmission through blood transfusion in South Africa. The aim of this study was to compare the suitability of four alternative models based on the information obtained from donors. Donations from new and lapsed donors were categorized in the highest applicable risk category in each model. The study was divided into two phases to achieve the aim. The first phase needed to determine suitable parameters for a model which uses the donor‟s age as an indicator. For this phase the ages of the regular donors returning an HIV-positive test result, were analysed. The second phase was to evaluate the effectiveness of the four suggested alternative blood donation risk categorization models against the model introduced by the SABTS in 1999. During this phase the donor demographic data and donation histories of donors who made donations at the Bloemfontein branch of the South African National Blood Service (SANBS) between October 2004 and September 2005, were analysed statistically. This phase honed in on two aspects to evaluate the effectiveness of the alternative models. Firstly the percentages of HIV-positive donations found in each risk category of each model, were determined as indicators of the residual risk of HIV-positive donations within the window period. Secondly the percentages of the collected blood donations allocated to each risk category within each model, were analysed to give an indication of the availability of “safe” blood associated with each of the models. The first phase of the study highlighted the difference in the age-group prevalence between male and female regular donors who returned an HIVpositive test result. Potentially suitable parameters for an Age-based Model were formulated by comparing this data with the ages of the donors who donated in Bloemfontein during the twelve months covered by this study. The second phase compared a Donation Interval Model, a Combination Model (using donation interval, gender and ethnic group as indicators), the SANBS 2005 Model (using age and gender as indicators) and an Agebased Model (using age and gender as indicators) with the SABTS 1999 Model (using gender and ethnic group as indicators). This study has shown that each of the models analysed has its advantages and disadvantages. The SANBS 2005 Model proved the best model without an ethnic indicator, for SANBS. Several recommendations regarding further investigation emanating from the results of this study were made.