Linda C. Stehling

Donation reactions among autologous donors

Studies of risk factors associated with reactions among autologous blood donors have been limited. Therefore, 2091 autologous and 4737 homologous donations were examined. Donors at greatest risk for reaction were autologous donors who had reactions at first donation; among 45 who made repeat donations for the same surgery, 17 (38%) had repeat reactions. The group least likely to experience reactions were the autologous donors ≥66 years old; they experienced a 1.9≥ percent (6/310) incidence of reactions. More reactions were seen in both autologous and homologous donors in the categories of first‐time donor, female gender, decreasing age, and lower weight. Multiple logistic regression analysis showed that all of these variables were independent predictors of donor reaction, with first‐time donation (odds ratio, 2.4) and female gender (odds ratio, 1.9) being the strongest predictors of reaction. Donor room personnel should be alerted that autologous donors who react at first donation are very likely to react at subsequent donations. Contrary to common concern, elderly autologous donors are least likely to have reactions.

Current transfusion practices of members of the american society of anesthesiologists: a survey.

Background The last published survey of transfusion practices among members of the American Society of Anesthesiologists (ASA) was conducted in 1981. The ASA Committee on Transfusion Medicine conducted a new transfusion survey in 2002. Methods The survey was mailed to 2,500 randomly selected active ASA members. The previous survey was modified to incorporate questions based on the ASA Practice Guidelines for Blood Component Therapy. The chi-square test was used for comparisons. Two-tailed P values of 0.05 or less were considered as nonchance differences. Results A total of 862 survey responses were completed by anesthesiologists who provided or directly supervised anesthesia for patients who may have required transfusion. In a given week, 62% rarely or never transfused 3 or more units of blood to the same patient. The percentage of anesthesiologists who responded that it is never or rarely (1% or less of the time) necessary to cancel elective surgery because of unavailability of blood products was 96% in 2002. In 1981, 92% responded that it was rarely necessary, and 8% said that it was occasionally necessary. The percentage of anesthesiologists who required patients undergoing elective surgery to have a hemoglobin concentration of at least 10 g/dl decreased from 65% to 9% (P < 0.001). Before intraoperative erythrocyte transfusion, 89% of respondents performed hemoglobin or hematocrit determinations routinely or sometimes. Intraoperative autologous transfusion equipment availability increased from 39% to 95% (P < 0.001). Awareness of the ASA Guidelines was 72%. Conclusions Transfusion practices have changed considerably since 1981. Current transfusion practices are, in general, consistent with the ASA Guidelines.

Double-blind comparison of butorphanol and meperidine in the treatment of post-surgical pain.

The efficacy and safety of butorphanol tartrate were compared in a double-blind manner to meperidine hydrochloride in 299 patients with moderate to severe post-operative pain. When analgesia was requested, patients were medicated with butorphanol (1.0 or 2.0 mg) or meperidine (40 or 80 mg) administered intramuscularly according to a pre-determined computer-generated random schedule. Evaluation of pain relief data showed no significant differences between butorphanol and meperidine at the low doses and at the high dose levels. Onset of analgesia, peak effect (thirty to sixty minutes) and duration of action (approximately four hours) were comparable. Thus, the data support a 40:1 butorphanol to meperidine potency ratio. There was little difference between the drugs with respect to adverse reactions, effects on vital signs, and variations in laboratory values. The incidence of nausea and vomiting was more common in the meperidine-treated patients. Respiratory depression occurred in three patients who received meperidine and in one to whom butorphanol was administered. One meperidine-treated patient experienced hallucinations, a phenomenon not observed following butorphanol. On the basis of these data, butorphanol appears to be a safe, well tolerated and highly effective analgesic for the treatment of moderate to severe postoperative pain.

Indications for perioperative blood transfusion in 1990

Rational transfusion practices are determined by clinical evaluation and utilization of appropriate laboratory tests. While the trend toward more conservative transfusion practices is laudable, blood transfusions should not be withheld because of fear of transfusion-transmitted disease. The blood supply is safer than ever before and advances in monitoring and laboratory testing are facilitating scientific approaches to blood administration.AbstractL’évaluation clinique et l’utilisation appropriée de tests de laboratoire permettent une approche rationnelle des transfusions sanguines. La tendance vers une approche plus conservatrice face aux transfusions est louable toutefois, on ne devrait pas indûment restreindre l’usage des transfusions par crainte des maladies qu’elles peuvent transmettre. Les stocks sanguins sont de plus en plus securitaires et l’amélioration du monitorage et des tests de laboratoire permettent une approche scientifique de la pratique transfusionnelle.

Risks of donation reactions among autologous and homologous donors.

> 65 years 015 0 1 no among donors. One of their aims was to identify any subgroups First-time donors 211 1152 in which there is an increased risk of reactions. We report our donors 2211480 61350 211 14 211 findings regarding the incidence of reactions during 1293 autologous and 2000 homologous donations collected in our blood bank in the same Deriod and bv the same medical staff. The 2411593 71402 6132

CHAPTER 3 – Autologous Blood Salvage Procedures

Autologous transfusion is not a luxury. Some states have passed legislation mandating that surgical patients be informed of the alternatives to homologous blood administration as well as the risks and benefits of transfusion. Technological advances have made autologous blood salvage in surgery, the postoperative period, and certain trauma situations a safe and relatively inexpensive procedure. While there is minimal data documenting the quality of blood which is administered without processing, extensive clinical experience attests to the safety of the procedure. Ample clinical and laboratory data support the safety of reinfusing processed blood.