* Neonatal and fetal immune response and in utero development issues
* Blood compatability and pre-transfusion testing issues specific to pediatric and neonatal transfusion
* Therapeutic apheresis including red blood cell exchange and prophylactic chronic erythrocytapheresis for sickle cell patients
* Also includes a section that concentrates on the consent, quality and legal issues of blood transfusion and donation
Structured to be a companion to the recently published Handbook of Transfusion Medicine, the Handbook of Pediatric Transfusion Medicine is dedicated to pediatric hematology-oncology and transfusion medicine, a field which remains ambiguous and which has generated few comprehensive texts. This book stands alone as one of the few texts that addresses transfusion issues specific to pediatric medicine. Written in an eminently readable style, this authoritative handbook is a requirement for any pediatric physician or caregiver. Neonatal and fetal immune response and in utero development issues Blood compatability and pre-transfusion testing issues specific to pediatric and neonatal transfusion Therapeutic apheresis including red blood cell exchange and prophylactic chronic erythrocytapheresis for sickle cell patients Also includes a section that concentrates on the consent, quality and legal issues of blood transfusion and donation
Front Cover 1
Handbook of Pediatric Transfusion Medicine 4
Copyright Page 5
Table of Contents 8
Preface 14
Acknowledgments 16
About the Editors 18
List of Contributors 20
Chapter 1. Blood Donation 22
Overview 22
Donor Recruitment 22
Autologous Donation 23
Directed Donation 24
Limited Donor Exposure 24
Blood Collection 24
Apheresis 29
Plasmapheresis 29
References 29
Chapter 2. Component Preparation and Storage 32
Introduction 32
Unique Transfusion Needs of the Neonatal and Pediatric Patient 32
Blood Donation Issues 38
Anticoagulant-Preservative Solutions 39
Individual Components for Transfusion 40
Record Keeping for Component Preparation 43
Storage of Blood and Blood Products 44
Summary 45
References 45
Chapter 3. Blood Components 48
Introduction 48
Whole Blood and Packed Red Blood Cells 48
Platelets 52
Granulocytes 54
Plasma Products 55
Cryoprecipitate 57
Ordering 57
Coagulation Factors 58
Albumin 59
Gamma-Globulins 60
References 63
Chapter 4. Red Blood Cell Antigens and Human Blood Groups 66
Introduction 66
ABO Blood Group System 66
RH Blood Group System 68
Kell Blood Group System 69
Duffy Blood Group System 70
Clinical Significance 70
Kidd Blood Group System 70
MNS Blood Group System 71
P Blood Group System 72
Lutheran Blood Group System 72
Lewis Blood Group System 73
Diego Blood Group System 74
Cartwright Blood Group System 74
Xg Blood Group System 74
Scianna Blood Group System 75
Dombrock Blood Group System 75
Colton Blood Group 76
LW Blood Group System 77
Chido-Rogers Blood Group System 77
Hh Blood Group System 77
XK Blood Group System 78
Gerbich Blood Group System 78
Cromer Blood Group System 78
Knops Blood Group System 79
Indian Blood Group System 79
Ok Blood Group System 79
RAPH Blood Group System 79
JMH Blood Group System 80
Cost Blood Group Collection 80
Er Blood Group Collection 80
Ii Blood Group Collection 80
Globoside Collection 81
Low-Prevalence Antigens 81
High-Prevalence Antigens 82
References 82
Chapter 5. Pretransfusion Compatibility Testing 84
Introduction 84
ABO(H) 84
Rh(D) 86
Other Red Cell Antigens 87
Direct Antiglobulin Test 88
Antibody Detection Test (Screen) 88
Crossmatch (XM) 90
Turnaround Times 91
Suggested Reading 92
References 82
Chapter 6. Serologic Investigation of Unexpected Antibodies 94
Introduction 94
Common Antibody Identification Methods 94
Process for Evaluation of Positive Antibody Detection Tests 98
References 104
Chapter 7. Leukoreduced Products: Prevention of Leukocyte-Related Transfusion-Associated Adverse Effects 106
Introduction 106
Rationale for Leukoreduction of Blood Components 106
Specific Indications for LR Products 106
Contraindications, Side Effects, and Hazards 109
Leukoreduction Technologies 109
Products, Standards, and Quality Control 110
Universal Leukoreduction 110
Leukoreduced Blood Products and Pediatric Transfusion Medicine 111
References 111
Chapter 8. Preparation of Blood Components to Reduce Cytomegalovirus and Other Infectious Risks 114
Introduction 114
Red Blood Cell and Platelet Components with Reduced Infectious Risks 114
Plasma Components, Derivatives, and Factors to Eliminate Pathogens 118
Nucleic Acid Targeted Inactivation Strategies 118
Summary 119
References 119
Chapter 9. Irradiated Products 122
History 122
Pathogenesis 122
Clinical Manifestations 123
Diagnosis of TA-GVHD 123
Time Course of Microchimerism 123
Groups at Risk 124
The Irradiation Process 124
Instrumentation for Irradiation 125
Components to be Irradiated 126
Storage of Red Cells and Platelets after Irradiation 127
Selection of Radiation Dose 128
Quality Assurance Measures 129
Confrming That Irradiation Occurred 129
New Methods in the Prevention of TA-GVHD 130
Treatment of TA-GVHD 131
References 131
Chapter 10. Washed and/or Volume- Reduced Blood Components 134
Introduction 134
Washed Red Blood Cells 134
Washed And Volume-Reduced Platelet Concentrates 138
References 140
Chapter 11. Technical Considerations/Mechanical Devices 142
Introduction 142
Intravenous Delivery Systems for Blood and Components 142
Exchange Transfusion in the Newborn 147
References 149
Chapter 12. Red Blood Cell Transfusions in the Neonate, Infant, Child, and Adolescent 152
Introduction 152
RBC Transfusions for Children and Adolescents 152
RBC Transfusions for Neonates and Infants 154
References 156
Chapter 13. Transfusion of the Pediatric Surgery, Trauma, and Intensive Care Unit Patient 158
Abstract 158
Age, Size, and Rate of Transfusion 158
Red Blood Cell Transfusion 160
Platelet Transfusions 161
Cryoprecipitate and Fresh Frozen Plasma 163
Hemostatic Agents in Acute Care 167
References 168
Chapter 14. Pediatric Transfusion in Developing Countries 170
Introduction 170
Special Transfusion Issues in Resource-Restricted Countries 170
Blood Collection and Processing in Developing Countries 172
Risks of Infectious Disease Transmission by Transfusion 174
Current Transfusion Practices 176
Prevention Measures to Reduce Need for Transfusion 177
References 177
Chapter 15. Exchange Transfusion in the Infant 180
Introduction 180
Rationale and Indications 180
Procedure 182
Selection of Donor Blood 183
Complications 184
References 185
Chapter 16. Granulocyte Transfusions in the Neonate and Child 188
Abstract 188
Introduction 188
Myelopoiesis 189
Neonatal Neutropenia and Dysfunction 189
Childhood Neutropenia 190
Mobilization of Donor Granulocytes 192
Therapeutic Granulocyte Transfusions in Children and Adults 194
Granulocyte Transfusion in the Neonate 198
Summary and Recommendations of Granulocyte Transfusions 199
References 200
Chapter 17. Extracorporeal Membrane Oxygenation and Cardiopulmonary Bypass 202
Introduction 202
Circuit for ECMO and CPB 202
ECMO 204
CPB 207
Summary 209
References 209
Chapter 18. Hemolytic Disease of the Newborn 212
Introduction 212
Immune-Mediated Hemolytic Disease 212
Rh Hemolytic Disease 213
ABO Hemolytic Disease 215
Hemolytic Disease Due to Other Red Cell Antibodies 216
T Activation 219
Autoimmune Hemolytic Disease 220
Red Cell Enzyme Deficiencies 220
Red Cell Membrane Defects 221
Disorders of Hemoglobin Synthesis 222
Other Causes of Hemolytic Disease in Neonates 223
Therapy 223
References 228
Chapter 19. Hemoglobinopathies 230
Introduction 230
Sickle Cell Disease 230
Thalassemias 238
References 239
Chapter 20. The Bleeding Child: Congenital and Acquired Disorders 242
Abstract 242
Introduction 242
Coagulation Overview 242
Clinical Evaluation of Bleeding Problems 243
Laboratory Evaluation 244
Specific Factor Assays 246
Inherited Coagulation Disorders 246
Acquired Hemorrhagic Disorders 259
References 262
Chapter 21. Transfusion of the Patient with Autoimmune Hemolysis 266
Introduction 266
Clinical Presentation and Laboratory Findings 266
Classification 266
Warm Autoimmune Hemolytic Anemia 267
Cold Agglutinin Syndrome 268
Mixed-Type Autoimmune Hemolytic Anemia 269
Drug-Induced Hemolytic Anemia 269
Less Common Types of Autoimmune Hemolytic Anemia 270
Transfusion Therapy in Autoimmune Hemolytic Anemia 271
References 272
Chapter 22. Platelet Transfusions in the Infant and Child 274
Introduction 274
Platelet Products and Special Preparations 274
Platelet Transfusions in Children 277
Platelet Transfusions in Neonates 280
Reactions to Platelet Transfusions 284
Potential Alternatives to Platelet Transfusions 286
References 286
Chapter 23. Bone Marrow–Derived Stem Cells 292
Introduction 292
Product Description 292
Collection and Storage 294
Special Preparation and Processing 295
Expected Response 299
Alternative HPC Sources 300
References 301
Chapter 24. Peripheral Blood Stem Cells 304
Introduction 304
Product Description 304
Collection 306
Special Preparation 308
Ordering and Administration 311
Potential Adverse Effects 312
Alternative HPC Sources 313
References 313
Chapter 25. Umbilical Cord Blood Stem Cells 316
Introduction 316
Collection, Storage, and Handling 316
Clinical Applications 318
References 320
Chapter 26. Transfusion Reactions 322
Introduction 322
Acute Hemolytic Transfusion Reactions 322
Febrile Nonhemolytic Transfusion Reactions 328
Allergic Transfusion Reactions 330
Delayed Hemolytic Transfusion Reactions 332
Special Considerations for Newborn Infants 335
References 336
Chapter 27. Noninfectious Complications of Pediatric Transfusion 338
Introduction 338
Transfusion Reactions 338
Metabolic Complications 341
Cardiac Overload 343
Alloimmunization 343
T Antigen Activation 343
Dilutional Coagulopathy 344
Complications of Iron Overload from Chronic Transfusion 344
References 346
Chapter 28. Infectious Complications 350
Introduction 350
Human Immunodeficiency Virus 350
Hepatitis 352
Human T-Cell Lymphotropic Virus (HTLV) 354
Cytomegalovirus 355
Parvovirus B19 356
Parasitic Infections 357
Creutzfeldt-Jakob Disease 358
Bacterial Infections 358
References 360
Chapter 29. Therapeutic Apheresis 364
Introduction 364
Goals of Therapeutic Apheresis 364
Indication Categories 366
Physiology and Adverse Effects 367
General Approach to Pediatric Patients Needing Therapeutic Apheresis 368
Planning Pediatric Procedures 369
Vascular Access 369
Hemodynamic Challenges 370
Procedural Modifications for Pediatric Patients 370
Summary 372
Suggested Reading 372
Chapter 30. Therapeutic Cytapheresis 374
Introduction 374
Evidence-Based Practice Guidelines 374
General Technical Considerations for Pediatrics 375
Erythrocytapheresis/Red Cell Exchange Transfusion 375
Leukapheresis 380
Plateletpheresis (Thrombocytapheresis) 382
Adverse Reactions 383
References 384
Chapter 31. Therapeutic Plasma Exchange: Rationales and Indications 386
Introduction 386
Guillain-Barré Syndrome 386
Chronic Inflammatory Demyelinating Polyneuropathy 388
Sydenham’s Chorea and PANDAS 389
Rasmussen’s Encephalitis 390
Thrombotic Thrombocytopenic Purpura 390
Hemolytic Uremic Syndrome 391
Familial Hypercholesterolemia 391
Refsum’s Disease 392
Focal Segmental Glomerulosclerosis 392
Solid Organ Transplantation 393
Other Diseases 394
Summary 395
References 395
Appendix. Transfusion Formulas 396
Approximate Blood Volumes (BV) 396
Plasma Volume (PV) 396
Red Blood Cell (RBC) Transfusion 396
Estimation of Blood Volume Exchanged 396
Partial Exchange Transfusion for Polycythemia 397
Exchange Transfusion for Anemia 397
Preparation of Blood Product with Specific Hct Using FFP 397
Platelet Transfusion 397
Coagulation 397
Massive Transfusions 398
Composition of Anticoagulants 398
Index 400
Blood Donation
Alfred J. Grindon, MD
OVERVIEW
During a typical year, about 14 million units of whole blood are collected in the United States. Most of these come from volunteer donors who give an average 1.6 units per year. The remainder of the collected units comes from donors designating their units for themselves (autologous donors, 4% of the total) or for another specific recipient (directed donors, less than 2% of the total) (Sullivan 2003). Perhaps 60% of the population is eligible to donate blood. Therefore, about 5% of eligible volunteer donors give annually. This amount of blood is usually sufficient to meet the needs of the recipient population, since, with the use of measures such as postponement of elective surgery, significant shortages have been found only in some parts of the country at specific times of the year (for instance, late summer and during and after the winter holiday season). However, the margin between units collected and units transfused has become substantially smaller over the last few years, causing concern about the elasticity of the blood supply (Simon 2003).
In addition to these units of whole blood, cytapheresis collections provide an increasing number of red blood cell collections (perhaps now an additional 300,000 units). Also, a significant majority of platelet doses transfused are platelets collected by apheresis.
The whole blood collected is usually separated into red cells and plasma for transfusion, or red cells, platelets, and “recovered” plasma (used for fractionation into plasma derivatives), at a rate of more than 2 components per unit collected. Of the more than 14 million units of collected units of red cells, about 13.5 million are transfused. Approximately 1.7% is discarded as a result of abnormal screening tests, and the remainder of the blood losses (as much as 50% of autologous units) occurs as a result of outdating.
Between 15% to 25% of the 8 million donors in the donor pool are lost annually and must be replaced with first-time donors (or the remaining donors must donate more frequently) to keep the number of donations constant. Further, the number of potential first-time donors must be greater than the number of units actually collected and tested, since first-time donors are approximately twice as likely to have disqualifying medical conditions or screening tests as repeat donors. Increasing concerns about the losses of potential donors from addition of new tests or new health history requirements (for example, travel-related deferrals for variant Creutzfeld Jacob Disease [vCJD]) make improvements in donor recruitment or donor retention increasingly important.
DONOR RECRUITMENT
Many studies have focused upon donor motivation in order to improve donor recruitment (Gillespie and Hillyer 2002). It has been shown, however, that most individuals who are able to donate conveniently and who are asked directly to do so, will give blood (Drake, Finkelstein, and Sapolsky 1982). The challenges are to find a way to ask directly and make it convenient to donate.
The classical successful blood drive, designed to address these concerns, is organized and held at a business or industry. The chief executive is asked to offer support in the provision of a top management leader, who develops a committee of employees (typically one committee member for each of 10 employees). These committee members ask their co-workers directly to donate at an upcoming blood drive, provide a specific appointment time, and remind them of their pledge on the day before or the day of the drive. The physical collection venue is located at the business, in the lunchroom, conference room, or other convenient on-site location. Such classical blood drives are usually successful.
Another approach is telephone recruitment by blood center employees to a conveniently located collection facility. The added costs of recruitment and the permanent facility are offset by the more efficient use of collection staff, who do not need to travel to and set up at a distant site. A small number of collections come from self-contained bloodmobiles (typically of four- to six-bed capacity), but this approach is generally ineffective unless supported by a strong telerecruitment effort.
Telephone recruitment is also an important tool for recruitment of those donors needed in greater frequency than found in the general population. Group O donors generally, and O Rh negative specifically, are always in short supply. For this reason, those using red cell cytapheresis techniques will preferentially recruit Group O donors for this procedure. Similarly, Group AB plasma is generally in short supply, and facilities obtaining plasma for transfusion consider telerecruitment of Group AB donors for plasmapheresis. Blood from donors known to be cytomegalovirus (CMV) seronegative may be needed for transfusion to specific recipients, such as transplant recipients or neonates. Telerecruitment is useful here also; for the latter group, the donor blood may be placed in a bag containing an anticoagulant-preservative solution suitable for neonatal recipients.
Some regions of the country have supported these approaches with an additional incentive: a blood “insurance” plan whereby annual donations from a certain percentage of a given group ensures that all the members of the group (and their families) are “covered.” Many centers use the provision of a personal health test, nonrelated to blood donation, such as cholesterol, prostate-specific antigen, blood sugar, or a test for hemochromatosis, as an incentive.
From time to time in the past, blood centers have used direct financial incentives or material incentives that have financial equivalents (event tickets, raffles). The increasing awareness that financial incentives are associated with a higher frequency of transfusion-transmitted disease (Eastlund 1998), along with current labeling requirements of the Food and Drug Administration (FDA) that such units be labeled as from a “paid donor” (but “Benefits, such as time off from work, membership in blood assurance programs, and cancellation of nonreplacement fees that are not readily convertible to cash, do not constitute payment within the meaning of this paragraph”) (21 CFR 606.121 (c)(5)), have generally eliminated such usage. Two exceptions exist. Some smaller centers that have demonstrated that their infectious disease marker frequency is less than that of volunteer donors, or some facilities that focus on more difficult-to-recruit plateletapheresis donors may still use financial motivation. In addition, the “source plasma” industry, whose plasma products are collected by plasmapheresis and are subsequently pooled and subjected to viral inactivation steps during the fractionation manufacturing process (and therefore carry a greatly reduced risk of transfusion-transmitted diseases), has traditionally used financial incentives.
AUTOLOGOUS DONATION
Patients may give blood for themselves before elective surgery (preoperative) or have their blood returned during the operative procedure (intraoperative). Preoperative autologous donation requires a donor who is healthy enough to give blood, but who is undergoing an operative procedure in the next 6 weeks that usually requires blood. Autologous donors can be drawn with lower hemoglobin standards (≥ 11 g/dL) and drawn weekly, but blood should not be drawn for a few days immediately before surgery to allow blood volume to be restored. Intraoperative salvage may be useful for procedures with large anticipated blood losses retrievable from a body cavity, such as for cardiovascular surgery.
The percentage of units of autologous blood collected preoperatively reached as high as 10% in some areas during the 1980s as a result of a general fear of transfusion-transmitted disease, but with the development of good testing for these diseases this percentage has subsequently fallen to about 4% of the total collected. While it is possible to collect, freeze, and store red blood cell units for up to 10 years, the cost and time required to prepare these units for transfusion make this practice impractical except in rare circumstances. These include patients whose red-cell antibodies make finding compatible allogeneic blood difficult, or for patients with several units of autologous blood already available but whose surgeries have been postponed.
Autologous donation for the pediatric population represents more of a challenge. To begin with, informed consent (or “assent”) is difficult, since the concern is usually not of the patient but of the parents. Because of the child’s size, collection of half units from older (larger) children may be all that is possible. Nevertheless, autologous blood may be used in the pediatric population for surgery where blood is usually required, such as for orthopedic spinal surgery.
DIRECTED DONATION
Directed donation is the donation of blood that is then specified for the use of a particular patient. Currently, directed donation represents only about 2% of the total blood collected. The collection of this blood represents a logistical challenge, since the blood must be handled separately and at the hospital, kept for as long a time as the patient might reasonably need it. Since donors of such blood must meet the same requirements as regular donors, directed donations are used for other patients when the need for transfusion of the intended recipient has passed. In a pediatric setting, directed donation is done at the desire of the parents and often with the intent of using parents...
| Erscheint lt. Verlag | 23.2.2004 |
|---|---|
| Sprache | englisch |
| Themenwelt | Sachbuch/Ratgeber |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Chirurgie | |
| Medizinische Fachgebiete ► Innere Medizin ► Hämatologie | |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Onkologie | |
| Naturwissenschaften ► Biologie ► Humanbiologie | |
| ISBN-10 | 0-08-049143-X / 008049143X |
| ISBN-13 | 978-0-08-049143-1 / 9780080491431 |
| Haben Sie eine Frage zum Produkt? |
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