The contributors review the appropriate use of fluids and of blood products, and describe the latest treatment options available to decrease the need for allogeneic blood products including:. The new edition is a key reference source for all those involved in the practice of blood management and conservation.
Request permission to reuse content from this site. What Evidence Do We Have? Added to Your Shopping Cart. Description Meeting the needs of patients while minimizing blood transfusions requires special expertise, precise monitoring and innovative techniques. Alternatively, one might maintain the current not-for-profit business model for whole blood collection and model ex vivo expansion on a for-profit model where economies of scale might work to reduce overall cost. Progress in ex vivo generation of megakaryocytes and platelets is not as advanced as development of red cells. The value of platelet transfusions in preventing hemorrhage in thrombocytopenic patients and patients with thrombocythemia is not disputed although the level at which platelet transfusions should be given prophylactically to thrombocytopenic patients to prevent hemorrhage was the subject of recent clinical trials.
Platelets may be manufactured from whole blood by centrifugation to produce platelet concentrate or prepared by apheresis. An adult dose of platelets would require pooling of 4—6 units of platelets depending on local practice or a single apheresis product. Both products are usually leukoreduced.
There is ongoing concern about the adequacy of platelet inventories for two reasons, the shelf life is short maximum of 5 days and platelet products stored at room temperature are more likely to be contaminated with bacteria [ 37 , 38 ]. Refractoriness to platelet transfusions is usually caused by anti-HLA antibodies. Antibodies to platelet-specific antigens may also be implicated. In neonatal thrombocytopenic purpura, the offending antibody is typically directed at platelet-specific antigens.
Refractoriness to platelet transfusions is a significant problem for multitransfused patients with hematologic malignancies receiving chemotherapy or undergoing hematopoietic stem cell transplantation. Identification of suitable products for alloimmunized patients involves HLA typing of the patient typically performed with DNA-based techniques , antibody screening for anti-HLA class I and anti-platelet-specific antibodies solid phase or flow cytometry as well as platelet crossmatching solid phase or flow cytometric techniques.
Complex computer algorithms for selecting HLA compatible donors based on epitope sharing have been developed to identify compatible products [ , ]. Thus the ability to generate platelet products ex vivo and platelet products lacking HLA antigens in serum free media would have great clinical value. Methods have been developed to generate platelets ex vivo from cord blood CD34 positive cells and from embryonic stem cells [ ]. Ex vivo generation of platelet products deficient in HLA class I antigen expression could have an enormous impact on the provision of platelet products to refractory patients.
These platelets appeared to have normal function in vitro. Granulocyte transfusions have not consistently demonstrated improved clinical outcomes in infected neutropenic patients. However, these inconsistent results may reflect heterogeneity in patient populations, failure to transfuse an adequate number of granulocytes, limited information on optimal storage conditions for granulocyte products, and difficulty in identifying a rapid reliable assay for determining granulocyte compatibility other than ABO. Studies of ex vivo generated neutrophils may provide valuable information on optimal storage conditions for neutrophils and may ultimately produce a product with a longer shelf-life.
Theoretically, ex vivo generated red blood cells will be produced on demand on a predictable schedule, will provide cellular products of more uniform composition with limited contamination by other cell types, will be associated with lower rates of transmission of infectious diseases, cause fewer allergic reactions, produce a lower rate of alloimmunization because extended matching will be possible, and will have longer in vivo survival while producing less iron overload than currently available products.
It is not possible to predict when these products will be approved for clinical use. Many complex issues related to scale-up production and the potential immunogenicity neoantigen formation of products produced in vitro remain to be resolved. However, the development of these products will inform and transform quality control and manufacturing processes for traditional blood products. National Center for Biotechnology Information , U. Journal List Stem Cells Int v. Published online Apr 8. Received Nov 9; Accepted Dec This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC. Abstract The primary focus of national blood programs is the provision of a safe and adequate blood supply.
Introduction In the last 30 years, transfusion medicine has evolved from a field focused on blood component therapy and red blood cell serology to include advanced cellular therapies produced by ex vivo expansion [ 1 , 2 ]. Open in a separate window. Materials and Methods The authors conducted searches on PubMed and Google using the following search terms: Perspective on Needs in Transfusion Medicine Since the beginning of modern transfusion therapy extraordinary efforts have been required to maintain a safe and adequate blood supply [ 23 — 25 ].
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The Blood Supply In developed nations the blood supply is adequate overall [ 60 — 62 ], but extreme weather conditions and natural disasters such as the recent earthquake and tsunami in Japan and flooding in the United States disrupt routine blood collection activities leading to temporary shortages. Prevention of Transfusion-Transmitted Infections: Alloimmunization As the scientific basis for producing better and safer products for transfusion through donor screening and product testing has made transfusion safer, alloimmunization resulting from transfusion has emerged as a major issue in clinical care.
Impact of Ex Vivo Generated Blood Cells on Needs in Transfusion Medicine Red blood cells have been successfully generated ex vivo from peripheral blood mononuclear cells, cord blood, and human-induced pluripotent stem cell hiPSC and human embryonic stem cell hESC lines. Component therapy to cellular therapy and beyond—a Darwinian approach to transfusion medicine.
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Transfusion Alternatives in Transfusion Medicine
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Transfusion Alternatives in Transfusion Medicine - Index
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Life, death, and the risk of transfusion: Henkel-Honke T, Oleck M. June 20, Last Revised: For reprint requests, please see our Content Usage Policy. Alternatives to Blood Transfusions.
6: Alternatives and adjuncts to blood transfusion
In some cases, options other than blood product transfusions may be used. Volume expanders When a patient has lost a lot of fluids, the body can go into a type of shock. Growth factors The body naturally makes hormone-like substances called hematopoietic growth factors that cause the bone marrow to make more blood cells. But they have some drawbacks that may limit their use in some cases: Unlike transfusions, growth factors often take many days or weeks to raise blood counts, so they may not be useful in people who need their blood cell levels raised quickly, such as those who are actively bleeding.
Some growth factors might cause certain types of cancer cells such as lymphocytic leukemia, multiple myeloma, head and neck cancer, breast cancer, cervical cancer, and some kinds of lung cancer cells to grow more quickly. Growth factors generally cost a lot more than transfusions.