Blood transfusion

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Blood transfusion is generally the process of receiving blood or blood products into a person's intravenous circulation. Transfusions are used for various medical conditions to replace lost components of blood. Early transfusions use whole blood, but modern medical practice generally only uses blood components, such as red blood cells, white blood cells, plasma, clotting factors, and platelets.

Video Blood transfusion

Medical use

Historically, transfusions of red blood cells were considered when hemoglobin levels fell below 100 g/L or hematocrit fell below 30%. Because each unit of blood given carries the risk, a lower trigger level than that at 70 to 80 g/L is now usually used because it has been shown to have better patient outcomes. Administration of a unit of blood is standard for hospitalized people who are not bleeding, with this treatment followed by reassessment and consideration of symptoms and hemoglobin concentrations. Patients with poor oxygen saturation may require more blood. A cautionary warning to use blood transfusion only with a more severe anemia is in part due to evidence that the results worsen if a larger amount is given. One can consider transfusions for people with symptoms of cardiovascular disease such as chest pain or shortness of breath. In cases where patients have low but cardiovascular stable hemoglobin levels, parenteral iron is the preferred choice based on efficacy and safety. Other blood products are given if needed, such as clotting deficiency.

Maps Blood transfusion

Procedures

Before blood transfusion is given, there are many steps taken to ensure the quality of blood products, compatibility, and safety to the recipient. In 2012, the national blood policy is enacted in 70% of countries and 62% of countries have specific laws covering the safety and quality of blood transfusions.

Blood donor

Blood transfusions usually use a blood source: a person (autologous transfusion), or others (allogeneous or homologous transfusions). The latter is much more common than the first. Using someone else's blood should start with a blood donation. Blood is most often donated as intravenous intravenous blood and collects it with anticoagulants. In developed countries, donations are usually anonymous to recipients, but products in blood banks can always be traced individually through the entire donation cycle, testing, segregation into components, storage, and administration to recipients. This allows management and investigation of any alleged transfusions related to disease transmission or transfusion reactions. In developing countries, donors are sometimes recruited specifically by or for recipients, usually family members, and donations occur immediately before the transfusion.

Processing and testing

Donated blood is usually processed after being collected, to make it suitable for use in certain patient populations. The collected blood is then separated into blood components by centrifugation: red blood cells, plasma, platelets, albumin protein, clotting factor concentrates, cryoprecipitate, fibrinogen concentrate, and immunoglobulin (antibodies). Red blood cells, plasma and platelets can also be donated individually through a more complex process called apheresis.

The World Health Organization (WHO) recommends that all donated blood be tested for transfusion of transmissible infections. These include HIV, Hepatitis B, Hepatitis C, Treponema pallidum (syphilis) and, if relevant, other infections that pose a risk to blood supply security, such as Trypanosoma cruzi (Chagas disease) and Plasmodium species (malaria). According to WHO, 25 countries can not screen all donated blood for one or more of: HIV; Hepatitis B; Hepatitis C; or syphilis. One of the main reasons for this is because the test kits are not always available. However, the prevalence of transfused-transmitted infections is much higher in low-income countries compared to middle- and high-income countries.
All donated blood should also be tested for the ABO blood type system and Rh blood group system to ensure that patients receive compatible blood.
In addition, in some countries platelet products are also tested for bacterial infections due to their higher propensity for contamination due to storage at room temperature. The presence of Cytomegalovirus (CMV) may also be tested because of the risk for certain immunocompromised recipients if given, such as those with organ or HIV transplants. However, not all blood is tested for CMV because only a certain amount of CMV-negative blood needs to be available to meet the patient's needs. In addition to positive for CMV, any product tested positive for infection is not used.
Reduction of leukocytes is the removal of white blood cells by screening. Leukoreduced blood products are less likely to cause alloimmunization of HLA (development of antibodies against certain blood types), non-hemolytic febrile transfusion reactions, cytomegalovirus infections, and transfusion-platelet refractoriness.
Pathogen Reduction Treatment involving, for example, the addition of riboflavin to subsequent UV exposure has been shown to be effective in inactivating pathogens (viruses, bacteria, parasites and white blood cells) in blood products. By disabling white blood cells in donated blood products, riboflavin and UV light treatments can also replace gamma irradiation as a method to prevent graft-versus-host disease (TA-GvHD).

Compatibility test

Before the recipient receives the transfusion, compatibility testing between donor and blood recipients should be performed. The first step before the transfusion is given is typing and filtering the recipient's blood. Typing the recipient's blood determines the status of ABO and Rh. The sample is then filtered for any alloantibodies that may react with donor blood. It takes about 45 minutes to complete (depending on the method used). Blood bank scientists also examine the patient's specific requirements (eg need for washing, unirradiated or negative CMV blood) and patient history to see if they have previously identified antibodies and other serological anomalies.

A positive screen guarantees an antibody/investigation panel to determine if it is clinically significant. An antibody panel comprises a commercially prepared red cell suspected O group of donors having phenotypes for antigens corresponding to commonly encountered and clinically significant alloantibodies. Donor cells may have homozygous expression (eg K k-), heterozygous (K k) or no expression of various antigens (K-k-). The phenotype of all the donor cells being tested is shown in the chart. The patient's serum was tested against various donor cells. Based on the patient's serum reaction to donor cells, a pattern will appear to confirm the presence of one or more antibodies. Not all antibodies are clinically significant (ie causing transfusion reactions, HDN, etc.). Once the patient has developed clinically significant antibodies it is essential that the patient receives antigen-negative red blood cells to prevent future transfusion reactions. Direct antiglobulin testing (Coombs test) is also performed as part of an antibody investigation.

If no antibodies are present, an instant spin crossmatch or computer-aided crossmatch is performed where the serum and rbc donor recipients are incubated. In the direct spin method, two drops of patient serum were tested against a drop of 3-5% of donor cell suspension in the test tube and spun in serofuge. Agglutination or haemolysis (ie, positive Coombs test) in the test tube is a positive reaction and the unit should not be transfused.

If antibodies are suspected, potential donor units must first be screened for antigens that match their phenotype. The antigen negative unit was then tested against the patient's plasma using an antiglobulin/indirect crossmatch technique at 37 degrees Celsius to improve reactivity and make the test easier to read.

In urgent cases where crossmatching can not be resolved, and the risk of hemoglobin dropping is greater than the risk of unfiltered blood transfusion, O-negative blood is used, followed by crossmatch as soon as possible. O-negative is also used for children and women of childbearing age. It is preferable for the laboratory to obtain a pre-transfusion sample in this case so that the type and screen can be performed to determine the actual blood type of the patient and to check for alloantibodies.

ABO and Rh system compatibility

This diagram shows the possibility of a match in blood transfusion between the donor and the receiver using ABO and Rh systems.

Patient getting blood transfusion in hospital clinic â€

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Adverse effects

In the same way that the safety of pharmaceutical products is supervised by pharmacovigilance, blood safety and blood products are controlled by hemovigen. It is defined by the World Health Organization (WHO) as a system "... to identify and prevent the occurrence or relapse of transfusions related to undesirable events, to improve the safety, efficacy and efficiency of blood transfusions, including all transfusion chain activities. recipient. "The system should include monitoring, identification, reporting, investigation, and analysis of near-term adverse events and reactions related to transfusion and manufacturing. In the UK, this data is collected by an independent organization called SHOT (Serious Hazards Of Transfusion).

Greater use of red blood cell counts is associated with a higher risk of infection. In those who were given only red blood with a significant anemia rate of infection was 12% whereas in those who were given red blood at a milder rate the rate of anemia infection was 17%.

Sometimes, blood products are contaminated with bacteria. This can lead to life-threatening infections known as transfusion-transmitted bacterial infections. The risk of severe bacterial infection is estimated, in 2002, about 1 in 50,000 platelet transfusions, and 1 in 500,000 red blood cell transfusions. Contamination of blood products, although rare, is still more common than the actual infection. The reason thrombocytes are more frequently contaminated than other blood products is that they are stored at room temperature for short periods of time. Contamination is also more common with longer storage duration, especially if it means more than 5 days. Contaminant sources include donor blood, donor skin, phlebotomist skin, and containers. Pollutant organisms vary widely, and include skin flora, intestinal flora, and environmental organisms. There are many strategies in blood and blood donor centers to reduce the risk of contamination. The exact diagnosis of transfusion transfusion bacterial infection includes the identification of positive culture on the recipient (without alternative diagnosis) as well as identification of the same organism in the blood of the donor.

Since the discovery of donor blood HIV testing in the mid/late 1980s, ELISA 1985, HIV transmission during transfusion has dropped dramatically. Previous donor blood tests included only tests for antibodies to HIV. However, due to a latent infection ("window period" in which an individual is infectious, but has not had time to develop antibodies) many HIV seropositive blood cases are missed. The development of nucleic acid testing for HIV-1 RNA has dramatically lowered the seropositive blood levels of donors to about 1 in 3 million units. Because HIV transmittance does not necessarily mean HIV infection, HIV infection can still occur at a lower rate.

Transmission of hepatitis C through transfusion is currently at a rate of about 1 in 2 million units. Like HIV, this low level has been linked to the ability to screen both antibodies and the RNA virus nucleic acid test in donor blood.

Other rare infectious infections include hepatitis B, syphilis, Chagas disease, cytomegalovirus infection (on immunocompromised recipients), HTLV, and Babesia.

Ineffectiveness

Ineffective ineffectiveness of transfusions or the inadequate efficacy of a particular unit of blood products, while itself not a "complication" per se , may indirectly cause complications - other than to cause the transfusion to be completely or partially failing to achieve its clinical goals. This can be very important for certain patient groups such as critical or neonatal care.

For red blood cells (RBC), by far the most frequently transfused product, poor transfusion efficacy can result from units damaged by so-called storage lesions - various biochemical and biomechanical changes that occur during storage. With red blood cells, this can decrease the viability and ability to tissue oxygenation. Although some biochemical changes are reversible after blood is transfused, biomechanical changes are less, and rejuvenating products have not been able to reverse this phenomenon. There is controversy about whether the age of a given product unit is a factor in the efficacy of transfusions, particularly about whether "older" blood directly or indirectly increases the risk of complications. Studies have not been consistent in answering this question, with some suggesting that older blood is less effective but with others showing no such difference; this development is followed by hospital blood bankers - who are doctors, usually pathologists, who collect and manage a transfusible blood supply unit.

Certain regulatory measures are performed to minimize RBC storage lesions - including maximum shelf life (currently 42 days), maximum automatic hemolysis threshold (currently 1% in the US, 0.8% in Europe), and a minimum post-operative rate survival of transfusion RBC in vivo (currently 75% after 24 hours). However, all of these criteria are applied universally which does not take into account the differences between product units. For example, the test for post-transfusion survival of RBC in vivo was performed on healthy volunteer samples, and then adherence was considered to all RBC units based on universal processing standards (GMP) (of course, Blood cell survival white by itself does not guarantee success, but it is a necessary prerequisite for cell function, and therefore serves as a regulatory proxy). Opinions vary for the "best" way to determine the efficacy of transfusion in patients in vivo . In general, there is no in vitro test to assess the quality or predict efficacy for specific RBC blood product units prior to their transfusion, although there are potentially relevant test explorations based on the nature of RBC membranes such as erythrocyte deformability and erythrocyte fragility (mechanical).

Doctors have adopted the so-called "restrictive protocols" - where transfusions are held to a minimum - in part because of the uncertainty recorded around storage lesions, in addition to the high cost of direct and indirect transfusions. Of course, the restrictive protocol is not an option with some very vulnerable patients who may require the best effort to quickly restore tissue oxygenation.

Although platelet transfusion is much less (relative to RBC), platelet storage lesions and resulting loss of efficacy are also of concern.

The known relationship between intraoperative blood transfusion and cancer recurrence has been established in colorectal cancer. In intra-operative blood transfusion lung cancer has been associated with previous cancer recurrence, worse survival rates and worse outcomes after lung resection. Also research shows us, the immune system failure caused by blood transfusions can be categorized as one of the main factors causing more than 10 different types of cancer that are completely related to blood transfusion and the innate and adaptive immune system. Allogenic blood transfusions, through five major mechanisms including T-lymphocytes, myeloid-derived suppressor cells (MDSCs), tumor-linked macrophages (TAMs), natural killer cells (NKCs), and dendritic cells (DCs) can assist defense mechanisms. On the other hand, the roles for each listed item include antitumor activation of cytotoxic T lymphocyte CD8 (CD8/CTL), inactivation of Treg, inactivation of STAT3 signaling pathways, bacterial use to enhance antitumor immune response and cellular immunotherapy.
Transfusion-associated volume overload is a common complication due to the fact that the blood product has a certain amount of volume. This is especially true for recipients with underlying cardiovascular or renal disease. Red blood cell transfusions can cause excessive volume when they have to be repeated due to inadequate efficacy (see above). Plasma transfusions are particularly susceptible to excess volume due to their hypertonicity.
Hypothermia can occur with transfusions with large amounts of blood products normally stored at cold temperatures. The core body temperature may drop as low as 32 Â° C and may produce physiological disorders. Prevention should be done by warming the blood to the ambient temperature before transfusion.
Transfusions with large numbers of red blood cells, whether due to severe bleeding and/or transfusion ineffectiveness (see above), can cause a tendency to bleed. This mechanism is thought to be caused by disseminated intravascular coagulation, along with the dilution of the recipient platelets and coagulation factors. Close monitoring and transfusions with platelets and plasma are indicated when necessary.
Metabolic alkalosis can occur with massive blood transfusions because the breakdown of the citrate stored in the blood becomes bicarbonate.
Hypocalcemia may also occur with massive blood transfusions because of the citric complex with serum calcium.
Blood doping is often used by athletes, drug addicts or military personnel for reasons such as to increase physical stamina, to falsify drug detection tests or just to stay active and alert during their respective time tasks. But the lack of inadequate knowledge and experience can turn blood transfusion into sudden death. For example, when an individual runs a sample of frozen blood directly in his blood vessels, this cold blood quickly reaches the heart, where it interferes with the heart's original speed that causes heart attacks and sudden death.

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Frequency of use

Globally about 85 million units of red blood cells are transfused in a given year.

In the United States, blood transfusions were performed nearly 3 million times during hospitalization in 2011, making it the most common procedure. The rate of hospitalization with blood transfusion was almost double that of 1997, from level 40 it remained to 95 per 10,000 residents. It was the most common procedure performed for patients 45 years and older in 2011, and among the five patients most common for patients between the ages of 1 and 44 years.

According to the New York Times: "Changes in treatment have eliminated the need for millions of blood transfusions, which is good news for patients who get procedures such as coronary bypass and other procedures that once require a lot of blood." And, "Blood bank income declined, and the decline could reach $ 1.5 billion a year this year [2014] from a high $ 5 billion in 2008." The job loss will reach as high as 12,000 in the next three to five years, roughly a quarter of the total in the industry, according to the Red Cross.

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History

Beginning with William Harvey's experiments on blood circulation, research on blood transfusion began in the 17th century, with successful experiments in animal transfusions. However, consecutive attempts by physicians for animal to human blood transfusions result in varied, often fatal outcomes.

Pope Innocent VIII is sometimes said to have been given "the first blood transfusion in the world" by his Jewish physician Giacomo in San Genesio, who drank it (by mouth) the blood of three 10-year-old boys. The children then died. The evidence for this story, however, is unreliable and may have been motivated by anti-Semitism.

Initial attempt

Animal blood

Working at the Royal Society in the 1660s, physician Richard Lower began examining the effects of blood volume changes on circulatory function and developing methods for cross-circulation studies in animals, eliminating freezing by enclosed arteriovenial connections. The new tools he was able to make enabled him to perform his first successful successful blood transfusion in front of his respected associates of the Royal Society.

According to Lower records, "... by the end of February 1665 [I] chose a medium-sized dog, opened his neck, and bleeding, until his strength was almost gone, then to redeem the big one, lost this dog in a second, blood from the cervical arteries of a sizeable mastiff, which has been tied together with the first, until the last animal shows... it is too full... by the flowing blood. "After he" sewed the veins, "the animal recovered" without any sign of discomfort or displeasure. "

Lower has performed the first blood transfusion between animals. He was then "requested by the Honorable [Robert] Boyle... to introduce the Royal Society with a procedure for the whole experiment," which he did in December 1665 in the Society of Philosophical Transactions.

The first animal-to-human blood transfusion was performed by Dr. Jean-Baptiste Denys, the prominent doctor for King LouisÃƒ, XIV of France, on June 15, 1667. He transfused sheep blood to a 15-year-old boy, who survived the transfusion. Denys made another transfusion into labor, which also survived. Both examples may be due to the small amount of blood actually transfused to these people. This allows them to withstand allergic reactions.

The third patient of Denys to undergo blood transfusion is Swedish Baron Gustaf Bonde. He received two transfusions. After the second transfusion, Bonde died. In the winter of 1667, Denys performed several transfusions on Antoine Mauroy with calf blood. In the third account, Mauroy died.

Six months later in London, Lower performed the first human blood transfusion of animals in England, where he "superintended the introduction in the arm [patient] at various times a few ounces of sheep's blood at a meeting of the Royal Society, and without any inconvenience for him." The recipient was Arthur Coga , "the subject of a harmless form of insanity." Sheep blood is used because of speculation about the value of inter-species blood exchange; it has been suggested that the blood of the gentle sheep can soothe spirits of the anxious person and that the shy may be made out of the blood of a more social creature. Coga received 20 shillings (equivalent to Ãƒ, Ã‚ Â£ 158 in 2016) to participate in the experiment.

Lower continues by pioneering new devices for proper blood flow control and blood transfusions; the design is substantially the same as modern syringes and catheters. Shortly afterwards, Lower moved to London, where his evolving practice soon left him with research.

This early experiment with animal blood triggered a hot controversy in England and France. Finally, in 1668, the Royal Society and the French government banned both procedures. The Vatican condemned this experiment in 1670. Blood transfusion falls in obscurity for the next 150 years.

Human blood

The science of blood transfusion began in the first decade of the twentieth century, with the discovery of different blood groups that led to the practice of mixing some blood from donors and recipients before transfusion (cross-matching initial form).

At the beginning of the 19th century, the English obstetrician Dr. James Blundell made an effort to treat bleeding with human blood transfusions using a syringe. In 1818 after experimenting with animals, he performed the first successful human blood transfusion to treat postpartum hemorrhage. Blundell uses the patient's husband as a donor, and takes four ounces of blood from his arm for a transfusion to his wife. During 1825 and 1830, Blundell performed 10 transfusions, five of which were useful, and published the results. He also found a number of instruments for blood transfusion. He made a huge sum of money from this business, roughly $ 2 million ($ 50 million real dollars).

In 1840, at St George's Hospital Medical School in London, Samuel Armstrong Lane, assisted by Dr. Blundell, performed the first successful blood transfusion to treat hemophilia.

However, early transfusions are risky and many result in the death of the patient. By the end of the nineteenth century, blood transfusion was considered a risky and dubious procedure, and was largely shunned by medical institutions.

Working to emulate James Blundell continues in Edinburgh. In 1845, the Edinburgh Journal described a successful blood transfusion in a woman with severe uterine bleeding. The subsequent transfusion was successful with Professor James Young Simpson's patient after whom the Simpson Memorial Hospital in Edinburgh was named.

The largest series of successful early transfusions took place at Edinburgh Royal Infirmary between 1885 and 1892. Edinburgh later became the home of the first blood donor and blood transfusion service.

Modern era

It was not until 1901, when Austrian Karl Landsteiner discovered three groups of human blood (O, A, and B), that blood transfusion was put into scientific base and became more secure.

Landsteiner discovered that adverse effects arise from mixing blood from two incompatible individuals. He found that when incompatible types are mixed, the immune response is triggered and the red blood cells collect. Immunological reactions occur when blood transfusion recipients have antibodies to donor blood cells. The destruction of red blood cells releases free hemoglobin into the bloodstream, which can be fatal. Landsteiner's work makes it possible to define blood type and allow a way of blood transfusion to be performed much safer. For this discovery he was awarded the Nobel Prize in Physiology and Medicine in 1930, and many other blood groups have been discovered since then.

George Washington Crile is credited with performing the first surgery using direct blood transfusions in 1906 at St Alexis Hospital in Cleveland while a professor of surgery at Case Western Reserve University.

Jan JanskÃƒÆ'Ã‚ Â¯ also found human blood group in 1907 which he ranks into four groups I, II, III, IV. Titled in Czech "HematologickÃƒÆ'Ã‚Â¡ studie u psychotic?". His nomenclature is still used in Russia and the former Soviet Union countries, where blood groups O, A, B, and AB are set to I, II, III, and IV respectively.

Moss's blood mating technique in 1910 Dr. William Lorenzo Moss (1876-1957) was widely used until World War II.

William Stewart Halsted, MD (September 23, 1852 - September 7, 1922) was an American surgeon who emphasized strict aseptic techniques during surgical procedures, was an early hero of newly discovered anesthesia, and introduced several new operations, including a radical mastectomy for breast cancer. Halsted returned to New York in 1880 and for the next six years led an extraordinarily strong and energetic life. He operates in many hospitals, including Roosevelt Hospital, College of Physicians and Surgeons, Charity Hospital, Emigrant Hospital, Bellevue Hospital, and Chambers Street Hospital. He is a very popular teacher, inspiring, and charismatic. In 1882 he performed one of the first gallbladder operations in the United States (cholecystotomy was performed on his mother on the kitchen table at 2 am). Halsted also performed one of the first blood transfusions in the United States. He was called to meet his sister after she gave birth. He finds him almost bloodless, and in bold motion withdraws his own blood, transfers his blood to his brother, and then operates it to save his life.

Blood Bank at WWI

While the first transfusion should be done directly from the donor to the recipient before coagulation, it was found that by adding anticoagulants and cooling the blood it was possible to keep it for several days, thus paving the way for the development of blood banks. John Braxton Hicks was the first to experiment with chemical methods to prevent blood clots at St. Mary's Hospital, London in the late 19th century. His efforts, using a soda phosphate, however, did not work.

The first non-direct transfusion was made on March 27, 1914 by Belgian physician Albert Hustin, though this was a diluted blood solution. Argentine doctor Luis Agote used a much lesser solution in November of that year. Both use sodium citrate as an anticoagulant.

The First World War acted as a catalyst for the rapid development of blood banks and transfusion techniques. Canadian doctors and Lt. Lawrence Bruce Robertson were instrumental in persuading the Royal Army Medical Corps to adopt the use of blood transfusions in Casualty Clearing Stations for the wounded. In October 1915, Robertson made his first wartime transfusion with a hypodermic needle to a patient suffering multiple bullet wounds. He follows this with the next four transfusions in the next few months and his success is reported to Sir Walter Morley Fletcher, director of the Medical Research Committee.

Robertson published his findings in the British Medical Journal in 1916 and, with the help of several like-minded individuals (including prominent physician Edward William Archibald who introduced the anticoagulant citrate method), was able to persuade British authorities of the benefits of blood transfusion. Robertson went on to establish the first blood transfusion apparatus at the Casualty Clearing Station on the Western Front in the spring of 1917.

Oswald Hope Robertson, a medical researcher and a US Army officer attached to RAMC in 1917, where he was instrumental in setting up the first blood bank, in preparation for the anticipated Third Ypres Battle. He used sodium citrate as an anticoagulant and the blood was extracted from punctures in the blood vessels and stored in bottles in the British and American Casualty Clearing Stations along the Front. He also experimented with preserving the separate red blood cells in ice bottles. Geoffrey Keynes, a British surgeon, developed a portable machine that can store blood to allow for easier transfusion.

Expansion

The world's first blood donor service was founded in 1921 by British Red Cross secretary Percy Oliver. That year, Oliver was contacted by King's College Hospital, where they desperately needed a blood donor. After donating, Oliver began arranging a blood donation volunteer registration system at a clinic around London, with Sir Geoffrey Keynes being appointed medical adviser. Volunteers are subjected to a series of physical tests to form their blood type. The London Blood Transfusion Service is free of charge and is growing rapidly in the first few years of its operation. By 1925, it provided services for nearly 500 patients and it was incorporated into the structure of the British Red Cross in 1926. Similar systems were established in other cities including Sheffield, Manchester and Norwich, and service work began to attract international attention. Similar services were established in France, Germany, Austria, Belgium, Australia and Japan.

An academic institution devoted to the science of blood transfusion was founded by Alexander Bogdanov in Moscow in 1925. Bogdanov was motivated, at least in part, by searching for eternal youth, and commented with satisfaction on improving his eyesight, balding suspension. , and other positive symptoms after receiving 11 whole blood transfusions. Bogdanov died in 1928 as a result of one of his experiments, when the blood of a student suffering from malaria and tuberculosis was given to him in transfusion. Following the leadership of Bogdanov, Vladimir Shamov and Sergei Yudin at the USSR pioneered cadaveric blood transfusions from donors who recently died. Yudin conducted the transfusion successfully for the first time on March 23, 1930 and reported seven first clinical transfusions with cadaveric blood at the Fourth Congress of Ukrainian Surgeons in Kharkiv in September. However, this method has never been used extensively, even in Russia.

One of the earliest blood banks was founded by Frederic DurÃƒÆ'Ã‚Â¡n-JordÃƒÆ' during the Spanish Civil War in 1936. Duran joined the Transfusion Service at Barcelona Hospital at the start of the conflict, but the hospital was soon overwhelmed by the demand for blood. and lack of available donors. With the support of the Ministry of Health of the Spanish Republican Army, Duran established a blood bank for the use of wounded soldiers and civilians. 300-400 mL of extracted blood was mixed with 10% citrate solution in a modified Duran Erlenmeyer thermos. Blood kept in sterile glass closed under pressure at 2 Ãƒ, Ã‚ Â° C. During 30 months of work, Barcelona Transfusion Service enrolled nearly 30,000 donors, and processed 9,000 liters of blood.

In 1937, Bernard Fantus, director of therapy at Cook County Hospital in Chicago, founded the first hospital blood bank in the United States. In creating a hospital laboratory that is preserved, refrigerated and stored blood donors, Fantus comes from the term "blood bank". Within a few years, blood banks of hospitals and communities were established throughout the United States.

Frederic DurÃƒÆ'Ã‚Â¡n-JordÃƒÆ' fled to England in 1938, and worked with Dr. Janet Vaughan at the Royal Postgraduate Medical School at Hammersmith Hospital to create a national blood bank system in London. With the outbreak of an imminent war in 1938, the War Office created an Army Blood Supply Depot (ABSD) in Bristol led by Lionel Whitby and controlled four large blood depots across the country. British policy through war was to supply military personnel with blood from a centralized depot, in contrast to the approach taken by the Americans and Germans in which troops ahead bleed to provide the needed blood. The British method proved more successful in meeting all the requirements adequately and over 700,000 dislocated donors during the war. The system evolved into a National Blood Transfusion Service established in 1946, the first national service to be implemented.

Medical progress

The blood collection program began in the United States in 1940 and Edwin Cohn pioneered the blood fractionation process. He worked the technique to isolate the blood serum albumin blood serum fraction, which is important for maintaining osmotic pressure in the blood vessels, preventing its collapse.

The use of blood plasma as a substitute for whole blood and for transfusion purposes was proposed in early 1918, in the correspondence column of the British Medical Journal, by Gordon R. Ward. At the beginning of World War II, liquid plasma was used in England. A major project, known as 'Blood for Britain' began in August 1940 to collect blood at a New York City hospital for plasma exports to the UK. A dry plasma package is developed, which reduces damage and makes transportation, packaging, and storage much simpler.

The resulting dry plasma package comes in two cans containing 400 ml bottles. One bottle containing enough distilled water to rearrange the dry plasma contained in another bottle. In about three minutes, the plasma will be ready for use and can remain fresh for about four hours. Dr. Charles R. Drew was appointed as a medical supervisor, and he was able to transform the reaction tube method into the first successful technique for mass production.

Another important breakthrough occurred in 1939-1940 when Karl Landsteiner, Alex Wiener, Philip Levine, and R.E. Stetson discovered the system of the Rhesus blood group, which was found to be the cause of most of the transfusion reactions up to that time. Three years later, the introduction by J.F. Loutit and Patrick L. Mollison of the acid-citrate-dextrose solution (ACD), which reduces the volume of anticoagulants, permitted transfusions of larger blood volume and allows long-term storage.

Carl Walter and W.P. Murphy Jr. introduced a plastic bag for blood collection in 1950. Replacing a fragile glass bottle with a durable plastic bag made from PVC allows the evolution of a collection system capable of safely and easily preparing several blood components from one whole unit of blood.

In the field of surgery the surrogate cancer lost a lot of blood becomes a big problem. High heart attack rate. In 1963, C. Paul Boyan and William S. Howland found that blood temperature and infusion rates greatly affected survival rates, and introduced blood warming to surgery.

Further extending the stored shelf life of blood is an anticoagulant preservative, CPDA-1, introduced in 1979, which increases blood supply and facilitates the sharing of resources among blood banks.

In 2006, there were about 15 million units of blood products transfused per year in the United States. In 2013, that number decreased to about 11 million units, due to a shift towards laparoscopic surgery and other surgical advances and studies which have shown that many transfusions are not needed. For example, standard care reduces the amount of blood transfusions from 750 to 200 ml.

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Custom population

Neonate

To ensure the safety of blood transfusions for pediatric patients, hospitals take additional precautions to avoid infection and prefer to use a specially tested child blood unit that is guaranteed negative for Cytomegalovirus. Most guidelines recommend the provision of CMV-negative blood components and not just leukoreduced components for newborns or low-birth-weight babies where the immune system is not fully developed. This particular requirement places additional restrictions on donor blood that can be donated for neonatal use. Neonatal transfusion usually falls into one of two categories:

"Top-up" transfusion, to compensate for lost investigations and correction of anemia.
Exchange transfusion (or partial exchange) is done to remove bilirubin, remove antibodies and red blood cell replacement (for example, due to secondary anemia due to thalassemia and other hemoglobinopathies).

Significant blood loss

A massive transfusion protocol is used when significant blood loss is present as in major trauma, when more than ten units of blood are required. The packed red blood cells, fresh frozen plasma, and platelets are generally given. Usually a higher ratio of fresh frozen plasma and platelets is given relative to the packed red blood cells.

Unknown blood type

Since the O blood type is negatively suited to anyone, it is often overused and limited. According to the American Association of Blood Banks, the use of this blood should be restricted to people with negative O blood, because no one else is compatible with them, and women who may be pregnant and for whom it is not possible to perform blood type tests. before giving them emergency care. Whenever possible, AABB recommends that negative blood O be preserved by using blood type tests to identify less scarce alternatives.

Religious objections

Jehovah's Witnesses reject the blood transfusion because of their belief that the blood is sacred.

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Researching alternatives

Although there are clinical situations where transfusions with red blood cells are the only clinically appropriate choice, doctors see whether alternatives are feasible. This can be caused by several reasons, such as patient safety, economic burden or scarcity of blood. Guidelines recommending blood transfusions should be provided for patients with or at risk of cardiovascular instability due to their anemia level. In this case, parenteral iron is recommended.

So far, there is no substitute for blood oxygen carrier , which is a typical blood transfusion (RBC) goal; however, there are many non-blood volume counters for cases where only volume recovery is required. This helps doctors and surgeons avoid the risk of disease transmission and immunosuppression, overcoming the shortage of chronic blood donors, and overcomes the concerns of Jehovah's Witnesses and others who have religious objections to receiving blood transfusions.

A number of blood substitutes have been explored (and still are), but so far they all suffer from many challenges. Most attempts to find suitable alternatives to blood have so far been concentrated on free-cell hemoglobin solutions. Blood substitutes can make transfusions more available in emergency medicine and pre-hospital EMS treatment. If successful, such blood substitutes can save many lives, especially in trauma where the outcome of large blood loss. Hemopure, a hemoglobin-based therapy, approved for use in South Africa.

Blood transfusion Vector Image - 1495185 | StockUnlimited

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Other uses

Small blood transfusions are used by a small proportion of drug addicts in South Africa to economically share the induced drug in daily practice known as Bluetoothing , named according to wireless technology of the same name.

How many blood transfusions can a person have? What to know

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Veterinary use

Veterinarians also provide transfusions to other animals. Various species require different levels of testing to ensure compatible compatibility. For example, cats have 3 known blood types, cattle have 11, dogs have 12, pigs 16 and horses have 34. However, in many species (especially horses and dogs), cross matching is not required before first transfusion, since antibodies to non-cell surface antigens are not constitutively expressed - that is, the animal must be sensitive before it will increase the immune response to transfused blood.

The practice of rare and experimental blood transfusion between species is a form of xenograft.

Rare West Nile Death Sparks Blood Transfusion Concerns | HuffPost

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References

Blood Transfusion Procedure - The ABO Blood Group System - YouTube

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External links

Cochrane Injuries Group, publishes a systematic review of interventions for traumatic injuries, which include evaluation of blood transfusions and blood transfusions
Cochrane Haematological Malignancies Group, publishes a systematic review of interventions for haematological disorders and evaluation of blood transfusions and blood transfusions.
Evidence of Library Transfusion sought sources of evidence for transfusion drugs.