bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transfusion‐Transmitted Infections
Authors: Barbara John A. J. 
Published: February 2008

SUMMARYAlthough the risks of transfusion‐transmitted infection are currently very small compared with other medical interventions, the perception remains that these risks are significant. Infection risks from recognized agents for which we select appropriate candidate donors and/or perform systematic laboratory testing include inadequacy of donor selection, errors in laboratory testing or inventory control, insensitivity of screening tests, and donations in the “window period” prior to seroconversion. Potential threats from emerging (or newly recognized) microbial agents remain a continuing reality. To date, however, GB‐virus C and TT‐virus, though transfusion‐transmissible, appear to be non‐pathogenic. Human herpes virus 8 (HHV‐8), the causative agent of Kaposi's sarcoma, has not been demonstrated to be transfusion‐transmissible and the potential threat from variant Creutzfeldt‐Jakob disease (vCJD) has also not yet been demonstrated. However, the risk from bacteria is demonstrable and, as viral risk is reduced, becomes proportionately more significant.Interventions to reduce risk include leukodepletion, extension of nucleic acid testing and/or testing for hepatitis C virus antigen, use of combined human immunodeficiency antigen plus antibody tests, and extended interventions to reduce bacterial risks. The safety yields and cost/benefit ratio of these interventions (often very low) need careful consideration, especially in the context of commercial pathogen inactivation systems soon to become available.
Transfusion‐Related Immunomodulation:
Authors: Vamvakas Eleftherios C. 
Published: February 2008

SUMMARYAllogeneic blood transfusion (ABT) has been claimed to cause deleterious clinical effects, including the recurrence of resected malignancies, postoperative bacterial infection, and virus activation. These purported adverse effects of ABT have been attributed to transfusion‐related immunomodulation (TRIM). However, the mechanism(s) of the TRIM effect(s) remains or remain to be defined, and the blood constituent(s) that might mediate TRIM effect(s) is or are unknown. Randomized, controlled trials (RCTs) have been conducted to investigate the TRIM effect(s), based on the assumption that the transfusion of autologous or leukoreduced allogeneic red blood cells is immunologically neutral. The findings of these RCTs have been highly contradictory, and the long‐standing hypothesis of a deleterious TRIM effect of ABT remains unresolved. This review examines the clinical evidence as to whether a deleterious TRIM effect exists and can be abrogated by leukoreducing transfused cellular blood components.
Anemia in Critically Ill Patients: How Much Can They Tolerate?
Authors: Linden Philippe Vander 
Published: February 2008

SUMMARYAnemia is a common occurrence in intensive care unit (ICU) patients and frequently results in allogeneic blood transfusion. In critical illness, patient tolerance to a reduction in the blood's oxygen‐carrying capacity may be reduced because of a blunting of the physiologic compensatory response mechanisms to – anemia and/or to an increase in tissue metabolic needs. Anemia has indeed been associated with an increased risk of mortality in critically ill patients, particularly in those with pre‐existing cardiovascular disease or in those with significant blood loss. Clinical trials comparing a liberal versus restrictive transfusion strategy defined by a specified hemoglobin (or hematocrit) concentration showed that mortality, morbidity and length of hospital stay seem unaffected by the transfusion strategy, even in hemodynamically stable cardiovascular disease patients. The absence of outcome improvement associated with a more liberal transfusion strategy remains largely to be elucidated. There is, however, some experimental evidence that blood transfusion may have adverse effects on tissue oxygen delivery because of erythrocyte storage‐related changes. The decision to transfuse a given patient must also take into account the risks associated with allogeneic blood, in particular those related to its potential immunosuppressive effects. There is no one “optimal” hemoglobin value for ICU patients, and the decision to transfuse should be made on a case‐by‐case basis, with each patient being assessed according to his or her clinical status, the underlying cause of anemia and the risk of potential complications. In any case, preventive measures should be taken whenever possible to limit the development of anemia in the ICU.
Decision Analysis in Transfusion Medicine – Practical Considerations
Authors: Adeyi Oyedele , AuBuchon James P. 
Published: February 2008

SUMMARYCost and cost‐effectiveness analyses have sometimes been regarded as inappropriate endeavors for a physician dedicated to the welfare of patients. While cost considerations alone should not be used as the decision‐making criterion in managing individual patients, the transfusion medicine physician nevertheless needs to appreciate the value of these analyses when making policy decisions for his or her laboratory and hospital. This article highlights the practical applications of decision analyses as decision‐making tools and recommends that they be regarded as useful adjuncts in the practice of transfusion medicine.
Impact of a Centralized Transfusion Service on Transfusion Costs: The Hospital Transfusion Service Versus the Blood Center Perspective
Authors: Triulzi Darrell J. , Hahn Linda 
Published: February 2008

SUMMARYA Centralized Transfusion Service (CTS) utilizes an integrated laboratory‐based approach to the delivery of transfusion medicine services within a region. The CTS model has emerged as probably the most cost‐efficient method for the delivery of these services. Its positive impact on both operational and component costs exceeds the level of hospital savings typically achieved by merely negotiating a “cheaper” red cell with the blood provider. Even the regional blood provider benefits from the superior management of the community's blood supply. Hospitals and hospital networks seeking to reduce transfusion‐associated costs should consider a CTS model.
Mechanism of Action of Recombinant Activated Factor VII
Authors: Lisman Ton , Groot Philip G. de 
Published: February 2008

SUMMARYRecombinant activated coagulation factor VII (rFVIIa, NovoSeven®) is indicated for the treatment of bleeding episodes or as a prophylactic hemostatic agent during surgery in patients with inhibitor‐complicated hemophilia. Currently, the use of rFVIIa for indications other than hemophilia is being investigated in clinical trials. The original idea behind the development of rFVIIa was that it would function via enhancement of tissue factor‐dependent coagulation. However, the effects of rFVIIa on hemostasis proved to be more complex than initially anticipated. This paper summarizes current data and hypotheses on the mechanism of action of rFVIIa, providing a general model for the molecular basis for the efficacy of rFVIIa in its different applications.
The Use of Recombinant Factor VIIa in Surgical Bleeding in Nonhemophiliac Patients
Authors: O'Connell Niamh M. , Perry David J. 
Published: February 2008

SUMMARYHemorrhage due to elective or emergency surgery results in significant patient morbidity and mortality and consumption of scarce transfusion resources. Recombinant factor VIIa (rFVIIa) has been proposed as a universal hemostatic agent which may be beneficial in reducing blood loss and in treating unexpected massive hemorrhage in surgical patients. In elective surgery, a small number of randomized studies have shown a limited benefit for rFVIIa in the reduction of transfusion requirements. In massive hemorrhage associated with surgery, two case series and a growing number of case reports suggest that rFVIIa is successful as salvage therapy. However, a number of questions remain regarding the optimal dose, the true rate of thromboembolic complications and the overall survival and cost benefit when rFVIIa is used for this indication. In this review, the role of rFVIIa in managing blood loss in surgical patients is assessed in the light of current evidence.
The Use of Recombinant Factor VIIa for Hemorrhage Control in Trauma Patients
Authors: Kenet Gili 
Published: February 2008

SUMMARYUncontrolled hemorrhage is the second leading cause of death from trauma. Most critically ill trauma patients suffer profound bleeding accompanied by systemic coagulopathy. The compassionate use of rFVIIa for uncontrolled hemorrhage was approved by the ethical committee of the Israeli Ministry of Health in late 1999. This manuscript reviews the published results of the first 19 Israeli trauma patients and the recent case series by Dutton and colleagues analyzing the early experience in critically ill trauma patients treated in Baltimore, MD, USA. Patients'survival was affected by severity of injury, the degree of coagulopathy prior to the drug's administration, and by coexistence of acidosis. In conclusion, the use of rFVIIa is currently recommended in massively bleeding patients, along with conventional surgical and hemostatic techniques. For optimal results, maximal correction of acidosis and coagulation parameters is advised prior to the drug's administration. Prospective, randomized placebo‐controlled trials of rFVIIa in traumatic injury are warranted.
Hemovigilance: Definition and Overview of Current Hemovigilance Systems
Authors: FABER Jean‐Claude 
Published: February 2008

SUMMARyHemovigilance, as a safety concept, appeared in the beginning of the 1990s. Its primary aim is to assure the surveillance of blood transfusion, to collect data on (serious) sequelae of blood transfusions, to inform health policy to improve transfusion standards, to assist in the formulation of guidelines in the field of transfusion and to increase the safety and quality of the entire transfusion process.Two different “poles” of systems exist. In France, where hemovigilance was rendered mandatory by law in 1994, the system is centralized and nationwide, with a legal obligation to notify in written form each and every side effect related to blood transfusion. In the UK, hemovigilance is a national voluntary scheme between professionals (SHOT, Serious Hazards of Transfusion). Learning from the lessons generated by the British and French systems enables the introduction, in other countries, of models representing “hybrids” of the two systems.Within the European Union, the recent European Blood Directive requires hemovigilance in each Member State; its provisions have to be transposed into national legislations within two years. In order to ally efforts at the Community level it would make sense to appeal to existing initiatives in this field that have proven that efficient cooperation is possible: the European Haemovigilance Network (EHN) has played a major role in bringing this important matter forward and in developing it into an efficient tool intended to increase safety and quality in European blood transfusion.
SHOT–A Voluntary System for the Reporting of Serious Hazards of Transfusion in the UK
Authors: Love Elizabeth M. , Jones Hilary , Williamson Lorna M. , Cohen Hannah , Todd Audrey , Soldan Kate , Revill John , Norfolk Derek R. , Barbara John , Atterbury Claire L.J. , Asher Deborah , Chapman Catherine 
Published: February 2008

SUMMARy Background: From 1996–2001 the SHOT scheme has collected a powerful body of data on serious transfusion complications in the UK from which to make firm recommendations for improvements in transfusion safety. The UK Blood Services issue approximately 3.5 million blood components annually. Results: With 413 eligible hospitals on the scheme, by year five, participation was running at 92%. Of 1,148 fully analyzed reports there were 699 (61%) “wrong blood” incidents. Of these, 161 were ABO incompatible transfusions leading to 11 deaths and 60 cases of major morbidity and 73 were RhD incompatible leading to potential RhD sensitization in 17 young females. Multiple errors occurred in 49% of cases. 55% of errors involved mis‐identification at the point of collection from the hospital storage site and/or bedside administration, whilst laboratories and prescription/sampling/request errors contributed 28% and <13% respectively. Immune complications comprised 35.7% of reports. 70 cases of possible TRALI over 5 years resulted in 49 cases of major morbidity and up to 20 deaths possibly related to transfusion. Transfusion‐transmitted infection (TTI) comprised < 3% of reports but of 39 confirmed TTIs 25 were bacterial contamination incidents (21 platelets, 4 red cells) resulting in 6 deaths (5 platelets; one red cells). Recommendations:“Wrong blood” incidents are avoidable errors. Efforts should be directed at developing computerized bedside identification systems to reduce human error. These can be linked to secure systems to reduce errors at the point of collection from storage and are also applicable in the drugs administration setting. Options to reduce the incidence of TRALI should be explored. Possible strategies to reduce bacterial contamination should be given appropriate priority.
Is the Clinical Significance of Blood Storage Lesions Underestimated?
Authors: Isbister James P. 
Published: February 2008

SUMMARyThere is a general agreement that blood and blood components all deteriorate from the moment they are removed from the donor's vein. Clinicians have expressed their concern for decades about the potential of the storage lesions having adverse effects on patients. However, this has been difficult to prove in clinical studies due to the multifactorial nature and complexity of many transfusion settings, especially hemorrhagic shock and trauma. The role of transfusion as a contributor to adverse consequences that are only possible and multifactorial such as those potentially due to storage lesions can only be identified by large, well‐conducted and controlled trials. If transfusion can be identified as a significant contributory factor to a specific complication its role is considered more as a risk factor rather than a direct 1:1 causal factor. Nevertheless, it is of interest to underline that many of the changes occurring during storage are related to the presence of leukocytes (especially granulocytes) and can be minimized by pre‐storage leukoreduction. Pre‐storage leukoreduction is now standard practice in many countries. Although its introduction has been for reasons other than the minimization of storage lesions, it is of interest to note hat it is probably the most effective intervention to improve the survival and the quality of red cell and platelet concentrates.
Should Albumin Be Used to Correct Hypoalbuminemia in the Critically Ill? No
Authors: AL‐Khafaji Ali , Webb Andrew R. 
Published: February 2008

SUMMARYHypoalbuminemia is the consequence of a disease process and successful treatment of the underlying disease should result in a gradual return to normal serum albumin values. There are many theoretical useful properties of albumin that make achieving normal serum values an attractive proposition. The available literature does not support the use of albumin to correct hypoalbuminemia. In fact we might do more harm than good by infusing albumin.
Cell Salvage – State of the Art and Cost‐Effectiveness
Authors: Haynes Sarah L. , Torella Francesco , McCollum Charles N. 
Published: February 2008

SUMMARYCell salvage is an autologous blood transfusion technique, which has been in common use for over twenty years. It has the obvious potential to reduce allogeneic blood usage as fresh red cells that would otherwise be lost are reinfused. Properly used, there is no risk of clerical error and no need to screen for transmissible disease. Although used extensively in the USA and Europe, the adoption of cell salvage, and indeed all autologous blood transfusion techniques, has been very slow in the UK. This may be partly due to the paucity of adequately powered randomized clinical trials demonstrating the efficacy and cost‐effectiveness of cell salvage. This article will review these aspects of cell salvage with particular emphasis on its routine use in vascular surgery.
Criteria for Clinical Transfusion Practice:Teaching of Transfusion Medicine
Authors: Maniatis Alice , Müller Norbert 
Published: February 2008

SUMMARYDevelopments in blood transfusion over the last two decades have been wide reaching. The variety of blood components available allows for a much more specific approach to each patient's needs. Safety parameters have to be taken into consideration in making choices, therefore knowledge of the risks of transfusion as well as of the availability of transfusion alternatives, is necessary. In addition, considerations of blood sufficiency or lack thereof, demand the use of transfusion, only in cases with proven efficacy. All these issues, well known to transfusion medicine specialists, are not necessarily registered by clinicians, many of whom, even today, consider blood transfusion a routine, simple and safe therapeutic maneuver. The European Union has emphasized in recent years the need for adoption by the EU states of similar criteria in the various areas of blood collection and transfusion, it was therefore of interest to inquire into transfusion practices in EU states and this was undertaken by the network of transfusion societies, EuroNet‐TMS, with the help of a questionnaire. Analysis of the responses reveals persistent heterogeneity in some areas, although there is a tendency for convergence.
The Use of Aprotinin in Pediatric Cardiac Surgery
Authors: Miller Bruce E. 
Published: February 2008

SUMMARYThe use of aprotinin in children undergoing cardiopulmonary bypass (CPB) attenuates activation of the coagulation and fibrinolytic systems, preserves platelet function, and reduces some inflammatory processes. The clinical outcomes in children as a result of these effects have varied among studies and patient populations, however, this is probably in large part due to variations in dosing regimens. Nevertheless, improved clinical outcomes have been consistently demonstrated in neonates undergoing primary sternotomies and in children undergoing repeat sternotomies or lung transplantation with the use of aprotinin. Such clinical outcomes create a strong argument for the routine administration of aprotinin to these subsets of children. The magnitude of beneficial clinical outcomes after aprotinin administration is dose‐dependent so, while a definitive dosing regimen has not been established for children, higher dose regimens should be employed. Indeed, the use of some very high dose regimens have indicated that aprotinin may even be beneficial in children, other than neonates, undergoing primary sternotomies. The occurrence of adverse effects from the use of aprotinin in children is low but allergic reactions from repeat exposures, especially within six months of the prior use of aprotinin, must be anticipated and guidelines followed to minimize their occurrence and effects. Aprotinin is a potent part of a clinician's arsenal when dealing with children undergoing CPB and its cost‐effective improvement of clinical outcomes justifies its consideration when planning the management strategy of these children.
Lymphadenopathy Caused byMycobacterium colombiense
Authors: Esparcia Óscar , Navarro Ferran , Quer Miquel , Coll Pere 
Published: February 2008

ABSTRACTWe report the case of a 3-year-old girl with lymphadenopathy caused by the recently described speciesMycobacterium colombiense. M. colombienseis a nonpigmented slow grower that is included in theMycobacterium aviumcomplex. Partial sequencing of the 16S rRNA gene was used for species identification.
Residue L143 of the Foot-and-Mouth Disease Virus Leader Proteinase Is a Determinant of Cleavage Specificity
Authors: Mayer Christina , Neubauer David , Nchinda Aloysius T. , Cencic Regina , Trompf Katja , Skern Tim 
Published: February 2008

ABSTRACTThe foot-and-mouth disease virus (FMDV) leader proteinase (Lpro) self-processes inefficiently at the Lpro/VP4 cleavage site LysLeuLys*GlyAlaGly (* indicates cleaved peptide bond) when the leucine at position P2 is replaced by phenylalanine. Molecular modeling and energy minimization identified the Lproresidue L143 as being responsible for this discrimination. The variant LproL143A self-processed efficiently at the Lpro/VP4 cleavage site containing P2 phenylalanine, whereas the L143M variant did not. LproL143A self-processing at the eIF4GII sequence AspPheGly*ArgGlnThr was improved but showed more-extensive aberrant processing. Residue 143 in Lprois occupied only by leucine and methionine in all sequenced FMDV serotypes, implying that these bulky side chains are one determinant of the restricted specificity of Lpro.
Rubella Virus Capsid Protein Interacts with Poly(A)-Binding Protein and Inhibits Translation
Authors: Ilkow Carolina S. , Mancinelli Valeria , Beatch Martin D. , Hobman Tom C. 
Published: February 2008

ABSTRACT
During virus assembly, the capsid proteins of RNA viruses bind to genomic RNA to form nucleocapsids. However, it is now evident that capsid proteins have additional functions that are unrelated to nucleocapsid formation. Specifically, their interactions with cellular proteins may influence signaling pathways or other events that affect virus replication. Here we report that the rubella virus (RV) capsid protein binds to poly(A)-binding protein (PABP), a host cell protein that enhances translational efficiency by circularizing mRNAs. Infection of cells with RV resulted in marked increases in the levels of PABP, much of which colocalized with capsid in the cytoplasm. Mapping studies revealed that capsid binds to the C-terminal half of PABP, which interestingly is the region that interacts with other translation regulators, including PABP-interacting protein 1 (Paip1) and Paip2. The addition of capsid to in vitro translation reaction mixtures inhibited protein synthesis in a dose-dependent manner; however, the capsid block was alleviated by excess PABP, indicating that inhibition of translation occurs through a stoichiometric mechanism. To our knowledge, this is the first report of a viral protein that inhibits protein translation by sequestration of PABP. We hypothesize that capsid-dependent inhibition of translation may facilitate the switch from viral translation to packaging RNA into nucleocapsids.
Equilibrium in the balance? Implications for landscape evolution from dryland environments
Authors: Bracken Louise J. , Wainwright John 
Published: February 2008

AbstractEquilibrium is a central concept in geomorphology. Despite the widespread use of the term, there is a great deal of variability in the ways equilibrium is portrayed and informs practice. Thus, there is confusion concerning the precise meanings and usage of the concept. In this chapter we draw on examples from dryland environments to investigate the practical implications of applying and testing the concept of equilibrium. Issues that we cover include the importance of scale and spatial variability, time, the assumption of constant environmental feedbacks and nonlinearities. The evaluation demonstrates that there are a range of problems inherent with using ideas of geomorphological equilibrium explicitly or implicitly to structure research in drylands. Many of these problems also apply to other environments.