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Transfusion Update
Kanchan Bhardwaj, BL Bhardwaj, Kusum K Thakur, Rajni Bassi, Harnoor Singh Bhardwaj
SECTION 1: CLINICAL HEMOTHERAPY
1:
Transfusion in Bone Marrow Failure Syndromes
INTRODUCTION
Congenital/Inherited Aplastic Anemia
Acquired Bone Marrow Failure
COMPONENT THERAPY
INDICATIONS FOR RBC TRANSFUSION3
Precautions
INDICATIONS OF PLATELET TRANSFUSION
Platelet Transfusion to Control Bleeding
Platelet Transfusion to Prevent Bleeding
Platelet Concentrate
GRANULOCYTE TRANSFUSION
Impact of Neutropenia
Indications of Granulocyte Transfusions9
Doses and Target Level
SYNTHETIC OXYGEN CARRIERS
Transfusion Related Risks
Transfusion Reactions
CONCLUSION
2:
Transfusion Therapy in Autoimmune Hemolytic Anemia
INDICATIONS FOR TRANSFUSION
RESPONSIBILITIES OF TRANSFUSION MEDICINE
Clinical
Technical
Pretransfusion Examinations
Selection of Blood for Transfusion
PATIENT MANAGEMENT
Role of Steroids in Treatment of AIHA
AUTOIMMUNE HEMOLYTIC ANEMIA
Controversies Regarding Transfusing Crossmatch-Incompatible Blood
3:
Sugar Free Antibodies: A New Treatment for Idiopathic Thrombocytopenic Purpura and Autoimmune Hemolytic Anemia
INTRODUCTION
SUGAR FREE ANTIBODIES IN IMMUNE THROMBOCYTOPENIC PURPURA
How does EndoS Exercise a Protective Function?
SUGAR FREE ANTIBODIES IN AUTOIMMUNE HEMOLYTIC ANEMIA
Mechanism of Action
Treatment of Anti-D with EndoS does not Affect the Binding of Anti-D to RBCs
EndoS Inhibits Phagocytosis and Adherence of Sensitized RBCs by Monocytes
EndoS Inhibits Oxygen Metabolite Production by Monocytes Induced by Sensitized RBCs
EndoS Inhibits IL-8 Secretion from Monocytes Induced by Sensitized RBCs
EndoS Inhibits Hemolysis of Sensitized RBCs and Prevents Binding of C1q to IgG-sensitized RBCs
EndoS Inhibits AIHA In Vivo
SUGAR FREE ANTIBODIES IN OTHER AUTOIMMUNE DISEASES
FUTURE OF THIS THERAPEUTIC MODALITY
4:
Transfusion Practice in Disseminated Intravascular Coagulation
PATHOPHYSIOLOGY
DIAGNOSIS
TREATMENT
Administration of Blood Components and Coagulation Factors
Platelets
Coagulation Factors
PROGNOSIS
5:
Transfusion Practice in Oncology
ANEMIA
Background
Multiple Factors can Cause or Contribute to Anemia in Patients with Malignancy
Management of Anemia in Cancer Patients
Choice of Agent, Dose Titration, and Supplemental Iron
THROMBOCYTOPENIA
Background
Approach to the Patient with Thrombocytopenia9 (Flow chart 1)
Complete Blood Count (CBC)
Additional Investigations
Treatment of Thrombocytopenia
NEUTROPENIA
Background
Classification of Neutropenia
Management of Isolated Neutropenia
Chronic Neutropenia
Myeloid Growth Factor Therapy
6:
Transfusion Practice in Coronary Interventions
INTRODUCTION
WHY BLEEDING AND EXCESS MORALITY POST PERCUTANEOUS CORONARY INTERVENTION?
CAN BLOOD TRANSFUSION IN PERCUTANEOUS CORONARY INTERVENTION PATIENTS BE HARMFUL ?
CONCLUSION
7:
Neurological ICU: Role of Red Blood Cell Transfusion
ROLE OF RED BLOOD CELL TRANSFUSIONS
ADVERSE EFFECTS OF TRANSFUSION
TRANSFUSION IN THE NEURO-ICU
Traumatic Brain Injury
Ischemic Stroke
Intracerebral Hemorrhage
Subarachnoid Hemorrhage
CONCLUSION
8:
Blood Transfusion Alternatives
PHARMACOLOGICAL AGENTS
DDAVP or Desmopressin
Epsilon Aminocaproic Acid
Danazol
Aprotinin (Trasypol)
Intravenous Immunoglobulins
Vitamin K
RECOMBINANT HEMATOPOIETIC GROWTH FACTORS
Recombinant Human Erythropoietin (R-HU EPO)
Other Blood Cell Growth Factors
Recombinant Human Antihemophilic Factor (Rh-Factor VIII)
RED CELL SUBSTITUTES
Constitution of an Ideal Blood Substitute
Hemoglobin Based Oxygen Carriers (HBOCs)
Stroma Free Hemoglobin and Crosslinked Hemoglobin
Microencapsulated Hemoglobin
Benefits
Challenges
Perfluorochemical Compounds
Disadvantages
PLATELET SUBSTITUTE
Platelet-derived Products
Frozen Platelets
Cold Liquid-stored Platelets
Photochemically Treated Platelets
Lyophilized Platelets
Platelet-derived Microparticles
Culture-derived Platelets
Synthetic Platelet Alternatives
Arg-Gly-Asp (RGD)-based Platelet Substitute
Fibrinogen-coated Albumin Microcapsules
Liposome-based Agents
Future Prospects
9:
Role of Whole Blood in Transfusion Practice
INDICATIONS OF WHOLE BLOOD TRANSFUSION
Acute Hemorrhage
Autologous Transfusion
Exchange Transfusions
Cardiovascular Surgery or Hemodialysis
Dengue Fever
10:
Management of Preoperative Anemia in Patients Undergoing Elective Surgery
PREVALENCE DEPENDS ON MANY FACTORS
Minimum Acceptable Hemoglobin Concentration
Procedures that Usually Do versus Do Not Require Transfusion
Significance of Preoperative Anemia
RECOMMENDATIONS FOR DETECTION, EVALUATION AND MANAGEMENT OF PREOPERATIVE ANEMIA IN ORTHOPEDIC SURGERY [NETWORK FOR ADVANCEMENT OF TRANSFUSION ALTERNATIVES (NATA)]
Management of Preoperative Anemia
CONCLUSION
11:
Blood Conservation Strategies
INTRODUCTION
METHODS
CONCLUSION
12:
Thromboelastography
13:
Transfusion Support in Cardiac Surgery
TRANSFUSION VARIABILITY IN CARDIAC SURGERY
POTENTIAL BENEFITS OF RED BLOOD CELL TRANSFUSION IN CARDIAC SURGERY
PREDICTORS OF ALLOGENEIC RED BLOOD CELL TRANSFUSION DURING CARDIAC SURGERY
Mechanism of Bleeding in Patients Undergoing Cardio Pulmonary Bypass
Point-of-Care (POC) Tests in Cardiac Surgery
Adverse Outcomes following Allogeneic Red Blood Cell Transfusion in Cardiac Surgery
Blood Conservation during Cardiac Surgery
14:
Transfusion Practice in Arthroplasty
INTRODUCTION
RECENT STUDIES AND RECOMMENDATIONS FOR SPECIFIC ORTHOPEDIC PROBLEMS
Primary Total Hip Replacement
Revision Hip Replacement
Primary Total Knee Arthroplasty
Bilateral Total Knee Arthroplasty
15:
Restricting Transfusion Requirements in Major Orthopedic Surgery and its Alternatives
INTRODUCTION
TECHNIQUES APPLICABLE TO ORTHOPEDIC SURGERY6
Choice of Anesthesia
Perioperative Use of Pharmacological Agents
Perioperative Erythropoietin
Preoperative Optimization of Medical Status
Predonation of Autologous Blood
Hemodilution Techniques
Blood Salvage Intra- and Postoperatively
ORTHOPEDIC TRAUMA
FUTURE
CONCLUSION
16:
Transfusion Support in Neurosurgery
INTRODUCTION
THRESHOLD FOR TRANSFUSION IN NEUROSURGERY IS UNCERTAIN
Cerebrovascular Surgery
Intracerebral Hemorrhage
Traumatic Brain Injury
Tumor Surgery
Interventional Neuroradiologic Procedures (Embolization, Acute Stroke)
Anticoagulated Patient
BLOOD CONSERVATION STRATEGIES
CONCLUSION
17:
Noninvasive Prenatal Screening for Rh Hemolytic Disease
POSSIBLE SOURCES OF ERROR
ETHICAL ASPECTS
COST/AVAILABILITY
CONCLUSION
Blood Group Determination
Sex Determination
18:
Antenatal Antibody Screening and Intrauterine Transfusion in Pregnancy
ANTENATAL TESTING AND HDN STATUS IN DEVELOPING COUNTRIES
INTRAUTERINE TRANSFUSION
19:
Antenatal Screening of Thalassemia
20:
Neonatal Transfusion Practice
GENERAL RECOMMENDATIONS (FETUSES, NEONATES, INFANTS AND CHILDREN)
Donors
Special Needs
Indications of Irradiation of Cellular Blood Components
Plasma and Platelet Compatibility
Administration
Pretransfusion Testing
Investigations on Maternal Sample
Investigations on Neonate Sample
Selection of Blood Component
Intrauterine Transfusion
Red Cell Preparations
Platelet Transfusions
TRANSFUSIONS OF PRETERM INFANTS
NEONATAL TRANSFUSIONS
Exchange Transfusion (ET)
Component and Procedure Specification
ABO Hemolytic Disease of the Newborn (HDN)
Red Cells for Top-up Transfusions in Neonates
Guidelines for Administration of Red Cells
Platelets for Neonatal Transfusions
Fresh Frozen Plasma for Neonatal Transfusions
Cryoprecipitate for Neonatal Transfusions
Granulocytes for Neonatal Transfusions
TRANSFUSIONS IN NECROTIZING ENTEROCOLITIS (NEC)
TRANSFUSIONS IN EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
21:
Transfusion Practice in Bone Marrow Transplantation and HLA Matching
HLA TYPING
TRANSFUSION PRACTICES
Key Points to Remember while Transfusing the Blood in a Transplant Patient (Pre or Post)
Importance of Using Leukodepleted Products
Gamma-irradiation of Blood Components and Transfusion Associated-Graft Versus Host Disease (TA-GVHD)
Rationale of Irradiation
Blood Products which Requires Irradiation
Indications
Donor/Recipient ABO Incompatibility and Transfusion Support
Incompatible Stem Cell Graft Infusion
ABO INCOMPATIBILITY IN BMT: GRAFT MANAGEMENT
Major ABO Incompatibility
Minor ABO Incompatibility
Major Incompatibility: Transfusion Management
Minor-side ABO incompatibility
Minor Incompatibility: Passenger Lymphocyte Syndrome
Example: Bidirectional ABO Incompatibility: Recipient is type A and Donor is type B
BLOOD GROUPS USED FOR TRANSFUSION SUPPORT
22:
Transfusion Practice in Renal Transplants Recipients
AUTO-RECOGNITION
ALLO-RECOGNITION
ALLOGRAFT REJECTION
Hyperacute Rejection
Acute Rejection
Humoral Rejection
Chronic Rejection
EVOLUTION OF TRANSFUSION IN RENAL TRANSPLANTATION
HLA and ABO Sensitization and Desensitization in Renal Transplantation
ABO Desensitization
Current Management/Treatment
Rationale for Therapeutic Apheresis
Duration and Discontinuation/ Number of Procedures
HLA Desensitization and AMR
Current Management/Treatment
Rationale for Therapeutic Apheresis
Duration and Discontinuation/ Number of Procedures
23:
Incompatible Blood Type Kidney Transplantation
ABO ANTIGENS AND ANTIBODIES
HISTORY
Splenectomy, Rituximab and No B-cell Depletion
ABOI-KT PREOPERATIVE MANAGEMENT
Antibody Measurement
B-cell Depletion
Antibody Depletion
USE OF IVIG
ACCOMMODATION
CURRENT PROTOCOL OF ABOI-KT
MINIMIZE IMMUNOSUPPRESSION
HISTOLOGICAL FINDINGS IN ABOI-KT
INCIDENCE OF ACUTE CELLULAR AND ANTIBODY MEDIATED REJECTION IN ABOI-KT
ADVERSE EFFECT OF ABOI-KT
Infection
Malignancy
CONCLUSION
24:
Transfusion Practice in Heart Transplant
BACKGROUND
PRETRANSPLANT WORK-UP
PROVISION OF LEUKOREDUCED BLOOD COMPONENTS
TRANSFUSION REQUIREMENTS DURING TRANSPLANT
FOLLOW-UP OF TRANSPLANT PATIENTS
ROLE OF PHOTOPHERESIS AND THERAPEUTIC PLASMA EXCHANGE IN CARDIAC TRANSPLANT PATIENTS
25:
Transfusion Practice in Liver Transplantation
TRANSFUSION PREDICTORS
Preoperative Factors
Child-Turcotte-Pugh (CTP) Score
Model for End-stage Liver Disease (MELD)
Etiology of Liver Disease
Preoperative Hematological Parameters
Previous Abdominal Surgery
Transjugular Intrahepatic Portosystemic Shunt (TIPSS)
Pre-existing Coagulopathy
Intraoperative Factors
Thromboelastography
Graft Quality
Graft-recipient Body Weight Ratio (GRWR)
Graft Preservation
Cold Ischemia Time
Surgical Technique
Blood Loss
Hemodynamics
Cell Salvage
Postoperative Factors
Primary Nonfunction (PNF) of Graft or Delayed Graft Function
Leaks at Anastomosis
Graft Versus Host Disease (GVHD)
Sepsis
Thrombocytopenia
DRUGS THAT MINIMIZE BLOOD LOSS
Antifibrinolytics
Recombinant Factor VIIa (rFVIIa)
OLT WITHOUT TRANSFUSION
TRANSFUSION SUPPORT
ABO Grouping
Selection of Compatible Blood Components
ABO Blood-type Selection6
Rho (D) Selection 6,7
Selection of Red Cell Units in Patients with Clinically Significant Alloantibodies
Use of Autologous Blood
Specialized Blood Components
CMV-reduced Risk Components
Leukocyte-reduced Blood Components
Irradiated Blood Components
Male only Plasma
Minor ABO-incompatible Transplants
Transfusion Protocol in Minor ABO Mismatched Liver Transplants6,7
Transfusion Protocol During Liver Transplantation
CONCLUSION
Multidisciplinary Approach
26:
Massive Transfusion Protocol
RATIONALE
DEFINITION OF MASSIVE TRANSFUSION8
PHYSIOLOGY OF HEMORRHAGIC SHOCK
COAGULOPATHY OF HEMORRHAGE AND MASSIVE TRANSFUSION
PREDICTING NEED FOR MTP
ADJUNCTS TO MTP
HYPOTHERMIA
REWARMING STRATEGIES
Passive External Rewarming
Active External Rewarming
Active Core Rewarming
ACIDOSIS
TRANEXAMIC ACID
RESUSCITATION IN PATIENTS REQUIRING MASSIVE TRANSFUSION
THROMBOELASTOGRAPhY (TEG) AND ROTATIONAL THROMBOELASTOMETRY (ROTEM)
Application
FACTOR rVIIA AND MTP
COMPLICATIONS OF MTP
MTP AFTER CONTROL OF HEMORRHAGE
MTP IN PEDIATRICS
SUMMARY
27:
Massive Transfusion in Obstetrical Hemorrhage
PRINCIPLE
DEFINITION
Causes of Massive Blood Loss
Goals in the Management of Transfusion in Severe Hemorrhage Include
Aim for and Maintain
BLOOD COMPONENT THERAPY
Packed Red Blood Cells (PRBCs)
Fresh Frozen Plasma
Platelets
Cryoprecipitate and Fibrinogen
RECOMBINANT FACTOR VIIA
Adverse Effects of Massive Transfusion
SUMMARY
Transfusion of Products
Documentation
28:
Inherited and Acquired Platelet Disorders: Diagnosis and Therapy
INTRODUCTION
METHODOLOGY
DISCUSSION
Clinical Features of Platelet Disorders
DIAGNOSIS
MANAGEMENT
Platelet Transfusion Triggers10
CONCLUSION
29:
Transfusion Practice in Dengue
CLINICAL MANAGEMENT
Indications of Red Cell Transfusion
Relationship of Platelet Counts and Hemorrhage in Dengue Fever
Prophylactic Platelet Transfusions in Dengue
Platelet Transfusion
Indications of Platelet Transfusion5 (Table 2)
Dose of Platelets
Risks of Platelet Transfusion
Use of Fresh Frozen Plasma/Cryoprecipitate5
Role of Recombinant Activated Factor VII (rFVIIa)
30:
Fetal and Neonatal Alloimmune Thrombocytopenia
PATHOGENESIS OF FNAIT
CLINICAL PRESENTATION
LABORATORY INVESTIGATIONS
THERAPY AND MANAGEMENT
Antenatal Management
NEWBORNS
CONCLUSION
31:
Clinicopathological Syndrome in Immune-mediated Heparin-induced Thrombocytopenia
PATHOGENESIS
CLINICAL FEATURES
DIAGNOSIS
Platelet Count Monitoring
PF4 ELISA Assay
14C-serotonin Release Assay
Other Functional Tests
Combining Clinical Assessment and Appropriate Laboratory Testing
MANAGEMENT
PREVENTION
KEY POINTS
INFORMATION TO THE PATIENT AND RECORD KEEPING
32:
Single Donor Platelets Versus Random Donor Platelets
INTRODUCTION
PREPARATION OF PLATELET CONCENTRATE1
Random Donor Platelet (Whole Blood Derived Platelets)
Single Donor Platelet (SDP)
RANDOM DONOR PLATELETS
Platelet Rich Plasma–Platelet Concentrate2
Buffy Coat Removal Method of Preparation of Platelet Concentrate
Advantages of BC–PC over PRP–PC
Advantages of Pooled Buffy Coat Method
Dose of Random Donor Platelet
SINGLE DONOR PLATELETS/PLATELETPHERESIS
General Requirements for Apheresis4
Specific Criteria for Selecting Plateletpheresis Donor4
Donors Who Participate in Serial Apheresis Program4
Procedure
Adverse Effects of Apheresis in Donor
Dose of Single Donor Platelets
Advantages of Single Donor Platelets5 (Table 1)
33:
Prophylactic Platelet Transfusion
TRANSFUSION TRIGGERS
Prophylaxis for Surgery3
Chronic Stable Thrombocytopenia
Massive Transfusion and Disseminated Intravascular Coagulation
Cardiopulmonary Bypass Surgery
Bone Marrow Failure (Due to Disease, Cytotoxic Therapy or Irradiation)
Platelet Function Disorders
Large/Infrequent Versus Small/Frequent Platelet Dosing Strategies2
34:
Maximizing the Resources: Multicomponent Collection
35:
Therapeutic Plateletpheresis
INTRODUCTION
THERAPEUTIC PLATELETPHERESIS
Thrombocytosis and the Rationale for Therapeutic Plateletpheresis (TP)
Practical Considerations of TP
Sample Therapeutic Plateletpheresis Orders
36:
Therapeutic Plasma Exchange
PLASMA EXCHANGE AS AN ALTERNATIVE TO IMMUNOGLOBULIN
37:
Therapeutic Erythrocytapheresis and Leucapheresis
PLASMA EXCHANGE (PE)
CYTAPHERESIS
Therapeutic Cytapheresis
Erythrocytapheresis
Leukocytapheresis
Plateletapheresis
Thrombocytapheresis
Clinical Applications of Therapeutic Erythrocytapheresis
38:
Red Cell Exchange in Clinical Practice
INTRODUCTION
RED BLOOD CELL EXCHANGE TECHNIQUE
INDICATIONS OF RED BLOOD CELL EXCHANGE1
SICKLE CELL DISEASE
Indications for Sickle Cell Disease4,5
MALARIA
BABESIOSIS
NITROBENZENE AND OTHER POISONINGS
HEMOLYTIC DISEASE OF NEWBORN
MISCELLANEOUS
CONCLUSION
39:
Transfusion Practice in Thalassemia
INTRODUCTION
PATHOPHYSIOLOGY
TRANSFUSION THERAPY
WHOM TO TRANSFUSE
COMPATIBILITY TESTING
TRANSFUSION REGIMEN
TRANSFUSION INTERVAL
CHARACTERISTICS OF BLOOD PRODUCTS FOR TRANSFUSION
Modified Packed RBCs
Leukoreduced
Washed Packed RBCs
Neocytes
EFFECTIVENESS OF TRANSFUSION THERAPY
Problem of thalassemia transfusion programs is developing countries
CONCLUSION
40:
Pediatrician and β-Thalassemia
INTRODUCTION
ROAD MAP
Diagnosing Thalassemia
MANAGEMENT
Caretaker Counselling
Blood Transfusion
Chelation Therapy
Deferoxamine
Deferasirox
Folic Acid
Stem Cell Transplantation
Splenectomy
COMPLICATIONS OF THALASSEMIA
FOLLOW-UP
PROGNOSIS
Morbidity and Mortality
PREVENTION
PRENATAL DIAGNOSIS
CONCLUSION
41:
Iron Overload in Chronically Transfused Patients: Diagnosis and Treatment
ASSESSMENT OF IRON OVERLOAD
Serum Ferritin
SQUID
MRI
MRI Assessment of Liver Iron
MRI Assessment of Cardiac Iron
MRI Assessment of Pancreatic Iron Overload
MRI in other Iron Overload Conditions
Iron Chelation
DESFERRIOXAMINE
Effect on Serum Ferritin
Effect on Liver Iron
Effect on Cardiac Iron
Deferasirox
Compliance
Recommended Dose
Combination Therapy
DFO and DFP
DFO and DFX
DFX and DFP
42:
Transfusion in Sickle Cell Anemia
43:
Advanced Therapies for Treatment of Hemophilia
INTRODUCTION
Advanced Therapies for Hemophilia Under Trial
Factor Repletion
Genetic Therapies
MANAGEMENT OF INHIBITORS
Management of Hemophilic Arthropathy
CONCLUSION
44:
Intervention in Bleeding Patients Bleeding Disorders: Lab Diagnosis
GENERAL ASPECTS
LABORATORY INVESTIGATIONS
Screening Tests
Specified Tests
Prothrombin Time
Prolongation of PT Indicates
APPT
Thrombin Time
Interpretation of Results
Fibrinogen Assay
Bleeding Time (Ivy Method)
Interpretation
Platelet Count
Blood Film Examination
Light Transmission Aggregometry
Thromboelastography
Thromboelastograph Hemostasis Analyzer (TEG)
Information Provided by TEG
Uses and Benefits of TEG
ROTEM
Platelet Mapping
Other New Technologies
SUMMARY
45:
Management of Coagulopathy in Liver Diseases
DEFECTS IN PRIMARY HEMOSTASIS
Intrinsic Factors
Extrinsic Factors
DEFECTS IN SECONDARY HEMOSTASIS
Fibrinolysis
Conclusion
OVERVIEW OF MANAGEMENT
Red Blood Cell Transfusions
Fresh Frozen Plasma
Issues Related to the Use of Cirrhotic Patients
Cryoprecipitate
Platelets
Pharmacologic Agents
Risks/Complications
Aprotonin: Serine Protease Inhibitor
Recombinant Factor VIIa
Vitamin K
SUMMARY
46:
Recombinant Activated Factor VII in Clinical Practice
MECHANISM OF ACTION
INDICATIONS
Approved Indications
United States Food and Drug Administration (FDA) Approved Indications
European Approved Indications
OFF-LABEL USES
Pharmacokinetics, Dosing and Laboratory Monitoring
Side Effects
47:
Plasma Versus Recombinant Clotting Factors
CLOTTING FACTOR CONCENTRATE
Demerits of Plasma factor concentrates
Inhibitors
Viral Infections/TTIs
CONCLUSION
48:
Solvent Detergent Treated Plasma in Clinical Use
INTRODUCTION
PRODUCTION OF SD PLASMA
PROPERTIES OF SD PLASMA
OCTAPLAS FOLLOW-UP STUDY
Risk of Fibrinolysis
Risk of Venous Thromboembolism
PHARMACOECONOMICS
CONCLUSION WITH EUROPEAN SD PLASMA
49:
Cryoprecipitate
CRYOPRECIPITATE CONSTITUENTS AND THEIR STABILITY
INDICATIONS
COMMON MISUSES
DOSES AND ADMINISTRATION OF FACTOR VIII CONCENTRATES
Example
PREPARATION, STORAGE AND QUALITY CONTROL
POOLING OF CRYOPRECIPITATE
POTENTIAL ADVERSE REACTIONS5
SECTION 2: CELLULAR THERAPIES
50:
Stem Cell Transplantation: Brief Overview
51:
Stem Cell in Regenerative Medicine: Applications and Cautions
TRANSLATION OF STEM CELL SCIENCE INTO REGENERATIVE MEDICINE
THREATS TO CLINICAL TRANSLATION AND TO THE INTEGRITY OF REGENERATIVE MEDICINE
52:
Stem Cell Therapy in Cardiovascular Diseases
INTRODUCTION
EMBRYONIC STEM CELL
ADULT STEM CELLS
MECHANISM OF ACTION OF STEM CELLS
TYPES OF CELLS CONTEMPLATED FOR CELLULAR REGENERATIVE THERAPY
Embryonic Stem Cell
Resident Cardiac Stem Cells
Skeletal Myoblasts
Human Adult Bone Marrow Derived Stem Cells
Mesenchymal Stem Cells
Endothelial Progenitor Cells
METHODS OF STEM CELL DELIVERY
Transvascular Route
Direct Injection into the Ventricular Wall
STEM CELL THERAPY FOR CARDIAC REPAIR
RESULTS OF STEM CELL TRANSPLANT IN CLINICAL TRIALS
Stem Cell Therapy in Acute Myocardial Infarction
Stem Cell Therapy in Chronic Ischemic Heart Failure
Stem Cell Therapy in Dilated Cardiomyopathy
CONCERNS
CONCLUSION
53:
Stem Cell Therapy for Diabetes Mellitus
INTRODUCTION
STEM CELL THERAPY FOR DIABETES
ETHICAL ISSUES WITH USE OF STEM CELLS
54:
Stem Cell Therapy in Peripheral Artery Disease
INTRODUCTION
Risk Profile of PAD
ABI AND DIAGNOSIS OF PAD
Peripheral Arterial Disease: Salient Points
STEM CELL THERAPY FOR PAD
Measures of Outcome of Stem Cell Therapy
CLINICAL TRIALS ON STEM CELL THERAPY FOR PAD
CURRENT STATUS OF STEM CELL THERAPY IN PAD
SUMMARY
GLOSSARY OF TERMS
55:
Role of Platelet Rich Plasma in Regenerative Medicine
INTRODUCTION
HISTORICAL PERSPECTIVE
BASIC SCIENCE OF PLATELET RICH PLASMA
PLATELET RICH PLASMA THERAPY
PREPARATION OF Platelet rich Plasma AND ITS APPLICATION
THERAPEUTIC PLATELET PRODUCTS8
INDICATIONS
CONTRAINDICATIONS11
SAFETY PROFILE
SUMMARY
FUTURE OF PLATELET RICH PLASMA IN REGENERATIVE MEDICINE
CONCLUSION
56:
Role of Platelet Rich Plasma in Plastic Surgery
PLATELET RICH PLASMA
RATIONALE FOR USE OF PLATELET RICH PLASMA
PLATELET RICH PLASMA IN PLASTIC SURGERY
Platelet Rich Plasma in Hair Transplantation
To Preserve and Enhance Hair Follicle Viability
To Promote and Enhance Tissue Repair and Healing
To Reinvigorate Dormant Hair Follicles
Skin Rejuvenation
Wound Healing
SAFETY, COMPLICATIONS, CONTRAINDICATIONS TO USE OF PLATELET RICH PLASMA
57:
Cord Blood Banking and Transplantation
INTRODUCTION
Cord Blood Transplantation in Thalassemia in India
Cord Blood Transplantation in India
Public Cord Blood Banking
CONCLUSION
58:
Erythropoiesis Stimulating Agents versus Red Cell Transfusion
INTRODUCTION
ERYTHROPOIESIS STIMULATING AGENTS
Adverse Effects of Erythropoiesis Stimulating Agents
Hypertension
Cardiovascular Complications
Pure Red Cell Aplasia
Iron Deficiency
Tumor Progression
Miscellaneous
RED CELL TRANSFUSION
Complications of Transfusions
Availability of High Quality Blood Products
Acute Hemolytic Reactions
Transfusion Associated Circulatory Overload
Iron Overload
Infectious Disease Transmission
Immune Injury
Impact of RBC Transfusion in Cancer
Miscellaneous
CONCLUSION
59:
Natural Killer Cells in Tumor and Transplantation
ORIGIN AND DISTRIBUTION OF NATURAL KILLER CELLS
MECHANISM OF CYTOTOXICITY
ROLE OF NATURAL KILLER CELLS IN TRANSPLANT IMMUNOLOGY
NATURAL KILLER CELLS AND CANCER SURVEILLANCE
CONCLUSION
60:
Potential and Hazards of Gene Therapy
HISTORICAL ASPECT
GENE THERAPY IN TRANSFUSION MEDICINE
PREREQUISITE FOR GENE THERAPY
GENE DELIVERY SYSTEMS
VECTOR DESIGN
VIRAL DELIVERY SYSTEMS
Adenoviruses
Retroviruses
Adeno Associated Viruses
Lentiviruses
NONVIRAL DELIVERY SYSTEMS
Advances in Globin Gene Therapy for the Treatment of Beta Thalassemia and Sickle Cell Anemia
REGULATORY ISSUES
Future of Gene Therapy
Challenges in Gene Targeting in Human Stem Cells
SECTION 3: BLOOD SAFETY
61:
Leucoreduction
APPROXIMATE LEUCOCYTES IN VARIOUS RED BLOOD CELL PREPARATIONS
CLINICAL INDICATIONS FOR LEUCOREDUCTION
Established Indications
Potential Benefits of Leucoreduction
Preparation of Leucoreduced Blood
METHODS OF LEUCODEPLETION
Leucofiltration
Low Leucocyte Apheresis Devices
Centrifugation and Buffy Coat Removal
Washing
Freezing and Deglycerolization
Quality Control of Leucodepletion (Table 3)
Febrile Nonhemolytic Transfusion Reactions
Mechanism of Febrile Nonhemolytic Transfusion Reactions
Clinical Evaluation of Febrile Nonhemolytic Transfusion Reactions
CMV Transmission and Leucocytes
HLA Alloimmunization
ADVERSE EFFECTS OF FILTRATION AND LEUCODEPLETION
UNIVERSAL LEUCODEPLETION VS SELECTIVE LEUCODEPLETION
Pros and Cons of Universal Leucoreduction
LEUCODEPLETION—INDIAN PERSPECTIVE
62:
Improving Blood Donor Screening by Nucleic Acid Technology
NEED FOR NUCLEIC ACID TECHNOLOGY
NUCLEIC ACID TECHNOLOGY
BLOOD DONOR SCREENING
EXPERIENCES OF DIFFERENT COUNTRIES
United States
Germany
United Kingdom
Italy
Hongkong
Japan
China
Egypt
Switzerland
South Africa
Thailand
India
63:
ID-NAT Versus MP-NAT
64:
Occult HBV Infection: A Risk for Transfusion
INTRODUCTION
Etiopathogenesis
Epidemiology
Clinical Implications of OBI
Preventive Strategies
65:
Current Status of Bacterial Detection in Blood Components
ABSTRACT
INTRODUCTION
CLINICAL RELEVANCE
METHODS TO REDUCE RISK OF POST TRANSFUSION SEPSIS
METHODS TO DETECT BACTERIAL CONTAMINATION IN BLOOD COMPONENT
INDIRECT RAPID BACTERIAL DETECTION TESTS
pH
Noninvasive pH Measurement
Noninvasive Oxygen Measurement
Platelet Aggregation
DIRECT METHODS OF BACTERIAL DETECTION
Microscopy
Scansystem
Culturing Methods
BacT/Alert
Enhanced Bacterial Detection System
Microcalorimetry
DIRECT RAPID DETECTION METHODS
Pan Genera Detection Test System
Fluorescence Activated Cell Sorting Analysis
Nucliec Acid Amplification Assay/Techniques
Bacterial Peptidoglycan Chromogenic Immunoassay
PATHOGEN REDUCTION
Technologies Under Development
66:
Pathogen Reduction Technology
PATHOGEN INACTIVATION IN PLATELET CONCENTRATES
PLATELET CONCENTRATES WITH AMOTOSALEN PHOTOCHEMICAL TREATMENT
RIBOFLAVIN AND ULTRAVIOLET LIGHT TREATED PLATELETS
METHYLENE BLUE TREATED PLATELETS
Pathogen Inactivation in Fresh Frozen Plasma Preparation
POTENTIAL SYSTEM FOR PATHOGEN INACTIVATION IN RED CELL CONCENTRATES
CONCLUSION
67:
Discarding of Blood and Blood Components
INTRODUCTION
CONCLUSION
RECOMMENDATIONS
68:
Adverse Transfusion Reactions
INTRODUCTION
CLASSIFICATION
ACUTE ADVERSE TRANSFUSION REACTION WITH IMMUNE CAUSES
Immediate Hemolytic Transfusion Reaction
INVESTIGATIONS TO BE DONE FOR IMMEDIATE HEMOLYTIC TRANSFUSION REACTION
Febrile Nonhemolytic Transfusion Reactions
Urticarial (Allergic) Reactions
Anaphylactic and Anaphylactoid Reactions
Transfusion Related Acute Lung Injury
ACUTE ADVERSE TRANSFUSION REACTION WITH NONIMMUNE CAUSES
Transfusion Associated Circulatory Overload
Bacterial Contamination (Infective Shock)
Physically or Chemically Induced Transfusion Reactions
DELAYED ADVERSE TRANSFUSION REACTION WITH IMMUNE CAUSES
Delayed Hemolytic Transfusion Reaction
Alloimmunization
Platelet Refractoriness
Post Transfusion Purpura
Transfusion-Associated Graft Versus Host Disease
Immunomodulatory Effects
DELAYED ADVERSE TRANSFUSION REACTION WITHOUT IMMUNE CAUSES
Iron Accumulation
Infectious Disease Transmission
CONCLUSION
69:
Hemovigilance and its Launch in India
INTRODUCTION
HEMOVIGILANCE SYSTEMS
OUTCOME OF HEMOVIGILANCE AROUND THE WORLD
Recommendations and Initiatives
Hemovigilance in India
Roadmap for Hemovigilance in the Country
An Initiation Phase (2012–13)
An Expansion and Consolidation Phase (2013–15)
An Expansion and Maintenance Phase (2015–16)
Optimization Phase (2017)
70:
Advances in Serological Assays for Screening Blood Donors for Infectious Agents
INTRODUCTION
Serological versus Molecular Assays
Evolution of Hepatitis C Virus Assays
Evolution of Human Immunodeficiency Virus Assays
Evolution of Hepatitis B Virus Assays
Syphilis Serology
Malaria
SECTION 4: MISCELLANEOUS
71:
The Evidence-based Transfusion Medicine
INTRODUCTION
EVIDENCE-BASED RED BLOOD CELLS UTILIZATION GUIDELINES
EVIDENCE-BASED PLATELET UTILIZATION GUIDELINES
EVIDENCE-BASED FRESH FROZEN PLASMA UTILIZATION GUIDELINES
EVIDENCE-BASED CRYOPRECIPITATE UTILIZATION GUIDELINES
LIMITATIONS OF EVIDENCE-BASED TRANSFUSION MEDICINE
CONCLUSION
72:
Blood Bank Accreditation
INTRODUCTION
TYPES OF BLOOD BANKS/CENTRES
SCOPE OF ACCREDITATION
Requirements of Accreditation Standards
Organization and Management
Accommodation and Environment
Personnel
Equipment
External Services and Supplies
Process Control
Identification of Deviations and Adverse Events
Performance Improvement
Document Control
Records
Internal Audit and Management Review
CONCLUSION
73:
National Plasma Policy for Access to Plasma Derived Proteins for Clinical/Therapeutic Use
INTRODUCTION
OBJECTIVES OF THE POLICY1
Objective 1
Strategy
Objective 2
Strategy
Objective 3
Strategy
Objective 4
Strategy
Objective 5
Strategy
74:
Ethical Issues in Transfusion Medicine
INTRODUCTION
INTERNATIONAL SOCIETY OF BLOOD TRANSFUSION CODE OF ETHICS
A CODE OF ETHICS FOR BLOOD DONATION AND TRANSFUSION
ETHICAL ISSUES RELATED TO DONORS
ETHICAL ISSUES RELATED TO PATIENTS
ETHICAL ISSUES RELATED TO BLOOD ESTABLISHMENTS
Indian Scenario of Ethical Issues in Transfusion Medicine
FUTURE PROSPECTIVES
CONCLUSION
75:
Gel Based Technology: Past, Present and Future
PRINCIPLE OF GEL TECHNOLOGY (FIG. 1)
PRACTICAL APPLICATIONS OF GEL TECHNOLOGY
ADVANTAGES OF GEL TECHNOLOGY
PAST, PRESENT AND FUTURE
76:
Automated Blood Grouping and Antibody Screening
AUTOMATION IN SEROLOGIC TESTING
SOLID-PHASE IMMUNOASSAYS
ERYTHROCYTE-MAGNETIZED TECHNOLOGY
VALIDATION OF AUTOMATED SYSTEMS3
EDGE OF AUTOMATION
77:
Molecular Genotyping and its Applications to Transfusion Medicine
SOLVING ABO BLOOD GROUP DISCREPANCIES
Antigen Typing when Antibody-based Typing Reagents are Unavailable or Only Weakly Reactive
IDENTIFICATION OF WEAKER AND PARTIAL VARIANTS OF RHD GENE
RHD ZYGOSITY TESTING
IDENTIFICATION OF DEL PHENOTYPES
PRENATAL DIAGNOSIS OF RHD IN FETUS
Typing of Blood Group Antigens in Recently Transfused Patients
ANTIGEN PROFILING IN DAT POSITIVE CASES
DIFFERENTIATION BETWEEN ALLOANTIBODY AND AUTOANTIBODY
QUALITY CONTROL IN REAGENT RED CELLS
SCREENING FOR RARE BLOOD GROUP DONORS
HPA, HLA and HNA Typing
Limitations of DNA-based Methods
CONCLUSION
78:
Rare Blood Group Registry
DEFINING RARE BLOOD
INTERNATIONAL RARE DONOR PROGRAM
NATIONAL STATUS
NEED FOR NATIONAL REGISTRY
IDENTIFICATION OF RARE DONORS
Methods for typing blood group types
FUTURE DIRECTIONS
79:
New Versus Old Blood
80:
Importance of Safe Blood Administration Practices
81:
Strategies to Reduce Unnecessary Transfusions
INDEX
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