List Archives

Mon May 31 14:18:27 BST 2010

I think that there are no satisfactory answers to these good questions.

In the UK having fresh whole blood available in a consistent and safe
way would require a very large change in the blood transfusion service,
even as new technologies in virological screening make rapid safety
checking possible. I think that without a large clinical trial (showing
cost effectiveness of fresh whole blood) it would be difficult to create
this scale of organisational change.

All RBC in the UK are leucoreduced. I think that there is good evidence
for partial leucodepletion (ie for risk groups only, such as the
immunocompremised) but that universal leucodepletion is not proven to be
cost effective. However the 'precautionary principle' is usually used to
justify the UK system. This is against a background of a very low public
and political tolerance to harm from blood transfusion (although I quite
agree that the public is unaware of most of the harm). The UK also has
the 'mad cow disease' concerns of prion disease in transfused blood to
factor into decision making.

Old blood is certainly a concern, and there has been a reduction in what
has been deemed acceptable storage times. At a recent presentation the
UK National Blood Transfusion Service gave the UK figures which showed
that almost all blood used was less than 10 days old - so there seems as
if there has been a change in practice, as I am sure that this would not
have been the case in the past.

For anyone interested in haemostatic resuscitation following trauma the
new European Guideline was published in Critical Care last month:
http://ccforum.com/content/pdf/cc8943.pdf

Tim.

-----Original Message-----
From: Kenneth Mattox [mailto:kmattox at aol.com] 
Sent: 30 May 2010 17:02
To: Trauma-List [TRAUMA.ORG]
Cc: Trauma-List [TRAUMA.ORG]
Subject: Re: Emergency/massive transfusion/ratios/best practice

Your question opens several chronic questions and issues, to which I  
have not been able to find satisfactory answers:

1.  For the non immunocompromised patient, is there ANY (not  
theoritical) advantage to leucoreduced RBCs?

2.  You mentioned "washed RBCs".   I had thought most people gave up  
on washed RBCs about the same time as they gave up on the Edsel.

3.  Do old stored RBCs carry and GIVE UP oxygen as effectively as  
FRESH RBCs?

4.  Are you not hyper CONCERNED about the increasing reports on the  
detrimental effects on inflammatory and immune responses in ICU  
patients from "OLD" banked blood and blood products?

Apparently all blood is not created equal.

k  (iPhone)

On May 30, 2010, at 11:04 AM, Charlene M Morris <cvmmorris at gmail.com>  
wrote:

> Unfortunately, there are indeed more transfusion reactions with the  
> old
> whole blood, Vic. THus the reasoning for washed rbcs and an  
> exponential
> decline with post tranfusion difficulties.
>
> cmm
>
> On Sun, May 30, 2010 at 10:19 AM, Vic Werlhof <werlhof at gmail.com>  
> wrote:
>
>>
>> Military still praises WHOLE blood.  Anyone have this option?<<<<
>>
>> Opinion - sure - When I was a lad, whole blood was readily available.
>> Seemed to work just fine. Someone came up with the very profitable  
>> idea of
>> parsing each unit and then selling the components for more than the  
>> intact
>> product was worth.  Now, we seem to have rediscovered whole blood -  
>> at
>> least
>> to a degree.  PRBCs + FFP is common.  Too bad that we can't just  
>> give the
>> real thing.  Much simpler and probably more effective.
>> Vic
>>
>>
>> --
>> trauma-list : TRAUMA.ORG <http://trauma.org/>
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>
>
>
> -- 
> Blessed are the cheesemakers, for they will bring Gouda!
> --cmm 3/10
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/

This e-mail, including any attached files, may contain confidential and / or privileged information and is intended for the exclusive use of the addressee(s) printed above. If you are not the addressee(s), any unauthorised review, disclosure, reproduction, other dissemination or use of this e-mail, or taking of any action in reliance upon the information contained herein, is strictly prohibited. If this e-mail has been sent to you in error, please return to the sender. No guarantee can be given that the contents of this email are virus free - The University Hospitals of Leicester NHS Trust cannot be held responsible for any failure by the recipient(s) to test for viruses before opening any attachments. The information contained in this e-mail may be the subject of public disclosure under the Freedom of Information Act 2000 - unless legally exempt from disclosure, the confidentiality of this e-mail and your reply cannot be guaranteed. Copyright in this email and any attachments created by us remains vested in the University Hospitals of Leicester NHS Trust. 

List Archives

For your convenience, find the Trauma List Archive Below

Emergency/massive transfusion/ratios/best practice