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1.  A Simple Guideline Reduces the Need for Red Blood Cell Transfusions in Swiss Hospitals: A Prospective, Multicentre, Before-and-After Study in Elective Hip and Knee Replacement 
Summary
Introduction
Optimising the use of blood has become a core task of transfusion medicine. Because no general guidelines are available in Switzerland, we analysed the effects of the introduction of a guideline on red blood cell (RBC) transfusion for elective orthopaedic surgery.
Methods
Prospective, multicentre, before-and-after study comparing the use of RBCs in adult elective hip or knee replacement before and after the implementation of a guideline in 10 Swiss hospitals, developed together with all participants.
Results
We included 2,134 patients, 1,238 in 7 months before, 896 in 6 months after intervention. 57 (34 or 2.7% before, 23 or 2.6% after) were lost before follow-up visit. The mean number of transfused RBC units decreased from 0.5 to 0.4 per patient (0.1, 95% CI 0.08–0.2; p = 0.014), the proportion of transfused patients from 20.9% to 16.9% (4%, 95% C.I. 0.7–7.4%; p = 0.02), and the pre-transfusion haemoglobin from 82.6 to 78.2 g/l (4.4 g/l, 95% C. I. 2.15–6.62 g/l, p < 0.001). We did not observe any statistically significant changes in in-hospital mortality (0.4% vs. 0%) and morbidity (4.1% vs. 4.0%), median hospital length of stay (9 vs. 9 days), follow-up mortality (0.4% vs. 0.2%) and follow-up morbidity (6.9% vs. 6.0%).
Conclusions
The introduction of a simple transfusion guideline reduces and standardises the use of RBCs by decreasing the haemoglobin transfusion trigger, without negative effects on the patient outcome. Local support, training, and monitoring of the effects are requirements for programmes optimising the use of blood.
doi:10.1159/000363540
PMCID: PMC4086767  PMID: 25053931
Transfusion; Surgery; Red blood cells; Guideline
2.  Transfusion Efficacy of Apheresis Platelet Concentrates Irradiated at the Day of Transfusion Is Significantly Superior Compared to Platelets Irradiated in Advance 
Summary
Background
Gamma irradiation is currently the standard care to avoid transfusion-associated graft-versus-host disease. Guidelines on gamma irradiation of blood components state that platelets (PLTs) can be irradiated at any stage in their 5-day storage and can thereafter be stored up to their normal shelf life of 5 days after collection. In this study, we explored whether the timing of irradiation has an effect on transfusion efficacy of apheresis PLT concentrates (APCs).
Methods
Based on the 1-hour percent PLT recovery (PPR1h), transfusion efficacy of 1,000 eligible APCs transfused to 144 children were evaluated retrospectively. PPR1h was compared in transfused APCs irradiated at the day of transfusion and APCs irradiated in advance.
Results
In univariate analysis, transfusion efficacy of APCs irradiated in advance was significantly lower than that of APCs irradiated at the day of transfusion (mean PPR1h 27.7 vs. 35.0%; p = 0.007). This was confirmed in multivariate analysis (p = 0.030). Compared to non-irradiated APCs, transfusion efficacy of APCs irradiated at the day of transfusion was not significantly inferior (mean difference −2.8%; 95% CI −6.1 to 0.5%; p = 0.092), but APCs irradiated in advance were clearly less efficient (mean difference −8.1%; 95% CI −12.2 to −4.0%; p < 0.001).
Conclusion
Our data strongly support that APCs should not be irradiated in advance, 1.e., ≥24 h before transfusion.
doi:10.1159/000363484
PMCID: PMC4086758  PMID: 25053930
Platelet transfusion; Platelet concentrates; Platelet storage; Gamma irradiation
3.  Platelet Recruitment during Multiple Donor Platelet Apheresis Differs between Cell Separators 
Summary
Background
Recruitment of platelets (PLT) during donor PLT apheresis may facilitate the harvest of multiple units within a single donation.
Methods
We compared two PLT apheresis procedures (Amicus and Trima Accel) in a prospective, randomized, paired cross-over study in 60 donors. The 120 donations were compared for depletion of circulating PLT in the donors, PLT yields and PLT recruitment. A recruitment was defined as ratio of total PLT yield and donor PLT depletion > 1.
Results
Despite comparable differences of pre- and post-apheresis PLT counts (87 × 109/l in Trima Accel vs. 92 × 109/l in Amicus, p = 0.383), PLT yields were higher with Trima Accel (7.48 × 1011 vs. 6.06 × 1011, p < 0.001), corresponding to a higher PLT recruitment (1.90 vs. 1.42, p < 0.001). We observed a different increase of WBC counts after aphereses, which was more pronounced with Trima Accel than with Amicus (1.30 × 109/l vs. 0.46 × 109/l, p < 0.001).
Conclusion
Both procedures induced PLT recruitment. This was higher in Trima Accel, contributing to a higher yield in spite of a comparable depletion of circulating PLT in the donors. This recruitment facilitates the harvest of multiple units within a single donation and seems to be influenced by the procedure utilized. The different increases of circulating donor white blood cells after donation need further investigation.
doi:10.1159/000328634
PMCID: PMC3128152  PMID: 21760764
Platelet apheresis; Platelet recruitment; Cell separator
4.  Prospective, Paired Crossover Comparison of the in vitro Quality of Red Blood Cells Collected by the Automate for Blood Collection Device or by a Conventional Method 
Summary
Background
The prevention of the citrate shock should improve the quality of red blood cells (RBCs). We compared a conventional whole blood donation method (CONV) with a ‘Automate for Blood Collection’ (ABC), enabling a metered addition of anticoagulant and hence a correct and constant RBC-to-anticoagulant ratio throughout donation. We evaluated the performance of the ABC device and the storage quality of RBC units.
Material and Methods
The study was designed as prospective, paired crossover study with two groups of 20 donors donating first with the ABC or CONV and switching to the alternative method after 12 weeks. We measured the processing data of donations and the storage quality of RBCs on days 1, 28, and 42.
Results
ABC whole blood donations showed a slightly higher volume before and after filtration. ABC-derived RBC units revealed higher values for haematocrit, mean cellular volume, potassium and lower values for mean corpuscular haemoglobin concentration and sodium until day 42. They further showed faster glucose consumption and lactate production until day 28.
Conclusion
The ABC device is suitable for whole blood collection. The quality of the obtained RBCs is comparable to that of CONV. Avoiding the citrate shock by the described method did not improve the investigated RBC storage quality parameters.
doi:10.1159/000226092
PMCID: PMC2941835  PMID: 20877668
Whole blood donation; Citrate shock; Red blood cell storage quality

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