Title Page

Copyright Page

Contents

List of Contributors

Preface

Chapter 1 Introduction: Two Centuries of Progress in Transfusion Medicine

Blood Donation Worldwide

Changing Landscape of Transfusion Risks

Immunohaematology

Clinical Use of Blood Components: Evolution Based on Evidence

Urgent Transfusion

Patients Requiring Chronic Transfusion Support

Obstetric, Neonatal and Paediatric Transfusion Medicine

Haemostasis and Transfusion

Cellular Therapies, Transplantation, Apheresis

The Future

Conclusion

References

Part I Basic Principles of Immunohaematology

Chapter 2 Essential Immunology for Transfusion Medicine

Cellular Basis of the Immune Response

B-Cell Activation and T-Cell-Dependent Antibody Formation

Humoral Immune Response

Antibody Effector Functions

Red Blood Cell Antibodies Illustrating the Above Principles

Antibody and Complement-Mediated Blood Cell Destruction

Clinical Aspects Related to Alloimmunisation Against Blood Cell Antigens

References

Further Reading

Chapter 3 Human Blood Group Systems

Introduction

The ABO System

The Rh System

Other Blood Group Systems

Biological Significance of Blood Group Antigens

References

Further Reading

Chapter 4 Human Leucocyte Antigens

Introduction

HLA Class I Genes

HLA Class II Genes

Genetic Organisation and Expression of HLA Class II Genes

Expression of HLA Molecules

Genetics

Function of HLA Molecules

Identification of HLA Gene Polymorphism

Formation of HLA Antibodies

Detection of HLA Antibodies

Clinical Relevance of HLA Antigens and Antibodies

HLA and Disease

References

Further Reading

Chapter 5 Platelet and Neutrophil Antigens

Antigens on Platelets and Granulocytes

Human Platelet Antigens

Human Neutrophil Antigens

References

Further Reading

Chapter 6 Pretransfusion Testing and the Selection of Red Cell Products for Transfusion

Introduction

Determining the Recipient’s ABO Group and Screening for Unexpected Antibodies

Crossmatching Techniques

Selection of Red Cells for Transfusion

Selection of Platelets and Plasma Components

References

Further Reading

Part II Complications of Transfusions

Chapter 7 Investigation of Acute Transfusion Reactions

Introduction

Understanding the Clinical Presentation and Differential Diagnosis

General Approach for Investigation and Treatment of Acute Transfusion Reactions

Algorithm

References

Further Reading

Chapter 8 Haemolytic Transfusion Reactions

Definition of a Haemolytic Transfusion Reaction

Pathophysiology of HTRs

Acute HTRs

Delayed HTRs

Acute Haemolysis from ABO‐Incompatible Platelet Transfusions

References

Further Reading

Chapter 9 Febrile and Allergic Transfusion Reactions

Introduction

Febrile Non-haemolytic Transfusion Reactions

Allergic Transfusion Reactions

References

Chapter 10 Lung Injury and Pulmonary Oedema After Transfusion

Definition

Incidence, Outcomes and Recipient Risk Factors

Clinical Manifestations

Differential Diagnosis

Pathogenesis

Lung Histology

Types of Blood Components That Can Cause TRALI

Mitigation Strategies

Patient Management

References

Further Reading

Chapter 11 Purported Adverse Effects of ‘Old Blood’

Introduction

In Vitro Changes During Red Cell Storage

Studies on Clinical Effects of ‘Old’ Red Cells

Conclusion

References

Further Reading

Chapter 12 Transfusion-Induced Immunomodulation

Introduction

Mitigation of Immunomodulation After Red Cell Transfusion

Leucocyte-Reduced Allogeneic Red Cell Transfusions Reduce Mortality In Cardiac Surgery

Observational and Cohort Studies of Transfusion Immunomodulation Link Red Cell Transfusions to Both Beneficial and Adverse Outcomes

Duration of Red Cell Storage and Immunomodulation

Experimental Studies and Transfusion Immunomodulation

Conclusion

References

Further Reading

Chapter 13 Transfusion-Associated Graft-Versus-Host Disease and Microchimerism

Transfusion-Associated Graft-Versus-Host Disease

Transfusion-Associated Microchimerism

References

Further Reading

Chapter 14 Posttransfusion Purpura '

Introduction

Definition

Incidence

Clinical Features

Differential Diagnosis

Laboratory Investigations

Pathophysiology

Management

Prevention of Recurrence of PTP

References

Further Reading

Chapter 15 Transfusion-Transmitted Infections

Introduction

Transmission of Infections by Blood Transfusion

Transfusion-Transmitted Infections: Detection and Management

Interventions to Minimise the Impact of Transfusion-Transmitted Infection

Transfusion-Transmitted Infectious Agents

References

Further Reading

Chapter 16 Bacterial Contamination

Incidence of Bacterial Contamination

Blood Components Implicated in Adverse Transfusion Reactions

Contaminant Bacterial Species

Sources of Contamination

Investigation of Transfusion Reactions

Prevention Strategies

References

Further Reading

Chapter 17 Emerging Infections and Transfusion Safety

Introduction

Emerging Infections

Approaches to the Management of Transfusion-Transmissible Emerging Infections

Assessing the Risk and Threat of Transfusion Transmissibility

Recognition of Transfusion Transmission of Emerging Infections

Interventions

References

Further Reading

Part III Practice in Blood Centres and Hospitals

Chapter 18 Regulatory Aspects of Blood Transfusion

Introduction

The Components of Blood Regulation

The Regulatory Bodies (Table 18.1)

The Role of Blood Transfusion Agencies and Health Professionals Vis‐À‐Vis Regulatory Agencies

References

Further Reading

Chapter 19 The Role of Haemovigilance in Transfusion Safety

Introduction

Origin and Structures

Definitions and Terminology in Haemovigilance Systems

Adverse Event Detection and Reporting

Haemovigilance System Limitations

Breadth of the System

Analysis of Incident Reports

Reporting Requirements Structure

Data Management

Learning from Experience

Future Directions

Intangible Benefits

References

Further Reading

Chapter 20 Donors and Blood Collection

Blood Donors: Paid, Directed, Payback and Altruistic

Risks to the Blood Donor

Iron Deficiency in Blood Donors

Blood Collection/Donation Process

Obligations to Donors

References

Further Reading

Chapter 21 Blood Donation Testing and the Safety of the Blood Supply

Introduction

Red Cell Serological Testing

Microbiological Testing of Blood Donations and Donor Follow‐Up

Quality Framework and Operational Issues

References

Further Reading

Chapter 22 Production and Storage of Blood Components

Whole Blood and Its Processing to Components

Collection of Components by Apheresis

Regulations, Specifications and Quality Monitoring

Red Blood Cell Production and Storage (Table 22.1)

Platelet Production and Storage (Table 22.2)

Plasma Production and Storage (Table 22.3)

Cryoprecipitate Production and Storage (see Table 22.3)

Granulocyte Production and Storage

Component Modifications

References

Further Reading

Chpater 23 Blood Transfusion in Hospitals

Introduction

Key Features of Hospital Transfusion Governance

Hospital Transfusion Committees

Working Together to Improve the Transfusion Process

Informed consent

Administration of Blood and Blood Components and Management of the Transfused Patient

Technologies to Reduce Patient Misidentification Errors in Administering Blood

Influencing Clinical Practice

Guidelines, Algorithms and Protocols

Clinical Audit

Surveys

National Schemes

Public and Political Perceptions and Fear of Litigation

Local Investigation and Feedback Following ‘Near Misses’ and Serious Adverse Events

Education and Continuing Professional Development

Centralisation of Transfusion Services

Maximum Surgical Blood Ordering Schedule (MSBOS)

Acknowledgement

References

Further Reading

Guidelines and Other Resources

Chapter 24 Blood Transfusion in a Global Context

Introduction

Safety and Supply

Use of Blood Products

Systems

Improvements

Conclusion: The Future of Blood Transfusion in a Global Context

References

Further Reading

Part IV Clinical Transfusion Practice

Chapter 25 Inherited and Acquired Coagulation Disorders

Normal Haemostasis

Investigation of Abnormal Haemostasis

Inherited Haemostatic Defects

Acquired Haemostatic Defects

Acknowledgement

References

Further Reading

Chapter 26 Massive Blood Loss

Definition and Burden of Massive Blood Loss

Haemorrhage-Related Mortality Following Injury

Coagulopathy after Injury

The Limits of Resuscitation with Conventional Blood Products

Efficacy of Damage Control Resuscitation

Can the Lessons of Damage Control Resuscitation for Trauma be Extended to Other Massive Haemorrhage Situations?

Massive Transfusion in Small Children

Conclusion

References

Further Reading

Chapter 27 Blood Management in Acute Haemorrhage and Critical Care

Introduction

Red Cell Transfusion

Treatment Adjuncts That Reduce Transfusion (see also Chapter 34)

Coagulopathy

Massive Blood Transfusion

Conclusion

References

Further Reading

Chapter 28 Point-of-Care Testing in Transfusion Medicine

Introduction

Limitations of Conventional Coagulation Testing

Point-of-Care Testing Options

Point-of-Care Testing in Transfusion Algorithms

References

Further Reading

Chapter 29 Haematological Disease

Introduction

Red Cell Transfusions

Platelet Transfusions

Granulocyte Transfusions

Approach to Complications Associated with Blood Transfusion in Haematology Patients

Iron Overload

References

Further Reading

Chapter 30 Blood Transfusion in the Management of Patients with Haemoglobinopathies

Introduction

α-Thalassaemia syndromes

β-Thalassaemia Syndromes

Sickle Cell Disease

Complications of Transfusions in Haemoglobinopathies

Iron Chelation

Acknowledgement

References

Further Reading

Chapter 31 Heparin-Induced Thrombocytopenia

Introduction

Pathogenesis

Epidemiology

Heparin-Induced Thrombocytopenia: A ‘Clinicopathological’ Syndrome

Laboratory Testing

Treatment

References

Further Reading

Chapter 32 Immunodeficiency and Immunoglobulin Therapy

Introduction

Primary Immunodeficiency Disorders

Immunoglobulin Therapy

References

Further Reading

Chapter 33 Transfusing Neonates and Infants

Introduction

Red Cell Transfusions for the Anaemia of Prematurity

Platelet Transfusions for the Thrombocytopenia of Prematurity

References

Further Reading

Part V Patient Blood Management

Chapter 34 Development of a Patient Blood Management Programme

Introduction

Step 1: Leverage Computerised Physician Order Entry (CPOE) Systems to Guide Evidence-Based Transfusions [1]

Step 2: Reduce All Forms of Waste Related to Blood Transfusion Practices

Step 3: Promote Alternative Blood Transfusion Methods and Systems

Step 4: Promote Anaemia Management Strategies

Step 5: Limit Iatrogenic Blood Loss

Step 6: Provide Blood Management Education, Awareness and Auditing for Clinicians

Cost of Blood

References

Further Reading

Chapter 35 Perioperative Patient Blood Management

Introduction

Anaemia and Major Surgery

Just Give Blood?

Patient Blood Management in Surgical Practice

Intraoperative Management

Major Haemorrhage

Post-operative Patient Blood Management

Conclusion

References

Further Reading

Chapter 36 Restrictive Transfusion Practice and How to Implement It

Introduction

Level 1 Evidence Supports Restrictive Red Cell Transfusion Practices

Strategies for Improving Blood Utilisation

Clinical Decision Support

Improving Blood Utilisation: The Stanford Experience

Future Directions

Conclusion

References

Further Reading

Chapter 37 Using Data to Support Patient Blood Management

Introduction

Transfusion Triggers and Targets

Blood Utilisation Metrics

Sources of Data

Data Extraction, Analysis and Presentation to Improve Practice

Clinical Outcome Data

Risk Adjustment

Crossmatch-to-Transfusion Ratio

Preoperative Anaemia Screening and Management

Conclusion

References

Further Reading

Part VI Cellular and Tissue Therapy and Organ Transplantation

Chapter 38 Regulation and Accreditation in Cellular Therapy

Introduction

Haematopoietic Stem Cell Transplant Activity

The Structure of SCT Programmes

European Union Directives and Legislation

The Human Tissue (HT) Act 2004

United States Food and Drug Administration

Non-governmental (Voluntary) Accreditation

Conclusion: How Do HSCT Programmes Respond to the Challenge?

References

Further Reading

Chapter 39 Stem Cell Collection and Therapeutic Apheresis

Introduction

Cell Separators

Patient Assessment and Treatment Planning

Haematopoietic Progenitor Cell Mobilisation

Peripheral Blood HPC Collection (Leucocytapheresis)

Plasma Exchange

Red Cell Exchange

Extracorporeal Photochemotherapy (Photopheresis)

Complications of Therapeutic Apheresis

References

Further Reading

Chapter 40 Haemopoietic Stem Cell Processing and Storage

Introduction

Transplant Procedures

Haemopoietic Progenitor Cell Products

Haemopoietic Progenitor Cell Product Assessment and Specialised Procedures

Storage of Haemopoietic Progenitor Cell Products

Cryopreservation

Thawing of Cryopreserved Haemopoietic Progenitor Cells

Quality Assurance

References

Further Reading

Chapter 41 Haematopoietic Stem Cell Transplantation

Introduction

Principles of Haematopoietic Stem Cell Transplants

Indications for haematopoietic stem cell transplants

Source of Stem Cells

Donor Care and Selection

Collecting Haematopoietic Stem Cells

Complications of Transplantation

Bone Marrow Transplant Outcome

Post-Bone Marrow Transplant Chimerism and Molecular Monitoring

Cytotoxic T-Cell Therapy

Regulatory Aspects of Haemopoietic Stem Cell Transplantation

Conclusion

References

Further Reading

Chapter 42 Cord Blood Transplantation

Introduction

Umbilical Cord Blood Banking

Clinical Outcomes of Umbilical Cord Blood Transplantation

Advantages and Disadvantages of Umbilical Cord Blood

Future Developments

Conclusion

References

Further Reading

Chapter 43 Recent Advances in Clinical Cellular Immunotherapy

Introduction

Cellular Immunotherapy in Haemopoietic Progenitor Cell Transplantation

Nonspecific T-Cell Immunotherapy

Tumour-Specific or Tumour-Restricted T-Cell Immunotherapy

Gene-Modified T-Cells for Immunotherapy

Tumour-Restricted Natural Killer Cell Immunotherapy

Passive Cellular Immunotherapy of Infectious Disease

Technical Advances Facilitating Translational Research in Cellular Immunotherapy

References

Further Reading

Chapter 44 Tissue Banking

Introduction

Regulation

Consent

Donor Selection and Testing

Tissue Procurement

Tissue Processing

Supply and Traceability of Tissues

Clinical Applications

Serious Adverse Events and Reactions

Advances in Tissue Processing and Regenerative Medicine

Conclusion

References

Further Reading

Part VII Development of the Evidence Base for Transfusion

Chapter 45 Observational and Interventional Trialsin Transfusion Medicine

Introduction

Types of Clinical Studies

Observational Studies

Randomised Controlled Trials

Conclusion

Acknowledgements

References

Further Reading

Chapter 46 Getting the Most Out of the Evidence for Transfusion Medicine

What is Meant by Evidence-Based Medicine?

Hierarchies of Clinical Evidence

Appraisal of Primary Research Evidence for Its Validity and Usefulness

Reviews: Narrative and Systematic

Comparative Effectiveness Research

Evidence Base for Transfusion Medicine

Are There Limitations to Evidence-Based Practice?

Conclusion

References

Further Reading

Chapter 47 A Primer on Biostatistics

Incidence and Prevalence

Statistics in Diagnostic Testing

Descriptive Statistics

Differentiating Types of Data and Statistical Tests to be Used

Determining Statistical Significance

Trial Hypotheses and Common Pitfalls of Interpretation

Meta-analyses and Forest Plots

Conclusion

References

Further Reading

Chapter 48 A Primer on Health Economics

Introduction

How Economists Think about Transfusions

Economic Evaluation in Transfusion Medicine

Conclusion

References

Further Reading

Chapter 49 Scanning the Future of Transfusion Medicine

Introduction

Blood Donor and Blood Supply Issues

Hospital Transfusion Service and Patient Care Perspectives

Cellular Therapy – A View to the Future

Afterthoughts

References

Index

Supplemental Images

EULA