Advertisement

Alternative Approaches to Prevention of Alloimmunisation: A Virtue of Reality?

  • J. Th. M. de Wolf
  • A. Westerterp-Maas
  • B. G. Hepkema
  • S. P. M. Lems
  • O. Plantinga
  • P. C. Das
  • C. Th. Smit Sibinga
  • E. Vellenga
Chapter
Part of the Developments in Hematology and Immunology book series (DIHI, volume 34)

Abstract

The main objectives of risk management in blood transfusion comes very close to the objectives of haemovigilance, described by McClelland [1] as: ‘the overall goal of haemovigilance must be to make clinical care safer for a patient who has a condition that may require some form of transfusion therapy. An important subsidiary purpose is to demonstrate to the public, patients and professionals the safety of existing transfusion systems. This needs to be done in a way that presents the risks and benefits of transfusion in a sensible perspective to show that where there are problems, these are recognised, effectively tackled and not ignored or kept secret’. As a clinician I feel very comfortable with such a definition because it is in a direct line of clinical practice. If a patient comes with abdominal pain the complaint is placed in perspective by generating a differential diagnosis including the most important possible causes. Then different pieces of information are used like history, physical examination, clinical laboratory tests and radiographic studies to help us refine the probability of disease for each significant diagnostic prospect. Another way of practice is to exclude every thinkable cause of abdominal pain by using every laboratory test, every radiographic study and every endoscopy you can perform. This last, in my opinion rejectable form of zero risk, defensive medicine is comparable with the reasoning of some people concerning blood transfusion.

Keywords

Acute Lymphocytic Leukemia Platelet Transfusion Transfusion Reaction Defensive Medicine Trap Study 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    McClelland B, Love E, Scott S, Williamson LM. Haemovigilance: concept, Europe and UK Initiatives. Vox Sang 1998; 74 (Suppl. 2): 431–39PubMedCrossRefGoogle Scholar
  2. 2.
    Goldfinger D, Lowe E. Prevention of adverse reactions to blood transfusion by the administration of saline-washed red blood cells. Transfusion 1981; 21: 277–80PubMedCrossRefGoogle Scholar
  3. 3.
    Menitove JE, McElligott MC, Aster RH. Febrile transfusion reaction: what blood component should be given next? Vox Sang 1982; 42: 318–21PubMedCrossRefGoogle Scholar
  4. 4.
    Heddle NM, Klama L, Singer J, Richards C, Fedak P, Walker I, Kelton JG. The role of plasma from platelet concentrates in transfusion reactions. N Engl J Med 1994; 331:625–28PubMedCrossRefGoogle Scholar
  5. 5.
    The Trial to Reduce Alloimmunization to Platelets Study Group. Leukocyte reduction and ultraviolet-B irradiation of platelets to prevent allimmunization and refractoriness to platelet transfusion. N Engl J Med 1997; 337: 1861–69CrossRefGoogle Scholar
  6. 6.
    Sniecinski I, O’Donnell MR, Nowicki B, Hill LR. Prevention of refractoriness and HLA-alloimmunization using filtered blood products. Blood 1988;71:1402–07PubMedGoogle Scholar
  7. 7.
    Andreu G, Dewailly J, Leberre C, et al. Prevention of HLA immunization with leukocyte poor packed red cells and platelet concentrates obtained by filtration. Blood 1988;72:964–69PubMedGoogle Scholar
  8. 8.
    Schiffer CA, Dutcher JP, Aisner J, Hogge D, Wiernik PH, Reilly JP. A randomized trial of leukocyte-depleted platelet transfusion to modify alloimmunization in patients with leukemia. Blood 1983;62:815–20PubMedGoogle Scholar
  9. 9.
    Marwijk Kooy M van, Prooijen HC van, Moes M, Bosma-Stants I, Akkerman J-W N. Use of leukocyte-depleted platelet concentrates for the prevention of refractoriness and primary HLA-alloimmunization: a prospective, randomized trial. Blood 1991;77:201–05PubMedGoogle Scholar
  10. 10.
    Oksanen K, Kekomaki R, Ruutu T, Koskimies S, Myllyla G. Prevention of alloimmunization in patients with acute leukemia by use of white cell-reduced blood components-a randomized trial. Transfusion 1991;31:588–94PubMedCrossRefGoogle Scholar
  11. 11.
    Handa M. Role of leukocyte depletion from platelet concentrates in reducing HLA alloimmunization and platelet refractoriness in polytransfusied patients: a prospective multicenter randomized study in Japan. In: Clinical application of leukocyte depletion. Ed. Sekiguchi S. Blackwell Scientific Publications. Oxford, 1993:212–22Google Scholar
  12. 12.
    Sintnicolaas K, Marwijk Kooy M van, Prooijen HC, et al. Leukocyte depletion of random single-donor platelet transfusion does not prevent secondary human leukocyte antigen-alloimmunization and refractoriness: a randomized prospective study. Blood 1995;85:824–28PubMedGoogle Scholar
  13. 13.
    Wolf J Th M de, Westerterp A, Smit Sibinga C Th, Halie MR. Prestorage leukocyte depletion is not necessarily required for the prevention of refractoriness to platelet transfusion. Blood 1995;86:3263PubMedGoogle Scholar
  14. 14.
    Bekkum DW van. The selective elimination of immunologically competent cells from bone marrow and lymphatic cell mixtures. Transplantation 1964;2:393–404CrossRefGoogle Scholar
  15. 15.
    Oh JH, McClure HM. Lymphocytotoxic antibodies induced by fresh blood, stored blood, and platelets in Rhesus Monkeys. Transpl Proc 1982;14:410–12Google Scholar
  16. 16.
    Fiebig E, Lane TA. Effect of storage and ultraviolet B irradiation on CD 14-bearing antigen-presenting cells (monocytes) in platelet concentrates. Transfusion 1994;34:8–46-51Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1999

Authors and Affiliations

  • J. Th. M. de Wolf
    • 1
    • 2
  • A. Westerterp-Maas
    • 1
    • 2
  • B. G. Hepkema
    • 1
    • 2
  • S. P. M. Lems
    • 1
    • 2
  • O. Plantinga
    • 1
    • 2
  • P. C. Das
    • 1
    • 2
  • C. Th. Smit Sibinga
    • 1
    • 2
  • E. Vellenga
    • 1
    • 2
  1. 1.Department of HaematologyUniversity HospitalGroningenNetherlands
  2. 2.Blood Bank Noord NederlandGroningenThe Netherlands

Personalised recommendations