Western Australia became the first jurisdiction in the world to adopt a system-wide program of patient blood management. It includes blood tests several weeks before scheduled surgery so anaemia can be treated and emphasis on surgical techniques which minimise blood loss. This program is credited with reducing WA’s use of red blood cells per 1,000 population from 30 in 2007–08 to 28.49 in 2010–11. This compares to a national average of 35.
Caution continues in the use of erythropoiesis-stimulating agents (ESAs):
Nevertheless, product developments in this space continue strongly.
Activities to raise awareness of the importance of the appropriateness of the use of products emerged on different products and from a number of studies.
Although its principal use is as a clotting agent in the treatment of haemophilia patients, rFVIIa is also used as an aid to coagulation in non-haemophilia patients.
A recent study reviewed the use of rFVIIa in patients without haemophilia27. It concluded that clinically significant benefits of rFVIIa as a general haemostatic agent in patients without haemophilia remain unproven. Given its potential risks, such use cannot be recommended and in most cases it should be restricted to clinical trials.
Two studies28 reported in the Annals of Internal Medicine on 19 April again raised concerns about off-label use of rFVIIa. One concluded that off-label use of rFVIIa in the [USA] hospital setting far exceeds use for approved indications. These patterns raise concern about the application of rFVIIa to conditions for which strong supporting evidence is lacking. The second concluded that limited available evidence for five off-label indications suggests no mortality reduction with rFVIIa use. For some indications, it increases thromboembolism..
Sealants and clotting bandages can both assist in reducing blood loss. There have been several new developments during the year.
French doctors announced the country’s first ‘saviour sibling’, conceived through in-vitro fertilisation and genetically selected to ensure he did not carry the gene for beta-thalassemia but was a close enough match to provide his sibling’s treatment cells from his umbilical cord blood.
A patient with beta-thalassemia became transfusion-free after gene therapy. Researchers fixed the faulty gene responsible for the condition in some of the patient’s own bone marrow stem cells and re-infused them. The team at Brigham and Women’s Hospital and Harvard Medical School in Boston and at the University of Paris now plan to treat patients who have sickle cell disease with gene therapy.
New research29 suggests patients having heart surgery who receive fewer blood transfusions do just as well as those who receive more.
A researcher has suggested that in patients requiring large volumes of blood products or displaying coagulopathy after injury, early and aggressive administration of blood component therapy may actually reduce the aggregate amount of blood required30.
A study of 81 patients treated with platelet-rich plasma after total knee replacement surgery found that only 2.4 per cent of the patients needed a blood transfusion, compared with the typical transfusion rates of 30–50 per cent31.
Dr Henry Cryer, UCLA Chief of trauma and emergency surgery, received a research grant from the National Trauma Institute (NTI) to study the use of fresh whole blood for transfusions at civilian trauma centres. Recent military studies indicate that transfusion of fresh whole blood may be more beneficial than individual blood components in patients with severe haemorrhage.
Scientists have developed a mathematical model reflecting how red blood cells change in size and haemoglobin content during their four-month lifespan. They said their research may allow prediction of who is likely to become anaemic, using routine hospital tests.
Iron deficiency is common during pregnancy. Intravenous iron given just once over a one-hour infusion was found to be effective and safe for iron-deficient women in a single-centre study reported at a poster session of the American Congress of Obstetricians and Gynecologists 59th Annual Clinical Meeting32.
Of particular interest is the UK-led trial of prophylactic platelet study (TOPPS) currently underway. This two-stage, randomised controlled trial of prophylaxis versus no-prophylaxis platelet transfusions in haematology/oncology patients following chemotherapy is investigating to what extent prophylactic platelet transfusions are clinically effective. Doses of platelets for this indication are a significant proportion of the total number of platelets transfused in Australia. If the findings are positive the level of demand for platelets could change.
The Canadian Cardiovascular Society has provided evidence-based recommendations on the use of antiplatelet therapy across all indications. These first-ever guidelines give physicians and other health professionals clear procedural recommendations, including how long a patient should take dual antiplatelet therapy, with appropriate use beyond a year. The full guidelines appeared in the Canadian Journal of Cardiology in 2011.
Platelets in the blood arise from cells known as megakaryocytes. Researchers at the Children’s Hospital of Philadelphia found that mature megakaryocytes infused into mice could generate platelets of normal size and function. They hope it might be possible to treat individuals with thrombocytopenia through mature megakaryocyte infusion.