Problems in transfusion therapy

Article Abstract:

The AIDS (acquired immunodeficiency syndrome) epidemic and fears that transfused blood could be infectious are influencing blood collection and transfusion. Two articles in the June 7, 1990, issue of The New England Journal of Medicine present research relevant to these issues. One describes how physicians are re-evaluating some long-held beliefs about the necessity for postoperative transfusion of patients. This includes those with sickle cell anemia (a chronic deficiency of hemoglobin, the molecule that transports oxygen in the blood). Autologous transfusion (with the patient's own blood, donated at an earlier time) is an alternative, but is not an option for sickle cell patients, unless the blood can be treated to remove its abnormal (sickled) cells. 'Directed' blood donation (by a friend or relative with compatible blood) may not be as free of HIV as patients would like to think. The case is presented of a black patient who began to manufacture alloantibodies against some of the molecules on donated red blood cells that differ between the races. Directed donations can reduce alloantibody formation, but can involve coercion of family members who may want to refrain from donating blood because they fear transmitting infection. Another way to reduce alloantibody formation is to identify the antigens in the recipient's own blood and to transfuse blood with identical antigens. The number of black donors needs to be increased and donors could be asked to volunteer information about their race (an idea acknowledged as controversial). Only blood from black donors would be administered to black recipients. Both articles lead to the same 'bottom line': transfusion before surgery should be based on rational criteria which can be evaluated in clinical trials. The racial aspects of blood collection and transfusion need to be aired openly. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Surveys, Donation of organs, tissues, etc., Tissue donation, Blood clotting, Blood coagulation, Blood donors, Blood donation, editorial

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Treatment of severe malaria in the United States with a continuous infusion of quinidine gluconate and exchange transfusion

Article Abstract:

In the past decade the incidence of malaria in the United States has increased ten times. Treatment may be delayed because the recommended medication is available only from the Centers for Disease Control. Between 1985 and 1987, 17 patients in the U.S. with malaria were treated and evaluated. One group was treated with intravenous quinidine gluconate, another with gluconate and exchange transfusions and the third with quinine dihydrochloride and exchange transfusions. The treatment nearly eradicated the illness in 28 to 72 hours after the start of the treatment. Thus, quinidine gluconate is an acceptable alternative to quinine dihydrocholoride.

United States, Evaluation, Drug therapy, Malaria, Quinidine

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