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Prior to the advent of recombinant erythropoietin in the late-1980s, blood transfusions were the mainstay of anaemia management in patients with end-stage renal failure, many of whom required “top-up” transfusions every 2 to 4 weeks to relieve the debilitating symptoms of severe anaemia. Erythropoietin therapy, however, allowed for the first time, such patients to achieve a sustained correction of anaemia, and there was a dramatic fall in both the use of red cell transfusions in dialysis units, as well as the associated transfusional iron overload prevalent in dialysis patients. Avoidance of blood transfusions improved access to, and outcomes of, kidney transplantation, due to reduced HLA sensitization. In recent years, however, there have been safety concerns regarding the use of erythropoiesis-stimulating agents (ESAs), and there are signs that the use of blood transfusions is once again increasing. The aim of this review is to reassess how important transfusion avoidance is in 2013, and whether we should still have the same concerns about HLA sensitization that we had 20 years ago. [ABSTRACT FROM PUBLISHER]

Anemia in cancer patients can be treated with transfusions, and 15% of patients with solid tumors are being treated by transfusions. Different cutoff values are used for transfusions, depending on clinical symptoms and patient characteristics, with a hemoglobin (Hb) level of <9 g/dL most commonly used. After the administration of one unit of red blood cells (RBC), the Hb rises with 1 g/dL, and the life span of transfused RBC is 100-110 days. Complications related to RBC transfusion are procedural problems, iron overload, viral and bacterial infections, and immune injury. RBC transfusions have been related to increased risk of the development of non-Hodgkin lymphoma and chronic lymphocytic leukemia, and are related to a worse treatment outcome in selected cancers. In addition, the cost of a transfusion for the patient and society is around 300-500 euros per unit transfused. RBC transfusions should be used carefully to correct anemia in patients with cancer. [ABSTRACT FROM AUTHOR]

Background. Erythropoiesis stimulating agents (ESA) have alleviated the need for blood transfusions in dialysis patients. Their impact on transfusion frequency in elderly chronic kidney disease (CKD) patients aged 65 years and older with non-dialysis-dependent CKD has not been studied. [ABSTRACT FROM PUBLISHER]

Darbepoetin alfa is an erythropoiesis-stimulating agent (ESA) approved for treating chemotherapy-induced anemia. This phase II, double-blind, placebo-controlled study examined the efficacy of darbepoetin alfa for treating anemia of cancer (AoC) in patients not receiving chemotherapy or radiotherapy. Patients were randomized 3:1 to receive darbepoetin alfa (6.75 µg/kg) or placebo every 4 weeks; the end of the study was at week 17. The primary endpoint was the percentage of patients with a hematopoietic response. Secondary endpoints included transfusion incidence and safety parameters. Efficacy analyses were performed on 162 patients in the darbepoetin alfa group and 56 patients in the placebo group. The Kaplan-Meier percentages of patients who achieved a hematopoietic response (darbepoetin alfa, 69%; placebo, 24%) or achieved the target hemoglobin (darbepoetin alfa, 85%; placebo, 50%) differed significantly between treatment groups. The transfusion incidence did not differ between treatment groups probably because of the low baseline transfusion rates in AoC patients. The incidence of adverse events (including on-study deaths) was similar in both groups. In conclusion, darbepoetin alfa appeared to be well tolerated and significantly increased hemoglobin levels in these AoC study patients. [ABSTRACT FROM AUTHOR]

Erythropoiesis-stimulating agents are indicated for the treatment of chemotherapy induced-anemia in cancer patients. Controlled clinical studies have shown that epoetin alfa consistently and significantly increases levels of hemoglobin (Hb), decreases the need for RBC transfusion, and improves the quality of life that is of such importance in cancer patients with a limited life expectancy. The rise achieved in Hb level correlates with an improvement in quality of life. Studies have also demonstrated that earlier initiation of epoetin therapy (i.e., starting treatment at an Hb level of 10-11 g/dl rather than waiting for Hb to fall to <10 g/dl) is associated with a faster achievement of an optimal Hb level, a lower transfusion requirement, and a maintained quality of life. [ABSTRACT FROM AUTHOR]

The unstimulated and induced production of granulocyte-macrophage colony-stimulating factor (GM-CSF), granulocyte colony-stimulating factor (G-CSF), IL-3, IL-6, stem cell factor (SCF), IL-1β, tumour necrosis factor-alpha) (TNF-α), TNF-β interferon-gamma (IFN-γ) and transforming growth factor-beta (TGF-β) was determined after culture of blood mononuclear cells from 22 patients with severe β-thalassaemia in a regular transfusion programme, five non-regularly transfused patients with β-thalassaemia intermedia and nine normal persons. A distinct pattern of cytokine production in thalassaemia patients was detected, namely a low unstimulated production of all cytokines and a significant increase in the stimulated production of IFN-γ, TNF-α and IL-1β; these abnormalities were more pronounced in the more heavily transfused older patients. The increased production of the above cytokines, which usually characterize the acute response to infectious agents and have a negative effect on erythropoiesis, may explain the deterioration of anaemia found in thalassemia patients during acute infections. [ABSTRACT FROM AUTHOR]

We assessed the prevalence of anti-hepatitis C virus (anti-HCV) antibodies and markers of hepatitis B virus (HBV) infection in patients of three haemodia lysis centres before initiating anti-HBV vaccinations. Of the 94 patients, 39 (41.5%) were anti-HCV positive (+) and 81(86.2%) were anti-hepatitis B core antigen (HBc) positive. There was a high rate of anti-HBc positivity among anti-HCV (+) patients (92.3%), although the presence of anti-HCV and anti-HBc antibodies were not significantly related to each other. Multiple blood transfusions (≥5 units) was a nsk factor for development of HCV infection (P≤0.02), while none of our patients admitted intravenous drug abuse. Although 53.8% of anti-HCV (+) patients have had moderate serum alanine aminotransferase (ALT) elevations during the study period, none has had considerable liver disease, nor did the increased ALT correlate with the presence of anti-HCV. Only two of 17 staff members participating in the survey were anti HCV (+), though almost every one gave a history of accidental needlestick exposure. All the study subjects were human immunodefloency virus (HIV) negative. Our results, obtained with the second-generation, highly specific enzyme immunoassay and verified by the immunoblot assay for anti-HCV antibodies, sup port a recent suggestion that earlier reports might have underestimated the true prevalence of anti-HCV anti bodies in haemodialysis patients. [ABSTRACT FROM PUBLISHER]

Purpose. A case of a fatal hypersensitivity reaction to gemtuzumab ozogamicin in a patient who received a platelet transfusion on the same day is presented. Summary. A 75-year-old man went to a hematology clinic in April 2005 because of anemia and thrombocytopenia. He was diagnosed with acute myelogenous leukemia (AML). In May 2005, the patient was started on induction chemotherapy with cytarabine and idarubicin. During the induction phase, the patient received platelet transfusions on multiple occasions without any evidence of transfusion reactions. He went into partial remission and received two cycles of cytarabine and idarubicin followed by one cycle of high-dose cytarabine. In March 2006, the patient relapsed, and he received dose number one of the first cycle of gemtuzumab ozogamicin at a dose of 9 mg/m² on March 28, 2006. He tolerated the infusion. He had received multiple platelet transfusions during the week before gemtuzumab infusion without reaction but received no transfusions on the same day as the gemtuzumab infusion. On April 4, 2006, the patient received an infusion of gemtuzumab at 11 a.m., and he received 6 units of leukocyte-depleted, irradiated platelets at 6:40 p.m. At 1 a.m. the next morning, the patient developed fever and shortness of breath and went into severe distress. Despite treatment, the patient died shortly after. Conclusion. A patient with AML developed severe respiratory distress and died after receiving gemtuzumab and 6 units of platelets on the same day. The fact that he had previously received gemtuzumab and platelets safely on separate days suggests that the gemtuzumab-platelet combination contributed to a fatal hypersensitivity reaction. [ABSTRACT FROM AUTHOR]