GERALD BLOOMFIELD, MD, MPH
- Department of Internal Medicine,The Johns Hopkins University
- School of Medicine, Baltimore
The experience with the latter procedures is based on the treatment of uterine myomas allergy medicine names purchase 50 mcg flonase with visa. Specific recommendations concerning acute massive blood loss in pregnancy and childbirth are: 1 allergy forecast reston va proven 50mcg flonase. Anticipate severe blood loss in high risk patients (for example allergy medicine 003 purchase flonase without a prescription, patients with retained placenta) allergy forecast pa cheap flonase 50 mcg with amex. Critically ill patients may also be more sensitive to the immunosuppressive and microvascular complications of blood transfusions. Therefore, it is important to know which transfusion policy is associated with the lowest mortality and morbidity. Blood Transfusion Guideline, 2011 181 181 Results Of the 16 potentially relevant reviews, three were evaluated in detail. One review by Gould et al performed a systematic literature search, but no systematic methods were reported (Gould 2007). There was also marginally less multi-organ failure in the restrictive group (Gould 2007). However, it should be noted that the erythrocyte component studied by Hebert et al was not leukocyte-reduced, therefore extrapolation to the Dutch situation may not be possible. This association may not be present then and death following transfusion may rather be associated with a patient who was in worse condition to begin with (Vincent 2008). However, several studies justify a restrictive policy, although there may still be patients who require an individualised transfusion regimen. These are patients with existing compromised tissue perfusion and/or oxygen transport capacity. Cardiac and pulmonary co-morbidity reduce this capacity and will undoubtedly influence the optimal transfusion trigger in such patients. Therefore, it is important to continuously check for signs indicating that the restrictive transfusion policy may be too restrictive. A possible generally applicable concept was recently described in patients with pre-existing anaemia prior to cardiac surgery. It was demonstrated that these patients with a lower 182 Blood Transfusion Guideline, 2011 baseline (pre-operative) Hb value were better able to tolerate a lower post-operative Hb value. In other words, the greater the Hb difference pre-operatively and post-operatively, the greater the mortality risk. This concept that requires further elucidation suggests that it is not so much the post-operative Hb value that should determine whether or not to give a transfusion, but rather the decrease in post-operative Hb as compared to the pre-operative Hb that seems to be critical (Karkouti 2008). This type of co-morbidity decreases tissue perfusion and/or oxygen transport capacity. Liberal limits may still be used in special circumstances, such as simultaneous coronary insufficiency, hypoxaemia, acute bleeding and lactate acidosis (Dellinger 2008). Prior to the sepsis recommendation in 2008 (Dellinger 2008), a survey of intensivists in Canada showed that more than 75% already implemented a restrictive policy (Hb < 80 g/L = 5. Level 3 B Zimmerman 2004 C Dellinger 2008, Vincent 2008 Other considerations Micro-circulatory imaging (under the tongue) has thusfar not shown large effects of erythrocyte transfusions in sepsis. The capillary perfusion only appears to improve in patients with abnormal initial values (Sakr 2007). In the case of sepsis, the venous mixed saturation (SvO2) may be used in addition to the Hb in determining the transfusion trigger (Vallet 2007). Sepsis is characterised by severe morbidity with a pathological redistribution of the perfusion and capillary leakage, resulting in abnormal tissue perfusion. As has been demonstrated in studies, the latter can probably be negatively influenced by haemodilution, but conversely this situation is not necessarily positively affected by transfusions. In this setting, it is very important that the actual transfusion-related improvement of a decreased oxygen consumption can be measured. In the case of sepsis, where there is ischaemia and perfusion redistribution at tissue level in one or more organs, the oxygen extraction measured locally in these organs can differ from the systemic value. Despite the lack of convincing scientific research on the effect of a restrictive transfusion policy in patients with sepsis, there appear to be enough indicators that point to the benefits of a more liberal transfusion policy, particularly in the acute unstable phase. In the case of acute anaemia in combination with sepsis the use of the Hb value alone as erythrocyte transfusion trigger is too simple a concept due to the severe morbidity. At this time it is as yet recommended to maintain an Hb value of 6 mmol/L as erythrocyte transfusion trigger following the 4-5-6 rule (see paragraph 5. This is particularly true for patients with symptomatic coronary sclerosis, especially in situations where the oxygen requirement of the heart is increased, such as exertion or in situations in which the availability of oxygen for the heart is decreased, such as tachycardia. In older patients who have recently suffered a myocardial infarction, the mortality increases significantly when the haematocrit value is below 0. In animal experiments, it has been determined that the critical limit for myocardial ischaemia due to anaemia with coronary sclerosis is elevated in comparison to the situation with normal coronary arteries (Wahr 1998, Spahn 1994, Levy 1993, 1992). Careful consideration of the study makes this conclusion less clear (Hajjar 2010). It was demonstrated recently that cardiac surgery patients with a low pre-operative Hb are better able to tolerate a lower post-operative Hb than patients with a high pre-operative Hb. This interesting concept requires further testing, but suggests that it is not 186 Blood Transfusion Guideline, 2011 so much the absolute post-operative Hb value that should determine whether or not to administer transfusions, but that the decrease in Hb during and after the surgery should also be taken into consideration. In older patients who recently suffered from a myocardial infarction, the mortality increases significantly when the haematocrit value is lower than 0. The extent of decrease of the postoperative Hb compared to the pre-operative Hb is possibly associated with a poorer outcome. B Doak 1995 In older patients who have recently suffered a myocardial infarction, the mortality increases significantly when the haematocrit value is lower than Level 3 0. B Carson 1996 Other considerations To summarise, the above-mentioned conclusions were based on old studies in which the erythrocyte components were not yet leukocyte-reduced. Furthermore, the aggregate of studies appears to point to a range for an optimal Hb and Ht: both high and lower Hb and Ht values appear to be associated with higher morbidity. It is particularly difficult to determine the lower limit of these ranges per individual patient. Due to the supposed correlation between mortality and the difference between the post-operative and pre-operative Hb values, the absolute decrease in Hb post-operatively compared to preoperatively should be considered as a transfusion trigger also in patients with cardiovascular disease. A critical limit for anaemia cannot be determined for the individual cardiovascularly compromised patient; an optimal range of Hb values must be taken into consideration. Due to the supposed correlation between mortality and the difference in postoperative versus pre-operative Hb, the absolute Hb decrease post-operative versus pre-operative should also be included in the decision whether or not to transfuse. In healthy volunteers, the cerebral function improveed after transfusion at Hb values between 3. A retrospective study found that the mortality in trauma patients with severe cerebral injury and an Ht < 0. However, Carlson et al demonstrated that patients had better neurological outcomes after longer periods with an Ht < 0. McIntyre found that in a sub-group analysis of the results from a previous randomised trial by Hebert et al (1999), for patients with moderate to severe brain trauma, there was no Blood Transfusion Guideline, 2011 189 189 difference in 30-day mortality and multiple organ failure between a liberal and a restrictive transfusion policy (2006). The brain-tissue oxygenation 1 hour after transfusions was the only primary endpoint for the short term. Transfusions improved the brain tissue oxygenation in 57% of the patients, with the extent of improvement correlating to the Hb increase. Patients with elevated cerebral pressure due to trauma or with a cerebral heamorhage can theoretically experience damage due to elevated cerebral perfusion caused by haemodilution (Hebert 1997). B Weiskopf 2005, 2006 Transfusions for cerebral trauma patients at a transfusion trigger of 8, 9 or 10 g/dL (5. Of continuing and great importance is that low Hb values with haemodilution in healthy volunteers results in decreased ability to react and memory dysfunction (Zygun 2009). It seems likely that particularly the damaged brain can be extra sensitive to an Hb < 6 mmol/L.
Other extracellular matrix components include elasticfibers allergy forecast lincoln ne buy cheap flonase 50mcg, adhesion molecules allergy medicine zyrtec vs claritin order flonase 50mcg fast delivery, and proteoglycans and glycosaminoglycans allergy shots lubbock safe flonase 50mcg. Basement membranes have a net negative charge and are composed of collagen and other extracellular matrix components allergy treatment otc discount flonase 50 mcg overnight delivery. A 16-year-old girl comes to the physician because of a "large growth" on her earlobe. She says that she began to notice it about 3 weeks after she got her ears pierced, and it has been growing "exponentially" ever since. Physical exarni~ation shows a 3-cm, firm tumor hanging from her left earlobe: Excessive production of which of the following types of collagen is associated with this conditionfi Her cook passed away 6 months ago, and she has been eating "tea and toast" ever since. Definition: presence of excess fluid in the intercellular space Edema can be localized or 2. Definition: an excessive amount of blood in a tissue or organ secondary to vasodilatation (active) or diminished venous outflow (passive) Table 5-1. Definition: sequence of events leading to the cessation of bleeding by the formaClotting is a balance between tion of a stable fibrin-platelet hemostatic plug two opposing forces: those b. Hemostasis involves interactions between the vascular wall, platelets, and the favoring the formation of a coagulation system stable thrombus versus those 2. Changes in blood flow cause turbulence and stasis, which favors clot formation ii. Membrane expression of the phospholipid complex, which is an important In a Nutshell platform for the coagulation cascade d. Common Platelet Disorders Thrombocytopenia Qualitative Defects Decreased production von Willebrand disease Aplastic anemia (drugs, virus, etc. Peripheral blood smear shows thrombocytopenia with enlarged immature platelets (megathrombocytes) iv. Bone marrow biopsy shows increased numbers of megakaryocytes with immature forms d. Splenectomy, which removes the site of platelet destruction and antibody, production 5. Peripheral blood smear shows thrombocytopenia and schistocytes, and reticulocytosis d. Laboratory tests for coagulation Patientson warfarin therapy should be monitored using i. Definition: inherited bleeding disorder characterized by either a deficiency or qualitative defect in von Willebrand factor b. Definition: any intravascular mass that has been carried down the bloodstream from its site of origin, resulting in the occlusion of a vessel 2. Common sites of infarction include the lower extremities, brain, intestine, kidney, and spleen d. Most infarcts (99%) result from thrombotic or embolic occlusion of an artery or vem ii. Occur in solid organs with a single blood supply such as the spleen, kidney, and heart d. Occur in organs with a dual blood supply or collateral circulation, such as the lung and intestines ii. General sequence of tissue changes after infarction: i ischemia -7 coagulative necrosis -7 inflammation -7 granulation tissue -7 fibrous scar, I I I F. Definition: shock is characterized by vascular collapse and widespread hypoperfusion I of cells and tissue due to reduced blood volume, cardiac output, or vascular tone I b. If the hypoxia persists, the cellular injury becomes irreversible, leading to the death of cells and the patient " 2. Release of endotoxins (bacterial walllipopolysaccharides) into the circulation iii. Anaphylactic shock (generalized vasodilatation)-type I hypersensitivity reaction 3. Stage I: compensation, in which perfusion to vital organs is maintained by reflex mechanisms 1. Development of a metabolic acidosis, electrolyte imbalances, and renal insufficiency c. Acute adrenal insufficiency 42 mtlClical Circulatory Pathology Chapter Summary Edema is the presence of excess fluid in the intercellular space. Causes of edema include increased hydrostatic pressure, hypoalbuminemia and decreased colloid pressure, lymphatic obstruction, and increased endothelial permeability. Transudates have low protein content and specific gravity,while exudates have high protein content and specific gravity. Hyperemia is an excessive amount of blood in a tissue or organ and can be due either to vasodilation (active hyperemia) or diminished venous outflow (passive hyperemia or congestion). Hemostasis is the sequence of events leading to cessation of bleeding by the formation of a stable fibrin-platelet hemostatic plug. Vascularwall injury triggers transient vasoconstriction, facilitation of platelet adhesion, and activation of both the extrinsic and intrinsic clotting pathways. Formation of a platelet thrombus occurs when platelets adhere to von Willebrand factor attached to subendothelial collagen, undergo shape change and degranulation, and then aggregate with additional platelets. Causes of thrombocytopenia due to decreased platelet production include aplastic anemia and tumor. Causes of qualitative platelet defects include von Willebrand disease, Bernard-Soulier syndrome, Glanzmann thrombasthenia, aspirin, and uremia. Von Willebrand disease is an inherited bleeding disorder characterized by a deficiency or qualitative defect in von Willebrand factor, which facilitatesformation of platelet clots. Factors involved in thrombus formation include endothelial injury, alterations in laminar blood flow, and hypercoagulability of blood. Thrombi can lead to a spectrum of outcomes, including vascular occlusion and infarction, embolism, thrombolysis, and organization and recanalization. J the term embolism is used for any intravascular mass that has been carried downstream from its site of origin, resulting in occlusion of a vessel. Ninety-eight percent of emboli are thromboembolia, but many other materials have also formed emboli. Pulmonary emboli are a common form of emboli that are often clinicallysilent but can cause infarction orsudden death. Systemic arterial emboli usually arise in the heart and may cause infarction in a I variety of sites, depending upon where they lodge. Ninety-nine percent of infarcts result from thrombotic occlusion of an artery or vein. Anemic infarcts occur in organs with a single blood supply, whereas hemorrhagic infarcts occur in organs with a dual blood supply or secondary to venous occlusion. The general sequence of tissue changes after infarction is: ischemia leads to coagulative necrosis, which leads to inflammation, which leads to granulation tissue, which leads to fibrous scar. Shock is characterized by vascular collapse and widespread hypoperfusion of cells and tissues due to reduced blood volume, cardiac output, or vascular tone. Shock has been clinicallydivided I i I into: compensated shock (Stage I), decompensated shock (Stage 11),and irreversible injury (Stage 111). A bone marrow biopsy shows increased number of megakaryocytes with immature forms. Which of the following groups of laboratory studies is most consistent with this disorderfi A 24-year-old pregnant woman comes to the emergency department because of vaginal bleeding, abdominal pain, and uterine contractions. Allof a sudden, the woman develops shortness of breath and oozing from the intravenous site on her right arm. Laboratory studies show a decreased platelet count, prolonged prothrombin time and partial thromboplastin time, decreased fibrinogen, and elevated fibrin split products. Severe mental retardation (most common cause of genetic mental retardation) Defined as a translocation n. Mongoloid facial features (flat face, low-bridged nose, and epicanthal folds) involvingtwo acrocentric chromosomes with the break ill. Broad short neck extremely large chromosome vr, Palmar (simian) crease and a tiny one, which is vu, Congenital heart defects typically lost. Lab: Down syndrome can be screened by assaying maternal serum levels of cc-fetoprotein, chorionic gonadotropin, and unconjugated estriol.
Buy 50 mcg flonase with visa. 10 Keys to Conquer Candida.
In addition allergy forecast in dallas order genuine flonase on line, these patients can have pain around the anal area (perianal) allergy symptoms due to mold discount flonase 50mcg line, and occasionally lymphangioma An abnormal structure that condrainage from the perianal area or the glands in the sists of a collection of blood vessels and lymph vesgroin allergy symptoms sore joints generic 50mcg flonase amex. Depending on its nature allergy shots pills buy flonase online now, a lymphangioma may grow lymphoid Referring to lymphocytes, a type of slowly or quickly. Lymphangiomas can cause probwhite blood cell, or to tissue in which lymphocytes lems because of their location. Lymphoid tissue is full of lymphocytes, phangioma around the larynx might cause a such as a lymph node. Lymphoid tissue is present throughout the body ultimately drains back into the bloodstream. Treatment options include chemo and may occur in the arm or leg after lymph vessels or radiation therapy. Treatment is like that of other lymLymphocytes are integrally involved in many phomas but must take into account the fact that the immune responses. For example, lymphocytic inflamtissue that is characterized by unusually large cells mation in the skin is skin that is infiltrated with when viewed microscopically. Since it is a tumor conlymphocytopenia, ranging from medication toxicity to sisting of early lymphocyte precursors (lyma variety of diseases. Lymphoblastc lymphoma is a term that has Lymphocytosis may be a marker that infection or been used in the past to refer to the presence of the disease is present. Treatment may include chemotherapy, radieases of the lymphoid cells and of cells from the ation, surgery, medications, and bone marrow reticuloendothelial system that usually occur in transplant. Diagnosis is sis (the destruction of red blood cells with the made via biopsy of a swollen lymph node, although release of hemoglobin). Treatment may include chemother-lytic Suffix having to do with lysis, as in apy, radiation, bone marrow transplantation, stemhemolytic anemia (anemia due to the destruction of cell transplantation, use of medication, and the use red blood cells). For example, macrocytic anemia is characterized by abnormally large red blood cells. Macrogenitosomia is associated with hormonal disorders that may also create changes in the internal sex organs. The urine of patients with multiple myeloma, a form of large protein is an antibody called macroglobulin or cancer that arises in plasma cells. Macroglossia is sometimes said to be associated with Macewen operation A surgical operation to Down syndrome, but in that disorder the tongue is repair inguinal hernia that was designed by Scottish actually large only in relationship to a smaller-thansurgeon Sir William Macewen. To brovascular disease (macroangiopathy in the determine if the testes are too large, a device called brain), and peripheral vascular disease (macroanan orchidometer is used that permits a testis to giopathy that affects, for example, vessels in the be compared to a series of plastic ovals (like minialegs). The opposite macrobiotic Referring to the macrobiota, a of macroorchidism is microorchidism. Macrophages are key playmacrobiotic diet A diet that incorporates ers in the immune response to foreign invaders of Ayurvedic principles of food combining, is based the body, such as infectious microorganisms. They mainly on brown rice and vegetables, and claims to are normally found in the liver, spleen, and conneclengthen life. For example, a macroscopic tumor is big enough to see withmacrocephaly An abnormally large head. Macrocephaly can be a normal variant or be a sign macrosomia An overly large body. A child with of pressure within the growing head during childmacrosomia has significant overgrowth, which can hood, such as from hydrocephalus. For example, a macula on to flat skin spots on the skin as macules, as opposed the skin is a small flat spot. Also known as simlogical disorder of cattle that results from infection ply macula. The most widely accepted theory is that the agent is a modified form of a normacular 1 Referring to a macule, a circummal cell surface component known as a prion. Also known as bovine spongicauses partial or total loss of macular vision, causform encephalopathy. Although Magendie, foramen of See foramen of some forms of macular degeneration affect young Magendie. This happens because the newly formed blood vessels leak fluid under the magnesium deficiency See deficiency, macula. A perbe especially careful about their magnesium intake son who has any of these changes in vision should because they can accumulate dangerous levels of consult an ophthalmologist without delay. Macules Maintenance therapy may be given to patients who are completely flat and can only be appreciated by visual inspection and not by touch. For example, the teres major musof malaria, which is caused by the parasite cle is larger than the teres minor muscle. Falciparum malaria is associated with high levels of parasites in the blood major depression See depression, major. Red blood cells that major histocompatability complex A cluster are infected with the parasite tend to sludge and of genes on chromosome 6 that encode a class of lead to microinfarctions (tiny areas of dead tissue cell surface molecules that are important for antidue to lack of oxygen) in capillaries in the brain, gen production and are critical in organ transplanliver, adrenal gland, intestinal tract, kidneys, lungs, tation. For example, osteomalacia is softening of bone, usually due to deficiency of calmale breast cancer See breast cancer, male. These hormones control the development of can be transmitted by the sting of the Anopheles the reproductive organs and other male charactermosquito or by a contaminated needle or transfuistics, such as body and facial hair, low voice, and sion. Other symptoms include male internal genitalia the internal genital vomiting, diarrhea, coughing, and yellowing of the structures of the male that are concerned with skin and eyes (jaundice). Treatment includes use of reproduction, including the testis, epididymis, ducoral or intravenous medication, particularly chlorotus deferens, seminal vesicle, ejaculatory duct, bulquine, mefloquine (brand name: Larium), or atobourethral gland, and prostate. Anti-malarial drugs can be taken by those traveling male organs of reproduction the sum total of to endemic areas for prevention of malaria. Among the many names for malaria also male external genitalia; male internal genitalia. The angle of the male pubic malleus A tiny bone in the middle ear that is arch and the sacrum are narrower as well. One of the dangers of malrotation of malformation, arteriovenous A malformation the intestine is that the intestine may be obstructed of blood vessels in the brain, brainstem, or spinal by abnormal bands or twist on its own blood supply, cord that is characterized by a complex tangled web a condition called volvulus. Malrotation of the intesof abnormal arteries and veins connected by one tine is usually not apparent until the intestine or more fistulas (abnormal communications). The outlook is good, malignancy A tumor that is malignant (cancereven when the disease is quite widespread. The most comwith a device that compresses and flattens the mon site of malignant giant cell tumor is the knee. A mammogram can help a health profesDiagnosis is made by examining a sample of the sional decide whether a lump in the breast is a affected area. A mammogram affected area, usually followed by chemotherapy or can cause pressure, discomfort, and some soreness radiation. If the mammogram result raises suspicions about cancer, malignant melanoma See melanoma. The American Cancer Society and the American College of malleability, brain See brain plasticity. After the age of 40, a mammothe-counter medications and some foods, so gram should be done yearly. In maple syrup urine where the mandible meets the upper jaw at the temdisease, the three branched-chain amino acids poral bone is called the temporomandibular joint. A mild form of mania that does not require Marfan syndrome An inherited disorder of conhospitalization is called hypomania. Displacement of the lens from the center of the pupil occurs in more manic In a state of mania. Patients with Marfan syndrome have an increased risk for retinal detachment, glaumanic depression See bipolar disorder.
Replacement of administration systems Administration systems for blood components pose a risk of bacterial growth allergy forecast huntington wv purchase flonase 50mcg otc. A study by Blest describes that this risk is reduced by replacing the administration system every 12 hours and at the end of the administration (Blest 2008) allergy gold filter cleaning buy genuine flonase on line. There is no recent literature available about rinsing the administration system after each blood transfusion allergy nj buy discount flonase 50mcg. Glucose 5% can cause haemolysis and may never be used to fill and/or rinse an administration system allergy treatment 197 buy flonase 50mcg on line. Calcium-containing solutions interact with a citrateBlood Transfusion Guideline, 2011 49 49 containing blood component and are therefore strongly discouraged. Administration of platelets and erythrocytes via the same administration set If platelets are administered via the same administration system that has previously been used for erythrocytes, the precipitate in the filter from the first transfusion will trap the platelets and hamper their administration. In practice, the administration of erythrocytes after transfusion of platelets does not pose any problems. The warming of erythrocytes is performed exclusively upon prescription of the treating doctor (following advice from the blood transfusion laboratory). Erythrocytes and plasma should only be warmed in equipment validated specifically for that purpose. Erythrocytes and plasma should never be warmed in a standard microwave oven, in warm water or on a central heating radiator. Administration speed of the various short shelf-life blood components in neonates, children and adults 50 Blood Transfusion Guideline, 2011 Recommendation* 2. Other considerations Slow administration and the possible use of a diuretic are advised for cardiac-compromised patients (see Recommendation 4 under 7. Identification of the correct component for the correct patient Recommendation* 2. Blood Transfusion Guideline, 2011 51 51 Identification of patient by employee administering the transfusion. The most crucial step in preventing incompatible transfusions is the bedside patient identification (surname, initials, date of birth, gender, patient identification number) and compatibility check (component blood group). This check takes place visually/in writing and is performed by two individuals, of whom at least one is an authorised employee or doctor. If identification checks are performed by means of scanning barcodes, then the process can be performed by one person. If a student administers a bloodcomponent, this must be performed under direct supervision. The person who performs the transfusion is ultimately responsible for the accuracy of the identification. The nurse should check prior to every transfusion that the component for transfusion matches the information on the request and that there are no abnormalities (such as damage, unusual discolouration or turbidity, the presence of large clots) upon visual inspection. This last check should be performed at the same time as the patient identification, with initials being placed again, unless the identification checks are performed by means of scanning the barcodes. If the identification at the bedside reveals any discrepancies for which no explanation has been given on the compatibility declaration, the unit of blood component should not be transfused. The blood transfusion laboratory must be informed of this and the unit should be returned. No distinction is made between the various blood comoponents for the checking of vital parameters. In addition, the following is also recorded after the blood transfusion: which component was administered; transfusion reaction yes/no. The severity of the reaction is proportional to the quantity administered at that moment. Therefore, it is advisable not to administer more than 20 mL of 1 blood component during the first 10 minutes. If no abnormalities are observed, the transfusion can then continue at the agreed administration speed. It is recommended that no more than 20 mL of the blood component be administered during the first 10 minutes of the transfusion. If no abnormalities are observed, the transfusion can then be continued at the agreed administration speed. One should wait at least 15 minutes after transfusion of an erythrocyte concentrate to measure the effect on Hb concentration. The simultaneous administration of blood components with intravenous medications through a single lumen infusionsystem Due to the possible occurrence of a reaction between the medicine and the bloodcomponent it is not recommended to administer blood components simultaneously with intravenous medication solutions through a single lumen infusion system. Undesirable immediate effects such as haemolysis and/or agglutination depend among other factors on the type of blood component, dosage of the medication and the duration of the contact between the two (van den Bos 2003). This and other studies show that the extent of haemolysis as a result of the simultaneous administration in the conditions examined is acceptable. However, it is difficult to extrapolate in vitro study results to clinical relevance (Murdock 2009). Other considerations the recommendation that medication and a blood component may not be administered simultaneously via a single lumen infusion system regularly causes practical problems. Medication may never be administered simultaneously with blood components via a single lumen infusion system. Medication can only be administered via a single lumen infusion system if a second administration system with a three-way stop cock is used whilst the administration of the blood component is halted temporarily. The infusion system (peripheral infusion) must be rinsed thoroughly before and after the administration of medication using an indifferent infusion solution such as NaCl 0. The transfusion may not be interrupted for longer than 2 hours and the transfusion line may never be disconnected in the meantime due to the risk of bacterial contamination. In general, double or triple lumen catheters are suitable for the simultaneous administration of blood components and medication. It is advisable to reserve one lumen specifically for the administration of blood components. Further research into the effect of the simultaneous administration of blood components and intravenous medication through a single lumen infusion system is recommended. Reactions and platelet increments after transfusion of platelet concentrates in plasma or an additive solution: a prospective, randomized study. Guide to the preparation, use and quality assurance of blood components,13 edition. Nonfatal intravascular hemolysis in a pediatric patient after transfusion of a platelet unit with high-titer anti-A. Systematic review of the optimal fluid for dilutional exchange transfusion in neonatal polycythaemia. Transfusion-associated infections with cytomegalovirus and other human herpesviruses. Granulocyte transfusions for preventing infections in patients with neutropenia or neutrophil dysfunction. Safety and efficacy of therapeutic early onset granulocyte transfusions in pediatric patients with neutropenia and severe infections. Rapid detection of antibodies to immunoglobulin A molecules by using the particle immunoassay. Granulocyte transfusions for treating infections in patients with neutropenia or neutrophil dysfunction. Granulocyte transfusions in neutropenic children: a systematic review of the literature.