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- Kamper-Jörgensen, Mads, et al.
(författare)
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Survival after blood transfusion
- 2008
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Ingår i: Transfusion. - : Wiley. - 0041-1132 .- 1537-2995. ; 48:12, s. 2577-2584
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Tidskriftsartikel (refereegranskat)abstract
- Long-term survival of transfusion recipients has rarely been studied. This study examines short- and long-term mortality among transfusion recipients and reports these as absolute rates and rates relative to the general population. Population-based cohort study of transfusion recipients in Denmark and Sweden followed for up to 20 years after their first blood transfusion. Main outcome measure was all-cause mortality. A total of 1,118,261 transfusion recipients were identified, of whom 62.0 percent were aged 65 years or older at the time of their first registered transfusion. Three months after the first transfusion, 84.3 percent of recipients were alive. One-, 5-, and 20-year posttransfusion survival was 73.7, 53.4, and 27.0 percent, respectively. Survival was slightly poorer in men than in women, decreased with increasing age, and was worst for recipients transfused at departments of internal medicine. The first 3 months after the first transfusion, the standardized mortality ratio (SMR) was 17.6 times higher in transfusion recipients than in the general population. One to 4 years after first transfusion, the SMR was 2.1 and even after 17 years the SMR remained significantly 1.3-fold increased. The survival and relative mortality patterns among blood transfusion recipients were characterized with unprecedented detail and precision. Our results are relevant to assessments of the consequences of possible transfusion-transmitted disease as well as for cost-benefit estimation of new blood safety interventions.
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| 3. |
- Tynell, Elsa, et al.
(författare)
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False-reactive microbiologic screening test results in Swedish blood donors - How big is the problem? : A survey among blood centers and deferred donors
- 2007
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Ingår i: Transfusion. - : Wiley. - 0041-1132 .- 1537-2995. ; 47:1, s. 80-89
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Screening of blood donors for markers of transfusion-transmissible infectious agents leads to a varying number of false-reactive test results and sometimes thereby temporary or permanent deferral of donors and also to loss of collected units. STUDY DESIGN AND METHODS: Data on false-reactive screening test results in 2002 and 2003 were collected from 19 blood centers in Sweden. A questionnaire was sent to donors deferred because of false-reactive screening test results to investigate their perception of the information and their reaction to the deferral. RESULTS: Testing of 21,189 samples from new donors and 423,543 donations from regular and/or repeat donors produced 1,059 false-reactive test results, mostly from hepatitis C virus antibody testing, and 299 deferrals. Six different human immunodeficiency virus tests led to between 0.02 and 0.2 percent false-reactive results. The deferral rate varied considerably between different counties. Of 204 deferred donors contacted, 180 (88%) answered the questionnaire. More than 80 percent were worried about their test results and worry was more common among those who did not feel sufficiently informed. CONCLUSION: The results imply that there is a need for a more standardized approach to the screening of blood donors and donations with the aim of minimizing the number of false-reactive screening test results. They also emphasize the importance of appropriate information and support to deferred donors.
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| 4. |
- Tynell, Elsa
(författare)
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Prevention of transfusion transmitted infections : donor screening and characteristics of recipient populations
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Minimising the risk for transfusion transmitted infections (TTIs) relies on selection of safe donors, including microbiological screening, and avoidance of unnecessary transfusions. Blood donor screening for HTLV-I and II, was introduced in Sweden in 1994. The first year six HTLV-I and no HTLV-II positive donors were found, which meant a prevalence of 2 per 100 000. The transmission rate at transfusion is estimated at 15% but only five percent of infected individuals will develop serious disease during their lifetime: tropical spastic paraparesis (TSP) after three to four years or adult T-cell lymphoma (ATL) after several decades. TTIs should be prevented but cost effectiveness needs to be considered. We estimated the cost for prevention of one death, due to transfusion transmitted HTLV disease (ATL), to $540 million when every donation was tested and $36 million when only new donors were tested. The number of prevented deaths would be almost the same (1/180 versus 1/2 10 years). As a result of this study only new donors are now tested in Sweden. The age and expected survival of blood transfusion recipients will affect the expected damage caused by transmitted infections, i. e. the development of clinical disease and the risk for secondary spread to infants and sex partners. Survival rates of transfusion recipients in Stockholm and Örebro counties in 1993 were found to be 66% after one year, 51% after 40 months and 39% after seven years for those in Örebro. The median age of recipients was 70 years and 21 % were 80 years or older. Adequate indications for transfusion are essential. Donated blood is a limited resource and a small risk of infection will always remain, in spite of rigorous safety. Among patients transfused in Örebro County in 1993 and 2000 survival rates were higher in operated patients, in younger patients and in females. Lower survival rates were seen in patients with cancer and in those receiving more than ten units. Overall one year survival rate in 2000 was higher than in 1993 despite higher age among recipients. Many donors are deferred temporarily or permanently because of false-reactive test results. A survey was performed in 19 blood centres in 11 counties. The viral screening tests showed between 0.01 and 0.2% false-reactive results and the variation for each test was about tenfold. There was also a great variation in deferral rates between counties. In a questionnaire study only 37% of deferred donors found the information at notification sufficient and over 80% were worried by their test result. There is need for a more standardised approach to the microbiological screening of donors, with the aim to minimise the number of false-reactive results, and need for better information and support to deferred donors.
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| 5. |
- Tynell, Elsa, et al.
(författare)
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Should plasma from female donors be avoided? : A population-based cohort study of plasma recipients in Sweden from 1990 through 2002
- 2010
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Ingår i: Transfusion. - : Wiley. - 0041-1132 .- 1537-2995. ; 50:6, s. 1249-1256
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Plasma from female donors has been implicated in the sometimes fatal complication known as transfusion-related acute lung injury. In studies of patients in intensive care units, worsened gas exchange of the lungs has also been attributed to female plasma. Despite a lack of population-based evidence, policies have already been introduced to exclude female donor plasma. STUDY DESIGN AND METHODS: Short-term mortality after plasma transfusion was investigated using data from the Scandinavian Donations and Transfusions (SCANDAT) database. A cohort of 92,565 patients in 30 Swedish hospitals were followed for 14 days after their first plasma transfusion. The relative risk (RR) of death in recipients of female plasma compared to recipients of only male plasma was estimated from Poisson regression. RESULTS: Recipients had median age 70 years, received a mean of 4.4 plasma units, and had an overall 14-day mortality of 8.43%. Sixty-eight percent were exposed to female plasma, with a 14-day mortality of 8.85% compared to 7.53% in the nonexposed group. After adjustment for potential confounding factors, the RRs were 1.16 (confidence interval [CI], 1.06-1.27) and 1.32 (CI, 1.17-1.49) for those receiving 3 to 4 and 5 or more units of female plasma, respectively. Risk estimates were increased in an analysis of deaths with a concomitant discharge diagnosis involving the respiratory or circulatory system or an adverse reaction. CONCLUSIONS: This large population-based cohort study of unselected patients suggests that transfusion of plasma from female donors confers a short-term survival disadvantage on recipients.
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