Could blood transfusions cause harm

“FOR the life of the flesh is in the blood. No soul of you shall eat blood.” So says the Bible’s book of Leviticus, and it is for this reason that Jehovah’s Witnesses shun blood transfusions. They do not, however, shun surgery. As long as surgeons use special techniques, Jehovah’s Witnesses can have surgery including operations with the greatest potential for blood loss, such as open heart surgery without ever receiving a drop of someone else’s blood.

Now some surgeons and anaesthetists are questioning whether every patient shouldn’t get the same treatment. Over the past decade a number of studies have found that, far from saving lives, blood transfusions can actually harm many patients.

The problem is not the much publicised risk of blood borne infectious agents, such as HIV, but the blood itself. Study after study has shown that transfusions, particularly those containing red blood cells, are linked to higher death rates in patients who have had a heart attack, undergone heart surgery, or who are in critical care. The exact nature of the link is uncertain, but it seems likely that chemical changes in ageing blood, their impact on the immune system, and the blood’s ability to deliver oxygen are key.

In fact, most experts now agree that the risk posed by the transfused blood itself is far greater than wholesale nhl jerseys china that of a blood borne infection. “Probably 40 to 60 per cent of blood transfusions are not good for the patients,” says Bruce Spiess, a cardiac anaesthesiologist at Virginia Commonwealth University in Richmond.

Such claims have led this week to the US National Institutes of Health issuing a call for proposals to study the problem. Also this week, the Joint Commission in Chicago, which accredits US hospitals, is holding the first of several meetings to look for ways to reduce the risks. It is expected to at least conclude that hospitals should be more selective in the use of transfusions.

Blood transfusion became a mainstay of medicine during the two world wars, where it was used as a last resort to save soldiers who had suffered massive blood loss. But now, far from being restricted to catastrophic bleeding, transfusions are routinely used as an optional treatment, most commonly for patients in intensive care or undergoing major surgery. In these situations, mostly small volumes of red cells are transfused, usually after they have been stored at 4 for anything up to 42 days.

The rationale behind such blood transfusions seems incontrovertible. Red cells deliver vital oxygen to tissues, and seriously ill patients who are also anaemic fare less well, so a transfusion should help. Those assumptions went untested for the better part of a century.

Things started to change in 1999 with a randomised controlled trial on 838 critical care patients in Canada that used haemoglobin levels to determine when a blood transfusion was given. Normal levels of haemoglobin, the oxygen carrying protein in red cells, range from 120 to 170 grams per litre. A normal haematocrit the proportion of red cells in the blood ranges from 36 to 50 per cent. Doctors decide whether to give a transfusion based on a number of factors, including haemoglobin levels and haematocrit, and the patient’s overall robustness. Many guidelines exist, and practice varies from one hospital or doctor to another, but it is common for patients to receive transfusions when their haemoglobin dips to between 70 and 100 g/l or their haematocrit to 21 to 30 per cent.

But the Canadian study found significantly fewer patients died in hospital, 22 versus 28 per cheap jerseys shop cent, if they received transfusions only when their haemoglobin fell below 70 g/l rather than when it fell below 100 g/l.

A more recent study has found that in heart attack patients with haematocrits of over 25 per cent, a transfusion is associated with more cheap nhl jerseys than three times the risk of death or a second heart attack within 30 days compared with not having a transfusion (Journal of the American Medical Association, vol 292, p 1555).

For almost 9000 patients who had heart surgery in the UK between 1996 and 2003, receiving a red cell transfusion was associated with three times the risk of dying in the following year and an almost sixfold risk of dying within 30 days of surgery compared with not receiving one. Transfusions were also associated with more infections and higher incidences of stroke, heart attack and kidney failure complications usually linked to a lack of oxygen in body tissues (Circulation, vol 116, p 2544).

“There is virtually no high quality study in surgery, or intensive or acute care outside of when you are bleeding to death that shows that blood transfusion is beneficial, and many that show it is bad for you,” says Gavin Murphy, a cardiac surgeon at the Bristol Heart Institute, who ran the UK study.

Organisations such as the American Society of Anaesthesiologists have started recommending that doctors be more conservative about ordering transfusions. But many experts worry that the recommendations are being ignored, and don’t go far enough. Transfusion, they say, should only be cheap wholesale jerseys used as a last resort, and far greater effort should go into preventing blood loss in the first place and ensuring patients are not anaemic before surgery.

“Usually when there is any clinical uncertainty about a treatment you don’t give it, but with transfusions we do,” says James Isbister of the Royal North Shore Hospital in Sydney, who is an adviser to the Australian Red Cross Blood Service.

A priority is to find out how transfusions can be harmful. One possibility is that they affect the patient’s immune system. Blood transfusions are typically teeming with cytokines chemicals that modify immune cells and both the cytokines and white blood cells in donated blood have been shown to affect the action of “recipient” immune cells in the lab. Before modern immunosuppressant drugs were developed, blood transfusions were sometimes used to achieve immunosuppression during kidney transplants.

Several of the recent studies have found an association between contracting infections in hospital and transfusions, which seems to support the theory. “The more units of blood patients receive, the more likely they are to get infections,” says Mary Rogers at the University of Michigan in Ann Arbor, who has studied transfusions in US heart surgery patients.

But people should not stop donating blood, stress experts. “Transfusion is critical in several situations such as severe haemorrhage. We also need blood for essential products such as antibodies and clotting factors for people with haemophilia,” says Isbister.Articles Connexes：

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The offensive line is the number one need for the Cowboys. The line must be able to protect Tony Romo and open holes for the running game. The Cowboys were not active in the free agency period and should use the draft and make a trade for players for the offensive Elite Blue Barry Sanders jersey line.

The defense will go through an overhaul with Monte Kiffin as the new defensive coach. The Cowboys still need more pass rushing ability from the outside. More depth in the secondary could help against opponents deep passing threat.

Dallas Cowboys Keys to Success1. Offensive Line George Johnson jersey use the Draft and/or make a trade.

2. Running Game draft a power runner or break Womens Barry Sanders jersey away runner in the draft. Give Murray back up and split the carries to lighten his load and maybe he will make it through the season.

3. Play Caller Jason Garrett needs to coach the team instead of trying to call plays at the same time.

4. Game Time Discipline keep the players focused on the game during the game. If a player is not playing well, bench Elite Mens Dan Orlovsky jersey him and insert another player who wants to play.

NFC East Prediction Standings 2013The 2013 NFC East Division race could be a battle with all four teams this season. The New York Giants will try to regain the East title after missing the NFL playoffs last season. The Washington Deandre Levy jersey Redskins are on the verge of taking control of the division if Robert Griffin III (RG3) can return from his leg injury healthy.

The Dallas Elite White Barry Sanders jersey Cowboys have rebuilt their coaching staff around Jason Garrett and signed Tony Romo to a long term contract. Dez Bryant finally lived up to expectation in the final half of the season. The Philadelphia Eagles have a new head coach, Chip Kelley, who will bring his fast break style of offense into the NFL.

The NFL Draft should bring in some new talent to upgrade each team where needed. It is still early, but here are the pre draft NFC East division prediction for the 2013 NFL football season. Predictions could change after the draft and potential trades before the season begins.

wavegirl22 5 years ago from New York, NY

Great Hub as always and I am right here on the sidelines waiting with great anticipation till the season starts. Loved seeing Romo interviews at the opening of training camp this past weekend. I wish I had better news to report on my NY Giants in that they might give the Boys a run for there money in the division but I am afraid that nothing is really going on for the Giants. Now dont get me wrong as I still will be cheering them on . Authenitc Womens Barry Sanders jersey especially come Mon night when the Boys meet up with the Giants! Redskins and McNabb may have something in Elite Blue Deandre Levy jersey store for the Boys but overall I think the Boys will have no trouble taking the NFC east .

Great Hub.

Teams have had time since last season to study tapes more to plan defenses.

Minnesota will go as far as Favre carries them. Favre is a year older and he had the best year of his career. I think this year will be the year he starts to slip.

Are you Ready for some Football? What a difference a couple of years makes. I first wrote this article in the summer of 2012 and have now updated it for the 2014 2015 season. When I first wrote the article, you could find very few of the top NFL players on Instagram and there were 7 8 teams that did NOT even have IG accounts yet. Few cheap fake oakleys of the teams were sharing many pictures many cheap replica oakleys had shared less than 20 photos.

Now, the world is completely different. You can find many replica oakleys fake oakley sunglasses of the top NFL stars using cheap replica oakleys Instagram, especially the young ones that started in college. cheap christian louboutin outle All of the NFL teams have gotten on board and many have share hundreds of photos understanding that the medium is perfectly suited to enhance the NFL fan experience. I have highlighted 20 of the more interesting players to follow in IG and all of the team handles.

Of course you cannot find all of the NFL players on Instagram. I replica oakleys have split up the list between NFC Players and AFC Players. I am also trying to highlight some of the interesting off field passions of these NFL players from philanthropy to business. cheap oakleys He also donates his time and money to many great causes and posts great photos of his time with sick kids at the Seattle Childrens’ Hospital. Russell has over 800,000 followers on IG. When he is not catching TD passes, Brandon is working on one of a dozen projects for a number of endeavors from fashion, to fitspeed, to children’s camps, but his replica Christian Louboutin real mission is fake ray bans his Foundation. The Brandon Marshall Foundation is raising awareness and helping victims of fake oakley sunglasses mental illness. What you might not know about Brandon is that he was replica oakleys diagnosed with Borderline Personality Disorder in 2010 and it explained much of his volatile off field issues up until that cheap oakley sunglasses time. Now he is helping others who are also suffering from mental health issues. On Instagram, Brandon has shared over 800 photos and has 145,000 followers. The Foundation also sells artwork cheap fake ray bans of many of the students at Gallery85 and much of the art will absolutely blow you away. Davis is also very active on Instagram having shared over 1250 photos and has 1.2 million followers. He led the NFC in rushing in 2013 with 1,607 yards and added another 530 receiving yards and also scored 11 TDs during the year. Lesean is not very active on Instagram yet sharing about 56 photos so far and he has 60,000 followers.

Robert Quinn, DL, St. Quinn anchors a resurgent Rams defense that should be good for many years. He played his college ball at LSU where he was an All American defensive back. Peterson has shared over 300 photos on IG and has cheap replica oakleys 145,000 followers. He has fake oakley sunglasses led the team in Tackles for each of the past two years. Willis is also very active on Instagram and has shared over 530 photos and has 325,000 followers. His unique fake oakleys outlet name comes from his Cameroonian father. In Nigerian, Ndamukong means “House of Spears” which is fairly fitting as he come cutting through Offensive Lines in the NFL. He has been a key part of what has become the best defense in the fake oakley sunglasses NFL. During his first 3 seasons, he registered 20 interceptions and 167 total tackles. As we all know from last years playoffs, Richard is not shy and that goes for Instagram too. He has shared over 400 photos and has 770,000 followers. He has developed into one of the most well rounded fake oakley sunglasses RB in the League. Over his first 6 years, he has combined for over 9,500 total yards and in 2013 he finished with over 1,900 yards. Matt is active on IG with over 175 photos posted and over 80,000 followers

Ten Top AFC Players on InstagramNote: I have only linked to the Instagram account of the first 3 players as the site limits the number of outgoing links on the page.

Jamaal Charles has become one of the best Running Backs in the NFL and one of the top 3 picks in any Fantasy Football draft because he is a threat as both a runner and a receiver. He scored 20 TDs in 2013. Charles is in his 7th season out of University of Texas. Jamaal is very active on Instagram sharing over 625 photos and has 100,000 followers.

It also takes talent to evaluate talent. The many superstars that came out of the Men Frederik Andersen Jersey first round of NFL drafts each year, expect to see just Elite White Kyle Palmieri Jersey as many disappointments. Drafting for Fantasy NFL can be quite a gamble and it Elite Black Ryan Kesler Jersey can cost million of Elite Black Kevin Bieksa Jersey dollars too for Elite Black Kyle Palmieri Jersey NFL teams.

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Blaine Gabbert (QB)

There aren’t a lot of Gabbert fans since his quite a small quarterback with physique 6’5″ and weighing in Men Jacob Larsson Jersey Women Corey Perry Jersey at 235 lbs. He has a bit of inaccuracy in his throws which is not so bad but disturbing to some. There’s a reason why the NFL world Women Jacob Larsson Jersey is enamored with him but others are just skeptical. If you want to draft him go ahead, but some say there’s nothing much special about him.

Jake Locker (QB)

He can be quite raw but he could really be a solid quarterback with solid coaching. He has a great potential waiting for him to become a great quarterback. Locker is very athletic and mobile and has leadership skills that NFL teams covet. Though his size isn’t ideal coming in at 6’3″ and 225 lbs, it’s close enough. He has the talent and should not go to waste.

Mark Ingram (RB)

Ingram is Authenitc Black Ryan Kesler Jersey tough and he could finish runs, which is loved by many. The problem is his speed, which can cause for some concern. Ingram isn’t a game breaker, but he’s a very intelligent, patient and instinctive running back with tremendous vision.

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OregonOpEdElizabeth HovdeDavid SarasohnThe Pacific University community is mourning discount ray bans the yeezy 750 new release loss of students Kiden Dilla and cheap ray bans Ayan Osman, who died in a car crash Monday

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Sotheby’s co head of contemporary art worldwide, who was cheap yeezy 750 boost on the cheap yeezy boost 750 phone with a client. The cheap yeezy boost Italian sale tallied 40.4 million pounds, within the estimated range but a slight decline from 41.4 million pounds sold in 2014. Eleven of the yeezy 350 new release 51 offered lots failed to find buyers. Fontana CasualtiesThe casualties included two paintings by Fontana, of the 12 offered. A large number of works by the Italian artist were available this week at Frieze and in galleries. Tornabuoni Art London opened a Fontana exhibition last week, featuring a white, pierced egg painting. Alberto Burri, who is having yeezy 750 for sale a retrospective at the Solomon R. Guggenheim Museum in New York, also did well. His 1961 "Bianco Plastica 1" sold for 2.6 million pounds, surpassing the high estimate of 2 million pounds. At least four people competed for the 750 boost free shipping work that featured a burnt plastic surface. Art dealer David Nahmad was the winner. A 1956 piece by Burri, "Combustione M.2," went for 1.8 million pounds, three times its low estimate of 600,000
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