Risk Management in Blood Transfusion: The Virtue of Reality: Proceedings of the Twenty-Third International Symposium on Blood Transfusion, Groningen 1998, organized by the Blood Bank Noord Nederland PDF
Preview Risk Management in Blood Transfusion: The Virtue of Reality: Proceedings of the Twenty-Third International Symposium on Blood Transfusion, Groningen 1998, organized by the Blood Bank Noord Nederland
RISK MANAGEMENTINBLOODTRANSFUSION: THE VIRTUE OF REALITY DEVELOPMENTS INHEMATOLOGYANDIMMUNOLOGY Volume34 Thetitlespublishedinthisseriesarelistedattheend01thisvolume. Risk Management in Blood Transfusion: The Virtue of Reality ProceedingsoftheTwenty-ThirdInternationalSymposium on BloodTransfusion,Groningen 1998, organizedbythe BloodBank Noord Nederland editedby c.TH.SMITSIBINGA BloodBankNoordNederland, Groningen,TheNetherlands and H.J.ALTER National InstitutesofHealth, Bethesda,MD,U.S.A. Springer-Science+Business Media, RY. Ac.I.P.Cataloguerecord forthisbookisavailablefromtheLibraryofCongress Printedonacid-freepaper ISBN978-1-4419-4822-9 ISBN978-1-4757-3009-8(eBook) DOI10.1007/978-1-4757-3009-8 All RightsReserved © 1999 SpringerScience+ßusiness MediaDordrecht OriginallypublishedbyKluwerAcademicPublishersin1999. SoftcoverreprintofthehardcoverIstedition1999 Nopartofthe materialprotectedbythiscopyrightnoticemaybereproducedor utilized inanyform orbyanymeans,electronicormechanical, includingphotocopying,recordingor byanyinformationstorage and retrievalsystem,without writtenpermission fromthecopyright owner. Risk: The RealityofVirtue Riskisaneverchangingconception ButtheconceptsasslipperyasaClintonrecollection. Tolerableriskhasbecometheexception Andzero-riskanimmaculateperception. Misinterpretationofriskandrecipientconfusion Hasledtounwarranteddonorexclusion Politiciansandconsumersseeminacollusion Thathasplacedgreatrestraintsontheartoftransfusion Zero-riskistheirdemandedconclusion Butisthispossible.orjustanillusion? Todaytherisksofblood areinfinitesimal Incidencessolowtheyrequireadecimal Inthepast,ratesthislowwerenotevenguessable Yetwe'vebeenaccusedofsinsthathavebecnconfcssible Fortunatelyallofthesesinshavenowbeenredressible Andwe'd beoutofthewoods- Ifonlylawyerswerenotsodamnaccessiblc. Soriskisintheeyeofthebeholder Forcingchoicesthatsecmeverbolder. We'vebecomeincreasinglyheroic Despiteriskcstimatesthatapproachthezeroic. Soonwc'Il bctestingforRlDNA Amoveforwhichthroughournoscswell pay Alreadythereissolvent-detergent Atpricesthatmakeonealmostregurgent Andnotfarbehindislightpluspsoralen Forfiscaldoomaretheseametaphoralin? Theoldrisksaregone.butweworry anew Whatifweinfecteventhefew? Whatifnewagcntsgetmixedinthcbrew? I1'sthetheoreticaL wecannoteschew. Sowe'Iladdthemolecularandalsoinactivate Sothatnothingwillevermuckupthefactor-eight Blood.yourabsolutevirtucwillsoonbcreality Andyourrisksnolongeracontentiouslegality BothsupplierandconsumerwillembraceYOl1rtotaliry Andwewillirnbidefromyourbagwithgreatjoviality. Harvey1.Alter.MD Baxter Acknowledgement ThispublicationhasbeenmadepossiblethroughthesupportofBaxter,which isgratefully acknowledged. VII CONTENTS ModeratorsandSpeakers IX Foreword.......... XI I.PerceptionofRisk DoesPerceivedRiskWithholdPeoplefromDonatingB1ood? 3 Ch.A.I V1ek ManagingRisksfromanInsurer's Perspective 23 A.Oosterlee BadB100dortheElixirofLife?PerceivedRiskofBloodTransfusions 27 M.L.Finucane TheRoleofCost-EffectivenessAnalysisinDefiningTransfusionMedicine Policy 47 IP.AuBuchon Discussion 59 11. Managementof Infection Defined Risks RisksofTransfusion-Transmitted Infection:AComparative Analysisof ThenandNow 69 H.J.Alter PreventionofTransfusionTransmissibleInfections:TheImpactofthe RecentPastonCurrentDecisionMaking 81 S.H.Kleinman Managementof Infection-DefinedRisks 95 n.v.Dodd ClosingtheWindowofEarlyHIVInfectionbyIncorporationof HIVp24AgDetection 105 J.vanBinsbergen GATTesting:AddedValue? 109 L.Noel Discussion 119 VIII IH. ManagementofImmune Defined Risks The RoleofTandB Cells inTransfusion-RelatedImmune Reactions: Cytokines and theRemoval ofApoptic Material 131 L.A. Aarden InvolvementofB-eells inPeripheral Serapie Pathogenesis 133 M.Klein Alternative Approaches toPreventionofAlloimmunisation:A Virtue of Reality? 141 J.Tb.M.de Wolf Transfusion-Associated ImmunomodulationinCancer Recurrenceand Postoperative Infection:Meta-AnalysisofRandomised ControlledTrials .....147 E.C.Vamvakas Does General LeukodepletionProvide AnyBetterOutcome? 163 C.L.vander Poel Discussion 169 IV. Risk Managementin Clinical Practice: Optimal vsMaximal Haemovigilance:An ApproachtoRisk Managementand Control 181 C.Tb.Smit Sibinga Evidence-BasedTransfusion Medicine:AFundamentalPart ofRisk Management 191 1.Kleijnen Safetyand SupplyIssues from ConsumersPoint ofView 20I B.O'Mahony The ValueofEducationto ImprovePerception,Acceptance and Communication ofTransfusion-RelatedRisk 207 K-F.Bopp This istheBloodyLimit 213 T.A. Kok The Virtue ofReality:Global Strategies inthe ManagementofTransfusion- Rclated Risks 219 F.Dclaney Discussion 223 Index 231 IX MODERATORSANDSPEAKERS Moderators HJ.Alter(chairman) - NationalInstitutesofHealth,Bethesda,MD, USA 1.P.AuBuchon - Dartmouth-HitchcockMedicalCenter,Lebanon, NH,USA L.Noel - LeChesnay,F CL. vanderPoel - SanguinBloodSupplyFoundation C.Tb.SmitSibinga - BloodBankNoordNederland,Groningen,NL HJ.C.deWit - SanguinBloodSupplyFoundation,Amsterdam, NL J.Th.M.deWolf - AcademicHospitalGroningen,Departmentof Haematology,Groningen,NL Speakers LA Aarden - CLB,DepartmentofAutoimmuneDiseases, Amsterdam,NL K-F.Bopp - HealthandSocialPolicyDivision,Councilof Europe,Strasbourg,F F.Delaney - DirectorateGeneralV, EuropeanCommission, Luxembourg,L R.Dodd - JcromeH.HollandLaboratory,AmericanRed Cross,Rockville,MD,USA M.L.Finucane - DecisionResearch,Eugene,OR,USA 1.Kleijnen - NHSCentreforReviewsandDissemination, UniversityofYork,York,UK M.Klein - DepartmentofPathology,UniversityofZürich, Zürich,CH x S.H.Kleinman - Victoria,BC,C TA Kok - PresidentD66politicalparty,ManagingDirector Strategy& DevelopmentAchmea,Achmea HoldingNY,Zeist,NL B.O'Mahony - PresidentWorldFederationofHemophilia, Montreal,Quebec,C A.Oosterlee - TheSt.PaniInternational InsuranceCompany Ltd,Amsterdam, NL E.C.Vamvakas - NewYorkYAMedicalCenter,NewYork,NY, USA ChAJ. Vlek - DepartmentofPsychology,Universityof Groningen,Groningen,NL Prepared Discussant J.vanBinsbergen - AkzoNobel,OrganonTeknika,Boxtei,NL
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