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Blood count

29 August 2008

A new Monash collaboration with the Red Cross seeks more information on one of the most common clinical practices.

Blood transfusions have been part of modern medicine ever since a British obstetrician performed the first successful transfusion of human blood in 1818. But while transfusions are commonplace and provide colourful fodder for hospital soap-operas, doctors still don't fully understand the possible outcomes of this dramatic treatment.

"There's some evidence now suggesting that a transfusion can have an adverse effect on your lungs and can cause some damage to the lungs, but those circumstances are not well understood," says Dr Louise Philips, from the School of Public Health and Preventive Medicine, who leads a new three-year project funded by the Australian Red Cross Blood Service to collect data on transfusion outcomes.

"What are the overall outcomes of giving a person blood, assuming that the blood is perfectly fine? What is it that it actually does to a person? Because it's been such an old practice, it never went through any of the clinical trials that nowadays would automatically happen if you were bringing in a new procedure or treatment."

The data will ultimately tell doctors exactly when they should administer a transfusion, or when it is not necessarily the best solution.

In addition to creating two new registries, the research team, including Dr Mark Polizzotto of the Red Cross, will also piggy-back onto existing Monash-administered registries such as the Cardiac Surgery Registry and the Victorian State Trauma Outcomes Registry, into which hospitals automatically enter information from a patient's stay.

This means that doctors could, for example, analyse the outcome from a case where two patients underwent identical cardiac surgery but one patient received a transfusion while the other didn't.

The new registries will track transfusions in the treatment of two rare blood diseases - Thrombotic Thrombocytopenic Purpura (TTP) and Neonatal Alloimmune Thrombocytopenia (NAIT) - which are treated by only a handful of specialists around Australia.

"Most of the doctors are very motivated to participate, because they're specialists that don't see these cases a lot, but when they do, they're very involved in the care of the patient, and don't have a lot of guidance about what's the best thing to do," says Dr Philips, who explains that the doctors will personally enter the data of patients suffering from these diseases into an online portal.

TTP causes destruction of red blood cells and can lead to bleeding, stroke and kidney failure due to blood clots in the circulatory system. NAIT creates haemorrhaging in fetuses due to a shortage of platelets, which are destroyed after the mother builds up antibodies towards them. In the case of NAIT, a transfusion administered at the right time before the birth of the child could curtail the worst case scenario: the death of the child.

"By collecting material from all over Australia, we'll be able to look at a bunch of people and make conclusions about treatment," says Dr Philips

The new registries will begin accepting data in coming weeks, while the existing registries should be configured by next year to receive transfusion information.

Blood count