John Napier - Academia.edu (original) (raw)

Papers by John Napier

BJA: British Journal of Anaesthesia, 1987

Clinical & Laboratory Haematology, 2008

Measurements have been made of cross-match/transfusion ratios (C/T ratio) and intervals between s... more Measurements have been made of cross-match/transfusion ratios (C/T ratio) and intervals between successive cross-matches on the same units of blood performed in three different major hospitals each providing a wide range of clinical services. Outdate rates were 4%, 15% and 25% respectively and were associated with C/T ratios of 1.3, 2.0 and 2.15. There were corresponding increases (means of 3.6, 4.5 and 5.0 days) in the length of time unused units of blood were left between successive cross-matches. Calculations of outdate rates from the above figures closely predicted the trend shown by observed non-use rates. It has thus been demonstrated that apparently small differences in blood bank practice can produce important variations in the efficiency of use of red cell units.

Partial table of contents: BLOOD COMPONENTS AND PRODUCTS. Blood Components and Products: A Brief ... more Partial table of contents: BLOOD COMPONENTS AND PRODUCTS. Blood Components and Products: A Brief Guide to Their Uses. BLOOD GROUP ANTIGENS AND ANTIBODIES. Blood Group Antigens and Antibodies. BLOOD TRANSFUSION MATERIALS AND THEIR USES. Red Cell Preparations. Transfusion of Red Cells. Platelet Transfusion. Granulocyte Transfusion. MEDICAL AND SURGICAL TRANSFUSION PROBLEMS. Acute Blood Loss. Transfusion for Massive Blood Loss. Cardiopulmonary Bypass Surgery. Management of Patients with Burns. Therapeutic Apheresis. PAEDIATRIC TRANSFUSION. Neonatal Transfusion Problems. Haemolytic Disease of the Newborn. TISSUE ANTIGENS: TRANSPLANTATION AND TRANSFUSION. Organ Transplantation and the Transfusion Laboratory. TRANSFUSION COMPLICATIONS. Harmful Effects of Transfusion. Infections Transmissible by Transfusion. ORGANIZATION AND MANAGEMENT. Organization and Management of Transfusion Practice. Further Reading: Medicolegal Aspects. Appendices. Index.

Erythrocytosis was found in 3 generations of an English family. The red cell mass was only modera... more Erythrocytosis was found in 3 generations of an English family. The red cell mass was only moderately increased in some of the affected members but was accompanied by an unusually low plasma volume. Oxygen affinity of Hb was normal. Change6 in serum and urinary erythropoietin showed an essentially normal pattern throughout a series of venesections. Venesection produced some transient clinical benefit in the older patient but there was no obvious change in the younger ones.

Transfusion Medicine, 1993

These guidelines were last published in 1988 (British Committee for Standards in Haematology, 198... more These guidelines were last published in 1988 (British Committee for Standards in Haematology, 1988). Since then, experience with autologous transfusion has grown and this has encouraged a revision of the guidelines. The term &#x27;autologous transfusion&#x27;has tended, ...

Blood Components and Products - A Brief Guide to their Uses Blood Group Antigens and Antibodies B... more Blood Components and Products - A Brief Guide to their Uses Blood Group Antigens and Antibodies Blood Transfusion Materials, and their Uses Red Cell Preparations Transfusion of Red Cells Platelet Transfusion Granulocyte Transfusion Coagulation Factors Treatment of Coagulation Disorders Congenital Bleeding Disorders Therapeutic Immunoglobins Fibronectin Materials for Plasma Volume Expansion Medical and Surgical Transfusion Problems Acute Blood Loss Transfusion for Massive Blood Loss Adult Respiratory Distress Syndrome Cardiopulmonary Bypass Surgery Haemodilution During Surgery Autologous Transfusion Management of Patients with Burns Auto Antibodies and Autoimmune Haemolysis Special Tranfusion Problems in General Medicine Medical and Surgical Transfusion Problems Therapeutic Apheresis Neonatal Transfusion Problems Paediatric Transfusion Haemolytic Disease of the Newborn Tissue Antigens Transplantation and Transfusion Transfusion Complications Causes of Adverse Reactions Infections Tra...

Clinical & Laboratory Haematology

Scandinavian Journal of Haematology, 1977

The amount and effectiveness of erythropoiesis was measured using 59Fe in 10 patients with the an... more The amount and effectiveness of erythropoiesis was measured using 59Fe in 10 patients with the anaemia of chronic disease and in 10 iron deficient patients with a comparable degree of anaemia. In both conditions the anaemia was the result of the failure of the marrow to compensate for a modest degree of peripheral haemolysis but ineffective erythropoiesis was significantly greater in iron deficiency than in chronic disease. The results suggest that although the peripheral blood picture is similar in both conditions the anaemia of chronic disease cannot be attributed simply to iron deficient erythropoiesis.

Scandinavian Journal of Haematology, 2009

The measurement of 59Fe clearance from the plasma is a well established means of investigating er... more The measurement of 59Fe clearance from the plasma is a well established means of investigating erythropoiesis. The effect of variation in plasma iron concentration, contamination by 59Fe not bound to transferrin and 59Fe counting accuracy on the 59Fe clearance curve are described. A valid analysis of the clearance curve cannot be made unless these errors are eliminated. A technique is presented which allows the clearance of [59Fe] transferrin to be studied free of extraneous influences.

Transfusion Medicine, 1997

Red cell transfusion for trauma and surgery has always been the mainstay of transfusion practice ... more Red cell transfusion for trauma and surgery has always been the mainstay of transfusion practice and, indeed, modern surgery without assured availability of blood for transfusion would seem to be unthinkable. For decades it has seemed that shed blood should be replaced with blood and the seeming safety of voluntary donations provided by well-managed transfusion services served soundly to establish the tradition in many surgeons’ minds. Increasingly, however, events over the last two decades have challenged this comfortable perception. Transfusion-transmitted viral infections have, in both the public and professional minds, become an increasing preoccupation whilst Society at large has developed an unrealistic expectation of ‘zero risk’ from medical treatment. Apart from the many well-known hazards of transfusion, attention has recently focused on more subtle, although still largely unproven, adverse effects of transfusion. Whether, for example, blood transfusion, through as yet poorly understood immunomodulating effects, may increase the risk of post-surgical infection or by similar mechanisms promote recurrence of tumour after cancer resection. Although frustratingly difficult to confirm, the potential effects of blood transfusion on post-operative surgical infection could have effects on morbidity and mortality far outweighing the burden of disease from transfusion-transmitted viral infection. For example, it has been estimated that for the one million surgical patients in the United States each year 25 000 will suffer the consequences of post-operative infection with its attendant morbidity and financial consequences (Dzik et al., 1996). Restraining influences on clinical practice have also come from other quarters as Cost Containment and Clinical Effectiveness as well as safety issues increasingly influence the physicians prescribing habits. Two papers in this issue of Transfusion Medicine address a common but important clinical scenario – namely management of blood loss in elderly subjects undergoing total hip or total knee replacement. Both groups of investigators have recognized the traditional and commonly accepted transfusion trigger of a haemoglobin of 10·0 g dL as an indicator for transfusion to be inappropriate. Both groups had encountered the practice in their respective institutions of giving blood replacement based on clinical impressions of need rather than any objective haematological estimate of red cell deficit and recognized this as being a potential cause of unnecessary transfusion. The two groups of investigators have chosen contrasting but complementary measures for reducing the need for allogeneic blood transfusions. Andrewset al. (1997) point to the high frequency of iron deficiency as a cause either for frank anaemia or of impairment of the bone marrow response to haemorrhage. They have demonstrated that the most vulnerable patients, those with anaemia, and in particular those with microcytic indices indicative of iron deficiency, benefit most from iron therapy as judged by protection against post-operative haemoglobin fall. Haematologists might have anxieties about this somewhat pragmatic approach to routine iron therapy without a more thorough examination of diagnosis and cause. However, the practice of these authors seems justified provided that iron therapy is limited to the perioperative phase and is not prolonged sufficiently to prevent the recognition of any other contributing morbidity. Andrewset al. also provided some evidence that preoperative iron supplementation could reduce transfusion needs. This was less than might have been expected because of the practice during the earlier phase of the study giving intraoperative blood replacement without reference to haematological status or to use of an unnecessarily high value of haemoglobin as an indicator for transfusion. Allogeneic transfusion needs in orthopaedic surgery can also be reduced by judicious use of autologous transfusion. Shenolikar et al. (1997) studied 100 total knee replacements carried out in patients with haemoglobin values exceeding 11·0 g dL . The patients were randomized into receiving conventional allogeneic blood when transfusion was judged to be necessary or the alternative of post-operative red cell salvage. The autologous transfusion group required in total only 17 units of supplementary allogeneic red cells as opposed to around 80 red cell units for the group of 50 patients randomized to receive allogeneic transfusions. As in the study of Andrewset al. these authors encountered a legacy practice of transfusing intraoperatively on the basis of clinical impressions rather than haematological criteria. This may have influenced blood use in the allogeneic group although why this did not apply to the post-operative Transfusion Medicine , 1997,7, 265–268

Clinical & Laboratory Haematology, 1987

The aims of this report are to present minimum guidelines for antibody screening and compatibilit... more The aims of this report are to present minimum guidelines for antibody screening and compatibility testing. In view of the high incidence of antibody detection failures found in recent international external proficiency trials, the Working Party does not advocate the omission of the anti-human globulin (AHG) test in the compatibility procedure for patients with negative antibody screens until such time as blind test trials demonstrate a much higher standard of test performance. The approach of these guidelines is mainly advisory, although details of important principles and techniques are given. The design of procedures for emergency situations is particularly difficult as, in the overall interests of the patient, sensitivity may have to be compromised. In this situation two pitfalls must be avoided--the issue of ABO incompatible blood because of inadequate and rushed procedures on the one hand, and failure to supply blood before the patient becomes irreversibly shocked on the other. An element of flexibility must therefore be allowed which requires a high level of training and an understanding of the clinical situation.