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A transfusion medicine physician at a large academic medical center in Philadelphia would like to know if any colleagues have had experience with requests for so-called "bubble filters" to be used during transfusion for patients with hereditary hemmorrhagic telangiectasia (HHT). According to the inquiring physician, because of arteriovenous malformations, such filters are recommended for all intravenous lines because the infusion of a small air bubble (harmless to non-HHT individual) can cause a stroke in a patient with HHT who has a right-to-left shunt at the level of the lungs. Interventional radiologists state that CT contrast media cannot be injected through these filters suggesting to this member that the transfusion of blood cells may be even more problematic. The only literature the inquiring physician can find regarding transfusion states that the "use of air filters is difficult because blood transfusion does not pass easily through an air filter". He does not know if "difficult" means that transfusion is possible, though blood flow is impeded to an extent, or if "difficult" means that red cells are actually lysed and platelets are inappropriately activated. |
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Please submit comments to the e-Network Forum. Ira A. Shulman, MD W. Tait Stevens, MD |
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