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PAPERS: Joost A van Hilten, Leo M G van de Watering, J Hajo van Bockel, Cornelis J H van de Velde, Job Kievit, Ronald Brand, Wilbert B van den Hout, Robert H Geelkerken, Rudi M H Roumen, Ronald M J Wesselink, Ankie W M M Koopman-van Gemert, Jan Koning, and Anneke Brand Effects of transfusion with red cells filtered to remove leucocytes: randomised controlled trial in patients undergoing major surgery BMJ 2004; 328: 1281 [Abstract] [Full text]

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Blood maturity may explain transfusion effects

Guy F Nash   (20 May 2004)

Comment about quality of scientific papers in the BMJ

A Stephen LAURENCE   (7 June 2004)

Blood maturity may explain transfusion effects 20 May 2004
Guy F Nash, RSO St.Marks Hospital Harrow, HA1 3UJ Send response to journal: Re: Blood maturity may explain transfusion effects	Dear Editor, we must congratulate Dr. van Hilten et al. for measuring the quantity of blood transfused in their study of leucodepleted vs. non filtered blood transfusion effects. We have found that the bioactive contents of stored blood profoundly change during even two weeks of storage (1). Blood is typically stored for a month, but may be administered to the patient at day one or day 30. Thus by measuring not only the quantity but also the maturity of the blood transfused, the large variations between the different hospitals in this study may be explained. Furthermore the current contradicting evidence for blood transfusion effecting infection, cancer survival, renal transplant survival and even Crohns recurrence may also be due to the heterogeneity of the blood transfused globally(leucodepleted vs. unfiltered, large volumes vs. small volumes, long shelf storage vs. shorter storage) 1. Stored blood products stimulate cancer . Nash GF, Chopada A, Patel H, Kakkar AK. British Journal of Surgery 2002; 89 s19 Competing interests: None declared
Comment about quality of scientific papers in the BMJ 7 June 2004
A Stephen LAURENCE, Consultant anaesthetist Royal Preston Hospital, PRESTON PR2 9HT Send response to journal: Re: Comment about quality of scientific papers in the BMJ	I read with interest, and then increasing incredulity, the article by van Hiltern et al (1) on the effect of filtration of transfused blood. I could see no mention anywhere of ethical considerations, nor of the justification of presumably not informing patients that they were unwitting participants in a randomised controlled trial. Worse was the fact that nowhere in the main text of the article was it stated that patients were in fact randomised, or by what method (locally-held codes at each hospital, central bureau randomisation etc). The only place that randomisation was mentioned was actually in the abstract and the title of the paper. I was always led to believe that the abstract should be succinct summary of the paper, and the paper itself should “stand alone”. Indeed, if, when reviewing a manuscript, one has to read the abstract in order to understand what is going on, this was the hallmark of a badly written paper, or worse a badly designed or conducted study. A lapse as seems to have occurred with this paper certainly would not have been allowed in a respectable specialist journal. 1. van Hiltern JA et al, Effects of transfusion with red cells filtered to remove leucocytes: Randomised controlled trial in patients undergoing major surgery. BMJ 2004; 328:1269-1326. Competing interests: None declared