Administration Of Platelets Research Articles

Prevention of postoperative bleeding after complex pediatric cardiac surgery by early administration of fibrinogen, prothrombin complex and platelets: a prospective observational study

BackgroundPostoperative bleeding is a major problem in children undergoing complex pediatric cardiac surgery. The primary aim of this prospective observational study was to evaluate the effect of an institutional approach consisting of early preventive fibrinogen, prothrombin complex and platelets administration on coagulation parameters and postoperative bleeding in children. The secondary aim was to study the rate of re-intervention and postoperative transfusion, the occurrence of thrombosis, length of mechanical ventilation, ICU stay and mortality.MethodsIn fifty children (age 0–6 years) with one or more predefined risk factors for bleeding after cardiopulmonary bypass (CPB), thrombelastography (TEG) and standard coagulation parameters were measured at baseline (T1), after CPB and reversal of heparin (T2), at sternal closure (T3) and after 12 h in the ICU (T4). Clinical bleeding was evaluated by the surgeon at T2 and T3 using a numeric rating scale (NRS, 0–10).ResultsAfter CPB and early administration of fibrinogen, prothrombin complex and platelets, the clinical bleeding evaluation score decreased from a mean value of 6.2 ± 1.9 (NRS) at T2 to a mean value of 2.1 ± 0.8 at T3 (NRS; P < 0.001). Reaction time (R), kinetic time (K), maximum amplitude (MA) and maximum amplitude of fibrinogen (MA-fib) improved significantly (P < 0.001 for all), and MA-fib correlated significantly with the clinical bleeding evaluation (r = 0.70, P < 0.001). The administered total amount of fibrinogen (mg kg− 1) correlated significantly with weight (r = − 0.42, P = 0.002), priming volume as percentage of estimated blood volume (r = 0.30, P = 0.034), minimum CPB temperature (r = − 0.30, P = 0.033) and the change in clinical bleeding evaluation from T2 to T3 (r = 0.71, P < 0.001). The incidence of postoperative bleeding (> 10% of estimated blood volume) was 8%. No child required a surgical re-intervention, and no cases of thrombosis were observed. Hospital mortality was 0%.ConclusionIn this observational study of children with an increased risk of bleeding after CPB, an early preventive therapy with fibrinogen, prothrombin complex and platelets guided by clinical bleeding evaluation and TEG reduced bleeding and improved TEG and standard coagulation parameters significantly, with no occurrence of thrombosis or need for re-operation.Trial registrationGerman Clinical Trials Register DRKS00018109 (retrospectively registered 27th August 2019).

Supplementation of Barium to Cold-Stored Platelets Improves Platelet Quality over 7 Days of Storage

Background: Hemorrhage is responsible for the majority of potentially survivable deaths amongst military and civilian sectors. Early interventions to manage bleeding during hemorrhagic injury, including administration of platelets (PLTs), are crucial for decreasing mortality. Cold-stored PLTs are an attractive treatment for active bleeding as they provide greater functional preservation and a reduced risk of bacterial sepsis than conventional room temperature stored PLTs. However, cold storage causes a rise in PLT intracellular calcium, subsequent activation of signaling pathways, and often results in aggregate formation. In this study, we hypothesized that storing PLTs in the cold with barium, a divalent cation chelated by citrate anticoagulant, would improve PLT quality. Methods: Apheresis PLTs in 100% plasma were collected from healthy donors (n=4). Briefly, 10 mL of PLTs were sterilely aliquotted and added to 15 mL mini-bags containing 0- (Control), 3-, or 6-mM BaCl2. Individual mini-bags were used for each timepoint and condition. Bags were incubated for 15 min at room temperature prior to long-term storage in a walk-in refrigerator (1°-6°C). Samples were assayed on days 1 (the day after collection) and 7 of storage for PLT metabolism, count, clot formation, clot retraction, and activation (phosphatidylserine, mitochondrial depolarization, GPIb, and P-Selectin). Data were reported as means±SD. Results: Compared to Control at day 7, BaCl2-treated bags exhibited higher PLT counts (Control: 422±215 x103 PLTs/µL; 3 mM BaCl2: 468±222 x103 PLTs/µL; 6 mM BaCl2: 697±194 x103 PLTs/µL), less PS exposure (Control: 6.3±3.5%; 3 mM BaCl2: 5.8±3 %; 6 mM BaCl2: 5.6±2.8 %), and less mitochondrial membrane depolarization. Additionally, glucose consumption and lactate production were lower in barium-supplemented PLTs. GPIb expression and P-Selectin was comparable amongst all groups. Hemostatic function, as assessed via thromboelastography and clot retraction, was not negatively affected by addition of BaCl2. In most assays, cold storage of PLTs with the higher concentration of BaCl2 (6 mM) seemed to confer the greatest advantages. Conclusion: Supplementation of barium to PLTs provides a promising avenue for transfusion medicine since PLT count is better preserved and activation is decreased compared to normal refrigerated storage. Future studies are warranted to determine the effects of barium supplementation on other aspects of cold-stored PLT function (e.g. procoagulant activity and PLT adhesion under physiologic flow) and with respect to alternate storage media (e.g. PLT additive solutions). Disclosures No relevant conflicts of interest to declare.

Early Allograft Dysfunction Following Liver Transplant: Impact of Obesity, Diabetes, and Red Blood Cell Transfusion

PurposeWe examined the role of obesity and intraoperative red blood cell (RBC) and platelet transfusion in early allograft dysfunction (EAD) following liver transplantation (LT). MethodsThis is a retrospective analysis of 239 adult deceased-donor LT recipients over a 10-year period. EAD was defined by Olthoff’s criteria. Data collection included donor (D) and recipient (R) age, body mass index (BMI) ≥ 35 kg/m2, diabetes mellitus, allograft macrosteatosis, and intraoperative (RBC) and platelet administration. We employed logistic regression to evaluate associations of these factors with EAD. Results are presented as odds ratios (OR) and 95% confidence intervals (CI) with corresponding P values. A P ≤ .05 was considered statistically significant. ResultsEAD occurred in 85 recipients (36%). Macrosteatosis data were available for 199 donors. In the multivariate analyses, BMI-D ≥ 35 kg/m2 increased the odds of developing EAD by 156% in the entire cohort (OR 2.56, 95% CI 1.09-6.01) and by 187% in recipients with macrosteatosis data (n = 199, OR 2.87, 95% CI 1.15-7.15). Each unit of RBCs increased the odds for EAD by 8% (OR 1.08, 95% CI 1.02-1.14) and, for the subgroup of 238 recipients with macrosteatosis data, by 9% (OR 1.09, 95% CI 1.02-1.16). ConclusionWe found a significant independent association of donor obesity and intraoperative RBC transfusion with EAD but no such association for platelet administration, MELD score, age, recipient obesity, and diabetes.

Association between transfusion of blood products and acute kidney injury following cardiac surgery.

Acute kidney injury (AKI) is a serious complication following cardiac surgery associated with increased mortality. Red blood cell transfusion enhances the risk of developing AKI. However, the impact of other blood products on AKI is virtually unexplored. The aim of this study was to explore if transfusion of red blood cells, fresh frozen plasma and platelets alone or in combination were associated with postoperative AKI. Patients undergoing elective on-pump cardiac surgery were included (n=1960) between 2012 to 2014. Transfusion data were collected intraoperatively and until the first postoperative day. AKI was classified according to the KDIGO criteria. Data were analysed using univariate and stepwise multiple logistic regression with adjustment for clinical risk factors and complementary blood products. AKI was observed in 542 patients (27.7%). In univariate analysis and following adjustment for clinical risk factors, administration of red blood cells, freshfrozen plasma and platelets were all independently associated with KDIGO stage 2-3. Following additional adjustment for complementary blood products, only red blood cell transfusion remained significantly associated with AKI. A dose-dependent association between volume of red blood cells and degree of AKI severity was observed. Transfusion of all blood products in a dose-dependent manner increased the risk for AKI. However, in multivariate analysis combining all blood products, only red blood cell transfusion remained significantly associated with AKI development.

Implementation of Perioperative Point-of-Care Platelet Function Analyses Reduces Transfusion Requirements in Cardiac Surgery: A Retrospective Cohort Study.

Platelet dysfunction is a common cause of bleeding, perioperative blood transfusion, and surgical re-exploration in cardiac surgical patients. We evaluated the effect of incorporating a platelet function analyzer utilizing impedance aggregometry (Multiplate, Roche, Munich, Germany) into our local transfusion algorithm on the rate of platelet transfusion and postoperative blood loss in patients undergoing coronary artery bypass grafting (CABG) surgery. Data were collected on patients undergoing CABG surgery from January 2015 to April 2017. Patients who underwent surgery before and after introduction of this algorithm were classified into prealgorithm and postalgorithm groups, respectively. The primary outcome was the rate of platelet transfusion before and after implementation of the Multiplate-based transfusion algorithm. Secondary outcomes included transfusion rate of packed red blood cells, postoperative blood loss at 12 and 24 hours, length of stay in the intensive care unit, and the hospital and mortality. A total of 726 patients were included in this analysis with 360 and 366 patients in the pre- and postalgorithm groups, respectively. Transfusion rates of platelets (p = 0.01) and packed red blood cells (p = 0.0004) were significantly lower following introduction of the algorithm in patients (n = 257) who had insufficient time to withhold antiplatelet agents. Receiver operating characteristic curves defined optimal cutoff points of arachidonic acid and adenosine diphosphate assays on the Multiplate to predict future platelet transfusion were 23AU and 43AU, respectively. The introduction of a Multiplate-based platelet transfusion algorithm showed a statistically significant reduction in the administration of platelets to patients undergoing urgent CABG surgery.

Comparison of intraoperative tranexamic acid and epsilon-aminocaproic acid in cardiopulmonary bypass patients.

ObjectiveTo compare tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) in patients undergoing cardiac surgery with cardiopulmonary bypass.MethodsOver a consecutive 2-year period, 824 adult cardiac surgery patients who received TXA during an EACA shortage were compared with 778 patients who received EACA postshortage. Patient characteristics and process and outcome variables were collected through chart review and database queries. This retrospective analysis used inverse probability of treatment weighting to control for confounding by indication, and propensity scores were calculated using a logistic regression model.ResultsIn adjusted models, overall transfusion rates for the TXA cohort (odds ratio [OR], 0.94; 95% confidence interval [95% CI], 0.81-1.10) and administration of platelets (OR, 1.04; 95% CI, 0.85-1.27), red blood cells (OR, 0.93; 95% CI, 0.80-1.09), fresh frozen plasma (OR, 1.00; 95% CI, 0.79-1.25), and cryoprecipitate (OR, 1.08; 95% CI, 0.71-1.64) were equivalent to the EACA cohort. In addition, there was no statistical difference with respect to stroke, seizure, mortality, reoperation for bleeding, chest tube drainage, and acute kidney injury. Patients who received TXA had shorter ventilator times (difference in medians −1.33 hours [95% CI, −1.86 to −0.80]) and lower postsurgical charges (difference of medians −$2913 [95% CI, −5147 to −679]).ConclusionsSubstituting TXA for EACA during cardiac surgery with cardiopulmonary bypass did not change transfusion rate or amount, nor was there a significant difference in chest tube drainage. Patients who received TXA had a statistically significant but not clinically significant lower postoperative ventilator times and charges without an increase in mortality, stroke, reoperation for bleeding, acute kidney injury, or seizures.

Trends in platelet distributions from 2008 to 2017: a survey of twelve national and regional blood collectors.

This multi-national study evaluated changes in platelet (PLT) unit distributions at 12 national or regional blood collectors over a 10-year period. Data on the total number of PLT distributions, the collection method, that is apheresis vs whole blood-derived (WBD), the PLT unit characteristics and post-collection modifications were obtained from 12 national or regional blood collectors from 2008 through 2017. Individual WBD PLT units were converted to apheresis equivalent units (i.e. a dose of PLTs) by dividing by 4, the typical pool size; WBD units that were pooled before distribution were counted as a single dose. Overall at these 12 blood collectors, the total number of PLTs distributed in 2008 was 1373200, which rose by 10·2% to 1513803 in 2017. The Japanese Red Cross, which distributes only apheresis PLTs, had a 13·4% increase in the number of distributions between the years 2008 and 2017, while the other 11 blood collectors combined demonstrated a 6·8% increase in distributions between these two years. Between the years 2008 and 2017, the changes in the proportion of apheresis, platelet-rich plasma and buffy coat PLT distributions were -29·9%, -70·7% and 80·0%, respectively. The number of PLT distributions increased during the 10-year study period despite prophylactic PLT transfusion thresholds having remained fairly consistent over the last decade. Perhaps this increase is in part driven by increased administration of platelets to patients with massive haemorrhage or an increase in stem cell transplantation. The use of buffy coat PLTs is increasing at these collectors.

Picking up the Pace: Decreasing Platelet Administration Safely and Effectively

BackgroundHematology-oncology patients often require blood and blood product transfusions, including platelets (PLTs), to maintain stability. Administering PLTs in a shorter timeframe may prove beneficial by possibly raising platelet counts to a higher level faster, and allowing patients to be disconnected from IV pumps sooner. ObjectiveTo evaluate the optimal (safe and effective) transfusion time by comparing standard administration of PLTs over 2–4 h to the investigational administration of PLTs over 30–45 min in the pediatric hematology-oncology inpatient population. MethodologyA pilot trial was conducted using a convenience sample of hematology-oncology children. Children prescribed a PLT transfusion while admitted to an inpatient unit were eligible. If randomized to the intervention group, the nurse administered the PLTs over 30–45 min. If randomized to the standard group, the nurse administered the PLTs over 2–4 h. Post transfusion PLTcount was drawn 30 min after completion. The child was monitored closely for adverse reactions. ResultsEleven participants were enrolled in the study and 20 PLT infusions administered. No adverse events were noted. There was not a significant difference in changes in PLT counts by group (post minus pre), p = 0.082. There was not a significant difference in post infusion PLT counts, p = 0.727. There was a significant difference in the rate of change in PLT counts by groups, p = 0.003. Nursing implicationsThis pilot study provides preliminary evidence that PLTs may be safely and effectively administered over 30–45 min in pediatric hematology-oncology patients. With quicker PLT administration, patients can be disconnected from IV pumps sooner.

CHANGES IN PLATELET AGGREGATION AND NIHSS AFTER ANTI-PLATELET THERAPY FOR ACUTE ISCHEMIC STROKE PATIENTS AT H. ADAM MALIK GENERAL HOSPITAL MEDAN

Background: Acute ischemic stroke is caused by blockage of the cerebral arteries due to thrombus originating from excessive clotting of platelets. Increased platelet activity impacts the risk of atherothrombosis. The clinical impact of this blockage can be seen in changes in platelet aggregation and NIHSS after anti-platelet administration. Objectives: This study aims to determine changes in platelet aggregation and NIHSS after administration of anti-platelet therapy in acute ischemic stroke patients. Methods: This study was a Quasi Experimental Study with the method of Pre and Post-test Only Group selected by consecutive non-random sampling technique, in which patients diagnosed with ischemic stroke treated at H Adam Malik General Hospital Medan. The study began from March to July 2020. Results: The study was conducted on 38 samples consisting of 18 men and 20 women with an average age of 58.92(±7.539) years. There was a significant change between platelet aggregation and NIHSS (p&lt;0.001). There was a significant relationship between platelet aggregation with NIHSS the first day before the administration of anti platelets (p=0.018) and correlation test (r=0.339) positive direction (unidirectional). There was no significant relationship between platelet aggregation with NIHSS in the seventh day after anti platelet administration (p=0.394). Conclusions: There were significant changes between platelet aggregation and NIHSS scores. There was a significant relationship between platelet aggregation and NIHSS the first day before anti platelet administration. There was no significant relationship between platelet aggregation and NIHSS in the seventh day after anti platelet administration.

Transfusing Platelets During Bypass Rewarming in Neonates Improves Postoperative Outcomes: A Randomized Controlled Trial.

In neonates, transfusion of platelets after hemodilution from cardiopulmonary bypass (CPB) has been standard. We hypothesize that platelet administration during the rewarming phase before termination of CPB would reduce coagulopathy, enhance hemostasis, reduce transfusion, and improve postoperative outcomes after neonatal cardiac surgery. A prospective, randomized trial was performed in 46 neonates. Controls received platelets only at the end of bypass with other blood products to assist in hemostasis. The treatment group received 10 mL/kg of platelets during the rewarming phase of bypass after cross-clamp release. After protamine, transfusion and perioperative management protocols were identical and constant among groups. Two neonates in each group were excluded secondary to postoperative need for extracorporeal support. Controls (n = 21) and treatment patients (n = 21) were similar in age, weight, case complexity, associated syndromes, single ventricle status, and CPB times. Compared to controls, the treatment group required 40% less postbypass blood products (58 ± 29 vs 103 ± 80 mL/kg, P = .04), and case completion time after protamine administration was 28 minutes faster (P = .016). The treatment group required fewer postoperative mediastinal explorations for bleeding (P = .045) and had a lower fluid balance (P = .04). The treatment group had shorter mechanical ventilation (P = .016) and length of intensive care unit times (P = .033). There were no 30-day mortalities in either group. Platelet transfusion during the rewarming phase of neonatal cardiac surgery was associated with reduced bleeding and improved postoperative outcomes, compared to platelets given after coming off bypass. Further studies are necessary to understand mechanisms and benefits of this strategy.

Platelet Administration During Cardiopulmonary Bypass in Neonates: A Universal Therapy Applied in a Novel Way.

Advances in pharmaceuticals (eg, factor concentrates), laboratory testing (eg, rotational thromboelastometry), and processes (eg, transfusion protocols) have contributed to improved outcomes regarding transfusion in neonates undergoing surgical repair for congenital heart disease. A novel strategy, platelets administered during the rewarming phase of cardiopulmonary bypass, as a solution to improved hemostasis, was prospectively evaluated in 42 neonates. Improved intraoperative and postoperative hemostasis was observed in neonates given platelets during the rewarming phase of cardiopulmonary bypass.

365 Incidence of Venous Thromboembolism in Critical Care Air Transport Team-Evacuated Casualties Transported to Landstuhl Regional Medical Center

Critically injured combat casualties are transported to Landstuhl Regional Medical Center (6-9 hour flights) via Critical Care Air Transport Teams (CCATTs). Immobility and prolonged air travel following traumatic injury may increase the risk of venous thromboembolism (VTE), yet studies on the incidence of VTE following traumatic injury and prolonged air transport are limited. Our objective was to determine factors associated with the incidence of VTE in patients evacuated from theater by CCATTs. We performed a retrospective record review of trauma patients evacuated from the combat setting by CCATT between March 2007 and December 2011. From CCATT records and Department of Defense Trauma Registry query we collected demographics, injury description, vital signs, labs, thromboprophylaxis, adverse events, and disposition up to 30 days. Data elements abstracted from theater medical records included VTE diagnostic information and relevant procedures with timestamps as available. Patients with at least one documented incidence of DVT or pulmonary embolism were grouped into VTE and compared to patients with no deep venous thrombosis or PE (No VTE). Continuous data were analyzed and reported as median (Interquartile Range), while categorical data were reported as frequencies and percentages. Regression models were performed to identify factors associated with the development of VTE. Of the 1351 CCATT records reviewed, 205 records had diagnoses of DVT (n=114), PE (n=69), or both (n=22). Thirty-five records had more than one occurrence of VTE documented. Subjects were male (98%) with median age of 24 (21-29) years. Comparing VTE versus No VTE there was no difference in age, sex, or injury severity. The VTE group was more likely to have sustained injuries related to a fall (5% versus 2%, p=0.015) or blast (75% versus 67%, p=0.027) compared to No VTE group. The VTE group was more likely to receive blood products pre-flight (p<0.001), during flight (p<0.001), and post-flight (p<0.001). The VTE and No VTE group received procoagulants, anticoagulants, and thromboprophylaxis pre-flight at similar rates. From regression models, a low pre-flight hemoglobin level (<8 g/dL), a pH of ≥7.4, and the administration of platelets were associated with VTE (p<0.001). Other pre-flight labs were similar between groups. There was no difference in proportion of patients who required ventilator support during transport (70% versus 65%, p=0.120), but after flight, the VTE group was more likely to be intubated (72% versus 65%, p=0.029). The VTE group compared to No VTE group was more likely to have an adverse event (such as aspiration pneumonia or cardiac arrest) post-flight (95% versus 90%, p=0.037). Mortality rates did not differ between groups (3.8% versus 4.1%, p=0.859). Of the survivors, the VTE group had more hospital days (p=0.047). The proportion of patients who continued to receive medical care (2.9% versus 2.8%) at 30 days post injury did not differ. The VTE group was more likely to receive blood products before, during, and after flight. Factors associated with VTE included a low hemoglobin level, pH of 7.4 or greater, and platelet administration in spite of the administration of anticoagulants. Further research is needed to determine whether this is related to low red cell to platelet ratios, continued bleeding, or other dysfunctional physiologic response in the coagulation system.

Blood utilisation and transfusion reactions in adult patients transfused with conventional or pathogen-reduced platelets.

SummaryPathogen‐reduced (PR) platelets are routinely used in many countries. Some studies reported changes in platelet and red blood cell (RBC) transfusion requirements in patients who received PR platelets when compared to conventional (CONV) platelets. Over a 28‐month period we retrospectively analysed platelet utilisation, RBC transfusion trends, and transfusion reaction rates data from all transfused adult patients transfused at the Yale‐New Haven Hospital, New Haven, CT, USA. We determined the number of RBC and platelet components administered between 2 and 24, 48, 72 or 96 h. A total of 3767 patients received 21 907 platelet components (CONV = 8912; PR = 12 995); 1,087 patients received only CONV platelets (1578 components) and 1,466 patients received only PR platelets (2604 components). The number of subsequently transfused platelet components was slightly higher following PR platelet components (P < 0·05); however, fewer RBCs were transfused following PR platelet administration (P < 0·05). The mean time‐to‐next platelet component transfusion was slightly shorter following PR platelet transfusion (P = 0·002). The rate of non‐septic transfusion reactions did not differ (all P > 0·05). Septic transfusion reactions (N = 5) were seen only after CONV platelet transfusions (P = 0·011). These results provide evidence for comparable clinical efficacy of PR and CONV platelets. PR platelets eliminated septic transfusion reactions without increased risk of other types of transfusions with only slight increase in platelet utilisation.

Antagonizing P2Y12 Receptor Inhibitors: Current and Future Options.

There are clinical scenarios where the balance between the risk of ischemic and bleeding events leads to the clinical decision to reverse the antiplatelet effect of P2Y12 receptor inhibitors. These scenarios comprise emergency situations such as active severe bleeding, urgent procedures with presumed high bleeding risk, or major trauma with (anticipated) bleeding. Supplementation of platelets has been investigated in ex vivo as well as in in vivo studies. These studies indicate that the inhibition of adenosine diphosphate-induced aggregation by the irreversibly binding thienopyridine derivatives clopidogrel and prasugrel can be reversed by administration of platelet concentrates. Supplementation of platelets in patients on prasugrel is more effective if this can be transfused > 6 hours after last dosing. Studies on the reversal effect obtained by administration of platelet concentrates in patients on ticagrelor show conflicting results. Experimental data suggest that administration of serum albumin might increase the reversal effect. A monoclonal antibody fragment (PB2452) for neutralizing ticagrelor is currently in clinical development. A recently published first in man study shows that reversal of platelet inhibition occurs within 5 minutes after start of administration and the effect is maintained for 20 to 24 hours after a 16-hour infusion which is by far the most effective approach for reversal of ticagrelor.

Interval changes in ROTEM values during cardiopulmonary bypass in pediatric cardiac surgery patients

IntroductionRotational thromboelastometry (ROTEM) has been shown to reduce the need for transfused blood products in adult and pediatric cardiac surgery patients. However, similar evidence in newborns, neonates, and young infants is lacking. We quantified ROTEM value changes in pediatric patients on cardiopulmonary bypass (CPB) before, during and after blood product transfusion.MethodsEach surgery had at least four interventions: initiating CPB; platelet administration during rewarming phase; post-CPB and following protamine and human fibrinogen concentrate (HFC) administration; and further component therapy if bleeding persisted and ROTEM indicated a deficiency. ROTEM assays were performed prior to surgery commencement, on CPB prior to platelet administration and following 38 mL/kg platelets, and post-CPB after protamine and HFC administration. ROTEM assays were also performed in the post-CPB period after further blood component therapy administration.ResultsData from 161 patients were analyzed. Regression models suggested significant changes in HEPTEM clotting time after all interventions. PLT administration during CPB improved HEPTEM α by 22.1° (p < 0.001) and FIBTEM maximum clot firmness (MCF) by 2.9 mm (p < 0.001). HFC administration after CPB termination significantly improved FIBTEM MCF by 2.6 mm (p < 0.001). HEPTEM MCF significantly increased after 3/4 interventions. HEPTEM α significantly decreased after two interventions and significantly increased after two interventions. Greatest perturbances in coagulation parameters occurred in patients ≤90 days of age.ConclusionCPB induced profound perturbations in ROTEM values in pediatric cardiac surgery patients. ROTEM values improved following PLT and HFC administration. This study provides important clinical insights into ROTEM changes in pediatric patients after distinct interventions.

Defining Usage and Clinical Outcomes Following Perioperative Fresh Frozen Plasma and Platelet Administration in Spine Surgery Patients.

This was a retrospective study. The main objectives of this study were to characterize the utilization of fresh frozen plasma (FFP) and platelets in spine surgery and the clinical outcomes following their administration. Blood component transfusion is often a crucial therapy during spine surgery. Little is known about the association between transfusion with FFP and/or platelets and perioperative morbidity in patients undergoing spine surgery. At a single large tertiary medical center, the surgical billing database was retrospectively queried for patients undergoing spinal surgery from 2008 to 2015. A univariate analysis compared patient characteristics for those who received FFP and/or platelets perioperatively and those who did not. To determine independent predictors of FFP and platelet administration and independent predictors of perioperative complications, both univariate and multivariate analyses were used. In total, 6931 patients met inclusion criteria. One thousand seven (14.5%) patients received perioperative FFP transfusion and 432 (6.2%) received platelets. In multivariate analysis, Charlson Comorbidity Index (CCI) ≥4, preoperative hemoglobin <12 g/dL, preoperative international normalized ratio (INR) ≥1.7, higher estimated blood loss, and receipt of packed red blood cell or platelet transfusion were associated with perioperative FFP administration (all P≤0.001). More than half of all patients received FFP with an INR trigger of <1.7. Those who received perioperative FFP were more likely to experience infection, increased length of stay, and ischemic, respiratory, thrombotic, and renal complications (all P<0.0001). Perioperative FFP [odds ratio (OR): 2.43], platelet transfusion (OR: 1.81), American Society of Anesthesiologists (ASA) grade 3 or 4 (OR: 1.84), CCI≥4 (OR: 1.75), and receipt of packed red blood cells (OR: 1.73) were independent predictors of experiencing any complication (all P≤0.008). The majority of patients were given FFP with a liberal INR trigger of >1.7. Perioperative FFP and platelet administration are independent predictors of perioperative complications following spine surgery.

Platelet function disorder in trauma patients, an underestimated problem? Results of a single center study

Plasmatic coagulation disorders in trauma patients are common and their management is subject to current guidelines. Less evidence exists for platelet function. Although it is known that several trauma-associated factors have a negative influence on platelet function, routine monitoring has not yet become established. A retrospective single center study was carried out at aGerman level 1 trauma center from 2010 to 2016. In all patients fulfilling the requirements for the German Trauma Society (DGU) Traumaregister® who were admitted directly from the scene of the incident, platelet function was analyzed using the Platelet Function Analyzer (PFA 100®) with adenosine diphosphate (ADP) and epinephrine as activation factors. After exclusion of patients with intake of long-term anticoagulant and antiaggregant medication, possible influencing factors of areduced platelet function were identified. The results from 310 patients (44.0 ± 14.7 years, 76% male, Injury Severity Score, ISS 28.4 ± 14.2 points) were available. Adelayed platelet activation was found in 25.5% using ADP and 31% using epinephrine. Laboratory parameters indicated agreater blood loss. Prolonged closure times were associated with an increased transfusion rate of packed red blood cell concentrates and ahigher mortality rate. Logistic regression revealed hemoglobin (Hb) and fibrinogen levels at admission to be independent predictors for adecreased platelet activation in the assay with ADP (p < 0.001, Cohen's f = 0.61) and with epinephrine (p < 0.001, f = 0.42). Approximately one quarter to one third of primarily admitted trauma patients without long-term anticoagulation medication showed adelayed platelet activation in the PFA-100 test. By considering all trauma patients an even higher rate can be expected. The Hb and fibrinogen levels at admission can be helpful to estimate platelet disorders. The development of platelet assays to guide the resuscitation of individual patients seems to be absolutely necessary. The contribution of platelet disorders to trauma-induced coagulopathy is not sufficiently understood. Regarding the importance assigned to platelet transfusion or administration of desmopressin, these aspects should be the subject of further research.

Routine Solid Phase Multiplex Anti-HLA Antibody Tests Predict Platelet Refractoriness.

No validated screening methods identify patients at risk for human leukocyte antigen (HLA) alloimmune-mediated platelet refractoriness (alloPR). We determined if bead-based HLA antibody tests could predict risk of developing HLA alloPR. Hematopoietic progenitor cell transplant patients screened for HLA antibodies without prior refractoriness were identified. Phenotype bead screening results were compared between patients who later did and did not develop alloPR. Seven of 27 patients identified subsequently developed alloPR. The panel reactive antibody (PRA) and mean fluorescence intensity (MFI) of the 10 most reactive beads in the initial screen were significantly higher among patients who later developed alloPR (P < .001). Specifically, PRA of more than 30% and mean MFI of 1,500 or more in the most reactive beads identified at-risk patients. Administration of HLA-compatible platelets yielded significant posttransfusion count increments compared with routine platelets. HLA antibody screening by phenotype bead assay may prospectively identify at-risk patients for the development of alloPR. However, clinical trials are needed to validate these findings.

Prophylactic Platelet Transfusions for Critically Ill Patients With Thrombocytopenia: A Single-Institution Propensity-Matched Cohort Study.

Thrombocytopenia is frequently encountered in critically ill patients, often resulting in prophylactic transfusion of platelets for the prevention of bleeding complications. However, the efficacy of this practice remains unclear. The objective of this study was to determine the relationship between prophylactic platelet transfusion and bleeding complications in critically ill patients. This is a retrospective cohort study of adults admitted to surgical, medical, or combined medical-surgical intensive care units (ICUs) at a single academic institution between January 1, 2009, and December 31, 2013. Inclusion criteria included age ≥18 years and a platelet count measured during ICU admission. Propensity-matched analyses were used to evaluate associations between prophylactic platelet transfusions and the outcomes of interest with a primary outcome of red blood cell transfusion in the ensuing 24 hours and secondary outcomes of ICU and hospital-free days and changes in sequential organ failure assessment scores. A total of 40,693 patients were included in the investigation with 3227 (7.9%) receiving a platelet transfusion and 1065 (33.0%) for which platelet transfusion was prophylactic in nature. In propensity-matched analyses, 994 patients with prophylactic platelet transfusion were matched to those without a transfusion. Patients receiving prophylactic platelets had significantly higher red blood cell transfusion rates (odds ratio 7.5 [5.9-9.5]; P < .001), fewer ICU-free days (mean [standard deviation] 20.8 [9.1] vs 22.7 [8.3] days; P = .004), fewer hospital-free days (13.0 [9.7] vs 15.8 [9.4] days; P < .001), and less improvement in sequential organ failure assessment scores (mean decrease of 0.2 [3.6] vs 1.8 [3.3]; P < .001) in the subsequent 24 hours. These findings appeared robust, persisting in multiple predefined sensitivity analyses. Prophylactic administration of platelets in the critically ill was not associated with improved clinical outcomes, though residual confounding may exist. Further investigation of platelet transfusion strategies in this population is warranted.

Upotreba autolognih hemoprodukata u mirnodopskim uslovima, vanrednim situacijama i ratu

Introduction In industrialized countries, autologous transfusion (AT) of blood and/or autologous blood products is often used. Objective To perform an analysis on the possibilities of using autologous blood products (ABP) in peace and in war. Methods In peacetime conditions, all AT strategies can be performed: 1) planned preoperative autologous blood and/or blood components collection (PPAB-BCC); 2) acute normovolemic hemodilution (ANH); 3) intraoperative blood salvage of autologous blood; 4) postoperative blood salvage; 5) administration of autologous platelets; 6) the use of autologous fibrin glue and autologous tissue adhesives; 7) the collection and storage of autologous erythrocytes and autologous fresh plasma. In emergency situations and war, the most applicable strategies are: a) ANH; b) intraoperative blood salvage; c) postoperative blood salvage; d) application of autologous fibrin glue and autologous tissue adhesives. Results In peace. PPAB-BCC was used for 314 patients, who were planned for elective surgery. AB was collected using intraoperative blood salvage in the amount of 520 ml for 281 patients. ANH was performed for 30 patients. For 20 of those, 780ml of blood was collected and they were operated on for colon cancer with rectum amputation and one nephrectomy was performed on a patient with single kidney neoplasm. ANH was performed on 9 orthopedic patients. Intraoperative autologous blood salvage in peaceful conditions was performed for 52 adult patients who underwent cardiac surgery procedures. The amount of autologous blood collected and reinfused ranged from 1,500 to 3,500 ml per patient. With the help of a Cell-Saver, autologous blood salvage was performed on 63 patients during pediatric heart surgery. The amount of intraoperative salvaged autologous blood per operation ranged from 210 ml to 620 ml. During the 1990s, doctors at the Military Medical Academy (MMA) used plateletrich autologous plasma on 38 patients who had diseased blood vessels replaced with dacron grafts. In war. During the civil war on the territory of former Yugoslavia, intraoperative salvage of autologous blood was performed on 25 wounded patients who suffered from closed pneumothorax due to blast injury, in which cased 500 ml to 1500 ml of autologous blood was collected. With the help of the 'Pleur-Evac autotransfusion system', immediately after collection, reinfused to the wounded patient during the helicopter transport to the MMA. Autologous fibrin glue was used to treat 10 wounded patients during reconstructive surgery procedures. Conclusion In peacetime conditions, the AT program should be organized in every hospital that has adequate conditions for its implementation. The implementation of AT is very important because it can serve as an alternative to homologous transfusion. Our experiences from the war on the territory of the former Yugoslavia tell us that certain strategies of the AT program can successfully be implemented even in emergency situations and during war.