Blood Components In Patients Research Articles

Comparison of transfusion-outcome in patients with massive bleeding receiving pathogen-reduced platelets prepared with two different technologies

BackgroundPlatelet concentrates(PCs) prepared with pathogen reduction technologies(PRT) are being used in routine treatment of onco-haematological patients since several years but less data are available for other pathologies. Study design and methodsThe aim of the study was to compare the efficacy of PCs prepared with two PRT for the treatment of patients with massive bleeding. The primary endpoint was the overall survival and in addition we analyzed the consumption of blood components in patients undergoing massive transfusion(MT). Subsequently we wanted to analyze additional known factors associated with higher in-hospital mortality.Retrospective analysis of two consecutive periods in which the PRT used were INTERCEPT and Mirasol, respectively. ResultsA total of 313 patients were included (76 % males; median age: 63 years; 160 in the INTERCEPT group and 153 in the Mirasol group).We found significantly higher use of platelets in the Mirasol cohort, measured either in absolute per patient number of units (3vs.4; p = 0.002) or after adjustment for the number of transfused red blood cells. The risk of death increased with age and the outof-hospital onset of bleeding, even after adjustment for one another (sub-distribution hazard ratio[sHR] 2.53, 95 % confidence interval [CI] 1.75–3.66, p < 0.001, and sHR 2.56, 95 % CI 1.82–3.60, p < 0.001, respectively). ConclusionPRT applied to platelets did not influence MT-related mortality, but differences were found for the efficacy of the PCs treated with the different PRT which were reflected in a heightened demand for transfusion when utilizing Mirasol-treated PCs. Factors associated with higher mortality were older age and out-of-hospital bleeding.

Аспекты применения транексамовой кислоты у пациентов с политравмой

Актуальность. В статье проанализированы особенности применения транексамовой кислоты у пациентов с политравмой. Цель исследования: изучить данные литературы об эффективности применения транексамовой кислоты у пациентов с политравмой и проанализировать частоту переливания компонентов крови у пациентов с политравмой в зависимости от времени назначения транексамовой кислоты после получения травмы. Материалы и методы. Проведено ретроспективное когортное исследование, в которое были включены 40 пациентов в возрасте от 22 до 56 лет с политравмой. Всех пациентов разделили на 2 группы: I группа — пациенты, у которых применяли транексамовую кислоту до 3 часов после возникновения политравмы, и II группа — больные, которые принимали транексамовую кислоту во временном промежутке 3–8 часов после возникновения политравмы. Результаты. Основным многофакторным условием для возникновения ранней коагулопатии у пациентов с политравмой является сочетание шока, вызванного кровотечением, и повреждения тканей, что приводит к генерации тромбин-тромбомодулинового комплекса, активации антикоагулянтной и фибринолитической систем. У пациентов, включенных в анализ данных в нашем исследовании, основными причинами политравмы были: дорожно-транспортное происшествие — у 34 пациентов (85 %), падение с высоты — у 6 пациентов (15 %). Средний возраст пациентов I группы составил 39,2 ± 17,3 года, во II группе — 41,9 ± 12,8 года. В исследование вошли 29 мужчин и 11 женщин. Не выявлено достоверных различий в тяжести состояния, структуре компонентов полиорганной недостаточности, антропометрических характеристиках пациентов обеих групп. Мы установили, что в I группе пациентов переливание эритроцитарной массы и свежезамороженной плазмы проводили в 14 случаях из 26, что составило 53 % от всех случаев политравмы в данной группе. Во II группе пациентов переливание компонентов крови проводили в 9 случаях из 14, то есть в 64 % от всех случаев из данной группы. Соответственно, частота переливания компонентов крови у пациентов II группы на 11 % выше по сравнению с пациентами I группы (p ≥ 0,05). Выводы. Полученные нами предварительные результаты свидетельствуют, что введение транексамовой кислоты до 3 часов после возникновения политравмы может снижать частоту гемотрансфузий.

The anemia correction in chronic diseases in perioperative period while performing prosthesis of aortal valve

Objective. To determine the impact of preoperative correction, using hydroxide of iron (III) erythropoietin, in patients, having the heart aortal failures, complicated by the chronic diseases anemia, on the postoperative anemia after doing the aortal valve prosthesis in accordance to the blood-preserving technology in the artificial blood circulation conditions. Materials and metods. The investigation was conducted in 83 patients, to whom the aortal valve prosthesis was performed with a blood-preserving technology in conditions of artificial blood circulation without application of hemo-concentrating columns and a cell-saver apparatus. All the patients were divided into three Groups in accordance to levels of hemoglobin, iron and the blood-preserving technologies applied. To the Group A 31 patients were included, in whom the initial concentration of hemoglobin, hematocrit and iron was normal. The patients were operated, using the donor’s blood components. To the Group B 37 patients were included, who were operated on without application of the donor’s blood components, using a blood-preserving technology in conditions of artificial blood circulation without application of hemo-concentrating columns and a cell-saver apparatus. In the Group C 15 patients were present, who have had initial preoperative anemia of chronic diseases with low values of hemoglobin, hematocrit and iron. Before the preoperative week a preoperative correction of anemia was conducted to them, using hydroxide of iron (III) and erythropoietin. Comparative characteristics of intraoperative application of the aortal valve prosthesis in the donor’s Group A, preoperative combined correction of anemia due to chronic illnesses - in the Group C, and of the blood-preserving technologies - in the Groups B and C are adduced. The impact of intraoperative application while performing the aortal valve prosthesis of the donor’s blood components, preoperative combined correction of the chronic diseases anemia with a blood-preserving technology in conditions of artificial blood circulation without application of hemo-concentrating columns and a cell-saver apparatus on the postoperative anemia level were investigated. Results. The data obtained witness, that in Group A with the objective to stabilize the levels of hemoglobin and hematocrit intraoperatively the donor’s blood components - (568.0 ± 93.0) ml of erythrocytic mass and (596.0 ± 48.0) ml of a fresh frozen plasm were needed, what constitutes 25% of the circulating blood volume. In Group B postoperatively after the aortal valve prosthesis in accordance to the blood-preserving technology without transfusion of the donor’s blood preparations a hemoglobin level have lowered down by 19.9% (p ˂ 0.05), hematocrit - by 17.5% (p ˂ 0.05), and a thrombocytes quantity - by 24.0% (p ˂ 0.05). Correction, performed for preoperative anemia, using hydroxide of iron (III) and erythropoietin to patients, suffering anemia due to chronic diseases in Group C, have had raised a serum iron level in 6.2 times (p ˂ 0.05), ferritin - in 5.4 times (p ˂ 0.05), and hemoglobin - by 6.7%. Performance of the aortal valve prosthesis in accordance to the blood-preserving technologies in conditions of artificial blood circulation without application of the donor’s blood components in patients of Group C have stabilized a postoperative level of the serum iron, hemoglobin and the thrombocytes quantity. Conclusion. In 18% of the patients, owing the heart aortal failures, the chronic diseases anemia is observed, caused by predominantly rheumatic inflammatory illnesses with moderate anemia and hypoferritinemia. Correction of anemia of chronic diseases, using hydroxide of iron (III) and stimulation of hematopoiesis with erythropoietin in preoperative period have raised the serum iron level in 6.2 times (p ˂ 0.05), coefficient of transferrin saturation by iron - by 41.9% (p ˂ 0.05), a ferritin level - in 5.5 times (p ˂ 0.05). For the levels of hemoglobin and hematocrit stabilization while doing the aortal valve prosthesis operation in patients of Group A the donor’s blood components - (568.0 ± 93.0) ml of erythrocytic mass and (596.0 ± 48.0) ml of the fresh frozen plasm, constituting 25% of the circulating blood volume, - were applied. In the patients of Group В after performance of the aortal valve prosthesis in accordance to the blood-preserving technology the level of hemoglobin by 17.4%, the serum iron - by 15.2% and the thrombocytes quantity - by 24.0% have lowered. Preoperative correction of anemia, using hydroxide of iron (III) and stimulation of hematopoiesis, applying erythropoietin in patients of Group C, to whom the aortal valve prosthesis was done with a blood-preserving technology in conditions of artificial blood circulation without application of hemo-concentrating columns and a cell-saver apparatus, have had lowered the postoperative anemia level by 11.7% (p ˂ 0.05).

1792. Viral DNA Loads in Various Blood Components of Patients with EBV-Positive T/NK Cell Lymphoproliferative Diseases

BackgroundEpstein–Barr virus (EBV) is associated with T- and NK-cell lymphoproliferative disorders (EBV T/NK-LPD). For diagnosis of EBV T/NK-LPD, quantification of EBV DNA loads in peripheral blood by real-time PCR has been widely used. However, optimal blood components and cut-off values for diagnosis were not fully evaluated.MethodsFifty-nine patients with EBV T/NK-LPD including chronic active EBV infection (CAEBV), severe mosquito bite allergy, hydroa vacciniforme-like lymphoproliferative disorder (HV), and EBV- hemophagocytic lymphohistiocytosis (EBV-HLH) were enrolled. EBV DNA loads were compared among disease categories in each blood component from the same whole blood sample. The association between EBV DNA loads and disease activity were evaluated in CAEBV patients. Furthermore, the diagnostic cut-off value for EBV DNA loads in whole blood from CAEBV patients as compared with infectious mononucleosis patients was determined.ResultsEBV DNA loads in whole blood and peripheral blood mononuclear cells (PBMCs) were not significantly different among disease categories, whereas EBV DNA loads in plasma were significantly higher in EBV- HLH patients than in HV patients. EBV DNA loads in whole blood and PBMCs showed strong correlation (Figure 1). EBV DNA loads in plasma were significantly higher in CAEBV patients with active disease than in those with inactive disease (median: 104.5 IU/mL vs. 100.8 IU/mL, P < 0.001) (Figure 2). Diagnostic cut-off values for whole blood EBV DNA loads of CAEBV patients as compared with those of infectious mononucleosis was 104.2 ( = 15,800) IU/mL (Figure 3).ConclusionMeasuring EBV DNA loads in whole blood can be considered as initial evaluation for diagnosis of EBV T/NK-LPD. EBV DNA loads in plasma are more closely related to disease activity of CAEBV than EBV DNA loads in whole blood and PBMCs. Disclosures All authors: No reported disclosures.

A study of some blood changes for patients with urticaria

The present study aims to determine changes in some blood components in patients with urticaria, included measurement of Complete Blood Count CBC, estimate thyroid hormone levels of thyroid T3 and T4 and TSH , in addition to estimating levels of antithyroglobulin Anti-Tg in the serum of patients with urticaria reviewers health centers in the town of Khalidiya and outpatient clinics in the town of Khalidiya-Anbar and Amiriyah-Baghdad for the period from 15/1/2016 up to 15/05/2016. The results showed no significant differences for each of the red blood count RBCs and Hb concentration and platelet count PLT at the level of probability (P

Consequences of Transfusing Blood Components in Patients With Trauma: A Conceptual Model.

Transfusion of blood components is often required in resuscitation of patients with major trauma. Packed red blood cells and platelets break down and undergo chemical changes during storage (known as the storage lesion) that lead to an inflammatory response once the blood components are transfused to patients. Although some evidence supports a detrimental association between transfusion and a patient's outcome, the mechanisms connecting transfusion of stored components to outcomes remain unclear. The purpose of this review is to provide critical care nurses with a conceptual model to facilitate understanding of the relationship between the storage lesion and patients' outcomes after trauma; outcomes related to trauma, hemorrhage, and blood component transfusion are grouped according to those occurring in the short-term (≤30 days) and the long-term (>30 days). Complete understanding of these clinical implications is critical for practitioners in evaluating and treating patients given transfusions after traumatic injury.

Blood Transfusion and Increased Perioperative Risk in Coronary Artery Bypass Grafts.

ObjectiveTo correlate blood transfusions and clinical outcomes during hospitalization in coronary artery bypass grafting surgery (CABG).MethodsTransfusion, clinical and hematological data were collected for 1,378 patients undergoing isolated or combined CABG between January 2011 and December 2012. The effect of blood transfusions was evaluated through multivariate analysis to predict three co-primary outcomes: composite ischemic events, composite infectious complications and hospital mortality. Because higher risk patients receive more transfusions, the hospital mortality outcome was also tested on a stratum of low-risk patients to isolate the effect of preoperative risk on the results.ResultsThe transfusion rate was 63.9%. The use of blood products was associated with a higher incidence of the three coprimary outcomes: composite infectious complications (OR 2.67, 95% CI 1.70 to 4.19; P<0.001), composite ischemic events (OR 2.42, 95% CI 1.70 to 3.46; P<0.001) and hospital mortality (OR 3.07, 95% CI 1.53 to 6.13; P<0.001). When only patients with logistic EuroSCORE ≤ 2% were evaluated, i.e., low-risk individuals, the mortality rate and the incidence of ischemic events and infectious complications composites remained higher among the transfused patients [6% vs. 0.4% (P<0.001), 11.7% vs. 24,3% (P<0.001) and 6.5% vs. 12.7% (P=0.002), respectively].ConclusionThe use of blood components in patients undergoing CABG was associated with ischemic events, infectious complications and hospital mortality, even in low-risk patients.

How do we transfuse blood components in cirrhotic patients undergoing gastrointestinal procedures?

The liver plays a pivotal role in hemostasis. Consequently, patients with cirrhosis frequently demonstrate abnormal coagulation profiles on routine laboratory tests. These tests mainly reflect decreased procoagulant proteins. However, in cirrhosis, complex changes also occur in anticoagulant and fibrinolytic pathways. Recent evidence demonstrates that patients with cirrhosis exist in a state of hemostatic rebalance. Accordingly, routine tests inadequately represent hemostatic alterations in these patients. Unfortunately, these tests are regularly used to guide the transfusion of blood components with the assumption that they will correct laboratory abnormalities and improve hemostasis in a bleeding patient or prevent excessive bleeding following a procedure. With an absence of both accurate laboratory testing to assess hemostasis and evidence-based guidelines to direct the transfusion of blood components, management of patients with cirrhosis poses a significant challenge to clinicians. Therefore, we developed multidisciplinary guidelines for the periprocedural transfusion of blood components in patients with cirrhosis based on concurrent evidence and personal experience at our medical center.

Blood redox state and survival in patients with rectal cancer

&lt;p&gt;The cells of an organism have a definite concentration of electrons that characterizes their stable redox status. Electrons are transported to the oxygen and create the potential energy to realize the cell functions such as growth&lt;br /&gt;and apoptosis. Imbalance in the redox state of cells initiates the development and progression of the most socially significant pathologies. The aim of the research was to study the blood redox state in patients with rectal cancer (RC ) (the levels of ceruloplasmin (CP), transferrin (TF) and “free iron” (“FI”), superoxyd-, NO-generating activity of neutrophils and platelets) and its impact on оverall survival (ОS ). Venous blood samples of 60 patients with RC (T2-4N0-2M0G2) and 20 donors were studied. The defining levels of CP, TF, “FI” in blood was performed by electron paramagnetic resonance (EPR) at the temperature of liquid nitrogen (T=77 K ). The blood redox state in patients with RC are formed by: 2 times reduced CP activity in comparison with the&lt;br /&gt;reference sample; 3 times reduced TF content and 10 times increased “FI” levels; slightly increased superoxide generating activity of neutrophils and 8–14 times increased superoxide generating activity of platelets; 3.7 and 4.3 times reduced NO generation rate of neutrophils and platelets, respectively. It was found that the survival in patients with RC was significantly influenced by the level of CP activity (p&amp;lt;0.044), levels of “FI” (p&amp;lt;0.026), superoxide generating activity of NADP·H-oxidase of neutrophils (p&amp;lt;0.043). It was found that the adenocarcinoma progression in patients with RC (T2-4N0-2M0G2) was ccompanied bychange in the blood redox state by reducing CP activity and level of TF that led to the emergence of “FI” and the increase of its level. Besides, the changes of superoxyde- and NO-generating activity NADP∙H-oxidase and iNOS of neutrophils and platelets significantly influenced the imbalance of the blood redox state in the patients. The state of redox forming blood components in patients correlated with the оverall 5-year survival. It was found that the CP&lt;/p&gt;&lt;p&gt;activity, the “FI” level and the superoxide-generating activity of NADP·H-xidase of neutrophils and platelets hadsignificant effect on ОS .&lt;/p&gt;

Médecine transfusionnelle : au-delà de l’apport de facteurs déficitaires

Blood transfusion frequently consists in bringing blood components in patients presenting with global deficiency of cells or of certain factors allowing, i.e. hemostasis or oxygenation; transfusion is thus performed on a short period, or on a period that corresponds to the recovery of the bone marrow (that is deficient either quantitatively or qualitatively). In some other circumstances, patients must receive transfusions as the one treatment of their pathology; this can be for life, when the deficiency has a genetic origin, or episodically in the case of autoimmune disorders. Once hemotherapy is initiated, one must appreciate the balance between the benefits and the risks or overload, and adjust with subtractions and exchanges (of blood components). This paper presents examples of two cases: hemotherapy in sickle cell patients, and patients undergoing plasma exchange programs.

Blood Banking and Transfusion Medicine for the Nephrologist

Therapeutic Apheresis Medicine Services work closely with Blood Banking and Transfusion Medicine Services (BBTMS). The BBTMS performs patient testing and provides blood components for patients undergoing therapeutic apheresis procedures. This article will provide an overview of blood component descriptions, patient testing, and blood component options and preparations for therapeutic apheresis procedures.

Transfusão de concentrado de hemácias na unidade de terapia intensiva

The anemia is a common problem upon admission of the patients in the intensive care unit being the red blood cell transfusion a frequent therapeutic. The causes of anemia in critical patients who under go red blood cell transfusion are several: acute loss of blood after trauma, gastrointestinal hemorrhage, surgery amongst others. Currently, few studies are available regarding the use of blood components in patients at intensive care unit. Although blood transfusions are frequent in intensive care unit, the optimized criteria for handling are not clearly defined, with no available guidelines. To analyze the clinical indications of the use of the red blood cell in the intensive care unit. The clinical history of the patients admitted in the intensive care unit were analyzed, revisiting which had have red blood cell transfusion in the period between January 1st 2005 and December 31 2005. The study was accepted by the Research Ethics Committee - Comitê de Ética em Pesquisa (CEP) - of the University of South of Santa Catarina (UNISUL). The transfusion rate was 19,33, and the majority of the patients were of the male gender. Their age prevalence was of 60 years old or older. The mortality rate among patients who under went red blood cell transfusion died was of 38,22%. The transfusions criterias were low serum hemoglobin (78%) and the hemoglobin pre - transfusion was 8,11 g/dL. Politrauma and sepsis/sepsis chock were the pre diagnosis criteria. A low hemoglobin level is the main clinical criteria with average hemoglobin pre - transfusion was 8,11 g/dL.

Gesundheitsökonomische Aspekte der Anwendung von Blut- und Plasmaprodukten

An adequate supply of blood components for patients depends on the population's willingness to donate blood as well as on a well-organized blood donation system. In order to ensure the blood supply, a high expenditure is necessary. The article at hand describes two areas of the use of blood and blood products. First, it considers the application of factor concentrates in haemophiliacs (approximately 3000-4000 patients are regularly in need of treatment). For the German statutory health insurance, the estimated yearly expenses for factor concentrates is approx. 450 million Euros, the average costs per patient and year and per treatment center range between 40,903 and 117,597 Euros. The costs for an immune tolerance therapy (ITT) for patients with inhibitors are estimated to be between 70,300 and 3,800,000 Euros for children, depending on the length of the therapy and the degree of severity. In the second part of the article, the authors outline the status quo of the economic evaluation of cellular blood products and present the results of a German cross-sectional survey on the use of erythrocytes in orthopaedic surgery. Within the scope of this hemotherapy study, the transfusion rates vary considerably within the participating treatment centers [elective hip joint replacement (THR): 17 and 94%]. The average blood loss also differs significantly. Comparing the treatment centers, the calculated blood loss during THR shows considerable differences (median blood loss in treatment center with lowest/treatment center with highest blood loss: 883 ml/2,975 ml). The acceptance of low intraoperative hemoglobin values in the clinics is high and diverse. These differences in transfusion procedures between the treatment centers clearly show the need to take effective action in the area of quality assurance in order to make the most of the existent savings potential. Transparency of treatment processes is a necessary condition for an economic assessment and for optimal resource allocation.

Ongoing Variability in Transfusion Practices in Cardiac Surgery Despite Established Guidelines.

Although blood utilization has been under considerable scrutiny for the past two decades, particularly for surgery, the international evolution of standards remains unknown. Therefore, the objective of this study was to compare the perioperative transfusion of blood components in patients undergoing coronary artery bypass graft (CABG) surgery in different countries. Transfusion practice was investigated prospectively among 16 countries (70 centers). Five-thousand sixty-five (5,065) randomly selected cardiac surgery patients in the Multicenter Study of Perioperative Ischemia Epidemiology II (EPI II) Study were evaluated. Utilization of red blood cells, fresh frozen plasma, and platelets was assessed by day, prior to, during and after surgery until hospital discharge. Intraoperative red blood cell (RBC) transfusion varied from 9 percent to 100 percent among the 16 countries, and 25 percent to 87 percent postoperatively (percent of transfused patients). Similarly, transfusion of fresh frozen plasma (FFP) varied from 0 percent to 98 percent intraoperatively and 3 percent to 95 percent postoperatively, and platelet (PL) transfusion from 0 percent to 51 percent and 0 percent to 39 percent, respectively. An analysis of the EuroSCORE (an internationally validated risk evaluation system for cardiac surgery) risk indices of the countries with the highest and lowest frequencies of use or amounts of each of type blood product failed to demonstrate a correlation between EuroSCOREs and maximum vs minimum frequency of use or amount of blood product administered. Establishment of international guidelines for utilization of blood products in CABG surgery appears necessary.

Transfusão de concentrado de hemácias em Unidade de Terapia Intensiva

HISTÓRIA E OBJETIVOS: A indicação de transfusão sangüinea em pacientes criticamente enfermos é complexa e pode ser influenciada por muitos fatores. Embora seja prática freqüente, poucos estudos são disponibilizados sobre o uso de sangue e hemocomponentes em pacientes sob cuidados intensivos. O objetivo deste trabalho é analisar a taxa e a incidência-densidade de transfusão de concentrado de hemácias (CH) na Unidade de Terapia Intensiva (UTI) do Hospital Universitário Prof. Polydoro Ernani de São Thiago (HU/UFSC), bem como descrever os critérios clínicos utilizados e os valores de hemoglobina pré-transfusionais. MÉTODOS: Foram selecionados os pacientes admitidos na UTI do HU/UFSC entre janeiro de 2003 e dezembro de 2004. RESULTADOS: Dos 654 pacientes analisados, 108 (16,51%) receberam transfusão de CH, com incidência-densidade de 3,80 por 100 pacientes-dia. O CH foi o hemocomponente mais utilizado, com um total de 257 eventos transfusionais e 549 unidades. Baixo nível de hemoglobina foi o critério mais utilizado (58%). Valores de hemoglobina pré-transfusional inferiores a 7,0 g/dL foram verificados em 51,75% das transfusões. INTERPRETAÇÃO E CONCLUSÕES: Nos últimos 15 anos, diversos autores analisaram taxas de transfusões de CH em UTIs, encontrando percentuais entre 19% e 85%. Atualmente, em pacientes criticamente enfermos, recomendam-se transfusões quando os níveis de hemoglobina são inferiores a 7,0 g/dL e evitam-se quando são superiores a 10,0 g/dL. Na UTI do HU/UFSC, o hemocomponente mais utilizado é o CH, com percentuais inferiores aos de UTIs de outras instituições. Baixa concentração de hemoglobina com valor pré-transfusional inferior a 7,0 g/dL é o principal critério de indicação.

Use of NovoSeven® in cases with massive bleeding following surgery with extracorporeal circulation

Bleeding complications still remain a real problem in patients undergoing long-time surgery with extracorporeal circulation. In these cases a large hemotransfusion is needed and the usual sequence with postoperative multiorganic failure affecting patient outcome. Recombinant activated factor VII (rFVIIa; NovoSeven®, Novo Nordisk A/S, Bagsvaerd, Denmark) was used in 15 patients undergoing open heart surgery or surgery for aorta and aortic arch aneurysms. All patients had normal coagulation parameters before surgery. In these patients massive bleeding (10–20 ml/min) have developed during intraoperative or early postoperative periods, but bloodloss rate have minimal reduction, despite infusions of fresh frozen plasma, cryoprecipitate plasma, platelet concentrate, Trasilol and e-aminocapronic acid. After one-time recombinant FVIIa NovoSeven administration (the dose of rFVIIa ranged between 60 and 90 mg/kg body weight), bleeding disappeared in 14 patients. In one patient the bloodloss rate had been decreased from 20 to 5.5 ml/min and then repeated NovoSeven administration (90 mg/kg body weight) stopped the bleeding and simultaneously stabilized some hemocoagulating parameters. rFVIIa (NovoSeven®) may be used to effective treatment massive bleeding and to reduce the amount of transfused blood components in patients undergoing long-time surgery with extracorporeal circulation.

HGV/GB virus C transmission by blood components in patients undergoing open-heart surgery.

To establish the rate of HGV/GB virus C (GBV-C) transmission by blood components in open-heart surgery patients. From 55 patients receiving blood components, sera were collected before and 2, 4, 6, 8, 10, 12, 16, 20, 26, and 32 weeks after heart surgery. Serum samples from patients and implicated blood donations were tested for HGV/GBV-C RNA by PCR. Recipients of RNA-positive blood components were also tested for the presence of E2 antibodies (E2Ab) by ELISA. Of 55 recipients, 18 received RNA-positive blood components. Of 14 recipients of RNA-positive blood components, who were negative for RNA or E2Ab before transfusion, 8 became RNA positive and one developed E2Ab after transfusion. Three recipients of RNA-positive blood components had E2Ab before transfusion, and none of these became RNA positive after transfusion. One of 18 recipients was RNA positive before and after transfusion. Of 55 recipients, 37 received RNA-negative blood components: 34 were RNA negative before and after transfusion. Of 37 recipients, 3 were RNA positive before and after transfusion. Of susceptible patients, 64 percent became infected with HGV/GVC-C when transfused with RNA-positive blood components. E2Ab-positive patients were protected against HGV/GBV-C infection.

HGV/GBV-C transmission by blood components in patients undergoing open-heart surgery

HGV/GBV-C transmission by blood components in patients undergoing open-heart surgery

Intraoperative use of platelet-plasmapheresis in vascular surgery

Study Objective: To determine, in a pilot study, whether pheresis of plasma and platelets before surgical blood loss, with reinfusion of the autologous plasma and platelets after completion of the aortic reconstruction, will result in decreased bleeding and decreased transfusion of allogenic blood components in patients undergoing elective aortic reconstruction. Design: Randomized study. Setting: University medical center. Interventions: Patients were randomized to perioperative (acute) platelet plasmapheresis (APP group) versus conventional blood component therapy (control group). In the APP group, blood was withdrawn after induction of anesthesia, to sequester approximately 300 mL of platelet rich plasma (PRP); platelet poor plasma (PPP) and red blood cells (RBC) were sequestered as well. An autotransfusion device was used to collect and re-infuse autologous RBC during the course of the operation in both groups. After completion of the aortic reconstruction, autologous PRP and PPP were re-infused in the APP group. Blood loss, volume of blood component transfusions, and preoperative and postoperative hemoglobin (Hb), hematocrit (Hct), platelet, international normalized ratio (INR), and activated partial thromboplastin time (aPTT) were recorded. Measurements and Main Results: There was no difference between groups in demographics, preoperative laboratory values, or surgical procedures, although more patients were treated for aneurysms (73% vs . 60%) and fewer for occlusive disease (20% vs . 40%) in the control versus APP group. Also, there were no differences between the control and APP groups in duration of operation, blood loss, volume of colloid infused, or volume of allogenic RBC and plasma transfused. Patients in the APP group received a greater volume of crystalloid solution (9.1 ± 3.4 L vs. 6.8 ± 3.0 L; p = 0.002), but fewer units of allogenic platelets than the control group (0.7 ± 1.0 units vs . 0.2 ± 0.4 units; p < 0.04). There were no differences in postoperative Hb, Hct, INR, aPTT, or fibrinogen. The platelet count was lower in the APP group than in the control group (123 ± 40 × 10 3 / mm 3 vs. 182 ± 51 × 10 3 / mm 3 ; p = 0.004). Conclusions: Perioperative platelet plasmapheresis led to fewer allogenic platelet transfusions in patients undergoing elective aortic reconstruction. However, there was no decrease in blood loss and no reduction in transfusion of allogenic RBC or plasma. Perioperative platelet plasmapheresis is not recommended for routine use in elective aortic reconstruction.

The use of blood components in patients with malignancy.

AbstractMany recent improvements in the management of patients with malignancy would have been impossible without parallel improvements in our ability to support patients through periods of severe bone marrow aplasia produced by the disease or aggressive therapy of the disease. The purpose of this article is to review the use of transfusion of platelets, erythrocytes, and granulocytes in the treatment of these patients.