Transfusion Of Blood Products Research Articles

The effect of the proportion of low-titer O whole blood for resuscitation in pediatric trauma patients on 6-, 12- and 24-hour survival.

Hemorrhage is a leading cause of death in pediatric patients. Accumulating data suggest that low-titer group O whole blood (LTOWB) improves clinical outcomes in the pediatric population. We examined what ratio of LTOWB to total blood product conferred a survival benefit in transfused pediatric trauma patients. We retrospectively examined a cohort of injured subjects younger than 18 years from the Trauma Quality Improvement Program database who received any quantity of LTOWB and no documented prehospital cardiac arrest. We created a variable representing the volume of transfused LTOWB divided by the total volume of all transfused blood products administered within the first 4 hours of admission, that is, the proportion of LTOWB transfused. We analyzed increasing proportions of transfused LTOWB to determine whether there was an inflection point conferring increased survival. From 2020 to 2022, 1,122 subjects were included in the analysis. The median (interquartile range) age was 16 (14-17) years. Firearms were the most common mechanism at 47% followed by collisions at 44%. The median composite injury severity score was 25 (16-34). Survival was 91% at 6 hours, 89% at 12 hours, and 88% at 24 hours. We noted an inflection point with improved survival at an LTOWB proportion of ≥30% of total volume of blood products received. The odds of survival at 6, 12, and 24 hours for those receiving ≥30% LTOWB was 1.85 (1.02-3.38), 2.09 (1.20-3.36), and 1.80 (1.06-3.08), and 3.55 (1.66-7.58), 3.71 (1.89-7.27), and 2.69 (1.44-5.02) when excluding those who died within 1 hour, respectively. Among LTOWB recipients, we found that a strategy of using LTOWB comprising at least 30% of the total transfusion volume within the first 4 hours was associated with improved survival at 6, 12, and 24 hours. Therapeutic/Care Management; Level III.

Coagulation and platelet function in cold-stored whole blood on missions in a helicopter emergency service.

Haemorrhage is a leading cause of morbidity and mortality in trauma, and prehospital transfusion of blood products is often necessary. Whole blood has been proposed to be the best alternative, but it is unclear whether, and how, storage and transport of the blood in a helicopter affects the blood units. We investigated the coagulation capacity and platelet function in whole blood at different time points during helicopter missions. Twenty units of low-titre group O RhD negative whole blood were collected from healthy volunteers and analysed before, during and after transport in a helicopter. Coagulation and platelet function, as measured by thromboelastography, and blood samples for pH, electrolytes, glucose and lactate were assessed at baseline and 24, 72 and 168 h after storage in the helicopter. Plasma concentrations of coagulation factors and haemoglobin and blood counts were measured at baseline and after 168 h. Plasma concentrations of coagulation factors and haemoglobin did not change during storage and transport. Platelet counts decreased from a baseline mean of 172 ± 29 × 109/L to a mean of 120 ± 28 × 109/L after 168 h, and platelet function worsened slightly but significantly by 8%-9% during storage and transport. pH and glucose decreased while potassium and lactate levels increased after 168 h compared with baseline. Storage and transport of whole-blood units in a rescue helicopter, for up to 168 h, had a slight impact on the blood quality. Storage of whole blood on board of the helicopter holds up to European standard, measured as temperature and haemolysis.

Rotational Thromboelastometry Guided Transfusion Protocol Versus Classic Transfusion Protocol in Reducing Blood Components Transfusion in Adult Patients Undergoing Elective Cardiac Surgery: A Randomized Clinical Trial

Aim: This study assessed the role of rotational thromboelastometry (ROTEM)-guided transfusion protocol in reducing blood product transfusion during cardiac surgeries. Methodology: This randomized, single-blind trial enrolled 32 patients who were randomized to receive either the ROTEM-guided transfusion protocol or the classic transfusion protocol. The primary outcome was the need for blood component transfusion after bypass and during the initial 24 postoperative hours. Secondary outcomes included residual heparin after reversal with protamine and blood loss postoperatively during the first 24 hours. Results: While differences in red blood cell transfusions post-bypass and within the first 24 hours postoperatively were observed, they were statistically non-significant. Fresh frozen plasma (FFP) transfusions differed post-bypass, without statistical significance. However, the ROTEM group had a statistically significant reduction in FFP units within the first 24 hours postoperatively (P<0.001). The number of platelet units transfused in the initial 24 hours postoperatively showed a difference between both groups, but it was statistically non-significant. However, ROTEM significantly reduced platelet use post-bypass (P<0.001). Blood loss also differed between groups but was statistically non-significant. Conclusions: The application of ROTEM-guided transfusion protocol reduces blood product transfusion (FPP and platelets) in patients undergoing elective cardiac surgery on cardiopulmonary bypass.

Quality of registration and adherence to guidelines for blood management in CABG surgeries: a case study

In many hospitals, patients undergoing cardiac surgery receive a higher amount of blood products transfusions compared to other disciplines. Blood transfusion comes with risks and drawbacks, such as increased morbidity and mortality across different patient groups, and specifically patients undergoing cardiac surgery, and high costs. Patient Blood Management (PBM) practices focus on the application of evidence based medical and surgical concepts in order to preserve the patient’s own blood. Unfortunately, studies suggest that only a small fraction of published guidelines are implemented and followed into daily clinical practicedue to clear guidance, concerns about risks, and lack of knowledge, interdisciplinary commitment or resources. The widespread adoption of electronic health record (EHR) offers the opportunity to improve clinical outcomes through use of decision support system to guide the healthcare providers through best practices and guidelines. Decision support systems can be active, data-based, patient-specific and act timely, and can be more useful that adding new clinical practice guidelines. This case study quantifies the quality of the data registration and provides the results for adherence to perioperative PBM guidelines for coronary artery bypass grafting (CABG) procedures during a three-year period (2018 to 2020), in the St. Antonius hospital, a single heart center that performs over 10% of the total number of heart operations in the Netherlands. With this case study we identify some of the possible improvement factors for PBM in our center. We also quantify the impact of the quality of the registration in the EHR on the analysis results and on possible implementation of decision support systems.

Association of Subcapsular Liver Hematoma With Preeclampsia, Eclampsia, or Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome.

To describe the presentation, outcomes, and management strategies for cases of subcapsular liver hematoma associated with preeclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. This was a case series of individuals with subcapsular liver hematoma managed at a single level IV center over a 10-year period, from 2013 to 2024. Presenting signs and symptoms, laboratory findings, time of onset, management strategies, acute perinatal and maternal outcomes, and long-term outcomes such as subsequent pregnancies were reviewed in the medical record and recorded. Data were summarized using descriptive statistics, with results reported as means, standard deviations, and ranges. Categorical variables were summarized as counts and percentages. There were 13 cases of subcapsular liver hematoma associated with preeclampsia, eclampsia, and HELLP syndrome between 2013 and 2024. In 10 of the 13 pregnancies (76.9%), delivery was preterm. The most common presenting symptoms were epigastric or right upper quadrant pain (53.8%), followed by abdominal distention (38.5%). Diagnosis of subcapsular liver hematoma was made in the antepartum period for six patients and was made in the postpartum for seven patients. The diagnosis was confirmed in all cases by computed tomography. Conservative management with close hemodynamic monitoring and transfusion of blood and blood products was sufficient in 11 (84.6%) patients; two patients underwent surgical exploration. The mean duration of hospital stay was 10 days (range 2-21 days). Maternal complications included pleural effusions, acute kidney injury, and pulmonary edema. There were no maternal deaths. There were four stillbirths and no neonatal deaths. Four people had five subsequent pregnancies; delivery was preterm in all five pregnancies, two pregnancies were complicated by subsequent HELLP syndrome, and one patient developed recurrent subcapsular liver hematoma. Subcapsular liver hematoma is a rare complication of preeclampsia, eclampsia, and HELLP syndrome that is associated with substantial maternal and perinatal morbidities. Conservative management with hemodynamic monitoring and transfusion of blood and blood products was sufficient for management in the majority of cases. All subsequent pregnancies resulted in preterm births.

The carbon footprint and energy consumption of liver transplantation.

There is growing interest in the environmental impact of surgical procedures, yet more information is needed specifically regarding liver transplantation. This study aims to quantify the total greenhouse gas emissions, or carbon footprint, associated with adult whole-size liver transplantation from donors after brain death, including the relevant back-table graft preparation. The carbon footprint was calculated retrospectively using a bottom-up approach. This approach sums the volumes of energy consumption (kWh), volatile anesthetics (ml), solid waste (kg), and units of blood products transfused for each transplant. These consumption values were converted using validated conversion factors to the equivalent mass of carbon dioxide released into the environment (kg CO2e). A total of 147 patients with a mean age of 55 years (male, 78.9%) who underwent liver transplants between 2021 and 2022 were analyzed, resulting in 45.5 tons CO2e. The mean (SD) carbon footprint for each procedure was 309.8 (33.2) kg CO2e [95% CI: 304.4; 315.3]. Total energy power consumption was 96.5 MW, contributing 65.4% of greenhouse emissions (29.8 tons CO2e), while volatile anesthetics, solid waste, and blood product transfusions contributed 8.0% (3.64 tons CO2e), 5.9% (2.7 tons CO2e), and 20.6% (9.4 tons CO2e), respectively. The duration of surgery (t = 29.0; p < 0.001), transfused red blood cells (t = 13.1; p < 0.001), fresh frozen plasma (t = 11.1; p < 0.001), platelets (t = 8.9; p < 0.001), and the use of an extracorporeal pump machine (t = 3.6; p < 0.001) had the greatest effects on greenhouse gas emissions. Liver transplantation requires significant energy and is associated with considerable greenhouse gas emissions, particularly during longer procedures. Transplant clinicians, hospital administrators, policymakers, and patients should be aware of the environmental impact of liver transplantation and collaborate to adopt sustainable energy practices.

Prevalence of Malaria among Newborns at the Markala CSRef

Malaria is a serious and potentially fatal parasitic infectious disease caused by several species of parasite belonging to the Plasmodium genus. The female Anopheles injects the parasite into humans in the form of a "sporozoite". This rapidly migrates via the bloodstream to the liver. Transmission can occur through mother-to-child transmission and transfusion of infected blood products. Objective: To study the prevalence of malaria among newborn babies in the paediatric ward of the CSRéf in Markala. Methodology: Cross-sectional, retrospective, descriptive study from 1st January to 30th December 2023. Results: The mean age at admission was 03 to 07 days and 08 to 14 days of life. The sex ratio was in favour of males (51%). The overall result for the prevalence of malaria according to the means of biological diagnosisused was 0.62% for the RDT compared with 56.52% for the GE. The weight range where the RDT was positive was weights over 3.5kg. The results for congenital malaria were 0% for RDT and 60% for GE. The sex-ratio was in favour of males (51%). The age range at admission was 3 to14 days. The highest number of cases was observed in the month of May. The overall prevalence of congenital malaria including the total number of babies with cord blood parasitaemia and peripheral blood parasitaemia was 18.6% and 56.8% respectively using microscopy and real-time PCR. The frequency of cases of submicroscopic congenital malaria (negative on thick blood smear and positive on PCR) was 12.2%). Theaverageadmissionweightofnewbornswas2.9kg+/-0.9andtheaveragebirthweightwas2,319g(160.03)and 83 (81.4%). Conclusion: Congenital and neonatal malaria is a public health problem in a malaria-endemic country such as Mali. We note a difference in diagnosis according to the different biological means of diagnosis (RDT and EW). Newborns showing signs of suspected sepsis should be screened and treated early.

Transfusion Rates in Free Flap Breast Reconstruction Patients: A Single-Centre Experience.

Background Previous studies have demonstrated low transfusion rates in breast reconstruction with deep inferior epigastric perforator (DIEP) flaps. We often employ the transverse upper gracilis (TUG) flap; however, perioperative transfusion rates have not previously been studied in this group. Due to the different dissection and exposure required, transfusion rates may vary. We aim to ensure that perioperative resource use is appropriate and efficient, particularly group and save (G&S) sampling preoperatively. The objective of this study is to quantify transfusion rates in all patients undergoing free flap-based breast reconstruction and to determine the necessity of preoperative G&S sampling. Methods We retrospectively reviewed the electronic patient records, the electronic transfusion system, operation notes, and prescription records of all patients undergoing breast reconstruction using free-flap tissue transfer over one year. We identified transfusion of red blood cells and the current practice of perioperative G&S sampling in this patient group. These data were analysed using descriptive statistics. Results Of the 124 patients undergoing breast reconstruction with a free flap, a DIEP-based flap was deployed in 105, and a TUG flap in 14; in the remaining five, a selection of other flaps were utilised. Three patients required transfusion of blood products during their admission (2.4%), all after DIEP flap-based reconstructions. All received two units of packed red blood cells, with one transfusion on each of days one to three postoperatively. The indication for all three was slow but ongoing bleeding with low haemoglobin (less than 80 g/L) on routine full blood count. All recovered well following this. We found a low rate of transfusion in patients undergoing free flap breast reconstruction, with only three of 124 requiring transfusion (2.4%), all DIEP flaps. In addition to the published literature regarding DIEP flaps, we also include several TUG flaps in this cohort and several other flap types. None of the three transfusions were emergent in nature; all were completed with fully cross-matched blood according to local protocols. Conclusion We recommend that preoperative G&S sampling is not routinely necessary for patients undergoing free flap breast reconstruction. Preoperative G&S should be considered for those with a risk of atypical anti-red cell antibodies (for example, if previously transfused or pregnant), as cross-matched blood may take several days to be made available. We expect this judicious use of G&S sampling to significantly reduce costs and laboratory resource use without a significant effect on the use of emergency red cell units.

Splenic vein rupture in pregnancy: A case report and systematic review of the literature.

Splenic vein aneurysm (SVA) rupture is a rare clinical entity, with few case reports detailing its occurrence during pregnancy. We describe a case of a SVA rupture and present a systematic review of the literature in relation to splenic vein rupture, with or without aneurysm. Our case was of a 30-year-old woman, Para 4 at 37 weeks' gestation who presented with significant abdominal pain and subsequent maternal collapse. Massive intra-abdominal hemorrhage was identified, with splenic vessel rupture suspected. A splenectomy and partial pancreatectomy were performed along with massive blood product transfusion. There was both maternal and fetal survival with no long-term sequelae at follow-up. Histological examination of the spleen and its vessels noted a SVA rupture. In a subsequent systematic review of the literature, we identified 10 cases of splenic vein rupture with only two previously documented cases of SVA rupture in pregnancy. Maternal and fetal survival has only been reported in two cases of splenic vein rupture, with ours being a third.

Preoperative coagulopathy and blood transfusion requirements in children with intraventricular lesions undergoing neurosurgery: a retrospective cohort study.

Pediatric patients undergoing neurosurgery pose risk of perioperative hemorrhage and clotting dysfunction which is increased in tumors with high vascularity, endothelial exposure, and necrosis. Lesions affecting the ventricular system may arise from several etiologies, including rare tumors. The present study aimed to study the preoperative coagulation and transfusion profile of pediatric patients undergoing neurosurgery for intraventricular lesions. A retrospective study of all paediatric patients who underwent surgery for intraventricular lesion was included from June 2014 to June 2022. Demographic data, preoperative and postoperative investigations, intraoperative blood loss, blood product transfusion, and duration of surgery were noted. Postoperative outcomes were also assessed. A total of 98 patients underwent surgery, the median age was 11.1years (1.0 to 17.0), with a male predominance (50.9%). The median blood loss during surgery was 500mL (300-812.5). The incidence of preoperative coagulopathy was 30.7%. The intraoperative packed blood cell and fresh frozen plasma transfusion requirement was noted in 50.9% and 5%, respectively. The median ICU stay and hospital stay was 6days (3-10) and 14days (4-77), respectively. The mortality rate in the study population was 7.7%. This study highlights the multifactorial nature of perioperative blood loss and transfusion requirements in pediatric patients undergoing surgery for intraventricular lesions. Factors such as tumor histopathology, preoperative hemoglobin levels, and surgical duration play a crucial role in determining transfusion needs.

Transforming the logistics of liver transplantation with normothermic machine perfusion: Clinical impact versus cost.

Normothermic machine perfusion (NMP) facilitates utilization of marginal liver allografts. It remains unknown whether clinical benefits offset additional costs in the real-world setting. We performed a comparison of outcomes and hospitalization costs for donor livers preserved by NMP versus static cold storage (SCS) at a high-volume center. Adult patients receiving deceased donor liver transplants preserved by either NMP (TransMedics Organ Care System) or SCS between January 1, 2021-December 31, 2023 were included. Donor and recipient characteristics, operative parameters, post-transplant outcomes, and hospitalization costs were compared. A total of 144 NMP and 149 SCS cases were included. A higher proportion of NMP cases were DCD (38.2% vs. 4.7%, p<0.001). Despite significantly higher LDRI (2.1 vs 1.7, p<0.001) and longer preservation time, (877 min vs. 355 min, p<0.001), NMP recipients experienced lower rates of reperfusion syndrome (4.3% vs 32.9%, p<0.001), less blood loss (1.5 L vs. 3.0 L, p<0.001), and required less blood product transfusion. This resulted in shorter operative time for NMP cases (357 min vs 438 min, p<0.001) and significant reductions in both ICU (3 days vs. 5 days, p=0.005) and hospital length of stay (11 days vs. 13 days, p=0.03). NMP facilitated the transition of cases to daytime hours (88.9% vs 46.3%, p<0.001). Despite the clinical and logistical benefits observed, index hospitalization costs were significantly higher in the NMP cohort ($256,810 vs. $209,144, p<0.001), driven largely by higher organ acquisition costs ($135,930 vs $50,940, p<0.001). In conclusion, utilization of NMP comes with an attendant increase in cost but provides substantial clinical benefit. Transplant programs must weigh these considerations in their practice environments before initiating an NMP program.

Impact of Preoperative Platelet ADP/P2Y12 Receptor Antagonist Management in Patients Undergoing Elective Isolated Coronary Artery Bypass Grafting

Background: Postoperative bleeding remains an important issue in patients undergoing coronary artery bypass grafting (CABG), being associated with blood product transfusions (BPT) and re-exploration. Since 2020, We have implemented a strict preoperative antithrombotic, specifically platelet ADP/P2Y12 receptor antagonist, management based on the results of a previous study of our institution. The objective of the present study was to assess its impact on clinical outcomes. Methods: Patients who underwent elective isolated CABG between 2017 and 2022 at the Catharina Hospital Eindhoven were included and divided into two groups, based on whether they were treated according to the modified antithrombotic management. The primary endpoints were perioperative BPT and re-exploration for bleeding. Secondary endpoints included length of hospital stay, in-hospital stroke, myocardial infarction (MI) and 30-day mortality. Propensity score matching was performed to compare outcomes of both cohorts. Results: A total of 1506 patients were included, of which 1064 belonged to the first historical cohort. The remaining 442 patients (second cohort) were treated according to the modified management. In the 439 matched pairs, the implementation of the strict protocol was associated with a reduced incidence of blood product transfusions (14.8% vs. 24.1%, p = 0.001) and a shorter length of hospital stay (5 [interquartile range (IQR) 4–6] days vs. 6 [IQR 5–7.5] days, p &lt; 0.001), whereas the incidence of postoperative MI and stroke did not differ. Re-exploration for bleeding was less frequently observed in the second cohort (1.4% vs. 3.6%, p = 0.052). Conclusions: The implementation of the modified strict preoperative ADP/P2Y12 antagonist management resulted in decreased incidence of blood product transfusions, shorter hospital stay and a clinically relevant decreased rate of re-exploration for bleeding.

Exploring the Association between Allogenic Blood Transfusion and Postoperative Infection Risk Following Intracranial Surgery: A Retrospective Cross-Sectional Analysis

Abstract Background Neurosurgical procedures pose a heightened risk of bleeding, often necessitating blood or blood product transfusions. However, allogenic blood transfusion has various adverse consequences, including the transmission of blood-borne infection and immune consequences. While multiple studies have indicated an increased incidence of postoperative infections among patients receiving allogenic blood transfusions, these investigations have primarily focused on non-neurosurgical populations. Therefore, this retrospective study aimed to explore the relationship between blood transfusions and the occurrence of postoperative infections in patients undergoing intracranial surgery for tumors and cerebral aneurysms. Methods All American Society of Anesthesiologists (ASA) class I to III patients who underwent intracranial surgery (tumors—supratentorial and infratentorial, aneurysm—anterior and posterior circulation) during 3 years (January 2017–December 2020) were included in the study. Results A total of 240 patients met the inclusion criteria. Perioperative blood transfusion was observed in 103 patients (42.9%). Postoperative infections were observed in 34 patients (14.16%). It was observed that the odds of developing a postoperative infection were 3.37 (p &lt; 0.001) times higher if the patient received a blood transfusion. Conclusion There exists a robust correlation between perioperative blood transfusion and the subsequent postoperative infection following craniotomy.

In COVID-19 Patients Supported with Extracorporeal Membrane Oxygenation, Intensive Care Unit Mortality Is Associated with the Blood Transfusion Rate.

Background: The COVID-19 pandemic markedly increased the number of patients with infection-related acute respiratory distress syndrome who required extracorporeal membrane oxygenation (ECMO) and multiple blood transfusions. This study aimed to assess a potential correlation between the daily rate of transfused blood products and the intensive care unit (ICU) outcome of ECMO-supported COVID-19 patients. Methods: Data were retrieved from the electronic databases of three Israeli tertiary care centers. All COVID-19 patients treated with ECMO for >3 days in these centers between July 2020 and November 2021 were included in the analysis. Results: The study incorporated 106 patients [median age 49 (17-73) years]. The median numbers of ECMO days and daily transfused packed red blood cell (PRBC) units were 20.5 (4-240) and 0.61 (0-2.82), respectively. In multivariate analysis, age ≥50 years was an independent factor for ICU mortality [odds ratio (OR) 4.47). In ECMO-supported patients for <38 days, transfusion of ≥0.85 units/day was associated with higher ICU mortality compared to that observed in patients transfused with <0.85 PRBC units/day (OR = 5.43; p < 0.004). Transfusion of ≥0.5 units/day combined with ECMO support of ≥38 days (OR = 17.9; p < 0.001) conferred the highest mortality risk. Conclusions: Three-quarters of patients <50 years old and half of patients ≥50 years were successfully discharged from ICU. Higher daily transfusion rates were associated with significantly increased ICU mortality, irrespective of ECMO duration. Reduced blood transfusion may improve the survival of these patients. This approach could also contribute to the measures taken to address the challenges of blood shortages occurring during pandemics and other global or national emergencies.

Association of febrile neutropenia episodes and blood product transfusions in children with acute leukemia.

Transfusion is vital supportive therapy in leukemias, but has significant potential febrile complications. In this study, we aimed to reveal the possible effects of blood product transfusions on febrile neutropenia episodes (FNEs) in children with acute leukemia. We obtained the relevant clinical and laboratory data from the medical records.Transfusions of red blood cell (RBC), platelet (PLT), and fresh frozen plasma (FFP) administered during FNE were recorded in detail. A total of 80 children with acute leukemia were included. A total of 235 FNE were investigated and the median age at first FNE was 4.72 years. At least one blood product transfusion was administered in 80.9 % (n = 190) of the patients with FN. The need for RBC, PLT, and total transfusions was higher in patients with AML and who were > 4 years-old. Bacteremia, gram-negative bacteria, and polymicrobial infections were more frequent in patients who received PLT transfusions. Complications were increased in patients who had ≥ 3 transfusions and had received multiple FFP and pooled PLT transfusions. Patients who received pooled PLT during previous FNE had an increased risk of death. Complications were more frequent, neutrophil count was lower, durations of neutropenia and medical treatment were longer in patients who had ≥ 3 transfusions.Bacteremia, gram-negative bacteria, and polymicrobial infections were more common in children who received PLT transfusions. Therefore, patients who need multiple transfusions, especially PLT and FFP transfusions, should be closely followed up during their FNE in terms consequences of transfusion as well as severity of underlying infection.

A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementation.

Until the beginning of the century, bleeding management was similar in elective surgeries or exsanguination scenarios: clotting tests were used to guide blood product orders and, while awaiting these results, an aggressive resuscitation with crystalloids was recommended. The high mortality rate in severe hemorrhages managed with this strategy endorsed the need for a special resuscitation plan. As a result, modifications were recommended to develop a new clinical approach to these patients, called "Damage Control Resuscitation". This strategy includes four principles: damage control surgery, minimization of crystalloids, permissive hypotension and hemostatic resuscitation. The latter involves the use of antifibrinolytics, correction of preconditions of hemostasis (calcium, pH and temperature) and the early and rapid restoration of intravascular volume with blood products. To enable timely availability and transfusion of blood products, specific actions in different hospital areas need to be synchronized, which are usually organized through Massive Transfusion Protocols or, as they have recently been rebranded, Major Hemorrhage Protocols (MHPs). Although these bundles of actions represent a paradigm change, essential aspects such as their historical evolution, theoretical foundations, terminology and operational elements have yet to be well explored. Considering the wide application range of these tools (emergency departments, interventional radiology, operating rooms and military fields), it is essential to integrate all professionals involved with severe hemorrhage scenarios in the implementation of the aforementioned protocols, from conception to execution and management. This review paper addresses MHP aspects relevant to anesthesiologists, transfusion services and other areas involved with the care of patients with severe bleeding.

REBOA in patients with high-grade liver injury may be associated with worse outcomes.

Although controversial, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to manage liver injuries. This matched cohort study evaluated outcomes in severe liver injuries treated with REBOA or without REBOA. Trauma Quality Improvement Program database study. Patients with high-grade liver injuries (IV and V) treated with REBOA were propensity score matched (1:2) with similar patients managed without REBOA. Outcomes included mortality and complications. 252 patients treated with REBOA were matched with 503 patients managed without REBOA. Overall mortality was significantly higher in the REBOA group [57.9​% vs. 35.2​% (p​<​0.001)]. The REBOA group patients had higher blood product transfusion requirements. REBOA use in patients with high-grade liver injuries may be associated with poorer outcomes.

A Systematic Approach to Reduce Blood Transfusions in Acute Type A Aortic Dissection Surgery

This study aimed to summarize our experience using a systematic approach to reduce blood transfusions in acute type A aortic dissection (ATAAD) surgery.From August 2016 to June 2020, 326 patients underwent ATAAD surgery in our center employing a systematic approach, which primarily included the following: Liu's aortic root repair technique, Liu's aortic arch inclusion technique with a frozen elephant trunk, moderate-to-mild hypothermia circulatory arrest, and application of centrifugal pump in cardiopulmonary bypass circuit. Patients were divided into two groups based on whether they had blood product transfusion during their hospital stay: transfusion group and transfusion-free group. Preoperative, intraoperative, and postoperative outcomes were compared between the 2 groups.In the transfusion group, 152 patients were included, and in the transfusion-free group, 174 patients were involved; the transfusion-free rate was 53.37%. Patients in the transfusion group were significantly older than those in the transfusion-free group, and there were more patients with preoperative anemia and malperfusion in the transfusion group. Overall in-hospital mortality was 5.21% (17/326), with 3 mortalities (1.72%) in the transfusion-free group and 14 mortalities (9.21%) in the transfusion group (P = 0.0025). At tested time points, the Hb levels of patients between the 2 groups were similar.In ATAAD patients, the transfusion group showed significantly older patient age, more incidences of preoperative anemia and malperfusion, and higher in-hospital mortality than the transfusion-free group. Through Liu's systematic approach, ATAAD surgery can be achieved and safely carried out in ATAAD patients without blood product transfusion in selected patients.

Comparison of syndromic and non-syndromic craniosynostosis cases followed in a tertiary pediatric intensive care unit: a case control study.

Craniosynostosis, marked by premature skull suture closure, manifests as isolated or syndromic cases. While isolated cases are more common, syndromic craniosynostoses are associated with a range of complications. This study aims to compare postoperative outcomes in isolated and syndromic craniosynostosis, hypothesizing greater complications in the latter. A case-control study was conducted with 30 pediatric patients with isolated (Group C) and syndromic (Group S) craniosynostosis undergoing surgery. Data on demographics, operative details, blood product transfusions, and postoperative complications were analyzed. Statistical analysis employed Chi-square, Fisher exact tests, and Mann-Whitney U tests. Perioperative bleeding and postoperative packed red blood cell (PRBC) transfusions were significantly higher in isolated cases. Morbidity analysis, including reoperation, massive bleeding, infection, hydrocephalus, and seizures indicated higher rates in syndromic cases. The rates of postoperative morbidities were 30% in syndromic and 10% in isolated cases (p = 0.053). Correlations revealed a low positive association between body weight and both PICU and hospital stays. Additionally, a low positive correlation was found between perioperative PRBC transfusion amount and PICU length of stay. The total number of morbidities showed a moderate positive correlation with PICU length of stay and a low positive correlation with hospital length of stay. Isolated craniosynostosis cases exhibited higher perioperative bleeding and PRBC transfusions, potentially influenced by surgery at an earlier age. Although complications tended to be elevated in syndromic cases, no significant differences were observed. This study underscores the necessity for meticulous perioperative care, emphasizing individualized approaches considering age-related factors and associated complications in managing craniosynostosis cases.

The Bleeding Edge: Managing Coagulation and Bleeding Risk in Patients with Cirrhosis Undergoing Interventional Procedures.

This review addresses the peri-procedural bleeding risks in patients with cirrhosis, emphasizing the need for careful coagulation assessment and targeted correction strategies. Liver disease presents a unique hemostatic challenge, where traditional coagulation tests may not accurately predict bleeding risk, complicating the management of procedures like paracentesis, endoscopic therapy, and various interventional procedures. As such, this paper aims to provide a comprehensive analysis of current data, guidelines, and practices for managing coagulation in cirrhotic patients, with a focus on minimizing bleeding risk while avoiding unnecessary correction with blood products. The objectives of this review are threefold: first, to outline the existing evidence on bleeding risks associated with common invasive procedures in cirrhotic patients; second, to evaluate the efficacy and limitations of standard and advanced coagulation tests in predicting procedural bleeding; and third, to examine the role of blood product transfusions and other hemostatic interventions, considering potential risks and benefits in this delicate population. In doing so, this review highlights patient-specific and procedure-specific factors that influence bleeding risk and informs best practices to optimize patient outcomes. This review progresses through key procedures often performed in cirrhotic patients. The discussion begins with paracentesis, a low-risk procedure, followed by endoscopic therapy for varices, and concludes with high-risk interventions requiring advanced hemostatic considerations. Each chapter addresses procedural techniques, bleeding risk assessment, and evidence-based correction approaches. This comprehensive structure aims to guide clinicians in making informed, evidence-backed decisions in managing coagulation in cirrhosis, ultimately reducing procedural complications and improving care quality for this high-risk population.