Patients Received Blood Products Research Articles

Transfusion-associated acute lung injury following albumin treatment in liver disease.

Transfusion-related acute lung injury is an infrequent adverse reaction observed in patients receiving blood products. The lung injury can range in severity and can be associated with both mortality and mortality. All blood products except albumin have been linked to cases of transfusion-related acute lung injury. In fact, albumin may be used as a salvage modality in severe transfusion-related acute lung injury. We report an alcoholic patient who developed lung injury following treatment with albumin in the setting of hypoalbuminaemia. A 41-year-old male with alcoholic liver disease was admitted for severe ascites and alcoholic hepatitis. Chest x-ray showed small pleural effusions at the lung bases with no overt pulmonary oedema. He received high doses of furosemide for lower extremity oedema. The patient received a total of two albumin infusions to augment the diuresis effect. He subsequently developed acute hypoxic respiratory failure with imaging showing interstitial and airspace abnormalities concerning for pulmonary oedema. He showed no additional signs of volume overload and was treated supportively until the condition improved. This is the first reported case of albumin-associated lung injury proximally related to albumin infusion. We aim to increase awareness of this possible sequelae among physicians.

Interplay between HIV and Human Pegivirus (HPgV) Load in Co-Infected Patients: Insights from Prevalence and Genotype Analysis.

Human pegivirus (HPgV) is transmitted through sexual or parenteral exposure and is common among patients receiving blood products. HPgV is associated with lower levels of human immunodeficiency virus (HIV) RNA and better survival among HIV-infected patients. This study aimed to investigate the prevalence of HPgV and determine its subtypes in HIV-infected individuals living in Istanbul, which has the highest rate of HIV infection in Türkiye. Total RNA extraction from plasma, cDNA synthesis, and nested PCR were performed for HPgV on plasma samples taken from 351 HIV-1-infected patients. The HPgV viral load was quantified on HPgV-positive samples. HPgV genotyping was performed by sequencing the corresponding amplicons. In the present study, the overall prevalence of HPgV RNA in HIV-infected patients was 27.3%. HPgV subtypes 1, 2a, and 2b were found, with subtype 2a being the most frequent (91.6%). Statistical analysis of HIV-1 viral load on HPgV viral load showed an opposing correlation between HIV-1 and HPgV loads. In conclusion, these data show that HPgV infection is common among HIV-positive individuals in Istanbul, Türkiye. Further comprehensive studies are needed to clarify both the cellular and molecular pathways of these two infections and to provide more information on the effect of HPgV on the course of the disease in HIV-infected individuals.

Did interventions in a massive transfusion protocol program change transfusion practice?

Abstract Current literature supports improved clinical outcomes in the setting of trauma when a Massive Transfusion Protocol (MTP) adheres to transfusion at, or close, to a 1:1 ratio (RBC:Plasma). At our institution, between 2008 and 2015, the number of MTP activations increased ten-fold, accompanied by increased wastage of blood products and stress on the transfusion service. In response, in 2016-2018, we undertook an extensive root-cause analysis, and deployed multiple interventions, including clinician education and multiple process changes to the MTP, which succeeded in reining in inappropriate activation of the MTP, as we have previously published. Heretofore, we have not addressed whether these interventions also affected the ratio of blood products transfused during MTPs activated at our institution. Here, we test the hypothesis that the changes deployed in 2016-2018 were associated with improved adherence to the desired 1:1 ratio. The study is a retrospective analysis of massive transfusion data collected from 2008 to 2022. We reviewed RBC and Plasma units transfused to all patients receiving blood products through the MTP during this period. All patients transfused seven or more RBC and/or Plasma units following MTP activation were included in the study (total n = 443). Activations were classified by year. For each patient, the (RBC:Plasma) ratio transfused was calculated and assessed for adherence to a 1:1 ratio, with a ratio of 2:1 or greater classified as “suboptimal”. Our institution does not use Whole Blood. MTP usage at our institution gradually increased from 2008, when the MTP was established, to 2016, when the MTP procedure was revised. Suboptimal transfusion ratios (RBC:Plasma) also increased from 2008-2016. Between 2008 and 2013, 15% of patients received suboptimal ratios following MTP activation. In 2014-2016, suboptimal ratios were observed in 25% of MTPs. Following multiple interventions, the frequency of MTP activation dropped precipitously, as described, and was accompanied by a decrease in the percentage of suboptimal ratios; in 2020 to 2022, 11% of MTPs involving seven or more transfused units had a suboptimal ratio. In summary, the dramatic increase in activations of the MTP observed between 2008 and 2016 at our medical center was accompanied by an increase in suboptimal RBC:Plasma transfusion ratios. Interventions deployed between 2016 and 2018 led not only to reduced blood wastage, and lower stress of BB staff, but also to improved adherence to best transfusion practices, in the form of appropriate (RBC:Plasma) ratios transfused during MTPs.

Analysis of Need for Intervention in Low-Grade Traumatic Splenic Injury.

Blunt splenic injuries are common traumatic injuries. Severe injuries may require blood transfusion, procedural, or operative intervention. Conversely, patients with low-grade injuries and normal vital signs frequently do not require intervention. The level and duration of monitoring required to safely manage these patients are unclear. We hypothesize that low-grade splenic trauma has a low rate of intervention and may not require acute hospitalization. This retrospective descriptive analysis included patients admitted to a level I trauma center with low injury burden (injury severity score <15) and The American Association for the Surgery of Trauma (AAST) grade 1 (G1) and 2 (G2) splenic injuries between January 2017 and December 2019 using the Trauma Registry of the American College of Surgeons (TRACS). The primary outcome was the need for any intervention. Secondary outcomes included time to intervention and length of stay. 107 patients met inclusion criteria. 87.9% required no intervention . 9.4% required blood products, with a median time to transfusion of 7.4hours from arrival. All patients receiving blood products had extenuating circumstances such as bleeding from other injuries, anticoagulant use, or medical comorbidities. 2 patients required splenic artery embolization, one presenting with return precautions 9days post-injury and 1 with significant comorbidities. One patient with concomitant bowel injury required splenectomy. Low-grade blunt splenic trauma has a low rate of intervention, which typically occurs within the first 12hours of presentation. This suggests that outpatient management with return precautions may be appropriate for select patients after a short interval of observation.

Prehospital predictors of the need for transfusion in patients with major trauma

PurposeSevere haemorrhage is a leading cause of early mortality following major trauma. By early identification of patients at risk, blood transfusion could already be initiated in the prehospital period. Aim of the study was to evaluate the extent to which prehospital lactate and base excess, which are known to be associated with trauma-induced coagulopathy, and additional clinical parameters are associated with the need for early transfusion.MethodsIn this prospective, single-centre observational study, trauma patients treated by a helicopter emergency medical service were included, regardless of the injury severity. Patients with coagulation-influencing drugs in long-term therapy were excluded. Blood samples obtained at the beginning of the prehospital treatment were analysed. Primary outcome was the association of lactate and base excess with the need for early transfusion (resuscitation room or immediate surgery). Receiver operating characteristic curves were created, and the area under the curve (AUROC) was calculated.ResultsBetween 2015 and 2018, 21 out of 130 adult trauma patients received blood products during the early in-hospital treatment. Both prehospital lactate and base excess were associated with the transfusion (AUROC 0.731 and 0.798, respectively). The optimal calculated cut-off values were 4 mmol/l (lactate) and − 2.5 mmol/l (base excess). When circulatory instability and suspected relevant bleeding were included, the association further improved (AUROC 0.871 and 0.866, respectively).ConclusionPrehospital lactate and base excess could be used in combination with other clinical parameters as indicators of the need for early transfusion. This relationship has yet to be confirmed in the current validation study.Trial registrationGerman Clinical Trials Register, www.drks.de (No. DRKS 00009559).

Donors with Positive Hepatitis B and C Infections and Their Demographic Characteristics, a Study in Jirof Blood Donation Center From 2011 to 2016

Introduction: Blood-borne infections have always been concerns for the health system, as well as patients receiving blood products. In the present study, our aim was to determine the prevalence of hepatitis B (HBV) and C (HCV) virus infections in the blood units donated in Jiroft city, Kerman province, Iran, during a 5-year period (2011-2016). We also analyzed the demographic characteristics of donors.Methods: This was a cross-sectional study. Records available in the blood center of Jiroft was used as the source for collecting the data required (i.e., demographic features, results of laboratory tests, etc.). SPSS software version 22 was used to analyze the data using descriptive statistics (frequency and percentage). The chi-square test was used to identify any association between categorical variables at a significant level of P &lt; 0.05.Results: The total number of blood donors was 36 117. Hepatitis B and C frequencies were 3.3 and 0.44 per 1000, respectively. The highest infection rates were observed in 21-30-year-old donors. The prevalence of hepatitis B and C were higher among first-time, married, and male donors. Hepatitis B and C frequencies indicated a decreasing trend, reaching 2 and 0.4 per 1000 in 2016 from the initial 5.2 and 0.55 per 1000 in 2011, respectively. The results of the Chi-square statistical test showed that the difference in the number of people who had hepatitis in the period of 2011-2016 had a statistically significant decreasing trend (P &lt; 0.001).Conclusion: The prevalence of hepatitis B and C infections in blood donors declined from 2011 to 2016. It is recommended to continue screening tests and educate donors to even lower blood-borne viral infections among Jiroft blood donors.

Prevalence of Adverse Transfusion Reactions in Hospitalized Patients in Tertiary Heart Center of Sari, Iran in 2014-2020

Introduction: Our study aimed to determine the prevalence of adverse transfusion reactions (ATRs), unexpected or undesirable effects resulting from the therapeutic use of blood products.&#x0D; Material and Methods: In this cross-sectional study, we assessed the medical records of ATR patients who were referred to Mazandaran Heart Center from March 2014 until July 2020. Patients needed blood transfusions during the operation for various reasons; complications related to blood administration were considered ATR. Age, sex, associated clinical signs, symptoms, and adverse response were composed of a patient's file checklist with ethical points. SPSS 16.0 was used for statistical analysis.&#x0D; Results: In this study, 23,206 blood products were used in hospitals as treatment, and there were 96 reactions (4%) because of transfusion, and 10 patients had a history of recent reactions. There was not any specific connection between the age of patients and the existence of complications. Most reactions were allergic (44%) and non-hemolytic febrile reactions (42%). It is essential to state that 91% of adverse reactions were slight ones, and only 5% led to the injury. Out of 96 patients with complications, 79 patients received blood products as pack cells; 6 patients received Fresh Frozen Plasma; 3 patients received autologous blood products, while this number was one for Blood Low Leukocytes and platelets (PLT).&#x0D; Conclusion: Based on this investigation, the risk of adverse transfusion reactions (ATRs) is 4%, and universally 85 million units of blood products are transfused every year. Consequently, investigation to reduce this number is required.

No evidence of SARS-CoV-2 transmission through transfusion of human blood products: A systematic review.

The presence of viral nucleic material in the circulation poses a theoretical risk of transmission through transfusion. However, little is known about the possibility of the actual transmission through transfusion or transplantation of blood products. A PROSPERO registered systematic review pooled evidence from PubMed/MEDLINE, Google Scholar and CINAHL. The search included studies on severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission through human blood products. In total 537 studies were extracted, and only eight articles (1.5%) were eligible for the final analysis. A total of 14 patients received blood products from coronavirus disease‐2019 (COVID‐19) virus‐positive donors, and six (42.9%) tested negative for COVID‐19 RT‐PCR for up to 14 days post‐transfusion/transplantation. There were no documented clinical details on the COVID‐19 test for eight (57.1%) blood products recipients. Of the eight patients, none of them developed any COVID‐19‐related symptoms. In conclusion, there is limited evidence of transfusion transmission of SARS‐CoV‐2 via human blood products. Consolidation of further evidence, as it emerges, is warranted.

Efficacy of the compensatory reserve measurement in an emergency department trauma population.

The Compensatory Reserve Measurement (CRM) is a novel method used to provide early assessment of shock based on arterial wave form morphology changes. We hypothesized that (1) CRM would be significantly lower in those trauma patients who received life-saving interventions compared with those not receiving interventions, and (2) CRM in patients who received interventions would recover after the intervention was performed. We captured vital signs along with analog arterial waveform data from trauma patients meeting major activation criteria using a prospective study design. Study team members tracked interventions throughout their emergency department stay. Ninety subjects met inclusion with 13 receiving a blood product and 10 a major airway intervention. Most trauma was blunt (69%) with motor vehicle collisions making up the largest proportion (37%) of injury mechanism. Patients receiving blood products had lower CRM values just prior to administration versus those who did not (50% versus 58%, p= .045), and lower systolic pressure (SBP; 95 versus 123 mmHg, p= .005), diastolic (DBP; 62 versus 79, p= .007), and mean arterial pressure (MAP; 75 versus 95, p= .006), and a higher pulse rate (HR; 101 versus 89 bpm, p= .039). Patients receiving an airway intervention had lower CRM values just prior to administration versus those who did not (48% versus 58%, p=.062); however, SBP, DBP, MAP, and HR were not statistically distinguishable (p ≥ .645). Our results support our hypotheses that the CRM distinguished those patients who received blood or an airway intervention from those who did not, and increased appropriately after interventions were performed.

Transfusion Dependence Is Common in Adults with Hemophagocytic Lymphohistiocytosis (HLH) and Is Associated with EBV Viremia

Introduction:HLH in adults is a fulminant, often fatal hyperinflammatory disorder that often mimics sepsis and is associated with significant cytopenias, primary and secondary infections, immunosuppression, and bleeding. The etiologies in adults are typically autoimmune disease or lymphoma. As a result, HLH patients are immunocompromised hosts who represent a distinct group of high blood product users. Importantly, the need for adequate blood product support can obligate care in tertiary or quaternary settings. The literature lacks sufficient description of transfusion need patterns and the factors associated with blood product use in HLH. This IRB approved resource utilization study investigates this unique group of patients' transfusion needs and seeks to identify factors associated significant cytopenias that result in transfusion dependence.Methods: We retrospectively identified and reviewed the charts of 59 HLH patients diagnosed between January 2012 and May 2017 at Stanford Health Care system. Patients were identified by search of the ICD9 code 288.4, ICD 10 76.1, 76.2 and associated keyword searches Hemophagocytic Syndromes in the EPIC electronic medical record system and by a similar keyword permutation search in PowerPath, the pathology department database. Data collected and evaluated included the patients' demographics, causes of HLH, transfusion requirements, primary and secondary infections, Charleston comorbidity index, SOFA score, times to diagnosis and therapy, HLH therapy, lengths of hospital stay, and survivorship. Data related to transfusion therapy was restricted to active HLH episodes only and was not collected after remission. Statistical analysis utilized Fisher exact test or 2 tailed t-test.Results: The median age of the patients was 52 (range 18-96; SD +/- 19). The majority of the patients had either malignancy or autoimmune disease: 56% had underlying malignancy with lymphoma in 88%; 22% had an underlying autoimmune disease. A concurrent infectious component was common and found in 17/33 of malignancy and 9/14 autoimmune patients. Eighty-five (85) % (50/59) of the patients received blood products, with the transfusion requirements per hospitalization as following, in units: PRBC , mean 7, median 4 (range 0-68); platelets, mean 7, median 2 (range 0-37); FFP mean 2, median 0 (range 0-13), and pooled cryoprecipitate mean 2, median 0 (range 0-13). Adult patients with EBV viremia (24/59) showed the highest rate of transfusion (92%), with a statistically significant increase in platelet and cryoglobulin usage amongst transfused patients (p = 0.008 and p = 0.04, respectively).Conclusions: This analysis finds that a high percentage of adult patients with HLH require transfusions. Our data suggests that adult HLH secondary to an infectious etiology, in particular EBV viremia, correlates with higher blood product usage. Further multi-center studies with larger number of patients are needed to further characterize and optimize transfusion therapy in the management of adults with HLH, as well as to establish the potential role of transfusion therapy of these immunocompromised hosts in the need to provide tertiary or quaternary care. DisclosuresNo relevant conflicts of interest to declare.

Epilepsy surgery in infants up to 3 months of age: Safety, feasibility, and outcomes: A multicenter, multinational study.

Drug-resistant epilepsy (DRE) during the first few months of life is challenging and necessitates aggressive treatment, including surgery. Because the most common causes of DRE in infancy are related to extensive developmental anomalies, surgery often entails extensive tissue resections or disconnection. The literature on "ultra-early" epilepsy surgery is sparse, with limited data concerning efficacy controlling the seizures, and safety. The current study's goal is to review the safety and efficacy of ultra-early epilepsy surgery performed before the age of 3months. To achieve a large sample size and external validity, a multinational, multicenter retrospective study was performed, focusing on epilepsy surgery for infants younger than 3months of age. Collected data included epilepsy characteristics, surgical details, epilepsy outcome, and complications. Sixty-four patients underwent 69surgeries before the age of 3months. The most common pathologies were cortical dysplasia (28), hemimegalencephaly (17), and tubers (5). The most common procedures were hemispheric surgeries (48 procedures). Two cases were intentionally staged, and one was unexpectedly aborted. Nearly all patients received blood products. There were no perioperative deaths and no major unexpected permanent morbidities. Twenty-five percent of patients undergoing hemispheric surgeries developed hydrocephalus. Excellent epilepsy outcome (International League Against Epilepsy [ILAE] grade I) was achieved in 66% of cases over a median follow-up of 41months (19-104 interquartile range [IQR]). The number of antiseizure medications was significantly reduced (median 2 drugs, 1-3 IQR, p<.0001). Outcome was not significantly associated with the type of surgery (hemispheric or more limited resections). Epilepsy surgery during the first few months of life is associated with excellent seizure control, and when performed by highly experienced teams, is not associated with more permanent morbidity than surgery in older infants. Thus surgical treatment should not be postponed to treat DRE in very young infants based on their age.

977 The Role of Group and Save Samples in Perioperative Management of Laparoscopic Appendicectomies: A 2-Cycle Quality Improvement Project (QIP)

Abstract Introduction Group and Save samples (G&amp;S) are routinely performed before laparoscopic appendectomies (LA). Cycle-1 of this QIP showed &amp;lt;1% of patients required blood products perioperatively. We recommended and implemented that a G&amp;S request should be at the clinician’s discretion and not routinely performed. Cycle-2 assesses the impact of our recommendation. Method In Cycle-1 patients who had undergone LA and laparoscopic conversion to open appendicectomies between January - December 2018 were identified using Operating Room Management Information System. Patients who had G&amp;S performed and patients receiving blood products were identified using the hospital’s electronic patient records and online pathology reporting service. Patients from December 2019 to June 2020 formed Cycle-2 of this QIP. Results 124 patients were included in Cycle-2 (versus 263 in Cycle-1). 58% of patients had G&amp;S taken (versus 99.6% in Cycle-1). 0.81% required a transfusion post-operatively (versus 0.76% in Cycle-1). The average number of G&amp;S per patient was reduced by 1.19, saving the Trust £23.80 per patient. Conclusions Blood products are not routinely required peri-operatively, therefore G&amp;S should be ordered at the clinician’s discretion. This safely saves the Trust significant cost and improves patient experience by eliminating the discomfort of unnecessary blood tests.

Changes in emergency department blood product use for major paediatric trauma following the implementation of a major haemorrhage protocol.

Fixed ratio blood product administration may improve outcomes in trauma patients with massive blood loss. The present study aimed to describe the impact of a major haemorrhage protocol (MHP) on the ratio of blood products administered for paediatric major trauma. Retrospective observational study in a state-designated paediatric major trauma centre in Melbourne, Australia. Children with major trauma who received blood products in the ED were identified from a hospital trauma registry. Blood product ratios before, during and after implementation of a hospital MHP were compared in consecutive 2 year blocks. Over a 6 year period, 767 major trauma patients were identified, of whom 47 received blood products in the ED and were included in the analysis; 14 pre-MHP implementation, 24 during-MHP implementation and nine post-MHP implementation. No patients received blood products at a ratio of 1:1:1 for red blood cells:fresh frozen plasma:platelets, respectively, during any time period. In this cohort of predominantly blunt trauma, blood products were infrequently administered in the ED because of the low prevalence of massive blood loss. Coagulopathy and hypofibrinogenaemia were commonly observed, nearly half of included patients were managed operatively and one quarter did not survive their injuries. The implementation of a MHP did not change the ratio of blood product administration in this cohort of patients because of the infrequency of massive blood loss. Future studies may focus on the impact of treating coagulopathy and hypofibrinogenaemia on patient-centred outcomes.

63. Menstrual Suppression in the Myelosuppressed: A Retrospective Chart Review

<h3>Background</h3> Adolescents receiving myelosuppressive cancer treatment are at high risk of abnormal uterine bleeding (AUB) in the setting of thrombocytopenia. There are no validated menstrual suppression regimens in this setting, and clinical management is based on studies in healthy women. There has been minimal evaluation of patterns of care in this population. <h3>Methods</h3> We established a retrospective cohort of patients who were aged 15-39y at diagnosis with new or relapsed lymphoma, acute myeloid leukemia, or sarcoma and treated with chemotherapy +/- radiation at a single tertiary pediatric institution between 2008-2019. Our aim was to understand patterns of care by describing patient characteristics and symptoms (packed red blood cell and/or platelet transfusions). The following was abstracted from the medical record: cancer diagnosis, chemotherapy, clinical characteristics, race/ethnicity, payor, menarchal age, menstrual pattern prior to therapy, and cycle control agents utilized. IRB approval was obtained. <h3>Results</h3> Our cohort included 52 patients, the majority of whom were newly diagnosed (73%) and received highly myelosuppressive chemotherapy (85%). The majority of patient records had no documentation of menstrual cycles (81%) or sexual history (89%). A minority of records documented discussion of potential therapy-related infertility (30%) or fertility preservation options (11%); all fertility preservation options discussed were accurate. Eighty-five percent of patients received blood product transfusions. The majority of patients (79%) were prescribed hormonal agents for menstrual suppression; the most utilized agents were depo-medroxyprogesterone (49%) and combined oral contraceptives (39%). The initiation of a menstrual suppression agent varied from prior to (20%), simultaneous with (25%), or after initiating (44%) chemotherapy (Table 1). <h3>Conclusions</h3> Despite AUB being a likely consequence for adolescents receiving myelosuppressive therapies, not all at-risk patients were prescribed menstrual suppression. Agents prescribed and timing of initiation varied widely. The majority of patients received blood products. The majority of patients did not have relevant gynecologic details documented by oncologists. Our study is limited by small sample size and being from a single institution. Ongoing work is evaluating these patterns in a larger cohort, aiming to understand differences in symptomatic AUB and healthcare utilization according to cycle control agents, along with the impact of AUB on adolescent quality of life.

Hypocalcemia in Military Casualties From Point of Injury to Surgical Teams in Afghanistan.

Hypocalcemia is a known sequela of citrated blood product transfusion. Civilian data suggest hypocalcemia on hospital admission is associated with worse outcomes. Initial calcium levels in military casualties have not previously been analyzed. The objective of this retrospective review aimed to assess the initial calcium levels in military trauma casualties at different Forward Surgical Teams (FST) locations in Afghanistan and describe the effects of prehospital blood product administration on arrival calcium levels. This is a retrospective cohort analysis of military casualties arriving from point of injury to one of two FSTs in Afghanistan from August 2018 to February 2019 split into four locations. The primary outcome was incidence of hypocalcemia (ionized calcium < 1.20 mmol/L). There were 101 patients included; 55 (54.5%) experienced hypocalcemia on arrival to the FST with a mean calcium of 1.16 mmol/L (95% confidence interval [CI], 1.14 to 1.18). The predominant mechanism of injury consisted of blast patterns, 46 (45.5%), which conferred an increased risk of hypocalcemia compared to all other patterns of injury (odds ratio = 2.42, P = .042). Thirty-eight (37.6%) patients required blood product transfusion. Thirty-three (86.8%) of the patients requiring blood product transfusion were hypocalcemic on arrival. Mean initial calcium of patients receiving blood product was 1.13 mmol/L (95% CI, 1.08 to 1.18), which was significantly lower than those who did not require transfusion (P = .01). Eight (7.9%) of the patients received blood products before arrival, with 6/8 (75%) presenting with hypocalcemia. Hypocalcemia develops rapidly in military casualties and is prevalent on admission even before transfusion of citrated blood products. Blast injuries may confer an increased risk of developing hypocalcemia. This data support earlier use of calcium supplementation during resuscitation.

Prehospital Transfusion of Red Blood Cells and Plasma by an Urban Ground-Based Critical Care Team

Prehospital blood component therapy poses a possible treatment option among patients with severe bleeding. The aim of this paper was to characterize patients receiving prehospital blood component therapy by a paramedic-doctor-staffed, ground-based prehospital critical care (PHCC) service. Bleeding patients with a clinical need for prehospital blood transfusion were included prospectively. The following data were collected: indication for transfusion, mechanism of injury, vital parameters, units of red blood cells (RBCs)/plasma transfused, degree of shock, demographics, and mortality. Twenty-one patients received blood products: 12 (57%) traumatic injuries and nine (43%) non-traumatic bleeds, with a median of 1.5 (range 1.0-2.0) units of RBCs and 1.0 (range 0.0-2.0) unit of plasma. The most frequent trigger to initiate transfusion was on-going excessive bleeding and hypotension. Improved systolic blood pressure (SBP) and milder degrees of shock were observed after transfusion. Mean time from initiation of transfusion to hospital arrival was 24 minutes. In-hospital, 11 patients (61%) received further transfusion and 13 (72%) had urgent surgery within 24 hours. Overall, 28-day mortality was 29% at 24-hours and 33% at 28-days. Prehospital blood component therapy is feasible in a ground-based prehospital service in a medium-sized Scandinavian city. Following transfusion, patient physiology and degree of shock were significantly improved.

Those with hemophilia or von Willebrand disease do not have increased perioperative complications following anterior cruciate ligament reconstruction: Results of a case-control large-database study

BackgroundThere is a lack of information on anterior cruciate ligament (ACL) reconstruction outcomes and complications for patients with congenital hypocoagulable conditions. The specific aim of this retrospective study was to report operative outcomes and complications for patients with congenital hypocoagulable disorders who underwent ACL reconstruction. MethodsWe performed a retrospective review of all patients who underwent an ACL reconstruction within Truven MarketScan Commercial Claims and Encounter Database from 2010 to 2014. Hemophilia A, hemophilia B and patients were identified. Patient demographics, cost of surgery, blood product use, concomitant injuries, repeat ACL injury, complications and various operative variables were collected. Statistical tests were conducted on SAS 9.4 2013. ResultsThirty-three hemophilia A, three hemophilia B, 63 von Willebrand factor patients, and 103,478 controls underwent ACL reconstruction. There is a statistically significant difference for hemarthrosis 1 year leading up to injury for hemophilia A compared with control (P = 0.0083). Total healthcare utilization 90 days after surgery was statistically significant for hemophilia A ($30,310 ± 52,745, P < 0.001) and von Willebrand factor ($20,355 ± 23,570, P < 0.001) compared with control ($14,564 ± 9512). Length of hospital stay, postoperative hemorrhage, concomitant injuries to the knee, additional ACL injury, infection rate, deep-vein thrombosis, and pulmonary embolism were not statistically significant. None of the hemophilia A or von Willebrand factor patients received blood products intraoperatively or postoperatively. ConclusionHemophilia A and von Willebrand factor patients had rates of postoperative complications and ACL re-injuries that were not statistically significant. Cost of healthcare utilization was identified as dramatically greater for hemophilia A and von Willebrand factor patients.

Clinical profile and outcome of carbapenem-resistant gram negative bacteremia in children with cancer in pediatric intensive care unit of a resource-limited country

ObjectiveThe prevalence of Carbapenem-Resistant Gram Negative Blood Stream Infection (CRGN-BSI) is increasing worldwide. However, there is a paucity of data in a vulnerable population “Children with cancer”. The objective of this study is to describe the clinical profile and outcome of children with cancer admitted in PICU with CRGN-BSI. MethodsWe retrospectively reviewed medical record of all children with cancer admitted in PICU who had CRGN-BSI from September 2017 to August 2019. Isolates with meropenem MIC ≤19 mg/dl were considered as Carbapenem Resistant. Responder was defined as negative blood culture in 5 days. Clinical profile and outcomes were obtained. Descriptive statistics were applied. ResultsOut of 1234 PICU admissions, 54 children with cancer developed CRGN-BSI (0.3%). The mean age of CRGN-BSI was 6.97 ± 4 years. 67% (n = 36) of these were male and 54% (n = 29) were malnourished. The primary diagnosis was hematological malignancy in 80% (n = 43) and 76% of the children used ICU therapies (mechanical ventilation [n = 14, 26%] and vasoactive inotropic support [n = 27, 50%]). All of them were neutropenic on admission and 98% patients received blood products. Pending blood culture results, 50% (n = 27) of the patients were started on meropenem. E-coli (n = 30, 56%) and Kelbseilla species (n = 14, 26%) were the most common isolates in our cohort and 46% (n = 25) of the patients were the responders. 18% (n = 10) were community acquired infection and 82% (n = 44) were health-care associated infections. The case-fatality rate was 35% (n = 19). Age, gender, nutritional status and empirical meropenem were not associated with mortality. ConclusionCRGN-BSI in children with underlying malignancy is a serious illness with high mortality. No single factor could determine the mortality in our study. We suggest study with larger sample size, early blood culture testing and rational use of Carbapenem.

Effect of the fresh whole blood transfusion on perioperative bleeding in adult patients undergoing emergency coronary artery bypass grafting surgery: a randomized study

Objective The present study aimed to assess the hemostatic effects of fresh whole blood (FWB) transfusion on bleeding and blood product transfusion in patients on clopidogrel undergoing emergency coronary artery bypass grafting surgery (CABG). Design A randomized study was conducted. Setting The study was conducted at a cardiac center. Patients and methods The study included 124 patients undergoing CABG surgery. The patients were divided into two groups: FWB group patients received two to six units of FWB after weaning off cardiopulmonary bypass and in the cardiac surgery ICU. Control group patients received blood products (packed red blood cells, platelets, fresh frozen plasma, or cryoprecipitate) after weaning off cardiopulmonary bypass and after surgery in cardiac surgery ICU. Total number of the transfused FWB, platelets, packed red blood cell, fresh frozen plasma, and cryoprecipitate (intraoperative and postoperative transfusion), bleeding time, and platelet aggregation function were measured. Moreover, the thorax closure time and amount of blood losses, re-exploration, pulmonary edema, and postoperative mechanical ventilation were monitored. Results FWB significantly decreased the blood loss and blood product transfusion compared with the control group (P=0.001 and 0.001, respectively). The bleeding time and platelet aggregation function were better in the FWB group compared with the control group (P=0.020 and 0.034, respectively). Moreover, the thorax closure time, cardiac tamponade, re-exploration, pulmonary edema, and postoperative mechanical ventilation decreased significantly in the FWB group compared with the control group (P Conclusion FWB decreased the blood loss, blood product transfusion, cardiac tamponade, and re-exploration in patients on preoperative clopidogrel undergoing emergency CABG.

Anesthetic Management of Patients After Traumatic Injury With Resuscitative Endovascular Balloon Occlusion of the Aorta.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a temporizing maneuver for noncompressible torso hemorrhage. To our knowledge, this single-center brief report provides the most extensive anesthetic data published to date on patients who received REBOA. As anticipated, patients were critically ill, exhibiting lactic acidosis, hypotension, hyperglycemia, hypothermia, and coagulopathy. All patients received blood products during their index operations and received less inhaled anesthetic gas than normally required for healthy patients of the same age. This study serves as an important starting point for clinician education and research into anesthetic management of patients undergoing REBOA.