Preparation Of Blood Products Research Articles

Non-invasive prediction of massive transfusion during surgery using intraoperative hemodynamic monitoring data

ObjectiveFailure to receive prompt blood transfusion leads to severe complications if massive bleeding occurs during surgery. For the timely preparation of blood products, predicting the possibility of massive transfusion (MT) is essential to decrease morbidity and mortality. This study aimed to develop a model for predicting MT 10 min in advance using non-invasive bio-signal waveforms that change in real-time. MethodsIn this retrospective study, we developed a deep learning-based algorithm (DLA) to predict intraoperative MT within 10 min. MT was defined as the transfusion of 3 or more units of red blood cells within an hour. The datasets consisted of 18,135 patients who underwent surgery at Seoul National University Hospital (SNUH) for model development and internal validation and 621 patients who underwent surgery at the Boramae Medical Center (BMC) for external validation. We constructed the DLA by using features extracted from plethysmography (collected at 500 Hz) and hematocrit measured during surgery. ResultsAmong 18,135 patients in SNUH and 621 patients in BMC, 265 patients (1.46%) and 14 patients (2.25%) received MT during surgery, respectively. The area under the receiver operating characteristic curve (AUROC) of DLA predicting intraoperative MT before 10 min was 0.962 (95% confidence interval [CI], 0.948–0.974) in internal validation and 0.922 (95% CI, 0.882–0.959) in external validation, respectively. ConclusionThe DLA can successfully predict intraoperative MT using non-invasive bio-signal waveforms.

Prognostic Role of Initial Thromboelastography in Emergency Department Patients with Primary Postpartum Hemorrhage: Association with Massive Transfusion.

The early prediction of the need for massive transfusions (MTs) and the preparation of blood products are essential for managing patients with primary postpartum hemorrhage (PPH). Thromboelastography (TEG) enables a thorough evaluation of coagulation status and is useful for guiding the treatment of hemorrhagic events in various diseases. We investigated the role of TEG in predicting the need for MT in patients with primary PPH. A retrospective observational study was conducted in the emergency department (ED) of a university-affiliated, tertiary referral center between November 2015 and August 2023. TEG was performed upon admission. We defined MT as the requirement for transfusion of more than 10 units of packed red blood cells within the first 24 h. The primary outcome was the need for MT. Among the 184 patients with initial TEG, 34 (18.5%) required MT. Except for lysis after 30 min, the MT and non-MT groups had significantly different TEG values. Based on multivariate analysis, an angle < 60 was an independent predictor of MT (odds ratio (OR) 7.769; 95% confidence interval (CI), 2.736-22.062), along with lactate (OR, 1.674; 95% CI, 1.218-2.300) and shock index > 0.9 (OR, 4.638; 95% CI, 1.784-12.056). Alpha angle < 60 degrees indicated the need for MT with 73.5% sensitivity, 72.0% specificity, and 92.3% negative predictive value. Point-of-care testing of TEG has the potential to be a useful tool in accurately predicting the necessity for MT in ED patients with primary PPH at an early stage.

Rapid detection of trace refrigerant impurities in low-temperature ethanol: A “background silence” method based on near-infrared spectroscopy

Low-temperature ethanol method is the main process for the preparation of blood products. Ethanol is cooled using plate heat exchangers with refrigerant fluid, and the ethylene glycol in the refrigerant is a toxic reagent, so the problem of refrigerant fluid leakage has become a concern for blood product companies. The lack of detection methods of refrigerant impurities in ethanol at this process stage can lead to serious safety issues and losses in the event of a refrigerant leak. In this study, a pattern recognition method based on near-infrared spectroscopy (NIRS), the “background silence” method, was developed for the detection of refrigerant impurities in ethanol. The method considered normal impurity-free ethanol solution samples as the background and impurity samples as the interference, made the background “silent” through linear regression, highlighted the changes brought by the interference factor, and then established a “background silence” pattern recognition system by calculating the RSD value at the characteristic data points, which realised the detection of trace refrigerant impurities in ethanol solution. The specificity and sensitivity of the method reached 100 %, and the detection limit can reach 0.25 ‰. The NIRS “background silence” method enables the detection of trace refrigerant impurities in ethanol solutions with reduced computational complexity compared with the widely used PLS-DA discrimination method. This study provides new methodological guidance for the detection of impurities in low content components, and lays the foundation for the application of the “background silence” method in practical production.

Orthognathic surgery in a patient with von Willebrand disease

Aim: This study aims to report the perioperative management of a patient with von Willebrand disease (vWd) who underwent orthognathic surgery. The report follows the guidelines of the Case Report Guidelines (CARE) and focuses on the steps taken to prevent bleeding during the surgical procedure. Methods: A 39-year-old female patient with skeletal Class III was treated with maxillary advancement and mandibular setback. Despite normal test results for ristocetin cofactor activity, measures were taken to prevent bleeding, including atraumatic surgical techniques, use of antifibrinolytic medication, induced hypotension during anesthesia, and preparation of blood products for transfusion during trans and postoperative periods if needed. In the end, these measures were not required. Results: The patient did not experience any bleeding during the surgical procedure or postoperative period, demonstrating the effectiveness of the measures taken to manage their blood dyscrasia. Two years after the surgery, the patient had satisfactory aesthetic and functional results and no evidence of relapse. Conclusion: Thus, this case report demonstrates that vWd does not prevent largescale oral and maxillofacial surgeries such as orthognathic surgery as long as proper precautions are taken pre-, intraand postoperatively.

Shock index as predictor of massive transfusion and mortality in patients with trauma: a systematic review and meta-analysis

BackgroundManagement of bleeding trauma patients is still a difficult challenge. Massive transfusion (MT) requires resources to ensure the safety and timely delivery of blood products. Early prediction of MT need may be useful to shorten the time process of blood product preparation. The primary aim of this study was to assess the accuracy of shock index to predict the need for MT in adult patients with trauma. For the same population, we also assessed the accuracy of SI to predict mortality.MethodsThis systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. We performed a systematic search on MEDLINE, Scopus, and Web of Science from inception to March 2022. Studies were included if they reported MT or mortality with SI recorded at arrival in the field or the emergency department. The risk of bias was assessed using the QUADAS-2.ResultsThirty-five studies were included in the systematic review and meta-analysis, for a total of 670,728 patients. For MT the overall sensibility was 0.68 [0.57; 0.76], the overall specificity was 0.84 [0.79; 0.88] and the AUC was 0.85 [0.81; 0.88]. Positive and Negative Likelihood Ratio (LR+; LR−) were 4.24 [3.18–5.65] and 0.39 [0.29–0.52], respectively. For mortality the overall sensibility was 0.358 [0.238; 0.498] the overall specificity 0.742 [0.656; 0.813] and the AUC 0.553 (confidence region for sensitivity given specificity: [0.4014; 0.6759]; confidence region for specificity given sensitivity: [0.4799; 0.6332]). LR+ and LR− were 1.39 [1.36–1.42] and 0.87 [0.85–0.89], respectively.ConclusionsOur study demonstrated that SI may have a limited role as the sole tool to predict the need for MT in adult trauma patients. SI is not accurate to predict mortality but may have a role to identify patients with a low risk of mortality.

Üçüncü Basamak Hastanede Obstetrik ve Jinekolojik Nedenlerle Yapılan Kan Transfüzyonlarının Değerlendirilmesi

Blood transfusion is defined as the delivery of blood components and coagulation factor concentrates to a patient. About half of transfusions between the ages of 20 and 35 are performed in Obstetrics and Gynecology Clinics. Electronic file records of 137 patients who underwent blood transfusion in Muğla Training and Research Hospital, Gynecology and Obstetrics Clinic between January 2014 and December 2018 were reviewed retrospectively. The demographic information of the patients, Hgb and Hct (before and after transfusion) values, and applied blood products and their amount were recorded. Of the patients who received blood transfusion, 79 were obstetric and 58 were gynecological patients. In obstetric cases, blood transfusion was most frequently performed after cesarean section (56.6%). Among the causes of transfusion, 43 (54%) patients had iron deficiency anemia, 10 (12.6%) patients had anemia after Dilatation/Curettage (D/C), and 5 (6.32%) patients had uterine atony. Diagnostic D/C and total abdominal hysterectomy were performed in 12 (20.68%) of 58 patients, who were transfused for gynecological reasons, with the diagnosis of menometrorrhagia, while myomectomy was performed in 10 of these patients (17.24%), total laparoscopic hysterectomy was performed in 9 (15.51%) patients, urogynecological surgery and laparoscopic cystectomy were performed in 5 (8.62%) patients, and medical treatment was given with the diagnosis of menometrorrhagia. The preparation and use of blood and blood products should be approached in a multidisciplinary manner, covering many branches, especially Gynecology and Obstetrics and Hematology. Anemia prophylaxis should be initiated beforehand and post-operative transfusion should be reduced in pregnant women and patients who will undergo surgery. Unnecessary transfusions should be avoided in order to avoid complications that may occur during and after transfusion.

Development and Deployment of Web Application Using Machine Learning for Predicting Intraoperative Transfusions in Neurosurgical Operations

Background and Aim: Preoperative blood product preparation is a common practice in neurosurgical patients. However, over-requesting of blood is common and leads to the wastage of blood bank resources. Machine learning (ML) is currently one of the novel computational data analysis methods for assisting neurosurgeons in their decision-making process. The objective of the present study was to use machine learning to predict intraoperative packed red cell transfusion. Additionally, a secondary objective focused on estimating the effectiveness of blood utilization in neurosurgical operations. Methods and Materials/Patients: This was a retrospective cohort study of 3,021 patients who had previously undergone neurosurgical operations. Data from the total cohort were randomly divided into a training dataset (N=2115) and a testing dataset (N=906). The supervised ML models of various algorithms were trained and tested with test data using both classification and regression algorithms. Results: Almost all neurosurgical conditions had a cross-match to transfusion ratio of more than 2.5. Support vector machine (SVM) with linear kernel, SVM radial kernel, and random forest (RF) classification had a performance with good AUC of 0.83,0.82, and 0.82, respectively, while RF regression had the lowest root mean squared error and mean absolute error. Conclusion: In almost all neurosurgical surgeries, preoperative overpreparation of blood products was detected. The ML algorithm was proposed as a high-performance method for optimizing blood preparation and intraoperative consumption. Furthermore, ML has the potential to be incorporated into clinical practice as a calculator for the optimal cross-match to transfusion ratio.

Isolation and Cultivation of Adipose-Derived Mesenchymal Stem Cells Originating from the Infrapatellar Fat Pad Differentiated with Blood Products: Method and Protocol

Adipose-derived mesenchymal stem cells (ASCs) are a promising source for clinical application in regenerative orthopedics. ASCs derived from the infra-patellar fat pad (IFP)-a distinct adipose structure in the knee-show superior regenerative potential compared to subcutaneous-fat-derived cells. Furthermore, it has been shown that blood products enhance ASCs' viability. A major challenge for clinical translation of both ASCs and blood products is the low comparability of obtained data due to non-standardized harvesting, isolation and preparation methods. The aim of this method-paper is to provide reproducible protocols to help standardize basic research in the field to build a sound basis for clinical translation with an emphasize on practicability. The presented protocols include (i) ASC isolation from the IFP, (ii) blood product preparation and (iii) ASC incubation with blood products.

Development and Validation of a Prediction Model for Need for Massive Transfusion During Surgery Using Intraoperative Hemodynamic Monitoring Data

Massive transfusion is essential to prevent complications during uncontrolled intraoperative hemorrhage. As massive transfusion requires time for blood product preparation and additional medical personnel for a team-based approach, early prediction of massive transfusion is crucial for appropriate management. To evaluate a real-time prediction model for massive transfusion during surgery based on the incorporation of preoperative data and intraoperative hemodynamic monitoring data. This prognostic study used data sets from patients who underwent surgery with invasive blood pressure monitoring at Seoul National University Hospital (SNUH) from 2016 to 2019 and Boramae Medical Center (BMC) from 2020 to 2021. SNUH represented the development and internal validation data sets (n = 17 986 patients), and BMC represented the external validation data sets (n = 494 patients). Data were analyzed from November 2020 to December 2021. A deep learning-based real-time prediction model for massive transfusion. Massive transfusion was defined as a transfusion of 3 or more units of red blood cells over an hour. A preoperative prediction model for massive transfusion was developed using preoperative variables. Subsequently, a real-time prediction model using preoperative and intraoperative parameters was constructed to predict massive transfusion 10 minutes in advance. A prediction model, the massive transfusion index, calculated the risk of massive transfusion in real time. Among 17 986 patients at SNUH (mean [SD] age, 58.65 [14.81] years; 9036 [50.2%] female), 416 patients (2.3%) underwent massive transfusion during the operation (mean [SD] duration of operation, 170.99 [105.03] minutes). The real-time prediction model constructed with the use of preoperative and intraoperative parameters significantly outperformed the preoperative prediction model (area under the receiver characteristic curve [AUROC], 0.972; 95% CI, 0.968-0.976 vs AUROC, 0.824; 95% CI, 0.813-0.834 in the SNUH internal validation data set; P < .001). Patients with the highest massive transfusion index (ie, >90th percentile) had a 47.5-fold increased risk for a massive transfusion compared with those with a lower massive transfusion index (ie, <80th percentile). The real-time prediction model also showed excellent performance in the external validation data set (AUROC of 0.943 [95% CI, 0.919-0.961] in BMC). The findings of this prognostic study suggest that the real-time prediction model for massive transfusion showed high accuracy of prediction performance, enabling early intervention for high-risk patients. It suggests strong confidence in artificial intelligence-assisted clinical decision support systems in the operating field.

“You Get What You Need”: Early Results of BloodTrack System on Reducing Inefficiencies in Blood Product Allocation

Abstract Introduction/Objective The preparation of blood products allocated for massive transfusion protocol (MTP) activation and surgical cases consumes much time and energy of blood bank technologists. Often, these blood products are returned to the blood bank unused. Clinicians may activate the MTP preemptively to ensure the availability of blood products in case they are needed. Most blood products ordered for surgeries are placed on hold and not transfused. These returned units require additional inspections before they can be made available again. To reduce these inefficiencies, we implemented the BloodTrack [Haemonetics, Boston, MA] system, wherein blood products are stored in remote refrigerators and made available to clinicians near the patients’ bedside. Besides safeguarding units placed on hold for surgeries, we hypothesized that BloodTrack would provide greater visibility of available products in the emergency department (ED), thus reducing the rate of preemptive MTP activations. Methods/Case Report From March 2022 onwards, BloodTrack refrigerators with OnDemand software were active in the ED, operating room (OR), and two intensive care (ICU) units. We educated ED, OR, and ICU nurses on the appropriate use of BloodTrack. MTP activations were recorded from August 2021 to June 2022. Data on units allocated to OR patients by BloodTrack were collected from software-generated logs. Data on units allocated to OR patients by BloodTrack were collected from software-generated logs. Results (if a Case Study enter NA) Since its introduction in March, BloodTrack has dispensed 92 red blood cell units, which represents 12% of the total 766 units assigned. The remainder of 674 units were unused, and represent substantial savings in time otherwise spent re-instating them. Moreover, the rates of preemptive MTP activations trended downwards, from 28% (32/113) in the 7 months prior to implementation, to 13% (3/24) after implementation. Conclusion In conclusion, our implementation of BloodTrack has led to reduced MTP activations, improved efficiency of our blood product allocation process, and developed interdisciplinary care team integration.

LBODP009 Resection Of An Adrenocorticotropic Hormone Secreting Pheochromocytoma In A Jehovah'S Witness Patient

Abstract Background: Pheochromocytomas are rare neuroendocrine tumors arising from chromaffincells in the adrenal medulla, and the excessive catecholamine secreted causes serious cardiovascular effects to the patient. Adrenalectomy is the definitive treatment with a morbidity rate of 40% and a mortality rate of 2%. Intraoperative bleeding is a major concern with any surgical procedure, thus preparation of blood products for possible transfusion during the perioperative period is prudent. A religious group known as the Jehovah's witnesses recommend blood transfusion refusal to its members. We encountered a case of a Jehovah's witness with pheochromocytoma requiring adrenalectomy. CASE: A case of 54 year old, Filipino male, a Jehovah's witnesses, hypertensive for 14 years, complained of 1 week vague right upper quadrant abdominal pain and bouts of headache. A CT scan of the abdomen with contrast revealed an 11.7x 12.2×10.3cm mass on the right adrenal. Biochemical tests were consistent with pheochromocytoma that is co-secreting with ACTH, but with no physical features of hypercortisolism. An elevated levels of 24 hours urine Metanephrine (8.95 mg/ 24hrs),24 hours urine cortisol (173.98 mcg /24 hours), serum ACTH (57 pg/ml), 8am serumcortisol (22.44 mcg/dl), and 1 mg Dexamethasone suppression 8am cortisol (18.85mcg/dl). Patient consented to surgery but signed a waiver of refusal to any blood transfusion. Erythropoietin 5000 IU SC three times per week was then initiated 1month prior to the surgery. Terazosin 25 mg three times a day followed by Metoprolol25 mg twice daily, for adequate alpha and beta blockade, and hydration prior to surgery was done. The Estimated blood loss during surgery was 600 ml, patient's hemoglobin level dropped to 98 g/L on the 7th post-operative day from pre-operative level of 125 g/L, hence, the Erythropoietin was continued until was discharged. The Histopathology report showed round cell neoplasm, with positive immunohistochemical stain for synaptophysin and chromogranin, and a weak positive of NSE (Neuro-specific enolase) consistent with pheochromocytoma.

Anesthesia management in patients with abnormally invasive placenta: A single-center experience

Aim: Postpartum hemorrhage is a life-threatening obstetric emergent clinical situation accompanied by blood loss of more than 500 ml after vaginal delivery and more than 1000 ml after cesarean section. This situation, frequently encountered in placental adhesion anomalies, is essential in terms of follow-up, treatment, and multidisciplinary management. We aimed to retrospectively evaluate the perioperative anesthesia management, transfusion requirement, and postoperative intensive care unit requirement of patients diagnosed with placental invasion anomaly who had an intraoperative hemorrhage&#x0D; Methods: In our single-center study, a total of 58 female patients diagnosed with of placental invasion anomaly with a cesarean section between 2017-2020 were examined. Patients under 18 years of age and missing data were excluded from the study. Demographic data of patients (age, American Society of Anesthesiologists score (ASA)), diagnosis, duration of operation, perioperative laboratory findings, anesthesia type, perioperative hemodynamics (highest heart rate, lowest mean arterial pressure, shock index), amount of bleeding, blood products, and fluids used, surgical interventions (B-Lynch, Bacri balloon application, uterine artery ligation, hysterectomy), intraoperative vasopressor/inotrope use, ICU stay, laboratory results in the first 24 hours postoperatively, and total hospital stay were recorded.&#x0D; Results: In the preoperative evaluation, 27 (46.5%) patients were diagnosed with placenta accreta, and placenta previa was diagnosed in 19 (32.7%) patients. Perioperatively mean of 3.08 ± 1.7 units of Red blood cell was used. In patients with postoperative intensive care unit hospitalization, the highest intraoperative lactate value was 3.5±1.8 mmol/L, shock index was 1.3±0.3 (0.6-1.8). In patients given intraoperative fibrinogen concentrate, the intraoperative shock index was 1.5±0.2 (0.9-1.8), the amount of intraoperative bleeding was 2575±302.2 ml, and the fibrinogen levels measured in the first 24 hours after surgery were 294.7±79.7 mg/dl.&#x0D; Conclusions: Anesthesia management of patients diagnosed with abnormal placental invasion is important because of significant hemorrhage. Due to unstable hemodynamics, preoperative blood product preparation with a multidisciplinary approach and a postoperative intensive care unit plan should be made for these patients.

Economic impact of a machine learning-based strategy for preparation of blood products in brain tumor surgery.

Globally, blood donation has been disturbed due to the pandemic. Consequently, the optimization of preoperative blood preparation should be a point of concern. Machine learning (ML) is one of the modern approaches that have been applied by physicians to help decision-making. The main objective of this study was to identify the cost differences of the ML-based strategy compared with other strategies in preoperative blood products preparation. A secondary objective was to compare the effectiveness indexes of blood products preparation among strategies. The study utilized a retrospective cohort design conducted on brain tumor patients who had undergone surgery between January 2014 and December 2021. Overall data were divided into two cohorts. The first cohort was used for the development and deployment of the ML-based web application, while validation, comparison of the effectiveness indexes, and economic evaluation were performed using the second cohort. Therefore, the effectiveness indexes of blood preparation and cost difference were compared among the ML-based strategy, clinical trial-based strategy, and routine-based strategy. Over a 2-year period, the crossmatch to transfusion (C/T) ratio, transfusion probability (Tp), and transfusion index (Ti) of the ML-based strategy were 1.10, 57.0%, and 1.62, respectively, while the routine-based strategy had a C/T ratio of 4.67%, Tp of 27.9%%, and Ti of 0.79. The overall costs of blood products preparation among the ML-based strategy, clinical trial-based strategy, and routine-based strategy were 30, 061.56$, 57,313.92$, and 136,292.94$, respectively. From the cost difference between the ML-based strategy and routine-based strategy, we observed cost savings of 92,519.97$ (67.88%) for the 2-year period. The ML-based strategy is one of the most effective strategies to balance the unnecessary workloads at blood banks and reduce the cost of unnecessary blood products preparation from low C/T ratio as well as high Tp and Ti. Further studies should be performed to confirm the generalizability and applicability of the ML-based strategy.

Effect of activation of Toll-like receptor signaling pathway of peripheral blood mononuclear cell in recombinant hepatitis B surface antigen immune response

Objective: To explore the effect and mechanism of activation of peripheral blood mononuclear cell (PBMC) Toll-like receptor (TLR3) signaling pathway in recombinant HBsAg (rHBsAg) immune response. Methods: White blood cells were collected from peripheral blood of 13 healthy donors in the preparation of blood products. PBMC was isolated and treated with Poly I:C (Poly I:C group) and PBS (control group) respectively. 48 h later, some cells were collected and the expressions of TLR3 signaling pathway proteins were detected by flow cytometry. After activating (Poly I:C group)/inactivating (control group) TLR3 signaling pathway, rHBsAg was given to both groups for 72 h, and the proportions of DC, T, B cells and their subsets in PBMC were detected by flow cytometry. Paired t-test, paired samples wilcoxon signed-rank test and canonical correlation analyses were used for statistical analysis. Results: The percentage of TLR3 protein-positive cells (19.21%) and protein expression (8 983.95), NF-κB protein expression (26 193.13), the percentage of pNF-κB protein-positive cells (13.73%) and its proportion in NF-κB (16.03%), and the percentage of pIRF3 protein-positive cells (12.64%) and its proportion in IRF3 (21.80%) in Poly I:C group were higher than those in control group (11.54%, 8 086.00, 22 340.66, 8.72%, 9.71%, 9.57%, 19.12%) (P<0.05), and the percentage of TRIF protein-positive cells (89.75%) and protein expression (304 219.54) were higher in Poly I:C group than in the control group (89.64%, 288 149.72) (P>0.05). After PBMC stimulation by rHBsAg, the proportions of mDC (2.90%), pDC (1.80%), B cell (5.31%) and plasma cell (67.71%) in Poly I:C group were significantly higher than those in the control group (1.83%, 0.81%, 4.23%, 58.82%) (P<0.05). Results of canonical correlation analysis showed that the expression of TLR3 protein was positively correlated with the proportions of plasma cells, the expression of pIRF3 protein was positively correlated with the proportions of plasma cells and mDC, and the percentage of pNF-κB protein-positive cells and the percentage of pIRF3 protein-positive cells were positively correlated with the proportion of CD4+T cells. Conclusions: Poly I:C can activate TLR3/TRIF/NF-κB and TLR3/TRIF/IRF3 signaling pathway, promote the function of downstream signaling molecules, and then promote the maturation of DC, induce the immune responses of CD4+T cell, and promote the maturation and activation of B cells and the immune response of rHBsAg.

Manual removal of the placenta and postpartum hemorrhage: A multicenter retrospective study.

In postpartum women, retained placenta is diagnosed in the absence of signs of placental separation and expulsion, and requires manual removal of the placenta (MROP). MROP may lead to massive hemorrhage, hemodynamic instability, and the need for emergency interventions including blood transfusion, interventional radiology, and hysterectomy. In this study, we aimed to identify the risk factors for retained placenta requiring MROP after vaginal delivery and postpartum hemorrhage (PPH) following MROP. A multicenter retrospective study was performed using data from women who delivered at term between 2010 and 2018 at 13 facilities in Japan. Of 36 454 eligible women, 112 women who required MROP were identified. Multivariate logistic regression analyses were conducted to evaluate the risk factors for retained placenta and PPH following MROP. A history of abortion, assisted reproductive technology (ART), instrumental delivery, and delivery of small-for-gestational-age infant were independent risk factors for MROP (adjusted odds ratios [95% confidence intervals]: 1.93 [1.28-2.92], 8.41 [5.43-13.05], 1.80 [1.14-2.82], and 4.32 [1.97-9.48], respectively). ART was identified as an independent risk factor for PPH (adjusted odds ratio [95% confidence interval]: 6.67 [2.42-18.36]) in patients who underwent MROP. ART pregnancies significantly increased the risk of retained placenta requiring MROP and PPH. Our results suggest that clinicians need consider patient transfer to a higher-level facility and preparation of sufficient blood products before initiating MROP in cases of ART pregnancies. Our study may assist in identifying high-risk women for PPH before MROP and in guiding treatment decisions, especially in facilities without a blood bank.

792 Intrauterine transfusion practice patterns among members of the society for Maternal-Fetal medicine

To describe practice pattern among providers of intrauterine transfusion (IUT). In this cross-sectional study, maternal-fetal medicine specialists (MFM) were surveyed regarding their IUT practices. The survey was made available to members of the Society for Maternal-Fetal Medicine (SMFM) via posting on the SMFM website and via distribution through the SMFM Special Delivery email list. IUT survey questions included number performed annually, location of procedure, perioperative medications, maternal analgesia, fetal access site, and postoperative care. Data were reported using descriptive statistics. A total of 51 respondents completed the survey. The majority (75%) reported an institutional rate of fewer than 10 IUT per year. The majority (81%) responded that fewer than 5 MFM perform IUT at their institution. While most IUT occur in the operating room (78% viable and 49% previable), previable cases were more likely to occur elsewhere when compared to viable cases (34% vs 14% in Labor/Delivery room; 17% vs 7% in ultrasound suite). There were a variety of responses regarding perioperative use of tocolytics, antibiotics, paralytics, and steroids (Figure 1). Of the 41 who provided information about immediate postoperative care, most reported a minimal fetal monitoring period of a few hours after the procedure, with only 9 (22%) reporting universal admission for extended overnight monitoring. The most commonly reported fetal access site was the placental cord insertion (PCI), followed by a free loop of cord (Figure 2). There appears to be a wide range of IUT-specific practices among IUT-performing members of SMFM. Consideration should be given to convening an expert panel to review the available evidence and provide a list of best practices for IUT. Additional topics to address include frequency of ultrasound monitoring following first IUT, threshold for repeating IUT, and latest gestational age to perform IUT. Querying blood bank personnel regarding IUT-specific preparation of blood products should be another focus of future research.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Placental Location Affects Cesarean Complications in Patients with Placenta Previa

Objective: Placenta previa may cause massive hemorrhage at antenatal, intrapartum or postpartum periods and is one of the leading causes of maternal morbidity and mortality. Anterior or posterior location of placenta previa can change cesarean technique and management of the operation. Aim of this study is to assess factors increasing intraoperative complications in patients with placenta previa and investigate the significance of anterior placenta location apart from other factors.Study Design: This is a retrospective cohort study which was conducted in one center including 83 patients followed with placenta previa in three years’ duration. Placental location, presence, and depth of myometrial invasion, previous uterine surgery and the type of uterine incision were evaluated. Intraoperative hemorrhage, need for blood transfusion and hysterectomy, complete blood count parameters of mother and newborn were compared between the anterior and posterior placenta previa.Results: Previous uterine surgery, abnormally invasive placenta and need for blood transfusion were significantly higher in patients with anterior placenta previa. The increasing number of previous cesarean operations enhanced placental invasion to cesarean scar area in anterior placentation, leading to higher rates of blood transfusion, classical incision, and hysterectomy. Also, when the patients with previous cesarean or classical incision were excluded, anterior placentation differed significantly when compared with posterior placentation with respect to hemoglobin differences between preoperative and postoperative values.Conclusion: Anterior location of placenta previa increases hemorrhagic complications. Placental location, presence, and depth of invasion should be assessed and timing of delivery should be planned with appropriate preparation of blood products before delivery.

Equipment and materials management

Equipment and materials management

Optimizing Perioperative Red Blood Cell Utilization and Wastage in Pediatric Craniofacial Surgery.

Utilization, wastage, and adverse consequences of assigning one full red blood cell (RBC) unit were investigated for children undergoing craniosynostosis surgery. The authors hypothesized that significant RBC wastage in the perioperative period exists for pediatric craniofacial surgery. The authors sought to determine what factors could guide patient-specific blood product preparation by evaluating utilization and wastage of RBCs in pediatric patients undergoing surgical correction of craniosynostosis. Eighty-five children with craniosynostosis undergoing surgical correction at our institution between July 2013 and June 2015 were identified. Fifty-three patients received RBC transfusion in the perioperative period, while 32 patients were not transfused. Primary outcome measures were intraoperative, postoperative, and total percent of RBC wastage. Secondary analysis compared the impact of patient weight and procedure type on perioperative RBC wastage. Of the 53 patients who received perioperative RBC transfusion, 35 patients received a volume of blood less than the full volume of the RBC unit while 18 patients received the full volume of blood. There was no significant relationship between perioperative RBC wastage, the type of craniofacial procedure performed, or the duration of surgical time. Children who received a perioperative transfusion and had RBC wastage weighed significantly less than those who received a full volume. These findings suggest that for craniofacial surgical patients weighing less than 10 kg, a protocol that splits cross-matched RBC units can decrease perioperative RBC wastage and blood donor exposure. A future prospective study will determine the success of this intervention as well as the potential to decrease exposure to multiple blood donors.

A new model and a Monte Carlo based Particle Swarm Optimization algorithm for the stochastic blood assignment problem

Blood and its products, in some cases, are the only vital and sanative medicine for the patients. Each donated blood unit is a valuable asset to protect the patients’ lives, and it should be avoided waste and non-optimal consumption. The assignment of blood and its products to hospitals is one of assignment problems, in which finding the optimal solution can lead to a reduction in mortality and waste of expenditure. In this research, a new model for the assignment of blood products in a stochastic environment is presented. The goal of the model is to minimize the preparation, deficiency and waste cost of blood products, while considering the constraints of the problem. The stochastic model is implemented in a real case and is solved by the Monte Carlo simulation method. Then, a random model is settled in a real problem in Yazd city and it is solved via a Monte Carlo based Particle Swarm Optimization algorithm. The results reveal that the solution of the hybrid algorithm can significantly reduce the costs of preparation, deficiency and waste of blood products.