Transfusion Of Components Research Articles

Assessment of blood transfusion use during hospital treatment of COVID-19 patients - a single center experience

Introduction/Objective. There is very limited data regarding the need for transfusion and its effect on the overall mortality of patients with coronavirus disease 2019 (COVID-19). The aim of our study is to determine the need for blood component transfusion in patents treated for COVID-19 infection. Methods. This retrospective observational study included 4426 COVID-19-positive patients treated at the Bezanijska Kosa University Hospital Medical Center between June 23, 2020 and May 2, 2021. Of these patients, 826 were treated in the intensive care units of the hospital. Of the total number of patients, 326 (7.4%) received transfusions. The clinical presentation, the structure of the applied transfusion therapy, the laboratory parameters, and the treatment outcome were analyzed in this study. Results. Of the 828 patients treated in the intensive care units, 151 (18.2%) patients required transfusion, while transfusion was necessary in a total of 4.9% of patients treated in the hospital wards. Of the total number of all transfused patients, 86% received erythrocytes, one-third of them received fresh frozen plasma, 10% received cryoprecipitate, while platelets were administered in around 6% of the patients. The mortality rate in the tested group was 46%. Conclusion. The frequency of the application of blood components was significantly higher in patients with a severe form of the disease. The presence of comorbidities did not affect the need for transfusion therapy. In the group of patients treated in the intensive care units, 85% received erythrocytes, 39% received fresh frozen plasma, 19% received cryoprecipitate and 7% received platelets.

Utilisation of Different Blood Components in Paediatric Patients: A Cross-sectional Study

Introduction: The term “blood component” refers to the separation of Whole Blood (WB) into packed red cells, platelet- rich plasma, Fresh Frozen Plasma (FFP), cryoprecipitate, and leukocytes. The practice of separating donated WB units into different blood components and supplying only those components to patients is now considered a standard practice in all blood banks. Therefore, regular auditing of blood usage and its components is essential to assess blood utilisation patterns. Aim: The aim of this study was to analyse the distribution and appropriateness of blood and blood product transfusions in children aged 1-18 years. Materials and Methods: A cross-sectional study was conducted over an 18-month period from December 1, 2014, to June 30, 2016, involving paediatric patients requiring blood and blood product transfusions, who presented to the Department of Paediatrics, Shri B.M. Patil Medical Hospital, Vijayapura, Karnataka, India. The study population consisted of children aged 1-18 years. Data from blood component requisition forms were collected, and reports of investigations such as pre-transfusion/ post-transfusion haematological parameters, coagulogram, and peripheral smear were recorded. Predetermined criteria were used to assess each transfusion episode. The results were then analysed, tabulated, and expressed as a percentage. The appropriateness of Packed Red Blood Cell (PRBC), platelet, and FFP transfusions was estimated using predetermined criteria. Data from blood component requisition forms were collected, coded, tabulated, analysed, and expressed as a percentage. Results: The study included 149 paediatric patients aged 1 to 18 years. Out of a total of 214 episodes of blood and blood component transfusions among the 149 patients, 102 episodes (47.7%) were WB transfusions, 67 episodes (31.3%) were packed red cell transfusions, 26 episodes (12.1%) were platelet transfusions, and 19 episodes (8.9%) were FFP transfusions. Out of the total 214 transfusion episodes, 126 (58.5%) were deemed appropriate, while 88 (41.5%) were deemed inappropriate. The most commonly inappropriately used component was WB, followed by platelets, FFP, and packed red cells. Inappropriateness of WB usage was primarily due to attempts to achieve haemostasis in bleeding patients, while sepsis was the most common indication for inappropriate platelet usage. Conclusion: This audit highlights significant variation in transfusion practice patterns among paediatricians. The most common indications for usage were found to be achieving haemostasis, threshold haemoglobin concentration, and sepsis in children.

Distribution of ABO and Rhesus Blood Groups among the Blood Donors in a Teaching Hospital of Hilly Region, Nepal: A Cross-sectional Study

INTRODUCTION: The ABO and Rhesus-D blood group systems are important and widely used in humans for transfusion of blood and blood components for various medical conditions. The purpose of this study was to determine the distribution of ABO and Rhesus D blood groups among blood donors at Karnali Academy of Health Sciences, Teaching Hospital, Jumla, Nepal. MATERIALS AND METHODS: From July 2019 to January 2022, a retrospective cross-sectional study among 800 blood donors was conducted using medical records from blood donors who donated blood in a Teaching Hospital of Jumla, Nepal. Microsoft Excel was used to analyze thedata, and the results were presented as frequency and percentage. RESULTS: The most common blood group was ‘A’ (30.6%) and the least common was ‘AB’ (14.5%) with a majority of male blood donors (84.6%). Only 2.2% of blood donors was Rhesus-negative, while 97.7% were Rhesus-positive. Considering ABO and Rhesus blood groups altogether, blood group ‘A’ Rhesuspositive (30.1%) was the most common and blood group ‘AB’ Rhesus-negative (0.1%) was the least common. CONCLUSIONS: Blood group ‘A’ was the most common, followed by blood groups ‘B’, ‘O’, and ‘AB’. The majority of the blood donors were Rhesus-positive, with blood group ‘AB’ Rhesus-negative being the most uncommon. This information would be helpful to the hospital’s blood bank in this rural hilly region, particularly in the hospital’s planning for blood transfusion services.

Dynamic laboratory control of iron deficiency correction in neurosurgical patients

Introduction. The concept of blood management in relation to the surgical treatment of surgical diseases recommends the correction of iron defi ciency anemia (IDA) at the prehospital stage. However, surgery is often performed for emergency indications, making it necessary to carry out treatment as soon as possible.Aim – to evaluate the possibilities of using delta hemoglobin (Delta-He) to monitor the effectiveness of IDA therapy in neurosurgical patients at the prehospital stage to reduce the time required to prepare patients for hospitalization.Materials and methods. A total of 42 patients were treated with high-dose iron preparations (iron [III] carboxymaltosate and iron [III] hydroxide oligoisomaltosate). During the treatment, the dynamics of the number of reticulocytes and the values of the hemoglobin delta were evaluated. Data are presented as median (IQR).Results. Treatment with high-dose iron preparations led to an increase in Delta-He values starting from days 1–2. Significant changes were recorded by days 3–4 from the start of therapy: from 2.2 (0.3–4.9) pg to 15.5 (13.8–10) pg on day 7. These changes were 2–3 days ahead of the increase in the number of reticulocytes in the corresponding blood samples: the number of reticulocytes significantly increased by days 5–6 from the start of treatment.Conclusion. The use of high-dose preparations of iron [III] carboxymaltosate and iron [III] hydroxide oligoisomaltosate in the form of infusion made it possible to prepare neurosurgical patients for hospitalization within a week. None of the patients required transfusion of erythrocyte-containing components of donated blood at any stage of surgical treatment. The ability to focus on Delta-He values instead of the number of reticulocytes during iron therapy made it possible to shorten the waiting period for the effect of drug exposure by 2–3 days.

Platelets play a dual role in the pathophysiology of transfusion-related acute lung injury

Platelets are increasingly recognized as key regulators of inflammatory and immune responses, through their interaction with endothelium and immune cells. Therefore they might have a role in transfusion-related acute lung injury (TRALI), in which endothelial cells and neutrophils are the key players. In this study, by a classic TRALI animal model, combining a custom-designed system for intravital confocal microscopy of pulmonary microvasculature and a platelet tracking technique, we found that thrombin-activated platelets transfusion aggravated TRALI while resting platelets transfusion alleviated TRALI. Promoting endogenous platelets activation also aggravated TRALI while inhibiting endogenous platelets activation alleviated TRALI. Activated platelets interfered with the stability of endothelial barrier function while resting platelets modulated the activation of neutrophils. Anti-thrombin could alleviate TRALI, which was not reproduced upon anti-GPIIbIIIa or anti-P-selectin In conclusion, platelets might play a dual role (protective and pathogenic) in TRALI, the balance between the two roles is highly dependent on whether platelets are activated by thrombin or not. This might explain the conflicting results of previous researches studying the contribution of platelets in TRALI by platelet depletion technology, in which the induction of TRALI and the condition of animals were different, hence the state of platelets during TRALI was different. Moreover, anti-platelet-activation (such as anti-thrombin) might be a better approach than anti-activated-platelets (such as anti-P-selectin) to search for potential therapies in TRALI. Considering the involvement of thrombin-activated platelets in TRALI, anti-thrombin might be needed when blood component transfusion is performed.

Blood component requirements in liver transplantation: effect of 2 thromboelastometry-guided strategies for bolus fibrinogen infusion—the TROMBOFIB randomized trial

BackgroundA low plasma fibrinogen level influences blood component transfusion. Thromboelastometry provides clinical guidance for fibrinogen replacement in liver transplantation (LT). ObjectivesWe hypothesized that infusions of fibrinogen concentrate to reach an A10FibTem value of 11 mm during LT could reduce red blood cell (RBC) and other component and fluid requirements in comparison to standard care. MethodsThis randomized, blinded, multicenter trial in 3 hospitals enrolled 189 LT-scheduled patients allocated to an intervention target (A10FibTem, 11 mm) or a standard target (A10FibTem, 8 mm); 176 patients underwent LT with fibrinogen replacement. Data were analyzed by intention-to-treat (intervention group, 91; control group, 85). Blood was extracted, and fibrinogen kits were prepared to bring each patient’s fibrinogen level to the assigned target at the start of LT, after portal vein clamping, and after graft reperfusion. The main outcome was the proportion of patients requiring RBC transfusion during LT or within 24 hours. ResultsThe proportion of patients requiring RBCs did not differ between the groups: intervention, 74.7% (95% CI, 65.5%-83.3%); control, 72.9% (95% CI, 62.2%-82.0%); absolute difference, 1.8% (95% CI, −11.1% to 14.78%) (P = .922). Thrombotic events occurred in 4% of the patients in both groups; reoperation and retransplantation rates and mortality did not differ. Nearly 70% of the patients in both groups required fibrinogen concentrate to reach the target. Using an 11-mm A10FibTem target increased the maximum clot firmness without affecting safety. However, this change provided no clinical benefits. ConclusionThe similar low plasma fibrinogen concentrations could explain the lack of significant between-group outcomes.

Balanced blood component resuscitation in trauma: Does it matter equally at different transfusion volumes?

BackgroundIt remains unclear whether the association between balanced blood component transfusion and lower mortality is generalizable to trauma patients receiving varying transfusion volumes. We sought to study the role red blood cell transfusion volume plays in the relationships between red blood cell:platelet and red blood cell:fresh frozen plasma ratios and 4-hour mortality. MethodsAdult patients in the 2013 to 2018 American College of Surgeons Trauma Quality Improvement Program database receiving ≥6 red blood cell, ≥1 platelet, and ≥1 fresh frozen plasma within 4 hours were included. The following 4 cohorts were defined based on 4-hour red blood cell transfusion volume: (1) 6 to 10 units, (2) 11 to 15 units, (3) 16 to 20 units, and (4) >20 units. The association between red blood cell:fresh frozen plasma, red blood cell:platelet, and 4-hour mortality was evaluated discretely for each red blood cell transfusion volume category, statistically adjusting for confounders. ResultsA total of 14,549 patients were included. In patients receiving 6 to 10 units of red blood cells, red blood cell:platelet ratios were not associated with 4-hour mortality, and only red blood cell:fresh frozen plasma ≥4:1 were associated with significantly higher odds of 4-hour mortality compared to 1:1. For patients receiving >10 red blood cell units, increasing red blood cell:platelet and red blood cell:fresh frozen plasma ratios were consistently associated with increased odds of 4-hour mortality. For example, in red blood cell volumes of 11 to 15, 16 to 20, and >20 units, risk-adjusted 4-hour mortality odds ratios for red blood cell:platelet ≥4:1 were 2.27 (1.47–3.51), 3.32 (2.26–4.90), and 3.01 (2.33–3.88), respectively. ConclusionThe association between balanced blood component transfusion and 4-hour mortality is not homogenous in trauma patients requiring different transfusion volumes and is specifically less evident in patients receiving lower volumes. Such findings should be considered in the current and future blood shortage crises across the nation.

CARDIAC SURGERY IN JEHOVAH'S WITNESSES: 337 CONSECUTIVE CASES

<h3>Objective</h3> Cardiac surgery is associated with high rates of allogenic blood transfusion, due to the invasiveness of the procedures, perioperative blood loss and use of extracorporeal circulation. For their refusal of transfusion of any blood component, cardiac surgery in Jehovah's Witnesses can be a challenge. Over the last few decades, our hospital has developed as the national expertise centre for cardiac surgery in adult Jehovah's Witnesses. The aim of this study was to describe the outcome of the Jehovah's Witnesses undergoing cardiac surgery in our centre. <h3>Design and Method</h3> In this retrospective review, data of all Jehovah's Witnesses undergoing cardiac surgery in our hospital were collected from the 1st of January 2001 to the 31st of January 2022. Descriptive statistics were used to analyze obtained data. The institutional protocol describing all perioperative care in this special group has been applied for 21 years. Preoperative treatment consisted of pre-operative discontinuation of anticoagulant and antiplatelet therapy, erythropoietin, folic acid, vitamin B12 and iron therapy in case of anemia. Transfusion of blood components or medication of human origin were avoided and intra-operative blood collection via cell-saver and transfusion of autologous blood was used. <h3>Results</h3> The study cohort consisted of 337 Jehovah's Witnesses undergoing cardiac surgery. 69% were men and the mean age was 68 years. Twenty-three patients (6.8%) were treated for anaemia. The mean Euroscore was 5.1 (range 0-18). Surgery was elective in 72.9% and emergent in 2.7% of patients. Coronary Artery Bypass Grafting (54.1%) was performed most, followed by aortic valve replacements (18.6%). The mean operation time was 226 ± 134 minutes, with a mean extracorporeal circulation time of 88 ±51 minutes. Mean preoperative hemoglobin levels were 9 mmol/L (range 6.1-11.5 mmol/L), dropping to 7.2 mmol/L (range 4.1-9.9 mmol/L) at hospital discharge. Mean blood loss was 439 ± 349 mL in the first 12-hours post-surgery. Maximum mean postoperative troponin levels were 428 ± 422 ng/L. Rethoracotomy and myocardial infarction occurred in 3.6% and 4.2% of patients, respectively. In 4.2% cases, post-operative myocardial infarction was diagnosed. On average, patients had an intensive care unit stay of 1.4 ± 1.8 days and hospital stay of 6.8 ± 4.2 days. Hospital mortality was 0.6%. <h3>Conclusions</h3> This study demonstrates that cardiac surgery in Jehovah's Witnesses is safe when adhering to a strict perioperative patient blood management protocol, with a mortality of only 0.6%. Further research needs to be conducted to compare these outcomes to our general population and discover whether our strategy used in Jehovah's Witnesses could safely be extended to a wider population.

EXPERIENCE OF HYPOFIBRINOGENEMIA CORRECTION AFTER CARDIAC SURGERY IN ICU

<h3>Objective</h3> Bleeding common complication after cardiac surgery, and requires blood component transfusion. Associated with increased risk of morbidity and mortality and associated costs. The pathophysiology of cardiac surgery-related bleeding is often multifactorial and may include acquired hypofibrinogenemia (fibrinogen level <1.5-2.0 g/L), which exacerbates blood loss. The effectiveness and safety of administering fibrinogen concentrate in cardiac surgery are limited. Studies are limited by their low sample size and large heterogeneity regarding the patient population. On this occasion correction of acquired hypofibrinogenemia in patients after cardiac surgery was initiated in our institution. <h3>Materials and Methods</h3> The research is based on a single-centre study and prospective observation of patients with acquired hypofibrinogenemia after cardiac surgery in an intensive care unit (ICU). Thus, 70 adult patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) for whom fibrinogen replacement was ordered in response to clinically significant bleeding deemed related to acquired hypofibrinogenemia were selected for the study. Patients were divided into two groups: the first group correction with fibrinogen concentrate and the second group correction with cryoprecipitate. Fibrinogen level was assessed before surgery, after surgery (before correction), and after correction (within 24 hours after correction with fibrinogen concentrate or cryoprecipitate). <h3>Results</h3> In the cryoprecipitate group, 21 patients (60%) were women and 14 (40%) men, mean age was 55±14.26, mean BMI was 28±3.25. In the fibrinogen concentrate group, 17 patients (49%) were women and 18 (51%) men, mean age was 54.14±14.7, mean BMI was 26.9±5.17. The average concentration of fibrinogen before surgery in the group with fibrinogen concentrate was 2.58±0.75 g/l, and in the group with cryoprecipitate, it was 2.38±0.88 g/l. The average concentration of fibrinogen after surgery (before correction) was 1.53±0.22 g/l in the group with fibrinogen concentrate, and in the group, with cryoprecipitate it was 1.4±0.2 g/l The average fibrinogen concentration after correction after 24 hours was 2.3 ± 0.57 g/l in the group with fibrinogen concentrate, and in the group with cryoprecipitate, it was 2.5 ± 0.84 g/l. The average fibrinogen concentration after correction after 48 hours was 3.4 ± 1.5 g/l in the group with fibrinogen concentrate, and in the group with cryoprecipitate it was 3.86 ± 2.62 g/l The average length of stay in the ICU in the group with fibrinogen concentrate was 11.5±24.3 days, and in the group with cryoprecipitate was 17.85±25.6 days. After treatment in the ICU, 32 patients were discharged and 3 died in the fibrinogen concentrate group, and 33 patients were discharged and 2 patients died in the cryoprecipitate group. Mortality in the group with fibrinogen concentrate was 8.5%, and in the group, with cryoprecipitate it was 5.7%. <h3>Conclusion</h3> According to the levels of fibrinogen in plasma, fibrinogen concentrate is as effective as cryoprecipitate in the treatment of hypofibrinogenemia and may be beneficial for patients after cardiac surgery.

How to improve issuing, transfusion and follow-up of blood components in Southern and Eastern Mediterranean countries? A benchmark assessment

To determine the existence of guidelines regarding the appropriate clinical use of blood and blood components, transfusion requests, and blood issuing/reception documents and procedures. The different bedside transfusion organizations/processes and hemovigilance are also analyzed. The ultimate objective is to identify safe potential options in order to improve blood safety at the lowest cost. Data emanating from eight Arabic eastern/southern Mediterranean countries who responded to five surveys were collected and tabulated. National recommendations for the clinical use of blood components especially for hemoglobinopathies are lacking in some countries. In matter of good practices in the prescription, issuing and reception of BCs, efforts were made either on national or local basis. Procedures regarding patient information and ethical issues are still lacking. Almost all Mediterranean countries apply two blood testing procedures on each patient sample. Only Morocco, Tunisia and Algeria perform bed side blood group testing; Egypt and Lebanon perform antibody screen and antiglobulin cross matching universally. Automation for blood testing is insufficiently implemented in almost all countries and electronic release is almost absent. National hemovigilance policy is implemented in Tunisia, Morocco, and Lebanon but the reporting system remains inoperative. Insufficient resources severely hinders the implementation of expensive procedures and programs; however, the present work identifies safe procedures that might save resources to improve other parts in the transfusion process (e.g. electronic release to improve safety in issuing). Moreover, setting up regulations regarding ethics in transfusing recipients along with local transfusion committees are crucially needed to implement hemovigilance in transfusion practice.

Transfusion-free Strategies in Liver and Pancreatic Surgery: A Predictive Model of Blood Conservation for Transfusion Avoidance in Mainstream Populations.

The objective of this study is to (1) describe the techniques and prove the feasibility of performing complex hepatobiliary and pancreatic surgery on a Jehovah Witness (JW) population. (2) Describe a strategy that offsets surgical blood loss by the manipulation of circulating blood volume to create reserve whole blood upon anesthesia induction. Major liver and pancreatic resections often require operative transfusions. This limits surgical options for patients who do not accept major blood component transfusions. There is also growing recognition of the negative impact of allogenic blood transfusions. A 23-year, single-center, retrospective review of JW patients undergoing liver and pancreatic resections was performed. We describe perioperative management and patient outcomes. Acute normovolemic hemodilution (ANH) is proposed as an important strategy for offsetting blood losses and preventing the need for blood transfusion. A quantitative mathematical formula is developed to provide guidance for its use. One hundred one major resections were analyzed (liver n=57, pancreas n=44). ANH was utilized in 72 patients (liver n=38, pancreas n=34) with median removal of 2 units that were returned for hemorrhage as needed or at the completion of operation. There were no perioperative mortalities. Morbidity classified as Clavien grade 3 or higher occurred in 7.0% of liver resection and 15.9% of pancreatic resection patients. Deliberate perioperative management makes transfusion-free liver and pancreatic resections feasible. Intraoperative whole blood removal with ANH specifically preserves red cell mass, platelets, and coagulation factors for timely reinfusion. Application of the described JW transfusion-free strategy to a broader general population could lessen blood utilization costs and morbidities.

Patient blood management strategies in vascular surgery

Transfusion of blood components can save lives, but like all therapeutics, it carries risks and costs. Therefore, transfusion should be used judiciously. Patient blood management provides safe and rational use of blood and blood products and is designed to improve patient outcomes by minimizing unnecessary exposure to blood products. In this review, perioperative patient blood management and techniques to minimize blood loss during vascular surgery are discussed.

Omics Markers of Red Blood Cell Transfusion in Trauma.

Red blood cell (RBC) transfusion is a life-saving intervention for millions of trauma patients every year worldwide. While hemoglobin thresholds are clinically driving the need for RBC transfusion, limited information is available with respect to transfusion efficacy at the molecular level in clinically relevant cohorts. Here, we combined plasma metabolomic and proteomic measurements in longitudinal samples (n = 118; up to 13 time points; total samples: 690) from trauma patients enrolled in the control of major bleeding after trauma (COMBAT) study. Samples were collected in the emergency department and at continuous intervals up to 168 h (seven days) post-hospitalization. Statistical analyses were performed to determine omics correlate to transfusions of one, two, three, five, or more packed RBC units. While confounded by the concomitant transfusion of other blood components and other iatrogenic interventions (e.g., surgery), here we report that transfusion of one or more packed RBCs—mostly occurring within the first 4 h from hospitalization in this cohort—results in the increase in circulating levels of additive solution components (e.g., mannitol, phosphate) and decreases in the levels of circulating markers of hypoxia, such as lactate, carboxylic acids (e.g., succinate), sphingosine 1-phosphate, polyamines (especially spermidine), and hypoxanthine metabolites with potential roles in thromboinflammatory modulation after trauma. These correlations were the strongest in patients with the highest new injury severity scores (NISS > 25) and lowest base excess (BE < −10), and the effect observed was proportional to the number of units transfused. We thus show that transfusion of packed RBCs transiently increases the circulating levels of plasticizers—likely leaching from the blood units during refrigerated storage in the blood bank. Changes in the levels of arginine metabolites (especially citrulline to ornithine ratios) are indicative of an effect of transfusion on nitric oxide metabolism, which could potentially contribute to endothelial regulation. RBC transfusion was associated with changes in the circulating levels of coagulation factors, fibrinogen chains, and RBC-proteins. Changes in lysophospholipids and acyl-carnitines were observed upon transfusion, suggestive of an effect on the circulating lipidome—though cell-extrinsic/intrinsic effects and/or the contribution of other blood components cannot be disentangled. By showing a significant decrease in circulating markers of hypoxia, this study provides the first multi-omics characterization of RBC transfusion efficacy in a clinically relevant cohort of trauma patients.

THE INITIAL ION SHIFT INDEX AS A PROGNOSTIC INDICATOR TO PREDICT PATIENT SURVIVAL IN TRAUMATIC DAMAGE CONTROL LAPAROTOMY PATIENTS.

Objective: The ion shift index (ISI), which considers extracellular fluid ions such as phosphate, calcium, and magnesium, represents the ion shift following ischemia; concentrations of these ions are maintained within narrow normal ranges by adenosine triphosphate-dependent homeostasis. The ISI is defined as follows: {potassium (mmol/L-1) + phosphate (mmol/L-1) + Mg (mmol/L-1)}/calcium (mmol/L-1). This study investigated the possibility of predicting the 30-day survival rate of patients who underwent traumatic damage control laparotomy by comparing ISI and other laboratory findings, as well as the initial Trauma and Injury Severity Score (TRISS) and shock indices. Methods: Among the 134 patients who underwent damage control surgery between November 2012 and December 2021, 115 patients were enrolled in this study. Data regarding injury mechanism, age, sex, laboratory findings, vital signs, Glasgow Coma Scale score, Injury Severity Score, Abbreviated Injury Scale score, blood component transfusion, type of surgery, postoperative laboratory outcomes, morbidity, mortality rates, fluids administered, and volume of transfusions were collected and analyzed. Results: In univariate analysis, the odds ratio of the initial ISI was 2.875 (95% confidence interval, 1.52-5.43; P = 0.04), which showed a higher correlation with mortality compared with other indices. The receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) were derived from different multivariable logistic regression models. The initial ISI had high sensitivity and specificity in predicting patient mortality (AUC, 0.7378). In addition, in the model combining the initial ISI, crystalloids, and TRISS, the AUC showed a high value (AUC, 0.8227). Conclusion: The ISI evaluated using electrolytes immediately after admission in patients undergoing traumatic damage control surgery may be a predictor of patient mortality.

Intraoperative methods for assessing blood loss: A review

Massive blood loss that develops during surgery is a common cause of life-threatening conditions and deaths in patients of any age.&#x0D; This study aimed to analyze domestic and foreign publications that present methods for determining the volume of intraoperative blood loss.&#x0D; The literature sources were searched in PubMed, Scopus, Web of Science, MEDLINE, eLibrary, and Russian Science Citation Index databases. The search was conducted in Russian and English using the following keywords: intraoperative blood loss, severity of blood loss, methods for assessing blood loss, direct methods, and indirect methods. The literature review included five articles from PubMed, nine from Scopus, six from Web of Science, two from MEDLINE, six from eLibrary, and four from Russian Science Citation Index.&#x0D; Massive blood loss is understood as a one-time loss according to some authors of 30% and according to others of 50% of the volume of the circulating blood or blood loss equal in volume to 23 mL/kg/min. Risk factors for the development of intraoperative complications such as massive blood loss are, in addition to surgical interventions, the features of surgical intervention, i.e., size of the incision, surgical duration, and anesthesia, which can increase blood loss. The intensity and degree of blood loss are very important in determining the indications for transfusion of blood components, replenishing the volume of circulating blood, and determining indications for intraoperative hemostasis, both medical and surgical. In neonates and young children, the risk of dangerous intraoperative blood loss is associated with anatomical and physiological features, i.e., a small volume of circulating blood and insufficiently mature compensatory mechanisms. In older children, a high risk of massive blood loss is associated with comorbidities, features of hemostasis, and use of drugs that slow down the blood coagulation process.&#x0D; To date, several methods are available for assessing intraoperative blood loss, but only a few are used in routine clinical practice. Each method has advantages and disadvantages. One of the main disadvantages is the complexity of the mechanisms for assessing blood loss, for example, weighing surgical materials or the patient before and after surgery, determining hemoglobin in the liquid after soaking the used surgical materials, and calculating indices using formulas. Most often, the assessment of blood loss is conducted according to the clinical picture (pallor of the skin and mucous membranes, weak pulse, lowering blood pressure, etc.).&#x0D; The results of the literature analysis showed insufficient research on determining the volume of intraoperative blood loss in pediatric practice, as evidenced by the small number of published scientific papers and the complete absence of randomized trials. Thus, further study of this problem is necessary.

National analysis of whole blood and component versus component transfusions in civilian trauma patients who underwent a thoracotomy or laparotomy: Toward improving patient outcomes and quality of care

BackgroundThis study aimed to investigate the associations of whole blood and component versus component transfusions with in-hospital mortality, complication rates, intensive care unit length of stay, and packed red blood cells transfusion volumes in adult civilian trauma patients. MethodsWe performed a retrospective cohort study of the American College of Surgeons Trauma Quality Program Participant Use File 2016 to 2019 dataset. Adult civilian trauma patients (aged >18 years) sustaining injuries of at least moderate severity who received whole blood and component or component within 4 hours of arrival and underwent thoracotomy or laparotomy were included. Multivariable regression analysis was used to compare outcomes between whole blood and component and component groups. ResultsA total of 37,384 patients met eligibility criteria, of which 218 received whole blood and component and 37,166 received component. There was no significant difference in in-hospital mortality between whole blood and component and component groups for those who underwent thoracotomy (adjusted odds ratio = 0.408, P = .413) or laparotomy (adjusted odds ratio = 1.046, P = .857). Thoracotomy patients who received whole blood and component had no difference in 4-hour or 24-hour pack red blood cell volumes (3336 mL vs 3106 mL, P = .754; 3 658mL vs 3,636mL, P = .982), intensive care unit length of stay (10.68 days vs 8.63 days, P = .542), or complications rates compared to those who received component. Laparotomy patients who received whole blood and component had no difference in 4 hour or 24-hour packed red blood cell volumes (2,758 mL vs 2,721mL, P = .927; 3,538 mL vs 3,385 mL, P = .754), intensive care unit length of stay (11.78 days vs 9.90 days, P = .177), or complications rates compared to those who received component. ConclusionStudy findings have indicated that a combined resuscitation with whole blood and component transfusion in adult civilian trauma patients is a viable alternative to component transfusion alone.

Blood transfusion in autoimmune rheumatic diseases

Autoimmune rheumatic disorders (ARD) represent a wide spectrum of disorders that affect in priority the joints, bones, muscles, and connective tissues. Examples of ARD include rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrome, polymyositis, systemic sclerosis, antiphospholipid syndrome and mixed connective tissue disease. Patients with ARD often require transfusion of red cell concentrates (RCC) or other blood-derived components. The presence of an autoimmune background, often complicated by the use of immunosuppressive medications, renders these patients quite vulnerable. Exposing them to RCC, when indicated, can trigger transfusion-related immunomodulation that can be aggravated by the role played by the donor microbiome, and the complement activation and the immune dysregulation induced by iron, leading to an amplification of the immune problems. Furthermore, patients are challenged by the transfused extracellular vesicles which could have a potentially negative role, particularly in patients with antiphospholipid syndrome. Despite the very vigorous screening, transfusion transmissible infections can still represent a risk to these patients, particularly in cytomegalovirus seronegative patients or when dormant pathogens are activated in the immunosuppressed transfusion recipient. The ARD population is also more at risk for transfusion-related reactions. One, therefore, has to consider a restrictive transfusion strategy if possible and, if needed, resort to the numerous blood bank procedures to reduce the immunogenicity of blood products or use safer, more targeted, industrial plasma-derived products subjected to purification and pathogen reduction technologies.

Evaluation of blood component transfusion in sick neonates- a retrospective study in a rural tertiary new-born care unit of Eastern India

Background: In recent past, blood transfusion in neonates has developed a lot improving the outcome particularly in premature and low birth weight babies. However, there are no globally followed standardised guidelines for neonatal blood transfusion. The present study conducted with the objective to evaluate the frequency, indications, complications and appropriateness of various blood components transfusion in sick newborn care unit (SNCU) of a resource poor setting.Methods: This retrospective, hospital based, single centre observational study is done in a tertiary care SNCU of a teaching hospital of eastern India. All SNCU admitted neonates who received blood/ blood component transfusion from October 2018 to September 2019 were evaluated for blood component usage and their indications and followed up throughout hospital stay. The data were statistically analysed using Microsoft Excel™ software.Results: In this study 219 neonates received a total of 359 bags of blood component transfusion. Out of these packed red blood cell (PRBC), fresh frozen plasma (FFP), random donor platelet and whole blood were 233 (64.90%), 97 (27.01%), 10 (2.78%) and 19 (5.29%) respectively. The major indications for transfusion were anaemia of prematurity (35.37%), sepsis (26.18%) and bleeding disorder (16.71%). The common transfusion-related complications observed in our study were cardiac abnormality (22.35%), electrolyte disturbance (6.40%) and hypoglycaemia (19.17%).Conclusions: Anaemia of prematurity was the foremost indication of transfusion. Multiple transfusions were associated with prematurity and low birth weight.

Comparison of uterine preservation versus hysterectomy in women with placenta accreta: A cross-sectional study.

Placenta accreta spectrum (PAS) is a major cause of obstetric bleeding in third trimester of pregnancy. This study aimed to compare the outcomes of uterine preservation surgery vs. hysterectomy in women with PAS. In this retrospective cross-sectional study, the records of 68 women with PAS referred to the Imam Khomeini hospital in Ahvaz, Iran, between March 2015 and February 2020 were included. The women were divided into 2 groups according to surgical approach: hysterectomy vs. uterine preservation (including just removing the lower segment, removing the lower segment with uterine artery ligation, or removing the lower segment with hypogastric artery ligation during cesarean section). The need for blood components transfusion (whole blood, packed cells, and fresh frozen plasma), maternal mortality, duration of surgery, and length of hospitalization were compared between groups. In total, we investigated 68 women between the ages of 24-45 yr (mean age of 32.88 5.08 yr). All participants were multiparous and underwent cesarean section. Furthermore, 28 women (41.2%) had a history of curettage. In total, 24 women (35.3%) underwent a hysterectomy, and 44 (64.7%) underwent uterine preservative surgeries. There were no significant differences between groups of hysterectomy and uterine preservative surgeries in terms of the need for blood components transfusion, maternal mortality, duration of surgery, and length of hospitalization. The results of this study showed no significant difference between groups regarding the studied outcomes. Therefore, conservative surgeries could be used to preserve the uterus instead of hysterectomy in women with PAS.

Blood management in patients with uterine myoma and anemia in the perioperative period

Introduction. In the structure of gynecological diseases, uterine myoma occupies one of the leading places and is accompanied by abnormal uterine bleeding, anemia, hemodynamic and hemostasiological disorders. Purpose. To optimize the management of the perioperative period in patients with uterine myoma and iron deficiency anemia (IDA) using methods of patient blood management (PBM). Materials and methods. The study group consisted of 94 patients with uterine myoma and IDA, who were examined and treated at the Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology. Of these, 74 patients made up the first, prospective group, who received IDA treatment with intravenous administration of ferric carboxymaltose during the perioperative period and during surgical treatment (laparoscopy / laparotomy and myomectomy), they underwent intraoperative autologous blood transfusion (IABT) using the cell salvage with Cell Saver 5+ apparatus. 20 women with myoma uterine and IDA constituted a comparison group (retrospective) who did not receive intravenous iron therapy in the perioperative period and did not undergo IABT. During surgical intervention (laparoscopy / laparotomy and myomectomy) or in the postoperative period, they received transfusion of donor erythrocyte-containing blood components according to indications. Results. All patients underwent surgical treatment in the amount of laparoscopy / laparotomy and myomectomy. During the operation, 74 patients of the main group underwent IABT in an average volume of 467.4 ± 327.8 ml. In the postoperative period, the patients of the main group continued to receive anemia therapy with intravenous administration of ferric carboxymaltose. And blood transfusions were not required in any patient of the main group. In patients of the second group, two (10 %) patients received donor erythrocyte suspension in an average volume of 358.2 ± 85.8 ml. Infectious and inflammatory complications: fever, inflammation of the postoperative suture, parametritis occurred in 6.8 % of women in the main group; in the comparison group – in 15 % of patients. Conclusions. Introduction into clinical practice of modern methods of blood management in patients with uterine myoma and IDA: the Infusion of intravenous high-dose ferric preparationsin the perioperative period, the use of Cell Saver devices for intra-operative autologous blood transfusion, helps to reduce the time of therapy, minimize transfusions of donor erythrocytes, reducing the frequency of infectious and inflammatory complications.