Risk Of Transfusion Research Articles

The safety of cell saver washing all shed mediastinal blood before re-transfusing it to the patient.

Cardiotomy suction blood is used in cardiopulmonary bypass (CPB) surgery to maintain blood volume in the CPB system, although it is known to contain micro emboli, cytokines and free plasma hemoglobin. Our aim was to investigate whether cell saver washing the cardiotomy suction blood before re-transfusing it is safe. This is a retrospective study of 1671 elective coronary artery bypass patients, 209 of whom had their pericardial blood processed in a cell saver (Ce-S group). PS matching was performed with patients who had their pericardial blood returned back to the CPB-system by the cardiotomy suction (Ca-S group). Perioperative transfusion requirements, surgical outcome, postoperative lab data and mortality were then compared. There were no differences in baseline characteristics or EuroSCORE between the groups. The number of patients requiring transfusions did not differ, but the patients in the Ca-S group received more platelets (0.34 ± 1.0 vs 0.16 ± 0.7 units, p = .03) than in the Ce-S group. CRP (c-reactive protein) levels at day 2 and 4 were higher in the Ca-S group (174.8 ± 67.2 and 148.9 ± 74.3mg/L vs 160.1 ± 64.6 and 125.9 ± 67.2mg/L, p = .03, p = .002) and so were ASAT (aspartate aminotransferase) levels (0.97 ± 0.8 vs 0.81 ± 0.6μkat/L, p = .03). Mortality, postoperative ventilation time, stroke, mediastinal infections and length of stay in the ICU were the same in both groups. In this retrospective study of patients undergoing elective CABG surgery, washing the cardiotomy suction blood before re-transfusion was not associated with higher risk of allogenic blood transfusion, postoperative stroke, mediastinal infections, or 30- and 365-days mortality. LU EPN 2016/4.

Prophylactic red cell transfusions for sickle cell disease pregnancy: increased use of therapy could transform outcomes.

Pregnancy for people with sickle cell disease (SCD) is high risk with persistently high rates of severe maternal and fetal mortality and morbidity. Transfusion therapy is the best-studied treatment for SCD in pregnancy; hydroxyurea is not usually used because of teratogenicity concerns. In high-resource settings, red cell transfusions are likely underutilized, while in low-resource settings, they may be altogether unavailable. A randomized controlled trial and meta-analysis, two of the strongest forms of clinical research, show transfusion significantly reduces maternal and fetal death, painful crisis, thrombosis, and acute respiratory failure. Downstream benefits of treatment are less well measured and may include improving maternal anemia, reducing opioid exposure, and avoiding hospitalization, which presents risk for additional complications. Alloimmunization is a particular transfusion risk in SCD. However, many strategies can mitigate this risk. Accordingly, the American Society of Hematology classifies chronic transfusion in pregnancy as low risk. Given the low risk classification, lack of alternative therapies, dismal, stagnant pregnancy outcomes and the potential for profound treatment benefit, wider use of chronic transfusion therapy for SCD pregnancy is likely indicated. This review discusses the benefits and potential risks of prophylactic transfusions for SCD pregnancy. Use of chronic transfusions during pregnancy is indicated to help urgently transform outcomes.

Mapping the landscape of machine learning models used for predicting transfusions in surgical procedures: a scoping review

Massive transfusion of blood products poses challenges in determining the need for transfusion and the appropriate volume of blood products. This review explores the use of machine learning (ML) models to predict transfusion risk during surgical procedure, focusing on the methodology, variables, and software employed to predict transfusion. This scoping review investigates the development and current state of machine learning models for predicting transfusion risk during surgical procedure, aiming to inform physicians about the field’s progress and potential directions.The review was conducted using the databases Cochrane, Embase, and PubMed. The search included keywords related to blood transfusion, statistical models, and surgical procedures. Peer-reviewed articles were included, while literature reviews, case reports, and non-human studies were excluded.A total of 40 studies met the inclusion criteria. The most frequently studied biological variables included haemoglobin, platelet count, international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, creatinine, white blood cells, and albumin. Clinical variables of importance included age, sex, surgery type, blood pressure, weight, surgery duration, american society of anesthesiology (ASA) status, blood loss, and body mass index (BMI). The software employed varied, with Python, R, SPSS, and SAS being the most commonly used. Logistic regression was the predominant methodology used in 20 studies.Our scoping review highlights the need for improved reporting and transparency in methodology, variables, and software used. Future research should focus on providing detailed descriptions and open access to codes of respective models, promoting reproducibility, and enhancing the clinical relevance of transfusion risk prediction models.

Bilateral total knee arthroplasty-analysis of risk factors for blood loss and blood transfusion

Background: Total knee arthroplasty in general is a safe and successful surgical procedure for end stage arthritis of the knee joint to relieve pain, correct the deformity and restore function in the joint. However, it is often associated with significant blood loss. In such cases, blood transfusion is not uncommon. Methods: 100 patients who underwent simultaneous bilateral TKA from April 2022 to December 2022 at Sant Parmanand Hospital, New Delhi were taken up for the study. Results: In this study among 100 patients who underwent simultaneous bilateral total knee replacement, 9% of the cases required blood transfusion. Preoperative haemoglobin (<12.64 gm/dl) continues to be a predictor in blood transfusions. A haemoglobin level of less than 10.34 gm/dl preoperatively, a postoperative haemoglobin day 1 level of less than 8.56gm/dl and a postoperative day 3 level of less than 7.49 gm/dl increases the necessity for blood transfusion in simultaneously performed bilateral TKAs. Conclusions: Asthma, Diabetes mellitus and patients on blood thinners are three major comorbidities than can cause increased blood loss. Age, gender, BMI and comorbidities are not related to the need for blood transfusion. Patients on blood thinners are at an increased risk for blood transfusion if they have a lower preoperative haemoglobin. Checking haemoglobin values on postoperative day 1 and day 3 are significant in terms of the need for blood transfusion.

Predictive Value of Cord Blood Bilirubin for Hyperbilirubinemia in Term Neonates with ABO Incompatibility

Introduction: Jaundice affects 60% of full-term and 80% of preterm neonates. Feto-maternal ABO incompatibilities occur in 20-25% of pregnancies, but severe haemolytic disease develops in only 10%. ABO-incompatible babies have doubled the risk of jaundice requiring treatment and a 5-10 times increased risk of exchange transfusions. Objective: Aim of this study was to determine if cord blood bilirubin (CBB) can predict hyperbilirubinemia in term babies with ABO setup prior to discharge that would help to decrease readmission and subsequently complications due to jaundice. Methods: A hospital-based prospective observational study was conducted at Patan Hospital. Cord blood group and bilirubin levels were collected from newborns of O positive mothers. Babies with A positive and B positive blood groups had their CBB levels measured and were followed daily for 72 hours. Serum bilirubin was tested based on clinical judgment to detect hyperbilirubinemia and treated per NICE guidelines. Data were analysed using SPSS v21.0, Mann-Whitney test, ANOVA, and ROC analysis. Results: Among 66 cases, significant hyperbilirubinemia was seen in 7 neonates (10.6%). It was more common in B positive babies (12.2%) compared to A positive (8%). Mean CBB was 3.45 ± 0.57 in those developing significant hyperbilirubinemia. A CBB of 2.95 mg/dL had the highest sensitivity (86%), specificity (94%), and negative predictive value (98%) for predicting hyperbilirubinemia in ABO setup babies. Conclusion: Term babies with ABO incompatibility and CBB<2.95 mg /dL are unlikely to need further evaluation, while those with cord bilirubin level ≥2.95 mg/dL should have frequent early follow-ups.

Antepartum risk factors and outcomes of massive transfusion for elective cesarean section: a nationwide retrospective cohort study

BackgroundPostpartum hemorrhage is one of the leading causes of maternal mortality and morbidity. The etiology of postpartum hemorrhage exhibits variations in relation to the mode of birth; consequently, risk factors for massive transfusion in elective cesarean section might diverge from those encountered in vaginal birth or emergency cesarean section. The main purpose of this study was to investigate antepartum risk factors of massive transfusion for elective cesarean section.MethodsWe conducted a retrospective cohort study based on data from a nationwide system that collected inpatient medical records from tertiary hospitals in mainland China. We included women who had undergone elective cesarean section from January 2013 to August 2018. Primary outcome was massive transfusion defined as transfusion of more than eight units of red blood cells on the day of childbirth. Candidate risk factors were identified by the 10th revision of International Classification of Diseases Codes of admission diagnoses. The relationship between each factor and massive transfusion was assessed using multivariable logistic regression.ResultsA total of 294,695 women were included and 572 of them received massive transfusion (incidence: 194 per 100,000 elective cesarean sections). Maternal age [adjusted odds ratio (aOR) 1.22; 95% confidence interval (CI) 1.10–1.48], anemia (aOR 1.66; 95% CI 1.34–2.05), thrombocytopenia (aOR 3.54; 95% CI 2.39–5.05), coagulopathy (aOR 25.92; 95% CI 8.59–69.50), hypoalbuminemia (aOR 2.97; 95% CI 1.86–4.53), hepatic dysfunction (aOR 1.65; 95% CI 1.04–2.47), uterine scar (aOR 1.39; 95% CI 1.15–1.67), multiple pregnancy (aOR 2.84; 95% CI 1.74–4.38), polyhydramnios (aOR 2.52; 95% CI 1.19–4.68) and placenta previa (aOR 25.03; 95% CI 21.04–29.77) were associated with massive blood transfusion for elective cesarean section. Among the women receiving massive blood transfusion, 7 (1.2%) died during hospitalization, 126 (22.0%) needed hysterectomy, 25 (4.4%) uterine packing and 57 (10.0%) uterine artery ligation.ConclusionsTen risk factors of massive transfusion were identified in women undergoing elective cesarean section. Our findings may facilitate blood products preparation and provide opportunities for applying prophylactic strategies prior to cesarean section for women at high risk of massive transfusion.

Assessment of routine pre-operative group and save testing in patients undergoing cholecystectomy: a retrospective cohort study.

Routine group and save (G&S) testing is frequently performed prior to cholecystectomy, despite growing evidence that a targeted approach is safe and avoids unnecessary investigations. This retrospective cohort study explored frequency of testing in our unit, rates of peri-operative blood transfusion and pre-operative risk factors for requiring transfusion. Health records of 453 consecutive adults who underwent cholecystectomy in a UK NHS trust were reviewed for blood transfusion up to 30 days post-operatively. We compared the need for transfusion against patient demographics, indication and urgency of surgery, and the number of prior emergency hospital attendances with gallstone complications. Logistic regression determined whether prior attendances with complications of gallstones independently predicted the need for transfusion. Peri-operative blood transfusions within 30 days of operation occurred in 1.1% of cases, with no requirement for uncrossmatched blood. Patients who received a blood transfusion tended to have higher American Society of Anesthesiologists (ASA) grades ( p = 0.017), were more likely to have an underlying primary haematological malignancy (20.0% vs. 0.2%; p = 0.022) and prior emergency hospital attendances with gallstone complications (median 4 vs. 1; p < 0.001). Logistic regression showed each prior emergency attendance was associated with 4.6-fold odds of transfusion ( p = 0.019). Receiver operating characteristic curve analysis showed an area under the curve of 0.92. Three or more attendances predicted need for transfusion with 60.0% sensitivity and 98.0% specificity. 74% of patients had at least one G&S sample taken pre-operatively, costing the trust approximately £3,800 per year in materials. The findings of this study suggest that pre-operative G&S testing prior to cholecystectomy is not routinely required. Increased frequency of prior emergency hospital attendances with gallstone complications and co-morbidities associated with coagulopathies were pre-operative risk factors for post-operative blood transfusion. More selective testing could provide large financial savings for health institutions without compromising patient safety.

Transfusion Risk in Open, Laparoscopic, and Robotic-Assisted Surgery: A Propensity Score Matched Case-Control Study across Surgical Disciplines

Introduction: Robotic-assisted surgery is increasingly performed in various surgical disciplines demonstrating improved oncological and functional outcomes compared to conventional surgery. Objective: Unclear is how robotic-assisted surgery affects perioperative anemia and the need for blood products. Methods: In this case-control study, 15,009 matched patient pairs undergoing urological, visceral, or thoracic surgery were included. Pairwise comparisons between robotic-assisted surgery, laparoscopic surgery, and open surgery were performed with propensity score matching. Results: Robotic-assisted surgery compared to open surgery was associated with a risk reduction of allogeneic red blood cell transfusion by RR: 0.32 (95% CI: 0.27–0.37) and a limited reduction of perioperative hemoglobin (perioperative hemoglobin difference of 0.40 g/dL, 95% CI: 0.31–0.49). Robotic-assisted surgery was associated with a shorter length of hospital stay by 4.29 days (95% CI: 3.74–4.84). Compared to laparoscopic surgery, robotic-assisted surgery had no significant effect on red blood cell transfusions (RR: 0.94, 95% CI: 0.75–1.18), perioperative hemoglobin (0.27 g/dL, 95% CI: 0.16–0.38), or length of hospital stay 0.53 days (95% CI: −0.14–1.19). Conclusions: Robotic-assisted and laparoscopic procedures are associated with reduced blood transfusions compared to open surgery and, thus the advancement of minimally invasive procedures constitutes an important measure to improve patient outcomes.

Association between iron deficiency anemia and severe maternal morbidity: A retrospective cohort study

PurposeWe examined the association between iron deficiency anemia (IDA) and severe maternal morbidity (SMM) during delivery and up to 1-year postpartum. MethodsIn a retrospective cohort study across 3 states, we computed adjusted relative risks (aRR) for SMM comparing individuals with IDA versus those without, using modified Poisson regression models. ResultsAmong 2459,106 individuals, 10.3 % (n = 252,240) had IDA. Individuals with IDA experienced higher rates of blood transfusion and non-transfusion SMM (329 and 122 per 10,000 deliveries, respectively) than those without IDA (33 and 46 per 10,000 deliveries, respectively). The risk of blood transfusion (aRR: 8.2; 95 % CI 7.9–8.5) and non-transfusion SMM (aRR: 1.9; 95 % CI: 1.8–2.0) were higher among individuals with IDA. The attributable risk per 10,000 deliveries due to IDA for blood transfusion and non-transfusion SMM during delivery were 29.5 (95 % CI: 28.9–30.0) and 5.7 (95 % CI: 5.3–6.2), respectively. Within 1-year postpartum, the relative risk of non-transfusion SMM (aRR:1.3; 95 % CI: 1.2–1.3) was 30 % higher among individuals with IDA. ConclusionIDA is associated with increased SMM risk. Addressing IDA in pregnant individuals may reduce SMM rates.

Comparative Analysis of Holmium Laser Enucleation of the Prostate (HoLEP) and Robotic-Assisted Simple Prostatectomy (RASP) in BPH Management: A Systematic Review and Meta-Analysis.

As the prevalence of benign prostatic hyperplasia (BPH) increases, the demand for surgical interventions that optimize patient outcomes while minimizing complications grows. This systematic review compares the efficacy, efficiency, and safety of holmium laser enucleation of the prostate (HoLEP) with robotic-assisted simple prostatectomy (RASP), providing insights for evidence-based surgical decision-making in BPH treatment. Adhering to PRISMA guidelines, the study protocol was registered with Prospero [CRD42024509627]. Searches were conducted in Medline, Embase, Web of Science, Scopus, and CINAHL up to February 1, 2024, to include studies that compare HoLEP and RASP in patients with BPH. Risk of bias was evaluated using the Newcastle Ottawa Scale. HoLEP and RASP demonstrated equivalent effectiveness in treating BPH, as shown by similar functional outcomes such as maximum urinary flow rate and postvoid residual volume. However, HoLEP outperformed RASP in several operational efficiency metrics, reducing operative time by 49.48 minutes, hospitalization duration by 1.5 days, and catheterization period by 3.8 days. HoLEP also significantly reduced the risk of blood transfusions by 75%. Patients undergoing RASP were 1.87 times more at risk for grade 2 complications and 3.41 times more at risk for developing grade 3 or above complications. HoLEP and RASP are effective for managing BPH. HoLEP shows advantages in recovery metrics and lower blood transfusion rates, while RASP benefits from ease of implementation in robotic-equipped facilities. Optimizing surgical outcomes will depend on reducing disparities in technique adoption, improving surgical training, and aligning with evidence-based guidelines.

Transfusion-Related Acute Lung Injury

Transfusion-Related Acute Lung Injury is one of the most vital forthcoming risks that need to be addressed, assessed, diagnosed and treated. Blood transfusion save lives, but the side effects of transfusion can be really adverse and concerning. Blood transfusion helps the patient recover from severe blood loss that might lead to severe complications like cardiogenic or hypovolemic shock. Over the years, the health care industry is working on reducing the possible risk and complications of blood transfusion. Worldwide trainings are provided on safe blood transfusion practices. Blood banks are verified with legal authority and inspections are done every now and then. Transfusion-Related Acute Lung Injury is the upcoming concerning issue that needs to be familiar with all health care workers especially nurses since they are the one who keep a close monitoring of patient during the blood transfusion process. Furthermore intervention can be planned accordingly to help manage Transfusion-Related Acute Lung Injury better and treat the symptoms as soon as possible.

The geriatric nutritional risk index predicts blood transfusion risk in elderly patients undergoing posterior lumbar interbody fusion: a retrospective study

BackgroundMalnutrition can lead to an increased risk of blood transfusion in elderly patients. The Geriatric Nutritional Risk Index (GNRI) is a tool used to assess nutritional status, but its predictive value for blood transfusion in elderly patients undergoing posterior lumbar interbody fusion (PLIF) is not well established. This study aimed to investigate the association between GNRI and the risk of perioperative blood transfusion in this population.MethodsA retrospective cohort study was conducted on elderly patients aged 60 and above who underwent PLIF at Qingdao University Affiliated Hospital. Preoperative GNRI was calculated using height, weight, and serum albumin levels. The primary outcome was perioperative blood transfusion. Logistic regression analysis was performed, adjusting for potential confounders such as demographic characteristics, comorbidities, surgical factors, and laboratory tests.ResultsA total of 1,246 elderly patients were included, with 144 (11.6%) requiring blood transfusion. After adjusting for all confounders, a lower GNRI was associated with a significantly higher risk of blood transfusion (OR = 2.4, 95% CI: 1.9–3.1, p < 0.001). Patients with a GNRI score below 92 had a significantly increased transfusion risk compared to those with normal GNRI scores (OR = 5.8, 95% CI: 3.7–9.1, p < 0.05). RCS analysis revealed a linear negative relationship between GNRI and transfusion risk.ConclusionThe GNRI is a strong predictor of perioperative blood transfusion risk in elderly patients undergoing PLIF. Preoperative nutritional assessment using GNRI may help identify high-risk patients, enabling tailored interventions to optimize outcomes.

Use of coagulation factor concentrates and blood transfusion in cardiac surgery: a retrospective cohort study of adults with hereditary and acquired bleeding disorders

BackgroundCardiac surgery poses a significant risk of perioperative bleeding and allogeneic blood transfusions, particularly in patients with bleeding disorders. Increasingly frequent use of coagulation factor concentrates could impact haemorrhagic risks, thromboembolic events, and costs. We describe the use of coagulation factor concentrates and allogeneic blood products in cardiac surgical patients with hereditary and acquired bleeding disorders to assess pertinent outcomes, including perioperative haemorrhage, thromboembolism, and hospital costs. MethodsWe conducted a retrospective cohort study using the Premier Health Database, including adult cardiac surgical patients diagnosed with hereditary or acquired bleeding disorders compared with those without bleeding disorders. ResultsPatients with acquired bleeding disorders required more extensive use of coagulation factor concentrates and blood products compared with those with hereditary bleeding disorders or without bleeding disorders. The highest exposures to coagulation factor concentrates were found in the acquired bleeding disorders group, with 24% receiving factor VIIa and 11.7% receiving prothrombin complex concentrate. This group also experienced significantly higher rates of complications, including a 15.8% rate of haemorrhage and a 19.2% rate of thromboembolic events. The acquired bleeding disorders group had longer intensive care and hospital stays, and the highest mortality rate (19.2%). The increased use of perioperative replacement of factor VIII and factor IX in the hereditary bleeding disorders group led to increased pharmacy costs but did not significantly impact blood bank charges. ConclusionsAcquired bleeding disorders in cardiac surgery patients are associated with increased use of haemostatic interventions, postoperative complications, and increased healthcare costs. Improved management of perioperative haemostasis and thromboprophylaxis strategies are essential for optimising patient outcomes and reducing expenses.

Major Publications in the Critical Care Pharmacotherapy Literature: 2023.

We aimed to summarize the most significant and impactful publications describing the pharmacotherapeutic care of critically ill patients in 2023. PubMed/MEDLINE and the Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update. Randomized controlled trials and prospective studies of adult critically ill patients assessing a pharmacotherapeutic intervention and reporting clinical endpoints published between January 1, 2023, and December 31, 2023, were eligible for inclusion in this article. Articles from a systematic search and the Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update were included. An a priori defined three-round modified Delphi process was employed to achieve consensus on the most impactful publications based on the following considerations: 1) overall contribution to scientific knowledge and 2) novelty to the literature. The systematic search and Clinical Pharmacy and Pharmacology Pharmacotherapy Literature Update returned a total of 1202 articles, of which 1164 were excluded. The remaining 38 articles underwent a three-round modified Delphi process. In each round, articles were independently scored based on overall contribution to scientific knowledge and novelty to the literature. Included articles are summarized and their impact discussed. Article topics included hydrocortisone for severe community-acquired pneumonia, inhaled amikacin for prevention of ventilator-associated pneumonia, methylene blue for septic shock, restrictive vs. liberal fluid management for sepsis-induced hypotension, andexanet alfa for major bleeding associated with factor Xa inhibitors, and early administration of four-factor prothrombin complex concentrate in patients with trauma at risk for massive transfusion. This review provides a summary and perspective on the potential impact of the most relevant articles in 2023 describing advances in the pharmacotherapeutic care of critically ill patients.

Recurrence of Severe Maternal Morbidity and Transfusion During Delivery Hospitalisations: A Retrospective Cohort Study.

To determine risks for non-transfusion severe maternal morbidity and transfusion during a second delivery hospitalisation based on clinical risk factors and obstetric complications from an index, first delivery hospitalisation. Retrospective cohort. Delivery hospitalisations in the 2010-2017 New York State Inpatient Database. Patients with a first index delivery hospitalisation followed by a second delivery hospitalisation during the study period were included. Clinical risk factors and obstetric complications were obtained from the first index delivery hospitalisation. Adjusted logistic regression models for non-transfusion severe maternal morbidity during the second delivery were performed with adjusted (aORs) odds ratios as measures of effect. These analyses were then repeated for the outcome of transfusion. Of 624 500 paired delivery hospitalisations to 312 250 women, severe maternal morbidity occurred among 0.85% of second deliveries (n = 2672). When adjusted analysis was performed, several clinical factors were associated with severe maternal morbidity in a subsequent pregnancy, including severe maternal morbidity during the index pregnancy (aOR 8.4, 95% CI 7.0, 9.9), transfusion (aOR 2.0, 95% CI 1.6, 2.4) and pregestational diabetes (aOR 2.2, 95% 1.6, 2.9). When analyses were repeated for transfusion, several factors were associated with increased risk, including severe maternal morbidity (aOR 1.5, 95% CI 1.2, 1.8), index transfusion (aOR 6.3, 95% CI 5.6, 7.0), chronic heart disease (aOR 1.6, 95% 1.4, 1.9) and pregestational diabetes (aOR 1.7, 95% 1.3, 2.2). Many obstetric complications and chronic conditions identified during an index delivery hospitalisation are associated with severe morbidity during a second, subsequent delivery. Index severe maternal morbidity is associated with the highest odds. These findings may be of use in patient counselling and risk stratification.

On the Frontlines of Pre-Hospital Care: The Efficacy of Freeze-Dried Plasma

Despite continued developments made in the field of trauma care, hemorrhagic shock resulting from trauma remains the leading cause of preventable death on the battlefield. The current methods being used for the treatment of patients with acute hemorrhage include dressing the wound in an attempt to stop the bleeding, along with intravenous administration of fluids intended to replace the blood loss and treat the accompanying shock. The question of what kind of fluid to use is one that fascinated many throughout history, consequentially leading to the development of physiological crystalloid based solutions on one hand and isolated blood products on the other. With its introduction, plasma was found to have significant clinical benefits, conceivably because plasma replenishes various coagulation proteins that are consumed during the coagulopathy that often accompanies traumatic injuries. In military and remote settings, the logistical limitations of plasma, namely the need to maintain a comprehensive cold-chain infrastructure and the complicated process of thawing the plasma, restricted the use of plasma in these settings. In World War II, these barriers were lifted as Freeze-Dried Plasma (FDP) was invented, not requiring any freezers and soon available. This product was vastly used during the war with hundreds of thousands treated, but then disremembered because of disease transmission issues such as hepatitis found among recipients in the 1960’s. Modern-day advanced techniques have improved the safety and made it possible to produce safe and effective dried plasma solving the previous problems, but still, FDP is currently used by only a few countries worldwide. In line with its unpopularity, little has been published regarding the clinical effects of this product. Purpose of this Study: To shed light on the clinical effectiveness of using freeze-dried plasma as a pre-hospital resuscitation fluid during the treatment of hemorrhagic shock in the pre-hospital setting. Methods: A retrospective analysis of data collected on trauma patients injured in the Syrian civil war and treated by the IDF from 2014 until 2016. Casualties who required long evacuation time (i.e., over 45 minutes) were chosen. Two groups of casualties were allocated according to weather FDP was used (N=29), or standard-care fluids were given (N=83). Results: Using FDP as part of the pre-hospital resuscitation was shown to be associated with an improvement in both vital signs and shock index score. Moreover, among these patients, a lower transfusion volume was needed throughout their hospitalization. However, an increased risk for mortality, increased risk of in-hospital blood transfusion, and increased risk of pre-hospital intubation were observed in the FDP treated group. Conclusions: The effectiveness of FDP presented inconclusive but promising results in lowering the severity of shock and reducing iatrogenic coagulopathy in trauma patients. Further research is needed to disprove the adverse outcomes of this study.

A machine learning-based Coagulation Risk Index predicts acute traumatic coagulopathy in bleeding trauma patients.

Acute traumatic coagulopathy (ATC) is a well-described phenomenon known to begin shortly after injury. This has profound implications for resuscitation from hemorrhagic shock, as ATC is associated with increased risk for massive transfusion (MT) and mortality. We describe a large-data machine learning-based Coagulation Risk Index (CRI) to test the early prediction of ATC in bleeding trauma patients. Coagulation Risk Index was developed using continuous vital signs (VSs) available during the first 15 minutes after admission at a single trauma center over 4 years. Data to compute the CRI were derived from continuous features of photoplethymographic and electrocardiographic waveforms, oximetry values, and blood pressure trends. Two groups of patients at risk for ATC were evaluated: critical administration threshold and patients who received an MT. Acute traumatic coagulopathy was evaluated in separate models and defined as an international normalized ratio (INR) >1.2 and >1.5 upon arrival. The CRI was developed using 2 years of cases for training and 2 years for testing. The accuracy of the models is described by area under the receiver operator curve with 95% confidence intervals. A total of 17,567 patients were available for analysis with continuous VS data, 52.8% sustained blunt injury, 30.2% were female, and the mean age was 44.6 years. The ability of CRI to predict ATC in critical administration threshold patients was excellent. The true positive and true negative rates were 95.6% and 88.3%, and 94.9% and 89.2% for INR >1.2 and INR >1.5, respectively. The CRI also demonstrated excellent accuracy in patients receiving MT; true positive and true negative rates were 92.8% and 91.3%, and 100% and 88.1% for INR >1.2 and INR >1.5, respectively. Using continuous VSs and large-data machine learning capabilities, the CRI accurately predicts early ATC in bleeding patients. Clinical application may guide early hemostatic resuscitation. Extension of this technology into the prehospital setting could provide earlier treatment of ATC. Retrospective, Prognostic Study; Level III.

The burden of pre-operative anaemia and postoperative outcomes in 15 166 surgical patients from a public hospital in Brazil: A retrospective cohort study.

Preoperative anaemia is associated with poor postoperative outcomes; however, few studies have reported its prevalence in developing countries and its association with significant postoperative outcomes. We aimed to identify the prevalence of anaemia and its association with postoperative outcomes in a major public hospital in Brazil. Retrospective cohort study. Single-centre, 860-bed, quaternary university-affiliated teaching hospital in Southern Brazil. We included adult patients who had undergone surgery between 2015 and 2019. Main outcome measures: The main outcome was the in-hospital 30-day postoperative mortality. According to the World Health Organisation, we defined anaemia and its sub-classification (mild, moderate, and severe). We developed Poisson regression models to examine the association between preoperative anaemia and outcomes. We included 15 166 patients, of whom 6387 (42.1%) were anaemic. After adjustment for confounding factors, patients with anaemia had an increased risk of in-hospital 30-day postoperative mortality (relative risk (RR) 1.69, 95% confidence interval (CI) 1.44 to 1.99, P < 0.001). Mild [relative risk (RR) 1.38, 95% CI 1.12 to 1.71, P = 0.003], moderate (RR 1.73, 95% CI 1.43 to 2.10, P < 0.001), and severe anaemia (RR 2.43, 95% CI 1.92 to 3.07, P < 0.001) were associated with the primary outcome. Anaemia increased the transfusion risk (RR 4.44, 95% CI 3.90 to 5.06, P < 0.001) and postoperative intensive care unit (ICU) admission (RR 1.09, 95% CI 1.04 to 1.16, P = 0.001). Four out of 10 patients had anaemia. These patients had an increased risk of adverse postoperative outcomes. Comprehension of the magnitude and impact of anaemia is essential to establish interventions in low-resource scenarios to optimise the patient's journey. Institutional Review Board Registration number 40522820000005327 (Brazilian CEP/CONEP System, available in https://plataformabrasil.saude.gov.br/).

Challenges in reliable preoperative blood ordering: A qualitative interview study.

Presurgical blood orders are important for patient safety during surgery, but excess orders can be costly to patients and the healthcare system. We aimed to assess clinician perceptions on the presurgical blood ordering process and perceived barriers to reliable decision-making. This descriptive qualitative study was conducted at a single large academic medical center. Semi-structured interviews were conducted with surgeons, anesthesiologists, nurse anesthetists, nurse practitioners working in preoperative assessment clinics, and transfusion medicine physicians to assess perceptions of current blood ordering processes. Interview responses were analyzed using an inductive open coding approach followed by thematic analysis. Twenty-three clinicians were interviewed. Clinicians felt that the current blood ordering process was frequently inconsistent. One contributor was a lack of information on surgical transfusion risk, related to lack of experience in ordering clinicians, insufficient communication between stakeholders, high turnover in academic settings, and lack of awareness of the maximum surgical blood ordering schedule. Other contributors included differing opinions about the benefits and harms of over- and under-preparing blood products, leading to variation in transfusion risk thresholds between clinicians, and disagreement about the safety of emergency-release blood. Several barriers to reliable decision-making for presurgical blood orders exist. Future efforts to improve ordering consistency may benefit from improved information sharing between stakeholders and education on safe transfusion practices.

Development and Validation of a Predictive Risk Score for Blood Transfusion in Patients Undergoing Curative-Intent Surgery for Intrahepatic Cholangiocarcinoma.

Among patients undergoing liver resection for intrahepatic cholangiocarcinoma (ICC), perioperative bleeding requiring blood transfusion is a common complication, yet preoperative identification of patients at risk for transfusion remains challenging. The objective of this study was to develop a preoperative risk score for blood transfusion requirement during surgery for ICC. Patients undergoing curative-intent liver surgery for ICC (1990-2020) were identified from a multi-institutional database. A predictive model was developed and validated. An easy-to-use risk calculator was made available online. Among 1420 patients, 300 (21.1%) received an intraoperative transfusion. Independent predictors of transfusion included severe preoperative anemia (OR = 1.65, 95% CI 1.10-2.47), T2 category or higher (OR = 2.00, 95% CI 1.36-3.02), positive lymph nodes (OR = 1.75, 95% CI 1.32-2.32) and major resection (OR = 2.56, 95%CI 1.85-3.58). Receipt of blood transfusion significantly correlated with worse outcomes. The model showed good discriminative ability in both training (AUC = 0.68, 95% CI 0.66-0.72) and bootstrapping validation (C-index = 0.67, 95% CI 0.65-0.70) cohorts. An online risk calculator of blood transfusion requirement was developed (https://catalano-giovanni.shinyapps.io/TransfusionRisk). Intraoperative blood transfusion was significantly associated with poor postoperative outcomes among patients undergoing surgery for ICC. The identification of patients at high risk of transfusion could improve perioperative patient care and blood resources allocation.