Units Of FFP Research Articles

Fast-Track Score to Predict the Feasibility of Early Extubation Post Liver Transplant

Background Over the past several years, the liver transplant community has embraced the concept of fast-tracking patients to facilitate earlier postoperative recovery. Aim Derive and validate a novel “fast-track” risk score that captures the demographic and clinical characteristics of DDLT patients to predict the likelihood of early extubation after surgery. Design Adult patients who underwent non-fulminant DDLT between January 2014 and July 2019 were included. The cohort was divided in 2 groups: patients extubated within 4 hours of surgery vs extubated after 4 h. Logistic regression was performed to identify the independent predictors of early extubation. The area under the curve (AUC) was calculated to measure the ability of the risk score to predict early extubation. The score was validated by applying coefficients of the regression model to the validation cohort and calculating the AUC. Results A total of 290 DDLT patients were included, of which 175 (60%) were in the “delayed extubation” group and 115 (40%) were in the “fast-track” group. Patients with a MELD <29, transfused <4 units of pRBCs, and transfused <5 units of FFP during surgery were 2.30 times, 5.74 times, and 3.09 times more likely to be extubated early, respectively. A risk score with an integer point scale was derived and exhibited an AUC of .80. The proportion of patients who were extubated early increased from 2.78% at a score of 0 to 66.67% at a score of 4. Conclusions The proposed score provides a fast and easy method to help identify DDLT patients suitable for early extubation.

Morbidity and mortality of patients with peritoneal malignancy following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

BackgroundThe purpose of this study was to record the incidence, and identify the prognostic variables of morbidity and mortality in patients with peritoneal malignancy undergoing cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC).MethodsThe files of patients with peritoneal malignancy who underwent CRS + HIPEC from 2015–2022 were retrieved. Morbidity and hospital mortality were recorded and correlated to a variety of clinical variables.ResultsA total of 44/192 (22.9%) patients were recorded with postoperative complications. Grade 3 and 4 complications were 12.5%. The possible prognostic variables of morbidity were the extent of peritoneal malignancy and the number of suture lines. The mortality rate was 2.5% (5 patients). The number of FFP units, and peritonectomy procedures were identified as possible prognostic variables of hospital mortality.ConclusionsThe morbidity rate in patients undergoing CRS + HIPEC is acceptable compared to morbidity of previous publications or major gastrointestinal surgical operations. The possible prognostic variables of morbidity are the extent of peritoneal malignancy, and the number of suture lines. The mortality rate is low. The possible prognostic variables of mortality are the number of FFP units, and the number of peritonectomy procedures.

The efficacy and safety of pre-hospital plasma in patients at risk for hemorrhagic shock: an updated systematic review and meta-analysis of randomized controlled trials.

Plasma is a critical element in hemostatic resuscitation post-injury, and its prompt administration within the prehospital setting may reduce the complications resulting from hemorrhage and shock. Our objective is to assess the efficacy and safety of prehospital plasma infusion in patients susceptible to hemorrhagic shock. We conducted our study by aggregating randomized controlled trials (RCTs) sourced from PubMed, EMBASE, Scopus, Web of Science, and Cochrane CENTRAL up to January 29, 2023. Quality assessment was implemented using the Cochrane RoB 2 tool. Our study protocol is registered in PROSPERO under ID: CRD42023397325. Three RCTs with 760 individuals were included. There was no difference between plasma infusion and standard care groups in 24-h mortality (P = 0.11), 30-day mortality (P = 0.12), and multiple organ failure incidences (P = 0.20). Plasma infusion was significantly better in the total 24-h volume of PRBC units (P = 0.03) and INR on arrival (P = 0.009). For all other secondary outcomes evaluated (total 24-h volume of packed FFP units, total 24-h volume of platelets units, massive transfusion, vasopressor need during the first 24h, any adverse event, acute lung injury, transfusion reaction, and sepsis), no significant differences were observed between the two groups. Plasma infusion in trauma patients at risk of hemorrhagic shock does not significantly affect mortality or the incidence of multiple organ failure. However, it may lead to reduced packed red blood cell transfusions and increased INR at hospital arrival.

Effects of Tariff on the Management of Blood Products in Fars Province Hospitals

Background In Iran, blood products were being delivered to healthcare centers without charge. For optimum usage and reducing wastage, the tariff was set on October 23, 2015. Thus, hospitals must pay for blood products to blood transfusion services and then the expenses are paid to healthcare centers by the insurance. Objectives This study aimed to explore the effects of the tariff policy on utilization pattern of blood products in healthcare centers of Fars province, Iran. Design This is a retrospective study which analyzes the recorded data. Methods Throughout this retrospective study, the number of units requested, delivered, returned, and return/delivery ratio of RBC, FFP, cryoprecipitate, and platelet were examined before and after the tariff in different cities of Fars province of Iran. Results After the tariff, return/delivery ratios of FFP, cryoprecipitate, and platelet increased in comparison with before tariff but were not statistically significant which means the return of unused units was increased after imposing tariff. Conclusion The results of this investigation showed that tariff may lead to more return of FFP, cryoprecipitate, and platelet units to the transfusion services of Fars province. More research must be performed to further approve it.

58 Achieving < 2cc/kg/%TBSA - A Restrictive Adjusted Ideal Body Weight Resuscitation Formula with Fresh Frozen Plasma

Abstract Introduction Fresh frozen plasma (FFP) is used as an adjunct in burn resuscitation as it decreases endothelial cell permeability by restoring the glycocalyx. The authors have previously demonstrated a reduction in fluid administration using adjusted ideal body weight (AIBW) index to adjust for avascular adipose tissue with an FFP rescue. Since publication, the authors have further restricted the fluid administered in this protocol and hypothesize that this iteration results in further reductions without an increase in clinically significant acute kidney injury (AKI) and need for dialysis. Methods A retrospective review of burn patients with 2nd/3rd degree burns of 20% TBSA admitted between 6/20-5/22 at a single academic burn center was performed. Demographics and injury characteristics were tracked along with ventilator free days, volume/type of fluids administered during resuscitation, UOP, max creatinine (Cr) in the 1st 72 hrs post injury, AKI requiring HD, length of stay (LOS), LOS O/E ratio (using NBR data), and death. Data was reported in medians + IQR. Subjects were resuscitated with 2mL/kg/%TBSA LR using an AIBW formula with FFP. AIBW index = ideal body weight + 0.3 [actual body weight – ideal body weight]. Those with 30-50% TBSA burns received 1 U FFP on admission; those with >50% TBSA had 2 U FFP. Starting hourly rate was calculated with 2 cc/AIBW in kg/%TBSA as a default, while 3 cc was used if mostly 3rd degree injury + inhalation. Nursing driven titration was done by 10-20% per hr based on deviation from target UOP of 30cc/hr. For very obese or small patients, the UOP goal was reset to 0.5cc/AIBW/hr by MD. If oliguric for 2 hrs, patients received 1-2 units of FFP as rescue therapy. Results Twenty-three patients were included in the study, and 10 received FFP during resuscitation. Burn size was 33% TBSA (IQR:27,38), and 3rd degree burn was 8% (IQR:3,15). Three subjects had inhalation injury, and 2 were resuscitated with 3cc/kg /%TBSA. Median fluid volume given over 24 hrs was 1.653 (IQR:1.022,2.358) cc/kg/%TBSA (including FFP). UOP was 0.67 cc/kg/hr (IQR:0.397,1.064). Ventilator free days was 29 (IQR: 24,30). One received a tracheostomy; 3 had escharotomies. Three (13%) patients had elevated Cr < 72 hours post injury (max creatinine- 1.7 mg/dL). LOS was 32 days (IQR:19,46) or 1.105 days/%TBSA. Median expected LOS was 88.5 days or 2.6 days/%TBSA based on NBR data. LOS O/E ratio was 0.42. Two patients died (9%). Conclusions Despite the single-arm, retrospective nature, this study suggests that patients who were treated with a restrictive AIBW formula plus FFP received less total fluid than the previously published iteration of the formula (1.63 vs 3.3cc/kg/%TBSA), and far less than the traditional Parkland formula. Even with reduced fluids, no one had a clinically significant AKI. Preliminary data suggests this protocol is safe and effective, but additional prospective study is necessary. Applicability of Research to Practice Treat burn shock and prevent over resuscitation

SUCCESSFUL ANAESTHETIC MANAGEMENT OF A CASE OF OPEN NEPHRECTOMY FOR GRADE 5 RENAL INJURY

Blunt trauma to the abdomen can cause damage to vital organs like spleen, liver, kidney and intestines and is associated with high morbidity. Hereby we are presenting a case of Grade 5 Renal Injury(shattered kidney) following blunt injury abdomen. A 21 year old male presented to our Emergency Room with history of RTA. He revealed history of severe abdominal pain. He presented with severe tachycardia (HR−140⁄minute),blood pressure and saturation were normal and GCS was 15⁄15. His CECT abdomen revealed shattered left kidney with subcapsular and perinephric collection with renal vascular injury. His hemoglobin was found to be 5.7g/dl, rest of the blood investigations were within normal limits. He was shifted to OT immediately and was proceeded with open nephrectomy. Post induction he devoloped severe hypotension and was started on iv crystalloids and colloids and minimal Nor adrenaline support. Intraoperatively 4 units of PRBC and 3 units of FFP were transfused. Around 1 litre of blood, bladder clots and a concealed hematoma in messentry were evacuated. Post transfusion ABG revealed metabolic acidosis. He was shifted to ICU with the ET Tube. He made an uneventful recovery in ICU and was extubated.Physiologically, hemodynamic compensatory mechanisms maintain vital organ perfusion till about 30% TBV loss, beyond which there is a risk of critical hypoperfusion. Massive blood loss is best managed by following the massive transfusion protocol (MTP).

An evaluation of blood components inventory management during Hajj and Umrah season at Makkah hospitals

Objectives: The current study aims to utilize blood bank data collected from the Army forces hospital in Makkah to improve transfusion services at Makkah hospitals and evaluate the inventory system during the Hajj season.
 Methods: Three years' results showed that blood centre production is not constant, with an average of 1800 units during Hajj season that includes Cryo (450), FFP (450), PLT (450), and PRBC (450) units. Moreover, data indicated that the average usage of units is 1119 during the same season (120 Cryo, 424 FFP, 207 PLT and 368 PRBC).
 Results: This demonstrated that the inventory of blood units fluctuates during the year with an overproduction of Cryo (80%), FFP (67%), PLT (83%) and PRBC (57%) units in Hajj Season. It can be concluded that the manner and effectiveness with which the present issues in Makkah blood banking are having a major impact on the current system used to obtain the nation's blood supply and the safety, adequacy, and operational cost of that supply.
 Conclusion: The current study recommends building a generic data warehouse with smart decision support systems that use artificial intelligence to maintain blood bank production and inventory system during the year, especially during Hajj and Umrah seasons.

Hemorrhagic Shock from Massive Retroperitoneal and Pelvic Hematoma After Stapled Hemorrhoidopexy

Background: Massive retroperitoneal and pelvic hematoma leading to hemorrhagic shock following stapled hemorrhoidectomy is rare. To the best of our knowledge at the time of this publication, there are no reported cases of postoperative pelvic or retroperitoneal hematoma without intraluminal bleeding reported after stapled hemorrhoidopexy. We describe such a case in a patient with grade III internal hemorrhoid who was treated with colonoscopy and stapled hemorrhoidectomy. Case Summary: A 64-year-old female with a past medical history significant for deep vein thrombosis and pulmonary embolism for which she was anticoagulated with warfarin presented with hemorrhoids and rectal bleeding and associated iron deficiency anemia. The warfarin was held five days prior to the planned combined colonoscopy and hemorrhoidectomy procedure. While still recovering in the post-anaesthesia care unit (PACU) a few hours post-operatively, she was found to be hypotensive, tachycardic, and somnolent. A CT abdomen/pelvis was obtained, which identified a large collection of blood in the pelvis and retroperitoneum. She was taken back to the OR for an emergent exploratory laparotomy and flexible sigmoidoscopy. She was admitted to the ICU where she required placement on BiPAP for respiratory acidosis and resuscitation with a total of seven units of pRBCs and two units of FFP. She was clinically stable three days later. Conclusion: In a patient with a history of chronic anticoagulation, one should consider intraluminal, retroperitoneal, and pelvic bleeding if the patient is in hemorrhagic shock after stapled hemorrhoidectomy. Furthermore, one should not rule out the possibility of retroperitoneal or pelvic bleeding even if there is no evidence of intraluminal bleeding. Emergent laparotomy and sigmoidoscopy may be considered for unstable patients with unidentified external bleeding.

Blood transfusion service in Poland in 2020

Background: The aim of this study was to present the basic aspects of the activity of Polish blood transfusion service (hereinafter referred to as Centers) in 2020, taking into account the conditions related to the ongoing COVID-19 pandemic. Materials and methods: Analysis of data forwarded to the Institute by the Polish Blood Transfusion Centers (Centers). Results: In 2020, 23 Centers and 136 local collection sites operated in Poland. Blood and blood components were also collected during 10,432 mobile collections. The overall number of blood donors was estimated at 569,914, the majority of which were non-remunerated donors (569,566, including 50,012 responders to donation appeals) as well as 25 remunerated donors and 323 autologous donors. Most frequent were whole blood collections (1,105,434) and the least frequent — granulocyte concentrate collections (82) and RBC collections by apheresis (16). Whole blood was collected mostly in local collection sites (46.84%), less frequently in Centers (30.62%) and mobile collection sites (22.54%). The most frequently prepared blood components were RBCs (1,089,978 units) and FFP (1,264,654 units). COVID-19 convalescent plasma was also collected (57 708 units). In 2020, a total of 77,485 units of PCs pooled from whole blood and 52,030 units of PCs from apheresis were prepared. Additional processing methods (leukocyte depletion, irradiation) were more frequently applied to PCs (55.47% leukodepleted, 44.53% both leuko-depleted and irradiated), than to RBC (21.03% leukodepleted, 9.85% both leukodepleted and irradiated, 0.06% irradiated). Pathogen inactivation technologies were applied to 14.21% of FFP units issued for clinical use and 11.01% of PCs. For various reasons the following amounts of blood components were wasted in 2020: 11,430 units of whole blood, 29,530 units of RBCs, 53,946 units of FFP, 1,691 units of apheresis PCs, 5,455 units of pooled PCs and 1,381 units of cryoprecipitate. As compared to the previous years, in 2020 almost all the indicators of the activity of the blood transfusion service in Poland have markedly decreased. Conclusions: The data presented in this study point to the significant impact that the COVID- 19 pandemic had on blood donation in Poland in 2020. The data may serve as a starting point for the analysis of issues related to the activity of organizational units of the Polish blood transfusion service and contribute to practical benchmarking. This in turn may prove beneficial to the transfusion community as a whole.

Anticoagulation is Associated with Increased Mortality in Splenic Injuries

IntroductionAnticoagulation (AC) is associated with worse outcomes after trauma in some but not all studies. To further investigate the effect of AC on outcomes in patients with splenic injury, we analyzed the Trauma Quality Programs Participant Use File (PUF) MethodsThe 2017 PUF was used to identify adult (18+ y) with all mechanisms and grades of splenic injury. Demographics, comorbidities, hospital course and outcomes were compared between AC and non-AC patients. ResultsA total of 18,749 patients were included, 622 were on AC. The AC patients were older but had comparable gender composition to non-AC patients. Injury Severity Score (18.2 versus 22.5) and rates of serious (AIS ≥ 3) injury were all lower in the AC group (P = 0.001).AC patients received fewer units of RBC (5.7 versus 8.0 units, P < 0.001) and FFP (3.9 versus 5.4 units, P < 0.001) in the first 24 h but underwent angiography at similar rates (23.6 versus 24.5%, P = 0.8). Among those who underwent angiography, patients were more likely to undergo embolization if they were on AC (89.7 versus 73.9%, P = 0.04). Rates of splenic surgery were comparable (19.3 versus 21.5%, P = 0.2) between AC versus non-AC patients. Median LOS was longer in AC patients (6.3 versus 5.6 d, P = 0.002). AC patients had a higher mortality (13.3 versus 7.0%, P = 0.001). In a multivariable binary logistic regression, AC was an independent risk factor for mortality with OR 1.4 (95% CI: 1.1-1.9) ConclusionsAnticoagulation is associated with increased mortality in patients with splenic injury.

A rare case of choriocarcinoma ovary: Case report

Introduction: Choriocarcinoma ovary is a rare neoplasm. It is gestational or nongestational. Very few cases of NGCO have been reported. Case Report: We describe a case of a multiparous 31 year old woman who came to gynae receiving room with acute pain abdomen in shock. On examination abdominal distension with ascitis was present. On pervaginal examination uterus was bulky, os was closed and tenderness in right fornice was present. Her UPT was positive and blood was aspirated in culdocentesis. Emergency laprotomy was done with a provisional diagnosis of ectopic pregnancy, followed by right sided salpingoophrectomy with left sided tubal ligation. A right ovarian mass around 6X7 cm was found ruptured and was bleeding profusely. There was 2 liters of haemoperitoneum. Patient was transfused 2 units of PCV and 4 units of FFP. Postoperative period was uneventful. Her βhcg levels were 42,416, 48 hours postsurgery. Histopathological and immunohistochemical report were suggestive of nongestational Choriocarcinoma ovary showing sheets of cytotrophoblastic and syncytiotrophoblastic cells and extensive areas of haemorrhage and necrosis. Patient was started on BEP chemotherapy. Computed tomographic scan revealed no brain or lung metastases. Though she took 3 cycles and went LAMA.She was followed up on phone and was reportedly alive and healthy. Keywords: Choriocarcinoma, Non gestational, Ovarian cancer.

Blood transfusion service in Poland in 2019

Background: In this study we evaluated the basic aspects of the activity of the Polish Blood Transfusion Service (hereinafter referred to as Centers) in 2019. Materials and methods: Retrospective analysis of the 2019-data supplied by the Centers. Results: In 2019, blood and blood components were collected in 21 Polish Centers and 129 local collection sites as well as during 13 048 mobile collections. The overall number of blood donors was estimated at 590 893, the majority of which were non-remunerated donors (590 280 — including 40 738 responders to donation appeals), as well as 57 remunerated donors and 556 autologous donors. Most frequent were whole blood collections (1 202 079) and least frequent — granulocyte concentrate collections (94) and RBCs collections by apheresis (48 donations). Whole blood was collected mostly in local collection sites (45.25%), in Centers (28.75%) and mobile collection sites (26%). Most frequently prepared blood components were RBCs — 1 180 333 units) and fresh frozen plasma (FFP — 1 344 092 units, 21.42% dedicated for clinical use). Platelet concentrates (PCs) collected by apheresis amounted to 53 379 units and 81 905 were whole blood-derived. Additional processing methods (leukocyte depletion, irradiation) were more frequently applied to PCs (43.34% leukocyte-depleted, 0.04% irradiated, 54.63% both leukocyte-depleted and irradiated) than to RBCs (18.71% leukocyte-depleted, 0.06% irradiated, 9.17% both leukocytedepleted and irradiated). Pathogen reduction technologies were applied to 20.76% of FFP units issued for clinical use (transfusion) and 11.87% of PCs. In 2019 — for a variety of reasons — 14 013 units of whole blood, 32 798 units of RBCs, 49 285 units of FFP, 1334 units of cryoprecipitate, 4778 units of pooled PCs and 1279 of apheresis PCs were wasted. Conclusions: Our study data may be considered as starting point for assessment of the tendencies observed in the Polish blood transfusion service and may serve practical-benchmarking with benefit to the transfusion community as a whole.

Thromboelastography does not reduce transfusion requirements in liver transplantation: A propensity score-matched study

Study objectiveTo compare total blood product requirements in liver transplantation (LT) assisted by thromboelastography (TEG) or conventional coagulation tests (CCTs). DesignRetrospective observational study. SettingA tertiary care referral center for LT. PatientsAdult patients undergoing LT from deceased donor. InterventionHemostasis was monitored by TEG or CCTs and corresponding transfusion algorithms were adopted. MeasurementsNumber and types of blood products (red blood cells, RBC; fresh-frozen plasma, FFP; platelets, PLT) transfused from the beginning of surgery until the admission to the intensive care unit. MethodsWe compared data retrospectively collected in 226 LTs, grouped according to the type of hemostasis monitoring (90 with TEG and 136 with CCTs, respectively). Confounding variables affecting transfusion needs (recipient age, sex, previous hepatocellular carcinoma surgery, Model for End Stage Liver Disease - MELD, baseline hemoglobin, fibrinogen, creatinine, veno-venous by pass, and trans-jugular intrahepatic portosystemic shunt) were managed by propensity score match (PSM). Main resultsThe preliminary analysis showed that patients in the TEG group received fewer total blood products (RBC + FFP + PLT; p = 0.001, FFP (p = 0.001), and RBC (p = 0.001). After PSM, 89 CCT patients were selected and matched to the 90 TEG patients. CCT and TEG matched patients received similar amount of total blood products. In a subgroup of 39 patients in the top MELD quartile (MELD ≥25), the TEG use resulted in lower consumption of FFP units and total blood products. Nevertheless, due to the low number of patients, any meaningful conclusion could be achieved in this subgroup. ConclusionsIn our experience, TEG-guided transfusion in LT does not reduce the intraoperative blood product consumption. Further studies are warranted to assess an advantage for TEG in either the entire LT population or the high-MELD subgroup of patients.

Efficacy of Intravenous Tranexamic Acid in Reducing Perioperative Blood Loss and Blood Product Transfusion Requirements in Patients Undergoing Multilevel Thoracic and Lumbar Spinal Surgeries: A Retrospective Study.

Introduction: Acute perioperative blood loss is a common and potentially major complication of multilevel spinal surgery, usually worsened by the number of levels fused and of osteotomies performed. Pharmacological approaches to blood conservation during spinal surgery include the use of intravenous tranexamic acid (TXA), an anti-fibrinolytic that has been widely used to reduce blood loss in cardiac and orthopedic surgery. The primary objective of this study was to assess the efficacy of intraoperative TXA in reducing estimated blood loss (EBL) and red blood cell (RBC) transfusion requirements in patients undergoing multilevel spinal fusion. Materials and Methods: This a single-center, retrospective study of subjects who underwent multilevel (≥7) spinal fusion surgery who received (TXA group) or did not receive (control group) IV TXA at The Ohio State University Wexner Medical Center between January 1st, 2016 and November 30th, 2018. Patient demographics, EBL, TXA doses, blood product requirements and postoperative complications were recorded. Results: A total of 76 adult subjects were included, of whom 34 received TXA during surgery (TXA group). The mean fusion length was 12 levels. The mean total loading, maintenance surgery and total dose of IV TXA was 1.5, 2.1 mg per kilo (mg/kg) per hour and 33.8 mg/kg, respectively. The mean EBL in the control was higher than the TXA group, 3,594.1 [2,689.7, 4,298.5] vs. 2,184.2 [1,290.2, 3,078.3] ml. Among all subjects, the mean number of intraoperative RBC and FFP units transfused was significantly higher in the control than in the TXA group. The total mean number of RBC and FFP units transfused in the control group was 8.1 [6.6, 9.7] and 7.7 [6.1, 9.4] compared with 5.1 [3.4, 6.8] and 4.6 [2.8, 6.4], respectively. There were no statistically significant differences in postoperative blood product transfusion rates between both groups. Additionally, there were no significant differences in the incidence of 30-days postoperative complications between both groups. Conclusion: Our results suggest that the prophylactic use of TXA may reduce intraoperative EBL and RBC unit transfusion requirements in patients undergoing multilevel spinal fusion procedures ≥7 levels.

Near-transection of abdominal aorta due to stab injury: a case report

Abdominal vascular injuries are amongst the most lethal injuries encountered by modern day trauma and vascular surgeons. Penetrating injuries to aorta have a wide spectrum of presentation mortality being 50-70%. 38-year-old male presented to emergency department with stab injury to abdomen with a knife stuck in-situ. Patient was conscious with herniating bowel loops from stab site. Bilateral limbs had good pulsations and no neurological deficit. Patient was taken for emergency laparotomy and found to have complete jejunal transection with near transection of aorta with knife stuck in the vertebra. Primary repair of aorta was done with prolene 5-0 along with jejuno-jejunal anastomosis. Patient was transfused with 12 units of blood and 8 units of FFP. Postoperatively patient recovered well and was discharged on post-operative day (POD) 14 with good recovery and follow up was uneventful. Spectrum of penetrating aortic injuries varies from stable patients to severely exsanguinated in vicious cycle of shock, acidosis, coagulopathy and arrhythmias causing high mortality and morbidity. Our case had contained retroperitoneal hematoma with stable vitals and good general condition and due to early diagnosis and timely institution of surgery the patient survived and recovered uneventfully. All abdominal stab injuries are to be taken as having vascular injuries. Surgery has to be taken up as an integral part of resuscitation with quickest and most effective diagnostics along with lifesaving procedures to have lesser morbidity and mortality.

Utilization pattern of blood and its components in a tertiary care super speciality hospital

Background: Blood is the most precious gift for human life. Blood transfusion services play a vital role in managing health care services. There is no substitute for blood and its components till date, therefore blood donation drive is very crucial. The primary responsibility of blood transfusion services is to provide safe, sufficient and timely supply of blood and blood products. There has been shift for usage of blood and blood components from the use of whole blood so that maximum utilization of this precious resource could be done. Aim and objectives was to study pattern of utilization of blood and blood components in a super speciality hospital with the indications for transfusions for different components during the study period.Methods: This retrospective study for 12 months (January 2019- December 2 019) on pattern of utilization of blood components was carried out in the department of immunohaematology and transfusion medicine in a super speciality hospital.Results: There were total of 90237 transfusions which were carried out during the study period of 12 months. During the study period, 366 stored whole blood units, 55300 Packed RBC units, 19111 FFP units, 14298 Random Donor Platelet units, 1119 single donor platelets and 43 cryoprecipitate units were issued for use in patients admitted to our hospital.Conclusions: Periodic review and audit of blood component usage becomes essential to assess the blood utilization pattern in any hospital.

S3459 Rare Presentation of Life-Threatening Hematemesis Due to GIST!

INTRODUCTION: Severe Upper GI bleed is usually caused by peptic ulcer disease or esophageal varices. Neoplasms, aortoenteric fistulas, and vascular lesions are uncommon etiologies. Patients usually present with hematemesis, melena, or both. Gastrointestinal stromal tumors (GIST) may be asymptomatic and discovered incidentally or may cause nonspecific symptoms like early satiety and fullness. Although GIST may cause upper GI bleed, GIST as a cause of upper GI bleed is very rare. We present a very unique case of massive upper GI bleed due to. CASE DESCRIPTION/METHODS: A 60-year-old male with hypertension and type 2 diabetes, was admitted for two days of melena and massive hematemesis on initial admission. He reported shortness of breath and palpitation, but denied abdominal or chest pain. He denied NSAIDs or blood thinner use. He appeared pale, sweaty with dried blood on his lips. Heart rate was 110 BPM and blood pressure was 90/50 mmHg. Abdomen was soft with no tenderness, rebound, mass lesion, or ascites. Initial laboratory values showed hemoglobin of 5.2 g/dL, leukocytes of 7,200/mm3, platelets of 230,000/mm3, prothrombin time of 12 sec, and INR of 1.05. Chemistry was normal. The patient was promptly resuscitated with a 5 units of packed RBCs, 3 units of FFP, 3 units of platelets, yet his hemoglobin only rose to 6.7. CT for abdomen showed mixed density products seen within the stomach. Upper endoscopy was showed a large amount of fresh blood clots in the gastric body. There was a large ulcerated submucosal gastric mass near the fundus measured 5 × 4.5cm. Biopsy obtained from the margin of the ulcer later showed evidence of GIST. Partial gastrectomy with complete excision of the mass was done. He remained stable in the postoperative period and was discharged home in a stable condition. DISCUSSION: GIST constitute the most common mesenchymal tumors of the gastrointestinal tract (GI). They account for approximately 0.1 to 3% of all GI neoplasms. GIST are often discovered incidentally during endoscopic procedures. Common presentations are abdominal pain, abdominal mass, iron deficiency anemia and GI obstruction. GIST are very rare to present as acute severe life threatening bleeding like our patient’s scenario. Timely surgical resection and radiologic embolization are the most effective methods in the management of GIST with acute bleeding, especially in patients with localized, non-metastatic tumors.Figure 1.: CT for abdomen showed mixed density products seen within the stomach.Figure 2.: 40 X Histologic features and patterns of gastrointestinal stromal tumor (GIST), Spindle cell GIST composed of fascicles of uniform, bland cells with pale, eosinophilic cytoplasm, Spindle cell GIST with myxoid change.Figure 3.: 20 X Histologic features and patterns of gastrointestinal stromal tumor (GIST), Spindle cell GIST composed of fascicles of uniform, bland cells with pale, eosinophilic cytoplasm, Spindle cell GIST with myxoid change.

10-year analysis of human immunodeficiency virus incidence in first-time and repeat donors in Brazil.

Incidence in first-time and repeat blood donors is an important measure of transfusion-transmitted HIV infection (TT-HIV) risk. This study assessed HIV incidence over time at four large blood centres in Brazil. Donations were screened and confirmed using serological assays for HIV from 2007 to 2016, and additionally screened by nucleic acid testing from 2011 forward. Limiting antigen (LAg) avidity testing was conducted on HIV seroreactive samples from first-time donors to classify whether an infection was recently acquired. We calculated incidence in first-time donors using the mean duration of recent infection and in repeat donors using classical methods. Time and demographic trends were assessed using Poisson regression. Over the 10-year period, HIV incidence in first-time donors was highest in Recife (45·1/100000 person-years (105 py)) followed by São Paulo (32·2/105 py) and then Belo Horizonte (23·3/105 py), and in repeat donors was highest in Recife (33·2/105 py), Belo Horizonte (27·5/105 py) and São Paulo (17·0/105 py). Results from Rio de Janeiro were available from 2013 to 2016 with incidence in first-time donors of 35·9/105 py and repeat donors from 2011 to 2016 of 29·2/105 py. Incidence varied by other donor demographics. When incidence was considered in 2-year intervals, no significant trend was evident. Overall residual risk of TT-HIV was 5·46 and 7·41 per million units of pRBC and FFP transfused, respectively. HIV incidence in both first-time and repeat donors varied by region in Brazil. Clear secular trends were not evident.

The Association of Increased FFP:RBC Transfusion Ratio to Primary Graft Dysfunction in Bleeding Lung Transplantation Patients

Lung transplantation is associated with a significant risk of needed transfusion. Although algorithm-based transfusion strategies that promote a high fresh frozen plasma:red blood cells (FFP:RBC) ratio have reduced overall blood product requirements in other populations, large-volume transfusions have been linked to primary graft dysfunction (PGD) in lung transplantation, particularly use of platelets and plasma. The authors hypothesized that in lung transplant recipients requiring large-volume transfusions, a higher FFP:RBC ratio would be associated with increased PGD severity at 72 hours. Observational retrospective review. Single tertiary academic center. Adult patients undergoing bilateral or single orthotopic lung transplantation and receiving >4 U PRBC in the first 72 hours from February 2014 to March 2019. None. Patient demographics, operative characteristics, blood transfusions, and outcomes including PGD scores and length of stay were collected. Eighty-nine patients received >4U PRBC, had available 72-hour PGD data, and were included in the study. These patients were grouped into a high-ratio (>1:2 units of FFP:RBC, N = 38) or low-ratio group (<1:2 units of FFP:RBC, N = 51). Patients in the high-ratio group received more transfusions and factor concentrates and had significantly longer case length. The high-ratio group had a higher rate of severe PGD at 72 hours (60.5% v 23.5%, p = 0.0013) and longer hospital length of stay (40 v 32 days, p = 0.0273). In bleeding lung transplantation patients at high risk for PGD, a high FFP:RBC transfusion ratio was associated with worsened 72-hour PGD scores when compared with the low-ratio cohort.

Effect of tranexamic acid administration time on blood product use in urban trauma patients.

To evaluate the effect of time to tranexamic acid administration on blood product usage in trauma patients and to assess the potential benefit of initiating a protocol for field administration by ground ambulance personnel. Adult patients with traumatic injuries who received 1 g of tranexamic acid during the period January 2014 through June 2016 were retrospectively identified via review of automated dispensing cabinet and electronic medical record data and cross-referencing with the New Mexico Trauma Registry. Exclusion criteria included tranexamic acid use for nontrauma indications, previous admission for trauma during the study period, and a lack of pertinent information regarding the time, type, or severity of trauma in available records. The primary outcome was blood product use (aggregate of units of platelets, packed red blood cells [pRBCs], and fresh frozen plasma [FFP]) in the first 24 hours of hospital admission. The analysis included 107 patient cases, with a median transport time of 20 minutes (range, 7-103 minutes); 73% of reported transport times were less than 30 minutes. All patients received a loading dose of tranexamic acid in the hospital, with the exception of 2 patients who received tranexamic acid in the field. Administration of a tranexamic acid loading dose was documented within 3 hours for 90.7% of patients, with a mean time to administration of 91.9 minutes. A mean (SD) total of 14.8 (16.0) units of blood products (range, 0-91 units) were administered, consisting of a mean (SD) of 8.0 (8.4) units of pRBCs (range, 0-48 units), 5.6 (7.5) units of FFP (range, 0-38 units), and 1.2 (1.7) units of platelets (range, 0-7 units). Time to tranexamic acid administration did not affect blood product usage in the first 24 hours of admission after adjusting for potential confounders. Earlier administration of tranexamic acid was not associated with a decrease in use of blood products. This finding, paired with the relatively short ground transport times typical for our institution, makes it unlikely that field administration of tranexamic acid would benefit the evaluated patient population.