Use Of Blood Product Transfusion Research Articles

The Influence of Maternal Psychological Manifestations on the Mother-Child Couple during the Early COVID-19 Pandemic in Two Hospitals in Timisoara, Romania.

The postpartum maternal physical and psychological state played a fundamental role in the mother-child relationship at the beginning of the COVID-19 pandemic. The aim of the study is to analyze the influence of maternal psychological manifestations on the mother-child couple through three objectives (briefly expressed): (I) Determination of the main acute and chronic conditions of newborns/infants. (II) Verification of the hypothesis of the existence of a link between the following neonatal variables: gestational age, birth weight, number of days of hospitalization, and specific neonatal therapies (oxygen, surfactant, and blood products' transfusion). (III) Verification of the influence of postpartum maternal psychological status on the mother-child couple through three hypotheses. This cross-sectional study was conducted in two hospitals in Timișoara, Romania, between 1 March and 1 September 2020, and included 165 mothers and their 175 newborns. Mothers answered the Edinburgh Postnatal Depression Scale, Spielberger's Inventory of State-Trait Anxiety, and the Collins and Read Revised Adult Attachment Scale. (I) The acute and chronic pathology of the infants in the study group was polymorphic. (II) Large correlations were identified between the following infant variables: gestational age with birth weight, and number of hospitalization days with birth weight, gestational age, and use of blood product transfusion (all p < 0.001). (III) (1) State anxiety was the only significant predictor of number of hospitalization days (p = 0.037), number of acute disorders (p = 0.028), and number of infant chronic diseases (p = 0.037). (2) Maternal depressive symptoms were the only predictor of postpartum maternal attachment (p = 0.018). (3) Depressive symptoms, state, and trait anxiety were non-significant in all models studied (all p > 0.05). Postpartum maternal physical and psychological state plays a fundamental role on the mother-child relationship in the new social and complex family conditions.

Blood conservation strategies in cardiac valve replacement

We aimed to evaluate whether blood conservation strategies including intraoperative autologous donation (IAD) could reduce perioperative blood transfusion for patients undergoing cardiac valve replacement including mitral valve replacement, aortic valve replacement (AVR), and double valve replacement (DVR).A total of 726 patients were studied over a 3-year period (2011–2013) after the implementation of IAD and were compared with 919 patients during the previous 36-month period (January 2008–December 2010). The method of small-volume retrograde autologous priming, strict blood transfusion standard together with IAD constituted a progressive blood-saving strategy.Baseline characteristics and preoperative information showed no statistically significant difference between IAD group and non-IAD group. Most of the postoperative morbidities are statistically the same in the 2 groups. Chest tube output (415.2 vs 1029.8 mL, P < 0.001) and postoperative respiratory failure (5.9% vs 8.6%, P = 0.039) favored the IAD group, whereas hematocrit levels were more favorable in the non-IAD group (30.3% vs 33.0% at the end of the operation, P < 0.001; 30.4% vs 31.5% at the time of discharge). The use of blood product transfusion was higher in the non-IAD group (22.6% vs 43.3%, P < 0.001). Binary multivariate logistic regression analysis showed that high age, non-IAD, DVR surgery, and absent smoking history are associated with a higher risk of intra-/postoperative blood transfusion.Blood conservation is effective and safe in cardiac valve replacement surgeries. The use of intraoperative autologous donation can lead to improved outcomes including a significantly lower rate of intra-/postoperative blood transfusion and postoperative complications.

Importance of Blood Conservation in Cardiac Surgery and Impact on Patients Refusing Blood Product Transfusions

The use of blood product transfusion is associated with increased mortality and morbidity in cardiac surgery. The risk of mortality has been shown to be 0.5% per unit of blood transfusion, with approximately an increase by 3 times in overall mortality and by 2 times in occurrence of major complications. There is substantial evidence showing that the amount of blood product transfusions has a major impact on length of hospital stay and overall cost. Respiratory failure, renal failure and increased rate of infections are commonly associated with increased rate of blood product transfusions. Furthermore, blood product transfusions expose to the risk of major and minor transfusion reactions, induce immuno-suppression and cause a systemic inflammatory response, which affect all organ systems [1]. For these reasons minimizing blood product transfusions has represented a major challenge for cardiac surgeons. It is calculated that 50% to 60% of cardiac surgery patients require blood product transfusions in the course of their hospitalization and that this number approaches 100% in face of high-risk and emergent operations [1]. The own nature of cardiac surgery, the frequent occurrence of intra and post-operative bleeding, the use of extra-corporeal circulation are all obvious causes for the almost ubiquitous use of blood product transfusions. Nevertheless, there has been an effort to minimize the utilization of allogenic blood product transfusions in cardiac surgery. It is unarguable at this point, based on the large body of evidence present in the literature, that blood product transfusions have a negative impact on mortality and morbidity of patients undergoing cardiac surgery.

Liberal use of tricuspid-valve annuloplasty during left-ventricular assist device implantation.

The study aimed to determine whether liberal use of tricuspid-valve repair (TVr) is associated with adverse outcomes. The study was a retrospective review of 51 implantable left-ventricular assist devices (LVADs) performed in a single center between January 2008 and December 2009. TVr using Edwards MC 3 annuloplasty ring was performed if there was either documented moderate or greater tricuspid regurgitation or severe annular dilatation. TVr was performed in 37 patients. One patient was converted to replacement intra-operatively. Compared with patients who did not have TVr, the age was similar (mean 52 vs 50 years, p=0.62), as was frequency of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 1 or 2 (43% vs 50%, p=0.13). Day 1 hemodynamics were also similar: mean central venous pressure (13.5 vs 14 mmHg; p=0.10) and mean pulmonary artery pressure (25 vs 25.6 mmHg; p=0.76), as was Day 1 bilirubin (3.1 vs 3.9 mg dl(-1), p=0.27). Median duration of mechanical ventilation (2 days) and inotropic support (5 days) and rates of bleeding were identical in both groups. Although there was a trend toward longer intensive care unit (ICU) stays in the TVr group (6 vs 5 days; p=0.12), as a group these patients experienced less use of blood-product transfusion and less hospital length of stay. Hospital mortality was similar in both groups (TVr 18.9%, no TVr 21.4%, p=0.7). TVr can be applied during LVAD implantation without 'obvious' increase in perioperative risk. As there are theoretical benefits to eliminating tricuspid regurgitation, our data argue for a more liberal approach to TVr at the time of LVAD implantation.

THE CORRECTION OF PROLONGED BLEEDING TIMES IN TWO BROTHERS BY PLATELET TRANSFUSIONS DESPITE NORMAL IN VITRO PLATELET TESTS

1. Two children with congenital disorders have been presented. 2. Laboratory evaluation of their problem revealed only prolonged bleeding times and positive cuff tests. 3. The transfusion of normal platelets, but not plasma, corrected their abnormal bleeding times. 4. The use of blood product transfusion as a means of establishing diagnosis was useful in our patients and is recommended in the study of all difficult bleeding problems.