Use Of Other Blood Products Research Articles

Effect of two different colloid priming strategies in infants weighing less than 5 kg undergoing on-pump cardiac surgeries.

Our aim was toexplore the effect of two different priming strategies (artificial colloid only vs. artificial colloid combined with human serum albumin) on the prognosis of children weighing less than 5 kg undergoing on-pump congenital heart disease (CHD) surgery. A total of 65 children weighing less than 5 kg who underwent on-pump CHD surgery in our hospital from September 2016 to December 2017 were enrolled in this study. The children were randomly divided into two groups: artificial colloid priming group (AC group, n=33) and artificial colloid combined albumin priming group (ACA group, n=32). The primary clinical endpoint was the peri-CPB colloid osmotic pressure (COP). Secondary clinical endpoints included perioperative blood product and hemostatic drug consumption, postoperative renal function, coagulation function, postoperative renal function, and postoperative recovery parameters. COP values were not significant in the priming system as well as peri-CPB time points between the two groups (P>.05). Platelet consumption in the AC group was significantly lower than that in the ACA group (P<.05). There were no significant differences in the use of other blood products and hemostatic drugs as well as perioperative coagulation parameters between the two groups (P>.05). Postoperative length of stay in the AC group was significantly lower than that in the ACA group (P<.05). There were no significant differences in mortality, postoperative mechanical ventilation time, ICU time, and perioperative adverse events (including postoperative AKI) occurrences between the two groups (P>.05). In the on-pump cardiac surgeries of patients weighing less than 5 kg, total colloidal priming would not affect peri-CPB COP values, postoperative coagulation function, and blood products consumption. Total artificial colloidal priming strategy is feasible in low-weight patients.

Predicting packed red blood cell transfusion in living donor liver transplantation: A retrospective analysis.

Background and Aims:Blood transfusion is unpredictable in liver transplantation and is associated with increased patient morbidity, mortality and cost. This retrospective analysis was conducted to detect factors which could predict intraoperative transfusion of more than four units of packed red blood cells (PRBCs) during elective living donor liver transplantation (LDLT).Methods:This was a single-centre retrospective study. Demographic, clinical and intraoperative data of 258 adult patients who underwent LDLT from March 2009 to January 2015 were analysed. Univariate and multivariate regression model was used to identify factors responsible for transfusion of more than four PRBCs (defined as massive transfusion [MT]).Results:On univariate regression analysis, preoperative factors like aetiology of liver disease, hypertension, history of spontaneous bacterial peritonitis, low haemoglobin and fibrinogen, high serum bilirubin, high blood urea and creatinine, high model for end-stage liver disease score, portal venous thrombosis, increased duration of surgery and anhepatic phase as well as increased use of other blood products were found to be significantly associated with MT. Multivariate logistic regression analysis revealed that the only independent factor associated with MT was the number of units of fresh frozen plasma transfused (odds ratio = 1.54 [95% CI (1.12–2.12)]).Conclusion:Many factors are responsible for the need for transfusion during LDLT. Preoperative factors alone do not accurately and consistently predict the need for MT as in our study. It is important to be prepared for need for MT during each transplant.

Twelve autologous blood transfusions in eight cats with haemoperitoneum.

The objectives of this study were to describe the clinical use and outcome of autologous transfusions in cats with intracavitary haemorrhage. A retrospective descriptive study was performed. Computerised medical records of a single referral centre were searched for cats receiving an autotransfusion. Medical records were evaluated for underlying disease process, autotransfusion technique, autotransfusion volume, time period over which the autotransfusion was given, packed cell volume (PCV) pre- and post-autotransfusion, percentage rise in PCV, use of other blood products and any complications of the procedure. Survival to discharge and survival at 2 months was documented. Between July 2012 and March 2018 a total of 12 autotransfusions were performed in eight cats. All patients were diagnosed with haemoperitoneum. Four of the eight cats were diagnosed with abdominal neoplasia, three had postoperative haemorrhage and one had a traumatic haemoperitoneum. Three cats received more than one autotransfusion. Blood was collected using a 23 G butterfly catheter and 20 ml syringe in 7/12 collections, a 23 G needle and 20 ml syringe in 2/12 collections and directly into syringes from the open abdomen at the time of surgery in 3/12 collections. A median volume of 50 ml (range 25-80 ml) was collected and administered, meaning a median volume of 16.5 ml/kg (range 9-26 ml/kg) was administered. The autologous transfusions were given over a median of 3 h (0.25-6 h). Five cats were given another blood product alongside the autotransfusion. Median percentage PCV increase was 5% (range 1-7%). Anticoagulant was used in 5/12 autotransfusions. No clinically relevant adverse effects were reported. Six of the eight cats survived to discharge. Two month survival was 60% (3/5). Autologous transfusion appears to be a safe and effective technique for stabilising cats with haemoperitoneum. This technique allows rapid and cheap provision of blood and avoids the need for an allogenic blood donor.

Low-dose 3-factor prothrombin complex concentrate for warfarin reversal prior to heart transplant.

Anticoagulation with warfarin is common in patients presenting for heart transplant. Prior to surgery, anticoagulation reversal is necessary to avoid significant intraoperative and perioperative bleeding complications. Commonly, warfarin reversal is achieved with vitamin K and fresh frozen plasma (FFP); however, these therapies have significant limitations. An alternative to FFP for reversal exists with prothrombin complex concentrate (PCC). A warfarin reversal protocol prior to heart transplant was implemented using low-dose PCC at our institution. To assess blood product use, effectiveness, and safety post-low-dose PCC administration in patients needing warfarin reversal prior to heart transplant compared with historical controls. This was a single-center, retrospective cohort study. The PCC cohort included patients undergoing heart transplant presenting with an international normalized ratio ≥1.5 on warfarin therapy and who received at least 1 dose of PCC. Blood product use was measured from postoperative day 0 to 2. The PCC and historical control cohorts included 16 and 50 patients, respectively. There was a significant reduction in the use of FFP (4 vs 8 units, P = 0.0239) in the PCC cohort compared with the historical control cohort. No differences were identified in the use of other blood products as well as other secondary efficacy or safety end points. Use of PCC, per the reversal protocol, prior to heart transplant reduced FFP use and showed a non-statistically significant trend toward reductions in the use of other blood products in the intraoperative and perioperative setting, with no difference identified in thrombotic or embolic complications compared with historical controls.

69: Prophylactic arterial catheterization may improve operative morbidity in suspected placenta accreta and reduce the need for hysterectomy

operative morbidity in suspected placenta accreta and reduce the need for hysterectomy Neeraj Desai, Hima Tam Tam, Adiel Fleischer Hofstra North Shore-LIJ School of Medicine, Division of Maternal-Fetal Medicine, Manhasset, NY OBJECTIVE: The optimal operative approach to placenta accreta (PA) is not well defined. We evaluated whether prophylactic arterial occlusion (CATH) techniques can decrease the need for routine cesareanhysterectomy and improve operative outcomes in patients with suspected PA. STUDY DESIGN: Retrospective study of all antenatally diagnosed PA at our institution from 1995-2011. Data regarding maternal demographics, operative procedure, EBL, PRBC, use of other blood products (FFP, cryo, or platelets), OR time, length of stay (LOS), and need for hysterectomy were collected. Cases with CATH, either Avitene embolization(UAE) or hypogastric balloon(BAL) were compared to controls without CATH. Data were analyzed using Fisher’s-exact and t-test. RESULTS: Of 78 identified PA, 63 had an antenatal diagnosis (Mean GA del 36wks); of these 39 had CATH, and 24 had no arterial occlusion. Maternal demographics were similar in both groups. CATH had significantly less EBL (2.0 vs.3.6l; p 0.0012), less PRBC (2.5 vs. 4.5U; p 0.0006), less need for additional blood products (15% vs. 42%; OR 0.25 [CI 0.07-0.84]; p 0.04) with no difference in OR time or LOS. In a subgroup analysis of CATH, 26 had intraoperative UAE immediately post delivery of infant while 13 had BAL. UAE vs. no occlusion also had decreased EBL and less PRBC transfusion (p 0.01). However, this reduction was not seen with BAL. 56 of 63 had attempt at uterine preservation; 35% in the CATH group required a hysterectomy vs. 88% without CATH (p 0.001). When the patient did have a hysterectomy, those that had CATH had similar EBL (3.0 vs.3.8l; p 0.41), and no significant differences in PRBC, use of other blood products, OR time,or LOS. When analyzed by type of CATH, there was a trend for lower EBL and PRBC vs. BAL, but this was nonsignificant. In the CATH group, only one complication (axillary hematoma) was observed. CONCLUSION: This is one of the largest series to date in the US that looks at the management of PA. Our findings suggest that a protocol that includes CATH may improve the likelihood of uterine conservation and reduces operative morbidity.

A systematic assessment of the quality of reporting for platelet transfusion studies

As evidence-based medicine assumes increasing importance, there is a need for high-quality reporting of clinical studies. A recent review of clinical platelet (PLT) studies indicated variability in reporting. We undertook a critical analysis of PLT transfusion studies to determine the quality of reporting. A systematic MEDLINE search for clinical studies of PLT transfusion was performed to identify articles. Relevant observational studies (OBS) were critiqued using the STROBE checklist and randomized controlled clinical trials (RCTs) using the CONSORT checklist. Studies were further evaluated with a PLT-specific checklist developed by the authors. Observations were analyzed descriptively and using Pareto analysis. A total of 772 articles were identified by the search. Eighty-six articles (23 RCTs and 63 OBS) met eligibility criteria. All RCTs, and a similar number of OBS (24), were randomly selected for analysis. Studies reported the scientific background and rationale, key results, and outcomes. OBS frequently did not consider bias and confounders. RCTs frequently did not explain bias, interim analyses, stopping rules, success of blinding, or weaknesses of multiple analyses. The PLT-specific critique found many studies adequately reported basics of the PLT product, PLT increment, and transfusion reactions. Studies frequently failed to report specific details of PLT compatibility, details of product preparation, and use of other blood products. Recently published articles of clinical PLT transfusion share common strengths and weaknesses. The quality of reporting may be improved by providing guidelines to authors and journal editors that list the essential elements of a well-reported clinical study of PLT transfusion.

Predictors of Blood Loss in Fronto-Orbital Advancement and Remodeling

Fronto-orbital advancement and remodeling for craniosynostosis is extensive surgery and is associated with potential risks; the most significant of these is blood loss. We prospectively studied 116 consecutive patients undergoing fronto-orbital advancement by the same surgical team for a 5-year 6-month period to determine what factors are associated with blood loss and transfusion of blood products. The data collected on the calvarial sutures involved were whether the patient had a diagnosed syndrome, the age at operation, the length of the operation, the estimated blood volume lost during the perioperative course, the number of units of packed cells transfused (donor exposures), and the use of other blood products. The mean (SD) total blood volume lost was 116% (5.4) of the estimated preoperative volume. The median number of whole units of packed cells transfused was 2 units. Other blood products were given in 28% of the cases. There was significantly greater blood loss in those patients with recognized craniofacial syndromes, pansynostosis, an operating time longer than 5 hours, and an age of 18 months or younger at operation. The use of other blood products was associated with those patients losing a blood volume higher than the mean.

Prothrombin complex concentrate (Beriplex P/N) in severe bleeding: experience in a large tertiary hospital

IntroductionMajor blood loss can often be life-threatening and is most commonly encountered in the settings of surgery and trauma. Patients receiving anticoagulant therapy are also at increased risk of bleeding. We investigated the use of a prothrombin complex concentrate (PCC; Beriplex P/N, CSL Behring, Marburg, Germany) to treat severe bleeding in a variety of settings: cardiac surgery, warfarin therapy and other surgery.MethodsThirty consecutive patients who had received PCC were identified from blood transfusion records. For cardiac surgery and warfarin reversal, PCC was administered in accordance with hospital protocols. PCC was administered to cardiac and other surgical patients responding poorly to recognized blood products, whereas it was administered first-line to patients with life-threatening bleeds and requiring warfarin reversal, in accordance with British Committee for Standards in Haematology guidelines. We conducted a retrospective analysis of patient records in order to ascertain PCC dose, use of other blood products and response to PCC (clotting screen results before and after PCC administration, haemostasis achievement, and survival).ResultsSix patients (20%) were excluded because of inadequate documentation (n = 5) or acquired haemophilia (n = 1). Therefore, 24 patients were included in the analysis: coronary artery bypass graft (n = 5), mitral/aortic valve replacement (n = 2), other surgery (n = 9) and warfarin reversal (n = 8). Most patients (83.3%) received no more than 1500 IU of Beriplex P/N 500. Considerable reduction in administration of other blood products was seen during the 24 hours after PCC administration. Partial or complete haemostasis was achieved in 14 out of 18 cases (77.8%). In total, 12 out of 24 patients (50%) died during the study; two-thirds of the deaths were considered unrelated to bleeding. No thrombotic complications or adverse drug reactions were observed.ConclusionThis study emphasizes the value of PCC in reversing the effects of oral anticoagulant therapy in bleeding patients. It also demonstrates the potential value of PCC in controlling bleeding in patients undergoing cardiac and other surgical procedures. The use of PCC in bleeding patients without hereditary or anticoagulation-related coagulopathy is novel, and further investigation is warranted. In the future, it may be possible to use PCC as a substitute for fresh frozen plasma in this setting; adequate documentation is crucial for all blood products.

The effect of aprotinin on blood loss in bilateral total knee arthroplasty

Twenty-five patients undergoing bilateral total knee arthroplasty were given aprotinin (1–2 million units) in doses adjusted for weight, infused at the end of the first arthroplasty. Blood management was compared with our previous series of 68 patients who were not treated with aprotinin. Blood drained and re-transfused in the first 6 h was significantly less in the aprotinin group (323 ml, S.D. 320) than the untreated group (1033 ml, S.D. 539, p<0.0005). The total blood drained was also less in the aprotinin group (713 ml compared to 1613 ml, p<0.0005) but this was accounted for soley by the difference in early blood loss. The use of other blood products was less in the aprotinin group (360 ml, S.D. 357 compared to 827 ml, S.D. 434, p<0.0005). The mean postoperative haemoglobin on the day following surgery was similar at around 10 g. There were no complications or adverse reactions to the use of aprotinin. We conclude that aprotinin significantly reduces early blood loss after bilateral knee arthroplasty. In our hands, we have found it to be safe. Further work is required to determine whether postoperative use may further reduce the need for blood transfusion.

Massive blood transfusion in the elective surgical setting

Massive haemorrhage in elective surgery can be either anticipated (e.g. organ transplantation) or unexpected. Management requires early recognition, securing haemostasis and maintenance of normovolaemia. Transfusion management involves the transfusion of packed red cells, platelet concentrates and plasma (fresh frozen plasma and cryoprecipitate). Blood product support should be based on clinical judgment and be guided by repeated laboratory tests of coagulation. Although coagulation tests may not provide a true representation of in vivo haemostasis, they do assist in management of haemostatic factors. Below critical levels (prothrombin time or activated partial thromboplastin time >1.8; fibrinogen <1.0 g/l; platelet count <80×10 9 l −1) it is difficult to achieve haemostasis. Despite seemingly adequate blood component therapy there remain situations where haemorrhage is uncontrollable. In this setting, alternative approaches must be considered. These include the use of other blood products (e.g. prothrombin complex concentrates; fresh whole blood; fibrin glue) and pharmacological agents (e.g. aprotinin). Complications of massive transfusion result in significant morbidity and mortality. These may be secondary to the storage lesion of the transfused blood products, disseminated intravascular coagulation, hypothermia or hypovolaemic shock. The use of fresh blood products and leucocyte-reduced packed red cells and platelets, may minimise some of the adverse clinical sequelae.

IgA content of frozen-thawed-washed red blood cells and blood products measured by radioimmunoassay.

The IgA concentration of various blood products was examined by a radioimmunoassay, and the lowest IgA concentrations were seen in frozen-thawed-washed red blood cells. The routine Regional Blood Transfusion Centre preparation contained a mean IgA concentration of 0.117 mg/l (n=21) in the frozen-thawed-washed red blood cell supernatant fluid. Further washing of frozen-thawed-washed red blood cells with saline reduced supernatant IgA concentrations to below the limit of IgA detection (less than 0.003 mg/l). Ordinary washed red blood cells and other blood plasma fractions contained substantial quantitites of IgA, supporting the view that frozen-thawed-washed red blood cells should be used for transfusion of patients at risk of developing reactions to IgA, and the need for caution in the use of other blood products in such patients.