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massive transfusion and elderly

Francesco Fiorini, Louise Braddick, Hasnain Hashim, Robert M Ayto, Alana Jacobs, Yetunde Baoku, Shahir S Hamdulay
A 73-year-old man presented with bilateral leg pain and swelling, and no history of trauma or bleeding disorders. Clinical examination, biochemistry and magnetic resonance imaging of the thighs were suggestive of muscle haematomas. These progressed significantly during the admission, requiring blood transfusion. Normal vascular anatomy on computed tomography, renal and liver function, and absence of infection made a bleeding diathesis more likely. This may be caused by coagulation defects, platelet disorders and vascular fragility...
March 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
Mahir Elder, Nimrod Blank, Amir Kaki, M Chadi Alraies, Cindy L Grines, Marvin Kajy, Reema Hasan, Tamam Mohamad, Theodore Schreiber
BACKGROUND: Right ventricular (RV) failure due to pulmonary embolism (PE) increases morbidity and mortality and contributes to prolonged hospital length of stay and higher costs of care. RV mechanical circulatory support (MCS) including Impella RP devices have been increasingly used in hemodynamically compromised PE patients who are refractory to intravascular volume expansion and inotropic therapy. However, effectiveness and safety of Impella RP, in hemodynamically unstable PE patients is unknown...
March 7, 2018: Journal of Interventional Cardiology
Corey S Scher
PURPOSE OF REVIEW: The percentage of people over the age of 65 is growing rapidly and anesthesiologists must develop a medical understanding that is comprehensive to meet the unique medical needs of this population. The changing physiology of an elderly population makes them extremely vulnerable to trauma and the administration of blood products. Although most of these cases involve orthopedic attention, it is not less dangerous as a blunt trauma case. RECENT FINDINGS: This article addresses some of the main concerns for the anesthesiologists of providing a hemostatic resuscitation in the geriatric population...
April 2018: Current Opinion in Anaesthesiology
Vanya Jaitly, Kimberly Klein, Hlaing Tint, Alice Chen, Paul Allison, Bindu Akkanti, Pranav Loyalka, Brian Castillo
Perioperative bleeding can be a serious life-threatening complication in adult patients undergoing cardiac surgery, given the older age and additional comorbidities present in this patient population. The standard treatment options include transfusion of blood components and surgical re-exploration. We report the first case of an elderly female patient treated with local administration of recombinant factor VIIa (rFVIIa) for intractable hemorrhagic pericardial effusion, which developed following a transcutaneous aortic valve replacement (TAVR) procedure for severe aortic stenosis...
August 1, 2017: Laboratory Medicine
Shozo Kanezaki, Masashi Miyazaki, Naoki Notani, Hiroshi Tsumura
BACKGROUND: Elderly polytrauma patients with pelvic fractures are at higher risk than young adults for severe medical outcomes and/or death in the early post-trauma phase. The aim of our study was to identify predictive factors of medical severity among geriatric polytrauma patients. METHODS: We conducted a retrospective cross-sectional study of polytrauma patients treated at our center, who had a pelvic fracture and at least two other injuries with an abbreviated injury score ≥3...
December 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Takao Ohmori, Taisuke Kitamura, Kimiaki Tanaka, Yuichi Saisaka, Junko Ishihara, Hirokazu Onishi, Tsuyoshi Nojima, Kotaro Yamamoto, Toshiyuki Matsumoto, Takamitsu Tokioka
INTRODUCTION: Among elderly patients with severe trauma, the sites of massive hemorrhage and their clinical characteristics are not well understood. Therefore, we investigated the sites of massive hemorrhage in patients with severe trauma, and compared the results for younger and elderly patients. METHODS: A cohort of severe trauma patients (Injury Severity Score ≥16) admitted from March 2007 to December 2014 was reviewed retrospectively. The inclusion criterion was massive bleeding, which was defined as bleeding that required the transfusion of ≥10 red cell concentrate units within 24 hours of admission, or as cases of early death that occurred despite continuous blood transfusion and before the patient could receive ≥10 red cell concentrate units within the first 24 hours after their admission...
February 2016: American Journal of Emergency Medicine
Jason S Murry, Andrea A Zaw, David M Hoang, Devorah Mehrzadi, Danielle Tran, Miriam Nuno, Matthew Bloom, Nicolas Melo, Daniel R Margulies, Eric J Ley
Massive transfusion protocol (MTP) is used to resuscitate patients in hemorrhagic shock. Our goal was to review MTP use in the elderly. All trauma patients who required activation of MTP at an urban Level I trauma center from January 1, 2011 to December 31, 2013 were reviewed retrospectively. Elderly was defined as age ≥ 60 years. Sixty-six patients had MTP activated: 52 nonelderly (NE) and 14 elderly (E). There were no statistically significant differences between the two cohorts for gender, injury severity score, head abbreviated injury scale, emergency department Glasgow Coma Scale, initial hematocrit, intensive care unit length of stay, or hospital length of stay...
October 2015: American Surgeon
James Wee, Wensheng Lua, Danny Thomas Louange
We report a case of a 73-year-old man with a background of aspirin use who fell and sustained a minimally displaced right superior pubic ramus fracture. He subsequently developed hypotension that necessitated fluid resuscitation, associated with a significant drop in blood haemoglobin levels that required a packed red blood cell transfusion. CT scans revealed the presence of two pelvic haematomas, with ongoing bleeding. An angiogram demonstrated bleeding from the superior vesical branch of the anterior division of the right internal iliac artery, which was successfully embolised with gelfoam slurry...
June 2013: Journal of Clinical Orthopaedics and Trauma
Takao Ohmori, Taisuke Kitamura, Kimiaki Tanaka, Yuichi Saisaka, Junko Ishihara, Hirokazu Onishi, Tsuyoshi Nojima, Koutarou Yamamoto, Toshiyuki Matusmoto, Takamitsu Tokioka
INTRODUCTION: Acute coagulopathy of trauma has been much discussed recently. However, the changes in coagulation markers after trauma in the elderly are unknown. Furthermore, the baseline fibrinogen level is high in elderly patients, and the question remains as to whether fibrinogen levels also decrease early and the degree of decrease in elderly trauma patients. The purpose of this study was to compare coagulation markers including the fibrinogen level on admission in younger and elderly severe trauma patients...
September 2015: Injury
Ali Bagher, Lina Andersson, Carl Johan Wingren, Anders Ottosson, Sakarias Wangefjord, Stefan Acosta
AIMS: We applied the new injury severity scoring system and studied mechanisms of injury and risk factors for mortality, in order to find potential preventive measures, in the present Scandinavian trauma cohort triaged through red trauma alarm according to the Medical Emergency Triage and Treatment System. METHODS: Individuals were identified in hospital and forensic records. New injury severity scoring system >15 was defined as major trauma. Inter-rater reliability of new injury severity scoring system was expressed as intra-class correlation coefficient with 95% confidence intervals...
July 2015: Scandinavian Journal of Public Health
R Loffroy, P Pottecher, V Cherblanc, S Favelier, L Estivalet, N Koutlidis, M Moulin, J P Cercueil, L Cormier, D Krausé
Intractable hematuria from the bladder or the prostate can be life-threatening and its management remains a difficult clinical problem. Severe bleeding can arise as a result of radiation cystitis, bladder carcinoma, cyclophosphamide-induced cystitis, severe infection, transurethral resection of the prostate and prostate cancer. When irrigation of the bladder through a three-way catheter and fulguration of the bleeding lesions fail to stop the hematuria, a life-threatening situation can develop, when blood transfusion fails to keep pace with the rate of blood loss...
November 2014: Diagnostic and Interventional Imaging
Shigeyoshi Makino
In Japan, transfusion medicine, which is supported by the voluntary blood donation system, is facing a risk of blood shortage. This is due to reduced donations by the younger generation as well as the falling birth rate and the aging of the population, with a consequent increase in the elderly population that depends on blood transfusions for conditions such as cancer and hematological and cardiovascular diseases. Therefore, to guarantee stable provision of blood products, in addition to implementing measures to promote blood donation, healthcare professionals must, as a policy, strictly follow the rules for appropriate use of blood products as defined in the "Criteria for the Use of Blood Products"...
April 2014: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Jonathan B Lundy, Clayton J Lewis, Leopoldo C Cancio, Andrew P Cap
OBJECTIVE: To report the use of a bovine hemoglobin-based oxygen carrier (HBOC-201) in an elderly patient sustaining extensive thermal injury unable to receive allogenic transfusion due to religious preference. METHODS: Case report and literature review describing steps required for acquisition and safe infusion of HBOC-201. RESULTS: Six units of HBOC-201 were infused in the perioperative period for anemia with signs of critically low oxygen delivery without adverse sequelae...
2014: International Journal of Burns and Trauma
Biswadev Mitra, Alexander Olaussen, Peter A Cameron, Tom O'Donohoe, Mark Fitzgerald
INTRODUCTION: Older age and blood transfusion have both been independently associated with higher mortality post trauma and the combination is expected to be associated with catastrophic outcomes. Among patients who received a massive transfusion post trauma, we aimed to investigate mortality at hospital discharge of patients ≥65 years old and explore variables associated with poor outcomes. METHODS: A retrospective review of registry data on all major trauma patients presenting to a level I trauma centre between 2006 and 2011 was conducted...
September 2014: Injury
Jian-Rong Guo, Xiao-Ju Jin, Jun Yu, Feng Xu, Yi-Wei Zhang, Hua-Chun Shen, Yi Shao
BACKGROUND: Acute normovolemic hemodilution (ANH) has been widely used to prevent the massive blood loss during hepatic carcinoma. The influences of ANH on coagulation function are still controversy, especially in elderly patients. The study observed ANH effects on coagulation function and fibrinolysis in elderly patients undergoing the disease. MATERIALS AND METHODS: Thirty elderly patients (aged 60-70 yr) with liver cancer (ASA I or II) taken hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANH group (n=15) and control group (n=15)...
2013: Asian Pacific Journal of Cancer Prevention: APJCP
Natalie Enninghorst, Debra McDougall, Julie A Evans, Krisztian Sisak, Zsolt J Balogh
BACKGROUND: The management of patients with femoral shaft fractures (FSFs) is often a decision making dilemma (damage-control orthopedics vs. early total care), with equivocal evidence. The comprehensive, population-based epidemiology of patients with FSF is unknown. The purpose of this prospective study was to describe the epidemiology of patients with FSF, with special focus on patient physiology and timing of surgery. METHODS: A 12-month prospective population-based study was performed on consecutive patients with FSF in an area with 850,000 population including all ages and prehospital deaths...
June 2013: Journal of Trauma and Acute Care Surgery
Ibrahim Aliosmanoglu, Mesut Gul, Murat Kapan, Zulfu Arikanoglu, Fatih Taskesen, Akin Onder, Mustafa Aldemir
AIM: Retroperitoneal hematomas (RPH) mostly occur after blunt and penetrating traumas. However, these hematomas may develop spontaneously in the elderly and the patients who use anticoagulants. Between January 2006 and December 2011, 31 patients with RPH were evaluated retropectively. The patients were allocated into three groups according to the underlying etiological factor: Group I; spontaneous RPH, group II; RPH caused by penetrating trauma, group III; RPH caused by blunt trauma. RESULTS: There were 22 (71%) male and 9 (29%) female patients with a mean age of 35...
January 2013: Annali Italiani di Chirurgia
Philip Büschel, Klaus Mönkemüller, Uwe von Falkenhausen, Lucia C Fry, Peter Malfertheiner, Hans Lippert, Frank Meyer
Gastrointestinal (GI) tract bleeding, in particular originating within the long segment of the small intestine, remains a diagnostic and therapeutic challenge. The authors describe the potential utility of emergency double balloon enteroscopy (DBE) for small bowel bleeding. An elderly woman was admitted because of a hypertensive crisis to the medical department of a regional hospital. Her medical history was significant for non-steroidal anti-inflammatory drug (NSAID) abuse. While in hospital she had massive obscure GI bleeding...
2011: BMJ Case Reports
Bedabrata Sarkar, Melissa E Brunsvold, Jill R Cherry-Bukoweic, Mark R Hemmila, Pauline K Park, Krishnan Raghavendran, Wendy L Wahl, Stewart C Wang, Lena M Napolitano
BACKGROUND: To examine the impact of an ongoing comprehensive performance improvement and patient safety (PIPS) program implemented in 2005 on mortality outcomes for trauma patients at an established American College of Surgeons (ACS)-verified Level I Trauma Center. METHODS: The primary outcome measure was in-hospital mortality. Age, Injury Severity Score (ISS), and intensive care unit admissions were used as stratifying variables to examine outcomes over a 5-year period (2004-2008)...
November 2011: Journal of Trauma
Thomas Lustenberger, Peep Talving, Beat Schnüriger, Barbara M Eberle, Marius J B Keel
BACKGROUND: Damage control (DC) strategy has significantly contributed to mortality reduction in massively bleeding and critically injured trauma victims. However, there is a lack of literature validating the effectiveness of this approach in the elderly population. METHODS: The trauma registry of a Level I trauma center was utilized to identify all severely injured patients [Injury Severity Score (ISS) ≥16] from January 1996 to December 2007 who underwent initial DC procedures...
January 2012: World Journal of Surgery
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