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hemostatic transfusion

Mitchell R Dyer, DaShawn Hickman, Norman Luc, Shannon Haldeman, Patricia Loughran, Christa Pawlwoski, Anirban Sen Gupta, Matthew D Neal
BACKGROUND: Clinical resuscitative treatment of traumatic hemorrhage involves transfusion of RBC, platelets and plasma in controlled ratios. However, use of such blood components, especially platelets, present many challenges including availability, portability, contamination risks, and short shelf-life, which limit the use of platelet transfusions outside of large trauma centers such as remote civilian hospitals and austere pre-hospital settings. This has prompted significant research in platelet substitutes that may resolve the above issues while providing platelet-mimetic hemostatic action...
March 12, 2018: Journal of Trauma and Acute Care Surgery
Joar Sivertsen, Hanne Braathen, Turid Helen F Lunde, Philip C Spinella, Warren Dorlac, Geir Strandenes, Torunn O Apelseth, Tor A Hervig, Einar K Kristoffersen, Level Iv Diagnostic Study
No abstract text is available yet for this article.
March 12, 2018: Journal of Trauma and Acute Care Surgery
Caroline Sut, Sofiane Tariket, Cécile Aubron, Chaker Aloui, Hind Hamzeh-Cognasse, Philippe Berthelot, Sandrine Laradi, Andreas Greinacher, Olivier Garraud, Fabrice Cognasse
Platelets transfusion is a safe process, but during or after the process, the recipient may experience an adverse reaction and occasionally a serious adverse reaction (SAR). In this review, we focus on the inflammatory potential of platelet components (PCs) and their involvement in SARs. Recent evidence has highlighted a central role for platelets in the host inflammatory and immune responses. Blood platelets are involved in inflammation and various other aspects of innate immunity through the release of a plethora of immunomodulatory cytokines, chemokines, and associated molecules, collectively termed biological response modifiers that behave like ligands for endothelial and leukocyte receptors and for platelets themselves...
2018: Frontiers in Medicine
Elizabeth Krachey, Kert Viele, Philip C Spinella, Marie E Steiner, Nicole D Zantek, Roger J Lewis
BACKGROUND: Storage of platelets at 4°C compared to 22°C may increase both hemostatic activity and storage duration; however, the maximum duration of cold storage is unknown. We report the design of an innovative, prospective, randomized, Bayesian adaptive, "duration-finding" clinical trial to evaluate the efficacy and maximum duration of storage of platelets at 4°C. METHODS: Patients undergoing cardiac surgery and requiring platelet transfusions will be enrolled...
March 8, 2018: Journal of Trauma and Acute Care Surgery
María Elena Arnáiz-García, Jose María González-Santos, Javier López-Rodríguez, Ana María Arnáiz-García, Javier Arnáiz
Postoperative bleeding with its important socioeconomic cost is associated with an increased morbidity and mortality. It causes hemodynamic instability, increases blood loss, and multiplies the number of transfusions required. Especially in vascular or aortic surgery, postoperative bleeding can become a life-threatening complication due to anticoagulant or antiaggregation preoperative status or postoperative coagulation dysfunction after a high level of heparinization. Presently described is the case of a patient who underwent an aortic valve and ascending aorta replacement...
March 2018: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
Parvez M Lokhandwala, Adrian O'Neal, Eshan U Patel, Patricia A R Brunker, Eric A Gehrie, Gang Zheng, Thomas S Kickler, Paul M Ness, Aaron A R Tobian
BACKGROUND: AABB standards state that cryoprecipitate should be transfused within 4 to 6 hours after thawing. We evaluated coagulation factor levels and sterility of thawed pooled cryoprecipitate to assess whether shelf life can be safely extended. STUDY DESIGN AND METHODS: Donor cryoprecipitate pools (n = 20, 10 group A, 10 group O) were held at ambient temperature and sampled at 0, 4, 8, 24, 48, 72, 96, and 120 hours post-thawing for fibrinogen, Factor (F)VIII, and von Willebrand factor (vWF) levels...
February 25, 2018: Transfusion
John B Holcomb
OBJECTIVES: Experience in the ongoing wars in Iraq and Afghanistan confirm that faster transport combined with effective prehospital interventions improves the outcomes of patients suffering hemorrhagic shock. Outcomes of patients with hemorrhagic shock and extremity bleeding have improved with widespread use of tourniquets and early balanced transfusion therapy. Conversely, civilian patients suffering truncal bleeding and shock have the same mortality (46%) over the last 20 years. To understand how to decrease this substantial mortality, one must first critically evaluate all phases of care from point of injury to definitive hemorrhage control in the operating room...
March 2018: Critical Care Medicine
Meghan Gilley, Suzanne Beno
PURPOSE OF REVIEW: Damage control resuscitation is an overall management strategy used in trauma patients to rapidly restore physiologic stability, while mitigating hypothermia, coagulopathy and acidosis. We review the evidence and current practice of damage control resuscitation in pediatric trauma patients with a specific focus on fluid management. RECENT FINDINGS: There have been a number of studies over the last several years examining crystalloid fluid resuscitation, balanced blood product transfusion practice and hemostatic agents in pediatric trauma...
February 22, 2018: Current Opinion in Pediatrics
Jennifer M Gurney, Philip C Spinella
PURPOSE OF REVIEW: Hemorrhage remains the primary cause of preventable death on the battlefield and in civilian trauma. Hemorrhage control is multifactorial and starts with point-of-injury care. Surgical hemorrhage control and time from injury to surgery is paramount; however, interventions in the prehospital environment and perioperative period affect outcomes. The purpose of this review is to understand concepts and strategies for successful management of the bleeding military patient...
April 2018: Current Opinion in Anaesthesiology
Tomaz Crochemore, Thiago Domingos Corrêa, Marcus D Lance, Cristina Solomon, Ary Serpa Neto, João Carlos de Campos Guerra, Priscila Scolmeister Lellis, Livia Muller Bernz, Natalia Nunes, Cassio Massashi Mancio, Ana Paula Hitomi Yokoyama, Eliézer Silva
BACKGROUND: Transfusion therapy is associated with increased morbidity, mortality and costs. Conventional coagulation tests (CCT) are weak bleeding predictors, poorly reflecting coagulation in vivo. Thromboelastometry (ROTEM) provides early identification of coagulation disorders and can guide transfusion therapy by goals, reducing blood components transfusion. OBJECTIVE: The aim of this study is to describe coagulation profile of critically ill patients using ROTEM and evaluate the association between CCT and thromboelastometry...
2018: PloS One
DaShawn A Hickman, Christa L Pawlowski, Andrew Shevitz, Norman F Luc, Ann Kim, Aditya Girish, Joyann Marks, Simi Ganjoo, Stephanie Huang, Edward Niedoba, Ujjal D S Sekhon, Michael Sun, Mitchell Dyer, Matthew D Neal, Vikram S Kashyap, Anirban Sen Gupta
Traumatic non-compressible hemorrhage is a leading cause of civilian and military mortality and its treatment requires massive transfusion of blood components, especially platelets. However, in austere civilian and battlefield locations, access to platelets is highly challenging due to limited supply and portability, high risk of bacterial contamination and short shelf-life. To resolve this, we have developed an I.V.-administrable 'synthetic platelet' nanoconstruct (SynthoPlate), that can mimic and amplify body's natural hemostatic mechanisms specifically at the bleeding site while maintaining systemic safety...
February 15, 2018: Scientific Reports
Benjamin T Miller, Andrew H Lin, Susan C Clark, Andrew P Cap, Joseph J Dubose
BACKGROUND: The U.S. Navy's casualty-receiving ships provide remote damage control resuscitation (RDCR) platforms to treat injured combatants deployed afloat and ashore. We report a significant mass casualty incident aboard the USS Bataan, and the most warm fresh whole blood (WFWB) transfused at sea for traumatic hemorrhagic shock since the Vietnam War. METHODS: Casualty-receiving ships have robust medical capabilities, including a frozen blood bank with packed red blood cells (pRBC) and fresh frozen plasma (FFP)...
February 13, 2018: Journal of Trauma and Acute Care Surgery
Sarina Levy-Mendelovich, Assaf Arie Barg, Nurit Rosenberg, Einat Avishai, Jacob Luboshitz, Mudi Misgav, Gili Kenet, Tami Livnat
INTRODUCTION: Congenital factor V deficiency (FVD) is a rare bleeding disorder with an estimated incidence of 1 in 1000,000 in the general population. Since the common coagulation tests do not correlate with the bleeding tendency there is an unmet need to predict FVD patients' bleeding hazard prior to surgical interventions. AIM: To optimize treatment prior to surgical interventions, using global coagulation assays, thrombin generation (TG) and rotating thromboelastogram (ROTEM)...
February 2, 2018: Blood Cells, Molecules & Diseases
Thomas J Cusack, J Ricardo Carhuapoma, Wendy C Ziai
PURPOSE OF REVIEW: Spontaneous intraparenchymal hemorrhage (IPH) is a prominent challenge faced globally by neurosurgeons, neurologists, and intensivists. Over the past few decades, basic and clinical research efforts have been undertaken with the goal of delineating biologically and evidence-based practices aimed at decreasing mortality and optimizing the likelihood of meaningful functional outcome for patients afflicted with this devastating condition. Here, the authors review the medical and surgical approaches available for the treatment of spontaneous intraparenchymal hemorrhage, identifying areas of recent progress and ongoing research to delineate the scope and scale of IPH as it is currently understood and treated...
February 3, 2018: Current Treatment Options in Neurology
Frédéric Garban, Audrey Guyard, Helene Labussière, Claude-Eric Bulabois, Tony Marchand, Christiane Mounier, Denis Caillot, Jacques-Olivier Bay, Valérie Coiteux, Aline Schmidt-Tanguy, Catherine Le Niger, Christine Robin, Patrick Ladaique, Simona Lapusan, Eric Deconinck, Carole Rolland, Alison M Foote, Anne François, Chantal Jacquot, René Tardivel, Pierre Tiberghien, Jean-Luc Bosson
Importance: Pathogen reduction of platelet concentrates may reduce transfusion-transmitted infections but is associated with qualitative impairment, which could have clinical significance with regard to platelet hemostatic capacity. Objective: To compare the effectiveness of platelets in additive solution treated with amotosalen-UV-A vs untreated platelets in plasma or in additive solution in patients with thrombocytopenia and hematologic malignancies. Design, Setting, and Participants: The Evaluation of the Efficacy of Platelets Treated With Pathogen Reduction Process (EFFIPAP) study was a randomized, noninferiority, 3-arm clinical trial performed from May 16, 2013, through January 21, 2016, at 13 French tertiary university hospitals...
February 1, 2018: JAMA Oncology
Christine M Leeper, Christine McKenna, Barbara A Gaines
BACKGROUND: Hypotension is a late finding in pediatric shock despite significant blood loss; consequently, recognition of hemodynamic compromise can be delayed. We sought to describe the impact of late stage shock in children, indicated by hypotension or trauma bay blood transfusion, and quantify the association with poor outcome. METHODS: Children age<18 from the Pennsylvania Trauma Outcome Study registry (2000-2013) were included. Primary outcome was mortality...
January 31, 2018: Journal of Trauma and Acute Care Surgery
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
Loren Laine, Stig B Laursen, Liam Zakko, Harry R Dalton, Jing H Ngu, Michael Schultz, Adrian J Stanley
OBJECTIVES: Numerous reviews indicate bloody hematemesis signifies more severe bleeding than coffee-grounds hematemesis. We assessed severity and outcomes related to bleeding symptoms in a prospective study. METHODS: Consecutive patients presenting with hematemesis or melena were categorized as bloody emesis (N=1209), coffee-grounds emesis without bloody emesis (N=701), or melena without hematemesis (N=1069). We assessed bleeding severity (pulse, blood pressure) and predictors of outcome (hemoglobin, risk stratification scores) at presentation, and outcomes of bleeding episodes...
January 30, 2018: American Journal of Gastroenterology
Jennifer Mourafetis, Norman Doctor, Simon Leung
PURPOSE: A case report describing use of idarucizumab for dabigatran reversal without the use of hemostatic agents in a patient who developed acute upper gastrointestinal (GI) bleeding while receiving triple antithrombotic therapy is presented. SUMMARY: A 77-year-old man with a complex cardiac history presented to the emergency room with chief complaints of black tarry stools and low blood pressures for 4 days. His past medical history included recent percutaneous coronary intervention (PCI) and drug-eluting stent (DES) placement, atrial fibrillation, hypertension, hyperlipidemia, coronary artery disease, coronary artery bypass graft surgery, stage 3 chronic kidney disease, and cholecystectomy...
February 15, 2018: American Journal of Health-system Pharmacy: AJHP
Mauro Panigada, Giacomo E Iapichino, Matteo Brioni, Giovanna Panarello, Alessandro Protti, Giacomo Grasselli, Giovanna Occhipinti, Cristina Novembrino, Dario Consonni, Antonio Arcadipane, Luciano Gattinoni, Antonio Pesenti
BACKGROUND: There is no consensus on the management of anticoagulation during extracorporeal membrane oxygenation (ECMO). ECMO is currently burdened by a high rate of hemostatic complications, possibly associated with inadequate monitoring of heparin anticoagulation. This study aims to assess the safety and feasibility of an anticoagulation protocol for patients undergoing ECMO based on thromboelastography (TEG) as opposed to an activated partial thromboplastin time (aPTT)-based protocol...
January 16, 2018: Annals of Intensive Care
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