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Blood product utilization

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https://www.readbyqxmd.com/read/28719428/blood-product-utilization-among-trauma-and-nontrauma-massive-transfusion-protocols-at-an-urban-academic-medical-center
#1
Eshan U Patel, Paul M Ness, Christi E Marshall, Thomas Gniadek, David T Efron, Peter M Miller, Joseph A Zeitouni, Karen E King, Evan M Bloch, Aaron A R Tobian
BACKGROUND: Hospital-wide massive transfusion protocols (MTPs) primarily designed for trauma patients may lead to excess blood products being prepared for nontrauma patients. This study characterized blood product utilization among distinct trauma and nontrauma MTPs at a large, urban academic medical center. METHODS: A retrospective study of blood product utilization was conducted in patients who required an MTP activation between January 2011 and December 2015 at an urban academic medical center...
July 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28718098/massive-hemorrhage-and-transfusion-in-the-operating-room
#2
Brian Muirhead, Andrew D H Weiss
PURPOSE: In this Continuing Professional Development module, we review the pathophysiology and clinical manifestations associated with massive hemorrhage as well as laboratory investigations and appropriate therapeutic measures. In addition to reviewing the available blood/plasma products and adjunct therapy, we also explore the role of the anesthesiologist in a massive transfusion protocol scenario. PRINCIPAL FINDINGS: Massive hemorrhage can be either anticipated or unexpected...
July 17, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28714229/implementing-a-protocol-to-optimize-blood-use-in-a-cardiac-surgery-service-results-of-a-pre-post-analysis-and-the-impact-of-high-volume-blood-users
#3
Juan B Grau, Jacqueline H Fortier, Cyrus Kuschner, Giovanni Ferrari, Mariano E Brizzio, Alex Zapolanski, Richard E Shaw
BACKGROUND: Blood transfusions are a common and costly intervention for cardiac surgery patients. Evidence suggests that a more restrictive transfusion strategy may reduce costs and transfusion-related complications without increasing perioperative morbidity and mortality. STUDY DESIGN AND METHODS: A transfusion-limiting protocol was developed and implemented in a cardiovascular surgery unit. Over a 5-year period, data were collected on patient characteristics, procedures, utilization of blood products, morbidity, and mortality, and these were compared before and after the protocol was implemented...
July 16, 2017: Transfusion
https://www.readbyqxmd.com/read/28704244/implementation-of-a-standardized-transfusion-protocol-for-cardiac-patients-treated-with-venoarterial-extracorporeal-membrane-oxygenation-is-associated-with-decreased-blood-component-utilization-and-may-improve-clinical-outcome
#4
Christine M Cahill, Neil Blumberg, Amy E Schmidt, Peter A Knight, Amber L Melvin, Howard T Massey, Joseph M Delehanty, Seth B Zebrak, Majed A Refaai
BACKGROUND: Extracorporeal membrane oxygenation supplies oxygenated blood to the body supporting the heart and lungs. Survival rates of 20% to 50% are reported among patients receiving ECMO for cardiac arrest, severe cardiogenic shock, or failure to wean from cardiopulmonary bypass following cardiac surgery. Bleeding is one of the most common complications in ECMO patients due to coagulopathy, systemic anticoagulation, and the presence of large bore cannulas at systemic pressure. Absence of a standardized transfusion protocol in this population leads to inconsistent transfusion practices...
July 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28699407/hydrogen-sulfide-and-glucose-homeostasis-a-tale-of-sweet-the-stink
#5
Ashley Untereiner, Lingyun Wu
SIGNIFICANCE: Among many endogenous mediators, the gasotransmitter hydrogen sulfide (H2S) plays an important role in the regulation of glucose homeostasis. Here we discuss different functional roles of H2S in several metabolic organs/tissues required in the maintenance of glucose homeostasis. Recent Advances: New evidence has emerged revealing the insulin sensitizing role of H2S in adipose tissue and skeletal muscle biology. Additionally, H2S was demonstrated to be a potent stimulator of gluconeogenesis via the induction and stimulation of various glucose-producing pathways in the liver...
July 12, 2017: Antioxidants & Redox Signaling
https://www.readbyqxmd.com/read/28697050/transfusion-requirement-in-burn-care-evaluation-tribe-a-multicenter-randomized-prospective-trial-of-blood-transfusion-in-major-burn-injury
#6
Tina L Palmieri, James H Holmes, Brett Arnoldo, Michael Peck, Bruce Potenza, Amalia Cochran, Booker T King, William Dominic, Robert Cartotto, Dhaval Bhavsar, Nathan Kemalyan, Edward Tredget, Francois Stapelberg, David Mozingo, Bruce Friedman, David G Greenhalgh, Sandra L Taylor, Brad H Pollock
OBJECTIVE: Our objective was to compare outcomes of a restrictive to a liberal red cell transfusion strategy in 20% or more total body surface area (TBSA) burn patients. We hypothesized that the restrictive group would have less blood stream infection (BSI), organ dysfunction, and mortality. BACKGROUND: Patients with major burns have major (>1 blood volume) transfusion requirements. Studies suggest that a restrictive blood transfusion strategy is equivalent to a liberal strategy...
July 10, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28697023/clot-dynamics-and-mortality-the-ma-r-ratio
#7
Stephanie A Savage, Ben L Zarzaur, Timothy H Pohlman, Brian L Brewer, Louis J Magnotti, Martin A Croce, Garrett H Lim, Ali C Martin
INTRODUCTION: The coagulopathy of trauma, illustrated by a short R-time, is common and well understood. The physiology behind this may be early thrombin burst with rapid clot formation. Rapid consumption of fibrinogen, however, may result in weak clot and substrate depletion, resulting in low MA. While these characteristics are interesting, utilizing TEG to identify those at risk for subsequent bleeding diathesis, especially in those who do not demonstrate early signs of physiologic derangement, is challenging...
July 8, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28695949/synthesis-and-biological-evaluation-of-the-ascidian-blood-pigment-halocyamine-a
#8
Hugo K H Fong, Jean Michel Brunel, Arlette Longeon, Marie-Lise Bourguet-Kondracki, David Barker, Brent R Copp
Synthesis of the antimicrobial marine natural product halocyamine A has been achieved utilizing a combination of Sonogashira coupling, ruthenium complex/ytterbium triflate catalyzed hydroamidation and solid-phase peptide synthesis (SPPS) chemistry. The synthetic natural product exhibited only modest levels of antibacterial activities but significant antioxidant activity.
July 11, 2017: Organic & Biomolecular Chemistry
https://www.readbyqxmd.com/read/28693362/veterinary-utility-of-dried-blood-spots-for-analysis-of-toxic-chlorinated-hydrocarbons
#9
Andreas F Lehner, Margaret Johnson, John Buchweitz
Dried blood spots (DBS) on filter paper provide a simple and convenient means of collecting, storing and shipping samples for veterinary diagnostics related to toxin exposures. This paper presents validation data on analysis of DBS for chlorinated persistent organic pollutants, specifically 4,4'-DDT and its breakdown product 4,4'-DDE, lindane and a representative polychlorinated biphenyl (PCB) congener PCB-153. Analysis was by gas chromatography with electron capture detection (GC-ECD). The method required one 12...
July 11, 2017: Toxicology Mechanisms and Methods
https://www.readbyqxmd.com/read/28686936/differentiation-of-low-and-high-grade-clear-cell-renal-cell-carcinoma-tumor-size-versus-ct-perfusion-parameters
#10
Chao Chen, Qinqin Kang, Bing Xu, Hairuo Guo, Qiang Wei, Tiegong Wang, Hui Ye, Xinhuai Wu
PURPOSE: To compare the utility of tumor size and CT perfusion parameters for differentiation of low- and high-grade clear cell renal cell carcinoma (RCC). MATERIALS AND METHODS: Tumor size, Equivalent blood volume (Equiv BV), permeability surface-area product (PS), blood flow (BF), and Fuhrman pathological grading of clear cell RCC were retrospectively analyzed. RESULTS: High-grade clear cell RCC had significantly higher tumor size and lower PS than low grade...
July 3, 2017: Clinical Imaging
https://www.readbyqxmd.com/read/28683893/a-comprehensive-choosing-wisely-quality-improvement-initiative-reduces-unnecessary-transfusions-in-an-academic-department-of-surgery
#11
Caitlin W Hicks, Jing Liu, William W Yang, Sandra R DiBrito, Daniel J Johnson, Alexandra Brito, Robert S D Higgins, Steven M Frank, Elizabeth C Wick
BACKGROUND: We implemented a comprehensive Choosing Wisely initiative to reduce unnecessary transfusions in an Academic Department of Surgery. METHODS: We conducted a survey- and lecture-based educational intervention to increase awareness about published transfusion guidelines. Monthly transfusion reports were subsequently distributed to all faculty, fellows, residents, and mid-level practitioners. Blood utilization measures were compared pre- vs. post-intervention to assess effectiveness...
June 29, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28682476/plasma-levels-of-hgf-and-plgf-predict-mortality-in-a-general-population-a-prospective-cohort-study
#12
Kristiina Santalahti, Aki Havulinna, Mikael Maksimow, Tanja Zeller, Stefan Blankenberg, Aki Vehtari, Heikki Joensuu, Sirpa Jalkanen, Veikko Salomaa, Marko Salmi
BACKGROUND: Circulating levels of growth factors involved in leukocyte production and angiogenesis could be indicative of underlying aberrations of tissue homeostasis and therefore be utilized as predictors of risk for all-cause cardiovascular disease (CVD) or cancer mortality. METHODS: Baseline plasma levels of a range of growth factors were measured in two cohorts of the population-based FINRISK study (1997 Discovery cohort, N=8444, aged 25-74; 2002 Replication cohort, N=2951, aged 51-74 years) using a multiplexed bead array methodology and ELISA...
July 6, 2017: Journal of Internal Medicine
https://www.readbyqxmd.com/read/28674896/blood-and-plasma-proteomics-targeted-quantitation-and-posttranslational-redox-modifications
#13
Julie A Reisz, Katelyn M Chessler, Monika Dzieciatkowska, Angelo D'Alessandro, Kirk C Hansen
Proteome profiling using mass spectrometry is extensively utilized to understand the physiological characteristics of cells, tissues, fluids, and many other biological matrices. From the earliest days of the proteomics era, exploratory analyses of the blood protein complement have attracted a great deal of interest, owing to the pivotal importance of blood cells and biofluids (serum, plasma) for research and biomedical purposes. Once challenged by the high dynamic range of protein concentrations, low sensitivity of mass spectrometers, and poor annotation of proteomics databases, the techniques in this field have quickly evolved in recent years, particularly in the areas of absolute quantification of proteins and in mapping of posttranslational modifications...
2017: Methods in Molecular Biology
https://www.readbyqxmd.com/read/28673934/activation-of-sf1-neurons-in-the-ventromedial-hypothalamus-by-dreadd-technology-increases-insulin-sensitivity-in-peripheral-tissues
#14
Eulalia A Coutinho, Shiki Okamoto, Ayako Wendy Ishikawa, Shigefumi Yokota, Nobuhiro Wada, Takahiro Hirabayashi, Kumiko Saito, Tatsuya Sato, Kazuyo Takagi, Chen-Chi Wang, Kenta Kobayashi, Yoshihiro Ogawa, Seiji Shioda, Yumiko Yoshimura, Yasuhiko Minokoshi
The ventromedial hypothalamus (VMH) regulates glucose and energy metabolism in mammals. Optogenetic stimulation of VMH neurons that express steroidogenic factor 1 (SF1) induces hyperglycemia. However, leptin acting via the VMH stimulates whole-body glucose utilization and insulin sensitivity in some peripheral tissues, whereas this effect of leptin appears to be mediated by SF1 neurons. We examined the effects of activation of SF1 neurons with DREADD (designer receptors exclusively activated by designer drugs) technology...
July 3, 2017: Diabetes
https://www.readbyqxmd.com/read/28671296/blood-use-in-patients-receiving-intensive-chemotherapy-for-acute-leukemia-or-hematopoietic-stem-cell-transplantation-the-impact-of-a-health-system-wide-patient-blood-management-program
#15
Michael F Leahy, Kevin M Trentino, Colleen May, Stuart G Swain, Hun Chuah, Shannon L Farmer
BACKGROUND: Little is published on patient blood management (PBM) programs in hematology. In 2008 Western Australia announced a health system-wide PBM program with PBM staff appointments commencing in November 2009. Our aim was to assess the impact this program had on blood utilization and patient outcomes in intensive chemotherapy for acute leukemia or hematopoietic stem cell transplantation. STUDY DESIGN AND METHODS: A retrospective study of 695 admissions at two tertiary hospitals receiving intensive chemotherapy for acute leukemia or undergoing hematopoietic stem cell transplantation between July 2010 and December 2014 was conducted...
July 3, 2017: Transfusion
https://www.readbyqxmd.com/read/28668197/improving-healthcare-value-through-clinical-community-and-supply-chain-collaboration
#16
Lisa Ishii, Renee Demski, K H Ken Lee, Zishan Mustafa, Steve Frank, Jean Paul Wolisnky, David Cohen, Jay Khanna, Joshua Ammerman, Harpal S Khanuja, Anthony S Unger, Lois Gould, Patricia Ann Wachter, Lauren Stearns, Ronald Werthman, Peter Pronovost
BACKGROUND: We hypothesized that integrating supply chain with clinical communities would allow for clinician-led supply cost reduction and improved value in an academic health system. METHODS: Three clinical communities (spine, joint, blood management) and one clinical community-like physician led team of surgeon stakeholders partnered with the supply chain team on specific supply cost initiatives. The teams reviewed their specific utilization and cost data, and the physicians led consensus-building conversations over a series of team meetings to agree to standard supply utilization...
March 2017: Healthcare
https://www.readbyqxmd.com/read/28666704/systemic-and-tissue-specific-effects-of-aliskiren-on-the-raas-and-carbohydrate-lipid-metabolism-in-obese-patients-with-hypertension
#17
Stefan Engeli, Marcus May, Juerg Nussberger, A H Jan Danser, William P Dole, Margaret F Prescott, Marion Dahlke, Sylvie Stitah, Parasar Pal, Michael Boschmann, Jens Jordan
Aliskiren penetrates adipose and skeletal muscle in hypertensive patients with abdominal obesity and reduces renin-angiotensin-aldosterone system activity. After discontinuation, blood pressure-lowering effects are observed possibly through drug-tissue binding. We performed microdialysis evaluation of adipose tissue and skeletal muscle before and during an insulin-modified frequently sampled intravenous glucose tolerance test (IM-FSIGT). Aliskiren 300 mg (n = 8) or amlodipine 5 mg (n = 8) once daily were administered during a 12-week randomized treatment period...
June 12, 2017: Journal of the American Society of Hypertension: JASH
https://www.readbyqxmd.com/read/28662614/thromboelastography-in-term-neonates
#18
Nicholas J Schott, Stephen P Emery, Courtney Garbee, Jonathan Waters
BACKGROUND: Thromboelastography (TEG) is utilized as a point-of-care test of coagulation function to improve evidence-based blood product replacement in adults. In contrast to standard indices of coagulation, TEG reflects the dynamic interactions among the elements involved in hemostasis, including fibrinolysis. Although normal adult values and various abnormalities have been characterized, normative values for term neonates have not been described. Studies of neonatal TEG remain limited and have small sample sizes with inconsistent methodology...
June 29, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28652577/human-in-vitro-induced-regulatory-t-cells-display-dlgh1dependent-and-pkc-%C3%AE-restrained-suppressive-activity
#19
Alexandra Zanin-Zhorov, Sudha Kumari, Keli L Hippen, Sarah C Merkel, Margaret L MacMillan, Bruce R Blazar, Michael L Dustin
In vitro induced human regulatory T cells (iTregs) have demonstrated in vivo therapeutic utility, but pathways regulating their function have not been elucidated. Here, we report that human iTregs generated in vitro from naïve cord blood cells preferentially recruit Disc large homolog 1 (Dlgh1) and exclude protein kinase C (PKC)-θ from immunological synapses formed on supported lipid bilayers with laterally mobile ICAM-1 and anti-CD3 mAb. Also, iTregs display elevated Dlgh1 overall and Dlgh1-dependent p38 phosphorylation, higher levels of phosphatase and tensin homolog (PTEN), and diminished Akt phosphorylation...
June 26, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28652573/extraordinarily-potent-proinflammatory-properties-of-lactoferrin-containing-immunocomplexes-against-human-monocytes-and-macrophages
#20
Lulu Hu, Xiaomin Hu, Kai Long, Chenhui Gao, Hong-Liang Dong, Qiao Zhong, Xiao-Ming Gao, Fang-Yuan Gong
Lactoferrin (LTF), an important first line defense molecule against infection, is a common target for humoral autoimmune reactions in humans. Since LTF is a multifunctional protein capable of activating innate immune cells via various surface receptors, we hypothesized that LTF-containing immune complexes (ICs) (LTF-ICs), likely formed in patients with high titer anti-LTF autoantibodies, could possess unique monocyte/macrophage-activating properties compared with other ICs. ELISA analysis on serum samples from rheumatoid arthritis (RA) patients (n = 80) and healthy controls (n = 35) for anti-LTF autoantibodies confirmed a positive correlation between circulating LTF-specific IgG and RA...
June 26, 2017: Scientific Reports
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