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blood transfusion protocol

Olivier Nardi, Elizabeth Zavala, Claude Martin, Serafim Nanas, Thomas Scheeren, Andrea Polito, Xavi Borrat, Djillali Annane
OBJECTIVE: Evaluation of the ratio of oxyhaemoglobin to total haemoglobin in skeletal muscle (StO2 ) using near-infrared spectroscopy may aid in the monitoring of patients with sepsis. This study assessed the benefits and risks of targeting StO2 in adults with severe sepsis or septic shock. DESIGN: A European randomised controlled trial was performed on two parallel groups. SETTING: Five intensive care units (ICU) in France, Greece, Spain and Germany were used for the study...
March 19, 2018: BMJ Open
Ashley C McGinity, Caroline S Zhu, Leslie Greebon, Elly Xenakis, Elizabeth Waltman, Eric Epley, Danielle Cobb, Rachelle Jonas, Susannah E Nicholson, Brian J Eastridge, Ronald M Stewart, Donald H Jenkins
The mortality from hemorrhage in trauma patients remains high. Early balanced resuscitation improves survival. These truths, balanced with the availability of local resources and our goals for positive regional impact, were the foundation for the development of our pre-hospital whole blood initiative-using low titer cold stored O RhD positive whole blood (LTOWB). The main concern with use of RhD positive blood is the potential development of isoimmunization in RhD negative patients. We used our retrospective massive transfusion protocol (MTP) data to analyze the anticipated risk of this change in practice...
March 16, 2018: Journal of Trauma and Acute Care Surgery
Duan Wang, Hui Zhu, Wei-Kun Meng, Hao-Yang Wang, Ze-Yu Luo, Fu-Xing Pei, Qi Li, Zong-Ke Zhou
BACKGROUND: Although randomized controlled trials have confirmed oral tranexamic acid (TXA) can provide similar blood-sparing efficacy compared with intravenous (IV) TXA in total knee arthroplasty (TKA), some concerns do remain about thromboembolic events after such systemic administration. Many studies have confirmed that intra-articular (IA) application of TXA can show similar blood-saving efficacy with minimal levels of systemic absorption compared with IV TXA. However, it remains unclear whether the efficacy and safety of oral TXA administration is equal to or less than that of IA administration in TKA without the use of a tourniquet and drain...
March 15, 2018: BMC Musculoskeletal Disorders
Nicholas Warner, Jackson Zheng, Greg Nix, Andrew D Fisher, Jeffery C Johnson, John E Williams, D Marc Northern, John S Hellums
The military's use of whole-blood transfusions is not new but has recently received new emphasis by the Tactical Combat Casualty Care Committee. US Army units are implementing a systematic approach to obtain and use whole blood on the battlefield. This case report reviews the care of the first patient to receive low titer group O whole blood (LTOWB) transfusion, using a new protocol.
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Charles S Briggs, Joshua A Sibille, Halim Yammine, Jocelyn K Ballast, William Anderson, Tzvi Nussbaum, Timothy S Roush, Frank R Arko
OBJECTIVE: Endovascular aneurysm repair (EVAR) has been shown to reduce mortality in the emergent repair of ruptured abdominal aortic aneurysms (AAAs). However, long-term survival data for this group of patients are lacking with contemporary endovascular endografts. The purpose of this study was to evaluate both 30-day mortality rates and 1-year survival in patients undergoing emergent EVAR in a 43-facility hospital system with a quaternary referral center with an established ruptured aneurysm protocol...
March 8, 2018: Journal of Vascular Surgery
Cheryl L Maier, Phillip J Gross, Christina L Dean, Satheesh Chonat, Andrew Ip, Morgan McLemore, Fuad El Rassi, Sean R Stowell, Cassandra D Josephson, Ross M Fasano
BACKGROUND: Fever accompanying vaso-occlusive crisis is a common presentation in patients with sickle cell disease (SCD) and carries a broad differential diagnosis. Here, we report a case of transfusion-transmitted malaria in a patient with SCD presenting with acute vaso-occlusive crisis and rapidly decompensating to multisystem organ failure (MSOF). CASE REPORT: An 18-year-old African American male with SCD was admitted after multiple days of fever and severe generalized body pain...
March 9, 2018: Transfusion
Shannon Broxton, Regina Medeiros, Adel Abuzeid, Corey Peterson, Autumn Schumacher
Massive transfusion protocols (MTPs) allow practitioners to follow a prescribed algorithm for the rapid replacement of blood products during a massive hemorrhage. They function as an established protocol to provide consistent treatment. Once implemented, the MTP must be evaluated to ensure best practice. The purpose of this clinical improvement project was to formally evaluate the use and efficacy of an MTP during its first year of implementation. The specific aims were to (1) determine whether MTP activations were missed; (2) compare outcomes between those patients managed by the MTP and those who were not; and (3) provide recommendations to the institution's stakeholders...
March 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
Rafael Uña Orejón, Estrella Mateo Torres, Iván Huercio Martínez, Cristina Jofré Escudero, Juan Gómez Rivas, Jesús Díez Sebastián, Maria Prado Ureta Tolsada
OBJECTIVE: The enhanced recovery after surgery program (ERAS) has become the base of perioperative management in various surgical specialties. However, limited data are available for radical cystectomy. METHODS: We have analyzed 124 patients undergoing radical cystectomy. For retrospective analysis, the patients were divided into two groups:Group A (n=72) included patients whose surgery was performed before the introduction of the ERAS protocol; and Group B (n=52) included patients who were treated following the items included in the ERAS protocol...
March 2018: Archivos Españoles de Urología
Carine Prisco Arnoni, Tatiane A De Paula Vendrame, Janaína Guilhem Muniz, Diana Gazito, Rosangela Duarte De Medeiros Person, Afonso J Pereira Cortez, Flavia R M Latini, Lilian Castilho
BACKGROUND: Vel is a high frequency blood group antigen and its alloantibody is involved in haemolytic transfusion reactions. After elucidation of the molecular basis of the Vel-negative phenotype defined by a 17-base pair deletion in SMIM1, genotyping has been the technique of choice to identify the Vel-negative phenotype, and molecular investigations have contributed to explain Vel expression variability. The present study was aimed at screening for Vel negative blood donors and characterising the genetic changes found in Brazilian donors with altered Vel expression...
January 11, 2018: Blood Transfusion, Trasfusione del Sangue
Álvaro López-Hualda, Cristina Dauder-Gallego, David Ferreño-Márquez, Javier Martínez-Martín
INTRODUCTION AND OBJECTIVE: Tranexamic acid (TXA) is commonly used to control postoperative blood loss in total knee arthroplasty. In order to avoid adverse effects associated with intravenous administration, topical use has been proposed as an alternative. Our aim was to evaluate the efficacy and safety of topical TXA in total knee arthroplasty. MATERIAL AND METHODS: A total of 90 patients scheduled for unilateral total knee arthroplasty were included in a prospective randomised study...
February 26, 2018: Medicina Clínica
Anna Clebone
PURPOSE OF REVIEW: Trauma is the most common cause of pediatric mortality. Much of the research that led to life-saving interventions in adults, however, has not been replicated in the pediatric population. Children have important physiologic and anatomic differences from adults, which impact hemostasis and transfusion. Hemorrhage is a leading cause of death in trauma, and children have important differences in their coagulation profiles. Transfusion strategies, including the massive transfusion protocol and use of antifibrinolytics, are still controversial...
April 2018: Current Opinion in Anaesthesiology
Anne-Sophie Bouthors, Benjamin Hennart, Emmanuelle Jeanpierre, Anne-Sophie Baptiste, Imen Saidi, Elodie Simon, Damien Lannoy, Alain Duhamel, Delphine Allorge, Sophie Susen
BACKGROUND: Postpartum haemorrhage (PPH) is the leading cause of maternal death worldwide. Tranexamic acid (TA), an antifibrinolytic drug, reduces bleeding and transfusion need in major surgery and trauma. In ongoing PPH following vaginal delivery, a high dose of TA decreases PPH volume and duration, as well as maternal morbidity, while early fibrinolysis is inhibited. In a large international trial, a TA single dose reduced mortality due to bleeding but not the hysterectomy rate. TA therapeutic dosages vary from 2...
March 1, 2018: Trials
Robert Benamouzig, Mourad Benallaoua, Jean-Christophe Saurin, Marouane Boubaya, Christophe Cellier, René Laugier, Magalie Vincent, Christian Boustière, Rodica Gincul, Elia Samaha, Philippe Grandval, Thomas Aparicio, Gheorghe Airinei, Bakhtiar Bejou, Cyriaque Bon, Jean-Jacques Raynaud, Vincent Levy, Denis Sautereau
Background: Gastrointestinal angiodysplasias (GIADs) could be responsible for recurrent bleeding and severe anemia. Somatostatin analogs could reduce transfusion requirements in these patients but no randomized controlled study is available. The main objective of the ANGIOPAS phase II double-blinded randomized, noncomparative study was to assess the effectiveness of pasireotide-LAR in reducing transfusion requirements in patients with refractory GIADs bleeding. Methods: A total of 22 patients with transfusion requirements ⩾6 units of packed red blood cells (pRBCs) during the 6 months prior to inclusion were randomized to receive pasireotide-LAR 60 mg ( n = 10) or placebo ( n = 12) every 28 days for 6 months...
2018: Therapeutic Advances in Gastroenterology
(no author information available yet)
When any fetal blood group factor inherited from the father is not possessed by the mother, antepartum or intrapartum fetal-maternal bleeding may stimulate an immune reaction in the mother. Maternal immune reactions also can occur from blood product transfusion. The formation of maternal antibodies, or "alloimmunization," may lead to various degrees of transplacental passage of these antibodies into the fetal circulation. Depending on the degree of antigenicity and the amount and type of antibodies involved, this transplacental passage may lead to hemolytic disease in the fetus and neonate...
March 2018: Obstetrics and Gynecology
(no author information available yet)
When any fetal blood group factor inherited from the father is not possessed by the mother, antepartum or intrapartum fetal-maternal bleeding may stimulate an immune reaction in the mother. Maternal immune reactions also can occur from blood product transfusion. The formation of maternal antibodies, or "alloimmunization," may lead to various degrees of transplacental passage of these antibodies into the fetal circulation. Depending on the degree of antigenicity and the amount and type of antibodies involved, this transplacental passage may lead to hemolytic disease in the fetus and neonate...
March 2018: Obstetrics and Gynecology
Rebecca Feldman Hamm, Eileen Wang, Kathleen O'Rourke, April Romanos, Sindhu K Srinivas
OBJECTIVE: Obstetric hemorrhage is a leading cause of morbidity and mortality. We sought to assess whether institution of a postpartum hemorrhage (PPH) bundle could improve maternal morbidity in our population. STUDY DESIGN: Preintervention data (PRE) was collected on all deliveries at Hospital of the University of Pennsylvania between October 15, 2013 and December 15, 2013. A two-pronged, multidisciplinary educational and procedural intervention related to PPH was instituted from March 2015 to June 2015...
February 19, 2018: American Journal of Perinatology
Jennifer K Workman, Jacob Wilkes, Angela P Presson, Yizhe Xu, John A Heflin, John T Smith
OBJECTIVES: To investigate the variation in care and cost of spinal fusion for adolescent idiopathic scoliosis (AIS), and to identify opportunities for improving healthcare value. STUDY DESIGN: Retrospective cohort study from the Pediatric Health Information Systems database, including children 11-18 years of age with AIS who underwent spinal fusion surgery between 2004 and 2015. Multivariable regression was used to evaluate the relationships between hospital cost, patient outcomes, and resource use...
February 6, 2018: Journal of Pediatrics
Hakan Ozdogu, Can Boga, Suheyl Asma, Ilknur Kozanoglu, Cigdem Gereklioglu, Mahmut Yeral, Nurhilal Turgut Buyukkurt, Soner Solmaz, Aslı Korur, Pelin Aytan, Erkan Maytalman, Mutlu Kasar
The Eastern Mediterranean is among the regions where sickle cell disease (SCD) is common. The morbidity and mortality of this disease can be postponed to adulthood through therapies implemented in childhood. The present study focuses on the organ damage-reducing effects of the Baskent Sickle Cell Medical Care Development Program (BASCARE), which was developed by a team who lives in this region and has approximately 25 years of experience. The deliverables of the program included the development of an electronic health recording system (PRANA) and electronic vaccination system; the use of low citrate infusion in routine prophylactic automatic erythrocyte exchange (ARCE) programs including pregnant women; the use of leukocyte-filtered and irradiated blood for transfusion; the use of magnetic resonance imaging methods (T2) for the management of transfusion-related hemosiderosis; and the implementation of an allogeneic hematopoietic stem cell transplantation protocol for adult patients...
February 2018: Medicine (Baltimore)
L J Terceros-Almanza, C García-Fuentes, S Bermejo-Aznárez, I J Prieto Del Portillo, C Mudarra-Reche, H Domínguez-Aguado, R Viejo-Moreno, J Barea-Mendoza, R Gómez-Soler, I Casado-Flores, M Chico-Fernández
OBJECTIVE: To validate the diagnostic ability of six different scores to predict massive bleeding in a prehospital setting. DESIGN: Retrospective cohort. SETTING: Prehospital attention of patients with severe trauma. SUBJECTS: Subjects with more than 15 years, a history of severe trauma (defined by code 15 criteria), that were initially assisted in a prehospital setting by the emergency services between January 2010 and December 2015 and were then transferred to a level one trauma center in Madrid...
February 4, 2018: Medicina Intensiva
James D Lin, Lawrence G Lenke, Jamal N Shillingford, Joseph L Laratta, Lee A Tan, Charla R Fischer, Mark A Weller, Ronald A Lehman
STUDY DESIGN: Retrospective review of high-dose tranexamic acid (TXA) use in consecutive patients. OBJECTIVE: To determine the safety profile of a high-dose TXA protocol in complex adult spinal deformity patients. SUMMARY OF BACKGROUND DATA: Adult spinal deformity (ASD) surgery may involve significant amounts of blood loss, especially when various osteotomy techniques are used. Antifibrinolytic agents such as TXA have been used to reduce intraoperative blood loss...
March 2018: Spine Deformity
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