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https://www.readbyqxmd.com/read/28939033/epsilon-aminocaproic-acid-to-reduce-blood-loss-and-transfusion-after-total-hip-and-total-knee-arthroplasty
#1
Juliann C Hobbs, Ian J Welsby, Cynthia L Green, Ishwori B Dhakal, Samuel S Wellman
BACKGROUND: Total hip and knee arthroplasty (THA and TKA) are associated with significant blood loss and some patients require postoperative blood transfusion. While tranexamic acid has been studied extensively among this population, we tested the hypothesis that epsilon aminocaproic acid (EACA) can reduce blood loss and transfusion after joint arthroplasty. METHODS: In April 2014, our Veterans Affairs Medical Center introduced a protocol to administer EACA during THA and TKA...
August 24, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28930957/clot-dynamics-and-mortality-the-ma-r-ratio
#2
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 thromboelastography (TEG) to identify those at risk of subsequent bleeding diathesis, especially in those who do not demonstrate early signs of physiologic derangement, is challenging...
October 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28919087/outcomes-of-restrictive-versus-liberal-transfusion-strategies-in-older-adults-from-nine-randomised-controlled-trials-a-systematic-review-and-meta-analysis
#3
Geoff I Simon, Alison Craswell, Ogilvie Thom, Yoke Lin Fung
BACKGROUND: Guidelines for patient blood management recommend restrictive transfusion practice for most adult patients. These guidelines are supported by evidence from randomised controlled trials (RCTs); however, one of the patient groups not explicitly examined in these studies is the geriatric population. We examined RCTs relevant to transfusion outcomes in older patients. Our aim was to determine whether special guidelines are warranted for geriatric patients, recognising the different pathophysiological characteristics of this group...
September 11, 2017: Lancet Haematology
https://www.readbyqxmd.com/read/28901549/effects-of-red-blood-cell-storage-time-on-transfused-patients-in-the-icu-protocol-for-a-systematic-review
#4
REVIEW
S L Rygård, A B Jonsson, M B Madsen, A Perner, L B Holst, P I Johansson, J Wetterslev
BACKGROUND: Patients in the intensive care unit (ICU) are often anaemic due to blood loss, impaired red blood cell (RBC) production and increased RBC destruction. In some studies, more than half of the patients were treated with RBC transfusion. During storage, the RBC and the storage medium undergo changes, which lead to impaired transportation and delivery of oxygen and may also promote an inflammatory response. Divergent results on the clinical consequences of storage have been reported in both observational studies and randomised trials...
September 13, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28886788/logistical-concerns-for-prehospital-blood-product-use-by-air-medical-services
#5
REVIEW
Patrick Maher, Richard Utarnachitt, Max J Louzon, Roxann Gary, Nina Sen, John R Hess
Over the past few decades, reports have described favorable results from transfusion of blood products in helicopter EMS (HEMS). Nevertheless, the initiation of a HEMS transfusion program requires consideration of many factors, some unique to each clinical site. This paper describes our experience developing a HEMS transfusion program in an urban non-hospital based HEMS program with a history of long transport times. When considering blood use away from the hospital, major consideration must be given to safe storage and monitoring of blood products both on the ground and while in flight...
September 2017: Air Medical Journal
https://www.readbyqxmd.com/read/28885411/improvement-in-outcomes-of-major-obstetric-hemorrhage-through-systematic-change
#6
Daniel W Skupski, David Brady, Isaac P Lowenwirt, Jason Sample, Stephanie N Lin, Rahul Lohana, Gary S Eglinton
OBJECTIVE: To report the outcomes over 14 years of sustained systematic institutional focus on the care of women with major obstetric hemorrhage, defined as estimated blood loss greater than 1,500 mL. METHODS: A retrospective cohort study of women with major obstetric hemorrhage at our hospital from 2000 to 2014 compares baseline conditions (age, multiparity, prior cesarean delivery, morbidly adherent placenta), morbidity (lowest mean temperature, lowest mean pH, coagulopathy, hysterectomy), and mortality among three time periods (period 1=January 2000 to December 2001, period 2=January 2002 to August 2005, period 3=September 2005 to December 2014)...
October 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28875548/bacterial-contamination-of-platelet-components-not-detected-by-bact-alert%C3%A2
#7
M A Abela, S Fenning, K A Maguire, K G Morris
OBJECTIVES: To investigate the possible causes for false negative results in BacT/ALERT® 3D Signature System despite bacterial contamination of platelet units. BACKGROUND: The Northern Ireland Blood Transfusion Service (NIBTS) routinely extends platelet component shelf life to 7 days. Components are sampled and screened for bacterial contamination using an automated microbial detection system, the BacT/ALERT® 3D Signature System. We report on three platelet components with confirmed bacterial contamination, which represent false negative BacT/ALERT® results and near-miss serious adverse events...
September 5, 2017: Transfusion Medicine
https://www.readbyqxmd.com/read/28863020/validating-the-physiologic-model-hummod-as-a-substitute-for-clinical-trials-involving-acute-normovolemic-hemodilution
#8
Charles R Sims, Luis R Delima, Arthur Calimaran, Robert Hester, W Andrew Pruett
BACKGROUND: Blood conservation strategies and transfusion guidelines remain a heavily debated clinical topic. Previous investigational trials have shown that acute isovolemic hemodilution does not limit adequate oxygen delivery; however, a true critical hemoglobin level has never been investigated or defined due to safety concerns for human volunteers. Validated physiologic modeling may be useful to investigate hemodilution at critical hemoglobin levels without the ethical or safety hazards of clinical trials...
August 31, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28858899/patients-undergoing-cesarean-delivery-after-exposure-to-oxytocin-during-labor-require-higher-postpartum-oxytocin-doses
#9
Amanda Foley, Ashley Gunter, Kenneth J Nunes, Sajid Shahul, Barbara M Scavone
BACKGROUND: Experts recommend postpartum oxytocin to prevent uterine atony and hemorrhage, but oxytocin may be associated with dose-dependent adverse effects, and the correct dose of postpartum oxytocin has yet to be determined. The effective dose in 90% of patients (ED90) of oxytocin after cesarean delivery may be higher in patients exposed to oxytocin during labor compared to patients unexposed. We therefore undertook this study to compare postpartum oxytocin requirements in patients exposed to oxytocin prior to cesarean delivery versus those not exposed, when all were treated according to a specific institutional protocol...
August 30, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28857793/initiation-and-termination-of-massive-transfusion-protocols-current-strategies-and-future-prospects
#10
John C Foster, Joshua W Sappenfield, Robert S Smith, Sean P Kiley
The advent of massive transfusion protocols (MTP) has had a significant positive impact on hemorrhaging trauma patient morbidity and mortality. Nevertheless, societal MTP guidelines and individual MTPs at academic institutions continue to circulate opposing recommendations on topics critical to MTPs. This narrative review discusses up-to-date information on 2 such topics, the initiation and termination of an MTP. The discussion for each begins with a review of the recommendations and supporting literature presented by MTP guidelines from 3 prominent societies, the American Society of Anesthesiologists, the American College of Surgeons, and the task force for Advanced Bleeding Care in Trauma...
August 29, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28852344/total-shoulder-arthroplasty-is-less-time-in-the-hospital-better
#11
Kyle R Duchman, Chris A Anthony, Robert W Westermann, Andrew J Pugely, Yubo Gao, Carolyn M Hettrich
BACKGROUND: The incidence of total shoulder arthroplasty (TSA) has increased significantly over the last decade. Short-stay protocols for other highvolume procedures have been shown to be safe and effective but have yet to be fully explored for TSA. Our purpose in comparing short-stay and inpatient TSA was to determine: (1) patient demographics and comorbidities, (2) 30-day morbidity, mortality, and readmissions using a matched analysis, and (3) independent predictors of 30-day complications...
2017: Iowa Orthopaedic Journal
https://www.readbyqxmd.com/read/28851694/dose-optimisation-of-intravenous-tranexamic-acid-for-elective-hip-and-knee-arthroplasty-the-effectiveness-of-a-single-pre-operative-dose
#12
R J M Morrison, B Tsang, W Fishley, I Harper, J C Joseph, M R Reed
OBJECTIVES: We have increased the dose of tranexamic acid (TXA) in our enhanced total joint recovery protocol at our institution from 15 mg/kg to 30 mg/kg (maximum 2.5 g) as a single, intravenous (IV) dose. We report the clinical effect of this dosage change. METHODS: We retrospectively compared two cohorts of consecutive patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) surgery in our unit between 2008 and 2013. One group received IV TXA 15 mg/kg, maximum 1...
August 2017: Bone & Joint Research
https://www.readbyqxmd.com/read/28846822/extended-pharmacologic-thromboprophylaxis-in-oncologic-liver-surgery-is-safe-and-effective
#13
Bradford J Kim, Ryan W Day, Catherine H Davis, Nisha Narula, Michael H Kroll, Ching-Wei D Tzeng, Thomas A Aloia
BACKGROUND: The incidence of venous thromboembolism remains high after liver surgery. OBJECTIVE: To evaluate the safety and efficacy of extended pharmacologic thromboprophylaxis in liver surgery for the prevention of venous thromboembolism (VTE). PATIENT/METHODS: From August 2013 to April 2015, 124 patients who underwent liver resection for malignancy were placed on an extended pharmacologic thromboprophylaxis protocol. Intraoperative VTE prophylaxis included Thrombo-Embolic Deterrent hose and sequential compression devices...
August 28, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28846577/rotational-thromboelastometry-significantly-optimizes-transfusion-practices-for-damage-control-resuscitation-in-combat-casualties
#14
Nicolas J Prat, Andrew D Meyer, Nichole K Ingalls, Julie Trichereau, Joseph J DuBose, Andrew P Cap
BACKGROUND: Up to 40% of combat casualties with a truncal injury die of massive hemorrhage before reaching a surgeon. This hemorrhage can be prevented with damage control resuscitation (DCR) methods, which are focused on replacing shed whole blood by empirically transfusing blood components in a 1:1:1:1 ratio of platelets:fresh frozen plasma:erythrocytes:cryoprecipitate (PLT:FFP:RBC:CRYO). Measurement of hemostatic function with rotational thromboelastometry (ROTEM) may allow optimization of the type and quantity of blood products transfused...
September 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28844765/extremely-low-transfusion-rates-contemporary-primary-total-hip-and-knee-arthroplasties
#15
Ida S Lindman, Lars V Carlsson
BACKGROUND: Considerable blood loss which requires transfusion is frequently reported after total hip and knee arthroplasties (THA and TKA). The purpose of this study is to review the transfusion rates in contemporary THA and TKA with optimized perioperative protocols including minimized surgical trauma and optimal perioperative patient care. METHODS: This retrospective study included 1442 consecutive patients receiving either a primary THA or a TKA from the same high-volume surgeon between January 2008 and December 2015...
July 29, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28841109/one-hundred-consecutive-endoscopic-repairs-of-sagittal-craniosynostosis-an-evolution-in-care
#16
Dennis C Nguyen, Scott J Farber, Gary B Skolnick, Sybill D Naidoo, Matthew D Smyth, Alex A Kane, Kamlesh B Patel, Albert S Woo
OBJECTIVE Endoscope-assisted repair of sagittal craniosynostosis was adopted at St. Louis Children's Hospital in 2006. This study examines the first 100 cases and reviews the outcomes and evolution of patient care protocols at our institution. METHODS The authors performed a retrospective chart review of the first 100 consecutive endoscopic repairs of sagittal craniosynostosis between 2006 and 2014. The data associated with length of hospital stay, blood loss, transfusion rates, operative times, cephalic indices (CIs), complications, and cranial remolding orthosis were reviewed...
August 25, 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/28840782/comparison-of-three-blood-transfusion-guidelines-applied-to-31-feline-donors-to-minimise-the-risk-of-transfusion-transmissible-infections
#17
Maria Luisa Marenzoni, Stefania Lauzi, Arianna Miglio, Mauro Coletti, Andrea Arbia, Saverio Paltrinieri, Maria Teresa Antognoni
Objectives The increased demand for animal blood transfusions creates the need for an adequate number of donors. At the same time, a high level of blood safety must be guaranteed and different guidelines (GLs) deal with this topic. The aim of this study was to evaluate the appropriateness of different GLs in preventing transfusion-transmissible infections (TTI) in Italian feline blood donors. Methods Blood samples were collected from 31 cats enrolled as blood donors by the owners' voluntary choice over a period of approximately 1 year...
August 1, 2017: Journal of Feline Medicine and Surgery
https://www.readbyqxmd.com/read/28838856/blood-transfusion-in-burn-patients-triggers-of-transfusion-in-a-referral-burn-center-in-iran
#18
S H Tavousi, A Ahmadabadi, A Sedaghat, M Khadem-Rezaiyan, Z Yaghoubi Moghaddam, M J Behrouzian, S Nemati, H Saghafi
OBJECTIVES: Blood and its derivatives are one of the most lifesaving products in the modern medicine practice. However, it is not an absolutely safe prescription. Many adverse effects such as infection, transfusion-related acute lung injury, immunosuppression, multi-organ dysfunction, acute respiratory syndrome, transfusion errors, transmission of infectious agents such as HIV, HBV, HCV are attributable to blood transfusion. The aim of this study was to describe how and when blood products were transfused in a referral burn center...
August 21, 2017: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
https://www.readbyqxmd.com/read/28837540/multi-institutional-analysis-of-neutrophil-to-lymphocyte-ratio-nlr-in-patients-with-severe-hemorrhage-a-new-mortality-predictor-value
#19
Juan Duchesne, Danielle Tatum, Glenn Jones, Brandy Davis, Rosemarie Robledo, Marc DeMoya, Terence O'Keeffe, Paula Ferrada, Tomas Jacome, Rebecca Schroll, Jordan Wlodarczyk, Priya Prikash, Brian Smith, Kenji Inaba, Desmond Khor, Marquinn Duke, Mansoor Khan
BACKGROUND: The neutrophil/lymphocyte ratio (NLR) has been associated as a predictor for increased mortality in critically ill patients. We sought to determine the relationship between NLR and outcomes in adult trauma patients with severe hemorrhage requiring the initiation of massive transfusion protocol (MTP). We hypothesized that the NLR would be a prognostic indicator of mortality in this population. METHODS: This was a multi-institutional retrospective cohort study of adult trauma patients (≥18 years) with severe hemorrhage who received MTP between November 2014 - November 2015...
August 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28836263/b-cells-require-type-1-interferon-to-produce-alloantibodies-to-transfused-kel-expressing-red-blood-cells-in-mice
#20
David R Gibb, Jingchun Liu, Manjula Santhanakrishnan, Prabitha Natarajan, David J Madrid, Seema Patel, Stephanie C Eisenbarth, Christopher A Tormey, Sean R Stowell, Akiko Iwasaki, Jeanne E Hendrickson
BACKGROUND: Alloantibodies to red blood cell (RBC) antigens can cause significant hemolytic events. Prior studies have demonstrated that inflammatory stimuli in animal models and inflammatory states in humans, including autoimmunity and viremia, promote alloimmunization. However, molecular mechanisms underlying these findings are poorly understood. Given that Type 1 interferons (IFN-α/β) regulate antiviral immunity and autoimmune pathology, the hypothesis that IFN-α/β regulates RBC alloimmunization was tested in a murine model...
August 23, 2017: Transfusion
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