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massive blood transfusion

P Michel, D Wähnert, M Freistühler, M G Laukoetter, S Rehberg, M J Raschke, P Garcia
BACKGROUND: Secondary abdominal compartment syndrome is well known as a life-threatening complication in critically ill patients in an intensive care unit. Massive crystalloid fluid resuscitation has been identified as the most important risk factor. The time interval from hospital admittance to the development of manifest abdominal compartment syndrome is usually greater than 24 hours. In the absence of any direct abdominal trauma, we observed a rapidly evolving secondary abdominal compartment syndrome shortly after hospital admittance associated with massive transfusion of blood products and only moderate crystalloid resuscitation...
October 19, 2016: Journal of Medical Case Reports
Takaki Emura, Kenji Hosoda, Shota Harai, Noboru Oyachi, Takeyuki Suzuki, Ken Takada, Koji Kobayashi, Hisatake Ikeda
BACKGROUND: Massive gastrointestinal bleeding in children, mostly caused by esophageal varices secondary to chronic liver disease, is uncommon. Dieulafoy lesion in the gastrointestinal tract is a rare but important cause of gastrointestinal bleeding; massive bleeding from this lesion can be fatal unless adequate treatment is promptly initiated. We report a case of gastric Dieulafoy lesion in a 2-year old successfully treated with endoscopic hemoclipping. CASE PRESENTATION: A 2-year-old Japanese boy was admitted to our department with sudden massive hematemesis...
October 19, 2016: Journal of Medical Case Reports
Nicholas M Studer, Ahmad H Yassin, Donald E Keen
INTRODUCTION: The current Tactical Combat Casualty Care Guidelines recommend tranexamic acid (TXA) administration for casualties in whom massive blood transfusion is anticipated. However, despite Hextend being the recommended resuscitation fluid, the guidelines recommend against using TXA with Hextend. This appears to be due to a concern about pharmaceutical compatibility, despite the absence of a direct study of compatibility in the literature. METHODS: Two solutions of Hextend and TXA were examined for compatibility...
October 2016: Military Medicine
Angela B Treml, Jed B Gorlin, Richard P Dutton, Barbara M Scavone
BACKGROUND: Massive transfusion protocols (MTPs) have been adopted in many hospitals, and they may improve outcomes, as well as decrease the number of blood products transfused. However, there are no specific guidelines regarding the number and types of products that should be included in these protocols. MTPs may vary from hospital to hospital. METHODS: A short, web-based survey was sent to blood bank medical directors at academic institutions to learn details about MTPs...
October 3, 2016: Anesthesia and Analgesia
J C Oldroyd, K M Venardos, N J Aoki, A J Zatta, Z K McQuilten, L E Phillips, N Andrianopoulos, D J Cooper, P A Cameron, J P Isbister, E M Wood
BACKGROUND: The Australian and New Zealand (ANZ) Massive Transfusion (MT) Registry (MTR) has been established to improve the quality of care of patients with critical bleeding (CB) requiring MT (≥ 5 units red blood cells (RBC) over 4 h). The MTR is providing data to: (1) improve the evidence base for transfusion practice by systematically collecting data on transfusion practice and clinical outcomes; (2) monitor variations in practice and provide an opportunity for benchmarking, and feedback on practice/blood product use; (3) inform blood supply planning, inventory management and development of future clinical trials; and (4) measure and enhance translation of evidence into policy and patient blood management guidelines...
October 6, 2016: BMC Research Notes
Precilla V Veigas, Jeannie Callum, Sandro Rizoli, Bartolomeu Nascimento, Luis Teodoro da Luz
INTRODUCTION: Viscoelastic assays have been promoted as an improvement over traditional coagulation tests in the management of trauma patients. Rotational thromboelastometry (ROTEM®) has been used to diagnose coagulopathy and guide hemostatic therapy in trauma. This systematic review of clinical studies in trauma investigates the ROTEM® parameters thresholds used for the diagnosing coagulopathy, predicting and guiding transfusion and predicting mortality. METHODS: Systematic literature search was performed using MEDLINE, EMBASE and Cochrane databases...
October 3, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Melvin E Stone, Stanley Kalata, Anna Liveris, Zachary Adorno, Shira Yellin, Edward Chao, Srinivas H Reddy, Michael Jones, Carlos Vargas, Sheldon Teperman
BACKGROUND: Critical administration threshold (≥3 units of packed red blood cells/h or CAT+) has been proposed as a new definition for massive transfusion (MT) that includes volume and rate of blood transfusion. CAT+ has been shown to eliminate survivor bias and be a better predictor of mortality than the traditional MT (>10 units/24h). End-tidal CO2 (ET CO2) negatively correlates with lactate and is an early predictor of shock in trauma patients. We conducted a pilot study to test the hypothesis that low ET CO2 on admission predicts CAT+...
July 5, 2016: Injury
Thomas G Poder, Denise Pruneau, Josée Dorval, Louis Thibault, Jean-François Fisette, Suzanne K Bédard, Annie Jacques, Patrice Beauregard
BACKGROUND: Blood warmers were developed to reduce the risk of hypothermia associated with the infusion of cold blood products. During massive transfusion, these devices are used with compression sleeve, which induce a major stress to red blood cells. In this setting, the combination of blood warmer and compression sleeve could generate hemolysis and harm the patient. We conducted this study to compare the impact of different pressure rates on the hemolysis of packed red blood cells and on the outlet temperature when a blood warmer set at 41...
2016: PloS One
Andra H James, Chad Grotegut, Homa Ahmadzia, Cathleen Peterson-Layne, Evelyn Lockhart
The purpose of this article is to review the use of blood products and hemostatic agents in the management of coagulopathy at the time of postpartum hemorrhage. Blood product administration strategies are broadly reviewed, including the role of the blood bank, the role of massive transfusion protocols, the role of laboratory monitoring, and the role of anesthesia management. Aspects of patient blood management are discussed. The concept refers to an evidence-based, comprehensive, multidisciplinary approach to optimizing the care of patients who might need transfusion and includes measures to avoid or minimize transfusion such as preoperative anemia management, cell salvage, and the use of hemostatic medication to reduce bleeding...
October 3, 2016: Seminars in Thrombosis and Hemostasis
S Morris, M H Yudin, J Callum, A Alam, J Herold, Y Lin
OBJECTIVES: To evaluate the current state of transfusion medicine (TM) knowledge among obstetricians using a valid assessment tool. BACKGROUND: Transfusion issues are common in obstetrical patients. METHODS: Knowledge topics were identified and rated by experts in obstetrics, anaesthesia, haematology and TM using a modified Delphi method. A knowledge assessment tool was developed and validated during pilot testing. The assessment tool, consisting of 15 multiple choice questions, was administered electronically to members of the Society of Obstetricians and Gynaecologists of Canada (SOGC)...
September 26, 2016: Transfusion Medicine
Maimoona Ahmed, Sunil T Pandya, Tarakeswari Supraneni
PURPOSE: To determine the risk factors and associated comorbidities with a relaparotomy after primary surgery in pregnant mothers and to identify preventable causes. METHODS: A retrospective observational study was done at a tertiary care centre from January 2009 till August 2014. All records of exploratory laparotomy following primary surgery in the obstetric population during this period were retrieved from the hospital database and analysed. RESULTS: The incidence of relaparotomy was 0...
October 2016: Journal of Obstetrics and Gynaecology of India
Rakesh Hasabe, Kumud Gupta, Pallavi Rathode
INTRODUCTION: Conventionally postpartum hemorrhage (PPH) has been defined as blood loss of more than 500 ml following vaginal delivery and 1000 ml following a cesarean section [Pritchard et al. in Am J Obstet Gynecol 84(10):1271-1282, (1962)]. Another definition labels PPH as any blood loss which causes a 10 % drop in hematocrit [Combs et al. in Obstet Gynecol 77:69-76, (1991)] or which threatens the hemodynamic stability of the patient and necessitates blood transfusion [Prendiville et al...
October 2016: Journal of Obstetrics and Gynaecology of India
Julien Pottecher, François-Xavier Ageron, Clémence Fauché, Denis Chemla, Eric Noll, Jacques Duranteau, Laurent Chapiteau, Jean-François Payen, Pierre Bouzat
BACKGROUND: Early and accurate detection of severe hemorrhage is critical for a timely trigger of massive transfusion (MT). Hemodynamic indices combining heart rate (HR) and either systolic (shock index [SI]) or pulse pressure (PP) (PP/HR ratio) have been shown to track blood loss during hemorrhage. The present study assessed the accuracy of prehospital SI and PP/HR ratio to predict subsequent MT, using the gray-zone approach. METHODS: This was a retrospective analysis (January 1, 2009, to December 31, 2011) of a prospectively developed trauma registry (TRENAU), in which the triage scheme combines patient severity and hospital facilities...
October 2016: Journal of Trauma and Acute Care Surgery
James Winearls, Michael Reade, Helen Miles, Andrew Bulmer, Don Campbell, Klaus Görlinger, John F Fraser
Hemorrhage in the setting of severe trauma is a leading cause of death worldwide. The pathophysiology of hemorrhage and coagulopathy in severe trauma is complex and remains poorly understood. Most clinicians currently treating trauma patients acknowledge the presence of a coagulopathy unique to trauma patients-trauma-induced coagulopathy (TIC)-independently associated with increased mortality. The complexity and incomplete understanding of TIC has resulted in significant controversy regarding optimum management...
October 2016: Anesthesia and Analgesia
John S Oh, Creighton C Tubb, Thomas P Poepping, Paul Ryan, Jonathan C Clasper, Adrian R Katschke, Caroline Tuman, Michael J Murray
BACKGROUND: The purposes of this study are to define the pattern of injuries sustained by dismounted troops exposed to improvised explosive devices blasts treated at a Role 3 combat support hospital and to assess injury patterns and mortality associated with the mechanism. Our hypothesis was that mortality is associated with pelvic fracture, massive transfusion, high Injury Severity Score (ISS), multiple limb amputations, and transfer from a Role 2 facility. STUDY DESIGN: Retrospective study of 457 patients...
September 2016: Military Medicine
Samy Figueiredo, Audrey Tantot, Jacques Duranteau
Viscoelastic haemostatic assays (VHAs), mainly thromboelastography (TEG) and the rotational thromboelastometry (ROTEM), provide global information on clot formation and dissolution at patient bedside, allowing fast identification of coagulation disorders. In trauma patients, VHAs are able to predict massive transfusion and mortality. These devices might also be used for applying targeted administration of procoagulant factors (e.g. fibrinogen concentrate) as an alternative to or in addition to using predefined fixed ratios of red blood cells: platelets: fresh frozen plasma/cryoprecipitate...
September 8, 2016: Minerva Anestesiologica
C Montan, U Hammar, A Wikman, E Berlin, J Malmstedt, J Holst, C M Wahlgren
OBJECTIVES: The aim was to study blood transfusions and blood product ratios in massively transfused patients treated for ruptured abdominal aortic aneurysms (rAAAs). METHODS: This was a registry based cohort study of rAAA patients repaired at three major vascular centres between 2008 and 2013. Data were collected from the Swedish Vascular Registry, hospitals medical records, and local transfusion registries. The transfusion data were analysed for the first 24 h of treatment...
September 4, 2016: European Journal of Vascular and Endovascular Surgery
Christopher P Michetti, Heather A Prentice, Elena Lita, Jeffrey Wright, Edmond Ng, Anna B Newcomb
BACKGROUND: We sought to examine the effect on blood usage of a new electronic order set restricting transfusion orders to specific evidence-based criteria for each unit (U) of red blood cells (RBC), plasma, and platelets. METHODS: Prospectively collected transfusion data for Trauma ICU patients were compared for the 12 months before (PRE) and 8 months after (POST) order set implementation. Criteria for RBC transfusion were 1 U only for hemoglobin <7 g/dL in stable patients or <8 g/dL with angina, myocardial infarction, or cardiogenic shock; 2 U for hemoglobin <5 g/dL; and multiple U in the presence of shock, hypotension, or bleeding...
November 2016: Journal of Trauma and Acute Care Surgery
Yuki Kojima, Takashi Ishigami, Masakazu Akiba
We report a case of chronic myelomonocytic leukaemia (CMMoL) in a 68-year-old man who developed osteomyelitis of the mandible. At the initial visit, he reported uncontrolled gingival bleeding, despite self-administered haemostasis. He complained of severe pain in the socket, despite potent opioid analgesia. After consultation with the internal medicine specialists, we undertook a surgical anti-inflammatory approach that included sequestrectomy with massive blood transfusion. His physical condition was ameliorated after the surgical procedure, and he was discharged from the hospital...
2016: Journal of Surgical Case Reports
Ruth S Hwu, Philip C Spinella, Martin S Keller, David Baker, Michael Wallendorf, Julie C Leonard
BACKGROUND: Massive transfusion protocols (MTPs) to address hemorrhage are understudied in children. The objective was to determine the effect of MTP implementation on outcomes of injured children. STUDY DESIGN AND METHODS: This was a retrospective comparison of injured children before and after MTP implementation for children less than 18 years old who presented in 2005 to 2014 and received red blood cells (RBCs) within 24 hours of arrival. Children were divided into groups based on pre-/post-MTP implementation and subgrouped based on receipt of massive transfusion (≥40 mL/kg RBCs or ≥80 mL/kg total blood products at 24 hr from arrival)...
August 29, 2016: Transfusion
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