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transfusion physiology

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https://www.readbyqxmd.com/read/28930957/clot-dynamics-and-mortality-the-ma-r-ratio
#1
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/28930917/shock-2017-military-supplement-an-overview-of-two-human-trials-of-perfluorocarbon-emulsions-in-non-cardiac-surgery
#2
Donat R Spahn, Peter E Keipert
Perfluorochemicals (PFCs) constitute one class of artificial oxygen carriers that are being produced completely synthetically. One formulation that has been evaluated extensively in clinical trials is a 60% w/v perflubron-based emulsion. Efficacy and safety of this perflubron emulsion was evaluated in a Phase 2 and a large prospective randomized Phase 3 multicenter European study, which collectively included a total of 639 patients. Perflubron emulsion was highly successful in improving organ function, reversing physiologic transfusion triggers and in reducing the need for allogeneic blood transfusions...
September 19, 2017: Shock
https://www.readbyqxmd.com/read/28914713/the-hyperfibrinolytic-phenotype-is-the-most-lethal-and-resource-intense-presentation-of-fibrinolysis-in-massive-transfusion-patients
#3
John R Taylor, Erin E Fox, John B Holcomb, Sandro Rizoli, Kenji Inaba, Martin A Schreiber, Karen Brasel, Thomas M Scalea, Charles E Wade, Eileen Bulger, Bryan A Cotton
BACKGROUND: Among bleeding patients, we hypothesized that the hyperfibrinolytic (HF) phenotype would be associated with the highest mortality, while shutdown (SD) patients would have the greatest complication burden. METHODS: Severely injured patients predicted to receive a massive transfusion at 12 level-1 trauma centers were randomized to one of two transfusion ratios as described in the PROPPR trial. Fibrinolysis phenotypes were determined based on admission clot lysis at 30 minutes (LY30): SD ≤0...
September 13, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28904480/association-of-massive-transfusion-for-resuscitation-in-gastrointestinal-bleeding-with-transfusion-related-acute-lung-injury
#4
James J Case, Nasreen Khan, Michael Delrahim, Jasmina Dizdarevic, Dane J Nichols, Martin A Schreiber, Thomas G Deloughery, Akram Khan
BACKGROUND AND AIMS: This study aimed to understand the use of massive transfusion (MT) for gastrointestinal bleeding (GIB). PATIENTS AND METHODS: We performed a retrospective analysis of patients admitted to our medical Intensive Care Unit (ICU) with GIB for the type of bleeding, quantity of blood products transfused, and risk of transfusion-related acute lung injury (TRALI) and death. MT was defined as transfusion of 10 or more units of red blood cell (RBC) within a 24-h period in a 1-unit RBC: 1-unit fresh frozen plasma: and 1-unit platelet ratio...
August 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28885956/combat-casualties-and-severe-shock-risk-factors-for-death-at-role-3-military-facilities
#5
Michelle F Buehner, Brian J Eastridge, James K Aden, Joseph J DuBose, Lorne H Blackbourne, Ramon F Cestero
BACKGROUND: Although significant research has been conducted on combat casualties receiving blood products, there is limited data for the subpopulation presenting in shock. The purpose of this study was to evaluate combat casualties arriving to a role 3 facility with an initial systolic blood pressure (SBP) ≤ 90 in order to identify clinical characteristics and associations between presentation, transfusion therapy, and mortality outcomes. METHODS: The Department of Defense Trauma Registry was queried from 2001 to 2010 for trauma-related casualties who arrived at a role 3 combat surgical facility with a SBP ≤ 90...
September 2017: Military Medicine
https://www.readbyqxmd.com/read/28877877/acute-blood-loss-stimulates-fibroblast-growth-factor-23-production
#6
Seham Rabadi, Ikemesit Udo, David Evan Leaf, Sushrut Waikar, Marta Christov
Fibroblast growth factor 23 (FGF23) production is upregulated by iron deficiency and hypoxia. However, the influence of acute blood loss, and the resulting increases in circulating erythropoietin, on FGF23 production is unknown. Using wild-type C57BL/6 mice, we show that acute loss of 10% total blood volume leads to an increase in plasma C-terminal FGF23 (cFGF23) levels within six hours, while plasma levels of intact FGF23, phosphate, calcium, parathyroid hormone, iron, and ferritin remain similar to control mice without acute blood loss...
September 6, 2017: American Journal of Physiology. Renal Physiology
https://www.readbyqxmd.com/read/28863020/validating-the-physiologic-model-hummod-as-a-substitute-for-clinical-trials-involving-acute-normovolemic-hemodilution
#7
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/28859918/vital-sign-based-shock-scores-are-poor-at-triaging-south-african-trauma-patients
#8
Robert Barnes, Damian Clarke, Zane Farina, Benn Sartorius, Petra Brysiewicz, Grant Laing, John Bruce, Victor Kong
BACKGROUND: Traumatic shock cannot be diagnosed by a single physiological measurement and a number of vital sign based combined shock scores (CSS) have been proposed to identify and triage trauma patients with shock. This audit uses data from a prospectively entered electronic trauma registry to compare the ability of these CSS to predict in-hospital mortality, need for surgery, need for blood transfusion and ICU admission. MATERIALS AND METHODS: The data used in the study was obtained from the Hybrid Electronic Medical Record (HEMR) in Pietermaritzburg from January 2012-September 2015...
August 28, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28835867/total-blood-loss-after-transfemoral-amputations-is-twice-the-intraoperative-loss-an-observational-cohort-study-of-81-nontraumatic-amputations
#9
Christian Wied, Peter T Tengberg, Morten T Kristensen, Gitte Holm, Thomas Kallemose, Anders Troelsen, Nicolai B Foss
INTRODUCTION: Underestimation of the actual blood loss in patients undergoing nontraumatic transfemoral amputation (TFA) can impact negatively on outcome in these often frail patients, with very limited physiological reserves. The primary aim of this study is to estimate the total blood loss (TBL) after TFA, and second, to evaluate the impact of blood loss on 30-day mortality and medical complications. METHODS: A single-center retrospective cohort study conducted from 2013 to 2015...
September 2017: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/28826760/evidence-based-red-blood-cell-transfusion-practices-in-cardiac-surgery
#10
REVIEW
Nishith N Patel, Gavin J Murphy
Cardiac surgical patients are among the highest consumers of allogeneic red blood cells (RBCs) due to the prevalence of anemia and bleeding. Up until recently, there was a paucity of high-quality evidence informing transfusion decisions in this patient group which led to wide variability in transfusion decision making. The article reviews and critically analyzes the available evidence for RBC transfusion in cardiac surgery, focusing on trials of transfusion triggers and age of blood, and provides suggestions for future research...
June 21, 2017: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/28821525/point-of-care-washing-of-allogeneic-red-blood-cells-for-the-prevention-of-transfusion-related-respiratory-complications-war-prc-a-protocol-for-a-multicenter-randomised-clinical-trial-in-patients-undergoing-cardiac-surgery
#11
Matthew A Warner, Ian J Welsby, Phillip J Norris, Christopher C Silliman, Sarah Armour, Erica D Wittwer, Paula J Santrach, Laurie A Meade, Lavonne M Liedl, Chelsea M Nieuwenkamp, Brian Douthit, Camille M van Buskirk, Phillip J Schulte, Rickey E Carter, Daryl J Kor
INTRODUCTION: The transfusion-related respiratory complications, transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), are leading causes of transfusion-related morbidity and mortality. At present, there are no effective preventive strategies with red blood cell (RBC) transfusion. Although mechanisms remain incompletely defined, soluble biological response modifiers (BRMs) within the RBC storage solution may play an important role. Point-of-care (POC) washing of allogeneic RBCs may remove these BRMs, thereby mitigating their impact on post-transfusion respiratory complications...
August 18, 2017: BMJ Open
https://www.readbyqxmd.com/read/28818213/the-natural-history-and-outcomes-of-line-associated-upper-extremity-deep-venous-thromboses-in-critically-ill-patients
#12
Joshua Underhill, Matthew A Sherman, Ryan Howard, Anthony Hage, Andrea Obi, Lena Napolitano, Dawn M Coleman
OBJECTIVE: Anticoagulation remains the standard of care for line-associated upper extremity deep venous thrombosis (UEDVT). This treatment carries the risk of hemorrhagic complications, possibly more so in surgical patients. Considering the low-risk profile of UEDVT-which is associated with fewer, less severe pulmonary emboli than lower extremity deep venous thrombosis-current UEDVT treatment guidelines may be overly aggressive. The goal of this study was to review outcomes of line-associated UEDVT in critically ill patients and to define the efficacy of current treatment protocols in pulmonary embolism (PE) prevention while avoiding hemorrhagic complications...
September 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28815186/children-are-not-little-adults-blood-transfusion-in-children-with-burn-injury
#13
REVIEW
Tina L Palmieri
Blood transfusion in burns larger than 20% total body surface area (TBSA) are frequent due to operative procedures, blood sampling, and physiologic response to burn injury. Optimizing the use of blood transfusions requires an understanding of the physiology of burn injury, the risks and benefits of blood transfusion, and the indications for transfusion. Age also plays a role in determining blood transfusion requirements. Children in particular have a different physiology than adults, which needs to be considered prior to transfusing blood and blood products...
2017: Burns and trauma
https://www.readbyqxmd.com/read/28815112/predicting-intervention-onset-in-the-icu-with-switching-state-space-models
#14
Marzyeh Ghassemi, Mike Wu, Michael C Hughes, Peter Szolovits, Finale Doshi-Velez
The impact of many intensive care unit interventions has not been fully quantified, especially in heterogeneous patient populations. We train unsupervised switching state autoregressive models on vital signs from the public MIMIC-III database to capture patient movement between physiological states. We compare our learned states to static demographics and raw vital signs in the prediction of five ICU treatments: ventilation, vasopressor administra tion, and three transfusions. We show that our learned states, when combined with demographics and raw vital signs, improve prediction for most interventions even 4 or 8 hours ahead of onset...
2017: AMIA Summits on Translational Science Proceedings
https://www.readbyqxmd.com/read/28814247/fluid-and-medication-considerations-in-the-traumatized-patient
#15
Amita Misir
This article reviews fluid therapy and medications in pediatric trauma. For resuscitation in the setting of hemorrhagic shock, isotonic crystalloid solution is the first-line agent of choice. Colloid solutions offer no additional benefit, introduce possible increased risks and cost more than crystalloids. Blood products, starting with pRBCs, should be introduced after 20-40 ml/kg of crystalloid has been administered if there is ongoing need for volume replacement. The use of a massive transfusion protocol of 1:1:1 (if >30 kg) or 30:20:20 (if <30 kg) of pRBCs:FFP:platelets is suggested after an initial 30 ml/kg of pRBcs have been administered...
August 14, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/28806274/transfusion-related-immunomodulation-a-reappraisal
#16
Lyla A Youssef, Steven L Spitalnik
PURPOSE OF REVIEW: This review summarizes current and prior observations regarding transfusion-related immunomodulation (TRIM) and puts these ideas into a modern immunological context, incorporating concepts from innate, adaptive, and nutritional immunity. We propose that TRIM research focus on determining whether there are specific, well-defined immunosuppressive effects from transfusing 'pure' red blood cells (RBCs) themselves, along with the by-products produced by the stored RBCs as a result of the 'storage lesion...
August 12, 2017: Current Opinion in Hematology
https://www.readbyqxmd.com/read/28800876/the-effects-of-red-blood-cell-transfusion-on-tissue-oxygenation-and-the-microcirculation-in-the-intensive-care-unit-a-systematic-review
#17
REVIEW
Nathan D Nielsen, Ignacio Martin-Loeches, Catherine Wentowski
The transfusion of red blood cells (RBCs) is a common intervention in intensive care unit (ICU) patients, yet the benefits are far from clear in patients with moderate anemia (eg, hemoglobin (Hb) levels of 7-10 g/dL). Determining which of these patients benefit, and how to even define benefit, from transfusion is challenging. As the intended physiological benefit underpinning RBC transfusion is to improve tissue oxygenation, several studies utilizing a wide range of assessment techniques have attempted to study the effects of transfusion on tissue oxygenation and microcirculatory function...
July 21, 2017: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/28771656/transfusion-practice-in-trauma-resuscitation
#18
REVIEW
Ashley M Eckel, John R Hess
Recognition of the acute coagulopathy of trauma and the limits of reconstituting whole blood with conventional blood components has led to a radical change in the way trauma patients with severe injuries are resuscitated. Massive transfusion protocols (MTP) have evolved toward the administration of conventional blood components in fixed ratios. Administration of a 1:1:1 unit ratio of fresh frozen plasma to whole-blood-derived platelets to packed red blood cells is now the most common strategy and the stated goal of directors of >80% of the level I trauma centers in the United States...
August 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28767544/compensatory-reserve-index-performance-of-a-novel-monitoring-technology-to-identify-the-bleeding-trauma-patient
#19
Michael Johnson, Abdul Alarhayem, Victor Convertino, Robert Carter, Kevin Chung, Ronald Stewart, John Myers, Daniel Dent, Lilian Liao, Ramon Cestero, Susannah Nicholson, Mark Muir, Martin Schwacha, David Wampler, Mark DeRosa, Brian Eastridge
INTRODUCTION: Hemorrhage is one of the most substantial causes of death after traumatic injury. Standard measures, including systolic blood pressure (SBP), are poor surrogate indicators of physiologic compromise until compensatory mechanisms have been overwhelmed. Compensatory Reserve Index (CRI) is a novel monitoring technology with the ability to assess physiologic reserve. We hypothesized CRI would be a better predictor of physiologic compromise secondary to hemorrhage than traditional vital signs...
August 1, 2017: Shock
https://www.readbyqxmd.com/read/28757117/-caracterization-of-hla-allo-immunization-and-clinical-impact-in-transfusion-and-organ-transplantation
#20
F Delbos, A Cesbron
Allo-immunizations against HLA antigens are known to be deleterious in transfusion and organ transplantation. The development of new tests based on solid phase assays for screening and identification of HLA antibodies in particular those using Luminex(®) bead based technology has completely changed the way of allo-immunization monitoring because of their extreme sensitivity. They allow a better characterization of these antibodies, identification of acceptable antigens and the use of virtual cross-matches...
July 27, 2017: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
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