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transfusion practice variability

Kevin Trentino, Shannon Farmer, Irwin Gross, Aryeh Shander, James Isbister
BACKGROUND: As defined by evidence-based medicine randomized controlled trials rank higher than observational studies in the hierarchy of clinical research. Accordingly, when assessing the effects of treatments on patient outcomes, there is a tendency to focus on the study method rather than also appraising the key elements of study design. A long-standing debate regarding findings of randomized controlled trials compared with those of observational studies, their strengths and limitations and questions regarding causal inference, has recently come into focus in relation to research assessing patient outcomes in transfusion medicine...
October 14, 2016: BMC Anesthesiology
Donald S Likosky, Timothy A Dickinson, Theron A Paugh
Cardiac surgery accounts for between 15% and 20% of all blood product utilization in the United States. A body of literature suggests that patients who are exposed to even small quantities of blood have an increased risk of morbidity and mortality, even after adjusting for pre-operative risk. Despite this body of literature supporting a restrictive blood management strategy, wide variability in transfusion rates exist across institutions. Recent blood management guidelines have shed light on a number of potentially promising blood management strategies, including acute normovolemic hemodilution (ANH) and retrograde autologous priming (RAP)...
September 2016: Journal of Extra-corporeal Technology
Giovanni Landoni, Antonio Pisano, Vladimir Lomivorotov, Gabriele Alvaro, Ludhmila Hajjar, Gianluca Paternoster, Caetano Nigro Neto, Nicola Latronico, Evgeny Fominskiy, Laura Pasin, Gabriele Finco, Rosetta Lobreglio, Maria Luisa Azzolini, Giuseppe Buscaglia, Alberto Castella, Marco Comis, Adele Conte, Massimiliano Conte, Francesco Corradi, Erika Dal Checco, Giovanni De Vuono, Marco Ganzaroli, Eugenio Garofalo, Gordana Gazivoda, Rosalba Lembo, Daniele Marianello, Martina Baiardo Redaelli, Fabrizio Monaco, Valentina Tarzia, Marta Mucchetti, Alessandro Belletti, Paolo Mura, Mario Musu, Giovanni Pala, Massimiliano Paltenghi, Vadim Pasyuga, Desiderio Piras, Claudio Riefolo, Agostino Roasio, Laura Ruggeri, Francesco Santini, Andrea Székely, Luigi Verniero, Antonella Vezzani, Alberto Zangrillo, Rinaldo Bellomo
OBJECTIVE: Of the 230 million patients undergoing major surgical procedures every year, more than 1 million will die within 30 days. Thus, any nonsurgical interventions that help reduce perioperative mortality might save thousands of lives. The authors have updated a previous consensus process to identify all the nonsurgical interventions, supported by randomized evidence, that may help reduce perioperative mortality. DESIGN AND SETTING: A web-based international consensus conference...
August 2, 2016: Journal of Cardiothoracic and Vascular Anesthesia
J Trent Magruder, Elena Blasco-Colmenares, Todd Crawford, Diane Alejo, John V Conte, Rawn Salenger, Clifford E Fonner, Christopher C Kwon, Jennifer Bobbitt, James M Brown, Mark G Nelson, Keith A Horvath, Glenn R Whitman
BACKGROUND: Variation in red blood cell (RBC) transfusion practices exists at cardiac surgery centers across the nation. We tested the hypothesis that significant variation in RBC transfusion practices between centers in our state's cardiac surgery quality collaborative remains even after risk adjustment. METHODS: Using a multiinstitutional statewide database created by the Maryland Cardiac Surgery Quality Initiative (MCSQI), we included patient-level data from 8,141 patients undergoing isolated coronary artery bypass (CAB) or aortic valve replacement at 1 of 10 centers...
August 20, 2016: Annals of Thoracic Surgery
Paolo Emilio Puddu, Loredana Iannetta, Attilio Placanica, Domenico Cuturello, Michele Schiariti, Olivia Manfrini
The role played by glycoprotein (GP) IIb/IIIa inhibitors (GPI) has continuously evolved until the most recent Guidelines whereby they were stepped down from class I to class II recommendation for treating acute coronary syndromes (ACS). GPI compete with a wider use of ADP inhibitors and novel anticoagulant drugs although GPI use has greatly narrowed. However, GPI may still have a role. Several criteria were proposed to define post-PCI anemia which is strictly related to bleeding and transfusion. In ACS, it should be important to define anemia in comparative terms versus baseline levels: ≥ 15% of red blood cell decrease should be a practical cut-off value...
November 1, 2016: International Journal of Cardiology
Eric Etchill, Jason Sperry, Brian Zuckerbraun, Louis Alarcon, Joshua Brown, Kevin Schuster, Lewis Kaplan, Greta Piper, Andrew Peitzman, Matthew D Neal
BACKGROUND: Massive transfusion practices have undergone several recent developments. We sought to examine institutional practices guiding hemostatic resuscitation in the setting of massive hemorrhage. STUDY DESIGN AND METHODS: A 37-question online survey was sent to American Association for the Surgery of Trauma members. RESULTS: A total of 191 surgeons from 125 institutions completed the survey. Level I and II centers composed 70 and 18% of responding sites, respectively...
October 2016: Transfusion
M T Bruun, K Pendry, J Georgsen, P Manzini, M Lorenzi, A Wikman, D Borg-Aquilina, E van Pampus, M van Kraaij, D Fischer, P Meybohm, K Zacharowski, C Geisen, E Seifried, G M Liumbruno, G Folléa, J Grant-Casey, P Babra, M F Murphy
BACKGROUND AND OBJECTIVES: Patient Blood Management (PBM) in Europe is a working group of the European Blood Alliance with the initial objective to identify the starting position of the participating hospitals regarding PBM for benchmarking purposes, and to derive good practices in PBM from the experience and expertise in the participating teams with the further aim of implementing and strengthening these practices in the participating hospitals. METHODS: We conducted two surveys in seven university hospitals in Europe: Survey on top indications for red blood cell use regarding usage of red blood cells during 1 week and Survey on PBM organization and activities...
August 10, 2016: Vox Sanguinis
Anshu Gupta, Shabnam Mirza, Sarbjeet Khurana, Roopali Singh, Sujata Chaturvedi, Bharat Singh
INTRODUCTION: The Rh blood group system is one of the most polymorphic and immunogenic blood group systems in humans. The expression of Rh blood group antigen is complex, among that Rh-D antigen is the most important antigen because of its immunogenicity. It is easy to detect D antigen in most of the cases. Sometimes, variable expression of Rh-D antigen leads to presence of weak forms. Weak D reacts variably with anti D sera and poses a problem in blood banking. Molecular genetics of Rh-D revealed that weak D antigen is a Rh-D phenotype that possesses less numbers of complete D antigens on the surface of red blood cells...
June 2016: Journal of Clinical and Diagnostic Research: JCDR
Ravi R Thiagarajan
OBJECTIVES: The objectives of this review are to discuss the use of extracorporeal membrane oxygenation following surgery for congenital heart disease, myocarditis and as a bridge to cardiac transplantation. In addition, the latest in circuit equipment, the management of anticoagulation and blood transfusions, and short- and long-term outcomes are reviewed. DATA SOURCE: MEDLINE, PubMed. CONCLUSIONS: The use of extracorporeal membrane oxygenation to support children with heart disease is increasing...
August 2016: Pediatric Critical Care Medicine
Grace Christou, Ahbinav Iyengar, Risa Shorr, Alan Tinmouth, Elianna Saidenberg, Dawn Maze, Jason Tay, Christopher Bredeson, David S Allan
BACKGROUND: Integrating evidence from randomized controlled trials (RCTs) into patient care is needed to optimize patient outcomes. Transfusion support during allogeneic hematopoietic cell transplantation (alloHCT) is a cornerstone of essential supportive care, yet optimal transfusion practices remain unclear. STUDY DESIGN AND METHODS: A scoping review of RCTs in alloHCT was conducted and 14 full-length articles on transfusion practice were identified that reported clinical outcomes after alloHCT...
October 2016: Transfusion
Rachel M Thompson, Cary W Thurm, David H Rothstein
OBJECTIVE: To evaluate perioperative red blood cell (RBC) ordering and interhospital variability patterns in pediatric patients undergoing surgical interventions at US children's hospitals. STUDY DESIGN: This is a multicenter cross-sectional study of children aged <19 years admitted to 38 pediatric tertiary care hospitals participating in the Pediatric Health Information System in 2009-2014. Only cases performed at all represented hospitals were included in the study, to limit case mix variability...
October 2016: Journal of Pediatrics
C Dollat, C Pierron, A Keslick, E Billoir, A François, P-H Jarreau
In France since 2002, the single-donor transfusion protocol, using four pediatric units from the same adult donor's packed red blood cells (PRBCs) in multiply transfused newborns, is recommended in preterm neonates to reduce the risks of infection and alloimmunization. This protocol is controversial, however, because it causes the transfusion of stored blood, which could have adverse consequences. Before the new recommendations of the French Haute Autorité de santé (National authority for health) in 2015, we conducted a national practice survey in 63 neonatal intensive care units (NICU) and a retrospective study of the characteristics of 103 children transfused within our unit, to better target beneficiaries...
September 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Jean-Sébastien Tremblay-Roy, Nancy Poirier, Thierry Ducruet, Jacques Lacroix, Karen Harrington
The optimal red blood cell transfusion threshold for postoperative pediatric cardiac surgery patients is unknown. This study describes the stated red blood cell transfusion practice of physicians who treat postoperative pediatric cardiac surgery patients in intensive care units. A scenario-based survey was sent to physicians involved in postoperative intensive care of pediatric cardiac surgery patients in all Canadian centers that perform such surgery. Respondents reported their red blood cell transfusion practice in four postoperative scenarios: acyanotic or cyanotic cardiac lesion, in a neonate or an infant...
October 2016: Pediatric Cardiology
Ziad Solh, Anthony K C Chan, Nancy M Heddle
BACKGROUND: Although not supported by strong evidence, premedication (pretransfusion medication) is commonly prescribed to patients who have had a transfusion reaction. The research questions were: 1) What are Canadian pediatric practitioners' views and practices regarding premedication and 2) what are barriers to reducing premedication overuse in pediatrics? STUDY DESIGN AND METHODS: An online survey targeted hematology/oncology, emergency medicine, general surgery, intensive care, and cardiac intensive care practitioners in all 16 Canadian pediatric tertiary hospitals...
September 2016: Transfusion
Garnet Suck, Yeh Ching Linn, Torsten Tonn
Clinical application of natural killer (NK) cells against leukemia is an area of intense investigation. In human leukocyte antigen-mismatched allogeneic hematopoietic stem cell transplantations (HSCT), alloreactive NK cells exert powerful anti-leukemic activity in preventing relapse in the absence of graft-versus-host disease, particularly in acute myeloid leukemia patients. Adoptive transfer of donor NK cells post-HSCT or in non-transplant scenarios may be superior to the currently widely used unmanipulated donor lymphocyte infusion...
March 2016: Transfusion Medicine and Hemotherapy
Ling-Qun Hu, Pamela Flood, Yunping Li, Weike Tao, Peishan Zhao, Yun Xia, May C Pian-Smith, Francis S Stellaccio, Jean-Pierre P Ouanes, Fengling Hu, Cynthia A Wong
The availability of labor analgesia is highly variable in the People's Republic of China. There are widespread misconceptions, by both parturients and health care providers, that labor epidural analgesia is harmful to mother and baby. Meanwhile, China has one of the highest cesarean delivery rates in the world, exceeding 50%. The goal of the nongovernmental No Pain Labor & Delivery (NPLD) is to facilitate sustainable increases in vaginal delivery rates by increasing access to safe neuraxial labor analgesia, thereby decreasing the cesarean delivery rate...
June 2016: Anesthesia and Analgesia
M Irem Baharoglu, Charlotte Cordonnier, Rustam Al-Shahi Salman, Koen de Gans, Maria M Koopman, Anneke Brand, Charles B Majoie, Ludo F Beenen, Henk A Marquering, Marinus Vermeulen, Paul J Nederkoorn, Rob J de Haan, Yvo B Roos
BACKGROUND: Platelet transfusion after acute spontaneous primary intracerebral haemorrhage in people taking antiplatelet therapy might reduce death or dependence by reducing the extent of the haemorrhage. We aimed to investigate whether platelet transfusion with standard care, compared with standard care alone, reduced death or dependence after intracerebral haemorrhage associated with antiplatelet therapy use. METHODS: We did this multicentre, open-label, masked-endpoint, randomised trial at 60 hospitals in the Netherlands, UK, and France...
June 25, 2016: Lancet
H W Clouston, P A Rees, H Shaker, S Duff, C C Kirwan
INTRODUCTION: Up to 6% of patients develop venous thromboembolism (VTE) following elective colorectal cancer surgery despite thromboprophylaxis. Clinical practices for perioperative thromboprophylaxis remains variable, particularly the use and duration of extended thromboprophylaxis. Identification of factors associated with a prolonged postoperative hypercoagulable state may allow the development of algorithms that allow more targeted thromboprophylaxis. AIM: To identify patient, tumour and surgical risk factors for prolonged (two and six weeks) hypercoagulability in colorectal cancer patients undergoing surgical resection...
April 2016: Thrombosis Research
Thomas A Schwann, Robert H Habib, Rakesh M Suri, J Matthew Brennan, Xia He, Vinod H Thourani, Milo Engoren, Gorav Ailawadi, Brian R Englum, Mark R Bonnell, James S Gammie
BACKGROUND: Anticoagulation with warfarin following bioprosthetic mitral valve replacement (BMVR) is recommended by multiple practice guidelines. We assessed practice variability and patient characteristics associated with warfarin prescription following BMVR. METHODS: We analyzed 7,637 patients in the Society of Thoracic Surgeons Database (January 1, 2008 to June 30, 2011) who were discharged following isolated primary nonemergent BMVR. Patients requiring preoperative warfarin, those with preoperative atrial fibrillation, or those with a contraindication to warfarin were excluded...
September 2016: Chest
Lise J Estcourt, Simon J Stanworth, Sally Hopewell, Carolyn Doree, Marialena Trivella, Edwin Massey
BACKGROUND: Despite modern antimicrobials and supportive therapy bacterial and fungal infections are still major complications in people with prolonged disease-related or treatment-related neutropenia. Transfusions of granulocytes have a long history of usage in clinical practice to support and treat severe infection in high-risk groups of patients with neutropenia or neutrophil dysfunction. However, there is considerable current variability in therapeutic granulocyte transfusion practice, and uncertainty about the beneficial effect of transfusions given as an adjunct to antibiotics on mortality...
2016: Cochrane Database of Systematic Reviews
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