scholarly journals Blood on board: The development of a prehospital blood transfusion program in a Canadian helicopter emergency medical service

CJEM ◽  
2018 ◽  
Vol 21 (3) ◽  
pp. 365-373 ◽  
Author(s):  
Chase Krook ◽  
Domhnall O’Dochartaigh ◽  
Doug Martin ◽  
Zoë Piggott ◽  
Ryan Deedo ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Helicopter Emergency Medical Service ◽  
Air Rescue ◽  
Packed Red Blood Cells ◽  
Standard Work ◽  
Emergency Medical ◽  
Set Up ◽  
Injured Patients

ABSTRACTObjectivePrehospital blood transfusion has been adopted by many civilian helicopter emergency medical services agencies, and early outcomes are positive. The Shock Trauma Air Rescue Society operates six bases in Western Canada and started a blood on board process in 2013 in Regina that has expanded to all bases. Two units of O negative packed red blood cells are carried on every mission. We describe the processes and standard work ensuring safe storage, administration, and stewardship of this important resource.MethodsThe packed red blood cells are stored in an inexpensive, reusable temperature controlled cooler at 1°C–6°C. Close collaboration with local transfusion services and adherence to Canadian transfusion standards contributes to safety and sustainability.ResultsFrom October 1, 2013 to October 10, 2017, the Shock Trauma Air Rescue Society administered blood to 431 patients. Of this total, 62.9% received blood carried on our aircraft. A total of 463 blood box units were administered, and the majority of patients (69.0%) received both units. Blood used in Calgary, Alberta was 100% traceable, and only 1.2% of total units dispensed was wasted. The vast majority of unused units were returned to circulation.ConclusionWe describe the process to set up and monitor a prehospital blood transfusion program. Our standard work and stewardship processes minimize wastage of blood while keeping it readily available for our critically ill and injured patients.

Retrolental Fibroplasia and Blood Transfusion in Very Low-Birth-Weight Infants

PEDIATRICS ◽  
1981 ◽  
Vol 68 (6) ◽  
pp. 770-774 ◽  
Author(s):  
Linda M. Sacks ◽  
David B. Schaffer ◽  
Endla K. Anday ◽  
George J. Peckham ◽  
Maria Delivoria-Papadopoulos
Keyword(s):  
Birth Weight ◽  
Blood Transfusion ◽  
Low Birth Weight ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Very Low Birth Weight ◽  
Statistical Significance ◽  
Low Birth Weight Infants ◽  
Retrolental Fibroplasia ◽  
Packed Red Blood Cells

The relative contribution of transfusions of adult blood to the development of retrolental fibroplasia (RLF) in very low-birth-weight infants was examined. Five years of experience with the expanded use of replacement and exchange transfusions in 90 infants with birth weight ≤1,250 gm was reviewed. Twenty percent of the infants developed cicatricial RLF. Exchange transfusion was not related to development of cicatricial RLF. The incidence of RLF in infants receiving ≥130 ml of packed red blood cells per kilogram of birth weight as replacement blood transfusion (RBT) was significantly higher (42.9%) than that in infants receiving 61 to 131 ml of packed red blood cells per kilogram (15.4%) and infants receiving ≤60 ml of packed red blood cells per kilogram (0%), P < .001. The need for RBT, however, was strongly correlated (r = .85, P < .001) with increasing duration of O2 therapy. When O2 therapy was controlled for, the association between RBT and RLF did not achieve statistical significance (P = .07). The association between RBT and RLF remained significant when adjusted for duration of therapy in fractional inspired oxygen (FIO2) >0.4. Further detailed studies of large numbers of susceptible infants are warranted to assess the magnitude of the contribution of transfusions of adult blood to development of RLF.

The Immunosuppressive Aspects of Blood Transfusion

1992 ◽  
Vol 7 (4) ◽  
pp. 176-188 ◽  
Author(s):  
Thomas A. Mickler ◽  
David E. Longnecker
Keyword(s):  
Blood Transfusion ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Renal Allograft ◽  
Autologous Blood ◽  
Immunosuppressive Effect ◽  
Solid Cancer ◽  
Infection Rates ◽  
Allograft Survival ◽  
Packed Red Blood Cells

Blood transfusion is associated with immunosuppression, although the exact etiology of the immunosuppressive effect is not fully understood. The clinical significance of the immunosuppressive effect of blood transfusion has been examined in three situations: (1) studies of renal allograft survival after renal transplantation, (2) outcome studies in patients who have had surgical resection of solid cancer tumors, and (3) studies of infection rates in postoperative patients. In each scenario, the data support the conclusion that transfusion is associated with immunosuppression as manifested by increased renal allograft survival, increased recurrence and mortality rates in patients with cancer, and increased infection rates in postoperative patients who are transfused. Not all studies demonstrate an immunosuppressive effect of transfusion. There are several possible explanations for these discrepancies. First, prognostic variables other than transfusion itself account for the outcome results in these retrospective studies. Second, the extent of immunosuppression may be influenced by the type of blood product transfused, the amount transfused, and the timing of the transfusion; these factors have not been considered in all studies. For example, whole blood has been implicated as having a greater immunosuppressive effect than packed red blood cells, and many studies have shown that more than three units of packed red blood cells are necessary to affect outcome. Controlled animal studies have tested the hypothesis that transfusions increase solid tumor growth or the risk for infection. These studies have yielded conflicting results. Nevertheless, evidence that blood transfusion influences clinical outcome mitigates that a decision to transfuse must consider both risks and benefits of a transfusion; the possible consequences of immunosuppression must be included among the risks. Use of autologous blood, erythropoietin, and, in the future, synthetic hemoglobin may lead to improved outcome in patients with certain disease processes.

Modification of Anemia Parameters after Blood Transfusion.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 966-966
Author(s):  
David Berz ◽  
Himani Singh ◽  
Elise McCormack ◽  
Eric Mazur
Keyword(s):  
Chronic Disease ◽  
Lactate Dehydrogenase ◽  
Iron Deficiency ◽  
Blood Transfusion ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Laboratory Evaluation ◽  
Packed Red Blood Cells ◽  
Iron Deficient ◽  
Significant Change

Abstract Background: Optimally the necessary laboratory evaluation for the diagnosis of the underlying causes for anemia is done before blood transfusion. However, clinical and logistical demands often mandate the transfusion of packed red blood cells before all the necessary parameters are obtained. It is poorly defined which impact transfusion has on the parameters necessary for the diagnosis of the underlying anemia cause. We conducted a prospective study to investigate the effect of the transfusion of two units packed red blood cells on lactate dehydrogenase(LDH), ferritin, transferrin, haptoglobin, total iron binding capacity(TIBC), folate, cyanocobalamine(B12), hemoglobin, MCV and hematocrit by measuring those tests before and at 6, 12, 24 and 48 hrs after transfusion. Patients and Methods: We included nineteen normovolemic, not actively bleeding consecutive patients; six of whom were diagnosed with anemia of chronic disease, one MDS and twelve iron deficiency anemias. Acutely bleeding patients, patients not able to give informed consent, prisoners under hospitalization and patients younger than 18 years old were excluded. All patients received transfusion of two units of packed red blood cells. The statistical analysis was performed using a repeated measurement ANOVA algorithm. Results: The transfusion of two units of packed red blood cells did not result in a significant change of ferritin, transferrin, haptoglobin, cyanocobalamin and lactate dehydrogenase throughout the observation period. Hemoglobin, MCV and hematocrit demonstrated an early change and equilibration without significant change after the first six hours post transfusion. Serum iron levels were transiently elevated in the severely iron deficient population, but returned back to baseline after 24hrs. Folate experienced a statistically significant, persistent change in the posttransfusion period. For the first 48 hrs post transfusion the following conclusions were made: First, the diagnosis of iron deficiency or chronic disease anemia is not confounded by blood transfusion, particularly when using ferritin as the predominant diagnostic parameter. Second, the diagnosis of hemolytic anemias, using haptoglobin and LDH is not interfered by transfusion of two units of packed red blood cells. Third, vitamin B12 deficiency can be diagnosed after transfusion, whilst folate deficiency on the base of red blood cell folate cannot.

scholarly journals P114: Blood on board: the development of a prehospital blood transfusion program in a Canadian helicopter emergency medical service

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S97-S97
Author(s):  
Z. Piggot ◽  
C. Krook ◽  
D. O’Dochartaigh ◽  
G. vanWerkhoven ◽  
J. Armstrong ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Helicopter Emergency Medical Service ◽  
Blood Bank ◽  
Hospital Environment ◽  
Electronic Temperature ◽  
Safe Storage ◽  
Standard Work ◽  
Emergency Medical

Introduction: Prehospital blood transfusion has been adopted by many civilian helicopter emergency medical service (HEMS) agencies and early outcomes are positive. Shock Trauma Air Rescue Service (STARS) operates six bases in Western Canada and in 2013 implemented a prehospital transfusion program. We describe the processes and standard work ensuring safe storage, administration, and stewardship of this precious resource. Our aim was to produce a sustainable and safe blood storage system that could be carried on each mission flown. Methods: Close collaboration with transfusion services and adherence to Canadian Transfusion Standards was key at each step of development. An inexpensive, reusable, temperature controlled thermal packaging device was obtained along with an electronic temperature logger. Conditioning of the device and temperature maintenance (1 6C) was tested to ensure safe storage conditions. Online training programs were developed for air medical crew (AMC) as well as transport physicians (TPs) regarding administration indications, safety, and stewardship processes. Blood traceability and usage was monitored on an ongoing basis for quality assurance. Results: Two units of O negative packed red blood cells (pRBCs) are now carried on each flight. The blood box is conditioned and prepared by transfusion services for routine exchange every 72 hours. If pRBCs are administered the blood bank is immediately notified for preparation of another cooler. Unused blood is returned to blood bank circulation. Conclusion: The introduction of the STARS blood on board program supports the provision of emergent transfusion to selected patients in the pre-hospital environment. Our standard work and stewardship processes minimize wastage of blood products while keeping it readily available for critically ill and injured patients. Subsequent work will aim to describe characteristics and patient centred outcomes.

Prolonged storage of packed red blood cells for blood transfusion

2011 ◽  
Author(s):  
Arturo J Martí-Carvajal ◽  
Daniel Simancas ◽  
Ricardo Hidalgo
Keyword(s):  
Blood Transfusion ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Prolonged Storage ◽  
Packed Red Blood Cells

α-Enolase From Injured Patients and Stored Packed Red Blood Cells Activates Pulmonary Endothelium and Serves as the First Event In a Two-Event Model of Neutrophil Cytotoxicity

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3355-3355
Author(s):  
Nicole Tucker ◽  
Monika Dzieciatkowska ◽  
Kirk Hansen ◽  
Samina Khan ◽  
Marguerite Kelher ◽  
...  
Keyword(s):  
Red Blood Cells ◽  
Blood Cells ◽  
Injury Severity ◽  
Conflicts Of Interest ◽  
Injured Patient ◽  
Post Injury ◽  
Packed Red Blood Cells ◽  
Severity Scores ◽  
Moonlighting Proteins ◽  
Injured Patients

Abstract Abstract 3355 A significant number of injured patients with intermediate injury severity scores (15<ISS<30) develop multiple organ failure (MOF), which clinically begins with acute lung injury (ALI). Transfusion of >6 units of stored PRBCs (≥28 days) is associated with the development of ALI/MOF on day 3 post injury (Am J Surg 178:502-4, 1999). The pro-inflammatory mediators, e.g. cytokines, responsible for MOF/ALI in the injured have remained elusive; therefore, we hypothesize that “moonlighting” proteins, which have defined intracellular function when released in the circulation, activate innate immunity and are etiologic in the development of ALI/MOF post-injury. Methods: Proteomics on the field blood (plasma) of 3 patients with blunt trauma who later developed ALI/MOF and the plasma from 3 units of packed red blood cells (PRBCs) on day 1 and day 42 were completed using 2-dimensional gel electrophoresis/mass spectroscopy (MALDI/TOF) with computer analyses of the resultant peptides. The proteins from whole cell lysates from Human pulmonary microvascular endothelial cells (HMVECs) were separted by SDS-PAGE, transferred to nitrocellulse and immunoblotted with antibodies to protease activated receptor-1 (PAR-1) and PAR-2. HMVECs were also incubated for 6 hours and 1) ICAM-1 was measured by flow cytometry, 2) isolated neutrophils (PMNs) were added allowed to settle and in selected wells PMN adherence to these activated HMVECs was measured by myeloperoxidase content in the lysate, or 3) after the PMNs settled, lysophosphatidylcholines (lyso-PCs) [4.5μM], lipids from stored platelets implicated in TRALI, were added and the number of viable HMVECs/mm2 were counted by microscopy. Results: HMVECs display immunoreactivity for both PAR-1 and PAR-2. Of the 243 proteins identified in the injured patients and the stored vs. fresh PRBCs, α-enolase increased by 10.8-fold and 4.4-fold respectively (p<.05 & p<.005). Both thrombin and α-enolase induced ICAM-1 expression in HMVECs (Table 1) which was inhibited (60±8%) by pre-treatment with the anti-protease leupeptin. α-Enolase also induced significant PMN adhesion vs. media control: Media: 3.1±1.5; α-enolase (50 μg/ml): 14.4±4.7; LPS: 35.5±0.7*. The α-enolase-activated HMVECs vs. buffer-treated lyso-PCs induced significant PMN-mediated cytotoxicity (Table 2). We conclude that α-enolase from the injured and stored but not fresh PRBCs causes pro-inflammatory activation of HMVECs resulting in PMN adherence and PMN cytotoxicity in a two-event in vitro model through activation of PARs receptors. Moonlighting proteins like the glycolytic lyase α-enolase may have unexpected pro-inflammatory activity, which predispose the injured patient to increased morbidity and mortality. Disclosures: No relevant conflicts of interest to declare.

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