scholarly journals A Prospective Randomized Clinical Trial of Efficacy of Algorithm-Based Point of Care Guided Hemostatic Therapy in Cyanotic Congenital Heart Disease Surgical Patients

2019 ◽  
Vol 03 (01) ◽  
pp. 08-16
Author(s):  
Ameya Karanjkar ◽  
Poonam Malhotra Kapoor ◽  
Sandeep Sharan ◽  
Vandana Bhardwaj ◽  
Vishwas Malik ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Point Of Care ◽  
Fresh Frozen Plasma ◽  
Surgical Patients ◽  
Blood Component ◽  
Chest Drain ◽  
Packed Red Blood Cells ◽  
Mechanical Ventilation Duration ◽  
Blood Component Therapy ◽  
Hemostatic Therapy

Abstract Objective Point of care (POC) testing-based algorithm-guided hemostatic therapy has been used in adult as well as pediatric cardiac surgical patients to administer blood components. The authors hypothesized that implementation of POC-based algorithm in pediatric cyanotic congenital surgical patients would reduce the exposure to blood component therapy and improve the clinical outcome. Design Prospective randomized control trial. Setting Single-center academic institute. Participants One hundred seventy pediatric congenital cyanotic surgical patients. Intervention Implementation of POC and conventional tests-based algorithms. Measurements and Main Results Algorithm-based blood component therapy was administered in each group. There were no group differences regarding the demographic, clinical, and laboratory characteristics. Amount of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate (primary outcomes) administered was significantly lower in POC group than that in the conventional group (p < 0.001). Among the secondary outcomes, the chest drain output at 6, 12, and 24 hours and number of re-explorations was comparable among both the groups. The duration of mechanical ventilation, duration of intensive care unit (ICU) stay, and hospital stay was significantly short in POC group (p = 0.008, <0.001 and 0.019, respectively). Conclusion Implementation of POC-based algorithm-guided hemostatic therapy reduced the exposure to blood and blood component therapy and was associated with reduced ICU and hospital stay in pediatric congenital cyanotic surgical patients.

scholarly journals Blood Component Therapy

2018 ◽  
Vol 9 (2) ◽  
pp. 142-147
Author(s):  
Shanaz Karim ◽  
Ehteshamul Hoque ◽  
Md Mazharul Hoque ◽  
Syeda Masooma Rahman ◽  
Kashfia Islam
Keyword(s):  
Red Blood Cells ◽  
Whole Blood ◽  
Blood Cells ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Packed Red Blood Cells ◽  
Medical College ◽  
Blood Component Therapy ◽  
Fresh Frozen ◽  
Cellular Components

Transfusion medicine has undergone advancements since its initiation in the early 20th century. One of these was the discovery that blood can be divided into individual components and delivered separately. Today, blood transfusions nearly always consist of the ad-ministration of 1 or more components of blood. Whole blood transfusion is now limited to situations involving massive resuscitation (trauma ) The most familiar cellular components include packed red blood cells (PRBC), washed PRBC, leukoreduced PRBC and pooled or aphaeresis platelets. Plasma products such as FFP or cryoprecipitate, ant hemophilic factor (CRYO). The transfusion of red blood cells (RBCs), platelets, fresh-frozen plasma (FFP), and cryoprecipitate has the potential of improving clinical outcomes in perioperative and peripartum settings. These benefits include improved tissue oxygenation and decreased bleeding. However, transfusions are not without risks or costs. With the advent of blood component therapy, each unit of whole blood collected serves the specific needs of several, rather than a single patient.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 142-147

scholarly journals The Utilization of Viscoelastic Testing to Guide Blood Component Therapy and Adjunctive Hemostatic Therapy for Postpartum Hemorrhage: A Narrative Review

2019 ◽  
pp. 272-286
Author(s):  
Baumgartner S ◽  
Shariff F ◽  
Vande Lune SA ◽  
Zackariya N ◽  
Grisoli A ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Point Of Care ◽  
Narrative Review ◽  
Blood Component ◽  
Clinical Parameters ◽  
Rotational Thromboelastometry ◽  
Coagulation Tests ◽  
Blood Component Therapy ◽  
History Of ◽  
Hemostatic Therapy

This narrative review discusses the history of the pathophysiologic principles and utilization of point-of-care (POC) viscoelastic tests (VETs) in the definition and treatment of postpartum hemorrhage (PPH). This paper addresses the epidemiology of PPH, describes the hemostatic changes that occur in pregnancy and in PPH, and demonstrates the utilization of viscoelastic testing in the identification and treatment of patients with PPH. Additionally, a description of rotational thromboelastometry (ROTEM) and thromboelastography (TEG), the two most commonly used VETs, is detailed in this paper. VETs have only recently been used to guide blood component therapy (BCT) in trauma in the last decade. The recent increased utilization of VETs to guide BCT in PPH is following a similar trend with a delay of ten years. In a similar fashion to the trauma literature, which expanded greatly within this last decade, the literature concerning the use of VETs in PPH has also increased in the last few years. However, because of differing pathophysiologies associated with the coagulopathy of PPH verses traumatic-induced coagulopathy (TIC), utilization of VETs has been more refined and focused on the VETs’ capacity to determine low fibrinogen and to guide the utilization of blood components and prohemostatic agents. The identification and treatment of PPH depends on clinical parameters, conventional coagulation tests (CCTs) including Clauss fibrinogen, and VETs. Successful treatment of PPH will no doubt include utilization of all three strategies with an increasing utilization of VETs in the future.

The physiology of blood in anaesthetic practice

2017 ◽  
Author(s):  
Hanane El Kenz ◽  
Philippe Van der Linden
Keyword(s):  
Blood Transfusion ◽  
Whole Blood ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Blood Components ◽  
Pathogen Inactivation ◽  
Septic Complications ◽  
Packed Red Blood Cells ◽  
Blood Component Therapy ◽  
Fresh Frozen

Following the discovery of the ABO blood groups by Landsteiner in 1901, Albert Hustin described the first transfusion of a whole blood unit in 1914. The modern transfusion era really begins in 1916 with the discovery of sodium citrate as an anticoagulant by the same physician, allowing blood conservation in dedicated packs. Since that time, many advances have been made especially over the past two decades in the storage, the conservation, and the laboratory testing of blood components and in transfusion medicine practice. Transfusion of whole blood has been replaced by blood component therapy, which consists of the administration of packed red blood cells, fresh frozen plasma, or platelets. Although blood transfusion is safer than ever, the risk of complications will never reach zero. The risk of infectious transfusion-transmitted diseases has been markedly reduced by the implementation of extensive infectious disease testing, donor selection, and pathogen-inactivation procedures. In countries with a high human development index, the leading causes of allogeneic blood transfusion-related deaths actually resulted from immunological and septic complications. The first section of this chapter describes the structure, function, and immunological aspects of the different blood components that are routinely transfused today. The second section details the composition of the different blood components, their indications, the pre-transfusion compatibility tests, and the main adverse effects associated with their transfusion.

Perioperative management of coagulation

2006 ◽  
Vol 26 (S 02) ◽  
pp. S3-S14 ◽  
Author(s):  
P. Innerhofer
Keyword(s):  
Coagulation Factor ◽  
Fresh Frozen Plasma ◽  
Laboratory Evaluation ◽  
Blood Component ◽  
Actual Case ◽  
Fresh Frozen ◽  
Coagulation Factor Concentrates ◽  
Hemostatic Therapy ◽  
Frozen Plasma

SummaryGuidelines of official societies for diagnosis and therapy of intraoperatively occurring hypocoagulability rely mainly on data of patients receiving whole blood transfusions. They recommend -provided that laboratory evaluation shows deficiency (values >1.5 fold normal)- administration of fresh frozen plasma, cryoprecipitate and platelet concentrates (platelet count <50 000 or <100 000/μl). This article describes the pathogenesis of coagulopathy in the light of the special intraoperative setting, emphasizes recent changes of blood component preparation, transfusion triggers, effects of volume therapy and challenges standard laboratory assays as reliable guide for intraoperative hemostatic therapy. The role of thrombelastographic monitoring is discussed as well as an alternative strategy to compensate deficiencies by the use of coagulation factor concentrates instead of or in addition to transfusion of FFP, a new concept which is illustrated by the presentation of an actual case report.

scholarly journals Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulation

2020 ◽  
Vol 15 (4) ◽  
pp. 459-465
Author(s):  
Young Sun Lee ◽  
Kyu Nam Kim ◽  
Min Kyu Lee ◽  
Jung Eun Sun ◽  
Hyun Jin Lim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Loss ◽  
Fresh Frozen Plasma ◽  
Massive Bleeding ◽  
Blood Component ◽  
Trauma Patients ◽  
Intraoperative Bleeding ◽  
Packed Red Blood Cells ◽  
Hemostatic Resuscitation ◽  
Traumatic Bleeding

Background: Appropriate blood component transfusion might differ between intraoperative massive bleeding and traumatic massive bleeding in the emergency department because trauma patients initially bleed undiluted blood and replacement typically lags behind blood loss. We compared these two blood loss scenarios, intraoperative and traumatic, using a computer simulation.Methods: We modified the multi-compartment dynamic model developed by Hirshberg and implemented it using STELLA 9.0. In this model, blood pressure changes as blood volume fluctuates as bleeding rate and transcapillary refill rate are controlled by blood pressure. Using this simulation, we compared the intraoperative bleeding scenario with the traumatic bleeding scenario. In both scenarios, patients started to bleed at a rate of 50 ml/min. In the intraoperative bleeding scenario, fluid was administered to maintain isovolemic status; however, in the traumatic bleeding scenario, no fluid was supplied for up to 30 min and no blood was supplied for up to 50 min. Each unit of packed red blood cells (PRBC) was given when the hematocrit decreased to 27%, fresh frozen plasma (FFP) was transfused when plasma was diluted to 30%, and platelet concentrate (PC) was transfused when platelet count became 50,000/ml.Results: In both scenarios, the appropriate ratio of PRBC:FFP was 1:0.47 before PC transfusion, and the ratio of PRBC:FFP:platelets was 1:0.35:0.39 after initiation of PC transfusion.Conclusion: The ratio of transfused blood component did not differ between the intraoperative bleeding and traumatic bleeding scenarios.

A 0.6-protamine/heparin ratio in cardiac surgery is associated with decreased transfusion of blood products

2020 ◽  
Vol 31 (3) ◽  
pp. 391-397
Author(s):  
Anne L M Goedhart ◽  
Bastiaan M Gerritse ◽  
Thijs C D Rettig ◽  
Martijn W A van Geldorp ◽  
Sander Bramer ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Thrombus Formation ◽  
Group Versus ◽  
Fresh Frozen Plasma ◽  
Interquartile Range ◽  
Postoperative Blood Loss ◽  
Blood Component ◽  
Packed Red Blood Cells ◽  
Blood Component Transfusion

Abstract OBJECTIVES In cardiac surgery, adequate heparinization is necessary to prevent thrombus formation in the cardiopulmonary bypass (CPB). To counteract the heparin effect after weaning from CPB, protamine is administered. The optimal protamine/heparin ratio is still unknown. METHODS In this before–after study, we evaluated the effect of a 0.6/1-protamine/heparin ratio implementation as of May 2017 versus a 0.8/1-protamine/heparin ratio on the 12-h postoperative blood loss and the amount of blood and blood component transfusions (fresh frozen plasma, packed red blood cells, fibrinogen concentrate, platelet concentrate and prothrombin complex concentrate) after cardiac surgery. A total of 2051 patients who underwent cardiac surgery requiring CPB between May 2016 and May 2018 were included. RESULTS In the 0.6/1-protamine/heparin ratio group, only 28.8% of the patients received blood component transfusion, compared to 37.9% of the patients in the 0.8/1-ratio group (P &lt; 0.001). The median 12-h postoperative blood loss was 230 ml (interquartile range 140–320) in the 0.6/1-ratio group versus 260 ml (interquartile range 155–365) in the 0.8/1-ratio group (P &lt; 0.001). CONCLUSIONS A 0.6/1-protamine/heparin ratio after weaning from CPB is associated with a significantly reduced 12-h postoperative blood loss and blood components transfusion.

scholarly journals Monitoring of hemostasis in cardiac surgical patients: impact of point-of-care testing on blood loss and transfusion outcomes

1997 ◽  
Vol 43 (9) ◽  
pp. 1684-1696 ◽  
Author(s):  
George J Despotis ◽  
J Heinrich Joist ◽  
Lawrence T Goodnough
Keyword(s):  
Blood Loss ◽  
Point Of Care ◽  
Coagulation Factor ◽  
Surgical Patients ◽  
Patient Specific ◽  
Blood Component ◽  
Multiple Point ◽  
Excessive Bleeding ◽  
Transfusion Requirements ◽  
Increased Risk

Abstract Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at increased risk for excessive perioperative blood loss requiring transfusion of blood products. Strategies to optimize administration of heparin and protamine and the assessment of their effects on coagulation are evolving in cardiac surgical patients. Two recent evaluations have focused on the use of multiple point-of-care (POC) coagulation assays for patient-specific adjustment of heparin and protamine dosage. These studies indicate that blood loss and transfusion requirements in cardiac surgical patients may be reduced with more accurate control of heparin anticoagulation and its reversal. Blood component administration in patients with excessive post-CPB bleeding is generally empiric in part, related to turnaround times of laboratory-based tests. Methods are now available for rapid, POC assessment of coagulation to allow appropriate, targeted therapy for acquired hemostatic abnormalities. Recent studies indicate that a rapid evaluation of thrombocytopenia and coagulation factor deficiencies with POC tests can facilitate the optimal administration of pharmacologic and transfusion-based therapy in patients who exhibit excessive bleeding after CPB. POC tests that assess platelet function have been developed, and their use may facilitate identification of which patients at risk for excessive blood loss may respond to pharmacologic interventions such as desmopressin acetate or antifibrinolytic agents.

scholarly journals Blood component therapy, demographic and outcome feature of pediatric acute lymphoblastic leukemia

2021 ◽  
Vol 6 (2) ◽  
pp. e37-e37
Author(s):  
Mehran Noroozi ◽  
Farid Ghazizadeh ◽  
Saba Fani
Keyword(s):  
Bone Marrow ◽  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Fresh Frozen Plasma ◽  
Study Data ◽  
Blood Component ◽  
Cross Sectional ◽  
Blood Component Therapy ◽  
Pediatric All ◽  
The Mean

Introduction: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, with an annual incidence rate of three to four cases per 100000 children. Most children with ALL frequently receive blood products including packed cells, platelets, fresh frozen plasma (FFP) and whole blood in the course of chemotherapy and these transfusions may affect ALL outcomes. Objectives: This study aimed to evaluate blood component therapy together with demographic and outcome features of pediatric ALL patients. Patients and Methods: Demographic information of 208 patients with pediatric ALL from February 2011 to August 2019 enrolled in this cross-sectional study. Data is gathered and rechecked from archive files and e-files of Motahari hospital. Results: The mean age of patients at diagnosis was 5.48±3.38 years and Pre-B ALL was the most common phenotype (94.3%). 130 Out of 208 patients were treated with the new protocol and 78 patients were treated with the BFM98 protocol. The majority of relapses were in the bone marrow. The average of received packed cell, platelet and FFP were 4.32±2.93, 5.97±7.09 and 5.29±6.6 units, respectively. The mean overall survival of patients was 3.42±2.58 years in 10 years. Conclusion: According to this study, most of the patients were 5 to 15 years old. Dominant subtype of disease was B-cell type. Most of the deaths were one to 6 years after diagnosis. The relapse rate was about 31% and most of them were in the bone marrow.

The Role of Thromboelastography in Directing Blood Product Usage in Infant Open Heart Surgery

2009 ◽  
Vol 4 (5) ◽  
pp. 282-290 ◽  
Author(s):  
Eric N. Mendeloff ◽  
George F. Glenn ◽  
Paul Tavakolian ◽  
Eugene Lin ◽  
Allison Leonard ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Blood Product ◽  
Open Heart Surgery ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Open Heart ◽  
Product Usage ◽  
Blood Component Therapy ◽  
Fresh Frozen

Objective Thromboelastography (TEG) measures the dynamics of clot formation in whole blood and provides data that can guide specific blood component therapy. This study analyzed whether the implementation of TEG affected blood product utilization and overall hemostasis in infants (6 months and younger) undergoing open heart surgery. Methods TEG values measured include R (time to fibrin formation), angle (fibrinogen formation), and MA (platelet function). Blood product usage, TEG values, and operative parameters were collected during surgery on 112 consecutive infants (66 acyanotic) undergoing open heart surgery within the first 6 months of life. Controls consisted of chart data on 70 consecutive patients (57 acyanotic) undergoing the same surgical procedures before implementation of TEG (pre-TEG). Results Using TEG, the pattern of blood product utilization changed. Compared with the pre-TEG era, TEG era patients demonstrated a significant increase in fresh frozen plasma usage intraoperatively (4.74 vs. 1.83 mL/kg; P < 0.001) and reduced postoperative use of platelets (1.69 vs. 3.74 mL/kg; P = 0.006) and cryoprecipitate (0.89 vs. 1.95 mL/kg; P = 0.149). Chest tube drainage was significantly reduced at 1, 2, and 24 hours in the TEG group. TEG angle and MA measurements suggest that fibrinogen and platelets of cyanotic patients are more sensitive to hemodilution than the acyanotic patients. Conclusions TEG allows for proactive, goal-directed blood component therapy with improved postoperative hemostasis in infants undergoing cardiopulmonary bypass.

scholarly journals Importance of haemovigilance and reports on transfusion reaction in blood component therapy

2012 ◽  
Vol 65 (1-2) ◽  
pp. 50-53 ◽  
Author(s):  
Jasmina Grujic ◽  
Zdravko Gulan ◽  
Zorana Budakov
Keyword(s):  
Blood Transfusion ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Safe Procedure ◽  
Transfusion Reaction ◽  
Blood Components ◽  
Blood Component Therapy ◽  
Fresh Frozen ◽  
Novi Sad ◽  
Transfusion Reactions

Introduction. Application of blood and blood components throughout decades is very successful and mostly safe procedure in patients? therapy. However, it may lead to unfavourable effects, such as transfusion reactions. Material and Methods. In the period from 2000 to 2009, 180 transfusion reactions were reported at the Department of Clinical Transfusion of the Service for Blood Transfusion of Vojvodina in Novi Sad. The aetiology of transfusion reactions was determined by examining pretransfusion and post-transfusion sample of patient?s blood and by examining the unit of blood component that induced reaction. Results. Out of 180 reported transfusion reactions, 98 (54.4%) were febrile non-haemolytic transfusion reactions, 69 (38.3%) allergic reactions and 2 (1.11%) haemolytic reactions. Blood components that caused most of transfusion reactions were erythrocytes (62.4%), fresh frozen plasma (11.2%) and platelets (14.4%). All patients underwent multiple transfusions. Discussion. The fact that only 0.13% transfusion reactions were reported, compared with data from literature (2-15%), points to the lack of regular reporting of transfusion reactions, as well as the fact that there is only one report of delayed transfusion reaction. Conclusions. To improve and make blood transfusion safer it is necessary to respect all pre-transfusion procedures, constant follow up of blood transfusion must be done and patients with diagnosed non-haemolytic transfusion reaction should be given leukocyte reduced blood components.

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