Out and Out It Goes . . . Where It Stops . . . Who Knows

2020 ◽  
pp. 23-32
Author(s):  
Danny Lammers ◽  
Christopher Marenco ◽  
Woo Do ◽  
John Horton
Keyword(s):  
Hemorrhagic Shock ◽  
Blood Cells ◽  
Early Recognition ◽  
Pediatric Trauma ◽  
Standard Of Care ◽  
Fresh Frozen Plasma ◽  
Trauma Patients ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Frozen Plasma

Pediatric trauma is the leading cause of death among children and adolescents. Unique variations in pediatric trauma patients require different approaches for pediatric patients than for adult patients. Early recognition of the subtle presentation of hemorrhagic shock is critical to initiate adequate resuscitation. The early use of blood transfusions is indicated for those nonresponsive to crystalloid boluses. Standard of care targets a goal of balanced administration of packed red blood cells (PRBC), fresh frozen plasma (FFP), and platelets (PLT): 1PRBC:1FFP:1PLT. Thromboelastography (TEG) and tranexamic acid (TXA) may have a role in the management of children in hemorrhagic shock.

Massive Transfusion

2018 ◽  
pp. 169-180
Author(s):  
Jay Berger
Keyword(s):  
Red Blood Cells ◽  
Blood Volume ◽  
Blood Cells ◽  
Massive Transfusion ◽  
Fresh Frozen Plasma ◽  
Metabolic Complications ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Life Threatening ◽  
Frozen Plasma

Massive transfusion is defined as transfusion of 3 units of packed red blood cells in less than 1 hour in an adult, replacement of more than 1 blood volume in 24 hours, or replacement of more than 50% of blood volume in 3 hours. Massive transfusion protocols are implemented in cases of life-threatening hemorrhage after trauma, during a surgical procedure, or during childbirth. These protocols are intended to minimize the adverse effects of hypovolemia, dilutional anemia, metabolic complications, and coagulopathy with early empiric replacement of blood products and transfusion of fresh frozen plasma, platelets, and packed red blood cells in a composition that approximates that of whole blood.

Primary Plasma Therapy For Thrombotic Thrombocytopenic Purpura

1981 ◽  
Author(s):  
D C Case
Keyword(s):  
Platelet Count ◽  
Blood Cells ◽  
Reticulocyte Count ◽  
Fresh Frozen Plasma ◽  
Red Cell ◽  
Peripheral Smear ◽  
Plasma Therapy ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Frozen Plasma

A 25-year old male was admitted for an episode of right sided headache and subsequent generalized seizure. On admission his temperature was 37.6°. He had generalized petechiae and conjunctival hemorrhages. Organomegaly and lymphadenopathy were absent. There was mild left sided weakness. The Hgb. was 6.9 g/dl., reticulocyte count 10%, WBC 11,500/mm3, and platelet count 10,000/mm3. There were numerous schistocytes on the peripheral smear; bone marrow revealed panhyperplasia. Coagulation studies were normal. The BUN was 30, and the creatinine 1.7 mg/dl. Plasma was positive for Hgb. CT scan was negative for gross intracranial bleeding. The diagnosis of T.T.P. was made. On admission, the patient received 10 units of platelets and 2 units of packed red blood cells. He did not require further red cell or platelet transfusions during the rest of his hospital course. He was then started on infusions of fresh-frozen plasma. He then received one unit every 3 hours for 6 days, one unit every 6 hours for 2 days, then one unit every 12 hours for 2 days and finally 1 unit daily for 5 days. The response was immediate. After the infusions were started, the hematologic parameters steadily improved. The patient’s hematuria rapidly improved. Further CNS symptoms did not appear. The patient’s Hgb. was 12 g/dl, and reticulocyte count was 2.5% by the 9th day. His platelet count was normal by the 4th day. The patient was discharged on the 15th day. Infusions of plasma were discontinued at the time of discharge. The patient required plasma therapy 4 weeks later for recurrent thrombocytopenia (50,000/mm3). The patient has remained normal for 9 months since therapy and further plasma has not been required. Primary plasma therapy for T.T.P. as sole treatment should be further studied.

scholarly journals The Role of Supportive Therapy in Pediatric Malignancies

2016 ◽  
Vol 62 (2) ◽  
pp. 251-256
Author(s):  
Zsuzsanna Erzsébet Papp ◽  
Mária-Adrienne Horváth
Keyword(s):  
Growth Factors ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Wide Spectrum ◽  
Fresh Frozen Plasma ◽  
Cancer Type ◽  
Infection Prophylaxis ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Frozen Plasma

AbstractChildhood cancer is a major psycho-social and health problem. International study groups establish complex, efficient, and concrete Cytostatic Protocols for every cancer type. During chemotherapy patients become extremely vulnerable to infections, so it is necessary to complete the treatment with blood substitution, anti-infection medication, growth factors and other complementary products.Materials and Methods: We studied the importance of the wide palette of adjuvant therapy near the intensive cytostatic treatment in the period of March 2014-November 2015 at the hemato-oncology department in Pediatric Clinic of Mures County Hospital.Results: In this period we treated 20 children (9 female, 11 male) aged between 9 months-18 years. We had 15 cases of haemopathies (13 acute leukemia and two lymphomas), and five solid tumors. Packed red blood cells, platelets, and fresh frozen plasma were given in the aplastic period. A patient benefited, on average, a total of 70ml/kg packed red blood cells and 50 U platelets. For infection prophylaxis and treatment every child benefited associated infective medication.Discussions: Packed red blood cells, platelets, and fresh frozen plasma were given to patients with a deficiency in the ability to produce normal blood cells which are temporarily worsened by chemotherapy. Antibiotic and antifungal medications are given to all febrile and neutropenic patients. We use wide spectrum antibiotics in association for preventing sepsis. Growth factors are stimulating the bone marrow to increase leukocyte number. Since introducing additional immunostimulant medication, we observed a significant decrease of infection in the aplastic period.Conclusions: Oncology protocols use only 3-5 cytostatic drugs. Maintaining the patient’s life during the treatment, it is necessary to use a large spectrum of supportive medications.

BLOOD PRODUCTS TRANSFUSION DURING 2012-13 IN PESHAWAR, PAKISTAN

2019 ◽  
Vol 16 (4) ◽  
pp. 105-108
Author(s):  
Rashid Azeem ◽  
Nadia Altaf ◽  
Syed Humayun Shah ◽  
Naeem Khattack ◽  
Muhammad Tariq Masood Khan ◽  
...  
Keyword(s):  
Health Care ◽  
Red Blood Cells ◽  
Whole Blood ◽  
Blood Cells ◽  
Fresh Frozen Plasma ◽  
Health Care Facilities ◽  
Blood Products ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Frozen Plasma

Background: Blood products transfusion has been a major treatment modality especially in critical care settings. The objectives of this study were to determine frequency and distribution of blood products transfusion in public and private health care facilities during 2012-2013 in Peshawar, Pakistan. Materials & Methods: This cross-sectional, study was conducted in the Department of Pathology, Northwest School of Medicine, Peshawar, Pakistan from 1st January 2012 to 31st December 2013. Sample size was 2,04,942 blood products transfusion, selected through consecutive non probability technique. All allogeneic cases of transfusions in inpatient and emergency were included. A total of six public, one private and two stand-alone blood banks were enrolled into the study. Demographic variable were name of the health care facility, sex and age groups of donors. Research variables were type of blood products transfusion (whole blood, packed red blood cell, fresh frozen plasma, platelets). All variables being categorical were described as count and percentages. Data was analyzed using software SPSS version 23. Results: Out of 2,04,942 units, 1,33,212 (65%) were men and 71,730 (35%) women. Packed red blood cells were the most commonly used component with 80227 units (39.1%), whole blood 77655 units (37.8%), Fresh frozen plasma 35932 units (17.5%) and platelets 11128 units (5.6%). Blood products transfusion was 46927 units (22.89%) in 65 years. Conclusion: Modal group was men. Packed red blood cells were the most frequently transfused blood component in hospitals of Peshawar especially Lady reading hospital. Most common age group was 18-40 years. Whole blood still comprises a significant fraction of transfusions which is alarming.

Utilization of rapid-infuser devices for massive blood loss

Perfusion ◽  
2005 ◽  
Vol 20 (2) ◽  
pp. 65-69 ◽  
Author(s):  
Alfred H Stammers ◽  
James D Murdock ◽  
Myra H Klayman ◽  
Cody Trowbridge ◽  
Bianca R Yen ◽  
...  
Keyword(s):  
Hemorrhagic Shock ◽  
Standard Of Care ◽  
Fresh Frozen Plasma ◽  
Volume Replacement ◽  
Fluid Replacement ◽  
Rapid Infusion ◽  
Myocar Dial ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Infusion Systems

Rapid volume replacement for severe hemorrhage continues to challenge the clinician involved in the care of the patient suffering hemorrhagic shock. We report on the development and utilization of two rapid-infuser systems for volume replacement in critically ill patients presenting in extremis. We have developed rapid-infusion circuits by using commercially available devices available at our institution. The primary pumping mechanism is either a centrifugal pump (Revolution™COBE Cardiovascular, Arvada, CO, USA), or the Myocar-dial Protection System (MPS™ - Quest Medical, Allen, TX, USA), and offers advantages over commercially available devices. Both circuits consist of a cardiotomy reservoir, a cardioplegia delivery set, assorted tubing and connectors, and a heater-cooler system. Between January and October of 2003, 15 procedures were performed which utilized one of these two devices. There were nine ruptured aneurysms, five traumas and one radical nephrectomy. The rapid infusion time averaged 228.59±105.7 min where 10.49±9.4 L of autotransfusion volume was processed, with 3.99±4.2 L of red cell volume reinfused. The allogeneic blood products that were transfused included packed red blood cells and fresh frozen plasma, as well as 5% albumin. There were no intraoperative deaths and the rapid-infuser was considered lifesaving in all instances. Mechanical rapid infusion systems may be lifesaving when severe hypovolemia or hemorrhagic shock is encountered. While both devices are able to meet the requirements of rapid fluid replacement, the MPS offers the most safety features and has become the standard of care at our institution.

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