scholarly journals Thromboelastogram-Guided Transfusion Therapy Reduces Blood-Component Transfusion and Improves Coagulation Function during Orthopedic Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yan Zhang ◽  
Yue Song ◽  
Yixin Zhang ◽  
Lu Yu ◽  
Kai Zhang
Keyword(s):  
Blood Cell ◽  
Orthopedic Surgery ◽  
Total Serum ◽  
Blood Component ◽  
Thrombin Time ◽  
Blood Products ◽  
Transfusion Therapy ◽  
Coagulation Function ◽  
Blood Component Transfusion ◽  
Significant Difference

Massive bleeding is a serious medical complication arising from trauma, surgery, and invasive procedures. In this case, timely and effective hemostasis must be applied to patients. The aim of this study is to compare transfusion therapies guided by thromboelastogram (TEG) and conventional coagulation tests (CCTs) during orthopedic surgery, focusing on blood-component transfusion and coagulation function of patients. The patients who underwent orthopedic surgery in our hospital from May 2019 to November 2020 were retrospectively analyzed. According to different transfusion-guiding strategies, the patients were assigned into the CCT group containing 214 patients and the TEG group containing 266 patients. The TEG group used fewer volumes of blood products including red blood cell (RBC) suspension, fresh-frozen plasma, cryoprecipitate, and apheresis platelets than the CCT group ( P < 0.05 ). After orthopedic surgery, the hemoglobin (Hb) and RBC counts were decreased, but the white blood cell (WBC) counts were increased in all patients receiving whether transfusion therapy guided by TEG or CCTs. Importantly, the TEG group exhibited fewer WBC counts concomitant with higher Hb and more RBC counts than the CCT group ( P < 0.05 ). There was no significant difference on the platelet (PLT) counts between the two groups before and after orthopedic surgery ( P > 0.05 ). Significant declines on thrombin time (TT), partial activated thromboplastin time (PATT), prothrombin time (PT), and d-dimer (D-D), along with an increase on fibrinogen (FIB) were observed in two groups after surgery. The TEG group showed reduced TT, PATT, PT, D-D, and elevated FIB compared to the CCT group ( P < 0.05 ). Posttransfusion, the K value (time to reach a certain clot strength) and R value (coagulation reaction time) were decreased, the angle (α) value (clot formation rate), MA value (maximum amplitude), and CI (coagulation index) were increased in the TEG group ( P < 0.05 ). When the liver function was assessed, it was found that the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total serum bilirubin (TBIL) were increased significantly, and albumin (ALB) was decreased between the two groups after surgery, but the TEG group with lower levels of ALT, AST, and TBIL and a higher level of ALB than the CCT group ( P < 0.05 ). With regard to the renal function, two groups had increased levels of serum creatinine (Scr) and blood urea nitrogen (BUN) with a declined uric acid (UA) level after surgery; however, the patients in the TEG group had lower levels of Scr and BUN and a higher level of UA compared to the CCT group ( P < 0.05 ). In view of above data, TEG-guided transfusion therapy could reduce use of blood products, optimize blood components, and improve coagulation function for patients undergoing orthopedic surgery. TEG-guided transfusion therapy may prevent liver and renal dysfunction after orthopedic surgery.

National Survey of Neonatal Transfusion Practices: I. Red Blood Cell Therapy

PEDIATRICS ◽  
1993 ◽  
Vol 91 (3) ◽  
pp. 523-529 ◽  
Author(s):  
Gary J. Levy ◽  
Ronald G. Strauss ◽  
Heather Hume ◽  
Lynn Schloz ◽  
Mark A. Albanese ◽  
...  
Keyword(s):  
Blood Cell ◽  
Medical School ◽  
Red Blood Cell ◽  
Fresh Frozen Plasma ◽  
Teaching Hospitals ◽  
Blood Component ◽  
Transfusion Therapy ◽  
Blood Component Transfusion ◽  
Red Blood Cell Transfusions ◽  
School Affiliation

Neonatal blood component transfusion practices during 1989 were surveyed via a questionnaire developed by the Pediatric Hemotherapy Committee of the American Association of Blood Banks. Of 1790 questionnaires mailed, 452 were selected to form the database for this analysis because they were from institutions in which neonates were transfused. Nearly all institutions contained intensive care units directed by neonatologists and were involved in the management of high-risk infants. Results from institutions serving as the primary pediatric teaching hospital of a medical school were compared with those with no medical school affiliation. Thirty-six percent of primary pediatric teaching hospitals and 52% of hospitals with no medical school affiliation performed pretransfusion testing in excess of that required, resulting in additional blood loss in neonates. Sixty-six percent of primary pediatric teaching hospitals used fresh frozen plasma to adjust the hematocrit of red blood cell concentrates prior to transfusion (a practice increasing donor exposure), compared with only 29% of hospitals with no medical school affiliation. The usual indication for small-volume red blood cell transfusions in severely ill neonates was to maintain a desired hematocrit level, whereas for stable infants, red blood cell transfusions were given to treat symptomatic anemia, rather than to maintain a predetermined hematocrit. As found in 1985, neonatal transfusion practices in 1989 were variable. However, improvements have occurred since 1985 to suggest that further research and educational efforts may serve to promote even better neonatal transfusion therapy.

Survey of the degree to which critical care nurses are performing current procedural terminology-coded services

1992 ◽  
Vol 1 (2) ◽  
pp. 91-98 ◽  
Author(s):  
HM Griffith ◽  
KR Robinson
Keyword(s):  
Critical Care ◽  
Bachelor's Degree ◽  
Critical Care Nurses ◽  
Blood Component ◽  
Current Procedural Terminology ◽  
Charge Nurses ◽  
Hospital Nursing ◽  
Blood Component Transfusion ◽  
Significant Difference ◽  
Post Hoc

PURPOSE: To identify the degree to which current procedural terminology-coded services are provided by critical care nurses. Current procedural terminology codes are used by government and private insurers for reimbursement for office, home, hospital, nursing home and emergency department services. METHOD: Out of 100 randomly selected registered nurses invited to participate in this national survey, 43 completed the survey questionnaire. The majority of respondents were 18 to 40 years old, had a bachelor's degree, had practiced nursing between 5 and 10 years, and were employed as staff or charge nurses in an intensive care or emergency room setting. RESULTS: More than 70% of the group were found to perform 28 codes. The codes performed by the greatest number (42) were blood or blood component transfusion and cardiopulmonary resuscitation. One-way analysis of variance applied to the amount of supervision the nurses received while performing the codes and the educational level of the nurses revealed a significant difference between the groups. Post hoc analysis of all possible group comparisons showed that diploma-prepared nurses reported significantly more supervision than nurses having a bachelor's or master's degree. CONCLUSION: This exploratory study indicates that critical care nurses frequently perform selected codes with little or no supervision by a physician.

scholarly journals Prevention of HLA immunization with leukocyte-poor packed red cells and platelet concentrates obtained by filtration

Blood ◽  
1988 ◽  
Vol 72 (3) ◽  
pp. 964-969 ◽  
Author(s):  
G Andreu ◽  
J Dewailly ◽  
C Leberre ◽  
MC Quarre ◽  
ML Bidet ◽  
...  
Keyword(s):  
Control Group ◽  
Blood Products ◽  
Platelet Concentrates ◽  
Transfusion Therapy ◽  
Immunization Rate ◽  
Significant Difference ◽  
Poor Group ◽  
Main Component ◽  
High Level ◽  
Packed Rbcs

Abstract HLA immunization is a common complication of transfusion therapy in 30% to 60% of oncohematologic patients. Evidence shows that leukocytes present in cellular blood products are the main component involved in the occurrence of HLA immunization, and several studies showed that leukocyte-poor blood products are less able to induce it. However, leukocyte-poor platelet concentrates obtained by conventional techniques, ie, centrifugation, frequently have a high level of remaining leukocytes. Cotton wool filter Imugard IG 500 can be used to obtain leukocyte-poor cellular blood products. The technique is easy to perform, even in an emergency, and can be used with either packed RBCs or platelet concentrates. Means of 97%, 92%, and 76% elimination of leukocytes are obtained for packed RBCs, pooled standard platelet concentrates, and single-donor platelet concentrates, respectively. Patients were randomized to receive either standard (control group) or filtered (leukocyte-poor group) blood products. Of 112 randomized patients, 69 were evaluable, 35 in the control group and 34 in the leukocyte-poor group. Both groups are comparable according to age, diagnosis, sex ratio, previous transfusions, and pregnancies. There is a significant difference in regard to the HLA immunization rate (31.4% in the control v 11.7% in the leukocyte-poor group, P less than .05) and frequency of refractoriness to platelet transfusions (46.6% v 11.7%, P less than .05). We conclude that this filtration technique can be an efficient means to reduce the HLA immunization rate in polytransfused oncohematologic patients.

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