Efficacy and Safety of Whole Blood Transfusion in Non-Trauma Patients

2021 ◽  
pp. 000313482110488
Author(s):  
Alison A. Smith ◽  
Rahaf Alkhateb ◽  
Maxwell Braverman ◽  
Charles P. Shahan ◽  
Benjamin Axtman ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Gastrointestinal Bleeding ◽  
Trauma Patient ◽  
Whole Blood ◽  
Trauma Patients ◽  
Efficacy And Safety ◽  
Future Studies ◽  
Severe Hemorrhage ◽  
Common Etiology ◽  
Traumatic Hemorrhage

Whole blood (WB) transfusion for trauma patients with severe hemorrhage has demonstrated early successful outcomes compared to conventional component therapy. The objective of this study was to demonstrate WB transfusion in the non-trauma patient. Consecutive adult patients receiving WB transfusion at a single academic institution were reviewed from February 2018 to January 2020. Outcomes measured were mortality and transfusion-related reactions. A total of 237 patients who received WB were identified with 55 (23.2%) non-trauma patients. Eight patients (14.5%) received pre-hospital WB. The most common etiology of non-traumatic hemorrhage was gastrointestinal bleeding (43.6%, n = 24/55). Approximately half of the non-trauma patients (n = 28/55) received component therapy. Transfusion-related events occurred in 3 patients. This study demonstrated that non-trauma patients could receive WB transfusions safely with infrequent transfusion-related events. Future studies should focus on determining if outcomes are improved in non-trauma patients who receive WB transfusions and defining specific transfusion criteria for this population.

Recombinant Factor VIIa: An Assessment of Evidence Regarding Its Efficacy and Safety in the Off-Label Setting

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 153-159 ◽  
Author(s):  
Aaron C. Logan ◽  
Lawrence T. Goodnough
Keyword(s):  
Factor Viia ◽  
Factor Ix ◽  
Major Surgery ◽  
Trauma Patients ◽  
Efficacy And Safety ◽  
Off Label ◽  
The Us ◽  
Assessment Of Evidence ◽  
Traumatic Hemorrhage ◽  
Uncontrolled Hemorrhage

Abstract Recombinant human factor VIIa (rFVIIa) is approved by the US Food and Drug Administration for use in the setting of hemorrhage associated with factor VIII or factor IX inhibitors in patients with congenital or acquired hemophilia. This indication represents only a small number of bleeding conditions. Since it became available, rFVIIa has been increasingly used in the management of off-label indications, ranging from emergent hemostasis in traumatic hemorrhage to prophylactic hemostasis in patients undergoing major surgery. Prominent off-label indications include the management of patients with coagulopathies, such as occurs in trauma patients experiencing massive and uncontrolled hemorrhage, and in patients undergoing cardiovascular surgery with cardiopulmonary bypass. Other occasions for use occur in patients with intact coagulation systems, with nontraumatic intracranial hemorrhage being the most common in this group. Uncertainties regarding the efficacy and safety associated with use of rFVIIa in these off-label scenarios have led to evidence-based assessments of patient outcomes, including mortality, the rate of thromboembolic adverse events, and posttreatment functional status. We review the evidence regarding the efficacy and safety of this important, but controversial, hemostatic agent in the off-label setting.

scholarly journals Transfusion Strategies in the Pre-Hospital Setting: Evaluating the Logistical Benefits of Pre-Hospital Whole Blood Transfusion, and a National Survey of Pre-Hospital Blood Transfusion

2021 ◽  
Author(s):  
Harriet Tucker ◽  
Laura Green ◽  
Karim Brohi ◽  
Rebecca Cardigan ◽  
Ross Davenport ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
National Survey ◽  
Whole Blood ◽  
Hospital Setting ◽  
Flow Time ◽  
Transfusion Practice ◽  
Blood Component ◽  
Trauma Patients ◽  
Time Analysis ◽  
Blood Component Transfusion

Abstract BackgroundPre-hospital blood component transfusion poses logistical challenges. Current patterns of pre-hospital blood use across the UK are not known. A potential benefit of providing a single combined component of whole blood is reduced need for multiple steps of administering separate components and more efficient use of time and resources by medical staff. .Objectivesto undertake a detailed time-analysis of the steps of pre-hospital combined component transfusion against separate blood component transfusion, and to determine current UK pre-hospital transfusion practice and users’ optimal pre-hospital transfusion strategyMethodsA three-arm cross-over major haemorrhage simulation study compared: flow-time (time from decision-to-transfuse [DTT] to complete transfusion); touch-time (direct team ’hands on’ contact time with transfusion process); and number of steps, people and equipment required for transfusion of 2 units of RCP [arm-A], 2 RBC + 2 TP [arm-B] or RBC + 2 Lyoplas [arm-C]). A national survey of current and optimal pre-hospital transfusion strategies was sent to 22 UK Air Ambulance Services (AAS) and 27 Major Trauma Centres (MTC) in December 2019. ResultsThe simulation demonstrated that arm-A had a shorter flow-time (median 6min 31sec vs. 12min 20 sec, vs 16min 29 sec) and touch-time (median 2min 31 seconds vs. 5min 21sec vs. 15min 3sec) than arm-B and arm-C respectively, and required fewer steps, equipment and checks. 18 MTCs and 18 AAS responded to the national survey (response rates of 67 and 82%). 10 transfused RBC/plasma (5 TP/5 Lyoplas), 4 RBC only, 2 Lyoplas only, 1 RBC/Lyoplas/Fibrinogen, and 1 ’red cell and plasma’ (only available at one hospital site). 89% replied that a combined component transfusion would be desirable, as it would reduce patient mortality (83%) and tasks on scene (75%). ConclusionThe time-analysis established the benefits for combined pre-hospital component transfusion in trauma patients. The national survey demonstrates the variation in current pre-hospital transfusion practice and reiterates that combined component transfusion pre-hospital may have logistical advantages over separate components.

Initial safety and feasibility of cold-stored uncrossmatched whole blood transfusion in civilian trauma patients

2016 ◽  
Vol 81 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Mark H. Yazer ◽  
Byron Jackson ◽  
Jason L. Sperry ◽  
Louis Alarcon ◽  
Darrell J. Triulzi ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Whole Blood ◽  
Trauma Patients ◽  
Civilian Trauma

Pathologic Fibrinolysis is More Common in a Rural Trauma Setting

2020 ◽  
pp. 000313482097372
Author(s):  
James M. Bardes ◽  
Daniel J. Grabo ◽  
Sijin Wen ◽  
Alison Wilson
Keyword(s):  
Trauma Team ◽  
Rural Environment ◽  
Trauma Patients ◽  
Future Studies ◽  
Factors Influencing ◽  
American College Of Surgeons ◽  
Level 1 ◽  
Transferred Patients ◽  
Prehospital Time ◽  
Level 1 Trauma Center

Introduction Fibrinolysis (lysis) has been extensively studied in trauma patients. Many studies on the distribution of lysis phenotype have been conducted in setting with short prehospital time. This study aimed to evaluate the distribution of lysis phenotypes in a population with prolonged prehospital times in a rural environment. Methods A retrospective study was performed at an American College of Surgeons-verified level 1 trauma center, serving a large rural population. Full trauma team activations from January 1, 2017 to August 31, 2018 were evaluated, and all patients with an ISS>15 analyzed. Thromboelastography was routinely performed on all participants on arrival. Lysis phenotypes were classified based on LY30 results: shutdown (≤.8%), physiologic (.9-2.9%), and hyper (>2.9%). Results 259 patients were evaluated, 134 (52%) presented direct from the scene. For scene patients, lysis distribution was 24% physiologic, 49% shutdown, and 27% hyper. Transferred patients demonstrated a reduction in physiologic lysis to 14% ( P = .03), shutdown present in 66%, and hyper in 20%. Empiric prehospital tranexamic acid was given to 18 patients, physiologic lysis was present in 6%, shutdown 72%, and hyper 22%; this increase was not statistically significant ( P = .5). Conclusion Fibrinolysis phenotypes are not consistent across all trauma populations. This study showed rural trauma patients had a significantly increased rate of pathologic lysis. This was consistent for scene and transfer patients who received care at another facility prior to arrival for definitive care. Future studies to evaluate the factors influencing these differences are warranted.

Does Gender Matter: A Multi-Institutional Analysis of Viscoelastic Profiles for 1565 Trauma Patients With Severe Hemorrhage

2021 ◽  
pp. 000313482110335
Author(s):  
Alison Smith ◽  
Juan Duchesne ◽  
Matthew Marturano ◽  
Shaun Lawicki ◽  
Kevin Sexton ◽  
...  
Keyword(s):  
Alpha Angle ◽  
Reaction Times ◽  
Maximum Amplitude ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Survival Difference ◽  
Severe Hemorrhage ◽  
Male Patients ◽  
Level I ◽  
Clot Formation Time

Background Viscoelastic tests including thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are being used in patients with severe hemorrhage at trauma centers to guide resuscitation. Several recent studies demonstrated hypercoagulability in female trauma patients that was associated with a survival advantage. The objective of our study was to elucidate the effects of gender differences in TEG/ROTEM values on survival in trauma patients with severe hemorrhage. Methods A retrospective review of consecutive adult patients receiving massive transfusion protocol (MTP) at 7 Level I trauma centers was performed from 2013 to 2018. Data were stratified by gender and then further examined by TEG or ROTEM parameters. Results were analyzed using univariate and multi-variate analyses. Results A total of 1565 patients were included with 70.9% male gender (n = 1110/1565). Female trauma patients were older than male patients (43.5 ± .9 vs 41.1 ± .6 years, P = .01). On TEG, females had longer reaction times (6.1 ± .9 min vs 4.8 ± .2 min, P = .03), increased alpha angle (68.6 ± .8 vs 65.7 ± .4, P < .001), and higher maximum amplitude (59.8 ± .8 vs 56.3 ± .4, P < .001). On ROTEM, females had significantly longer clot time (99.2 ± 13.7 vs 75.1 ± 2.6 sec, P = .09) and clot formation time (153.6 ± 10.6 sec vs 106.9 ± 3.8 sec, P < .001). When comparing by gender, no difference for in-hospital mortality was found for patients in the TEG or ROTEM group ( P > .05). Multivariate analysis showed no survival difference for female patients (OR 1.11, 95% CI .83-1.50, P = .48). Conclusions Although a difference between male and females was found on TEG/ROTEM for certain clotting parameters, no difference in mortality was observed. Prospective multi-institutional studies are needed.

An Analysis of Patients Dead on Arrival in the American College of Surgeons Trauma Quality Program Participant Use File Data Set

2021 ◽  
pp. 000313482110110
Author(s):  
Adel Elkbuli ◽  
Scott Rowe ◽  
Shahm Raslan ◽  
Aleeza Ali ◽  
Brad Boserup ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Patient Outcomes ◽  
Motor Vehicle ◽  
Trauma Patients ◽  
Data Set ◽  
Program Participant ◽  
Quality Program ◽  
Field Triage ◽  
American College Of Surgeons ◽  
Mode Of Transportation

Background Trauma patient care begins on-scene as field triage and mode of transportation are determinants of patient outcomes. This study evaluates the US national patterns of dead on arrival (DOA) among the trauma population. Methods A cross-sectional review of the American College of Surgeons (ACS) Trauma Quality Program Participant Use File (TQP-PUF) data set (2013-2017) was performed. Trauma patients reported as DOA were stratified by ISS into low (<15), intermediate (15-24), or high (≥25) severity. Each group was then subdivided by patient demographics, mechanism, type of injury, and mode of transportation. Results Of the 4 336 816 injury cases in the TQP-PUF data set, 33 199 were DOA (.77%). 77.1% (25 604/33 199) of DOAs were male. In the low-ISS group, .36% (13 272/3 639 811) were DOA; in the intermediate-ISS group, 1.2% (4868/421 994) were DOA; and in the high-ISS group, 5.5% (15 059/275 011) were DOA. Motor vehicle collisions (MVCs) (11 262) and firearms (8894) were the most common injury types, equating to 60.7% of DOAs. Falls accounted for 9.1% of all DOAs. The most common DOA age-group was 18-64 years, followed by ≥65 years. Conclusion DOA trauma patients are predominately adult men suffering fatal blunt force injuries most frequently via MVC. DOAs are caused by all ranges of injury severity. We recommend further development of prevention programs thereby reducing the prevalence of common traumatic injuries, notably MVC, falls, and firearms to improve survival. Future studies should also investigate the access to and distribution of trauma centers and the role of helicopter, ground, and police transport modalities and transport time on and reducing DOAs and improving trauma patient outcomes.

scholarly journals Preemptive intravenous iron therapy versus autologous whole blood therapy for early postoperative hemoglobin level in patients undergoing bimaxillary orthognathic surgery: a prospective randomized noninferiority trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Min Suk Chae ◽  
Mihyun Lee ◽  
Min Ho Choi ◽  
Je Uk Park ◽  
Misun Park ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Group ◽  
Whole Blood ◽  
Orthognathic Surgery ◽  
Hemoglobin Level ◽  
Iron Therapy ◽  
Iron Group ◽  
Autologous Whole Blood ◽  
Bimaxillary Orthognathic Surgery ◽  
Iv Iron

Abstract Background Previous studies have reported the efficacy and safety of intravenous (IV) iron therapy during the perioperative period as an alternative and adjunct to allogeneic blood transfusion. Preemptive IV iron therapy provides noninferior hemoglobin levels on postoperative day (POD) 1 compared to autologous whole blood therapy (AWBT) in healthy patients who had undergone bimaxillary orthognathic surgery. Methods This was a prospective, patient-randomized, noninferiority trial. After excluding 2 patients, 64 patients were divided into two groups: the IV iron therapy group (patients received IV iron infusion 4 weeks before surgery; n = 32) and the AWBT group (2 units of autologous whole blood were collected 4 and 2 weeks before surgery; n = 32). The primary outcome was hemoglobin level on POD 1 and the prespecified noninferiority limit was − 1 g/dL. Results Baseline data were comparable, including hemoglobin and iron levels, between the two groups. Immediately before surgery, the levels of hemoglobin, iron, and ferritin were higher in the IV iron group than in the AWBT group. The mean treatment difference (iron group—whole blood group) in hemoglobin level on POD 1 between the two groups was 0.09 (95% CI = − 0.83 to 1.0). As the lower limit of the 95% CI (− 0.83) was higher than the prespecified noninferiority margin (δ = − 1), noninferiority was established. On POD 2, the hemoglobin level became lower in the iron group, which eventually led to greater requirement of allogeneic blood transfusion compared to the whole blood group. However, the iron group did not require allogeneic blood transfusion during or early after surgery, and the whole blood group showed continuously higher incidence of overt iron deficiency compared to the iron group. Conclusion As collection of autologous whole blood caused overt iron loss and anemia before surgery and intraoperative transfusion of whole blood was not able to prevent the occurrence of persistent iron deficiency after surgery, IV iron therapy was found to have potential benefits for iron homeostasis and subsequent erythropoiesis in healthy patients early after bimaxillary orthognathic surgery. Trial registration: Clinical Research Information Service, Republic of Korea, approval number: KCT0003680 on March 27, 2019. https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=15769&sLeft=2&ltype=my&rtype=my.

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