Red blood cell transfusion requirements for patients on extracorporeal membrane oxygenation

Perfusion ◽  
2021 ◽  
pp. 026765912199894
Author(s):  
Min H Choi ◽  
Nkosi H Alvarez ◽  
Brian M Till ◽  
Yevgeniy Tsypin ◽  
Bailey Sparks ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Blood Cell ◽  
Extracorporeal Membrane Oxygenation ◽  
Red Blood Cell ◽  
Transfusion Requirement ◽  
Bleeding Complications ◽  
Transfusion Requirements ◽  
Group A ◽  
Group B ◽  
Vv Ecmo

Background: Extracorporeal membrane oxygenation (ECMO) is a rescue procedure used for cardiac and pulmonary dysfunction. Patients on ECMO often require blood transfusions to maintain oxygen delivery and recover from bleeding complications. Goals of the current study were to determine transfusion requirements while on ECMO, and incidence and transfusion requirements for bleeding complications. Methods: Packed red blood cell (PRBC) transfusions and bleeding complications were identified by retrospective chart review of patients on ECMO from 2010 to 2018 at our institution. Patients were categorized into those who did not bleed (group A) and those who bled (group B). Incidence, sites of bleed, and transfusion requirement for each bleeding were analyzed. Results: Among 217 patients including veno-arterial (VA) ( n = 148) and veno-venous (VV) ( n = 69) ECMO, we identified 62 patients without bleeding complications (group A) and 155 patients with bleeding complications (group B). In group A, transfusion requirement was 0.6 PRBC/day for VA-ECMO ( n = 42) and 0.2 PRBC/day for VV-ECMO ( n = 20) (p = 0.0015). In group B, number of PRBC given per event per day for bleeding complications during ECMO was mediastinal/thoracic bleed (83 events, 4.7 PRBC/event/day), gastrointestinal bleed (59 events, 4.8 PRBC/event/day), cannulation site bleed (88 events, 3.6 PRBC/event/day), and nasopharyngeal bleed (103 events, 2.8 PRBC/event/day). Thirty-day hospital mortality rate was co-related to transfusion requirement (area under ROC curve: 0.70). Conclusion: Patients without clinical bleeding still required transfusion, with higher rates observed with VA- than VV-ECMO. Transfusion requirements dramatically increased when patients developed various bleeding complications and had a significant impact on 30-day mortality rate.

scholarly journals Safety and Cost Effectiveness of a 10 × 109/L Trigger for Prophylactic Platelet Transfusions Compared With the Traditional 20 × 109/L Trigger: A Prospective Comparative Trial in 105 Patients With Acute Myeloid Leukemia

Blood ◽  
1998 ◽  
Vol 91 (10) ◽  
pp. 3601-3606 ◽  
Author(s):  
Hannes Wandt ◽  
Markus Frank ◽  
Gerhard Ehninger ◽  
Christiane Schneider ◽  
Norbert Brack ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Myeloid Leukemia ◽  
Platelet Transfusion ◽  
Bleeding Complications ◽  
Group A ◽  
Red Blood Cell Transfusions ◽  
Group B ◽  
Acute Myeloid

Abstract In 105 consecutive patients with de novo acute myeloid leukemia (French-American-British M3 excluded), we compared prospectively the risk of bleeding complications, the number of platelet and red blood cell transfusions administered, and the costs of transfusions using two different prophylactic platelet transfusion protocols. Two hundred sixteen cycles of induction or consolidation chemotherapy and 3,843 days of thrombocytopenia less than 25 × 109/L were evaluated. At the start of the study, each of the 17 participating centers decided whether they would use a 10 × 109/L prophylactic platelet transfusion trigger (group A/8 centers) or a 20 × 109/L trigger (group B/9 centers). Bleeding complications (World Health Organization grade 2-4) during treatment cycles were comparable in the two groups: 20 of 110 (18%) in group A and 18 of 106 (17%) in group B (P = .8). Serious bleeding events (grade 3-4) were generally not related to the patient's platelet count but were the consequence of local lesions and plasma coagulation factor deficiencies due to sepsis. Eighty-six percent of the serious bleeding episodes occurred during induction chemotherapy. No patient died of a bleeding complication. There were no significant differences in the number of red blood cell transfusions administered between the two groups, but there were significant differences in the number of platelet transfusions administered per treatment cycle: pooled random donor platelet concentrates averaged 15.4 versus 25.4 (P < .01) and apheresis platelets averaged 3.0 versus 4.8 (P < .05) for group A versus group B, respectively. This resulted in the cost of platelet therapy being one third lower in group A compared with group B without any associated increase in bleeding risk.

scholarly journals Safety and Cost Effectiveness of a 10 × 109/L Trigger for Prophylactic Platelet Transfusions Compared With the Traditional 20 × 109/L Trigger: A Prospective Comparative Trial in 105 Patients With Acute Myeloid Leukemia

Blood ◽  
1998 ◽  
Vol 91 (10) ◽  
pp. 3601-3606 ◽  
Author(s):  
Hannes Wandt ◽  
Markus Frank ◽  
Gerhard Ehninger ◽  
Christiane Schneider ◽  
Norbert Brack ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Myeloid Leukemia ◽  
Platelet Transfusion ◽  
Bleeding Complications ◽  
Group A ◽  
Red Blood Cell Transfusions ◽  
Group B ◽  
Acute Myeloid

In 105 consecutive patients with de novo acute myeloid leukemia (French-American-British M3 excluded), we compared prospectively the risk of bleeding complications, the number of platelet and red blood cell transfusions administered, and the costs of transfusions using two different prophylactic platelet transfusion protocols. Two hundred sixteen cycles of induction or consolidation chemotherapy and 3,843 days of thrombocytopenia less than 25 × 109/L were evaluated. At the start of the study, each of the 17 participating centers decided whether they would use a 10 × 109/L prophylactic platelet transfusion trigger (group A/8 centers) or a 20 × 109/L trigger (group B/9 centers). Bleeding complications (World Health Organization grade 2-4) during treatment cycles were comparable in the two groups: 20 of 110 (18%) in group A and 18 of 106 (17%) in group B (P = .8). Serious bleeding events (grade 3-4) were generally not related to the patient's platelet count but were the consequence of local lesions and plasma coagulation factor deficiencies due to sepsis. Eighty-six percent of the serious bleeding episodes occurred during induction chemotherapy. No patient died of a bleeding complication. There were no significant differences in the number of red blood cell transfusions administered between the two groups, but there were significant differences in the number of platelet transfusions administered per treatment cycle: pooled random donor platelet concentrates averaged 15.4 versus 25.4 (P < .01) and apheresis platelets averaged 3.0 versus 4.8 (P < .05) for group A versus group B, respectively. This resulted in the cost of platelet therapy being one third lower in group A compared with group B without any associated increase in bleeding risk.

scholarly journals Per-operative Advantages of Transanal Endorectal Pull Through (TERPT) Over Swenson’s Procedure in the Surgical Treatment of Rectosigmoid Hirschsprung’s Disease (HD)

1970 ◽  
pp. 16-20
Author(s):  
Abu Saleh Md Waliullah ◽  
Shoheli Alam ◽  
MA Aziz ◽  
AR Khan
Keyword(s):  
Blood Loss ◽  
Transfusion Requirement ◽  
Control Group ◽  
Operative Duration ◽  
Transfusion Requirements ◽  
Study Results ◽  
Group A ◽  
Pull Through ◽  
Group B ◽  
A Prospective Study

Introduction: Popular Swenson's pull through (1948) is still the most commonly practiced 'Gold Standard' of operative treatment for rectosigmoid hirschsprung's disease (HD). But minimally invasive transanal endorectal pull through (TERPT) is now being increasingly practiced worldwide for its treatment in many centers. Here we are describing our comparative experience between TERPT and Swenson's pull through, at Dhaka Shishu Hospital to show the per-operative advantages of the former over the latter. Materials and methods: It is a prospective study at Dhaka Shishu Hospital during January 2000 to December 2001 in 32 (age, body weight and resected Rectosigmoid length matched) biopsy confirmed patients of HD divided into two Groups: Gr. A (na = 16) and Gr. B (nb = 16) patients who underwent TERPT and Swenson's pull through respectively. Unpaired 't' and χ2 (with Yate's correction) tests were used for statistical analysis whereas operative duration, volume of blood loss and transfusion requirements were used as parameters of the study. Results: For study Group A (TERPT) - operative time, volume of blood loss and transfusion requirement were significantly lesser (P < 0.01, P < 0.001 and P < 0.001 respectively) than the control Group B (Swenson's procedure). Conclusions: Through this small comparative study, TERPT was found to be more advantageous than the Swenson's pull through procedure in terms of operative duration, blood loss and transfusion requirement. Key words: TERPT; Swenson's; Compare. DOI: 10.3329/bjch.v31i1.6068 Bangladesh Journal of Child Health 2007; Vol.31(1-3): 12-15

Transfusion Requirements in Nonmyeloablative Allogeneic Stem Cell Transplantation for Hematologic Malignancies.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4178-4178
Author(s):  
Jason W. Brown ◽  
Darrell J. Triulzi
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Platelet Transfusion ◽  
Transfusion Requirement ◽  
Hematologic Malignancies ◽  
Packed Red Blood Cells ◽  
Transfusion Requirements ◽  
Cell Transplants

Abstract Nonmyeloablative allogeneic stem cell transplants (NM-ASCT) are increasingly being utilized to treat hematologic malignancies in settings where high dose, fully ablative regimens would not be tolerated. We identified 10 male and 13 female patients (n=23) ranging in age from 19 to 63 years old (mean=48) representing all patients whom had undergone NM-ASCT in the last five years. NM-ASCT were performed for acute myelogenous leukemia (n=7), non-Hodgkin’s lymphoma (n=6), Hodgkin’s disease (n=4), multiple myeloma (n=3), myelodysplastic syndrome (n=2), and acute lymphoblastic leukemia (n=1). The majority of patients had undergone at least one previous stem cell transplant (n=16). The mean number of stem cells infused per kilogram at time of transplant was 4.72 X 106 ±1.97 X 106 stem cells and mean time to engraftment was 15.8 ±5.15 days (3 consecutive days with ANC &gt;500). All of the subjects required both platelet and red cell transfusion during the period of analysis. Mean transfusion requirements in the 7 days prior to transplantation were 3.1 ±5.9 units of platelets and 1.2 ±1.5 units of packed red blood cells. Mean platelet transfusion requirements 90 days post transplant were 73.7 ±79.7 units and mean red cell requirements 11.6 ±8.3 units. Total mean transfusion requirements during the time period analyzed were 76.9 ±82.2 units of platelets and 12.8 ±8.9 units of packed red blood cells. There was no significant correlation between the number of stem cells infused per kilogram on day of transplant, the number of previous transplants, or the time to engraftment with red blood cell or platelet transfusion requirements. Our data illustrate a higher proportion of patients requiring platelet transfusions (100% vs. 23%) and red blood cell transfusions (100% vs. 63%) as well as a higher platelet transfusion requirement (median 48 vs. 0 units) and packed red blood cell transfusion requirement (median 11 vs. 2 units) than other authors have reported in a 60 day period in HLA-matched sibling NM-ASCT [Weissinger et al. Blood 98(13):3584-8, 2001]. As is illustrated by the percentage of patients undergoing previous fully ablative stem cell transplants, our patients represent a heavily pretreated population and this may account for the higher transfusion requirements seen in this analysis. Although patients undergoing NM-ASCT receive reduced intensity therapy, in our analysis their transfusion requirements remain substantial.

scholarly journals An in vivo assessment of the use of Haematopan B12 in the treatment of experimentally induced anaemia in domestic rabbits.

2021 ◽  
Vol 32 (2) ◽  
pp. 301-307
Author(s):  
A. A. Adedapo ◽  
A. B. Saba ◽  
O.A. Dina
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Study Group ◽  
Group A ◽  
Domestic Rabbits ◽  
Group B ◽  
Hb Concentration ◽  
In Vivo Assessment ◽  
Rbc Count

A total of 15 domestic rabbits divided into 3 groups of 5 animals per group were used in this study Group A animals (control) were not bled but those in groups B and C were bled to induce anaemia. Group B were left to recover by normal haemopoiesis while those in group C were treated with Hematopan B12*, a commercially prepared haematinic. The post-bleeding treatment haematologic values were obtained at given intervals (7 days) and compared with the pre-bleeding values earlier obtained. The result of this study showed that the group B animals recovered gradually by physiologic haemopoeisis while animals in group C showed accelerated recovery since these animals had a better and faster response in terms of white blood cell (WBC), red blood cell (RBC) count and haemoglobin (Hb) concentration. Thus Haematopan B12 is an effective haematinic. 

Early vs. late treatment with darbepoetin alfa in patients with genitourinary tumors during chemotherapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18583-18583
Author(s):  
K. Elandt ◽  
P. Horak ◽  
K. C. Schieder ◽  
R. Leikermoser ◽  
R. Altmann ◽  
...  
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Early Treatment ◽  
Darbepoetin Alfa ◽  
Red Blood Cell Transfusion ◽  
Rank Test ◽  
Late Treatment ◽  
Group A ◽  
The Mean ◽  
Group B

18583 Background: Anemia is a common complication in patients who receive anticancer therapy. We evaluated the efficacy of darbepoetin alfa in early vs. late treatment in patients with genitourinary tumors undergoing chemotherapy. We wanted to investigate whether an early onset of treatment with darbepoetin alfa reduces frequency of red blood cell transfusion and increases patients’ QoL. Methods: Patients on chemotherapeutic treatment for a urogenital neoplasia and a hemoglobin between 10–12 g/dl were randomized between an immediate start of treatment with darbepoetin alfa 150 μg sc weekly (group A) and a Hb below 10 g/dl or clinical symptoms (group B). Results: 52 patients out of 68 (76.5%) completed the trial, 7/40 patients (17%) in group A and 9/28 patients (32%) in group B withdraw from the study. An intent to treat analysis was performed and showed a significant superiority (p = 0.023, log-rank test) for the early treatment. In group A, only 12.5% of patients (5/40) received at least one red blood cell transfusion compared to group B, where 39% of the patients (11/28) received a transfusion. In group A the mean Hb level increased steadily, starting with a baseline value of 11.0 g/dl. In week 21 a mean Hb level of 12.8 g/dl was reached, resulting in an overall increase in Hb of 1.8 g/dl. In group B, which had a comparable baseline Hb level of 10.9 g/dl, the mean Hb value decreased initially during the first 4 weeks to 10.0 g/dl. In week 21 a level of 11.4 g/dl was reached, resulting in a total Hb-increase of 0.5 g/dl. When anemia treatment was initiated early, the mean Hb level always remained in the range of 11 to 13 g/dl from the beginning of the study, in the B group the mean level of 11 g/dl was first achieved after 12 weeks. 35% in group A compared to 54% in group B (p = 0.13) experienced a dose doubling. The mean values (EORTC-QLQ-C30) of all symptom scales in group A were markedly below those in group B with the highest difference for dyspnea, 29.1 points (p < 0.001). Conclusions: Early treatment with darbepoetin alfa in patients with urogenital cancer results in optimal hemoglobin levels according to EORTC guidelines and consequently in a reduction of red blood cells transfusion. Furthermore, in patients with earlier initiation of treatment a clinically significant improvement of dyspnea can be observed. [Table: see text]

Evaluation of the Sepacell RS-2000® (LeukoConnect) Sterile Dock Leukocyte Reduction Filter Set with Red Blood Cells Collected using Trima.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4113-4113
Author(s):  
Sandy C. Campbell ◽  
Jennifer E. Mauldin ◽  
Kristy L. McShan ◽  
M. Dean Elfath
Keyword(s):  
Blood Cell ◽  
Ambient Temperature ◽  
Red Blood Cell ◽  
Limit Of Detection ◽  
Hold Time ◽  
Additional Time ◽  
Filtration Time ◽  
Group A ◽  
Filtration Condition ◽  
Group B

Abstract As automated red blood cell (RBC) collections become more prevalent, sterile dock filtration will continue to be an important means of leukoreduction (LR). This study evaluated the performance of the Baxter Sepacell RS-2000 sterile dock leukocyte reduction filter set with RBCs collected using Trima, which were filtered either immediately at ambient temperature, or refrigerated and then filtered 6–8 or 68–72 hours post-collection. 180 RBC units were collected using Trima (Gambro BCT, Lakewood, CO) and filtered with the Sepacell RS-2000 (Baxter Healthcare, Deerfield, IL). Units within Group A (n=60) were filtered at ambient temperature immediately after collection. Units within Group B (n=60) and C (n=60) were refrigerated and filtered at 6–8 or 68–72 hours post-collection respectively. Pre- and Post-filtration hematocrits were performed on the Cell-Dyn 3700 (Abbott Laboratories, Abbott Park, IL) to determine RBC percent recovery. Residual leukocytes in the final product were counted using either the FACSCalibur flow cytometer (BD Biosciences, San Jose, CA). Relevant data is presented in Table 1 below. This study demonstrated that the Sepacell RS-2000 (LeukoConnect) sterile dock filter yielded red cell units that met or exceeded the FDA and AABB standards for leukoreduction when filtering refrigerated red blood cell (RBC) units collected on Trima at 6–8 or 68–72 hours post-collection. 60 out of 60 (100%) LR-RBC units in Groups B and C contained residual white blood cell (WBC) counts at or below the limit of detection of 0.3 x 105. 55 of 60 (92%) LR-RBC units in Group A contained residual WBC &lt; 5x106. 38 of 60 (63 %) LR-RBC units within this group contained residual WBC = 1x106. The hold-time prior to ambient filtration for Group A averaged 1:37 ± 0:18. Filtration was initiated &lt; 3 hours post-collection for all units within this group. There is speculation that a correlation may exist between the temperature of the unit at the time of filtration and leukocyte reduction performance for this filtration condition. This correlation was not assessed by this study and warrants further investigation. It was also noted that 11 out of 180 total units (6%) achieved RBC recovery results slightly less than 85%. Unexpected variability in volume recovery for these units can be attributed to inadequate drainage time of the filter. Allowing additional time for complete drainage of the filter would be expected to result in all units achieving &gt; 85% recovery. Table 1 Parameters Group A Group B Group C Mean ± SD (n=60) (n=60) (n=60) Storage & Filtration Condition Ambient (&lt; 3hrs) 1–6°C (6–8hrs) 1–6°C (68–72hrs) Filtration Time (min) 11 ± 1 24 ± 5 27 ± 6 Residual WBC count (1x106) 1.81 ± 3.33 0.30 ± 0.00 0.30 ± 0.00 % RBC Recovery 88 ± 2 87 ± 2 88 ± 2

Red Blood Cell Variables in Young and Mature High-Trained Football Players

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3749-3749
Author(s):  
Janet G. Grudeva ◽  
Nickolay Boyadjiev ◽  
Zdravko Taralov ◽  
Ilia Batashki
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
Red Blood Cell ◽  
Football Players ◽  
Working Capacity ◽  
Blood Cell Count ◽  
Corpuscular Haemoglobin ◽  
Group A ◽  
Mean Corpuscular Haemoglobin ◽  
Group B

Abstract A suboptimal values of the haematological variables has often been recorded in young athletes involved in intense physical activity. There have even been reports of “sports anemia” associated with intensive physical training. There are profound studies describing the haematological changes of the soccer players after training or 90 min match. Our previous studies demonstrated lower values of red blood cell count (RBC), packed cell volume (HCT), haemoglobin concentration (HGB) in highly trained football players than in untrained controls of the same pubescent age. THE AIM: It was a matter of interest to evaluate the haematological status of 2314 football players (15.11±2.89 yrs old) and to compare the results for pre-pubescent, pubescent and mature boys recruited in the study and also to relate the values obtained to the individulal aerobic functional capacity. MATERIAS: A total of 2314 highly trained football players were included in the study. Their mean±SD age, weight, and BMI were: 15.11±2.89 yrs, 56.33±13.28 kg, and 19.62±2.58 kg/m2. The sportsmen were divided into three groups in accordance with their age: pre-pubescent (9–14 years) group A (n=1178) − 13.22±1.05 yrs (158.6±12.6 months); pubescent (15–19 years) group B (n=1029) − 16.57±1.04 yrs (198.9±12.6 months); and mature (20–35 years) group C (n=107) − 24.30±3.78 yrs (291.6±45.3 months) old. Profound clinical examination of all sportsmen was performed at the day before obtaining the blood samples. Haematological variables including RBC, HCT, HGB, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin content (MCHC), white blood cell count (WBC) and platelet count (PLT) were analysed on a Sysmex K800 (Japan) analyser. Each football player passed also PWC170-test for assessment the working capacity on AT-104 Spiro-Ergo equipment (Schiller, Switzerland). RESULTS: All haematological variables in the groups were found in normal ranges, but the RBC was highest in group B (5.17±0.28 *1012/l vs. 5.03±0.28 *1012/l for group A, and 5.08±0.41 *1012/l for group C). Group A demonstrated not only lowest values for the RBC, but also for the HGB (144.7±6.4 g/l vs. 149.1±6.0 g/l for group B, and 151.8±7.5 g/l for group C, P&lt;0.001), and for HCT (0.437±0.02 vs. 0.451±0.02 for group B, and 0.451±0.03 for group C, P&lt;0.001). Group A demonstrated similar values for the above basic red blood cell parameters to these measured for great male group of same age. The pre-pubescent football players (group A) had lower MCV (87.1±2.8 fl), than the players of group B (87.5±2.9 fl) and than the players from group C (88.1±3.0 fl). No evidences for blood dilution as a result of long-term training had been found in groups B and C. There was not difference in the WBC and PLT between pre-pubescent, pubescent and mature footballers. The mature players (C-group) demonstrated higher PWC/kg than pre-pubescent (20.6±2.3 vs. 19.2±2.3 kgm/min/kg), and than pubescent boys (19.8±2.7 kgm/min/kg). Significant correlations were obtained between the age and HGB, and between the age and HCT in groups A (0.19 and 0.19 respectively) and B (0.24 and 0.15 respectively). Good correlations were found between RBC and PWC170/kg in all groups investigated. CONCLUSIONS: Pre-pubescent highly trained football players have lower values of the red blood cell variables than pubescent and mature footballers, which correlates with lower aerobic working capacity.

Hemoglobin trigger and approach to red blood cell transfusions during veno-venous extracorporeal membrane oxygenation: the international TRAIN-ECMO survey

Perfusion ◽  
2019 ◽  
Vol 34 (1_suppl) ◽  
pp. 39-48 ◽  
Author(s):  
Gennaro Martucci ◽  
Giacomo Grasselli ◽  
Kenichi Tanaka ◽  
Fabio Tuzzolino ◽  
Giovanna Panarello ◽  
...  
Keyword(s):  
Blood Cell ◽  
Extracorporeal Membrane Oxygenation ◽  
Critically Ill ◽  
Red Blood Cell ◽  
Critically Ill Patients ◽  
Transfusion Practice ◽  
Red Blood Cell Transfusion ◽  
Case Volume ◽  
Membrane Oxygenation ◽  
Vv Ecmo

Introduction: Optimal red blood cell transfusion practice during veno-venous extracorporeal membrane oxygenation (VV ECMO) is still under debate. This survey aimed to assess the Hb trigger (also comparing with other critically ill patients) and major physiologic determinants considered for transfusions during veno-venous extracorporeal membrane oxygenation. Methods: Voluntary Web-based survey, endorsed by the European Society of Intensive Care Medicine, conducted among VV ECMO pratictioners worldwide. Results: A total of 447 respondents worldwide answered the questionnaire: 277 (61.9%) from Europe, 99 (22.1%) from North America, 36 (8.2%) from Asia and Oceania, and 35 (7.8%) from Central and South America. Among the respondents, 59.2% managed less than 12 venous extracorporeal membrane oxygenation runs/year, 19.4% between 12 and 24 runs/year, and 21.4% more than 24 runs/year. Of the respondents, 54.4% do not use a predefined Hb trigger in veno-venous extracorporeal membrane oxygenation, and, while the rate of adoption of a defined trigger varied worldwide, the effective value of Hb did not differ significantly among macro-regions. In patients on veno-venous extracorporeal membrane oxygenation, the Hb trigger to initiate red blood cell transfusion, was higher than in other critically ill patients: 9.1 ± 1.8 g/dL versus 8.3 ± 1.7 g/dL, p < 0.01. The Hb trigger was lower in centers with more than 24 venous extracorporeal membrane oxygenation runs/year (8.4 mg/dL (95% CI: 7.7-8.9)); (8.9 mg/dL (95% CI: 8.2-9.7)) in centers with between 12 and 24 venous extracorporeal membrane oxygenation runs/year; and (9.6 mg/dL (95% CI: 9.1-10.0)) in centers with fewer than 12 venous extracorporeal membrane oxygenation runs/year (p < 0.01). Several and variable adjunctive parameters are considered in cases of uncertainty for transfusion: the principal are hemodynamic status, SvO2, lactates, and fluid balance. Conclusion: Although the use of a predefined Hb trigger is still under-adopted among centers with low or median extracorporeal membrane oxygenation case volume, the majority of respondents use a higher Hb trigger for veno-venous extracorporeal membrane oxygenation patients compared with other critically ill patients. Higher volume centers tolerate lower Hb levels.

scholarly journals Atypical Evolution of Secondary Hemolytic Uremic Syndrome Defined as Paraneoplastic Syndrome under Eculizumab and Palbociclib Therapies

2021 ◽  
Vol 14 (1) ◽  
pp. 676-680
Author(s):  
Quentin Perrier ◽  
Johan Noble ◽  
Steven Grangé ◽  
Pierrick Bedouch ◽  
Rachel Tetaz ◽  
...  
Keyword(s):  
Blood Cell ◽  
Hemolytic Uremic Syndrome ◽  
Red Blood Cell ◽  
Transfusion Requirement ◽  
Breast Adenocarcinoma ◽  
Slight Reduction ◽  
Dramatic Reduction ◽  
Line Therapy ◽  
Good Clinical Condition ◽  
Uremic Syndrome

Thrombotic microangiopathy (TMA) is most of the time caused by thrombotic thrombocytopenic purpura or hemolytic uremic syndrome. A 60-year-old female was diagnosed in 2014 with mammary breast adenocarcinoma treated by several-line therapy: mastectomy, docetaxel, cyclophosphamide, radiotherapy, doxorubicine, and capecitabine. By mid-November, the patient was admitted to the hospital with regenerative, mechanical, and hemolytic anemia, schistocytes at 3%, and thrombopenia (99 G/L), associated with high blood transfusion requirement. After 9 sessions of plasmapheresis, there was no significant improvement in the biological parameters, nor after 2 cycles of paclitaxel. The patient was then treated with eculizumab during 4 weeks, with a slight reduction in blood requirement, and simultaneously with palbociclib. Since being treated with palpociclib, she had a great reduction in blood requirement and a good clinical condition. To conclude, we reported an initial moderate improvement of paraneoplasm-related TMA syndrome under eculizumab therapy with a slight reduction in red blood cell requirement; however, palbociclib therapy achieved a very good response with a dramatic reduction in red blood cell requirement.

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