Massive Transfusion in Wartime: Experience from Northern Israel, Summer 2006.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4017-4017
Author(s):  
Eldad J. Dann ◽  
Najib Dally ◽  
Judith Chezar ◽  
Moshe Michaelson ◽  
Mirit Barzelay ◽  
...  
Keyword(s):  
Injury Severity ◽  
Massive Transfusion ◽  
Secondary Trauma ◽  
Fresh Frozen Plasma ◽  
Factor Vii ◽  
Packed Red Blood Cells ◽  
Medical Centers ◽  
Fresh Frozen ◽  
Level I ◽  
Frozen Plasma

Abstract In July 2006 hostilities erupted in Israel/Lebanon. Reported here is the experience of three medical centers in Northern Israel during 33 days of the warfare; the Rambam Health Care Campus in Haifa - a level I trauma center, the Rebecca Sieff Hospital in Safed and the Western Galilee Hospital in Nahariah - both secondary trauma centers. 504, 1138 and 868 wounded were presented to the three medical centers and 281, 415 and 195, respectively, required hospitalization. Sixty, 32 and 15 hospitalized patients were concomitantly transfused in each corresponding center, representing 20%, 7% and 7%, respectively, of admitted patients. Patients with an injury severity score of ≥16 had a higher need for blood products than those less severely injured, with a mean packed red blood cell (PRBC) transfusion of 7 versus 4 units (p=0.03) and FFP transfusion of 13 versus 1.5 units (p=0.002), respectively. Twenty four soldiers and one civilian had massive transfusions and twenty three of these patients survived. The median ratio between transfused fresh frozen plasma (FFP) and packed red blood cells (PRBC) was 0.8, ranging from a ratio of 0.25 to 1.3. Among 25 massively transfused patients 21 received cryoprecipitate and 19 - platelets. The median prothrombin time (INR) and partial thromboplastin time (PTT) increased during the first 2 hours after admission from 1.29 to 1.51 and from 33.6 seconds to 39 seconds, respectively. In the cohort of massively transfused patients 3 individuals additionally received 3 g of tranexamic acid, while another 2 patients were treated with recombinant factor VII. In conclusion, massively transfused patients with wartime penetrating injuries have an ongoing coagulopathy despite vigorous replacement therapy, which needs to be continued until the patients are stabilized. Early intervention and consultation in the Emergency Room by transfusion-service specialists is essential to the overall management of critically and massively wounded patients in wartime. Wounded (hospitalized) Transfused patients Packed RBC units FFP units Cryo units Platelet units Massive transfusion (patients) Rambam 504 (281) 60 463 413 266 258 21 Rebecca Sieff 1138 (415) 32 134 34 50 30 4 Western Galilee 868 (195) 15 71 68 51 10 1

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.

scholarly journals High Ratio Resuscitation in Patients with Systemic acquired Coagulopathy vs Endogenous Acute Coagulopathy

2014 ◽  
Vol 3 (2) ◽  
pp. 68-72
Author(s):  
Robert Derenbecker
Keyword(s):  
Injury Severity ◽  
Traumatic Injury ◽  
Retrospective Chart Review ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
High Ratio ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Level I ◽  
Transfusion Ratio

ABSTRACT Background Two main mechanisms of coagulopathy related to trauma have been described: systemic acquired coagulopathy (SAC) and endogenous acute coagulopathy (EAC). Resuscitation with high ratios of fresh frozen plasma to packed red blood cells (FFP:PRBC) has been shown to improve patient outcomes. Systemic acquired coagulopathy is related to acidosis, hypothermia and hemodilution. Endogenous acute coagulopathy is related to severe hemorrhage and shock, with resultant effects on intrinsic clotting pathways inducing coagulopathy more rapidly than SAC. We hypothesize that high ratio resuscitation will show improved mortality outcomes for both SAC and EAC. Study Design A retrospective chart review was performed for patients at an urban level I trauma center. All patients with international normalized ratio (INR) > 1.2 during the first 6 hours after admission who received operative intervention and at least 6 units of PRBCs following traumatic injury were included. Patients with INR > 1.2 on admission were stratified to the EAC group while patients with normal admission INR with subsequent postoperative increase in INR > 1.2 were stratified into the SAC group. Transfusion ratios for FFP:PRBC were also collected for each patient. High ratio resuscitation was defined as FFP:PRBC ≥ 1:2 and low as FFP:PRBC < 1:2. Outcomes between groups were analyzed. Results Total of 95 patients met inclusion criteria. Fifty-six (59%) patients met criteria for EAC and 39 (41%) patients developed criteria for SAC during the first 6 hours of admission. The initial average base deficit was greater in EAC vs SAC patients (–6.3 vs –4.8, p = 0.03). Endogenous acute coagulopathy patients had a higher initial INR than SAC (1.4 vs 1.1, p = 0.001), and a higher average injury severity score (ISS) (27.6 vs 21.5, p = 0.03). Regarding transfusion ratios, for both EAC and SAC, a high transfusion ratio when compared to a low transfusion ratio conveyed improved mortality (EAC: 32.5 vs 81%, p = 0.01; SAC:9 vs 64.7%, p = 0.03). For high ratio resuscitation in both groups, patients with SAC showed improved mortality compared to EAC (9 vs 32.5%, p = 0.01). Conclusion For patients with EAC and SAC, a high transfusion ratio conveyed an overall improvement in mortality. However, subgroup analysis demonstrated that despite a high transfusion ratio, EAC patients continued to have a significantly higher mortality than SAC patients. Further investigations into the mechanisms involved in EAC and interventions to improve outcomes are needed. How to cite this article Duchesne J, Derenbecker R. High Ratio Resuscitation in Patients with Systemic acquired Coagulopathy vs Endogenous Acute Coagulopathy. Panam J Trauma Crit Care Emerg Surg 2014;3(2):68-72.

When Enough is Enough: Impact of Packed Red Blood Cells in Massive Transfusion Outcomes

2013 ◽  
Vol 79 (8) ◽  
pp. 810-814 ◽  
Author(s):  
Kira Long ◽  
Jiselle Bock Heaney ◽  
Eric R. Simms ◽  
Norman E. McSwain ◽  
Juan C. Duchesne
Keyword(s):  
Red Blood Cells ◽  
Blood Cells ◽  
Survival Benefit ◽  
Massive Transfusion ◽  
Fresh Frozen Plasma ◽  
Survival Advantage ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Level I ◽  
The Impact

Massive transfusion protocol (MTP) with fresh-frozen plasma and packed red blood cells (PRBCs) in a 1:1 ratio is one of the most common resuscitative strategies used in patients with severe hemorrhage. There are no studies to date that examine the best postoperative hematocrit range as a marker for survival after MTP. We hypothesize a postoperative hematocrit dose-dependent survival benefit in patients receiving MTP. This was a 53-month retrospective analysis of patients with intra-abdominal injuries requiring surgery and transfusion of 10 units PRBCs or more at a single Level I trauma center. Groups were defined by postoperative hematocrit (less than 21, 21 to 29, 29.1 to 39, and 39 or more). Kaplan-Meier (KM) survival probability was calculated. One hundred fifty patients requiring operative abdominal explorations and 10 units PRBCs or more were identified. There were no significant differences in demographics between groups. When comparing postoperative hematocrit groups, relative to a hematocrit of less than 21 per cent in KM survival analysis, an overall survival advantage was only evident in patients transfused to hematocrits 29.1 to 39 per cent ( P < 0.03; odds ratio [OR], 0.284; 95% confidence interval [CI], 0.089 to 0.914). This survival advantage was not seen in the other groups (21 to 29: OR, 0.352; 95% CI, 0.103 to 1.195 or 39% or greater: OR, 0.107; 95% CI, 0.010 to 1.121). This is the first study to examine the impact of postoperative hematocrit as an indicator of survival after MTP in the trauma patient. Transfusion to hematocrits between 29.1 and 39 per cent conveyed a survival benefit, whereas resuscitation to supraphysiologic hematocrits 39 per cent or greater conveyed no additional survival benefit. This study highlights the need for judicious PRBC administration during MTP and its potential impact on survival in patients with postoperative supraphysiologic hematocrits.

Blood Transfusions in Trauma: Six-Year Analysis of the Transfusion Practices at a Level I Trauma Center

2008 ◽  
Vol 74 (10) ◽  
pp. 953-957 ◽  
Author(s):  
Pedro G.R. Teixeira ◽  
Didem Oncel ◽  
Demetrios Demetriades ◽  
Kenji Inaba ◽  
Ira Shulman ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Negative Impact ◽  
Fresh Frozen Plasma ◽  
Blood Transfusions ◽  
Trauma Patients ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Level I ◽  
Injured Patients

The objective of this study was to analyze the transfusion practices in trauma patients in one institution. A retrospective analysis of the Trauma Registry linked with the Blood Bank Database of a Level 1 trauma center was conducted. Over 6 years, 17 per cent of the 25,599 trauma patients received blood transfusions. The overall mortality in transfused patients was 20 per cent and remained the same during the study period. There was no change in the proportion of patients receiving transfusions throughout the years, however there was a significant 23.5 per cent reduction in the mean number of packed red blood cells (PRBC) units transfused (P < 0.001 for trend). This reduction in PRBC used remained true and even more evident in the group of more severely injured patients (Injury Severity Score ≥ 16), with a 27.9 per cent decrease in mean units of PRBC (P < 0.001 for trend). The highest reduction in PRBC transfusion was seen in blunt trauma patients (34.6%, P < 0.001). During the study period there was a concurrent increase in mean units of fresh frozen plasma used (60.7%, P < 0.001) and no change in the use of platelets and cryoprecipitate. In conclusion, transfusions of PRBC were significantly reduced over time in trauma patients without any evident negative impact on mortality.

scholarly journals The epidemiology of overtransfusion of red cells in trauma resuscitation patients in the context of a mature massive transfusion protocol

2021 ◽  
Author(s):  
Timothy Cowan ◽  
Natasha Weaver ◽  
Alexander Whitfield ◽  
Liam Bell ◽  
Amanda Sebastian ◽  
...  
Keyword(s):  
Injury Severity ◽  
Haemoglobin Concentration ◽  
Fresh Frozen Plasma ◽  
Trauma Patients ◽  
Trauma Resuscitation ◽  
Packed Red Blood Cells ◽  
Clinical Consequences ◽  
Fresh Frozen ◽  
Transfusion Protocol ◽  
Frozen Plasma

Abstract Purpose Packed red blood cell (PRBC) transfusion remains an integral part of trauma resuscitation and an independent predictor of unfavourable outcomes. It is often administered urgently based on clinical judgement. These facts put trauma patients at high risk of potentially dangerous overtransfusion. We hypothesised that trauma patients are frequently overtransfused and overtransfusion is associated with worse outcomes. Methods Trauma patients who received PRBCs within 24 h of admission were identified from the trauma registry during the period January 1 2011–December 31 2018. Overtransfusion was defined as haemoglobin concentration of greater than or equal to 110 g/L at 24 h post ED arrival (± 12 h). Demographics, injury severity, injury pattern, shock severity, blood gas values and outcomes were compared between overtransfused and non-overtransfused patients. Results From the 211 patients (mean age 45 years, 71% male, ISS 27, mortality 12%) who met inclusion criteria 27% (56/211) were overtransfused. Patients with a higher pre-hospital systolic blood pressure (112 vs 99 mmHg p < 0.01) and a higher initial haemoglobin concentration (132 vs 124 p = 0.02) were more likely to be overtransfused. Overtransfused patients received smaller volumes of packed red blood cells (5 vs 7 units p = 0.049), fresh frozen plasma (4 vs 6 units p < 0.01) and cryoprecipitate (6 vs 9 units p = 0.01) than non-overtransfused patients. Conclusion More than a quarter of patients in our cohort were potentially given more blood products than required without obvious clinical consequences. There were no clinically relevant associations with overtransfusion.

Preparation of a Factor VII Concentrate

1979 ◽  
Author(s):  
A.J. MacLeod ◽  
I. Dickson
Keyword(s):  
Specific Activity ◽  
Fresh Frozen Plasma ◽  
Factor Vii ◽  
Batch Adsorption ◽  
Citrate Buffer ◽  
Linear Gradient ◽  
Fresh Frozen ◽  
Frozen Plasma ◽  
Phosphate Citrate Buffer

A factor VII concentrate has been prepared from pooled citrated fresh frozen plasma following removal of cryoprecipitate and factors II, IX and X. The method involved batch adsorption on DEAE-Sephadex A-50, fractionation of the subsequent batch eluate by PEG precipitation and passage through a column of DEAE-Sepharose CL-.6B. A phosphate-citrate buffer pH 6.9 was used throughout, this was made 0.2M with NaCl for the batch elution and a 0 - 0.2H NaCl linear gradient was used to elute the components from the column. Factor VII activity was clearly resolved from the bulk of the protein, including caeruloplasmin, and could be recovered as a concentrate at about 20 U FVII/ml with a specific activity of in excess of 1 U FVII/mg of protein and an overall recovery of 40% to 50%

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