Adding AB Plasma Units to Emergency Release O Negative Red Blood Cells (RBC) Issued to the Emergency Department (ED)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4333-4333
Author(s):  
Jennifer C. Andrews ◽  
Susan Weiss ◽  
Maurene Viele ◽  
Lawrence T Goodnough
Keyword(s):  
Conflicts Of Interest ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Trauma Patients ◽  
Time Period ◽  
Academic Hospitals ◽  
Wastage Rate ◽  
Fresh Frozen ◽  
Level I ◽  
Frozen Plasma

Abstract Abstract 4333 Background: Recent studies have shown improved mortality and decreased early coagulopathy in trauma patients with administration of RBCs, platelets and fresh frozen plasma in a 1:1:1 ratio (Shaz BH et al. Transfusion 2010;50:493–500). As a result, massive transfusion protocols (MTP) have become common at large academic institutions with level I trauma programs. Our institution recently added 2 units of AB plasma to our standard ED trauma cooler which contains 2 units of O negative RBCs and which is ordered by ED staff upon notification of an incoming trauma patient. The treating physicians can escalate blood component support by ordering an MTP if indicated. The purpose of this study was to assess the use and wastage of plasma and RBCs in the ED trauma cooler. Methods: Orders received for the trauma cooler from January 1 2011 to June 30 2011 at a large academic Trauma I center were reviewed retrospectively. Transfusions of RBC and plasma for each order were assessed as well as wastage of plasma or RBCs not transfused. Patients may have used more blood products than initially issued in the ED trauma cooler. Results: Ninety one orders were received for an ED trauma cooler during the 6-month period assessed. Fifteen (16%) of 91 orders resulted in transfusion of RBCs. Nine (10%) of 91 orders resulted in transfusion of plasma. Five of 182 (3%) plasma units issued were wasted because temperature parameters were exceeded before return to the transfusion service (TS). No untransfused RBC units were wasted and all were returned to available inventory. See table. The 15 O negative RBC units transfused from the ED trauma cooler during this time period represent 0.8% (15/1891) of our medical center's transfused O negative RBC units, and the 14 AB plasma units transfused or wasted from the ED trauma cooler represent 2% (14/573) of the AB plasma units transfused by the TS. Conclusion: Of the 48 academic hospitals participating in the 2009 University Health System Consortium (UHC) Efficient Blood Management Benchmarking Project, the published mean wastage of plasma was 3.36% (range 0.36% – 9.44%). Our 3% wastage rate for AB plasma in the ED trauma cooler was within this range. The addition of 2 units of AB plasma to the ED trauma cooler with 2 units of O negative RBCs was feasible at our institution with acceptable wastage of plasma and no undue strain on our supply and inventory of donor O negative RBC and AB plasma. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Experience with uncrossmatched blood refrigerator in emergency department

2018 ◽  
Vol 3 (1) ◽  
pp. e000184 ◽  
Author(s):  
Charles T Harris ◽  
Michael Totten ◽  
Daniel Davenport ◽  
Zhan Ye ◽  
Julie O’Brien ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Judgment ◽  
Fresh Frozen Plasma ◽  
Trauma Patients ◽  
Provider Education ◽  
Level Of Evidence ◽  
Ready Availability ◽  
Fresh Frozen ◽  
Level I ◽  
Frozen Plasma

BackgroundUncrossmatched packed red blood cell (PRBC) transfusion is fundamental in resuscitation of hemorrhagic shock. Ready availability of uncrossmatched blood can be achieved by storing uncrossmatched blood in a blood bank refrigerator in the emergency department (ED), but could theoretically lead to inappropriate uncrossmatched use.MethodsThis retrospective study was performed at a level I trauma center from January 2013 to March 2014. Possibly inappropriate transfusion was defined as patients who received at least one unit of blood from the ED refrigerator and no more than two units of PRBC in the first 24 hours. Deaths within the first 24 hours were excluded. Patients who received blood from the ED refrigerator who received ≤2 units total in 24 hours were compared with those who received >2 units.Results158 adults received blood from the ED refrigerator. 140 (88.6%) were trauma patients. 37 (23.4%) received massive transfusion (MT). 42 (26.6%) deaths were excluded. 29 patients received ≤2 units and 87 received >2 units in the first 24  hours. The ≤2 units group had a higher systolic blood pressure (116  mm Hg vs. 102  mm Hg, p=0.042), lower base deficit (6.4 mEq/L vs. 9.4 mEq/L, p=0.032), higher hematocrit (34% vs. 30%, p=0.024), lower rate of MT protocol activation (27.6% vs. 58.6%, p=0.005), and lower rates of transfusion of fresh frozen plasma (17.2% vs. 54.0%, p=0.001) and platelets (13.8% vs. 39.1%, p=0.012). Appropriately transfused patients were more likely to have evidence of shock with active, non-compressible hemorrhage. Potentially inappropriate uses were more likely in patients either without evidence of hemorrhage or without signs of shock.DiscussionStoring uncrossmatched blood in the ED is an effective way to get PRBCs transfused quickly in hemorrhaging patients and is associated with a low rate of unnecessary uncrossmatched transfusion. Provider education and good clinical judgment are imperative to prevent unnecessary use.Level of evidenceLevel III, therapeutic.

Factors Affecting Transfusion of Fresh Frozen Plasma, Platelets, and Red Blood Cells During Elective Coronary Artery Bypass Graft Surgery

2003 ◽  
Vol 127 (4) ◽  
pp. 415-423
Author(s):  
Randal Covin ◽  
Maureen O'Brien ◽  
Gary Grunwald ◽  
Bradley Brimhall ◽  
Gulshan Sethi ◽  
...  
Keyword(s):  
Blood Cells ◽  
Prediction Models ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Artery Bypass Graft ◽  
Blood Components ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Context.—The ability to predict the use of blood components during surgery will improve the blood bank's ability to provide efficient service. Objective.—Develop prediction models using preoperative risk factors to assess blood component usage during elective coronary artery bypass graft surgery (CABG). Design.—Eighty-three preoperative, multidimensional risk variables were evaluated for patients undergoing elective CABG-only surgery. Main Outcome Measures.—The study endpoints included transfusion of fresh frozen plasma (FFP), platelets, and red blood cells (RBC). Multivariate logistic regression models were built to assess the predictors related to each of these endpoints. Setting.—Department of Veterans Affairs (VA) health care system. Patients.—Records for 3034 patients undergoing elective CABG-only procedures; 1033 patients received a blood component transfusion during CABG. Results.—Previous heart surgery and decreased ejection fraction were significant predictors of transfusion for all blood components. Platelet count was predictive of platelet transfusion and FFP utilization. Baseline hemoglobin was a predictive factor for more than 2 units of RBC. Some significant hospital variation was noted beyond that predicted by patient risk factors alone. Conclusions.—Prediction models based on preoperative variables may facilitate blood component management for patients undergoing elective CABG. Algorithms are available to predict transfusion resources to assist blood banks in improving responsiveness to clinical needs. Predictors for use of each blood component may be identified prior to elective CABG for VA patients.

Perioperative management of coagulation

2006 ◽  
Vol 26 (S 02) ◽  
pp. S3-S14 ◽  
Author(s):  
P. Innerhofer
Keyword(s):  
Coagulation Factor ◽  
Fresh Frozen Plasma ◽  
Laboratory Evaluation ◽  
Blood Component ◽  
Actual Case ◽  
Fresh Frozen ◽  
Coagulation Factor Concentrates ◽  
Hemostatic Therapy ◽  
Frozen Plasma

SummaryGuidelines of official societies for diagnosis and therapy of intraoperatively occurring hypocoagulability rely mainly on data of patients receiving whole blood transfusions. They recommend -provided that laboratory evaluation shows deficiency (values >1.5 fold normal)- administration of fresh frozen plasma, cryoprecipitate and platelet concentrates (platelet count <50 000 or <100 000/μl). This article describes the pathogenesis of coagulopathy in the light of the special intraoperative setting, emphasizes recent changes of blood component preparation, transfusion triggers, effects of volume therapy and challenges standard laboratory assays as reliable guide for intraoperative hemostatic therapy. The role of thrombelastographic monitoring is discussed as well as an alternative strategy to compensate deficiencies by the use of coagulation factor concentrates instead of or in addition to transfusion of FFP, a new concept which is illustrated by the presentation of an actual case report.

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.

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

Hemolytic Intravascular Anemia (HIA) Microangiopathic-Like and Deep Venous Thrombosis (DVT) Due to Ozone Exposure: Case Report

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5278-5278
Author(s):  
Luis Fernando Cortázar-Benítez ◽  
Pablo Vargas Viveros ◽  
Alfredo Aiza Alvarez ◽  
Rafael Hurtado Monroy
Keyword(s):  
Conflicts Of Interest ◽  
Laboratory Data ◽  
Peripheral Blood Smear ◽  
Fresh Frozen Plasma ◽  
Ozone Exposure ◽  
Fresh Frozen ◽  
The Right ◽  
Glucose 6 Phosphate Dehydrogenase ◽  
Frozen Plasma

Abstract Abstract 5278 HIA due to ozone exposure on patients with glucose 6 phosphate dehydrogenase deficiency (G6PDd) is extremely rare. The purpose of this report is to describe in detail a case of HIA and DVT on a woman without G6PDd, with a successful treatment with fresh frozen plasma (FFP) transfusion and Thrombolysis. The patient is a 36 years old woman, that 3 months before she was diagnosed with multiple sclerosis (MS) because paresthesias in the fingers of her left foot and she received treatment with blood ozone exposure (at unknown dose) in 3 sessions each week for 3 months. The patient attended to our center with severe anemic syndrome during the last 2 weeks and disabling pain of her left leg of 12 hours of evolution. Physical examination showed pale ++++, jaundice ++, functional systolic murmur grade IV, without adenomegaly or splenomegaly, increasing volume, induration, erythema and intense pain from the ankle to the popliteal space of her left leg. The urine was dark. Laboratory data were haemoglobin 5 g/dL, hematocrit 17%, reticulocytes 62%, and platelets 281×109/L. Peripheral blood smear showed esquistocytes +++ and spherocytes ++, suggesting intravascular hemolysis. Total bilirrubin 2.99mg/dL, direct bilirubin 0.57, and LDH 750 U/L. Doppler ultrasound: obstruction of the deep and superficial venous system of tibial, peroneal and left popliteal veins. Four red cells units were transfused and FFP transfusion was started every 6 hours, anticoagulation with enoxaparina sodium (1mg/Kg/day) and thrombolysis with rhTPA 100 mg for 3 hours infusion. The patient successfully improved with increase and maintenance of hemoglobin, decrease of the reticulocytes count and evident clinical improvement of her left leg. She was in-hospital for 8 days at the end of which was achieved ambulation, Doppler showed remission of DVT. The association between exposure to ozone and HIA has not been informed in the absence of G6PD deficiency, and today, little is known of the ideal treatment. Though plasmapheresis is the treatment of choice in a HIA, the presence of DVT and be in a period appropriate for thrombolysis, determined the use of FFP transfusion as the main treatment. The right clinical evolution observed in the treatment of our patient gave her solving clinical problems. Ozone has been widely used for a variety of off-label purposes. In vitro experiments had demonstrated hemolysis with ozone concentration > 30 mcg/mL, therefore this case must represent an important alert for those ozone users, however the mechanism of hemolysis because ozone exposure remains to be elucidated. Disclosures: No relevant conflicts of interest to declare.

Fresh Frozen Plasma (FFP) Usage and Appropriateness in Adult Medical in-Patients: A Retrospective Audit

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4375-4375
Author(s):  
Raghava Reddy Levaka Veera ◽  
Doron Schneider ◽  
Peter V. Pickens
Keyword(s):  
Vitamin K ◽  
Conflicts Of Interest ◽  
Fresh Frozen Plasma ◽  
Bleeding Complications ◽  
Medical Patients ◽  
Nursing Time ◽  
Inappropriate Use ◽  
Retrospective Audit ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Abstract 4375 BACKGROUND: The use of Fresh Frozen Plasma (FFP) has increased considerably in recent years. In the USA there was 70% increase in the use of plasma in 10 years between 1991 and 2001. Around 3.9 million units were transfused in 2001 and 5.7 million units in 2009. FFP is often used inappropriately globally and studies evaluating FFP use in the US are scarce. We conducted a study to assess the trends of FFP use, its implications, appropriateness, and impact of FFP on International Normalized Ratio (INR) in hospitalized adult medical patients with an elevated INR. DESIGN AND METHODS: The study was a retrospective audit of all adult medical in-patients with an INR of 1.2 or higher who received FFP during a 3 month period from December 1, 2011 to February 28, 2012 admitted to Abington Memorial Hospital. A list of all patients who received FFP during the study period was obtained from the blood bank. Patients with major trauma, surgical, post-op, pediatric and obstetric/gynecological patients were excluded. Data was collected on demographics, indications of FFP, pre and post transfusion INR and effect of FFP on pre-transfusion INR. Partial thromboplastin time values (PTT) were not collected. RESULTS: A total of 479 units of FFP were transfused to 97 patients over 114 transfusion episodes. Of the 97 patients, 51 were male (52.6%) and 46 were female (47.3%) with a mean age of 70.4 yrs (median 73 yrs, range 19–95 yrs). Of the total 479 units of FFP, 233 units (48.6%) were given to patients who were not actively bleeding (n=53) with a mean pre-transfusion INR (pre-INR) of 2.82 (range 1.5 to >10, SD 1.6). Warfarin related coagulopathy was noted in 65 patients (67%) and 340 units of FFP (71%) were transfused to these patients. FFP units transfused as pre-procedural prophylaxis were 176 out of 479 (36.7%). Twenty transfusion episodes amounting to 53 units of FFP (11.1%) were given to patients who were not actively bleeding and had a pre-INR of <2. Six patients did not get the planned procedure done and received 25 units (5.2%) of FFP. Of 15 patients who received FFP as pre-procedure prophylaxis with INR <2, only one (6.6%) had normalized post-transfusion INR (post-INR), 5 (33.3%) had post-INR of <1.5 and none had any bleeding complications. Inappropriate use of FFP in this study was noted to be 23.7% (114/479 units of FFP). Mean improvement in INR per unit of FFP for all transfusion episodes (n=114) was 0.36, with mean pre-INR of 3.28 (range 1.5 to >10) and mean post-INR of 1.72 (range 1.2 to 4.2). Mean improvement in INR/FFP in patients with pre-INR <2 vs. those with pre-INR 2 or higher was 0.22 vs. 0.42 respectively (p=0.021). Mean improvement in INR/FFP was significantly higher in patients with warfarin related coagulopathy vs. in those secondary to other causes (0.46 vs. 0.33, p=0.001). Patients who received vitamin K concurrently with FFP had higher mean improvement in INR/FFP than those who did not receive vitamin K (0.45 vs. 0.17, p=0.001). It was also noted that timing of post-INR check was very heterogeneous. Two patients developed an allergic reaction needing stoppage of transfusion and further treatment. Approximately $6,840 were wasted in direct costs ($60 per unit) in just 3 months for only medical in-patients excluding indirect costs (estimated at $100 per unit= $11,400) such as technician, nursing time; transfusion sets, pre-medication, etc. CONCLUSION: Inappropriate use of FFP remains high even among medical in-patients. This study is consistent with previous studies in finding warfarin reversal as the major indication of FFP use and higher the pre-INR, higher was the improvement in INR. Especially, high percentage of use of FFP for pre-procedural prophylaxis with mild elevation of INR is alarming; therefore, studies evaluating restrictive vs. liberal use of FFP are needed. *ICU=Intensive care unit, PCU= Progressive care unit, ER= Emergency room, GMF= General medical floor. Disclosures: No relevant conflicts of interest to declare.

Is there a role for aggressive use of fresh frozen plasma in massive transfusion of civilian trauma patients?

2008 ◽  
Vol 196 (6) ◽  
pp. 948-960 ◽  
Author(s):  
Frederick A. Moore ◽  
Teresa Nelson ◽  
Bruce A. McKinley ◽  
Ernest E. Moore ◽  
Avery B. Nathens ◽  
...  
Keyword(s):  
Massive Transfusion ◽  
Fresh Frozen Plasma ◽  
Trauma Patients ◽  
Civilian Trauma ◽  
Fresh Frozen ◽  
Frozen Plasma

scholarly journals An Institutional Survey of Warfarin Reversal in the Setting of Life-Threatening Bleeds

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4981-4981
Author(s):  
Ian Garrahy ◽  
Tushar Pawar ◽  
Anthony Donato ◽  
Amber Stevenson ◽  
Daniel Forman
Keyword(s):  
Conflicts Of Interest ◽  
Factor Viia ◽  
Fresh Frozen Plasma ◽  
P Value ◽  
Anticoagulation Management ◽  
Clinical Scenarios ◽  
Fresh Frozen ◽  
Life Threatening ◽  
Warfarin Reversal ◽  
Frozen Plasma

Introduction: The bleeding risk of warfarin is well known. Therapeutic options for warfarin reversal in life-threatening bleeds include fresh frozen plasma (FFP), recombinant factor VIIa (rFVIIa), and prothrombin complex concentrate (PCC). Despite the theoretical advantage and clinical evidence supporting PCC, it is not widely used in the US. Methods: An online anonymous questionnaire was sent to all providers in the Tower Health System asking them about their practice, specialty, degree, years in practice, and basic questions regarding their comfort and frequency of prescribing anticoagulants. The questionnaire also asked the providers how they would manage ten various clinical scenarios related to anticoagulation management. One question specifically addressed the management of warfarin reversal in an 85-year-old presenting with hemorrhagic shock. Analysis of variance was used to compare the scoring means between groups while linear regression and Pearson's correlation coefficient measured the relationship between years of practice and test scores. Results: Out of 404 responders, 232 (57.4%) selected an incorrect answer and 212 (52.5%) incorrectly selected fresh frozen plasma as the answer to the question (see uploaded image) that addressed warfarin reversal in the setting of major bleeding. Those providers who answered this question correctly and those who answered it incorrectly had mean scores of 68.26% and 52.16% respectively on the overall survey (p value 0.000). Conclusion: As compared to FFP, the use of PCC for warfarin reversal is associated with a significant reduction in all-cause mortality. This project demonstrates a professional practice gap and serves to highlight an area in medicine where many providers are not practicing in accordance with evidence-based practice. Furthermore, this particular question from the survey discovered that providers who performed better on the survey were more likely to answer questions regarding anticoagulation reversal correctly. Figure Disclosures No relevant conflicts of interest to declare.

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