Characteristics of Acute Transfusion Reactions and its related factors in Cipto Mangunkusumo Hospital Jakarta, Indonesia

Latar belakang: Reaksi transfusi akut (RTA) merupakan sekelompok kejadian yang tidak diinginkan akibat pemberian transfusi darah. Manifestasi dari RTA bervariasi dari yang ringan hingga mengancam nyawa. Saat ini, data mengenai reaksi transfusi di Indonesia masih sangat terbatas. Dalam studi ini, kami bertujuan untuk memberikan gambaran mengenai karakteristik RTA dan faktor-faktor yang mempengaruhinya. Metode: Studi ini merupakan studi retrospektif yang melibatkan 288 subyek dengan RTA. Studi dilakukan di Rumah Sakit Dr. Cipto Mangunkusumo, dimulai sejak Januari hingga Desember 2017. RTA dikelompokkan berdasarkan sistem tubuh yang mengalami manifestasi, serta derajat manifestasinya. Hasil: Sel darah merah merupakan produk darah utama yang ditransfusikan ke subyek, diikuti dengan konsentrat trombosit, plasma segar beku, dan kriopresipitat. Lima gejala utama dari RTA adalah gatal, demam/kenaikan suhu tubuh, menggigil, urtikaria, dan angioedema. Berdasarkan sistem tubuh yang terkena, umumnya RTA bermanifestasi sebagai gejala pada kulit (56.6%). Berdasarkan derajat manifestasinya, RTA umumnya dikategorikan dalam derajat ringan (55.9%). Anak-anak cenderung mengalami manifestasi yang ringan (64.8%) dan utamanya bermanifestasi pada kulit (65.4%). Riwayat transfusi mempengaruhi derajat RTA secara signifikan. RTA derajat sedang dan gejala konstitusional lebih banyak ditemukan pada subyek yang mendapat PRC dibanding produk darah lainnya. Kesimpulan: Umumnya RTA bermanifestasi sebagai gejala dermatologi. Hanya sedikit kasus RTA yang disebabkan oleh reaksi inkompatibilitas. Manifestasi dan derajat RTA juga dipengaruhi oleh umur, riwayat transfusi, dan jenis komponen darah. Kata kunci: Transfusi darah, reaksi transfusi akut, riwayat transfuse, usia Abstract Background: Acute transfusion reactions (ATRs) are a group of adverse events caused by blood transfusions. Manifestations of ATRs vary from mild to life threatening. At present, data about transfusion reactions in Indonesia are still limited. In this study, we aim to determine the characteristics of ATRs and its related factors. Methods: This was a retrospective study of 288 subjects with ATRs. The study was conducted in Cipto Mangunkusumo Hospital, started from January to December 2017. ATRs were categorized based on the body systems affected and degree of manifestations. Results: Packed red cells (PRC) was the predominant blood product (51.4%) which was transfused to subjects, followed by thrombocyte concentrate (TC), fresh frozen plasma (FFP), and cryoprecipitate. Five most common predominant symptoms of ATRs were pruritus/itch, febrile/increased temperature, chills, transient urticaria, and angioedema. Based on the affected body systems, the majority of ATRs manifested as dermatologic symptoms (56.6%). Based on the degree of manifestations, the majority of ATRs were categorized as mild degree (55.9%). Children tended to have milder symptoms (64.8%), which mostly manifested as dermatologic symptoms (65.4%). History of transfusion affected the degree of ATR significantly. Moderate degree of ATRs and constitutional symptoms were found more common in subjects who received PRC than other blood products. Conclusion: Most of ATRs manifest as dermatologic symptoms, which represent allergic reactions. Only a small portion of ATRs are caused by incompatibility reactions. The manifestation and degree of ATRs are also affected by age, history of transfusion, and type of blood components. Keywords: Blood transfusion, acute transfusion reaction, transfusion history, age

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Congenital thrombotic thrombocytopenic purpura presenting in adulthood with recurrent cerebrovascular events

BMJ Case Reports ◽

10.1136/bcr-2019-229481 ◽

2019 ◽

Vol 12 (10) ◽

pp. e229481

Author(s):

Emma Tenison ◽

Ashar Asif ◽

Mathew Sheridan

Keyword(s):

Thrombotic Thrombocytopenic Purpura ◽

Fresh Frozen Plasma ◽

Vessel Occlusion ◽

Thrombocytopenic Purpura ◽

Antibody Titres ◽

Fresh Frozen ◽

Life Threatening ◽

History Of ◽

Congenital Thrombotic Thrombocytopenic Purpura ◽

A Disintegrin And Metalloproteinase

Congenital thrombotic thrombocytopenic purpura (cTTP) is a rare, life-threatening disease, characterised by episodes of microangiopathic haemolytic anaemia (MAHA), thrombocytopenia and small vessel thrombosis. We describe a case of cTTP first diagnosed at age 70 years in a female presenting with an acute ischaemic stroke and thrombocytopenia, in whom A Disintegrin And Metalloproteinase with a Thrombospondin type 1 Motif, member 13 (ADAMTS13) levels were <10%, suggestive of thrombotic thrombocytopaenic purpura (TTP). The patient underwent plasma exchange and started rituximab for presumed immune TTP; however, anti-ADAMTS13 antibody titres were negative on two occasions. This, together with a history of pregnancies complicated by presumed disseminated intravascular coagulation, and two previous episodes of sepsis with MAHA, prompted investigation for cTTP, which was confirmed by genetic testing. Despite treatment with infusions of solvent/detergent-treated, virus-inactivated fresh frozen plasma, she has re-presented with further neurological deficit, associated with new infarcts on imaging. cTTP has a varied phenotype which, as demonstrated in this case, can include large vessel occlusion.

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Assessment of clinical parameters among patients with snake poison induced coagulopathy

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20184209 ◽

2018 ◽

Vol 5 (6) ◽

pp. 1374

Author(s):

Hariprasad S. ◽

Neha Sukhani

Keyword(s):

Hospital Stay ◽

Disseminated Intravascular Coagulation ◽

Fresh Frozen Plasma ◽

Snake Bite ◽

Systemic Complications ◽

Intravascular Coagulation ◽

Fresh Frozen ◽

Life Threatening ◽

History Of ◽

Prolonged Hospital

Background: Snakes are poikilothermic carnivorous reptiles that have evolved the venomous apparatus for the purpose of procurement of food. Snake bite can result in local and systemic complications. Major systemic complications include acute renal failure, neurologic abnormalities requiring ventilator support and disseminated intravascular coagulation. Disseminated intravascular coagulation can result in serious life-threatening systemic complications like haemorrhage, infarction and even death if the treatment is delayed. The present study was undertaken to study the clinical profile of the snake bite patients who develop coagulopathy and to study the role of coagulation markers to evaluate the morbidity and mortality of snake bite victims.Methods: Hundred patients consecutively admitted with history of snakebite were studied. Patients who have developed local signs of envenomation due to snake bite were included in the study group. The coagulation profile was assessed by doing blood investigations.Results: In this study, patients who developed coagulopathy had prolonged hospital stay and requirement of more blood products transfusion causing increased morbidity. 43 patients (35.8%) had platelets less than 1 lakh and approximately hospitalized for 26 days sand INR was more than 1.5 in 112 patients (93.3%) and hospitalized for 22 days and they received fresh frozen plasma. The survival rate in this study was 86% followed by 13.3% deaths.Conclusions: Use of clinical and laboratory parameter evaluation needed to identify the coagulopathy very early to reduce the hospital stay and mortality.

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Superwarfarin (Long-Acting Anti-coagulant Rodenticides) Poisoning: from Pathophysiology to Laboratory-Guided Clinical Management

10.33176/aacb-19-00029 ◽

2019 ◽

Vol 40 (4) ◽

pp. 175-185 ◽

Cited By ~ 2

Author(s):

Yeow-Kuan Chong ◽

Tony Wing-Lai Mai

Keyword(s):

Prothrombin Time ◽

Vitamin K ◽

Coagulation Factors ◽

Fresh Frozen Plasma ◽

The Body ◽

High Dose ◽

Fresh Frozen ◽

History Of ◽

K Deficiency ◽

Long Acting

Superwarfarins are long-acting anticoagulant rodenticides developed from warfarin. The mechanism of action is by inhibition of vitamin K epoxide reductase, resulting in the inability of the body to recycle vitamin K. Deficiency of vitamin K thereafter leads to inability for the body to synthesise vitamin K-dependent coagulation factors, factor II, VII, IX, and X, leading to prolonged prothrombin time. Due to the bulky aromatic sidechains, superwarfarins have a much longer half-life when compared to warfarin, and exposure to superwarfarins results in a prolonged period of anticoagulation which can result in clinical bleeding. Diagnosis is straight forward in patients with known history of superwarfarin exposure but has proved difficult for patients who did not report superwarfarin intake. Superwarfarin poisoning should therefore be suspected in all patients with unexplained prolongation of prothrombin time, and can be confirmed by their detection in serum. Treatment for superwarfarin poisoning includes rapid correction of factor deficiencies with either four factor prothrombin complex concentrate or fresh frozen plasma in patients with active bleeding, and high dose vitamin K therapy given multiple times per day for a prolonged period of weeks to months.

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‘Do not Do’ Recommendations in Hemophilia

Cardiovascular & Haematological Disorders - Drug Targets ◽

10.2174/1871529x20666200305111323 ◽

2020 ◽

Vol 20 (3) ◽

pp. 168-174

Author(s):

Hortensia De la Corte-Rodriguez ◽

E. Carlos Rodriguez-Merchan ◽

M. Teresa Alvarez-Roman ◽

Monica Martin-Salces ◽

Victor Jimenez-Yuste

Keyword(s):

Improve Patient Safety ◽

Health Resources ◽

Fresh Frozen Plasma ◽

Factor Ix ◽

Levels Of Care ◽

Fresh Frozen ◽

History Of ◽

Improve Patient ◽

Different Levels ◽

Frozen Plasma

Background: It is important to discard those practices that do not add value. As a result, several initiatives have emerged. All of them try to improve patient safety and the use of health resources. Purpose: To present a compendium of "do not do recommendations" in the context of hemophilia. Methods: A review of the literature and current clinical guidelines has been made, based on the best evidence available to date. Results: The following 13 recommendations stand out: 1) Do not delay the administration of factor after trauma; 2) do not use fresh frozen plasma or cryoprecipitate; 3) do not use desmopressin in case of hematuria; 4) do not change the product in the first 50 prophylaxis exposures; 5) do not interrupt immunotolerance; 6) do not administer aspirin or NSAIDs; 7) do not administer intramuscular injections; 8) do not do routine radiographs of the joint in case of acute hemarthrosis; 9) Do not apply closed casts for fractures; 10) do not discourage the performance of physical activities; 11) do not deny surgery to a patient with an inhibitor; 12) do not perform instrumental deliveries in fetuses with hemophilia; 13) do not use factor IX (FIX) in patients with hemophilia B with inhibitor and a history of anaphylaxis after administration of FIX. Conclusions: The information mentioned previously can be useful in the management of hemophilia, from different levels of care. As far as we know, this is the first initiative of this type regarding hemophilia.

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A fatal toxic shock-like syndrome post COVID-19 infection in a child

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01070-z ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Houda Ajmi ◽

Wissem Besghaier ◽

Wafa Kallala ◽

Abdelhalim Trabelsi ◽

Saoussan Abroug

Keyword(s):

Ejection Fraction ◽

Pediatric Intensive Care ◽

Fresh Frozen Plasma ◽

Multiple Organ ◽

Clinical Feature ◽

Fresh Frozen ◽

Life Threatening ◽

High Doses ◽

Definition Of ◽

High Level

Abstract Background Children affected by Coronavirus disease 2019 (COVID-19) showed various manifestations. Some of them were severe cases presenting with multi-system inflammatory syndrome (MIS-C) causing multiple organ dysfunction. Case presentation We report the case of a 12-year-old girl with recent COVID-19 infection who presented with persistent fever, abdominal pain and other symptoms that meet the definition of MIS-C. She had lymphopenia and a high level of inflammatory markers. She was admitted to pediatric intensive care unit since she rapidly developed refractory catecholamine-resistant shock with multiple organ failure. Echocardiography showed a small pericardial effusion with a normal ejection fraction (Ejection Fraction = 60%) and no valvular or coronary lesions. The child showed no signs of improvement even after receiving intravenous immunoglobulin, fresh frozen plasma, high doses of Vasopressors and corticosteroid. His outcome was fatal. Conclusion Pediatric patients affected by the new COVID-19 related syndrome may show severe life-threatening conditions similar to Kawasaki disease shock syndrome. Hypotension in these patients results from heart failure and the decreased cardiac output. We report a new severe clinical feature of SARS-CoV-2 infection in children in whom hypotension was the result of refractory vasoplegia.

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Congenital ADAMTS-13 deficiency presenting as life-threatening thrombosis during pregnancy

BMJ Case Reports ◽

10.1136/bcr-2020-239901 ◽

2021 ◽

Vol 14 (8) ◽

pp. e239901

Author(s):

Faheema Hasan ◽

Anshul Gupta ◽

Dinesh Chandra ◽

Soniya Nityanand

Keyword(s):

Late Presentation ◽

Fresh Frozen Plasma ◽

Artery Thrombosis ◽

Fresh Frozen ◽

Life Threatening ◽

A Disintegrin And Metalloproteinase ◽

Thrombospondin Type 1 Repeats ◽

Frozen Plasma ◽

Plasma Infusions

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease characterised by thrombocytopenia, microangiopathic haemolytic anaemia and microvascular thrombosis. Congenital TTP accounting for less than 5% of all TTP cases can have a late presentation in adulthood mostly triggered by predisposing factors such as infection, pregnancy and inflammation. We present a case of a 23-year-old woman who presented to us in the postpartum period with mesenteric artery thrombosis with infarcts and later was diagnosed as a case of TTP based on congenital a disintegrin and metalloproteinase with thrombospondin type 1 repeats 13 (ADAMTS-13) deficiency detected on ADAMTS-13 levels and gene sequencing. She was successfully managed initially with therapeutic plasma exchanges and is now on prophylactic fortnightly fresh frozen plasma infusions at 15 mL/kg body weight and continues to be in remission.

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Organophosphorus Poisoning

Journal of Nepal Medical Association ◽

10.31729/jnma.170 ◽

2008 ◽

Vol 47 (172) ◽

Cited By ~ 24

Author(s):

Buddhi Prasad Paudyal

Keyword(s):

Signs And Symptoms ◽

Clinical Problem ◽

Acute Poisoning ◽

The Body ◽

Organophosphorus Insecticides ◽

Basic Principles ◽

Initial Management ◽

Organophosphorus Poisoning ◽

Life Threatening ◽

History Of

Acute poisoning by organophosphorus (OP) compounds is a major global clinical problem, withthousands of deaths occurring every year. Most of these pesticide poisoning and subsequentdeaths occur in developing countries following a deliberate self ingestion of the poison. Metacid(Methyl parathion) and Nuvan (Dichlorovos) are commonly ingested OP pesticides; Dimethoate,Profenofos, and Chlorpyrifos are other less frequently ingested compounds in Nepal. The toxicityof these OP pesticides is due to the irreversible inhibition of acetylcholinesterase (AChE) enzymeleading to accumulation of acetylcholine and subsequent over-activation of cholinergic receptorsin various parts of the body. Acutely, these patients present with cholinergic crisis; intermediatesyndrome and delayed polyneuropathy are other sequel of this form of poisoning. The diagnosisdepends on the history of exposure to these pesticides, characteristic manifestations of toxicityand improvements of the signs and symptoms after administration of atropine. The supportivetreatment of OP poisoning includes the same basic principles of management of any acutelypoisoned patient i.e., rapid initial management of airways, breathing, and circulation. Gastriclavage and activated charcoal are routinely used decontamination procedures, but their valuehas not been conclusively proven in this poisoning. Atropine is the mainstay of therapy, andcan reverse the life threatening features of this acute poisoning. However, there are no clearcut guidelines on the dose and duration of atropine therapy in OP poisoning. Cholinesterasereactivators, by regenerating AChE, can reverse both the nicotinic and muscarinic effects;however, this benefit has not been translated well in clinical trials. All these facts highlight thatthere are many unanswered questions and controversies in the management of OP poisoningand there is an urgent need for research on this aspect of this common and deadly poisoning.Key Words: poisoning, organophosphorus insecticides, decontamination, antidotes

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Massive Transfusion

Anesthesiology: A Problem-Based Learning Approach ◽

10.1093/med/9780190850692.003.0019 ◽

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.

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Solvent/detergent-treated plasma: a virus-inactivated substitute for fresh frozen plasma

Blood ◽

10.1182/blood.v79.3.826.826 ◽

1992 ◽

Vol 79 (3) ◽

pp. 826-831 ◽

Cited By ~ 235

Author(s):

B Horowitz ◽

R Bonomo ◽

AM Prince ◽

SN Chin ◽

B Brotman ◽

...

Keyword(s):

Sindbis Virus ◽

Animal Studies ◽

Coagulation Factor ◽

Fresh Frozen Plasma ◽

Complete Inactivation ◽

Virus Safety ◽

Fresh Frozen ◽

History Of ◽

Triton X ◽

Frozen Plasma

Abstract Fresh frozen plasma (FFP) is prepared in blood banks world-wide as a by- product of red blood cell concentrate preparation. Appropriate clinical use is for coagulation factor disorders where appropriate concentrates are unavailable and when multiple coagulation factor deficits occur such as in surgery. Viral safety depends on donor selection and screening; thus, there continues to be a small but defined risk of viral transmission comparable with that exhibited by whole blood. We have prepared a virus sterilized FFP (S/D-FFP) by treatment of FFP with 1% tri(n-butyl)phosphate (TNBP) and 1% Triton X-100 at 30 degrees C for 4 hours. Added reagents are removed by extraction with soybean oil and chromatography on insolubilized C18 resin. Treatment results in the rapid and complete inactivation of greater than or equal to 10(7.5) infectious doses (ID50) of vesicular stomatitis virus (VSV) and greater than or equal to 10(6.9) ID50 of sindbis virus (used as marker viruses), greater than or equal to 10(6.2) ID50 of human immunodeficiency virus (HIV), greater than or equal to 10(6) chimp infectious doses (CID50) of hepatitis B virus (HBV), and greater than or equal to 10(5) CID50 of hepatitis C virus (HCV). Immunization of rabbits with S/D-FFP and subsequent adsorption of elicited antibodies with untreated FFP confirmed the absence of neoimmungen formation. Coagulation factor content was comparable with that found in FFP. Based on these laboratory and animal studies, together with the extensive history of the successful use of S/D-treated coagulation factor concentrates, we conclude that replacement of FFP with S/D-FFP, prepared in a manufacturing facility, will result in improved virus safety and product uniformity with no loss of efficacy.

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Caution in diagnosing angioedema as anaphylaxis

BMJ Case Reports ◽

10.1136/bcr-2019-230329 ◽

2019 ◽

Vol 12 (9) ◽

pp. e230329 ◽

Cited By ~ 2

Author(s):

Shivam Patel ◽

Roshan Mathew ◽

Sanjeev Bhoi

Keyword(s):

Ace Inhibitor ◽

Fatal Outcome ◽

Fresh Frozen Plasma ◽

Definitive Treatment ◽

Common Presentation ◽

Good Outcome ◽

Fresh Frozen ◽

Life Threatening ◽

The Common ◽

Frozen Plasma

Angioedema is one of the commonest life-threatening conditions with good outcome timely definitive treatment. However, failure to recognise the common presentation of an uncommon bradykinin-mediated angioedema in time may lead to fatal outcome in the emergency department (ED). We report a case of a 79-year-old male patient who presented to ED with features of ACE inhibitor-induced angioedema which was identified and resuscitated by the emergency physician with use of fresh frozen plasma (FFP) leading to prompt recovery and good outcome.

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