DIFFERENCES IN CHANGES OF HEMOGLOBIN BETWEEN 6-12 HOURS AND 12-14 HOURS AFTER TRANSFUSION

Each year more than 41,000 blood donations are needed every day and 30 million blood components are transfused. Blood products that can be transfused include Packed Red Cells (PRC), Whole Blood (WB), Thrombocyte Concentrate (TC), Fresh Frozen Plasma (FFP). Monitoring Hemoglobin (Hb) after transfusion is essential for assessing the success of a transfusion. The time factor after transfusion for Hemoglobin (Hb) examination needs to be established, analyze to judge the success of a blood transfusion which is performed. The aim of this study was to analyze the differences in changes of hemoglobin between 6-12 hours, and 12-24 hours after-transfusion. This study was retrospective observational using secondary data. The subjects were patients who received PRC, and WBC transfusion. At 6-12, and 12-24 hours after-transfusion, hemoglobin, RBC, and hematocrit were measured. Then the data were analyzed by unpaired t-test. The collected data included the results of the Hb pre-transfusion, 6-12, and 12-24 hours after-transfusion. The subjects of this study were 98 people. The administration of transfusion increased by 10-30% in hemoglobin concentration at 6-12 hours after-transfusion. While at 12-24 hours after-transfusion, hemoglobin after-transfusion increased 15-37% from the baseline. Hemoglobin values were not different at any of the defined after-transfusion times (p = 0.76 (p>0.05)). Hemoglobin values were not different at 6-12 hours, and 12-24 hours after-transfusion. Keywords: Hemoglobin, measurement, after-transfusion

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Outcome of Major Hemorrhage at a Major Cardiothoracic Center in Patients with Activated Major Hemorrhage Protocol versus Nonactivated Protocol

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0040-1718869 ◽

2021 ◽

Vol 47 (01) ◽

pp. 074-083

Author(s):

Kathryn W. Chang ◽

Steve Owen ◽

Michaela Gaspar ◽

Mike Laffan ◽

Deepa R. J. Arachchillage

Keyword(s):

Fresh Frozen Plasma ◽

Electronic Records ◽

Blood Products ◽

Major Hemorrhage ◽

Fresh Frozen ◽

Dilutional Coagulopathy ◽

Baseline Characteristics ◽

The Impact ◽

Frozen Plasma ◽

Baseline Hemoglobin

AbstractThis study aimed to determine the impact of major hemorrhage (MH) protocol (MHP) activation on blood administration and patient outcome at a UK major cardiothoracic center. MH was defined in patients (> 16 years) as those who received > 5 units of red blood cells (RBCs) in < 4 hours, or > 10 units in 24 hours. Data were collected retrospectively from patient electronic records and hospital transfusion databases recording issue of blood products from January 2016 to December 2018. Of 134 patients with MH, 24 had activated MHP and 110 did not have activated MHP. Groups were similar for age, sex, baseline hemoglobin, platelet count, coagulation screen, and renal function with no difference in the baseline clinical characteristics. The total number of red cell units (median and [IQR]) transfused was no different in the patients with activated (7.5 [5–11.75]) versus nonactivated (9 [6–12]) MHP (p = 0.35). Patients in the nonactivated MHP group received significantly higher number of platelet units (median: 3 vs. 2, p = 0.014), plasma (median: 4.5 vs. 1.5, p = 0.0007), and cryoprecipitate (median: 2 vs. 1, p = 0.008). However, activation of MHP was associated with higher mortality at 24 hours compared with patients with nonactivation of MHP (33.3 vs. 10.9%, p = 0.005) and 30 days (58.3 vs. 30.9%, p = 0.01). The total RBC and platelet (but not fresh frozen plasma [FFP]) units received were higher in deceased patients than in survivors. Increased mortality was associated with a higher RBC:FFP ratio. Only 26% of patients received tranexamic acid and these patients had higher mortality at 30 days but not at 24 hours. Deceased patients at 30 days had higher levels of fibrinogen than those who survived (median: 2.4 vs. 1.8, p = 0.01). Patients with activated MHP had significantly higher mortality at both 24 hours and 30 days despite lack of difference in the baseline characteristics of the patients with activated MHP versus nonactivated MHP groups. The increased mortality associated with a higher RBC:FFP ratio suggests dilutional coagulopathy may contribute to mortality, but higher fibrinogen at baseline was not protective.

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Transfusion of blood products

10.1093/med/9780199642663.003.0011 ◽

2016 ◽

Author(s):

Alison Smith

Keyword(s):

Blood Transfusion ◽

Carrying Capacity ◽

Blood Cells ◽

Fresh Frozen Plasma ◽

Major Haemorrhage ◽

Blood Products ◽

Unlimited Supply ◽

Fresh Frozen ◽

Oxygen Carrying Capacity ◽

Frozen Plasma

The transfusion of blood products may be required in the pre- and post-operative periods. However, there are inherent risks associated with blood transfusion, and there is not an unlimited supply of blood donations available. When a patient is anaemic, red blood cells should be transfused to maintain the oxygen-carrying capacity of blood. Blood products, such as platelets and fresh frozen plasma, are transfused to correct a coagulopathy and during major haemorrhage. This chapter reviews the physiology of blood, including ABO compatibility and rhesus status, the main blood products available for transfusion, and transfusion policy, including the treatment of major haemorrhage and the refusal of blood products.

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Blood transfusion

10.1093/med/9780199683307.003.0017 ◽

2015 ◽

Author(s):

Drew Provan ◽

Trevor Baglin ◽

Inderjeet Dokal ◽

Johannes de Vos

Keyword(s):

Blood Transfusion ◽

Red Blood Cells ◽

Intravenous Immunoglobulin ◽

Blood Cells ◽

Platelet Transfusion ◽

Fresh Frozen Plasma ◽

Blood Products ◽

Fresh Frozen ◽

Religious Reasons ◽

Frozen Plasma

Introduction - Using the blood transfusion laboratory - Transfusion of red blood cells - Platelet transfusion - Fresh frozen plasma - Intravenous immunoglobulin - Transfusion transmitted infections - Irradiated blood products - Strategies for reducing blood transfusion in surgery - Maximum surgical blood ordering schedule (MSBOS) - Patients refusing blood transfusion for religious reasons, i.e. Jehovah’s Witnesses

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Blood transfusion

10.1093/med/9780199683307.003.0017_update_001 ◽

2018 ◽

Author(s):

Drew Provan ◽

Trevor Baglin ◽

Inderjeet Dokal ◽

Johannes de Vos ◽

Shubha Allard ◽

...

Keyword(s):

Blood Transfusion ◽

Red Blood Cells ◽

Intravenous Immunoglobulin ◽

Blood Cells ◽

Platelet Transfusion ◽

Fresh Frozen Plasma ◽

Blood Products ◽

Fresh Frozen ◽

Religious Reasons ◽

Frozen Plasma

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Clinical Results of a Massive Blood Transfusion Protocol for Postpartum Hemorrhage in a University Hospital in Japan: A Retrospective Study

Medicina ◽

10.3390/medicina57090983 ◽

2021 ◽

Vol 57 (9) ◽

pp. 983

Author(s):

Daigo Ochiai ◽

Yushi Abe ◽

Rie Yamazaki ◽

Tomoe Uemura ◽

Ayako Toriumi ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Postpartum Hemorrhage ◽

Blood Cells ◽

Correlation Coefficients ◽

Fresh Frozen Plasma ◽

Blood Products ◽

Fresh Frozen ◽

Transfusion Protocol ◽

Frozen Plasma

Background and objectives: Massive postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide. A massive transfusion protocol (MTP) may be used to provide significant benefits in the management of PPH; however, only a limited number of hospitals use MTP protocol to manage massive obstetric hemorrhages, especially in Japan. This study aimed to assess the clinical outcomes in patients in whom MTP was activated in our hospital. Materials and Methods: We retrospectively reviewed the etiology of PPH, transfusion outcomes, and laboratory findings among the patients treated with MTP after delivery in our hospital. Results: MTP was applied in 24 cases (0.7% of deliveries). Among them, MTP was activated within 2 h of delivery in 15 patients (62.5%). The median estimated blood loss was 5017 mL. Additional procedures to control bleeding were performed in 19 cases, including transarterial embolization (18 cases, 75%) and hysterectomy (1 case, 4.2%). The mean number of units of red blood cells, fresh frozen plasma, and platelets were 17.9, 20.2, and 20.4 units, respectively. The correlation coefficients of any two items among red blood cells, fresh frozen plasma, platelets, blood loss, and obstetrical disseminated intravascular coagulation score ranged from 0.757 to 0.892, indicating high levels of correlation coefficients. Although prothrombin time and activated partial thromboplastin time levels were significantly higher in the <150 mg/dL fibrinogen group than in the ≥150 mg/dL fibrinogen group at the onset of PPH, the amount of blood loss and blood transfusion were comparable between the two groups. Conclusions: Our MTP provides early access to blood products for patients experiencing severe PPH and could contribute to improving maternal outcomes after resuscitation in our hospital. Our study suggests the implementation of a hospital-specific MTP protocol to improve the supply and utilization of blood products to physicians managing major obstetric hemorrhage.

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Use of Blood Components in Major Obstetric Hemorrhage: Preliminary Findings from the Australian and New Zealand Massive Transfusion Registry (ANZ-MTR)

Blood ◽

10.1182/blood.v124.21.1563.1563 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1563-1563 ◽

Cited By ~ 1

Author(s):

Naomi J Aoki ◽

Kylie Venardos ◽

Nick Andrianopoulos ◽

Zoe K Mcquilten ◽

Amanda J Zatta ◽

...

Keyword(s):

Blood Cells ◽

Massive Transfusion ◽

Fibrinogen Level ◽

Fresh Frozen Plasma ◽

Blood Components ◽

Blood Products ◽

Obstetric Hemorrhage ◽

Laboratory Results ◽

Fresh Frozen ◽

Frozen Plasma

Abstract Introduction: Major obstetric hemorrhage (MOH) can develop rapidly and, due to the unique characteristics of maternity patients, early recognition and management can be challenging. Use of blood components in MOH can be life-saving however there is uncertainty about optimal use of these products and the role of adjunctive therapies. The ANZ-MTR generates observational data on current transfusion management and outcomes in critically bleeding patients receiving massive transfusion (MT) across all clinical settings. This study aimed to describe the transfusion strategies used in the MOH population and report their outcomes. Methods: Patients who had a MOH and received a MT (≥5 units of red blood cells [RBC] in 4h) between April 2011 and December 2013 at 15 Australian & NZ hospitals were identified. Data on the type and volume of blood products transfused as well as selected laboratory results and clinical outcomes were reviewed. Results: A total of 154 cases were identified and reviewed, representing 6% of the total ANZ-MTR cohort. Median age was 34 [IQR29-37] years and 99% of women had a Charlson Comorbidity Index score ≤ 1. Table 1 presents the blood products transfused. The median [IQR] fresh frozen plasma (FFP) to RBC ratio and platelets to RBC ratio was 0.6 [0.3-0.8] and 0.1 [0-0.2], respectively. FFP, platelets and cryoprecipitate were transfused in 87%, 66% and 49% of patients. Prothrombinex-HT was administered to 1 patient and 3 patients received rFVIIa. Table 2 presents the laboratory results taken prior to MT onset as well as the lowest and highest result reported within 24hours after the MT onset. Fibrinogen levels following MT onset was available for 121 (79%) patients. Of these, 46% women had a fibrinogen level <2 g/L of which 34% did not receive cryoprecipitate. Mean [SD] hemoglobin level 24h post-MT onset was 108g/L [19]. Regarding patient outcomes, median [IQR] hospital length of stay was 8 [4-43] days, 59 (38%) women were admitted to ICU, 40 (26%) underwent a subtotal or total hysterectomy and 3 (1.9%) died in-hospital. Table 1. Number of patients and median number of units transfused 24h post-MT onset (n = 154). Blood product n (%) Median units (IQR) Red blood cells 154 (100) 7 [6-10] Fresh frozen plasma 134 (87) 4 [2-6] Platelets 102 (66.2) 1 [0-1] Cryoprecipitate 76 (49.4) 0 [0-5] Table 2. Laboratory values* reported Value prior to MT onset Lowest value 0-24h post-MT onset Highest value 0-24h post-MT onset Hemoglobin (g/L) 102 [81-120], 84 77 [67-90]; 92 108 [95-119]; 92 INR 1.1 [0.9-1.2]; 33 1.1 [.9-1.2]; 72 1.3 [1.1-1.4]; 72 aPPT(s) 31 [28-35]; 39 31 [29-34]; 88 37 [33-46]; 88 Fibrinogen level (g/L) 3.2 [1.6-3.9]; 25 1.9 [1.4-2.6]; 79 2.9 [2.5-3.5]; 79 Platelet Count (109/L) 210 [158-249];84 102 [74-135]; 92 146 [110-190]; 92 pH 7.3 [7.3-7.4]; 22 7.3 [7.2-7.3]; 70 7.4 [7.4-7.5]; 70 *Data are Median [IQR]; % patients with laboratory test available Conclusion: Women with MOH requiring massive transfusion were generally healthier and younger than patients of other clinical contexts in the ANZ-MTR. Although there were few in-hospital deaths reported (1.9%), a large proportion of the cohort required a hysterectomy during their hospital admission. Further information on transfusion practice, including understanding optimal blood component ratios, is required to inform clinical practice and minimize risk in the obstetric setting. Disclosures McLintock: Novo Nordisk Australasia: Honoraria.

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STUDY OF INDICATIONS OF BLOOD COMPONENTS IN OBSTETRIC HEMORRHAGE AT A TERTIARY CARE CENTRE IN SOUTH INDIA

10.36106/gjra/2301479 ◽

2020 ◽

pp. 43-45

Author(s):

Sushama D ◽

Kumari K.C. Usha ◽

Anumole Jose

Keyword(s):

Blood Transfusion ◽

Fresh Frozen Plasma ◽

Uterine Atony ◽

Red Cells ◽

Strong Positive Correlation ◽

Blood Components ◽

Obstetric Hemorrhage ◽

Common Indication ◽

Fresh Frozen ◽

Frozen Plasma

Blood transfusion is an essential part of management of many indications in obstetrics. A prospective study was conducted with objectives to portray the indications, mean usage and inter-relationship of blood components in obstetric hemorrhages. Out of total 10063 obstetric patients, 405 patients (N) required transfusion (4.02% incidence). Detailed clinical and transfusion history and management was recorded and analyzed. A total of 1386 units (55% packed red cells, 19% platelet concentrates, 24% fresh frozen plasma and 2% cryoprecipitate) of blood components were used to treat obstetric hemorrhage cases. Most common indication for blood transfusion was observed to be uterine atony (37%) followed by abruption (18.5%) and genital tract trauma during delivery (14.8%) and other causes. A strong positive correlation of PRC usage was observed with the number of units (usage) of PC, FFP and Cryoprecipitate units transfused to the patients with obstetric hemorrhage (P<0.00001; P<0.00001 and P=0.002786 respectively). Most common indication for transfusion of blood components was uterine atony. Maximum mean usages of packed red cells, platelet concentrate and fresh frozen plasma were for placenta accreta/percreta/increta.

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Management of Massive Blood Transfusion-a case study

Pulse ◽

10.3329/pulse.v5i1.20189 ◽

2014 ◽

Vol 5 (1) ◽

pp. 39-43

Author(s):

Sufia Khatun Lima ◽

Monowara Begum ◽

Anil Kumar Gupta ◽

Lutful Aziz ◽

SP Mitra

Keyword(s):

Blood Transfusion ◽

Multidisciplinary Approach ◽

Fresh Frozen Plasma ◽

General Surgeon ◽

Blood Products ◽

Massive Blood Transfusion ◽

Fresh Frozen ◽

Transfusion Protocol ◽

Frozen Plasma

Management of a complicated obstetric patient with profuse bleeding following caesarean section (under GA) required massive blood transfusion was managed properly with multidisciplinary approach in ICU. The involvement of obstetrician, anesthesiologist, intensivist, general surgeon, hematologist & gastroenterologist as a team in a single setup is essential for the management of such patients and the best outcome. The patient received total 117 units of blood products among which 20 units whole blood, 17 units packed red blood cell, 40 units of fresh frozen plasma and 40 units of platelet concentrate. Despite this massive blood transfusion, the patient recovered fully with minimal complications as we follow the near standard blood transfusion protocol. DOI: http://dx.doi.org/10.3329/pulse.v5i1.20189 Pulse Vol.5 January 2011 p.39-43

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The usage of blood components in obstetrics

Medicina ◽

10.3390/medicina46080081 ◽

2010 ◽

Vol 46 (8) ◽

pp. 561 ◽

Cited By ~ 2

Author(s):

Dalia Adukauskienė ◽

Audronė Veikutienė ◽

Agnė Adukauskaitė ◽

Vincentas Veikutis ◽

Kęstutis Rimaitis

Keyword(s):

Blood Transfusion ◽

Fresh Frozen Plasma ◽

Massive Bleeding ◽

Therapeutic Options ◽

Blood Components ◽

Blood Products ◽

Obstetric Hemorrhage ◽

Risk Of Death ◽

Obstetric Emergencies ◽

Fresh Frozen

Major obstetric hemorrhage remains the leading cause of maternal morbidity and mortality worldwide. Even though blood transfusion may be a life-saving procedure, an inappropriate usage of blood products in obstetric emergencies especially in cases of massive bleeding is associated with increased morbidity and risk of death. Thorough knowledge of the etiology, pathophysiology, and optimal therapeutic options of major obstetric hemorrhage may help to avoid lethal outcomes. There are evidence-based data about some risks related with transfusion of blood components: acute or delayed hemolytic, febrile, allergic reactions, transfusion-related acute lung injury, negative immunomodulative effect, transmission of infectious diseases, dissemination of cancer. This is why the indications for allogeneic blood transfusion are restricted, and new safer methods are being discovered to decrease the requirement for it. Red cell alloimmunization may develop in pregnancy; therefore, all pregnant women should pass screening for irregular antibodies. Antierythrocytic irregular antibodies may occur due to previous pregnancies or allogeneic red blood cell transfusions, and it is important for blood cross-matching in the future. Under certain circumstances, such as complicated maternal history, severe coagulation abnormalities, severe anemia, the preparation of cross-matched blood is necessary. There is evidence of very significant variation in the use of blood products (red cells, platelets, fresh frozen plasma, or cryoprecipitate) among clinicians in various medical institutions, and sometimes indications for transfusion are not correctly motivated. The transfusion of each single blood product must be performed only in case of evaluation of expected effect. The need for blood products and for their combination is necessary to estimate for each patient individually in case of obstetric emergencies either. Indications for transfusion of blood components in obstetrics are presented in order to improve the skills of doctors and to optimize therapeutic options in obstetric emergencies.

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Effects of implementing rotational thromboelastometry in cardiac surgery: A retrospective cohort study

Journal of Perioperative Practice ◽

10.1177/1750458920950662 ◽

2021 ◽

pp. 175045892095066

Author(s):

Minna Kallioinen ◽

Mika Valtonen ◽

Marko Peltoniemi ◽

Ville-Veikko Hynninen ◽

Tuukka Saarikoski ◽

...

Keyword(s):

Cardiac Surgery ◽

Prothrombin Complex Concentrate ◽

Fresh Frozen Plasma ◽

Blood Products ◽

Rotational Thromboelastometry ◽

Number Of Patients ◽

Fresh Frozen ◽

The Mean ◽

To Receive ◽

Frozen Plasma

Since 2013, rotational thromboelastometry has been available in our hospital to assess coagulopathy. The aim of the study was to retrospectively evaluate the effect of thromboelastometry testing in cardiac surgery patients. Altogether 177 patients from 2012 and 177 patients from 2014 were included. In 2014, the thromboelastometry testing was performed on 56 patients. The mean blood drainage volume decreased and the number of patients receiving platelets decreased between 2012 and 2014. In addition, the use of fresh frozen plasma units decreased, and the use of prothrombin complex concentrate increased in 2014. When studied separately, the patients with a thromboelastometry testing received platelets, fresh frozen plasma, fibrinogen and prothrombin complex concentrate more often, but smaller amounts of red blood cells. In conclusion, after implementing the thromboelastometry testing to the practice, the blood products were given more cautiously overall. The use of thromboelastometry testing was associated with increased possibility to receive coagulation product transfusions. However, it appears that thromboelastometry testing was mostly used to assist in management of major bleeding.

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