scholarly journals Maternal-fetal Blood Major Crossmatching in Merino Sheep

2020 ◽  
Vol 70 (4) ◽  
pp. 355-358
Author(s):  
Gabrielle C Musk ◽  
Haruo Usuda ◽  
Helen Kershaw ◽  
Matthew W Kemp ◽  
Claire R Sharp
Keyword(s):  
Cesarean Delivery ◽  
Ex Vivo ◽  
Fresh Frozen Plasma ◽  
Fetal Blood ◽  
Blood Samples ◽  
Packed Red Blood Cells ◽  
Fetal Plasma ◽  
Fresh Frozen ◽  
Cross Matching ◽  
Incompatibility Reactions

To determine the incidence of ex vivo incompatibility between ovine maternal RBCs and fetal plasma, we performed cross-matching of blood samples from ewes and from lambs delivered by cesarean section. Twenty-one date-mated singleton pregnant Merino ewes were anesthetized for cesarean delivery of the fetus. At the time of delivery, paired maternal and fetal blood samples were collected and subsequently separated for storage as packed red blood cells and fresh frozen plasma. Gel column major cross matching was performed within 2 wk. All fetus-dam crossmatches were major crossmatches, combining fetal (recipient) plasma with dam (donor) RBCs. 172 individual dam-dam cross matches were performed. Two of these tests were incompatible (1.2%). In addition, 19 fetal blood samples collected immediately after cesarean delivery were crossmatched with 21 maternal samples to generate 174 maternal-fetal individual cross matches. No maternal-fetal incompatibility reactions were observed. The results of this study demonstrate that all maternal donors and fetal recipients were compatible. In addition, the incidence of an incompatible crossmatch between adult ewes was 1.2%. These data suggest that lambs may not be born with antibodies against other blood types, but rather may acquire such antibodies at some time during early life. In addition, these data suggest the risk of incompatibility reactions between ewes of a similar breed and from a single farm of origin is very low.

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.

Primary Plasma Therapy For Thrombotic Thrombocytopenic Purpura

1981 ◽  
Author(s):  
D C Case
Keyword(s):  
Platelet Count ◽  
Blood Cells ◽  
Reticulocyte Count ◽  
Fresh Frozen Plasma ◽  
Red Cell ◽  
Peripheral Smear ◽  
Plasma Therapy ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Frozen Plasma

A 25-year old male was admitted for an episode of right sided headache and subsequent generalized seizure. On admission his temperature was 37.6°. He had generalized petechiae and conjunctival hemorrhages. Organomegaly and lymphadenopathy were absent. There was mild left sided weakness. The Hgb. was 6.9 g/dl., reticulocyte count 10%, WBC 11,500/mm3, and platelet count 10,000/mm3. There were numerous schistocytes on the peripheral smear; bone marrow revealed panhyperplasia. Coagulation studies were normal. The BUN was 30, and the creatinine 1.7 mg/dl. Plasma was positive for Hgb. CT scan was negative for gross intracranial bleeding. The diagnosis of T.T.P. was made. On admission, the patient received 10 units of platelets and 2 units of packed red blood cells. He did not require further red cell or platelet transfusions during the rest of his hospital course. He was then started on infusions of fresh-frozen plasma. He then received one unit every 3 hours for 6 days, one unit every 6 hours for 2 days, then one unit every 12 hours for 2 days and finally 1 unit daily for 5 days. The response was immediate. After the infusions were started, the hematologic parameters steadily improved. The patient’s hematuria rapidly improved. Further CNS symptoms did not appear. The patient’s Hgb. was 12 g/dl, and reticulocyte count was 2.5% by the 9th day. His platelet count was normal by the 4th day. The patient was discharged on the 15th day. Infusions of plasma were discontinued at the time of discharge. The patient required plasma therapy 4 weeks later for recurrent thrombocytopenia (50,000/mm3). The patient has remained normal for 9 months since therapy and further plasma has not been required. Primary plasma therapy for T.T.P. as sole treatment should be further studied.

scholarly journals The Role of Supportive Therapy in Pediatric Malignancies

2016 ◽  
Vol 62 (2) ◽  
pp. 251-256
Author(s):  
Zsuzsanna Erzsébet Papp ◽  
Mária-Adrienne Horváth
Keyword(s):  
Growth Factors ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Wide Spectrum ◽  
Fresh Frozen Plasma ◽  
Cancer Type ◽  
Infection Prophylaxis ◽  
Packed Red Blood Cells ◽  
Fresh Frozen ◽  
Frozen Plasma

AbstractChildhood cancer is a major psycho-social and health problem. International study groups establish complex, efficient, and concrete Cytostatic Protocols for every cancer type. During chemotherapy patients become extremely vulnerable to infections, so it is necessary to complete the treatment with blood substitution, anti-infection medication, growth factors and other complementary products.Materials and Methods: We studied the importance of the wide palette of adjuvant therapy near the intensive cytostatic treatment in the period of March 2014-November 2015 at the hemato-oncology department in Pediatric Clinic of Mures County Hospital.Results: In this period we treated 20 children (9 female, 11 male) aged between 9 months-18 years. We had 15 cases of haemopathies (13 acute leukemia and two lymphomas), and five solid tumors. Packed red blood cells, platelets, and fresh frozen plasma were given in the aplastic period. A patient benefited, on average, a total of 70ml/kg packed red blood cells and 50 U platelets. For infection prophylaxis and treatment every child benefited associated infective medication.Discussions: Packed red blood cells, platelets, and fresh frozen plasma were given to patients with a deficiency in the ability to produce normal blood cells which are temporarily worsened by chemotherapy. Antibiotic and antifungal medications are given to all febrile and neutropenic patients. We use wide spectrum antibiotics in association for preventing sepsis. Growth factors are stimulating the bone marrow to increase leukocyte number. Since introducing additional immunostimulant medication, we observed a significant decrease of infection in the aplastic period.Conclusions: Oncology protocols use only 3-5 cytostatic drugs. Maintaining the patient’s life during the treatment, it is necessary to use a large spectrum of supportive medications.

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.

scholarly journals Treatment of Massive Bladder Hemorrhage of Cancerous Etiology Using Selective Embolization

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 69s-69s
Author(s):  
T. Ząbkowski ◽  
P. Piasecki ◽  
L. Bodnar ◽  
T. Syryło ◽  
H. Zieliński ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Fresh Frozen Plasma ◽  
Therapeutic Success ◽  
Selective Embolization ◽  
Packed Red Blood Cells ◽  
Internal Iliac ◽  
Fresh Frozen ◽  
Anterior Division ◽  
Muscle Invasive

Background: Massive and intractable bladder hemorrhage of cancerous etiology are very dangerous and directly life-threatening. Its treatment is very difficult and complicated because of the severity of bladder tumor and the general poor condition of the patient which does not enable a radical surgical treatment. Aim: To evaluate the efficiency of the treatment of massive bladder hemorrhage of cancerous etiology using internal iliac artery selective embolization of anterior division. Methods: From January 2006 through June 2015, 23 patients (17 male and 6 female) were admitted to Urology Department as a matter of urgency because of massive bladder hemorrhage of cancerous etiology secondary to muscle-invasive bladder cancer (MIBC) - 14 patients, rectal cancer (RC) with invading bladder - 2 patients, bowel cancer with invading bladder - 2 patients, prostate cancer (PC) with invading bladder - 3 patients and cervical cancer with invading bladder - 2 patients ( Fig 1 ). The mean age of patients was 63.5 (range 37-80). In all patients, internal iliac artery selective embolization of anterior division was performed. The baseline mean hematocrit level during admission of patients to hospital was 23%, after embolization - 27.5%. In 14 patients it was necessary a mean of 6 transfusion units of packed red blood cells (PRBCs), range 2-16 transfusion units of PRBCs. 6 patients also required a mean of 8 transfusion units of fresh frozen plasma (FFP), range 2-27 transfusion units of FFP. Results: In 20 (86.96%) patients, therapeutic success was achieved after the first procedure. In 3 (13.04%) patients who developed hematuria after 12-38 days from the first endovascular procedure, the next successful embolization was performed bilaterally. It was not developed any major complications after embolization. Conclusion: Embolization of internal iliac artery is considered as a highly effective and minimally invasive method in case of massive bladder hemorrhage of cancerous etiology.[Figure: see text]

Retrospective evaluation of the indications, safety and effects of fresh frozen plasma transfusions in 36 cats (2014–2018)

2019 ◽  
Vol 22 (8) ◽  
pp. 696-704
Author(s):  
Elizabeth T Mansi ◽  
Jennifer E Waldrop ◽  
Elizabeth B Davidow
Keyword(s):  
Retrospective Study ◽  
Fresh Frozen Plasma ◽  
Packed Red Blood Cells ◽  
Tolerable Risk ◽  
Coagulation Testing ◽  
Before And After ◽  
Referral Hospitals ◽  
Fresh Frozen ◽  
Frozen Plasma ◽  
Transfusion Reactions

Objectives The goals of this study were to classify the indications, risks, effects on coagulation times and outcomes of cats receiving fresh frozen plasma (FFP) transfusions in clinical practice. Methods This was a retrospective study of FFP transfusions administered in two referral hospitals from 2014 to 2018. Transfusion administration forms and medical records were reviewed. Information was collected on indication, underlying condition, coagulation times and signs of transfusion reactions. Seven-day outcomes after FFP administration were also evaluated when available. Results Thirty-six cats received 54 FFP transfusions. Ninety-four percent of cats were administered FFP for treatment of a coagulopathy. Twenty cats had paired coagulation testing before and after FFP administration. Eighteen of these cats had improved coagulation times after receiving 1–3 units of FFP. Eight of the 36 cats had probable transfusion reactions (14.8% of 54 FFP transfusions). These reactions included respiratory signs (n = 4), fever (n = 2) and gastrointestinal signs (n = 2). Five of the eight cats with probable reactions had received packed red blood cells contemporaneously. Overall mortality rate during hospitalization was 29.7%, with 52.8% (n = 19/36) of cats confirmed to be alive 7 days after discharge. Conclusions and relevance This retrospective study shows that FFP transfusions improve coagulation times in cats. Transfusion reactions are a risk, and risk–benefit ratios must be measured prior to administration and possible reactions monitored. In the study cats, the FFP transfusions appeared to be a tolerable risk given the benefit to prolonged coagulation times.

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.

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