scholarly journals Resuscitation Patterns and Massive Transfusion for the Critical Bleeding Dog—A Multicentric Retrospective Study of 69 Cases (2007–2013)

2022 ◽  
Vol 8 ◽  
Author(s):  
Claire Tucker ◽  
Anna Winner ◽  
Ryan Reeves ◽  
Edward S. Cooper ◽  
Kelly Hall ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Total Protein ◽  
Blood Product ◽  
Massive Transfusion ◽  
Reference Interval ◽  
Blood Products ◽  
Critical Bleeding ◽  
Wide Range ◽  
Resuscitation Fluid ◽  
Median Plasma

Objective: To describe resuscitation patterns of critically bleeding dogs, including those receiving massive transfusion (MT).Design: Retrospective study from three universities (2007–2013).Animals: Critically bleeding dogs, defined as dogs who received ≥ 25 ml/kg of blood products for treatment of hemorrhagic shock caused by blood loss.Measurements and Main Results: Sixty-nine dogs were included. Sources of critical bleeding were trauma (26.1%), intra/perioperative surgical period (26.1%), miscellaneous (24.6%), and spontaneous hemoabdomen (23.1%). Median (range) age was 7 years (0.5–18). Median body weight was 20 kg (2.6–57). Median pre-transfusion hematocrit, total protein, systolic blood pressure, and lactate were 25% (10–63), 4.1 g/dl (2–7.1), 80 mm Hg (20–181), and 6.4 mmol/L (1.1–18.2), respectively. Median blood product volume administered was 44 ml/kg (25–137.4). Median plasma to red blood cell ratio was 0.8 (0–4), and median non-blood product resuscitation fluid to blood product ratio was 0.5 (0–3.6). MT was given to 47.8% of dogs. Survival rate was 40.6%. The estimated odds of survival were higher by a factor of 1.8 (95% CI: 1.174, 3.094) for a dog with 1 g/dl higher total protein above reference interval and were lower by a factor of 0.6 (95% CI: 0.340, 0.915) per 100% prolongation of partial thromboplastin time above the reference interval. No predictors of MT were identified.Conclusions: Critical bleeding in dogs was associated with a wide range of resuscitation patterns and carries a guarded to poor prognosis.

Intraoperative Resuscitation by Specialized Trauma Nurse Clinicians Improves Adherence to Massive Transfusion Protocol

2020 ◽  
Vol 86 (1) ◽  
pp. 35-41
Author(s):  
L. Andrew May ◽  
Kevin N. Harrell ◽  
Christopher M. Bell ◽  
Angela Basham-Saif ◽  
Donald E. Barker ◽  
...  
Keyword(s):  
Blood Product ◽  
Trauma Registry ◽  
Massive Transfusion ◽  
Blood Products ◽  
Packed Red Blood Cells ◽  
Massive Blood Loss ◽  
Massive Transfusion Protocol ◽  
Nurse Clinicians ◽  
Level I ◽  
Transfusion Protocol

A massive transfusion protocol (MTP) was implemented at a Level I trauma center in 2007 for patients with massive blood loss. A goal ratio of plasma to pheresed platelets to packed red blood cells (PRBCs) of 1:1:1 was established. From 2007 to 2014, trauma nurse clinicians (TNCs) administered the MTP during initial resuscitation and anesthesia personnel administered the MTP intraoperatively. In 2015, TNCs began administering the MTP intraoperatively. This study evaluates intraoperative blood product ratios and crystalloid volume administered by anesthesia personnel or TNCs. A retrospective review of trauma registry patients requiring MTP from 2007 to 2017 was performed. Patient data were stratified according to MTP administration by either anesthesia personnel (2007–2015) or TNCs (2015–2017). Ninety-seven patients were included with 54 anesthesia patients and 44 TNC patients. Patients undergoing resuscitation by MTP administered by TNCs received less median crystalloid (3000 mL vs 1500 mL, P < 0.001). The ratio of plasma:PRBC (0.75 vs 0.93, P = 0.027) and platelets:PRBC (0.75 vs 1.04, P = 0.003) was found to be significantly closer to 1:1 for TNC patients. MTP intraoperative blood product administration by TNCs reduced the amount of infused crystalloid and improved adherence to MTP in achieving a 1:1:1 ratio of blood products.

Fatal Complication of Transfusion of No Irradiated Blood Product in an Immunocompetent Recipient.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4016-4016
Author(s):  
Gregorio Campos-Cabrera ◽  
Virginia Campos-Cabrera ◽  
Salvador Campos-Cabrera ◽  
Jose Luis Campos-Villagomez
Keyword(s):  
Rural Areas ◽  
World Literature ◽  
Blood Product ◽  
Leukocytoclastic Vasculitis ◽  
Tertiary Care ◽  
Solid Organ ◽  
Blood Products ◽  
Fatal Complication ◽  
Wide Range ◽  
Hematological Cancers

Abstract Transfusion-associated graft versus host disease (TA-GVHD) is a rare, but almost always a fatal complication. It has a mortality rate above 90%. For the development of TA-GVHD is need immunocompetent cells in the blood product, incompatibility in HLA alloantigen, immune failure of the recipient against the donor cells. The exact incidence is unknown, but more than 200 cases have been reported in the world literature and the molecular test for diagnostic where performed only in a very few of them. Thirty-five years old woman with multiple fractures in right leg from a car accident was treated in her rural town, she received a fresh whole blood transfusion from her sister and then went for surgery, antibiotics and analgesia where given; six days after she developed erytroderma in the upper chest, two days later generalized bone pain and weakness were aggregated, the next day erithroderma generalize and started with diarrhea and jaundice; her evolution was torpid with fever, more weakness and jaundice, pallor, purpura and oropharyngeal pain. She was sent for hematological evaluation to our tertiary care institution, and a TA-GVHD was considerate; a work up on that was performed and the CBC showed pancytopenia, LFT with elevation of bilirubins, transaminases and alkaline phosphatase; the bone marrow aspiration and biopsy with aplasia, the skin biopsy with lymphoid infiltration, junction of epidermis with dermis was intact and no leukocytoclastic vasculitis. She received methylprednisolone, cyclosporine, filgrastim, wide range antibiotics and amphotericin B, leukoreduced and irradiated blood products. Her evolution was torpid with deterioration of her conditions and 48 hour later she died of septic shock. There is no effective treatment for TA-GVHD and no difference between early o delayed diagnostic, the evolution is almost always fatal, that is why the prevention is needed with the leukoreduction and irradiation of blood products, specially in recipients with clear risk for development of TA-GVHD: congenital immunodeficiencies, fetuses y newborns, hematological cancers, solid tumors in chemotherapy, hemopoiectic and solid organ transplanted, and first and second degree relatives. Better policies, technology, education for the primary care physician and access to blood products with high quality is needed to prevent this type of complications, specially in rural areas where transfusions with whole fresh blood from relatives are performed commonly. Figure Figure Figure Figure

Massive Transfusion in Non-Trauma Patients,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3376-3376 ◽  
Author(s):  
Lisa M Baumann Kreuziger ◽  
Josh Salzman ◽  
Amar T Subramanian ◽  
Colleen T. Morton ◽  
David J Dries
Keyword(s):  
Hospital Mortality ◽  
Blood Product ◽  
Massive Transfusion ◽  
Factor Vii ◽  
Component Ratio ◽  
Blood Products ◽  
Major Hemorrhage ◽  
Activated Factor Vii ◽  
The Impact ◽  
Transfusion Reactions

Abstract Abstract 3376 Background: Hemorrhagic shock accounts for a significant number of deaths in patients with acute injury. Early administration of multicomponent blood product transfusion in high plasma to red cell ratios have been associated with decreased mortality. Significant bleeding may occur in many settings outside of injury, including abdominal aortic aneurysm (AAA) rupture and postpartum or gastrointestinal hemorrhage. At a Level I Adult and Pediatric Trauma Center, activation of a Massive Transfusion Protocol (MTP) provides immediate release of sets of blood products with high component ratios (i.e. 1 unit plasma for every 1 unit PRBC) for patients with severe injury. The protocol has also been utilized in patients with major bleeding from non-trauma etiologies. To our knowledge, there are no systematic studies of the effectiveness of blood transfusion with high component ratios in non-traumatic hemorrhage; therefore, we performed a retrospective case review of patients transfused via the MTP for non-traumatic indications and outcomes at our institution. Methods: Clinical data for 58 patients with non-traumatic activation of the MTP between October 2009 and May 2011 was reviewed. Medications, laboratory parameters prior to transfusion, medical conditions affecting bleeding, and amount of blood products administered were evaluated. Outcomes including 24 hour and in-hospital mortality and incidence of transfusion reactions including Transfusion Related Acute Lung Injury (TRALI) were assessed. Associations between medications or medical problems and transfused blood products, as well as component ratio on mortality were assessed using logistic regression. Fisher's exact test was used to examine the impact of transfusion reactions including TRALI on mortality. Results: Forty-nine of 58 patients studied (84%) received blood products after activation of the MTP. Patients ranged in age between 19 and 82 years-old (median 61 years) and 69% were male. Thirty eight percent of patients had the MTP activated for vascular catastrophies (AAA), 24% for GI bleeding, 16% for open heart surgery, and 10% for obstetrical complications. Patients on average received 9 units of red blood cells (range 0–39 units), 6.6 units of plasma (range 0–34 units), and 1.5 apheresis units of platelets (range 0–5). Twelve patients (24%) received cryoprecipitate. Administered adjunctive medications included activated factor VII for 11 patients (22%), aminocaproic acid in 14 patients (28%), vitamin K in 15 patients (30%), and desmopressin in 6 patients (12%). The odds of a patient receiving activated Factor VII increased significantly as the units of PRBCs increased (OR = 3.925; 95% CI = 1.15 – 13.38). Concurrent medications most likely to affect bleeding included heparin in 26 patients (53%), aspirin in 18 patients (37%), and warfarin in 4 patients (8%). Active liver failure was seen in 11 patients (22%), renal failure in 16 patients (32%), and one patient with either a hematologic or solid malignancy. Patient's medications or these medical diagnoses were not associated with the amount of blood product transfused. Twenty one patients (43%) died during the hospitalization, and six patients (12% of total) died within the first 24 hours. In hospital mortality for patients with GI hemorrhage was the highest at 66%. No patients died after receiving transfusion for obstetric complications. Influence of ratio of Plasma:PRBC transfusion on in-hospital morality was seen with mortality of 80% in the <1:4 group, 60% in 1:4–1:2 group, and 36% in both 1:2 to 1:1 and ≥1:1 groups. These differences were not statistically significant, however, potentially due to sample size. Three patients experienced signs and symptoms consistent with TRALI but no other transfusion reactions were found. These cases were not associated with mortality (24-hour or in hospital) and were not correlated with the component ratio. Conclusions: MTPs with infusion of blood products with high ratios of plasma to red cells compared to transfusion with low ratios have improved mortality in patients with hemorrhage due to trauma. Our data suggests the applicability of MTP as part of resuscitation in the management of acute hemorrhage in non-trauma settings. Transfusion reactions were infrequent. Therefore, physicians should strive for transfusion of high ratios of Plasma:PRBC in all instances of major hemorrhage. Disclosures: Off Label Use: Use of activated factor VII to assist with cessation of hemorrhage in patients without hemophilia.

Open and laparoscopic surgeries are associated with comparable 90 day morbidities and mortalities following ERAS protocols- A retrospective Study. (Preprint)

2020 ◽  
Author(s):  
BHAVIN VASAVADA ◽  
Hardik Patel
Keyword(s):  
Multivariate Analysis ◽  
Retrospective Study ◽  
Mortality Rate ◽  
Operative Time ◽  
Univariate Analysis ◽  
Morbidity And Mortality ◽  
Morbidity Rate ◽  
Blood Products ◽  
Asa Score

UNSTRUCTURED All the gastrointestinal surgeries performed between April 2016 to march 2019 in our institution have been analysed for morbidity and mortality after ERAS protocols and data was collected prospectively. We performed 245 gastrointestinal and hepato-biliary surgeries between April 2016 to march 2019. Mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. Mean ASA score was 2.40, mean operative time was 111 minutes, mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall 90 days mortality rate was 8.5% and over all morbidity rate was around 9.79% . On univariate analysis morbidity was associated significantly with higher CDC grade of surgeries, higher ASA grade, more operative time, more blood products use, more hospitalstay, open surgeries,HPB surgeries and luminal surgeries(non hpb gastrointestinal surgeries) were associated with higher 90 days morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90 days mortality was predicted by grade of surgeries, higher ASA grade, more operative time, more blood products use, open surgeries and emergency surgeries. However on multivariate analysis only more blood products used was independently associated with mortality There is no difference between 90 day mortality and moribidity rates between open and laparoscopic surgeries.

scholarly journals Transfusion Medicine Informatics: Analysis of User Burden from Clinical Decision Support Alerts in Promoting Patient Blood Management

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S123-S124
Author(s):  
H C Tsang ◽  
P Mathias ◽  
N Hoffman ◽  
M B Pagano
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Blood Product ◽  
Clinical Decision ◽  
Blood Products ◽  
Blood Management ◽  
Before And After ◽  
Blood Utilization ◽  
Transfusion Ratio ◽  
Major Project

Abstract Introduction/Objective To increase efficiency of blood product ordering and delivery processes and improve appropriateness of orders, a major project to implement clinical decision support (CDS) alerts in the electronic medical record (EMR) was undertaken. A design team was assembled including hospital and laboratory medicine information technology and clinical informatics, transfusion services, nursing and clinical services from medical and surgical specialties. Methods Consensus-derived thresholds in hemoglobin/hematocrit, platelet count, INR, and fibrinogen for red blood cell (RBC), platelet, plasma, and cryoprecipitate blood products CDS alerts were determined. Data from the EMR and laboratory information system were queried from the 12-month period before and after implementation and the data was analyzed. Results During the analysis period, 5813 RBC (avg. monthly = 484), 1040 platelet (avg. monthly = 87), 423 plasma (avg. monthly = 35), and 88 cryoprecipitate (avg. monthly = 7) alerts fired. The average time it took for a user to respond was 5.175 seconds. The total amount of time alerts displayed over 12 months was 5813 seconds (~97 minutes of user time) compared to 56503 blood products transfused. Of active CDS alerts, hemoglobin/RBC alerts fired most often with ~1:5 (31141 RBC units) alert to transfusion ratio and 4% of orders canceled (n=231) when viewing the alert, platelet alerts fired with ~1:15 (15385 platelet units) alert to transfusion ratio and 6% orders canceled (n=66), INR/plasma alerts fired with ~1:21 (8793 plasma units) alert to transfusion ratio and 10% orders canceled (n=41), cryoprecipitate alerts fired with ~1:13 (1184 cryoprecipitate units) alert to transfusion ratio and 10% orders canceled (n=9). Overall monthly blood utilization normalized to 1000 patient discharges did not appear to have statistically significant differences comparing pre- versus post-go-live, except a potentially significant increase in monthly plasma usage at one facility with p = 0.34, although possibly due to an outlier single month of heavy usage. Conclusion Clinical decision support alerts can guide provider ordering with minimal user burden. This resulted in increased safety and quality use of the ordering process, although overall blood utilization did not appear to change significantly.

EXPRESS: Method dependent variation in TSH and FT4 reference intervals in pregnancy: a systematic review

2021 ◽  
pp. 000456322110269
Author(s):  
O E Okosieme ◽  
Medha Agrawal ◽  
Danyal Usman ◽  
Carol Evans
Keyword(s):  
Systematic Review ◽  
Reference Interval ◽  
First Trimester ◽  
Reference Intervals ◽  
Assay Method ◽  
Specific Reference ◽  
Upper Limits ◽  
Wide Range ◽  
Assay Methods ◽  
In Pregnancy

Background: Gestational TSH and FT4 reference intervals may differ according to assay method but the extent of variation is unclear and has not been systematically evaluated. We conducted a systematic review of published studies on TSH and FT4 reference intervals in pregnancy. Our aim was to quantify method-related differences in gestation reference intervals, across four commonly used assay methods, Abbott, Beckman, Roche, and Siemens. Methods: We searched the literature for relevant studies, published between January 2000 and December 2020, in healthy pregnant women without thyroid antibodies or disease. For each study, we extracted trimester-specific reference intervals (2.5–97.5 percentiles) for TSH and FT4 as well as the manufacturer provided reference interval for the corresponding non-pregnant population. Results: TSH reference intervals showed a wide range of study-to-study differences with upper limits ranging from 2.33 to 8.30 mU/L. FT4 lower limits ranged from 4.40–13.93 pmol/L, with consistently lower reference intervals observed with the Beckman method. Differences between non-pregnant and first trimester reference intervals were highly variable, and for most studies the TSH upper limit in the first trimester could not be predicted or extrapolated from non-pregnant values. Conclusions: Our study confirms significant intra and inter-method disparities in gestational thyroid hormone reference intervals. The relationship between pregnant and non-pregnant values is inconsistent and does not support the existing practice in some laboratories of extrapolating gestation references from non-pregnant values. Laboratories should invest in deriving method-specific gestation reference intervals for their population.

scholarly journals Prehospital resuscitation

2021 ◽  
Vol 6 (1) ◽  
pp. e000729
Author(s):  
Alexandra M P Brito ◽  
Martin Schreiber
Keyword(s):  
Young People ◽  
Tranexamic Acid ◽  
New Technologies ◽  
Blood Product ◽  
Traumatic Injury ◽  
Trauma Patients ◽  
Blood Products ◽  
Front Line ◽  
The Usa ◽  
Review Current

Traumatic injury is the leading cause of death in young people in the USA. Our knowledge of prehospital resuscitation is constantly evolving and is often informed by research based on military experience. A move toward balanced blood product resuscitation and away from excessive crystalloid use has led to improvements in outcomes for trauma patients. This has been facilitated by new technologies allowing more front-line use of blood products as well as use of tranexamic acid in the prehospital setting. In this article, we review current practices in prehospital resuscitation and the studies that have informed these practices.

scholarly journals Hypocalcemia in Military Casualties From Point of Injury to Surgical Teams in Afghanistan

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 300-304
Author(s):  
Jeffrey R Conner ◽  
Linda C Benavides ◽  
Stacy A Shackelford ◽  
Jennifer M Gurney ◽  
Edward F Burke ◽  
...  
Keyword(s):  
Blood Product ◽  
Calcium Supplementation ◽  
Cohort Analysis ◽  
Blood Product Transfusion ◽  
Blood Products ◽  
Military Trauma ◽  
Retrospective Cohort Analysis ◽  
Increased Risk ◽  
Surgical Teams ◽  
Patterns Of Injury

ABSTRACT Introduction Hypocalcemia is a known sequela of citrated blood product transfusion. Civilian data suggest hypocalcemia on hospital admission is associated with worse outcomes. Initial calcium levels in military casualties have not previously been analyzed. The objective of this retrospective review aimed to assess the initial calcium levels in military trauma casualties at different Forward Surgical Teams (FST) locations in Afghanistan and describe the effects of prehospital blood product administration on arrival calcium levels. Materials and Methods This is a retrospective cohort analysis of military casualties arriving from point of injury to one of two FSTs in Afghanistan from August 2018 to February 2019 split into four locations. The primary outcome was incidence of hypocalcemia (ionized calcium &lt; 1.20 mmol/L). Results There were 101 patients included; 55 (54.5%) experienced hypocalcemia on arrival to the FST with a mean calcium of 1.16 mmol/L (95% confidence interval [CI], 1.14 to 1.18). The predominant mechanism of injury consisted of blast patterns, 46 (45.5%), which conferred an increased risk of hypocalcemia compared to all other patterns of injury (odds ratio = 2.42, P = .042). Thirty-eight (37.6%) patients required blood product transfusion. Thirty-three (86.8%) of the patients requiring blood product transfusion were hypocalcemic on arrival. Mean initial calcium of patients receiving blood product was 1.13 mmol/L (95% CI, 1.08 to 1.18), which was significantly lower than those who did not require transfusion (P = .01). Eight (7.9%) of the patients received blood products before arrival, with 6/8 (75%) presenting with hypocalcemia. Conclusions Hypocalcemia develops rapidly in military casualties and is prevalent on admission even before transfusion of citrated blood products. Blast injuries may confer an increased risk of developing hypocalcemia. This data support earlier use of calcium supplementation during resuscitation.

Desmopressin Reduces Transfusion Needs after Surgery

2008 ◽  
Vol 109 (6) ◽  
pp. 1063-1076 ◽  
Author(s):  
Giuseppe Crescenzi ◽  
Giovanni Landoni ◽  
Giuseppe Biondi-Zoccai ◽  
Federico Pappalardo ◽  
Massimiliano Nuzzi ◽  
...  
Keyword(s):  
Blood Loss ◽  
Excess Mortality ◽  
Blood Product ◽  
Meta Analysis ◽  
Blood Product Transfusion ◽  
Blood Products ◽  
Hemostatic Agents ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Transfusion Requirements

Background Perioperative pathologic microvascular bleeding is associated with increased morbidity and mortality and could be reduced by hemostatic drugs. At the same time, safety concerns regarding existing hemostatic agents include excess mortality. Numerous trials investigating desmopressin have lacked power to detect a beneficial effect on transfusion of blood products. The authors performed a meta-analysis of 38 randomized, placebo-controlled trials (2,488 patients) investigating desmopressin in surgery and indicating at least perioperative blood loss or transfusion of blood products. Methods Pertinent studies were searched in BioMed Central, CENTRAL, and PubMed (updated May 1, 2008). Further hand or computerized searches involved recent (2003-2008) conference proceedings. Results In most of the included studies, 0.3 microg/kg desmopressin was used prophylactically over a 15- to 30-min period. In comparison with placebo, desmopressin was associated with reduced requirements of blood product transfusion (standardized mean difference = -0.29 [-0.52 to -0.06] units per patient; P = 0.01), which were more pronounced in the subgroup of noncardiac surgery and were without a statistically significant increase in thromboembolic adverse events (57/1,002 = 5.7% in the desmopressin group vs. 45/979 = 4.6% in the placebo group; P = 0.3). Conclusions Desmopressin slightly reduced blood loss (almost 80 ml per patient) and transfusion requirements (almost 0.3 units per patient) in surgical patients, without reduction in the proportion of patients who received transfusions. This meta-analysis suggests the importance of further large, randomized controlled studies using desmopressin in patients with or at risk of perioperative pathologic microvascular bleeding.

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