Consequences of Transfusing Blood Components in Patients With Trauma: A Conceptual Model

2017 ◽  
Vol 37 (2) ◽  
pp. 18-30 ◽  
Author(s):  
Allison R. Jones ◽  
Susan K. Frazier
Keyword(s):  
Conceptual Model ◽  
Traumatic Injury ◽  
Blood Component ◽  
Blood Components ◽  
Storage Lesion ◽  
Trauma Outcomes ◽  
Packed Red Blood Cells ◽  
Blood Component Transfusion ◽  
Patient’S Outcome

Transfusion of blood components is often required in resuscitation of patients with major trauma. Packed red blood cells and platelets break down and undergo chemical changes during storage (known as the storage lesion) that lead to an inflammatory response once the blood components are transfused to patients. Although some evidence supports a detrimental association between transfusion and a patient’s outcome, the mechanisms connecting transfusion of stored components to outcomes remain unclear. The purpose of this review is to provide critical care nurses with a conceptual model to facilitate understanding of the relationship between the storage lesion and patients’ outcomes after trauma; outcomes related to trauma, hemorrhage, and blood component transfusion are grouped according to those occurring in the short-term (≤30 days) and the long-term (>30 days). Complete understanding of these clinical implications is critical for practitioners in evaluating and treating patients given transfusions after traumatic injury.

From Donor to Recipient: Considerations for Blood Transfusion Outcomes Research

2017 ◽  
Vol 19 (5) ◽  
pp. 491-498
Author(s):  
Allison R. Jones ◽  
Michelle R. Brown ◽  
David E. Vance
Keyword(s):  
Patient Care ◽  
Patient Outcomes ◽  
Outcomes Research ◽  
Current Evidence ◽  
Patient Specific ◽  
Blood Component ◽  
Blood Components ◽  
Packed Red Blood Cells ◽  
Blood Component Transfusion ◽  
Donor Characteristics

Donated blood can be broken down into blood components for use in patient care. This article focuses primarily on packed red blood cells (PRBCs), as they experience breakdown during storage that may adversely impact patient outcomes. Patients require PRBC transfusions for a number of clinical reasons. Although transfusions of PRBCs provide some clinical benefit, they are also associated with increased morbidity and mortality across multiple patient populations, albeit the mechanisms underlying this relationship remain unclear. With an aging, more acutely ill population requiring aggressive treatment and a lack of transfusion alternatives, research focused on PRBCs has gained momentum. Proper interpretation of research findings on the part of clinicians depends on accurate data collection that includes aspects of both the transfused blood components and the recipients. The purpose of this article is to examine stored PRBC factors, blood-donor characteristics, transfusion-specific factors, and patient-specific characteristics as they relate to patient outcomes research. Challenges associated with performing and interpreting outcomes of transfusion-related research are presented. Implications of current evidence for patient care, such as awareness of benefits as well as risks associated with blood component transfusion, are also provided.

A 0.6-protamine/heparin ratio in cardiac surgery is associated with decreased transfusion of blood products

2020 ◽  
Vol 31 (3) ◽  
pp. 391-397
Author(s):  
Anne L M Goedhart ◽  
Bastiaan M Gerritse ◽  
Thijs C D Rettig ◽  
Martijn W A van Geldorp ◽  
Sander Bramer ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Thrombus Formation ◽  
Group Versus ◽  
Fresh Frozen Plasma ◽  
Interquartile Range ◽  
Postoperative Blood Loss ◽  
Blood Component ◽  
Packed Red Blood Cells ◽  
Blood Component Transfusion

Abstract OBJECTIVES In cardiac surgery, adequate heparinization is necessary to prevent thrombus formation in the cardiopulmonary bypass (CPB). To counteract the heparin effect after weaning from CPB, protamine is administered. The optimal protamine/heparin ratio is still unknown. METHODS In this before–after study, we evaluated the effect of a 0.6/1-protamine/heparin ratio implementation as of May 2017 versus a 0.8/1-protamine/heparin ratio on the 12-h postoperative blood loss and the amount of blood and blood component transfusions (fresh frozen plasma, packed red blood cells, fibrinogen concentrate, platelet concentrate and prothrombin complex concentrate) after cardiac surgery. A total of 2051 patients who underwent cardiac surgery requiring CPB between May 2016 and May 2018 were included. RESULTS In the 0.6/1-protamine/heparin ratio group, only 28.8% of the patients received blood component transfusion, compared to 37.9% of the patients in the 0.8/1-ratio group (P < 0.001). The median 12-h postoperative blood loss was 230 ml (interquartile range 140–320) in the 0.6/1-ratio group versus 260 ml (interquartile range 155–365) in the 0.8/1-ratio group (P < 0.001). CONCLUSIONS A 0.6/1-protamine/heparin ratio after weaning from CPB is associated with a significantly reduced 12-h postoperative blood loss and blood components transfusion.

scholarly journals Audit of transfusion practices in pediatrics in a tertiary care hospital

2020 ◽  
Vol 7 (6) ◽  
pp. 1424
Author(s):  
Vaishnavi Iyengar ◽  
Anjali Parekh ◽  
Sanjay Natu
Keyword(s):  
Red Blood Cells ◽  
Blood Cells ◽  
Tertiary Care ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Care Hospital ◽  
Blood Components ◽  
Tertiary Care Centre ◽  
Blood Component Transfusion ◽  
British Committee

Background: Audit of transfusion practices in pediatric patients was performed to study indications, clinical profile and whether transfusions were in accordance to guidelines.Methods: Retrospective analysis of all episodes of transfusions from a tertiary care centre was done. The study period was from January 2018 to December 2018.Patients in the age group of 4 months to 12 years were enrolled in the study. The data was reviewed according to the British Committee for Standards in Haematology guidelines for transfusion.Results: During the study period of 12 months,168 units of hemocomponents were transfused to children, 66.07% (111/168) of the total products transfused were packed red cell units, followed by 36 units (21.42%) of fresh frozen plasma and 21 units (12.5%) platelets. Overall usage of blood components was found to be appropriate in 58.33% (98/111). Red blood cells were the most appropriately transfused (64.86 %) (72 units out of 111) blood product as compared to 42.85% of platelets (9/21) and 47.22% of FFP (17/36).Conclusions: Most frequently transfused blood components are red blood cells in pediatrics. Inappropriate transfusion of blood components is hinders the utility of this valuable resource, Thus it becomes necessary to conduct regular audit of blood component transfusion for optimum utilization.

scholarly journals Impact of transfusion of blood components on the recipient immune system

2021 ◽  
Vol 23 (6) ◽  
pp. 1307-1318
Author(s):  
T. V. Glazanova ◽  
E. R. Shilova ◽  
A. V. Chechetkin ◽  
L. N. Bubnova
Keyword(s):  
Immune System ◽  
Immune Modulation ◽  
Hla Antigens ◽  
Perioperative Period ◽  
Blood Component ◽  
Malignant Neoplasms ◽  
Blood Components ◽  
Transfusion Therapy ◽  
Storage Lesion

Transfusions of blood provide essential therapeutic measures in a number of pathological conditions. However, when carrying out blood component therapy, it is important to consider probability of post-transfusion complications. Most of them are immune-mediated side effects. The unfavorable consequences of blood transfusions can manifest at long-range time periods, and pathogenesis of these phenomena may be associated not only with the presence of alloantibodies. They may be caused by alloimmunization to HLA antigens, leukocyte factors, including cytokines, products of leukocyte degranulation, as well as storage-related erythrocyte damage («storage lesion»), immunomodulatory properties of extracellular vesicles or microparticles derived from blood components, and other factors. Despite significant number of publications on this issue, a lot of unresolved issues still remain, concerning transfusion-related effects of blood components on the immune system of recipients. The review article provides the results of current studies in this area. We present and discuss the results of current studies and the features of transfusion-mediated immunomodulation (TRIM) revealed over recent years, when transfusing different blood components. The role of plasma factors, microparticles, platelets and erythrocytes, HLA sensitization and microchimerism in the development of TRIM is highlighted, the data on occurrence and clinical features of TRIM in perioperative period are presented. A separate section of the review provides information about recent clinical studies, devoted to the issues of TRIM in different clinical cohorts, including newborns, patients with malignant neoplasms, immunocompromised patients after heart and vascular surgery. The data on TRIM incidence in the patients with exhausted immune system due to previous disease or treatment, severe comorbidity, extensive surgical thoracic/abdominal intervention and artificial circulation are also in scope. As based on the studies performed, the role of distinct measures, e.g., washing of erythrocyte concentrates, leukodepletion, and gamma irradiation are discussed in view of potential TRIM prevention. The results of published research do not allow us to draw definite conclusions about the effects of blood component transfusion on the immune system of recipients with respect to differences between the studied groups of patients, characteristics of the studied disorders and clinical situations, diversity of hemocomponents, as well as varying standards of transfusion therapy adopted in different countries. However, the systematic literature review may provide some guidance in transfusion-mediated immune modulation.

The physiology of blood in anaesthetic practice

2017 ◽  
Author(s):  
Hanane El Kenz ◽  
Philippe Van der Linden
Keyword(s):  
Blood Transfusion ◽  
Whole Blood ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Blood Components ◽  
Pathogen Inactivation ◽  
Septic Complications ◽  
Packed Red Blood Cells ◽  
Blood Component Therapy ◽  
Fresh Frozen

Following the discovery of the ABO blood groups by Landsteiner in 1901, Albert Hustin described the first transfusion of a whole blood unit in 1914. The modern transfusion era really begins in 1916 with the discovery of sodium citrate as an anticoagulant by the same physician, allowing blood conservation in dedicated packs. Since that time, many advances have been made especially over the past two decades in the storage, the conservation, and the laboratory testing of blood components and in transfusion medicine practice. Transfusion of whole blood has been replaced by blood component therapy, which consists of the administration of packed red blood cells, fresh frozen plasma, or platelets. Although blood transfusion is safer than ever, the risk of complications will never reach zero. The risk of infectious transfusion-transmitted diseases has been markedly reduced by the implementation of extensive infectious disease testing, donor selection, and pathogen-inactivation procedures. In countries with a high human development index, the leading causes of allogeneic blood transfusion-related deaths actually resulted from immunological and septic complications. The first section of this chapter describes the structure, function, and immunological aspects of the different blood components that are routinely transfused today. The second section details the composition of the different blood components, their indications, the pre-transfusion compatibility tests, and the main adverse effects associated with their transfusion.

High-level long-term white blood cell microchimerism after transfusion of leukoreduced blood components to patients resuscitated after severe traumatic injury

Transfusion ◽  
2005 ◽  
Vol 45 (8) ◽  
pp. 1280-1290 ◽  
Author(s):  
Tzong-Hae Lee ◽  
Teresa Paglieroni ◽  
Garth H. Utter ◽  
Daniel Chafets ◽  
Robert C. Gosselin ◽  
...  
Keyword(s):  
Blood Cell ◽  
White Blood Cell ◽  
Traumatic Injury ◽  
Blood Components ◽  
Severe Traumatic Injury ◽  
High Level

Quantification of Thrombelastographic Changes After Blood Component Transfusion in Patients with Liver Disease in the Intensive Care Unit

1995 ◽  
Vol 81 (2) ◽  
pp. 272-278
Author(s):  
Douglas G. Clayton ◽  
Adelaida M. Miro ◽  
David J. Kramer ◽  
Nathaniel Rodman ◽  
Stanley Wearden
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Disease ◽  
Blood Component ◽  
Blood Component Transfusion

The association of psychiatric and neurological comorbidities with outcomes in traumatic injury patients

2021 ◽  
pp. 009121742198914
Author(s):  
Jennifer Brady ◽  
R David Hayward ◽  
Elango Edhayan
Keyword(s):  
Length Of Stay ◽  
Psychiatric Illness ◽  
Traumatic Injury ◽  
Lower Mortality ◽  
Linear Modeling ◽  
Psychiatric Comorbidities ◽  
Trauma Outcomes ◽  
Hospital Stays ◽  
The Impact ◽  
The Relationship

Introduction Mental illness is a well-known risk factor for injury and injury recidivism. The impact of pre-existing psychiatric illness on trauma outcomes, however, has received less attention. Our study examines the relationship of pre-existing psychiatric illness on trauma outcomes including length of stay, cost, and mortality. Methods Patient data were obtained from the Healthcare Cost and Utilization Project’s State Inpatient Database. All patients admitted for trauma in the Detroit metropolitan area from 1/1/2006 to 12/31/2014 were included. The relationship between individual psychiatric comorbidities (depression, psychosis, and other neurological disorders) and outcomes were evaluated with logistic regression (mortality) and generalized linear modeling (length of stay and cost). Results Over 260,000 records were reviewed. Approximately one-third (29.9%) of patients had one or more psychiatric diagnoses. Patients with depression had longer hospital stays (RR = 1.12, p < 0.001) and higher costs (RR = 1.07, p < 0.001), but also lower mortality (OR = 0.69, p < 0.001). Patients with psychosis had longer stays (RR = 1.18, p < 0.001), higher costs (RR = 1.02, p = 0.002), and lower mortality (OR = 0.61, p < 0.001). Patients with other neurological comorbidities had higher mortality (OR = 1.23, p < 0.001), longer stays (RR = 1.29, p < 0.001), and higher costs (RR = 1.10, p < 0.001). Conclusion Patients with a psychiatric disorder required longer care and incurred greater costs, whereas mortality was higher for only those with a neurological disorder. Identifying patients’ psychiatric comorbidities at the time of admission for trauma may help optimize treatment. Addressing these conditions may help reduce the cost of trauma care.

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