The need for blood products in patients with crush syndrome

2010 ◽  
Vol 5 (5) ◽  
pp. 295-301 ◽  
Author(s):  
Rumeyza Kazancioglu, MD ◽  
Binnur Pinarbasi, MD ◽  
Bahar Artim Esen, MD ◽  
Aydin Turkmen, MD ◽  
Mehmet S. Sever, MD
Keyword(s):  
Task Force ◽  
Human Albumin ◽  
Fresh Frozen Plasma ◽  
Crush Syndrome ◽  
Blood Products ◽  
Medical Problems ◽  
Multisystem Involvement ◽  
Tertiary Center ◽  
Fresh Frozen ◽  
Mass Disasters

Objectives: Crush syndrome is typical for multisystem involvement because of coexisting major surgical and/or medical problems. Treatment of patients with crush syndrome following mass disasters is even more problematic as hundreds of patients are admitted to hospitals and need therapy at once. In this study, the authors evaluated the need of blood and blood products in patients hospitalized due to crush syndrome after the Marmara earthquake in a single center.Methods: The clinical and laboratory variables regarding 60 patients with crush syndrome (30 males and 30 females; mean age: 31.3 _ 13.8 years) hospitalized at a tertiary center that were documented on the preformed questionnaires distributed by International Society of Nephrology Task Force at the aftermath of the earthquake were analyzed by Statistical Package for Social Sciences for Windows software version 13.0 (SPSS Inc, Chicago, IL, USA).Results: Thirty-nine patients (16 males and 23 females; mean age: 30.1 _ 12.6 years) were transfused with 589 U of blood, 840 U of fresh frozen plasma, and 172 U of human albumin during the hospitalization. Most of the transfusions were performed during the first week after the hospitalization.Conclusions: As a result, the preparation for disasters should also include logistic plans for obtaining sufficient amount of blood and blood products to be used in the early aftermath of the event.

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

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.

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

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.

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

2018 ◽  
Vol 24 (2) ◽  
pp. 108
Author(s):  
Rosita Linda ◽  
Devita Ninda
Keyword(s):  
Blood Transfusion ◽  
Secondary Data ◽  
Hemoglobin Concentration ◽  
Fresh Frozen Plasma ◽  
Blood Components ◽  
Blood Products ◽  
Fresh Frozen ◽  
Frozen Plasma ◽  
Hemoglobin Measurement ◽  
Baseline Hemoglobin

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 

Identification of Wasted Blood Products at Staten Island University Hospital in 2020 and Institutional Efforts to Reduce Wastage

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S156-S157
Author(s):  
M Toprak ◽  
I M Asuzu ◽  
G Morvillo ◽  
F Kiran ◽  
B Chae ◽  
...  
Keyword(s):  
Shelf Life ◽  
Blood Product ◽  
Low Cost ◽  
Fresh Frozen Plasma ◽  
University Hospital ◽  
Blood Component ◽  
Blood Products ◽  
Staten Island ◽  
Team Members ◽  
Fresh Frozen

Abstract Introduction/Objective Blood products are precious resources obtained from donors who donate with the intention to help people. These blood products however do not always go to the patients, instead sometimes ending up in the waste. It is inevitable to have some degree of the wastage due to limited blood product shelf life, the inherent need to have stock on hand at all times, and the often unpredictable demand of these products. However, it is possible to minimize the wastage of blood products with careful management of inventories, proper documentation, and education1. In this study, we aim to identify the amount and cost of wasted blood products at Staten Island University Hospital in 2020, the reasons behind the wastage, and solutions to reduce the wastage. Methods/Case Report A retrospective statistical analysis of blood product waste data in 2020 was performed manually with Microsoft Excel. Wastage rate and average cost was calculated, the reasons behind the wastage were identified, and low cost interventions to reduce wastage were planned. Results (if a Case Study enter NA) Total number of the wasted blood product is 425 which represents 3.8% of the total inventory at a total cost of $ 97,309.46 which does not include the hours spend by the lab personnel for the wasted products. The most wasted blood component is fresh frozen plasma (FFP) (Table 1). Thawing the frozen blood products (FFP and cryoprecipitate) significantly shortens the shelf life and triggers a lot of wastage through expiration (Table 2). 32.5 % of the wasted products are wasted due to expiration on the shelf (Diagram 1). Other reasons for the wastage includes patient unreadiness, patient refusal, late return of unused products etc. (Graph 1). Conclusion Educating clinical and laboratory team members about the reasons for wasted blood products and strategies to reduce it might significantly reduce the wastage. Appropriate activation and immediate deactivation of massive transfusion protocol (MTP) would be one of the most important aspect of this education. Expired thawed blood product is the largest contributor to wastage, and MTP is the main reason for thawing. Preventing unnecessary MTP activation minimizes over-thawing and therefore minimizes the expiration and wastage. Documentation of the wasted blood product should be improved to better identify the reasons behind wastage.

Transfusion of blood products

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.

Thrombin Generation in Newborn Plasma Is Critically Dependent on the Concentration of Prothrombin

1990 ◽  
Vol 63 (01) ◽  
pp. 027-030 ◽  
Author(s):  
Maureen Andrew ◽  
Barbara Schmidt ◽  
Lesley Mitchell ◽  
Bosco Paes ◽  
Frederick Ofosu
Keyword(s):  
Thrombin Generation ◽  
Fresh Frozen Plasma ◽  
Factor Ix ◽  
Blood Products ◽  
Platelet Concentrates ◽  
Term Infants ◽  
Cord Plasma ◽  
Coagulation Proteins ◽  
Fresh Frozen ◽  
Frozen Plasma

SummaryThe ability to generate thrombin is decreased and delayed in plasma from the healthy newborn infant compared to the adult. Only 30 to 50% of peak adult thrombin activity can be produced in neonatal plasma. To test whether this observation can be explained by the low neonatal levels of the contact or vitamin K dependent factors, we measured neonatal thrombin generation after raising the concentration of these factors to adult values. We also determined whether the addition of a variety of blood products to neonatal plasma improved thrombin generation. An amidolytic method was used to quantitate intrinsic (APTT) and extrinsic (PT) pathway thrombin generation in defibrinated pooled cord plasma from healthy term infants. Added individually, factors VII, IX, X or the contact factors (CF) failed to alter the rate or the total amount of thrombin generated in neonatal plasma. In contrast, the addition of prothrombin increased the total amount of thrombin generated to above adult values in both the APTT and the PT systems but did not alter the rate of thrombin generation. The rate of thrombin generation in cord plasma shortened after a combination of II, IX, X and CF was added to the APTT system or II, VII and X to the PT system. In both systems, the total amount of thrombin generated was linearly related to the initial prothrombin concentration. Each of fresh frozen plasma, cryoprecipitate, plasma from platelet concentrates, or factor IX concentrate (in amounts used therapeutically) caused an increase in the total amount of thrombin generated which was related to the increase in prothrombin concentration. Thus, the total amount of thrombin generated in newborn plasma is critically dependent on the prothrombin concentration whereas the rate at which thrombin is generated is dependent on the levels of many other coagulation proteins in combination.

scholarly journals Human immunodeficiency virus seroprevalence in children received multiple transfusions or blood products in the Department of Child Health Faculty of Medicine University of Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta

2019 ◽  
Vol 28 (11-12) ◽  
pp. 233-30
Author(s):  
C. S. Matondang ◽  
Arwin Akib ◽  
Syawitri P. Siregar ◽  
Maria Abdulsalam ◽  
Jeanne Latu ◽  
...  
Keyword(s):  
Child Health ◽  
General Hospital ◽  
Fresh Frozen Plasma ◽  
Red Cells ◽  
Human Immunoglobulin ◽  
Red Cross ◽  
Confirmatory Test ◽  
Blood Products ◽  
Myelocytic Leukemia ◽  
Fresh Frozen

From March 1987 till February 1988, 350 serological examinations to HJV antibodies have been carried out. Sera were taken from children visiting the Department of. Child Health Faculty of Medicine University of Indonesia I Dr. Cipto Mangunkusumo General Hospital, Jakarta, who had received blood or blood products transfusions more than three times. All blood or blood products were made locally by the Jndonesian Red Cross in Jakarta, except for Human immunoglobulin and Koate. The age ranged from 9 months Ia 22 years with a mean age of 8,02 years. They consisted of 207 males and 143 females; 33 patients with hemophilia, 250 patients with thalassemia, 41 patients with blood malignancy, and 26 patients with other diseases. Sera were tested by a commercially available ELISA HIV assay produced by Abbott (macro ELISA) and Behring (micro ELISA). Repeatable positive sera were confirmed by Western blatt. The majority of patients in this study got their first transfusion on more than 5 years ago with a high consumption of blood components, namely 16.252 units of packed red cells, 6111 units of cryoprecipitate, 537 units of thrombocyte suspension, 96 units of fresh frozen plasma, 35 units of human immunoglobulin, and 15 vials of Koate. Two out of 350 sera were repeatable positive for HIV antibody but confirmatory test by Western blatt were negative. One sera was from a 17-year-o/d gM with thalassemia who had received 129 units of packed red cells transfusions since 1979, and the other was from a 2-year-o/d girl with chronic myelocytic leukemia who had received 24 units of packed red cells. The rest of the sera were negative. This zero prevalence finding suggests that in Indonesia transfusion of blood or blood products still plays a limited role in the epidemic of AIDS in children.

Blood products and fluid therapy

2016 ◽  
Author(s):  
Richard Telford
Keyword(s):  
Fluid Therapy ◽  
Massive Transfusion ◽  
Fresh Frozen Plasma ◽  
Red Cells ◽  
Cell Salvage ◽  
Blood Products ◽  
Blood Conservation ◽  
Jehovah’S Witnesses ◽  
Fresh Frozen ◽  
Frozen Plasma

This chapter discusses the anaesthetic uses of blood products and other fluids. It begins with a discussion of blood products (red cells, platelets, fresh frozen plasma, and so on). It goes on to describe blood conservation techniques such as cell salvage. Massive transfusion is discussed with its protocol. The problems posed by Jehovah’s Witnesses who refuse blood products are explored. The chapter concludes with a discussion of fluid and electrolyte therapy.

Blood transfusion

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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