Evolution of Practices in a French Trauma Centre: Decrease in Blood Transfusions and Fresh Frozen Plasma to Red Blood Cell Ratios

Abstract Abstract 4358 Background Addition of purine analogues to standard induction therapy of acute myeloid leukemia (AML) had previously been demonstrated to increase complete remission rate and does not aggravate infectious complications. The aim of this study was to analyze whether the use of cladribine or fludarabine during induction and consolidation treatment increase the need for more frequent transfusions of red blood cell concentrates, platelet concentrates and fresh frozen plasma. Material and methods 118 AML patients, included in two consecutive randomized trials between 1999–2006 in a single centre were analyzed. Induction therapy consisted of daunorubicin + cytarabine (DA-7, n=53) alone or in combination with cladribine or fludarabine (DAC-7 + DAF-7, n=65). Consolidation included one course of high-dose AraC + mitoxantrone and one course of high-dose AraC +/− purine analogues. A median age was 45(17-58) years and 48(20-60) years for patients treated with and without purine analogues, respectively. Results During induction treatment 7 (1-19) units of red blood cell concentrates (median and range) was transfused in the group with purine analogues compared to 6 (1-23) in the group without purine analogues, p=0,24. Number of transfused platelet concentrates bags was 6 (1-30) in the group of purine analogues and 7 (0-19) in the group without purine analogues, p = 0.49. In the group with purine analogues 0 (0-31) units of fresh frozen plasma was transfused compared to 0 (0-26) in the group without purine analogues, p = 0.91. During HAM consolidation therapy 3 (0-11) units of red blood cell concentrates was transfused in the group with purine analogues compared to 2 (0-9) in the group without purine analogues, p = 0.15. Number of transfused platelet concentrates bags in the group with purine analogues was 2 (0-8) vs. 2 (0-12) in the group without purine analogues, p = 0.25. In the course of HAM consolidation treatment - 0 (0-56) units of fresh frozen plasma was transfused in the group with purine analogues compared to 0 (0-0) in the group without purine analogues, p = 0.027. During HD Ara-C consolidation therapy 3 (0-7) units of red blood cell concentrates was transfused in the group with purine analogues compared to 2 (0-5) in the group without purine analogues, p = 0.03. Number of transfused platelet concentrates bags in the group treated with purine analogues was 3 (1-12) vs. 3 (1-6) in the group without purine analogues, p = 0.61. In the course of HD Ara-C consolidation treatment 0 (0-9) units of fresh frozen plasma was transfused in the group with purine analogues compared to 0 (0-11) in the group without purine analogues, p=0,34. Conclusions The vast majority of the obtained results did not reveal any significant differences between the group of AML patients treated with or without purine analogues. During HAM consolidation treatment statistical significance for more fresh frozen plasma units transfused was shown in the patients treated with purine analogues, although the median value was the same in both groups (0). This situation was random and independent of prior use of purine analogues in the induction therapy, because in one of the woman-patient gynecological complications and DIC occurred (bleeding from uterine fibroids). This situation required intensive supportive therapy including fresh frozen plasma transfusions. In one case 56 units of fresh frozen plasma was transfused and in second arm of the study was not applied a plasma transfusions in any patient. Also during second (HD Ara-C) consolidation treatment number of transfused units of RBC's concentrates was significant higher in the group of patients treated with purine analogues, although the median values were similar (3 vs 2). These differences may arise from the fact that in some patients - especially in group of patients treated with purine analogues who obtained the better results of therapy – second HD Ara-C treatment was also more often followed by mobilization and collection of stem cells from peripheral blood for transplantation. In the procedure of stem cells collection a higher hematocrit value is recommended – so frequent decision for RBC's transfusions was made in this group of patients. We conclude that the use of purine analogues in the treatment of AML patients does not increase the need for more frequent transfusions of red blood cell concentrates, platelet concentrates and fresh frozen plasma. Disclosures: No relevant conflicts of interest to declare.

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Metagenomics analysis of red blood cell and fresh-frozen plasma units

Transfusion ◽

10.1111/trf.14148 ◽

2017 ◽

Vol 57 (7) ◽

pp. 1787-1800 ◽

Cited By ~ 13

Author(s):

Pierre Lau ◽

Samuel Cordey ◽

Francisco Brito ◽

Diderik Tirefort ◽

Thomas J. Petty ◽

...

Keyword(s):

Blood Cell ◽

Red Blood Cell ◽

Fresh Frozen Plasma ◽

Fresh Frozen ◽

Frozen Plasma ◽

Metagenomics Analysis

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Mo1164 Red Blood Cell Transfusion Is Associated With Increased Rebleeding but Fresh Frozen Plasma With Increased Mortality in Acute Non-Variceal Upper Gastrointestinal Bleeding

Gastroenterology ◽

10.1016/s0016-5085(15)32109-0 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-626

Author(s):

Kavitha Subramaniam ◽

Katrina Spilsbury ◽

Oyekoya Ayonrinde ◽

Faye Latchmiah ◽

Syed A. Mukhtar ◽

...

Keyword(s):

Blood Cell ◽

Gastrointestinal Bleeding ◽

Red Blood Cell ◽

Upper Gastrointestinal Bleeding ◽

Fresh Frozen Plasma ◽

Red Blood Cell Transfusion ◽

Fresh Frozen ◽

Upper Gastrointestinal ◽

Frozen Plasma

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Examining 1:1 vs. 4:1 Packed Red Blood Cell to Fresh Frozen Plasma Ratio Transfusion During Pediatric Burn Excision

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa001 ◽

2020 ◽

Vol 41 (3) ◽

pp. 443-449 ◽

Cited By ~ 2

Author(s):

Shawn Tejiram ◽

Soman Sen ◽

Kathleen S Romanowski ◽

David G Greenhalgh ◽

Tina L Palmieri

Keyword(s):

Blood Cell ◽

Body Surface ◽

Red Blood Cell ◽

Total Body Surface Area ◽

Blood Stream ◽

Fresh Frozen Plasma ◽

Plasma Transfusion ◽

Fresh Frozen ◽

Total Body ◽

Frozen Plasma

Abstract Blood transfusions following major burn injury are common due to operative losses, blood sampling, and burn physiology. While massive transfusion improves outcomes in adult trauma patients, literature examining its effect in critically ill children is limited. The study purpose was to prospectively compare outcomes of major pediatric burns receiving a 1:1 vs. 4:1 packed red blood cell to fresh frozen plasma transfusion strategy during massive burn excision. Children with >20% total body surface area burns were randomized to a 1:1 or 4:1 packed red blood cell/fresh frozen plasma transfusion ratio during burn excision. Parameters examined include patient demographics, burn size, pediatric risk of mortality (PRISM) scores, pediatric logistic organ dysfunction scores, laboratory values, total blood products transfused, and the presence of blood stream infections or pneumonia. A total of 68 children who met inclusion criteria were randomized into two groups (n = 34). Mean age, PRISM scores, estimated blood loss (600 ml (400–1175 ml) vs. 600 ml (300–1150 ml), P = 0.68), ventilator days (5 vs. 9, P = 0.47), and length of stay (57 vs. 60 days, P = 0.24) had no difference. No differences in frequency of blood stream infection (20 vs. 18, P = 0.46) or pneumonia events (68 vs. 116, P = 0.08) were noted. On multivariate analysis, only total body surface area burn size, inhalation injury, and PRISM scores (P < 0.05) were significantly associated with infections.

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