Factors Affecting Transfusion of Fresh Frozen Plasma, Platelets, and Red Blood Cells During Elective Coronary Artery Bypass Graft Surgery

2003 ◽  
Vol 127 (4) ◽  
pp. 415-423
Author(s):  
Randal Covin ◽  
Maureen O'Brien ◽  
Gary Grunwald ◽  
Bradley Brimhall ◽  
Gulshan Sethi ◽  
...  
Keyword(s):  
Blood Cells ◽  
Prediction Models ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Artery Bypass Graft ◽  
Blood Components ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Context.—The ability to predict the use of blood components during surgery will improve the blood bank's ability to provide efficient service. Objective.—Develop prediction models using preoperative risk factors to assess blood component usage during elective coronary artery bypass graft surgery (CABG). Design.—Eighty-three preoperative, multidimensional risk variables were evaluated for patients undergoing elective CABG-only surgery. Main Outcome Measures.—The study endpoints included transfusion of fresh frozen plasma (FFP), platelets, and red blood cells (RBC). Multivariate logistic regression models were built to assess the predictors related to each of these endpoints. Setting.—Department of Veterans Affairs (VA) health care system. Patients.—Records for 3034 patients undergoing elective CABG-only procedures; 1033 patients received a blood component transfusion during CABG. Results.—Previous heart surgery and decreased ejection fraction were significant predictors of transfusion for all blood components. Platelet count was predictive of platelet transfusion and FFP utilization. Baseline hemoglobin was a predictive factor for more than 2 units of RBC. Some significant hospital variation was noted beyond that predicted by patient risk factors alone. Conclusions.—Prediction models based on preoperative variables may facilitate blood component management for patients undergoing elective CABG. Algorithms are available to predict transfusion resources to assist blood banks in improving responsiveness to clinical needs. Predictors for use of each blood component may be identified prior to elective CABG for VA patients.

Ongoing Variability in Transfusion Practices in Cardiac Surgery Despite Established Guidelines.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 947-947 ◽  
Author(s):  
Stephanie A. Snyder-Ramos ◽  
Patrick Moehnle ◽  
Yi-Shin Weng ◽  
Bernd W. Boettiger ◽  
Alexander Kulier ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Evaluation System ◽  
Blood Product ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Fresh Frozen Plasma ◽  
Transfusion Practice ◽  
Cabg Surgery ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Although blood utilization has been under considerable scrutiny for the past two decades, particularly for surgery, the international evolution of standards remains unknown. Therefore, the objective of this study was to compare the perioperative transfusion of blood components in patients undergoing coronary artery bypass graft (CABG) surgery in different countries. Transfusion practice was investigated prospectively among 16 countries (70 centers). Five-thousand sixty-five (5,065) randomly selected cardiac surgery patients in the Multicenter Study of Perioperative Ischemia Epidemiology II (EPI II) Study were evaluated. Utilization of red blood cells, fresh frozen plasma, and platelets was assessed by day, prior to, during and after surgery until hospital discharge. Intraoperative red blood cell (RBC) transfusion varied from 9 percent to 100 percent among the 16 countries, and 25 percent to 87 percent postoperatively (percent of transfused patients). Similarly, transfusion of fresh frozen plasma (FFP) varied from 0 percent to 98 percent intraoperatively and 3 percent to 95 percent postoperatively, and platelet (PL) transfusion from 0 percent to 51 percent and 0 percent to 39 percent, respectively. An analysis of the EuroSCORE (an internationally validated risk evaluation system for cardiac surgery) risk indices of the countries with the highest and lowest frequencies of use or amounts of each of type blood product failed to demonstrate a correlation between EuroSCOREs and maximum vs minimum frequency of use or amount of blood product administered. Establishment of international guidelines for utilization of blood products in CABG surgery appears necessary.

Transfusion Requirements and Blood Bank Support in Heart and Lung Transplantation

2020 ◽  
Vol 52 (1) ◽  
pp. 74-79
Author(s):  
Dong-Won Yoo ◽  
Hyun-Ji Lee ◽  
Seung-Hwan Oh ◽  
In Suk Kim ◽  
Hyung-Hoi Kim ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Red Blood Cells ◽  
Blood Cells ◽  
Fresh Frozen Plasma ◽  
Blood Component ◽  
Blood Products ◽  
Transfusion Requirements ◽  
Blood Banks ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Objective Transplantations may require massive transfusion of blood products. Therefore, blood banks need to predict, prepare, and supply the required amount of blood products. Methods We measured the volume of transfused blood components as red blood cells, fresh frozen plasma, platelets, and cryoprecipitate in 54 and 89 patients who received heart and lung transplantation, respectively, in our hospital between January 2012 and December 2019. Results Platelets were the most frequently transfused blood component. Transfusion volumes during heart and lung transplantation surgeries differed: red blood cells, 7.83 units vs 14.84 units; fresh frozen plasma, 2.67 units vs 12.29 units; platelets, 13.13 units vs 23.63 units; and cryoprecipitate, 1.74 units vs 2.57 units; respectively. The average transfusion volume of transplants was different each year. Conclusion Periodic evaluation of transfusion requirements will facilitate the efficient management of blood products at the time of transplantation and help blood banks predict changes in blood requirements.

scholarly journals Use of Blood Components in Major Obstetric Hemorrhage: Preliminary Findings from the Australian and New Zealand Massive Transfusion Registry (ANZ-MTR)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1563-1563 ◽  
Author(s):  
Naomi J Aoki ◽  
Kylie Venardos ◽  
Nick Andrianopoulos ◽  
Zoe K Mcquilten ◽  
Amanda J Zatta ◽  
...  
Keyword(s):  
Blood Cells ◽  
Massive Transfusion ◽  
Fibrinogen Level ◽  
Fresh Frozen Plasma ◽  
Blood Components ◽  
Blood Products ◽  
Obstetric Hemorrhage ◽  
Laboratory Results ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Introduction: Major obstetric hemorrhage (MOH) can develop rapidly and, due to the unique characteristics of maternity patients, early recognition and management can be challenging. Use of blood components in MOH can be life-saving however there is uncertainty about optimal use of these products and the role of adjunctive therapies. The ANZ-MTR generates observational data on current transfusion management and outcomes in critically bleeding patients receiving massive transfusion (MT) across all clinical settings. This study aimed to describe the transfusion strategies used in the MOH population and report their outcomes. Methods: Patients who had a MOH and received a MT (≥5 units of red blood cells [RBC] in 4h) between April 2011 and December 2013 at 15 Australian & NZ hospitals were identified. Data on the type and volume of blood products transfused as well as selected laboratory results and clinical outcomes were reviewed. Results: A total of 154 cases were identified and reviewed, representing 6% of the total ANZ-MTR cohort. Median age was 34 [IQR29-37] years and 99% of women had a Charlson Comorbidity Index score ≤ 1. Table 1 presents the blood products transfused. The median [IQR] fresh frozen plasma (FFP) to RBC ratio and platelets to RBC ratio was 0.6 [0.3-0.8] and 0.1 [0-0.2], respectively. FFP, platelets and cryoprecipitate were transfused in 87%, 66% and 49% of patients. Prothrombinex-HT was administered to 1 patient and 3 patients received rFVIIa. Table 2 presents the laboratory results taken prior to MT onset as well as the lowest and highest result reported within 24hours after the MT onset. Fibrinogen levels following MT onset was available for 121 (79%) patients. Of these, 46% women had a fibrinogen level <2 g/L of which 34% did not receive cryoprecipitate. Mean [SD] hemoglobin level 24h post-MT onset was 108g/L [19]. Regarding patient outcomes, median [IQR] hospital length of stay was 8 [4-43] days, 59 (38%) women were admitted to ICU, 40 (26%) underwent a subtotal or total hysterectomy and 3 (1.9%) died in-hospital. Table 1. Number of patients and median number of units transfused 24h post-MT onset (n = 154). Blood product n (%) Median units (IQR) Red blood cells 154 (100) 7 [6-10] Fresh frozen plasma 134 (87) 4 [2-6] Platelets 102 (66.2) 1 [0-1] Cryoprecipitate 76 (49.4) 0 [0-5] Table 2. Laboratory values* reported Value prior to MT onset Lowest value 0-24h post-MT onset Highest value 0-24h post-MT onset Hemoglobin (g/L) 102 [81-120], 84 77 [67-90]; 92 108 [95-119]; 92 INR 1.1 [0.9-1.2]; 33 1.1 [.9-1.2]; 72 1.3 [1.1-1.4]; 72 aPPT(s) 31 [28-35]; 39 31 [29-34]; 88 37 [33-46]; 88 Fibrinogen level (g/L) 3.2 [1.6-3.9]; 25 1.9 [1.4-2.6]; 79 2.9 [2.5-3.5]; 79 Platelet Count (109/L) 210 [158-249];84 102 [74-135]; 92 146 [110-190]; 92 pH 7.3 [7.3-7.4]; 22 7.3 [7.2-7.3]; 70 7.4 [7.4-7.5]; 70 *Data are Median [IQR]; % patients with laboratory test available Conclusion: Women with MOH requiring massive transfusion were generally healthier and younger than patients of other clinical contexts in the ANZ-MTR. Although there were few in-hospital deaths reported (1.9%), a large proportion of the cohort required a hysterectomy during their hospital admission. Further information on transfusion practice, including understanding optimal blood component ratios, is required to inform clinical practice and minimize risk in the obstetric setting. Disclosures McLintock: Novo Nordisk Australasia: Honoraria.

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 

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.

Perioperative management of coagulation

2006 ◽  
Vol 26 (S 02) ◽  
pp. S3-S14 ◽  
Author(s):  
P. Innerhofer
Keyword(s):  
Coagulation Factor ◽  
Fresh Frozen Plasma ◽  
Laboratory Evaluation ◽  
Blood Component ◽  
Actual Case ◽  
Fresh Frozen ◽  
Coagulation Factor Concentrates ◽  
Hemostatic Therapy ◽  
Frozen Plasma

SummaryGuidelines of official societies for diagnosis and therapy of intraoperatively occurring hypocoagulability rely mainly on data of patients receiving whole blood transfusions. They recommend -provided that laboratory evaluation shows deficiency (values >1.5 fold normal)- administration of fresh frozen plasma, cryoprecipitate and platelet concentrates (platelet count <50 000 or <100 000/μl). This article describes the pathogenesis of coagulopathy in the light of the special intraoperative setting, emphasizes recent changes of blood component preparation, transfusion triggers, effects of volume therapy and challenges standard laboratory assays as reliable guide for intraoperative hemostatic therapy. The role of thrombelastographic monitoring is discussed as well as an alternative strategy to compensate deficiencies by the use of coagulation factor concentrates instead of or in addition to transfusion of FFP, a new concept which is illustrated by the presentation of an actual case report.

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