Essential aspects for the administration of blood components in hospitalized patients: A narrative literature review

Introduction Transfusion medicine develops and disseminates guidelines that govern the optimal conditions for transfusion. The purpose of this article is to review the current evidence on the use of blood components. Methods We searched PubMed, Scholar Google, ScienceDirect, SciELO and Cochrane web portals, as well as official documents published in the Chilean Society of Hematology. Articles from the last ten years were included, of which 42 were appropriate for this narrative literature review. Conclusion First of all, there is a controversy between two types of strategies regarding the practice of red blood cell transfusion: a liberal strategy and a restrictive strategy. Second, for the management of coagulopathies, clotting times do not reflect the true ability of patients to clot. Third, to reverse the effect of coumadin, the administration of vitamin K would suffice over the use of fresh frozen plasma. Fourth, the use of physiological triggers could help define the best time for a transfusion.

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

Archives of Pathology & Laboratory Medicine ◽

10.5858/2003-127-0415-fatoff ◽

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.

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

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v24i2.1306 ◽

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

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EVALUATION OF FUNCTIONING AND STATUS OF IMPLEMENTATION OF HEMOVIGILANCE PROGRAM OF INDIA IN THE BLOOD BANKS OF SOUTHERN KERALA

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i2.22479 ◽

2018 ◽

Vol 11 (2) ◽

pp. 143

Author(s):

Sreekumar Pk ◽

Pramod Kumar Tm ◽

Partha Sarathi G ◽

Debasish Gupta ◽

Pallavi Prakash

Keyword(s):

Training Programs ◽

Fresh Frozen Plasma ◽

Blood Components ◽

Blood Banks ◽

Fresh Frozen ◽

Awareness Programs ◽

Pro Forma ◽

Survey Approach ◽

And Training ◽

Frozen Plasma

Objective: The objective of this study is to evaluate the functioning and status of implementation of hemovigilance program of India (HvPI) in the blood banks of southern Kerala.Methods: It was a survey approach to analyze the facilities, working nature, and status of implementation of hemovigilance program by the blood banks located in the three districts of southern Kerala. Both goevrnment and private sector blood banks were subjected to the survey. Standard pro forma was used to collect the data. Collected data were analyzed by percentages and ratios.Results: A total of 40 blood banks were covered in the study. All the blood banks were licensed for handling whole blood. 23 blood banks were licensed for handling blood components. 6 blood banks process 100% blood into components. Majority of blood banks have excellent demand for components. Packed red cells, platelet concentrate, and fresh frozen plasma were the significant components among the prepared components. Majority of the blood banks under the survey had hospital transfusion committee (HTC). 25 blood banks replied as the HvPI is an excellent/good system. However, only 11 blood banks were enrolled in the HvPI. Training programs for the resident doctors and nurses regarding with adverse transfusion reaction and their reporting were not conducted by 17 blood banks.Conclusion: Except very few blood banks, all are need more awareness and training programs. Attention should be given in the area such as underreporting, poor implementation of hemovigilance, only serious reactions reporting, and avoiding minor reactions. Core factor is proper functioning of HTC and awareness programs about hemovigilance system.

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A High Fresh Frozen Plasma: Packed Red Blood Cell Transfusion Ratio Decreases Mortality in All Massively Transfused Trauma Patients Regardless of Admission International Normalized Ratio

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e318227f152 ◽

2011 ◽

Vol 71 ◽

pp. S358-S363 ◽

Cited By ~ 55

Author(s):

Lisa M. Brown ◽

Seppo O. Aro ◽

Mitchell J. Cohen

Keyword(s):

Blood Cell ◽

Red Blood Cell ◽

International Normalized Ratio ◽

Fresh Frozen Plasma ◽

Red Blood Cell Transfusion ◽

Trauma Patients ◽

Fresh Frozen ◽

Transfusion Ratio ◽

Frozen Plasma

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Red blood cell transfusion is associated with further bleeding and fresh-frozen plasma with mortality in nonvariceal upper gastrointestinal bleeding

Transfusion ◽

10.1111/trf.13446 ◽

2015 ◽

Vol 56 (4) ◽

pp. 816-826 ◽

Cited By ~ 12

Author(s):

Kavitha Subramaniam ◽

Katrina Spilsbury ◽

Oyekoya T. 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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Prothrombin complex concentrates versus fresh frozen plasma for warfarin reversal A systematic review and meta-analysis

Thrombosis and Haemostasis ◽

10.1160/th16-04-0266 ◽

2016 ◽

Vol 116 (11) ◽

pp. 879-890 ◽

Cited By ~ 72

Author(s):

Chatree Chai-Adisaksopha ◽

Christopher Hillis ◽

Deborah M. Siegal ◽

Ron Movilla ◽

Nancy Heddle ◽

...

Keyword(s):

Volume Overload ◽

Fresh Frozen Plasma ◽

Red Blood Cell Transfusion ◽

Cochrane Library ◽

Increased Risk ◽

Significant Difference ◽

All Cause Mortality ◽

Fresh Frozen ◽

Warfarin Reversal ◽

Frozen Plasma

SummaryUrgent reversal of warfarin is required for patients who experience major bleeding or require urgent surgery. Treatment options include the combination of vitamin K and coagulation factor replacement with either prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP). However, the optimal reversal strategy is unclear based on clinically relevant outcomes. We searched in MEDLINE, EMBASE and Cochrane library to December 2015. Thirteen studies (5 randomised studies and 8 observational studies) were included. PCC use was associated with a significant reduction in all-cause mortality compared to FFP (OR= 0.56, 95 % CI; 0.37–0.84, p=0.006). A higher proportion of patients receiving PCC achieved haemostasis compared to those receiving FFP, but this was not statistically significant (OR 2.00, 95 % CI; 0.85–4.68). PCC use was more likely to achieve normalisation of international normalised ratio (INR) (OR 10.80, 95 % CI; 6.12–19.07) and resulted in a shorter time to INR correction (mean difference –6.50 hours, 95 %CI; –9.75 to –3.24). Red blood cell transfusion was not statistically different between the two groups (OR 0.88, 95 % CI: 0.53–1.43). Patients receiving PCC had a lower risk of post-transfusion volume overload compared to FFP (OR 0.27, 95 % CI; 0.13–0.58). There was no statistically significant difference in the risk of thromboembolism following administration of PCC or FFP (OR 0.91, 95 % CI; 0.44–1.89). In conclusion, as compared to FFP, the use of PCC for warfarin reversal was associated with a significant reduction in all-cause mortality, more rapid INR reduction, and less volume overload without an increased risk of thromboembolic events.Supplementary Material to this article is available online at www.thrombosis-online.com.

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