[Indications for use of labile blood products and the physiology of blood transfusion in medicine. The French Agency for the Health Safety of Health Products]

[Spontaneous hematoma of right angle of the transverse mesocolon: exceptional complication of anticoagulant therapy with vitamin K]

L'hématome spontané du méso de l'angle colique droit et du transverse est une complication rare du traitement anticoagulant par antivitamine K. Nous rapportons un cas d'hématome spontané du méso de l'angle colique droit et du transverse associé à un hémopéritoine de grande abondance chez un patient traité par antivitamine K pour embolie pulmonaire consécutive à une fracture des plateaux tibiaux droits. Le diagnostic doit être fait en urgence. L’échographie abdominale et la tomodensitométrie confirment le diagnostic. Le traitement non opératoire est la règle. Le traitement chirurgical est indiqué en cas de complications telles que la rupture de l'hématome.

Patient blood management in Europe

Preoperative anaemia is common in patients undergoing orthopaedic and other major surgery. Anaemia is associated with increased risks of postoperative mortality and morbidity, infectious complications, prolonged hospitalization, and a greater likelihood of allogeneic red blood cell (RBC) transfusion. Evidence of the clinical and economic disadvantages of RBC transfusion in treating perioperative anaemia has prompted recommendations for its restriction and a growing interest in approaches that rely on patients' own (rather than donor) blood. These approaches are collectively termed ‘patient blood management’ (PBM). PBM involves the use of multidisciplinary, multimodal, individualized strategies to minimize RBC transfusion with the ultimate goal of improving patient outcomes. PBM relies on approaches (pillars) that detect and treat perioperative anaemia and reduce surgical blood loss and perioperative coagulopathy to harness and optimize physiological tolerance of anaemia. After the recent resolution 63.12 of the World Health Assembly, the implementation of PBM is encouraged in all WHO member states. This new standard of care is now established in some centres in the USA and Austria, in Western Australia, and nationally in the Netherlands. However, there is a pressing need for European healthcare providers to integrate PBM strategies into routine care for patients undergoing orthopaedic and other types of surgery in order to reduce the use of unnecessary transfusions and improve the quality of care. After reviewing current PBM practices in Europe, this article offers recommendations supporting its wider implementation, focusing on anaemia management, the first of the three pillars of PBM.

[Pediatric transfusion practices: A single-center retrospective study]

OBJECTIVES

This study aimed to describe the professional practices in pediatric transfusion to assess the accuracy of transfusion guidelines in children.

METHODS

The study retrospectively analyzed the characteristics of all the pediatric transfusions prescribed in the Clermont-Ferrand (France) university hospital center over 1 year and determined whether they conformed to the national guidelines.

RESULTS

One thousand six hundred and seven blood products were delivered to 233 children (806 red cell units, 670 platelet units, and 131 plasma units), accounting for 5.3% of the center's whole blood products. Transfusions were mainly prescribed by the oncohematology unit (68.2%), the intensive care unit (15.4%), and for surgery (10.2%). Ten adverse events were reported in eight patients (0.6% of transfusions). The prescription conformed to the national guidelines in 35.9%, 41.6%, and 80.9% of the red blood cell, platelet, and plasma unit transfusions, respectively. Nonconformity was mainly due to abusive irradiation and "cytomegalovirus seronegative" specifications.

CONCLUSION

Malignancies, intensive care, and surgery are the main indications for transfusion in children. Substantial discrepancy between recommendations and actual practices was observed. This illustrates the variability of risk evaluation. This should be made simpler by the use of photochemical pathogen inactivation techniques.

[Techniques of preparation and indications of labile blood products]

Labile blood products are obtained from samples of whole blood or aphaeresis. The techniques of preparation evolve with technological advances, which allow both an increasing automation and an intensification of the sanitary safety of the blood products. Over the last ten years, thanks to the availability of new technologies, several measures have been introduced in order to reduce the risk of transmission of pathogens and prevent the onset of transfusion-related acute lung injury (TRALI): leukoreduction, use of platelet storage solutions, inactivation of plasma and presumably of platelets in a very near future. The control of transfusion risk also depends on proper use of labile blood products. To assist the prescriber in his treatment options and to standardize practices, the French Agency for Sanitary Safety of Health Products has issued recommendations in terms of utilization of blood products that are detailed in this review of major labile blood products available.