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Morgan KM, Abou Khalil E, Feeney EV, Spinella PC, Lucisano AC, Gaines BA, Leeper CM. The Efficacy of Low-Titer Group O Whole Blood Compared With Component Therapy in Civilian Trauma Patients: A Meta-Analysis. Crit Care Med 2024; 52:e390-e404. [PMID: 38483205 DOI: 10.1097/ccm.0000000000006244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
OBJECTIVES To assess if transfusion with low-titer group O whole blood (LTOWB) is associated with improved early and/or late survival compared with component blood product therapy (CT) in bleeding trauma patients. DATA SOURCES A systematic search of PubMed, CINAHL, and Web of Science was performed from their inception through December 1, 2023. Key terms included injury, hemorrhage, bleeding, blood transfusion, and whole blood. STUDY SELECTION All studies comparing outcomes in injured civilian adults and children who received LTOWB versus CT were included. DATA EXTRACTION Data including author, publication year, sample size, total blood volumes, and clinical outcomes were extracted from each article and reported following the Meta-analysis Of Observational Studies in Epidemiology guidelines. Main outcomes were 24-hour (early) and combined 28-day, 30-day, and in-hospital (late) mortality rates between recipients of LTOWB versus CT, which were pooled using random-effects models. DATA SYNTHESIS Of 1297 studies reviewed, 24 were appropriate for analysis. Total subjects numbered 58,717 of whom 5,164 received LTOWB. Eleven studies included adults-only, seven included both adults and adolescents, and six only included children. The median (interquartile range) age for patients who received LTOWB and CT was 35 years (24-39) and 35.5 years (23-39), respectively. Overall, 14 studies reported early mortality and 22 studies reported late mortality. LTOWB was associated with improved 24-hour survival (risk ratios [RRs] [95% CI] = 1.07 [1.03-1.12]) and late (RR [95% CI] = 1.05 [1.01-1.09]) survival compared with component therapy. There was no evidence of small study bias and all studies were graded as a moderate level of bias. CONCLUSIONS These data suggest hemostatic resuscitation with LTOWB compared with CT improves early and late survival outcomes in bleeding civilian trauma patients. The majority of subjects were injured adults; multicenter randomized controlled studies in injured adults and children are underway to confirm these findings.
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Affiliation(s)
- Katrina M Morgan
- Department of Surgery and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Erin V Feeney
- Department of Surgery and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Philip C Spinella
- Department of Surgery and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Amelia C Lucisano
- Department of Surgery and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Barbara A Gaines
- Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Christine M Leeper
- Department of Surgery and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
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2
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Mihalko EP, Srinivasan AJ, Rahn KC, Seheult JN, Spinella PC, Cap AP, Triulzi DJ, Yazer MH, Neal MD, Shea SM. Hemostatic In Vitro Properties of Novel Plasma Supernatants Produced from Late-storage Low-titer Type O Whole Blood. Anesthesiology 2023; 139:77-90. [PMID: 37027803 PMCID: PMC10247395 DOI: 10.1097/aln.0000000000004574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
BACKGROUND The use of low-titer group O whole blood is increasing. To reduce wastage, unused units can be converted to packed red blood cells. Supernatant is currently discarded post-conversion; however, it could be a valuable transfusable product. The aim of this study was to evaluate supernatant prepared from late-storage low-titer group O whole blood being converted to red blood cells, hypothesizing it will have higher hemostatic activity compared to fresh never-frozen liquid plasma. METHODS Low-titer group O whole blood supernatant (n = 12) prepared on storage day 15 was tested on days 15, 21, and 26 and liquid plasma (n = 12) on 3, 15, 21, and 26. Same-day assays included cell counts, rotational thromboelastometry, and thrombin generation. Centrifuged plasma from units was banked for microparticle characterization, conventional coagulation, clot structure, hemoglobin, and additional thrombin generation assays. RESULTS Low-titer group O whole blood supernatant contained more residual platelets and microparticles compared to liquid plasma. At day 15, low-titer group O whole blood supernatant elicited a faster intrinsic clotting time compared to liquid plasma (257 ± 41 vs. 299 ± 36 s, P = 0.044), and increased clot firmness (49 ± 9 vs. 28 ± 5 mm, P < 0.0001). Low-titer group O whole blood supernatant showed more significant thrombin generation compared to liquid plasma (day 15 endogenous thrombin potential 1,071 ± 315 vs. 285 ± 221 nM·min, P < 0.0001). Flow cytometry demonstrated low-titer group O whole blood supernatant contained significantly more phosphatidylserine and CD41+ microparticles. However, thrombin generation in isolated plasma suggested residual platelets in low-titer group O whole blood supernatant were a greater contributor than microparticles. Additionally, low-titer group O whole blood supernatant and liquid plasma showed no difference in clot structure, despite higher CD61+ microparticle presence. CONCLUSIONS Plasma supernatant produced from late-storage low-titer group O whole blood shows comparable, if not enhanced, in vitro hemostatic efficacy to liquid plasma. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Emily P. Mihalko
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Amudan J. Srinivasan
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Katelin C. Rahn
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Jansen N. Seheult
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Philip C. Spinella
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
- Department of Critical Care, University of Pittsburgh, Pittsburgh, PA
| | - Andrew P. Cap
- United States Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas
| | - Darrell J. Triulzi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mark H. Yazer
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Matthew D. Neal
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
- Department of Critical Care, University of Pittsburgh, Pittsburgh, PA
| | - Susan M. Shea
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA
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Santangini MR, Leuckel SN, King KA, Cheves TA, Sweeney JD. In vitro comparison of CPD whole blood with conventional blood components. Transfus Apher Sci 2023; 62:103526. [PMID: 36041978 DOI: 10.1016/j.transci.2022.103526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/04/2022] [Accepted: 08/23/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Resuscitation of severely injured trauma patients is commonly performed using red blood cells in additive solution supplemented with plasma and platelet concentrates. There is an increasing interest in the use of low anti-A titer Group O whole blood (LTOWB) in the early management of the resuscitation. It is unclear whether clinical outcome is improved using this approach. METHODS Expired units of CPD-LTOWB were studied on Day 22 and expired units of thawed plasma on Day 6 and Day 7. LTOWB was assessed for hemoglobin content, clotting factor levels and platelet numbers and function using thromboelastography (TEG) and impedance aggregation. Assays of fibrinogen and FV, FVIII, FVII and FX were performed on the expired plasma. The LTOWB hemoglobin was compared to red cells in additive solution (AS-RBCs) and the clotting factor levels to those of expired thawed plasma. Platelet function was compared to fresh whole blood samples from healthy subjects. RESULTS LTOWB contained slightly more hemoglobin than the AS-RBCs (Medians, 66 v 59 G), and the plasma content of fibrinogen was similar. Other clotting factors were reduced by approximately 15% except for FVIII which was 30% less. Both TEG and impedance aggregometry showed evidence of residual platelet function despite the prolonged period of refrigerator storage. CONCLUSION LTOWB contains higher hemoglobin and adequate clotting factors, and residual platelet function is demonstrated indicating that this product would be expected to be at least equivalent to a single unit of each of the conventional components commonly used in trauma resuscitation.
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Affiliation(s)
| | - Stephanie N Leuckel
- Division of Trauma and Surgical Critical Care, Providence, RI, USA; Lifespan Academic Medical Center and the Alpert Medical School of Brown University, Providence, RI, USA
| | - Karen A King
- Department of Coagulation and Transfusion Medicine, Providence, RI, USA
| | - Tracey A Cheves
- Department of Coagulation and Transfusion Medicine, Providence, RI, USA
| | - Joseph D Sweeney
- Department of Coagulation and Transfusion Medicine, Providence, RI, USA; Lifespan Academic Medical Center and the Alpert Medical School of Brown University, Providence, RI, USA.
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4
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Cooper JL, Sharp CR, Boyd CJ, Claus MA, Rossi G. The hemostatic profile of cold-stored whole blood from non-greyhound and greyhound dogs over 42 days. Front Vet Sci 2023; 10:1135880. [PMID: 36937016 PMCID: PMC10019821 DOI: 10.3389/fvets.2023.1135880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/08/2023] [Indexed: 03/06/2023] Open
Abstract
Objectives To compare the hemostatic characteristics of cold-stored whole blood (CSWB) from non-greyhound dogs (NGD) and greyhound dogs (GD) over 42 days of storage, notably, platelet closure time (PCT) (NGD only), manual platelet count (PLT) (GD only), ellagic acid (INTEM) and tissue factor activated (EXTEM) rotational thromboelastometry, prothrombin (PT) and activated partial thromboplastin time (aPTT), fibrinogen concentration (FIB), and the activities of factors (F) FII, FV, FVII, FVIII, FIX, FX, FXIII antigen (FXIII:Ag), and von Willebrand factor antigen (vWF:Ag). Design Whole blood from 10 NGD and 10 GD, was refrigerated in CPD blood bags at 4°C for 42 days. Blood was analyzed before refrigeration (day 0) and at day 1 (d1), 3, 5, 7, 10, 14, 17, 21, 24, 28, 31, 35, 38, and 42. Multivariate linear mixed effects models were created to evaluate coagulation parameters over time and compare NGD and GD. Data are summarized as estimated marginal means with 95% confidence intervals. Significance was set at P < 0.05. Results The PCT for all NGD CSWB was above the device limit by d7. The PLT for GD CSWB did not change during storage. The mean alpha-angle for INTEM and EXTEM decreased to <50% of baseline at d38 and d31 for NGD, and d31 and d17 for GD CSWB. The mean maximum clot firmness (MCF) for INTEM and EXTEM reduced to <50% of baseline at d42 and d28 for both GD and NGD. PT and aPTT for NGD and GD increased over time. For NGD CSWB, the mean FVIII and vWF:Ag activities decreased to <50% of baseline at d7 and d28, respectively, and FIB reached 0.982 g/dL by d24. For GD CSWB, FVIII, FXIII:Ag and FV activities decreased to <50% of baseline by d3, d38, and d38, respectively, and FIB was 0.982 g/dL at baseline. Alpha-angle and MCF for both INTEM and EXTEM, and activities for FII, FV, FIX, FXIII:Ag were significantly lower, and vWF:Ag was significantly higher overall in GD CSWB compared with NGD. A significant difference in the pattern of change over time was detected between NGD and GD in EXTEM alpha-angle, INTEM and EXTEM MCF, FII, and FVIII activities. Conclusions The in vitro viscoelastic parameters of GD and NGD CSWB declines over 42 days, but numerous hemostatic parameters (INTEM and EXTEM alpha-angle and MCF, activity of FII, FV, FV, FVII, FIX, FX, FXIII:Ag, vWF:Ag, and FIB) remain within 50% of baseline for more than 14 days. CSWB from GD compared to NGD has reduced hemostatic activity overall, but a similar pattern of decline for most parameters over time.
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Affiliation(s)
- James L. Cooper
- School of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
| | - Claire R. Sharp
- School of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
- *Correspondence: Claire R. Sharp
| | - Corrin J. Boyd
- School of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
| | - Melissa A. Claus
- School of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
- Perth Veterinary Specialists, Osborne Park, WA, Australia
| | - Gabriel Rossi
- School of Veterinary Medicine, Murdoch University, Murdoch, WA, Australia
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5
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Schubert P, Culibrk B, Bhakta V, Closas T, Sheffield WP, Devine DV, McTaggart K. Minimal impact of anticoagulant on in vitro whole blood quality throughout a 35-day cold-storage regardless of leukoreduction timing. Transfusion 2022; 62 Suppl 1:S98-S104. [PMID: 35748674 DOI: 10.1111/trf.16977] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is increasing interest in leukoreduced whole blood (WB) as a transfusion product for trauma patients. In some jurisdictions, few leukoreduced filters are approved or appropriate for WB leukoreduction and quality information is therefore limited. This study assessed the impact of filtration timing of WB collected in CPDA-1 versus CPD on in vitro quality. STUDY DESIGN AND METHODS WB was collected in CPDA-1 or CPD and leukoreduction filtered either after 3-8 h (early) or 18-24 h (late) from stop bleed time. In vitro quality was assessed after filtration and throughout 5 weeks of storage at 4°C. Cell count and hemoglobin levels were determined by hematology analyzer, platelet activation and responsiveness to ADP by surface expression of P-selectin by flow cytometry, hemolysis by HemoCue, and metabolic parameters by blood gas analyzer. Hemostatic properties were assessed by rotational thromboelastometry. Plasma protein activities and clotting times were determined by automated coagulation. RESULTS Although there were some data points which showed statistically significant differences associated with anticoagulant choices or the filtration timing, no general trend in inferiority/performance could be discerned. After 35 days' storage, only clotting time, alpha angle and factor II in the early filtration arm comparing anticoagulants and prothrombin time and factor II in the CPDA-1 study arm comparing filtration timing showed a significant difference. CONCLUSION In vitro WB quality seems to be independent on the choice of anticoagulant and filtration timing supporting WB hold-times to up to 24 h, increasing operational flexibility for transfusion services.
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Affiliation(s)
- Peter Schubert
- Medical Affairs and Innovation, Canadian Blood Services, Vancouver, Canada.,Center for Blood Research, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Brankica Culibrk
- Medical Affairs and Innovation, Canadian Blood Services, Vancouver, Canada.,Center for Blood Research, Vancouver, Canada
| | - Varsha Bhakta
- Medical Affairs and Innovation, Canadian Blood Services, Hamilton, Canada
| | - Tatiana Closas
- Medical Affairs and Innovation, Canadian Blood Services, Vancouver, Canada
| | - William P Sheffield
- Medical Affairs and Innovation, Canadian Blood Services, Hamilton, Canada.,Department Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Dana V Devine
- Medical Affairs and Innovation, Canadian Blood Services, Vancouver, Canada.,Center for Blood Research, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Ken McTaggart
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
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6
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There and Back Again: The Once and Current Developments in Donor-Derived Platelet Products for Products for Hemostatic Therapy. Blood 2022; 139:3688-3698. [PMID: 35482959 DOI: 10.1182/blood.2021014889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/20/2022] [Indexed: 01/19/2023] Open
Abstract
Over 100 years ago, Duke transfused whole blood to a thrombocytopenic patient to raise the platelet count and prevent bleeding. Since then, platelet transfusions have undergone numerous modifications from whole blood-derived platelet-rich plasma to apheresis-derived platelet concentrates. Similarly, the storage time and temperature have changed. The mandate to store platelets for a maximum of 5-7 days at room temperature has been challenged by recent clinical trial data, ongoing difficulties with transfusion-transmitted infections, and recurring periods of shortages, further exacerbated by the COVID-19 pandemic. Alternative platelet storage approaches are as old as the first platelet transfusions. Cold-stored platelets may offer increased storage times (days) and improved hemostatic potential at the expense of reduced circulation time. Frozen (cryopreserved) platelets extend the storage time to years but require storage at -80 °C and thawing before transfusion. Lyophilized platelets can be powder-stored for years at room temperature and reconstituted within minutes in sterile water but are probably the least explored alternative platelet product to date. Finally, whole blood offers the hemostatic spectrum of all blood components but has challenges, such as ABO incompatibility. While we know more than ever before about the in vitro properties of these products, clinical trial data on these products are accumulating. The purpose of this review is to summarize the findings of recent preclinical and clinical studies on alternative, donor-derived platelet products.
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7
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Muñoz C, Macia C, Hernández E, Alcalá M, Guzmán-Rodríguez M, Orlas C, Caicedo Y, García A, Parra M, Ordóñez C. Sangre total leucorreducida y filtro ahorrador de plaquetas preserva su función hemostática por 21 días: ¿La resucitación hemostática podría ser una realidad en Colombia? REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La resucitación hemostática es una estrategia para compensar la pérdida sanguínea y disminuir el impacto de la coagulación inducida por trauma. Debido a que la disponibilidad de transfundir una razón equilibrada de hemocomponentes es difícil de lograr en el entorno clínico, la sangre total ha reaparecido como una estrategia fisiológica, con ventajas logísticas, que le permiten ser accesible para iniciar tempranamente la resucitación hemostática. El objetivo de este estudio fue evaluar las propiedades celulares, coagulantes y viscoelásticas de la sangre total almacenada por 21 días.
Métodos. Las unidades de sangre total fueron obtenidas de 20 donantes voluntarios sanos. Se procesaron mediante un sistema de leucorreducción ahorrador de plaquetas y fueron almacenadas en refrigeración (1-6°C) sin agitación. Se analizaron los días 0, 6, 11 y 21. Las bolsas fueron analizadas para evaluar las líneas celulares, niveles de factores de coagulación y propiedades viscoelásticas mediante tromboelastografía.
Resultados. El conteo eritrocitario y la hemoglobina se mantuvieron estables. El conteo de plaquetas tuvo una reducción del 50 % al sexto día, pero se mantuvo estable el resto del seguimiento. Los factores de coagulación II-V-VII-X, fibrinógeno y proteína C se mantuvieron dentro del rango normal. La tromboelastografía mostró una prolongación en el tiempo del inicio de la formación del coágulo, pero sin alterar la formación final de un coágulo estable.
Conclusiones. La sangre total leucorreducida y con filtro ahorrador de plaquetas conserva sus propiedades hemostáticas por 21 días. Este es el primer paso en Colombia para la evaluación clínica de esta opción, que permita hacer una realidad universal la resucitación hemostática del paciente con trauma severo.
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8
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Martinaud C, Fleuriot E, Pasquier P. Implementation of Low Titer Whole Blood for French overseas operations: O positive or negative products in massive hemorrhage? Transfus Clin Biol 2022; 29:164-167. [DOI: 10.1016/j.tracli.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
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9
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Huish S, Green L, Kempster C, Smethurst P, Wiltshire M, Prajapati C, Allen E, Cardigan R. A comparison of platelet function in cold-stored whole blood and platelet concentrates. Transfusion 2021; 61:3224-3235. [PMID: 34622949 DOI: 10.1111/trf.16657] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/09/2021] [Accepted: 07/25/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is renewed interest in the use of whole blood (WB) for the resuscitation of trauma patients. Platelet function in stored WB compared to platelet concentrates is not well established and was assessed in vitro in this study. METHODS Leucocyte-depleted cold-stored WB (CS-WB) was prepared using a Terumo WB-SP Imuflex kit and held at 2-6°C alongside: (A) UK standard pooled platelets stored at 20-24°C (RT-PLTS), (B) pooled platelets stored at 2-6°C (CS-PLTS), and (C) platelet-rich plasma produced using the Terumo kit (CS-PRP), for 21 days. A series of in vitro assays were assessed platelet function. RESULTS Platelet count was retained to 57 ± 14% of starting number at day 21 in CS-WB. Over time, CS-WB platelets become more activated, with increased CD62P expression (day 1: 7 ± 3.7% vs. day 21: 59 ± 17.1%) and annexin V binding (day 1: 2 ± 0.2% vs. day 21: 21 ± 15.1%). For comparison, 18.6 ± 6% of platelets in RT-PLTS demonstrated CD62P expression at day 7, whereas annexin V binding in RT-PLTS at day 7 was 2.6 ± 0.5%. Over storage, aggregatory response to agonists decreased in all arms. Functional platelet microparticles increased steadily in CS-WB throughout storage. CONCLUSION During storage, platelet count reduced in CS-WB, whereas CD62P expression and annexin V binding increased. This was accompanied by a reduced aggregatory response, although compared to 7-day-old RT-PLTS, CS-WB maintained a maximal response to agonists for longer, suggesting that the shelf life for CS-WB can be considered for up to 21 days.
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Affiliation(s)
- Sian Huish
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK
| | - Laura Green
- Department of Clinical, NHS Blood and Transplant, London, UK.,Blizzard Institute, Queen Mary University of London, London, UK.,Department of Haematology, Barts Health NHS Trust UK, London, UK
| | - Carly Kempster
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK
| | - Peter Smethurst
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK
| | - Michael Wiltshire
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK
| | | | - Elisa Allen
- Statistics and Clinical Studies, NHS Blood and Transplant, Stoke Gifford, UK
| | - Rebecca Cardigan
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK.,Department of Haematology, University of Cambridge, Cambridge, UK
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10
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Jones AR, Miller JL, Jansen JO, Wang HE. Whole Blood for Resuscitation of Traumatic Hemorrhagic Shock in Adults. Adv Emerg Nurs J 2021; 43:344-354. [PMID: 34699424 PMCID: PMC8555430 DOI: 10.1097/tme.0000000000000376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Injured patients with traumatic hemorrhagic shock often require resuscitation with transfusion of red blood cells, plasma, and platelets. Resuscitation with whole blood (WB) has been used in military settings, and its use is increasingly common in civilian practice. We provide an overview of the benefits and challenges, guidelines, and unanswered questions related to the use of WB in the treatment of civilian trauma-related hemorrhage. Implications for advanced practice nurses and nursing staff are also discussed.
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Affiliation(s)
- Allison R Jones
- School of Nursing (Drs Jones and Miller), and Division of Trauma and Acute Care Surgery & Center for Injury Science (Dr Jansen), University of Alabama at Birmingham; The Ohio State University (Dr Wang)
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11
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Schubert P, Chen Z, Bhakta V, Culibrk B, Wambolt R, Sheffield WP, Devine DV, McTaggart K. Cold-stored leukoreduced whole blood: Extending the time between donation and filtration has minimal impact on in vitro quality. Transfusion 2021; 61 Suppl 1:S131-S143. [PMID: 34269454 DOI: 10.1111/trf.16540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/21/2021] [Accepted: 05/28/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Leukoreduced whole blood (LR-WB) has received renewed attention as alternative to component-based transfusion in trauma. According to the manufacturer's instructions, leukoreduction should be carried out within 8 h after collection. This study assessed impact of (1) WB collection bag, (2) LR filtration, and (3) timing of filtration on in vitro quality. STUDY DESIGN AND METHODS WB collected into different vendor bags was held at room temperature for <8 h or >16 h but <24 h prior to LR. In vitro quality was assessed before and after filtration, and throughout 3 weeks of storage at 4°C. Cell count and hemoglobin levels were determined by hematology analyzer, platelet activation, and responsiveness to ADP by surface expression of P-selectin by flow cytometry, hemolysis by HemoCue, and metabolic parameters by blood gas analyzer. Hemostatic properties were assessed by rotational thromboelastometry. Plasma protein activities and clotting times were determined by automated coagulation analyzer or quantitative immunoblotting. RESULTS Bag type had no impact on WB in vitro quality. LR by filtration had some impact, but is aligned with data in the literature. The time between donation and filtration resulted in some statistically significant differences in metabolic activity, platelet yield, platelet activation, and factor protein activity initially; however, these differences in in vitro quality attributes decreased throughout 21-day cold storage. CONCLUSION WB hold time showed only a minor impact on WB in vitro quality, so it may be possible for blood processing facilities to explore extended hold times prior to filtration in order to provide greater operational flexibility.
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Affiliation(s)
- Peter Schubert
- Centre for Innovation, Canadian Blood Services, Vancouver, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Zhongming Chen
- Centre for Innovation, Canadian Blood Services, Vancouver, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, Canada
| | - Varsha Bhakta
- Centre for Innovation, Canadian Blood Services, Hamilton, Canada
| | - Brankica Culibrk
- Centre for Innovation, Canadian Blood Services, Vancouver, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, Canada
| | - Richard Wambolt
- Centre for Innovation, Canadian Blood Services, Vancouver, Canada
| | - William P Sheffield
- Centre for Innovation, Canadian Blood Services, Hamilton, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Dana V Devine
- Centre for Innovation, Canadian Blood Services, Vancouver, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Ken McTaggart
- Centre for Innovation, Canadian Blood Services, Ottawa, Canada
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12
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Rice J, Bill JR, Razatos A, Marschner S. Platelet aggregation in whole blood is not impaired by a platelet-sparing leukoreduction filter and instead depends upon the presence of leukocytes. Transfusion 2021; 61 Suppl 1:S90-S100. [PMID: 34269461 DOI: 10.1111/trf.16521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent studies characterizing in vitro hemostatic properties of whole blood (WB) leukoreduced (LR) with a platelet-sparing filter have described subtle, if any, changes to viscoelastic clotting; however, reductions in platelet (PLT) content and impedance aggregometry (IA) responses have been noted. The effects of filtration of WB (i.e., filter-contact effects, reduction in platelet and leukocyte count) have not been rigorously investigated as to their individual impacts on platelet IA responses. STUDY DESIGN AND METHODS WB units from healthy donors were collected and characterized to assess the effects of platelet-sparing leukoreduction (LR) upon the in vitro hemostatic measures of platelet IA and thromboelastometry. Further characterization of platelet IA responses was carried out in WB samples to delineate the effects of platelet count and leukocyte presence/absence upon the response. RESULTS WB filtration reduced the platelet count and IA responses but had no impact on viscoelastic clotting measures in fresh WB. Experiments revealed that IA responses have a linear correlation with platelet count in both apheresis platelets and WB and that passage of platelets through the WB-LR filter has no impact upon the strength of this response. Further experiments in LR WB showed that addition of autologous leukocytes back to the platelets fully restored the platelet aggregation response to pre-filtration levels. CONCLUSION WB filtration results in platelet count reduction and leukocyte removal; however, platelet IA is not degraded by passage through the filter. Apparent declines in platelet IA responses can be fully attributed to the reduction in platelet count and the removal of leukocytes.
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Affiliation(s)
- Joseph Rice
- Terumo Blood and Cell Technologies, Inc., Lakewood, Colorado, USA
| | - Jerome R Bill
- Terumo Blood and Cell Technologies, Inc., Lakewood, Colorado, USA
| | - Anna Razatos
- Terumo Blood and Cell Technologies, Inc., Lakewood, Colorado, USA
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Clements T, McCoy C, Assen S, Cardenas J, Wade C, Meyer D, Cotton BA. The prehospital use of younger age whole blood is associated with an improved arrival coagulation profile. J Trauma Acute Care Surg 2021; 90:607-614. [PMID: 33405468 DOI: 10.1097/ta.0000000000003058] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Recent in vitro data have shown that the hemostatic profile of whole blood (WB) degrades significantly after 14 days, yet the optimal storage remains debated. We hypothesized that arrival coagulation studies would be improved in patients receiving younger WB in the prehospital setting. METHODS This study was approved by our institutional institutional review board. We evaluated all trauma patients who received prehospital blood products by our helicopter service between July 2017 and July 2019. "Young" WB was defined as 14 days or less. Patients who received at least 1 U of young WB were classified as YOUNG, while the remainder was classified as OLD. Continuous data are presented as medians (25th-75th interquartile range) with comparisons performed using Wilcoxon rank sum. Assessments of clinical hemostatic potential included arrival platelet cell count and rapid thrombelastography. Multivariate regression analysis was also performed (Stata 12.1; College Station, TX). RESULTS A total of 220 patients received prehospital WB during the study period. Of these, 153 patients received YOUNG WB, while 67 were transfused only OLD WB units. There were no differences in demographics, prehospital or arrival physiology, or Injury Severity Score among the two groups. The measures of clot initiation (activated clotting time) and kinetics (k time) were improved, as were the measures of clot acceleration/fibrinogen function (angle) and platelet function (maximum amplitude). As well, arrival platelet count was higher in the YOUNG cohort. No significant differences in postarrival transfusion were noted (p = 0.220). Multivariate analysis showed the greatest differences in maximum amplitude and α angle but failed to reach significance. CONCLUSION Previous in vitro data have suggested deterioration of platelet function in cold-stored WB after 14 days. The current study demonstrated decreased global hemostasis by clinically available laboratory tests, especially related to fibrinogen and platelet interactions on univariate, but not multivariate analysis. This did not translate into increased transfusion requirements. Further studies are needed to determine the optimal storage duration for cold-stored WB for transfusion in the bleeding trauma patient, as well as rule out the presence of confounding variables. LEVEL OF EVIDENCE Therapeutic, level IV.
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Affiliation(s)
- Thomas Clements
- From the Cumming School of Medicine (T.C., S.A.), University of Calgary; Center of Translational Injury Research and the Department of Surgery, McGovern Medical School (C.M., J.C., C.W., D.M., B.A.C.), University of Texas Health Science Center, Houston, Texas
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14
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Hemostatic potential of cold-stored non-leukoreduced whole blood over time: An assessment of platelet function and thrombin generation for optimal shelf life. J Trauma Acute Care Surg 2021; 89:429-434. [PMID: 32467473 DOI: 10.1097/ta.0000000000002799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Cold-stored low-titer whole blood (WB) is becoming increasingly used as the preferred product for initial hemorrhagic shock resuscitation. The purpose of this study was to identify whether the current 21-day shelf life is the optimal duration for storage of WB, maintaining hemostatic efficacy. METHODS Five units of fresh low-titer group O WB (non-leukoreduced) were acquired from our regional blood center. These units were stored at 4°C for up to 21 days as per current clinical storage guidelines in our emergency department. Hemostatic parameters were measured in vitro at 0 days, 7 days, 14 days, and 21 days. Assessments of hemostatic potential included cell count, rapid thrombelastography (r-TEG) and kaolin thrombelastography (TEG), multiplate impedance aggregometry, and calibrated automated thrombogram (CAT). Univariate analysis, including one-way analysis of variance with repeated measures, was performed (STATA 12.1). RESULTS Compared with baseline product (0 days), both platelet count and platelet function of WB showed sharp decreases at 7 days and again at 14 days. Platelet function deterioration was noted by r-TEG c (MA), TEG-MA, and multiplate arachidonic acid and adenosine diphosphate (all p < 0.001). With respect to clot initiation, r-TEG ACT and TEG R-time were similar over the 21-day shelf life (p = 0.058 and p = 0.620, respectively). Thrombin generation assessed by CAT demonstrated stable endogenous thrombin potential over the course of storage (p = 0.162), but increased peak thrombin generation and quicker time to peak generation after 7 days. CONCLUSION While the platelet function of WB degrades significantly at 7 days (and again at 14 days), clot initiation remains stable over time, and thrombin generation appears to be improved at 7 days. This study supports a current storage limit for cold-stored, low-titer WB of 14 days.
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15
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Hervig TA, Doughty HA, Cardigan RA, Apelseth TO, Hess JR, Noorman F, Bohoněk M, Yazer MH, Lu J, Wendel S, Sparrow RL. Re-introducing whole blood for transfusion: considerations for blood providers. Vox Sang 2020; 116:167-174. [PMID: 32996604 DOI: 10.1111/vox.12998] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/11/2020] [Indexed: 12/31/2022]
Abstract
Whole blood is the original blood preparation but disappeared from the blood bank inventories in the 1980s following the advent of component therapy. In the early 2000s, both military and civilian practice called for changes in the transfusion support for massive haemorrhage. The 'clear fluid' policy was abandoned and replaced by early balanced transfusion of platelets, plasma and red cells. Whole blood is an attractive alternative to multi-component therapy, which offers reduced hemodilution, lower donor exposure and simplified logistics. However, the potential for wider re-introduction of whole blood requires re-evaluation of haemolysins, storage conditions and shelf-life, the need for leucocyte depletion/ pathogen reduction and inventory management for blood providers. This review addresses these questions and calls for research to define the optimal whole blood product and the indications for its use.
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Affiliation(s)
- Tor A Hervig
- Blood Bank, Haugesund hospital, Haugesund, Norway
| | | | | | - Torunn O Apelseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - John R Hess
- Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Femke Noorman
- Quality, Research and Development, Military Blood Bank, Leiden, Netherlands
| | - Miloš Bohoněk
- Hematology, Biochemistry and Blood Transfusion, Central Military Hospital Prague, Prague, Czech Republic
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jia Lu
- Defence Medical & Environmental Research Institute, DSO National Laboratories (Kent Ridge), Singapore City, Singapore
| | | | - Rosemary L Sparrow
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
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16
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McRae HL, Kara F, Milito C, Cahill C, Blumberg N, Refaai MA. Whole blood haemostatic function throughout a 28-day cold storage period: an in vitro study. Vox Sang 2020; 116:190-196. [PMID: 32966635 DOI: 10.1111/vox.13005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In recent years, there has been renewed interest in whole blood (WB) transfusion, particularly in damage control resuscitation, in part due to the ability to provide the adequate ratio of blood components in a single transfusion. However, there is insufficient evidence to suggest that WB units maintain their haemostatic function during storage, which could compromise their quality and efficacy if transfused. Here, we evaluate the in vitro haemostatic function of stored WB units over a 28-day refrigeration period. METHODS Standard WB units were collected from healthy volunteers and stored at 4°C for 28 days. Samples were collected from each unit on several days throughout the storage period and tested for complete blood count (CBC), WB aggregation, clot kinetics as measured by thromboelastography (TEG), closure time and plasma-free haemoglobin. RESULTS Throughout the storage period, there were gradual, significant decreases in platelet count and function, including WB aggregation in response to collagen (P < 0·05) and closure time with epinephrine (P < 0·0005). Plasma-free haemoglobin increased substantially (by 163%) throughout the storage period. However, TEG results remained relatively stable for 3 weeks, indicating possible preservation of haemostatic function during that time. CONCLUSION This study shows that clot kinetics (as measured by TEG) in WB units stored at 4°C are preserved for up to 21 days. However, high levels of free haemoglobin raise concern for the potential risks of transfusing stored WB. Clinical studies are required to evaluate optimal storage times and outcomes of patients resuscitated with WB as compared to blood components.
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Affiliation(s)
- Hannah L McRae
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Ferhat Kara
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Chelsea Milito
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Christine Cahill
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Neil Blumberg
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Majed A Refaai
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, University of Rochester Medical Center, Rochester, NY, USA
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17
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Quality of Platelets in Stored Whole Blood. Transfus Med Rev 2020; 34:234-241. [PMID: 33051112 DOI: 10.1016/j.tmrv.2020.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/29/2022]
Abstract
Transfusion of whole blood rather than blood components is gaining popularity. It is easy to use, with one transfusion product to administer rather than 3, and is held at one storage temperature. It only contains anticoagulant-preservative solution, while components contain various storage solutions, which in theory may induce dilution coagulopathy. In this review, the quality of platelets in stored whole blood is summarized. In cold-stored whole blood, the platelet count declines by 1% to 2% per day. The responsiveness to various agonists declines during the storage time, but this appears to have a limited impact on clotting time or on clot strength as measured with thromboelastography. Animal studies have confirmed that platelets from stored whole blood participate equally well in clot formation. The recovery of platelets in stored whole blood is acceptable during at least 15 days of storage. The survival of platelets after transfusion is only 1 day, but this is likely to be sufficient for the intended patient group requiring massive transfusions, as the platelets are rapidly consumed in the wound area. In addition to the logistic benefits, there are drawbacks, most importantly having a sufficiently large inventory with an acceptable outdating rate, particularly since massive transfusions are rare, while requiring a lot of whole blood. The positive experience of the United States military with whole blood transfusion is often brought forward for introduction in the civilian blood bank, but patients with trauma are only a small fraction of the civilian population requiring massive transfusions. It needs to be determined whether in the resourceful environment of the hospital, these patients benefit from whole blood transfusions. Optimization of whole blood storage, with focus on platelet quality, needs to be performed to allow extension of the storage time beyond 15 days to a point where the number of units in inventory and outdating can be balanced.
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18
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Fadeyi EA, Saha AK, Naal T, Martin H, Fenu E, Simmons JH, Jones MR, Pomper GJ. A comparison between leukocyte reduced low titer whole blood vs non-leukocyte reduced low titer whole blood for massive transfusion activation. Transfusion 2020; 60:2834-2840. [PMID: 32888344 DOI: 10.1111/trf.16066] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/06/2020] [Accepted: 07/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hemorrhagic shock is the leading cause of survivable death in trauma patients and recent literature has focused on resuscitation strategies including transfusing low-titer group O whole blood (LTOWB). Debate remains regarding whether leukocyte reduced (LR) whole blood is of clinical benefit or detriment to patients requiring massive transfusion. This study compares survival outcomes between LR-LTOWB and non-LR LTOWB. STUDY DESIGN AND METHODS The objective of this prospective, observational study was to detect any difference in 24-hour survival between patients receiving LR-LTOWB and non-LR LTOWB during their massive transfusion activation. Secondary objectives were to report any difference in ICU LOS, ventilation days, in-hospital survival, and hospital LOS. Data collected included patient sex, age, mechanism of injury, Injury Severity Score (ISS), Trauma Injury Severity Score (TRISS), cause of death, and number of LTOWB transfused. RESULTS A total of 167 patients received 271 LTOWB transfusions. There were 97 patients that received 168 units of LR-LTOWB while 70 patients received 103 units of non-LR LTOWB. The two study groups were comparable in terms of age, sex, ISS, TRISS, and the number of LTOWB transfused. The use of LR LTOWB during the initial massive transfusion activation in traumatically injured patients was not associated with increased 24-hour survival compared to when using non-LR LTOWB. No transfusion associated adverse events were reported. CONCLUSIONS The administration of either LR or non-LR LTOWB was not associated with >24 hours survival in patients presenting with massive hemorrhage. The high cost and the rapid decline in platelet count of LR whole blood may be a consideration.
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Affiliation(s)
- Emmanuel A Fadeyi
- Department of Pathology & Laboratory Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.,Department of Pathology & Laboratory Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Amit K Saha
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Tawfeq Naal
- Department of Pathology & Laboratory Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.,Department of Pathology & Laboratory Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Harrison Martin
- Department of Pathology & Laboratory Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.,Department of Pathology & Laboratory Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Elena Fenu
- Department of Pathology & Laboratory Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.,Department of Pathology & Laboratory Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Julie H Simmons
- Department of Pathology & Laboratory Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Mary Rose Jones
- Department of Pathology & Laboratory Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Gregory J Pomper
- Department of Pathology & Laboratory Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.,Department of Pathology & Laboratory Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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19
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Jackson B, Murphy C, Fontaine MJ. Current state of whole blood transfusion for civilian trauma resuscitation. Transfusion 2020; 60 Suppl 3:S45-S52. [DOI: 10.1111/trf.15703] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Bryon Jackson
- Department of Pathology, University of Maryland School of Medicine Baltimore Maryland
| | - Colin Murphy
- Department of Pathology, University of Maryland School of Medicine Baltimore Maryland
| | - Magali J. Fontaine
- Department of Pathology, University of Maryland School of Medicine Baltimore Maryland
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20
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Acker JP, Seghatchian J. Opportunities for standardization of cold stored, low-titre group O WB products. Transfus Apher Sci 2020; 59:102787. [PMID: 32354678 DOI: 10.1016/j.transci.2020.102787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Interest in the use of cold-stored low-titre, group O whole blood (LTO-WB) in civilian trauma medicine has motivated regional and national blood services to explore the operational implications of providing this product to their hospital customers. While simpler to produce, store and administer than conventional blood components, LTO-WB is only distributed by a limited number of civilian blood services to date. To improve the availability of LTO-WB, there are still a number of clinical and basic research challenges that need to be addressed including 1. Standardization of the methods and definitions for what constitutes "low-titre" whole blood; 2. Updating regulatory standards for the in vitro quality of cold stored whole blood; 3. Development of standards for the post-storage component separation of red blood cells from cold stored whole blood; and 4. Optimization of the logistics for collection and distribution of cold stored whole blood in regional and national blood systems. The main objective of this concise overview is to highlight the opportunities for future research and product development efforts that will improve the availability of standardised LTO-WB products in emergency cases to the benefit of all concerned.
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Affiliation(s)
- Jason P Acker
- Centre for Innovation, Canadian Blood Services, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
| | - Jerard Seghatchian
- International Consultancy in Strategic Safety/Quality Improvements of Blood- Derived Bioproducts and Suppliers Quality Audit / Inspection, London, England, UK
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21
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Sivertsen J, Braathen H, Lunde THF, Kristoffersen EK, Hervig T, Strandenes G, Apelseth TO. Cold-stored leukoreduced CPDA-1 whole blood: in vitro quality and hemostatic properties. Transfusion 2020; 60:1042-1049. [PMID: 32187700 DOI: 10.1111/trf.15748] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Some jurisdictions require leukoreduction of cellular blood components. The only whole blood collection set with a platelet-saving filter uses citrate-phosphate-dextrose (CPD) as storage solution. Substituting CPD with citrate-phosphate-dextrose-adenine (CPDA-1) increases shelf life from 21 to 35 days. This would simplify prehospital and rural resupply and reduce wastage. We investigated in vitro quality and hemostatic properties of CPDA-1 whole blood leukoreduced with a platelet-saving filter. STUDY DESIGN AND METHODS CPDA-1 whole blood was leukoreduced using a platelet-saving filter and stored 35 days. EDQM requirements, hematology, metabolic parameters, thromboelastography, light transmission aggregometry, fibrinogen, factor VIII, and interleukin-6 were measured on Days 0, 1, 14, 21, and 35 and compared to non-leukoreduced blood. RESULTS All units met EDQM requirements. Leukoreduction yielded residual white blood cell count <1 × 106 and 87% platelet recovery on Day 1. It caused reduction in thromboelastography parameters, but not aggregometry response. No hemolysis >0.8% was observed. Factor VIII was higher on Day 35 in the leukoreduced group, 37.9 (95% CI: 26.0, 49.8) versus 13.8 (9.4, 18.2) IU/dL. In both groups, aggregation was significantly reduced by Day 14. Thromboelastography showed remaining platelet activity on Day 35, MA 46.9 (42.1, 51.7) in the leukoreduced and 44.3 (39.6, 49.0) mm in the non-leukoreduced group. Fibrinogen was within reference ranges at Day 35 (>2 g/dL). Interleukin-6 was not detectable. CONCLUSION Leukoreducing CPDA-1 whole blood with a platelet-saving filter did not compromise hemostatic properties. We encourage development of a single bag CPDA-1 whole blood collection set with in-line platelet-saving filter.
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Affiliation(s)
- Joar Sivertsen
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Hanne Braathen
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Turid Helen Felli Lunde
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Einar K Kristoffersen
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Tor Hervig
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Geir Strandenes
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Norwegian Armed Forces Joint Medical Services, Sessvollmoen, Norway
| | - Torunn O Apelseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
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22
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Vulliamy P, Thaventhiran AJ, Davenport RA. What's new for trauma haemorrhage management? Br J Hosp Med (Lond) 2019; 80:268-273. [PMID: 31059346 DOI: 10.12968/hmed.2019.80.5.268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Uncontrolled haemorrhage is the leading cause of preventable death from injury and is a major contributor to the global burden of disease. The majority of deaths resulting from bleeding occur within the first 3 hours of hospital admission, and the window for meaningful intervention is therefore extremely small. Resuscitative efforts during active bleeding should focus on maintaining haemostatic function with blood product transfusion and early administration of tranexamic acid. Achieving control of haemorrhage is the overarching treatment priority and may require temporising measures before definitive surgical or radiological intervention. This review summarizes the contemporary approaches to resuscitation of bleeding trauma patients, options for achieving haemorrhage control, and current areas of active research including organ protective resuscitation and suspended animation.
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Affiliation(s)
- Paul Vulliamy
- Clinical Lecturer and Specialist Registrar in General Surgery, Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London
| | - Anthony J Thaventhiran
- Clinical Research Fellow and Specialist Registrar in General Surgery, Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London
| | - Ross A Davenport
- Consultant Surgeon and Senior Lecturer, Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London E1 2AT
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23
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Gallaher JR, Schreiber MA. A Review of Whole Blood: Current Trauma Reports. CURRENT TRAUMA REPORTS 2019. [DOI: 10.1007/s40719-019-00178-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Martinaud C, Tiberghien P, Bégué S, Sailliol A, Gross S, Pouget T, Ausset S. Rational and design of the T-STORHM Study: A prospective randomized trial comparing fresh whole blood to blood components for acutely bleeding trauma patients. Transfus Clin Biol 2019; 26:198-201. [DOI: 10.1016/j.tracli.2019.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/24/2019] [Indexed: 12/12/2022]
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Thomas KA, Shea SM, Yazer MH, Spinella PC. Effect of leukoreduction and pathogen reduction on the hemostatic function of whole blood. Transfusion 2019; 59:1539-1548. [PMID: 30980757 DOI: 10.1111/trf.15175] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is renewed interest in the use of whole blood (WB) for resuscitation of patients in hemorrhagic shock. Leukoreduction with platelet-sparing filters and pathogen reduction may be used to improve the safety profile of WB, yet the effects of leukoreduction and pathogen reduction on WB hemostatic function are not well characterized. STUDY DESIGN AND METHODS Blood from 32 healthy group O donors was divided into treatment groups (n = 8 for each group): untreated, pathogen reduced (PR+ ), leukoreduced using an in-line filter (LR+ ), or PR+ LR+ . Units were stored without agitation for 21 days between 1° and 6°C, with sampling on days 0 (pre- and post-treatments), 1, 3, 5, 10, 15, and 21 for hemostatic function as assessed by thromboelastometry, thrombin generation, platelet activation factors, and platelet impedance aggregometry. RESULTS From day 3 (D3) to D15 of storage, platelet count was reduced in PR+ /LR+ units compared to PR- /LR- units. From D10 to D21 of storage, maximum clot firmness (MCF) was reduced in PR+ /LR+ units compared to PR- /LR- units. From D3 to D21 of storage, platelet aggregation was reduced in PR+ /LR+ units compared to PR- /LR- units. Total thrombin generation was similar in all groups from D0 to D21. CONCLUSIONS The combination of LR with a platelet-sparing filter and PR significantly reduces hemostatic function compared to either treatment alone or untreated WB. The clinical consequences of LR and PR of WB in patients with severe bleeding should be examined in trials before both are used in combination in patients.
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Affiliation(s)
- Kimberly A Thomas
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Susan M Shea
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Mark H Yazer
- Institute for Transfusion Medicine, The University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Philip C Spinella
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri.,Coagulation and Blood Research Program, United States Army Institute of Surgical Research, FT Sam Houston, San Antonio, Texas
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26
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Morris MC, Veile R, Friend LA, Oh D, Pritts TA, Dorlac WC, Spinella PC, Goodman MD. Effects of whole blood leukoreduction on platelet function and hemostatic parameters. Transfus Med 2019; 29:351-357. [PMID: 31382318 DOI: 10.1111/tme.12622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 01/04/2023]
Abstract
AIMS/OBJECTIVES The aim of this study was to evaluate the hemostatic consequences of whole blood leukoreduction (LR). BACKGROUND Whole blood is being used for trauma resuscitation in the military, and an increasing number of civilian trauma centres across the nation. The benefits of LR, such as decreased infectious and transfusion-related complications, are well established, but the effects on hemostatic parameters remain a concern. METHODS Twenty-four units of whole blood were assigned to one of the four groups: non-leukoreduced (NLR), leukoreduced at 1 h and a height of 33 in. (LR-1), leukoreduced at 4 h and a height of 33 in. (LR-4(33)), or leukoreduced at 4 h and a height of 28 in. (LR-4(28)). Viscoelastic parameters, platelet aggregation, cell counts, physiological parameters and thrombin potential were evaluated immediately before and after LR, and on days 1, 7, 14 and 21 following LR. RESULTS The viscoelastic parameters and thrombin generation potential were unchanged between the groups. Platelet aggregation was reduced in the LR-1 group compared with NLR after 7 days. The LR-4(28) group also showed a trend of reduced platelet aggregation compared with NLR. Aggregation in LR-4(33) was similar to NLR throughout the storage time. Physiological and electrolyte changes over the whole blood storage period were not affected by LR. CONCLUSION Our study shows that whole blood can be LR at 4 h after collection and a height of 33 in. while maintaining platelet count and without altering platelet function and hemostatic performance.
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Affiliation(s)
- M C Morris
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - R Veile
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - L A Friend
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - D Oh
- Department of Pathology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Hoxworth Blood Center, Cincinnati, Ohio, USA
| | - T A Pritts
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - W C Dorlac
- Department of Surgery, University of Colorado and UC Health, Ft. Collins, Colorado, USA
| | - P C Spinella
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - M D Goodman
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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27
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Kristoffersen EK, Apelseth TO. Platelet functionality in cold‐stored whole blood. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/voxs.12501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Einar K. Kristoffersen
- Department of Immunology and Transfusion Medicine Haukeland University Hospital Bergen Norway
- Department of Clinical Sciences University of Bergen Bergen Norway
| | - Torunn Oveland Apelseth
- Department of Immunology and Transfusion Medicine Haukeland University Hospital Bergen Norway
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28
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Yazer MH, Spinella PC. Review of low titre group O whole blood use for massively bleeding patients around the world in 2019. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/voxs.12495] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mark H. Yazer
- Department of Pathology The Institute for Transfusion Medicine University of Pittsburgh Pittsburgh PA USA
- Tel Aviv University Tel Aviv‐Yafo Israel
- University of Southern Denmark Odense Denmark
| | - Philip C. Spinella
- Department of Pediatrics Division of Critical Care Medicine Washington University in St Louis St Louis MO USA
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29
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Seheult JN, Bahr MP, Spinella PC, Triulzi DJ, Yazer MH. The Dead Sea needs salt water… massively bleeding patients need whole blood: The evolution of blood product resuscitation. Transfus Clin Biol 2019; 26:174-179. [PMID: 31262629 DOI: 10.1016/j.tracli.2019.06.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 01/30/2023]
Abstract
Whole blood, that is blood that is not manufactured into its component red blood cells (RBC) plasma, and platelets (PLT) units, was the mainstay of transfusion for many years until it was discovered that the component parts of a blood donation could be stored under different conditions thereby optimizing the storage length of each product. The use of low anti-A and -B titer group O whole blood (LTOWB) has recently been rediscovered for use in massively bleeding trauma patients. Whole blood has several advantages over conventional component therapy for these patients, including simplifying the logistics of the resuscitation, being more concentrated than whole blood that is reconstituted from conventional components, and providing cold-stored PLTs, amongst other benefits. While randomized controlled trials to determine the efficacy of using LTOWB in the resuscitation of massively bleeding trauma patients are currently underway, retrospective data has shown that massively bleeding recipients of LTOWB with traumatic injury do not have worse outcomes compared to patients who received conventional components and, in some cases, recipients of LTOWB have more favourable outcomes. This paper will describe some of the advantages of using LTOWB and will discuss the emerging evidence for its use in massively bleeding patients.
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Affiliation(s)
- J N Seheult
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
| | - M P Bahr
- Vitalant, 3636 Boulevard of the Allies, Pittsburgh, PA 15213, USA.
| | - P C Spinella
- Department of Pediatrics, Division of Critical Care Medicine, Washington University in St Louis, 660 S Euclid Avenue # 8124, Saint Louis, MO 63110, USA.
| | - D J Triulzi
- Vitalant, 3636 Boulevard of the Allies, Pittsburgh, PA 15213, USA; Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15269, USA.
| | - M H Yazer
- Vitalant, 3636 Boulevard of the Allies, Pittsburgh, PA 15213, USA; Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15269, USA.
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30
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31
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Young PP, Borge PD. Making whole blood for trauma available (again): the American Red Cross experience. Transfusion 2019; 59:1439-1445. [DOI: 10.1111/trf.15166] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Pampee P. Young
- Biomedical ServicessAmerican Red Cross Philadelphia Pennsylvania
- Department of Pathology and Cell and Molecular BiologyVanderbilt University Medical Center Nashville Tennessee
| | - P. Dayand Borge
- Biomedical ServicessAmerican Red Cross Philadelphia Pennsylvania
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32
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Thanasrisuebwong P, Surarit R, Bencharit S, Ruangsawasdi N. Influence of Fractionation Methods on Physical and Biological Properties of Injectable Platelet-Rich Fibrin: An Exploratory Study. Int J Mol Sci 2019; 20:ijms20071657. [PMID: 30987117 PMCID: PMC6479392 DOI: 10.3390/ijms20071657] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/19/2019] [Accepted: 03/30/2019] [Indexed: 12/13/2022] Open
Abstract
Injectable platelet-rich fibrin (i-PRF) has been used as an autografting material to enhance bone regeneration through intrinsic growth factors. However, fractionation protocols used to prepare i-PRF can be varied and the effects of different fractionation protocols are not known. In this study, we investigated the influence of different fractions of i-PRF on the physical and biological properties derived from variations in i-PRF fractionation preparation. The i-PRF samples, obtained from the blood samples of 10 donors, were used to harvest i-PRF and were fractioned into two types. The yellow i-PRF fractionation was harvested from the upper yellow zone, while the red i-PRF fractionation was collected from both the yellow and red zone of the buffy coat. The viscoelastic property measurements, including the clot formation time, α-angle, and maximum clot firmness, were performed by rotational thromboelastometry. The fibrin network was examined using a scanning electron microscope. Furthermore, the concentration of growth factors released, including VEGF, TGF-β1, and PDGF, were quantified using ELISA. A paired t-test with a 95% confidence interval was used. All three viscoelastic properties were statistically significantly higher in the yellow i-PRF compared to the red i-PRF. The scanning electron microscope reviewed more cellular components in the red i-PRF compared to the yellow i-PRF. In addition, the fibrin network of the yellow i-PRF showed a higher density than that in the red i-PRF. There was no statistically significant difference between the concentration of VEGF and TGF-β1. However, at Day 7 and Day 14 PDGF concentrations were statistically significantly higher in the red i-PRF compared to the yellow group. In conclusion, these results showed that the red i-PRF provided better biological properties through the release of growth factors. On the other hand, the yellow i-PRF had greater viscoelastic physical properties. Further investigations into the appropriate i-PRF fractionation for certain surgical procedures are therefore necessary to clarify the suitability for each fraction for different types of regenerative therapy.
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Affiliation(s)
- Prakan Thanasrisuebwong
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand.
- Ph.D. program in Oral Biology, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand.
| | - Rudee Surarit
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand.
| | - Sompop Bencharit
- Department of General Dentistry, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA.
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, VA 23298, USA.
| | - Nisarat Ruangsawasdi
- Department of Pharmacology, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand.
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33
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Sesok-Pizzini D, Friedman D, Cianfrani L, Jobes D. How do I support a pediatric cardiac surgery program utilizing fresh whole blood? Transfusion 2019; 59:1180-1182. [PMID: 30887527 DOI: 10.1111/trf.15235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Deborah Sesok-Pizzini
- Departments of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia and the Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Friedman
- Departments of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia and the Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laurene Cianfrani
- The American Red Cross-Penn Jersey Region, Philadelphia, Pennsylvania
| | - David Jobes
- Departments of Anesthesia and Critical Care, The Children's Hospital of Philadelphia and the Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
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34
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Haddaway K, Bloch EM, Tobian AAR, Frank SM, Sikorski R, Cho BC, Zheng G, Jani J, Lokhandwala PM, Lawrence CE, Blagg L, Ness PM, Kickler TS, Gehrie EA. Hemostatic properties of cold-stored whole blood leukoreduced using a platelet-sparing versus a non-platelet-sparing filter. Transfusion 2019; 59:1809-1817. [PMID: 30741432 DOI: 10.1111/trf.15159] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/07/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Whole blood (WB) is an appealing alternative to component-based transfusion in patients with significant bleeding. Historically, WB was transfused less than 48 hours after collection and was not leukoreduced (LR). However, LR components are now standard in many hospitals and LR WB is desirable. We investigated the effect of the type of LR filter used, as well as storage duration, on coagulation laboratory testing of WB. STUDY DESIGN AND METHODS Ten units of LR WB-5 units manufactured with a Food and Drug Administration (FDA)-approved platelet (PLT)-sparing filter (WB-PS) and 5 units manufactured with an FDA-approved non-PLT-sparing filter (WB-NPS)-underwent complete blood count, PLT function analyzer (PFA [PFA-100]), thromboelastography (TEG), prothrombin time (PT), partial thromboplastin time (PTT), Factor (F)V activity, chromogenic FVIII, thrombin generation, and microparticle quantification on Storage Days 3, 5, 7, 10, and 14. RESULTS WB-PS contains more PLTs than WB-NPS (mean, 71 × 109 /L vs. 1 × 109 /L, p < 0.001). WB-PS yielded essentially normal TEG tracings, while TEG tracings of WB-NPS were grossly abnormal (mean reaction time, 7.0 min for WB-PS vs. 9.7 min for WB-NPS, p < 0.001; mean alpha-angle 54.9° vs. 38.1°, p < 0.001; mean maximum amplitude, 54.9 mm vs. 13.9 mm, p < 0.001). PFA-100 closure was more common among units of WB-PS compared to units of WB-NPS (72% vs. 4%, p < 0.001). PT, PTT, and factor activities were not dramatically affected by the LR filter. CONCLUSION The choice LR filter has a major impact on the hemostatic properties of WB. Although storage of WB is associated with a rapid decline in PLT count, hemostasis as assessed by TEG and PFA-100 is not diminished over a 2-week storage period.
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Affiliation(s)
- Kathy Haddaway
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven M Frank
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,The Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert Sikorski
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian C Cho
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gang Zheng
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jayesh Jani
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Parvez M Lokhandwala
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney E Lawrence
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lorraine Blagg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul M Ness
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas S Kickler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric A Gehrie
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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35
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Condron M, Scanlan M, Schreiber M. Massive transfusion of low-titer cold-stored O-positive whole blood in a civilian trauma setting. Transfusion 2018; 59:927-930. [PMID: 30592054 DOI: 10.1111/trf.15091] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Based on the improved outcomes achieved with fresh whole blood in cases of military trauma as well as with 1:1:1 transfusion strategies for massive traumatic hemorrhage in civilian settings, there has been resurgent interest in using whole blood for civilian trauma patients. There have been reports of giving up to 4 units of low-titer cold-stored O-positive to these patients. This is the first modern report of a massive transfusion with unrestricted low-titer group O whole blood (LTOWB) use in a civilian trauma patient. STUDY DESIGN AND METHODS This is a case report describing the resuscitation and massive transfusion of LTOWB of a 69-year-old man struck by an automobile. RESULTS While working to achieve hemorrhage control, the patient received 38 units of LTOWB, 13 units of RBCs, 12 units of fresh frozen plasma, 2 packs of platelets, and 2 units of cryoprecipitate. No evidence of hemolytic reaction was observed. The patient was O positive. Monitoring by thrombelastography revealed adequate clot initiation and propagation, but decreased clot strength (49.6 and 50.2) and a drop in fibrinogen (from 207 to 141) during the resuscitation. CONCLUSION This is the first report of a massive transfusion for civilian trauma based on cold-stored whole blood in the recent era. While this patient suffered a tremendous burden of traumatic injury and his recovery is not yet complete, his LTOWB resuscitation was successful. Frequent monitoring of coagulation status with thrombelastography during utilization of LTOWB is indicated because the efficacy of its components (particularly platelets) is not yet fully understood.
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Affiliation(s)
- Mary Condron
- Division of Trauma and Acute Care Surgical Services, St Charles Medical Center, Bend, Oregon, USA
| | - Mick Scanlan
- Division of Pathology, Oregon Health & Science University, Portland, Oregon
| | - Martin Schreiber
- Division of Trauma, Critical Care & Acute Care Surgery, Oregon Health & Science University, Portland, Oregon
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36
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Yazer MH, Nessen SC, Cap AP. How shall we transfuse Hippolyta? The same way whether on or off the battlefield. Am J Obstet Gynecol 2018; 219:124-125. [PMID: 29601797 DOI: 10.1016/j.ajog.2018.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/22/2018] [Indexed: 01/31/2023]
Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Institute for Transfusion Medicine, Pittsburgh, PA.
| | | | - Andrew P Cap
- US Army Institute of Surgical Research, Sam Houston, TX
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