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Potassium Level Variation Following Packed Cell Transfusion in Critically Ill Adult Patients-How Alert Should We Be? J Clin Med 2022; 11:jcm11113117. [PMID: 35683501 PMCID: PMC9181596 DOI: 10.3390/jcm11113117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 02/01/2023] Open
Abstract
One of the most clinically important effects following the administration of packed cell transfusion (PCT) is hyperkalemia, which can cause severe life-threatening cardiac arrhythmias. This retrospective population-based cohort study included adults hospitalized between January 2007 and December 2019 in a general intensive care unit for 24 h or more, with normal levels of serum potassium on admission. We assessed changes in serum potassium levels after administration of one unit of packed cells and sought to identify clinical parameters that may affect these changes. We applied adjusted linear mixed models to assess changes in serum potassium. The mean increase in serum potassium was 0.09 mEq/L (C.U 0.04−0.14, p-value < 0.001) among the 366 patients who were treated with a single PCT compared to those not treated with PCT. Increased serum potassium levels were also found in patients who required mechanical ventilation, and to a lesser degree in those treated with vasopressors. Hypertension, the occurrence of a cerebrovascular accident, and increased creatinine levels were all associated with reduced serum potassium levels. Due to the small rise in serum potassium levels following PCT, we do not suggest any particular follow-up measures for critically ill patients who receive PCT.
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Bhat A, Podstawczyk D, Walther BK, Aggas JR, Machado-Aranda D, Ward KR, Guiseppi-Elie A. Toward a hemorrhagic trauma severity score: fusing five physiological biomarkers. J Transl Med 2020; 18:348. [PMID: 32928219 PMCID: PMC7490913 DOI: 10.1186/s12967-020-02516-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/04/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To introduce the Hemorrhage Intensive Severity and Survivability (HISS) score, based on the fusion of multi-biomarker data; glucose, lactate, pH, potassium, and oxygen tension, to serve as a patient-specific attribute in hemorrhagic trauma. MATERIALS AND METHODS One hundred instances of Sensible Fictitious Rationalized Patient (SFRP) data were synthetically generated and the HISS score assigned by five clinically active physician experts (100 [5]). The HISS score stratifies the criticality of the trauma patient as; low(0), guarded(1), elevated(2), high(3) and severe(4). Standard classifier algorithms; linear support vector machine (SVM-L), multi-class ensemble bagged decision tree (EBDT), artificial neural network with bayesian regularization (ANN:BR) and possibility rule-based using function approximation (PRBF) were evaluated for their potential to similarly classify and predict a HISS score. RESULTS SVM-L, EBDT, ANN:BR and PRBF generated score predictions with testing accuracies (majority vote) corresponding to 0.91 ± 0.06, 0.93 ± 0.04, 0.92 ± 0.07, and 0.92 ± 0.03, respectively, with no statistically significant difference (p > 0.05). Targeted accuracies of 0.99 and 0.999 could be achieved with SFRP data size and clinical expert scores of 147[7](0.99) and 154[9](0.999), respectively. CONCLUSIONS The predictions of the data-driven model in conjunction with an adjunct multi-analyte biosensor intended for point-of-care continual monitoring of trauma patients, can aid in patient stratification and triage decision-making.
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Affiliation(s)
- Ankita Bhat
- Center for Bioelectronics, Biosensors and Biochips (C3B®), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843 USA
| | - Daria Podstawczyk
- Department of Process Engineering and Technology of Polymer and Carbon Materials, Wroclaw University of Science and Technology, Norwida 4/6, 50-373 Wroclaw, Poland
| | - Brandon K. Walther
- Center for Bioelectronics, Biosensors and Biochips (C3B®), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843 USA
- Department of Cardiovascular Sciences, Houston Methodist Institute for Academic Medicine and Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX 77030 USA
| | - John R. Aggas
- Center for Bioelectronics, Biosensors and Biochips (C3B®), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843 USA
| | - David Machado-Aranda
- Departments of Emergency Medicine and Biomedical Engineering, Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI 48109 USA
- Department of Surgery, Division of Acute Care Surgery, University of Michigan, Ann Arbor, MI 48109 USA
| | - Kevin R. Ward
- Department of Surgery, Division of Acute Care Surgery, University of Michigan, Ann Arbor, MI 48109 USA
| | - Anthony Guiseppi-Elie
- Center for Bioelectronics, Biosensors and Biochips (C3B®), Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843 USA
- Department of Cardiovascular Sciences, Houston Methodist Institute for Academic Medicine and Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX 77030 USA
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77843 USA
- ABTECH Scientific, Inc, Biotechnology Research Park, 800 East Leigh Street, Richmond, VA 23219 USA
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AlMoshary M, Mussaed EA, Arab-din M. Biochemical profile changes in stored donor blood for transfusion. Pak J Med Sci 2019; 35:1697-1700. [PMID: 31777518 PMCID: PMC6861460 DOI: 10.12669/pjms.35.6.220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/26/2019] [Accepted: 08/05/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This study's aim was to find out that how various biochemical parameters of donor blood are affected during storage. METHODS This cross-sectional study was conducted in hematology Unit of Rehman Medical Institute, Peshawar and Fatimid Foundation, Peshawar Khyber Pakhtunkhwa, over a period of six months from June 2018 to November 2018. This study includes 300 healthy volunteer donors. Analysis of stored blood was done at 0, 3, 7, 14- and 21-days interval. Data were recorded and analyzed in SPSS v 20. A p value of less than 0.05 was taken as significant. RESULTS Three hundred healthy volunteer donors were included in the study in which 63% were male and 37% were females. Mean age was 26.54±7.3 years with age range from 23-46 years. Out of 300 donors 15.33% were O+, 35.33%, 9.66% B+, 8.33% A+, 7.66% AB+, 7.66% O-, 7% A- and 9% B-. Significant. Changes were observed in serum potassium, LDH, pH, serum chloride, serum sodium and AST levels. (p:<0.001). however, storage did not affect rest of the parameters. CONCLUSION This study reveals that during storage certain changes occur in haematological and biochemical parameters which ultimately may put patients at risk.
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Affiliation(s)
- May AlMoshary
- Dr. May AlMoshary. MD. Basic Science department (Hematology), College of medicine, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Eman Al Mussaed
- Dr. Eman Al Mussaed. MD. Basic Science department (Hematology), College of medicine, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Maria Arab-din
- Dr. Maria Arab-din. MBBS, MPhil (Scholar). Khyber Medical University, Peshawar, Pakistan
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Oyet C, Okongo B, Onyuthi RA, Muwanguzi E. Biochemical changes in stored donor units: implications on the efficacy of blood transfusion. J Blood Med 2018; 9:111-115. [PMID: 29970970 PMCID: PMC6022818 DOI: 10.2147/jbm.s163651] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Blood transfusion with allogeneic blood products is a common medical intervention to treat anemia or prepare patients for surgical procedures. Generally, the blood units are secured and stored prior to expected transfusion. During storage, a number of biochemical changes occur (generally known as storage lesion), which can affect the efficacy of blood transfusion. The aim of the study was to evaluate the biochemical changes that occur in blood units during storage and to project the impact of these changes on transfusion. Methods The study protocol was approved by the Faculty of Medicine Research Ethics committee of Mbarara University of Science and Technology. A total of 200 blood recipients were categorized into two study arms: group I received fresh blood (n=100) and group II received old blood (n=100), who were formally consented and recruited consecutively. A total of 2 mL of venous blood was collected from each participant in EDTA tubes before transfusion (for pre-transfusion hemoglobin [Hb] estimation) and after transfusion (for post-transfusion Hb estimation). Each crossmatched unit was sampled to collect plasma for pH, lactate and potassium assays. Data were analyzed with STATA version 12.0. Results A total of 200 blood transfusion recipients aged 1–60 years were enrolled in the study. Up to 60% of the participants were females. The pH of the stored blood dropped from 7.4 to 7.2 in the first 3 days to ~7.0 by day 11 and to <7.0 by day 35 (p=0.03). The average rise in lactate level was 25 g/dL in blood stored for 0 to 11 days and 32.4 g/dL in blood stored for 21–35 days. The highest increase was encountered in blood stored beyond 28 days: 40–57 g/dL by 35 days (p=0.001). Potassium levels equally increased from ~4.6 mmol/L in the first 5 days of storage to ~14.3 mmol/L by 11 days. From the third week of blood storage and beyond, there was exponential increase in potassium levels, with the highest record in blood units stored from 30 to 35 days (p=0.068). Conclusion Whole blood stored for >14 days has reduced efficacy with increased markers of red cell storage lesion such as increased potassium level, lactate and fall in pH. These lesions increase the length of hospital stay.
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Affiliation(s)
- Caesar Oyet
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda,
| | - Benson Okongo
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda,
| | - Richard Apecu Onyuthi
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda,
| | - Enoch Muwanguzi
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda,
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5
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Rizos CV, Milionis HJ, Elisaf MS. Severe hyperkalemia following blood transfusions: Is there a link? World J Nephrol 2017; 6:53-56. [PMID: 28101452 PMCID: PMC5215209 DOI: 10.5527/wjn.v6.i1.53] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/06/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
Patients with gastrointestinal bleeding often require large volume blood transfusion. Among the various side effects of blood transfusion, the increase of potassium levels is a serious one which is often overlooked. We report a case of severe hyperkalemia in a patient with gastric bleeding after large volume transfusion of packed red blood cells. The patient had hyperkalemia at baseline associated with his receiving medication as well as acute renal failure following hypovolemia. The baseline hyperkalemia was further aggravated after massive transfusions of packed red blood cells in a short period of time. The associated pathogenetic mechanisms resulting in the increase of potassium levels are presented. A number of risk factors which increase the risk of hyperkalemia after blood transfusion are discussed. Moreover, appropriate management strategies for the prevention of blood transfusion associated hyperkalemia are also presented. Physicians should always keep in mind the possibility of hyperkalemia in cases of blood transfusion.
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Guerado E, Medina A, Mata MI, Galvan JM, Bertrand ML. Protocols for massive blood transfusion: when and why, and potential complications. Eur J Trauma Emerg Surg 2015; 42:283-95. [PMID: 26650716 DOI: 10.1007/s00068-015-0612-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 11/23/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE An update paper on massive bleeding after major trauma. A review of protocols to address massive bleeding, and its possible complications, including coagulation abnormalities, complications related to blood storage, immunosuppression and infection, lung injury associated with transfusion, and hypothermia is carried out. METHODS Literature review and discussion with authors' experience. RESULTS Massive bleeding is an acute life-threatening complication of major trauma, and consequently its prompt diagnosis and treatment is of overwhelming importance. Treatment requires rapid surgical management together with the massive infusion of colloid and blood. CONCLUSIONS Since massive transfusion provokes further problems in patients who are already severely traumatized and anaemic, once this course of action has been decided upon, a profound knowledge of its potential complications, careful monitoring and proper follow-up are all essential. To diagnose this bleeding, most authors favour, as the main first choice tool, a full-body CT scan (head to pelvis), in non-critical severe trauma cases. In addition, focused abdominal sonography for trauma (FAST, an acronym that highlights the necessity of rapid performance) is a very important diagnostic test for abdominal and thoracic bleeding. Furthermore, urgent surgical intervention should be undertaken for patients with significant free intraabdominal fluid and haemodynamic instability. Although the clinical situation and the blood haemoglobin concentration are the key factors considered in this rapid decision-making context, laboratory markers should not be based on a single haematocrit value, as its sensitivity to significant bleeding may be very low. Serum lactate and base deficit are very sensitive markers for detecting and monitoring the extent of bleeding and shock, in conjunction with repeated combined measurements of prothrombin time, activated partial thromboplastin time, fibrinogen and platelets.
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Affiliation(s)
- E Guerado
- Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Autovía A-7, Km 187, 29603, Marbella, Malaga, Spain.
| | - A Medina
- Department of Haematology, Hospital Costa del Sol, 29603, Marbella, Spain
| | - M I Mata
- Department of Haematology, Hospital Costa del Sol, 29603, Marbella, Spain
| | - J M Galvan
- Intensive Care Unit, Hospital Costa del Sol, 29603, Marbella, Spain
| | - M L Bertrand
- Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Autovía A-7, Km 187, 29603, Marbella, Malaga, Spain
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Bolanos JA, Yuan CM, Little DJ, Oliver DK, Howard SR, Abbott KC, Olson SW. Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members. Clin J Am Soc Nephrol 2015; 10:1732-9. [PMID: 26336911 PMCID: PMC4594058 DOI: 10.2215/cjn.00890115] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 06/30/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Mortality and CKD risk have not been described in military casualties with post-traumatic AKI requiring RRT suffered in the Iraq and Afghanistan wars. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This is a retrospective case series of post-traumatic AKI requiring RRT in 51 military health care beneficiaries (October 7, 2001-December 1, 2013), evacuated to the National Capital Region, documenting in-hospital mortality and subsequent CKD. Participants were identified using electronic medical and procedure records. RESULTS Age at injury was 26±6 years; of the participants, 50 were men, 16% were black, 67% were white, and 88% of injuries were caused by blast or projectiles. Presumed AKI cause was acute tubular necrosis in 98%, with rhabdomyolysis in 72%. Sixty-day all-cause mortality was 22% (95% confidence interval [95% CI], 12% to 35%), significantly less than the 50% predicted historical mortality (P<0.001). The VA/NIH Acute Renal Failure Trial Network AKI integer score predicted 60-day mortality risk was 33% (range, 6%-96%) (n=49). Of these, nine died (mortality, 18%; 95% CI, 10% to 32%), with predicted risks significantly miscalibrated (P<0.001). The area under the receiver operator characteristic curve for the AKI integer score was 0.72 (95% CI, 0.56 to 0.88), not significantly different than the AKI integer score model cohort (P=0.27). Of the 40 survivors, one had ESRD caused by cortical necrosis. Of the remaining 39, median time to last follow-up serum creatinine was 1158 days (range, 99-3316 days), serum creatinine was 0.85±0.24 mg/dl, and eGFR was 118±23 ml/min per 1.73 m(2). No eGFR was <60 ml/min per 1.73 m(2), but it may be overestimated because of large/medium amputations in 54%. Twenty-five percent (n=36) had proteinuria; one was diagnosed with CKD stage 2. CONCLUSIONS Despite severe injuries, participants had better in-hospital survival than predicted historically and by AKI integer score. No patient who recovered renal function had an eGFR<60 ml/min per 1.73 m(2) at last follow-up, but 23% had proteinuria, suggesting CKD burden.
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Affiliation(s)
- Jonathan A Bolanos
- Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Christina M Yuan
- Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Dustin J Little
- Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - David K Oliver
- Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Steven R Howard
- Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Kevin C Abbott
- Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Stephen W Olson
- Nephrology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
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Gill K, Fink JC, Gilbertson DT, Monda KL, Muntner P, Lafayette RA, Petersen J, Chertow GM, Bradbury BD. Red blood cell transfusion, hyperkalemia, and heart failure in advanced chronic kidney disease. Pharmacoepidemiol Drug Saf 2015; 24:654-62. [DOI: 10.1002/pds.3779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/18/2015] [Accepted: 03/06/2015] [Indexed: 11/05/2022]
Affiliation(s)
| | - Jeffrey C. Fink
- Department of Medicine; University of Maryland; Baltimore MD USA
| | - David T. Gilbertson
- Chronic Disease Research Group; Minneapolis Medical Research Foundation; Minneapolis MN USA
| | - Keri L. Monda
- Center for Observational Research; Amgen Inc.; Thousand Oaks CA USA
| | - Paul Muntner
- Department of Epidemiology; University of Alabama; Birmingham Birmingham AB USA
| | - Richard A. Lafayette
- Division of Nephrology; Stanford University School of Medicine; Palo Alto CA USA
| | | | - Glenn M. Chertow
- Division of Nephrology; Stanford University School of Medicine; Palo Alto CA USA
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Opoku-Okrah C, Acquah BKS, Dogbe EE. Changes in potassium and sodium concentrations in stored blood. Pan Afr Med J 2015; 20:236. [PMID: 27386032 PMCID: PMC4919675 DOI: 10.11604/pamj.2015.20.236.5851] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/13/2015] [Indexed: 01/10/2023] Open
Abstract
Potassium is the principal intracellular cation with sodium being the principal extracellular cation. Maintenance of the distribution of potassium and sodium between the intracellular and the extracellular compartments relies on several homeostatic mechanisms. This study analysed the effect of blood storage on the concentrations of potassium and sodium in stored blood and also determine any variations that may exist in their concentrations. 50 mls of blood was sampled each from 28 units of evenly mixed donated blood in citrate phosphate dextrose adenine (CPDA-1) bags immediately after donation into satellite bag and stored at 4oC. Potassium and sodium concentration determinations were done on each of the 28 samples on day 0 (before blood was initially stored in the fridge), day 5, day 10, day 15 and day 20 of storage using the Roche 9180 ISE Electrolyte Analyser (Hoffmann-La Roche Ltd, Switzerland). data analysis showed significant changes in the potassium and sodium concentrations with a continuous rise in potassium and a continuous fall in sodium. A daily change of 0.59 mmol/l and 0.50 mmol/l was observed in the potassium and sodium concentrations respectively. We showed steady but increased daily concentrations of potassium and decrease concentrations of sodium in blood stored over time at 4oC.
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Affiliation(s)
- Clement Opoku-Okrah
- Department of Medical Laboratory Technology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Benjamin Kojo Safo Acquah
- Department of Medical Laboratory Technology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Elliot Eli Dogbe
- Transfusion Medicine Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Abstract
Haemorrhage remains a major cause of potentially preventable deaths. Rapid transfusion of large volumes of blood products is required in patients with haemorrhagic shock which may lead to a unique set of complications. Recently, protocol based management of these patients using massive transfusion protocol have shown improved outcomes. This section discusses in detail both management and complications of massive blood transfusion.
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Affiliation(s)
- Vijaya Patil
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Madhavi Shetmahajan
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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Winter KM, Johnson L, Kwok M, Reid S, Alarimi Z, Wong JKL, Dennington PM, Marks DC. Understanding the effects of gamma-irradiation on potassium levels in red cell concentrates stored in SAG-M for neonatal red cell transfusion. Vox Sang 2014; 108:141-50. [DOI: 10.1111/vox.12194] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/30/2014] [Accepted: 08/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- K. M. Winter
- Research and Development; Australian Red Cross Blood Service; Sydney NSW Australia
| | - L. Johnson
- Research and Development; Australian Red Cross Blood Service; Sydney NSW Australia
| | - M. Kwok
- Research and Development; Australian Red Cross Blood Service; Sydney NSW Australia
| | - S. Reid
- Research and Development; Australian Red Cross Blood Service; Sydney NSW Australia
| | - Z. Alarimi
- Medical, Transplantation and Quality Services; Australian Red Cross Blood Service; Sydney NSW Australia
| | - J. K. L. Wong
- Medical, Transplantation and Quality Services; Australian Red Cross Blood Service; Sydney NSW Australia
| | - P. M. Dennington
- Medical, Transplantation and Quality Services; Australian Red Cross Blood Service; Sydney NSW Australia
| | - D. C. Marks
- Research and Development; Australian Red Cross Blood Service; Sydney NSW Australia
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Kotanen CN, Guiseppi-Elie A. Monitoring systems and quantitative measurement of biomolecules for the management of trauma. Biomed Microdevices 2014; 15:561-77. [PMID: 23494594 DOI: 10.1007/s10544-013-9756-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Continued high morbidity and complications due to trauma related hemorrhage underscores the fact that our understanding of the detailed molecular events of trauma are inadequate to bring life-saving changes to practice. The current state of efficacy and advances in biomedical microdevice technology for trauma diagnostics concerning hemorrhage and hemorrhagic shock was considered with respect to vital signs and metabolic biomarkers. Tachycardia and hypotension are markers of hemorrhagic shock in decompensated trauma patients. Base deficit has been predicative of injury severity at hospital admission. Tissue oxygen saturation has been predicative of onset of multiple organ dysfunction syndrome. Blood potassium levels increase with onset of hemorrhagic shock. Lactate is a surrogate for tissue hypoxia and its clearance predicts mortality. Triage glucose measurements have been shown to be specific in predicting major injuries. No vital sign has yet to be proven effective as an independent predictor of trauma severity. Point of care (POC) devices allow for rapid results, easy sample preparation and processing, small sample volumes, small footprint, multifunctional analysis, and low cost. Advances in the field of in-vivo biosensors has provided a much needed platform by which trauma related metabolites can be monitored easily, rapidly and continuously. Multi-analyte monitoring biosensors have the potential to explore areas still undiscovered in the realm of trauma physiology.
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Affiliation(s)
- Christian N Kotanen
- Center for Bioelectronics, Biosensors and Biochips, Clemson University Advanced Materials Center, 100 Technology Drive, Anderson, SC 29625, USA.
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Borland C, Bottrill F, Jones A, Sparkes C, Vuylsteke A. The significant blood resistance to lung nitric oxide transfer lies within the red cell. J Appl Physiol (1985) 2014; 116:32-41. [DOI: 10.1152/japplphysiol.00786.2013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The lung nitric oxide (NO) diffusing capacity (DlNO) mainly reflects alveolar-capillary membrane conductance (Dm). However, blood resistance has been shown in vitro and in vivo. To explore whether this resistance lies in the plasma, the red blood cell (RBC) membrane, or in the RBC interior, we measured the NO diffusing capacity (Dno) in a membrane oxygenator circuit containing ∼1 liter of horse or human blood exposed to 14 parts per million NO under physiological conditions on 7 separate days. We compared results across a 1,000-fold change in extracellular diffusivity using dextrans, plasma, and physiological salt solution. We halved RBC surface area by comparing horse and human RBCs. We altered the diffusive resistance of the RBC interior by adding sodium nitrite converting oxyhemoglobin to methemoglobin. Neither increased viscosity nor reduced RBC size reduced Dno. Adding sodium nitrite increased methemoglobin and was associated with a steady fall in Dno ( P < 0.001). Similar results were obtained at NO concentrations found in vivo. The RBC interior appears to be the site of the blood resistance.
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Affiliation(s)
- Colin Borland
- Department of Anaesthetic Research, Papworth Hospital, Cambridgeshire, United Kingdom
| | - Fiona Bottrill
- Department of Anaesthetic Research, Papworth Hospital, Cambridgeshire, United Kingdom
| | - Aled Jones
- Department of Anaesthetic Research, Papworth Hospital, Cambridgeshire, United Kingdom
| | - Chris Sparkes
- Department of Anaesthetic Research, Papworth Hospital, Cambridgeshire, United Kingdom
| | - Alain Vuylsteke
- Department of Anaesthetic Research, Papworth Hospital, Cambridgeshire, United Kingdom
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14
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Gruber M, Breu A, Frauendorf M, Seyfried T, Hansen E. Washing of banked blood by three different blood salvage devices. Transfusion 2012; 53:1001-9. [PMID: 22897672 DOI: 10.1111/j.1537-2995.2012.03853.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Storage lesions in red blood cells (RBCs) lead to an accumulation of soluble contaminants that can compromise the patient. Organ failures, coagulopathies, and cardiovascular events including lethal cardiac arrest have been reported, especially with massive transfusion or in pediatric patients. Washing improves the quality of stored RBCs, and autotransfusion devices have been proposed for intraoperative processing, but these devices were designed for diluted wound blood, and limited data on their performance with RBCs are available. STUDY DESIGN AND METHODS Three autotransfusion devices (Electa, Sorin; CATS, Fresenius; OrthoPAT, Haemonetics) differing in function of their centrifugation chambers were evaluated with RBCs at the end of their shelf life and with dilutions thereof. Elimination rates of potassium, plasma free hemoglobin, total protein, citrate, acid equivalents, and iomeprol added as a marker substance were analyzed, in addition to RBC recoveries. RESULTS Product hematocrit (Hct) levels ranged between 54.8 and 72.6%. RBC recovery rates were between 62.7 and 95.0%, the lowest being with the OrthoPAT processing of undiluted RBCs. Plasma elimination rates increased with predilution and ranged from 46.6% to 99.5%, the lowest being with the CATS and undiluted RBCs. Washing did not change pH and buffering capacity of RBCs. CONCLUSION Autotransfusion devices offer a practical and obviously economical option to wash banked RBCs intraoperatively to prevent hyperkalemia and other disturbances in massive transfusion or pediatric patients. Predilution improves elimination rates, especially in devices that produce high product Hct levels. With a Y-tubing the RBCs should bypass reservoir and vacuum, and the procedure should be guarded by a policy and procedure manual and a quality management system.
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Affiliation(s)
- Michael Gruber
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
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Jansen JO, Thomas GOR, Adams SA, Tai NRM, Russell R, Morrison J, Clasper J, Midwinter M. Early management of proximal traumatic lower extremity amputation and pelvic injury caused by improvised explosive devices (IEDs). Injury 2012; 43:976-9. [PMID: 21907338 DOI: 10.1016/j.injury.2011.08.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/19/2011] [Accepted: 08/18/2011] [Indexed: 02/02/2023]
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16
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Nickell JR, Shih A. Anesthesia case of the month. Administration of aged packed RBCs. J Am Vet Med Assoc 2011; 239:1429-31. [PMID: 22087716 DOI: 10.2460/javma.239.11.1429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jordan R Nickell
- Department of Small Animal Clinical Science, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA
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17
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Correction: Anesthesia Case of the Month. J Am Vet Med Assoc 2011. [DOI: 10.2460/javma.239.11.1431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Le Noël A, Mérat S, Ausset S, De Rudnicki S, Mion G. [The damage control resuscitation concept]. ACTA ACUST UNITED AC 2011; 30:665-78. [PMID: 21764247 DOI: 10.1016/j.annfar.2011.05.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 05/26/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Damage control is a strategy of care for bleeding trauma patients, involving minimal rescue surgery associated to perioperative resuscitation. The purpose of this review is to draw up a statement on current knowledge available on damage control. DATA SOURCES References were obtained from recent review articles, personal files, and Medline database research of English and French publications. All categories of articles on this topic have been selected. DATA SYNTHESIS Historical damage control surgery, that consist of abbreviated laparotomy with second-look after resuscitation, is now included in a wider concept called "damage control resuscitation", addressing the lethal triad (coagulopathy, hypothermia and acidosis) at an early phase. Care is focused on coagulopathy prevention. Early resuscitation, or damage control ground zero, has been improved: aggressive management of hypothermia, bleeding control techniques, permissive hypotension concept and early use of vasopressors. Transfusion practices also have evolved: early platelets and coagulation factors administration, use of hemostatic agents like recombinant FVIIa, whole blood transfusion, denote the damage control hematology. Progress in surgical practices and development of arteriographic techniques lead to wider indications of damage control strategy.
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Affiliation(s)
- A Le Noël
- Département d'anesthésie-réanimation, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France
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19
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Abstract
The supernatant potassium concentration [K+] of red blood cell (RBC) units is frequently much higher than normal human plasma potassium levels, especially in units nearing the end of their storage life. Clinical hyperkalemia resulting from RBC transfusions has been recognized as a transfusion complication for decades, and there have been reported cardiac arrests attributed to transfusion-associated hyperkalemia. This review summarizes the evidence surrounding RBC [K+] levels, effects of irradiation and washing on [K+], the evidence for clinical hyperkalemia and cardiac arrests resulting from transfusion, predictors of post-transfusion hyperkalemia, and their preventative strategies. Key points include: (a) the [K+] (in mmol/L) increases linearly and is approximately equal to the number of days of RBC unit storage; (b) irradiation causes a rapid increase in [K+]; (c) there is potentially sufficient potassium in the supernatant of current RBC preparations to lead to hyperkalemia with large transfusion volumes; (d) any rise in patient potassium after transfusion is usually transient due to the redistribution of the potassium load; (e) transfusion-associated hyperkalemic cardiac arrests probably do occur, although it is difficult to prove this fact conclusively; and (f) promising strategies to combat transfusion-associated hyperkalemia include RBC washing, the use of in-line potassium filters, and the use of traditional treatments for hyperkalemia such as the use of insulin.
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20
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Abstract
Hemorrhage remains a major cause of preventable death following both civilian and military trauma. The goals of resuscitation in the face of hemorrhagic shock are restoring end-organ perfusion and maintaining tissue oxygenation while attempting definitive control of bleeding. However, if not performed properly, resuscitation can actually exacerbate cellular injury caused by hemorrhagic shock, and the type of fluid used for resuscitation plays an important role in this injury pattern. This article reviews the historical development and scientific underpinnings of modern resuscitation techniques. We summarized data from a number of studies to illustrate the differential effects of commonly used resuscitation fluids, including isotonic crystalloids, natural and artificial colloids, hypertonic and hyperoncotic solutions, and artificial oxygen carriers, on cellular injury and how these relate to clinical practice. The data reveal that a uniformly safe, effective, and practical resuscitation fluid when blood products are unavailable and direct hemorrhage control is delayed has been elusive. Yet, it is logical to prevent this cellular injury through wiser resuscitation strategies than attempting immunomodulation after the damage has already occurred. Thus, we describe how some novel resuscitation strategies aimed at preventing or ameliorating cellular injury may become clinically available in the future.
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Affiliation(s)
- Heena P Santry
- Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
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21
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Abstract
Massive transfusion (MT) is a lifesaving treatment of hemorrhagic shock, but can be associated with significant complications. The lethal triad of acidosis, hypothermia, and coagulopathy associated with MT is associated with a high mortality rate. Other complications include hypothermia, acid/base derangements, electrolyte abnormalities (hypocalcemia, hypomagnesemia, hypokalemia, hyperkalemia), citrate toxicity, and transfusion-associated acute lung injury. Blood transfusion in trauma, surgery, and critical care has been identified as an independent predictor of multiple organ failure, systemic inflammatory response syndrome, increased infection, and increased mortality in multiple studies. Once definitive control of hemorrhage has been established, a restrictive approach to blood transfusion should be implemented to minimize further complications.
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Affiliation(s)
- Kristen C Sihler
- University of Michigan School of Medicine, Ann Arbor, MI 48109-0033, USA
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22
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Au BK, Dutton WD, Zaydfudim V, Nunez TC, Young PP, Cotton BA. Hyperkalemia Following Massive Transfusion in Trauma. J Surg Res 2009; 157:284-9. [DOI: 10.1016/j.jss.2009.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 04/17/2009] [Accepted: 05/01/2009] [Indexed: 11/28/2022]
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23
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Abstract
PURPOSE OF REVIEW To bring together in one review article, the most current and relevant evidence relating to military trauma resuscitation. RECENT FINDINGS The main themes highlighted by this review are coagulopathy of trauma shock (CoTS), damage control resuscitation, haemostatic resuscitation, the management of massive transfusion, use of adjuvant drugs for haemostasis and use of an empiric massive transfusion protocol. SUMMARY The review aims to educate the readership in recent advances in trauma practice, culminating in a novel empiric massive transfusion algorithm seamlessly guiding the clinician through the initial resuscitation stage resulting in reduced mortality, morbidity, coagulopathy and decreased overall blood product usage.
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Affiliation(s)
- Rob Dawes
- 16 Air Assault Medical Regiment, Royal Army Medical Corps, UK
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24
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Kunadian V, Zorkun C, Gibson WJ, Nethala N, Harrigan C, Palmer AM, Ogando KJ, Biller LH, Lord EE, Williams SP, Lew ME, Ciaglo LN, Buros JL, Marble SJ, Gibson CM. Transfusion associated microchimerism: a heretofore little-recognized complication following transfusion. J Thromb Thrombolysis 2008; 27:57-67. [PMID: 18766299 DOI: 10.1007/s11239-008-0268-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 08/20/2008] [Indexed: 11/26/2022]
Abstract
Potent antiplatelet and antithrombotic agents have significantly reduced mortality in the setting of acute coronary syndromes and percutaneous coronary intervention. However these agents are associated with increased bleeding which is in turn associated with adverse clinical outcomes. In many centers, transfusion is often used to correct for blood loss. Blood transfusion in the setting of acute coronary syndrome has been associated with adverse clinical outcomes including increased mortality. Transfusion associated microchimerism (TA-MC) is a newly recognized complication of blood transfusion. There is engraftment of the donor's hematopoietic stem cells in patients who then develop microchimerism. This article discusses the association of bleeding/blood transfusion with adverse outcomes and the potential role of TA-MC in clinical outcomes.
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Affiliation(s)
- Vijayalakshmi Kunadian
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 350 Longwood Avenue, First Floor, Boston, MA 02115, USA
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