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Kiyatkin ME, Mladinov D, Jarzebowski ML, Warner MA. Patient Blood Management, Anemia, and Transfusion Optimization Across Surgical Specialties. Anesthesiol Clin 2023; 41:161-174. [PMID: 36871997 PMCID: PMC10066799 DOI: 10.1016/j.anclin.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Patient blood management (PBM) is a systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood and minimizing allogenic transfusion need and risk. According to the PBM approach, the goals of perioperative anemia management include early diagnosis, targeted treatment, blood conservation, restrictive transfusion except in cases of acute and massive hemorrhage, and ongoing quality assurance and research efforts to advance overall blood health.
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Affiliation(s)
- Michael E Kiyatkin
- Department of Anesthesiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Domagoj Mladinov
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Mary L Jarzebowski
- Department of Anesthesiology, University of Michigan, 1540 East Hospital Drive, Ann Arbor, MI 48109, USA
| | - Matthew A Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, 200 1st Street, Rochester, MN 55905, USA
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2
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Unger K, Martin LG. Noncardiogenic pulmonary edema in small animals. J Vet Emerg Crit Care (San Antonio) 2023; 33:156-172. [PMID: 36815753 DOI: 10.1111/vec.13278] [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: 11/13/2020] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To review various types of noncardiogenic pulmonary edema (NCPE) in cats and dogs. ETIOLOGY NCPE is an abnormal fluid accumulation in the lung interstitium or alveoli that is not caused by cardiogenic causes or fluid overload. It can be due to changes in vascular permeability, hydrostatic pressure in the pulmonary vasculature, or a combination thereof. Possible causes include inflammatory states within the lung or in remote tissues (acute respiratory distress syndrome [ARDS]), airway obstruction (post-obstructive pulmonary edema), neurologic disease such as head trauma or seizures (neurogenic pulmonary edema), electrocution, after re-expansion of a collapsed lung or after drowning. DIAGNOSIS Diagnosis of NCPE is generally based on history, physical examination, and diagnostic imaging. Radiographic findings suggestive of NCPE are interstitial to alveolar pulmonary opacities in the absence of signs of left-sided congestive heart failure or fluid overload such as cardiomegaly or congested pulmonary veins. Computed tomography and edema fluid analysis may aid in the diagnosis, while some forms of NCPE require additional findings to reach a diagnosis. THERAPY The goal of therapy for all types of NCPE is to preserve tissue oxygenation and reduce the work of breathing. This may be achieved by removing the inciting cause (eg, airway obstruction) and cage rest in mild cases and supplemental oxygen in moderate cases and may require mechanical ventilation in severe cases. PROGNOSIS Prognosis is generally good for most causes of veterinary NCPE except for ARDS, although data are scarce for some etiologies of NCPE.
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Affiliation(s)
- Karin Unger
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington, USA
| | - Linda G Martin
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington, USA
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3
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Desai A, Oh D, Rao EM, Sahoo S, Mahajan UV, Labak CM, Mauria R, Shah VS, Nguyen Q, Herring EZ, Elder T, Stout A, Shammassian BH. Impact of anemia on acute ischemic stroke outcomes: A systematic review of the literature. PLoS One 2023; 18:e0280025. [PMID: 36603022 DOI: 10.1371/journal.pone.0280025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Anemia has been reported in nearly 40% of acute ischemic stroke (AIS) patients and is linked to significant morbidity and disability. The presence of anemia is associated with worse outcomes in AIS, specifically in the presence of large vessel occlusion (LVO). An optimal hemoglobin (Hb) target specific to this pathology has not yet been established. The goal of this review is to systematically review literature that observes the association that exists between AIS outcomes and hemoglobin (Hb) levels. METHODS A systematic review was performed in accordance with guidelines for the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to identify studies from 2008-2022. The following inclusion and exclusion criteria were used: studies of adult patients with AIS; must describe outcomes with regard to Hb levels in AIS (not limited to LVO); must be written in English. The clinical variables extracted included Length of Stay (LOS), modified rankin score (mRS), Hb levels, and mortality. RESULTS A total of 1,154 studies were gathered, with 116 undergoing full text review. 31 studies were included in this review. The age of patients ranged from 61.4 to 77.8. The presence of anemia in AIS increased LOS by 1.7 days on average and these patients also have a 15.2% higher rate of mortality at one year, on average. DISCUSSION This data suggests that the contemporary thresholds for treating anemia in AIS patients may be inadequate because anemia is strongly associated with poor outcomes (e.g., mRS>2 or mortality) and increased LOS in AIS patients. The current generalized Hb threshold for transfusion (7 g/dL) is also used in AIS patients, however, a more aggressive transfusion parameter should be further explored based on these findings. Further studies are required to confirm these findings and to determine if a more liberal RBCT threshold will result in clinical benefits.
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Affiliation(s)
- Ansh Desai
- Case Western Reserve School of Medicine, Cleveland, OH, United States of America
| | - David Oh
- Case Western Reserve School of Medicine, Cleveland, OH, United States of America
| | - Elizabeth M Rao
- Case Western Reserve School of Medicine, Cleveland, OH, United States of America
| | - Saswat Sahoo
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States of America
| | - Uma V Mahajan
- Case Western Reserve School of Medicine, Cleveland, OH, United States of America
| | - Collin M Labak
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Rohit Mauria
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Varun S Shah
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Quang Nguyen
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Eric Z Herring
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Theresa Elder
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Amber Stout
- Case Western Reserve School of Medicine, Cleveland, OH, United States of America
| | - Berje H Shammassian
- Division of Neurocritical Care, Department Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States of America
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4
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Perez-Viloria ME, Lopez K, Malik F, Yatham P, Lopez O, Oh KS, Alghamdi S, Garcia G. Transfusion-Related Acute Lung Injury (TRALI) in Postoperative Anesthesia Care Unit (PACU) After One Unit of Platelets: A Case Report. Cureus 2022; 14:e29274. [PMID: 36277519 PMCID: PMC9576366 DOI: 10.7759/cureus.29274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/17/2022] [Indexed: 12/03/2022] Open
Abstract
Transfusion-related acute lung injury (TRALI) following transfusion of all plasma-containing blood products is a rare but serious syndrome characterized by the acute onset of non-cardiogenic pulmonary edema with severe hypoxemia with or without symptoms of hypotension, pinkish frothy secretions, fever, and cyanosis. In this report, we present a case of a 66-year-old female with a medical history significant for hypertension, hyperlipidemia, hepatitis C, liver cirrhosis, tobacco use disorder, metastatic spindle cell carcinoma of the lung status post chemotherapy who developed TRALI after administration of one unit of platelets. Although a rare occurrence, there can be a considerable risk of TRALI following transfusion of all plasma-containing blood products and there is great importance in considering each patient’s risk factors for TRALI development prior to blood product administration.
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5
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Peng C, Yang F, Yu J, Chen C, He J, Jin Z. Temporal trends, predictors of blood transfusion and in-hospital outcomes among patients with severe burn injury in the United States-A national database-based analysis. Transfusion 2022; 62:1537-1550. [PMID: 35789008 DOI: 10.1111/trf.16999] [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: 12/23/2021] [Revised: 04/13/2022] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Severe burn can be accompanied by life-threatening bleeding on some occasions, thus, blood transfusion is often required in these patients during their hospitalization. Therefore, we aimed to examine temporal trends, predictors, and in-hospital outcomes of blood transfusion in these patients in the United States. METHODS The National Inpatient Sample was used to identify severe burn patients between January 2010 and September 2017 in the United States. Trends in the utilization of blood transfusion were analyzed using the Cochran-Armitage trend test. Moreover, propensity score matching (PSM) was employed, and then in-hospital outcomes were compared between these two groups in the matched cohort. Multivariable logistic regressions were further used to validate the results of PSM. RESULTS Among 27,260 severe burn patients identified during the study period, 2120 patients (7.18%) received blood transfusion. Blood transfusion rates decreased significantly from 9.52% in 2010 to 5.02% in 2017 (p for trend <.001). In the propensity-matched cohort (2120 pairs with and without transfusion), patients transfused were at increased risk of in-hospital mortality (13.3% vs 8.77%, p < .001), overall postoperative complications (88.3% vs 72.59%, p < .001), longer hospital stays (defined as > median hospital stays = 5 d) (73.8% vs 50.6%, p < .001) and increased overall cost (defined as > median overall costs = 30,746) (81.6% vs 57.3%, p < .001). This was also the case for the multivariable analysis. CONCLUSIONS Blood transfusion following severe burn injury may be associated with worse clinical outcomes. The utility for blood transfusion in burn patients warrants further prospective exploration.
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Affiliation(s)
- Chi Peng
- Department of Health Statistics, The Second Military Medical University, Shanghai, China
| | - Fan Yang
- Department of Plastic Surgery and Burns, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China.,Institute of Pathology and Southwest Cancer Center, Southwest Hospital, The Third Military Medical University, Chongqing, China
| | - Jian Yu
- Department of Health Statistics, The Second Military Medical University, Shanghai, China
| | - Chenxin Chen
- Department of Health Statistics, The Second Military Medical University, Shanghai, China
| | - Jia He
- Department of Health Statistics, The Second Military Medical University, Shanghai, China
| | - Zhichao Jin
- Department of Health Statistics, The Second Military Medical University, Shanghai, China
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6
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Glab-ampai K, Kaewchim K, Saenlom T, Thepsawat W, Mahasongkram K, Sookrung N, Chaicumpa W, Chulanetra M. Human Superantibodies to 3CL pro Inhibit Replication of SARS-CoV-2 across Variants. Int J Mol Sci 2022; 23:ijms23126587. [PMID: 35743031 PMCID: PMC9223907 DOI: 10.3390/ijms23126587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 11/16/2022] Open
Abstract
Broadly effective and safe anti-coronavirus agent is existentially needed. Major protease (3CLpro) is a highly conserved enzyme of betacoronaviruses. The enzyme plays pivotal role in the virus replication cycle. Thus, it is a good target of a broadly effective anti-Betacoronavirus agent. In this study, human single-chain antibodies (HuscFvs) of the SARS-CoV-2 3CLpro were generated using phage display technology. The 3CLpro-bound phages were used to infect Escherichia coli host for the production the 3CLpro-bound HuscFvs. Computerized simulation was used to guide the selection of the phage infected-E. coli clones that produced HuscFvs with the 3CLpro inhibitory potential. HuscFvs of three phage infected-E. coli clones were predicted to form contact interface with residues for 3CLpro catalytic activity, substrate binding, and homodimerization. These HuscFvs were linked to a cell-penetrating peptide to make them cell-penetrable, i.e., became superantibodies. The superantibodies blocked the 3CLpro activity in vitro, were not toxic to human cells, traversed across membrane of 3CLpro-expressing cells to co-localize with the intracellular 3CLpro and most of all, they inhibited replication of authentic SARS-CoV-2 Wuhan wild type and α, β, δ, and Omicron variants that were tested. The superantibodies should be investigated further towards clinical application as a safe and broadly effective anti-Betacoronavirus agent.
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Affiliation(s)
- Kittirat Glab-ampai
- Center of Research Excellence in Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (K.G.-a.); (K.K.); (T.S.); (W.T.); (K.M.); (N.S.); (W.C.)
| | - Kanasap Kaewchim
- Center of Research Excellence in Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (K.G.-a.); (K.K.); (T.S.); (W.T.); (K.M.); (N.S.); (W.C.)
- Graduate Program in Immunology, Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Thanatsaran Saenlom
- Center of Research Excellence in Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (K.G.-a.); (K.K.); (T.S.); (W.T.); (K.M.); (N.S.); (W.C.)
| | - Watayagorn Thepsawat
- Center of Research Excellence in Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (K.G.-a.); (K.K.); (T.S.); (W.T.); (K.M.); (N.S.); (W.C.)
| | - Kodchakorn Mahasongkram
- Center of Research Excellence in Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (K.G.-a.); (K.K.); (T.S.); (W.T.); (K.M.); (N.S.); (W.C.)
| | - Nitat Sookrung
- Center of Research Excellence in Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (K.G.-a.); (K.K.); (T.S.); (W.T.); (K.M.); (N.S.); (W.C.)
- Biomedical Research Incubator Unit, Department of Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Wanpen Chaicumpa
- Center of Research Excellence in Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (K.G.-a.); (K.K.); (T.S.); (W.T.); (K.M.); (N.S.); (W.C.)
| | - Monrat Chulanetra
- Center of Research Excellence in Therapeutic Proteins and Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (K.G.-a.); (K.K.); (T.S.); (W.T.); (K.M.); (N.S.); (W.C.)
- Correspondence: ; Tel.: +662-419-2934
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7
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EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis. J Hepatol 2022; 76:1151-1184. [PMID: 35300861 DOI: 10.1016/j.jhep.2021.09.003] [Citation(s) in RCA: 105] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 12/11/2022]
Abstract
The prevention and management of bleeding and thrombosis in patients with cirrhosis poses several difficult clinical questions. These Clinical Practice Guidelines have been developed to provide practical guidance on debated topics, including current views on haemostasis in liver disease, controversy regarding the need to correct thrombocytopenia and abnormalities in the coagulation system in patients undergoing invasive procedures, and the need for thromboprophylaxis in hospitalised patients with haemostatic abnormalities. Multiple recommendations in this document are based on interventions that the panel feels are not useful, even though widely applied in clinical practice.
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8
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Matthews K, Lamoureux ES, Myrand-Lapierre ME, Duffy SP, Ma H. Technologies for measuring red blood cell deformability. LAB ON A CHIP 2022; 22:1254-1274. [PMID: 35266475 DOI: 10.1039/d1lc01058a] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Human red blood cells (RBCs) are approximately 8 μm in diameter, but must repeatedly deform through capillaries as small as 2 μm in order to deliver oxygen to all parts of the body. The loss of this capability is associated with the pathology of many diseases, and is therefore a potential biomarker for disease status and treatment efficacy. Measuring RBC deformability is a difficult problem because of the minute forces (∼pN) that must be exerted on these cells, as well as the requirements for throughput and multiplexing. The development of technologies for measuring RBC deformability date back to the 1960s with the development of micropipette aspiration, ektacytometry, and the cell transit analyzer. In the past 10 years, significant progress has been made using microfluidics by leveraging the ability to precisely control fluid flow through microstructures at the size scale of individual RBCs. These technologies have now surpassed traditional methods in terms of sensitivity, throughput, consistency, and ease of use. As a result, these efforts are beginning to move beyond feasibility studies and into applications to enable biomedical discoveries. In this review, we provide an overview of both traditional and microfluidic techniques for measuring RBC deformability. We discuss the capabilities of each technique and compare their sensitivity, throughput, and robustness in measuring bulk and single-cell RBC deformability. Finally, we discuss how these tools could be used to measure changes in RBC deformability in the context of various applications including pathologies caused by malaria and hemoglobinopathies, as well as degradation during storage in blood bags prior to blood transfusions.
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Affiliation(s)
- Kerryn Matthews
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada.
- Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
| | - Erik S Lamoureux
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada.
- Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
| | - Marie-Eve Myrand-Lapierre
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada.
| | - Simon P Duffy
- Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
- British Columbia Institute of Technology, Vancouver, BC, Canada
| | - Hongshen Ma
- Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada.
- Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada
- Department of Urologic Science, University of British Columbia, Vancouver, BC, Canada
- Vancouver Prostate Centre, Vancouver General Hospital, Vancouver, BC, Canada
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9
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Kumar A, Sharma E, Marley A, Samaan MA, Brookes MJ. Iron deficiency anaemia: pathophysiology, assessment, practical management. BMJ Open Gastroenterol 2022; 9:e000759. [PMID: 34996762 PMCID: PMC8744124 DOI: 10.1136/bmjgast-2021-000759] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/20/2021] [Indexed: 02/07/2023] Open
Abstract
The WHO has recognised iron deficiency anaemia (IDA) as the most common nutritional deficiency in the world, with 30% of the population being affected with this condition. Although the most common causes of IDA are gastrointestinal bleeding and menstruation in women, decreased dietary iron and decreased iron absorption are also culpable causes. Patients with IDA should be treated with the aim of replenishing iron stores and returning the haemoglobin to a normal level. This has shown to improve quality of life, morbidity, prognosis in chronic disease and outcomes in pregnancy. Iron deficiency occurs in many chronic inflammatory conditions, including congestive cardiac failure, chronic kidney disease and inflammatory bowel disease. This article will provide an updated overview on diagnosis and management of IDA in patients with chronic conditions, preoperative and in pregnancy. We will discuss the benefits and limitations of oral versus intravenous iron replacement in each cohort, with an overview on cost analysis between the different iron formulations currently on the market.
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Affiliation(s)
- Aditi Kumar
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Esha Sharma
- Inflammatory Bowel Disease Unit, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Alexandra Marley
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Mark A Samaan
- Inflammatory Bowel Disease Unit, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Matthew James Brookes
- Department of Gastroenterology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Research Institue, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
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10
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Islamzada E, Matthews K, Lamoureux E, Duffy SP, Scott MD, Ma H. Blood unit segments accurately represent the biophysical properties of red blood cells in blood bags but not hemolysis. Transfusion 2021; 62:448-456. [PMID: 34877683 DOI: 10.1111/trf.16757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/25/2021] [Accepted: 11/19/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The biophysical properties of red blood cells (RBCs) provide potential biomarkers for the quality of donated blood. Blood unit segments provide a simple and nondestructive way to sample RBCs in clinical studies of transfusion efficacy, but it is not known whether RBCs sampled from segments accurately represent the biophysical properties of RBCs in blood bags. STUDY DESIGN AND METHODS RBCs were sampled from blood bags and segments every two weeks during 8 weeks of storage at 4°C. RBC deformability was measured by deformability-based sorting using the microfluidic ratchet device in order to derive a rigidity score. Standard hematological parameters, including mean corpuscular volume (MCV), red cell distribution width (RDW), mean cell hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and hemolysis were measured at the same time points. RESULTS Deformability of RBCs stored in blood bags was retained over 4 weeks storage, but a progressive loss of deformability was observed at weeks 6 and 8. This trend was mirrored in blood unit segments with a strong correlation to the blood bag data. Strong correlations were also observed between blood bag and segment for MCV, MCHC, and MCH but not for hemolysis. CONCLUSION RBCs sampled from blood unit segments accurately represent the biophysical properties of RBCs in blood bags but not hemolysis. Blood unit segments provide a simple and nondestructive sample for measuring RBC biophysical properties in clinical studies.
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Affiliation(s)
- Emel Islamzada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerryn Matthews
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erik Lamoureux
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Simon P Duffy
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Institute of Technology, Vancouver, British Columbia, Canada
| | - Mark D Scott
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Hongshen Ma
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada.,School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Prostate Centre, Vancouver General Hospital, Vancouver, British Columbia, Canada
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11
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van den Akker TA, Grimes ZM, Friedman MT. Transfusion-Associated Circulatory Overload and Transfusion-Related Acute Lung Injury. Am J Clin Pathol 2021; 156:529-539. [PMID: 33822854 DOI: 10.1093/ajcp/aqaa279] [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] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To review the new current diagnostic criteria of transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) from the literature while highlighting distinguishing features. We provide comprehensive understanding of the importance of hemovigilance and its role in appropriately identifying and reporting these potentially fatal transfusion reactions. METHODS A review of the English language literature was performed to analyze TACO and TRALI while providing further understanding of the rationale behind the historical underrecognition and underreporting. RESULTS Our review demonstrates the new 2018 and 2019 case definitions for TACO and TRALI, respectively. With more comprehensive diagnostic strategies, adverse transfusion events can be better recognized from mimicking events and underlying disease. In addition, there are mitigation strategies in place to help prevent complications of blood product transfusion, with emphasis on the prevention of TACO and TRALI. CONCLUSIONS TACO and TRALI are potentially fatal adverse complications of blood transfusion. Both have been historically underrecognized and underreported due to poor defining criteria and overlapping symptomatology. Developing a thorough clinical understanding between these two entities can improve hemovigilance reporting and can contribute to risk factor identification and preventative measures.
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Affiliation(s)
- Tayler A van den Akker
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zachary M Grimes
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark T Friedman
- Department of Pathology, NYU Long Island School of Medicine, Mineola, NY, USA
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12
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Turner SS, Davidson JM, Elabiad MT. Changes in urinary kidney injury molecule-1 levels after blood transfusions in preterm infants. Sci Rep 2021; 11:11690. [PMID: 34083688 PMCID: PMC8175397 DOI: 10.1038/s41598-021-91209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/24/2021] [Indexed: 11/14/2022] Open
Abstract
Literature supports an association between transfusions and gut injury in preterm infants. We hypothesized that packed red blood (PRBC) transfusions are associated with kidney inflammation marked by a rise in urinary levels of Kidney Injury Molecule 1 (KIM-1). Prospectively, KIM-1 levels were measured before and then at 6, 12 and 24 h after a PRBC transfusion. Results are presented as mean (± SD) and median (IQR). Thirty-four infants, birth weight 865 (± 375) g, had higher pretransfusion KIM-1 levels of 2270 (830, 3250) pg/mg than what is normal for age. These were not associated with hematocrit levels. KIM-1 levels peaked between 6 and 12 h after the transfusion. Levels peaked to 3300 (1990, 6830) pg/mg; levels returned to pretransfusion levels of 2240 (1240, 3870) pg/mg by 24 h, p < 0.01. The 24-h post-transfusion KIM-1 levels were similar to pretransfusion levels, p = 0.63. PRBC transfusions in preterm infants are associated with an elevation in urinary KIM-1 levels. The mechanism of this association may be important in studying transfusion associated organ injury. KIM-1, as an inflammatory marker, may be helpful in assessing the effect of different transfusion volumes or in evaluating operational thresholds of anemia in premature infants.
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Affiliation(s)
- Stephanie S Turner
- Ochsner Baptist Medical Center, 2700 Napoleon Ave, New Orleans, LA, 70115, USA
| | - Jennifer M Davidson
- Department of Pediatrics, Division of Neonatology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Mohamad T Elabiad
- Department of Pediatrics, Division of Neonatology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
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13
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Platelet extracellular vesicles mediate transfusion-related acute lung injury by imbalancing the sphingolipid rheostat. Blood 2021; 137:690-701. [PMID: 33232973 DOI: 10.1182/blood.2020005985] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022] Open
Abstract
Transfusion-related acute lung injury (TRALI) is a hazardous transfusion complication with an associated mortality of 5% to 15%. We previously showed that stored (5 days) but not fresh platelets (1 day) cause TRALI via ceramide-mediated endothelial barrier dysfunction. As biological ceramides are hydrophobic, extracellular vesicles (EVs) may be required to shuttle these sphingolipids from platelets to endothelial cells. Adding to complexity, EV formation in turn requires ceramide. We hypothesized that ceramide-dependent EV formation from stored platelets and EV-dependent sphingolipid shuttling induces TRALI. EVs formed during storage of murine platelets were enumerated, characterized for sphingolipids, and applied in a murine TRALI model in vivo and for endothelial barrier assessment in vitro. Five-day EVs were more abundant, had higher long-chain ceramide (C16:0, C18:0, C20:0), and lower sphingosine-1-phosphate (S1P) content than 1-day EVs. Transfusion of 5-day, but not 1-day, EVs induced characteristic signs of lung injury in vivo and endothelial barrier disruption in vitro. Inhibition or supplementation of ceramide-forming sphingomyelinase reduced or enhanced the formation of EVs, respectively, but did not alter the injuriousness per individual EV. Barrier failure was attenuated when EVs were abundant in or supplemented with S1P. Stored human platelet 4-day EVs were more numerous compared with 2-day EVs, contained more long-chain ceramide and less S1P, and caused more endothelial cell barrier leak. Hence, platelet-derived EVs become more numerous and more injurious (more long-chain ceramide, less S1P) during storage. Blockade of sphingomyelinase, EV elimination, or supplementation of S1P during platelet storage may present promising strategies for TRALI prevention.
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Jakob DA, Benjamin ER, Cremonini C, Demetriades D. Management and outcomes of severe pelvic fractures in level I and II ACS verified trauma centers. Am J Surg 2020; 222:227-233. [PMID: 33131692 DOI: 10.1016/j.amjsurg.2020.10.031] [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: 09/03/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the management strategies and outcomes of isolated severe pelvic fractures in level I and II ACS verified trauma centers. METHODS ACS-TQIP database study, including patients with blunt, isolated severe pelvic facture (AIS 3-5). RESULTS 2629 level I and 1277 level II patients were included. Early blood product transfusion was significantly higher, pharmacological VTE prophylaxis significantly lower and ICU length of stay significantly longer in level II centers (p < 0.001). On multivariate analysis, treatment at level II centers was independently associated with increased overall complications, specifically ARDS, but not mortality. CONCLUSIONS In isolated severe pelvic fractures there was a significantly higher use of early blood products, less VTE pharmacological prophylaxis, longer ICU length of stay and higher overall complications and ARDS in level II centers. Blood product utilization and pharmacological VTE prophylaxis are potential areas of quality improvement in level II centers.
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Affiliation(s)
- Dominik A Jakob
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County University of Southern California Medical Center, University of Southern California Los Angeles, CA, 90033, USA.
| | - Elizabeth R Benjamin
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County University of Southern California Medical Center, University of Southern California Los Angeles, CA, 90033, USA.
| | - Camilla Cremonini
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County University of Southern California Medical Center, University of Southern California Los Angeles, CA, 90033, USA.
| | - Demetrios Demetriades
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County University of Southern California Medical Center, University of Southern California Los Angeles, CA, 90033, USA.
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15
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Osama M, Syed SH, Nasir HMSA, Zaidi SR. Four-Factor Prothrombin Complex Concentrate: An Indispensable Adjunct in Coagulopathy of Trauma Management - A Comparative Review of the Literature over 2 Decades. Eur Surg Res 2020; 61:51-61. [PMID: 32966972 DOI: 10.1159/000509876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/01/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Damage control resuscitation forms the cornerstone of management in trauma surgery. Several blood products have been widely used for preoperative transfusions prior to emergency surgeries and for hemorrhage control in trauma. Prothrombin complex concentrate (PCC) is now being introduced as an essential component of damage control resuscitation. SUMMARY We did a comparative descriptive analysis of several single and multi-institutional clinical trials and retrospective cohort studies. The primary focus of these studies was a comparison between PCC and other transfusion modalities including recombinant factor VIIa, fresh-frozen plasma, and fibrinogen based on several vital parameters. The parameters included rapid international normalized ratio reversal, hospital length of stay, cost-effectiveness, mortality rate, and rate of thromboembolic complications. KEY POINTS Although still awaiting its approval from the FDA for use in traumatic coagulopathy, 4-factor PCC has shown far more convincing results in contrast to former transfusion modalities, even 3-factor PCC. However, more prospective extensive clinical trials on national levels are needed to compare its effectiveness to 3-factor PCC and gather promising recognition in the trauma care fraternity.
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Affiliation(s)
- Muhammad Osama
- Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Sohaib Hasan Syed
- Department of Internal Medicine, St. Mary Mercy Hospital, Livonia, Michigan, USA,
| | | | - Syeda Ramsha Zaidi
- Department of Internal Medicine, St. Mary Mercy Hospital, Livonia, Michigan, USA
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16
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Budeyri A, Kocamer Simsek B, Yardimci MM, Anlatici R, Cankus MC. Management of a Multi-Level Forearm Microsurgical Reconstruction and the Following Transfusion-Related Acute Lung Injury. Cureus 2020; 12:e10385. [PMID: 33062506 PMCID: PMC7550022 DOI: 10.7759/cureus.10385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Transfusion-related acute lung injury (TRALI) is a clinical syndrome characterized by acute respiratory distress following blood transfusion. This case-based technical report documents a case on the management of a multi-level forearm microsurgical reconstruction and the following TRALI syndrome that developed shortly after blood transfusion in a 29-year-old male. Multilevel microsurgical revascularization was performed via saphenous vein autograft arterial reconstruction from the proximal 1/3 ulnar artery to the ulnar side of the deep superficial palmar arterial arch. TRALI was resolved with intensive care unit monitoring and treatment. There are several reports of TRALI in literature, as well as proposed mechanisms of pathogenesis, however, no case on the management of a multilevel forearm arterial reconstruction via a long saphenous vein autograft and associated TRALI syndrome have been reported.
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Affiliation(s)
- Aydin Budeyri
- Department of Orthopaedics and Traumatology, Sanko University, Gaziantep, TUR.,The Shoulder Center, Baylor University Medical Center at Dallas, Dallas, USA
| | | | | | - Recep Anlatici
- Department of Plastic Surgery, Sanko University, Gaziantep, TUR
| | - Mehmet C Cankus
- Department of Orthopaedics and Traumatology, Sanko University, Gaziantep, TUR
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17
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Chang JC. Acute Respiratory Distress Syndrome as an Organ Phenotype of Vascular Microthrombotic Disease: Based on Hemostatic Theory and Endothelial Molecular Pathogenesis. Clin Appl Thromb Hemost 2020; 25:1076029619887437. [PMID: 31775524 PMCID: PMC7019416 DOI: 10.1177/1076029619887437] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a life-threatening noncardiogenic circulatory disorder of the lungs associated with critical illnesses such as sepsis, trauma, and immune and collagen vascular disease. Its mortality rate is marginally improved with the best supportive care. The demise occurs due to progressive pulmonary hypoxia and multi-organ dysfunction syndrome (MODS) with severe inflammation. Complement activation is a part of immune response against pathogen or insult in which membrane attack complex (MAC) is formed and eliminates microbes. If complement regulatory protein such as endothelial CD59 is underexpressed, MAC may also cause pulmonary vascular injury to the innocent bystander endothelial cell of host and provokes endotheliopathy that causes inflammation and pulmonary vascular microthrombosis, leading to ARDS. Its pathogenesis is based on a novel "two-path unifying theory" of hemostasis and "two-activation theory of the endothelium" promoting molecular pathogenesis. Endotheliopathy activates two independent molecular pathways: inflammatory and microthrombotic. The former triggers the release inflammatory cytokines and the latter promotes exocytosis of unusually large von Willebrand factor multimers (ULVWF) and platelet activation. Inflammatory pathway initiates inflammation, but microthrombotic pathway more seriously produces "microthrombi strings" composed of platelet-ULVWF complexes, which become anchored on the injured endothelial cells, and causes disseminated intravascular microthrombosis (DIT). DIT is a hemostatic disease due to lone activation of ULVWF path without activated tissue factor path. It leads to endotheliopathy-associated vascular microthrombotic disease (EA-VMTD), which orchestrates consumptive thrombocytopenia, microangiopathic hemolytic anemia, and MODS. Thrombotic thrombocytopenic purpura (TTP)-like syndrome is the hematologic phenotype of EA-VMTD. ARDS is one of organ phenotypes among MODS associated with TTP-like syndrome. The most effective treatment of ARDS can be achieved by counteracting the activated microthrombotic pathway based on two novel hemostatic theories.
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Affiliation(s)
- Jae C Chang
- Department of Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA
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18
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Nair PM, Rendo MJ, Reddoch-Cardenas KM, Burris JK, Meledeo MA, Cap AP. Recent advances in use of fresh frozen plasma, cryoprecipitate, immunoglobulins, and clotting factors for transfusion support in patients with hematologic disease. Semin Hematol 2020; 57:73-82. [PMID: 32892846 PMCID: PMC7384412 DOI: 10.1053/j.seminhematol.2020.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Indexed: 02/07/2023]
Abstract
Hematologic diseases include a broad range of acquired and congenital disorders, many of which affect plasma proteins that control hemostasis and immune responses. Therapeutic interventions for these disorders include transfusion of plasma, cryoprecipitate, immunoglobulins, or convalescent plasma-containing therapeutic antibodies from patients recovering from infectious diseases, as well as concentrated pro- or anticoagulant factors. This review will focus on recent advances in the uses of plasma and its derivatives for patients with acquired and congenital hematologic disorders.
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Affiliation(s)
- Prajeeda M. Nair
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
| | - Matthew J. Rendo
- San Antonio Military Medical Center, JBSA Fort Sam Houston, TX, USA
| | | | - Jason K. Burris
- San Antonio Military Medical Center, JBSA Fort Sam Houston, TX, USA
| | - Michael A. Meledeo
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
| | - Andrew P. Cap
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA,Uniformed Services University, Bethesda, MD, USA,Corresponding author. Andrew P. Cap, MD, PhD, United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234. Tel.: +1-210-539-4858 (office), +1-210-323-6908 (mobile)
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19
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Islamzada E, Matthews K, Guo Q, Santoso AT, Duffy SP, Scott MD, Ma H. Deformability based sorting of stored red blood cells reveals donor-dependent aging curves. LAB ON A CHIP 2020; 20:226-235. [PMID: 31796943 DOI: 10.1039/c9lc01058k] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A fundamental challenge in the transfusion of red blood cells (RBCs) is that a subset of donated RBC units may not provide optimal benefit to transfusion recipients. This variability stems from the inherent ability of donor RBCs to withstand the physical and chemical insults of cold storage, which ultimately dictate their survival in circulation. The loss of RBC deformability during cold storage is well-established and has been identified as a potential biomarker for the quality of donated RBCs. While RBC deformability has traditionally been indirectly inferred from rheological characteristics of the bulk suspension, there has been considerable interest in directly measuring the deformation of RBCs. Microfluidic technologies have enabled single cell measurement of RBC deformation but have not been able to consistently distinguish differences between RBCs between healthy donors. Using the microfluidic ratchet mechanism, we developed a method to sensitively and consistently analyze RBC deformability. We found that the aging curve of RBC deformability varies significantly across donors, but is consistent for each donor over multiple donations. Specifically, certain donors seem capable of providing RBCs that maintain their deformability during two weeks of cold storage in standard test tubes. The ability to distinguish between RBC units with different storage potential could provide a valuable opportunity to identify donors capable of providing RBCs that maintain their integrity, in order to reserve these units for sensitive transfusion recipients.
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Affiliation(s)
- Emel Islamzada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada and Centre for Blood Research, University of British Columbia, Canada
| | - Kerryn Matthews
- Centre for Blood Research, University of British Columbia, Canada and Department of Mechanical Engineering, University of British Columbia, Canada.
| | - Quan Guo
- Department of Mechanical Engineering, University of British Columbia, Canada.
| | - Aline T Santoso
- Centre for Blood Research, University of British Columbia, Canada and Department of Mechanical Engineering, University of British Columbia, Canada.
| | - Simon P Duffy
- Centre for Blood Research, University of British Columbia, Canada and Department of Mechanical Engineering, University of British Columbia, Canada. and British Columbia Institute of Technology, Canada
| | - Mark D Scott
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada and Centre for Blood Research, University of British Columbia, Canada and Canadian Blood Services, Canada
| | - Hongshen Ma
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada and Centre for Blood Research, University of British Columbia, Canada and Department of Mechanical Engineering, University of British Columbia, Canada. and School of Biomedical Engineering, University of British Columbia, Canada
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20
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Arslan D, Yildizdas D, Horoz OO, Aslan N, Leblebisatan G. Transfusion-Associated Acute Lung Injury following Donor Granulocyte Transfusion in Two Pediatric Patients. J Pediatr Intensive Care 2019; 8:251-254. [PMID: 31673463 DOI: 10.1055/s-0039-1694991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/06/2019] [Indexed: 10/26/2022] Open
Abstract
Transfusion-associated acute lung injury (TRALI) is one of the complications seen due to transfusion. Hypoxemia and bilateral pulmonary infiltration in posteroanterior chest roentgenogram is seen in all cases during transfusion or within the first 6 hours; fever, hypotension, and pink frothy bleeding from endotracheal tube may also be seen. It can be seen following the administration of any blood product. The management strategies for TRALI include withholding the transfusion, positive pressure breathing support, and diuretics. There are few reported cases of TRALI occurring following donor granulocyte transfusion (DGT). In this article, we discuss two cases of TRALI following DGT transfusion.
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Affiliation(s)
- Didar Arslan
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Dincer Yildizdas
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ozden Ozgur Horoz
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Nagehan Aslan
- Department of Pediatric Intensive Care, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Goksel Leblebisatan
- Department of Pediatric Hematology, Çukurova University Faculty of Medicine, Adana, Turkey
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21
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Abstract
Abstract
Transfusion-related acute lung injury is a leading cause of death associated with the use of blood products. Transfusion-related acute lung injury is a diagnosis of exclusion which can be difficult to identify during surgery amid the various physiologic and pathophysiologic changes associated with the perioperative period. As anesthesiologists supervise delivery of a large portion of inpatient prescribed blood products, and since the incidence of transfusion-related acute lung injury in the perioperative patient is higher than in nonsurgical patients, anesthesiologists need to consider transfusion-related acute lung injury in the perioperative setting, identify at-risk patients, recognize early signs of transfusion-related acute lung injury, and have established strategies for its prevention and treatment.
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22
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Weymouth W, Long B, Koyfman A, Winckler C. Whole Blood in Trauma: A Review for Emergency Clinicians. J Emerg Med 2019; 56:491-498. [DOI: 10.1016/j.jemermed.2019.01.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/09/2019] [Accepted: 01/21/2019] [Indexed: 11/26/2022]
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23
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Sung TY, Jee YS, Lee SJ, You HJ, Jeong KS, Kang PS. Transfusion-related acute lung injury in a parturient diagnosed with myelodysplastic syndrome - A case report -. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.1.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Tae-Yun Sung
- Department of Anesthesiology and Pain Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Young Seok Jee
- Department of Anesthesiology and Pain Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Seok-jin Lee
- Department of Anesthesiology and Pain Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Hwang Ju You
- Department of Anesthesiology and Pain Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Ki Soon Jeong
- Department of Anesthesiology and Pain Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Po-Soon Kang
- Department of Anesthesiology and Pain Medicine, Konyang University College of Medicine, Daejeon, Korea
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24
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Schenk B, Lindner AK, Treichl B, Bachler M, Hermann M, Larsen OH, Fenger-Eriksen C, Wally D, Tauber H, Velik-Salchner C, Fries D. Fibrinogen supplementation ex vivo increasesclot firmness comparable to platelet transfusion in thrombocytopenia. Br J Anaesth 2018; 117:576-582. [PMID: 27799172 DOI: 10.1093/bja/aew315] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fibrinogen concentrate can improve clot firmness and offers a better safety profile than platelet concentrates. Reduction or avoidance of blood transfusions represents a strategy to reduce associated risks. We investigated whether supplementation of fibrinogen concentrate ex vivo can compensate for clot strength as compared with platelet transfusion in vivo METHODS: One hundred patients in need of platelet transfusion (PT) were enrolled. Blood samples were collected immediately before PT and at 1 h and 24 h after PT. Fibrinogen concentrate was added to these citrated whole blood samples at concentrations of 50, 100, 200 and 400 mg kg-1 and the maximum clot firmness (MCF) was analysed using ROTEM thromboelastometry. RESULTS Fibrinogen supplementation increased MCF significantly and dose-dependently before and after PT. The effect of fibrinogen concentrate (equivalent to doses of 100 and 200 mg kg-1) ex vivo was comparable to that of PT in vivo, whereas 400 mg kg-1 fibrinogen significantly improved MCF compared with PT (P < 0.001). CONCLUSIONS Fibrinogen concentrate can match the effect of PT on MCF in thrombocytopenia. This potential alternative haemostatic intervention should be evaluated in clinical trials.
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Affiliation(s)
- B Schenk
- Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - A K Lindner
- Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - B Treichl
- Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - M Bachler
- Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - M Hermann
- Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - O H Larsen
- Center for Haemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University Hospital, Skejby - Brendstrupgårdsvej 100, 8200 Aarhus, Denmark
| | - C Fenger-Eriksen
- Center for Haemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University Hospital, Skejby - Brendstrupgårdsvej 100, 8200 Aarhus, Denmark.,Department of Anaesthesiology, Aarhus University Hospital, Skejby - Brendstrupgårdsvej 100, 8200 Aarhus, Denmark
| | - D Wally
- Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - H Tauber
- Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - C Velik-Salchner
- Department of Anaesthesiology and General Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - D Fries
- Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
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Oechslin P, Zalunardo MP, Inci I, Schlaepfer M, Grande B. Established and potential predictors of blood loss during lung transplant surgery. J Thorac Dis 2018; 10:3845-3848. [PMID: 30069385 DOI: 10.21037/jtd.2018.05.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lung transplantation is an established therapeutic procedure for end stage lung diseases. Its success may be impaired by perioperative complications. Intraoperative blood loss and the resulting blood transfusion are among the most common complications. The various factors contributing to increased blood loss during lung transplantation are only scarcely investigated and not yet completely understood. This is in sharp contrast to other surgical fields, as in orthopedic surgery, liver transplantation and cardiac surgery the contributors to blood loss are well identified. This narrative review article aims to highlight the acknowledged factors influencing blood loss in lung transplantation (such as double vs. single lung transplant) and to discuss potential factors that may be of interest for further research or helpful to develop strategies targeting risk factors in order to minimize blood loss during lung transplantation and finally improve patient outcome.
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Affiliation(s)
- Pascal Oechslin
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Marco P Zalunardo
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Ilhan Inci
- Departement of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Martin Schlaepfer
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Bastian Grande
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.,Simulation Center, University Hospital Zurich, Zurich, Switzerland
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26
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Carneiro JMGVDM, Alves J, Conde P, Xambre F, Almeida E, Marques C, Luís M, Godinho AMMG, Fernandez-Llimos F. Factor XIII-guided treatment algorithm reduces blood transfusion in burn surgery. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 29269148 PMCID: PMC9391805 DOI: 10.1016/j.bjane.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background and objectives Major burn surgery causes large hemorrhage and coagulation dysfunction. Treatment algorithms guided by ROTEM® and factor VIIa reduce the need for blood products, but there is no evidence regarding factor XIII. Factor XIII deficiency changes clot stability and decreases wound healing. This study evaluates the efficacy and safety of factor XIII correction and its repercussion on transfusion requirements in burn surgery. Methods Randomized retrospective study with 40 patients undergoing surgery at the Burn Unit, allocated into Group A those with factor XIII assessment (n = 20), and Group B, those without assessment (n = 20). Erythrocyte transfusion was guided by a hemoglobin trigger of 10 g.dL−1 and the other blood products by routine coagulation and ROTEM® tests. Analysis of blood product consumption included units of erythrocytes, fresh frozen plasma, platelets, and fibrinogen. The coagulation biomarker analysis compared the pre- and post-operative values. Results and conclusions Group A (with factor XIII study) and Group B had identical total body surface area burned. All patients in Group A had a preoperative factor XIII deficiency, whose correction significantly reduced units of erythrocyte concentrate transfusion (1.95 vs. 4.05, p = 0.001). Pre- and post-operative coagulation biomarkers were similar between groups, revealing that routine coagulation tests did not identify factor XIII deficiency. There were no recorded thromboembolic events. Correction of factor XIII deficiency in burn surgery proved to be safe and effective for reducing perioperative transfusion of erythrocyte units.
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27
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Algoritmo de tratamento guiado pelo fator XIII reduz a transfusão sanguínea na cirurgia de queimados. Braz J Anesthesiol 2018; 68:238-243. [DOI: 10.1016/j.bjan.2017.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/30/2017] [Accepted: 11/20/2017] [Indexed: 11/19/2022] Open
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28
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Osterman JL, Arora S. Blood Product Transfusions and Reactions. Hematol Oncol Clin North Am 2017; 31:1159-1170. [DOI: 10.1016/j.hoc.2017.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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29
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Lim J, Miles L, Litton E. Intravenous Iron Therapy in Patients Undergoing Cardiovascular Surgery: A Narrative Review. J Cardiothorac Vasc Anesth 2017; 32:1439-1451. [PMID: 29246691 DOI: 10.1053/j.jvca.2017.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Jolene Lim
- Intensive Care Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Lachlan Miles
- Department of Anaesthesia, Austin Health, Melbourne, Australia; Anaesthesia, Perioperative and Pain Medicine Unit, School of Medicine, University of Melbourne, Parkville, Australia
| | - Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia; Australia.
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30
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Marsden NJ, Van M, Dean S, Azzopardi EA, Hemington-Gorse S, Evans PA, Whitaker IS. Measuring coagulation in burns: an evidence-based systematic review. Scars Burn Heal 2017; 3:2059513117728201. [PMID: 29799542 PMCID: PMC5965330 DOI: 10.1177/2059513117728201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Dynamic monitoring of coagulation is important to predict both haemorrhagic and thrombotic complications and to guide blood product administration. Reducing blood loss and tailoring blood product administration may improve patient outcome and reduce mortality associated with transfusion. The current literature lacks a systematic, critical appraisal of current best evidence on which clinical decisions may be based. Objectives Establishing the role of different coagulation markers in burn patients, diagnosing coagulopathy, tailoring blood product administration and indicating prognosis. Methods Literature during 2004-2017 from the Cochrane Library, PubMed, Scopus, Medline and Embase was reviewed. Eligibility criteria included randomised controlled trials, systematic reviews, multi-/single-centre study and meta-analyses. Keywords searched were 'burns', 'blood coagulation disorders', 'rotem', 'blood coagulation' and 'thromboelastography'. The PRISMA flow system was used for stratification and the CASP framework for appraisal of the studies retrieved. Results In total, 13 articles were included after inclusion/exclusion criteria had been applied to the initial 79 studies retrieved. Hypercoagulation increases in proportion to the severity of thermal injury. Whole blood testing, using thrombelastography (TEG) and rotation thromboelastometry (ROTEM), was superior to standard plasma based tests, including prothrombin time (PT) and activated partial thromboplastin time (APTT) at detecting burn-related coagulopathies. Conclusions Routine laboratory markers such as PT/APTT are poor indicators of coagulation status in burns patients. Viscoelastic tests, such as TEG and ROTEM, are efficient, fast and have a potential use in the management of burn patients; however, strong evidence is lacking. This review highlights the need for more randomised controlled trials, to guide future practice.
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Affiliation(s)
- Nicholas J Marsden
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK.,Welsh Centre for Burns and Plastic Surgery, Swansea, UK
| | - Martin Van
- Welsh Centre for Burns and Plastic Surgery, Swansea, UK
| | - Samera Dean
- Welsh Centre for Burns and Plastic Surgery, Swansea, UK
| | - Ernest A Azzopardi
- Welsh Centre for Burns and Plastic Surgery, Swansea, UK.,Reconstructive Surgery and Regenerative Medicine Group, Institute of Life Science, College of Medicine, Swansea University, Wales, UK
| | | | - Phillip A Evans
- NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK.,Reconstructive Surgery and Regenerative Medicine Group, Institute of Life Science, College of Medicine, Swansea University, Wales, UK
| | - Iain S Whitaker
- Welsh Centre for Burns and Plastic Surgery, Swansea, UK.,Reconstructive Surgery and Regenerative Medicine Group, Institute of Life Science, College of Medicine, Swansea University, Wales, UK
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Klein A, Collier T, Yeates J, Miles L, Fletcher S, Evans C, Richards T. The ACTA PORT-score for predicting perioperative risk of blood transfusion for adult cardiac surgery. Br J Anaesth 2017; 119:394-401. [DOI: 10.1093/bja/aex205] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2017] [Indexed: 01/09/2023] Open
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32
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Cogle CR, Reddy SR, Chang E, Papoyan E, Broder MS, McGuire M, Binder G. Early treatment initiation in lower-risk myelodysplastic syndromes produces an earlier and higher rate of transfusion independence. Leuk Res 2017; 60:123-128. [DOI: 10.1016/j.leukres.2017.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/12/2017] [Accepted: 07/31/2017] [Indexed: 12/18/2022]
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A microengineered model of RBC transfusion-induced pulmonary vascular injury. Sci Rep 2017; 7:3413. [PMID: 28611413 PMCID: PMC5469736 DOI: 10.1038/s41598-017-03597-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/02/2017] [Indexed: 11/08/2022] Open
Abstract
Red blood cell (RBC) transfusion poses significant risks to critically ill patients by increasing their susceptibility to acute respiratory distress syndrome. While the underlying mechanisms of this life-threatening syndrome remain elusive, studies suggest that RBC-induced microvascular injury in the distal lung plays a central role in the development of lung injury following blood transfusion. Here we present a novel microengineering strategy to model and investigate this key disease process. Specifically, we created a microdevice for culturing primary human lung endothelial cells under physiological flow conditions to recapitulate the morphology and hemodynamic environment of the pulmonary microvascular endothelium in vivo. Perfusion of the microengineered vessel with human RBCs resulted in abnormal cytoskeletal rearrangement and release of intracellular molecules associated with regulated necrotic cell death, replicating the characteristics of acute endothelial injury in transfused lungs in vivo. Our data also revealed the significant effect of hemodynamic shear stress on RBC-induced microvascular injury. Furthermore, we integrated the microfluidic endothelium with a computer-controlled mechanical stretching system to show that breathing-induced physiological deformation of the pulmonary microvasculature may exacerbate vascular injury during RBC transfusion. Our biomimetic microsystem provides an enabling platform to mechanistically study transfusion-associated pulmonary vascular complications in susceptible patient populations.
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McVey MJ, Kim M, Tabuchi A, Srbely V, Japtok L, Arenz C, Rotstein O, Kleuser B, Semple JW, Kuebler WM. Acid sphingomyelinase mediates murine acute lung injury following transfusion of aged platelets. Am J Physiol Lung Cell Mol Physiol 2017; 312:L625-L637. [DOI: 10.1152/ajplung.00317.2016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 11/22/2022] Open
Abstract
Pulmonary complications from stored blood products are the leading cause of mortality related to transfusion. Transfusion-related acute lung injury is mediated by antibodies or bioactive mediators, yet underlying mechanisms are incompletely understood. Sphingolipids such as ceramide regulate lung injury, and their composition changes as a function of time in stored blood. Here, we tested the hypothesis that aged platelets may induce lung injury via a sphingolipid-mediated mechanism. To assess this hypothesis, a two-hit mouse model was devised. Recipient mice were treated with 2 mg/kg intraperitoneal lipopolysaccharide (priming) 2 h before transfusion of 10 ml/kg stored (1–5 days) platelets treated with or without addition of acid sphingomyelinase inhibitor ARC39 or platelets from acid sphingomyelinase-deficient mice, which both reduce ceramide formation. Transfused mice were examined for signs of pulmonary neutrophil accumulation, endothelial barrier dysfunction, and histological evidence of lung injury. Sphingolipid profiles in stored platelets were analyzed by mass spectrophotometry. Transfusion of aged platelets into primed mice induced characteristic features of lung injury, which increased in severity as a function of storage time. Ceramide accumulated in platelets during storage, but this was attenuated by ARC39 or in acid sphingomyelinase-deficient platelets. Compared with wild-type platelets, transfusion of ARC39-treated or acid sphingomyelinase-deficient aged platelets alleviated lung injury. Aged platelets elicit lung injury in primed recipient mice, which can be alleviated by pharmacological inhibition or genetic deletion of acid sphingomyelinase. Interventions targeting sphingolipid formation represent a promising strategy to increase the safety and longevity of stored blood products.
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Affiliation(s)
- Mark J. McVey
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, Ontario, Canada
- Departments of Anesthesia and Physiology, University of Toronto, and Department of Anesthesia and Pain Medicine Sickkids Hospital, Toronto, Ontario, Canada
| | - Michael Kim
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Arata Tabuchi
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Victoria Srbely
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Lukasz Japtok
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Christoph Arenz
- Institute for Chemistry, Humboldt University, Berlin, Germany
| | - Ori Rotstein
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Surgery University of Toronto, Toronto, Ontario, Canada
| | - Burkhard Kleuser
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - John W. Semple
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, Ontario, Canada
- Departments of Pharmacology, Medicine, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Wolfgang M. Kuebler
- Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Surgery University of Toronto, Toronto, Ontario, Canada
- Department of Physiology University of Toronto, Toronto, Ontario, Canada
- Institute of Physiology, Charité-Univcersitätsmedizin Berlin, Germany; and
- German Heart Institute, Berlin, Germany
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35
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da Silveira Cavalcante L, Branch DR, Duong TT, Yeung RS, Acker JP, Holovati JL. The immune-stimulation capacity of liposome-treated red blood cells. J Liposome Res 2017; 28:173-181. [DOI: 10.1080/08982104.2017.1295991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Luciana da Silveira Cavalcante
- Canadian Blood Services Centre for Innovation, Edmonton, AB, Canada,
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada,
| | - Donald R. Branch
- Canadian Blood Services Centre for Innovation, Toronto, ON, Canada,
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada,
| | - Trang T. Duong
- The Hospital for Sick Children, Toronto, ON, Canada, and
| | - Rae S.M. Yeung
- The Hospital for Sick Children, Toronto, ON, Canada, and
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Jason P. Acker
- Canadian Blood Services Centre for Innovation, Edmonton, AB, Canada,
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada,
| | - Jelena L. Holovati
- Canadian Blood Services Centre for Innovation, Edmonton, AB, Canada,
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada,
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Abstract
Hydroxyurea, blood transfusions, and hematopoietic stem cell transplantation represent the 3 disease-modifying therapies in children with sickle cell disease (SCD). Blood transfusions play an increasingly important role in both prevention and management of SCD complications in this age group. This review will focus on the indications of blood transfusion in children with SCD and modalities of its administration. It will also highlight the complications of this life-saving therapy and ways of optimizing transfusion to minimize its associated risks.
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37
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Younesi MR, Louni Aligoudarzi S, Bigdeli R, Lashgari M, Mazaheri H, Asgary V. Alloimmunization against platelets, granulocytes and erythrocytes in multi-transfused patients in Iranian population. Transfus Apher Sci 2016; 55:205-211. [DOI: 10.1016/j.transci.2016.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/13/2016] [Accepted: 06/10/2016] [Indexed: 12/20/2022]
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38
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Abstract
Massive transfusion practices were transformed during the 1970s without solid evidence supporting the use of component therapy. A manual literature search was performed for all references to the lethal triad, acute or early coagulopathy of trauma, fresh whole blood, and component transfusion therapy in massive trauma, and damage control resuscitation. Data from recent wars suggest traditional component therapy causes a nonhemostatic resuscitation worsening the propagation of the lethal triad hastening death. These same studies also indicate the advantage of fresh whole blood over component therapy even when administered in a 1:1:1 replacement ratio.
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39
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Ehieli EI, Howard LE, Monk TG, Ferrandino MN, Polascik TJ, Walther PJ, Freedland SJ. Effect of positive end-expiratory pressure on blood loss during retropubic and robot-assisted laparoscopic radical prostatectomy. Int J Urol 2016; 23:674-8. [PMID: 27225958 DOI: 10.1111/iju.13125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 04/18/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study the effect of end-expiratory pressure used during anesthesia on blood loss during radical prostatectomy. METHODS We evaluated 247 patients who underwent either radical retropubic prostatectomy or robot-assisted laparoscopic prostatectomy at a single institution from 2008 to 2013 by one of four surgeons. Patient characteristics were compared using t-tests, rank sum or χ(2) -tests as appropriate. The association between positive end-expiratory pressure and estimated blood loss was tested using linear regression. RESULTS Patients were classified into high (≥4 cmH2 O) and low (≤1 cmH2 O) positive-end expiratory pressure groups. Estimated blood loss in radical retropubic prostatectomy was higher in the high positive end-expiratory pressure group (1000 mL vs 800 mL, P = 0.042). Estimated blood loss in robot-assisted laparoscopic prostatectomy was lower in the high positive end-expiratory pressure group (150 mL vs 250 mL, P = 0.015). After adjusting for other factors known to influence blood loss, a 5-cmH2 O increase in positive end-expiratory pressure was associated with a 34.9% increase in estimated blood loss (P = 0.030) for radical retropubic prostatectomy, and a 33.0% decrease for robot-assisted laparoscopic prostatectomy (P = 0.038). CONCLUSIONS In radical retropubic prostatectomy, high positive end-expiratory pressure was associated with higher estimated blood loss, and the benefits of positive end-expiratory pressure should be weighed against the risk of increased estimated blood loss. In robot-assisted laparoscopic prostatectomy, high positive end-expiratory pressure was associated with lower estimated blood loss, and might have more than just pulmonary benefits.
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Affiliation(s)
- Eric I Ehieli
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren E Howard
- Department of Urology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Terri G Monk
- University of Missouri Health System, Columbia, Missouri, USA
| | - Michael N Ferrandino
- Department of Urology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Thomas J Polascik
- Department of Urology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Philip J Walther
- Department of Urology, Duke University Medical Center, Durham, North Carolina, USA.,Department of Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Stephen J Freedland
- Department of Surgery Section, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.,Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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40
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Abstract
Post-operative pulmonary complications (PPCs) occur in 5–10% of patients undergoing non-thoracic surgery and in 22% of high risk patients. PPCs are broadly defined as conditions affecting the respiratory tract that can adversely influence clinical course of the patient after surgery. Prior risk stratification, risk reduction strategies, performing short duration and/or minimally invasive surgery and use of anaesthetic technique of combined regional with general anaesthesia can reduce the incidence of PPCs. Atelectasis is the main cause of PPCs. Atelectasis can be prevented or treated by adequate analgesia, incentive spirometry (IS), deep breathing exercises, continuous positive airway pressure, mobilisation of secretions and early ambulation. Pre-operative treatment of IS is more effective. The main reason for post-operative pneumonia is aspiration along the channels formed by longitudinal folds in the high volume, low pressure polyvinyl chloride cuffs of the endotracheal tubes. Use of tapered cuff, polyurethane cuffs and selective rather than the routine use of nasogastric tube can decrease chances of aspiration. Acute lung injury is the most serious PPC which may prove fatal.
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41
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42
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43
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Xing Z, Wang QS, Yang QN, Meng LX, Tong HX. Transfusion-related acute lung injury in paediatric surgical patients: a retrospective study. Transfus Apher Sci 2015; 51:215-8. [PMID: 25458904 DOI: 10.1016/j.transci.2014.08.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 05/02/2014] [Accepted: 08/19/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the occurrence of transfusion-related acute lung injury(TRALI) in Chinese paediatric patients. As such, a retrospective review of medical records from January 2008 to December 2011 was undertaken. OBJECTIVE To determine the incidence of TRALI and its risk factors in children (age <14 years). STUDY DESIGN AND METHODS All medical records of Sheng Jing Hospital from January 2008 to December 2011 were reviewed retrospectively using the hospital’s record system. Paediatric surgical patients who had been diagnosed clinically with acute lung injury were included. Transfusion data were collected, together with risk factors such as sepsis and aspiration. RESULTS In total, 1495 patients were involved in the study. Thirty-five cases were analysed further as they had acute lung injury, pulmonary oedema and respiratory distress. TRALI was confirmed in two of these cases. The average duration of transfusion was found to be significantly longer in patients with TRALI compared with controls, and the percentage of female donors was significantly higher for patients with TRALI. CONCLUSION The incidence of TRALI was found to be lower than reported previously, but TRALI is under-recognised, under-reported and undertreated.
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Affiliation(s)
- Z Xing
- Anaesthesia Department, ShengJing Hospital of China Medical University, Shenyang, China
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44
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Sonic Estimation of Elasticity via Resonance: A New Method of Assessing Hemostasis. Ann Biomed Eng 2015; 44:1405-24. [PMID: 26399992 DOI: 10.1007/s10439-015-1460-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/13/2015] [Indexed: 10/23/2022]
Abstract
Uncontrolled bleeding threatens patients undergoing major surgery and in care for traumatic injury. This paper describes a novel method of diagnosing coagulation dysfunction by repeatedly measuring the shear modulus of a blood sample as it clots in vitro. Each measurement applies a high-energy ultrasound pulse to induce a shear wave within a rigid walled chamber, and then uses low energy ultrasound pulses to measure displacements associated with the resonance of that shear wave. Measured displacements are correlated with predictions from finite difference time domain models, with the best fit corresponding to the modulus estimate. In our current implementation each measurement requires 62.4 ms. Experimental data was analyzed using a fixed-viscosity algorithm and a free-viscosity algorithm. In experiments utilizing human blood induced to clot by exposure to kaolin, the free-viscosity algorithm quantified the shear modulus of formed clots with a worst-case precision of 2.5%. Precision was improved to 1.8% by utilizing the fixed-viscosity algorithm. Repeated measurements showed a smooth evolution from liquid blood to a firm clot with a shear modulus between 1.4 and 3.3 kPa. These results show the promise of this technique for rapid, point of care assessment of coagulation.
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45
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Hauck-Dlimi B, Ruppel R, Zimmermann R, Strobel J, Reil A, Eckstein R, Zingsem J. Transfusion-related alloimmune neutropenia with no pulmonary complications: one donor-five cases. Transfusion 2015; 56:84-90. [PMID: 26388439 DOI: 10.1111/trf.13333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 07/17/2015] [Accepted: 07/29/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Neutrophil alloantibodies are well-known triggers of transfusion-related acute lung injury (TRALI) and also cause immune neutropenia. Alloimmune neutropenia due to transfusion is an isolated phenomenon that is only rarely identified. Its incidence is specified in the literature as being less than one in 10,000 transfused plasma-containing units. We expect that this phenomenon is underreported. STUDY DESIGN AND METHODS We observed five cases of alloimmune neutropenia with no respiratory complications with only one case initially reported as a suspected transfusion reaction. The other four cases were detected in the course of the subsequent lookback investigation. RESULTS The first case was reported as a potential transfusion reaction when a female patient showed a decrease in the white blood cell count after a platelet (PLT) transfusion. Examinations of the donor blood revealed an antibody against the human neutrophil antigen HNA-1b; the recipient was typed HNA-1b positive and HNA-1a negative. After examining the blood counts of other patients who previously received PLT concentrates from the same donor, we identified four other patients with an unreported decrease in the leukocyte and/or granulocyte count of more than approximately 50% after transfusion. CONCLUSION HNA antibodies are generally regarded as potential triggers of TRALI. Here we describe an HNA antibody that reproducibly caused transfusion-related neutropenia only without pulmonary complications. Factors predisposing patients to TRALI development are widely discussed. Our case suggests that antibody characteristics are also relevant in the development of TRALI. Current measures to prevent TRALI should also prevent transfusion-related alloimmune neutropenia.
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Affiliation(s)
| | - Renate Ruppel
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
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46
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Álvarez P, Carrasco R, Romero-Dapueto C, Castillo RL. Transfusion-Related Acute Lung Injured (TRALI): Current Concepts. Open Respir Med J 2015; 9:92-6. [PMID: 26312100 PMCID: PMC4541453 DOI: 10.2174/1874306401509010092] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 02/01/2023] Open
Abstract
Transfusion-related acute lung injury (TRALI) is a life-threatening intervention that develops within 6 hours of transfusion of one or more units of blood, and is an important cause of morbidity and mortality resulting from transfusion. It is necessary to dismiss other causes of acute lung injury (ALI), like sepsis, acute cardiogenic edema, acute respiratory distress syndrome (ARDS) or bacterial infection. There are two mechanisms that lead to the development of this syndrome: immune-mediated and no immune- mediated TRALI. A common theme among the experimental TRALI models is the central importance of neutrophils in mediating the early immune response, and lung vascular injury. Central clinical symptoms are dyspnea, tachypnea, tachycardia, cyanosis and pulmonary secretions, altogether with other hemodynamic alterations, such as hypotension and fever. Complementary to these clinical findings, long-term validated animal models for TRALI should allow the determination of the cellular targets for TRALI-inducing alloantibodies as well as delineation of the underlying pathogenic molecular mechanisms, and key molecular mediators of the pathology. Diagnostic criteria have been established and preventive measures have been implemented. These actions have contributed to the reduction in the overallnumber of fatalities. However, TRALI still remains a clinical problem. Any complication suspected of TRALI should immediately be reported.
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Affiliation(s)
- P Álvarez
- Unidad de Paciente Crítico, Hospital Metropolitano La Florida, Santiago, Chile ; Facultad de Medicina, Universidad Finis Terrae, Chile
| | - R Carrasco
- Departamento de Medicina, Universidad de Chile, Hospital Salvador, Santiago, Chile
| | - C Romero-Dapueto
- Servicio de Medicina Física y Rehabilitación, Clínica Alemana de Santiago, Santiago, Chile
| | - R L Castillo
- Programa de Fisiopatología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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McNair E, Marcoux JA, Bally C, Gamble J, Thomson D. Bivalirudin as an adjunctive anticoagulant to heparin in the treatment of heparin resistance during cardiopulmonary bypass-assisted cardiac surgery. Perfusion 2015; 31:189-99. [PMID: 25934498 DOI: 10.1177/0267659115583525] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Heparin resistance (unresponsiveness to heparin) is characterized by the inability to reach acceptable activated clotting time values following a calculated dose of heparin. Up to 20% of the patients undergoing cardiothoracic surgery with cardiopulmonary bypass using unfractionated heparin (UFH) for anticoagulation experience heparin resistance. Although UFH has been the "gold standard" for anticoagulation, it is not without its limitations. It is contraindicated in patients with confirmed heparin-induced thrombocytopenia (HIT) and heparin or protamine allergy. The safety and efficacy of the use of the direct thrombin inhibitor bivalirudin for anticoagulation during cardiac surgery has been reported. However, there have been no reports on the treatment of heparin resistance with bivalirudin during CPB. In this review, we report the favorable outcome of our single-center experience with the alternative use of bivalirudin in the management of anticoagulation of heparin unresponsive patients undergoing coronary artery bypass graft surgery.
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Affiliation(s)
- E McNair
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada Department of Surgery, Division of Cardiac Surgery, Saskatoon Health Region, Saskatoon, SK, Canada
| | - J-A Marcoux
- Department of Surgery, Division of Cardiac Surgery, Saskatoon Health Region, Saskatoon, SK, Canada
| | - C Bally
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - J Gamble
- Department of Anesthesiology and Pain Management, College of Medicine and Saskatoon Health Region, Saskatoon, SK, Canada
| | - D Thomson
- Department of Surgery, Division of Cardiac Surgery, Saskatoon Health Region, Saskatoon, SK, Canada
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48
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Elhenawy AM, Meyer SR, Bagshaw SM, MacArthur RG, Carroll LJ. Role of preoperative intravenous iron therapy to correct anemia before major surgery: study protocol for systematic review and meta-analysis. Syst Rev 2015; 4:29. [PMID: 25874460 PMCID: PMC4369835 DOI: 10.1186/s13643-015-0016-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/24/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Preoperative anemia is a common and potentially serious hematological problem in elective surgery and increases the risk for perioperative red blood cell (RBC) transfusion. Transfusion is associated with postoperative morbidity and mortality. Preoperative intravenous (IV) iron therapy has been proposed as an intervention to reduce perioperative transfusion; however, studies are generally small, limited, and inconclusive. METHODS/DESIGN We propose performing a systematic review and meta-analysis. We will search MEDLINE, EMBASE, EBM Reviews, Cochrane-controlled trial registry, Scopus, registries of health technology assessment and clinical trials, Web of Science, ProQuest Dissertations and Theses, and conference proceedings in transfusion, hematology, and surgery. We will contact our study drug manufacturer for unpublished trials. Titles and abstracts will be identified and assessed by two reviewers for potential relevance. Eligible studies are: randomized or quasi-randomized clinical trials comparing preoperative administration of IV iron with placebo or standard of care to reduce perioperative blood transfusion in anemic patients undergoing major surgery. Screening, data extraction, and quality appraisal will be conducted independently by two authors. Data will be presented in evidence tables and in meta-analytic forest plots. Primary efficacy outcomes are change in hemoglobin concentration and proportion of patients requiring RBC transfusion. Secondary outcomes include number of units of blood or blood products transfused perioperatively, transfusion-related acute lung injury, neurologic complications, adverse events, postoperative infections, cardiopulmonary complications, intensive care unit (ICU) admission/readmission, length of hospital stay, acute kidney injury, and mortality. Dichotomous outcomes will be reported as pooled relative risks and 95% confidence intervals. Continuous outcomes will be reported using calculated weighted mean differences. Meta-regression will be performed to evaluate the impact of potential confounding variables on study effect estimates. DISCUSSION Reducing unnecessary RBC transfusions in perioperative medicine is a clinical priority. This involves the identification of patients at risk of receiving transfusions along with blood conservation strategies. Of potential pharmacological blood conservation strategies, IV iron is a compelling intervention to treat preoperative anemia; however, existing data are uncertain. We propose performing a systematic review and meta-analysis evaluating the efficacy and safety of IV iron administration to anemic patients undergoing major surgery to reduce transfusion and perioperative morbidity and mortality. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015016771.
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Affiliation(s)
- Abdelsalam M Elhenawy
- School of Public Health, University of Alberta, 4075 RTF, 8308 114 Street, Edmonton, Alberta, T6G 2E1, Canada.
| | - Steven R Meyer
- Division of Cardiac Surgery, Department of Cardiac Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada.
| | - Sean M Bagshaw
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada.
| | - Roderick G MacArthur
- Division of Cardiac Surgery, Department of Cardiac Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada.
| | - Linda J Carroll
- School of Public Health, University of Alberta, 4075 RTF, 8308 114 Street, Edmonton, Alberta, T6G 2E1, Canada.
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Adams F, Bellairs G, Bird AR, Oguntibeju OO. Biochemical storage lesions occurring in nonirradiated and irradiated red blood cells: a brief review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:968302. [PMID: 25710038 PMCID: PMC4325969 DOI: 10.1155/2015/968302] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/06/2015] [Accepted: 01/06/2015] [Indexed: 12/20/2022]
Abstract
Red blood cells undergo a series of biochemical fluctuations during 35-42-day storage period at 1°C to 6°C. The sodium/potassium pump is immobilised causing a decrease in intracellular potassium with an increase in cytoplasmic sodium levels, glucose levels decline, and acidosis occurs as a result of low pH levels. The frailty of stored erythrocytes triggers the formation of haemoglobin-containing microparticles and the release of cell-free haemoglobin which may add to transfusion difficulties. Lipid peroxidation, oxidative stress to band 3 structures, and other morphological and structural molecular changes also occur leading to spheroechinocytes and osmotic fragility. These changes that transpire in the red cells during the storage period are referred to as "storage lesions." It is well documented that gamma irradiation exacerbates storage lesions and the reports of increased potassium levels leading to adverse reactions observed in neonates and infants have been of particular concern. There are, however, remarkably few systematic studies comparing the in vitro storage lesions of irradiated and nonirradiated red cell concentrates and it has been suggested that the impact of storage lesions on leucocyte reduced red blood cell concentrate (RBCC) is incomplete. The review examines storage lesions in red blood cells and their adverse effects in reference to blood transfusion.
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Affiliation(s)
- F. Adams
- Training Department, Western Province Blood Transfusion Service, Cape Town 7450, South Africa
| | - G. Bellairs
- Western Province Blood Transfusion Service, Cape Town 7450, South Africa
| | - A. R. Bird
- Western Province Blood Transfusion Service, Cape Town 7450, South Africa
| | - O. O. Oguntibeju
- Oxidative Stress Research Centre, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville, Cape Town 7535, South Africa
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Middelburg RA, van der Bom JG. Transfusion-related acute lung injury not a two-hit, but a multicausal model. Transfusion 2014; 55:953-60. [PMID: 25494846 DOI: 10.1111/trf.12966] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/28/2014] [Accepted: 10/28/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The etiology of transfusion-related acute lung injury (TRALI) is often referred to as a "two-hit model," the first hit being patient predisposition and the second being a transfusion. This model lumps all patient-related risk factors together and thereby may hamper identification of individual, potentially preventable or modifiable risk factors. STUDY DESIGN AND METHODS Like any disease, TRALI is multicausal in nature. To be able to effectively scrutinize all contributing causes, we need to clearly describe this multicausality as completely as possible. Several models are already commonly used to describe the multicausality of other diseases, including threshold models and the sufficient cause model. RESULTS Here we describe the application of two different multicausal models to TRALI. These models can readily describe any potential scenario for the etiology of TRALI. First we will introduce the intuitively appealing threshold model, which shows some similarities with the Bux and Sachs threshold model for TRALI. Second we discuss the more abstract sufficient cause model. CONCLUSIONS Both models have their strengths and limitations. Both are, however, better equipped than the two-hit model to describe the multicausal nature of TRALI. Further identification of all involved risk factors and the complex interplay between them is facilitated by these models.
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Affiliation(s)
- Rutger A Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Jon J. van Rood Center for Clinical Transfusion Research, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Jon J. van Rood Center for Clinical Transfusion Research, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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