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Asante A, Nguyen PL, Henrichs K, Masel D, Refaai M, Blumberg N. Platelet Transfusions, Mortality, and ABO Identicality in Premature Newborns. Am J Perinatol 2024; 41:1592-1593. [PMID: 37863071 DOI: 10.1055/a-2195-6120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Affiliation(s)
- Akua Asante
- Transfusion Medicine Division, Department of Laboratory Medicine and Pathology, University of Rochester, Rochester, New York
| | - Phuong-Lan Nguyen
- Transfusion Medicine Division, Department of Laboratory Medicine and Pathology, University of Rochester, Rochester, New York
| | - Kelly Henrichs
- Transfusion Medicine Division, Department of Laboratory Medicine and Pathology, University of Rochester, Rochester, New York
| | - Debra Masel
- Transfusion Medicine Division, Department of Laboratory Medicine and Pathology, University of Rochester, Rochester, New York
| | - Majed Refaai
- Transfusion Medicine Division, Department of Laboratory Medicine and Pathology, University of Rochester, Rochester, New York
| | - Neil Blumberg
- Transfusion Medicine Division, Department of Laboratory Medicine and Pathology, University of Rochester, Rochester, New York
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Blumberg N, Asante AA, Nguyen PLT, Heal JM. Platelet Transfusions: The Good, the Bad, and the Ugly. Anesth Analg 2024; 138:921-924. [PMID: 38621279 DOI: 10.1213/ane.0000000000006918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Neil Blumberg
- From the Transfusion Medicine Division, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, New York
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Bougie DW, Reese SE, Birch RJ, Bookwalter DB, Mitchell PK, Roh D, Kreuziger LB, Cable RG, Goel R, Gottschall J, Hauser RG, Hendrickson JE, Hod EA, Josephson CD, Kahn S, Kleinman SH, Mast AE, Ness PM, Roubinian NH, Sloan S. Associations between ABO non-identical platelet transfusions and patient outcomes-A multicenter retrospective analysis. Transfusion 2023; 63:960-972. [PMID: 36994786 PMCID: PMC10175171 DOI: 10.1111/trf.17319] [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] [Received: 11/17/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Due to platelet availability limitations, platelet units ABO mismatched to recipients are often transfused. However, since platelets express ABO antigens and are collected in plasma which may contain ABO isohemagglutinins, it remains controversial as to whether ABO non-identical platelet transfusions could potentially pose harm and/or have reduced efficacy. STUDY DESIGN AND METHODS The large 4-year publicly available Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) database was used to investigate patient outcomes associated with ABO non-identical platelet transfusions. Outcomes included mortality, sepsis, and subsequent platelet transfusion requirements. RESULTS Following adjustment for possible confounding factors, no statistically significant association between ABO non-identical platelet transfusion and increased risk of mortality was observed in the overall cohort of 21,176 recipients. However, when analyzed by diagnostic category and recipient ABO group, associations with increased mortality for major mismatched transfusions were noted in two of eight subpopulations. Hematology/Oncology blood group A and B recipients (but not group O) showed a Hazard Ratio (HR) of 1.29 (95%CI: 1.03-1.62) and intracerebral hemorrhage group O recipients (but not groups A and B) showed a HR of 1.75 (95%CI: 1.10-2.80). Major mismatched transfusions were associated with increased odds of receiving additional platelet transfusion each post-transfusion day (through day 5) regardless of the recipient blood group. DISCUSSION We suggest that prospective studies are needed to determine if specific patient populations would benefit from receiving ABO identical platelet units. Our findings indicate that ABO-identical platelet products minimize patient exposure to additional platelet doses.
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Affiliation(s)
| | - Sarah E. Reese
- Public Health and Epidemiology Practice, Westat, Rockville, MD
| | | | | | | | | | | | | | - Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Ronald George Hauser
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
| | - Jeanne E. Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
- Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, GA
| | - Eldad A. Hod
- Columbia University Irving Medical Center, New York, NY
| | - Cassandra D. Josephson
- Cancer and Blood Disorders Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, FL., and Departments of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Alan E Mast
- Blood Research Institute, Versiti Milwaukee WI
| | - Paul M. Ness
- American Red Cross Scientific Affairs, Farmington, CT
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Gupta GK, Henrichs K, Nilsson K, Wagner S, Brown B, Masel D, Gestring ML, Vella MA, Refaai MA, Blumberg N. Reduction of anti-A and anti-B isoagglutinin titers of group O whole blood units employing an ABO antibody immune adsorption column. Transfus Apher Sci 2023:103686. [PMID: 36894466 DOI: 10.1016/j.transci.2023.103686] [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: 11/10/2022] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Massive hemorrhage is a leading cause of death from trauma. There is growing interest in group O whole blood transfusions to mitigate coagulopathy and hemorrhagic shock. Insufficient availability of low-titer group O whole blood is a barrier to routine use. We tested the efficacy of the Glycosorb® ABO immunoadsorption column to reduce anti-A/B titers in group O whole blood. METHODS Six group O whole blood units were collected from healthy volunteers, and centrifuged to separate platelet poor plasma. Platelet-poor plasma was filtered through a Glycosorb® ABO antibody immunoabsorption column, then reconstituted to prepare post-filtration whole blood. Anti-A/B titers, CBC, free hemoglobin, and thromboelastography (TEG) assays were performed on pre-and post-filtration whole blood. RESULTS Mean( ± SEM) anti-A (224 ± 65 pre vs 13 ± 4 post) and anti-B (138 ± 38 pre vs 11 ± 4 post) titers were significantly reduced (p = 0.004) in post-filtration whole blood. No significant changes were detected in CBC, free hemoglobin, and TEG parameters on day 0. Free hemoglobin increased throughout storage (48 mg/dl ± 24 Day 0 vs 73 ± 35 Day 7 vs 96 ± 44 Day 14; p = 0.14). CONCLUSIONS The Glycosorb® ABO column can significantly reduce anti-A/B isoagglutinin titers of group O whole blood units. Glycosorb® ABO could be employed to provide whole blood with lower risk of hemolysis and other consequences of infusing ABO incompatible plasma. Preparation of group O whole blood with substantially reduced anti-A/B would also increase the supply of low-titer group O whole blood for transfusion.
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Affiliation(s)
- Gaurav K Gupta
- Transfusion Medicine/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA.
| | - Kelly Henrichs
- Transfusion Medicine/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA.
| | - Kurt Nilsson
- Glycorex Transplantation AB, Section of Hematology, Lund, Sweden.
| | - Stephen Wagner
- American Red Cross Holland Laboratory, Rockville, MD, USA.
| | - Bethany Brown
- American Red Cross Holland Laboratory, Rockville, MD, USA.
| | - Debra Masel
- Transfusion Medicine/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA.
| | - Mark L Gestring
- Acute Care Surgery and Trauma, Department of Surgery, University of Rochester, Rochester, NY, USA.
| | - Michael A Vella
- Acute Care Surgery and Trauma, Department of Surgery, University of Rochester, Rochester, NY, USA.
| | - Majed A Refaai
- Transfusion Medicine/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA.
| | - Neil Blumberg
- Transfusion Medicine/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA.
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Blumberg N, Heal JM. How do we forecast tomorrow's transfusion? - Next generation transfusion practices to improve recipient safety. Transfus Clin Biol 2023; 30:31-34. [PMID: 36096445 DOI: 10.1016/j.tracli.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recipient safety measures play a key role in overall transfusion efficacy. The key advances in safety over the first century of transfusion medicine have been the development of techniques to prevent hemolytic transfusion reactions, hemolytic disease of the newborn and transmission of viral pathogens. While these risks remain important, they affect many fewer patients than previously. We propose that some of the most important current safety issues relate to toxicities broadly encompassed by the immunomodulatory effects of allogeneic transfusion. These include (1) universal leukoreduction to mitigate nosocomial infections, inflammation and organ injury, (2) removal of stored supernatant and its attendant toxic contents that cause dysfunctional immunity and organ injury, (3) avoiding infusing ABO incompatible antigen and antibody that can lead to bleeding, platelet refractoriness and inflammation, (3) minimizing prophylactic transfusions (particularly of plasma and platelets) except where benefit is proven, and (4) avoiding use of normal saline which is linked to renal failure and possibly hemolysis. Accompanying these safety measures will be the continued growth of one of the most important safety measures, patient blood management, which has as one benefit the avoidance of unnecessary and harmful transfusions. Reducing the toxicity of transfusions will enhance the improved clinical outcomes seen with patient blood management.
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Affiliation(s)
- Neil Blumberg
- Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Box 608, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Joanna Mary Heal
- Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Box 608, 601 Elmwood Avenue, Rochester, NY 14642, USA
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Josephson CD, Glynn S, Mathew S, Birch R, Bakkour S, Kreuziger LB, Busch MP, Chapman K, Dinardo C, Hendrickson J, Hod EA, Kelly S, Luban N, Mast A, Norris P, Custer B, Sabino E, Sachais B, Spencer BR, Stone M, Kleinman S. The Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P): A research program striving to improve blood donor safety and optimize transfusion outcomes across the lifespan. Transfusion 2022; 62:982-999. [PMID: 35441384 PMCID: PMC9353062 DOI: 10.1111/trf.16869] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P) is a new iteration of prior National Heart, Lung, and Blood Institute (NHLBI) REDS programs that focus on improving transfusion recipient outcomes across the lifespan as well as the safety and availability of the blood supply. STUDY DESIGN AND METHODS The US program includes blood centers and hospitals (22 including 6 free-standing Children's hospitals) in four geographic regions. The Brazilian program has 5 participating hemocenters. A Center for Transfusion Laboratory Studies (CTLS) and a Data Coordinating Center (DCC) support synergistic studies and activities over the 7-year REDS-IV-P program. RESULTS The US is building a centralized, vein-to-vein (V2V) database, linking information collected from blood donors, their donations, the resulting manufactured components, and data extracts from hospital electronic medical records of transfused and non-transfused patients. Simultaneously, the Brazilian program is building a donor, donation, and component database. The databases will serve as the backbone for retrospective and prospective observational studies in transfusion epidemiology, transfusion recipient outcomes, blood component quality, and emerging blood safety issues. Special focus will be on preterm infants, patients with sickle cell disease, thalassemia or cancer, and the effect of donor biologic variability and component manufacturing on recipient outcomes. A rapid response capability to emerging safety threats has resulted in timely studies related to Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2). CONCLUSIONS The REDS-IV-P program endeavors to improve donor-recipient-linked research with a focus on children and special populations while also maintaining the flexibility to address emerging blood safety issues.
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Affiliation(s)
- Cassandra D. Josephson
- Departments of Pathology and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Simone Glynn
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sunitha Mathew
- Public Health and Epidemiology Practice, Westat, Rockville, Maryland, USA
| | - Rebecca Birch
- Public Health and Epidemiology Practice, Westat, Rockville, Maryland, USA
| | - Sonia Bakkour
- Vitalant Research Institute, University of California San Francisco, San Francisco, California, USA
| | | | - Michael P. Busch
- Vitalant Research Institute, University of California San Francisco, San Francisco, California, USA
| | - Kathleen Chapman
- Public Health and Epidemiology Practice, Westat, Rockville, Maryland, USA
| | - Carla Dinardo
- Immunohematology, Faculdade de Medicina da Universidade de Sao and Fundacao Pro-Sangue, São Paulo, Brazil
| | - Jeanne Hendrickson
- Departments of Pediatrics and Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eldad A. Hod
- Department of Pathology & Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Shannon Kelly
- Department of Pediatric Hematology & Oncology, UCSF Benioff Children’s Hospital, Oakland, California, USA
| | - Naomi Luban
- Children’s Research National Institute, Children’s National Hospital, Washington, District of Columbia, USA
| | - Alan Mast
- Versiti Blood Research Institute, Versiti, Milwaukee, Wisconsin, USA
| | - Philip Norris
- Vitalant Research Institute, University of California San Francisco, San Francisco, California, USA
| | - Brian Custer
- Vitalant Research Institute, University of California San Francisco, San Francisco, California, USA
| | - Ester Sabino
- Department of Infectious Disease, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | | | - Bryan R. Spencer
- Scientific Affairs, American Red Cross, Dedham, Massachusetts, USA
| | - Mars Stone
- Vitalant Research Institute, University of California San Francisco, San Francisco, California, USA
| | - Steve Kleinman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Victoria, British Columbia, Canada
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Chung Y, Ko DH, Lim J, Kim KH, Kim H. Choice of ABO Group for Blood Component Transfusion in ABO-Incompatible Solid Organ Transplantation: A Questionnaire Survey in Korea and Guideline Proposal. Ann Lab Med 2022; 42:105-109. [PMID: 34374356 PMCID: PMC8368232 DOI: 10.3343/alm.2022.42.1.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/17/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022] Open
Abstract
The number of ABO-incompatible solid organ transplantations (ABOi SOTs) has markedly increased worldwide since the early 2000s. We investigated the choice of ABO group for blood component transfusion in ABOi SOT. We conducted a survey by e-mailing a questionnaire to blood bank specialists at 77 major hospitals in Korea, among whom 34 responded to the survey. In major ABOi SOT, for red blood cells (RBCs), the recipient’s type (70.6%) was the most common choice, followed by group O (29.4%); for platelets, group AB (50.0%) was the most common choice, followed by the donor type (38.2%); for plasma, group AB (55.9%) was the most common choice, followed by the donor type (32.4%). In bidirectional ABOi SOT, for RBCs, the recipient’s type (55.9%) was the most common choice, followed by group O (44.1%); for platelets and plasma, group AB was the most common choice (94.1% and 97.1%, respectively). The policies for transfusion in ABOi SOT were diverse. We suggest a guideline on the choice of ABO group for transfusion in ABOi SOT to secure patient health and enable an efficient use of blood components.
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Affiliation(s)
- Yousun Chung
- Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Dae-Hyun Ko
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihyang Lim
- Department of Laboratory Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyeong-Hee Kim
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Hyungsuk Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
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Essential Role of Rho-Associated Kinase in ABO Immune Complex-Mediated Endothelial Barrier Disruption. Biomedicines 2021; 9:biomedicines9121851. [PMID: 34944667 PMCID: PMC8698390 DOI: 10.3390/biomedicines9121851] [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: 09/28/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 11/17/2022] Open
Abstract
ABO immune complexes (ABO-IC) formed by ABO-incompatible antigen-antibody interaction are associated with hemolysis and platelet destruction in patients transfused with ABO-nonidentical blood products. However, the effects of ABO-IC on endothelial cells (EC) are unclear. ABO-IC were formed in vitro from normal donor-derived plasma and serum. Human pulmonary artery EC (HPAEC) were cultured and treated with media, ABO-identical and –non-identical plasma, and ABO-IC. EC barrier integrity was evaluated using transendothelial electrical resistance (TEER), scanning electron microscopy (SEM), vascular endothelial (VE)-cadherin and phalloidin staining, and Rho-associated Kinase (ROCK) inhibitor treatment. TEER revealed significant/irreversible barrier disruption within 1–2 h of exposure to ABO non-identical plasma and ABO-IC; this occurred independently of EC ABO type. Treatment with ABO-IC resulted in decreased VE-cadherin staining and increased phalloidin staining in a time-dependent manner, suggesting that the resultant increased EC barrier permeability is secondary to actin stress fiber formation and loss of cell surface VE-cadherin. Inhibition of ROCK was effective in protecting against IC-induced barrier disruption even two hours after ABO-IC exposure. ABO-IC causes increased EC barrier permeability by decreasing cell surface VE-cadherin and promoting stress fiber formation, which is preventable by inhibiting ROCK activation to protect against EC contraction and gap formation.
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Auvinen MK, Zhao J, Lassén E, Lubenow N, Seger Mollén A, Watz E, Wikman A, Edgren G. Patterns of blood use in Sweden from 2008 to 2017: A nationwide cohort study. Transfusion 2020; 60:2529-2536. [PMID: 32964488 DOI: 10.1111/trf.16092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transfusion patterns in Sweden have not been characterized on a nationwide level. STUDY DESIGN AND METHODS We conducted a nationwide descriptive cohort study in Sweden from 2008 to 2017. Data on blood donors, donations, component manufacture, transfusions, and transfused patients were extracted from Swedish portion of the Scandinavian Donations and Transfusions (SCANDAT3-S) database. RESULTS A total of 708 436 patients received 5 587 684 red cell, plasma, or platelet transfusions during the study period. The age-standardized transfusion rate decreased markedly during the study period for red cell units (from 53 to 39 units/1000 persons) and plasma units (from 11 to 4.9 units/1000 persons), but remained relatively constant for platelet concentrates. The transfusion rate was 30%-40% higher in males than in females in the first year of life, and higher in males over 45 years than in females. Between age 20 and 45, the majority of red cells were transfused to female patients with obstetric indications, whereas trauma was the predominant indication for male contemporaries. In females over 80 years, the largest proportion of red cells were administered due to trauma. Overall, hematological patients received 36% of all platelet units. There were large regional differences in transfusion rates for red cell units, ranging from less than 30 to greater than 60/1000 persons. CONCLUSION Transfusion rates in Sweden remain high but have decreased strikingly during the study period - with the exception of platelet transfusions. Based on the available data, it is difficult to draw firm conclusions about whether transfusion rates can be further reduced.
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Affiliation(s)
- Marja-Kaisa Auvinen
- Department of Clinical Immunology and Transfusion Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Jingcheng Zhao
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ewa Lassén
- Department of Clinical Immunology and Transfusion Medicine, Umeå University Hospital, Umeå, Sweden
| | - Norbert Lubenow
- Department of Clinical Immunology and Transfusion Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Agneta Seger Mollén
- Department of Clinical Immunology and Transfusion Medicine, Linköping University, Linköping, Sweden.,Department of Biomedicine and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Emma Watz
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Agneta Wikman
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Gustaf Edgren
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Södersjukhuset, Stockholm, Sweden
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Seheult JN, Dunbar NM, Hess JR, Tuott EE, Bahmanyar M, Campbell J, Fontaine M, Khan J, Ko A, Mi J, Murphy MF, Nykoluk T, Poisson J, Raval JS, Shih A, Sperry JL, Staves J, Wong M, Yan MTS, Ziman A, Yazer MH. Transfusion of blood components containing ABO-incompatible plasma does not lead to higher mortality in civilian trauma patients. Transfusion 2020; 60:2517-2528. [PMID: 32901965 DOI: 10.1111/trf.16008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/10/2020] [Accepted: 07/09/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND This study investigated the effect on mortality of transfusing ABO-incompatible plasma from all sources during trauma resuscitation. METHODS Demographic, transfusion, and survival data were retrospectively extracted on civilian trauma patients. Patients were divided by receipt of any quantity of ABO-incompatible plasma from any blood product (incompatible group) or receipt of solely ABO-compatible plasma (compatible group). The primary outcome was 30-day mortality, while other outcomes included 6- and 24-hour mortality. Mixed-effects logistic regression was used to model the effect of various predictor variables, including receipt of incompatible plasma, on mortality outcomes. RESULTS Nine hospitals contributed data on a total of 2618 trauma patients. There were 1282 patients in the incompatible group and 1336 patients in the compatible group. In both the unadjusted and adjusted models, the 6-hour, 24-hour, and 30-day mortality rates were not significantly different between these groups. The patients in the incompatible group were then divided into high volume (>342 mL) and low volume (≤342 mL) incompatible plasma recipients. In the adjusted model, the high-volume group had higher 24-hour mortality when the Trauma Injury Severity Score survival prediction was >50%. Mortality at 6 hours and 30 days was not higher in this model. The low-volume group did not have increased mortality at any of the time points in this adjusted model. CONCLUSION The transfusion of incompatible plasma in civilian trauma resuscitation does not lead to higher 30-day mortality. The finding of higher mortality in a select group of recipients in the secondary analysis warrants further study.
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Affiliation(s)
- Jansen N Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Vitalant, Pittsburgh, Pennsylvania, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - John R Hess
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Erin E Tuott
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mohammad Bahmanyar
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Jessica Campbell
- Department of Pathology and Laboratory Medicine, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, David Geffen School of Medicine, UCLA (University of California, Los Angeles), Los Angeles, California, USA
| | - Magali Fontaine
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jenna Khan
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Ara Ko
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jian Mi
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Michael F Murphy
- NHS Blood & Transplant, and Oxford Biomedical Research Centre, Oxford, UK
| | - Tara Nykoluk
- Department of Surgery, David Geffen School of Medicine, UCLA (University of California, Los Angeles), Los Angeles, California, USA
| | - Jessica Poisson
- Department of Pathology, Duke University, Durham, North Carolina, USA
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Andrew Shih
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jason L Sperry
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Julie Staves
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Michelle Wong
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Matthew T S Yan
- Department of Pathology and Laboratory Medicine, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Alyssa Ziman
- Department of Pathology and Laboratory Medicine, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, David Geffen School of Medicine, UCLA (University of California, Los Angeles), Los Angeles, California, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Vitalant, Pittsburgh, Pennsylvania, USA
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Silva ALDO, Bassolli L, Ferreira P, Utiyama E, Dezan MR, Costa-Neto A, Conrado MCAV, Oliveira VB, Bonifácio SL, Fernandes FLA, Rocha V, Mendrone-Júnior A, Dinardo CL. Transfusion of ABO non-identical platelets increases the severity of trauma patients at ICU admission. Hematol Transfus Cell Ther 2020; 43:287-294. [PMID: 32798060 PMCID: PMC8446227 DOI: 10.1016/j.htct.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/26/2020] [Accepted: 06/01/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Transfusion of ABO-compatible non-identical platelets (PTLs), fresh plasma (FP) and red blood cells (RBCs) has been associated with increased morbidity and mortality of recipients. Trauma victims are frequently exposed to ABO non-identical products, given the need for emergency transfusions. Our goal was to evaluate the impact of the transfusion of ABO non-identical blood products on the severity and all-cause 30-day mortality of trauma patients. METHODS This was a retrospective single-center cohort, which included trauma patients who received emergency transfusions in the first 24 h of hospitalization. Patients were divided in two groups according to the use of <3 or ≥3 ABO non-identical blood products. The patient severity, measured by the Acute Physiology and Chronic Health Evaluation (APACHEII) score at ICU admission, and the 30-day mortality were compared between groups. RESULTS Two hundred and sixteen trauma patients were enrolled. Of these, 21.3% received ≥3 ABO non-identical blood products (RBCs, PLTs and FP or cryoprecipitate). The transfusion of ≥3 ABO non-identical blood products in the first 24 h of hospitalization was independently associated with a higher APACHEII score at ICU admission (OR = 3.28 and CI95% = 1.48-7.16). Transfusion of at least one unit of ABO non-identical PTLs was also associated with severity (OR = 10.89 and CI95% = 3.38-38.49). Transfusion of ABO non-identical blood products was not associated with a higher 30-day mortality in the studied cohort. CONCLUSION The transfusion of ABO non-identical blood products and, especially, of ABO non-identical PLTs may be associated with the greater severity of trauma patients at ICU admission. The transfusion of ABO non-identical blood products in the trauma setting is not without risks.
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Affiliation(s)
| | - Lucas Bassolli
- Faculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil
| | - Pedro Ferreira
- Faculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil
| | - Edivaldo Utiyama
- Faculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil
| | | | - Abel Costa-Neto
- Faculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil
| | | | | | | | - Frederico Leon Arrabal Fernandes
- Faculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil; Departamento de Pneumologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Vanderson Rocha
- Fundação Pró-Sangue (Hemocentro), São Paulo, SP, Brazil; Faculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil; Churchill Hospital, NHS BT, Oxford University, Oxford, United Kingdom
| | | | - Carla Luana Dinardo
- Fundação Pró-Sangue (Hemocentro), São Paulo, SP, Brazil; Faculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil; Instituto de Medicina Tropical, University of São Paulo, São Paulo, SP, Brazil.
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12
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Refaai MA, Cahill C, Masel D, Schmidt AE, Heal JM, Kirkley SA, Blumberg N. Is It Time to Reconsider the Concepts of "Universal Donor" and "ABO Compatible" Transfusions? Anesth Analg 2019; 126:2135-2138. [PMID: 29099432 DOI: 10.1213/ane.0000000000002600] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Majed A Refaai
- From the Department of Pathology and Laboratory Medicine, Transfusion Medicine Unit, University of Rochester Medical Center, Rochester, New York
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13
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Blumberg N, Heal JM, Masel D, Refaai MA. The precautionary principle and use of Group A plasma in recipients of unknown ABO blood group. Transfusion 2018. [PMID: 29528152 DOI: 10.1111/trf.14466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Neil Blumberg
- Transfusion Medicine Unit/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Joanna M Heal
- Transfusion Medicine Unit/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Debra Masel
- Transfusion Medicine Unit/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
| | - Majed A Refaai
- Transfusion Medicine Unit/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY
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14
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Kreuger AL, Rostgaard K, Middelburg RA, Kerkhoffs JLH, Edgren G, Erikstrup C, Pedersen OB, Titlestad K, Nielsen KR, Ostrowski SR, Voldstedlund M, van der Bom JG, Ullum H, Hjalgrim H. Storage time of platelet concentrates and risk of a positive blood culture: a nationwide cohort study. Transfusion 2017; 58:16-24. [PMID: 29168187 DOI: 10.1111/trf.14401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Concern of transfusion-transmitted bacterial infections has been the major hurdle to extend shelf life of platelet (PLT) concentrates. We aimed to investigate the association between storage time and risk of positive blood cultures at different times after transfusion. STUDY DESIGN AND METHODS We performed a nationwide cohort study among PLT transfusion recipients in Denmark between 2010 and 2012, as recorded in the Scandinavian Donations and Transfusions (SCANDAT2) database. Linking with a nationwide database on blood cultures (MiBa), we compared the incidence of a positive blood culture among recipients of PLTs stored 6 to 7 days (old) to those receiving fresh PLTs (1-5 days), using Poisson regression models. We considered cumulative exposures in windows of 1, 3, 5, and 7 days. RESULTS A total of 9776 patients received 66,101 PLT transfusions. The incidence rate ratio (IRR) of a positive blood culture the day after transfusion of at least one old PLT concentrate was 0.77 (95% confidence interval [CI], 0.54-1.09) compared to transfusion of fresh PLT concentrates. The incidence rate of a positive blood culture was lower the day after receiving one old compared to one fresh PLT concentrate (IRR, 0.57; 95% CI, 0.37-0.87). Three, 5, or 7 days after transfusion, storage time was not associated with the risk of a positive blood culture. CONCLUSION Storage of buffy coat-derived PLT concentrates in PAS-C up to 7 days seems safe regarding the risk of a positive blood culture. If anything, transfusion of a single old PLT concentrate may decrease this risk the following day.
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Affiliation(s)
- Aukje L Kreuger
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Rutger A Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jean-Louis H Kerkhoffs
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Haga Hospital, Den Haag, the Netherlands
| | - Gustav Edgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Hematology Center, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole B Pedersen
- Department of Clinical Immunology, Naestved Hospital, Naestved, Denmark
| | - Kjell Titlestad
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Kaspar R Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Immunology, the Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Marianne Voldstedlund
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Henrik Ullum
- Department of Clinical Immunology, the Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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15
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Winearls J, Reade M, Miles H, Bulmer A, Campbell D, Görlinger K, Fraser JF. Targeted Coagulation Management in Severe Trauma: The Controversies and the Evidence. Anesth Analg 2017; 123:910-24. [PMID: 27636575 DOI: 10.1213/ane.0000000000001516] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Hemorrhage in the setting of severe trauma is a leading cause of death worldwide. The pathophysiology of hemorrhage and coagulopathy in severe trauma is complex and remains poorly understood. Most clinicians currently treating trauma patients acknowledge the presence of a coagulopathy unique to trauma patients-trauma-induced coagulopathy (TIC)-independently associated with increased mortality. The complexity and incomplete understanding of TIC has resulted in significant controversy regarding optimum management. Although the majority of trauma centers utilize fixed-ratio massive transfusion protocols in severe traumatic hemorrhage, a widely accepted "ideal" transfusion ratio of blood to blood products remains elusive. The recent use of viscoelastic hemostatic assays (VHAs) to guide blood product replacement has further provoked debate as to the optimum transfusion strategy. The use of VHA to quantify the functional contributions of individual components of the coagulation system may permit targeted treatment of TIC but remains controversial and is unlikely to demonstrate a mortality benefit in light of the heterogeneity of the trauma population. Thus, VHA-guided algorithms as an alternative to fixed product ratios in trauma are not universally accepted, and a hybrid strategy starting with fixed-ratio transfusion and incorporating VHA data as they become available is favored by some institutions. We review the current evidence for the management of coagulopathy in trauma, the rationale behind the use of targeted and fixed-ratio approaches and explore future directions.
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Affiliation(s)
- James Winearls
- From the *Intensive Care Unit, Gold Coast University Hospital, Southport, Queensland, Australia; †Gold Coast University Hospital Critical Care Research Group, Queensland, Australia; ‡Joint Health Command, Australian Defence Force and Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia; §Heart Foundation Research Centre, School of Medicine, Griffith University, Gold Coast, Queensland, Australia; ∥Trauma Department, Gold Coast University Hospital, Queensland, Australia; ¶Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany; #Tem International GmbH, Munich, Germany; and **Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Queensland, Australia
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16
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Abstract
Peripartum hemorrhage (PPH) is a frequent obstetric emergency situation with increasing incidence in the last decades. It requires a fast, coordinated and interdisciplinary management. This life-threatening situation is often recognized too late and not adequately treated (too little is done too late); therefore, it is important to be aware of the most important risk factors for PPH known as the 4 Ts (i.e. tonus, trauma, tissue and thrombin). Due to the special patient population there is only little evidence-based data on hemostatic therapy in this situation; therefore, the currently available studies on the therapy of PPH is discussed.
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17
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van Hoeven LR, Hooftman BH, Janssen MP, de Bruijne MC, de Vooght KMK, Kemper P, Koopman MMW. Protocol for a national blood transfusion data warehouse from donor to recipient. BMJ Open 2016; 6:e010962. [PMID: 27491665 PMCID: PMC4985976 DOI: 10.1136/bmjopen-2015-010962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Blood transfusion has health-related, economical and safety implications. In order to optimise the transfusion chain, comprehensive research data are needed. The Dutch Transfusion Data warehouse (DTD) project aims to establish a data warehouse where data from donors and transfusion recipients are linked. This paper describes the design of the data warehouse, challenges and illustrative applications. STUDY DESIGN AND METHODS Quantitative data on blood donors (eg, age, blood group, antibodies) and products (type of product, processing, storage time) are obtained from the national blood bank. These are linked to data on the transfusion recipients (eg, transfusions administered, patient diagnosis, surgical procedures, laboratory parameters), which are extracted from hospital electronic health records. APPLICATIONS Expected scientific contributions are illustrated for 4 applications: determine risk factors, predict blood use, benchmark blood use and optimise process efficiency. For each application, examples of research questions are given and analyses planned. CONCLUSIONS The DTD project aims to build a national, continuously updated transfusion data warehouse. These data have a wide range of applications, on the donor/production side, recipient studies on blood usage and benchmarking and donor-recipient studies, which ultimately can contribute to the efficiency and safety of blood transfusion.
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Affiliation(s)
- Loan R van Hoeven
- Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Babette H Hooftman
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Mart P Janssen
- Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Karen M K de Vooght
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Kemper
- Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, The Netherlands
| | - Maria M W Koopman
- Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The Netherlands
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18
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Yazdanbakhsh K, Nandi V. Red blood cell non-ABO-identical transfusions are harmful: really? Transfusion 2016; 56:543-5. [PMID: 26954449 DOI: 10.1111/trf.13505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 12/30/2015] [Indexed: 12/01/2022]
Affiliation(s)
| | - Vijay Nandi
- Data Analytic Services, New York Blood Center, New York, NY
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19
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Balvers K, Saleh S, Zeerleder SS, Klinkspoor JH, Goslings JC, Juffermans NP. Are there any alternatives for transfusion of AB plasma as universal donor in an emergency release setting? Transfusion 2016; 56:1469-74. [DOI: 10.1111/trf.13527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Kirsten Balvers
- Trauma Unit, Department of Surgery; Academic Medical Center; Amsterdam the Netherlands
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam the Netherlands
| | - Sarah Saleh
- Trauma Unit, Department of Surgery; Academic Medical Center; Amsterdam the Netherlands
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam the Netherlands
| | - Sacha S. Zeerleder
- Department of Hematology; Academic Medical Center; Amsterdam the Netherlands
- Department of Immunopathology; Sanquin Research; Academic Medical Center; Amsterdam the Netherlands
| | - J. Henriette Klinkspoor
- Laboratory for General Clinical Chemistry; Academic Medical Center; Amsterdam the Netherlands
| | - J. Carel Goslings
- Trauma Unit, Department of Surgery; Academic Medical Center; Amsterdam the Netherlands
| | - Nicole P. Juffermans
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam the Netherlands
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20
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Abstract
The spectrum of adverse reactions to blood product transfusion ranges from a benign clinical course to serious morbidity and mortality. There have been many advances in technologies and transfusion strategies to decrease the risk of adverse reactions. Our aim is to address a few of the advancements in increasing the safety of the blood supply, specifically pathogen reduction technologies, bacterial contamination risk reduction, and transfusion associated acute lung injury risk mitigation strategies.
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Affiliation(s)
- Thomas S Rogers
- Blood Bank & Transfusion Medicine, University of Vermont Medical Center, Burlington, Vermont, 05401, USA; Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vermont, 05401, USA
| | - Mark K Fung
- Blood Bank & Transfusion Medicine, University of Vermont Medical Center, Burlington, Vermont, 05401, USA; Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vermont, 05401, USA
| | - Sarah K Harm
- Blood Bank & Transfusion Medicine, University of Vermont Medical Center, Burlington, Vermont, 05401, USA; Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vermont, 05401, USA
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21
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Zaffuto BJ, Conley GW, Connolly GC, Henrichs KF, Francis CW, Heal JM, Blumberg N, Refaai MA. ABO-immune complex formation and impact on platelet function, red cell structural integrity and haemostasis: anin vitromodel of ABO non-identical transfusion. Vox Sang 2015; 110:219-26. [DOI: 10.1111/vox.12354] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/17/2015] [Accepted: 09/11/2015] [Indexed: 12/22/2022]
Affiliation(s)
- B. J. Zaffuto
- James P. Wilmot Cancer Center; University of Rochester Medicine; Rochester NY USA
- Department of Medicine; University of Rochester Medicine; Rochester NY USA
| | - G. W. Conley
- Department of Pathology and Laboratory Medicine; University of Rochester Medicine; Rochester NY USA
| | - G. C. Connolly
- James P. Wilmot Cancer Center; University of Rochester Medicine; Rochester NY USA
- Department of Medicine; University of Rochester Medicine; Rochester NY USA
| | - K. F. Henrichs
- Department of Pathology and Laboratory Medicine; University of Rochester Medicine; Rochester NY USA
| | - C. W. Francis
- James P. Wilmot Cancer Center; University of Rochester Medicine; Rochester NY USA
- Department of Medicine; University of Rochester Medicine; Rochester NY USA
| | - J. M. Heal
- James P. Wilmot Cancer Center; University of Rochester Medicine; Rochester NY USA
- Department of Medicine; University of Rochester Medicine; Rochester NY USA
| | - N. Blumberg
- Department of Pathology and Laboratory Medicine; University of Rochester Medicine; Rochester NY USA
| | - M. A. Refaai
- Department of Pathology and Laboratory Medicine; University of Rochester Medicine; Rochester NY USA
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22
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Abdelfattah K, Cripps MW. Thromboelastography and Rotational Thromboelastometry use in trauma. Int J Surg 2015; 33:196-201. [PMID: 26384835 DOI: 10.1016/j.ijsu.2015.09.036] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/21/2015] [Accepted: 09/02/2015] [Indexed: 02/07/2023]
Abstract
The appropriate resuscitation of patients in hemorrhagic shock is critical to improving survival. Current strategies for massive transfusions utilize fixed ratio protocols to rapidly deliver plasma and platelets to the patient. However, there is some concern that these larger volumes of transfusions can lead to untoward effects. Efforts are ongoing to provide patient-specific transfusion therapy in order to avoid excess transfusions. Thromboelastography (TEG) or Rotational Thromboelastometry (ROTEM) are two viscoelastic analyzers capable of providing Viscoelastic testing.
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Affiliation(s)
- Kareem Abdelfattah
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Michael W Cripps
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
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23
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Spitalnik SL, Triulzi D, Devine DV, Dzik WH, Eder AF, Gernsheimer T, Josephson CD, Kor DJ, Luban NLC, Roubinian NH, Mondoro T, Welniak LA, Zou S, Glynn S. 2015 proceedings of the National Heart, Lung, and Blood Institute's State of the Science in Transfusion Medicine symposium. Transfusion 2015; 55:2282-90. [PMID: 26260861 DOI: 10.1111/trf.13250] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 06/30/2015] [Accepted: 06/30/2015] [Indexed: 01/28/2023]
Abstract
On March 25 and 26, 2015, the National Heart, Lung, and Blood Institute sponsored a meeting on the State of the Science in Transfusion Medicine on the National Institutes of Health (NIH) campus in Bethesda, Maryland, which was attended by a diverse group of 330 registrants. The meeting's goal was to identify important research questions that could be answered in the next 5 to 10 years and which would have the potential to transform the clinical practice of transfusion medicine. These questions could be addressed by basic, translational, and/or clinical research studies and were focused on four areas: the three "classical" transfusion products (i.e., red blood cells, platelets, and plasma) and blood donor issues. Before the meeting, four working groups, one for each area, prepared five major questions for discussion along with a list of five to 10 additional questions for consideration. At the meeting itself, all of these questions, and others, were discussed in keynote lectures, small-group breakout sessions, and large-group sessions with open discourse involving all meeting attendees. In addition to the final lists of questions, provided herein, the meeting attendees identified multiple overarching, cross-cutting themes that addressed issues common to all four areas; the latter are also provided. It is anticipated that addressing these scientific priorities, with careful attention to the overarching themes, will inform funding priorities developed by the NIH and provide a solid research platform for transforming the future practice of transfusion medicine.
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Affiliation(s)
- Steven L Spitalnik
- Department of Pathology & Cell Biology, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York
| | - Darrell Triulzi
- Institute for Transfusion Medicine and Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dana V Devine
- Canadian Blood Services and the Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Walter H Dzik
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anne F Eder
- National Headquarters, American Red Cross, Rockville, Maryland
| | - Terry Gernsheimer
- Department of Medicine, University of Washington, Seattle, Washington
| | - Cassandra D Josephson
- Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Daryl J Kor
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Naomi L C Luban
- Division of Laboratory Medicine, Center for Cancer and Blood Disease, Children's National Health System, and the Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Nareg H Roubinian
- Blood Systems Research Institute, and the Department of Laboratory Medicine, University of California, San Francisco, California
| | - Traci Mondoro
- Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Lisbeth A Welniak
- Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Shimian Zou
- Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Simone Glynn
- Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland
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24
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Prophylactic plasma and platelet transfusion in the critically Ill patient: just useless and expensive or even harmful? BMC Anesthesiol 2015; 15:86. [PMID: 26054337 PMCID: PMC4556318 DOI: 10.1186/s12871-015-0074-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/01/2015] [Indexed: 12/14/2022] Open
Abstract
It is still common practice to correct abnormal standard laboratory test results, such as increased INR or low platelet count, prior to invasive interventions, such as tracheostomy, central venous catheter insertion or liver biopsy, in critically ill patients. Data suggest that 30-90 % of plasma transfused for these indications is unnecessary and puts the patient at risk. Plasma transfusion is associated with a high risk of transfusion-associated adverse events such as transfusion-associated circulatory overload (TACO), transfusion-related lung injury (TRALI), transfusion-related immunomodulation (TRIM), and anaphylaxis/allergic reactions. Therefore, the avoidance of inappropriate plasma transfusion bears a high potential of improving patient outcomes. The prospective study by Durila et al., published recently in BMC Anesthesiology, provides evidence that tracheostomies can be performed without prophylactic plasma transfusion and bleeding complications in critically ill patients despite increased INR in case of normal thromboelastometry (ROTEM) results. Thromboelastometry-based restrictive transfusion management helped avoid unnecessary plasma and platelet transfusion, and should reduce the incidence of transfusion-related adverse events and transfusion-associated hospital costs. Therefore, the authors believe that thromboelastometry-based strategies should be implemented to optimize patient blood management in perioperative medicine.
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25
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Novak DJ, Bai Y, Cooke RK, Marques MB, Fontaine MJ, Gottschall JL, Carey PM, Scanlan RM, Fiebig EW, Shulman IA, Nelson JM, Flax S, Duncan V, Daniel-Johnson JA, Callum JL, Holcomb JB, Fox EE, Baraniuk S, Tilley BC, Schreiber MA, Inaba K, Rizoli S, Podbielski JM, Cotton BA, Hess JR. Making thawed universal donor plasma available rapidly for massively bleeding trauma patients: experience from the Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial. Transfusion 2015; 55:1331-9. [PMID: 25823522 PMCID: PMC4469576 DOI: 10.1111/trf.13098] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/21/2014] [Accepted: 11/21/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND The Pragmatic, Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial was a randomized clinical trial comparing survival after transfusion of two different blood component ratios for emergency resuscitation of traumatic massive hemorrhage. Transfusion services supporting the study were expected to provide thawed plasma, platelets, and red blood cells within 10 minutes of request. STUDY DESIGN AND METHODS At the 12 Level 1 trauma centers participating in PROPPR, blood components transfused and delivery times were tabulated, with a focus on universal donor (UD) plasma management. The adequacy of site plans was assessed by comparing the bedside blood availability times to study goals and the new American College of Surgeons guidelines. RESULTS Eleven of 12 sites were able to consistently deliver 6 units of thawed UD plasma to their trauma-receiving unit within 10 minutes and 12 units in 20 minutes. Three sites used blood group A plasma instead of AB for massive transfusion without complications. Approximately 4700 units of plasma were given to the 680 patients enrolled in the trial. No site experienced shortages of AB plasma that limited enrollment. Two of 12 sites reported wastage of thawed AB plasma approaching 25% of AB plasma prepared. CONCLUSION Delivering UD plasma to massively hemorrhaging patients was accomplished consistently and rapidly and without excessive wastage in high-volume trauma centers. The American College of Surgeons Trauma Quality Improvement Program guidelines for massive transfusion protocol UD plasma availability are practicable in large academic trauma centers. Use of group A plasma in trauma resuscitation needs further study.
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Affiliation(s)
- Deborah J. Novak
- Department of Pathology, College of Medicine, University of Arizona
| | - Yu Bai
- Department of Pathology and Laboratory Medicine, Medical School, University of Texas Health Science Center at Houston
| | - Rhonda K. Cooke
- Department of Pathology, School of Medicine, University of Maryland
| | - Marisa B. Marques
- Division of Laboratory Medicine, Department of Pathology, School of Medicine, University of Alabama at Birmingham
| | | | | | - Patricia M. Carey
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati
| | - Richard M. Scanlan
- Division of Laboratory Medicine, Department of Pathology, Oregon Health and Science University
| | - Eberhard W. Fiebig
- Department of Laboratory Medicine, University of California, San Francisco
| | - Ira A. Shulman
- Department of Pathology, Keck School of Medicine, University of Southern California
| | - Janice M. Nelson
- Department of Pathology, Keck School of Medicine, University of Southern California
| | - Sherri Flax
- Clinical Laboratories, Regional Medical Center
| | - Veda Duncan
- Clinical Laboratories, Regional Medical Center
| | | | | | - John B. Holcomb
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston
| | - Erin E. Fox
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston
| | - Sarah Baraniuk
- Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston
| | - Barbara C. Tilley
- Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston
| | - Martin A. Schreiber
- Division of Trauma, Critical Care and Acute Care Surgery, School of Medicine, Oregon Health and Science University
| | - Kenji Inaba
- Division of Trauma and Critical Care, University of Southern California
| | - Sandro Rizoli
- Trauma and Acute Care Surgery, St Michael's Hospital, University of Toronto
| | - Jeanette M. Podbielski
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston
| | - Bryan A. Cotton
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston
| | - John R. Hess
- Department of Laboratory Medicine, University of Washington
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ABO matching of platelet transfusions - "Start Making Sense". "As we get older, and stop making sense…" - The Talking Heads (1984). BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:347-50. [PMID: 25761325 DOI: 10.2450/2015.0001-15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ekelund K, Hanke G, Stensballe J, Wikkelsøe A, Albrechtsen CK, Afshari A. Hemostatic resuscitation in postpartum hemorrhage - a supplement to surgery. Acta Obstet Gynecol Scand 2015; 94:680-692. [PMID: 25660118 DOI: 10.1111/aogs.12607] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 10/14/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND Postpartum hemorrhage is a potentially life-threatening albeit preventable condition that persists as a leading cause of maternal death. Identification of safe and cost-effective hemostatic treatment options remains crucial as a supplement to surgery and uterotonic agents. OBJECTIVE This review summarizes the background, current evidence and recommendations with regard to the role of fibrinogen, tranexamic acid, prothrombin complex concentrate, desmopressin, and recombinant factor VIIa in the treatment of patients with postpartum hemorrhage. The benefits and evidence behind traditional standard laboratory tests and viscoelastic hemostatic assays, i.e. thromboelastography TEG(®) and thromboelastometry ROTEM(®) , are discussed. In addition we assess and elaborate on the current paradigm and evidence for transfusion of these patients. DATA SOURCES Publications between 1994 and 2014 were identified from PubMed, EMBASE, Cochrane Library databases, and ClinicalTrial.gov. RESULTS Viscoelastic hemostatic assays were found to provide a real-time continuum of coagulation and fibrinolysis when introduced as a supplement in transfusion management of postpartum hemorrhage. Fibrinogen should be considered when hypofibrinogenemia is identified. Early administration of 1-2 g tranexamic acid is recommended, followed by an additional dose in cases of ongoing bleeding. Uncontrolled hemorrhage requires early balanced transfusion. CONCLUSION Despite the lack of conclusive evidence for optimal hemostatic resuscitation in postpartum hemorrhage, the use of viscoelastic hemostatic assays, fibrinogen, tranexamic acid and balanced transfusion therapy may prove to be potentially pivotal in the treatment of postpartum hemorrhage.
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Affiliation(s)
- Kim Ekelund
- Department of Anesthesia, Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gabriele Hanke
- Department of Anesthesia, Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Stensballe
- Department of Anesthesia, Center of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anne Wikkelsøe
- Department of Anesthesiology, Copenhagen University Hospital, Herlev Hospital, Herlev, Denmark
| | - Charlotte Krebs Albrechtsen
- Department of Anesthesia, Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Arash Afshari
- Department of Anesthesia, Juliane Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Edgren G, Rostgaard K, Vasan SK, Wikman A, Norda R, Pedersen OB, Erikstrup C, Nielsen KR, Titlestad K, Ullum H, Melbye M, Nyrén O, Hjalgrim H. The new Scandinavian Donations and Transfusions database (SCANDAT2): a blood safety resource with added versatility. Transfusion 2015; 55:1600-6. [DOI: 10.1111/trf.12986] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/01/2014] [Accepted: 11/12/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Gustaf Edgren
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
- Hematology Centre; Karolinska University Hospital; Stockholm Sweden
| | - Klaus Rostgaard
- Department of Epidemiology Research; Statens Serum Institut; Copenhagen Denmark
| | - Senthil K. Vasan
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Agneta Wikman
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | - Rut Norda
- Department of Immunology, Genetics and Pathology; Uppsala University; Uppsala Sweden
| | | | - Christian Erikstrup
- Department of Clinical Immunology; Aarhus University Hospital; Aarhus Denmark
| | - Kaspar René Nielsen
- Department of Clinical Immunology; Aalborg University Hospital; Aalborg Denmark
| | - Kjell Titlestad
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | - Henrik Ullum
- Department of Clinical Immunology; the Blood Bank; Rigshospitalet; University Hospital of Copenhagen; Copenhagen Denmark
| | - Mads Melbye
- Department of Epidemiology Research; Statens Serum Institut; Copenhagen Denmark
- Department of Clinical Medicine; Copenhagen University; Copenhagen Denmark
- Department of Medicine; Stanford School of Medicine; Stanford California
| | - Olof Nyrén
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Henrik Hjalgrim
- Department of Epidemiology Research; Statens Serum Institut; Copenhagen Denmark
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Holbro A, Stern M, Infanti L, O'Meara A, Drexler B, Frey BM, Tiercy JM, Passweg JR, Gassner C, Buser A, Sigle JP. Impact of recipient ABH secretor status on outcome in minor ABO-incompatible hematopoietic stem cell transplantation. Transfusion 2015; 55:64-9. [PMID: 24990435 DOI: 10.1111/trf.12768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/19/2014] [Accepted: 05/22/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The impact of ABO incompatibility on hematopoietic stem cell transplantation (HSCT) outcome is controversial. As ABH substances are expressed on tissues and secreted in body fluids, they could drive an immune response in minor ABO-incompatible HSCT. The aim of the study was to investigate the prognostic role of the recipients' ABH secretor status. STUDY DESIGN AND METHODS Patients who underwent minor ABO-incompatible HSCT were included. Secretor status was determined either serologically or by molecular genetics. RESULTS Between March 1996 and June 2012, a total of 176 patients received minor ABO-incompatible HSCT and 150 (85%) were secretors. Incidence and severity of acute graft-versus-host disease (GVHD) and chronic GVHD did not differ between secretors and nonsecretors (cumulative incidences ± standard errors: acute GVHD on Day 100, 41 ± 11 and 46 ± 5%, p = 0.59; chronic GVHD at 2 years, 52 ± 13 and 56 ± 5%, p = 0.62, for secretors and nonsecretors, respectively). Additionally, nonrelapse mortality (NRM) and overall survival (OS) were similar in the two groups (2-year NRM, 27 ± 9 and 23 ± 3%, p = 0.45; 4-year OS, 64 ± 10 and 55 ± 4%, p = 0.28, for secretors and nonsecretors, respectively). CONCLUSION The recipients' ABH secretor status in minor ABO-incompatible HSCT has no prognostic impact on major transplant outcomes.
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Affiliation(s)
- Andreas Holbro
- Division of Hematology, University Hospital, Basel, Switzerland; Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland
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Cooling L. Going from A to B: the safety of incompatible group A plasma for emergency release in trauma and massive transfusion patients. Transfusion 2014; 54:1695-7. [PMID: 25041147 DOI: 10.1111/trf.12730] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Laura Cooling
- Department of Pathology, University of Michigan, Ann Arbor, MI.
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Da Luz LT, Nascimento B, Shankarakutty AK, Rizoli S, Adhikari NK. Effect of thromboelastography (TEG®) and rotational thromboelastometry (ROTEM®) on diagnosis of coagulopathy, transfusion guidance and mortality in trauma: descriptive systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:518. [PMID: 25261079 PMCID: PMC4206701 DOI: 10.1186/s13054-014-0518-9] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 08/29/2014] [Indexed: 11/26/2022]
Abstract
Introduction The understanding of coagulopathies in trauma has increased interest in thromboelastography (TEG®) and thromboelastometry (ROTEM®), which promptly evaluate the entire clotting process and may guide blood product therapy. Our objective was to review the evidence for their role in diagnosing early coagulopathies, guiding blood transfusion, and reducing mortality in injured patients. Methods We considered observational studies and randomized controlled trials (MEDLINE, EMBASE, and Cochrane databases) to February 2014 that examined TEG®/ROTEM® in adult trauma patients. We extracted data on demographics, diagnosis of early coagulopathies, blood transfusion, and mortality. We assessed methodologic quality by using the Newcastle-Ottawa scale (NOS) for observational studies and QUADAS-2 tool for diagnostic accuracy studies. Results Fifty-five studies (12,489 patients) met inclusion criteria, including 38 prospective cohort studies, 15 retrospective cohort studies, two before-after studies, and no randomized trials. Methodologic quality was moderate (mean NOS score, 6.07; standard deviation, 0.49). With QUADAS-2, only three of 47 studies (6.4%) had a low risk of bias in all domains (patient selection, index test, reference standard and flow and timing); 37 of 47 studies (78.8%) had low concerns regarding applicability. Studies investigated TEG®/ROTEM® for diagnosis of early coagulopathies (n = 40) or for associations with blood-product transfusion (n = 25) or mortality (n = 24). Most (n = 52) were single-center studies. Techniques examined included rapid TEG® (n =12), ROTEM® (n = 18), TEG® (n = 23), or both TEG® and rapid TEG® (n = 2). Many TEG®/ROTEM® measurements were associated with early coagulopathies, including some (hypercoagulability, hyperfibrinolysis, platelet dysfunction) not assessed by routine screening coagulation tests. Standard measures of diagnostic accuracy were inconsistently reported. Many abnormalities predicted the need for massive transfusion and death, but predictive performance was not consistently superior to routine tests. One observational study suggested that a ROTEM®-based transfusion algorithm reduced blood-product transfusion, but TEG®/ROTEM®-based resuscitation was not associated with lower mortality in most studies. Conclusions Limited evidence from observational data suggest that TEG®/ROTEM® tests diagnose early trauma coagulopathy and may predict blood-product transfusion and mortality in trauma. Effects on blood-product transfusion, mortality, and other patient-important outcomes remain unproven in randomized trials. Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0518-9) contains supplementary material, which is available to authorized users.
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Görlinger K, Shore-Lesserson L, Dirkmann D, Hanke AA, Rahe-Meyer N, Tanaka KA. Management of hemorrhage in cardiothoracic surgery. J Cardiothorac Vasc Anesth 2014; 27:S20-34. [PMID: 23910533 DOI: 10.1053/j.jvca.2013.05.014] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Bleeding is an important issue in cardiothoracic surgery, and about 20% of all blood products are transfused in this clinical setting worldwide. Transfusion practices, however, are highly variable among different hospitals and more than 25% of allogeneic blood transfusions have been considered inappropriate. Furthermore, both bleeding and allogeneic blood transfusion are associated with increased morbidity, mortality, and hospital costs. In the past decades, several attempts have been made to find a universal hemostatic agent to ensure hemostasis during and after cardiothoracic surgery. Most drugs studied in this context have either failed to reduce bleeding and transfusion requirements or were associated with severe adverse events, such as acute renal failure or thrombotic/thromboembolic events and, in some cases, increased mortality. Therefore, an individualized goal-directed hemostatic therapy ("theranostic" approach) seems to be more appropriate to stop bleeding in this complex clinical setting. The use of point-of-care (POC) transfusion and coagulation management algorithms guided by viscoelastic tests such as thromboelastometry/thromboelastography in combination with POC platelet function tests such as whole blood impedance aggregometry, and based on first-line therapy with fibrinogen and prothrombin complex concentrate have been associated with reduced allogeneic blood transfusion requirements, reduced incidence of thrombotic/thromboembolic and transfusion-related adverse events, and improved outcomes in cardiac surgery. This article reviews the current literature dealing with the management of hemorrhage in cardiothoracic surgery based on POC diagnostics and with specific coagulation factor concentrates and its impact on transfusion requirements and patients' outcomes.
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Affiliation(s)
- Klaus Görlinger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
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Chhibber V, Greene M, Vauthrin M, Bailey J, Weinstein R. Is group A thawed plasma suitable as the first option for emergency release transfusion? (CME). Transfusion 2014; 54:1751-5; quiz 1750. [DOI: 10.1111/trf.12537] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/12/2013] [Accepted: 11/18/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Vishesh Chhibber
- Division of Transfusion Medicine; UMass Memorial Medical Center; Worcester Massachusetts
- Department of Medicine; UMass Memorial Medical Center; Worcester Massachusetts
- Department of Pathology; UMass Memorial Medical Center; Worcester Massachusetts
- Transfusion Medicine Service; UMass Memorial Medical Center; Worcester Massachusetts
- University of Massachusetts Medical School; Worcester Massachusetts
| | - Mindy Greene
- Transfusion Medicine Service; UMass Memorial Medical Center; Worcester Massachusetts
| | - Michelle Vauthrin
- Transfusion Medicine Service; UMass Memorial Medical Center; Worcester Massachusetts
| | - Jeff Bailey
- Division of Transfusion Medicine; UMass Memorial Medical Center; Worcester Massachusetts
- Department of Medicine; UMass Memorial Medical Center; Worcester Massachusetts
- Transfusion Medicine Service; UMass Memorial Medical Center; Worcester Massachusetts
- University of Massachusetts Medical School; Worcester Massachusetts
| | - Robert Weinstein
- Division of Transfusion Medicine; UMass Memorial Medical Center; Worcester Massachusetts
- Department of Medicine; UMass Memorial Medical Center; Worcester Massachusetts
- Department of Pathology; UMass Memorial Medical Center; Worcester Massachusetts
- Transfusion Medicine Service; UMass Memorial Medical Center; Worcester Massachusetts
- University of Massachusetts Medical School; Worcester Massachusetts
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Kleinman S, Busch MP, Murphy EL, Shan H, Ness P, Glynn SA. The National Heart, Lung, and Blood Institute Recipient Epidemiology and Donor Evaluation Study (REDS-III): a research program striving to improve blood donor and transfusion recipient outcomes. Transfusion 2013; 54:942-55. [PMID: 24188564 DOI: 10.1111/trf.12468] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/11/2013] [Accepted: 09/11/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) is a 7-year multicenter transfusion safety research initiative launched in 2011 by the National Heart, Lung, and Blood Institute. STUDY DESIGN AND METHODS The domestic component involves four blood centers, 12 hospitals, a data coordinating center, and a central laboratory. The international component consists of distinct programs in Brazil, China, and South Africa, which involve US and in-country investigators. RESULTS REDS-III is using two major methods to address key research priorities in blood banking and transfusion medicine. First, there will be numerous analyses of large "core" databases; the international programs have each constructed a donor and donation database while the domestic program has established a detailed research database that links data from blood donors and their donations, the components made from these donations, and data extracts from the electronic medical records of the recipients of these components. Second, there are more than 25 focused research protocols involving transfusion recipients, blood donors, or both that either are in progress or are scheduled to begin within the next 3 years. Areas of study include transfusion epidemiology and blood utilization, transfusion outcomes, noninfectious transfusion risks, human immunodeficiency virus-related safety issues (particularly in the international programs), emerging infectious agents, blood component quality, donor health and safety, and other donor issues. CONCLUSIONS It is intended that REDS-III serve as an impetus for more widespread recipient and linked donor-recipient research in the United States as well as to help assure a safe and available blood supply in the United States and in international locations.
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Affiliation(s)
- Steven Kleinman
- Department of Pathology, University of British Columbia, Victoria, British Columbia, Canada
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Dirkmann D, Burggraf M, Brendt P, Hußmann B, Peters J, Lendemans S. Kontroversen im Gerinnungsmanagement. Notf Rett Med 2013. [DOI: 10.1007/s10049-013-1713-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Case scenario: management of trauma-induced coagulopathy in a severe blunt trauma patient. Anesthesiology 2013; 119:191-200. [PMID: 23514719 DOI: 10.1097/aln.0b013e31828fc627] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cid J, Harm SK, Yazer MH. Platelet transfusion - the art and science of compromise. Transfus Med Hemother 2013; 40:160-71. [PMID: 23922541 PMCID: PMC3725020 DOI: 10.1159/000351230] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 02/26/2013] [Indexed: 11/19/2022] Open
Abstract
SUMMARY Many modern therapies depend on platelet (PLT) transfusion support. PLTs have a 4- to 7-day shelf life and are frequently in short supply. In order to optimize the inventory PLTs are often transfused to adults without regard for ABO compatibility. Hemolytic reactions are infrequent despite the presence of 'high titer' anti-A and anti-B antibodies in some of the units. Despite the low risk for hemolysis, some centers provide only ABO identical PLTs to their recipients; this practice might have other beneficial outcomes that remain to be proven. Strategies to mitigate the risk of hemolysis and the clinical and laboratory outcomes following ABO-matched and mismatched transfusions will be discussed. Although the PLTs themselves do not carry the D antigen, a small number of RBCs are also transfused with every PLT dose. The quantity of RBCs varies by the type of PLT preparation, and even a small quantity of D+ RBCs can alloimmunize a susceptible D- host. Thus PLT units are labeled as D+/-, and most transfusion services try to prevent the transfusion of D+ PLTs to D- females of childbearing age. A similar policy for patients with hematological diseases is controversial, and the elements and mechanisms of anti-D alloimmunization will be discussed.
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Affiliation(s)
- Joan Cid
- Apheresis Unit, Department of Hemotherapy-Hemostasis, CDB, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Sarah K. Harm
- Department of Pathology, University of Pittsburgh, PA, USA
| | - Mark H. Yazer
- Department of Pathology, University of Pittsburgh, PA, USA
- The Institute for Transfusion Medicine, Pittsburgh, PA, USA
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Yazer M, Eder AF, Land KJ. How we manage AB plasma inventory in the blood center and transfusion service. Transfusion 2013; 53:1627-33. [PMID: 23614505 DOI: 10.1111/trf.12223] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/12/2013] [Accepted: 03/20/2013] [Indexed: 11/28/2022]
Abstract
The growing use of group AB plasma in the United States in recent years poses unique challenges to blood centers and transfusion services. Blood centers must collect sufficient plasma components from a limited pool of group AB donors while taking steps to improve transfusion safety that further restricts the available supply. Transfusion services, on the other hand, must use the finite resource in the most conscientious and medically appropriate manner. Recently, many investigations have challenged long-held beliefs about transfusion practice and appropriate indications for blood components across a variety of specialties. Balancing supply and demand of group AB plasma requires collaboration between blood suppliers and transfusion services, and opportunities for improvement exist on both sides of the equation.
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Affiliation(s)
- Mark Yazer
- Department of Pathology, University of Pittsburgh and The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania, USA
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Grottke O, Frietsch T, Maas M, Lier H, Rossaint R. [Dealing with massive bleeding and associated perioperative coagulopathy: recommendations for action of the German Society of Anaesthesiology and Intensive Care Medicine]. Anaesthesist 2013; 62:213-16, 218-20, 222-4. [PMID: 23407716 DOI: 10.1007/s00101-012-2136-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Massive bleeding with coagulopathy and hemorrhagic shock poses a potential threat to life in numerous clinical settings. Optimal treatment including the prevention of exsanguination necessitates a standardized and interdisciplinary approach. Several studies have shown the importance of massive transfusion protocols and standardized coagulation algorithms to improve survival of severely bleeding patients and to avoid secondary complications. Thus, the Helsinki declaration for patient safety in anesthesiology demands the implementation of clinical practice guidelines for the treatment of patients requiring massive transfusion. This paper introduces a standardized algorithm for the treatment of patients with massive bleeding which was developed in consensus with the German Society of Anaesthesiology and Intensive Care Medicine (DGAI).
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Affiliation(s)
- O Grottke
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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Görlinger K, Bergmann L, Dirkmann D. Coagulation management in patients undergoing mechanical circulatory support. Best Pract Res Clin Anaesthesiol 2013; 26:179-98. [PMID: 22910089 DOI: 10.1016/j.bpa.2012.04.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 03/25/2012] [Accepted: 04/20/2012] [Indexed: 12/28/2022]
Abstract
The incidence of bleeding and thrombo-embolic complications in patients undergoing mechanical circulatory support therapy remains high and is associated with bad outcomes and increased costs. The need for anticoagulation and anti-platelet therapy varies widely between different pulsatile and non-pulsatile ventricular-assist devices (VADs) and extracorporeal membrane oxygenation (ECMO) systems. Therefore, a unique anticoagulation protocol cannot be recommended. Notably, most thrombo-embolic complications occur despite values of conventional coagulation tests being within the targeted range. This is due to the fact that conventional coagulation tests such as international normalised ratio (INR), activated partial thromboplastin time (aPTT) and platelet count cannot detect hyper- or hypofibrinolysis, hypercoagulability due to tissue factor expression on circulating cells or increased clot firmness, and platelet aggregation as well as response to anti-platelet drugs. By contrast, point-of-care (POC) whole blood viscoelastic tests (thromboelastometry/-graphy) and platelet function tests (impedance or turbidimetric aggregometry) reflect in detail the haemostatic status of patients undergoing mechanical circulatory support therapy and the efficacy of their anticoagulation and antiaggregation therapy. Therefore, monitoring of haemostasis using POC thromboelastometry/-graphy and platelet function analysis is recommended during mechanical circulatory support therapy to reduce the risk of bleeding and thrombo-embolic complications. Notably, these haemostatic tests should be performed repeatedly during mechanical circulatory support therapy since thrombin generation, clot firmness and platelet response may change significantly over time with a high inter- and intra-individual variability. Furthermore, coagulation management can be hampered in non-pulsatile VADs by acquired von Willebrand syndrome, and in general by acquired factor XIII deficiency as well as by heparin-induced thrombocytopenia. In addition, POC testing can be used in bleeding patients to guide calculated goal-directed therapy with allogeneic blood products, haemostatic drugs and coagulation factor concentrates to optimise the haemostasis and to minimise transfusion requirements, transfusion-associated adverse events and to avoid thrombo-embolic complications, as well. However, coagulation management in patients undergoing mechanical circulatory support therapy is somehow like navigating between Scylla and Charybdis, and development of protocols based on POC testing seems to be beneficial.
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Affiliation(s)
- Klaus Görlinger
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinkum Essen, Universität Duisburg-Essen, Hufelandstrasse 55, D-45122 Essen, Germany.
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Abstract
<b><i>Hintergrund: </i></b>Das Gerinnungsmanagement in der postoperativen Phase stellt eine komplexe Herausforderung dar. Einerseits führt eine bereits präoperativ vorbestehende oder intraoperativ erworbene Beeinträchtigung der Blutgerinnung zu einem erhöhten Risiko für Nachblutungen. Andererseits sind Patienten in der postoperativen Phase einem erhöhten Risiko für thromboembolische Komplikationen ausgesetzt. Zudem drängen vermehrt neue orale Antikoagulanzien und Thrombozytenaggregationshemmer auf den Markt, für deren perioperativen Einsatz noch wenig Erfahrung besteht. <b><i>Methode: </i></b>Literaturübersicht. <b><i>Ergebnisse: </i></b>Das postoperative Gerinnungsmanagement sollte individualisiert nach einer Diagnostik mit klassischen Gerinnungstests und Point-of-Care(POC)-Diagnoseverfahren erfolgen. Verglichen mit dem intraoperativen Gerinnungsmanagement bestehen Unterschiede. <b><i>Schlussfolgerungen: </i></b>Das Ziel des postoperativen Gerinnungsmanagements ist eine Gerinnungsaktivität, die eine suffiziente Wundheilung zulässt, ohne thromboembolische Ereignisse zu begünstigen. Im Falle einer postoperativen Blutung sollte zur Diagnostik neben den klassischen Gerinnungstests auf viskoelastische POC-Verfahren zurückgegriffen werden. Neben der bedarfsadaptierten Substitution von Gerinnungsfaktoren ist die Aufrechterhaltung der Rahmenbedingungen der Gerinnung von entscheidender Bedeutung (Normothermie, physiologischer pH-Wert, Normokalziämie). Die Fortführung einer bestehenden Antikoagulation mit neuen oralen Antikoagulanzien ist eine Einzelfallentscheidung. Für ihren perioperativen Einsatz gib es noch keine Leitlinien.
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Schneider T. Plasmas thérapeutiques. Transfus Clin Biol 2012; 19:148-9. [DOI: 10.1016/j.tracli.2012.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 07/06/2012] [Indexed: 11/15/2022]
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Maréchal I, Volle P, Girault C, Hervé I. Incompatibilité transfusionnelle sur transfusion de plasmas compatibles ABO non isogroupes. Transfus Clin Biol 2012. [DOI: 10.1016/j.tracli.2012.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Plasma utilization has increased over the past two decades, and there is a growing concern that many plasma transfusions are inappropriate. Plasma transfusion is not without risk, and certain complications are more likely with plasma than other blood components. Clinical and laboratory investigations of the patients suffering reactions after infusion of fresh-frozen plasma (FFP) define the etiology and pathogenesis of the panoply of adverse effects. We review here the pathogenesis, diagnosis, and management of the risks associated with plasma transfusion. Risks commonly associated with FFP include: 1) transfusion-related acute lung injury, 2) transfusion-associated circulatory overload, and 3) allergic and/or anaphylactic reactions. Other less common risks include 1) transmission of infections, 2) febrile nonhemolytic transfusion reactions, 3) red blood cell alloimmunization, and 4) hemolytic transfusion reactions. The effects of pathogen inactivation or reduction methods on these risks are also discussed. Fortunately, a majority of the adverse effects are not lethal and are adequately treated in clinical practice.
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Affiliation(s)
- Suchitra Pandey
- Department of Laboratory Medicine, University of California, San Francisco, California 94143, USA
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Refaai MA, Carter J, Henrichs KF, Davidson DC, Pollock SJ, Casey AE, Spinelli SL, Phipps RP, Francis CW, Blumberg N. Alterations of platelet function and clot formation kinetics after in vitro exposure to anti-A and -B. Transfusion 2012; 53:382-93. [PMID: 22624532 DOI: 10.1111/j.1537-2995.2012.03718.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND ABO-mismatched platelets (PLTs) are commonly transfused despite reported complications. We hypothesized that because PLTs possess A and B antigens on their surface, ABO-mismatched transfused or recipient PLTs could become activated and/or dysfunctional after exposure to anti-A or -B in the transfused or recipient plasma. We present here in vitro modeling data on the functional effects of exposure of PLTs to ABO antibodies. STUDY DESIGN AND METHODS PLT functions of normal PLTs of all ABO types were assessed before and after incubation with normal saline, ABO-identical plasma samples, or O plasma samples with varying titers of anti-A and anti-B (anti-A/B). Assays used for this assessment include PLT aggregation, clot kinetics, thrombin generation, PLT cytoskeletal function, and mediator release. RESULTS Exposure of antigen-bearing PLTs to O plasma with moderate to high titers of anti-A/B significantly inhibits aggregation, prolongs PFA-100 epinephrine closure time, disrupts clot formation kinetics, accelerates thrombin generation, reduces total thrombin production, alters PLT cytoskeletal function, and influences proinflammatory and prothrombotic mediator release. CONCLUSIONS Our findings demonstrate a wide range of effects that anti-A/B have on PLT function, clot formation, thrombin generation, PLT cytoskeletal function, and mediator release. These data provide potential explanations for clinical observations of increased red blood cell utilization in trauma and surgical patients receiving ABO-nonidentical blood products. Impaired hemostasis caused by anti-A/B interacting with A and B antigens on PLTs, soluble proteins, and perhaps even endothelial cells is a potential contributing factor to hemorrhage in patients receiving larger volumes of ABO-nonidentical transfusions.
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Affiliation(s)
- Majed A Refaai
- Department of Pathology and Laboratory Medicine, the James P. Wilmot Cancer Center, University of Rochester, Rochester, New York 14642, USA.
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Görlinger K, Fries D, Dirkmann D, Weber CF, Hanke AA, Schöchl H. Reduction of Fresh Frozen Plasma Requirements by Perioperative Point-of-Care Coagulation Management with Early Calculated Goal-Directed Therapy. ACTA ACUST UNITED AC 2012; 39:104-113. [PMID: 22670128 DOI: 10.1159/000337186] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 08/02/2011] [Indexed: 01/28/2023]
Abstract
BACKGROUND: Massive bleeding and transfusion of packed red blood cells (PRBC), fresh frozen plasma (FFP) and platelets are associated with increased morbidity, mortality and costs. PATIENTS AND METHODS: We analysed the transfusion requirements after implementation of point-of-care (POC) coagulation management algorithms based on early, calculated, goal-directed therapy with fibrinogen concentrate and prothrombin complex concentrate (PCC) in different perioperative settings (trauma surgery, visceral and transplant surgery (VTS), cardiovascular surgery (CVS) and general and surgical intensive care medicine) at 3 different hospitals (AUVA Trauma Centre Salzburg, University Hospital Innsbruck and University Hospital Essen) in 2 different countries (Austria and Germany). RESULTS: In all institutions, the implementation of POC coagulation management algorithms was associated with a reduction in the transfusion requirements for FFP by about 90% (Salzburg 94%, Innsbruck 88% and Essen 93%). Furthermore, PRBC transfusion was reduced by 8.4-62%. The incidence of intraoperative massive transfusion (≥10 U PRBC) could be more than halved in VTS and CVS (2.56 vs. 0.88%; p < 0.0001 and 2.50 vs. 1.06%; p = 0.0007, respectively). Platelet transfusion could be reduced by 21-72%, except in CVS where it increased by 115% due to a 5-fold increase in patients with dual antiplatelet therapy (2.7 vs. 13.7%; p < 0.0001). CONCLUSIONS: The implementation of perioperative POC coagulation management algorithms based on early, calculated, goal-directed therapy with fibrinogen concentrate and PCC is associated with a reduction in the transfusion requirements for FFP, PRBC and platelets as well as with a reduced incidence of massive transfusion. Thus, the limited blood resources can be used more efficiently.
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Affiliation(s)
- Klaus Görlinger
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Germany
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Henrichs KF, Howk N, Masel DS, Thayer M, Refaai MA, Kirkley SA, Heal JM, Blumberg N. Providing ABO-identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence. Transfusion 2012; 52:635-40. [PMID: 21895675 PMCID: PMC3235249 DOI: 10.1111/j.1537-2995.2011.03329.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are multiple benefits to transfusing only ABO-identical blood components. Historically our institution routinely transfused ABO-nonidentical platelets (PLTs) and cryoprecipitate to surgical patients. In April 2005, we implemented a policy of transfusing only ABO-identical components whenever feasible, regardless of outdating or logistic considerations. STUDY DESIGN AND METHODS Technical staff closely monitored product usage and adjusted blood center orders based on recent utilization and planned transfusions. When unable to provide ABO-identical PLTs, ABO-compatible PLTs were washed to remove incompatible plasma. Data on outdating were collected for 18 months before and after implementation. We compared transfusion reaction and red blood cell (RBC) alloimmunization incidence for 4 years preceding (2001-2004) and subsequent (2006-2009) to implementation. RESULTS In the year after implementation, only 11 of 410 surgical patients received ABO-nonidentical PLTs (2.7%). There was a 5.6% increase in outdating of PLTs. Transfusing ABO-identical components was associated with significant reductions in febrile (-46%; 8.0 to 4.3 per 10,000 components; p < 0.0001) and allergic transfusion reactions (-23%; from 7.0 to 5.4 per 10,000 components; p = 0.025). A progressive reduction in de novo RBC alloimmunization incidence also occurred (-50% by 2009; p = 0.03). CONCLUSIONS Providing ABO-identical PLTs to almost all patients was feasible in our setting by changing ordering and inventorying procedures and making the ABO-identical policy a staff priority. Unexpected and striking reductions in febrile and allergic reactions and RBC alloimmunization were observed, of uncertain causal relationship to this ABO policy change, which will require further study.
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Affiliation(s)
- Kelly F Henrichs
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA
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Taraldsrud E, Kjollesdal KS, Pripp AH, Solheim BG. ABO identical versus ABO compatible plasma transfusions. Vox Sang 2012; 103:177-8. [DOI: 10.1111/j.1423-0410.2012.01592.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Impact of the duration of platelet storage in critically ill trauma patients. ACTA ACUST UNITED AC 2012; 71:1766-73; discussion 1773-4. [PMID: 22182887 DOI: 10.1097/ta.0b013e31823bdbf9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is increasing evidence that the duration of red blood cell (RBC) storage negatively impacts outcomes. Data regarding prolonged storage of other blood components, however, are lacking. The aim of this study was to evaluate how the duration of platelet storage affects trauma patient outcomes. METHODS Trauma patients admitted to a Level I trauma center requiring platelet transfusion (2006-2009) were retrospectively identified. Apheresis platelets (aPLT) containing ≥3 × 10(11) platelets/unit were used exclusively. Patients were analyzed in three groups: those who received only aPLT stored for ≤3 days, 4 days, and 5 days. The outcomes included mortality and complications (sepsis, acute respiratory distress syndrome, renal, and liver failure). RESULTS Three hundred eighty-one patients were available for analysis (128 received aPLT ≤3 days old; 109 = 4 days old; and 144 = 5 days old). There were no significant demographic differences between groups. Patients receiving aPLT aged = 4 days had significantly higher Injury Severity Score (p = 0.022) and were more likely to have a head Abbreviated Injury Scale ≥3 (p = 0.014). There were no differences in volumes transfused or age of RBC, plasma, cryoprecipitate, or factor VIIa. After adjusting for confounders, exposure to older aPLT did not impact mortality; however, with increasing age, complications were significantly higher. The rate of sepsis, in particular, was significantly increased (5.5% for aPLT ≤3 days vs. 9.2% for aPLT = 4 days vs. 16.7% for aPLT = 5 days, adjusted p = 0.033). For acute respiratory distress syndrome and renal and liver failure, similar trends were observed. CONCLUSIONS In critically ill trauma patients, there was a stepwise increase in complications, in particular sepsis, with exposure to progressively older platelets. Further evaluation of the underlying mechanism and methods for minimizing exposure to older platelets is warranted.
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