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Klein M, Hassan L, Katz R, Abuhasira R, Boyko M, Gabay O, Frank D, Binyamin Y, Novack V, Frenkel A. Challenging the Interpretation of White Blood Cell Counts in Patients with Sepsis Following Packed Cell Transfusion. J Clin Med 2023; 12:3912. [PMID: 37373614 DOI: 10.3390/jcm12123912] [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: 04/25/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Critically ill patients with sepsis often require packed cell transfusions (PCT). However, PCT may affect white blood cell (WBC) counts. We conducted a population-based retrospective cohort study to trace changes in WBC count following PCT in critically ill patients with sepsis. We included 962 patients who received one unit of PCT while hospitalized in a general intensive care unit, and 994 matched patients who did not receive PCT. We calculated the mean values of WBC count for the 24 h before and 24 h after PCT. Multivariable analyses using a mixed linear regression model were performed. The mean WBC count decreased in both groups, but more in the non-PCT group (from 13.9 × 109/L to 12.2 × 109/L versus 13.9 × 109/L to 12.8 × 109/L). A linear regression model showed a mean decrease of 0.45 × 109/L in WBC count over the 24 h following the start of PCT. Every 1.0 × 109/L increase in the WBC count prior to PCT administration showed a corresponding decrease of 0.19 × 109/L in the final WBC count. In conclusion, among critically ill patients with sepsis, PCT causes only mild and clinically non-prominent changes in WBC count.
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Affiliation(s)
- Moti Klein
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Lior Hassan
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
- Clinical Research Center, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Rivka Katz
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Ran Abuhasira
- Clinical Research Center, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Matthew Boyko
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Ohad Gabay
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Dmitry Frank
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
- Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
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Klein M, Hassan L, Binyamin Y, Frank D, Boyko M, Zlotnik A, Raab T, Novack V, Frenkel A. BODY TEMPERATURE VARIATION AFTER PACKED CELL TRANSFUSION IN ADULT PATIENTS WITH SEPSIS-WHERE WILL THE PENDULUM STOP? Shock 2023; 59:877-881. [PMID: 37119807 DOI: 10.1097/shk.0000000000002129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
ABSTRACT Background : Critically ill patients with sepsis often require packed cell transfusions (PCTs). Packed cell transfusion causes changes in body's core temperature. Objective : To trace the course and amplitude of body core temperature after PCT in adults with sepsis. Methods : We conducted a population-based retrospective cohort study of patients with sepsis who received one unit of PCT during their hospitalization in a general intensive care unit during 2000-2019. A control group was established by matching each of these patients to a patient who did not receive PCT. We calculated the mean values of urinary bladder temperature for the 24 h before and 24 h after PCT. To evaluate the effect of PCT on body core temperature, multivariable analyses using a mixed linear regression model were performed. Results : The study comprised 1,100 patients who received one unit of PCT and 1,100 matched patients. The mean temperature before PCT was 37.3°C. Immediately from initiation of PCT, body temperature decreased, to a minimum of 37.0°C. During the 24 subsequent hours, the temperature increased gradually and consistently, until a peak temperature of 37.4°C. In a linear regression model, body core temperature increased by a mean 0.06°C in the first 24 h after PCT and decreased by a mean 0.65°C for every 1.0°C increase before PCT. Conclusions : Among critically ill patients with sepsis, PCT itself causes only mild and clinically insignificant temperature changes. Thus, significant changes in core temperature during the 24 h after PCT may indicate an unusual clinical event that requires clinicians' immediate attention.
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Affiliation(s)
- Moti Klein
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dmitry Frank
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Matthew Boyko
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tehila Raab
- Department of Internal Medicine, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Shih AW, Liu A, Elsharawi R, Crowther MA, Cook RJ, Heddle NM. Systematic reviews of guidelines and studies for single versus multiple unit transfusion strategies. Transfusion 2018; 58:2841-2860. [DOI: 10.1111/trf.14952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Andrew W. Shih
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver British Columbia Canada
- Department of Pathology, Vancouver Coastal Health Authority; Vancouver British Columbia Canada
| | - Aixin Liu
- Department of Medicine; Queens University; Kingston Ontario Canada
| | - Radwa Elsharawi
- Department of Medicine, School of Medicine; Wayne State University; Detroit Michigan
| | - Mark A. Crowther
- Department of Medicine; McMaster University; Hamilton Ontario Canada
| | - Richard J. Cook
- Department of Health Research, Methods and Impact; McMaster University; Hamilton Ontario Canada
- McMaster Centre for Transfusion Research; McMaster University; Hamilton Ontario Canada
| | - Nancy M. Heddle
- Department of Medicine; McMaster University; Hamilton Ontario Canada
- McMaster Centre for Transfusion Research; McMaster University; Hamilton Ontario Canada
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Warkiani ME, Wu L, Tay AKP, Han J. Large-Volume Microfluidic Cell Sorting for Biomedical Applications. Annu Rev Biomed Eng 2015; 17:1-34. [DOI: 10.1146/annurev-bioeng-071114-040818] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Majid Ebrahimi Warkiani
- BioSystems and Micromechanics IRG, Singapore–MIT Alliance for Research and Technology (SMART) Centre, Singapore 138602;
- School of Mechanical and Manufacturing Engineering, Australian Centre for NanoMedicine, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Lidan Wu
- Department of Biological Engineering and
| | - Andy Kah Ping Tay
- BioSystems and Micromechanics IRG, Singapore–MIT Alliance for Research and Technology (SMART) Centre, Singapore 138602;
| | - Jongyoon Han
- BioSystems and Micromechanics IRG, Singapore–MIT Alliance for Research and Technology (SMART) Centre, Singapore 138602;
- Department of Biological Engineering and
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
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Abstract
Coagulopathy is a potential problem for many critically ill patients, placing them at risk for hemorrhage. Critical illness activates both hemostasis and the inflammatory-immune system, leading to both physiological and potentially pathophysiological responses. Following complex surgery or trauma, patients are at high risk for development of problems such as thrombocytopenia and postoperative bleeding, challenging nurses to recognize and manage these problems. The clinical manifestations of coagulopathy may be obvious or occult, and correlation with the coagulation panel results is a complex process. Transfusion of blood and components has long been an important part of patient management, but is known to put patients at risk for transfusion-related complications. Current clinical practice guidelines provide blood conservation strategies and criteria to guide decisions on transfusion therapy.
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Affiliation(s)
- Diane K Dressler
- Marquette University, College of Nursing, Milwaukee, WI 53201-1881, USA.
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Munro CL, Savel RH. Advancing critical care through interdisciplinary research. Am J Crit Care 2012; 21:5-7. [PMID: 22210692 DOI: 10.4037/ajcc2012198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Cindy L. Munro
- Cindy L. Munro is the nurse coeditor of the American Journal of Critical Care. She is associate dean for research and innovation at the University of South Florida, College of Nursing, Tampa, Florida. Richard H. Savel is the physician coeditor of the American Journal of Critical Care. He is the medical co-director of the surgical intensive care unit at Montefiore Medical Center and an associate professor of clinical medicine and neurology at the Albert Einstein College of Medicine, both in New York City
| | - Richard H. Savel
- Cindy L. Munro is the nurse coeditor of the American Journal of Critical Care. She is associate dean for research and innovation at the University of South Florida, College of Nursing, Tampa, Florida. Richard H. Savel is the physician coeditor of the American Journal of Critical Care. He is the medical co-director of the surgical intensive care unit at Montefiore Medical Center and an associate professor of clinical medicine and neurology at the Albert Einstein College of Medicine, both in New York City
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