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Spector J, Kennedy A, Nedelcu E. BBDash: An Electron-based tool for analyzing blood product utilization. J Pathol Inform 2024; 15:100370. [PMID: 38524917 PMCID: PMC10959693 DOI: 10.1016/j.jpi.2024.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/02/2024] [Accepted: 02/17/2024] [Indexed: 03/26/2024] Open
Abstract
Blood transfusions can be associated with side effects ranging from occasional febrile reactions to extremely rare fatal reactions. Monitoring blood product orders and ensuring appropriate utilization is therefore an important strategy to ensure patient safety. However, data extracted from laboratory information systems can be difficult to interpret. We created BBDash, an Electron-based tool that reads Sunquest reports to create easy-to-interpret graphs related to blood product utilization.
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Affiliation(s)
- Jacob Spector
- Boston Children’s Hospital, Dept. of Clinical Informatics, Galleria Room 110, 300 Longwood Ave, Boston, MA 02130, United States
| | - Adrienne Kennedy
- University of California San Francisco, Dept. of Laboratory Medicine, 505 Parnassus Ave., San Francisco, CA 94143, United States
| | - Elena Nedelcu
- University of California San Francisco, Dept. of Laboratory Medicine, 505 Parnassus Ave., San Francisco, CA 94143, United States
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An SJ, Ngwira N, Davis D, Gallaher J, Charles A. Transfusion and Mortality in Acute Care Surgical Patients in Malawi: A Propensity-Matched Analysis. J Surg Res 2024; 297:121-127. [PMID: 38489932 PMCID: PMC11023752 DOI: 10.1016/j.jss.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/09/2024] [Accepted: 01/26/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Information on transfusion-associated outcomes is limited in sub-Saharan Africa. We sought to characterize predictors of mortality in transfused patients with acute care surgical conditions in Malawi. METHODS We performed a retrospective propensity-matched analysis of patients with acute care surgical conditions at Kamuzu Central Hospital in Malawi from 2013 to 2021. We compared outcomes between patients who did and did not receive transfusions. RESULTS A total of 7395 patients were included. Transfused patients (n = 1086) were older (median 43 y with interquartile range 30-59, versus 39 y [interquartile range 27-53] in the nontransfused group, P < 0.01), had a higher proportion of females (41% versus 27%, P < 0.01), presented earlier to the hospital (median 2.9 versus 3.7 d, P = 0.02), and with lower hemoglobin levels (27% versus 1% < 7 g/dL, P < 0.01). They had a lower rate of surgical intervention (48% versus 59%, P < 0.01) but a higher rate of complications (62% versus 33%, P < 0.01). Crude in-hospital mortality was 25.5% for the transfused group and 12.8% for the nontransfused group (P < 0.01). After propensity matching, transfused patients had three times the odds of mortality compared to nontransfused patients (odds ratio 3.3, 95% confidence interval 2.3, 4.8). CONCLUSIONS In this propensity-matched study, transfused surgical patients were more likely to experience in-hospital mortality. These results suggest that the transfusion requirement reflects critical illness and warrants further investigation in this low-resource setting.
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Affiliation(s)
- Selena J An
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Natasha Ngwira
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Dylane Davis
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
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Buckley CT, Lee YL, Michele Schuler A, Langley RJ, Kutcher ME, Barrington R, Audia JP, Simmons JD. Deleterious effects of plasma-derived cellular debris in a porcine model of hemorrhagic shock. Injury 2024; 55:111300. [PMID: 38160196 DOI: 10.1016/j.injury.2023.111300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 11/20/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Recent studies identify large quantities of inflammatory cellular debris within Fresh Frozen Plasma (FFP). As FFP is a mainstay of hemorrhagic shock resuscitation, we used a porcine model of hemorrhagic shock and ischemia/reperfusion to investigate the inflammatory potential of plasma-derived cellular debris administered during resuscitation. METHODS The porcine model of hemorrhagic shock included laparotomy with 35 % hemorrhage (Hem), 45 min of ischemia from supraceliac aortic occlusion with subsequent clamp release (IR), followed by protocolized resuscitation for 6 h. Cellular debris (Debris) was added to the resuscitation phase in three groups. The four groups consisted of Hem + IR (n = 4), Hem + IR + Debris (n = 3), Hem + Debris (n = 3), and IR + Debris (n = 3). A battery of laboratory, physiologic, cytokine, and outcome data were compared between groups. RESULTS As expected, the Hem + IR group showed severe time dependent decrements in organ function and physiologic parameters. All animals that included both IR and Debris (Hem + IR + Debris or IR + Debris) died prior to the six-hour end point, while all animals in the Hem + IR and Hem + Debris survived. Cytokines measured at 30-60 min after initiation of resuscitation revealed significant differences in IL-18 and IL-1β between all groups. CONCLUSIONS Ischemia and reperfusion appear to prime the immune system to the deleterious effects of plasma-derived cellular debris. In the presence of ischemia and reperfusion, this model showed the equivalency of 100 % lethality when resuscitation included quantities of cellular debris at levels routinely administered to trauma patients during transfusion of FFP. A deeper understanding of the immunobiology of FFP-derived cellular debris is critical to optimize resuscitation for hemorrhagic shock.
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Affiliation(s)
- Colin T Buckley
- Department of Surgery, University of South Alabama, Mobile, AL, United States
| | - Yannleei L Lee
- Department of Surgery, University of South Alabama, Mobile, AL, United States
| | - A Michele Schuler
- Department of Comparative Medicine, University of South Alabama, United States; Department of Microbiology and Immunology, University of South Alabama, United States
| | - Raymond J Langley
- Department of Cellular & Molecular Pharmacology, University of South Alabama, United States
| | | | - Robert Barrington
- Department of Microbiology and Immunology, University of South Alabama, United States
| | - Jonathon P Audia
- Department of Microbiology and Immunology, University of South Alabama, United States
| | - Jon D Simmons
- Department of Surgery, University of South Alabama, Mobile, AL, United States; Department of Cellular & Molecular Pharmacology, University of South Alabama, United States.
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Madkaiker D, Iyer K, Jagriti, Chenna D, Mohan G, Shastry S. S.O.S. - Save our supplies: Understanding reasons to tackle the challenge of wasted returned blood products. Transfus Clin Biol 2024; 31:76-80. [PMID: 38211935 DOI: 10.1016/j.tracli.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To evaluate the return of blood components across different hospital areas, reasons for the same and suggest preventive strategies which might reduce out of controlled temperature storage (CTS) blood logistics and wastage. MATERIAL AND METHODS A retrospective audit was carried out in the department of Transfusion Medicine from January 2019 to December 2022. Data related to returned blood components was compiled using departmental records and blood centre software entries. RESULTS A total of 218 instances of returned components were noted and the total number of components returned were 442 (0.4% of all issued components) (38.4% (170) packed red blood cells, 16.2% (72) single donor cryoprecipitate concentrate, 19.6% (87) platelet concentrate and 25.5% (113) fresh frozen plasma). Components were returned back within 30 mins in only 27% (59/218) of all instances . Wards followed by high dependency units/intensive care units were noted to have the highest number of instances (86 (39.4%) and 69 (31.6%) respectively) with emergency department having the least,comprising 19 instances (8.7%). 77.9% (170/218) instances were observed for routine transfusion requests and 44.5% (97/218) of all instances could have been prevented by an appropriate clinical status assessment of the patient. CONCLUSION Stakeholders such as clinicians, transfusion laboratory professional and nursing staff must take consolidated efforts to eliminate wastage of blood components. Instances of returned blood components can be targeted by the hospital quality team as a quality improvement project.
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Affiliation(s)
- Deep Madkaiker
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kartik Iyer
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jagriti
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Deepika Chenna
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ganesh Mohan
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shamee Shastry
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Fuchs C, Scheer CS, Wauschkuhn S, Vollmer M, Meissner K, Hahnenkamp K, Gründling M, Selleng S, Thiele T, Borgstedt R, Kuhn SO, Rehberg S, Scholz SS. Continuation of chronic antiplatelet therapy is not associated with increased need for transfusions: a cohort study in critically ill septic patients. BMC Anesthesiol 2024; 24:146. [PMID: 38627682 PMCID: PMC11022363 DOI: 10.1186/s12871-024-02516-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The decision to maintain or halt antiplatelet medication in septic patients admitted to intensive care units presents a clinical dilemma. This is due to the necessity to balance the benefits of preventing thromboembolic incidents and leveraging anti-inflammatory properties against the increased risk of bleeding. METHODS This study involves a secondary analysis of data from a prospective cohort study focusing on patients diagnosed with severe sepsis or septic shock. We evaluated the outcomes of 203 patients, examining mortality rates and the requirement for transfusion. The cohort was divided into two groups: those whose antiplatelet therapy was sustained (n = 114) and those in whom it was discontinued (n = 89). To account for potential biases such as indication for antiplatelet therapy, propensity score matching was employed. RESULTS Therapy continuation did not significantly alter transfusion requirements (discontinued vs. continued in matched samples: red blood cell concentrates 51.7% vs. 68.3%, p = 0.09; platelet concentrates 21.7% vs. 18.3%, p = 0.82; fresh frozen plasma concentrates 38.3% vs. 33.3%, p = 0.7). 90-day survival was higher within the continued group (30.0% vs. 70.0%; p < 0.001) and the Log-rank test (7-day survivors; p = 0.001) as well as Cox regression (both matched samples) suggested an association between continuation of antiplatelet therapy < 7 days and survival (HR: 0.24, 95%-CI 0.10 to 0.63, p = 0.004). Sepsis severity expressed by the SOFA score did not differ significantly in matched and unmatched patients (both p > 0.05). CONCLUSIONS The findings suggest that continuing antiplatelet therapy in septic patients admitted to intensive care units could be associated with a significant survival benefit without substantially increasing the need for transfusion. These results highlight the importance of a nuanced approach to managing antiplatelet medication in the context of severe sepsis and septic shock.
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Affiliation(s)
- Christian Fuchs
- Department of Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Christian S Scheer
- Department of Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Steffi Wauschkuhn
- Department of Psychosomatic Medicine and Psychotherapy, Ernst von Bergmann Hospital, Potsdam, Germany
| | - Marcus Vollmer
- Institute of Bioinformatics, University Medicine Greifswald, Greifswald, Germany
| | - Konrad Meissner
- Department of Anaesthesiology, University Medical Center Göttingen, Göttingen, Germany
| | - Klaus Hahnenkamp
- Department of Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Gründling
- Department of Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Sixten Selleng
- Department of Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Thiele
- Institute of Transfusion Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Rainer Borgstedt
- Department of Anaesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine and Pain Therapy, Medical School, Protestant Hospital of the Bethel Foundation, Bielefeld University, University Medical Center OWL, Burgsteig 13, 33617, Bielefeld, Germany
| | - Sven-Olaf Kuhn
- Department of Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Sebastian Rehberg
- Department of Anaesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine and Pain Therapy, Medical School, Protestant Hospital of the Bethel Foundation, Bielefeld University, University Medical Center OWL, Burgsteig 13, 33617, Bielefeld, Germany
| | - Sean Selim Scholz
- Department of Anaesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine and Pain Therapy, Medical School, Protestant Hospital of the Bethel Foundation, Bielefeld University, University Medical Center OWL, Burgsteig 13, 33617, Bielefeld, Germany.
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Bolscher M, Koster SCE, Koopmans M, Haitsma Mulier JLG, Derde LPG, Juffermans NP. Anti-inflammatory therapies are associated with delayed onset of anemia and reduction in transfusion requirements in critically ill patients: results from two studies. Crit Care 2024; 28:114. [PMID: 38594746 PMCID: PMC11003051 DOI: 10.1186/s13054-024-04898-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Anemia is a hallmark of critical illness, which is largely inflammatory driven. We hypothesized that the use of anti-inflammatory agents limits the development of anemia and reduces the need for red blood cell (RBC) transfusions in patients with a hyper-inflammatory condition due to COVID-19. METHODS An observational cohort (n = 772) and a validation cohort (a subset of REMAP-CAP, n = 119) of critically ill patients with hypoxemic respiratory failure due to COVID-19 were analyzed, who either received no treatment, received steroids or received steroids plus IL-6 blocking agents. The trajectory of hemoglobin (Hb) decline and the need for RBC transfusions were compared using descriptive statistics as well as multivariate modeling. RESULTS In both cohorts, Hb level was higher in the treated groups compared to the untreated group at all time points. In the observational cohort, incidence and number of transfused patients were lower in the group receiving the combination treatment compared to the untreated groups. In a multivariate analysis controlling for baseline Hb imbalance and mechanical ventilation, receipt of steroids remained associated with a slower decline in Hb level and the combination treatment remained associated with a slower decline of Hb and with less transfusions. Results remained the same in the validation cohort. CONCLUSION Immunomodulatory treatment was associated with a slower decline in Hb level in critically ill patients with COVID-19 and with less transfusion. Findings point toward inflammation as an important cause for the occurrence of anemia in the critically ill.
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Affiliation(s)
- Madelief Bolscher
- Department of Intensive Care, OLVG Hospital, Oosterpark 9, Amsterdam, The Netherlands
| | | | - Matty Koopmans
- Department of Intensive Care, OLVG Hospital, Oosterpark 9, Amsterdam, The Netherlands
| | | | - Lennie P G Derde
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care, Erasmus Medical Center, Molewaterplein 40, Rotterdam, The Netherlands.
- Laboratory of Translational Intensive Care, Erasmus Medical Center, Molewaterplein 40, Rotterdam, The Netherlands.
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Gao B, Liu Y, Yao YT. Efficacy and safety of tranexamic acid in patients undergoing thoracic surgery: a systematic review and PRIMSA-compliant meta-analysis. J Cardiothorac Surg 2024; 19:195. [PMID: 38594703 PMCID: PMC11005289 DOI: 10.1186/s13019-024-02716-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/29/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES Perioperative bleeding poses a significant issue during thoracic surgery. Tranexamic acid (TXA) is one of the most commonly used antifibrinolytic agents for surgical patients. The purpose of the current study was designed to investigate the efficacy and safety of TXA in patients undergoing thoracic surgery. METHODS An extensive search of PubMed, Web of Science (WOS), Cochrane Library (trials), Embase, OVID, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP electronic databases was performed to identify studies published between the inception of these databases and March 2023. The primary outcomes included perioperative blood loss and blood transfusions. Secondary outcomes of interest included the length of stay (LOS) in hospital and the incidence of thromboembolic events. Weighted mean differences (WMDs) or odds ratios (OR) with 95% confidence intervals (CI) were used to determine treatment effects for continuous and dichotomous variables, respectively. RESULTS Five qualified studies including 307 thoracic surgical patients were included in the current study. Among them, 65 patients were randomly allocated to the group receiving TXA administration (the TXA group); the other 142 patients were assigned to the group not receiving TXA administration (the control group). TXA significantly reduced the quantity of hemorrhage in the postoperative period (postoperative 12h: WMD = -81.90 ml; 95% CI: -139.55 to -24.26; P = 0.005; postoperative 24h: WMD = -97.44 ml; 95% CI: -121.44 to -73.44; P< 0.00001); The intraoperative blood transfusion volume (WMD = -0.54 units; 95% CI: -1.06 to -0.03; P = 0.04); LOS in hospital (WMD = -0.6 days; 95% CI: -1.04 to -0.16; P = 0.008); And there was no postoperative thromboembolic event reported in the included studies. CONCLUSIONS The present study demonstrated that TXA significantly decreased blood loss within 12 and 24 hours postoperatively. A qualitative review did not identify elevated risks of safety outcomes such as thromboembolic events. It also suggested that TXA administration was associated with shorter LOS in hospital as compared to control. To validate this further, additional well-planned and adequately powered randomized studies are necessary.
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Affiliation(s)
- Bin Gao
- Department of Anesthesiology, Huzhou Central Hospital, The Affiliated Central Hospital of Huzhou University, No. 1558, Sanhuan North Road, Huzhou, 313000, China
| | - Yang Liu
- Department of Anesthesiology, Huzhou Central Hospital, The Affiliated Central Hospital of Huzhou University, No. 1558, Sanhuan North Road, Huzhou, 313000, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
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Kim HJ, Shin HJ, Lee SW, Heo S, Lee SH, Kim JE, Son HS, Jung JS. Improvement of Transfusion Practice in Cardiothoracic Surgery Through Implementing a Patient Blood Management Program. J Chest Surg 2024:jcs.23.160. [PMID: 38584377 DOI: 10.5090/jcs.23.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/15/2024] [Accepted: 01/26/2024] [Indexed: 04/09/2024] Open
Abstract
Background In this study, we examined the impact of a patient blood management (PBM) program on red blood cell (RBC) transfusion practices in cardiothoracic surgery. Methods The PBM program had 3 components: monitoring transfusions through an order communication system checklist, educating the medical team about PBM, and providing feedback to ordering physicians on the appropriateness of transfusion. The retrospective analysis examined changes in the hemoglobin levels triggering transfusion and the proportions of appropriate RBC transfusions before, during, and after PBM implementation. Further analysis was focused on patients undergoing cardiac surgery, with outcomes including 30-day mortality, durations of intensive care unit and hospital stays, and rates of pneumonia, sepsis, and wound complications. Results The study included 2,802 patients admitted for cardiothoracic surgery. After the implementation of PBM, a significant decrease was observed in the hemoglobin threshold for RBC transfusion. This threshold dropped from 8.7 g/dL before PBM to 8.3 g/dL during the PBM education phase and 8.0 g/dL during the PBM feedback period. Additionally, the proportion of appropriate RBC transfusions increased markedly, from 23.9% before PBM to 34.9% and 58.2% during the education and feedback phases, respectively. Among the 381 patients who underwent cardiac surgery, a significant reduction was noted in the length of hospitalization over time (p<0.001). However, other clinical outcomes displayed no significant differences. Conclusion PBM implementation effectively reduced the hemoglobin threshold for RBC transfusion and increased the rate of appropriate transfusion in cardiothoracic surgery. Although transfusion practices improved, clinical outcomes were comparable to those observed before PBM implementation.
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Affiliation(s)
- Hee Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyeon Ju Shin
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Suk Woo Lee
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Korea
| | - Seonyeong Heo
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seung Hyong Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ji Eon Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ho Sung Son
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jae Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Korea
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Burananayok S, Nachatri W, Choothanorm P, Kusolthammarat K, Jaruthamsophon K, Yodsawad C, Limsakul P, Charupanit K. COVID-19 impact on blood donor characteristics and seroprevalence of transfusion-transmitted infections in southern Thailand between 2018 and 2022. Sci Rep 2024; 14:7920. [PMID: 38575642 PMCID: PMC10995202 DOI: 10.1038/s41598-024-57584-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 03/19/2024] [Indexed: 04/06/2024] Open
Abstract
Blood safety is a critical aspect of healthcare systems worldwide involving rigorous screening, testing, and processing protocols to minimize the risk of transfusion-transmitted infections (TTIs). The present study offers a comprehensive assessment of the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis among blood donors in southern Thailand. It explores the consequences of the COVID-19 pandemic on the blood transfusion service, donor characteristics, and the prevalence of TTIs. A retrospective analysis of 65,511 blood donors between 2018 and 2022 was conducted at Songklanagarind Hospital, Thailand. The socio-demographic characteristics of the donors were examined using the Chi-square test to assess the relationship between TTIs serological positivity and donor characteristics. The donors were divided into pre-COVID-19 (2018-2019) and during COVID-19 (2020-2022) groups to evaluate the impacts of COVID-19. The study found that HBV had the highest overall prevalence at 243 per hundred thousand (pht), followed by syphilis (118 pht), HCV (32 pht), and HIV (31 pht) over a five-year period of study. After COVID-19, the prevalence of HBV decreased by 21.8%; HCV decreased by 2.1%; HIV increased by 36.4%; and syphilis increased by 9.2%. The socio-demographic characteristics and TTIs prevalence were significantly altered over time. This study provides insights into blood donor characteristics and TTIs prevalence in southern Thailand, highlighting the understanding of the impact of COVID-19 on the spread of TTIs.
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Affiliation(s)
- Suparat Burananayok
- Blood Bank and Transfusion Medicine Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Wilaiwan Nachatri
- Blood Bank and Transfusion Medicine Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pimpilalai Choothanorm
- Blood Bank and Transfusion Medicine Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kantarat Kusolthammarat
- Blood Bank and Transfusion Medicine Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kanoot Jaruthamsophon
- Blood Bank and Transfusion Medicine Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Human Genetic Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chaninporn Yodsawad
- Blood Bank and Transfusion Medicine Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Praopim Limsakul
- Division of Physical Science, Faculty of Science, Prince of Songkla University, Songkhla, Thailand
- Center of Excellence for Trace Analysis and Biosensor (TAB-CoE), Faculty of Science, Prince of Songkla University, Songkhla, Thailand
| | - Krit Charupanit
- Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
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Patriquin CJ, Bogdanovic A, Griffin M, Kelly RJ, Maciejewski JP, Mulherin B, Peffault de Latour R, Röth A, Selvaratnam V, Szer J, Al-Adhami M, Horneff R, Tan L, Yeh M, Panse J. Safety and Efficacy of Pegcetacoplan in Adult Patients with Paroxysmal Nocturnal Hemoglobinuria over 48 Weeks: 307 Open-Label Extension Study. Adv Ther 2024:10.1007/s12325-024-02827-8. [PMID: 38573482 DOI: 10.1007/s12325-024-02827-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/19/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, life-threatening disease characterized by complement-mediated hemolysis and thrombosis. Pegcetacoplan, the first targeted complement component 3 (C3) PNH therapy, was safe and efficacious in treatment-naive and pre-treated patients with PNH in five clinical trials. METHODS The 307 open-label extension (OLE) study (NCT03531255) is a non-randomized, multicenter extension study of long-term safety and efficacy of pegcetacoplan in adult patients with PNH who completed a pegcetacoplan parent study. All patients received pegcetacoplan. Outcomes at the 48-week data cutoff (week 48 of 307-OLE or August 27, 2021, whichever was earlier) are reported. Hemoglobin concentrations, Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scores, and transfusion avoidance were measured. Hemoglobin > 12 g/dL and sex-specific hemoglobin normalization (i.e., male, ≥ 13.6 g/dL; female, ≥ 12 g/dL) were assessed as percentage of patients with data available and no transfusions 60 days before data cutoff. Treatment-emergent adverse events, including hemolysis, were reported. RESULTS Data from 137 patients with at least one pegcetacoplan dose at data cutoff were analyzed. Mean (standard deviation [SD]) hemoglobin increased from 8.9 (1.22) g/dL at parent study baseline to 11.6 (2.17) g/dL at 307-OLE entry and 11.6 (1.94) g/dL at data cutoff. At parent study baseline, mean (SD) FACIT-Fatigue score of 34.1 (11.08) was below the general population norm of 43.6; scores improved to 42.8 (8.79) at 307-OLE entry and 42.4 (9.84) at data cutoff. In evaluable patients, hemoglobin > 12 g/dL occurred in 40.2% (43 of 107) and sex-specific hemoglobin normalization occurred in 31.8% (34 of 107) at data cutoff. Transfusion was not required for 114 of 137 patients (83.2%). Hemolysis was reported in 23 patients (16.8%). No thrombotic events or meningococcal infections occurred. CONCLUSION Pegcetacoplan sustained long-term improvements in hemoglobin concentrations, fatigue reduction, and transfusion burden. Long-term safety findings corroborate the favorable profile established for pegcetacoplan. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03531255.
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Affiliation(s)
- Christopher J Patriquin
- Hematology & Apheresis Medicine, University Health Network, Toronto General Hospital, Toronto, ON, Canada.
| | - Andrija Bogdanovic
- Clinic of Hematology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Morag Griffin
- Department of Haematology, St. James's University Hospital, Leeds, UK
| | - Richard J Kelly
- Department of Haematology, St. James's University Hospital, Leeds, UK
| | - Jaroslaw P Maciejewski
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian Mulherin
- Hematology Oncology of Indiana, Indianapolis, IN, USA
- Ascension St. Vincent Carmel, Carmel, IN, USA
| | - Régis Peffault de Latour
- French Reference Center for Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria, Paris, France
- Assistance Publique-Hôpitaux de Paris, Saint-Louis Hospital, Université Paris Cité, Paris, France
| | - Alexander Röth
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, Essen, Germany
| | | | - Jeffrey Szer
- Department of Clinical Haematology, The Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | - Lisa Tan
- Swedish Orphan Biovitrum AB, Stockholm, Sweden
- Lisa Tan Pharma Consulting Ltd, Cambridge, UK
| | | | - Jens Panse
- Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Aachen, Germany
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
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11
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Jani VP, Jani VP, Munoz C, Cabrales P. A mathematical model of tissue axial and radial diffusion in the microvasculature for intravascular microscopy and phosphorescence quenching data. Comput Biol Med 2024; 174:108406. [PMID: 38603898 DOI: 10.1016/j.compbiomed.2024.108406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/28/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
This study aims to extend earlier Krogh Cylinder Models of an oxygen profile by considering axial diffusion and analytically solving Fick's Law Partial Differential Equation with novel boundary conditions via the separation of variables. We next prospectively collected a total of 20 animals, which were randomly assigned to receive either fresh or two-week-old stored red blood cell (RBC) transfusions and PQM oxygen data were measured acutely (90 min) or chronically (24 h). Transfusion effects were evaluated in vivo using intravital microscopy of the dorsal skinfold window chamber in Golden Syrian Hamsters. Hamsters were initially hemorrhaged by 50% of total blood volume and resuscitated 1-h post hemorrhage. PQM data were subsequently collected and fit the derived 2D Krogh cylinder model. Systemic hemodynamics (mean arterial pressure, heart rate) were similar in both pre and post-transfusion with either stored or fresh cells. Transfusion with stored cells was found to impair axial and radial oxygen gradients as quantified by our model and consistent with previous studies. Specifically, we observed a statistically significant decrease in the arteriolar tissue radial oxygen gradient after transfusion with stored RBCs at 24 h compared with fresh RBCs (0.33 ± 0.17 mmHg μ m-1 vs, 0.14 ± 0.12 mmHg μ m-1; p = 0.0280). We also observed a deficit in the arteriolar tissue oxygen gradient (0.03 ± 0.01 mmHg μ m-1 fresh vs. 0.018 ± 0.007 mmHg μ m-1 stored; p = 0.0185). We successfully derived and validated an analytical 2D Krogh cylinder model in an animal model of microhemodynamic oxygen diffusion aberration secondary to storage lesions.
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Affiliation(s)
- Vinay P Jani
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, 92093-0412, USA
| | - Vivek P Jani
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Carlos Munoz
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, 92093-0412, USA
| | - Pedro Cabrales
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, 92093-0412, USA.
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Nuñez JH, Colomina J, Angles F, Pallisó F, Acosta HF, Mateu D, Novellas M. Routine pretransfusion testing before primary total hip or knee arthroplasty are an expensive and wasteful routine. Systematic review and meta-analysis. Arch Orthop Trauma Surg 2024; 144:1585-1595. [PMID: 38416137 DOI: 10.1007/s00402-024-05243-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/17/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND The excessive routine ordering of pretransfusion tests (blood typing, screening, and cross-matching) for surgical cases incurs significant unnecessary costs and places an undue burden on transfusion services. This study aims to systematically review the literature regarding the necessity of routine pretransfusion tests before total hip arthroplasty (THA) or total knee arthroplasty (TKA) and summarize their outcomes. STUDY METHODS A systematic review and meta-analysis were performed. The study's characteristics, the prevalence of over-ordering pretransfusion tests, transfusion rates, and potential cost savings to the healthcare system were analyzed. RESULTS The study included 17,667 patients. Pooled results revealed a 96.3% over-ordering pretransfusion test rate (95% CI: 0.92-1.00; p < 0.001) among patients undergoing primary THA or TKA. The pooled prevalence of hospital transfusion rate was 3.6%. Notably, there were statistically significant differences in preoperative hemoglobin (Hb) levels between patients not requiring transfusion (Hb = 13.9 g/dl; 95% CI 12.59-15.20; p < 0.001) and those needing transfusion (Hb = 11.9 g/dl; 95% CI 10.69-13.01; p < 0.001) (p = 0.03). The per-patient total cost savings ranged from 28.63 to 191.27 dollars. DISCUSSION Our study suggests that routine pre-transfusion testing for all patients undergoing primary THA or TKA may be unnecessary. We propose limiting pretransfusion test orders to patients with preoperative hemoglobin levels below 12 g/dl in unilateral primary TKA or THA. This targeted approach can result in significant cost savings for healthcare systems and transfusion services by reducing the over-ordering of pretransfusion tests in these surgical procedures.
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Affiliation(s)
- Jorge H Nuñez
- Department of Orthopedic Surgery, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, Terrassa, Barcelona, 08221, Spain.
- Artro-Esport, Centro Médico Teknon, Carrer de Vilana, 12, Barcelona, 08022, Spain.
| | - Jordi Colomina
- Department of Orthopedic Surgery, University Hospital Santa Maria, Gestió de Serveis Sanitaris, Alcalde Rovira Roure, 44, Lleida, 25198, Spain
- Multidisciplinary Research Group in Musculoskeletal Pathology, Fragility and Pain Treatment, Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré, IRBLleida, Av Alcalde Rovira Roure 80, Lleida, 25198, Spain
| | - Francesc Angles
- Department of Orthopedic Surgery, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, Terrassa, Barcelona, 08221, Spain
- Departament de Cirugia, Universitat de Barcelona, Barcelona, Spain
| | - Francesc Pallisó
- Department of Orthopedic Surgery, University Hospital Santa Maria, Gestió de Serveis Sanitaris, Alcalde Rovira Roure, 44, Lleida, 25198, Spain
- Multidisciplinary Research Group in Musculoskeletal Pathology, Fragility and Pain Treatment, Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré, IRBLleida, Av Alcalde Rovira Roure 80, Lleida, 25198, Spain
| | - Héctor F Acosta
- Department of Orthopedic Surgery, University Hospital Santa Maria, Gestió de Serveis Sanitaris, Alcalde Rovira Roure, 44, Lleida, 25198, Spain
- Multidisciplinary Research Group in Musculoskeletal Pathology, Fragility and Pain Treatment, Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré, IRBLleida, Av Alcalde Rovira Roure 80, Lleida, 25198, Spain
| | - David Mateu
- Departament de Cirugia, Universitat de Barcelona, Barcelona, Spain
- Department of Orthopaedic Surgery, Consorci Sanitari Integral, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, 08970, Spain
| | - Marga Novellas
- Department of Anaesthesiology, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, Terrassa, Barcelona, 08221, España
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13
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Pereira P, Seghatchian J. Spotlights on the trends in performance assessment of qualitative in vitro diagnostic medical devices in transfusion medicine. Transfus Apher Sci 2024; 63:103887. [PMID: 38310031 DOI: 10.1016/j.transci.2024.103887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 01/14/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Abstract
For reliable clinical decisions in transfusion medicine, assessing the performance of qualitative tests performed in medical laboratories is critical. When false results are reported, these can lead to an adverse reaction to blood components. Good performance assessment practices are essential for this kind of scenario, and they still remain as one of the many unmet high-priority challenges in this area. This paper aims to provide an overview of the current trends in this field. A review of the IFCC-IUPC. qualitative vocabulary was carried out, and a particular focus was given to the evaluation protocols CLSI EP12-A3 and Eurachem AQA, such as the European Union Regulation for class D in vitro diagnostic medical devices. There is a consistency between the current protocols and recognized performance assessment principles, which are mandatory in transfusion service labs. We believe that a revised imprecision interval approach and models based on emerging qualitative test types may prove beneficial in the long run. It is also important to emphasize the uncertainty of proportions to mitigate the risk of misclassification.
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Affiliation(s)
- Paulo Pereira
- R&D Department, Portuguese Institute of Blood and Transplantation, Lisbon, Portugal.
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection and DDR Strategy, London, UK
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14
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Jentsch U, Vermeulen M, van den Berg K, Swanevelder R, Creel D, Jacobs G, Hemingway-Foday JJ, Nyoni C, Murphy EL, Custer B. A case-control study of risk factors for incident hepatitis B virus infection in South African blood donors. Int J Infect Dis 2024; 141:106958. [PMID: 38373648 PMCID: PMC11034725 DOI: 10.1016/j.ijid.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES Hepatitis B virus (HBV) infection remains a global health problem. Risk factors for HBV infection are usually assessed in prevalent rather than incident infections. To identify demographic and behavioral risks associated with incident HBV among South African blood donors. METHODS A case-control study was performed between November 2014 and January 2018. Cases were blood donors testing positive for HBV DNA with or without hepatitis B surface antigen but negative for antibody to hepatitis B core antigen. Participants completed an audio computer-assisted structured interview on exposures during the previous 6 months. Sex-specific multivariable logistic regression yielded independent associations between risks and HBV infection. RESULTS 56 females and 37 males with incident HBV were compared to 438 female and 439 male controls, respectively. For females, risk factors were accepting money or goods for sex, using agents to prepare one's anus prior to anal sex, penetrating injury, non-Black race, and lower educational status. Men reporting homosexual or bisexual orientation or sex with other men, previous injury, referral for HBV testing, or lack of medical insurance were at increased risk. For both sexes, having more than two male sexual partners increased risk. CONCLUSIONS Sexual behaviors predominated over parenteral exposures as risks for incident HBV in both female and male blood donors.
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Affiliation(s)
- Ute Jentsch
- The South African National Blood Service, Johannesburg, South Africa.
| | - Marion Vermeulen
- The South African National Blood Service, Johannesburg, South Africa; University of the Free State, Bloemfontein, South Africa
| | - Karin van den Berg
- The South African National Blood Service, Johannesburg, South Africa; University of the Free State, Bloemfontein, South Africa
| | - Ronél Swanevelder
- The South African National Blood Service, Johannesburg, South Africa
| | | | - Genevieve Jacobs
- The South African National Blood Service, Johannesburg, South Africa
| | | | - Cynthia Nyoni
- The South African National Blood Service, Johannesburg, South Africa
| | - Edward L Murphy
- University of California San Francisco, San Francisco, USA; Vitalant Research Institute, San Francisco, USA
| | - Brian Custer
- Vitalant Research Institute, San Francisco, USA; University of California San Francisco, San Francisco, USA
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15
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Mokhtar G, Adly A, Baky AA, Ezzat D, Hakeem GA, Hassab H, Youssry I, Ragab I, Florez I, Sherief LM, El-Ekiaby M, Zakaria M, Hesham M, Shaheen N, Salama N, Salah N, Afifi RAA, El-Ashry R, Youssef S, Ragab S, Habib SA, Omar T, Amer Y, Wali Y, Makkeyah S. Transfusion of blood components in pediatric age groups: an evidence-based clinical practice guideline adapted for the use in Egypt using 'Adapted ADAPTE'. Ann Hematol 2024; 103:1373-1388. [PMID: 38388746 PMCID: PMC10940419 DOI: 10.1007/s00277-024-05657-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
Pediatric transfusion is a complex area of medicine covering a wide age range, from neonates to young adults. Compared to adult practice, there is a relative lack of high-quality research to inform evidence-based guidelines. We aimed to adapt the pre-existing high-quality practice guidelines for the transfusion of blood components in different pediatric age groups to be available for national use by general practitioners, pediatricians, and other health care professionals. The guideline panel included 17 key leaders from different Egyptian institutions. The panel used the Adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to the target context of use. The guideline covered all important aspects of the indications, dosing, and administration of packed red cells, platelets, and fresh frozen plasma. It also included transfusion in special situations, e.g., chronic hemolytic anemia and aplastic anemia, management of massive blood loss, malignancies, surgery, recommendations for safe transfusion practices, and recommendations for modifications of cellular blood components. The final version of the adapted clinical practice guideline (CPG) has been made after a thorough review by an external review panel and was guided by their official recommendations and modifications. A set of implementation tools included algorithms, tables, and flow charts to aid decision-making in practice. This adapted guideline serves as a tool for safe transfusion practices in different pediatric age groups.
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Affiliation(s)
- Galila Mokhtar
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Amira Adly
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Ashraf Abdel Baky
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Pediatrics, MTI University, Cairo, Egypt
- Department of Pediatrics, Armed Forces College of Medicine (AFCM), Cairo, Egypt
| | - Dina Ezzat
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Beni Suef University, Beni Suef, Egypt
| | - Gehan Abdel Hakeem
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Minia University, Minia, Egypt
| | - Hoda Hassab
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Alexandria University, Alexandria, Egypt
| | - Ilham Youssry
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Cairo University, Giza, Egypt
| | - Iman Ragab
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Ivan Florez
- Department of Pediatrics, University of Antioquia, Medellin, Colombia
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Laila M Sherief
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Magdy El-Ekiaby
- Department of Clinical Pathology and Transfusion Medicine, Shabrawishi Hospital, Cairo, Egypt
| | - Marwa Zakaria
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Mervat Hesham
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Naglaa Shaheen
- Pediatric Hematology Department, Misr Children's Hospital, Health Insurance Organization, Cairo, Egypt
| | - Niveen Salama
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Cairo University, Giza, Egypt
| | - Nouran Salah
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Rasha A A Afifi
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Cairo University, Giza, Egypt
| | - Rasha El-Ashry
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Mansoura University, Monsoura, Egypt
| | - Salwa Youssef
- Department of Clinical Pathology and Transfusion Medicine, Ain Shams University, Cairo, Egypt
| | - Seham Ragab
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Menoufia University, Menoufia, Egypt
| | - Sonia A Habib
- Pediatric Hematology and Oncology Unit, National Research Center, Giza, Egypt
| | - Tarek Omar
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasser Amer
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
- Department of Pediatrics, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yasser Wali
- Pediatric Hematology/Oncology Unit, Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sara Makkeyah
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt.
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16
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Callaghan NI, Quinn J, Liwski R, Chisholm N, Cheng C. Process Mining Uncovers Actionable Patterns of Red Blood Cell Unit Wastage in a Health Care Network. Transfus Med Rev 2024; 38:150827. [PMID: 38642414 DOI: 10.1016/j.tmrv.2024.150827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/22/2024]
Abstract
Packed red blood cell transfusions are integral to the care of the critically and chronically ill patient, but require careful storage and a large, coordinated network to ensure their integrity during distribution and administration. Auditing a Transfusion Medicine service can be challenging due to the complexity of this network. Process mining is an analytical technique that allows for the identification of high-efficiency pathways through a network, as well as areas of challenge for targeted innovation. Here, we detail a case study of an efficiency audit of the Transfusion Medicine service of the Nova Scotia Health Administration Central Zone using process mining, across a period encompassing years prior to, during, and after the acute COVID-19 pandemic. Service efficiency from a product wastage perspective was consistently demonstrated at benchmarks near globally published optima. Furthermore, we detail key areas of continued challenge in product wastage, and suggest potential strategies for further targeted optimization.
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Affiliation(s)
- Neal I Callaghan
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason Quinn
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, Halifax, Nova Scotia, Canada
| | - Robert Liwski
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, Halifax, Nova Scotia, Canada
| | - Natalie Chisholm
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, Halifax, Nova Scotia, Canada
| | - Calvino Cheng
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, Halifax, Nova Scotia, Canada.
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El Hawat S, Saliby R, Sleilaty G, El Asmar A, Ghosn A. Optimizing the transfusion strategy in surgical patients in a Lebanese university hospital. Perioper Med (Lond) 2024; 13:20. [PMID: 38491398 PMCID: PMC10941477 DOI: 10.1186/s13741-024-00374-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 03/01/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND AND PURPOSE Our aim was to analyze factors that influence transfusion requirements in surgical patients in order to achieve a transfusion-saving strategy. METHODS Data was collected from patient's files at the Notre Dame de Secours-Jbeil University Hospital Center between January 2017 and June 2019. Selection was made for 400 patients who had undergone surgery and required transfusion. The studied variables were age, sex, and type of surgery whether planned or urgent with its expected level of bleeding. The presence of chronic anemia, coronary artery disease, values of hemoglobin and hematocrit before and after transfusion, iron status preoperatively, and post-operation complications were also noted. RESULTS The analysis of 400 transfused surgical patients showed that the mean age was 62 ± 18 years with 52.5% women and 47.5% men. In 82.3% of patients, surgical bleeding was expected, 77.8% of surgeries were scheduled, and 22.3% were urgent. Fifty-two percent of patients were known to have coronary artery disease. Orthopedic (35%) and cardiothoracic (29.5%) surgeries had the highest transfusion rate. Among all patients, only 106 patients (26.5%) underwent a preoperative iron workup. The pre-transfusion levels of hemoglobin were 9.9 ± 0.6 and hematocrit of 29.7 ± 1.9. 26.3% of patients had a post-transfusion complication. On the other hand, 19.5% of women and 20% of men were already anemic when admitted to the hospital. Anemic women required 7.6 times more transfusions than non-anemic, while anemic men required 12.38 times more transfusions than non-anemic men. Age, presence of coronary artery disease, and chronic anemia have been found to be factors increasing the risk of post-transfusion complications. Finally, urgent and unplanned surgeries are 2.9 times more likely to cause post-transfusion complications. CONCLUSION This study therefore confirms that anemic patients are more likely to receive perioperative blood transfusions. Consequently, in order to reduce blood transfusion and its complications, it would be beneficial primarily to diagnose and treat anemia preoperatively. Other transfusion-saving strategies could also be useful in the setting of surgical bleeding, such as the use of tranexamic acid and different autologous transfusion methods like the cell saver.
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Affiliation(s)
- Stephanie El Hawat
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Department of Laboratory Medicine, Notre Dame Des Secours University Hospital Center (CHUNDS), P.O. Box 3, Byblos, Lebanon.
| | - Rita Saliby
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | | | - Alain El Asmar
- Division of Emergency Medicine, Department of Internal Medicine, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Anthony Ghosn
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Department of Anesthesiology, Notre Dame Des Secours University Hospital Center (CHUNDS), P.O. Box 3, Byblos, Lebanon
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Figueira CO, Guida JPS, Surita FG, Antolini-Tavares A, Saad ST, Costa FF, Fertrin KY, Costa ML. Sickle cell disease and increased adverse maternal and perinatal outcomes in different genotypes. Hematol Transfus Cell Ther 2024:S2531-1379(24)00056-7. [PMID: 38494406 DOI: 10.1016/j.htct.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/23/2023] [Accepted: 02/12/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD) comprises a heterogeneous group of inherited hemolytic disorders that increases the risk of maternal and perinatal complications due to chronic systemic inflammatory response, endothelial damage and vaso-occlusion. The contribution of genotypes to the severity of outcomes during pregnancy is not completely established. METHODS A retrospective study of medical charts was performed to compare maternal and perinatal outcomes in Hb SS, Hb SC disease and sickle-beta thalassemia (Hb Sβ) pregnancies followed at a high-risk antenatal care unit over a 6-year period. A descriptive analysis of morphological findings was performed of the placenta when pathology reports were available. RESULTS Sixty-two SCD pregnant women [25 Hb SS (40 %), 29 Hb SC (47 %) and 8 Hb Sβ (13 %)] were included. Overall, SCD was associated with maternal complications (77 %), preterm birth (30 %), cesarean section (80 %) and a need of blood transfusion. In general there were no statistically significant differences between genotypes. The only significant difference was the hemoglobin level at first antenatal care visit which was lower for the homozygous genotype (7.7 g/dL) compared to Hb SC and Hb Sβ (9.7 g/dL and 8.4 g/dL, respectively; p-value = 0.01). Ten of 15 evaluated placentas showed abnormal morphological findings CONCLUSION: SCD, regardless of the underlying genotype, is associated with increased adverse maternal and perinatal outcomes and placental abnormalities associated with maternal vascular malperfusion.
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Affiliation(s)
- Camilla Olivares Figueira
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil
| | - José Paulo S Guida
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil
| | - Fernanda G Surita
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil
| | - Arthur Antolini-Tavares
- Department of Pathological Anatomy, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo St, Campinas, São Paulo 13083-887, Brazil
| | - Sara T Saad
- Department of Hematology and Hemotherapy, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo St, Campinas, São Paulo 13083-887, Brazil
| | - Fernando F Costa
- Department of Hematology and Hemotherapy, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo St, Campinas, São Paulo 13083-887, Brazil
| | - Kleber Y Fertrin
- Division of Hematology, Department of Medicine, University of Washington, WA 98195, Seattle, WA, USA
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil.
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Le Gallo M, Moutereau S, Gentil M, Pirenne F. Study of the antigenic characteristics of red blood cells units and their sickle cell disease recipients and the G6PD activity of transfused red blood cells units. Transfus Clin Biol 2024:S1246-7820(24)00040-5. [PMID: 38462030 DOI: 10.1016/j.tracli.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Transfusion has a central place in the treatment of patients with sickle cell disease (SCD). Matching blood groups of red blood cell (RBC) units with the blood groups of the patient is essential to prevent alloimmunization and delayed hemolytic transfusion reaction. African ancestry donors have the best phenocompatibility with patients of the same origin, however their RBCs may present characteristic that can alter quality of the unit such as glucose-6-phosphate dehydrogenase (G6PD) deficiency. The objective is to analyze transfusion protocol, immunization rate and mismatch situations of SCD recipients and to evaluate the frequency of G6PD deficiency in RBCs units from African ancestry donors. METHODS Samples of units transfused to SCD patients were analyzed. Transfusion data were collected from institutional databases. The activity of G6PD was measured in the segment of the RBC units. RESULTS A total of 98 segments of units transfused to 37 SCD recipients in 41 transfusions episodes was collected. Among patients, 35.1% (n = 13) had no antibodies; 10.8% (n = 4) had antibodies against Fya/Fyb, Jka/Jkb, M/N, S/s; 21.6% (n = 8) against RH/K antigens. In all cases, the protocols were in line with the recommendations. G6PD deficiency was observed in 9 units, that were all collected from Afro-Caribbean donors. CONCLUSION The transfusion protocol is established to prevent immunological reactions due to disparities in blood group antigens between donors and SCD recipients. However, the units of African ancestry donors, which allowed the best compatibility, displayed a high rate of G6PD deficiency. The storage and recovery impact of this deficiency must be evaluated.
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Affiliation(s)
- Morgane Le Gallo
- Etablissement français du sang, Hôpital Henri Mondor, 1 rue Gustave Eiffel, 94010 Créteil, France; Laboratoire d'hématologie, Centre hospitalier universitaire Angers, 4 rue Larrey, 49100 Angers, France.
| | - Stéphane Moutereau
- Laboratoire de biochimie, AP-HP, Hôpital Henri Mondor, 1 rue Gustave Eiffel, 94010 Créteil, France; INSERM U955 équipe 2, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Mélanie Gentil
- Etablissement français du sang, Hôpital Henri Mondor, 1 rue Gustave Eiffel, 94010 Créteil, France
| | - France Pirenne
- Etablissement français du sang, Hôpital Henri Mondor, 1 rue Gustave Eiffel, 94010 Créteil, France; INSERM U955 équipe 2, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
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20
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Kayama A, Eto K. Mass production of iPSC-derived platelets toward the clinical application. Regen Ther 2024; 25:213-219. [PMID: 38260088 PMCID: PMC10801197 DOI: 10.1016/j.reth.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/06/2023] [Accepted: 12/17/2023] [Indexed: 01/24/2024] Open
Abstract
The ex vivo production of platelets from induced pluripotent cells (iPSCs) may offer a safer and sustainable alternative for transfusions and drug delivery systems (DDS). However, the mass production of the clinically required number of iPSC-derived platelets (iPSC-PLTs) is challenging. Here, we introduce recent technologies for mass production and the first-in-human clinical trial using ex vivo iPSC-PLTs. To this end, we established immortalized megakaryocyte progenitor cell lines (imMKCLs) as an expandable master cell bank (MCB) through the overexpression of c-MYC, BMI1 and BCL-XL, which modulated megakaryopoiesis and thrombopoiesis. We also optimized a culture cocktail for maturation of the imMKCLs by mixing an aryl hydrocarbon receptor (AhR) antagonist, SR1/GNF-316; a Rho-associated protein kinase (ROCK) inhibitor, Y-27632/Y-39983; and a small-molecule compound replacing recombinant thrombopoietin (TPO), TA-316. Finally, we discovered the importance of turbulence on the manufacturing of intact iPSC-PLTs, allowing us to develop a turbulence-based bioreactor, VerMES. Combination of the MCB and VerMES enabled us to produce more than 100 billion iPSC-PLTs, leading to the first-in-human clinical trial. Despite these advancements, many challenges remain before expanding the clinical implementation of this strategy.
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21
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Hirano T, Yamada K, Terayama T, Iwasaki Y, Yamamoto R, Shinohara K. Concomitant severe traumatic brain injury is not associated with increased red blood cell transfusion volumes in patients with pelvic fractures: A retrospective observational study. Injury 2024; 55:111296. [PMID: 38184413 DOI: 10.1016/j.injury.2023.111296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/15/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Traumatic brain injury (TBI)-associated coagulopathy significantly influences survival outcomes in patients with multiple injuries. Severe TBI can potentially affect systemic hemostasis due to coagulopathy; however, there is limited evidence regarding whether the risk of hemorrhage increases in patients with pelvic fractures complicated with TBI. Therefore, through multivariable analysis, we aimed to examine the association between severe TBI and increased blood transfusion requirements in patients with pelvic fractures. MATERIALS AND METHODS This retrospective observational study was conducted at a tertiary care facility in Japan. Patients aged 16 years or older with pelvic fractures who were admitted to our intensive care unit between April 2014 and December 2021 were included in the analysis. The patients were categorized into no to mild and severe TBI groups according to whether the Head Abbreviated Injury Scale (AIS) score was 3 or higher. The primary outcome was the number of red blood cell (RBC) units transfused within 24 h after arrival at the hospital. The primary outcome was analyzed using univariable and multivariable linear regression analyses. The covariates used for the multivariable linear regression analysis were age, sex, antithrombotic therapy, mechanism of injury, Pelvic AIS score, and extravasation on contrast-enhanced computed tomography on admission. RESULTS We identified 315 eligible patients (221 and 94 in the no to mild and severe TBI groups, respectively). In the univariable analysis, the RBC transfusion volume within 24 h after arrival was significantly higher in the severe TBI group than in the no to mild TBI group (2.53-unit increase; 95 % confidence interval [CI]: 0.46-4.61). However, in the multivariable analysis, no statistically significant association was detected between severe TBI and the RBC transfusion volume within 24 h after arrival at the hospital (0.87-unit increase; 95 % CI: -1.11-2.85). CONCLUSIONS Concomitant severe TBI was not associated with increased RBC transfusion volumes in patients with pelvic fractures on multivariable analysis.
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Affiliation(s)
- Takaki Hirano
- Department of Anesthesiology and Emergency Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, Japan; Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, Japan.
| | - Kohei Yamada
- Department of Traumatology and Critical Care Medicine, National Defense Medical College Hospital, 3-2 Namiki, Tokorozawa, Saitama, Japan
| | - Takero Terayama
- Department of Emergency, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya-Ku, Tokyo Japan
| | - Yudai Iwasaki
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Ryohei Yamamoto
- Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, Japan; Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Yoshida-honmachi, Kyoto Sakyo-ku, Kyoto, Japan
| | - Kazuaki Shinohara
- Department of Anesthesiology and Emergency Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, Japan
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Musallam KM, Cappellini MD, Coates TD, Kuo KHM, Al-Samkari H, Sheth S, Viprakasit V, Taher AT. Αlpha-thalassemia: A practical overview. Blood Rev 2024; 64:101165. [PMID: 38182489 DOI: 10.1016/j.blre.2023.101165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
α-Thalassemia is an inherited blood disorder characterized by decreased synthesis of α-globin chains that results in an imbalance of α and β globin and thus varying degrees of ineffective erythropoiesis, decreased red blood cell (RBC) survival, chronic hemolytic anemia, and subsequent comorbidities. Clinical presentation varies depending on the genotype, ranging from a silent or mild carrier state to severe, transfusion-dependent or lethal disease. Management of patients with α-thalassemia is primarily supportive, addressing either symptoms (eg, RBC transfusions for anemia), complications of the disease, or its transfusion-dependence (eg, chelation therapy for iron overload). Several novel therapies are also in development, including curative gene manipulation techniques and disease modifying agents that target ineffective erythropoiesis and chronic hemolytic anemia. This review of α-thalassemia and its various manifestations provides practical information for clinicians who practice beyond those regions where it is found with high frequency.
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Affiliation(s)
- Khaled M Musallam
- Center for Research on Rare Blood Disorders (CR-RBD), Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | - M Domenica Cappellini
- Department of Clinical Sciences and Community, University of Milan, Ca' Granda Foundation IRCCS Maggiore Policlinico Hospital, Milan, Italy
| | - Thomas D Coates
- Hematology Section, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Kevin H M Kuo
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hanny Al-Samkari
- Center for Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sujit Sheth
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Vip Viprakasit
- Department of Pediatrics & Thalassemia Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Tanyildiz M, Gungormus A, Erden SE, Ozden O, Bicer M, Akcevin A, Odemis E. Approach to red blood cell transfusions in post-operative congenital heart disease surgery patients: when to stop? Cardiol Young 2024; 34:676-683. [PMID: 37800309 DOI: 10.1017/s1047951123003463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
BACKGROUND The best transfusion approach for CHD surgery is controversial. Studies suggest two strategies: liberal (haemoglobin ≤ 9.5 g/dL) and restrictive (waiting for transfusion until haemoglobin ≤ 7.0 g/dL if the patient is stable). Here we compare liberal and restrictive transfusion in post-operative CHD patients in a cardiac intensive care unit. METHODS Retrospective analysis was conducted on CHD patients who received liberal transfusion (2019-2021, n=53) and restrictive transfusion (2021-2022, n=43). RESULTS The two groups were similar in terms of age, gender, Paediatric Risk of Mortality-3 score, Paediatric Logistic Organ Dysfunction-2 score, Risk Adjustment for Congenital Heart Surgery-1 score, cardiopulmonary bypass time, vasoactive inotropic score, total fluid balance, mechanical ventilation duration, length of cardiac intensive care unit stay, and mortality. The liberal transfusion group had a higher pre-operative haemoglobin level than the restrictive group (p < 0.05), with no differences in pre-operative anaemia. Regarding the minimum and maximum post-operative haemoglobin levels during a cardiac intensive care unit stay, the liberal group had higher haemoglobin levels in both cases (p<0.01 and p=0.019, respectively). The number of red blood cell transfusions received by the liberal group was higher than that of the restrictive group (p < 0.001). There were no differences between the two groups regarding lactate levels at the time of and after red blood cell transfusion. The incidence of bleeding, re-operation, acute kidney injury, dialysis, sepsis, and systemic inflammatory response syndrome was similar. CONCLUSIONS Restrictive transfusion may be preferable over liberal transfusion. Achieving similar outcomes with restrictive transfusions may provide promising evidence for future studies.
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Affiliation(s)
- Murat Tanyildiz
- Department of Pediatric Intensive Care, Koc University School of Medicine, Istanbul, Turkey
| | - Asiye Gungormus
- Department of Pediatric Intensive Care, Koc University School of Medicine, Istanbul, Turkey
| | - Selin Ece Erden
- Department of Pediatric Intensive Care, Koc University School of Medicine, Istanbul, Turkey
| | - Omer Ozden
- Department of Pediatric Intensive Care, Koc University School of Medicine, Istanbul, Turkey
| | - Mehmet Bicer
- Department of Cardiovascular Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Atif Akcevin
- Department of Cardiovascular Surgery, Koc University School of Medicine, Istanbul, Turkey
| | - Ender Odemis
- Department of Pediatric Cardiology, Koc University School of Medicine, Istanbul, Turkey
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24
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Fu X, Yan D, Huang W, Xie X, Zhou Y, Li H, Wang Y, Pei S, Yao R, Li N. Efficacy of fresh frozen plasma transfusion in decompensated cirrhosis patients with coagulopathy admitted to ICU: a retrospective cohort study from MIMIC-IV database. Sci Rep 2024; 14:4925. [PMID: 38418492 PMCID: PMC10902319 DOI: 10.1038/s41598-024-54379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/12/2024] [Indexed: 03/01/2024] Open
Abstract
We aimed to explore the association between FFP transfusion and outcomes of DC patients with significant coagulopathy. A total of 693 DC patients with significant coagulopathy were analyzed with 233 patients per group after propensity score matching (PSM). Patients who received FFP transfusion were matched with those receiving conventional therapy via PSM. Regression analysis showed FFP transfusion had no benefit in 30-day (HR: 1.08, 95% CI 0.83-1.4), 90-day (HR: 1.03, 95% CI 0.80-1.31) and in-hospital(HR: 1.30, 95% CI 0.90-1.89) mortality, associated with increased risk of liver failure (OR: 3.00, 95% CI 1.78-5.07), kidney failure (OR: 1.90, 95% CI 1.13-3.18), coagulation failure (OR: 2.55, 95% CI 1.52-4.27), respiratory failure (OR: 1.76, 95% CI 1.15-2.69), and circulatory failure (OR: 2.15, 95% CI 1.27-3.64), and even associated with prolonged the LOS ICU (β: 2.61, 95% CI 1.59-3.62) and LOS hospital (β: 6.59, 95% CI 2.62-10.57). In sensitivity analysis, multivariate analysis (HR: 1.09, 95%CI 0.86, 1.38), IPTW (HR: 1.11, 95%CI 0.95-1.29) and CAPS (HR: 1.09, 95% CI 0.86-1.38) showed FFP transfusion had no beneficial effect on the 30-day mortality. Smooth curve fitting demonstrated the risk of liver failure, kidney failure and circulatory failure increased by 3%, 2% and 2% respectively, for each 1 ml/kg increase in FFP transfusion. We found there was no significant difference of CLIF-SOFA and MELD score between the two group on day 0, 3, 7, 14. Compared with the conventional group, INR, APTT, and TBIL in the FFP transfusion group significantly increased, while PaO2/FiO2 significantly decreased within 14 days. In conclusion, FFP transfusion had no beneficial effect on the 30-day, 90-day, in-hospital mortality, was associated with prolonged the LOS ICU and LOS hospital, and the increased risk of liver failure, kidney failure, coagulation failure, respiratory failure and circulatory failure events. However, large, multi-center, randomized controlled trials, prospective cohort studies and external validation are still needed to verify the efficacy of FFP transfusion in the future.
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Affiliation(s)
- Xiangjie Fu
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Danyang Yan
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wanting Huang
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xi Xie
- Department of Clinical Laboratory, Hunan Prevention and Treatment Institute for Occupational Diseases, University of South China, Changsha, Hunan, China
| | - Yiran Zhou
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huan Li
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanjie Wang
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Siya Pei
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Run Yao
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Ning Li
- Department of Blood Transfusion, Clinical Transfusion Research Center, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Rapier JJ, Daley M, Smith SE, Goh SL, Margale S, Smith I, Thomson BM, Tesar PJ, Pearse BL. Implementation of Patient Blood Management in Orthotopic Heart Transplants: A Single Centre Retrospective Observational Review. Heart Lung Circ 2024:S1443-9506(24)00040-4. [PMID: 38365499 DOI: 10.1016/j.hlc.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/20/2023] [Accepted: 01/01/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Blood transfusion in the perioperative cardiothoracic setting has accepted risks including deep sternal wound infection, increased intensive care unit length of stay, lung injury, and cost. It has an immunomodulatory effect which may cause allo-immunisation. This may influence long-term survival through immune-mediated factors. Targeting coagulation defects to reduce unnecessary or inappropriate transfusions may reduce these complications. METHODS In 2012, an institution-wide patient blood management evidence-based algorithmic bleeding management protocol was implemented at The Prince Charles Hospital, Brisbane, Australia. The benefit of this has been previously reported in our lung transplant and cardiac surgery (excluding transplants) cohorts. This study aimed to investigate the effect of this on our orthotopic heart transplant recipients. RESULTS After the implementation of the protocol, despite no difference in preoperative haemoglobin levels and higher risk patients (EuroSCORE 20 vs 26; p=0.013), the use of packed red blood cells (13.0 U vs 4.4 U; p=0.046) was significantly lower postoperatively and fresh frozen plasma was significantly lower both intra- and postoperatively (7.4 U vs 0.6 U; p<0.001, and 3.3 U vs 0.6 U; p=0.011 respectively). Concurrently, the use of prothrombin complex concentrate (33% vs 78%; p<0.001) and desmopressin (5% vs 22%; p=0.0028) was significantly higher in the post-protocol group, while there was less use of recombinant factor VIIa (15% vs 4%; p=0.058). Intraoperative units of cryoprecipitate also rose from 0.9 to 2.0 (p=0.006). CONCLUSIONS We have demonstrated that a targeted patient blood management protocol with point-of-care testing for heart transplant recipients is correlated with fewer blood products used postoperatively, with some increase in haemostatic products and no evidence of increased adverse events.
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Affiliation(s)
- Jacob J Rapier
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia.
| | - Michael Daley
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Susan E Smith
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Sean L Goh
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Swaroop Margale
- Department of Anaesthesia and Perfusion, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Ian Smith
- Department of Anaesthesia and Perfusion, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Bruce M Thomson
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Peter J Tesar
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Bronwyn L Pearse
- Department of Surgery and Critical Care, The Prince Charles Hospital, Brisbane, Qld, Australia
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Fujiwara G, Okada Y, Shiomi N, Sakakibara T, Yamaki T, Hashimoto N. Derivation of Coagulation Phenotypes and the Association with Prognosis in Traumatic Brain Injury: A Cluster Analysis of Nationwide Multicenter Study. Neurocrit Care 2024; 40:292-302. [PMID: 36977962 DOI: 10.1007/s12028-023-01712-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/01/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The pathogenesis and pathophysiology of traumatic coagulopathy during traumatic brain injury is not well understood, and the appropriate treatment strategy for this condition has not been established. This study aimed to evaluate the coagulation phenotypes and their effect on prognosis in patients with isolated traumatic brain injury. METHODS In this multicenter cohort study, we retrospectively analyzed data from the Japan Neurotrauma Data Bank. Adults with isolated traumatic brain injury (head abbreviated injury scale > 2; abbreviated injury scale of any other trauma < 3) who were registered in the Japan Neurotrauma Data Bank were included in this study. The primary outcome was the association of coagulation phenotypes with in-hospital mortality. Coagulation phenotypes were derived using k-means clustering with coagulation markers, including prothrombin time international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), fibrinogen (FBG), and D-dimer (DD) on arrival at the hospital. Multivariable logistic regression analyses were conducted to calculate the adjusted odds ratios of coagulation phenotypes with their 95% confidence intervals (CIs) for in-hospital mortality. RESULTS In total, 556 patients were enrolled and five coagulation phenotypes were identified. The median (interquartile range) score for the Glasgow Coma Scale was 6 (4-9). Cluster A (n = 129) had the closest to normal coagulation values; cluster B (n = 323) had a mild high DD phenotype; cluster C (n = 30) had a prolonged PT-INR phenotype with a higher frequency of antithrombotic medication in elderly patients than in younger patients; cluster D (n = 45) had a low amount of FBG, high DD, and prolonged APTT phenotype with a high incidence of skull fracture; and cluster E (n = 29) had a low amount of FBG and extremely high DD phenotype with high energy trauma and a high incidence of skull fracture. In the multivariable logistic regression analysis, the association of clusters B, C, D, and E with in-hospital mortality yielded the corresponding adjusted odds ratios of 2.17 (95% CI 1.22-3.86), 2.61 (95% CI 1.01-6.72), 10.0 (95% CI 4.00-25.2), and 24.1 (95% CI 7.12-81.3), respectively, relative to cluster A. CONCLUSIONS This multicenter, observational study identified five different coagulation phenotypes of traumatic brain injury and showed associations of these phenotypes with in-hospital mortality.
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Affiliation(s)
- Gaku Fujiwara
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc, 2-4-1, Ohashi, Ritto, Shiga, Japan.
| | - Yohei Okada
- Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan
| | - Naoto Shiomi
- Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Ritto, Shiga, Japan
| | | | - Tarumi Yamaki
- Department of Neurosurgery, Kyoto Kujo Hospital, Kyoto, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Xhaard A, Bouton M, Delugin L, Giraud C, Guyon A, Giroux-Lathuile C, Hajjout K, Nicolas P, Peyrard T, Ratie V, Boisnard A, Capelle L, Godin S, Traineau R, Yacoub-Agha I, Leprêtre AC. [ Transfusion management and immuno-hematological follow-up after allogeneic hematopoietic cell transplantation: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2024; 111:S78-S83. [PMID: 37055307 DOI: 10.1016/j.bulcan.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 04/15/2023]
Abstract
The French High Authority of Health (HAS) and National Drug Safety (ANSM) agencies recommendations issued in 2014, the French General Direction of Health (DGS) instruction published in November 2021, the French National Blood Bank (EFS) guidelines and the data available in the literature globally define "good transfusion practices" but provide little information about the immuno-hematological and transfusion management of patients who have received an allogeneic hematopoietic stem transplantation (allo-HCT). The aim of this workshop was to harmonize these practices in situations for which there are currently no recommendations. In order to anticipate possible transfusion issues after allo-HCT, we recommend performing, before the transplantation, an extended red blood cell phenotyping of the donor and a detection of HLA alloimmunization in the recipient. We recommend to systematically perform for minor ABO mismatches: a direct antiglobulin test between D8 and D20, and for major ABO mismatches; a titration of anti-A/anti-B antibodies and an erythrocyte chimerism at D100. At one-year post-transplant, we recommend carrying out an erythrocyte chimerism to allow, if necessary, the update of transfusion counselling (RH phenotype, irradiation of packed red blood cells).
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Affiliation(s)
- Aliénor Xhaard
- AP-HP, hôpital Saint-Louis, service d'hématologie-greffe, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - Muriel Bouton
- EFS Nouvelle-Aquitaine, site de Pessac Haut-Lévêque, avenue de Magellan, Pessac, France
| | - Laurence Delugin
- EFS Bretagne, laboratoire immuno-hématologie érythrocytaire, rue Pierre-Jean-Gineste, 35011 Rennes cedex, France
| | - Christine Giraud
- CHU de Poitiers, service d'hématologie et de thérapie cellulaire, 2, rue de la Miletrie, 86021 Poitiers, France; Centre de soins, EFS NVAQ, site de Poitiers, laboratoire de thérapie cellulaire, 350, avenue Jacques-Cœur, BP 482, 86012 Poitiers cedex, France
| | - Alizée Guyon
- EFS Bourgogne-Franche-Comté, 8, rue du Docteur Jean-François-Xavier-Girod, 25000 Besançon, France
| | | | - Khadija Hajjout
- Centre régional de transfusion sanguine de Rabat, Rabat, Maroc
| | - Pascal Nicolas
- EFS Grand-Est, 10, rue Spielmann, 67000 Strasbourg, France
| | | | - Vanessa Ratie
- EFS Bourgogne-Franche-Comté, 8, rue du Docteur Jean-François-Xavier-Girod, 25000 Besançon, France
| | - Anne Boisnard
- AP-HP, hôpital Necker, service d'hématologie adulte, 151, rue de Sèvres, 75015 Paris, France
| | - Lucie Capelle
- CHU de Lille, service hématologie pédiatrique, Lille, France
| | - Sandrine Godin
- CHU de Lille, service hématologie pédiatrique, Lille, France
| | | | - Ibrahim Yacoub-Agha
- Université de Lille, CHU de Lille, Infinite, Inserm U1286, 59000 Lille, France
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Sukhon F, Jabri A, Al-Abdouh A, Alameh A, Alhuneafat L, Jebaje ZA, Khader S, Mhanna M, Koenig G, Alaswad K, Villablanca P, AlQarqaz M. Liberal versus conservative transfusion strategy for patients with acute myocardial infarction and anemia: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102247. [PMID: 38040217 DOI: 10.1016/j.cpcardiol.2023.102247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND A hemoglobin (Hb) level goal of 7-8 g/dL is a standard care threshold, prompting blood transfusion. The debate over whether acute myocardial infarction (MI) patients benefit from a more liberal transfusion strategy prompted a meta-analysis of relevant trials. METHODS We performed a meta-analysis of randomized controlled trials (RCTs) comparing liberal and restrictive transfusion strategies in anemic MI patients. Primary outcomes were recurrent MI and death/MI, while secondary outcomes included stroke, revascularization, heart failure, and all-cause mortality. Due to the limited trials, we utilized the Paul-Mendele method with Hartung Knapp adjustment. RESULTS Involving 2155 patients with liberal transfusion and 2170 with conservative transfusion across four RCTs, liberal transfusion did not significantly reduce MI (relative risk [RR] 0.85; 95 % CI 0.72 - 1.02, p = 0.07) or death/MI (RR 0.88; 95 % CI 0.45 - 1.71, p = 0.57). No significant differences were observed in all-cause mortality (RR 0.82; 95 % CI 0.25 - 2.68, p = 0.63), stroke (RR 0.89; 95 % CI 0.48 - 1.64, p = 0.50), revascularization (RR 0.93; 95 % CI 0.48 - 1.80, p = 0.68), or heart failure (RR 1.14; 95 % CI 0.04 - 28.84, p = 0.88). CONCLUSION Our meta-analysis supports current medical guidelines, reinforcing the practice of limiting transfusions in acute MI patients to those with an Hb level of 7 or 8 g/dL. Liberal transfusion strategies did not show improved clinical outcomes.
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Affiliation(s)
- Fares Sukhon
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Ahmad Jabri
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA
| | - Ahmad Al-Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Anas Alameh
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Laith Alhuneafat
- Cardiovascular Disease Insititute, University of Minnesota, Minneapolis, MN, USA
| | - Zaid Al Jebaje
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA
| | - Safwan Khader
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Mohammed Mhanna
- Division of Cardiovascular Medicine, University of Iowa, IA, USA
| | - Gerald Koenig
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA
| | - Khaldoon Alaswad
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA
| | - Pedro Villablanca
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA
| | - Mohammad AlQarqaz
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA.
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Matos L, Morgado I, Santos L, Camisa R, Benvindo P, Pereira P. A targeted survey on teachers' perception of training/education for blood donation in high school students: An invited case report for enhancing and retention of dedicated donors in Portugal. Transfus Apher Sci 2024; 63:103876. [PMID: 38310032 DOI: 10.1016/j.transci.2024.103876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Promoting blood donation requires understanding and identifying the factors that motivate donations so that strategies for retaining and increasing loyalty can be developed. Transfusion literacy can be improved through school-based teaching and information about giving and solidarity to promote the development of future donors. For the purpose of aligning any strategies and motivational dynamics that promote adherence to informed donation and loyalty among students in the municipality of Coimbra. This study was undertaken to assess the perception of secondary school teachers regarding the students' knowledge of blood donation. A survey was conducted among teachers from seven public schools in Coimbra with regard to the 3rd and Secondary cycles. Based on the data, people give blood for a feeling of personal satisfaction and peer influence, as well as for the satisfaction of helping others. Blood donation should be made a focal point of relevance and interest in the school community, by implementing programs, projects, and dissemination actions targeting this target group. We are extremely glad and most enthusiastic to be invited to share our study through what's happening with the readers globally.
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Affiliation(s)
- Lídia Matos
- Coimbra Blood and Transplantation Center, Portuguese Institute of Blood and Transplantation, Portugal.
| | - Irene Morgado
- Coimbra Blood and Transplantation Center, Portuguese Institute of Blood and Transplantation, Portugal
| | - Luís Santos
- Coimbra Blood and Transplantation Center, Portuguese Institute of Blood and Transplantation, Portugal
| | - Rui Camisa
- Coimbra Blood and Transplantation Center, Portuguese Institute of Blood and Transplantation, Portugal
| | - Paulo Benvindo
- Portuguese Institute of Blood and Transplantation, Portugal
| | - Paulo Pereira
- R&D Department, Portuguese Institute of Blood and Transplantation, Portugal
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Wang S, Yang J, Lin L. Intravenous Application of Tranexamic Acid in Patients Undergoing Plastic Surgery: A Systematic Review and Meta-analysis with GRADE Quality Assessment. Aesthetic Plast Surg 2024; 48:543-558. [PMID: 37721624 DOI: 10.1007/s00266-023-03637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/07/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) is a versatile antifibrinolytic agent that is widely used in modern surgeries. This review assessed the safety and efficacy of intravenous (IV) TXA in plastic surgery versus controls. METHODS This review selected English-language Randomized controlled trials (RCTs) evaluating IV TXA effects in plastic surgery from four electronic databases, PubMed, Web of Science, Embase, and Cochrane Library up to April 9, 2023. Primary outcomes were blood loss volume (BLV) and transfusion occurrence, with operation time and surgical field assessment as secondary outcomes. IV TXA-related complications were also important indicators. Meta-analyses and qualitative analyses were conducted and the quality of the evidence was assessed. RESULTS Thirty RCTs with 2150 patients were included. The total standard mean difference (SMD) of BLV and pooled relative risk of transfusion occurrence between the IV TXA and the control groups were - 1.11 (95% CI, - 1.42 to - 0.80) and 0.36 (95% CI, 0.23 to 0.55) respectively, indicating a significant blood loss reduction with IV TXA treatment, while an ambiguous outcome of operation time was observed, with an SMD of - 0.22 (95% CI, - 0.42 to - 0.02). The quality of evidence for BLV and transfusion occurrence was low and medium, respectively. A quantitative analysis of surgical field assessment was not performed because of the substantial heterogeneity in scoring methods. No IV TXA-related complications were observed. CONCLUSIONS In plastic surgery, IV TXA administration results in less blood loss, reduced need for transfusion and better surgical fields but probably does not increase the risk of adverse events. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Senmao Wang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Jingwen Yang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China
| | - Lin Lin
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
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Takahashi Y, Yoshii R, Amaya F, Sawa T, Ogawa S. Effect of acute normovolemic hemodilution in patients undergoing cardiac surgery with remimazolam anesthesia. J Anesth 2024; 38:98-104. [PMID: 38150014 DOI: 10.1007/s00540-023-03290-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE The reduced effects of allogeneic transfusion with acute normovolemic hemodilution (ANH) have been reported. Harvesting a large volume of blood may maximize the effect in patients with low body weight, and the prevention of hypotension is important. Remimazolam is an anesthetic with few circulatory responses. Our aim was to evaluate whether high-volume ANH reduces the need for transfusion in cardiac patients under remimazolam anesthesia. METHODS In this retrospective single-center study, we enrolled cardiopulmonary bypass (CPB) patients who received remimazolam anesthesia. Changes in hemodynamic parameters were assessed. The numbers of blood transfusions and chest tube outputs were also evaluated. RESULTS In a total of 51 patients, ANH was performed in 27 patients with a mean body mass index of 23.2 (ANH volume: 740 ± 222 mL). No significant differences were observed in mean blood pressure during blood collection. The intraoperative amount of red blood cell (RBC) transfusion was significantly lower in the ANH group than in the control group (431 ± 678 and 1260 ± 572 mL, p < 0.001). The avoidance rates of RBC were 66.7 and 4.2%, respectively. The multivariate analysis result revealed that ANH correlated with RBC, with an odds ratio of 0.067 (95% confidence interval 0.005-0.84, p < 0.05). The postoperative bleeding at 24 h was significantly lower in the ANH group (455 ± 228 and 797 ± 535 mL, p < 0.01). CONCLUSION In patients undergoing CPB, ANH reduced intraoperative transfusion amount and postoperative bleeding. Hemodynamic changes during blood collection were minimal under remimazolam anesthesia and high-volume ANH was feasible.
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Affiliation(s)
- Yuya Takahashi
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryogo Yoshii
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumimasa Amaya
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo, Kyoto, 602-8566, Japan
| | - Teiji Sawa
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoru Ogawa
- Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
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Gonçalves H, Rodrigues C, Silva HF, Pereira P. Insights on trends in the management of metrological analysis of devices in blood and transfusion medicine services: Verification based on their fitness for purpose and suitability for their respective applications. Transfus Apher Sci 2024; 63:103874. [PMID: 38233312 DOI: 10.1016/j.transci.2024.103874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
In the field of blood and transfusion medicine, European Directorate for the Quality of Medicines & HealthCare recommends practices for metrological devices. Monitoring and measurement resources, as well as their permitted metrological limits, must be considered in this regard. We must understand variables such as metrological domains, the International System of Units, metrological traceability, and metrological requirements and controls in the field of transfusions in order to understand these metrological devices. An approach to metrological analysis and subsequent actions was constructed using flowcharts. As part of this methodology, a metrological device was selected, along with regulatory and normative requirements. A calibration and a test were conducted to demonstrate the application of the figure based on current recommendations. Current recommendations are consistent with the suggested ROC approach. The metrological devices must be verified based on their suitability for their respective applications (fitness-for-purpose).
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Affiliation(s)
| | - Carla Rodrigues
- Metrology Department, Portuguese Institute of Blood and Transplantation, Portugal
| | - Hugo F Silva
- DEQ-ISEL/IPL, Departamento de Engenharia Química do ISEL/IPL, Portugal; CQE: Centro de Química Estrutural, Institute of Molecular Sciences, Faculdade de Ciencias, Universidade de Lisboa, Portugal
| | - Paulo Pereira
- R&D Department, Portuguese Institute of Blood and Transplantation, Portugal
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Charuvila S, Imam MS, Reza T, Datta PK, Aziz TT, Davidson S, Sumi SA, Alam S, Ismail M, Banu T, Lakhoo K. A Prospective Observational Study of Preoperative Anaemia Management Aided by Bedside Haemoglobin Testers in a Low-Resource Setting. J Pediatr Surg 2024; 59:305-309. [PMID: 38030532 DOI: 10.1016/j.jpedsurg.2023.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023]
Abstract
AIM Paediatric-preoperative anaemia management is challenging in settings where clinical judgment is used to diagnose anaemia owing to a lack of timely, affordable preoperative haemoglobin testing. We analysed anaemia management in such a setting after the introduction of point-of-care bedside haemoglobin testers. METHOD 1033 children who underwent surgery at a hospital in Bangladesh were included in this study. 569 underwent major surgery, and 464 underwent minor surgery and belonged to predominantly ASA category 1 or 2. RESULTS 940/1033 children underwent preoperative anaemia testing. Average haemoglobin was 11.7 g/dL. 103/1033 children were deemed clinically anaemic. However, 285 children were found to have anaemia based on bedside testing. Sensitivity of clinical judgement was 33.68% (95 % CI 28.22%-39.49%), and the specificity was 99.08% (95 % CI 98.02%-99.66%). 63/1033 had preoperative anaemia treatment, of whom 60 underwent transfusion. Subgroup analysis of children with haemoglobin <10 g/dL (n = 124) was done to compare conservative vs liberal transfusion strategy. 43/124 of this subset was transfused. Average length of stay for those transfused was 11.7 days, and those who weren't was 9.9 days (p = 0.087). 4 patients in the transfused subgroup required post-op ICU, and only 1 patient in the conservatively managed arm required ICU (p = 0.048). CONCLUSION This study demonstrates the positive impact of bedside haemoglobin testers as they have resulted in a significantly higher proportion of children diagnosed with anaemia at a fraction of the cost and logistics involved in laboratory testing. Further research on haemoglobin thresholds is required to understand the safety and long-term impact of restrictive transfusion in the surgical context. LEVEL OF EVIDENCE 2c (Grading as per the Oxford Centre for Evidence Based Medicine).
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Affiliation(s)
- Somy Charuvila
- University of Oxford, Nuffield Department of Surgical Sciences, Oxford, UK.
| | - Md Sharif Imam
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh
| | - Tanjim Reza
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh
| | - Pranay Kumar Datta
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh
| | - Tasmiah Tahera Aziz
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh
| | - Sarah Davidson
- University of Oxford, Nuffield Department of Surgical Sciences, Oxford, UK
| | - Sharmin Alam Sumi
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh
| | - Sakibul Alam
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh
| | - Mohammad Ismail
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh
| | - Tahmina Banu
- Chittagong Research Institute for Children Surgery [CRICS], Chittagong, Bangladesh.
| | - Kokila Lakhoo
- University of Oxford, Nuffield Department of Surgical Sciences, Oxford, UK.
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Luo XP, Peng J, Zhou L, Liao H, Jiang XC, Tang X, Tang D, Liu C, Liu JH. Intramedullary administration of tranexamic acid reduces bleeding in proximal femoral nail antirotation surgery for intertrochanteric fractures in elderly individuals: A randomized controlled trial. Chin J Traumatol 2024:S1008-1275(24)00006-3. [PMID: 38429175 DOI: 10.1016/j.cjtee.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 03/03/2024] Open
Abstract
PURPOSE Intertrochanteric fractures undergoing proximal femoral nail antirotation (PFNA) surgery are associated with significant hidden blood loss. This study aimed to explore whether intramedullary administration of tranexamic acid (TXA) can reduce bleeding in PFNA surgery for intertrochanteric fractures in elderly individuals. METHODS A randomized controlled trial was conducted from January 2019 to December 2022. Patients aged over 60 years with intertrochanteric fractures who underwent intramedullary fixation surgery with PFNA were eligible for inclusion and grouped according to random numbers. A total of 249 patients were initially enrolled, of which 83 were randomly allocated to the TXA group and 82 were allocated to the saline group. The TXA group received intramedullary perfusion of TXA after the bone marrow was reamed. The primary outcomes were total peri-operative blood loss and post-operative transfusion rate. The occurrence of adverse events was also recorded. Continuous data was analyzed by unpaired t-test or Mann-Whitney U test, and categorical data was analyzed by Pearson Chi-square test. RESULTS The total peri-operative blood loss (mL) in the TXA group was significantly lower than that in the saline group (577.23 ± 358.02 vs. 716.89 ± 420.30, p = 0.031). The post-operative transfusion rate was 30.67 % in the TXA group and 47.95 % in the saline group (p = 0.031). The extent of post-operative deep venous thrombosis and the 3-month mortality rate were similar between the 2 groups. CONCLUSION We observed that intramedullary administration of TXA in PFNA surgery for intertrochanteric fractures in elderly individuals resulted in less peri-operative blood loss and decreased transfusion rate, without any adverse effects, and is, thus, recommended.
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Affiliation(s)
- Xiang-Ping Luo
- Department of Orthopaedic, Hengyang Central Hospital, Hengyang, 421001, Hunan province, China.
| | - Jian Peng
- Department of Orthopaedic, Hengyang Central Hospital, Hengyang, 421001, Hunan province, China
| | - Ling Zhou
- Department of Orthopaedic, Hengyang Central Hospital, Hengyang, 421001, Hunan province, China
| | - Hao Liao
- Department of Orthopaedic, Hengyang Central Hospital, Hengyang, 421001, Hunan province, China
| | - Xiao-Chun Jiang
- Department of Orthopaedic, Hengyang Central Hospital, Hengyang, 421001, Hunan province, China
| | - Xiong Tang
- Department of Orthopaedic, Hengyang Central Hospital, Hengyang, 421001, Hunan province, China
| | - Dun Tang
- Department of Orthopaedic, Hengyang Central Hospital, Hengyang, 421001, Hunan province, China
| | - Chao Liu
- Department of Orthopaedic, Hengyang Central Hospital, Hengyang, 421001, Hunan province, China
| | - Jian-Hui Liu
- Department of Orthopaedic, Hengyang Central Hospital, Hengyang, 421001, Hunan province, China
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Wang C, Lebedeva V, Yang J, Anih J, Park LJ, Paczkowski F, Roshanov PS. Desmopressin to reduce periprocedural bleeding and transfusion: a systematic review and meta-analysis. Perioper Med (Lond) 2024; 13:5. [PMID: 38263259 PMCID: PMC10804695 DOI: 10.1186/s13741-023-00358-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024] Open
Abstract
We systematically reviewed the literature to investigate the effects of peri-procedural desmopressin in patients without known inherited bleeding disorders undergoing surgery or other invasive procedures. We included 63 randomized trials (4163 participants) published up to February 1, 2023. Seven trials were published after a 2017 Cochrane systematic review on this topic. There were 38 trials in cardiac surgery, 22 in noncardiac surgery, and 3 in non-surgical procedures. Meta-analyses demonstrated that desmopressin likely does not reduce the risk of receiving a red blood cell transfusion (25 trials, risk ratio [RR] 0.95, 95% confidence interval [CI] 0.86 to 1.05) and may not reduce the risk of reoperation due to bleeding (22 trials, RR 0.75, 95% CI 0.47 to 1.19) when compared to placebo or usual care. However, we demonstrated significant reductions in number of units of red blood cells transfused (25 trials, mean difference -0.55 units, 95% CI - 0.94 to - 0.15), total volume of blood loss (33 trials, standardized mean difference - 0.40 standard deviations; 95% CI - 0.56 to - 0.23), and the risk of bleeding events (2 trials, RR 0.45, 95% CI 0.24 to 0.84). The certainty of evidence of these findings was generally low. Desmopressin increased the risk of clinically significant hypotension that required intervention (19 trials, RR 2.15, 95% CI 1.36 to 3.41). Limited evidence suggests that tranexamic acid is more effective than desmopressin in reducing transfusion risk (3 trials, RR 2.38 favoring tranexamic acid, 95% CI 1.06 to 5.39) and total volume of blood loss (3 trials, mean difference 391.7 mL favoring tranexamic acid, 95% CI - 93.3 to 876.7 mL). No trials directly informed the safety and hemostatic efficacy of desmopressin in advanced kidney disease. In conclusion, desmopressin likely reduces periprocedural blood loss and the number of units of blood transfused in small trials with methodologic limitations. However, the risk of hypotension needs to be mitigated. Large trials should evaluate desmopressin alongside tranexamic acid and enroll patients with advanced kidney disease.
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Affiliation(s)
- Carol Wang
- Department of Medicine, Western University, London, ON, Canada
| | | | - Jeffy Yang
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Lily J Park
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Freeman Paczkowski
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Pavel S Roshanov
- Department of Medicine, Western University, London, ON, Canada.
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
- Population Health Research Institute, Hamilton, ON, Canada.
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Link H, Kerkmann M, Holtmann L, Detzner M. Anemia diagnosis and therapy in malignant diseases: implementation of guidelines-a representative study. Support Care Cancer 2024; 32:113. [PMID: 38240843 PMCID: PMC10799088 DOI: 10.1007/s00520-023-08267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/18/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE Anemia in cancer should be diagnosed and treated according to guideline recommendations. The implementation of ESMO and German guidelines and their effect on anemia correction was analyzed. METHODS This retrospective epidemiological study, representative for Germany, analyzed data on anemia management of cancer patients with anemia ≥ grade 2. The Guideline Adherence Score (GLAD) for diagnosis (GLAD-D) and therapy (GLAD-T) was defined as follows: 2 points for complete, 1 point for partial, 0 point for no adherence. RESULTS Data were analyzed for 1046 patients. Hb levels at diagnosis of anemia were 8-10 g/dL in 899 (85.9%) patients, 7-8 g/dL in 92 (8.7%), and < 7 g/dL (5.0%) in 52. Transferrin saturation was determined in 19% of patients. Four hundred fifty-six patients received RBC (43.6%), 198 (18.9%) iron replacement, 106 (10.1%) ESA, and 60 (5.7%) vitamin B12 replacement. 60.6% of patients receiving iron replacement were treated intravenously and 39.4% were treated orally. Two hundred eighty-eight (36.6%) of 785 patients receiving transfusions had no guideline-directed indication. GLAD-D was 2 in 310 patients (29.6%), 1 in 168 (16.1%), and 0 in 568 (54.3%). GLAD-T was 2 in 270 patients (25.8%), 1 in 320 patients (30.6%), and 0 in 456 patients (43.6%). Higher GLAD-D significantly correlated with higher GLAD-T (τB = 0.176, p < 0.001). GLAD-T 2 was significantly associated with greater Hb increase than GLAD-T 0/1 (p < 0.001) at 28 days (10.2 vs. 9.7 g/dL) and at 2 months (10.4 vs. 9.9 g/dL). CONCLUSIONS Anemia assessment is inadequate, transfusion rates too high, and iron and ESA therapy too infrequent. TRIAL REGISTRATION ClinicalTrials.gov, NCT05190263, date: 2022-01-13.
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Affiliation(s)
- Hartmut Link
- Internal Medicine, Hematology and Medical Oncology, D-67661, Kaiserslautern, Germany.
- Working Groups Supportive Care (AGSMO), Medical Oncology (AIO) of the German Cancer Society, Berlin, Germany.
| | - Markus Kerkmann
- MMF GmbH, Lindberghweg 132, D-48155, Münster, Germany
- Working Groups Supportive Care (AGSMO), Medical Oncology (AIO) of the German Cancer Society, Berlin, Germany
| | - Laura Holtmann
- MMF GmbH, Lindberghweg 132, D-48155, Münster, Germany
- Working Groups Supportive Care (AGSMO), Medical Oncology (AIO) of the German Cancer Society, Berlin, Germany
| | - Markus Detzner
- AIO-Studien-gGmbH, Kuno-Fischer-Straße 8, D-14057, Berlin, Germany
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Carlsen MIS, Brede JR, Medby C, Uleberg O. Transfusion practice in Central Norway - a regional cohort study in patients suffering from major haemorrhage. BMC Emerg Med 2024; 24:3. [PMID: 38185648 PMCID: PMC10773117 DOI: 10.1186/s12873-023-00918-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND In patients with major hemorrhage, balanced transfusions and limited crystalloid use is recommended in both civilian and military guidelines. This transfusion strategy is often applied in the non-trauma patient despite lack of supporting data. The aim of this study was to describe the current transfusion practice in patients with major hemorrhage of both traumatic and non-traumatic etiology in Central Norway, and discuss if transfusions are in accordance with appropriate massive transfusion protocols. METHODS In this retrospective observational cohort study, data from four hospitals in Central Norway was collected from 01.01.2017 to 31.12.2018. All adults (≥18 years) receiving massive transfusion (MT) and alive on admission were included. MT was defined as transfusion of ≥10 units of packed red blood cells (PRBC) within 24 hours, or ≥ 5 units of PRBC during the first 3 hours after admission to hospital. Clinical data was collected from the hospital blood bank registry (ProSang) and electronic patient charts (CareSuite PICIS). Patients undergoing cardiothoracic surgery or extracorporeal membrane oxygenation treatment were excluded. RESULTS A total of 174 patients were included in the study, of which 85.1% were non-trauma patients. Seventy-six per cent of all patients received plasma:PRBC in a ratio ≥ 1:2 (high ratio) and 59.2% of patients received platelets:PRBC in a ratio ≥ 1:2 (high ratio). 32.2% received a plasma:PRBC-ratio ≥ 1:1, and 23.6% platelet:PRBC-ratio ≥ 1:1. Median fluid infusion of crystalloids in all patients was 5750 mL. Thirty-seven per cent of all patients received tranexamic acid, 53.4% received calcium and fibrinogen concentrate was administered in 9.2%. CONCLUSIONS Most patients had a non-traumatic etiology. The majority was transfused with high ratios of plasma:PRBC and platelet:PRBC, but not in accordance with the aim of the local protocol (1:1:1). Crystalloids were administered liberally for both trauma and non-trauma patients. There was a lower use of hemostatic adjuvants than recommended in the local transfusion protocol. Awareness to local protocol should be increased.
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Affiliation(s)
- Marte Irene Skille Carlsen
- Department of Anesthesiology and Intensive Care Medicine, St Olav's University Hospital, Trondheim, Norway.
- Department of Traumatology, St. Olav's University Hospital, Trondheim, Norway.
| | - Jostein Rødseth Brede
- Department of Anesthesiology and Intensive Care Medicine, St Olav's University Hospital, Trondheim, Norway
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
- Department of Research and Development, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Christian Medby
- Department of Anesthesiology and Intensive Care Medicine, St Olav's University Hospital, Trondheim, Norway
- Department of Traumatology, St. Olav's University Hospital, Trondheim, Norway
- Norwegian Armed Forces Joint Medical Services, Sessvollmoen, Norway
| | - Oddvar Uleberg
- Department of Emergency Medicine and Pre-hospital Services, St Olav's University Hospital, Trondheim, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Kwon HJ, Park S, Park YH, Baik SM, Park DJ. Development of blood demand prediction model using artificial intelligence based on national public big data. Digit Health 2024; 10:20552076231224245. [PMID: 38250146 PMCID: PMC10798124 DOI: 10.1177/20552076231224245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024] Open
Abstract
Objective Modern healthcare systems face challenges related to the stable and sufficient blood supply of blood due to shortages. This study aimed to predict the monthly blood transfusion requirements in medical institutions using an artificial intelligence model based on national open big data related to transfusion. Methods Data regarding blood types and components in Korea from January 2010 to December 2021 were obtained from the Health Insurance Review and Assessment Service and Statistics Korea. The data were collected from a single medical institution. Using the obtained information, predictive models were developed, including eXtreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LGBM), and category boosting (CatBoost). An ensemble model was created using these three models. Results The prediction performance of XGBoost, LGBM, and CatBoost demonstrated a mean absolute error ranging from 14.6657 for AB+ red blood cells (RBCs) to 84.0433 for A+ platelet concentrate (PC) and a root mean squared error ranging from 18.5374 for AB+ RBCs to 118.6245 for B+ PC. The error range was further improved by creating ensemble models, wherein the department requesting blood was the most influential parameter affecting transfusion prediction performance for different blood products and types. Except for the department, the features that affected the prediction performance varied for each product and blood type, including the number of RBC antibody screens, crossmatch, nationwide blood donations, and surgeries. Conclusion Based on blood-related open big data, the developed blood-demand prediction algorithm can efficiently provide medical facilities with an appropriate volume of blood ahead of time.
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Affiliation(s)
- Hi Jeong Kwon
- Department of Laboratory Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sholhui Park
- Department of Laboratory Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Young Hoon Park
- Division of Hematology–Oncology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Seung Min Baik
- Division of Critical Care Medicine, Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Dong Jin Park
- Department of Laboratory Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Azarkane M, Rijnhout TWH, van Merwijk IAL, Tromp TN, Tan ECTH. Impact of accidental hypothermia in trauma patients: A retrospective cohort study. Injury 2024; 55:110973. [PMID: 37563046 DOI: 10.1016/j.injury.2023.110973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/05/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Trauma patients with hypothermia have substantial increases in mortality and morbidity. In severely injured patients, hypothermia is common with a rate up to 50% in various geographic areas. This study aims to elucidate the incidence, predictors, and impact of hypothermia on outcomes in severely injured patients. METHODS This was a retrospective cohort study which included trauma patients with an Injury Severity Score (ISS) ≥ 16 admitted to a level 1 trauma center in the Netherlands between January 1, 2015 and December 31, 2021. Primary outcome was incidence of hypothermia on arrival at the emergency department. Factors associated with hypothermia were identified. Secondary outcomes were transfusion requirement, mortality, and intensive care unit (ICU) admission. Logistic regression analysis was used to identify associations. RESULTS A total of 2032 severely injured patients were included of which 257 (12.6%) were hypothermic on hospital arrival. Predictors for hypothermia on hospital arrival included higher ISS, prehospital intubation, cervical spine immobilization, winter months, systolic blood pressure (SBP) < 90 mmHg and Glasgow Coma Scale (GCS) ≤ 8. Hypothermia was independently associated with transfusion requirement (OR, 2.68; 95% CI, 1.94 - 3.73; p < 0.001), mortality (OR, 2.12; 95% CI, 1.40 - 3.19; p < 0.001) and more often ICU admission (OR, 1.81; 95% CI, 1.10 - 2.97, p = 0.019). CONCLUSIONS In this study, hypothermia was present in 12.6% of severely injured patients. Hypothermia was associated with increased transfusion requirement, mortality, and ICU admission. Identified predictors for hypothermia included the severity of injury, intubation, and immobilization, as well as winter season, SBP < 90 mmHg, and GCS ≤ 8.
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Affiliation(s)
- Mozdalefa Azarkane
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Tim W H Rijnhout
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Isa A L van Merwijk
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tjarda N Tromp
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Edward C T H Tan
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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El-Beshlawy A, Dewedar H, Hindawi S, Alkindi S, Tantawy AA, Yassin MA, Taher AT. Management of transfusion-dependent β-thalassemia (TDT): Expert insights and practical overview from the Middle East. Blood Rev 2024; 63:101138. [PMID: 37867006 DOI: 10.1016/j.blre.2023.101138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
β-Thalassemia is one of the most common monogenetic diseases worldwide, with a particularly high prevalence in the Middle East region. As such, we have developed long-standing experience with disease management and devising solutions to address challenges attributed to resource limitations. The region has also participated in the majority of clinical trials and development programs of iron chelators and more novel ineffective erythropoiesis-targeted therapy. In this review, we provide a practical overview of management for patients with transfusion-dependent β-thalassemia, primarily driven by such experiences, with the aim of transferring knowledge to colleagues in other regions facing similar challenges.
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Affiliation(s)
- Amal El-Beshlawy
- Department of Pediatric Hematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hany Dewedar
- Thalassemia Center, Latifa Hospital, Dubai, United Arab Emirates
| | - Salwa Hindawi
- Department of Hematology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Salam Alkindi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Azza A Tantawy
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed A Yassin
- Department of Hematology and Oncology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Liaud-Laval G, Libert N, Pissot M, Chrisment A, Ponsin P, Boutonnet M, De Rudnicki S, Pasquier P, Martinez T. Severe hypocalcemia at admission is associated with increased transfusion requirements: A retrospective study in a level 1 trauma center. Injury 2024; 55:111168. [PMID: 37926665 DOI: 10.1016/j.injury.2023.111168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/27/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION In recent years, hypocalcemia has been added to the "lethal triad" of the trauma patient, thus constituting the "lethal diamond". Nevertheless, its proper role remains debated. The aim of this study is to evaluate the association between severe hypocalcemia at admission and 24 h- transfusion requirements in severe trauma patients in a level 1 trauma center. STUDY DESIGN AND METHODS In a monocentric retrospective observational study from January 2015 to May 2021, 137 traumatized adult patients transfused within 24 h after hospital admission was included in the study. The threshold for severe hypo ionized calcemia was ≤ 0.9 mmol/L. RESULTS 137 patients were included in the study, 23 presented with severe hypo-iCa at admission, 111 moderate hypo-iCa (0.9-1.2 mmol/L) and 3 normal iCa (≥ 1.2 mmol/L). Patients with severe hypo-iCa at admission had higher severity scores (SAPSII 58 IQR [51-70] vs. 45 IQR [32-56]; p = 0.001 and ISS 34 IQR [26-39] vs. 26 IQR [17-34]; p = 0.003). 24 h-transfusion requirements were greater for patients with severe hypo-iCa, regardless of the type of blood products transfused. There was a significant negative correlation between admission iCa and 24 h-transfusion (r = -0.45, p < 0.001). The difference in mortality was not significant between the two groups (24 h mortality: 17 % (4/23) for severe hypo-iCa vs. 8 % (9/114) for non-severe hypo-iCa; p = 0.3). DISCUSSION This study highlights the high prevalence of severe hypocalcemia in trauma patients and its association with increased 24 h- transfusion requirements.
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Affiliation(s)
- Grégoire Liaud-Laval
- Federation of anesthesiology, intensive care unit, burns and operating theater. Percy Military Training Hospital, Clamart, France
| | - Nicolas Libert
- Federation of anesthesiology, intensive care unit, burns and operating theater. Percy Military Training Hospital, Clamart, France; École du Val-de-Grâce, French Military Medical Service Academy. Paris, France
| | - Matthieu Pissot
- Federation of anesthesiology, intensive care unit, burns and operating theater. Percy Military Training Hospital, Clamart, France
| | - Anne Chrisment
- Federation of anesthesiology, intensive care unit, burns and operating theater. Percy Military Training Hospital, Clamart, France
| | - Pauline Ponsin
- Federation of anesthesiology, intensive care unit, burns and operating theater. Percy Military Training Hospital, Clamart, France
| | - Mathieu Boutonnet
- Federation of anesthesiology, intensive care unit, burns and operating theater. Percy Military Training Hospital, Clamart, France; École du Val-de-Grâce, French Military Medical Service Academy. Paris, France
| | - Stéphane De Rudnicki
- Federation of anesthesiology, intensive care unit, burns and operating theater. Percy Military Training Hospital, Clamart, France
| | - Pierre Pasquier
- Federation of anesthesiology, intensive care unit, burns and operating theater. Percy Military Training Hospital, Clamart, France; 1(ère) chefferie du service de santé, French military medical service, Villacoublay, France; École du Val-de-Grâce, French Military Medical Service Academy. Paris, France
| | - Thibault Martinez
- Federation of anesthesiology, intensive care unit, burns and operating theater. Percy Military Training Hospital, Clamart, France.
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Tamura T, Suzuki S, Fujii T, Hirai T, Imaizumi T, Kubo Y, Shibata Y, Narita Y, Mutsuga M, Nishiwaki K. Thromboelastographic evaluation after cardiac surgery optimizes transfusion requirements in the intensive care unit: a single-center retrospective cohort study using an inverse probability weighting method. Gen Thorac Cardiovasc Surg 2024; 72:15-23. [PMID: 37173610 PMCID: PMC10180616 DOI: 10.1007/s11748-023-01941-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE There are no reports from Japan showing the effects of using the thromboelastography algorithm on transfusion requirements after Intensive Care Unit (ICU) admission, and post-implementation knowledge regarding the thromboelastography algorithm under the Japanese healthcare system is insufficient. Therefore, this study aimed to clarify the effect of the TEG6s thromboelastography algorithm on transfusion requirements for patients in the ICU after cardiac surgery. METHODS We retrospectively compared the requirements for blood transfusion up to 24 h after ICU admission using the thromboelastography algorithm (January 2021 to April 2022) (thromboelastography group; n = 201) and specialist consultation with surgeons and anesthesiologists (January 2018 to December 2020) (non-thromboelastography group; n = 494). RESULTS There were no significant between-group differences in terms of age, height, weight, body mass index, operative procedure, duration of surgery or cardiopulmonary bypass, body temperature, or urine volume during surgical intervention. Moreover, there was no significant between-group difference in the amount of drainage at 24 h after ICU admission. However, crystalloid and urine volumes were significantly higher in the thromboelastography group than in the non-thromboelastography group. Additionally, fresh-frozen plasma (FFP) transfusion volumes were significantly lower in the thromboelastography group. However, there were no significant between-group differences in red blood cell count or platelet transfusion volume. After variable adjustment, the amount of FFP used from the operating room to 24 h after ICU admission was significantly reduced in the thromboelastography group. CONCLUSIONS The thromboelastography algorithm optimized transfusion requirements at 24 h after admission to the ICU following cardiac surgery.
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Affiliation(s)
- Takahiro Tamura
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Shogo Suzuki
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tasuku Fujii
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takahiro Hirai
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takahiro Imaizumi
- Department of Advanced Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
- Department of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoko Kubo
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasuyuki Shibata
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yuji Narita
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kimitoshi Nishiwaki
- Department of Anesthesiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Wu L, Peng X, Zhuo X, Zhu G, Xie X. Development and Validation of a Risk-Prediction Nomogram for Preoperative Blood Type and Antibody Testing in Spinal Fusion Surgery. Orthop Surg 2024; 16:111-122. [PMID: 38044447 PMCID: PMC10782259 DOI: 10.1111/os.13946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVE With advancements in minimally invasive techniques, the use of spinal fusion surgery is rapidly increasing and transfusion rates are decreasing. Routine preoperative ABO/Rh blood type and antibody screening (T&S) laboratory tests may not be appropriate for all spinal fusion patients. Herein, we constructed a nomogram to assess patient transfusion risk based on various risk factors in patients undergoing spinal fusion surgery, so that preoperative T&S testing can be selectively scheduled in appropriate patients to reduce healthcare and patient costs. METHODS Patients who underwent spinal fusion surgery between 01/2020 and 03/2023 were retrospectively examined and classified into the training (n = 3533, 70%) and validation (n = 1515, 30%) datasets. LASSO and multivariable logistic regression were used to analyze risk factors for blood transfusion. Nomogram predictive model was built according to the independent predictors and mode predictive power was validated using consistency index (C-index), Hosmer-Lemeshow (HL) test, calibration curve analysis and area under the curve (AUC) for receiver operating characteristic (ROC) curve. Bootstrap resampling was used for internal validation. Decision curve analysis (DCA) was applied to evaluate the model's performance in the clinic. RESULTS Being female, age, BMI, admission route, critical patient, operative time, heart failure, end-stage renal disease or chronic kidney disease (ESRD or CKD), anemia, and coagulation defect were predictors of blood transfusion for spinal fusion. A prediction nomogram was developed according to a multivariate model with good discriminatory power (C-index = 0.887); Bootstrap resampling internal validation C-index was 0.883. Calibration curves showed strong matching between the predicted and actual probabilities of the training and validation sets. HL tests for the training and validation sets had p-values of 0.327 and 0.179, respectively, indicating good calibration. When applied to the training set, the following parameters were found: AUC: 0.895, 95% CI: 0.871-0.919, sensitivity 78.2%, specificity 86.7%, positive predictive value 29.4% and negative predictive value 98.2%. If the model were applied in the training set, 2911 T&S tests (82.4%) would be eliminated, equaling a RMB349,320 cost reduction. The AUC in the internal validation was: 0.879, 95% CI: 0.839-0.927, sensitivity 75.2%, specificity 88.8%, positive predictive value 34.3%, negative predictive value 97.9%, would eliminate 1276 T&S tests (84.2%), saving RMB 153,120. The DCA curve indicated good clinical application value. CONCLUSION The nomogram based on 10 independent factors can help healthcare professionals predict the risk of transfusion for patients undergoing spinal fusion surgery to target preoperative T&S testing to appropriate patients and reduce healthcare costs.
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Affiliation(s)
- Linghong Wu
- Guangxi Key Laboratory of Orthopaedic Biomaterials Development and Clinical TranslationLiuzhou Worker's HospitalLiuzhouChina
| | | | | | - Guangwei Zhu
- West Hospital (Orthopaedic Hospital)Liuzhou Worker's HospitalLiuzhouChina
| | - Xiangtao Xie
- Spine SurgeryLiuzhou Worker's HospitalLiuzhouChina
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Guhlich M, Maag TE, Dröge LH, Hille A, Donath S, Bendrich S, Schirmer MA, Nauck F, Leu M, Riggert J, Gallwas J, Rieken S. Hemostatic radiotherapy in clinically significant tumor-related bleeding: excellent palliative results in a retrospective analysis of 77 patients. Radiat Oncol 2023; 18:203. [PMID: 38124078 PMCID: PMC10734078 DOI: 10.1186/s13014-023-02391-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Significant bleeding of tumor sites is a dreaded complication in oncological diseases and often results in clinical emergencies. Besides basic local and interventional procedures, an urgent radiotherapeutic approach can either achieve a bleeding reduction or a bleeding stop in a vast majority of patients. In spite of being used regularly in clinical practice, data reporting results to this therapy approach is still scarce. METHODS We retrospectively analyzed 77 patients treated for significant tumor-related bleeding at our clinic between 2000 and 2021, evaluating treatment response rate, hemoglobin levels, hemoglobin transfusion necessity, administered radiotherapy dose and overall survival. RESULTS Response rate in terms of bleeding stop was 88.3% (68/77) in all patients and 95.2% (60/63) in the subgroup, wherein radiotherapy (RT) was completed as intended. Hemoglobin transfusions decreased during treatment in a further subgroup analysis. Median overall survival (OS) was 3.3 months. Patients with primary tumors (PT) of the cervix (carcinoma of the cervix, CC) or endometrium (endometrioid carcinoma, EDC) and patients receiving the full intended RT dose showed statistically significant better OS in a multivariable cox regression model. Median administered dose was 39 Gy, treatment related acute toxicity was considerably low. CONCLUSIONS Our data show an excellent response rate with a low toxicity profile when administering urgent radiotherapy for tumor related clinically significant bleeding complications. Nonetheless, treatment decisions should be highly individual due to the low median overall survival of this patient group.
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Affiliation(s)
- Manuel Guhlich
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany.
| | - Teresa Esther Maag
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Leif Hendrik Dröge
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Andrea Hille
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Sandra Donath
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Stephanie Bendrich
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Markus Anton Schirmer
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Friedemann Nauck
- Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Leu
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Joachim Riggert
- Department of Transfusion Medicine, University Medical Center Gottingen, Göttingen, Germany
| | - Julia Gallwas
- Clinic of Gynecology and Obstetrics, University Medical Center Göttingen, Göttingen, Germany
| | - Stefan Rieken
- Clinic of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
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45
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Andersen CC, Stark MJ, Kirpalani HM. Thresholds for Red Blood Cell Transfusion in Preterm Infants: Evidence to Practice. Clin Perinatol 2023; 50:763-774. [PMID: 37866846 DOI: 10.1016/j.clp.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Rapid blood loss with circulatory shock is dangerous for the preterm infant as cardiac output and oxygen-carrying capacity are simultaneously imperilled. This requires prompt restoration of circulating blood volume with emergency transfusion. It is recommended that clinicians use both clinical and laboratory responses to guide transfusion requirements in this situation. For preterm infants with anemia of prematurity, it is recommended that clinicians use a restrictive algorithm from one of two recently published clinical trials. Transfusion outside these algorithms in very preterm infants is not evidence-based and is actively discouraged.
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Affiliation(s)
- Chad C Andersen
- Department of Perinatal Medicine, Women's and Children's Hospital and Robinson Research Institute, University of Adelaide, South Australia.
| | - Michael J Stark
- Department of Perinatal Medicine, Women's and Children's Hospital and Robinson Research Institute, University of Adelaide, South Australia
| | - Haresh M Kirpalani
- Children's Hospital of Philadelphia at University Pennsylvania, Philadelphia, USA; McMaster University, Hamilton, Ontario, Canada
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46
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Russell N, Al-Adli N, Shank C, Carey S, Ajayi O. Utility of routine type and cross for anterior cervical discectomy and fusion: A retrospective review. N Am Spine Soc J 2023; 16:100280. [PMID: 37915967 PMCID: PMC10616372 DOI: 10.1016/j.xnsj.2023.100280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023]
Abstract
Background Preoperative type and screen and type and cross are routinely obtained in patients undergoing elective cervical spine surgeries. This is despite low perioperative transfusion rates, particularly in patients undergoing anterior cervical discectomy and fusion (ACDF). Methods We conducted a retrospective cohort study at a single tertiary medical center of all patients 18 years of age or older undergoing elective ACDF for degenerative cervical spine disease between January 2016 and January 2021. Our primary outcome measures included the frequency of type and screen/crossmatch orders, rate of perioperative transfusion, and crossmatch to transfusion (C/T) ratio. Secondary outcomes included differences between preoperative and postoperative hemoglobin and hematocrit. Results In total, 1,162 patients were identified. There were no cases of intraoperative transfusion. The overall transfusion rate was less than 1%, with only 1 patient receiving a blood product transfusion during their hospital admission. This patient received 2 units of platelets for severe preoperative thrombocytopenia. Yet, 961 patients (83%) received ABO/Rh blood typing and screening and 647 patients (56%) had their blood typed and crossed. A total of 1,318 units of blood were crossmatched, with no units of packed red blood cells (pRBCs) transfused and only 2 units of platelets transfused, achieving a high crossmatch to transfusion (C/T) ratio of 659:1. Conclusions Among 1,162 patients who underwent elective ACDF at our institution, there were no patients who required an intraoperative or emergent blood transfusion. Furthermore, routine type and screen and crossmatch in patients undergoing elective ACDF at our insitution is associated with a high C/T ratio, suggestive of inefficient usage of blood products.
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Affiliation(s)
- Nicole Russell
- Anne Burnett School of Medicine, Texas Christian University, TCU Box 297085, Fort Worth, TX 76129, United States
| | - Nadeem Al-Adli
- Anne Burnett School of Medicine, Texas Christian University, TCU Box 297085, Fort Worth, TX 76129, United States
| | - Christopher Shank
- Anne Burnett School of Medicine, Texas Christian University, TCU Box 297085, Fort Worth, TX 76129, United States
- Department of Neurosurgery, Texas Health Harris Methodist Hospital, Fort Worth, TX 76104, United States
| | - Shannon Carey
- Department of Neurosurgery, Texas Health Harris Methodist Hospital, Fort Worth, TX 76104, United States
| | - Olaide Ajayi
- Anne Burnett School of Medicine, Texas Christian University, TCU Box 297085, Fort Worth, TX 76129, United States
- Department of Neurosurgery, Texas Health Harris Methodist Hospital, Fort Worth, TX 76104, United States
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47
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Zapf MAC, Fabbri DV, Andrews J, Li G, Freundlich RE, Al-Droubi S, Wanderer JP. Development of a machine learning model to predict intraoperative transfusion and guide type and screen ordering. J Clin Anesth 2023; 91:111272. [PMID: 37774648 PMCID: PMC10623374 DOI: 10.1016/j.jclinane.2023.111272] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/12/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
STUDY OBJECTIVE To develop an algorithm to predict intraoperative Red Blood Cell (RBC) transfusion from preoperative variables contained in the electronic medical record of our institution, with the goal of guiding type and screen ordering. DESIGN Machine Learning model development on retrospective single-center hospital data. SETTING Preoperative period and operating room. PATIENTS The study included patients ≥18 years old who underwent surgery during 2019-2022 and excluded those who refused transfusion, underwent emergency surgery, or surgery for organ donation after cardiac or brain death. INTERVENTION Prediction of intraoperative transfusion vs. no intraoperative transfusion. MEASUREMENTS The outcome variable was intraoperative transfusion of RBCs. Predictive variables were surgery, surgeon, anesthesiologist, age, sex, body mass index, race or ethnicity, preoperative hemoglobin (g/dL), partial thromboplastin time (s), platelet count x 109 per liter, and prothrombin time. We compared the performances of seven machine learning algorithms. After training and optimization on the 2019-2021 dataset, model thresholds were set to the current institutional performance level of sensitivity (93%). To qualify for comparison, models had to maintain clinically relevant sensitivity (>90%) when predicting on 2022 data; overall accuracy was the comparative metric. MAIN RESULTS Out of 100,813 cases that met study criteria from 2019 to 2021, intraoperative transfusion occurred in 5488 (5.4%) of cases. The LightGBM model was the highest performing algorithm in external temporal validity experiments, with overall accuracy of (76.1%) [95% confidence interval (CI), 75.6-76.5], while maintaining clinically relevant sensitivity of (91.2%) [95% CI, 89.8-92.5]. If type and screens were ordered based upon the LightGBM model, the predicted type and screen to transfusion ratio would improve from 8.4 to 5.1. CONCLUSIONS Machine learning approaches are feasible in predicting intraoperative transfusion from preoperative variables and may improve preoperative type and screen ordering practices when incorporated into the electronic health record.
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Affiliation(s)
- Matthew A C Zapf
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Daniel V Fabbri
- Department of Biomedical Informatics and Department of Computer Science, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Andrews
- Department of Pathology, Microbiology and Immunology and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gen Li
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert E Freundlich
- Department of Anesthesiology and Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samer Al-Droubi
- HealthIT Department, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan P Wanderer
- Department of Anesthesiology and Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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Ryvlin J, Javed K, la Garza Ramos RD, Hamad M, Essibayi MA, Gelfand Y, Murthy S, Yassari R. Is perioperative blood transfusion associated with postoperative thromboembolism or infection after metastatic spinal tumor surgery? Clin Neurol Neurosurg 2023; 235:108052. [PMID: 37980825 DOI: 10.1016/j.clineuro.2023.108052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/04/2023] [Accepted: 11/10/2023] [Indexed: 11/21/2023]
Abstract
STUDY DESIGN Retrospective cohort. SUMMARY OF BACKGROUND DATA Patients with metastatic spine disease who undergo surgical intervention have a high risk of requiring red blood cell (RBC) transfusion. Perioperative transfusion has been independently associated with increased risk of venous thromboembolic (VTE) and infectious complications following orthopedic procedures and degenerative spinal intervention; however, literature within spine oncology is limited. OBJECTIVE To determine the association between perioperative RBC transfusion and postoperative VTE or infection following spinal tumor surgery. METHODS A total of 153 patients who underwent surgery for spinal metastases between April 2012 and April 2022 were included. Medical records were reviewed to identify RBC transfusion administered either intraoperatively or within 96 h following surgery. The primary endpoints were: 1) development of any VTE or 2) development of any infection within 30 days following surgery. Any VTE was defined as deep vein thrombosis or pulmonary embolism, and any infection was defined as pneumonia, meningitis, Clostridium difficile infection, urinary tract infection, surgical site infection, or sepsis. Logistic regression analyses were performed. RESULTS Of the 153 patients included in the study, 43 % received a perioperative RBC transfusion. The overall incidence of postoperative VTE and infection was 15 % and 22 %, respectively. In univariate analysis, perioperative transfusion was not associated with postoperative VTE (odds ratio [OR] 2.41; 95 % confidence interval [CI] 0.97-6.00; p = 0.058) but was associated with infection (OR 3.02; 95 % CI 1.36-6.73; p = 0.007). After adjusting for confounders such as performance status, operative time, and surgical extent, transfusion was not associated with both VTE (OR 1.25; 95 % CI 0.36-4.32; p = 0.727) or infection (OR 1.86; 95 % CI 0.70-4.92; p = 0.210). While not statistically significant, sub-analyses demonstrated a trend towards increased VTE incidence in patients requiring transfusion earlier (within 24 h) as opposed to later postoperatively. CONCLUSIONS We found that perioperative transfusion was not an independent predictor of 30-day postoperative VTE or infection in patients undergoing metastatic spinal surgery. Further exploration of time-dependent transfusion outcomes is warranted.
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Affiliation(s)
- Jessica Ryvlin
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Kainaat Javed
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rafael De la Garza Ramos
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mousa Hamad
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Muhammed Amir Essibayi
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yaroslav Gelfand
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Saikiran Murthy
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Reza Yassari
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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49
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Dion PM, Greene A, Beckett A, von Vopelius-Feldt J, Nolan B. A comparative analysis of current out-of-hospital transfusion protocols to expert recommendations. Resusc Plus 2023; 16:100498. [PMID: 38026143 PMCID: PMC10663952 DOI: 10.1016/j.resplu.2023.100498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Aim This study aimed to compare current out-of-hospital transfusion (OHT) protocols in Canadian civilian critical care transport organizations (CCTO) to expert recommendations and explore the variability and potential benefits of standardizing OHT practices across Canada. Methods A comprehensive cross-sectional study was conducted, encompassing all seven Canadian CCTOs that provide OHT. The study assessed adherence to expert recommendations and examined specific aspects of the transfusion process, such as indications for transfusion and cessation criteria. Results The study found an 89% adherence to expert recommendations for OHT among Canadian CCTOs. It highlighted a strong alignment between current practices and recommendations, possibly attributed to collaborative frameworks like the CAN-PATT network. However, notable variability and ambiguity were observed in transfusion indications and cessation criteria. The study also emphasized the potential benefits of standardizing OHT practices, such as improved policy formulation, better interpretation of emerging literature, and evaluation of OHT efficacy. Conclusion This cross-sectional study assessed how Canadian CCTOs implement OHT practices compared to expert-recommended practices. The findings underscore the importance of structured protocols in trauma management. Given the consistency in OHT protocol adoption and the comprehensive approach across CCTOs, there's a solid foundation for managing trauma patients in prehospital and transport settings across Canada. As OHT practices continue to evolve, sustained efforts are vital to refine, adapt, and elevate patient care standards in trauma management.
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Affiliation(s)
- Pierre-Marc Dion
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Canadian Forces Health Services, Canadian Armed Forces, Ottawa, Ontario, Canada
| | - Adam Greene
- Air Operations, British Columbia Emergency Health Services, British Columbia, Canada
- School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Andrew Beckett
- Canadian Forces Health Services, Canadian Armed Forces, Ottawa, Ontario, Canada
- Department of Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Johannes von Vopelius-Feldt
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Ornge, Mississauga, Ontario, Canada
| | - Brodie Nolan
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Ornge, Mississauga, Ontario, Canada
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50
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Salem A, Patel RM. Blood Donor Sex and Outcomes in Transfused Infants. Clin Perinatol 2023; 50:805-820. [PMID: 37866849 PMCID: PMC10688602 DOI: 10.1016/j.clp.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Red blood cell transfusion is common in neonatal intensive care. Multiple trials have evaluated different thresholds for when to administer red blood cell transfusion. In contrast, there has been less focus on studies of the characteristics of red blood cells transfused into neonates. In this review, the authors summarize the emerging literature on the potential impact of the sex of blood donors on outcomes in transfused neonates using a systematic search strategy. The authors review the uncertainty generated from studies with conflicting findings and discuss considerations regarding the impact of blood donor sex and other characteristics on neonatal outcomes.
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Affiliation(s)
- Anand Salem
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, 2015 Uppergate Drive Northeast, Atlanta, GA 30322, USA
| | - Ravi Mangal Patel
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, 2015 Uppergate Drive Northeast, Atlanta, GA 30322, USA.
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