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Revista Do Colegio Brasileiro de... 2015Trauma is one of the world's leading causes of death within the first 40 years of life and thus a significant health problem. Trauma accounts for nearly a third of the... (Review)
Review
Trauma is one of the world's leading causes of death within the first 40 years of life and thus a significant health problem. Trauma accounts for nearly a third of the lost years of productive life before 65 years of age and is associated with infection, hemorrhagic shock, reperfusion syndrome, and inflammation. The control of hemorrhage, coagulopathy, optimal use of blood products, balancing hypo and hyperperfusion, and hemostatic resuscitation improve survival in cases of trauma with massive hemorrhage. This review discusses inflammation in the context of trauma-associated hemorrhagic shock. When one considers the known immunomodulatory effects of traumatic injury, allogeneic blood transfusion, and the overlap between patient populations, it is surprising that so few studies have assessed their combined effects on immune function. We also discuss the relative benefits of curbing inflammation rather than attempting to prevent it.
Topics: Humans; Inflammation; Practice Guidelines as Topic; Shock, Hemorrhagic; Systemic Inflammatory Response Syndrome; Wounds and Injuries
PubMed: 26517804
DOI: 10.1590/0100-69912015004013 -
Journal of Veterinary Internal Medicine May 2019Development of equine platelet concentrate (PC) would aid management of cases requiring transfused platelets (PLTs), where adminstration of whole-blood or platelet-rich...
BACKGROUND
Development of equine platelet concentrate (PC) would aid management of cases requiring transfused platelets (PLTs), where adminstration of whole-blood or platelet-rich plasma (PRP) might be contraindicated.
OBJECTIVES
To test and validate a method for production of an equine PRP-PC product.
ANIMALS
Six healthy Thoroughbred geldings from a research herd.
METHODS
In this prospective experimental study, whole blood was collected and processed through multiple centrifugation steps to yield 120 mL of PC. The PC was stored at 22°C and gently and continuously agitated. Measurements of PLT count, pH, and concentrations of glucose, lactate, electrolytes, lactate dehydrogenase (LDH), and aspartate aminotransferase (AST), as well as partial pressures of oxygen and carbon dioxide were performed on days 0, 1, 2, 3, 5, and 7. Platelet aggregometry and bacterial culture were also performed.
RESULTS
The PC always had a PLT count of ≥550 × 10 cells/μL. Aggregometry graph amplitude (P < .0001) and area under the curve (P < .05) significantly decreased over time. Sodium, chloride, lactate (P < .0001), and oxygen (P < .01) concentrations significantly increased over time. pH (P < .001), glucose and bicarbonate concentrations (P < .0001) significantly decreased over time. There was no significant difference in potassium concentration, PLT count, LDH and AST activities and no bacterial growth from culture.
CONCLUSIONS AND CLINICAL IMPORTANCE
The described technique yielded a PC that meets the standards of the American Association of Blood Banks for human PC.
Topics: Animals; Blood Platelets; Blood Preservation; Centrifugation; Hematology; Horses; Male; Platelet Count; Platelet-Rich Plasma; Prospective Studies
PubMed: 30868640
DOI: 10.1111/jvim.15472 -
Stroke Jan 2020Background and Purpose- Patients with active malignancy are at risk for intracerebral hemorrhage (ICH). We aimed to characterize perihematomal edema (PHE) and hematoma...
Background and Purpose- Patients with active malignancy are at risk for intracerebral hemorrhage (ICH). We aimed to characterize perihematomal edema (PHE) and hematoma volumes after spontaneous nontraumatic ICH in patients with cancer without central nervous system involvement. Methods- Patients with active malignancy who developed ICH were retrospectively identified through automated searches of institutional databases. Control patients were identified with ICH and without active cancer. Demographic and cancer-specific data were obtained by chart review. Hematoma and PHE volumes were determined using semiautomated methodology. Univariate and multivariate linear regression models were created to assess which variables were associated with hematoma and PHE expansion. Results- Patients with cancer (N=80) and controls (N=136) had similar demographics (all >0.20), although hypertension was more prevalent among controls (=0.004). Most patients with cancer had received recent chemotherapy (n=45, 56%) and had recurrence of malignancy (n=43, 54%). Patients with cancer were thrombocytopenic (median platelet count 90 000 [interquartile range, 17 500-211 500]), and most had undergone blood product transfusion (n=41, 51%), predominantly platelets (n=38, 48%). Thirty-day mortality was 36% (n=29). Patients with cancer had significantly increased PHE volumes (23.67 versus 8.61 mL; =1.88×10) and PHE-to-ICH volume ratios (2.26 versus 0.99; =2.20×10). In multivariate analyses, variables associated with PHE growth among patients with cancer were ICH volume (β=1.29 [95% CI, 1.58-1.30] =1.30×10) and platelet transfusion (β=15.67 [95% CI, 3.61-27.74] =0.014). Variables associated with 30-day mortality were ICH volume (odds ratio, 1.06 [95% CI, 1.03-1.10] =6.76×10), PHE volume (odds ratio, 1.07 [95% CI, 1.04-1.09] =7.40×10), PHE growth (odds ratio, 1.05 [95% CI, 1.01-1.10] =0.01), and platelet transfusion (odds ratio, 1.48 [95% CI, 1.22-1.79] =0.0001). Conclusions- Patients with active cancer who develop ICH have increased PHE volumes. PHE growth was independent of thrombocytopenia but associated with blood product transfusion. Thirty-day mortality was associated with PHE and ICH volumes and blood product transfusion.
Topics: Aged; Brain Edema; Cerebral Hemorrhage; Edema; Female; Hematoma; Humans; Male; Middle Aged; Neoplasms; Retrospective Studies; Severity of Illness Index
PubMed: 31744426
DOI: 10.1161/STROKEAHA.119.027085 -
Biomolecules Jul 2021Potentially toxic plasticizers are commonly added to polyvinyl chloride medical devices for transfusion in order to improve their flexibility and workability. As the...
Potentially toxic plasticizers are commonly added to polyvinyl chloride medical devices for transfusion in order to improve their flexibility and workability. As the plasticizers are not chemically bonded to the PVC, they can be released into labile blood products (LBPs) during storage. Ideally, LBPs would be used in laboratory studies of plasticizer migration from the medical device. However, short supply (i.e., limited stocks of human blood in collection centres) has prompted the development of specific simulants for each type of LBP in the evaluation of new transfusion devices. We performed a Delphi study with a multidisciplinary panel of 24 experts. In the first (qualitative) phase, the panel developed consensus definitions of the specification criteria to be met by each migration simulant. Next, we reviewed the literature on techniques for simulating the migration of plasticizers into LBPs. A questionnaire was elaborated and sent out to the experts, and the replies were synthesized in order to obtain a consensus. The qualitative study established specifications for each biological matrix (whole blood, red blood cell concentrate, plasma, and platelet concentrate) and defined the criteria required for a suitable LBP simulant. Ten criteria were suggested: physical and chemical characteristics, opacity, form, stability, composition, ability to mimic a particular clinical situation, ease and safety of use, a simulant-plastic interaction correlated with blood, and compatibility with analytical methods. The questionnaire data revealed a consensus on the use of natural products (such as pig's blood) to mimic the four LBPs. Opinions diverged with regard to synthetic products. However, an isotonic solution and a rheological property modifier were considered to be of value in the design of synthetic simulants. Consensus reached by the Delphi group could be used as a database for the development of simulants used to assess the migration of plasticizers from PVC bags into LBPs.
Topics: Blood Banks; Blood Cells; Blood Platelets; Blood Preservation; Blood Transfusion; Delphi Technique; Erythrocytes; Hematology; Humans; Hydrogen-Ion Concentration; Interdisciplinary Communication; Materials Testing; Plasma; Plasticizers; Polyvinyl Chloride; Surface Properties; Surveys and Questionnaires; Viscosity
PubMed: 34439748
DOI: 10.3390/biom11081081 -
Medicina Intensiva Nov 2015Massive haemorrhage is common and often associated with high morbidity and mortality. We perform a systematic review of the literature, with extraction of the...
Massive haemorrhage is common and often associated with high morbidity and mortality. We perform a systematic review of the literature, with extraction of the recommendations from the existing evidences because of the need for its improvement and the management standardization. From the results we found, we wrote a multidisciplinary consensus document. We begin with the agreement in the definitions of massive haemorrhage and massive transfusion, and we do structured recommendations on their general management (clinical assessment of bleeding, hypothermia management, fluid therapy, hypotensive resuscitation and damage control surgery), blood volume monitoring, blood products transfusion (red blood cells, fresh frozen plasma, platelets and their best transfusion ratio), and administration of hemostatic components (prothrombin complex, fibrinogen, factor VIIa, antifibrinolytic agents).
Topics: Antifibrinolytic Agents; Blood Transfusion; Brain Injuries, Traumatic; Colloids; Contraindications; Crystalloid Solutions; Emergencies; Fluid Therapy; Hemorrhage; Hemostatic Techniques; Hemostatics; Humans; Hypotension; Hypothermia; Isotonic Solutions; Plasma Substitutes; Resuscitation; Shock, Hemorrhagic; Triage; Wounds and Injuries
PubMed: 26233588
DOI: 10.1016/j.medin.2015.05.002 -
Perspectives in Health Information... 2015Radio-frequency identification (RFID) technology is used by hospital supply chains to track medical products and monitor inventories. Hospitals have also begun... (Review)
Review
Radio-frequency identification (RFID) technology is used by hospital supply chains to track medical products and monitor inventories. Hospitals have also begun incorporating RFID technology as part of their transfusion processes. The purpose of this review was to analyze how healthcare organization supply chains can benefit from the utilization of RFID systems in transfusion service departments. The methodology for this study was a literature review following the steps of a systematic review with a total of 52 sources referenced. RFID technology is used to manage and track blood products from the initial donor phlebotomy to final disposition or product transfusion. RFID-enabled transfusion practices have successfully increased provider productivity and product quality through work-time reduction and error reduction. Findings of this research study suggest that RFID has provided improvements in quality of care and efficiency, while initial costs, security, and privacy appear to be the principal barriers to adoption.
Topics: Humans; Materials Management, Hospital; Radio Frequency Identification Device; Transfusion Medicine
PubMed: 26396555
DOI: No ID Found -
Scandinavian Journal of Trauma,... Feb 2015Haemorrhage is a leading cause of death in paediatric trauma patients. Predefined massive transfusion protocols (MTP) have the potential to significantly reduce... (Review)
Review
Haemorrhage is a leading cause of death in paediatric trauma patients. Predefined massive transfusion protocols (MTP) have the potential to significantly reduce mortality by treating haemorrhagic shock and coagulopathy, in adhering to the principles of haemostatic resuscitation with rapid administration of balanced ratios of packed red blood cells (RBC), fresh frozen plasma (FFP) and platelets (PLT).Because of their substantial physiological reserve, initial vital signs may not be good predictors of early haemorrhage in paediatric patients. Determining the triggers for MTP activation in paediatric trauma patients is challenging, and the optimal blood product ratio that will increase survival in massively bleeding paediatric trauma patients has yet to be determined. To date, only a few small descriptive studies and case reports have investigated the use of predefined MTP in paediatric trauma patients.MTP with increased FFP or PLT to RBC ratios combined with viscoelastic haemostatic assay (VHA) guided haemostatic resuscitation have not yet been tested in paediatric populations but based on results from adult trauma patients, this therapeutic approach seems promising.Considering the high prevalence of early coagulopathy in paediatric trauma patients, immediate identification and implementation of VHA-directed treatment of traumatic coagulopathy could ensure faster haemostasis and thereby, potentially, reduce bleeding as well as the total transfusion requirements and further improve outcome in paediatric trauma patients. Prospective randomized trials investigating this therapeutic approach in paediatric trauma patients are highly warranted.
Topics: Blood Coagulation Disorders; Blood Transfusion; Child; Hemorrhage; Humans; Transfusion Reaction; Wounds and Injuries
PubMed: 25888054
DOI: 10.1186/s13049-015-0097-z -
Canadian Association of Radiologists... May 2015Whenever elevated signal intensity is displayed at magnetic resonance imaging (MRI) within an ovarian lesion on unenhanced T1-weighted sequences, some specific diagnoses... (Review)
Review
Whenever elevated signal intensity is displayed at magnetic resonance imaging (MRI) within an ovarian lesion on unenhanced T1-weighted sequences, some specific diagnoses should be considered because only 3 main components may be responsible for this T1-hyperintensity at MRI: fat, blood products, and proteinaceous or mucinous material. The associated clinical data and concomitant use of T2-weighted sequences and fat-saturation techniques is mandatory to make this tissue characterization possible. The goal of this pictorial review is to provide a simple radiologic reasoning and the differential diagnoses to consider in the presence of spontaneous elevated signal intensity on T1-weighted sequences within a cystic or solid ovarian tumour.
Topics: Abscess; Adipose Tissue; Cystadenoma, Mucinous; Diagnosis, Differential; Endometriosis; Female; Hematoma; Humans; Magnetic Resonance Imaging; Ovarian Cysts; Ovarian Neoplasms; Struma Ovarii; Teratoma
PubMed: 25578742
DOI: 10.1016/j.carj.2014.07.006 -
European Journal of Trauma and... Feb 2023In military trauma, disaster medicine, and casualties injured in remote locations, times to advanced medical and surgical treatment are often prolonged, potentially...
Resuscitation with whole blood or blood components improves survival and lessens the pathophysiological burden of trauma and haemorrhagic shock in a pre-clinical porcine model.
PURPOSE
In military trauma, disaster medicine, and casualties injured in remote locations, times to advanced medical and surgical treatment are often prolonged, potentially reducing survival and increasing morbidity. Since resuscitation with blood/blood components improves survival over short pre-surgical times, this study aimed to evaluate the quality of resuscitation afforded by blood/blood products or crystalloid resuscitation over extended 'pre-hospital' timelines in a porcine model of militarily relevant traumatic haemorrhagic shock.
METHODS
This study underwent local ethical review and was done under the authority of Animals (Scientific Procedures) Act 1986. Forty-five terminally anaesthetised pigs received a soft tissue injury to the right thigh, haemorrhage (30% blood volume and a Grade IV liver injury) and fluid resuscitation initiated 30 min later [Group 1 (no fluid); 2 (0.9% saline); 3 (1:1 packed red blood cells:plasma); 4 (fresh whole blood); or 5 (plasma)]. Fluid (3 ml/kg bolus) was administered during the resuscitation period (maximum duration 450 min) when the systolic blood pressure fell below 80 mmHg. Surviving animals were culled with an overdose of anaesthetic.
RESULTS
Survival time was significantly shorter for Group 1 compared to the other groups (P < 0.05). Despite the same triggers for resuscitation when compared to blood/blood components, saline was associated with a shorter survival time (P = 0.145), greater pathophysiological burden and significantly greater resuscitation fluid volume (P < 0.0001).
CONCLUSION
When times to advanced medical care are prolonged, resuscitation with blood/blood components is recommended over saline due to the superior quality and stability of resuscitation achieved, which are likely to lead to improved patient outcomes.
Topics: Swine; Animals; Shock, Hemorrhagic; Resuscitation; Hemorrhage; Blood Component Transfusion; Liver; Fluid Therapy
PubMed: 35900383
DOI: 10.1007/s00068-022-02050-6 -
Eastern Mediterranean Health Journal =... Mar 2019As blood is a scarce and expensive resource, irrational blood usage places huge burden on health expenditures. In response to this challenge, governments and health care... (Comparative Study)
Comparative Study
BACKGROUND
As blood is a scarce and expensive resource, irrational blood usage places huge burden on health expenditures. In response to this challenge, governments and health care providers are developing different strategies to optimize blood utilization. Among these strategies is trying to raise the public awareness on the actual costs of the blood production and changing the cost recovery systems of blood and blood components.
AIMS
This study aims to compare cost recovery and financing systems of blood and blood products in different countries.
METHODS
This research was an email-based survey of 30 countries from four HDI categories. All related literature was reviewed.
RESULTS
Out of 28 countries, 19 have blood and blood products that are provided totally free of charge to the patients. In nine countries blood and blood products are totally or partially chargeable to the patients.
CONCLUSIONS
In countries with low and lower-middle income economies, total or partial costs of blood and blood products are recovered directly from the patients. While countries in which blood and blood products are 'free of charge' for patients are mostly categorized in upper-middle- or high-income economies with well-developed healthcare and insurance systems. There is no clear relation between blood usage and the type of cost recovery system. However, having an efficient cost recovery system will help blood establishments to sustain their service delivery.
Topics: Blood; Blood Transfusion; Cost-Benefit Analysis; Fees, Medical; Health Expenditures; Healthcare Financing; Humans; Insurance Coverage; Surveys and Questionnaires
PubMed: 30942474
DOI: 10.26719/emhj.18.020