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1.
Zhonghua Yu Fang Yi Xue Za Zhi ; 58(8): 1213-1218, 2024 Aug 06.
Artículo en Chino | MEDLINE | ID: mdl-39142891

RESUMEN

Objective: To construct a prediction model for the clinical supply of blood components in Xi'an City from 2023 to 2025. Methods: Based on the blood supply data of the Blood Management Information System of Shaanxi Provincial Blood Center from January 2013 to December 2022, a gray prediction model and an exponential curve fitting model were used to construct the prediction model, and the optimal prediction model was determined according to the error parameters of the relevant indicators of the model. The supply of blood components in Xi'an from 2023 to 2025 was predicted. Results: The fitting equations of the exponential curve fitting model to predict the supply of suspended red blood cells, platelets and cryoprecipitate in Xi'an were, x(1)(t+1)=1.16e0.04t,x(1)(t+1)=1.04e0.12t and x(1)(t+1)=1.01e1.10t, respectively. The mean absolute errors (mean relative errors) of the exponential curve fitting model in predicting the supply of suspended red blood cells, platelets and cryoprecipitate in Xi'an were 10 488.7 (0.05%), 2 114.9 (0.08%) and 3 089.6 (0.07%), respectively, which were lower than those of the gray prediction model, about 10 488.7 (3.44%), 2 152.78 (8.20%) and 3 441.35 (7.92%), respectively. The exponential curve fitting model predicted that the clinical supply of blood components in Xi'an would increase year by year from 2023 to 2025, and the clinical supply of suspended red blood cells, platelets, and cryoprecipitate in Xi'an would increase to 409 467 U, 69 818 therapeutic volume and 94 724 U, respectively by 2025. Conclusion: The exponential curve fitting model can make a good prediction of the clinical supply of blood components in Xi'an City.


Asunto(s)
Bancos de Sangre , Humanos , China , Transfusión de Componentes Sanguíneos , Plaquetas , Eritrocitos , Modelos Teóricos , Predicción
2.
Syst Rev ; 13(1): 196, 2024 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-39054473

RESUMEN

BACKGROUND: Leukoreduction has been used to limit the risk of adverse events. The most commonly used methodology is filtration (pre- or post-storage). However, whether pre-storage filtration is better than post-storage filtration needs to be clearly defined, particularly for countries that still use post-storage filtration. This study aimed to synthesize the best available evidence on the effectiveness of pre-storage filters compared with post-storage filters for transfusion reactions, for the occurrence of infections, for the length of hospital stay, and for the death of patients undergoing leukoreduced transfusion. METHODS: We searched the MEDLINE (PubMed), CINAHL (EBSCO), PsycINFO (APA), Scopus (Elsevier), The Cochrane Library (J. Wiley), Web of Science Core Collection (Clarivate Analytics), Embase (Elsevier), and LILACS (VHL) databases and gray literature for eligible studies in August 2020 and updated the search in October 2023. The Joanna Briggs Institute critical assessment tools were applied to analyze the quality appraisal of the studies. GRADE was used to determine the certainty of the evidence. RESULTS: The meta-analysis showed that pre-storage filtration was a protective factor for the occurrence of febrile non-hemolytic transfusion reaction in red blood cells (RR 0.49, 95% CI 0.41-0.59) and platelet concentrate transfusions (RR 0.16, 95% CI 0.12-0.22). The same did not occur for post-surgical infection after platelet concentrate transfusions (RR 0.82, 95% CI 0.65-1.04). Only one study analyzed the length of hospital stay and showed no significant difference between patients who received leukoreduced transfusions according to the type of filter used. According to the GRADE criteria, the certainty of the evidence for febrile non-hemolytic transfusion reactions was low for red blood cells and very low for platelet concentrate due to the high risk of bias. Infection was a low risk due to imprecision. CONCLUSIONS: The results of this review showed that the certainty of recommending the best type of filter (pre- or post-storage) for the benefit of the outcomes analyzed is still fragile; therefore, more robust evidence is needed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020192202.


Asunto(s)
Filtración , Procedimientos de Reducción del Leucocitos , Humanos , Procedimientos de Reducción del Leucocitos/métodos , Filtración/instrumentación , Conservación de la Sangre/métodos , Tiempo de Internación , Reacción a la Transfusión , Transfusión de Componentes Sanguíneos/efectos adversos
3.
Transfus Apher Sci ; 63(4): 103970, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38964256

RESUMEN

In an attempt to mitigate transfusion-related acute lung injury (TRALI), the Oslo Blood Center screened 1369 thrombapheresis donors for human leucocyte antigen (HLA)-specific antibodies. Anti-HLA antibodies were found in 200 donors who were deferred from donation of plasma-rich products. In a retrospective study, 2562 transfusions of thrombocytes (both apheresis and whole blood-derived) from 150 of these donors were subject to a thorough look back-investigation. Reports of 14 transfusion reactions were identified, none of which were classified as TRALI. Our study supports previous data indicating that the risk of TRALI is low. The value of screening for anti-HLA antibodies and subsequent deferral of donors with high levels of such antibodies remains questionable.


Asunto(s)
Lesión Pulmonar Aguda Postransfusional , Humanos , Masculino , Femenino , Lesión Pulmonar Aguda Postransfusional/etiología , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Reacción a la Transfusión/prevención & control , Reacción a la Transfusión/inmunología , Antígenos HLA/inmunología , Antígenos de Histocompatibilidad Clase I/inmunología , Transfusión de Componentes Sanguíneos/efectos adversos
5.
Vox Sang ; 119(8): 851-858, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38858164

RESUMEN

BACKGROUND AND OBJECTIVES: A plasma transfusion dose should be weight-based (10-20 mL/kg), which equates to three to four units in an average-sized adult; therefore, the transfusion of single units under most circumstances is sub-therapeutic. MATERIALS AND METHODS: This retrospective observational study examined the prevalence of single-unit plasma transfusion in adults within a 12-hospital system from 1 January 2018, to 31 December 2019. RESULTS: During the study period, 5791 patients received plasma transfusions. The overall prevalence of single-unit plasma was 17.1% for 988 patients. The majority, 3047 (52.6%), occurred at one hospital, 2132 (36.9%) among five hospitals and 612 (10.7%) at the remaining six hospitals. Cardiac and gastrointestinal (GI)/transplant transfused 2707 (46.8%), combined respiratory, neurological, orthopaedic and congenital/dermatology/other comprised 2133 (36.9%) of the six hospitals that transfused less than 200 patients, four (66.7%) transfused single units above the overall prevalence. CONCLUSION: In this hospital system, more than one in six patients received a transfusion of a single plasma unit. Six of the 12 hospitals had 89.5% of the patients who were transfused plasma. Six service lines transfused 83.7% of all patients receiving plasma. Hospitals that infrequently transfused plasma were more likely to under-dose.


Asunto(s)
Transfusión de Componentes Sanguíneos , Plasma , Humanos , Estudios Retrospectivos , Masculino , Femenino , Adulto , Persona de Mediana Edad
6.
Hum Exp Toxicol ; 43: 9603271241260655, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38861017

RESUMEN

Organophosphorus (OP) poisoning is a significant cause of morbidity and mortality worldwide. Recent research has explored new approaches to improving treatment options, which present several challenges. This study aimed to evaluate the role of fresh frozen plasma (FFP) as an adjunctive therapy for acute OP intoxication. A prospective single-blinded randomized clinical trial was conducted on patients of both sexes admitted to the Intensive Care Unit (ICU) of the Poison Control Center at Ain Shams University Hospital (PCC-ASUH) with acute OP toxicity during the period from the beginning of August 2022 to the end of July 2023. According to the Peradeniya score, Group I consisted of 48 patients (52%) with moderate OP poisoning, and Group II consisted of 44 patients (48%) with severe OP poisoning. Patients in the moderate group were assigned to receive either standard treatment (Group Ia, n = 24) or standard treatment plus FFP (Group Ib, n = 24). In addition, patients in the severe group were assigned to receive either standard treatment (Group IIa, n = 22) or standard treatment plus FFP (Group IIb, n = 22). A total of 46 patients received FFP transfusion. The authors demonstrated that the early use of a total of nine packs of FFP (250 mL each) over three consecutive days significantly reduced the total doses of atropine and oximes, the total hospitalization period, and the requirement for mechanical ventilation in patients with OP poisoning, both in the moderate and severe groups.


Asunto(s)
Intoxicación por Organofosfatos , Plasma , Humanos , Femenino , Masculino , Intoxicación por Organofosfatos/terapia , Adulto , Persona de Mediana Edad , Método Simple Ciego , Estudios Prospectivos , Transfusión de Componentes Sanguíneos , Adulto Joven , Antídotos/uso terapéutico
7.
J Thromb Haemost ; 22(8): 2184-2194, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-38795872

RESUMEN

Prothrombin time (PT) and its derivative international normalized ratio (INR) are frequently ordered to assess the coagulation system. Plasma transfusion to treat incidentally abnormal PT/INR is a common practice with low biological plausibility and without credible evidence, yet INR targets appear in major clinical guidelines and account for the majority of plasma use at many institutions. In this article, we review the historical origins of INR targets. We recount historical milestones in the development of the PT, discovery of vitamin K antagonists (VKAs), motivation for INR standardization, and justification for INR targets in patients receiving VKA therapy. Next, we summarize evidence for INR testing to assess bleeding risk in patients not on VKA therapy and plasma transfusion for treating mildly abnormal INR to prevent bleeding in these patients. We conclude with a discussion of the parallels in misunderstanding of historic PT and present-day INR testing with lessons from the past that might help rationalize plasma transfusion in the future.


Asunto(s)
Anticoagulantes , Coagulación Sanguínea , Hemorragia , Relación Normalizada Internacional , Tiempo de Protrombina , Vitamina K , Humanos , Relación Normalizada Internacional/historia , Historia del Siglo XX , Vitamina K/antagonistas & inhibidores , Historia del Siglo XXI , Coagulación Sanguínea/efectos de los fármacos , Anticoagulantes/uso terapéutico , Anticoagulantes/historia , Hemorragia/historia , Hemorragia/sangre , Tiempo de Protrombina/historia , Transfusión de Componentes Sanguíneos/historia , Historia del Siglo XIX , Valor Predictivo de las Pruebas , Monitoreo de Drogas/historia , Plasma
8.
Transfusion ; 64(7): 1223-1232, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38769631

RESUMEN

BACKGROUND: Blood components are costly and scarce. The Blood Stocks Management Scheme (BSMS) was established in the United Kingdom (UK) to support hospital transfusion services and national blood services through collection, analysis, and monthly feedback of data on blood component inventory and wastage management. There is a growing evidence base on how best to deliver feedback for quality improvement. We assessed the quality and utility of the monthly BSMS component reports. METHODS: We assessed the content of BSMS reports issued in March 2023 against established criteria for effective feedback. Two researchers independently rated whether criteria spanning the five domains of goal setting, data collection, feedback content, feedback display and feedback delivery were fully, partially or not met. Disagreements were resolved through discussion. We conducted an online questionnaire survey of recipients of BSMS reports during March 2023 to assess their use of reports and seek suggestions for improvement. RESULTS: Five out of 20 criteria for effective feedback were fully met. Areas for improvement included placing more emphasis in the feedback on positive change, linking data and summary messages, and including specific suggestions for action. Respondents highlighted the value of benchmarked comparisons with other hospital transfusion services. CONCLUSION: There is scope for enhancing the effectiveness and utility of BSMS feedback reports and hence reducing wastage of blood components. This methodology for evaluation of feedback could be utilized to improve other areas of transfusion practice.


Asunto(s)
Transfusión de Componentes Sanguíneos , Humanos , Reino Unido , Encuestas y Cuestionarios , Retroalimentación , Bancos de Sangre/normas , Mejoramiento de la Calidad , Transfusión Sanguínea/normas
9.
Surg Infect (Larchmt) ; 25(4): 291-299, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38700750

RESUMEN

Background: Packed red blood cell (PRBC) transfusion has been shown to increase nosocomial infection risk in the injured population; however, the post-traumatic infectious risk profiles of non-PRBC blood products are less clear. We hypothesized that plasma (fresh frozen plasma [FFP]), platelet (PLT), and cryoprecipitate administration would not be associated with increased rates of nosocomial infections. Patients and Methods: We performed a retrospective, matched, case-control study utilizing the American College of Surgeons National Trauma Data Bank data for 2019. We included all patients who received any volume of PRBC within four hours of presentation. Our outcome of interest was any infection. Controls were matched to cases using individual matching with a desired 1:3 case:control ratio. Bivariable analysis according to infection status, and multivariable logistic regression modeling the development of infection were then performed upon the matched data. Results: A total of 1,563 infectious cases were matched to 3,920 non-infectious controls. First four-hour transfusion volumes for FFP, PLT, and cryoprecipitate in the infection group exceeded those in the control group. The first four-hour FFP transfusion volume (per unit odds ratio [OR], 1.02; 95% confidence interval [CI], 0.99-1.04; p = 0.28) and cryoprecipitate transfusion volume (per unit OR, 1.01; 95% CI, 0.99-1.02; p = 0.43) were similar in cases and controls whereas PLT transfusion volume (per unit OR, 0.92; 95% CI, 0.86-0.98; p = 0.01) was lower in cases of infection than in controls. Conclusions: Fresh frozen plasma, PLT, and cryoprecipitate transfusion volumes were not independent risk factors for the development of nosocomial infection in a trauma population. PLT transfusion volume was associated with less infection.


Asunto(s)
Plasma , Heridas y Lesiones , Humanos , Estudios Retrospectivos , Masculino , Femenino , Adulto , Heridas y Lesiones/complicaciones , Heridas y Lesiones/terapia , Heridas y Lesiones/epidemiología , Persona de Mediana Edad , Estudios de Casos y Controles , Fibrinógeno/análisis , Infección Hospitalaria/epidemiología , Factor VIII , Transfusión de Componentes Sanguíneos/estadística & datos numéricos , Transfusión de Componentes Sanguíneos/efectos adversos , Anciano , Bases de Datos Factuales , Adulto Joven
11.
Clin Lab ; 70(4)2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38623670

RESUMEN

BACKGROUND: The aim was to explore the treatment of a case of congenital thrombotic thrombocytopenic purpura induced by pregnancy complicated with cerebral vasospasm. METHODS: We present a case study of congenital TTP where disease onset occurred during two separate pregnancies. Interestingly, the disease course exhibited distinct differences on each occasion. Additionally, following plasma transfusion therapy, there was a transient occurrence of cerebral vasospasm. RESULTS: In this case, ADAMTS13 levels reached their lowest point three days after delivery during the first pregnancy, triggering morbidity. Remarkably, a single plasma transfusion of 400 mL sufficed for the patient's recovery. Nonetheless, a recurrence of symptoms transpired during her second pregnancy at 24 weeks of gestation. Plasma transfusions were administered during and after delivery. Sudden convulsions developed. ADAMTS13 ac-tivity returned to normal, but cranial MRA revealed constrictions in the intracranial segments of both vertebral arteries, the basilar artery, and the lumen of the anterior, middle, and posterior cerebral arteries. A subsequent cranial MRA conducted a month later showed no lumen stenosis, indicating spontaneous recovery. CONCLUSIONS: These findings highlight the importance of careful consideration when administering plasma transfusions in congenital TTP during pregnancy. Moreover, the development of novel therapeutic approaches such as recombinant ADAMTS13 is crucial for minimizing complications and optimizing patient care.


Asunto(s)
Complicaciones Hematológicas del Embarazo , Púrpura Trombocitopénica Trombótica , Vasoespasmo Intracraneal , Humanos , Embarazo , Femenino , Púrpura Trombocitopénica Trombótica/complicaciones , Púrpura Trombocitopénica Trombótica/diagnóstico , Púrpura Trombocitopénica Trombótica/terapia , Complicaciones Hematológicas del Embarazo/diagnóstico , Complicaciones Hematológicas del Embarazo/terapia , Transfusión de Componentes Sanguíneos/efectos adversos , Vasoespasmo Intracraneal/complicaciones , Vasoespasmo Intracraneal/terapia , Plasma
12.
Transfusion ; 64(6): 1116-1131, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38623793

RESUMEN

BACKGROUND: Previous systematic reviews have revealed an inconsistency of outcome definitions as a major barrier in providing evidence-based guidance for the use of plasma transfusion to prevent or treat bleeding. We reviewed and analyzed outcomes in randomized controlled trials (RCTs) to provide a methodology for describing and classifying outcomes. STUDY DESIGN AND METHODS: RCTs involving transfusion of plasma published after 2000 were identified from a prior review (Yang 2012) and combined with an updated systematic literature search of multiple databases (July 1, 2011 to January 17, 2023). Inclusion of publications, data extraction, and risk of bias assessments were performed in duplicate. (PROSPERO registration number is: CRD42020158581). RESULTS: In total, 5579 citations were identified in the new systematic search and 22 were included. Six additional trials were identified from the previous review, resulting in a total of 28 trials: 23 therapeutic and five prophylactic studies. An increasing number of studies in the setting of major bleeding such as in cardiovascular surgery and trauma were identified. Eighty-seven outcomes were reported with a mean of 11 (min-max. 4-32) per study. There was substantial variation in outcomes used with a preponderance of surrogate measures for clinical effect such as laboratory parameters and blood usage. CONCLUSION: There is an expanding literature on plasma transfusion to inform guidelines. However, considerable heterogeneity of reported outcomes constrains comparisons. A core outcome set should be developed for plasma transfusion studies. Standardization of outcomes will motivate better study design, facilitate comparison, and improve clinical relevance for future trials of plasma transfusion.


Asunto(s)
Transfusión de Componentes Sanguíneos , Hemorragia , Plasma , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Hemorragia/terapia , Hemorragia/prevención & control , Hemorragia/etiología , Resultado del Tratamiento
14.
Transfus Med ; 34(3): 175-181, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38576265

RESUMEN

BACKGROUND: The interest in re-introducing whole blood (WB) transfusion for the management of traumatic major haemorrhage is increasing. However, due to the current leucodepletion filters used in the UK a WB component was not readily available. Instead, an alternative but similar component, leucocyte depleted red cell and plasma (LD-RCP), which provided a unique experience in assessing the feasibility of a WB component was used whilst a WB component was being manufactured. STUDY DESIGN AND METHODS: Between November 2018 and October 2020, LD-RCP replaced RBC as standard of care for all trauma patients with major haemorrhage in London. The aims of the study were to assess (a) deliverability, (b) component wastage and (c) safety. RESULTS: Over the study period a total of 1208 LD-RCP units were delivered, of which 96.5% were delivered 'On Time In Full' (OTIF). Of the 1208 units, 733 (60.68%) were transfused and 475 (39.3%) units were wasted. Component wastage reduced significantly throughout the study (p = 0.001). A total of 177 patients had a blood group recorded, 86 were group O and 91 were non-group O. There was no statistically significantly difference between haemoglobin (p = 0.422), or bilirubin levels (p = 0.084) between group O and non-group O patients. DISCUSSION: It was feasible for NHS Blood and Transplant to deliver LD-RCP on time in full, however component wastage was high due to short shelf life and limited use of the component. Low titre group O LD-RCP units were not associated with clinical evidence of haemolysis.


Asunto(s)
Transfusión de Componentes Sanguíneos , Estudios de Factibilidad , Hemorragia , Heridas y Lesiones , Humanos , Masculino , Hemorragia/terapia , Hemorragia/sangre , Femenino , Adulto , Persona de Mediana Edad , Heridas y Lesiones/terapia , Heridas y Lesiones/sangre , Reino Unido , Anciano
15.
J Med Virol ; 96(4): e29603, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38619025

RESUMEN

This study aims to assess the safety, virological, and clinical outcomes of convalescent plasma transfusion (CPT) in immunocompromised patients hospitalized for coronavirus disease 2019 (COVID-19). We conducted a retrospective multicenter cohort study that included all immunosuppressed patients with COVID-19 and RNAemia from May 2020 to March 2023 treated with CPT. We included 81 patients with hematological malignancies (HM), transplants, or autoimmune diseases (69% treated with anti-CD20). Sixty patients (74%) were vaccinated, and 14 had pre-CPT serology >264 BAU/mL. The median delay between symptom onset and CPT was 23 days [13-31]. At D7 post-CPT, plasma PCR was negative in 43/64 patients (67.2%), and serology became positive in 25/30 patients (82%). Post-CPT positive serology was associated with RNAemia negativity (p < 0.001). The overall mortality rate at D28 was 26%, being higher in patients with non-B-cell HM (62%) than with B-cell HM (25%) or with no HM (11%) (p = 0.02). Patients receiving anti-CD20 without chemotherapy had the lowest mortality rate (8%). Positive RNAemia at D7 was associated with mortality at D28 in univariate analysis (HR: 3.05 [1.14-8.19]). Eight patients had adverse events, two of which were severe but transient. Our findings suggest that CPT can abolish RNAemia and ameliorate the clinical course in immunocompromised patients with COVID-19.


Asunto(s)
COVID-19 , Neoplasias Hematológicas , Humanos , COVID-19/terapia , Transfusión de Componentes Sanguíneos , Sueroterapia para COVID-19 , Estudios de Cohortes , Plasma , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/terapia , Huésped Inmunocomprometido , Viremia
16.
Acta Anaesthesiol Scand ; 68(6): 753-763, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38467589

RESUMEN

BACKGROUND: Fresh frozen plasma (FFP) transfusion is used to manage coagulopathy and bleeding in cardiac surgery patients despite uncertainty about its safety and effectiveness. METHODS: We performed a propensity score matched analysis of the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database including patients from 39 centres from 2005 to 2018. We investigated the association of perioperative FFP transfusion with mortality and other clinical outcomes. RESULTS: Of 119,138 eligible patients, we successfully matched 13,131 FFP recipients with 13,131 controls. FFP transfusion was associated with 30-day mortality (odds ratio (OR), 1.41; 99% CI, 1.17-1.71; p < .0001), but not with long-term mortality (hazard ratio (HR), 0.92; 99% CI, 0.85-1.00; p = .007, Holm-Bonferroni α = 0.0004). FFP was also associated with return to theatre for bleeding (OR, 1.97; 99% CI, 1.66-2.34; p < .0001), prolonged intubation (OR, 1.15; 99% CI, 1.05-1.26; p < .0001) and increased chest tube drainage (Mean difference (MD) in mL, 131; 99% CI, 120-141; p < .0001). It was also associated with reduced postoperative creatinine levels (MD in g/L, -6.33; 99% CI, -10.28 to -2.38; p < .0001). CONCLUSION: In a multicentre, propensity score matched analysis, perioperative FFP transfusion was associated with increased 30-day mortality and had variable associations with secondary clinical outcomes.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Plasma , Humanos , Femenino , Masculino , Anciano , Persona de Mediana Edad , Atención Perioperativa/métodos , Puntaje de Propensión , Transfusión Sanguínea/estadística & datos numéricos , Transfusión Sanguínea/métodos , Resultado del Tratamiento , Australia , Transfusión de Componentes Sanguíneos/estadística & datos numéricos , Nueva Zelanda , Complicaciones Posoperatorias/epidemiología
17.
Transfusion ; 64 Suppl 2: S167-S173, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38511866

RESUMEN

BACKGROUND: Prehospital blood transfusions are increasing as a treatment for bleeding trauma patients at risk for exsanguination. Triggers for starting transfusion in the field are less studied. We analyzed the factors affecting the decision of physicians to start prehospital blood product transfusion (PHBT) in blunt adult trauma patients. STUDY DESIGN AND METHODS: Data of all adult blunt trauma patients from the Helsinki Trauma Registry between March 2016 and July 2021 were retrospectively analyzed. Univariate analysis for the identification of predictive factors and multivariate regression analysis for their importance as predictive factors for the initiation of PHBT were applied. RESULTS: There were 1652 patients registered in the database. A total of 556 of them were treated by a physician-level prehospital emergency care unit, of which by transfusion-capable unit in 394 patients. PHBT (red blood cells and/or plasma) was started in 19.8% of the patients. We identified three statistically highly important clinical triggers for starting PHBT: high crystalloid volume need, shock index ≥0.9, and need for prehospital pleural decompression. DISCUSSION: PHBT in blunt adult trauma patients is initiated in ~20% of the patients in Southern Finland. High crystalloid volume need, shock index ≥0.9 and prehospital pleural decompression are associated with the initiation of PHBT, probably reflecting patients at high risk for bleeding.


Asunto(s)
Servicios Médicos de Urgencia , Sistema de Registros , Heridas no Penetrantes , Humanos , Masculino , Femenino , Finlandia/epidemiología , Heridas no Penetrantes/terapia , Adulto , Persona de Mediana Edad , Estudios Retrospectivos , Transfusión Sanguínea , Anciano , Transfusión de Componentes Sanguíneos , Médicos
18.
Tex Heart Inst J ; 51(1)2024 03 18.
Artículo en Inglés | MEDLINE | ID: mdl-38494437

RESUMEN

OBJECTIVE: This study sought to identify periprocedural risk predictors that affect long-term prognosis in patients with chronic obstructive pulmonary disease (COPD) undergoing isolated coronary artery bypass grafting (CABG). METHODS: All consecutive 4,871 patients undergoing isolated CABG between May 2005 and June 2021 were included. Patients with and without COPD were compared for baseline demographics and preoperative characteristics. A propensity-matched analysis was used to compare the 2 groups. The primary outcome was long-term incidence of all-cause death. RESULTS: After matching, 767 patients each were included in the COPD and non-COPD groups; mean age was 71.6 and 71.4 years (P = .7), respectively; 29.3% and 32% (P = .2) were women, respectively. Intraoperatively, median (IQR) operating room time was higher in the COPD group than in the non-COPD group (5.9 [5.2-7.0] hours vs 5.8 [5.1-6.7] hours, respectively; P = .01). Postoperatively, intensive care unit stay (P = .03), hospital length of stay (P = .0004), and fresh frozen plasma transfusion units (P = .012) were higher in the COPD group than in the non-COPD group. Thirty-day mortality was not different between groups (1.3% in the COPD group vs 1% in the non-COPD group; P = .4). Median follow-up time was 4.0 years. The rate of all-cause death was higher in the COPD group than in the non-COPD group (138 patients [18.3%] vs 109 patients [14.5%], respectively; P = .042). Periprocedural risk predictors for all-cause death in patients with COPD were atrial fibrillation, diabetes, male sex, dialysis, ejection fraction less than 50%, peripheral vascular disease, and Society of Thoracic Surgeons Predicted Risk of Mortality score greater than 4%. CONCLUSION: Patients with COPD undergoing isolated CABG had a significantly higher incidence of all-cause death than those without COPD. Herein, risk predictors are provided for all-cause death in patients undergoing isolated CABG.


Asunto(s)
Enfermedad de la Arteria Coronaria , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Masculino , Femenino , Resultado del Tratamiento , Transfusión de Componentes Sanguíneos , Plasma , Puente de Arteria Coronaria/efectos adversos , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/cirugía , Factores de Riesgo , Estudios Retrospectivos
19.
Crit Care Med ; 52(7): e390-e404, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38483205

RESUMEN

OBJECTIVES: To assess if transfusion with low-titer group O whole blood (LTOWB) is associated with improved early and/or late survival compared with component blood product therapy (CT) in bleeding trauma patients. DATA SOURCES: A systematic search of PubMed, CINAHL, and Web of Science was performed from their inception through December 1, 2023. Key terms included injury, hemorrhage, bleeding, blood transfusion, and whole blood. STUDY SELECTION: All studies comparing outcomes in injured civilian adults and children who received LTOWB versus CT were included. DATA EXTRACTION: Data including author, publication year, sample size, total blood volumes, and clinical outcomes were extracted from each article and reported following the Meta-analysis Of Observational Studies in Epidemiology guidelines. Main outcomes were 24-hour (early) and combined 28-day, 30-day, and in-hospital (late) mortality rates between recipients of LTOWB versus CT, which were pooled using random-effects models. DATA SYNTHESIS: Of 1297 studies reviewed, 24 were appropriate for analysis. Total subjects numbered 58,717 of whom 5,164 received LTOWB. Eleven studies included adults-only, seven included both adults and adolescents, and six only included children. The median (interquartile range) age for patients who received LTOWB and CT was 35 years (24-39) and 35.5 years (23-39), respectively. Overall, 14 studies reported early mortality and 22 studies reported late mortality. LTOWB was associated with improved 24-hour survival (risk ratios [RRs] [95% CI] = 1.07 [1.03-1.12]) and late (RR [95% CI] = 1.05 [1.01-1.09]) survival compared with component therapy. There was no evidence of small study bias and all studies were graded as a moderate level of bias. CONCLUSIONS: These data suggest hemostatic resuscitation with LTOWB compared with CT improves early and late survival outcomes in bleeding civilian trauma patients. The majority of subjects were injured adults; multicenter randomized controlled studies in injured adults and children are underway to confirm these findings.


Asunto(s)
Hemorragia , Heridas y Lesiones , Humanos , Sistema del Grupo Sanguíneo ABO , Transfusión de Componentes Sanguíneos/métodos , Transfusión Sanguínea/métodos , Transfusión Sanguínea/estadística & datos numéricos , Hemorragia/terapia , Hemorragia/mortalidad , Mortalidad Hospitalaria , Heridas y Lesiones/terapia , Heridas y Lesiones/mortalidad , Heridas y Lesiones/complicaciones
20.
Transfusion ; 64 Suppl 2: S155-S166, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38501905

RESUMEN

BACKGROUND: Blood products form the cornerstone of contemporary hemorrhage control but are limited resources. Freeze-dried plasma (FDP), which contains coagulation factors, is a promising adjunct in hemostatic resuscitation. We explore the association between FDP alone or in combination with other blood products on 24-h mortality. STUDY DESIGN AND METHODS: This is a secondary data analysis from a cross-sectional prospective observational multicenter study of adult trauma patients in the Western Cape of South Africa. We compare mortality among trauma patients at risk of hemorrhage in three treatment groups: Blood Products only, FDP + Blood Products, and FDP only. We apply inverse probability of treatment weighting and fit a multivariable Cox proportional hazards model to assess the hazard of 24-h mortality. RESULTS: Four hundred and forty-eight patients were included, and 55 (12.2%) died within 24 h of hospital arrival. Compared to the Blood Products only group, we found no difference in 24-h mortality for the FDP + Blood Product group (p = .40) and a lower hazard of death for the FDP only group (hazard = 0.38; 95% CI, 0.15-1.00; p = .05). However, sensitivity analyses showed no difference in 24-h mortality across treatments in subgroups with moderate and severe shock, early blood product administration, and accounting for immortal time bias. CONCLUSION: We found insufficient evidence to conclude there is a difference in relative 24-h mortality among trauma patients at risk for hemorrhage who received FDP alone, blood products alone, or blood products with FDP. There may be an adjunctive role for FDP in hemorrhagic shock resuscitation in settings with significantly restricted access to blood products.


Asunto(s)
Liofilización , Hemorragia , Plasma , Heridas y Lesiones , Humanos , Femenino , Masculino , Hemorragia/mortalidad , Hemorragia/terapia , Hemorragia/etiología , Adulto , Heridas y Lesiones/mortalidad , Heridas y Lesiones/terapia , Heridas y Lesiones/complicaciones , Heridas y Lesiones/sangre , Persona de Mediana Edad , Estudios Prospectivos , Estudios Transversales , Sudáfrica/epidemiología , Transfusión de Componentes Sanguíneos , Resucitación/métodos
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