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1.
Transfusion ; 61 Suppl 1: S22-S31, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34269432

RESUMO

BACKGROUND: Civilian and military guidelines recommend early balanced transfusion to patients with life-threatening bleeding. Low titer group O whole blood was introduced as the primary blood product for resuscitation of massive hemorrhage at Haukeland University Hospital, Bergen, Norway, in December 2017. In this report, we describe the whole blood program and present results from the first years of routine use. STUDY DESIGN AND METHODS: Patients who received whole blood from December 2017 to April 2020 were included in our quality registry for massive transfusions. Post-transfusion blood samples were collected to analyze isohemagglutinin (anti-A/-B) and hemolysis markers. Administration of other blood products, transfusion reactions, and patient survival (days 1 and 30) were recorded. User experiences were surveyed for both clinical and laboratory staff. RESULTS: Two hundred and five patients (64% male and 36% female) received 836 units in 226 transfusion episodes. Patients received a mean of 3.7 units (range 1-35) in each transfusion episode. The main indications for transfusion were trauma (26%), gastrointestinal (22%), cardiothoracic/vascular (18%), surgical (18%), obstetric (11%), and medical (5%) bleeding. There was no difference in survival between patients with blood type O when compared with non-group O. Haptoglobin level was lower in the transfusion episodes for non-O group patients, however no clinical hemolysis was reported. No patients had conclusive transfusion-associated adverse events. Both clinical and laboratory staff preferred whole blood to component therapy for massive transfusion. DISCUSSION: The experience from Haukeland University Hospital indicates that whole blood is feasible, safe, and effective for in-hospital treatment of bleeding.


Assuntos
Transfusão de Sangue , Ressuscitação , Reação Transfusional/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/métodos , Criança , Pré-Escolar , Feminino , Hemólise , Hospitais , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Ressuscitação/métodos , Reação Transfusional/sangue , Reação Transfusional/patologia , Adulto Jovem
2.
Transfusion ; 61 Suppl 1: S80-S89, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34269444

RESUMO

BACKGROUND: Collection of non-leukoreduced citrate-phosphate-dextrose-adenine (CPDA-1) whole blood is performed in walking blood banks. Blood collected under field conditions may have increased risk of bacterial contamination. This study was conducted to examine the effects of WBC reduction and storage temperature on growth of Escherichia coli (ATCC® 25922™) in CPDA-1 whole blood. METHODS: CPDA-1 whole blood of 450 ml from 10 group O donors was inoculated with E. coli. Two hours after inoculation, the test bags were leukoreduced with a platelet-sparing filter. The control bags remained unfiltered. Each whole blood bag was then split into three smaller bags for further storage at 2-6°C, 20-24°C, or 33-37°C. Bacterial growth was quantified immediately, 2 and 3 h after inoculation, on days 1, 3, 7, and 14 for all storage temperatures, and on days 21 and 35 for storage at 2-6°C. RESULTS: Whole blood was inoculated with a median of 19.5 (range 12.0-32.0) colony-forming units per ml (CFU/ml) E. coli. After leukoreduction, a median of 3.3 CFU/ml (range 0.0-33.3) E. coli remained. In the control arm, the WBCs phagocytized E. coli within 24 h at 20-24°C and 33-37°C in 9 of 10 bags. During storage at 2-6°C, a slow self-sterilization occurred over time with and without leukoreduction. CONCLUSIONS: Storage at 20-24°C and 33-37°C for up to 24 h before leukoreduction reduces the risk of E. coli-contamination in CPDA-1 whole blood. Subsequent storage at 2-6°C will further reduce the growth of E. coli.


Assuntos
Preservação de Sangue , Segurança do Sangue , Infecções por Escherichia coli/microbiologia , Escherichia coli/crescimento & desenvolvimento , Procedimentos de Redução de Leucócitos , Adenina/química , Preservação de Sangue/métodos , Citratos/química , Escherichia coli/isolamento & purificação , Glucose/química , Humanos , Temperatura
3.
Transfusion ; 61 Suppl 1: S313-S325, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34269450

RESUMO

BACKGROUND: The current global pandemic has created unprecedented challenges in the blood supply network. Given the recent shortages, there must be a civilian plan for massively bleeding patients when there are no blood products on the shelf. Recognizing that the time to death in bleeding patients is less than 2 h, timely resupply from unaffected locations is not possible. One solution is to transfuse emergency untested whole blood (EUWB), similar to the extensive military experience fine-tuned over the last 19 years. While this concept is anathema in current civilian transfusion practice, it seems prudent to have a vetted plan in place. METHODS AND MATERIALS: During the early stages of the 2020 global pandemic, a multidisciplinary and international group of clinicians with broad experience in transfusion medicine communicated routinely. The result is a planning document that provides both background information and a high-level guide on how to emergently deliver EUWB for patients who would otherwise die of hemorrhage. RESULTS AND CONCLUSIONS: Similar plans have been utilized in remote locations, both on the battlefield and in civilian practice. The proposed recommendations are designed to provide high-level guidance for experienced blood bankers, transfusion experts, clinicians, and health authorities. Like with all emergency preparedness, it is always better to have a well-thought-out and trained plan in place, rather than trying to develop a hasty plan in the midst of a disaster. We need to prevent the potential for empty shelves and bleeding patients dying for lack of blood.


Assuntos
Bancos de Sangue , Bancos de Sangue/métodos , Preservação de Sangue/métodos , Transfusão de Sangue/métodos , COVID-19/epidemiologia , Defesa Civil , Serviço Hospitalar de Emergência , Humanos , Pandemias
5.
Anesthesiology ; 133(6): 1173-1183, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32902572

RESUMO

BACKGROUND: This pilot trial focused on feasibility and safety to provide preliminary data to evaluate the hemostatic potential of cold-stored platelets (2° to 6°C) compared with standard room temperature-stored platelets (20° to 24°C) in adult patients undergoing complex cardiothoracic surgery. This study aimed to assess feasibility and to provide information for future pivotal trials. METHODS: A single center two-stage exploratory pilot study was performed on adult patients undergoing elective or semiurgent complex cardiothoracic surgery. In stage I, a two-armed randomized trial, platelets stored up to 7 days in the cold were compared with those stored at room temperature. In the subsequent single-arm stage II, cold storage time was extended to 8 to 14 days. The primary outcome was clinical effect measured by chest drain output. Secondary outcomes were platelet function measured by multiple electrode impedance aggregometry, total blood usage, immediate and long-term (28 days) adverse events, length of stay in intensive care, and mortality. RESULTS: In stage I, the median chest drain output was 720 ml (quartiles 485 to 1,170, n = 25) in patients transfused with room temperature-stored platelets and 645 ml (quartiles 460 to 800, n = 25) in patients transfused with cold-stored platelets. No significant difference was observed. The difference in medians between the room temperature- and cold-stored up to 7 days arm was 75 ml (95% CI, -220, 425). In stage II, the median chest drain output was 690 ml (500 to 1,880, n = 15). The difference in medians between the room temperature arm and the nonconcurrent cold-stored 8 to 14 days arm was 30 ml (95% CI, -1,040, 355). Platelet aggregation in vitro increased after transfusion in both the room temperature- and cold-stored platelet study arms. Total blood usage, number of adverse events, length of stay in intensive care, and mortality were comparable among patients receiving cold-stored and room temperature-stored platelets. CONCLUSIONS: This pilot trial supports the feasibility of platelets stored cold for up to 14 days and provides critical guidance for future pivotal trials in high-risk cardiothoracic bleeding patients.


Assuntos
Plaquetas/fisiologia , Preservação de Sangue/métodos , Procedimentos Cirúrgicos Cardíacos , Criopreservação/métodos , Transfusão de Plaquetas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Agregação Plaquetária/fisiologia , Temperatura , Fatores de Tempo
6.
Vox Sang ; 115(6): 515-524, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32249930

RESUMO

BACKGROUND: Warm autoantibodies (WAA) are antibodies that react with an antigen on a patient's own red-blood-cells and can complicate compatibility testing whether or not they cause clinical haemolysis. The goal of this study was to understand the overall prevalence of WAA, the risk of RBC alloimmunization and determine whether RBC selection practices have an impact on alloimmunization. MATERIALS AND METHODS: Records of patients (>1 year of age) with an indirect antibody detection test (IAT) and serologic evidence of WAA over a 10-year-period were included. Eight centres from 5 countries collectively reviewed 1 122 245 patients who had an IAT. RESULTS: Of patients having IAT, 1214 had WAA (0·17%). Transfusion information for 1002 of the patients was available; 631 were transfused after identification of the WAA (63%); of the transfused patients, 390 received prophylactic antigen-matched (PAM) RBCs and 241 did not. Of the 372 patients with WAA who were transfused and had serologic testing 30+ days following transfusion (30-2765 days), 56 developed new RBC alloimmunization (15·1%). Patients who were transfused using a PAM strategy were not protected from new RBC alloimmunization [14·6% (31 of 212 patients) having PAM transfusion approach compared with those not receiving PAM approach (15·6%, 25 of 160 patients, P = 0·8837)]. CONCLUSIONS: The prevalence of WAA in patients having an IAT is low (<1%). A significant portion of patients with WAA form new RBC alloimmunization (15·1%); however, the use of PAM approach for RBC selection was not found to be protective against new alloimmunization.


Assuntos
Anemia Hemolítica Autoimune/epidemiologia , Autoanticorpos/imunologia , Transfusão de Sangue Autóloga/métodos , Adulto , Anemia Hemolítica Autoimune/etiologia , Transfusão de Sangue Autóloga/efeitos adversos , Eritrócitos/imunologia , Feminino , Humanos , Masculino
7.
Transfusion ; 60(7): 1544-1551, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32319702

RESUMO

BACKGROUND: Increasing numbers of emergency medical service agencies and hospitals are developing the capability to administer blood products to patients with hemorrhagic shock. Cold-stored whole blood (WB) is the only single product available to prehospital providers who aim to deliver a balanced resuscitation strategy. However, there are no data on the safety and in vitro characteristics of prehospital stored WB. This study aimed to describe the effects on in vitro quality of storing WB at remote helicopter bases in thermal insulating containers. STUDY DESIGN AND METHODS: We conducted a two-armed single-center study. Twenty units (test) were stored in airtight thermal insulating containers, and 20 units (controls) were stored according to routine procedures in the Haukeland University Hospital Blood Bank. Storage conditions were continuously monitored during emergency medical services missions and throughout remote and blood bank storage. Hematologic and metabolic variables, viscoelastic properties, and platelet (PLT) aggregation were measured on Days 1, 8, 14, and 21. RESULTS: Storage conditions complied with the EU guidelines throughout remote and in-hospital storage for 21 days. There were no significant differences in PLT aggregation, viscoelastic properties, and hematology variables between the two groups. Minor significantly lower pH, glucose, and base excess and higher lactate were observed after storage in airtight containers. CONCLUSION: Forward cold storage of WB is safe and complies with EU standards. No difference is observed in hemostatic properties. Minor differences in metabolic variables may be related to the anaerobic conditions within the thermal box.


Assuntos
Resgate Aéreo , Glicemia/metabolismo , Plaquetas/metabolismo , Preservação de Sangue , Agregação Plaquetária , Plaquetas/citologia , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Estudos Prospectivos , Fatores de Tempo
8.
J Agromedicine ; 25(1): 65-72, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31030638

RESUMO

In a farmer, a diagnosis of hypersensitivity pneumonitis (HP) might cause drastic changes in life, and guidance concerning future prospects within farming requires a best possible etiological diagnosis. We aimed to assess (1) if immunological analyses based on material samples from the work environment could be used to improve the etiologic diagnosis in a farmer suffering from HP, and (2) if combining a longitudinal immunological investigation of workplace material with a realistic work place inhalation challenge could be used to optimize counselling with respect to further employment within farming. A realistic workplace inhalation challenge was performed to explore potential associations between exposure, symptoms and immune responses. Material samples were collected from various places on the farm, and enzyme-linked immunosorbent assay (ELISA) was performed to identify possible IgE and IgG antibodies in patient serum towards these material samples. Electrophoresis (SDS-PAGE) and immunoblot were used to detect the specific proteins in the material samples that were recognized by ELISA. The patient's symptoms were reproduced by the workplace challenge, and more severe symptoms were associated with increased serum levels of specific IgG antibodies towards material samples from the workplace. The immunoblot detected IgG binding proteins in agreement with known allergens of the fungi Alternaria and Pullularia. Combining realistic workplace challenge with immunological analyses of workplace material may improve the basis for counselling farmers with farmer´s lung concerning future work within farming.


Assuntos
Alveolite Alérgica Extrínseca/etiologia , Criação de Animais Domésticos , Pulmão de Fazendeiro/etiologia , Exposição Ocupacional/análise , Adulto , Alérgenos/efeitos adversos , Alternaria/imunologia , Alveolite Alérgica Extrínseca/diagnóstico , Aureobasidium/imunologia , Pulmão de Fazendeiro/diagnóstico , Fazendeiros , Feminino , Humanos , Imunoglobulina E/sangue , Imunoglobulina G/sangue , Dispositivos de Proteção Respiratória
9.
Vox Sang ; 114(8): 783-794, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31637738

RESUMO

INTRODUCTION: In vitro qualitative differences exist in red cell concentrates (RCCs) units processed from whole blood (WB) depending on the method of processing. Minimal literature exists on differences in processing and variability in quality data. Therefore, we collected information from blood manufacturers worldwide regarding (1) details of WB collection and processing used to produce RCCs and (2) quality parameters and testing as part of routine quality programmes. METHODS: A secure web-based survey was developed, refined after pilot data collection and distributed to blood centres. Descriptive analyses were performed. RESULTS: Data from ten blood centres in nine countries were collected. Six blood centres (60%) processed RCCs using the top-and-top (TAT) method which produces RCCs and plasma, and eight centres (80%) used the bottom-and-top (BAT) which additionally produces buffy coat platelets. Five of the centres used both processing methods; however, four favoured BAT processing. One centre utilized the Reveos automated system exclusively. All centres performed pre-storage leucoreduction. Other parameters demonstrated variability, including active cooling at collection, length of hold before processing, donor haemoglobin limits, acceptable collection weights, collection sets, time to leucoreduction, centrifugation speeds, extraction devices and maximum RCC shelf life. Quality marker testing also differed amongst blood centres. Trends towards higher RCC unit volume, haemolysis and residual leucoctyes were seen in the TAT compared with BAT processing across centres. CONCLUSION: Methods and parameters of WB processing and quality testing of RCCs differ amongst surveyed blood manufacturers. Further studies are needed to assess variations and to potentially improve methods and product quality.


Assuntos
Bancos de Sangue/normas , Preservação de Sangue/normas , Eritrócitos/citologia , Bancos de Sangue/métodos , Preservação de Sangue/métodos , Humanos , Inquéritos e Questionários
10.
Transfusion ; 59(8): 2652-2661, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31150571

RESUMO

BACKGROUND: Cold storage of platelets may extend shelf life compared to room temperature storage. This study aimed to investigate in vitro platelet quality and function in cold-stored and delayed-cold-stored nonagitated apheresis platelets in platelet additive solution during storage for 21 days. STUDY DESIGN AND METHODS: Ten double apheresis platelet concentrates in 37% plasma/63% PAS-IIIM were split into two groups; nonagitated 2 to 6°C storage (CSPs) and delayed cold storage (DCSPs) with 7 days agitated storage at 20-24°C followed by nonagitated cold storage for 14 additional days. Platelet count, metabolism, viscoelastic properties, and aggregation ability were measured on Days 1, 7, 14, and 21. RESULTS: All platelet units, both CSPs and DCSPs, complied with the EU guidelines throughout storage for 21 days. Swirling was not detectable after cold storage. Cold storage improved platelet function; however, DCSP on Day 7 showed poorer results compared to CSP. Cold storage slowed down metabolism, with lower lactate and higher glucose concentrations in the CSP compared to the DCSP throughout storage for 21 days. CONCLUSION: Cold storage of platelets improved platelet function in in vitro assays, even though delayed cold storage on Day 7 showed poorer results compared to continuous cold storage. This difference could be explained by accelerated metabolism and higher glucose consumption during the period of room temperature storage. Cold storage and delayed cold storage could ease inventory management. Further studies investigating the in vitro and clinical effects of cold-stored and delayed-cold-stored platelets are encouraged.


Assuntos
Plaquetas/metabolismo , Preservação de Sangue , Temperatura Baixa , Plaquetoferese , Plaquetas/citologia , Feminino , Humanos , Masculino , Testes de Função Plaquetária , Estudos Prospectivos , Fatores de Tempo
11.
J Med Case Rep ; 13(1): 177, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31177991

RESUMO

BACKGROUND: Desmoid tumors are intermediary malignant, fibrous lesions occurring in various soft tissues. Surgical treatment is relentlessly challenging because of the propensity for local aggressive behavior and high risk of recurrence. Consequently, a wide range of oncological drugs and radiation therapy are being used; however, outcomes are unpredictable. We investigated whether local treatment with an oncolytic peptide could be beneficial in a patient with an unresectable desmoid tumor. CASE PRESENTATION: In a young 29-year-old Caucasian woman who was diagnosed with a retromammary desmoid tumor infiltrating deeply into the anterior thoracic wall, surgery was considered excessively mutilating, and observation was recommended. The lesion progressed, however, and caused debilitating pain, despite nonsteroidal anti-inflammatory medication. Subcutaneous injections of human interferon-α (Multiferon®) resulted in reduced growth kinetics but had to be terminated because of development of symptomatic pneumonitis. Frequently used oncological treatment was withheld because of the toxicity profile, and the patient was instead included in a phase I study investigating transdermal intratumoral injection of LTX-315, an oncolytic peptide that induces anticancer immune responses ( ClinicalTrials.gov , NCT01986426 ). A marked increase of CD8+ tumor-infiltrating T cells in the lesion was complemented by upregulation of immune gene signature (including effector T-cell, T-helper type 1 cell, chemokine, and cytokine genes). These changes were followed by gradual symptom relief and long-term disease stabilization, indicating clinical benefit. LTX-315 was well tolerated until termination in week 16 after a serious allergic reaction. CONCLUSIONS: Our patient was treated with repeated intratumoral injections of LTX-315, resulting in tumor regression accompanied by upregulation of immune genes and T-cell infiltration. Local application of immunotherapy, minimizing systemic side effects, represents a novel treatment modality in desmoid tumors that should be tested in further clinical trials.


Assuntos
Fibromatose Agressiva , Oligopeptídeos/administração & dosagem , Parede Torácica , Adulto , Antineoplásicos/administração & dosagem , Linfócitos T CD8-Positivos/imunologia , Diagnóstico Diferencial , Feminino , Fibromatose Agressiva/imunologia , Fibromatose Agressiva/patologia , Fibromatose Agressiva/fisiopatologia , Fibromatose Agressiva/terapia , Humanos , Injeções Intralesionais , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Indução de Remissão , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Carga Tumoral
12.
Transfusion ; 59(S2): 1446-1452, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30980744

RESUMO

The shift toward using a transfusion strategy in a ratio to mimic whole blood (WB) functionality has revitalized WB as a viable option to replace severe blood loss in civilian health care. A military-civilian collaboration has contributed to the reintroduction of WB at Haukeland University Hospital in Bergen, Norway. WB has logistical and hemostatic advantages in both the pre- and in-hospital settings where the goal is a perfectly timed balanced transfusion strategy. In this paper, we describe an event leading to activation of our emergency WB collection strategy for the first time. We evaluate the feasibility of our civilian walking blood bank (WBB) to cover the need of a massive amount of blood in an emergency situation. The challenges are discussed in relation to the different stages of the event with the recommendations for improvement in practice. We conclude that the use of pre-screened donors as a WBB in a civilian setting is feasible. The WBB can provide platelet containing blood components for balanced blood resuscitation in a clinically relevant time frame.


Assuntos
Bancos de Sangue , Doadores de Sangue , Segurança do Sangue , Seleção do Doador , Hospitais Militares , Medicina Militar , Bancos de Sangue/organização & administração , Bancos de Sangue/normas , Segurança do Sangue/métodos , Segurança do Sangue/normas , Seleção do Doador/organização & administração , Seleção do Doador/normas , Feminino , Hospitais Militares/organização & administração , Hospitais Militares/normas , Humanos , Masculino , Medicina Militar/métodos , Medicina Militar/organização & administração , Medicina Militar/normas , Noruega
13.
Transfusion ; 58(11): 2720-2727, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30260483

RESUMO

BACKGROUND: Surveys are a common tool used to gather information about practices across many medical specialties. The quality of survey reporting impacts the strength of any conclusions. Thorough and accurate reporting of survey-based research is critical for evaluation of the validity, reliability, and generalizability of the results. The objective of this study was to appraise the quality of recently reported surveys in transfusion medicine (TM). STUDY DESIGN AND METHODS: A systematic review of the literature was performed to identify studies evaluating clinical practices in TM that used a questionnaire as the research tool and were published between January 2001 and November 2017. Manuscripts that met eligible criteria were appraised using a modified Survey Reporting Guideline questionnaire. RESULTS: The search identified 1632 references, from which 54 abstracts met eligibility criteria for analysis. Only seven (13%) manuscripts reported reliability and validity of the survey tool, 26 (48%) provided a description of the survey population and sample frame, and 11 (20%) indicated the representativeness of the underlying population. Additional reporting limitations included 31 (57%) manuscripts reporting the response rate calculation, two (4%) the analysis of nonresponse error, nine (17%) the method description for handling of missing data, 11 (20%) the analysis of responder and nonresponder characteristics, and 23 (43%) explicitly discussed the generalizability of the results. CONCLUSION: Our findings document quality deficiencies in the reporting of research conducted using surveys in TM. Validated guidelines for the reporting of survey-based clinical research should be developed and applied to improve the quality of survey reporting in TM.


Assuntos
Medicina Transfusional , Projetos de Pesquisa Epidemiológica , Humanos , Inquéritos e Questionários
14.
J Trauma Acute Care Surg ; 84(6S Suppl 1): S120-S124, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29462086

RESUMO

BACKGROUND: Intraosseous (IO) vascular access is increasingly used as an emergency tool for achieving access to the systemic circulation in critically ill patients. The role of IO transfusion of blood in damage control resuscitation is however questionable due to possible inadequate flow rate and hemolysis. Some experts claim that IO transfusion is contraindicated. In this study, we have challenged this statement by looking at flow rates of autologous fresh whole blood reinfusion and hemolysis using two of the commonly used Food and Drug Administration-approved and Conformité Européenne (CE)-marked sternal needles. Additionally, the success rate of sternal access between the two devices is evaluated. METHODS: Volunteer professional military personnel, were enrolled prospectively in a nonrandomized observational study design. We collected 450 mL of autologous whole blood from each participant. Participants were divided into the following three groups of 10: Tactically Advanced Lifesaving IO Needle (T.A.L.O.N.) IO, FAST1 IO, and intravenous group. The reinfusion was done by gravity only. Blood sampling was performed before blood collection and 30 minutes after reinfusion. Investigation of hemolysis was performed by measurements of haptoglobin and lactate dehydrogenase. Success rate was evaluated by correct aspiration of bone marrow. RESULTS: Median reinfusion rate was 46.2 mL/min in the FAST1 group, 32.4 mL/min in the T.A.L.O.N. group, and 74.1 mL/min in the intravenous group. Blood samples from all participants were within normal ranges. There was no statistically significant difference in haptoglobin and lactate dehydrogenase between the groups. In the FAST1 group, 1 (9%) of 11 procedures failed. In the T.A.L.O.N. group, 4 (29%) of 14 procedures failed. CONCLUSION: Although preferable, achieving peripheral venous access in the bleeding patient is a major problem. Our findings suggest that fresh whole-blood transfusion through the IO route is safe, reliable, and provide sufficient flow for resuscitation. LEVEL OF EVIDENCE: Therapeutic/Care management study, level III.


Assuntos
Coleta de Amostras Sanguíneas/métodos , Transfusão de Sangue Autóloga/métodos , Infusões Intraósseas , Ressuscitação , Esterno , Adulto , Preservação de Sangue , Emergências , Feminino , Hemólise , Humanos , Infusões Intraósseas/efeitos adversos , Infusões Intraósseas/métodos , Infusões Intravenosas , Masculino , Agulhas , Estudos Prospectivos , Ressuscitação/métodos , Adulto Jovem
15.
Platelets ; 23(4): 299-308, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22273511

RESUMO

Several studies report that patients who are treated with selective serotonin reuptake inhibitors (SSRIs) for depression may have increased risk of bleeding, particularly from the gastrointestinal tract. This may be related to low intraplatelet serotonin concentrations. Several blood banks do not store platelets from donors using SSRIs for transfusion, although the possible effects of SSRIs on platelet storage are not documented. We conducted a case-control pilot study of apheresis platelet concentrates prepared from donors using SSRIs (n=8) and from donors without medication (n=10). The platelet concentrates were stored for 5 days. Light transmission aggregometry (LTA), thrombelastography (TEG), and flow cytometric analyses were preformed for in vitro measurements of platelet function. Platelet function and platelet serotonin content were investigated in whole blood and in platelet concentrates stored for up to 5 days. LTA, TEG, and flow cytometric analysis of glycoprotein expression did not reveal any significant differences between the two groups. All 18 platelet concentrates performed well according to the standards set for platelet quality in relation to transfusion. Blood donors using SSRIs had significantly lower platelet serotonin compared to blood donors without medication. The results from our pilot study indicate that platelets from donors using SSRIs may be suitable for transfusion after storage for 5 days, but further laboratory and clinical studies are necessary to confirm this.


Assuntos
Plaquetas/efeitos dos fármacos , Inibidores de Captação de Serotonina/farmacologia , Adulto , Gasometria , Plaquetas/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Agregação Plaquetária/efeitos dos fármacos , Contagem de Plaquetas , Glicoproteínas da Membrana de Plaquetas/metabolismo , Transfusão de Plaquetas , Serotonina/metabolismo , Tromboelastografia
16.
Transfus Med Rev ; 26(4): 321-32, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22237134

RESUMO

Benchmarking is as a structured continuous collaborative process in which comparisons for selected indicators are used to identify factors that, when implemented, will improve transfusion practices. This study aimed to identify transfusion medicine studies reporting on benchmarking, summarize the benchmarking approaches used, and identify important considerations to move the concept of benchmarking forward in the field of transfusion medicine. A systematic review of published literature was performed to identify transfusion medicine-related studies that compared at least 2 separate institutions or regions with the intention of benchmarking focusing on 4 areas: blood utilization, safety, operational aspects, and blood donation. Forty-five studies were included: blood utilization (n = 35), safety (n = 5), operational aspects of transfusion medicine (n = 5), and blood donation (n = 0). Based on predefined criteria, 7 publications were classified as benchmarking, 2 as trending, and 36 as single-event studies. Three models of benchmarking are described: (1) a regional benchmarking program that collects and links relevant data from existing electronic sources, (2) a sentinel site model where data from a limited number of sites are collected, and (3) an institutional-initiated model where a site identifies indicators of interest and approaches other institutions. Benchmarking approaches are needed in the field of transfusion medicine. Major challenges include defining best practices and developing cost-effective methods of data collection. For those interested in initiating a benchmarking program, the sentinel site model may be most effective and sustainable as a starting point, although the regional model would be the ideal goal.


Assuntos
Benchmarking/métodos , Transfusão de Sangue/normas , Segurança do Sangue/métodos , Transfusão de Sangue/métodos , Medicina Baseada em Evidências/métodos , Hospitais , Humanos , Projetos de Pesquisa , Reação Transfusional , Resultado do Tratamento
17.
Transfus Apher Sci ; 43(3): 411-414, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21075686

RESUMO

It is an important goal in transfusion practice to improve the quality and safety of platelet transfusions. Accordingly, blood services have implemented several complimentary measures such as continual improvement in donor selection, donor testing, newer development in collection/processing, including the diversion of the first part of collection to reduce the potential risk of bacterial contamination and the use of various platelet additive solutions and reduction in donor exposures through production multiple doses by apheresis procedures. Unfortunately despite considerable improvement in blood components safety bacterial transmission by platelet transfusion remains the major microbial cause of morbidity and mortality in transfusion medicine. Currently two major interventions are in practice, in some establishments, to reduce bacterial transfusion by platelets: selective/full bacterial screening and pathogen inactivation. The later is also effective against most known and unknown emerging nucleic acid containing viruses, as well as, parasites. In addition it also reduces the side effect associated with leucocytes, making its implementation highly appealing. In recent years, two methods for pathogen inactivation/reduction (abbreviation used later in this paper PI) of platelet concentrates have become available. Pathogen inactivation was the original term for the technology, but as it is argued that the inactivation may not be complete, some authors prefer the term "pathogen reduction". Although PI of cellular blood components is considered to be a "dream solution" to the problem of transfusion-related transmission of infectious diseases, the implementation of these precautionary interventional methods is not yet universally approved. The aim of this paper is to discuss some of the key issues in the debate on implementation of PI methods for platelet concentrates.


Assuntos
Plaquetas/microbiologia , Segurança do Sangue/métodos , Desinfecção , Transfusão de Plaquetas/efeitos adversos , Patógenos Transmitidos pelo Sangue , Humanos
18.
Blood Transfus ; 8(3): 186-92, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20671879

RESUMO

BACKGROUND: The Mirasol Pathogen Reduction Technology system for platelets and plasma uses riboflavin and UV light to introduce irreparable lesions into nucleic acids thereby inhibiting pathogen and white blood cell replication and reducing the load of infectious pathogens. The aim of the present study was to evaluate low plasma buffy coat platelet concentrates obtained from the OrbiSac System and to examine the effects on the development of platelet storage lesion during storage in platelet additive solution. MATERIAL AND METHODS: Twenty buffy coat platelet concentrates were generated by pooling five individual units using the OrbiSac System. Riboflavin was added during the final pooling step, and the units were exposed to UV light. The bag was removed after the target energy of 6.24 J/mL had been delivered and 150 mL of platelet additive solution were added prior to storage. Platelet quality was assessed by pH, swirl, CD62P expression, lactate dehydrogenase, lactate production and glucose consumption rates over 7 days of storage. RESULTS: Buffy coat platelet concentrates generated on the OrbiSac contained an average 3.5 +/- 0.6 x 10(11) platelets at a concentration of 2976+/- 406 x 10(6)/mL. After addition of 150 mL platelet additive solution the storage concentration was 1043 +/- 148x 10(6)/mL. Values obtained for pH, lactate production and glucose consumption rates were all within the limits of previously established correlations between in vitro cell quality and in vivo performance of Pathogen Reduction Technology-treated platelets in plasma. DISCUSSION: In vitro studies show that OrbiSac-derived platelets treated with the Mirasol Pathogen Reduction Technology system preserve adequate function, which would indicate acceptable in vitro viability.


Assuntos
Buffy Coat/citologia , Plaquetas/citologia , Preservação de Sangue/métodos , Tecnologia Biomédica , Sobrevivência Celular , Glucose/metabolismo , Humanos , Concentração de Íons de Hidrogênio , Ácido Láctico/biossíntese , Soluções Farmacêuticas , Contagem de Plaquetas , Riboflavina/farmacologia , Raios Ultravioleta
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