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1.
J Spec Oper Med ; 21(2): 29-33, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34105118

RESUMO

BACKGROUND: Administration of fresh whole blood (FWB) is a life-saving treatment that prolongs life until definitive surgical intervention can be performed; however, collecting FWB is a time-consuming and resource-intensive process. Furthermore, it may be difficult to collect sufficient FWB to treat critically wounded patients or multiple-hemorrhaging casualties. This study describes the effect of airdrop on FWB and explores the possibility of using airdrop to deliver FWB to combat medics treating casualties in the prehospital setting when FDA-approved, cold-stored blood products are not readily available and timely casualty evacuation (CASEVAC) is not feasible. METHODS: Four units of FWB were collected from volunteer donors and loaded into a blood cooler that was dropped from a fixed-wing aircraft under a standard airdrop training bundle (SATB) parachute. A control group of 4 units of FWB was stored in a blood cooler that was not dropped. Baseline and postintervention laboratory samples were measured in both airdropped and control units, including full blood counts, prothrombin time/partial thromboplastin time/international normalized ratio (PT/PTT/INR), pH, lactate, potassium, indirect bilirubin, glucose, fibrinogen, lactate dehydrogenase, and peripheral blood smears. RESULTS: The blood cooler, cooling bags, and all 4 FWB units did not sustain any damage from the airdrop. There was no evidence of hemolysis. All airdropped blood met parameters for transfusion per the Whole Blood Transfusion Clinical Practice Guideline of the Joint Trauma System (JTS). CONCLUSIONS: Airdrop of FWB in a blood cooler with a SATB parachute may be a viable way of delivering blood products to combat medics treating hemorrhaging patients in the prehospital setting, although further research is needed to fully validate the safety of this method of FWB delivery.


Assuntos
Transfusão de Sangue , Hemorragia , Hemorragia/terapia , Humanos , Chuva
2.
J Spec Oper Med ; 21(2): 89-91, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34105129

RESUMO

Fresh whole blood transfusion is advantageous when operating far-forward for both its availability and its physiological advantages over component therapy. However, the far-forward environment may place high physical performance demands on the donor immediately after donation. The aim of this paper was to briefly review the current literature on the effects of whole blood donation on a male donor's immediate physical performance after a standard donation volume of one unit (~450mL). Studies demonstrate reductions in peak volume of oxygen (VO2peak) of ~4% to 15% and time to exhaustion (TTE) of ~10% to 19% in the first 24 to 48 hours after donation. Anaerobic or cognitive performance has not been shown to decrease, but data on these parameters are limited. Donor physical performance decrements after a standard 450mL donation are minimal and may be mitigated through proper exercise training because training status may positively affect many variables that blood donation temporarily attenuates.


Assuntos
Doadores de Sangue , Consumo de Oxigênio , Transfusão de Sangue , Exercício Físico , Teste de Esforço , Humanos , Masculino
3.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 29(3): 910-916, 2021 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-34105493

RESUMO

OBJECTIVE: To investigate the indentification method of samples mistyped as O phenotype and to explore the precision transfusion strategy. METHODS: The blood samples from donors and patients admitted in our center from 2018 to 2019 was collected. The samples with O phenotype suspected subtypes were further determined by tube test, adsorption-elution test, etc. Molecular testing was used to sequence the related blood type genes of the subjects. RESULTS: Among 14 subjects misjudged as O, 11 different genotypes were identified, in which 3 blood donors were Ael02/O02, Bel03/O02, and one para-Bombay with B101/O02 (FUT1: h3h3; FUT2: Se357Se357); the genotypes of 11 patients were Ael02/O01, 2 cases with Ael02/O02, Ael08/O01, Aw37/O02, Aw43/O02, Bel03/O01, 3 cases with Bel03/O02, and one case was para-Bombay with A102/B101 (FUT1: h3h3; FUT2: Se357Se357). CONCLUSION: The phenotypes of Ael, Bel, Aw and para-Bombay subtypes are easily misjudged as type O. Molecular technology is helpful to identify the genotype of subtypes, and the corresponding transfusion strategies could be reasonably performed.


Assuntos
Sistema ABO de Grupos Sanguíneos , Transfusão de Sangue , Alelos , Fucosiltransferases/genética , Genótipo , Humanos , Fenótipo
4.
Medicine (Baltimore) ; 100(20): e25420, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011021

RESUMO

ABSTRACT: This retrospective study investigated the preventive effect of intravenous esomeprazole (IVEO) in the prevention of nonvarices upper gastrointestinal bleeding (NUGIB).This study enrolled 130 patients with NUGIB and all of them underwent successful endoscopic hemostasis, of which 65 cases received routine management and IVEO (Group A) and the other 65 cases received routine management alone (Group B). The primary outcome (recurrent bleeding rate within 72-hour, 7-day, and 30-day), and secondary outcomes ((all-cause mortality, bleeding-related mortality, blood transfused, hospital stay (day), and incidence of adverse events)) were compared between 2 groups.Patients in the group A showed lower recurrent bleeding rate within 72-hour(P < .05), 7-day (P < .05), and 30-day (P < .05), than that of patients in the group B. However, no significant differences were identified in all-cause mortality(P = .26), bleeding-related mortality (P = .57), blood transfused (P = .33), and hospital stay (P = .74) between 2 groups. In addition, both groups had similar safety profile.This study found that routine management and IVEO was superior to the routine management alone for preventing the recurrent bleeding rate after successful endoscopic hemostasis in patients with NUGIB.


Assuntos
Esomeprazol/administração & dosagem , Hemostase Endoscópica/estatística & dados numéricos , Úlcera Péptica Hemorrágica/terapia , Inibidores da Bomba de Prótons/administração & dosagem , Prevenção Secundária/métodos , Adolescente , Adulto , Idoso , Transfusão de Sangue/estatística & dados numéricos , Terapia Combinada/métodos , Terapia Combinada/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Infusões Intravenosas/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/mortalidade , Recidiva , Estudos Retrospectivos , Prevenção Secundária/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
5.
BMC Musculoskelet Disord ; 22(1): 457, 2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011340

RESUMO

BACKGROUND: Patients with systemic lupus erythematosus are more likely to receive THA than the general population. However, it is controversial whether SLE increases the risk of complications from THA. The purpose of this retrospective study was to reassess the risks from THA in patients with SLE under the management model of enhanced recovery after surgery. METHODS: Patients with systemic lupus erythematosus diagnosed from December 2011 to December 2017 and treated with THA were compared with THA patients with osteoarthritis. The data were extracted from the medical record system of our department. The chi-square test and t-test were used for comparison. RESULTS: The postoperative blood loss in patients with SLE was significantly higher than that in the control group, and the postoperative hemoglobin (Hb) and hematocrit (Hct) in the control group were lower than those in the control group (P < 0.05). There was no significant difference in the rate of blood transfusion (9.733 vs 8.133 P = 0.3148) or other complications between the two groups (P > 0.05). CONCLUSION: Well-controlled and well-managed SLE will not increase the risk of complications in THA, but can increase the amount of perioperative blood loss. Therefore, perioperative blood management is still essential in SLE patients.


Assuntos
Artroplastia de Quadril , Lúpus Eritematoso Sistêmico , Osteoartrite , Artroplastia de Quadril/efeitos adversos , Transfusão de Sangue , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Osteoartrite/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
6.
Ceska Gynekol ; 86(2): 110-113, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34020557

RESUMO

OBJECTIVE: The aim of this research is to present our experiences with the surgical treatment of gynecological patients among Jehovahs Witnesses. Moreover, the medical, moral, and ethical problems in this regard have been highlighted. METHODS: 75 Jehovahs Witnesses patients were operated on for various benign and malignant gynecological diseases between 2007 and 2018. All of these patients were operated on according to the rules of blood-sparing surgery. RESULTS: The operations were assessed according to the dia-gnosis, mode of surgery, estimated blood loss, and disease outcome. Excessive blood loss did not occur during any of these operations, and the estimated blood loss for the same procedure was 10 to 550 mL. CONCLUSION: Jehovahs Witnesses gynecological patients is a group of high-risk patients because they refuse to undergo blood transfusion. Nevertheless, the principles of blood-sparing surgery should be applied to not only Jehovahs Witnesses patients but also to all patients in general. Even if a blood transfusion is the last resort to solve issues pertaining to excessive blood loss during complicated operations, the said procedure always carries certain risks. Therefore, blood transfusion should be performed only on rare occasions. Jehovahs Witnesses patients categorically refuse blood transfusion even if it is the only way to save ones life. Even though the legislation of the Czech Republic deals with this problem, there are other moral and ethical aspects that need to be addressed in this regard.


Assuntos
Procedimentos Médicos e Cirúrgicos sem Sangue , Testemunhas de Jeová , Transfusão de Sangue , República Tcheca , Hemorragia , Humanos
7.
Curr Opin Anaesthesiol ; 34(3): 352-356, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33935184

RESUMO

PURPOSE OF REVIEW: In the past years, patient blood management (PBM) has evolved to improve patient's care and safety. Anemia is one of the most common medical diseases in the world and is an independent risk factor for morbidity and mortality. Iron deficiency is the main cause for anemia and constitutes a potentially preventable condition with a great impact on surgical outcome. However, preoperative anemia management is not yet established in most hospitals. Changing workflows and re-thinking is challenging. Numerous published studies confirmed the positive effect of preoperative anemia diagnosis and treatment recently. RECENT FINDINGS: Iron supplementation in iron-deficient anemic (IDA) patients reduce the need for allogenic blood transfusion thereby improving perioperative outcome. SUMMARY: Since the introduction of PBM programs, important movements towards early detection and therapy of preoperative anemia have been observed. However, preoperative anemia management is not implemented on a large scale as many healthcare professionals are not aware of the most recent findings in the field. Preoperative anemia management, particularly iron supplementation in IDA patients, has proven to be highly effective and has a tremendous effect on patient safety and outcome.


Assuntos
Anemia , Anemia/diagnóstico , Anemia/epidemiologia , Anemia/etiologia , Transfusão de Sangue , Humanos , Ferro , Cuidados Pré-Operatórios , Fatores de Risco
8.
BMJ Case Rep ; 14(5)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011642

RESUMO

A 50-year-old woman, with a background of autoimmune haemolytic anaemia, presented to the emergency department with lethargy and shortness of breath. Investigations revealed a haemoglobin level of 50 g/L. High dose steroids were administered and blood transfusion prescribed. However, the blood transfusion was delayed due to a positive antibody screen and concerns regarding administering blood when the patient was pyrexic. The delay resulted in a significant deterioration in the patient's clinical state with her haemoglobin level falling to 26 g/L 24 hours later. She was urgently transfused with blood and made a full recovery. This report analyses the delays for transfusion and how these could have been minimised. First, guidelines advise that emergency blood should be considered in life-threatening circumstances. Second, fever is not always a contraindication for transfusion, particularly in an emergency setting.


Assuntos
Anemia Hemolítica Autoimune , Anemia Hemolítica Autoimune/complicações , Anemia Hemolítica Autoimune/diagnóstico , Anemia Hemolítica Autoimune/terapia , Transfusão de Sangue , Dispneia , Serviço Hospitalar de Emergência , Feminino , Febre , Humanos , Pessoa de Meia-Idade
9.
BMC Musculoskelet Disord ; 22(1): 496, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34049508

RESUMO

BACKGROUND: We compared blood loss and transfusion frequency between the lateral decubitus and the supine position in patients undergoing hip replacement surgery due to femoral neck fractures. METHODS: We retrospectively included femoral neck fracture patients treated with either hemi (HA) or total hip arthroplasty (THA). We included a total of 626 patients, of which 313 patients underwent surgery in the lateral decubitus position and 313 patients in the supine position. Preoperative and day 1 postoperative blood measures including hemoglobin (Hb), hematocrit (Hct), and red blood cell count (RBC) were evaluated, as well as transfusion records analyzed. RESULTS: The following decrease of laboratory parameters between pre- and 1st day postoperative measures was noted: RBC: -0.77 G/L (± 0.5 G/L, median = -0.80 G/L; range: -0.50 - -1.10 G/L); Hct: -7.08 % (± 4.7 %, range: -4.70 - -9.90 G/L); Hb: -2.36 g/dL (± 1.6 g/dL, range: -1.50. - -3.40 g/dL). We did not observe significant differences in transfusion frequency between the two study cohorts (p = 0.735 for THA, p = 0.273 for HA). No influence of patient positioning on Hb-decrease, Hct-decrease, or RBC-decrease was noted in our two-way ANOVA models with consideration of implant type and fixation technique (F(3,618) = 1.838, p = 0.139; F(3,618) = 2.606, p = 0.051; F(3,618) = 1.407, p = 0.240). CONCLUSIONS: We did not observe  significant differences in perioperative blood values and transfusion rates in association with patient positioning in patients undergoing hip replacement surgery for femoral neck fractures. LEVEL OF EVIDENCE: Level III, retrospective cohort study.


Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral , Artroplastia de Quadril/efeitos adversos , Transfusão de Sangue , Fraturas do Colo Femoral/cirurgia , Humanos , Posicionamento do Paciente , Estudos Retrospectivos
10.
Stud Health Technol Inform ; 281: 223-227, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34042738

RESUMO

Blood products and their derivatives are perishable commodities that require an efficient inventory management to ensure both a low wastage rate and a high product availability rate. To optimize blood product inventory, blood transfusion services need to reduce wastage by avoiding outdates and improve availability of different blood products. We used advance visualization techniques to design and develop a highly interactive real-time web-based dashboard to monitor the blood product inventory and the on-going blood unit transactions in near-real-time based on analysis of transactional data. Blood transfusion staff use the dashboard to locate units with specific characteristics, investigate the lifecycle of the units, and efficiently transfer units between facilities to minimize outdates.


Assuntos
Bancos de Sangue , Transfusão de Sangue , Humanos
11.
Clin Med (Lond) ; 21(3): 201-203, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34001570

RESUMO

The Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) decided that its 2011 recommendations on consent for blood transfusion needed to be reviewed and revised due to evidence of poor compliance and recent legal guidance on consent. The recommendations are to ensure that patients are informed about and understand the purpose, benefits and potential risks of transfusion, and have an opportunity to discuss their treatment options. They should be incorporated into local practices for all patients.


Assuntos
Comitês Consultivos , Transfusão de Sangue , Humanos , Consentimento Livre e Esclarecido
12.
J Pak Med Assoc ; 71(2(B)): 602-607, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33941943

RESUMO

OBJECTIVE: To compare upper versus lower calyceal approaches in percutaneous nephrolithotomy for managing renal calculi. METHODS: The retrospective study was conducted in the Department of Urology, The Kidney Centre Post-Graduate Training Institute, Karachi, and comprised data of patients who underwent percutaneous nephrolithotomy from January 2014 to January 2015. Patients were divided into upper pole puncture group A and lower pole puncture group B. Data was analysed using SPSS 17. RESULTS: Of the 198 patients, 147(74.2%) were males and 51(25.8%) were females. The overall mean age was 40.64±14.02 years. Of the total, 69(34.84%) were in group A and 129(65.15%) were in group B. Inter-group difference was significant in pre- and post-operative haemoglobin (p<0.05). Post-operative outcomes showed that blood transfusion, stone clearance and complication like tube thoracostomy had significant association with both the groups (p<0.05). Complete clearance was seen in 152(76.8%) patients; 40(74.1%) in group A and 102(81.6%) in group B. CONCLUSIONS: The success rate was found to be better in lower calyceal puncture group than upper calyceal puncture group for the management of renal calculi.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Nefrostomia Percutânea , Adulto , Transfusão de Sangue , Feminino , Humanos , Cálculos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
13.
Am J Case Rep ; 22: e930705, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33946094

RESUMO

BACKGROUND Atypical manifestations of Graves' disease (GD) such as anemia have been noticed in the last decades. Anemia is present in up to 34% of patients with GD, yielding various anemia types such as GD anemia, pernicious anemia, iron deficiency anemia, and autoimmune hemolytic anemia (AIHA). So far, AIHA is the rarest manifestation of anemia in GD. CASE REPORT We report a case of 29-year-old woman with initial presentation of typical anemia. Further findings revealed GD signs and symptoms such as orbitopathy, increased appetite along with loss of weight, and hand tremors. Laboratory findings showed very low hemoglobin (3.9 g/dL), reticulocytosis, elevated indirect bilirubin, and positive direct Coomb's test. Later, thyroid function testing showed decreased TSH, elevated fT4, and positive TrAb. The diagnosis of GD was made, with AIHA as initial presenting manifestation. The patient was treated using corticosteroids followed by anti-thyroid without any blood transfusion and responded well. CONCLUSIONS In this case, typical AIHA was the initial presenting manifestation of GD and should not be overlooked since delayed diagnosis increases morbidity and mortality. Thyroid function assessment may be needed to search for etiologies of AIHA. Regardless of the exact underlying pathophysiology, AIHA under GD generally responds well to anti-thyroid and steroid treatment.


Assuntos
Anemia Hemolítica Autoimune , Doença de Graves , Adulto , Anemia Hemolítica Autoimune/diagnóstico , Transfusão de Sangue , Feminino , Doença de Graves/complicações , Doença de Graves/diagnóstico , Humanos
15.
Gan To Kagaku Ryoho ; 48(4): 563-565, 2021 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-33976049

RESUMO

A female in her 70s was diagnosed as sigmoid colon cancer. Laparoscopic sigmoidectomy was performed. Chylous ascites was observed after starting oral intake. As we changed the patient's diet to a low fat diet, the chylous ascites disappeared. There are certain numbers of reports of the cases improved by fasting or only fat decreased meal. It is important to prevent this complications using appropriate surgical devices.


Assuntos
Ascite Quilosa , Laparoscopia , Transfusão de Sangue , Ascite Quilosa/etiologia , Ascite Quilosa/terapia , Feminino , Humanos , Complicações Pós-Operatórias , Período Pós-Operatório
16.
Rev Col Bras Cir ; 48: e20202777, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33978122

RESUMO

The spleen is one of the most frequently affected organs in blunt abdominal trauma. Since Upadhyaya, the treatment of splenic trauma has undergone important changes. Currently, the consensus is that every splenic trauma presenting with hemodynamic stability should be initially treated nonoperatively, provided that the hospital has adequate structure and the patient does not present other conditions that indicate abdominal exploration. However, several topics regarding the nonoperative management (NOM) of splenic trauma are still controversial. Splenic angioembolization is a very useful tool for NOM, but there is no consensus on its precise indications. There is no definition in the literature as to how NOM should be conducted, neither about the periodicity of hematimetric control, the transfusion threshold that defines NOM failure, when to start venous thromboembolism prophylaxis, the need for control imaging, the duration of bed rest, and when it is safe to discharge the patient. The aim of this review is to make a critical analysis of the most recent literature on this topic, exposing the state of the art in the NOM of splenic trauma.


Assuntos
Traumatismos Abdominais , Ferimentos não Penetrantes , Transfusão de Sangue , Hemodinâmica , Humanos , Escala de Gravidade do Ferimento , Estudos Retrospectivos , Baço/lesões , Resultado do Tratamento , Ferimentos não Penetrantes/terapia
17.
Immunohematology ; 37(1): 1-4, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33962485

RESUMO

D- red blood cells (RBCs), always in short supply, and Rh immune globulin (RhIG) are not needed for patient care if D+ RBCs can safely be transfused. According to a recent work group recommendation, patients with the RHD*weak D type 4.0 allele can be considered D+. We report an African American woman who presented for delivery at the end of the third trimester, at which time anti-U and a serologic weak D phenotype were recognized, requiring U-, D- RBC units. We obtained 3 U- RBC units, including 1 D- unit. Later, the RHD*weak D type 4.0 allele was determined by RHD genotyping, only 6 days before delivery. The patient had an uneventful vaginal delivery of a D+ baby. No transfusion was needed for mother or baby. In this case, a pregnant woman with the RHD*weak D type 4.0 allele can safely be managed as D+, relaxing the unnecessary D- restriction for the limited U- RBC supply. The procured U-, D- RBC unit was frozen with 14 days of shelf-life remaining. To conserve D- RBC units, not limited to U-, for patients with a definite need, we recommend molecular analysis of a serologic weak D phenotype before a transfusion becomes imminent. The best time to resolve a serologic weak D phenotype with RHD genotyping is early in a pregnancy. Immunohematology 2021;37:1-4 .D­ red blood cells (RBCs), always in short supply, and Rh immune globulin (RhIG) are not needed for patient care if D+ RBCs can safely be transfused. According to a recent work group recommendation, patients with the RHD*weak D type 4.0 allele can be considered D+. We report an African American woman who presented for delivery at the end of the third trimester, at which time anti-U and a serologic weak D phenotype were recognized, requiring U­, D­ RBC units. We obtained 3 U­ RBC units, including 1 D­ unit. Later, the RHD*weak D type 4.0 allele was determined by RHD genotyping, only 6 days before delivery. The patient had an uneventful vaginal delivery of a D+ baby. No transfusion was needed for mother or baby. In this case, a pregnant woman with the RHD*weak D type 4.0 allele can safely be managed as D+, relaxing the unnecessary D­ restriction for the limited U­ RBC supply. The procured U­, D­ RBC unit was frozen with 14 days of shelf-life remaining. To conserve D­ RBC units, not limited to U­, for patients with a definite need, we recommend molecular analysis of a serologic weak D phenotype before a transfusion becomes imminent. The best time to resolve a serologic weak D phenotype with RHD genotyping is early in a pregnancy. Immunohematology 2021;37:1­4 .


Assuntos
Sistema do Grupo Sanguíneo Rh-Hr , Imunoglobulina rho(D) , Alelos , Transfusão de Sangue , Eritrócitos , Feminino , Genótipo , Humanos , Gravidez , Sistema do Grupo Sanguíneo Rh-Hr/genética , Imunoglobulina rho(D)/genética
18.
Adv Exp Med Biol ; 1269: 379-386, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33966246

RESUMO

The effectiveness of blood transfusions can be impacted by storage and extensive processing techniques that involve treatment of red blood cells (RBCs) with pathogen reduction technologies (e.g., UV-light and chemical treatment), ex vivo stem cell derivation/maturation methods, and bioengineering of RBCs using nanotechnology. Therefore, there is a need to have methods that assess the evaluation of the effectiveness of transfusions to achieve their intended purpose: to increase oxygenation of critical tissues. Consequently, there has been intense interest in the development of techniques targeted at optimizing the assessment of RBC quality in preclinical and clinical settings. We provide a critical assessment of the ability of currently used methods to provide unambiguous information on oxygen levels in tissues and conclude that they cannot do this. This is because they are based on surrogates for the true goal of transfusion, which is to increase oxygenation of critical organs. This does not mean that they are valueless, but it does indicate that other methods are needed to provide direct measurements of oxygen in tissues. We report here on the initial results of a method that can provide direct assessment of the impact of the transfusion on tissue oxygen: EPR oximetry. It has the potential to provide such information in both preclinical and clinical settings for the assessment of blood quality posttransfusion.


Assuntos
Transfusão de Eritrócitos , Oxigênio , Transfusão de Sangue , Eritrócitos , Oximetria
19.
Can J Anaesth ; 68(6): 894-917, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33993459

RESUMO

PURPOSE: In this Continuing Professional Development module, we review the practical pharmacology of tranexamic acid and its clinical use in trauma, obstetrics, and major orthopedic surgery. PRINCIPAL FINDINGS: Tranexamic acid is a synthetic drug that inhibits fibrinolysis. Multiple clinical trials in various clinical settings have shown that it can reduce blood loss, transfusion rates, and bleeding-associated mortality. In trauma and obstetrical bleeding, early tranexamic acid administration (< three hours) may have greater clinical benefits. Overall, tranexamic acid use appears safe with no significant increase of thromboembolic or seizure events. Nevertheless, current evidence has limitations related to wide heterogeneity in dose, route, and timing of drug administration, as well as generalizability of the large-scale trial findings to higher income nations. CONCLUSIONS: Tranexamic acid is an efficacious and safe pharmacological-based blood conservation technique in the management of clinically significant hemorrhage. All anesthesiologists should have a good understanding of the pharmacotherapeutic properties and perioperative role of tranexamic acid therapy both inside and outside of the operating room. The use of tranexamic acid is likely to continue to rise with endorsement by various clinical guidelines and healthcare organizations. Further quantitative research is needed to evaluate optimal dosing and drug efficacy in these clinical scenarios.


Assuntos
Antifibrinolíticos , Obstetrícia , Ácido Tranexâmico , Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue , Hemorragia , Humanos , Ácido Tranexâmico/uso terapêutico
20.
Am J Case Rep ; 22: e931758, 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33941758

RESUMO

BACKGROUND Certain health conditions have been proven to have an effect on the severity of COVID-19, the disease caused by SAR-COV-2. The list of identified comorbid conditions includes hematological diseases, with sickle cell disease (SCD) falling into this category. CASE REPORT This case series examines the history, presentation, and clinical course of 5 patients with SCD who tested positive for SAR-COV-2 during the spring and summer of 2020. These patients experienced COVID-19 severities ranging from a mild cough and congestion to 8-day hospitalizations requiring blood transfusions. CONCLUSIONS While there is still a great amount of research on the interaction between COVID-19 and SCD needed, from this study we have concluded that patients with SCD do not always present with the classic COVID-19 triad of cough, shortness of breath, and fever. Often, these patients present with symptoms of vaso-occlusive crisis (VOC), including severe leg, flank, and chest pain, as was seen in 4 of 5 of our patients. We, and several other researchers, believe that this association between COVID-19 and VOC could be due to COVID-19 triggering inflammatory cytokines (notably IL-6) leading to system-wide inflammation, which induces sickling of the red blood cells. Based on this report, we recommend that SCD patients presenting with VOC who have had exposure to SAR-COV-2 be promptly tested for SAR-COV-2 to guide treatment and reduce mortality and morbidity in this vulnerable population.


Assuntos
Anemia Falciforme/complicações , Dor no Peito/etiologia , Dor no Flanco/etiologia , SARS-CoV-2 , Adulto , Anemia Falciforme/terapia , Transfusão de Sangue , COVID-19/complicações , COVID-19/diagnóstico , Citocinas/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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