RESUMO
BACKGROUND: The availability of a safe blood supply is a key component of transfusion medicine. A decade of decreased blood use, decreased payment for products, and a dwindling donor base have placed the sustainability of the US blood supply at risk. STUDY DESIGN AND METHODS: A literature review was performed for blood center (BC) and hospital disaster management, chronically transfusion-dependent diseases, and appropriate use of group O-negative red blood cells (RBCs), and the Choosing Wisely campaign. The aim was to identify current practice and to make recommendations for BC and hospital actions. RESULTS: While BCs are better prepared to handle disasters than after the 9/11 attacks, messaging to the public remains difficult, as donors often do not realize that blood transfused during a disaster was likely collected before the event. BCs and transfusion services should participate in drafting disaster response plans. Hospitals should maintain inventories adequate for patients in the event supply is disrupted. Providing specialty products for transfusion-dependent patients can strain collections, lead to increased use of group O RBCs, and create logistical inventory challenges for hospitals. The AABB Choosing Wisely initiative addresses overuse of blood components to optimally use this precious resource. Group O-negative RBCs should be transfused only to patients who truly need them. CONCLUSIONS: Collecting and maintaining a blood supply robust enough to handle disasters and transfusion-dependent patients in need of specialty products is challenging. Collaboration of all parties should help to optimize resources, ensure appropriate collections, improve patient care, and ultimately result in a robust, sustainable blood supply.
Assuntos
Transfusão de Componentes Sanguíneos/ética , Doadores de Sangue/estatística & dados numéricos , Segurança do Sangue/métodos , Medicina Transfusional/organização & administração , Sistema ABO de Grupos Sanguíneos/classificação , Sistema ABO de Grupos Sanguíneos/imunologia , Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Doadores de Sangue/provisão & distribuição , Segurança do Sangue/estatística & dados numéricos , Comportamento Cooperativo , Planejamento em Desastres/legislação & jurisprudência , Eritrócitos/imunologia , Feminino , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Satisfação do Paciente/estatística & dados numéricosAssuntos
Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Índice de Gravidade de Doença , Tromboelastografia/métodos , COVID-19 , Teste para COVID-19 , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2Assuntos
Remoção de Componentes Sanguíneos/métodos , Troca Plasmática/métodos , Volume Plasmático/fisiologia , Amputação Cirúrgica , Peso Corporal , Feminino , Hematócrito/métodos , Humanos , Masculino , Obesidade/complicações , Plasmaferese , Padrões de Prática Médica , Gravidez , Complicações na Gravidez , Projetos de Pesquisa , Sociedades Médicas , Inquéritos e Questionários , Estados UnidosRESUMO
BACKGROUND: The focused abdominal sonography in trauma (FAST) examination is a routine component of the initial work-up of trauma patients. However, it does not identify patients with retroperitoneal hemorrhage associated with significant pelvic trauma. A wide pubic symphysis (PS) is indicative of an open book pelvic fracture and a high risk of retroperitoneal bleeding. STUDY OBJECTIVES: We hypothesized that an ultrasound image of the PS as part of the FAST examination (FAST-PS) would be an accurate method to determine if pubic symphysis diastasis was present. METHODS: This is a comparative study of a diagnostic test on a convenience sample of 23 trauma patients at a Level 1 Trauma Center. The PS was measured sonographically in the Emergency Department (ED) and post-mortem (PM) at the State Medical Examiner. The ultrasound (US) measurements were then compared with PS width on anterior-posterior pelvis radiograph. RESULTS: Twenty-three trauma patients were evaluated with both plain radiographs and US (11 PM, 12 ED). Four patients had radiographic PS widening (3 PM, 1 ED) and 19 patients had radiographically normal PS width; all were correctly identified with US. US measurements were compared with plain X-ray study by Bland-Altman plot. With one exception, US measurements were within 2 standard deviations of the radiographic measurements and, therefore, have excellent agreement. The only exception was a patient with pubic symphysis wider than the US probe. CONCLUSION: Bedside ultrasound examination may be able to identify pubic symphysis widening in trauma patients. This potentially could lead to faster application of a pelvic binder and tamponade of bleeding.
Assuntos
Diástase da Sínfise Pubiana/diagnóstico por imagem , Sínfise Pubiana/diagnóstico por imagem , Sínfise Pubiana/lesões , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Radiografia , Sensibilidade e Especificidade , UltrassonografiaAssuntos
Artérias/lesões , Doadores de Sangue , Flebotomia/efeitos adversos , Adolescente , Humanos , MasculinoRESUMO
We report two rare examples of Epstein-Barr virus (EBV)-associated inflammatory pseudotumor of the spleen. One patient presented with night sweats, abdominal pain, and weight loss and was found to have a splenic mass on CT scan suspected of lymphoma. The splenic mass in second patient was found incidentally at the time of work up for kidney stones. The pathologic examination of these splenectomy specimens showed similar histologic features. However, the spindle cells were composed of EBV-infected follicular dendritic cells in one case whereas the second case lacked significant follicular dendritic cell proliferation and showed only focal EBV-infected cells suggesting that these proliferations are heterogenous in nature.