TRANSFUSION ISSUES
Perioperative blood transfusion in combat casualties: a pilot study.
J Trauma. 2009 Apr;66(4 Suppl):S150-6.Allogeneic blood
transfusions in combat casualties were associated with impaired wound
healing, increased perioperative infection rate, and resource utilization.
In addition, the extent of blood transfusion was associated with significant
differences in inflammatory chemokine and cytokine release.
BLOOD MANAGEMENT
MELD score and blood product requirements during liver transplantation: no
link. Transplantation.
2009 Jun 15;87(11):1689-94. In recent years, improvements in surgical and
anesthetic techniques have greatly decreased the amount of blood products
transfused. We have published a median of 0 for all intraoperative blood
products transfused. Some authors argue that these results could be possible
merely because of the relatively healthy cohort in terms of model of
end-stage liver disease (MELD) score.The logistic regression analysis found
that only two variables were linked to RBC transfusion; starting hemoglobin
value and phlebotomy. In this series, the MELD score was as high as US
series and did not predict blood losses and blood product requirement during
liver transplantation. If the MELD system has to be implemented to
prioritize orthotopic liver transplantation, it should be revisited, and the
starting hemoglobin value should be added to the equation.
Red blood cell use outside the operating theater: a prospective
observational study with modeling of potential blood conservation during
severe blood shortages.
Transfusion. 2009 Jun 4. [Epub ahead of print] National guidance
recommends planning for future blood shortages, but few studies have
evaluated how reduced demand could be achieved acutely. The relative use of
RBC units across specialties was as follows: medical, 74%; surgical, 22%;
and other, 4%. For medical and surgical patients, respectively, 31 and 10%
of all RBC units were transfused for anemia without evidence of bleeding,
and 38 and 12% were transfused for non-life-threatening bleeding. Eight-five
percent of all patients who received transfusions had stable vital signs
before transfusion. Our model suggested that only 11% of RBCs would be
conserved by cancellation of major surgery, whereas 23% to 47% of all RBCs
could be conserved by controlling transfusions to medical patients. In
institutions with patterns of blood use similar to ours, control of
transfusion.s to medical patients is the most effective response to acute
blood shortages.
ERYTHROPOIETIC THERAPY
Androgens and Erythropoiesis: A Review.
J Endocrinol Invest. 2009 Apr 7. [Epub ahead of print] Review.
Association between androgens and erythropoiesis has been known for more
than seven decades. Androgens stimulate hematopoietic system by various
mechanisms. These include stimulation of erythropoietin release, increasing
bone marrow activity and iron incorporation into the red cells
GASTROINTESTINAL
BLEEDING
Long-acting somatostatin analogue therapy in obscure-overt
gastrointestinal bleeding in noncirrhotic portal hypertension: a case
report and literature review.Eur
J Gastroenterol Hepatol. 2009 May 30. [Epub ahead of print]
Case report
ERYTHROPOIETIC THERAPY
Efficacy of preoperative recombinant human erythropoietin administration
for reducing transfusion requirements in patients undergoing surgery for
hip fracture repair. An observational cohort study.
Vox Sang. 2009 Jun 3. [Epub ahead of print] In anaemic hip
fracture patients managed with perioperative intravenous iron and
restrictive transfusion protocol, preoperative administration of rHuEPO
is associated with reduced allogeneic blood transfusion (ABT)
requirements. However, appropriate training, education and awareness are
needed to avoid protocol violations and to limit further exposure to ABT
and ABT-related risks.
BLOOD MANAGEMENT
Bench-to-bedside review: Optimising emergency reversal of vitamin K
antagonists in severe haemorrhage - from theory to practice.
Crit Care. 2009;13(2):209. Epub 2009 Apr 22. Critical care
physicians are increasingly facing patients receiving oral
anticoagulation for either cessation of major haemorrhage or to reverse
the effects of vitamin K antagonists ahead of emergency surgery. Rapid
reversal of anticoagulation is particularly essential in cases of
life-threatening bleeding. In these situations, guidelines recommend the
concomitant administration of prothrombin complex concentrates (PCCs)
and oral or intravenous vitamin K for the fastest normalisation of the
international normalised ratio (INR). Despite their universal
recommendation, PCCs remain underused by many physicians who prefer to
opt for fresh frozen plasma despite its limitations in anticoagulant
reversal, including time to reverse INR and high risk of
transfusion-related acute lung injury. In contrast, the lower volume
required to normalise INR with PCCs and the room temperature storage
facilitate faster preparation and administration time, thus increasing
the speed at which haemorrhages can be treated.
COAGULANTS
The effect of an intravenous bolus of tranexamic acid on blood loss in
total hip replacement.
J Bone Joint Surg Br. 2009 Jun;91-B(6):776-783. The study
showed that the administration of a standardised pre-operative bolus of
1 g of tranexamic acid was cost-effective in reducing the blood loss and
transfusion requirements after total hip replacement, especially in
women.
TRANSFUSION ISSUES
Intraoperative
transfusion of 1 u to 2 u packed red blood cells is associated with
increased 30-day mortality, surgical-site infection, pneumonia, and
sepsis in general surgery patients.
J Am Coll Surg. 2009 May;208(5):931-937.e2. Epub 2009 Mar 26.
Intraoperative transfusion of PRBCs increases risk for mortality and
several morbidities in general surgery patients. These risks,
substantial for even 1 U, remain after adjustment for transfusion
propensity and numerous risk factors available in the American College
of Surgeons National Surgical Quality Improvement Program. Transfusion
for mildly hypovolemic or anemic patients should be discouraged in light
of these risks.
BLOOD MANAGEMENT
Perioperative
blood conservation.
Eur J Anaesthesiol. 2009 May 14. [Epub ahead of print]. Review
Blood loss in surgical oncology: Neglected quality indicator?
J Surg
Oncol. 2009 May 22;99(8):508-512. [Epub ahead of print] Blood
loss is a modifiable quality indicator for oncologic cancer surgery.
Surgical oncologists need to alter their surgical technique to promote
bloodless surgery and decrease the variability in reported blood loss
and rates of blood transfusion
SURGICAL TECHNOLOGIES
[First robotic-assisted laparoscopic liver resection in Latin America.]Arq
Gastroenterol. 2009 Jan-Mar;46(1):78-80. Portuguese Case
report
TRANSFUSION ISSUES
Red blood cell supernatant potentiates LPS-induced proinflammatory
cytokine response from peripheral blood mononuclear cells.
J Interferon Cytokine Res. 2009 Jun;29(6):333-8 Packed red
blood cell supernatant potentiates proinflammatory
lipopolysaccharide-induced cytokine secretion from PBMCs. This response
is accentuated with storage duration and partially attenuated with
leukoreduction. These findings may partially explain the immune
activation seen clinically after blood transfusion.
Cytomegalovirus infection in critically ill patients: a systematic
review.
Crit Care. 2009 May 14;13(3):R68. [Epub ahead of print] CMV
infection occurs in 0-36% of critically ill patients, mostly between
4-12 days after ICU admission. Potential risk factors for CMV infection
include sepsis, requirement of mechanical ventilation, and transfusions.
CMV infection frequently occurs in critically ill immunocompetent
patients and may be associated with poor outcomes
The association of perioperative red blood cell transfusions and
decreased long-term survival after cardiac surgery.
Anesth Analg. 2009 Jun;108(6):1741-6. Exposure to 1 or 2 U of
RBCs was associated with a 16% increased hazard of decreased survival
after cardiac surgery.
First transmission of human immunodeficiency virus Type 1 by a cellular
blood product after mandatory nucleic acid screening in Germany.
Transfusion. 2009 May 11. [Epub ahead of print] This case
represents the first documented HIV-1 transmission by transfusion of red
blood cells after mandatory introduction of HIV-1 NAT for blood
screening in Germany. Low viral load and mismatches in the primer/probe
region might explain the detection failure of the NAT screening assay. A
certain risk remains that new virus variants contain mutations at
positions critical for amplification or detection of viral genomes.
Swine flu concerns impact blood supply on Long Island
The threat of
the swine flu has started affecting the blood supply on Long Island,
N.Y., as several schools in the area canceled their blood drives when
they were forced to close, and some potential donors declined to give
blood for fear that it may weaken their immune systems. The Long Island
Blood Services said it collected 3,000 fewer blood pints in April
compared with the same month last year.
SURGICAL TECHNOLOGIES
The impact of robotics on practice management of endometrial cancer:
transitioning from traditional surgery.
Int J Med Robot. 2009 May 19. [Epub ahead of print] Robotics
was associated with significantly less blood loss (p < 0.0001).
Complication rates were significantly lower in the robotic group
compared to the laparotomy group (p = 0.05).
Comparison of Robotic-assisted versus Retropubic Radical Prostatectomy
Performed by a Single Surgeon.
Anticancer Res. 2009 May;29(5):1637-42. Significant
differences were found in blood loss (robotic-assisted laparoscopic
radical prostatectomy 314 mL vs. retropubic radical prostatectomy 912 mL)
and transfusion rates (RALP 13.3% vs. RRP 60%) between groups.
TRANSFUSION ISSUES
[TRALI and TACO: Diagnostic and clinical management.].
Transfus Clin Biol. 2009 May 11. [Epub ahead of print] French.
Review
Red Blood Cell Supernatant Potentiates LPS-Induced Proinflammatory
Cytokine Response From Peripheral Blood Mononuclear Cells.
J Interferon Cytokine Res. 2009 May 14. [Epub ahead of print]
Allogeneic blood transfusion has an immunomodulatory capacity on its
recipients through accumulation of immunologically active substances
with blood storage, and prestorage leukoreduction reduces many of these
mediators
CELL SALVAGE
Cell salvage at caesarean section: the need for an evidence-based
approach.
BJOG. 2009 May;116(6):743-7 Haemorrhage, a leading cause of
maternal morbidity and mortality, is frequently associated with
caesarean section. Allogeneic blood is an increasingly rare and scare
resource. Intraoperative Cell Salvage (IOCS) offers the possibility of
improving outcome and reducing allogeneic blood transfusion in cases of
haemorrhage at caesarean section. The available literature on the use of
IOCS in obstetrics demonstrates that there is limited evidence to
support or refute the use of IOCS at caesarean section.
COAGULATION
The role of thromboelastometry and recombinant factor VIIa in trauma.
Curr Opin Anaesthesiol. 2009 Apr;22(2):281-8. Recent evidence
encourages the early use of rFVIIa and thromboelastography in the severe
trauma patient with hemorrhagic shock, as a component of the damage
control strategy. rFVIIa may decrease short-term mortality and the rate
of required blood components during resuscitation, with no apparent
increase in thromboembolic complications. Thromboelastometry enables
better and earlier recognition of the coagulopathy accompanying such
trauma patients. In patients with traumatic brain injury and
coagulopathy, rFVIIa may delay or even halt the need for surgery, with
no proven decrease in mortality. In those who needed urgent
neurosurgical intervention, rFVIIa may rapidly correct the coagulopathy,
enabling earlier and safer surgical intervention.
BLOOD SUBSTITUTES
Glutaraldehyde-polymerized bovine hemoglobin and phosphodiesterase-5
inhibition.
Crit Care Med. 2009 Apr 20. [Epub ahead of print] The HBOC
used in this study resulted in pulmonary and systemic hypertension,
reduced cardiac output, and oxygen delivery. These negative consequences
of HBOC treatment can be largely overcome by combing HBOC treatment with
a PDE5 inhibitor (sildenafil). Thus, these data support the continued
investigation of combined HBOC and PDE5 inhibitor treatment in
circumstances in which HBOC therapy is being considered.
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