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.