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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Massive transfusion protocol: the reason it is necessary

Abstract

Objective. The purpose of this study is to identify problems of emergency transfusion at the bedside and to determine need for massive transfusion protocol.

Methods. We included patients who met the criteria for “trauma team activation” and were admitted to division of trauma. The amount of blood product transfused in each unit was investigated for balanced transfusion. We also investigated the compliance with assessment of blood consumption score. The correlation between the time elapsed from patient visit to first transfusion order and time elapsed from first transfusion order to transfusion start was analyzed. Finally, we investigated various factors which serve to influence the decision-making process regarding early transfusion order.

Results. Ratio of packed Red blood cells (pRBC): Fresh frozen plasma (FFP) was well-balanced, but platelet transfusion done was much lower than pRBC and FFP in emergency room. The application of emergency blood release did not match the criteria of assessment of blood consumption (ABC) score. The time from the first transfusion order to the transfusion start was found to be constant irrespective of time from patient visit to first transfusion order. And, the time from the first transfusion order to transfusion start did not differ significantly among patients with early transfusion order and delayed transfusion order. Only systolic blood pressure of < 90 mmHg was identified as a major predictor for early transfusion order.

Conclusion. Balanced transfusion is not easy and emergency transfusion could be delayed at the bedside. Integrated and systematic structures for massive transfusion protocol would be invaluable and indispensable.

Key words: transfusion, emergency, protocol

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Treatment with Erythropoietin in Neonatology

Abstract

The article presents the basics and control of erythropoiesis in the fetus and the newborn, the development of anaemia of prematurity and its treatment, with an emphasis on the use of human recombinant erythropoietin. The Intensive Care Unit of the Paediatric Clinic Maribor began treating anaemia of prematurity with erythropoietin in 2000. After introducing the treatment, the clinic found that the number of blood product transfusions and the needed blood volume decreased. In addition to erythropoietin, this was the result of stricter criteria for applying transfusion of concentrated erythrocytes.

Key words: preterm infant, anaemia of prematurity, erythropoietin, transfusion

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Indications for blood transfusions in critical illness

Abstract

Transfusion of blood products should improve tissue oxygenation and reduce negative consequences of anaemia. At the same time, adverse effects of transfusion, such as infections, immunologic reactions and mistransfusion, could be deleterious. Most transfusion guidelines suggest looking at the combination of haemoglobin or haematocrit levels in addition to clinical signs in the decision making process for a blood transfusion. The problem with such indications is that the clinical evaluation may be misleading in severely ill patients and haemoglobin levels that impair oxygen delivery cannot be determined easily. Many studies attempted to establish more convenient parameters, such as oxygen saturation from mixed and central venous blood, tissue oxygen extraction and other methods. Although the results from these studies are conflicting, it appears that global oxygenation parameters are a good indicator for a blood transfusion in some categories of critically ill patients.

Key words: haemoglobin concentration, global oxygenation parameters, transfusion, critical illness

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Transfusion Related Acute Lung Injury: A severe case triggered with anti-HLA class II antibodies in the recipient

Abstract

Transfusion-related acute lung injury (TRALI) is a serious clinical syndrome associated with the transfusion of plasma-containing blood components. The classic TRALI syndrome is characterized by the suddenly onset of respiratory failure within 2-6 hrs of the transfusion of a blood product, generally transient, resolves within 48-96 hrs spontaneously, and has a better prognosis. Nonetheless there is an expanded definition of TRALI syndrome up to 72 hrs, which is called delayed TRALI. The potential causes of TRALI can be explained by two distinct mechanism including the anti-leukocyte antibodies in donor plasma or in recipient plasma with the reverse mechanism, and biological response modifiers in susceptible individuals. This report highlights the succesful management of a classic TRALI case that was seen approximately two hours after the transfusion of a packed red blood cell and triggered with anti-HLA class II antibodies in the recipient with reverse mechanism accompanied by neutropenia together.

Key words: transfusion, acute lung injury, transfusion related acute lung injury, anti HLA antibodies

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Biochemical changes in the patient’s plasma after red blood cell transfusion

Abstract

Introduction. The study aimed at in vivo assessment of the impact of administered red blood cells (RBCs) concentrates on the plasma levels of K+, lactate, pH, Na+, Ca++ and glucose, depending on the volume and age of administered products. Biochemical changes occurring during the storage of these products were studied in vitro simultaneously.
Materials and methods. Arterial blood samples were collected in vivo from patients before and after RBCs transfusion and plasma levels of biochemical parameters were determined. A group of 80 RBCs samples was analyzed simultaneously, with the samples being equally distributed throughout the recommended storage time of 1–35 days.
Results. The age of RBCs concentrate results in increased potassium and lactate levels and decreased pH, sodium and glucose levels in the RBCs samples. The concentrations were in the following ranges: potassium 4.0–40.5 mmol/L; lactate 4.1–28.0 mmol/L; pH 7.0–6.65; sodium 137–116 mmol/L; glucose 29.0–14.0 mmol/L. A prospectively selected group of 46 patients were administered a total of 354 RBCs units. The mean age of RBCs concentrates was 16.18 days. The number of administered RBCs units ranged from 2 to 38, a mean of 7.7 RBCs units/patient. The administration of 1 RBCs unit was associated with a mean in vivo increase of the potassium level by 0.07 mmol/L and lactate level by 0.13 mmol/L.
Conclusion. The administration of larger amounts of RBCs concentrates may lead to an increase in the patient’s plasma levels of potassium and lactate. This increase is proportional to the age and volume of RBCs.

Key words: red blood cells, transfusion, hyperkalemia, lactate

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