Transfusion medicine reviews
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Plasma protein therapies have been sheltered historically from the scrutiny of evidence-based medicine. Thus, a number of albumin solutions became part of the established therapeutic armamentarium with a very modest evidence base. As evidence-based medicine has turned its focus on plasma protein therapies, albumin's appropriate use has become increasingly questioned. ⋯ Albumin's manufacture yields products which vary between different brands, as well as occasionally between batches from the same brand. These changes affect albumin's physiologic properties and may contribute to the different therapeutic effects observed in clinical practice. More clinical investigations of albumin's therapeutic role are needed before its unique biological features can be shown to result in therapeutically useful drugs.
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Since a report in October 2007 of dramatic improvements in trauma mortality in a military population when massive transfusion of red blood cells (RBC) was accompanied by plasma replacement at 1:1 proportions, interest in the plasma-to-RBC ratio during resuscitation in both the trauma and transfusion communities has been intense. Over the 7-month period from August 2008 through February 2009, a further 9 major studies examining experience with plasma replacement in massively transfused civilian trauma patients have been published. This flood of observational studies is likely to continue. In this review, the authors examine the findings of these initial studies, highlighting the epidemiologic and analytic methodologies used, and the likely influence of these methodologies on the reported outcomes.
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Cryoprecipitate is a diverse product containing factor VIII, von Willebrand factor, fibrinogen, fibronectin, factor XIII, and platelet microparticles. The role of this complex product in the management of hemostasis has not been well studied (excluding patients with factor VIII deficiency). There are insufficient data to determine the clinical setting where this product might be clinically efficacious despite its widespread use in multiple different clinical scenarios. ⋯ The most common current indication for the use of this product is hypofibrinogenemia in the setting of massive hemorrhage. There are insufficient data in the literature to determine the efficacy, safety, and dosage in this patient population. Despite 45 years of the use of this product, we still have a lot to learn regarding the optimal use of cryoprecipitate.
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Biography Historical Article
Blood transfusion in World War I: the roles of Lawrence Bruce Robertson and Oswald Hope Robertson in the "most important medical advance of the war".
The demonstration and acceptance of the life-saving potential of blood transfusion in the resuscitation of combat casualties came in two parts. First, Canadian surgeon Major Lawrence Bruce Robertson showed that direct transfusion of uncrossmatched blood from the veins of a donor to a patient could save the lives of many moribund casualties, even if a few died of acute hemolytic reactions. Second, US Army Captain Oswald Hope Robertson showed that stored, syphilis-tested, universal donor whole blood could be given quickly and safely in forward medical units. With these demonstrations, the Royal Army Medical Corps adopted transfusion and declared it the most important medical advance of the war.