Transfus Apher Sci
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Randomized Controlled Trial Multicenter Study Comparative Study
A multi-centre randomised controlled trial of Transfusion Indication Threshold Reduction on transfusion rates, morbidity and healthcare resource use following cardiac surgery: study protocol.
Thresholds for red blood cell transfusion following cardiac surgery vary by hospital and surgeon. The TITRe2 multi-centre randomised controlled trial aims to randomise 2000 patients from 17 United Kingdom centres, and tests the hypothesis that a restrictive transfusion threshold will reduce postoperative morbidity and health service costs compared to a liberal threshold. ⋯ The primary outcome is a binary composite outcome of any serious infectious or ischaemic event in the first three months after randomisation. Many challenges have been encountered in the set-up and running of the study.
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The aim of our study was to determine whether red blood cells (RBCs) and fresh frozen plasma (FFP) transfusion is independently associated with the development of acute lung injury (ALI) in patients after cardiac surgery. In retrospective study, 165 patients were included. The results showed total fresh RBCs transfusion were not significantly increased in patients who developed ALI compared with patients who did not develop ALI (4.7 ± 2.4, 4 [0-12] units VS 4.0 ± 1.9, 3 [0-9] units, P = 0.119). ⋯ Multivariable logistic regression analysis showed that only age and CPB time were independent factors for ALI, but not for total RBCs and FFP transfused, with the adjusted OR 0.952 (95% CI 0.762-1.189, P=0.664), and 1.000 (95% CI 0.999-1.001, P = 0.480), respectively. In subgroup analysis, female patients showed a lower ALI incidence in low RBCs transfused group (23.9% VS 45.0%, OR 0.38, 95% CI 0.15-0.98) and in low FFP transfused group (22.0% VS 44.4%, OR 0.35, 95% CI 0.14-0.90). Our study demonstrates that red blood cells and fresh-frozen plasma transfusion are not related with ALI after cardiac surgery in our institution.
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Transfusion-related acute lung injury (TRALI) is a devastating transfusion-associated adverse event. There is a paucity of data on the incidence and characteristics of TRALI cases that occur perioperatively. We classified suspected perioperative TRALI cases reported to Canadian Blood Services between 2001 and 2012, and compared them to non-perioperative cases to elucidate factors that may be associated with an increased risk of developing TRALI in the perioperative setting. ⋯ CBS data has provided insight into the nature of TRALI cases that occur perioperatively; this group represents a large proportion of TRALI cases.
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Coagulopathy after sever injury predicts the requirements of blood products, organ failure and mortality in traumatic patients. The early onset and complexity of traumatic coagulopathy preclude the understanding the underlying mechanism. The aim of the study is to characterize the early coagulation alteration in a swine model with multi-trauma and shock. ⋯ After traumatic hemorrhagic shock, hypercoagulation turned into hypocoagulation in a short period, which was probably caused by hypoperfusion.
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Immunization against RhD is the major cause of hemolytic disease of the fetus and newborn (HDFN), which causes fetal or neonatal death. The introduction of postnatal immune prophylaxis in the 1960s drastically reduced immunization incidents in pregnant, D-negative women. In several countries, antenatal prophylaxis is combined with postnatal prophylaxis to further minimize the immunization risk. ⋯ Based on an analysis of cell-free fetal DNA from the plasma of pregnant women, this approach has recently undergone technical improvements and rapid clinical implementation. As a screening assay, the sensitivity is >99.3% from a gestational age of approximately 10-11 weeks. In addition, fetal RhD genotyping is widely used to assess the risk of HDFN in anti-D immunized women.