Transfus Apher Sci
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This report is prepared for The Hemostasis and Oxygenation Research (THOR) Network and based on presentations of invited THOR investigators. In order to make it available to a larger group of interested readers it has been agreed to publish the report in TRASCI, as a "what is happening?" in view of its importance and novelty. On June 14th 2011 the first symposium on fresh whole blood (FWB) was held in Bergen, Norway. ⋯ A three-year research proposal has been developed by the THOR network to determine (1) if FWB donation adversely affects donor performance of combat related skills, (2) the optimal storage solution, temperature, and acceptable storage duration for FWB, (3) the logistics of providing FWB in a combat environment safely to include optimal transport and administration methods. The symposium speakers were tasked with reviewing current data on; coagulopathy associated with massive traumatic bleeding, immunology of transfusion, outcomes associated with FWB use, logistic and medical issues of the use of FWB in far forward situations, training required for medics on FWB collection and administration, the risks of FWB and stored blood components and methods to mitigate these risks. The meeting concluded with a discussion of the THOR network's three-year research program.
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Hemostasis is of critical importance in achieving a positive outcome in any surgical intervention. Different hemostatic methods can be employed and topical hemostatic agents are used in a wide variety of surgical settings. ⋯ Surgeons should be familiar with topical hemostatics to ensure an appropriate use. Our purpose is to illustrate the currently available agents, their mechanism of action and their effective applications, in order to ensure an optimal use in operating room.
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Massive bleeding accounts for more than 50% of all trauma-related deaths within the first 48h following hospital admission and it can significantly raise the mortality rate of any kind of surgery. Despite this great clinical relevance, evidence on the management of massive bleeding is surprisingly scarce, and its treatment is often based on empirical grounds. Successful treatment of massive haemorrhage depends on better understanding of the associated physiological changes as well as on good team work among the different specialists involved in the management of such a complex condition.
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Multicenter Study
Change in transfusion practice in massively bleeding patients.
This retrospective study evaluates changes in transfusion practice and modified blood product utilisation that occurred over the course of eleven years in patients receiving massive transfusion. The mean number of fresh frozen plasma units transfused increased from 9.0 ± 7.9 in 1998 to 11.3 ± 6.7 in 2008 (p=0.03). ⋯ The proportion of cryoprecipitate increased from 0.03 ± 0.19 in 1998 to 1.3 ± 1.6 in 2008 (p=0.001). Along with these changes was a trend toward decreased mortality (p=0.05).
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Case Reports
Treatment of status epilepticus with plasmapheresis in a patient with thrombotic thrombocytopenic purpura.
Thrombotic thrombocytopenic purpura (TTP) is a syndrome with numerous neurological manifestations including altered mental status and seizures. However, status epilepticus (SE) has rarely been reported in this condition. Signs may be transient or fluctuate; however, permanent deficits do occur. ⋯ Since the introduction of plasma infusions and exchanges, the prognosis of the disease has improved dramatically; remissions now occur in 80-90% of patients. Altered mental status in TTP often resolves with plasmapheresis. Likewise, we successfully treated a patient with thrombotic thrombocytopenic purpura (TTP) with pronounced clinical effects of status epilepticus with plasmapheresis and steroid treatment.