Transfusion
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Hemorrhage is a leading cause of potentially preventable death in both civilian and military trauma patients. Animal data have shown that hemostatic bandages reduce hemorrhage and improve survival. This article reports recent clinical observations regarding the efficacy and evolution of use of two new hemostatic bandages employed in the global war on terrorism. ⋯ Hemostatic agents stop or decrease bleeding. Whereas HemCon appears to be safe, QuikClot may produce superficial burns. These new hemostatic agents have a place in the surgical armamentarium to assist in controlling internal hemorrhage from truncal and pelvic hemorrhage, especially during damage-control surgery.
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Most cases of human babesiosis in North America are caused by Babesia microti, which is endemic in the northeastern and upper midwestern United States. Although the disease is usually transmitted by a tick bite, there has been an increase in the number of transfusion-transmitted cases reported. We describe a fatal case of transfusion-transmitted babesiosis in a nonendemic state, Delaware. ⋯ We believe that this is the first reported case of transfusion-transmitted babesiosis in Delaware, a nonendemic state. Our case illustrates that clinicians should consider babesiosis in the differential diagnosis of immunocompromised patients who have fever and recent transfusion history, even in areas where babesiosis is not endemic. It also demonstrates the need for better preventive strategies including more sensitive, specific, and rapid blood donor screening tests to prevent transfusion-transmitted babesiosis.
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Babesia microti, the primary cause of human babesiosis in the United States, is an intraerythrocytic parasite endemic to the Northeast and upper Midwest. Published studies indicate that B. microti increasingly poses a blood safety risk. The American Red Cross Hemovigilance Program herein describes the donor and recipient characteristics of suspected transfusion-transmitted B. microti cases reported between 2005 and 2007. ⋯ Transfusion-transmitted B. microti can be a significant cause of transfusion-related morbidity and mortality, especially in infant, elderly, and asplenic blood recipients. These data demonstrate the need for interventions, in both endemic and nonendemic areas of the United States, to reduce patient risk.
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Current estimates of 70 cases of transfusion-transmitted Babesia microti, with 12 associated deaths, suggest that Babesia is a growing blood safety concern. The extent of Babesia infections among blood donors has not been well defined. To determine how common exposure to B. microti is among blood donors, a seroprevalence study was undertaken in the American Red Cross Northeast Division. ⋯ Foci of statistically higher B. microti seroprevalence among blood donors were observed; however, B. microti transfusion transmission risk exists for blood collected throughout Connecticut and portions of Massachusetts. Similarly, a seasonal peak was identified; nevertheless, seropositive donations were found year-round. Thus, geographic and/or seasonal exclusion methods are insufficient to fully safeguard the blood supply from Babesia transmission. Steps should be taken to reduce risk of transfusion-transmitted B. microti, perhaps through implementation of year-round, regional testing.
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Excessive use of blood components during liver transplantation should be avoided because it has been associated with poor outcomes and it may stress blood bank resources. ⋯ Liver donor's age and recipient's SCr are important in preoperatively predicting blood use during liver transplantation.