Transfusion
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Multicenter Study Observational Study
The second Austrian benchmark study for blood use in elective surgery: results and practice change.
Five years after the first Austrian benchmark study demonstrated relatively high transfusion rate and an abundance of nonindicated transfusions in elective surgeries, this study was conducted to investigate the effects of the first benchmark study. ⋯ The second benchmark study demonstrates substantial intercenter variability and small but significant reductions in RBC transfusions and RBC loss. Even though the main independent predictors of transfusion were the relative lost RBC volume followed by the relative preoperative and the lowest relative postoperative hemoglobin, preoperative anemia was not adequately treated in many patients, underscoring the importance of patient blood management in these patients.
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Emily Cooley was a highly regarded medical technologist and morphologist. The "Emily Cooley Lectureship and Award" was established to honor her, in particular, and medical technologists, in general. This article reviews some basic concepts about the "life of a red blood cell" (RBC) and uses these to discuss the actual and potential consequences that occur in patients after clearance of transfused refrigerator storage-damaged RBCs by extravascular hemolysis.
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Observational Study
Coagulation management with factor concentrates in liver transplantation: a single-center experience.
Allogeneic blood products transfusion during liver transplantation (LT) can be associated with increased morbidity and mortality. Data on thromboelastometry (ROTEM)-guided coagulation management with coagulation factor concentrates (CFCs)-fibrinogen concentrate and/or prothrombin complex concentrate (PCC)-are sparse. We aimed to retrospectively evaluate the safety events observed with this approach in our clinic. ⋯ In LT, ROTEM-guided treatment with fibrinogen concentrate and/or PCC did not appear to increase the occurrence of thrombosis and ischemic events compared to patients who did not receive these concentrates.
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Based on biblical doctrines, patients of the Jehovah's Witness faith refuse allogeneic blood transfusion. Cardiac surgery carries a high risk of blood transfusion, but has been performed in Jehovah's Witnesses for many years. The literature contains information on the outcomes of this cohort, but does not detail the perioperative care of these patients. This article describes a single institution's experience in perioperative care of Jehovah's Witnesses undergoing cardiac surgery. ⋯ This case series demonstrates that bloodless cardiac surgery can be performed in select patients refusing allogeneic blood transfusion.
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Despite evidence supporting restrictive red blood cell (RBC) transfusion thresholds and the associated clinical practice guidelines, clinical practice has been slow to change in the intensive care unit (ICU). Our aim was to identify barriers to conservative transfusion practice adherence. ⋯ Our study identified several provider and system barriers to evidence-based transfusion practices including knowledge differences, overly optimistic estimates of current practice, and heterogeneous transfusion practice in each ICU. Further work is necessary to develop targeted interventions to improve evidence-based RBC transfusion practices.