Transfusion
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Transfusion-related acute lung injury (TRALI) is a serious, sometimes fatal complication of transfusion, attributed to white blood cell (WBC)-reactive antibodies present in the blood product. This study investigated incidence and etiology in the Netherlands. ⋯ TRALI is the most serious transfusion complication in the Netherlands, causing severe morbidity and mortality. Antibodies were found in the majority of the cases, but causality with proven incompatibility could be established in 21 cases (48%). Female FFP products were involved in 57% of proven alloimmune cases and would theoretically be prevented using male FFP only.
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The 30-minute rule, whereby intact red blood cell (RBC) products may be returned to stock if returned to 4 degrees C storage within 30 minutes of issue, was established many years ago. It was based on observations that the core temperature of units of whole blood removed from storage temperatures of 1 to 6 degrees C, and left at room temperature, would reach 10 degrees C at between 45 minutes and 1 hour. ⋯ In view of our results, and the range of RBC products now available, it may be timely for blood services to review and reduce the 30-minute rule.
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The optimal hemoglobin (Hb) level in acute myocardial infarction (MI) is unknown. The goal of this study was to determine the optimal Hb concentration in acute MI and whether transfusion of fresh blood to correct anemia reduces myocardial injury and improves outcome. ⋯ Anemia increases infarct size and decreases cardiac function and survival in acute MI. Transfusion of anemic animals up to 100 g/L Hb with fresh blood reduces infarct size and improves cardiac function. However, transfusion to 120 g/L Hb did not demonstrate any additional benefit and was associated with larger infarcts.
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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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Randomized Controlled Trial Multicenter Study Controlled Clinical Trial
The treatment of bleeding is to stop the bleeding! Treatment of trauma-related hemorrhage.
The secret with any alternative to transfusion is to minimize the need for transfusion in the first place. This can be done by reducing the volume of blood loss. The volume of blood being lost can be reduced by direct methods where possible (i.e., hemostasis at the point of bleeding), or by improving the coagulation profile of the patient, thereby improving the extrinsic coagulation. Recombinant activated factor VII (rFVIIa) offers theoretical possibilities of improving the coagulation profile. ⋯ Treatment with adjunctive rFVIIa significantly reduces transfusion requirements in the 48 hours after severe injury and these procoagulant effects may improve clinical outcome at 30 days.