Transfusion
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Despite evidence supporting the use of restrictive hemoglobin (Hb) transfusion triggers in critically ill patients, translation of this evidence into practice remains inconsistent. It was hypothesized that clinicians believe that longer-term ventilated patients require a higher Hb, particularly when ischemic heart disease coexists. ⋯ In response to scenarios, clinicians in the United Kingdom believe that a more liberal transfusion practice is required for patients failing weaning trials after 6 days of mechanical ventilation than the current evidence base supports.
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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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Trauma patients are at risk of developing an acute coagulopathy of trauma (ACT) related to tissue injury, shock, and hemodilution. ACT is incompletely understood, but is similar to disseminated intravascular coagulation (DIC) and is associated with poor outcome. ⋯ Thrombin generation studies indicate that Trauma with ACT patients show dysregulated hemostasis characterized by excessive non-wound-related thrombin generation due to a combination of circulating procoagulants capable of activating coagulation systemically and reduced inhibitor levels allowing systemic thrombin generation to continue once started.
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Randomized Controlled Trial
Impact of fresh-frozen plasma from male-only donors versus mixed-sex donors on postoperative respiratory function in surgical patients: a prospective case-controlled study.
To reduce the risk of transfusion-related acute lung injury (TRALI), plasma products are mainly made from male donors in some countries because of the lower possibility of alloimmunization; other countries are considering this policy. The advantage of male-only fresh-frozen plasma (FFP) should be examined in a prospective case-control study. ⋯ Our data suggests that the use of FFP derived from male donors may be advantageous for posttransfusion pulmonary function, although PD is also determined by background characteristics.