Transfusion
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Bleeding upon major surgery or severe trauma is treated by transfusion with crystalloids, colloids, or plasma. This treatment, however, can lead to dilutional coagulopathy and impaired hemostasis. We investigated the suitability of two integrative coagulation tests to measure the hemostatic activity of diluted plasma. ⋯ Thrombin generation and clot formation are reduced at a plasma dilution of more than 40 percent. In either process, PLTs can partly compensate for the dilution effect. In vitro dilution with colloids impaired fibrin clot elasticity compared to saline.
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More than 90 percent of extremely low-birth-weight infants receive one or more transfusions of red blood cells (RBCs). The objective was to assess if RBC transfusions may induce significant changes of plasma acid-base, electrolyte, and glucose status in extremely preterm infants. ⋯ RBC transfusions were effective in correcting anemia in our patients and induced a slight increase of pH and pO(2) and decrease of Ca(2+) and glycemia, which were not clinically relevant. A linear direct correlation was observed between potassium intake by RBC transfusions and changes of kalemia in our infants, but there was not an increase of K(+) plasma level after transfusions.
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Multicenter Study
Cryoprecipitate use in 25 Canadian hospitals: commonly used outside of the published guidelines.
Canadian Blood Services' disposition reports suggested considerable variation in cryoprecipitate use and prompted this national audit. ⋯ A 2-month audit of cryoprecipitate use in Canada revealed that the majority of cryoprecipitate use in Canada is not in accordance with published guidelines.
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Hemoglobin (Hb) solutions are potential alternatives to blood transfusion when native oxygen (O(2))-carrying capacity is lacking. Polymerized bovine Hb (PBH) solutions are characterized by its vasoactivity, low O(2) affinity, oncotic effect, prolonged shelf life, and stability. Responses to facilitated O(2) transport, after exchange transfusion with PBH, were studied in the hamster window chamber model during acute extreme anemia to determine how PBH affects microvascular perfusion and tissue oxygenation. ⋯ Further studies to establish acellular Hb optimal dosage, efficacy, safety, and effects on outcome are indicated before these solutions are implemented in routine practice.
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Nucleic acid testing (NAT) for hepatitis C virus (HCV) and human immunodeficiency virus (HIV) has been implemented in several European countries and in the United States, while hepatitis B virus (HBV) NAT is still being questioned by opinions both in favor and against such an option, depending on the HBV endemicity, health care resources, and expected benefits. ⋯ NAT implementation has improved blood safety by reducing the risk of entering 2.5 HCV and 1.8 HIV infectious units per million donations into the blood supply. The yield of NAT in detecting infectious blood before transfusion was higher for HBV than for HCV or HIV. However, the benefit of HBV NAT in terms of avoided HBV-related morbidity and mortality in blood recipients needs to be further evaluated.