Transfusion
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Randomized Controlled Trial Multicenter Study Comparative Study
Prevention of bedside errors in transfusion medicine (PROBE-TM) study: a cluster-randomized, matched-paired clinical areas trial of a simple intervention to reduce errors in the pretransfusion bedside check.
Transfusion of the incorrect blood component is a frequent serious incident associated with transfusion and often involves misidentification of the patient and/or the unit of blood. The objective of this study was to assess the effect of a simple intervention designed to improve performance of the bedside check and to observe the durability of any effect. The intervention was a tag on blood bags reminding staff to check the patient's wristband. The tag was positioned in such a way that the transfusionist was required to remove the tag to spike the unit. ⋯ A simple intervention in the form of a barrier warning label on blood bags reminding staff to check the patient's wristband failed to improve bedside transfusion practice. The robust study design developed for this study could be applied to investigate other interventions to improve the safety of bedside transfusion practice.
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Prophylactic platelet (PLT) transfusions are given as a standard care in patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT). This retrospective analysis evaluates utilization of blood transfusions, risk of bleeding, and survival in 480 HSCT patients at 10 x 10(9) and 20 x 10(9) per L prophylactic trigger levels. ⋯ Patients who bled were usually placed on a higher threshold before the onset of their major bleeding event and were not exposed to additional risk of bleeding from thrombocytopenia. Similarity in bleeding incidence between study periods appears to associate with adjustments to high-risk conditions and may not reflect consequences of the lower transfusion threshold.
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Meta Analysis
The intention-to-treat principle in clinical trials and meta-analyses of leukoreduced blood transfusions in surgical patients.
The scientific method requires that only experiments actually and correctly performed be used to draw conclusions. The intention-to-treat principle requires that all patients, even those not or improperly treated, be included. In clinical trials and meta-analyses investigating leukoreduced blood transfusions to reduce postoperative infections, the intention-to-treat principle and the scientific method have been variably applied. ⋯ When data restricted to patients receiving transfusions are analyzed, and no data absent from the actual investigations are introduced, leukoreduced transfusions substantially and significantly reduce the odds of postoperative infection by approximately 50 percent. These results demonstrate the importance of including only scientifically valid data in clinical trials and meta-analyses. The intention-to-treat principle should never lead to inclusion of data not actually derived from experimental results.
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Comparative Study Clinical Trial
Proactive administration of platelets and plasma for patients with a ruptured abdominal aortic aneurysm: evaluating a change in transfusion practice.
Continued hemorrhage remains a major contributor of mortality in massively transfused patients and those who survive have a higher platelet (PLT) count and a shorter prothrombin time and activated partial thromboplastin time (APTT) than nonsurvivors. It was considered that early substitution with PLTs and fresh-frozen plasma (FFP) would prevent development of coagulopathy and thus improve survival. ⋯ This study suggests that proactive administration of PLTs and FFP improves coagulation competence, reduces postoperative hemorrhage, and increases survival in massively bleeding rAAA patients.
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Comparative Study
In vitro quality of red blood cells (RBCs) collected by multicomponent apheresis compared to manually collected RBCs during 49 days of storage.
New technologic developments enable automated collection and preparation of red blood cells (RBCs). This study's aim was to evaluate quality of apheresis-derived RBCs (ARBCs) collected as single units along with platelets (RBC-Ps) or double units (2-RBCs) with four different apheresis systems. ⋯ ARBCs exhibited better predictability in volume and absolute RBC mass than MRBCs and demonstrated sufficient in vitro quality throughout storage, even though lower ATP preservation and higher methemoglobin formation were observed compared to MRBCs probably due to differences in glucose metabolism.