Transfusion
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Randomized Controlled Trial Multicenter Study Comparative Study
Plasma transfusion in liver transplantation: a randomized, double-blind, multicenter clinical comparison of three virally secured plasmas.
The clinical equivalence of plasma treated to reduce pathogen transmission and untreated plasma has not been extensively studied. A clinical trial was conducted in liver transplant recipients to compare the efficacy of three plasmas. ⋯ Compared to both Q-FFP and S/D-FFP, use of MB-FFP was associated with a moderate increase in volume transfused, partly explained by a difference in unit volume and bleeding risk factors. Q-FFP was associated with fewer units transfused than either S/D-FFP or MB-FFP.
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A systematic review of randomized controlled trials and observational studies assessing platelet (PLT) transfusion therapy identified gaps in the descriptions of trial design, variables of the PLT products transfused, and outcomes. We aimed to systematically develop a reporting guideline to aid in designing, reporting, and critiquing PLT trials. ⋯ Use of the Delphi method was successful in finding consensus on items to include in reports of a clinical PLT transfusion study. The final checklist and explanatory guide will be useful for authors and editors to improve the reporting of PLT transfusion trials.
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Variables of hemostasis before surgery might indicate an elevated risk of bleeding. We determined hemostasis tests and standardized bleeding history and their association with bleeding and transfusion requirements in cardiopulmonary bypass (CPB) surgery. ⋯ A standardized bleeding history may help to identify patients undergoing CPB surgery whose risk of bleeding is elevated. ADP-induced MEA appears to predict postoperative bleeding and PC transfusion requirements, while AA-induced MEA and preoperative Hb indicate the need for RBCs. The time of aspirin withdrawal before surgery influences perioperative blood loss and PC transfusion.
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Extracorporeal membrane oxygenation (ECMO) provides lifesaving hemodynamic and respiratory support to neonatal and pediatric patients with a variety of congenital or acquired cardiopulmonary defects. Successful ECMO support requires close collaboration among multiple services, including critical care medicine, perfusion, and transfusion medicine services. Neonatal and pediatric ECMO patients require significant transfusion support, both at the time of cannulation and after the ECMO circuit has been established, often with little advance notice. ⋯ In this article, we describe our protocol for transfusion support for ECMO and potential ECMO patients, which was developed to address a number of issues, including identifying and stratifiying ECMO candidate patients, streamlining the ordering and communication processes, and improving blood product turnaround times and availability. Additional measures of quality improvement are also discussed. As the number of centers performing ECMO procedures remains high, we believe that our experience may be of interest to our colleagues in transfusion medicine and critical care.