Transfusion
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Multicenter Study
Patient blood transfusion management: discharge hemoglobin level as a surrogate marker for red blood cell utilization appropriateness.
Blood transfusion management strategies minimize transfusion-associated risks, enhance outcomes, and reduce costs. We explored an association of discharge hemoglobin (Hb) with pretransfusion Hb, transfusion indications, and red blood cell (RBC) transfusions. We stipulate that patients with discharge Hb concentrations greater than 10.0 g/dL, or even 9.0 g/dL, received excessive RBC transfusions. ⋯ In aggregate, overutilization exceeded 20%. At the focus hospital, approximately one-quarter of patients receiving transfusions had a Hb concentration greater than 10.0 g/dL at discharge. Transfused patients' discharge Hb concentration represents an effective indicator for retrospective monitoring of transfusion appropriateness. In light of the large number of patients receiving even number transfusions, reviewing Hb levels after transfusion of each RBC unit could reduce unnecessary transfusions. Retrospective review of discharge Hb data focuses providers on transfusion outcomes and affords an educational opportunity for blood utilization management.
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Blood dilution is a frequent complication of massive transfusion during trauma and surgery. This article investigates the quantitative effects of blood plasma dilution on thrombin generation in the context of intersubject variability. ⋯ Dilutional effects on thrombin generation in a human population can be predicted from trends identified for the "average" subject and then refined by performing an analysis of actual subjects in the study group. The MS and PH are dilution indicators that are both sensitive and reliable across a large subject group and could potentially be used as disease markers in the diagnosis of coagulopathic conditions.
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Monitoring of patients' vital sign values (VSVs) during hemotherapy may have an important role in the recognition and mitigation of transfusion-associated circulatory overload (TACO). Knowledge regarding VSVs and other patient characteristics in bedside-reported TACO or fluid challenge-suspected transfusion reactions (TACO/FC-STRs) is limited. ⋯ Trend monitoring of peritransfusion VSVs, especially blood pressures, may aid in the bedside recognition of TACO/FC-STRs. A subset of these patients may also present with febrile and/or inflammatory signs and symptoms.
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United Arab Emirates (UAE) has a heterogeneous population consisting of more than 160 nationalities and 85% of the population being non-UAE. In 2007, Dubai Blood Donation Centre (DBDC), the major local supplier of blood in the UAE, introduced six-minipool nucleic acid test (NAT) for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), which in 2008 upgraded to individual-donation (ID)-NAT. The aim of this study was to analyze the efficacy of the donor screening program in the UAE and evaluate the impact of NAT on the yield and residual risk of transfusion-transmissible viral infections (TTVIs). ⋯ Incidence rates and estimated residual risk indicate that the current risk of TTVIs attributable to blood donation is relatively low in the UAE. The study recommends the parallel use of both serology and ID-NAT TTVIs screening in blood donations and suggests the exclusion of antibody to hepatitis B core antigen-positive donations as this can eliminate the potential infectivity of these units with marginal effects on the blood stock in UAE.