Transfusion
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Clinical guidelines recommend a restrictive transfusion strategy in nonhemorrhaging critically ill patients. ⋯ Between 1997 and 2007, important and sustained changes have occurred in our MICU physician transfusion practices, with overall reductions in the proportion of patients transfused, mean pretransfusion Hb level, and nadir Hb level in patients who were not transfused.
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Trypanosoma cruzi, the etiologic agent of Chagas disease, is a potential threat to transfusion recipients in the United States. The cost-effectiveness of seven testing strategies was evaluated against no testing and hierarchically in incremental analysis. Donor-specific strategies included testing donors born in endemic countries, testing all donors a specific number of times, or testing all donors every time. Component-specific strategies are based on screening platelet-containing donations. ⋯ Selective T. cruzi screening generates nearly the same effectiveness as universal screening, but at a reduced cost. Outcomes and associated costs of Chagas disease take longer to materialize than the average life expectancy of transfusion recipients.
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Randomized Controlled Trial
Association between length of storage of transfused red blood cells and multiple organ dysfunction syndrome in pediatric intensive care patients.
The objective was to determine if there is an association between red blood cell (RBC) storage time and development of new or progressive multiple organ dysfunction syndrome (MODS) in critically ill children. ⋯ Stable critically ill children who receive RBC units with storage times longer than 2 to 3 weeks may be at greater risk of developing new or progressive MODS.
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The purpose of this study was to evaluate the ability of uncrossmatched transfusions in the emergency department (ED) to predict early (< 6 hr) massive transfusion (MT) of red blood cells (RBCs) and blood components. ⋯ Patients receiving uncrossmatched RBCs in the ED are more than three times more likely to receive early MT of RBCs. Additionally, patients transfused with ED RBCs are more likely to receive 6 units or more of plasma and two or more apheresis PLT transfusions. Given these findings, ED transfusion of uncrossmatched RBCs should be considered a potential trigger for activation of an institution's MT protocol.