Influence of the leukoreduction moment of blood components on the clinical outcomes of transfused patients in the emergency department.

OBJECTIVES: to investigate the influence of the leukoreduction moment (preor post-storage) of blood components on the clinical outcomes of patients transfused in the emergency department. METHODS: retrospective cohort study of patients aged 18 years or older who received preor post-storage leukoreduced red blood cell or platelet concentrate in the emergency department and remained in the institution for more than 24 hours. A generalized mixed-effects model was applied in the analyses. RESULTS: in a sample of 373 patients (63.27% male, mean age 54.83) and 643 transfusions (69.98% red blood cell), it was identified that the leukoreduction moment influenced the length of hospital stay (p<0.009), but was not dependent on the transfused blood component (p=0.124). The leukoreduction moment had no effect (p>0.050) on transfusion reactions, healthcare-associated infections, or mortality. CONCLUSIONS: patients who received pre-storage leukoreduced blood components in the emergency department had a shorter length of hospital stay.

Institutional trends over a decade in catheter-directed interventions for pulmonary embolism.

OBJECTIVE: Catheter-directed interventions (CDIs) are commonly performed for acute pulmonary embolism (PE). The evolving catheter types and treatment algorithms impact the use and outcomes of these interventions. This study aimed to investigate the changes in CDI practice and their impact on outcomes. METHODS: Patients who underwent CDIs for PE between 2010 and 2019 at a single institution were identified from a prospectively maintained database. A PE team was launched in 2012, and in 2014 was established as an official Pulmonary Embolism Response Team. CDI annual use trends and clinical failures were recorded. Clinical success was defined as physiologic improvement in the absence of major bleeding, perioperative stroke or other procedure-related adverse event, decompensation for submassive or persistent shock for massive PE, the need for surgical thromboembolectomy, or death. Major bleeding was defined as requiring a blood transfusion, a surgical intervention, or suffering from an intracranial hemorrhage. RESULTS: There were 372 patients who underwent a CDI for acute PE during the study period with a mean age of 58.9 ± 15.4 years; there were males 187 (50.3%) and 340 patients has a submassive PE (91.4%). CDI showed a steep increase in the early Pulmonary Embolism Response Team years, peaking in 2016 with a subsequent decrease. Ultrasound-assisted thrombolysis was the predominant CDI technique peaking at 84% of all CDI in 2014. Suction thrombectomy use peaked at 15.2% of CDI in 2019. The mean alteplase dose with catheter thrombolysis techniques decreased from 26.8 ± 12.5 mg in 2013 to 13.9 ± 7.5 mg in 2019 (P < .001). The mean lysis time decreased from 17.2 ± 8.3 hours in 2013 to 11.3 ± 8.2 hours in 2019 (P < .001). Clinical success for the massive and the submassive PE cohorts was 58.1% and 91.2%, respectively; the major bleed rates were 25.0% and 5.3%. There were two major clinical success peaks, one in 2015 mirroring our technical learning curve and one in 2019 mirroring our patient selection learning curve. The clinical success decrease in 2018 was primarily derived from blood transfusions owing to acute blood loss during suction thrombectomy. CONCLUSIONS: CDIs for acute PE have rapidly evolved with high success rates. Multidisciplinary approaches among centers with appropriate expertise are advisable for the safe and successful implementation of catheter interventions.

Tranexamic acid in Neurosurgery: a controversy indication-review.

Tranexamic acid (TXA) is one of the measures indicated to reduce bleeding and the need for volume replacement. However, data on risks and benefits are controversial. This study analyzes the effectivity and risks of using tranexamic acid in neurosurgery. We selected articles, published from 1976 to 2019, on the PubMed, EMBASE, Science Direct, and The Cochrane Database using the descriptors: "tranexamic acid," "neurosurgery," "traumatic brain injury," "subdural hemorrhage," "brain aneurysm," and "subarachnoid hemorrhage." TXA can reduce blood loss and the need for blood transfusion in trauma and spinal surgery. Despite the benefits of TXA, moderate-to-high doses are potentially associated with neurological complications (seizures, transient ischemic attack, delirium) in adults and children. In a ruptured intracranial aneurysm, the use of TXA can considerably reduce the risk of rebleeding, but there is weak evidence regarding its influence on mortality reduction. The TXA use in brain surgery does not present benefit. However, this conclusion is limited because there are few studies. TXA in neurosurgeries is a promising method for the maintenance of hemostasis in affected patients, mainly in traumatic brain injury and spinal surgery; nevertheless, there is lack of evidence in brain and vascular surgeries. Many questions remain unanswered, such as how to determine the dosage that triggers the onset of associated complications, or how to adjust the dose for chronic kidney disease patients.

Serological screening in donors in Mexico: advances and technology / Tamizaje serológico en donadores de México: avances y tecnología

The residual risk of transfusion-related infections has decreased dramatically in countries that have routinely implemented serological screening. Most of the donation in Mexico is from replacement practice, a risk factor for positive serology. In Mexico, the altruistic donation is only 2.7%. The heterogeneity of technical factors, regional factors and internal policies of each center influences the variability of data on the prevalence of positive screening, as well as the prevalence of confirmed cases. The main advantage of nucleic acid technology is the detection of donors in the period of serological window or occult infections, being occult hepatitis reports in Mexican donors from 1 to 3.4%. The limitation of available technology, the scope of the clinic and perspectives, invites us to improve technology and health policies in the interest of transfusion safety.

El riesgo residual de las infecciones relacionadas a la transfusión ha disminuido drásticamente en los países que han implementado rutinariamente el tamizaje serológico. La mayor parte de la donación en México es de reposición, factor de riesgo para serología positiva, y en donde la donación altruista es de apenas 2.7%. La heterogeneidad de factores técnicos, regionales y políticas internas de cada centro influyen en la variabilidad de datos en prevalencia del tamizaje positivo, así como en la prevalencia de casos confirmados. La principal ventaja de la tecnología de ácidos nucleicos es la detección de donadores en periodo de ventana serológico o de infecciones ocultas, con reportes de hepatitis ocultas en donadores de 1-3.4% en México. Las limitantes de la tecnología disponible, el alcance de la clínica y de las perspectivas, nos invita a la mejora tecnológica y de las políticas sanitarias en aras de la seguridad transfusional.

Clinical Impact of Protamine Titration-Based Heparin Neutralization in Patients Undergoing Coronary Bypass Grafting Surgery.

OBJECTIVES: A hemostasis management system (HMS) is a point-of-care method for heparin and protamine titration. The authors hypothesized that protamine dosing over the HMS estimate would be associated with elevated activated clotting time (ACT), increased bleeding, and transfusion owing to protamine's anticoagulant activity. DESIGN: A retrospective cohort study. SETTING: Single-center university hospital. PARTICIPANTS: One hundred eighty-nine patients undergoing elective coronary artery bypass grafting surgery. INTERVENTIONS: Patients were stratified into 3 groups per ratio of actual total administered protamine versus the HMS-derived protamine estimate: (1) low-ratio (≤66% of HMS estimate), (2) moderate-ratio (66%-100% of HMS estimate), and (3) high-ratio (>100% of HMS estimate). MEASUREMENTS AND MAIN RESULTS: The primary endpoints were post-protamine ACT, and residual heparin levels on HMS among the 3 groups in addition to bleeding and transfusion. There were 54 (28.6%) patients in the low, 95 (50.3%) in the moderate, and 40 (21.2%) in the high-ratio group. The high-ratio patients who were overdosed with protamine relative to the HMS estimate had elevated ACT, international normalized ratio, and activated partial thromboplastin time values, and subsequently received more red blood cell (RBC) and non-RBC transfusions compared to lower-ratio groups. Higher actual/HMS protamine ratios were associated independently with post-protamine ACT elevations after adjustment for sex, body mass index (BMI), and cardiopulmonary bypass (CPB) time. CONCLUSION: Most patients received the protamine dose sufficiently close to the HMS estimate, but protamine dosing above the HMS estimate occurred in both obese and nonobese patients, which was associated independently with prolonged ACT after adjusting for sex, BMI, and CPB time.

Leucorredução de hemocomponentes na medicina veterinária / Leukoreduction of blood components in veterinary medicine

Essa revisão tem como objetivo informar e atualizar sobre a utilização daredução leucocitária na terapia transfusional, com ênfase na técnica defiltração de leucócitos e suas aplicabilidades na medicina veterinária. Aleucorredução (LR) é um procedimento realizado para reduzir o número deleucócitos de um hemocomponente, a fim de se evitar as reações adversasprovocadas pela exposição dos leucócitos do doador ao receptor. Dentre asvárias técnicas de leucorredução existentes, a filtração tem-se mostradocomo a mais eficiente, com retenção de aproximadamente 99,9% dosleucócitos. Na medicina, a filtração de leucócitos mostrou eficácia naredução de casos de febre não hemolítica, aloimunização, refratariedadeplaquetária e transmissão de citomegalovírus. Estudos com animaistambém observaram a redução dos casos de refratariedade plaquetária emcães e a diminuição da concentração de mediadores pró-inflamatórios debolsas leucorreduzidas armazenadas. A redução de leucócitos dehemocomponentes ainda é pouco conhecida e raramente adotada naterapia de animais. Diversos benefícios vêm sendo relatados para aaplicação clínica da LR, e potencialmente, outros estudos podem serconduzidos com sangue total e seus subprodutos na medicina veterinária.

The article aims to inform and update on the use of leukocyte reduction in transfusion therapy, with emphasis on filtering technique of leukocytes and their applicability in veterinary medicine. Leukoreduction is a procedure to reduce the number of leukocytes from a blood component, in order to avoid the adverse reactions caused by the exposure of leukocytes donor to recipient. Among the various methods of leukoreduction, filtration has proven to be the most efficient, with retention of approximately 99.9% of leukocytes. In medicine, leukocyte filtration was effective in reducing cases of febrile nonhemolytic reactions, alloimmunization, platelet refractoriness and cytomegalovirus transmission. Animal studies also observed the reduction of platelet refractoriness cases in dogs and decreased concentration of proinflammatories mediators of leukoreduction stored bags. The blood components leukocyte reduction is still little known and rarely adopted in the pet therapy. Several benefits have been reported for the clinical application of LR and potentially another studies could be conducted with whole blood and its products in veterinary medicine.

Leucorredução de hemocomponentes na medicina veterinária / Leukoreduction of blood components in veterinary medicine

Essa revisão tem como objetivo informar e atualizar sobre a utilização daredução leucocitária na terapia transfusional, com ênfase na técnica defiltração de leucócitos e suas aplicabilidades na medicina veterinária. Aleucorredução (LR) é um procedimento realizado para reduzir o número deleucócitos de um hemocomponente, a fim de se evitar as reações adversasprovocadas pela exposição dos leucócitos do doador ao receptor. Dentre asvárias técnicas de leucorredução existentes, a filtração tem-se mostradocomo a mais eficiente, com retenção de aproximadamente 99,9% dosleucócitos. Na medicina, a filtração de leucócitos mostrou eficácia naredução de casos de febre não hemolítica, aloimunização, refratariedadeplaquetária e transmissão de citomegalovírus. Estudos com animaistambém observaram a redução dos casos de refratariedade plaquetária emcães e a diminuição da concentração de mediadores pró-inflamatórios debolsas leucorreduzidas armazenadas. A redução de leucócitos dehemocomponentes ainda é pouco conhecida e raramente adotada naterapia de animais. Diversos benefícios vêm sendo relatados para aaplicação clínica da LR, e potencialmente, outros estudos podem serconduzidos com sangue total e seus subprodutos na medicina veterinária.(AU)

The article aims to inform and update on the use of leukocyte reduction in transfusion therapy, with emphasis on filtering technique of leukocytes and their applicability in veterinary medicine. Leukoreduction is a procedure to reduce the number of leukocytes from a blood component, in order to avoid the adverse reactions caused by the exposure of leukocytes donor to recipient. Among the various methods of leukoreduction, filtration has proven to be the most efficient, with retention of approximately 99.9% of leukocytes. In medicine, leukocyte filtration was effective in reducing cases of febrile nonhemolytic reactions, alloimmunization, platelet refractoriness and cytomegalovirus transmission. Animal studies also observed the reduction of platelet refractoriness cases in dogs and decreased concentration of proinflammatories mediators of leukoreduction stored bags. The blood components leukocyte reduction is still little known and rarely adopted in the pet therapy. Several benefits have been reported for the clinical application of LR and potentially another studies could be conducted with whole blood and its products in veterinary medicine.(AU)

Transfusão sanguínea emergencial e, jabuti-piranga (Chelonoidis carbonaria): relato de caso / Emergency blood transfusion in piranga-tortoise (Chelonoidis carbonaria): case report

A transfusão de sangue ainda se apresenta como um recurso pouco explorado na clínica de animais silvestres e exóticos. Entre os grupos de animais silvestres rotineiramente atendidos na clínica, os répteis apresentam o menor volume de referências disponíveis sobre o assunto. Este trabalho relata um caso no qual a transfusão de sangue foi efetuada com sucesso em um exemplar de jabuti-piranga (Chelonoidis carbonaria) adulto. A decisão da realização da transfusão sanguínea baseou-se nos achados de exames físicos e laboratoriais, traduzidos por intensa dispneia e valores de eritrograma significativamente abaixo dos limites de referência para a espécie. Para realização do procedimento, foi selecionado como doador um exemplar da mesma espécie, adulto e saudável. A transfusão foi realizada de forma direta, o volume total de 30ml de sangue (1% do peso corpóreo) foi coletado do doador e sequencialmente infundido no receptor. A reavaliação laboratorial do paciente, 24 horas após a transfusão, mostrou aumento do número total de eritrócitos, da concentração de hemoglobina e do hematócrito. A conclusão obtida foi que a transfusão foi um recurso adequado no manejo do paciente réptil em condições críticas.

Blood transfusion is still a tool not much explored in wild animal clinics. Among the groups of wild animals, reptiles feature the lowest amount of references available on this subject. This report shows a successful case of blood transfusion in an adult red-footed tortoise (Chelonoidis carbonaria). The decision for the blood transfusion was based on the results of physical and laboratory examinations, which have shown intense dyspnea and haematology values significantly below the limits of previous references for this reptile. To carry out the procedure, an adult and healthy animal of the same species was selected as donor. The transfusion was performed directly and a blood volume of 30ml (1% of body weight) was collected from the donor and sequentially infused into the recipient. Laboratory reassessment of the patient, 24 hours after transfusion, showed an increase in the total number of erythrocytes, hemoglobin concentration and hematocrit. The conclusion was that the applied procedure was satisfactory for reptile in a critical condition.

Transfusão sanguínea emergencial e, jabuti-piranga (Chelonoidis carbonaria): relato de caso / Emergency blood transfusion in piranga-tortoise (Chelonoidis carbonaria): case report

A transfusão de sangue ainda se apresenta como um recurso pouco explorado na clínica de animais silvestres e exóticos. Entre os grupos de animais silvestres rotineiramente atendidos na clínica, os répteis apresentam o menor volume de referências disponíveis sobre o assunto. Este trabalho relata um caso no qual a transfusão de sangue foi efetuada com sucesso em um exemplar de jabuti-piranga (Chelonoidis carbonaria) adulto. A decisão da realização da transfusão sanguínea baseou-se nos achados de exames físicos e laboratoriais, traduzidos por intensa dispneia e valores de eritrograma significativamente abaixo dos limites de referência para a espécie. Para realização do procedimento, foi selecionado como doador um exemplar da mesma espécie, adulto e saudável. A transfusão foi realizada de forma direta, o volume total de 30ml de sangue (1% do peso corpóreo) foi coletado do doador e sequencialmente infundido no receptor. A reavaliação laboratorial do paciente, 24 horas após a transfusão, mostrou aumento do número total de eritrócitos, da concentração de hemoglobina e do hematócrito. A conclusão obtida foi que a transfusão foi um recurso adequado no manejo do paciente réptil em condições críticas.(AU)

Blood transfusion is still a tool not much explored in wild animal clinics. Among the groups of wild animals, reptiles feature the lowest amount of references available on this subject. This report shows a successful case of blood transfusion in an adult red-footed tortoise (Chelonoidis carbonaria). The decision for the blood transfusion was based on the results of physical and laboratory examinations, which have shown intense dyspnea and haematology values significantly below the limits of previous references for this reptile. To carry out the procedure, an adult and healthy animal of the same species was selected as donor. The transfusion was performed directly and a blood volume of 30ml (1% of body weight) was collected from the donor and sequentially infused into the recipient. Laboratory reassessment of the patient, 24 hours after transfusion, showed an increase in the total number of erythrocytes, hemoglobin concentration and hematocrit. The conclusion was that the applied procedure was satisfactory for reptile in a critical condition.(AU)

Patient Blood Management: An International Perspective.

This article describes practices in patient blood management (PBM) in 4 countries on different continents that may provide insights for anesthesiologists and other physicians working in global settings. The article has its foundation in the proceedings of a session at the 2014 AABB annual meeting during which international experts from England, Uganda, China, and Brazil presented the programs and implementation strategies in PBM developed in their respective countries. To systematize the review and enhance the comparability between these countries on different continents, authors were requested to respond to the same set of 6 key questions with respect to their country's PBM program(s). Considerable variation exists between these country regions that is driven both by differences in health contexts and by disparities in resources. Comparing PBM strategies from low-, middle-, and high-income countries, as described in this article, allows them to learn bidirectionally from one another and to work toward implementing innovative and preferably evidence-based strategies for improvement. Sharing and distributing knowledge from such programs will ultimately also improve transfusion outcomes and patient safety.

Monitoração e avaliação clínica da eficácia da transfusão de sangue total e concentrado de hemácias em cães / Monitoring and evaluation of the efficacy of whole blood and packed red cells transfusion in dogs

A terapia transfusional tem grande potencial de salvar vidas na clínica de pequenos animais, e é usada principalmente na terapêutica de emergência em animais anêmicos, entretanto este procedimento está associado a vários riscos. Uma das formas de minimizá-los é pela monitoração constante durante a transfusão sanguínea, permitindo assim avaliar a melhora clínica do paciente. O objetivo deste trabalho foi avaliar a eficácia da transfusão de sangue total e de concentrado de hemácias em cães anêmicos, por meio da monitoração dos parâmetros vitais. Foram avaliadas 77 transfusões em cães, sendo 52 de sangue total armazenado e 25 de concentrado de hemácias. Durante todo o procedimento aferiu-se (a cada 15-30 minutos) a temperatura, frequência cardíaca, frequência respiratória e a coloração de mucosas dos pacientes, além do tempo de preenchimento capilar. Os resultados obtidos mostraram que ambos os componentes promoveram melhora dos parâmetros avaliados a partir de 45 minutos do início da transfusão sanguínea, principalmente da frequência cardíaca, coloração de mucosas e tempo de preenchimento capilar (p<0,05). A transfusão bem sucedida proporcionou melhora clínica aparente a partir de duas horas do início do procedimento.

Transfusion therapy has a great potential to save lives in small animals practice, and it has been used mainly in the emergency treatment for anemic animals, although this procedure is related to certain risks. A manner to minimize these risks is through keeping close monitoring during the time of transfusion, which furthermore allows an evaluation of recovering of the patient. The aim of the present research was to evaluate the efficacy of whole blood and packed red cells transfusions in anemic dogs. Seventy-seven transfusions in dogs have been done, 52 of whole blood and 25 of packed red cells, measuring (every 15-30 minutes) temperature, cardiac and breathing frequency, mucous tissue color and capillaries filling time throughout the procedure. The outcome shows that both compounds, may cause improvements to every assessed parameters 45 minutes from the start of the transfusion mainly to cardiac frequency, mucous tissue color and capillaries filling time (p<0.05). The success of a transfusion ensures apparent clinical improvement from two hours of the onset of the procedure.

Monitoração e avaliação clínica da eficácia da transfusão de sangue total e concentrado de hemácias em cães / Monitoring and evaluation of the efficacy of whole blood and packed red cells transfusion in dogs

A terapia transfusional tem grande potencial de salvar vidas na clínica de pequenos animais, e é usada principalmente na terapêutica de emergência em animais anêmicos, entretanto este procedimento está associado a vários riscos. Uma das formas de minimizá-los é pela monitoração constante durante a transfusão sanguínea, permitindo assim avaliar a melhora clínica do paciente. O objetivo deste trabalho foi avaliar a eficácia da transfusão de sangue total e de concentrado de hemácias em cães anêmicos, por meio da monitoração dos parâmetros vitais. Foram avaliadas 77 transfusões em cães, sendo 52 de sangue total armazenado e 25 de concentrado de hemácias. Durante todo o procedimento aferiu-se (a cada 15-30 minutos) a temperatura, frequência cardíaca, frequência respiratória e a coloração de mucosas dos pacientes, além do tempo de preenchimento capilar. Os resultados obtidos mostraram que ambos os componentes promoveram melhora dos parâmetros avaliados a partir de 45 minutos do início da transfusão sanguínea, principalmente da frequência cardíaca, coloração de mucosas e tempo de preenchimento capilar (p<0,05). A transfusão bem sucedida proporcionou melhora clínica aparente a partir de duas horas do início do procedimento.(AU)

Transfusion therapy has a great potential to save lives in small animals practice, and it has been used mainly in the emergency treatment for anemic animals, although this procedure is related to certain risks. A manner to minimize these risks is through keeping close monitoring during the time of transfusion, which furthermore allows an evaluation of recovering of the patient. The aim of the present research was to evaluate the efficacy of whole blood and packed red cells transfusions in anemic dogs. Seventy-seven transfusions in dogs have been done, 52 of whole blood and 25 of packed red cells, measuring (every 15-30 minutes) temperature, cardiac and breathing frequency, mucous tissue color and capillaries filling time throughout the procedure. The outcome shows that both compounds, may cause improvements to every assessed parameters 45 minutes from the start of the transfusion mainly to cardiac frequency, mucous tissue color and capillaries filling time (p<0.05). The success of a transfusion ensures apparent clinical improvement from two hours of the onset of the procedure.(AU)

El rol social de la donación de sangre. Un caso de detección de brucelosis / The social role of the blood donation. Detection's case of brucellosis

En el siguiente artículo se expondrá, a partir del análisis de un caso clínico hallado en el Servicio de Hemoterapia del Hospital Materno infantil San Roque (Paraná, Entre Ríos). la importancia de la donación de sangre como factor fundamental en la detección de patologías encubiertas o desconocidas para un donan­te. En el caso en cuestión y, a partir de pertenecer a una zona endémica, se reconoce la importancia en la detección de un caso de Brucelosis.

In the following article it will be exposed, from the analysis a clinical case, found in the Service of Hemoterapia of the infantile Maternal Hospital San Roque (Paraná, Entre Ríos), the importance of the donation of blood like fundamental factor in the detection of concealed pathologies or strangers for a donor. In the case at issue and, from belonging to an endemic zone, the importance in the detection of a case of Brucelosis is recognized.