RESUMO
Complex surgery associated with major hemorrhage presents particular risks for Jehovah's Witnesses who do not accept transfusion of blood products. Intraoperative use of two cell saver machines simultaneously can maximize the yield of salvaged blood from both the operative field and from washed surgical swabs and can potentially be life-saving.
Assuntos
Síndrome Antifosfolipídica , Tromboembolia Venosa , Administração Oral , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Humanos , Fatores de Risco , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/etiologiaRESUMO
There has been a significant surge in admissions to critical care during the coronavirus disease 2019 (COVID-19) pandemic. At present, the demands on blood components have not been described. We reviewed their use during the first 6 weeks of the outbreak from 3 March 2020 in a tertiary-level critical care department providing venovenous extracorporeal membrane oxygenation (vv-ECMO). A total of 265 patients were reviewed, with 235 not requiring ECMO and 30 requiring vv-ECMO. In total, 50 patients required blood components during their critical care admission. Red cell concentrates were the most frequently transfused component in COVID-19-infected patients with higher rates of use during vv-ECMO. The use of fresh frozen plasma, cryoprecipitate and platelet transfusions was low in a period prior to the use of convalescent plasma.
Assuntos
Betacoronavirus , Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Infecções por Coronavirus/terapia , Cuidados Críticos/estatística & dados numéricos , Pneumonia Viral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Infecções por Coronavirus/sangue , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/métodos , Bases de Dados Factuais , Transfusão de Eritrócitos/estatística & dados numéricos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Fator VIII/uso terapêutico , Feminino , Fibrinogênio/uso terapêutico , Hemorragia/epidemiologia , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Plasma , Transfusão de Plaquetas/estatística & dados numéricos , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Utilização de Procedimentos e Técnicas , SARS-CoV-2RESUMO
Hyperhemolysis is a severe and potentially life-threatening complication of transfusion described in numerous case reports and gaining recognition since 2009 via the UK Serious Hazards of Transfusion scheme. Although it is predominantly seen in patients with sickle cell disease, there are several reports of this complication in patients with other hemoglobinopathies as well as patients with a range of other hematologic diagnoses who have blood transfusions as part of their management. Our understanding of the underlying pathophysiology of this subtype of delayed transfusion reaction has increased over the last few years; however, there are still questions, which remain unanswered. In our center alone, we have encountered 9 cases in the last 5 years both in the adult and pediatric population. Here we discuss our experience in the diagnosis and management of this complication, and review other cases reported in the literature and the various existing theories behind the pathophysiology of this process. We also discuss the role of genotyping and using DNA technology to aid selection of the most appropriate blood for this patient group. With an increased awareness of hyperhemolysis, it would be advantageous to finally develop international registries to determine the true incidence of hyperhemolysis, better understand the pathophysiology, identify markers to predict which patients are at risk, and inform management guidelines.
