Transfusion alternatives in transfusion medicine : TATM最新文献

{"title":"Role of HES 130/0.4 in resuscitation of patients with major burn injury: HES 130/0.4 IN MAJOR BURN INJURY","authors":"G. Sudhakar, P. Lakshmi","doi":"10.1111/J.1778-428X.2008.00107.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2008.00107.X","url":null,"abstract":"SUMMARY \u0000 \u0000 \u0000To investigate whether hydroxyethyl starch (HES) 130/0.4 can be used safely in the initial resuscitation (first 48 hours after admission) of burned patients, and more particularly whether its use in the early treatment of burns can reduce crystalloid overload. Burn patients with a total burn surface area over 30% were randomized to two groups receiving either crystalloids (Ringer's lactate) only or HES 130/0.4 (Voluven®, Fresenius Kabi, Bad Homburg, Germany) along with crystalloids for resuscitation. During the first 48 post-burn hours (PBH), fluid requirements were estimated using the Parkland formula and fluids were administered according to the study protocol. During the study, randomization had to be abandoned due to clinical and ethical reasons. The difference between ‘Fluid required’ and ‘Fluid given’ was recorded as either ‘Fluid saved’ or ‘Fluid excess’. Patients’ body weight and limb circumferences were measured as a guide to quantify the edema. Ten patients in the control group received Ringer's lactate solution only and 22 patients in the HES group received HES 130/0.4 plus Ringer's lactate solution for resuscitation. During the whole study period, mean fluid saving was 15.9% in the control group (n = 3) and 44.7% in the HES group (n = 20) (P = 0.0151). Mean fluid excess was 16.6% in the control group (n = 7) and 12.4% in HES group (n = 2) (P = 0.7120). By the end of 48 PBH, parameters related to tissue edema (mean rise in body weight and circumferences of burned and unburned areas) were significantly more favorable in the HES group (P = 0.0071, P < 0.0001 and P < 0.0001, respectively). Although the other management methods were the same in both groups, nine of 10 patients (90%) in the control group compared with 11 of 22 patients (50%) in the HES group died during their hospitalization (P = 0.0341). HES 130/0.4 appears to be a promising artificial plasma volume expander for burn resuscitation as compared with standard management. Further well-designed studies with large sample sizes are required to confirm these findings and explore the pharmacodynamic mechanisms involved.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":"10 1","pages":"43-50"},"PeriodicalIF":0.0,"publicationDate":"2008-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2008.00107.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: blood transfusion in countries with limited resources","authors":"D. Teo, N. Dhingra","doi":"10.1111/J.1778-428X.2008.00110.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2008.00110.X","url":null,"abstract":"","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":"10 1","pages":"51-52"},"PeriodicalIF":0.0,"publicationDate":"2008-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2008.00110.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical guidelines, audits and hemovigilance in managing blood transfusion needs: CLINICAL GUIDELINES, AUDITS AND HEMOVIGILANCE","authors":"T. Nel","doi":"10.1111/J.1778-428X.2008.00104.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2008.00104.X","url":null,"abstract":"SUMMARY \u0000 \u0000The transfusion of blood and blood components is a critical element for the delivery of a healthcare service to patients. Tools to help improve the safety of the blood supply of a country include: (i) clinical (transfusion) guidelines to direct transfusion practices; (ii) audit systems to monitor adherence to the guidelines as well as the effects of adjustments to the guidelines; and (iii) the hemovigilance program which monitors the entire blood supply value chain, develops measures and solutions to problems that threaten or might threaten the safety of blood component recipients, and monitors the implementation of these corrective actions. Establishing guidelines, implementing audit systems and hemovigilance programs are achieved more readily in developing countries with limited resources available, if a step-up approach is used. If these tools are instigated on an inappropriate level as initial programs, they will be unattainable and most initiatives would fail because the performance targets are unrealistically high. Starting with an elementary approach, acknowledging the shortcomings of it while creating a culture of continuous improvement, is the preferred option.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":"10 1","pages":"61-69"},"PeriodicalIF":0.0,"publicationDate":"2008-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2008.00104.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63388991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing situations of acute blood loss with limited resources","authors":"P. Fenton","doi":"10.1111/J.1778-428X.2006.00066.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2006.00066.X","url":null,"abstract":"SUMMARY \u0000 \u0000 \u0000Death from acute blood loss is a common event in many parts of the world. Most of the half-million-plus maternal deaths worldwide are due to postpartum hemorrhage. While a state of general nonreportage exists in under-resourced countries, it is clear that shortage of blood and trained clinical manpower are important causes of mortality, even for those lucky few who do make it to hospital. These factors and methods of resuscitation are considered in this review of the clinical scene and simple techniques available to treat hemorrhagic shock in under-resourced countries.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":"10 1","pages":"82-89"},"PeriodicalIF":0.0,"publicationDate":"2008-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2006.00066.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63388015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building sustainable blood services in developing countries","authors":"J. Koistinen","doi":"10.1111/J.1778-428X.2008.00105.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2008.00105.X","url":null,"abstract":"SUMMARY \u0000 \u0000 \u0000Countries with low and medium human development index (least developed and developing countries) represent 82% of the human population but use only 39% of the global blood supply. Additional funding for blood services is needed in these countries, but that alone does not level out this unfair balance. Political will of the decision makers to acknowledge the existence blood transfusions and blood banks and to create an organization for them is a prerequisite for development. Acceptance of blood transfusion as a specialty in medicine and national coordination of the blood services provide better service even with the already existing financial input given to blood transfusion. Different models for blood service operations exist; a centralized national blood service is not the only alternative and may not be feasible in large countries, but national coordination is beneficial even for them. Education of the public for voluntary, non-remunerated blood donation and training of the personnel can be achieved even with limited resources, and guidance as well as training material is available, e.g. from the World Health Organization. Regulation of blood services helps in improving the safety of blood transfusion, but lack of laws and regulations must not be accepted as an excuse for not organizing the blood services. International assistance may be necessary after decisions of a nationally organized or coordinated blood service system have been reached, and implementation is planned. However, without local commitment at all levels – national, regional and local – sustainability cannot be expected.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":"10 1","pages":"53-60"},"PeriodicalIF":0.0,"publicationDate":"2008-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2008.00105.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing situations of acute blood loss with limited resources: MANAGING ACUTE BLOOD LOSS","authors":"P. Fenton","doi":"10.1111/j.1778-428x.2007.00066.x","DOIUrl":"https://doi.org/10.1111/j.1778-428x.2007.00066.x","url":null,"abstract":"","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":"10 1","pages":"82-89"},"PeriodicalIF":0.0,"publicationDate":"2008-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1778-428x.2007.00066.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63388692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of hemophilia in resource-limited countries","authors":"Y. Ayob","doi":"10.1111/J.1778-428X.2008.00108.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2008.00108.X","url":null,"abstract":"SUMMARY \u0000 \u0000Hemophilia is a rare congenital bleeding disorder that requires lifelong treatment. Prevalence is not affected by race, ethnicity or socioeconomics. However, there are considerably fewer hemophiliacs diagnosed in resource-limited countries than in the developed world. Management requires replacement therapy that many developing countries find difficult to provide. While the developed world has moved to using recombinant therapy, many developing countries are struggling to provide plasma to the hemophiliacs, let alone plasma-derived fractionated factor concentrate. Financial constraint is the major cause of these disparities. This is understandable as more pressing public health issues such as infectious diseases affect a larger population and require more urgent attention. However, there have been successes. Some developing countries are able to provide plasma through their blood transfusion program while some managed to secure government support to provide factor concentrates. Management protocols are developed to ensure their effective use. The World Federation of Hemophilia and national hemophilia societies have helped focus attention to the hemophiliacs and increase awareness on the management of their condition. Strong leadership and the development of a national program that includes proper planning and implementation can bring about improvement in the care of hemophiliacs in resource-limited countries that would help them achieve their full potential and not be a social and economic burden to these countries.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":"10 1","pages":"70-74"},"PeriodicalIF":0.0,"publicationDate":"2008-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2008.00108.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Descriptive study of perioperative transfusion practices in Spanish hospitals","authors":"M. Basora, M. Colomina, V. Moral, J. Llau, M. Vila, L. Durán, S. Silva, C. Sánchez","doi":"10.1111/J.1778-428X.2008.00093.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2008.00093.X","url":null,"abstract":"SUMMARY \u0000 \u0000 \u0000In order to identify opportunities to enhance blood-sparing strategies, we studied blood-transfusion practices in patients undergoing scheduled major surgery in Spain. This prospective, multicenter epidemiological study involved 20 Spanish hospitals. We recorded the pre- and postoperative hemoglobin concentrations, the estimated and calculated blood loss, the number of patients transfused and the blood-sparing techniques used. A total of 359 patients from 18 centers were included in the analysis. Mean preoperative hemoglobin concentration was 13.7 ± 1.6 g/dL. In 29% of the patients, preoperative hemoglobin concentration was lower than 13 g/dL. All surgeries combined, mean estimated blood loss was 845 ± 659 mL and mean calculated blood loss 1722 ± 1021 mL. The percentage of patients transfused with allogeneic blood was 28.4% altogether and ranged from 47.2% in cardiac surgery patients to 4.5% in plastic-maxillofacial surgery patients. Blood-sparing techniques were used only in 70 patients (19.4%). For a large percentage patients who underwent scheduled major surgery, blood transfusion was needed and perioperative blood loss was underestimated. Blood-sparing techniques were underused in non-orthopedic surgery, despite the fact that sufficient time was available to plan appropriate blood-sparing measures.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":"10 1","pages":"9-16"},"PeriodicalIF":0.0,"publicationDate":"2008-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2008.00093.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63388859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a restrictive transfusion protocol reduces the need for allogeneic blood transfusion in proximal humerus fracture repair without affecting patient outcome: preliminary observations","authors":"J. Cuenca, J. García-Erce, M. Muñoz, A. Martínez, A. Peguero, A. Herrera","doi":"10.1111/J.1778-428X.2008.00095.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2008.00095.X","url":null,"abstract":"SUMMARY \u0000 \u0000 \u0000Shoulder arthroplasty may be associated with considerable blood loss, and some patients require allogeneic blood transfusion (ABT). However, there is almost no information available for proximal humerus fracture (PHF) repair surgery. We therefore evaluated the influence of two transfusion protocols on ABT requirements in patients undergoing hemiarthroplasty surgery for PFH. We assessed the requirements for ABT in 78 patients receiving hemiarthroplasty for PHF, who were managed with a conservative transfusion protocol [hemoglobin(Hb) < 9.0 g/dL; group 1; n = 31] or a restrictive transfusion protocol (Hb < 8.0 g/dL and/or clinical signs/symptoms of anemia/hypoxemia; group 2; n = 47). Overall, the ABT rate (12% vs. 48%; P = 0.001) and the transfusion index (0.2 ± 0.7 vs. 0.9 ± 1.0 unit/patient; P = 0.001) were lower in group 2 than in group 1. The differences in transfusion rate and transfusion index between groups were significant for patients with Hb < 13.0 g/dL (75% vs. 18%, for groups 1 and 2, respectively; P = 0.001), but not for those with Hb ≥ 13.0 g/dL (20% vs. 7%; P = 0.180). The implementation of a restrictive transfusion protocol seems to be effective in reducing ABT, especially in PHF patients with preoperative Hb < 13.0 g/dL.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":"10 1","pages":"17-21"},"PeriodicalIF":0.0,"publicationDate":"2008-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2008.00095.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63388880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative efficacy of recombinant activated factor VII in a microcythemic patient: a case report","authors":"A. David, Bruna Lucchetti, A. Sinardi","doi":"10.1111/J.1778-428X.2008.00102.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2008.00102.X","url":null,"abstract":"SUMMARY \u0000 \u0000 \u0000Recombinant activated factor VII (rFVIIa) was initially developed for the treatment of hemorrhagic episodes in hemophilic patients with inhibitors to factors VIII and IX. After its introduction, it has also been used off-label to enhance hemostasis in bleeding episodes not responsive to conventional therapy. Evidence so far indicates that the use of rFVIIa in hemophilic and nonhemophilic patients is both safe and effective in controlling bleeding. However, no data exist for the use of rFVIIa in critical bleeding in microcythemic (beta-thalassemia) patients. We report a case of uncontrolled intra-abdominal hemorrhage during urgent explorative laparotomy, 10 days after endoscopic sphincterotomy and open coledocotomy in the treatment of common bile duct lithiasis following colecystectomy, in a microcythemic patient. While the conventional methods to achieve hemostasis failed, the use of rFVIIa successfully controlled the bleeding. Further research is needed to determine the use of rFVIIa in microcythemic patients.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":"10 1","pages":"30-33"},"PeriodicalIF":0.0,"publicationDate":"2008-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2008.00102.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63388943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}