العنوان البديل: Transfusion for post-partum haemorrhage: What's new in 2011?

المؤلفون: Bonnet, M.-P.^1,2,3,4, Tesnière, A.^1,2, Mignon, A.^1,2 alexandre.mignon@cch.aphp.fr

المصدر: Transfusion Clinique et Biologique. Apr2011, Vol. 18 Issue 2, p129-132. 4p.

مصطلحات موضوعية: *FROZEN blood, *UTERINE hemorrhage, *PUERPERIUM, *BLOOD transfusion, *ANTIFIBRINOLYTIC agents, *HYSTERECTOMY, *BLOOD coagulation factor VIII

مصطلحات جغرافية: FRANCE

الملخص (بالإنجليزية): Abstract: Post-partum haemorrhage is the first cause of maternal death in France. In addition to the treatment of the cause, its treatment consists in the association of procoagulant drugs and blood transfusion. At risk situations requiring blood transfusion are well identified. However, they are not found in one third of the actually transfused patients. Therefore, for all deliveries, the medical team should be prepared to face a post-partum haemorrhage and to transfuse. As post-partum haemorrhage onset is most frequently acute, it is rare to be able to base the transfusion decision on biological parameters such as haemoglobin concentration and / or coagulation tests. The recently defined policy of early use of fresh frozen plasma in order to better control the coagulopathy frequently associated with a large haemorrhage has not been established in obstetrical situations. However, it is recommended to apply it in large volume post-partum haemorrhage, with a fresh frozen plasma/red blood cells concentrate ratio between 1/1 and 1/2. The post-partum haemorrhage treatment may benefit from the use of drugs, the most frequently used being antifibrinolytics, such as tranexemic acid, which help to reduce the magnitude of post-partum haemorrhage. Conversely, activated factor VII use should be restricted to situations where all other conventional treatments failed, as a last attempt to avoid hysterectomy. [Copyright &y& Elsevier]

Abstract (French): Résumé: L’hémorragie du post-partum est la première cause de mortalité maternelle en France. Outre la recherche et le traitement de la cause, sa prise en charge requiert essentiellement, l’association de médicaments pro-coagulants et la transfusion de produits sanguins labiles. Les situations à risque hémorragique majeur nécessitant le recours à la transfusion sont bien documentées, mais elles sont absentes chez un tiers des femmes effectivement transfusées. Ainsi, la prise en charge transfusionnelle est potentiellement nécessaire pour tout accouchement, même sans facteur de risque identifié préalablement. Le caractère souvent brutal de l’hémorragie du post-partum rend difficile une décision basée sur les résultats biologiques de concentration d’hémoglobine et de coagulation. Les concepts récents sur l’intérêt d’une transfusion précoce de plasma frais congelé pour, entre autres, mieux maîtriser la coagulopathie qui accompagne fréquemment un saignement important n’ont pas été établis dans des situations d’hémorragie du post-partum. Néanmoins, de nombreux arguments sont en faveur de cette approche, en respectant un ratio plasma frais congelé/concentré de globule rouges compris entre 1/1 et 1/2. Une fibrinolyse étant fréquemment associée à l’hémorragie du post-partum, la mesure de la concentration en fibrinogène est importante pour la prise en charge de l’hémorragie du post-partum, et pour décider de la poursuite de la transfusion de plasma frais congelé, voire de concentré de fibrinogène dont la place précise reste à définir. Les interventions médicamenteuses associées contribuent à cette prise en charge. En premier lieu, l’usage d’antifibrinolytiques (acide tranexamique) employés à titre préventif permet le plus souvent de réduire le syndrome hémorragique. Quant au facteur VII activé, il doit être réservé uniquement en cas d’échec des traitements d’hémostase conventionnels, mais si possible avant la réalisation d’une hystérectomie, et à condition que tous les traitements conventionnels aient été entrepris au préalable.

المؤلفون: Mirzamani, N.^1,2 nedamir19@yahoo.com, Molana, A.^1,2, Poorani, E.^1,2

المصدر: Transfusion & Apheresis Science. Apr2009, Vol. 40 Issue 2, p109-113. 5p.

مصطلحات موضوعية: *FROZEN blood, *BLOOD coagulation factors, *BLOOD coagulation disorders, *BLOOD coagulation tests, *MEDICAL practice, *HEMATOLOGY

مصطلحات جغرافية: IRAN

مستخلص: Abstract: Background: Fresh frozen plasma (FFP) is a major source of coagulation factor replacement therapy for patients with clotting factor deficiency. Although FFP is readily available for use in clinical practice its administration isn’t without risk. Studies on the use of FFP reveal that it is often overused or inappropriately used. We undertook an audit to assess the appropriateness of FFP transfusion in Gorgan’s hospitals. Methods: This was a retrospective, audit done at 5 hospitals in Gorgan city regarding the use of 1592 units of FFP issued to 346 patients from March 2006 to March 2007. The appropriateness of FFP transfusion was analyzed according to British Council for Standardization in Hematology (BCSH) Guidelines 2004. Results: In this audit we identified a high rate of inappropriate FFP usage (53% of transfusion episodes). Most ‘Inappropriate’ FFP usage occurred when there was active bleeding, with normal (or unmeasured) coagulation tests (30% of transfusion episodes). In only 66% of FFP-transfused patients were coagulation variable measured at any point in the hospital episode. Conclusion: Inappropriate usage of FFP is often seen in medical facility and the right solution is needed to curb the misuse of this component. Regular utilization audit can identify correctable errors in transfusion practices. Formal education programs and existing information on FFP use should be directed to professionals ordering FFP. [Copyright &y& Elsevier]

المؤلفون: Rumph, Brady, Bolliger, Daniel, Narang, Nikhil, Molinaro, Ross J., Levy, Jerrold H., Szlam, Fania, Tanaka, Kenichi A.

المصدر: Journal of Cardiothoracic & Vascular Anesthesia; Jun2010, Vol. 24 Issue 3, p408-412, 5p

مصطلحات موضوعية: HEMOSTATICS, WARFARIN, FIBRINOGEN polymorphisms, BLOOD plasma, BLOOD coagulation disorders, PLATELET aggregation inhibitors, COMPARATIVE studies, FROZEN blood

مستخلص: Objective: The authors hypothesized that various hemostatic products may differently affect viscoelastic clot formation depending on their respective procoagulant activity and fibrinogen content. Design: In vitro coagulopathy modeling using warfarin-treated plasma (international normalized ratio, 2.8-3.8) and fibrinogen-deficient plasma evaluated by rotational thromboelastometry (ROTEM; Pentapharm, Munich, Germany). Setting: A university laboratory. Intervention: Different volumes of cryoprecipitate, fresh frozen plasma (FFP), fibrinogen concentrate, and platelet concentrate were mixed with each abnormal plasma to simulate the in vivo transfusions of 250 mL to 1,000 mL. Three thromboelastometric variables that reflect the rate and extent of clot growth were measured: (1) coagulation time (CT), (2) angle, and (3) maximal clot firmness (MCF). Measurements and Main Results: In warfarin-treated plasma, the addition of FFP, cryoprecipitate, and platelets led to a dose-dependent improvement of CT and angle, whereas MCF increased with cryoprecipitate or platelets only. The addition of fibrinogen concentrate improved MCF and angle but not CT. In fibrinogen-deficient plasma, the addition of cryoprecipitate, platelets, and fibrinogen concentrate led to a dose-dependent improvement of ROTEM variables, whereas the addition of FFP resulted in significantly longer CT and lower MCF values compared with other hemostatic products. The addition of platelets in the presence of cytochalasin D (a platelet inhibitor) resulted in improvements of ROTEM variables that were similar to when FFP was added to warfarin-treated and fibrinogen-deficient plasma. Conclusions: Cryoprecipitate supports clot formation on ROTEM more efficiently than FFP because of the high fibrinogen content. Improved ROTEM variables after platelet addition are presumably caused by increased interaction among thrombin-activated platelets and fibrinogen. [Copyright &y& Elsevier]

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المؤلفون: Kor, Daryl J., Stubbs, James R., Gajic, Ognjen

المصدر: Best Practice & Research: Clinical Anaesthesiology; Mar2010, Vol. 24 Issue 1, p51-64, 14p

مصطلحات موضوعية: FROZEN blood, BLOOD coagulation, MEDICAL screening, HEMORRHAGE, BLOOD transfusion, BLOOD coagulation factors, WARFARIN, PATIENTS, BLOOD coagulation disorders, ANIMALS, ANTICOAGULANTS, BLOOD coagulation tests, BLOOD plasma, PERIOPERATIVE care, PREVENTION

مستخلص: Clinical studies support the use of perioperative fresh frozen plasma (FFP) in patients who are actively bleeding with multiple coagulation factor deficiencies and for the prevention of dilutional coagulopathy in patients with major trauma and/or massive haemorrhage. In these settings, current FFP dosing recommendations may be inadequate. However, a substantial proportion of FFP is transfused in non-bleeding patients with mild elevations in coagulation screening tests. This practice is not supported by the literature, is unlikely to be of benefit and unnecessarily exposes patients to the risks of FFP. The role of FFP in reversing the effects of warfarin anticoagulation is dependent on the clinical context and availability of alternative agents. Although FFP is commonly transfused in patients with liver disease, this practice needs broad reconsideration. Adverse effects of FFP include febrile and allergic reactions, transfusion-associated circulatory overload and transfusion-related acute lung injury. The latter is the most serious complication, being less common with the preferential use of non-alloimmunised, male-donor predominant plasma. FP24 and thawed plasma are alternatives to FFP with similar indications for administration. Both provide an opportunity for increasing the safe plasma donor pool. Although prothrombin complex concentrates and factor VIIa may be used as alternatives to FFP in a variety of specific clinical contexts, additional study is needed. [ABSTRACT FROM AUTHOR]

: Copyright of Best Practice & Research: Clinical Anaesthesiology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Sulemanji, Demet S.¹, Bloom, Jonathan D.², Dzik, Walter H.³, Jiang, Yandong¹ yjiang@partners.org

المصدر: Journal of Clinical Anesthesia. Aug2012, Vol. 24 Issue 5, p364-369. 6p.

مصطلحات موضوعية: *BLOOD transfusion, *BLOOD plasma, *FROZEN blood, *CARDIAC output, *HEMODYNAMICS, *CALCIUM

مستخلص: Abstract: Study Objectives: 1) To develop an in vitro system to simulate the kinetics of ionized calcium in mixed venous blood during rapid transfusion of fresh frozen plasma (FFP) and 2) to use the in vitro data to estimate the effect of the transfusion rate relative to cardiac output (CO) on ionized calcium. Design: Experimental study. Setting: Research laboratory of an academic hospital. Measurements: Citrated FFP was mixed with compatible heparinized whole blood at various volume ratios in vitro to simulate the mixed venous blood obtained at various flow ratios of FFP transfusion to the recipient’s venous system in vivo. Ionized calcium was measured after each mixture. Main Results: Mixing FFP and whole blood at volume ratios of 0:100, 5:95, 10:90, and 15:85 yielded ionized calcium levels (mean ± SD, mmol/L) of 1.23, 0.81 ± 0.02, 0.54 ± 0.08, and 0.34 ± 0.02, respectively. The 50% reduction in ionized calcium occurred at a volume ratio of 7:93. Conclusions: An instantaneous 50% reduction in ionized calcium occurs in vitro at a proportion equivalent to a transfusion rate of FFP representing 7% of CO. [Copyright &y& Elsevier]

العنوان البديل: Fresh frozen plasma and transfusional contribution in cardiac surgery (English)

المؤلفون: Nubret-le-Coniat, K., Marty, J.-C., Calderon, J., Pérez, P., Puntous, M., Janvier, G.

المصدر: IRBM; Jun2009 Supplement 1, Vol. 30, pS31-S34, 0p

مصطلحات موضوعية: BLOOD platelet transfusion, CARDIAC surgery, FROZEN blood, CARDIOPULMONARY bypass, SURGICAL hemostasis, HEMORRHAGE risk factors

الملخص (بالإنجليزية): Summary: During a cardiac act of surgery with cardiopulmonary bypass (CPB), the consecutive surgical lesions with the act of dissection and the contact of blood with thrombogenic surfaces involve an activation of the hemostasis and raise the hemorrhagic risk. The indications of the transfusion of fresh frozen plasma (FFP) in cardiac surgery are not consensual and very make to the object of argumentations “medico-surgical team dependant” related to complexity on the situation. In France, the decree of the 12/3/1991stipulates that “the use with the fine therapeutic ones of FFP is strictly reserved for the situations which it requires in an indisputable way”. If the major indication of FFP is limited to the treatment and the assumption of responsibility of the hemorrhages of medical causes, it proves that, in certain situations in cardiac surgery, the FFP are also used like products of filling. This complexity of approach of the transfusional practices explains the great disparity of regulations from one center to another like showed it the Plasmacard study. In this study, among the patients presenting a serious bleeding, 60 % of them received a transfusion of FFP with a median volume varying from 7.14ml/kg with 20.87ml/kg according to the centers. No clinical study showed that the prophylactic administration of FFP improves the hemostasis with the waning of a CPB. Nevertheless, the prescription of FFP associated or not with other hemostatic blood products, is recommended for any microvascular bleeding. These prescriptions aim to compensate a hemostatic failure which it is difficult to evaluate and to envisage by standardized procedures. [Copyright &y& Elsevier]

Abstract (French): Résumé: Au cours d’un acte de chirurgie cardiaque avec circulation extracorporelle (CEC), les lésions chirurgicales consécutives à l’acte de dissection et le contact du sang avec les surfaces thrombogènes entraînent une activation de l’hémostase et majorent le risque hémorragique. Les indications de la transfusion de plasma frais congelé (PFC) en chirurgie cardiaque ne sont pas consensuelles et font l’objet d’argumentations très « équipe médico-chirurgicale dépendante », liées à la complexité de la situation. En France, l’Arrêté du 03/12/1991 stipule que « l’utilisation à des fins thérapeutiques de PFC est strictement réservée aux situations qui l’exigent de façon indiscutables ». Si l’indication majeure de PFC est limitée au traitement et à la prise en charge des hémorragies de causes médicales, il s’avère que, dans certaines situations en chirurgie cardiaque, les PFC sont également prescrits comme produits de remplissage. Cette complexité d’approche des pratiques transfusionnelles explique la grande disparité de prescriptions d’un centre à l’autre comme l’a démontré l’étude Plasmacard. Dans cette étude, parmi les patients présentant un saignement grave, 60 % d’entre eux ont reçu une transfusion de PFC avec un volume médian variant de 7,14ml/kg à 20,87ml/kg selon les centres. Aucune étude clinique n’a démontré que l’administration prophylactique de PFC améliore l’hémostase au décours d’une CEC. Néanmoins, la prescription de PFC, associée ou non à d’autres produits sanguins hémostatiques, est recommandée pour tout saignement microvasculaire. Ces prescriptions ont pour objectif de suppléer un manquement hémostatique qu’il est difficile d’évaluer et de prévoir par des procédures standardisées.

: Copyright of IRBM is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Jones, Larry M.¹ Larry.jones@osumc.edu, Deluga, Nicholas² Nicholas.Deluga@osumc.edu, Bhatti, Puneet³ bhatti.16@buckeyemail.osu.edu, Scrape, Scott R.⁴ Scott.scrape@osumc.edu, Bailey, John K.¹ john.bailey@osumc.edu, Coffey, Rebecca A.¹ Rebecca.coffey@osumc.edu

المصدر: Burns (03054179). Mar2017, Vol. 43 Issue 2, p397-402. 6p.

مصطلحات موضوعية: *BURNS & scalds, *LUNG injuries, *BLOOD transfusion, *FROZEN blood, *RESUSCITATION, *BURNS & scalds complications, *TREATMENT for burns & scalds, *BLOOD plasma, *RED blood cell transfusion, *SHOCK (Pathology), *DISEASE incidence, *RETROSPECTIVE studies, *ACUTE diseases, *THERAPEUTICS

مصطلحات جغرافية: UNITED States

الشركة/الكيان: CANADIAN Blood Services

مستخلص: Introduction: Resuscitation from burn shock using fresh frozen plasma (FFP) has been described. Critics of FFP resuscitation cite the development of transfusion related acute lung injury (TRALI) as a deterrent to its use. This study examines the occurrence of TRALI with FFP resuscitation of critically ill burned patients.Methods: A retrospective chart review was conducted of severely burned patients who received FFP resuscitation. Data points included age, TBSA, TBSA full thickness, presence of alternate etiologies of acute lung injury, total FFP administered, and signs and symptoms of TRALI as defined per the Canadian Blood Services Consensus Conference.Results: Eighty-three patients met the definition of severe burn and received FFP resuscitation. Of those, 65 met exclusion criteria. Eighteen patients were left for analysis with only one found to have signs and symptoms of TRALI. That patient suffered a 53.5% TBSA burn, received a total of 6228ml FFP, had no competing etiologies of ALI, and was diagnosed with TRALI within 6h of completing the FFP transfusion.Conclusion: The possible occurrence of TRALI in burn patients receiving FFP resuscitation should be weighed against the reported benefits of such a resuscitation strategy. [ABSTRACT FROM AUTHOR]

المؤلفون: Johansson, Pär I.¹ per.johansson@rh.regionh.dk

المصدر: Transfusion & Apheresis Science. Dec2010, Vol. 43 Issue 3, p401-405. 5p.

مصطلحات موضوعية: *HEMOSTATICS, *ERYTHROCYTES, *BLOOD platelets, *FROZEN blood, *THROMBELASTOGRAPHY, *MORTALITY, *BLOOD transfusion, *BLOOD banks

مستخلص: Abstract: Background: Continued hemorrhage remains a major cause of mortality in massively transfused patients, many of whom develop coagulopathy. A review of transfusion practice for these patients at our hospital revealed that a significant proportion received suboptimal transfusion therapy. Survivors had higher platelets count than non-survivors. Methods: For massively transfused patients with hemodynamic instability, we introduced the concept of transfusion packages comprising five units of red blood cells, five units of fresh frozen plasma and two units of platelet concentrates. Thrombelastogram analysis was validated for routine laboratory use and implemented in the blood bank for monitoring coagulopathy and guiding transfusion therapy. Anaesthetists at our hospital were trained in functional haemostasis management based on analysis of thrombelastograms. Results: Intraoperative administration of transfusion packages for patients operated on for a ruptured abdominal aortic aneurysm was associated with a reduction in mortality from 56% to 34% (p =0.02). When comparing massively transfused patients treated with hemostatic control resuscitation, i.e., transfusion package therapy during hemodynamic instability and thromboelastogram – monitored and guided transfusion therapy, with controls treated in accordance with existing transfusion guidelines, mortality was reduced from 31% to 20% (p =0.002). Conclusion: The initiative from the blood bank, i.e., transfusion packages for patients with uncontrollable bleeding and based on the thromboelastogram when hemodynamic control is established, has improved the transfusion practice and survival in massively transfused patients at our hospital. [ABSTRACT FROM AUTHOR]

المؤلفون: Zhang, Li-Min¹ azai2010@126.com, Li, Rui¹, Zhao, Xiao-Chun², Zhang, Qian³, Luo, Xing-Liao⁴

المصدر: World Neurosurgery. Aug2017, Vol. 104, p381-389. 9p.

مصطلحات موضوعية: *BLOOD plasma, *BRAIN injuries, *BLOOD transfusion, *MORTALITY, *FROZEN blood

مستخلص: Background The fresh frozen plasma (FFP) transfusion threshold and timing for traumatic brain injury (TBI)-associated coagulopathy are controversial. Thus, a multicenter retrospective study was conducted to determine whether or not FFP transfusion is associated with poor outcomes after severe TBI. Methods Data from decompressive craniotomy after blunt force trauma that took place between December 2013 and June 2016 were collected in a multicenter chart. The primary outcomes were mortality and survival, as well as worse outcomes (defined as a Glasgow Outcome Scale [GOS] score ≤3) and better outcomes (GOS score ≥4). Secondary outcomes included 90-day survival rates in all patients with or without FFP transfusion, as well as length of hospital stay in patients with a better prognosis (GOS score ≥4). Univariate analysis, bivariate logistic regression, Spearman rank correlation, and Kaplan-Meier analysis were performed to account for the association between perioperative FFP transfusion and different outcomes. Results Bivariate logistic analysis showed that mortality and worse outcomes were correlated with FFP transfusion and Glasgow Coma Scale score ( P < 0.05). Kaplan-Meier analysis suggested that mortality was statistically higher in the FFP transfusion groups compared with the no FFP transfusion groups, regardless of the severity of TBI ( P < 0.05). The overall complications, acute respiratory distress syndrome, and pneumonia rate were significantly higher for patients receiving FFP transfusion ( P < 0.05). Conclusions Increased perioperative FFP infusion was independently associated with mortality or worse outcomes across a spectrum of surgical risk profiles. [ABSTRACT FROM AUTHOR]