Transfusion medicine reviews
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Recent evidence points to isolated deficiency of the largest multimers of von Willebrand factor (VWF)-known as von Willebrand syndrome type 2A (VWS-2A)-as a risk factor for bleeding from gastrointestinal (GI) angiodysplasia. This disorder is not widely recognized, perhaps because most patients do not exhibit generalized hemostatic impairment (bleeding is generally restricted to GI angiodysplasia) and because all but the largest multimers of VWF remain detectable in the plasma (thus, routine screening tests for VWS-2A are usually normal). ⋯ We critically review the evidence implicating VWS-2A as a risk factor for bleeding GI angiodysplasia. We hypothesize that VWS-2A secondary to cardiovascular disease other than severe aortic stenosis, such as peripheral arterial occlusive disease, could explain why elderly patients often develop recurrent GI bleeding or iron deficiency anemia from GI angiodysplasia.
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Coagulopathy in patients with severe trauma is related to platelet and coagulation factor loss, consumption, and dysfunction. It is exacerbated by dilution, acidosis, and hypothermia. Hemorrhage control, warming, and appropriate blood product support are lifesaving. Further improvements in hemorrhage control will save additional lives and resources.
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There is evidence to suggest that there exists considerable variation in red blood cell (RBC) transfusion practices, especially in the surgical specialties. This is in large part related to difficulties in defining specific transfusion threshold criteria, given that there is no minimum acceptable hemoglobin threshold concentration and there is variability in assigning importance to patient factors. The purpose of this study is to identify patient-related factors that might be associated with the need for allogeneic RBC transfusion in surgical patients. ⋯ This systematic review shows that preoperative anemia, advancing age, female gender, and small body size are often associated with perioperative allogeneic RBC transfusion. However, the retrospective nature of most of the studies and the small sample sizes make it difficult to formulate a clinically useful prediction rules regarding allogeneic RBC transfusion. Ongoing research in designing large prospective cohort studies evaluating transfusion patterns are needed to further elucidate how patient characteristics impact the transfusion threshold.
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Review Meta Analysis Comparative Study
Transfusion triggers: a systematic review of the literature.
Most clinical practice guidelines recommend restrictive red blood cell (RBC) transfusion practices with the goal of minimizing transmission of blood-borne pathogens. The purpose of this review is to compare clinical outcomes in patients randomized to restrictive versus liberal transfusion thresholds (triggers). We conducted a search of OVID Medline, Current Contents, the Cochrane Library, and bibliographies of published studies. ⋯ However, most of the data on clinical outcomes were generated by a single trial. The effects of conservative transfusion triggers on functional status, morbidity, and mortality, particularly in patients with cardiac disease, need to be tested in further large clinical trials. In countries with inadequate screening of donor blood, the data may constitute a stronger basis for avoiding transfusion with allogeneic RBCs.
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Babesiosis is an emerging zoonotic disease that has begun to have a noticeable impact on transfusion medicine. This is reflected in the growing medical literature on the topic. There has been no review to summarize the various ways in which babesiosis influences transfusion medicine. ⋯ Despite the development of novel and improved diagnostic tests, these tests are not readily available for the mass screening of blood donors. Improved strategies to assess and prevent transfusion-associated babesiosis are required. Current measures cannot be relied on to identify infected donors with a high degree of sensitivity or to protect susceptible recipients from this parasite.