Transfusion medicine
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Cryoprecipitate is an allogeneic blood product prepared from human plasma. It contains factors VIII, von Willebrand factor (vWF), fibrinogen, fibronectin and factor XIII. Its use was first described in the 1960s for treatment of patients with factor VIII deficiency. ⋯ Now, the most common use of cryoprecipitate is fibrinogen replacement in patients with acquired hypofibrinogenaemia and bleeding. Despite almost 50 years of use, evidence of efficacy is limited. This review provides an overview of the history of cryoprecipitate use, the current debates on the use of this product and future developments.
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Transfusion medicine · Jun 2012
Review Meta AnalysisThe use of trauma transfusion pathways for blood component transfusion in the civilian population: a systematic review and meta-analysis.
This study was undertaken to determine if, amongst civilian trauma patients requiring massive transfusion (MT), the use of a formal trauma transfusion pathway (TTP), in comparison with transfusion without a TTP, is associated with a reduction in mortality, or changes in indices of coagulation, blood product utilisation and complications. A systematic review of three bibliographic databases, reference lists and conference proceedings was conducted. Studies were included if comparisons were made between patients receiving transfusion with and without a TTP. ⋯ In summary, the use of TTPs appears to be associated with a reduction in mortality amongst trauma patients requiring MT without a clinically significant increase in the number of PRBC transfused and a potential reduction in plasma transfusion. Effects of TTPs on platelet transfusion, indices of coagulation and complications remain unclear. A randomised controlled trial is warranted.
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Transfusion medicine · Aug 2008
ReviewFresh blood for everyone? Balancing availability and quality of stored RBCs.
Effective, prolonged ex vivo storage of red blood cells is an essential requirement for inventory management of each nation's blood supply. Current blood storage techniques are the development of a century of research. Blood undergoes metabolic and structural deterioration during prolonged ex vivo storage. ⋯ Here, we critically examine the details of the above-mentioned study. Numerous substantial flaws in data analysis and presentation may have led to an erroneous conclusion about the effect of blood storage age and perioperative mortality. Given the fundamental importance of a safe and adequate blood supply to national healthcare, the question of the proper storage age for blood should be studied using a prospective study design.
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Modern warfare causes severe injuries, and despite rapid transportation to theater regional trauma centers, casualties frequently arrive coagulopathic and in shock. Conventional resuscitation beginning with crystalloid fluids to treat shock causes further dilutional coagulopathy and increased hemorrhagic loss of platelets and coagulation factors. Established coagulopathy was difficult to reverse in the face of uncontrolled hemorrhage. ⋯ Retrospective assessments of this 1:1 therapy strongly suggested that it resulted in improved hemostasis, shorter ventilator times, and improved survival. Component therapy, when available, appears to be as effective as fresh whole blood. In field emergencies, fresh whole blood can be lifesaving.
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Transfusion medicine · Dec 2007
ReviewTransfusion-transmitted infections among multitransfused patients in Iran: a review.
Transfusion-transmitted infections (TTI) continue to be a major challenge for Blood transfusion organizations across the world. The problem is more serious in the developing countries with lower economic means. ⋯ The present article reviews the situation in Iran, where prevalence of the major viruses of concern, namely, hepatitis B virus, hepatitis C virus (HCV) and human immunodeficiency virus, studied in these patients is reported over a 9-year period. It is demonstrated that HCV is the most prevalent TTI and remains a major health problem for these patients.