Transfus Apher Sci
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Two decades of war in south-west Asia has demonstrated the essential role of primary resuscitation with blood products in the care of critically injured soldiers. This idea has been widely adopted and is being critically tested in civilian trauma centers. The need for red cells, plasma and platelets to be immediately available in remote locations creates a logistic burden that will best be eased by innovative new blood products such as longer-stored liquid RBCs, freeze-dried plasma, small-volume frozen platelets, and coagulation factor concentrates such as fibrinogen concentrates and prothrombin complex concentrates. ⋯ It also will allow treatment in other austere environments such as the hundreds of small hospitals in the US which serve as Levels 3 and 4 trauma centers but do not currently have thawed plasma or platelets available. Such small trauma centers currently care for half of all the trauma patients in the country. Proving the new generation of blood products work, will help assure their widest availability in emergencies.
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Comparative Study
Results of a preoperative autologous blood donation program for patients undergoing elective major spine surgery.
Spinal surgery has been shown to have a high blood transfusion requirement. Preoperative autologous blood donation (PABD) is a strategy to reduce the allogeneic transfusions in this subset of patients. ⋯ The preoperative autologous blood donation program designed in our hospital was effective for reducing allogeneic transfusion in mostly young patients under major elective spinal surgery. However and as expected, their inclusion in the program increased the risk to be transfused.
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Randomized Controlled Trial
The effects of non-leukoreduced red blood cell transfusions on microcirculation in mixed surgical patients.
The impact of the storage process on oxygen-carrying properties of red blood cells and the efficacy of red blood cell (RBC) transfusions concerning tissue oxygenation remain an issue of debate in transfusion medicine. Storage time and leukocyte content probably interact since longer storage duration is thought to cause greater accumulation of leukocyte-derived cytokines and red blood cell injury. ⋯ Fresh non-leukoreduced RBC transfusions but not RBCs stored for more than 3weeks, were effective in improving microciruculatory perfusion by elevating the number of perfused microvessels in mixed surgical patients.
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We report a case of refractory heparin-induced thrombocytopenia with thrombosis (HITT) with prolonged thrombocytopenia and multiple thrombotic complications that failed to improve despite aggressive treatment. A 60 year old female with a prior history of venous thromboembolism was admitted with an acute pulmonary embolism, and developed HITT after several days on heparin therapy. ⋯ She eventually required bilateral limb amputation, and only after removal of the gangrenous limbs did her platelet count show sustained improvement. We discuss the possible contribution of infection to her prolonged course.
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Therapeutic plasma exchange is established treatment for patients with thrombotic thrombocytopenic purpura (TTP) and for refractory cases immunosuppressive therapy can also be considered. We present a refractory case of TTP which was managed with therapeutic plasma exchange and rituximab.