Transfus Apher Sci
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This paper describes the history and pathogenesis of TRALI and illustrates this with personal experience of the condition over 15 years at a single hospital. It discusses the contribution of transfusion to ALI seen in critically ill patients, and the effect of preventative measures taken in the UK.
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The epidemiology of red cell transfusion is changing. Surgical use has decreased due to reduced transfusion triggers and better operative techniques. ⋯ The evidence for and against transfusion at different levels of anaemia is discussed. The appropriate level of haemoglobin at which to recommend transfusion depends on the indication for transfusion, the patient's co-morbidities and the quality of the red cells available.
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More than 50% of all red cells are used to treat patients who are hemorrhaging either due to spontaneous bleeding, trauma or surgery and all platelet products and most plasma is given to prevent or treat bleeding patients. Therefore, knowledge of hemostasis is important to transfusion medicine specialists. There are three requirements to function in this capacity. One, understand the test used to assess hemostasis; two: understand the composition of blood components thoroughly and three, have a knowledge of the clinical studies in which hemostasis risk was assessed using tests of hemostasis and the clinical utility of blood components in bleeding risk attenuation.
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We investigated the effect of administering a transfusion package encompassing 5 red blood cells (RBC), 5 fresh frozen plasma (FFP), and 2 platelet concentrates (PC) on clot formation and stability as evaluated by Thrombelastograph (TEG) in 10 patients presenting with massive bleeding. Blood was obtained before and after administering the transfusion packages. ⋯ In 8 patients damage control surgery was successful and 6 of these patients survived. The result indicates that an early balanced transfusion strategy maintains haemostatic competence in massively bleeding patients.
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Apheresis is used as therapeutic approach to improve outcome of patients with severe sepsis, septic shock and multi organ dysfunction syndrome. The concept is to reduce the extent of toxins and cytokines as well as other activators of the various cascade systems. In addition the replacement of plasma, in some of the protocols, helps to substitute with substances that are consumed/complex bound by the inflammatory reactions during the severe clinical condition. This article reviews literature in the field of adsorption technologies as well as plasma exchange techniques.