Transfusion
-
The majority of fresh-frozen plasma (FFP) is transfused in the United States in the management of acquired bleeding disorders. The prothrombin time (PT), and its derivative the international normalized ratio (INR), is the most common test used to detect the presence and gauge the severity of these disorders. Observation studies have shown that the PT correlates poorly with clinical bleeding and that transfusion of plasma often achieves no measurable change in the INR nor is of any known clinical benefit. ⋯ A program of engagement and interdiction using evidence-based guidelines can successfully decrease the use of FFP without any observable increase in unexpected bleeding.
-
Review Case Reports
Nonlethal, attenuated, transfusion-associated graft-versus-host disease in an immunocompromised child: case report and review of the literature.
Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare complication of transfusion of nonirradiated blood components. It usually affects children in high-risk groups, including those who have primary immunodeficiencies (PIDs). It usually presents with skin, hepatic, digestive, and hematologic involvement and is normally fatal. ⋯ A high index of suspicion is required for the diagnosis and proper management of PID. The administration of nonirradiated blood components in the first year of life, sometimes before the clinical suspicion of a PID, is of great concern. TA-GVHD may be more prevalent than reported in the literature and it is possibly a nonidentified cause of death in recipients with unexplained death and nondiagnosed PID.
-
Management of severe symptomatic anemia is exceptionally challenging when blood transfusions cannot be administered. Use of hemoglobin (Hb)-based oxygen carriers as "bridging treatment" can be an option. ⋯ This report documents the successful management of profound anemia in an acute leukemia patient who refused blood transfusion, with the use of Hemopure, to save the patient from the devastating effects of ischemia associated with severe anemia. Hemopure may represent a life-saving intervention in patients with severe symptomatic anemia when blood transfusion is not an option.
-
Review Meta Analysis Comparative Study
The effect of plasma transfusion on morbidity and mortality: a systematic review and meta-analysis.
Plasma transfusion is increasingly performed without clear consensus on indications. We systematically reviewed the literature to summarize the available evidence regarding the benefits and harms of plasma transfusion in common clinical settings. ⋯ Very-low-quality evidence suggests that plasma infusion in the setting of massive transfusion for trauma patients may be associated with a reduction in the risk of death and multiorgan failure. A survival benefit was not demonstrated in most other transfusion populations.