Transfusion
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Excessive use of blood components during liver transplantation should be avoided because it has been associated with poor outcomes and it may stress blood bank resources. ⋯ Liver donor's age and recipient's SCr are important in preoperatively predicting blood use during liver transplantation.
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Despite evidence supporting the use of restrictive hemoglobin (Hb) transfusion triggers in critically ill patients, translation of this evidence into practice remains inconsistent. It was hypothesized that clinicians believe that longer-term ventilated patients require a higher Hb, particularly when ischemic heart disease coexists. ⋯ In response to scenarios, clinicians in the United Kingdom believe that a more liberal transfusion practice is required for patients failing weaning trials after 6 days of mechanical ventilation than the current evidence base supports.
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Trauma patients are at risk of developing an acute coagulopathy of trauma (ACT) related to tissue injury, shock, and hemodilution. ACT is incompletely understood, but is similar to disseminated intravascular coagulation (DIC) and is associated with poor outcome. ⋯ Thrombin generation studies indicate that Trauma with ACT patients show dysregulated hemostasis characterized by excessive non-wound-related thrombin generation due to a combination of circulating procoagulants capable of activating coagulation systemically and reduced inhibitor levels allowing systemic thrombin generation to continue once started.
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Randomized Controlled Trial
Impact of fresh-frozen plasma from male-only donors versus mixed-sex donors on postoperative respiratory function in surgical patients: a prospective case-controlled study.
To reduce the risk of transfusion-related acute lung injury (TRALI), plasma products are mainly made from male donors in some countries because of the lower possibility of alloimmunization; other countries are considering this policy. The advantage of male-only fresh-frozen plasma (FFP) should be examined in a prospective case-control study. ⋯ Our data suggests that the use of FFP derived from male donors may be advantageous for posttransfusion pulmonary function, although PD is also determined by background characteristics.