Transfusion
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Randomized Controlled Trial
A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints.
Most neonates less than 1.0 kg birth weight need red blood cell (RBC) transfusions. Delayed clamping of the umbilical cord 1 minute after delivery transfuses the neonate with autologous placental blood to expand blood volume and provide 60 percent more RBCs than after immediate clamping. This study compared hematologic and clinical effects of delayed versus immediate cord clamping. ⋯ Although a 1-minute delay in cord clamping significantly increased RBC volume/mass and Hct, clinical benefits were modest. Clinically significant adverse effects were not detected. Consider a 1-minute delay in cord clamping to increase RBC volume/mass and RBC iron, for neonates 30 to 36 weeks' gestation, who do not need immediate resuscitation.
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Current red blood cell (RBC) transfusion guidelines assume that most acutely anemic patients can tolerate hemoglobin (Hb) concentrations as low as 6.0 to 7.0 g per dL and recommend that range as the transfusion threshold in patients who have no overt signs of organ dysfunction. Nonetheless, "normal" Hb concentrations vary widely in the population, and this variability may influence patients' tolerance of acute anemia. This retrospective cohort study was carried out to test this hypothesis. ⋯ The degree of acute anemia that patients can safely tolerate during cardiac surgery is inversely related to their baseline Hb concentration. Current transfusion guidelines do not account for this relationship.
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Randomized Controlled Trial
Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied.
In total knee arthroplasty surgery, a blood conservation program is applied as a normal clinical practice to avoid allogenic transfusions. The objective of this study was to assess the effectiveness of tranexamic acid to reduce transfusions in total knee replacement even when a blood conservation program is applied. ⋯ Tranexamic acid reduces blood losses and transfusion requirements even when a blood conservation program was used and it questions the usefulness of the postoperative reinfusion drains.
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Comparative Study Clinical Trial
Perioperative management of aspirin resistance after off-pump coronary artery bypass grafting: possible role for aprotinin.
Aspirin is the only drug proven to reduce saphenous vein graft (SVG) failure, but aspirin resistance (ASA-R) frequently occurs after off-pump coronary artery bypass grafting (OPCAB). The factors, mechanism, and best means for preventing and/or treating ASA-R have not been established. This study hypothesizes that thrombin production during OPCAB stimulates this acquired ASA-R. ⋯ ASA-R is a common post-OPCAB event whose frequency may be reduced by intraoperative use of aprotinin, possibly via TF and thrombin suppression. Improved perioperative PLT function after OPCAB may also inadvertently enhance the clinical relevance of these potential antithrombotic effects.
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The rapid provision of red cell (RBC) units to patients needing blood urgently is an issue of major importance in transfusion medicine. The development of electronic issue (sometimes termed "electronic crossmatch") has facilitated rapid provision of RBC units by avoidance of the serologic crossmatch in eligible patients. A further development is the issue of blood under electronic control at blood refrigerator remote from the blood bank. ⋯ This study evaluated a combination of remote blood issue with an end-to-end electronically controlled hospital transfusion process, ERBI. ERBI reduced the time to make blood available for surgical patients and improved the efficiency of hospital transfusion.