Introduction
Currently greater than 94% of the US platelet supply is collected by apheresis. A survey to determine the attitudes of members of America's Blood Centers (ABC) toward whole blood derived ...(WBD) platelets was designed in light of current platelet supply issues.
Methods
An on‐line survey was distributed to medical directors of the 47 ABC members.
Results
Responses were received from 44/47 (94%) ABC members. There were 15/43 (35%) centers that are currently providing WBD platelets. Seventy percent of the respondents agreed or agreed strongly that WBD and apheresis platelets were clinically equivalent, with approximately 16% indicating that they did not have an opinion on their equivalency and 14% indicating that they were not clinically equivalent. Forty‐four percent of respondents felt that their customers would agree or strongly agree that these products are clinically equivalent, while 26% felt that their customers did not know or were neutral on clinical equivalency. The main barrier to WBD platelet implementation was logistic/inventory management issues, followed by bacterial contamination risk mitigation. There were 21/43 (49%) respondents who indicated they are not considering producing WBD platelets to mitigate shortages. Respondents indicated they might begin producing WBD platelets if there was evidence of increasing customer demand, increased reimbursement, inability to supply apheresis platelets, if pathogen reduction became available for WBD platelets, if the platelet shortage worsened.
Conclusions
The majority of blood collectors consider WBD platelets clinically equivalent to apheresis, however wider adoption of WBD platelets is still hindered by challenges with logistics and inventory management.
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BACKGROUND: In 2010, transfusion‐associated circulatory overload (TACO) was the second most common cause of transfusion‐related mortality reported to the Food and Drug Administration. We sought to ...determine the rate of TACO caused by plasma transfusion.
STUDY DESIGN AND METHODS: This study was conducted in two parts: 1) A retrospective analysis to determine the prevalence of TACO reactions caused by plasma at a tertiary care hospital from 2003 to 2010 was performed by analyzing the blood bank's electronic transfusion reaction records and 2) active surveillance of plasma recipients to determine if unreported TACO reactions had occurred over a 1‐month period at the same hospital.
RESULTS: Eighty‐seven reactions to plasma had been reported to the blood bank from 2003 through 2010. Of these reactions 23% (20/87) were TACO. The historical prevalence rate of TACO was 1 in 1566 (95% confidence interval CI, 1:2564‐1:1014). During the prospective 1‐month surveillance period, 84 patients received a total of 272 units of plasma, and four TACO reactions in separate patients (4.8%) were identified, none of which were reported to the blood bank. The prevalence rate of TACO in the prospective study was 1 in 68 (95% CI, 1:250‐1:27). In total, most patients (14/24) were in the intensive care unit when they experienced TACO and on average they had received 4.0 ± 2.3 units of plasma at an average rate of 647 ± 315 mL/hr before the TACO reaction.
CONCLUSIONS: Passive reporting of TACO grossly underestimates its actual prevalence. Educational efforts are needed to enhance physician recognition of TACO reactions.
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The aim of this study was to assess the survival impact of low-titer group O whole blood (LTOWB) in injured pediatric patients who require massive transfusion.
Limited data are available regarding ...the effectiveness of LTOWB in pediatric trauma.
A prospective observational study of children requiring massive transfusion after injury at UPMC Children's Hospital of Pittsburgh, an urban academic pediatric Level 1 trauma center. Injured children ages 1 to 17 years who received a total of >40 mL/kg of LTOWB and/or conventional components over the 24 hours after admission were included. Patient characteristics, blood product utilization and clinical outcomes were analyzed using Kaplan-Meier survival curves, log rank tests and Cox proportional hazards regression analyses. The primary outcome was 28-day survival.
Of patients analyzed, 27 of 80 (33%) received LTOWB as part of their hemostatic resuscitation. The LTOWB group was comparable to the component therapy group on baseline demographic and physiologic parameters except older age, higher body weight, and lower red blood cell and plasma transfusion volumes. After adjusting for age, total blood product volume transfused in 24 hours, admission base deficit, international normalized ratio (INR), and injury severity score (ISS), children who received LTOWB as part of their resuscitation had significantly improved survival at both 72 hours and 28 days post-trauma adjusted odds ratio (AOR) 0.23, P = 0.009 and AOR 0.41, P = 0.02, respectively; 6-hour survival was not statistically significant (AOR = 0.51, P = 0.30). Survivors at 28 days in the LTOWB group had reduced hospital LOS, ICU LOS, and ventilator days compared to the CT group.
Administration of LTOWB during the hemostatic resuscitation of injured children requiring massive transfusion was independently associated with improved 72-hour and 28-day survival.
Background
Low‐titer group O whole blood (LTOWB) use is increasing due to data suggesting improved outcomes and safety. One barrier to use is low availability of RhD‐negative LTOWB. This survey ...examined US hospital policies regarding the selection of RhD type of blood products in bleeding emergencies.
Study Design and Methods
A web‐based survey of blood bank directors was conducted to determine their hospital's RhD‐type selection policies for blood issued for massive bleeding.
Results
There was a 61% response rate (101/157) and of those responses, 95 were complete.
Respondents indicated that 40% (38/95) use only red blood cells (RBCs) and 60% (57/95) use LTOWB. For hospitals that issue LTOWB (N = 57), 67% are supplied only with RhD‐positive, 2% only with RhD‐negative, and 32% with both RhD‐positive and RhD‐negative LTOWB. At sites using LTOWB, RhD‐negative LTOWB is used exclusively or preferentially more commonly in adult females of childbearing potential (FCP) (46%) and pediatric FCP (55%) than in men (4%) and boys (24%). RhD‐positive LTOWB is used exclusively or preferentially more commonly in men (94%) and boys (54%) than in adult FCP (40%) or pediatric FCP (21%). At sites using LTOWB, it is not permitted for adult FCPs at 12%, pediatric FCP at 21.4%, and boys at 17.1%.
Conclusion
Hospitals prefer issuing RhD‐negative LTOWB for females although they are often ineligible to receive RhD‐negative LTOWB due to supply constraints. The risk and benefits of LTOWB compared to the rare occurrence of hemolytic disease of the fetus/newborn (HDFN) need further examination in the context of withholding a therapy for females that has the potential for improved outcomes.
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The transfusion of cold-stored uncrossmatched whole blood (WB) has not been extensively used in civilian trauma resuscitation. This report details the initial experience with the safety and ...feasibility of using WB in this setting after a change of practice at a Level 1 trauma center was instituted.
Up to two units of uncrossmatched group O positive WB that was leukoreduced using a platelet-sparing filter from male donors were transfused to male trauma patients with hypotension secondary to bleeding. Hemolytic marker haptoglobin and reports of transfusion reactions in these patients were followed. Additionally, transfusion volumes and outcomes were compared to a historical cohort of male trauma patients who received at least one red blood cell (RBC) unit, but not WB, during the first 24 hours of admission.
There were 47 WB patients who were transfused with a mean (SD) of 1.74 (0.61) WB units. The median haptoglobin concentration on post-WB transfusion Day 1 was 25.1 (9.3) mg/dL in 7 of 30 non-group O recipients. No adverse reactions in temporal relation to the WB transfusions were reported. There were 145 male historical control patients identified who were resuscitated with component therapy; the median volume of incompatible plasma transfused to the WB versus component therapy group was not significantly different (1,000 vs. 800 mL, respectively; p = 0.38); the mean plasma:RBC (0.99 0.47 vs. 0.77 0.73, respectively; p = 0.006) and platelet:RBC (0.72 0.40 vs. 0.51 0.734, respectively; p < 0.0001) ratios were significantly higher in the WB group.
Transfusion of two units of cold-stored uncrossmatched WB is feasible and seems to be safe in civilian trauma resuscitation. Determining the efficacy of WB with regard to reducing the number of blood products transfused in the first 24 hours or improving recipient survival will require a larger randomized trial.
Therapeutic study, level IV.
Raising the standards on whole blood Yazer, Mark H; Cap, Andrew P; Spinella, Philip C
The journal of trauma and acute care surgery,
06/2018, Volume:
84, Issue:
6S Suppl 1
Journal Article
Background
The effect of major trauma on subsequent fertility is poorly described. If women have lower fertility after trauma, they would have a lower risk of anti‐D mediated hemolytic disease of the ...fetus and newborn in a future pregnancy following the transfusion of RhD‐positive blood to RhD‐negative women during their resuscitation.
Study Design and Methods
Data was obtained from the Care Register for Health Care, National Medical Birth Register, and open access data from Statistic Finland to evaluate the effect of major trauma (traumatic brain injuries, spine, pelvic, hip/thigh fractures) on the age‐specific number of births during years 1998–2018. The total number of births before a specific maternal age for different trauma populations was calculated and these were compared to the corresponding number of births in the general population.
Results
There were 50,923 injured women in this study. All injured women, including when analyzed by the nature of their injury, demonstrated lower expected numbers of births starting at approximately 28 years of age compared to the general population of women in Finland. At age 49, the expected number of births in the general population was approximately 1.8, whereas for all injured women 0.6, women with TBIs and spine fractures 0.6, women with pelvic fractures 0.5, and women with hip or thigh fractures 0.3.
Discussion
Injured women are predicted to have lower fertility rates compared to the general population of Finnish women. The lower fertility rate should be considered when planning a blood product resuscitation strategy for injured women.
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