In June 2011 the Canadian National Advisory Committee on Blood and Blood Products sponsored an international consensus conference on transfusion and trauma. A panel of 10 experts and two external ...advisors reviewed the current medical literature and information presented at the conference by invited international speakers and attendees. The Consensus Panel addressed six specific questions on the topic of blood transfusion in trauma. The questions focused on: ratio-based blood resuscitation in trauma patients; the impact of survivorship bias in current research conclusions; the value of nonplasma coagulation products; the role of protocols for delivery of urgent transfusion; the merits of traditional laboratory monitoring compared with measures of clot viscoelasticity; and opportunities for future research. Key findings include a lack of evidence to support the use of 1:1:1 blood component ratios as the standard of care, the importance of early use of tranexamic acid, the expected value of an organized response plan, and the recommendation for an integrated approach that includes antifibrinolytics, rapid release of red blood cells, and a foundation ratio of blood components adjusted by results from either traditional coagulation tests or clot viscoelasticity or both. The present report is intended to provide guidance to practitioners, hospitals, and policy-makers.
PURPOSE OF REVIEWThe purpose of this review is to provide an overview of concepts recently presented in the literature that impact our understanding of transfusion related acute lung injury (TRALI) ...and transfusion associated circulatory overload (TACO), and how to distinguish between the two disorders.
RECENT FINDINGSAn exceptionally clear review article by Brux and Sachs clarified the two-hit model of TRALI pathogenesis. The TRALI definition developed at the 2004 consensus conference helped demonstrate that TRALI is likely underreported. Brain natriuretic peptide can be useful in distinguishing cardiogenic from noncardiogenic pulmonary edema. Blood centers are implementing male predominant plasma programs to limit TRALI, and preliminary evidence suggests that this is a useful intervention.
SUMMARYTACO and TRALI have emerged as important causes of posttransfusion morbidity and mortality. As understanding of their pathogenesis improves, incidence, risk factors, differences, and possible preventive interventions are becoming clearer. There is no sentinel feature that distinguishes TRALI from TACO. Developing a thorough clinical profile including presenting signs and symptoms, fluid status, cardiac status including measurement of brain natriuretic peptide, and leukocyte antibody testing is the best strategy currently available to distinguish the two disorders.
BACKGROUND
Cryopreserved red blood cell concentrates (RCCs) are often required for patients with rare blood groups. Although transfusions from blood relatives are irradiated before transfusion, ...research has yet to make clear if this is necessary in cryopreserved RCCs. Given insufficient evidence to the contrary, irradiation of cryopreserved RCCs has been recommended, but the effect of irradiation timing is unknown. Therefore, this study was performed to assess the effect of RCC irradiation pre‐ and postcryopreservation on RCC quality.
STUDY DESIGN AND METHODS
Nine whole blood units from healthy donors were processed into RCCs using the buffy coat method. ABO‐ and Rh‐matched units were pooled and split into three groups: precryopreservation irradiation (pre‐CIG), postcryopreservation irradiation (post‐CIG), and nonirradiated controls. Hemoglobin, hematocrit, white blood cell (WBC) count, extracellular potassium, mean cell volume, red blood cell (RBC) morphology, and RBC deformability were measured.
RESULTS
Extracellular potassium was greater in the irradiated conditions when compared to the nonirradiated controls and was greater in the post‐CIG group when compared to the pre‐CIG group (p < 0.05). WBC counts decreased after cryopreservation in all groups to values lower than the sensitivity of the assay. RBC deformability was greater in the post‐CIG group when compared to the pre‐CIG group and control group. No other significant differences were observed between groups.
CONCLUSION
Irradiation of RCCs can be performed pre‐ or postcryopreservation with little effect on the RCC product, as both irradiated groups resulted in RCCs that were comparable to the nonirradiated cryopreserved RCCs.
Iron deficiency anemia (IDA) accounts for the majority of anemia cases across the globe and can lead to impairments in both physical and cognitive functioning. Oral iron supplementation is the first ...line of treatment to improve the hemoglobin level for IDA patients. However, gaps still exist in understanding the appropriate dosing regimen of oral iron. The current trial proposes to evaluate the feasibility of performing this study to examine the effectiveness and side-effect profile of oral iron once daily versus every other day.
In this open-label, pilot, feasibility, randomized controlled trial, 52 outpatients over 16 years of age with IDA (defined as hemoglobin < 12.0 g/dL in females and < 13.0 g/dL in males and ferritin < 30 mcg/L) will be enrolled across two large academic hospitals. Participants are randomized in a 1:1 ratio to receive 300 mg oral ferrous sulfate (60 mg of elemental iron) either every day or every other day for 12 weeks. Participants are excluded if they are as follows: (1) pregnant and/or currently breastfeeding, (2) have a disease history that would impair response to oral iron (e.g., thalassemia, celiac disease), (3) intolerant and/or have an allergy to oral iron or vitamin C, (4) on new anticoagulants in the past 6 months, (5) received IV iron therapy in the past 12 weeks, (6) have surgery, chemotherapy, or blood donation planned in upcoming 12 weeks, (7) a creatinine clearance < 30 mL/min, or (8) hemoglobin less than 8.0 g/dL with active bleeding. The primary outcome is feasibility to enroll 52 participants in this trial over a 2-year period to determine the effectiveness of daily versus every other day oral iron supplementation on hemoglobin at 12 weeks post-initiation and side-effect profile.
The results of this trial will provide additional evidence for an appropriate dosing schedule for treating patients with IDA with oral iron supplementation. Additional knowledge will be gained on how the dosing regimen of oral iron impacts quality of life and hemoglobin repletion in IDA patients. If this trial is deemed feasible, it will inform the development and implementation of a larger multicenter definitive trial.
ClinicalTrials.gov: NCT03725384 . Registered 31 October 2018.
We conducted a reliability study comparing single data entry (SE) into a Microsoft Excel spreadsheet to entry using the existing forms (EF) feature of the Teleforms software system, in which optical ...character recognition is used to capture data off of paper forms designed in non-Teleforms software programs. We compared the transcription of data from multiple paper forms from over 100 research participants representing almost 20,000 data entry fields. Error rates for SE were significantly lower than those for EF, so we chose SE for data entry in our study. Data transcription strategies from paper to electronic format should be chosen based on evidence from formal evaluations, and their design should be contemplated during the paper forms development stage.
Summary
Individuals with lupus anticoagulants (LA) are at risk for thromboembolism(TE). Chronic inflammation is an important characteristicin LA patients which may dispose for TE. Platelets play akey ...role in inflammation and TE. We therefore investigated genepolymorphisms as well as plasma levels of platelet receptors aspredictors of TE in 107 LA patients. We compared 74 patientswith a history of thromboembolic disease (TE+),56 with venousthrombosis (VT), 12 with arterial thrombosis (AT), and six patientswho had both, with 33 LA patients without previousthrombosis (TE-).The P-selectin Pro715 allele was slightly morefrequent inVT (OR=3.167,95 % CI 0.955–10.503;p=0.0594),butno patient with AT had this allele (OR=0.099, 95 % CI0.001–0.790; p=0.0238) which therefore may protect from AT. Plasma levels of P-selectin, collected a median of 35 months(range 2–329 months) after the last thrombotic event, werehigher in patients withVT (p=0.0096) than inTE-,but not withAT(p=0.4713).These high P-selectin levels were not explained bythe P-selectin polymorphism. The CA repeat polymorphism inthe 3’-noncoding region of CD154 was significantly associatedwith the development of AT (OR=4.035, 95 % CI 1.329–12.249;p=0.0138). Plasma levels of CD154 were not significantly differentamong the subgroups. Thus, theThr715Pro polymorphism ofP-selectin and CA repeats of CD154 are differentiating betweenthe risk for VT and AT. Further, soluble P-selectin is elevated inLA patients with previousVT, but its role to predictVT needs to be evaluated in prospective studies.
This is the second published case report of Lleuprolide acetate for depot suspension (LD)-induced mania. Both reports detail a patient with a prior psychiatric history of both depressive and ...hypomanic episodes. While depression is a predictable and documented side effect of LD and menopause (especially in those with a previoushistory of symptoms), manic reactions are rare and unexplained. Possible causative mechanismsbehind the LD-induced manic episodes are discussed, and we suggest that patients with a single previous hypomanic episode are at risk for LD-induced mania.
Summary We developed a personal digital assistant–based knowledgebase of surgical pathology report content recommendations and performed an experimental trial to test if the knowledgebase improved ...report completeness. The 15 experimental group and 13 control group residents were given microscope slides and corresponding reports with the final diagnosis section blanked-out, and were asked to complete the final diagnosis section during 3 study episodes (T0, T1, and T2). At T0 (baseline), experimental group and control group produced reports of comparable completeness. During T1, experimental group was allowed to use the knowledgebase while completing reports. During T1, experimental group produced more complete reports and were better judges of report completeness than control group. At T2, when neither group used the knowledgebase, experimental group's performance was still statistically better than control group's. Use of the knowledgebase did not ensure report completeness, but was associated with more complete reports and more accurate judgments of report completeness, and this performance advantage persisted in the absence of the knowledgebase.
PDF
