bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraoperative Autotransfusion of RBC and PRP
Authors: Gombotz Hans , Kulier Alexander 
Published: February 2008

SUMMARYWhen IAT is used, the patient's shed blood is collected continuously from the wound site during surgery. The salvaged red cells are stored in a dedicated reservoir and subsequently processed by cell separation (continuous centrifugation), washed with saline, concentrated and retransfused to the patient. In the context of perioperative blood saving strategies, IAT has gained standard‐of‐care status in many surgical procedures as it is especially cost‐effective when the anticipated intraoperative blood loss is likely to exceed 1000 mL (major orthopedic, cardiac, vascular and emergency trauma surgery). IAT is not primarily recommended for cancer surgery or whenever the operative field is contaminated.Intraoperative plasmapheresis (IP) is used in cardiac surgery to minimize coagulation deficiencies caused by the traumatizing effects of cardiopulmonary bypass (CPB) on platelets. A substantial amount of the patient's circulating platelets is withdrawn prior to heparinization and initiation of CPB. The collected autologous platelet‐rich plasma is then stored at room temperature, preserving platelet function and plasmatic coagulation factors, and retransfused to the patient after heparin reversal. There is controversy about the actual blood saving benefit of IP, but this method may be effective in complicated procedures precipitating high blood loss and long CPB times. In addition, IP may be used when other autologous whole blood harvesting techniques are not an option.
Hemorrhagic Shock and Early Resuscitation: the Cons
Authors: Bickell William H. 
Published: February 2008

SUMMARYAlthough intravenous fluid administration is considered universally indicated for patients with post‐traumatic hypotension of presumed hemorrhagic origin, there are no prospective clinical trials which have adequately validated this practice. Moreover, recent hemorrhage models that incorporate a vascular injury, as well as recently completed clinical trials, have indicated that attempts to restore blood pressure before surgical hemostasis may have the undesirable effect of accentuating hemorrhage and mortality.
Pharmacological Strategies to Decrease Excessive Blood Loss in Cardiac Surgery: Meta‐analysis of Clinically Relevant Endpoints*
Authors: Levi Marcel , E.Cromheecke Manon , Jonge Evert de , Prins Martin H. , Mol Bas J. M. de , Briët Ernest , Büller Harry R. 
Published: February 2008

SUMMARYBackground:Excessive bleeding may complicate cardiac surgery, and is associated with increased morbidity and mortality. Pharmacological strategies to decrease perioperative bleeding have been investigated in a large number of controlled trials, most of which have shown a decrease in blood loss. However, most studies lacked sufficient power to detect a beneficial effect on clinically more relevant outcomes. We did a meta‐analysis of all randomized, controlled trials of the three most frequently used pharmacological strategies to decrease perioperative blood loss (aprotinin, lysine analogues [aminocaproic acid and tranexamic acid], and desmopressin).Methods:Studies were included if they reported at least one clinically relevant outcome (mortality, rethoracotomy, proportion of patients receiving a transfusion, or perioperative myocardial infarction) in addition to perioperative blood loss. In addition, a separate meta‐analysis was done for studies concerning complicated cardiac surgery.Findings:We identified 72 trials (8409 patients) that met the inclusion criteria. Treatment with aprotinin decreased mortality almost two‐fold (odds ratio 0.55 [95% CI 0.34‐0.90]) compared with placebo. Treatment with aprotinin and with lysine analogues decreased the frequency of surgical re‐exploration (0.37 [0.25‐0.55], and 0.44 [0.22‐0.90], respectively). These two treatments also significantly decreased the proportion of patients receiving any allogeneic blood transfusion. By contrast, the use of desmopressin resulted in a small decrease in perioperative blood loss, but was not associated with a beneficial effect on other clinical outcomes. Aprotinin and lysine analogues did not increase the risk of perioperative myocardial infarction; however, desmopressin was associated with a 2.4‐fold increase in the risk of this complication. Studies in patients undergoing complicated cardiac surgery showed similar results.Interpretation:Pharmacological strategies that decrease perioperative blood loss in cardiac surgery, in particular aprotinin and lysine analogues, also decrease mortality, the need for rethoracotomy, and the proportion of patients receiving a blood transfusion.
Recombinant Activated Factor VII for Adjunctive Hemorrhage Control in Trauma*
Authors: Martinowitz Uri , Kenet Gili , Segal Eran , Luboshitz Jacob , Lubetsky Aharon , Ingerslev Jorgen , Lynn Mauricio 
Published: February 2008

SUMMARY Background: Recombinant activated factor VII (rFVIIa) was approved for treatment of hemorrhages in patients with hemophilia who develop inhibitors to factors VIII or IX. Conditions with increased thromboembolic risk, including trauma with or without disseminated intravascular coagulation, were considered a contraindication for the drug. The mechanism of action of rFVIIa suggests enhancement of hemostasis limited to the site of injury without systemic activation of the coagulation cascade. Therefore, use of the drug in trauma patients suffering uncontrolled hemorrhage appears to be rational. Methods: Seven massively bleeding, multitransfused (median, 40 units [range, 25–49 units] of packed cells), coagulopathic trauma patients were treated with rFVIIa (median, 120 μg/kg [range, 120–212 μg/kg]) after failure of conventional measures to achieve hemostasis. Results: Administration of rFVIIa resulted in cessation of the diffuse bleed, with significant decrease of blood requirements to 2 units (range, 1–2 units) of packed cells (p < 0.05); shortening of prothrombin time and activated partial thromboplastin time from 24 seconds (range, 20–31.8 seconds) to 10.1 seconds (range, 8–12 seconds) (p < 0.005) and 79 seconds (range, 46–110 seconds) to 41 seconds (range, 28–46 seconds) (p < 0.05), respectively; and an increase of FVII level from 0.7 IU/mL (range,0.7‐0.92 IU/mL) to 23.7 IU/mL (range, 18–44 IU/mL) (p < 0.05). Three of the seven patients died of reasons other than bleeding or thromboembolism. Conclusion: The results of this report suggest that in trauma patients rFVIIa may play a role as an adjunctive hemostatic measure, in addition to surgical hemostatic techniques, and provides the motivation for controlled animal and clinical trials.
A Recommended Blood Management Practices in Total Joint Replacement Surgery
Authors: Keating E. Michael , Meding John B. 
Published: February 2008

SUMMARYConcern about the safety of allogeneic blood transfusion, including the risk of viral infection and immunosuppression, has led to the development of transfusion options in total joint replacement. These options include intraoperative and postoperative blood salvage, autologous donation, hemodilution, and the use of recombinant human erythropoietin (epoetin alfa). Blood salvage, either intraoperative or postoperative, has been shown not to be cost‐effective at our institution, other than in revision hip replacements, because not enough blood is collected. Autologous donation is not helpful in primary hip or knee surgery. One‐third of patients undergoing joint replacement surgery have hemoglobin (Hb) levels between 10 and 13 g/dL preoperatively. The most efficient way to decrease allogeneic risk in these patients is with epoetin alfa. The use of epoetin alfa decreases allogeneic risk to an acceptable 12.9%. Patients with preoperative hemoglobin above 15 g/dL undergoing single total knee or total hip replacement do not need anything since their allogeneic risk is minimal at our institution.
Erythropoietin Use in Pediatric Oncology
Authors: Porter Joanne C. 
Published: February 2008

SUMMARYAnemia is commonly seen in patients with cancer, whether it is from the disease process itself or from treatment. Anemia can cause fatigue and diminished quality of life in adult cancer patients. Children tolerate anemia well; however, they frequently receive intensive chemotherapy schedules, which aggravate the anemia and require red cell transfusion. Recombinant human erythropoietin stimulates erythropoiesis in the bone marrow and has been shown to effectively eliminate the anemia seen in renal failure. Erythropoietin has also been shown to ameliorate anemia, decrease transfusion needs, and improve the quality of life in adult cancer patients receiving chemotherapy and radiation. In several pediatric oncology trials, children demonstrate similar effects of increased hemoglobin and decreased red cell transfusion needs in response to exogenous erythropoietin. This review will discuss the adult studies that laid the foundation for the pediatric oncology trials utilizing recombinant human erythropoietin in the treatment of anemia. It will also delineate some of the remaining controversial issues surrounding recombinant human erythropoietin use in pediatric patients.
Blood Conservation During Pediatric Cardiac Surgery
Authors: Gomez Daniel , Olshove Vincent , Weinstein Samuel , Davis J. Terrance 
Published: February 2008

SUMMARYEliminating blood product exposure in pediatric cardiac surgery is a challenging and difficult task. Avoidance of allogeneic blood products decreases the risk of a transfusion reaction and potential complications. Various strategies have been explored to decrease donor exposure from the preoperative through the postoperative period. In this paper, the authors review the current literature on blood conservation techniques and examine the changing practice of blood use and blood conservation in the field of pediatric cardiac surgery.
Transfusion‐Related Acute Lung Injury
Authors: Kokkini Garyfallia 
Published: February 2008

SUMMARYTransfusion‐related acute lung injury (TRALI) is the adult respiratory distress syndrome arising from transfusion of a plasma‐containing blood product. It occurs within 1–6 hours of transfusion and is the third leading cause of transfusion‐related mortality in developed countries. TRALI patients present with dyspnea, hypotension, fever, and bilateral noncardiogenic pulmonary edema. Effective treatment includes stopping the transfusion and providing supportive care, whose intensity will depend on the clinical picture. Approximately 80% of TRALI patients recover within 96 hours. TRALI may result from multiple mechanisms. In most cases, pathogenesis appears to reflect the presence of granulocyte or HLA antibodies in donor blood. These react with and fix complement to antigens in the recipient, which leads to granulocyte aggregation, activation, and severe capillary leakage. Preventive measures should focus on limiting exposure to donors most likely to precipitate TRALI. Implicated donors are multiparous females and donors with previous multiple exposure to allogeneic transfusions. Clear recommendations and guidelines for preventing TRALI are needed.
The Effects of Fluid Optimization on Outcome Following Major Surgery
Authors: Levett Denny Z. H. , Grocott Michael P W. , Mythen Michael G. 
Published: February 2008

SUMMARYThe appropriate administration of intravenous fluid therapy to maintain an effective circulating volume and prevent inadequate tissue perfusion is a core element of the perioperative practice of anesthesia. The choice of fluid in a variety of different clinical situations can now be rationally guided by an understanding of the physicochemical and biological properties of the crystalloid and colloid solutions available. Deciding how much fluid to give has traditionally been more controversial. Fluid therapy should be titrated to rational physiological end‐points, directed by appropriate cardiovascular monitoring. Goal‐directed “optimization” of intravascular volume and organ blood flow aims to ensure adequate tissue perfusion and cellular oxygenation. There is a substantial body of literature demonstrating that mortality following major surgery can be significantly reduced by goal‐directed approaches to perioperative hemodynamic management. This literature will be reviewed and implications for current anesthetic practice discussed.
Use of Albumin in the Intensive Care Unit
Authors: Dubois Marc‐Jacques , Vincent A Jean‐Louis 
Published: February 2008

SUMMARYThe use of albumin in the critical care setting is a very controversial issue. Although not a new situation, we have seen a renewed interest in this question, especially after the publication of one particular meta‐analysis. Much has been said about its publication, but it merits a brief review. Hypoalbuminemia, no longer considered to be “acceptable” or even inevitable in critically ill patients, has also been revisited. We will examine the issue by reviewing studies that have tried to correct the condition, the mechanisms by which it appears and its prognostic value. Finally, a great deal of work has been done to gain a better understanding of albumin and its properties beyond the most commonly accepted, namely maintenance of plasma oncotic pressure. A review of the research will help us to recognize that more randomized controlled trials are warranted.
Hypertonic Solutions May Prevent Multiple Organ Failure in Humans: Myth or Reality?
Authors: Boldt Joachim 
Published: February 2008

SUMMARYHypertonic solutions have been proposed as an effective means of fluid resuscitation in the treatment of refractory hypovolemic shock. Due to the hypertonicity of these solutions, only a small volume of fluid is necessary to effectively restore cardiovascular functions. They seem to have positive effects on correcting perfusion due to various mechanisms. They may also prevent trauma‐induced immunosuppression. In various clinical settings, an improved blood flow may avoid the development of organ dysfunction and improve outcome. However, except for trauma patients, there are only few clinical studies available on the use of hypertonic solutions. Therefore, the question of whether a hypertonic volume replacement could positively influence organ perfusion and prevent the development of organ dysfunction in the critically ill deserves further investigations.
Hazards of Homologous Blood Transfusion
Authors: Isbister James P. 
Published: February 2008

SUMMARYIn the current era of evidence‐based medical practice, clinicians should ensure they have a good understanding of the potential benefits of and indications for potentially dangerous homologous blood component therapy. More attention is now being given to assessing the appropriateness of homologous transfusion therapy, with efforts to establish better evidence of improvements in patient outcomes. Such an approach allows for a more logical and realistic analysis of the risk/benefit equation in clinical management. In this summary of our current knowledge of the potential hazards of homologous blood transfusion, transfusion‐transmitted infections are not addressed in detail, as most of the major problems relating to HIV and viral hepatitis have been solved and good reviews are available in the literature. In this review of the potential hazards of homologous blood transfusion, the focus is on many of the other areas of concern regarding the risk/benefit equation for homologous transfusion. Transfusion‐related immunosuppression, the clinical significance of storage lesions, the potential adverse effects of leukocytes, error minimization, transfusion‐related lung injury and less well‐known immunological incompatibilities are addressed.
The Use of Recombinant Factor VIIa in Platelet Disorders: Thrombocytopenia and Thrombocytopathia
Authors: Hoffman Ron , Brenner Benjamin 
Published: February 2008

SUMMARYRecombinant FVlla is considered nowadays an universal hemostatic agent while its primary role has been for treatment of hemophilic patients with inhibitors. Its unique mode of action makes FVlla a usefull tool to induce hemostasis in patients with defective thrombin generation with severe bleeding diathesis. The use of rFVlla in thrombocytopathic and thrombocytopenic associated bleeding disorders is discussed.
Recombinant Factor VIIa: The Possibilities for Monitoring
Authors: Escobar Miguel A. 
Published: February 2008

SUMMARYRecombinant factor VIIa was developed for the treatment of bleeding in patients with hemophilia and inhibitors. Because of its unique mechanism of action, binding weakly to activated platelets independent of factors VIII or IX and enhancing factor X activation, systemic activation of the coagulation does not seem to occur. Thus, a local burst of thrombin induces hemostasis at the site of bleeding. The monitoring of this local event (thrombin generation) has not been developed. Assays that use non‐flow techniques, like the PT and aPTT, do not reflect physiological hemostatic conditions and have a limited application in the monitoring of rFVIIa. On the other hand, experimental models that use whole blood under shear force and that can indirectly measure thrombin generation may have a potential role in the monitoring of rFVIIa.
Overview of the French Hemovigilance
Authors: Wautier Jean‐Luc , Hossenlopp Claudine 
Published: February 2008

SUMMARyHemovigilance began in France in 1993 and was reorganized in 1998.The Hemovigilance Unit is now part of the drug security agency (Agence Française de Sécurité Sanitaire des Produits de Santé, AFSSAPS) and has recently published its annual report. The number of deaths related to transfusion is decreasing but still significant (45 in 2001). Causes are most frequently undetermined (24) but when identified, are related to inadequate medical care (8) and to immunological incompatibility (3). Adverse reactions are frequently immunological (78%), and risks of viral transmission are significantly reduced. Progress in the safety of blood products is evident; however, their clinical use should still be improved.
Hemovigilance in Countries with Scarce Resources –A WHO Perspective
Authors: Dhingra Neelam , Hafner Valentina , Xueref Serge 
Published: February 2008

SUMMARyIn many parts of the world, people continue to die due to shortage of blood and blood products. The safety of blood transfusion therapy remains a continuing concern, particularly where resources are scarce. The different stages of economic and social development are reflected in the existing status of the countries health care systems and that of their national blood transfusion services. The lack of quality systems, standardization and traceability of collected blood along the blood transfusion chain are the major contributing factors to the undesired outcomes of transfusion and increased risk of transfusion‐transmissible infections, namely HIV/AIDS and hepatitis. Hemovigilance as a concept and developed operational system, supports the continuous improvement of quality and safety of transfusion practices. Once the minimum safety requirements are in place, implementation of quality systems in the blood transfusion service throughout the entire blood transfusion chain has to be considered the first mandatory step for establishing hemovigilance systems. The challenge awaiting countries with scarce resources is the implementation of their own hemovigilance system in a sustainable way.The integrated approach for a safer blood supply developed by WHO is aimed at building capacities at a national level, through advocacy, infrastructure development, technical support, training and documentation, and it creates the necessary grounds for establishment of hemovigilance systems. By further increasing its commitment in this area, WHO fulfils its leadership role in preventing risk factors for major disease burden and in organizing equitable health services, in line with its strategic directions.Based on existing data and locally gained experience, joint programs and related expertise can be developed, strengthening inter‐country, regional and global collaboration for a safer, adequate blood supply.
Strength of the Evidence Generated From Reports of Clinical Research
Authors: Vamvakas Eleftherios C. 
Published: February 2008

SUMMARyPositive or negative findings in clinical research may represent true‐positive or true‐negative results, which reflect a relationship that does or does not exist in the reference population of interest. Alternatively, positive or negative findings in clinical research may represent false‐positive or false‐negative results, which are due to chance, bias, and/or confounding factors. If such alternative explanations for the results of a study have been ruled out, a valid statistical association is reported. A judgment of a cause‐and‐effect relationship is based on the totality of all available evidence, and it can also be made from a large, double‐blind, and correctly conducted and analyzed randomized controlled trial.
The Colloid Crystalloid Debate: Are We Asking the Right Question?
Authors: Moretti Eugene W. , Robertson Kerri M. , GAN Tong J. 
Published: February 2008

SUMMARYControversy remains over the best resuscitation fluid (colloid or crystalloid) to use in hypovolemic patients. Most randomized clinical trials done to address this issue were conducted in critically ill patients with mortality as their primary endpoint. Unfortunately these studies were insufficiently powered to detect a difference. Many recent meta‐analyses suffer from limitations that include: dated studies, poor blinding, marked heterogeneity, and disparate therapeutic goals. The type of resuscitation fluid may have little impact on mortality. A properly designed clinical trial that would detect a difference in mortality would be burdensome on limited resources. The effect of these differing fluid types on the quality of a patient's postoperative recovery, as it relates to nausea, vomiting, edema, and pain, may be a more meaningful endpoint for investigation.This review presents the findings of recent meta‐analyses and addresses some common limitations of these reviews. Data on the quality of postoperative recovery with differing fluid regimens is presented, and their effect on renal function and coagulation profiles is examined.The emphasis on the quality of postoperative recovery with the potential to reduce the length of stay shouldn't be minimized. Perhaps the time has come to design clinical trials that study the impact of IV fluids on patient recovery during their hospital stay, rather than mortality.
Introduction of a Cell Salvage Service
Authors: Thomas Dafydd 
Published: February 2008

SUMMARYIn the early 1990s it became apparent to a number of clinicians working at our institution that there was a need to develop a blood conservation program. At the time, the fear of viral transmission via blood transfusion had once more become a reality with the problems related to hepatitis C. This issue came close on the heels of the HIV epidemic, which had required enormous resource to minimize the risk of transfusion‐transmitted infection. The positive aspects of minimizing allogeneic transfusion and only resorting to this treatment when alternatives were not available seemed to be in keeping with the best ideals of preventative medicine. The formation of a hospital transfusion committee and the central use of cell salvage in the hospital's blood conservation policy has led to an atmosphere of awareness and improved knowledge about transfusion issues. The introduction of a cell salvage service has not only allowed better use of allogeneic supplies but in many cases prevented the need for allogeneic transfusion altogether. Other measures have led to improved transfusion practice but the presence in the main theater suite of a cell salvage service has acted as a catalyst to promote better blood transfusion within our institution.