Neonatal Dieulafoy Lesion Requiring Massive Transfusion Protocol and Surgical Intervention

Neonatology ◽  
2020 ◽  
Vol 117 (3) ◽  
pp. 380-383
Author(s):  
Derek Leaderer ◽  
Nicholas Laconi ◽  
Jamie Brown ◽  
J. Lauren Ruoss ◽  
Diomel de la Cruz ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Massive Transfusion ◽  
Blood Products ◽  
Severe Condition ◽  
Surgical Ligation ◽  
Massive Transfusion Protocol ◽  
Life Threatening ◽  
Timely Fashion ◽  
Dieulafoy Lesion ◽  
Transfusion Protocol

Neonatal Dieulafoy lesion is a rare but severe condition that can be life-threatening if not intervened upon in a timely fashion. In the general population, the majority of lesions are successfully treated with endoscopic or angiographic intervention. Surgery is usually reserved for cases that fail endoscopic or angiographic intervention. We present a case of neonatal Dieulafoy lesion that occurred less than 24 h after delivery with hematemesis. The patient required large volume resuscitation and massive transfusion of blood products for acute blood loss. The lesion was successfully treated with surgical ligation after a failed attempt at endoscopic intervention.

scholarly journals Blood Transfusion in Obstetric Cases

2020 ◽  
pp. 197-200
Author(s):  
Ali Sungkar ◽  
Raymond Surya
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Massive Transfusion ◽  
Patient Blood Management ◽  
Blood Products ◽  
Blood Management ◽  
Transfusion Therapy ◽  
Massive Transfusion Protocol ◽  
Life Threatening ◽  
Transfusion Protocol

Objective: To discuss about blood loss in an obstetric setting, the role of blood transfusion, and patient blood management.Methods: Literature review.Results: Severe anaemia with hemoglobin level less than 7 g/dL or late gestation (more than 34 weeks) and/ or significant symptoms of anaemia, the recommendation is giving only single unit transfusion followed by clinical reassessment for further transfusion. In postpartum hemorrhage (PPH), massive transfusion protocols are commonly used description as large volume of blood products over a brief period to a patient with uncontrolled or severe hemorrhage, transfusion more than 10 RBC units within 24 hours, transfusion more than 4 RBC units in 1 hour with anticipation of continued need for blood, replacement of more than 50% of total blood volume by blood products within 3 hours. All obstetric units have a clear-cut massive transfusion protocol for the initial management of life-threatening PPH, considering early transfusion therapy with RBCs and FFP.Conclusion: Patient blood management aims to maintain hemoglobin concentration, optimize haemostasis, and minimize blood loss in effort to improve patient outcomes. Massive transfusion protocol in management of life-threatening should depend on each obstetric unit.Keywords: blood transfusion, obstetric cases, patient blood management.   Abstrak Tujuan: Untuk mendiskusikan tentang hilang darah dalam obstetric, peran transfusi darah, dan patient blood management.Metode: Kajian pustaka.Hasil: Anemia berat dengan nilai hemoglobin kurang dari 7 g/dL atau kehamilan lanjut (lebih dari 34 minggu) dan/ atau gejala nyata anemia, rekomendasi ialah memberikan satu unit transfusi diikuti dengan penilainan klinis untuk transfusi lebih lanjut. Pada perdarahan postpartum, protokol transfusi massif umum digambarkan sebagai volume darah yang dibutuhkan jumlah banyak dalam periode singkat, transfusi lebih dari 10 sel darah merah dalam 24 jam atau lebih dari 1 jam, penggantian lebih dari 50% total volume darah dalam 3 jam. Seluruh unit obstetric memiliki protokol transfusi massif yang jelas untuk taalaksana awal perdarahan postpartum dengan mempertimbangkan transfusi awal untuk komponen sel darah merah dan FFP.Kesimpulan: Patient blood management bertujuan untuk menjaga konsentrasi hemoglobin, optimalisasi hemostasis, dan minimalisasi hilang darah untuk meningkatkan luaran pasien. Protokol transfusi masfi dalam tatalaksana yang mengancam nyawa sangat bergantung pada setiap unit obstetrik.Kata kunci: kasus obstetri, patient blood management, transfusi darah  

Intraoperative Resuscitation by Specialized Trauma Nurse Clinicians Improves Adherence to Massive Transfusion Protocol

2020 ◽  
Vol 86 (1) ◽  
pp. 35-41
Author(s):  
L. Andrew May ◽  
Kevin N. Harrell ◽  
Christopher M. Bell ◽  
Angela Basham-Saif ◽  
Donald E. Barker ◽  
...  
Keyword(s):  
Blood Product ◽  
Trauma Registry ◽  
Massive Transfusion ◽  
Blood Products ◽  
Packed Red Blood Cells ◽  
Massive Blood Loss ◽  
Massive Transfusion Protocol ◽  
Nurse Clinicians ◽  
Level I ◽  
Transfusion Protocol

A massive transfusion protocol (MTP) was implemented at a Level I trauma center in 2007 for patients with massive blood loss. A goal ratio of plasma to pheresed platelets to packed red blood cells (PRBCs) of 1:1:1 was established. From 2007 to 2014, trauma nurse clinicians (TNCs) administered the MTP during initial resuscitation and anesthesia personnel administered the MTP intraoperatively. In 2015, TNCs began administering the MTP intraoperatively. This study evaluates intraoperative blood product ratios and crystalloid volume administered by anesthesia personnel or TNCs. A retrospective review of trauma registry patients requiring MTP from 2007 to 2017 was performed. Patient data were stratified according to MTP administration by either anesthesia personnel (2007–2015) or TNCs (2015–2017). Ninety-seven patients were included with 54 anesthesia patients and 44 TNC patients. Patients undergoing resuscitation by MTP administered by TNCs received less median crystalloid (3000 mL vs 1500 mL, P < 0.001). The ratio of plasma:PRBC (0.75 vs 0.93, P = 0.027) and platelets:PRBC (0.75 vs 1.04, P = 0.003) was found to be significantly closer to 1:1 for TNC patients. MTP intraoperative blood product administration by TNCs reduced the amount of infused crystalloid and improved adherence to MTP in achieving a 1:1:1 ratio of blood products.

The Use of Recombinant FVIIa in a Structured Massive Transfusion Protocol: A Novel Approach.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4142-4142
Author(s):  
Majed A. Refaai ◽  
Kathryn Tchorz ◽  
John Forestner ◽  
Raymond Morris ◽  
Marty Koch ◽  
...  
Keyword(s):  
Massive Transfusion ◽  
Blood Type ◽  
Blood Component ◽  
P Value ◽  
Trauma Patients ◽  
Blood Products ◽  
Packed Red Blood Cells ◽  
Massive Transfusion Protocol ◽  
Novel Approach ◽  
Transfusion Protocol

Abstract Background: Trauma has become the second leading cause of death worldwide, despite advances in modern trauma resuscitation practices. Appropriate and timely blood component therapy in the severely injured trauma patient could prevent adverse outcome due to coagulopathy. Recombinant FVIIa has been used to achieve adequate hemostasis in trauma patients in the field. Materials and Methods: In June 2004, a massive transfusion protocol (MTP) was established in Parkland Memorial Hospital in Dallas, TX for patients presenting with trauma. Major goals of the MTP were 1) to achieve faster turn around times for these products, 2) to provide an appropriate ratio of blood components in order to prevent coagulopathy of massive transfusion and use of rFVIIa to achieve better hemostasis, and 3) to reduce wastage of blood products. At all times, the Blood Bank keeps ready for emergency release 4 units each of type A and O thawed plasma (TP) and 2 units of AB TP (5 days expiration). The MTP consists of three shipments that may be repeated, if necessary. Each shipment consists of 5 packed red blood cells (PRBCs) and 2 TP. One dose of platelets is added to the second shipment, and one dose of cryoprecipitate (10 units) and rFVIIa (4.8 mg) is added to the third shipment. If the MTP goes to the 6th shipment, 2.4 mg rFVIIa is given. Once initiated, the first MTP shipment is ready for pick up in 15 minutes. If blood type can not be determined, type O RBCs with type AB TP are sent in the first shipment (Rh matching depends upon inventory and the patient’s gender). We compared MTP blood component usage in 173 trauma patients during a 24-months period with pre-MTP historical data in 67 trauma patients from the previous 12 months. Results: The average TAT of the first shipment in MTP was 9 ± 0.4 minutes. No TAT assessments of the first shipment were possible in the pre-MTP cases because there was no initiation time available. When comparing the average TATs of second and third shipments of MTP versus pre-MTP cases, however, significant reductions were achieved (18 ± 1.8 vs. 42 ± 30 and 30 ± 2.5 vs. 44 ± 31 minutes, respectively). There was a significant reduction in blood component usage with MTP as compared to pre-MTP (Table) though the mortality had not changed. The blood component wastage (especially cryoprecipitate) had decreased significantly. Conclusions: There was a significant reduction in TAT and blood products used in following establishment of MTP; this was most likely due to prevention and/or early treatment of dilutional coagulopathy and achievement of adequate hemostasis with use of rFVIIa. Table Group PRBCs Thawed Plasma Platelets CRYO rFVIIa TAT (2nd Shipment) TAT (3rd Shipment) *Pre-MTP (n = 20), CRYO = cryoprecipitate, TAT = turn-around time, N/P = not performed Pre-MTP (n = 67) 24.2 ± 16.3 11.2 ± 8.3 3.1 ± 3.5 1.6 ± 1.7 0.2 ± 0.4 42 ± 30* 44 ± 31* MTP (n = 173) 17.5 ± 12.4 6.7 ± 5.6 1.2 ± 1.4 0.7 ± 0.8 0.4 ± 0.6 18 ± 1.8 33 ± 2.5 P value 0.0055 &lt;0.001 &lt;0.001 &lt;0.001 00.0032 N/P N/P

How we treat: management of life-threatening primary postpartum hemorrhage with a standardized massive transfusion protocol

Transfusion ◽  
2007 ◽  
Vol 47 (9) ◽  
pp. 1564-1572 ◽  
Author(s):  
Matthew Burtelow ◽  
Ed Riley ◽  
Maurice Druzin ◽  
Magali Fontaine ◽  
Maurene Viele ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Massive Transfusion ◽  
Massive Transfusion Protocol ◽  
Life Threatening ◽  
Transfusion Protocol

Hypovolemic Shock

2017 ◽  
Author(s):  
Paul David Weyker ◽  
Christopher Allen-John Webb ◽  
Tricia E. Brentjens
Keyword(s):  
Plasma Volume ◽  
Massive Transfusion ◽  
Hypovolemic Shock ◽  
Perioperative Period ◽  
Blood Products ◽  
Massive Transfusion Protocol ◽  
Common Causes ◽  
Volume Blood ◽  
General Studies ◽  
Transfusion Protocol

Broadly defined, hypovolemia represents inadequate circulating plasma volume leading to decreased cardiac preload and thus decreased cardiac output and blood pressure. Many classification schemes have been proposed to categorize hypovolemia based on relative levels of decreased plasma volume. Common causes of hypovolemic shock during the perioperative period include hemorrhage and diuretic use. In general, studies support a conservative hemoglobin goal of about 7 g/dL as compared with a liberal goal of 10 g/dL in hemodynamically stable patients without active cardiac ischemia or risk factors. In patients with large volume blood loss, institutionally approved massive transfusion protocols can help provide blood products quickly. The trauma literature supports a balanced massive transfusion protocol using a 1:1:1 (plasma:platelet:red blood cell) strategy of transfusion.

Massive Transfusion Protocols in Obstetric Hemorrhage: Theory versus Reality

2021 ◽  
Author(s):  
Bahram Salmanian ◽  
Steven L. Clark ◽  
Shiu-Ki R. Hui ◽  
Sarah Detlefs ◽  
Soroush Aalipour ◽  
...  
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Massive Transfusion ◽  
Fresh Frozen Plasma ◽  
Laboratory Evaluation ◽  
Blood Products ◽  
Massive Transfusion Protocol ◽  
Fresh Frozen ◽  
Transfusion Protocol ◽  
Frozen Plasma

Objective Massive transfusion protocols are widely implemented in obstetrical practice in case of severe hemorrhage; however, different recommendations exist regarding the appropriate ratios of blood product components to be transfused. We report our extensive experience with massive component transfusion in a referral center in which the standard massive transfusion protocol is modified by ongoing clinical and laboratory evaluation. Study Design A retrospective chart review of all patients who had massive transfusion protocol activation in a level 4 referral center for obstetrical practice was performed from January 2014 to January 2020. Data collected included the etiology of obstetrical hemorrhage, number of blood products of each type transfused, crystalloid infusion, and several indices of maternal morbidity and mortality. Data are presented with descriptive statistics. Results A total of 62 patients had massive transfusion protocol activation, of which 97% received blood products. Uterine atony was found to be the most common etiology for massive hemorrhage (34%), followed by placenta accreta spectrum (32%). The mean estimated blood loss was 1,945 mL. A mean of 6.5 units of packed red blood cells, 14.8 units of fresh frozen plasma and cryoprecipitate, and 8.3 units of platelets were transfused per patient. No maternal deaths were seen. Conclusion The ratios of transfused packed red blood cell to fresh frozen plasma/cryoprecipitate and of packed red blood cell to platelet units varied significantly from the fixed initial infusion ratio called for by our massive transfusion protocol resulting in universally favorable maternal outcomes. When rapid laboratory evaluation of hematologic and clotting parameters is available, careful use of this information may facilitate safe modification of an initial fixed transfusion ratio based on etiology of the hemorrhage and individual patient response. Key Points

Blood Provision for Cardiac Ablation (CA) Procedures in the Catheterization Laboratory; a Veteran Affairs Medical Center (VAMC) Experience in a Non-Trauma Center Setting

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S167-S168
Author(s):  
J M Petersen ◽  
V Patel ◽  
D Jhala
Keyword(s):  
Quality Assurance ◽  
Massive Transfusion ◽  
Medical Center ◽  
Case Series ◽  
Blood Bank ◽  
Cardiac Ablation ◽  
Cardiac Perforation ◽  
Catheterization Laboratory ◽  
Massive Transfusion Protocol ◽  
Transfusion Protocol

Abstract Introduction/Objective Cardiac perforation is a life-threatening complication (~1% risk, with reported rates between 0.2% to 5%) of CA procedures. As cardiac perforation may lead to extensive bleeding, it would be reasonable for a medical center carrying out CA to be capable of arranging for a massive transfusion protocol and for surgical repair as required. However, there is sparse literature to guide a non-trauma medical center implementing a CA program on what the number of red blood cell (RBC) units for crossmatch should be for each case. Methods In interdisciplinary collaborative meetings, the CA program logistics were agreed to between the multiple clinical services. Given the case series on the amount of drained blood in complicated cases, there was agreement that three units of RBCs would be crossmatched for each case. Education was provided on the massive transfusion protocol and on blood bank procedures. As part of quality assurance/quality improvement, records were reviewed from the beginning of the CA program (10/1/2019) to 1/31/2019 to determine number of patient cases, crossmatched units, and transfused units for quality assurance purposes. Results A total of fifteen patients underwent CA procedures, for which three units were crossmatched for each patient. As there were no cardiac perforations with the cardiac ablation procedures so far, no units were transfused. The organized approach for ensuring adequate blood bank support and education led to the reassurance, alleviation of clinical anxiety, and building of a successful CA program. Education sessions completed with thorough understanding of blood bank procedures including the massive transfusion protocol, labeling of blood bank specimens, and on ordering of blood for crossmatch. Conclusion This study provides a reference that may provide helpful guidance to other blood banks on what the number of RBCs to be crossmatched prior to each CA procedure. Multidisciplinary collaborative meetings in advance are an essential component for ensuring adequate support for CA procedures or any new service that requires blood product support. Thorough education of clinical staff on blood bank procedures particularly the massive transfusion protocol is also recommended. This procedure for massive transfusion should be available to be referred to in real time.

Managing Massive Transfusion Protocol During Cardiopulmonary Bypass in the Setting of Penetrating Traumatic Injury

2020 ◽  
pp. 000313482097977
Author(s):  
Dov Levine ◽  
Sivaveera Kandasamy ◽  
James Alford Flippin ◽  
Hirohisa Ikegami ◽  
Rachel L. Choron
Keyword(s):  
Cardiopulmonary Bypass ◽  
Massive Transfusion ◽  
Traumatic Injury ◽  
Massive Transfusion Protocol ◽  
Transfusion Protocol
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