Thromboelastogram-Guided Transfusion Therapy Reduces Blood-Component Transfusion and Improves Coagulation Function during Orthopedic Surgery

Massive bleeding is a serious medical complication arising from trauma, surgery, and invasive procedures. In this case, timely and effective hemostasis must be applied to patients. The aim of this study is to compare transfusion therapies guided by thromboelastogram (TEG) and conventional coagulation tests (CCTs) during orthopedic surgery, focusing on blood-component transfusion and coagulation function of patients. The patients who underwent orthopedic surgery in our hospital from May 2019 to November 2020 were retrospectively analyzed. According to different transfusion-guiding strategies, the patients were assigned into the CCT group containing 214 patients and the TEG group containing 266 patients. The TEG group used fewer volumes of blood products including red blood cell (RBC) suspension, fresh-frozen plasma, cryoprecipitate, and apheresis platelets than the CCT group ( P < 0.05 ). After orthopedic surgery, the hemoglobin (Hb) and RBC counts were decreased, but the white blood cell (WBC) counts were increased in all patients receiving whether transfusion therapy guided by TEG or CCTs. Importantly, the TEG group exhibited fewer WBC counts concomitant with higher Hb and more RBC counts than the CCT group ( P < 0.05 ). There was no significant difference on the platelet (PLT) counts between the two groups before and after orthopedic surgery ( P > 0.05 ). Significant declines on thrombin time (TT), partial activated thromboplastin time (PATT), prothrombin time (PT), and d-dimer (D-D), along with an increase on fibrinogen (FIB) were observed in two groups after surgery. The TEG group showed reduced TT, PATT, PT, D-D, and elevated FIB compared to the CCT group ( P < 0.05 ). Posttransfusion, the K value (time to reach a certain clot strength) and R value (coagulation reaction time) were decreased, the angle (α) value (clot formation rate), MA value (maximum amplitude), and CI (coagulation index) were increased in the TEG group ( P < 0.05 ). When the liver function was assessed, it was found that the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total serum bilirubin (TBIL) were increased significantly, and albumin (ALB) was decreased between the two groups after surgery, but the TEG group with lower levels of ALT, AST, and TBIL and a higher level of ALB than the CCT group ( P < 0.05 ). With regard to the renal function, two groups had increased levels of serum creatinine (Scr) and blood urea nitrogen (BUN) with a declined uric acid (UA) level after surgery; however, the patients in the TEG group had lower levels of Scr and BUN and a higher level of UA compared to the CCT group ( P < 0.05 ). In view of above data, TEG-guided transfusion therapy could reduce use of blood products, optimize blood components, and improve coagulation function for patients undergoing orthopedic surgery. TEG-guided transfusion therapy may prevent liver and renal dysfunction after orthopedic surgery.

Transfusion Related Acute Lung Injury (TRALI): A Rare Case after Single Packed Red Blood Cell (PRBC) Unit Transfusion

Transfusion Related Acute Lung Injury (TRALI) is a rare but serious adverse event of allogeneic blood component transfusion, manifested typically by shortness of breath, a non-productive cough, fever, and hypotension, mostly seen after plasma component transfusion collected from female donors. We here present a rare case of TRALI requiring Intensive Care Unit (ICU) support after transfusion of single Packed Red Blood Cell (PRBC) unit collected from a male donor. The present case emphasizes that TRALI to be ruled out first in any patient showing acute /respiratory distress within 6hrs of transfusion, with prompt management and notification to transfusion services.

BLOOD TRANSFUSION PRACTICES IN OBSTETRICS AND GYNAECOLOGY AT TERTIARY CARE CENTRE: A RETROSPECTIVE STUDY.

Background: This study was undertaken to ascertain the total patients receiving a transfusion, indications for transfusion, various blood components used, the timing of transfusion, and the presence of any risk factors in the patients transfused. Methods: Transfusion request forms of 2998 patients admitted to the Department of Gynaecology and Obstetrics in the zanana Hospital, SMS Medical College and attached group of hospitals Jaipur from May 2020 to July 2020were retrospectively reviewed for the types and volume of blood component transfused. Indication for each blood component transfusion was noted. Patients who had MOH were further analyzed to estimate the ratio of components transfused. Results: We have experienced 898 obstetric patients who underwent blood component transfusion during the study period. Out of these, 440 (49%) and 458 (51%) were primigravida and multigravida respectively. The mean age of patients who received transfusion was 27 years. The maximum number of patients was in the age group of 21–32 years Conclusion: Anemia during pregnancy is a significant cause of maternal mortality and morbidity. The decision for transfusion was done in this study when the Hb<7 gm%, and there were <4 weeks for delivery or in labor Keywords: Hb, Anemia, Pregnancy.

Transfusion Strategies in the Pre-Hospital Setting: Evaluating the Logistical Benefits of Pre-Hospital Whole Blood Transfusion, and a National Survey of Pre-Hospital Blood Transfusion

BackgroundPre-hospital blood component transfusion poses logistical challenges. Current patterns of pre-hospital blood use across the UK are not known. A potential benefit of providing a single combined component of whole blood is reduced need for multiple steps of administering separate components and more efficient use of time and resources by medical staff. .Objectivesto undertake a detailed time-analysis of the steps of pre-hospital combined component transfusion against separate blood component transfusion, and to determine current UK pre-hospital transfusion practice and users’ optimal pre-hospital transfusion strategyMethodsA three-arm cross-over major haemorrhage simulation study compared: flow-time (time from decision-to-transfuse [DTT] to complete transfusion); touch-time (direct team ’hands on’ contact time with transfusion process); and number of steps, people and equipment required for transfusion of 2 units of RCP [arm-A], 2 RBC + 2 TP [arm-B] or RBC + 2 Lyoplas [arm-C]). A national survey of current and optimal pre-hospital transfusion strategies was sent to 22 UK Air Ambulance Services (AAS) and 27 Major Trauma Centres (MTC) in December 2019. ResultsThe simulation demonstrated that arm-A had a shorter flow-time (median 6min 31sec vs. 12min 20 sec, vs 16min 29 sec) and touch-time (median 2min 31 seconds vs. 5min 21sec vs. 15min 3sec) than arm-B and arm-C respectively, and required fewer steps, equipment and checks. 18 MTCs and 18 AAS responded to the national survey (response rates of 67 and 82%). 10 transfused RBC/plasma (5 TP/5 Lyoplas), 4 RBC only, 2 Lyoplas only, 1 RBC/Lyoplas/Fibrinogen, and 1 ’red cell and plasma’ (only available at one hospital site). 89% replied that a combined component transfusion would be desirable, as it would reduce patient mortality (83%) and tasks on scene (75%). ConclusionThe time-analysis established the benefits for combined pre-hospital component transfusion in trauma patients. The national survey demonstrates the variation in current pre-hospital transfusion practice and reiterates that combined component transfusion pre-hospital may have logistical advantages over separate components.