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Summary: Viscoelastic haemostatic assays provide rapid testing at the bed‐side that identify all phases of haemostasis, from initial fibrin formation to clot lysis. In obstetric patients, altered haemostasis is common as pregnancy is associated with coagulation changes that may contribute to bleeding events such as postpartum haemorrhage, as well as thrombosis events. In this narrative review, we examine the potential clinical utility of viscoelastic haemostatic assays in postpartum haemorrhage and consider the current recommendations for their use in obstetric patients. We discuss the clinical benefits associated with the use of viscoelastic haemostatic assays due to the provision of (near) real‐time readouts with a short turnaround, coupled with the identification of coagulation defects such as hypofibrinogenaemia. The use of viscoelastic haemostatic assay‐guided algorithms may be beneficial to diagnose coagulopathy, predict postpartum haemorrhage, reduce transfusion requirements and monitor fibrinolysis in women with obstetric haemorrhage. Further studies are required to assess whether viscoelastic haemostatic assay‐guided treatment improves clinical outcomes, and to confirm the utility of prepartum viscoelastic haemostatic assay measurements for identifying patients at risk of postpartum haemorrhage. [ABSTRACT FROM AUTHOR]

Background and objectives Extracorporeal membrane oxygenation ( ECMO) is a method of life support for either isolated cardiac failure or respiratory failure, with or without cardiac failure. When used for hemodynamic support, the ECMO circuit presents a non-endothelialized, artificial surface to blood inciting an inflammatory response which activates haemostatic pathways. Anticoagulation may complicate a pre-existing coagulopathy and/or inadequate surgical hemostasis of varying severity. There is no standardized method to achieve and monitor anticoagulation or guide transfusion therapy during ECMO. We tested the hypothesis that institutions across the world conduct similar management of anticoagulation and transfusion during adult ECMO support. Methods This is a descriptive, self-reporting cross-sectional survey of anticoagulation and transfusion practice for patients age 18 or older on ECMO. This 38 multiple-choice question survey was sent to 166 institutions, internationally, utilizing adult ECMO. About 32·4% (54) of institutions responded. Responses were anonymously collected. Descriptive analyses were calculated. Results Our findings indicate there appears to be a significant practice variation among institutions regarding anticoagulation and transfusion during adult ECMO support. Discussion The lack of standard practices among institutions may reflect a paucity of data regarding optimal anticoagulation and transfusion for patients requiring ECMO. Standardized protocols for anticoagulation and transfusion may help increase quality of care for and reduce morbidity, mortality and cost to patients and healthcare centres. Further study is required for standardized, high quality care. [ABSTRACT FROM AUTHOR]

The authors focus on patient blood management (PBM) associated with transfusion medicine. The authors state that PBM is about applying the latest and highest-quality evidence to the practice of transfusion medicine, and mention significance of development of the transfusion practitioner (TP) in PBM. The authors cite example of promulgation of tranexamic acid (TXA) by the hospital transfusion committee, transfusion medicine physicians, and PBM committee.

SUMMARY Objectives To determine what percentage of red blood cell ( RBC) units that were issued to the operating room ( OR) were returned unused, and to determine how often all of the RBCs that were issued for a patient were returned unused using the institution's maximum surgical blood ordering schedule ( MSBOS) as a guide. Background The MSBOS provides guidelines for blood ordering, but is merely a suggestion for the ordering clinicians. This study examined how closely ordering practices followed the MSBOS, and how often ordered RBCs were actually transfused. Methods For a 4-week period, RBC issue and utilization data were collected on elective surgery patients who were eligible for electronic cross-match at a tertiary care hospital. These data were compared to the MSBOS. Results There were 1350 surgical procedures performed. Of these cases, 439 patients had a type and screen (T&S) performed, and 215/439 (49%) patients had at least 1 RBC issued during their case. To these 215 patients, 742 RBC units were issued and 537/742 (72%) of these units were returned to the blood bank unused. In 152/215 (71%) cases with issued RBCs, all of the RBCs were returned to the blood bank unused. Amongst the surgical categories in this study, the percentage of cases where none of the issued RBCs were transfused ranged from 38 to 93%. Conclusions Significant numbers of RBC units are issued but not transfused during surgery. Involving the surgical team in the blood issuing process and using a data-driven MSBOS may reduce the number of unused units. [ABSTRACT FROM AUTHOR]

The article discusses the implementation aspect of a blood management programme in the hospital for immediate blood requirements such as postoperative period. Topics include regulation of amount of erythrocyte transfusion, taking care before transfusion, and implementation of patient blood management in transfusion.

Objectives: To determine the extent of RBC sublethal injury in male donor units as measured by both the mechanical fragility index (MFI) and percentage haemolysis after RBCs underwent leucoreduction (LR), irradiation (IRRAD), and washing. Background: RBCs frequently undergo post-collection processing to meet certain recipient's special needs. The extent of haemolysis and sublethal injury following these interventions has not been fully characterised. Methods: Eight to ten day old male, AS-5 RBCs underwent either LR, IRRAD or washing. A control group of male, AS-5 RBCs were unmanipulated. The MFI, percent haemolysis, and plasma free haemoglobin (PFHb) were measured immediately after manipulation and, for a series of irradiated RBCs, 28 days after irradiation (IRRAD28). Results: The MFI of the washed units was significantly higher than unmanipulated, LR, IRRAD, IRRAD28 units ( P < 0·0001). The percent haemolysis was highest in the IRRAD28 units (1·4%) followed by the washed units (0·74%); the other three units demonstrated significantly less haemolysis ( P < 0·0001). The largest mean total amount of PFHb per unit was found in the IRRAD28 units (500·5 mg/unit) followed by the washed units (149·8 mg/unit); the mean total amount of PFHb in the three other types of units was significantly less than that found in both the IRRAD28 and washed units ( P at least < 0·001). Conclusion: There is a significant quantity of PFHb in IRRAD28 RBC units, and potentially in washed allogeneic RBC units. Clinical correlation is required to determine if this quantity of PFHb and the transfusion of potentially fragile RBCs causes adverse events. [ABSTRACT FROM AUTHOR]

The mechanical fragility index (MFI) is an in vitro measure of sublethal injury to RBCs. In our previous experiments, we demonstrated that an increase in sublethal injury (increasing MFI) was a component of the RBC storage lesion, and that the MFI was significantly higher amongst the RBC units from male donors compared to pre-menopausal female donors during storage. It was hypothesized that hormonal or menstrual factors contributed to this difference. In this study, we found that RBC units donated by post-menopausal women demonstrated an MFI that was significantly higher than those donated by pre-menopausal women throughout storage. [ABSTRACT FROM AUTHOR]

Background The mechanical fragility index (MFI) is an in vitro measurement of the extent of RBC sublethal injury. Sublethal injury might constitute a component of the RBC storage lesion, thus the MFI was determined serially during routine RBC storage. Methods Leucoreduced AS-5- and SAGM-preserved RBCs were stored under routine blood bank conditions. The mechanical fragility (MF) of each unit was serially measured during storage. Results For both AS-5 and SAGM units, male and female RBCs demonstrated statistically significant increases in the MFI during storage. The MFI was significantly lower in AS-5 units compared to SAGM units throughout storage. Female RBCs had significantly lower MFI vs. male RBCs in both AS-5 and SAGM units at all times. No significant differences in MFI were observed between ABO groups for both genders for AS-5 RBCs. Conclusions The MF of RBCs increases during storage. Both gender and preservation solution influenced the MFI; however, the male:female MFI ratios were similar at all time-points and remained stable, suggesting that gender-based biological differences exist independent of storage solution. The MF could be a useful test for evaluating the effect of novel interventions intended to mitigate the susceptibility of RBCs to sublethal injury during storage. [ABSTRACT FROM AUTHOR]

Background Study Design and Methods Results Conclusions Liberal or overtransfusion (OT) may be regarded as “inappropriate,” but it is not reported as a transfusion‐related adverse event. A definition of OT is lacking. OT may include overdosing of components, giving the incorrect component, or unnecessary administration without evidence of need for transfusion. OT can be associated with hypercoagulability, thrombosis, alloimmunization, increased mortality, longer hospital stay, increased infection rates, and adverse cardiocirculatory events.In 2023, an expert panel formed a hemovigilance international taskforce embedded in the German Interdisciplinary Taskforce for Clinical Hemotherapy (IAKH). The group was charged with proposing simple criteria to be used by hemovigilance systems to document instances of OT.This international initiative combined a narrative review of the literature for the rate and outcomes of OT with transfusion error reports to propose a definition for OT, including a definition for transfusion‐induced hypercoagulopathy (TIH), three new codes for OT/TIH and subcodes A to G, three severity categories (serious adverse event, adverse event, near miss), and four incident codes (definite, probable, possible, not determinable). These codes can be used by hemovigilance systems to appropriately document instances of OT.Global adoption of these codes within hemovigilance systems would assist with the recognition and reporting of instances of OT, promote effective policies for adequate clinical administration techniques, and support technical guidelines for avoidance of OT. Thereby, incorporation of OT into hemovigilance strategies could support adequate use of blood products, increase patient safety, and facilitate blood supply and availability. [ABSTRACT FROM AUTHOR]

In December 1983, Harefield Hospital started a programme for combined heart and lung transplantation. Fifty-two transplants have been successfully performed, with 36 survivors (April 1986). Patient selection and anaesthetic management of both donor and recipient are discussed. Two case histories are presented which illustrate the principles of anaesthetic management and postoperative care.