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Jennifer A. Horst Philip C. Spinella Julie C. Leonard Cassandra D. Josephson Christine M. Leeper 《Transfusion》2023,63(Z3):S10-S17
Background
Hypofibrinogenemia is an important risk factor for poor outcomes in children with severe bleeding. There is a paucity of data on the impact of cryoprecipitate transfusion on outcomes in pediatric patients with life-threatening hemorrhage (LTH).Study Design and Methods
This secondary analysis of a multicenter prospective observational study of children with LTH investigated subjects who were categorized by receipt of cryoprecipitate during their resuscitation and according to the etiology of their bleeding: trauma, operative, and medical. Bivariate analysis was performed to identify variables associated with 6-h, 24-h, and 28-day mortality. Cox Hazard regression models were generated to adjust for potential confounders.Results
Cryoprecipitate was transfused to 33.9% (152/449) of children during LTH. The median (Interquartile range) time to cryoprecipitate administration was 108 (47–212) minutes. Children in the cryoprecipitate group were younger, more often female, with higher BMI and pre-LTH PRISM score and lower platelet counts. After adjusting for PRISM score, bleeding etiology, age, sex, RBC volume, platelet volume, antifibrinolytic use and cardiac arrest, cryoprecipitate administration was independently associated with lower 6-h mortality, Hazard Ratio (95% CI), 0.41 (0.19–0.89), (p = 0.02) and 24-h mortality, Hazard Ratio (95% CI), 0.46 (0.24–0.89), (p = 0.02).Conclusion
Cryoprecipitate transfusion to children with LTH was associated with reduced early mortality. A prospective randomized trial is needed to determine if cryoprecipitate can improve outcomes in children with LTH. 相似文献2.
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Vogt KN Van Koughnett JA Dubois L Gray DK Parry NG 《Transfusion medicine (Oxford, England)》2012,22(3):156-166
This study was undertaken to determine if, amongst civilian trauma patients requiring massive transfusion (MT), the use of a formal trauma transfusion pathway (TTP), in comparison with transfusion without a TTP, is associated with a reduction in mortality, or changes in indices of coagulation, blood product utilisation and complications. A systematic review of three bibliographic databases, reference lists and conference proceedings was conducted. Studies were included if comparisons were made between patients receiving transfusion with and without a TTP. Data were extracted by two independent reviewers on population characteristics, transfusion strategies, blood product utilisation, indices of coagulation, clinical outcomes and complications. Data were pooled using a random effects model and heterogeneity explored. Seven observational studies met all eligibility criteria. Amongst 1801 patients requiring MT, TTPs were associated with a significant reduction in mortality (RR 0·69, 95% CI 0·55, 0·87). No significant increase in the mean number of PRBC transfused between TTP and control patients was seen (MD -1·17 95% CI -2·70, 0·36). When studies assessing only trauma patients were considered, TTPs were associated with a reduction in the mean number of units of plasma transfused (MD -2·63, 95% CI -4·24, -1·01). In summary, the use of TTPs appears to be associated with a reduction in mortality amongst trauma patients requiring MT without a clinically significant increase in the number of PRBC transfused and a potential reduction in plasma transfusion. Effects of TTPs on platelet transfusion, indices of coagulation and complications remain unclear. A randomised controlled trial is warranted. 相似文献
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Chun Tat Lui Oi Fung Wong Kwok Leung Tsui Chak Wah Kam Siu Man Li Mina Cheng Ka Kit Gilberto Leung 《The American journal of emergency medicine》2018,36(8):1444-1450
Background
Currently existing predictive models for massive blood transfusion in major trauma patients had limitations for sequential evaluation of patients and lack of dynamic parameters.Objective
To establish a predictive model for predicting the need of massive blood transfusion major trauma patients, integrating dynamic parameters.Design
Multi-center retrospective cohort study.Setting
Four designated trauma centers in Hong Kong.Methods
Trauma patients aged > 12 years were recruited from the trauma registries from 2005 to 2012. MBT was defined as delivery of ≥ 10 units of packed red cells within 24 h. Split sampling method was adopted for model building and validation. Multivariate logistic regression was adopted for model building, with weight assigned based on logarithmic of adjusted odds ratios. The performance of the dynamic MBT score (DMBT) was compared with the PWH score and the Trauma Associated Severe Hemorrhage (TASH) score in the validation data set.Results
4991 patients were included in the study. The DMBT was established with 8 parameters: systolic blood pressure, heart rate, hemoglobin, hemoglobin drop within the first 2 h, INR, base deficit, unstable pelvic fracture and hemoperitoneum in radiological imaging. At cut-off score of 6 the DMBT achieved sensitivity of 78.2% and specificity of 89.2%. In the validation set, the AUCs of the DMBT, PWH score, and TASH score were 0.907, 0.844, and 0.867 respectively.Conclusions
The DMBT score allows both snapshot and sequential activation along the trauma care pathway and has better performance than the PWH score and TASH score. 相似文献6.
The emergency room transfusion score (ETS): prediction of blood transfusion requirement in initial resuscitation after severe trauma 总被引:2,自引:0,他引:2
Ruchholtz S Pehle B Lewan U Lefering R Müller N Oberbeck R Waydhas C 《Transfusion medicine (Oxford, England)》2006,16(1):49-56
The presented study was initiated to develop a scoring system for the prediction of red blood cell transfusion requirement in the early care of trauma patients. All trauma patients admitted to our institution who needed trauma team activation were evaluated during a 4-year period. A set of nine parameters with possible predictive value for the need of blood transfusion was recorded. All relevant data can be acquired during the first 10 min in the emergency room (ER). The data underwent multivariate logistic regression analysis for correlation and the calculation of predictive power. To transform the model into a practical score, we rounded all coefficients. The predictive power of the score was evaluated based on a linear regression equation. Of the 1103 patients (Injury Severity Score [ISS] 21 +/- 16) included in the study, 116 (10.5%; ISS 39 +/- 18) received blood in the ER. Early transfusion need was significantly correlated with systolic blood pressure (SBP) <90 mmHg (coefficient 2.5), SBP 90-120 mmHg (1.5), free fluid in abdominal ultrasound (2.0), clinically unstable pelvic ring fracture (1.5), age 20-60 years (0.5), age >60 years (1.5), admission from scene (1.0), traffic accident (1.0) and fall from >3 m (1.0). The probability for transfusion exponentially increased with the sum of points in the ER transfusion score, i.e. from 0.7% at one point to 5% at three points and 97% at 9.5 points maximum. To establish a practical cutoff point (risk <5%) a low-risk group was defined at 相似文献
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孙立涛 《临床医学研究与实践》2021,6(10):91-93
目的分析大量输血对创伤患者炎症因子、凝血功能的影响。方法选取2018年1月至2019年12月在我院接受治疗的88例创伤患者作为研究对象,根据输血量将其分为观察组(48例,大量输血)和对照组(40例,少量输血)。比较两组患者输血前及输血后1、5 d的炎症因子水平及凝血功能指标。结果输血后1 d,观察组的CRP、IL-6、TNF-α水平均明显高于输血前及对照组(P<0.05);输血后5 d,两组的各项血清炎症因子水平比较,差异无统计学意义(P>0.05)。输血后1 d,观察组PT、APTT及TT明显长于输血前及对照组,FIB水平明显低于输血前及对照组(P<0.05);输血后5 d,两组的各项凝血功能指标比较,差异无统计学意义(P>0.05)。结论大量输血能够挽救创伤患者的生命安全,但会对患者炎症因子水平、凝血功能产生一定的影响,治疗期间应予以高度关注。 相似文献
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L. M. McDaniel E. W. Etchill J. S. Raval M. D. Neal 《Transfusion medicine (Oxford, England)》2014,24(3):138-144
The aim of this article was to review recent developments in the resuscitation of both trauma and non‐trauma patients in haemorrhagic shock. Strategies for the resuscitation of massively haemorrhaging patients and the use of massive transfusion protocols (MTPs) have been a major focus of the trauma literature over the past several years. The application of haemostatic resuscitation practices and MTPs to non‐trauma populations has long been in practice, but has only recently been the subject of active research. Medline and PubMed were reviewed for ‘massive transfusion’ (MT) from 2012 to present. Non‐English and paediatric articles were excluded. Articles were systematically reviewed for their relevance to MT. There were eight major areas of development identified. In recent MT literature, there was an increased focus on massively haemorrhaging non‐trauma patients, the role of acute traumatic coagulopathy, the use of thromboelastography (TEG), and the impact of MTPs on blood product waste and efficiency of product delivery. Other developments included additional MT prediction tools and The PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study. There was also interest in re‐evaluating the clinical relevance of the current MT definition and identifying new foci for MT. These recent developments reflect efforts to better understand and manage non‐traumatic haemorrhage and to address prior limitations in the trauma literature. Inevitably, new questions have been raised, which will likely direct ongoing and future research in MT. 相似文献
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目的 探讨回输腹腔穿刺引流自体血在闭合性脾损伤非手术治疗中的安全性与可行性.方法 对2008年1月至2011年12月安徽省立医院急诊外科94例闭合性脾损伤患者进行综合评估,将其中符合非手术治疗指征并且具有输血指征的44例单纯性脾损伤患者随机(随机数字法)分为治疗组与对照组,观察两组间年龄、性别、创伤评分、损伤分级、腹腔引流血液有核细胞计数、淀粉酶、腹腔引流血液量、输血量及损伤至输血间隔时间有无显著差异,然后治疗组回输腹腔引流自体血,对照组输入异体红细胞,比较两组患者输血前后24 h以及治疗后在血液动力学、血液成分及凝血指标等方面的差异.结果 两组患者输血后血液动力学指标及贫血指标均显著改善;两组患者输血后各项生理指标变化差异无统计学意义.结论 伤情评估及腹腔穿刺引流血检验后,回输腹腔穿刺引流自体血可用于闭合性脾损伤非手术治疗,与输入异体红细胞同样安全有效. 相似文献
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Cryoprecipitate prepared from plasma treated with methylene blue plus light: increasing the fibrinogen concentration 总被引:1,自引:0,他引:1
Hornsey VS Young DA Docherty A Hughes W Prowse CV 《Transfusion medicine (Oxford, England)》2004,14(5):369-374
When cryoprecipitate is prepared from plasma which has been treated with methylene blue plus light (MB) for the purpose of virus inactivation, clottable fibrinogen content is 40% lower compared with units prepared from untreated plasma. Initial studies showed that when frozen MB plasma units were removed to +2 to +6 degrees C for 4 h and then returned to -40 degrees C prior to cryoprecipitation, fibrinogen recoveries increased from 24 to 42%. Although fibrinogen yield improved when plasma units were stored at +2 to +6 degrees C for varying lengths of time, FVIII levels decreased with increasing time. Conditioning for 8 h was studied in more detail. Groups of two plasma units were mixed together, divided into two equal units, frozen/thawed and treated with MB. One of each pair was stored continually at -40 degrees C, whereas the other was removed to +2 to +6 degrees C for 8 h. Samples were assayed for fibrinogen, FVIII, VWF:Ristocetin cofactor activity (RCo), VWF:Ag and VWF:Collagen binding (CB). The cryoprecipitate fibrinogen content increased to a mean of 207 mg unit(-1). VWF:Ag, VWF:RCo and VWF:CB recoveries also increased. FVIII recovery decreased from 50 to 45% (mean 124 iu unit(-1)). Conditioning has been validated for routine production of cryoprecipitate from imported plasma. 相似文献
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Measurement of haemolysis markers following transfusion of uncrossmatched,low‐titre,group O+ whole blood in civilian trauma patients: initial experience at a level 1 trauma centre 下载免费PDF全文
J. N. Seheult D. J. Triulzi L. H. Alarcon J. L. Sperry A. Murdock M. H. Yazer 《Transfusion medicine (Oxford, England)》2017,27(1):30-35
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目的探讨大量输血与血清钾变化的相关性。方法回顾性分析2007年3月至2010年12月所有非挤压伤病人大量输血(观察组)和非输血患者(对照组)的临床资料,采用多因素分析方法分析输血前后血钾变化规律及影响因素。结果手术和输血前、后两组血清钾水平无显著差异(P>0.05),但术后12 h内观察组的高钾血症发生率高于对照组(P<0.05),而12 h后两组高血钾的发生率无显著差异(P>0.05)。Logistic回归分析显示术前高血钾(P<0.05)和术后低pH值(P<0.05)是导致术后高钾血症的主要原因,而与大量输血治疗无明显相关性(P>0.05)。结论非挤压伤病人大量输血并不是导致高钾血症的发生的直接原因,但同样需要动态监测输血前后的血钾变化。 相似文献