Appropriateness of red blood cell use in orthopedic surgery and traumatology: analysis of transfusion practice

Introduction and purpose  

The need for perioperative patient blood management measures aiming at improving patient outcomes and reducing the need for transfusion is increasingly recognized. This study determines to what degree the utilization of packed red blood cells (PRBCs) is appropriate in orthopedic and trauma surgery and identifies the factors that lead to inappropriate transfusion practice.     

Patient blood management in Europe

Preoperative anaemia is common in patients undergoing orthopaedic and other major surgery. Anaemia is associated with increased risks of postoperative mortality and morbidity, infectious complications, prolonged hospitalization, and a greater likelihood of allogeneic red blood cell (RBC) transfusion. Evidence of the clinical and economic disadvantages of RBC transfusion in treating perioperative anaemia has prompted recommendations for its restriction and a growing interest in approaches that rely on patients' own (rather than donor) blood. These approaches are collectively termed 'patient blood management' (PBM). PBM involves the use of multidisciplinary, multimodal, individualized strategies to minimize RBC transfusion with the ultimate goal of improving patient outcomes. PBM relies on approaches (pillars) that detect and treat perioperative anaemia and reduce surgical blood loss and perioperative coagulopathy to harness and optimize physiological tolerance of anaemia. After the recent resolution 63.12 of the World Health Assembly, the implementation of PBM is encouraged in all WHO member states. This new standard of care is now established in some centres in the USA and Austria, in Western Australia, and nationally in the Netherlands. However, there is a pressing need for European healthcare providers to integrate PBM strategies into routine care for patients undergoing orthopaedic and other types of surgery in order to reduce the use of unnecessary transfusions and improve the quality of care. After reviewing current PBM practices in Europe, this article offers recommendations supporting its wider implementation, focusing on anaemia management, the first of the three pillars of PBM.     

Impact of Ganogerma applanatum extraction on haematological profiles of laboratory rats: a preliminary study in Nigeria

ObjectiveExtracts of Ganoderma species have been widely used as herbal medicines in the treatment of several infections. This study was carried out to ascertain the haematological properties of aqueous Ganoderma applanatum (G. applanatum).MethodsSixty albino rats grouped into six equal groups (10 each) of A to F consisting of tests and controls. Laboratory albino rats in groups A, B and C were infected with Trypanosoma brucei brucei (T. brucei brucei) while groups A and B (test) were treated with aqueous G. applanatum extract; other groups served as control. Microscopy and haematological profiles from the albino rats were monitored on daily basis for blood parasites, packed cell volume (PCV), haemoglobin concentration (HC), total red blood cell count (RBC), mean cell haemoglobin (MCH), mean cell volume (MCV), mean cell haemoglobin concentration (MCHC), and total white blood cell count (WBC).ResultsAlbino rats in groups A, B and C infected with T. brucei brucei and treated with various concentrations of aqueous G. applanatum showed a progressive reduction in PCV, HC, RBC, MCH and MCHC compared to the controls (P<0.05). All the infected rats died by day 14 of the experiment from parasitaemia.ConclusionsG. applanatum lacks ability to boost haematological profiles of anaemic laboratory rats and also of no use in the treatment of African trypanosomiasis. Higher doses of the fungal extract may be required to test on laboratory rats with less lethal biological stimulants of anaemia before proving or otherwise its true haematological properties.     

Enhancing trauma education worldwide through telemedicine

Advances in information and communication technologies are changing the delivery of trauma care and education. Telemedicine is a tool that can be used to deliver expert trauma care and education anywhere in the world. Trauma is a rapidly-evolving field requiring access to readily available sources of information. Through videoconferencing, physicians can participate in continuing education activities such as Grand Rounds, seminars, conferences and journal clubs. Exemplary programs have shown promising outcomes of teleconferences such as enhanced learning, professional collaborations, and networking. This review introduces the concept of telemedicine for trauma education, and highlights efforts of programs that are utilizing telemedicine to unite institutions across the world.