Bleeding, Hemorrhagic Shock, and the Global Blood Supply

Faria, Isabella; Thivalapill, Neil; Makin, Jennifer; Puyana, Juan Carlos; Raykar, Nakul

doi:10.1016/j.ccc.2022.06.013

Cited by 12 publications

(11 citation statements)

References 68 publications

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“…Overall, our findings suggest that implementing a transfusion threshold of 6–7 g/dl may alleviate the strain on RBC resources and reduce associated costs in patients with extensive burns, without impacting prognostic outcomes, in comparison to a transfusion threshold of 7–8 g/dl. Although COVID-19 was successfully curtailed, blood scarcity is still a global and long-established problem that involves multiple factors including donor recruitment, blood collection, blood testing, blood processing, blood distribution, blood transfusion management, and so on 17 , 32 . A modeling study showed that in 2017, the global unmet demand for blood products was equivalent to 1849 units per 100,000 population 33 .…”

Section: Discussionmentioning

confidence: 99%

“…However, though adopting the restrictive transfusion strategy, the treatment of extensive burn patients still required large amounts of RBC products. In the period of blood resources absence, RBC products were still unable to meet the needs of all patients 15 – 17 . Some extensive burn patients were forced to adopt an “ultra-restrictive” transfusion strategy, in which RBC transfusion thresholds were < 7 g/dl or even < 6 g/dl.…”

Section: Introductionmentioning

confidence: 99%

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Ultra-restrictive red blood cell transfusion strategies in extensively burned patients

Wang,

Zhu,

Duan

et al. 2024

Sci Rep

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In recent years, due to the shortage of blood products, some extensive burn patients were forced to adopt an “ultra-restrictive” transfusion strategy, in which the hemoglobin levels of RBC transfusion thresholds were < 7 g/dl or even < 6 g/dl. This study investigated the prognostic impacts of ultra-restrictive RBC transfusion in extensive burn patients. This retrospective multicenter cohort study recruited extensive burns (total body surface area ≥ 50%) from three hospitals in Eastern China between 1 January 2016 and 30 June 2022. Patients were divided into an ultra-restrictive transfusion group and a restrictive transfusion group depending on whether they received timely RBC transfusion at a hemoglobin level < 7 g/dl. 1:1 ratio propensity score matching (PSM) was performed to balance selection bias. Modified Poisson regression and linear regression were conducted for sensitive analysis. Subsequently, according to whether they received timely RBC transfusion at a hemoglobin level < 6 g/dl, patients in the ultra-restrictive transfusion group were divided into < 6 g/dl group and 6–7 g/dl group to further compare the prognostic outcomes. 271 eligible patients with extensive burns were included, of whom 107 patients were in the ultra-restrictive transfusion group and 164 patients were in the restrictive transfusion group. The ultra-restrictive transfusion group had a significantly lower RBC transfusion volume than the restrictive transfusion group (11.5 [5.5, 21.5] vs 17.3 [9.0, 32.5] units, p = 0.004). There were no significant differences between the two groups in terms of in-hospital mortality, risk of infection, hospital length of stay, and wound healing time after PSM or multivariate adjustment (p > 0.05). Among the ultra-restrictive transfusion group, patients with RBC transfusion threshold < 6 g/dl had a significantly higher hospital mortality than 6–7 g/dl (53.1% vs 21.3%, p = 0.001). For extensive burn patients, no significant adverse effects of ultra-restrictive RBC transfusion were found in this study. When the blood supply is tight, it is acceptable to adopt an RBC transfusion threshold of < 7 g/dL but not < 6 g/dL.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ultra-restrictive red blood cell transfusion strategies in extensively burned patients

Wang,

Zhu,

Duan

et al. 2024

Sci Rep

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“…Especially during the years 2019-2022 with the COVID-19 pandemic, decreased blood donations and increased demand for blood products led to an increase in the number of patients experiencing ultra-restrictive transfusion 28 . Although COVID-19 was successfully curtailed, blood scarcity is still a global and long-established problem that involves multiple factors including donor recruitment, blood collection, blood testing, blood processing, blood distribution, blood transfusion management, and so on 17,29 . A modeling study showed that in 2017, the global unmet demand for blood products was equivalent to 1849 units per 100,000 population 30 .…”

Section: Discussionmentioning

confidence: 99%

“…However, though adopting the restrictive transfusion strategy, the treatment of extensive burn patients still required large amounts of RBC products. In the period of blood resources absence, RBC products were still unable to meet the needs of all patients [15][16][17] . Some extensive burn patients were forced to adopt an "ultra-restrictive" transfusion strategy, in which RBC transfusion thresholds were < 7g/dl or even < 6 g/dL.…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of ultra-restrictive RBC transfusion in extensive burn patients: a retrospective multicenter cohort study running headline: ultra-restrictive transfusion in burns

Wang,

Zhu,

Duan

et al. 2023

Preprint

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Background In recent years, due to the shortage of blood products, some extensive burn patients were forced to adopt an “ultra-restrictive” transfusion strategy, in which the hemoglobin levels of RBC transfusion thresholds were < 7g/dl or even < 6 g/dL. This study investigated the prognostic impacts of ultra-restrictive RBC transfusion in extensive burn patients. Material and methods This retrospective multicenter cohort study recruited extensive burns (total body surface area ≥ 50%) from three hospitals in Eastern China between 1 January 2016 and 30 June 2022. Patients were divided into an ultra-restrictive transfusion group and a restrictive transfusion group depending on whether they received timely RBC transfusion at a hemoglobin level < 7 g/dL. 1:1 ratio propensity score matching (PSM) was performed to balance selection bias. Modified Poisson regression and linear regression were conducted for sensitive analysis. Subsequently, according to whether they received timely RBC transfusion at a hemoglobin level < 6 g/dl, patients in the ultra-restrictive transfusion group were divided into < 6 g/dl group and ≥ 6 g/dl group to further compare the prognostic outcomes. Results 271 eligible patients with extensive burns were included, of whom 107 patients were in the ultra-restrictive transfusion group and 164 patients were in the restrictive transfusion group. The ultra-restrictive transfusion group had a significantly lower RBC transfusion volume than the restrictive transfusion group (11.5 [5.5, 21.5] vs 17.3 [9.0, 32.5] units, p = 0.004). There were no significant differences between the two groups in terms of in-hospital mortality, risk of infection, hospital length of stay, and wound healing time after PSM or multivariate adjustment (p > 0.05). Among the ultra-restrictive transfusion group, patients with RBC transfusion threshold < 6 g/dl had a significantly higher hospital mortality than ≥ 6 g/dl (53.1% vs 21.3%, p = 0.001). Conclusion For extensive burn patients, no significant adverse effects of ultra-restrictive RBC transfusion were found in this study. When the blood supply is tight, it is acceptable to adopt an RBC transfusion threshold of < 7 g/dL but not < 6g/dL.

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“…Blood-contacting medical devices and implants are in high demand due to the high prevalence of cardiovascular and other diseases as well as trauma. Cardiovascular diseases cause approximately 30% of all deaths worldwide, while 40% of all deaths associated with trauma can be attributed to hemorrhage; , therefore, it is crucial to explore new treatment options and biointerfaces to effectively address these complications. In this regard, novel engineered biomaterials have gained significant attention as a promising approach to improve outcomes for patients with cardiovascular diseases and bleeding complications and decrease mortality rates.…”

Section: Introductionmentioning

confidence: 99%

Bacterial-Nanocellulose-Based Biointerfaces and Biomimetic Constructs for Blood-Contacting Medical Applications

et al. 2023

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Understanding the interaction between biomaterials and blood is critical in the design of novel biomaterials for use in biomedical applications. Depending on the application, biomaterials can be designed to promote hemostasis, slow or stop bleeding in an internal or external wound, or prevent thrombosis for use in permanent or temporary medical implants. Bacterial nanocellulose (BNC) is a natural, biocompatible biopolymer that has recently gained interest for its potential use in blood-contacting biomedical applications (e.g., artificial vascular grafts), due to its high porosity, shapeability, and tissue-like properties. To promote hemostasis, BNC has been modified through oxidation or functionalization with various peptides, proteins, polysaccharides, and minerals that interact with the coagulation cascade. For use as an artificial vascular graft or to promote vascularization, BNC has been extensively researched, with studies investigating different modification techniques to enhance endothelialization such as functionalizing with adhesion peptides or extracellular matrix (ECM) proteins as well as tuning the structural properties of BNC such as surface roughness, pore size, and fiber size. While BNC inherently exhibits comparable mechanical characteristics to endogenous blood vessels, these mechanical properties can be enhanced through chemical functionalization or through altering the fabrication method. In this review, we provide a comprehensive overview of the various modification techniques that have been implemented to enhance the suitability of BNC for blood-contacting biomedical applications and different testing techniques that can be applied to evaluate their performance. Initially, we focused on the modification techniques that have been applied to BNC for hemostatic applications. Subsequently, we outline the different methods used for the production of BNC-based artificial vascular grafts and to generate vasculature in tissue engineered constructs. This sequential organization enables a clear and concise discussion of the various modifications of BNC for different blood-contacting biomedical applications and highlights the diverse and versatile nature of BNC as a natural biomaterial.

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Bleeding, Hemorrhagic Shock, and the Global Blood Supply

Cited by 12 publications

References 68 publications

Ultra-restrictive red blood cell transfusion strategies in extensively burned patients

Ultra-restrictive red blood cell transfusion strategies in extensively burned patients

Prognostic impact of ultra-restrictive RBC transfusion in extensive burn patients: a retrospective multicenter cohort study running headline: ultra-restrictive transfusion in burns

Bacterial-Nanocellulose-Based Biointerfaces and Biomimetic Constructs for Blood-Contacting Medical Applications

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