Blood product transfusion and wastage rates in obstetric hemorrhage

Yazer, Mark H.; Dunbar, Nancy M.; Cohn, Claudia S.; Dillon, Jessica L.; Eldib, Howida; Jackson, Bryon; Kaufman, Richard M.; Murphy, Michael; O’Brien, Kerry L.; Raval, Jay S.; Seheult, Jansen N.; Staves, Julie; Waters, Jonathan H.

doi:10.1111/trf.14571

Cited by 7 publications

(6 citation statements)

References 34 publications

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“…Cryoprecipitate is a nonpurified product; hence, in addition to fibrinogen it contains fibronectin and platelet microparticles, as well as coagulation factors VIII, XIII, and von Willebrand factor . Its fibrinogen content varies widely (from 3-30 g/L per unit); in most cases it must be maintained and shipped in a frozen state and then thawed and pooled (typically 5-10 unit pools) before administration; and it has a limited shelf life after thawing (<4-6 hours), increasing wastage . Fibrinogen concentrates are pathogen-reduced and purified; have standardized fibrinogen content (20 g/L); are lyophilized, allowing for easy storage, reconstitution, and administration; and have longer shelf life after reconstitution (up to 24 hours), which reduces wastage.…”

Section: Introductionmentioning

confidence: 99%

“…6 Its fibrinogen content varies widely (from 3-30 g/L per unit); in most cases it must be maintained and shipped in a frozen state and then thawed and pooled (typically 5-10 unit pools) before administration; and it has a limited shelf life after thawing (<4-6 hours), increasing wastage. 7,8 Fibrinogen concentrates are pathogen-reduced and purified; have standardized fibrinogen content (20 g/L); are lyophilized, allowing for easy storage, reconstitution, and administration; and have longer shelf life after reconstitution (up to 24 hours), which reduces wastage. There is divergent practice regarding the preferred product for fibrinogen replacement.…”

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confidence: 99%

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Effect of Fibrinogen Concentrate vs Cryoprecipitate on Blood Component Transfusion After Cardiac Surgery

Callum

Farkouh

Scales

et al. 2019

JAMA

126

147

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IMPORTANCE Excessive bleeding is a common complication of cardiac surgery. An important cause of bleeding is acquired hypofibrinogenemia (fibrinogen level <1.5-2.0 g/L), for which guidelines recommend fibrinogen replacement with cryoprecipitate or fibrinogen concentrate. The 2 products have important differences, but comparative clinical data are lacking.OBJECTIVE To determine if fibrinogen concentrate is noninferior to cryoprecipitate for treatment of bleeding related to hypofibrinogenemia after cardiac surgery. DESIGN, SETTING, AND PARTICIPANTSRandomized clinical trial at 11 Canadian hospitals enrolling adult patients experiencing clinically significant bleeding and hypofibrinogenemia after cardiac surgery (from February 10, 2017, to November 1, 2018). Final 28-day follow-up visit was completed on November 28, 2018.INTERVENTIONS Fibrinogen concentrate (4 g; n = 415) or cryoprecipitate (10 units; n = 412) for each ordered dose within 24 hours after cardiopulmonary bypass. MAIN OUTCOMES AND MEASURESPrimary outcome was blood components (red blood cells, platelets, plasma) administered during 24 hours post bypass. A 2-sample, 1-sided test for the ratio of the mean number of units was conducted to evaluate noninferiority (threshold for noninferiority ratio, <1.2). RESULTSOf 827 randomized patients, 735 (372 fibrinogen concentrate, 363 cryoprecipitate) were treated and included in the primary analysis (median age, 64 [interquartile range, 53-72] years; 30% women; 72% underwent complex operations; 95% moderate to severe bleeding; and pretreatment fibrinogen level, 1.6 [interquartile range, 1.3-1.9] g/L). The trial met the a priori stopping criterion for noninferiority at the interim analysis after 827 of planned 1200 patients were randomized. Mean 24-hour postbypass allogeneic transfusions were 16.3 (95% CI, 14.9 to 17.8) units in the fibrinogen concentrate group and 17.0 (95% CI, 15.6 to 18.6) units in the cryoprecipitate group (ratio, 0.96 [1-sided 97.5% CI, −ϱ to 1.09; P < .001 for noninferiority] [2-sided 95% CI, 0.84 to 1.09; P = .50 for superiority]). Thromboembolic events occurred in 26 patients (7.0%) in the fibrinogen concentrate group and 35 patients (9.6%) in the cryoprecipitate group. CONCLUSIONS AND RELEVANCEIn patients undergoing cardiac surgery who develop clinically significant bleeding and hypofibrinogenemia after cardiopulmonary bypass, fibrinogen concentrate is noninferior to cryoprecipitate with regard to number of blood components transfused in a 24-hour period post bypass. Use of fibrinogen concentrate may be considered for management of bleeding in patients with acquired hypofibrinogenemia in cardiac surgery.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Effect of Fibrinogen Concentrate vs Cryoprecipitate on Blood Component Transfusion After Cardiac Surgery

Callum

Farkouh

Scales

et al. 2019

JAMA

126

147

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“…For the above reasons, we still see a role for an MTP in any paediatric institution, despite the limited evidence. However, wastage may potentially follow the implementation of an MTP, and many centres have reported an increase in blood wastage rates following its implementation [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, upon returning the product to the blood bank, the products are often outside of acceptable temperature ranges, making it unsafe for it to be diverted to other patients [ 6 ]. Wastage rates in adult studies are reported to range from 2–7% [ 11 , 13 ]. Our institution’s wastage rate is at 1.5%, which is a comparatively low figure.…”

Section: Discussionmentioning

confidence: 99%

Blood Lost: A Retrospective Review of Blood Wastage from a Massive Transfusion Protocol in a Tertiary Paediatric Hospital

et al. 2022

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Background: The paediatric massive transfusion protocol (MTP) is activated in the paediatric population for both trauma and non-trauma related indications. While it helps to improve the efficiency and efficacy of the delivery of blood products, it can also result in increased wastage. We aimed to evaluate the wastage rates from our paediatric MTP activations from 2013 to 2018. Method: As part of an audit, we retrospectively reviewed the records of the paediatric patients who had MTP activations. We collected the following data: reason for MTP activation, weight of patient, number of cycles of MTP required, blood products used, blood products wasted, deviation from our institution’s recommended MTP blood product ratio, and reason for wastage. Result: We had 26 paediatric MTP activations within the audit period. There was an overall wastage rate of 1.5%, with wastage occurring in 3 out of 26 patients. The reason for all wastage was demise of the patient. Most patients’ transfusion ratios deviated from our institution’s MTP protocol. Conclusion: Our wastage rates are low likely because of clear MTP activation guidelines and a flexible MTP workflow.

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“…The incorporation of cryoprecipitate into MTPs has led not only to increased demand for product but also to a disproportionate increase in wastage. This is because, unlike thawed plasma, cryoprecipitate has a shelf life of only 4 or 6 hours after thawing, which precludes its reuse if returned to the blood bank after being issued as part of an MTP 22,23 . Even with the increase in wastage, management of cryoprecipitate inventory to allow for strict adherence to ABO compatibility has not often presented the same challenges as that of platelets and AB plasma, until now.…”

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confidence: 99%

Time to stop worrying about ABO incompatible cryoprecipitate transfusions in adults

Khan

Dunbar

2021

Transfusion

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Time to stop worrying about ABO incompatible cryoprecipitate transfusions in adults ABO determination is the foundation of pretransfusion testing, with the goal of preventing acute hemolytic reactions due to the transfusion of ABO-incompatible blood products. ABO compatibility is generally taught using a simplified schema based on strict adherence to matching for the presence/absence of antigen/antibody: • Group O is universal red blood cell (RBC) donor; group AB is universal RBC recipient. • Group AB is universal plasma donor; group O is universal plasma recipient.

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Blood product transfusion and wastage rates in obstetric hemorrhage

Abstract: Although the rates of receiving a transfusion of at least one blood product when one is ordered was high, many of the issued units were returned, especially for RBCs.

Cited by 7 publications

References 34 publications

Effect of Fibrinogen Concentrate vs Cryoprecipitate on Blood Component Transfusion After Cardiac Surgery

Effect of Fibrinogen Concentrate vs Cryoprecipitate on Blood Component Transfusion After Cardiac Surgery

Blood Lost: A Retrospective Review of Blood Wastage from a Massive Transfusion Protocol in a Tertiary Paediatric Hospital

Time to stop worrying about ABO incompatible cryoprecipitate transfusions in adults

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