Massive transfusion and massive transfusion protocol

Patil, Vijaya; Shetmahajan, Madhavi

doi:10.4103/0019-5049.144662

Cited by 105 publications

(79 citation statements)

References 39 publications

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“…Pulmonary hypertension was defined as peak tricuspid regurgitation velocity >2.8 m/sec in preoperative echocardiography. Massive transfusion was defined as transfusion of >10 units of packed red blood cells …”

Section: Methodsmentioning

confidence: 99%

Appraisal of Cardiac Ejection Fraction With Liver Disease Severity: Implication in Post–Liver Transplantation Mortality

et al. 2020

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Background and Aims Enhanced sympathetic nervous activation and peripheral vasodilation in end‐stage liver disease (ESLD) may limit the importance of left ventricular ejection fraction (LVEF) as an influential prognosticator. We sought to understand the LVEF and cardiac dimensions in ESLD patients in order to define the LVEF threshold to predict all‐cause mortality after liver transplantation (LT). Approach and Results Data were collected prospectively from the Asan LT Registry between 2008 and 2016, and outcomes were retrospectively reviewed. LVEF, end‐diastolic volume index (EDVI), and end‐diastolic elastance (Eed) were measured by preoperative echocardiography. Of 2,799 patients, 452 (16.2%) had LVEF ≤ 60%, with 29 (1.0%) having LVEF < 55% and 269 (9.6%) had LVEF ≥ 70%. Over a median of 5.4‐year follow‐up, 329 (11.8%) patients died: 104 (3.7%) died within 90 days. LVEF (range, 30%‐81%) was directly proportionate to Model for End‐stage Liver Disease (MELD) scores, an index of liver disease severity, in survivors but showed a fixed flat‐line pattern in nonsurvivors (interaction P = 0.004 between groups), with lower EDVI (P = 0.013) and higher Eed (P = 0.001) in the MELD ≥ 20 group. Patients with LVEF ≤ 60% had higher 90‐day (13% vs. 7.4%; log rank, P = 0.03) and median 5.4‐year (26.7% vs. 16.2%; log rank, P = 0.003) mortality rates in the MELD ≥ 20 group, respectively, compared to those with LVEF > 60%. Specifically, in the MELD > 35 group, median 5.4‐year mortality rate was 53.3% in patients with LVEF ≤ 60% versus 24% in those with LVEF > 60% (log rank P < 0.001). By contrast, mortality rates of LVEF ≤ 60% and > 60% were similar in the MELD < 20 group (log rank P = 0.817). Conclusions LVEF ≤ 60% is strongly associated with higher post‐LT mortality rates in the MELD ≥ 20 group, indicating the need to appraise both LVEF and liver disease severity simultaneously. Enhanced diastolic elastance with low EDVI provides insights into pathogenesis of low LVEF in nonsurvivors with MELD ≥ 20.

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Section: Methodsmentioning

confidence: 99%

Appraisal of Cardiac Ejection Fraction With Liver Disease Severity: Implication in Post–Liver Transplantation Mortality

et al. 2020

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“…There were no postoperative fistulae. There were no cases of massive transfusion [5] and so far no reports of any patient deaths. All our patients eventually went home in good health.…”

Section: Resultsmentioning

confidence: 94%

Starting Gynaec-Oncology Services in a Medical College

Podder

Jyothi

2016

Indian J Gynecol Oncolog

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Purpose Gynaec-Oncology Division was started within the Department of Obstetrics and Gynaeology in a private Medical College hospital on 01-01-2015 with the existing resources. The purpose was to provide specialized care to women afflicted with gynaecological malignancies, and also to train residents-the future practitioners, in GynaecOncology. At the end of 1 year, a retrospective analysis of patient outcomes was carried out to determine the feasibility of having a Gynaec-Oncology Division within the Department of Obstetrics and Gynaecology in a Medical College hospital. Methods It was decided to locate the Gynaec-Oncology Out-Patient Department (OPD)/Clinic adjacent to Radiation Oncology and Medical Oncology OPDs. Admissions were made in Obstetrics and Gynaecology wards under the three respective units. Patients were posted for surgery in the common Obstetrics and Gynaecology operation theatre. Postoperative monitoring was done by the same staff in charge of the common postoperative ward. Results There was an increase in the number of outpatients and inpatients as compared to the previous year. More complex and challenging cases were performed, with comprehensive staging being performed as a routine. The most common postoperative complication encountered was wound gape. Burst abdomen was the most serious complication encountered. There were no cases of injuries to vital structures, massive transfusion, fistulae and patient deaths. All the patients eventually went home in good health.Conclusions A Gynaec-Oncology Division can very well be started within the Department of Obstetrics and Gynaecology of Medical Colleges without any additional infrastructure and without any compromise on quality of care. Though radical surgeries are known to have much higher complication rates, it also depends to a large extent on the doctor's personal involvement and quality of postoperative care. In a country like India where Institutions have to stretch themselves beyond their means to provide care to its growing population, medical fraternity must try and provide the maximum by optimally utilizing the existing facilities.

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“…As noted previously, maternal vital signs typically do not change drastically until significant blood loss has occurred (10). Inadequate early resuscitation and hypoperfusion may lead to lactic acidosis, systemic inflammatory response syndrome with accompanying multiorgan dysfunction, and coagulopathy (87). In women with ongoing bleeding that equates to the blood loss of 1,500 mL or more or in women with abnormal vital signs (tachycardia and hypotension), immediate preparation for transfusion should be made (18,19,39).…”

Section: What Is Best Practice For Blood Product Replacement During Amentioning

confidence: 99%

“…Massive transfusion is associated with hyperkalemia from packed red blood cells and citrate (used as a preservative in stored blood products) toxicity that will typically worsen hypocalcemia. The combination of acidosis, hypocalcemia, and hypothermia all contribute to worsening coagulopathy and increased morbidity (87,97). Overzealous resuscitation with crystalloid also can be associated with dilution-related coagulopathy and can contribute to pulmonary edema (98).…”

Section: What Is the Management Approach For Secondary Or Delayed Posmentioning

confidence: 99%

Tranexamic acid as adjuvant treatment for postpartum hemorrhage: a systematic review protocol

Fahrenholtz

Bonanno²,

Martin

2019

JBI Database of Systematic Reviews and Implementation Reports

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Maternal hemorrhage, defined as a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process, remains the leading cause of maternal mortality worldwide (1). Additional important secondary sequelae from hemorrhage exist and include adult respiratory distress syndrome, shock, disseminated intravascular coagulation, acute renal failure, loss of fertility, and pituitary necrosis (Sheehan syndrome).Hemorrhage that leads to blood transfusion is the leading cause of severe maternal morbidity in the United States closely followed by disseminated intravascular coagulation (2). In the United States, the rate of postpartum hemorrhage increased 26% between 1994 and 2006 primarily because of increased rates of atony (3). In contrast, maternal mortality from postpartum obstetric hemorrhage has decreased since the late 1980s and accounted for slightly more than 10% of maternal mortalities (approximately 1.7 deaths per 100,000 live births) in 2009 (2, 4). This observed decrease in mortality is associated with increasing rates of transfusion and peripartum hysterectomy (2)(3)(4).The purpose of this Practice Bulletin is to discuss the risk factors for postpartum hemorrhage as well as its evaluation, prevention, and management. In addition, this document will encourage obstetrician-gynecologists and other obstetric care providers to play key roles in implementing standardized bundles of care (eg, policies, guidelines, and algorithms) for the management of postpartum hemorrhage.

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Massive transfusion and massive transfusion protocol

Cited by 105 publications

References 39 publications

Appraisal of Cardiac Ejection Fraction With Liver Disease Severity: Implication in Post–Liver Transplantation Mortality

Appraisal of Cardiac Ejection Fraction With Liver Disease Severity: Implication in Post–Liver Transplantation Mortality

Starting Gynaec-Oncology Services in a Medical College

Tranexamic acid as adjuvant treatment for postpartum hemorrhage: a systematic review protocol

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