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

Seheult, Jansen N.; Triulzi, Darrell J.; Alarcon, Louis H.; Sperry, Jason L.; Murdock, Alan D.; Yazer, Mark H.

doi:10.1111/tme.12372

Cited by 111 publications

(109 citation statements)

References 19 publications

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“…Detailed information about the logistics of the LTOWB program implemented at this civilian trauma center are presented elsewhere . Briefly, the program was implemented in December 2014 when 2 units of LTOWB were available for transfusion to hypotensive male trauma patients.…”

Section: Methodsmentioning

confidence: 99%

“…A nongroup O recipient would therefore be at risk of hemolysis from the anti‐A and anti‐B that is contained in the group O whole blood unit itself. It has been demonstrated that the transfusion of up to 4 units of LTOWB to civilian trauma patients did not cause laboratory or clinically apparent changes that were suggestive of hemolysis among the nongroup O recipients compared to the group O recipients . These studies were limited by the nonspecific nature of the changes in the biochemical parameters of hemolysis that occur in trauma patients, and on the blood bank's reliance on a passive reporting mechanism for adverse clinical events related to the LTOWB administration.…”

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confidence: 99%

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Clinical outcomes among low‐titer group O whole blood recipients compared to recipients of conventional components in civilian trauma resuscitation

et al. 2018

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

Clinical outcomes among low‐titer group O whole blood recipients compared to recipients of conventional components in civilian trauma resuscitation

et al. 2018

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“…Group A plasma has been safely used in bleeding trauma patients and “Safety of the use of group A plasma in trauma: the STAT study” showed no difference in clinical outcomes between ABO identical group (A type patients that received A plasma) and ABO minor incompatible group (B/AB patients that received A plasma) . In addition, initial experience with low titer O whole blood units that are given to bleeding trauma patients showed no evidence of hemolysis among nongroup O recipients …”

Section: Discussionmentioning

confidence: 99%

Low titer A plasma in three AB patients for therapeutic plasma exchange

Kaplan

Sevcik

Kiss

2018

J of Clinical Apheresis

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Background Currently, low titer A plasma is used on a routine basis in bleeding trauma patients of unknown AB type. Three AB non‐bleeding apheresis patients are presented here who safely received a combination of AB and low titer A plasma during therapeutic plasma exchange (TPE). One control AB patient received AB plasma only. Methods Data was obtained retrospectively on number of procedures, volume replaced, total plasma, and A plasma volumes including hemolysis laboratory data. Average A plasma volume and % of A plasma out of total plasma volume used were calculated. Results Two female AB patients were treated for thrombotic thrombocytopenic purpura (TTP) with TPE and a third female AB patient was treated for microangiopathic hemolytic anemia. Patient 1 received a total of 12 procedures, 10/12 with AB+A plasma (average 916.3 ±84.6 mL). Patient 2 received a total of 12 procedures, 4/12 with AB+A plasma (average 1210.5 ±27.9 mL). Patient 3 received a total of six procedures, four out of six procedures with AB+A plasma (average 1009.8 ±80.3 mL). Patient 4, control, received AB plasma only. Percent of A plasma volume exchanged ranged between 23.8% and 47.8%. Haptoglobin, LDH, hemoglobin, and total bilirubin were monitored and trends were comparable with the control patient. The patients had a negative follow up direct antiglobulin test, adequate platelet recovery and a favorable clinical outcome with treatments. Conclusions TPE was effectively performed without evidence of increased hemolysis using up to 47.8% of low titer A plasma. This approach can reduce strains on limited supplies of AB plasma whereas providing a vital treatment alternative for AB patients undergoing TPE with plasma replacement.

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“…There is conflicting evidence that transfusion of stored blood can lead to hemolysis [29–31] and so far, there is no evidence that a blood prime causes higher PHb levels. Many of our subjects (45/60, 75%) received a circuit blood prime with no difference in ΔPHb from those who did not.…”

Section: Discussionmentioning

confidence: 99%

Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass

Kim‐Campbell

Gretchen

Callaway

et al. 2017

Critical Care Medicine

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Objective To determine the relationship between the production of cell-free plasma hemoglobin (PHb) and acute kidney injury (AKI) in infants and children undergoing cardiopulmonary bypass (CPB) for cardiac surgery. Design Prospective observational study Setting 12-bed cardiac ICU in a university-affiliated children’s hospital Patients Children were prospectively enrolled during their pre-operative outpatient appointment with the following criteria: >1month to <18 years old, procedures requiring CPB, no preexisting renal dysfunction. Interventions None Measurements and Main Results Plasma and urine were collected at baseline (in a subset), the beginning and end of CPB, and 2h and 24h after CPB in 60 subjects. Levels of PHb increased during CPB and were associated (p<0.01) with CPB duration (R2=0.22), depletion of Hp at end and 24h after CPB (R2=0.12 and 0.15, respectively), LDH levels at end CPB (R2=0.27), and change in creatinine (R2=0.12). 43% of patients developed AKI. There was an association between PHb level and change in creatinine that varied by age (overall [R2=0.12, p<0.01], in age >2yrs [R2=0.22, p<0.01], and in <2yrs [R2=0.03, p=0.42]). Change in PHb and male gender were found to be risk factors for AKI (OR 1.02 and OR 3.78, p<0.05). Conclusions Generation of PHb during CPB and male gender are associated with subsequent renal dysfunction in low risk pediatric patients, especially in those >2yrs of age. Further studies are needed to determine whether specific subgroups of pediatric patients undergoing CPB would benefit from potential treatments for hemolysis and PHb-associated renal dysfunction.

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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

Abstract: Administration of ≤2 units of cWB in civilian trauma resuscitation was not associated with clinically significant changes in laboratory haemolysis markers. Efficacy will be determined when larger quantities are transfused.

Cited by 111 publications

References 19 publications

Clinical outcomes among low‐titer group O whole blood recipients compared to recipients of conventional components in civilian trauma resuscitation

Clinical outcomes among low‐titer group O whole blood recipients compared to recipients of conventional components in civilian trauma resuscitation

Low titer A plasma in three AB patients for therapeutic plasma exchange

Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass

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