Our own blood is still the best thing to have in our veins

Frenzel, Tim; Aken, Hugo Van; Westphal, Martin

doi:10.1097/aco.0b013e3283103e84

Cited by 10 publications

(9 citation statements)

References 59 publications

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“…In the absence of benefit, these transfusions only confer risk to the recipients. PBM can reduce all patients' exposure to allogeneic blood by effectively managing the most precious resource-the patient's own blood [76].…”

Section: Discussionmentioning

confidence: 99%

Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management

2011

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The objective of this paper is to introduce clinicians and health care professionals to the concept of patient blood management (PBM) and to explain the difference between PBM and the concept of "appropriate use" of blood products. The five reasons why modern health systems need to shift from product-focused transfusion practice to PBM are also presented. These are: the aging population with a leveraged demand for blood products opposed to a shrinking donor base; the growing awareness that transfusion is a complex service involving many different cost centers within a hospital and representing a multiple of the blood product cost; the continuous effort to protect blood pools from known, new, or re-emerging pathogens while facing uncertainty over their potentially long silent carrier states; the emerging evidence that transfusion is an independent risk factor for adverse outcomes; and finally, a lack of evidence for benefit of transfusion for the vast majority of recipients. The Oncologist 2011;16(suppl 3):3-11

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Section: Discussionmentioning

confidence: 99%

Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management

2011

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“…Thus the question remains, what is the best resuscitation fluid to minimize the inflammatory complications of severe trauma? The patient's own blood would certainly be the best intravascular fluid to be administered (75). Indeed, the patient's own blood is perfectly immunologically matched, contains no risk of new exposure to infectious agents, contains components and mediators that are not commercially available, and typically does not contain elevated levels of storage damaged red blood cells.…”

Section: Relationship Between Inflammatory Response and Fluid Resuscimentioning

confidence: 99%

“…Also, there is no citrate or other exogenous anti-coagulant preservatives. Current resuscitation fluids fall short of these desired properties and transfused blood products carry considerable risks of their own (75-78). In fact, red blood cell administration is considered by many to be the most frequent “transplant procedure” performed worldwide.…”

Section: Relationship Between Inflammatory Response and Fluid Resuscimentioning

confidence: 99%

“…Transfusion initiated immune responses, although largely overshadowed by the massive response due to the traumatic injury itself, are significant (79). Fresh frozen plasma, especially the AB negative units included in a MTP protocol for blind use, carry significant risks for inflammation associated morbidity such as transfusion related acute lung injury (TRALI) and acute respiratory distress syndrome (ARDS), as well as transfusion associated circulatory overload (TACO) (13, 75, 80). Prompt administration of appropriate blood products to the correct subset of patients can significantly decrease the total blood product requirements (81).…”

Section: Relationship Between Inflammatory Response and Fluid Resuscimentioning

confidence: 99%

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Inflammatory response to trauma

Pierce

Pittet

2014

Current Opinion in Anaesthesiology

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Purpose of this review Recent studies have changed our understanding of the timing and interactions of the inflammatory processes and coagulation cascade following severe trauma. This review highlights this information and correlates its impact on the current clinical approach for fluid resuscitation and treatment of coagulopathy for trauma patients. Recent findings Severe trauma is associated with a failure of multiple biologic emergency response systems that includes imbalanced inflammatory response, acute coagulopathy of trauma (ACOT), and endovascular glycocalyx degradation with microcirculatory compromise. These abnormalities are all inter-linked and related. Recent observations show that after severe trauma: 1) pro-inflammatory and anti-inflammatory responses are concomitant, not sequential and 2) resolution of the inflammatory response is an active process, not a passive one. Understanding these interrelated processes is considered extremely important for the development of future therapies for severe trauma in humans. Summary Traumatic injuries continue to be a significant cause of mortality worldwide. Recent advances in understanding the mechanisms of end-organ failure, and modulation of the inflammatory response has important clinical implications regarding fluid resuscitation and treatment of coagulopathy.

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“…PBM identifies a patient at risk of allogeneic transfusion and formulates a multimodal and multidisciplinary (Table 2), yet individualized, plan for reducing or eliminating the need for allogeneic transfusion 24,29‐31 . Hitherto, PBM has been mainly used to avoid RBC transfusion, 32‐36 and—in the realm of RBCs—PBM treats preoperative anemia and coagulopathy before admission to the hospital, minimizes iatrogenic blood losses, conserves the patient's own blood by a variety of approaches and minimizes perioperative bleeding, and administers transfusion only when proven (by randomized controlled trials [RCTs] 37,38 ) rather than postulated (based on pathophysiology) benefit can be expected from the transfusion.…”

Section: As‐low‐as‐reasonably‐achievable Risk and Patient‐centric Tramentioning

confidence: 99%

Reasons for moving toward a patient‐centric paradigm of clinical transfusion medicine practice

Vamvakas¹

2012

Transfusion

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The combination of patient blood management (PBM) modalities and multicomponent apheresis permits us to administer even safer transfusions than those using the "safer-than-ever" blood components distributed in the beginning of the 21st century. PBM identifies a patient at risk of transfusion and formulates a multidisciplinary and multimodal-yet individualized-plan for reducing the need for allogeneic transfusion. Multicomponent apheresis can collect any combination of red blood cells, platelets, and plasma from the same donor during the same donation, and it should eventually reserve all components harvested from the same donation for transfusion to the same recipient. Together, PBM and multicomponent apheresis represent a new paradigm-the patient-centric paradigm-of transfusion medicine whose purpose is to reduce the transfusion risk for each individual patient to the level of the ALARA (as-low-as-reasonably-achievable) risk. PBM and multicomponent apheresis can meet a patient's transfusion needs with at least twofold fewer allogeneic donor exposures, thereby reducing the risk of infectious and immunologic complications of transfusion by at least twofold. The reduction in risk includes the leading cause of transfusion-related mortality (transfusion-related acute lung injury) and the cardinal threat to transfusion safety (the next "HIV-like" pathogen to emerge in the future). Once it is determined that PBM and multicomponent apheresis can replace the current blood-procurement system at a "reasonable" cost and without jeopardizing the supply of blood and components, the patient-centric paradigm should replace the current, component-centric paradigm of transfusion medicine to reduce the transfusion risk to the level of the ALARA risk.

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Our own blood is still the best thing to have in our veins

Cited by 10 publications

References 59 publications

Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management

Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management

Inflammatory response to trauma

Reasons for moving toward a patient‐centric paradigm of clinical transfusion medicine practice

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