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Статті в журналах з теми "Erythrocyte transfusion/methods"
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Karkouti, Keyvan, Duminda N. Wijeysundera, Terrence M. Yau, Stuart A. McCluskey, Christopher T. Chan, Pui-Yuen Wong, Mark A. Crowther, Siroos Hozhabri, and W. Scott Beattie. "Advance Targeted Transfusion in Anemic Cardiac Surgical Patients for Kidney Protection." Anesthesiology 116, no. 3 (March 1, 2012): 613–21. http://dx.doi.org/10.1097/aln.0b013e3182475e39.
Повний текст джерелаАнотація:
Introduction : Acute kidney injury (AKI) is a serious complication of cardiac surgery, and preoperative anemia and perioperative erythrocyte transfusion are important risk factors. Prophylactic erythrocyte transfusion in anemic patients may, therefore, protect against AKI. Methods : In this unblinded, parallel-group, randomized pilot trial, 60 anemic patients (hemoglobin 10-12 g/dL) undergoing cardiac surgery with cardiopulmonary bypass were randomized (1:1) to prophylactic transfusion (2 units of erythrocytes transfused 1 to 2 days before surgery (n = 29) or standard of care (transfusions as indicated; n = 31). Between-group differences in severity of perioperative anemia, transfusion, and AKI (more than 25% drop in estimated glomerular filtration rate) were measured. The relationships between transfusion, iron levels, and AKI were also measured. Results : Perioperative anemia and erythrocyte transfusions were lower in the prophylactic transfusion group--median (25th, 75th percentiles) for nadir hemoglobin was 8.3 (7.9, 9.1) versus 7.6 (6.9, 8.2) g/dL (P = 0.0008) and for transfusion was 0 (0, 2) versus 2 (1, 4) units (P = 0.0002)--but between-group AKI rates were comparable (11 patients per group). In 35 patients with iron studies, perioperative transfusions were directly related to postoperative transferrin saturation (correlation coefficient 0.6; P = 0.0002), and high (more than 80%) transferrin saturation was associated with AKI (5/5 vs. 8/30; P = 0.005), implicating transfusion-related iron overload as a cause of AKI. Conclusions : In anemic patients, prophylactic erythrocyte transfusion reduces perioperative anemia and erythrocyte transfusions, and may reduce plasma iron levels. Adequately powered studies assessing the effect of this intervention on AKI are warranted.
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Muenster, Stefan, Arkadi Beloiartsev, Binglan Yu, E. Du, Sabia Abidi, Ming Dao, Gregor Fabry, et al. "Exposure of Stored Packed Erythrocytes to Nitric Oxide Prevents Transfusion-associated Pulmonary Hypertension." Anesthesiology 125, no. 5 (November 1, 2016): 952–63. http://dx.doi.org/10.1097/aln.0000000000001294.
Повний текст джерелаАнотація:
Abstract Background Transfusion of packed erythrocytes stored for a long duration is associated with increased pulmonary arterial pressure and vascular resistance. Prolonged storage decreases erythrocyte deformability, and older erythrocytes are rapidly removed from the circulation after transfusion. The authors studied whether treating stored packed ovine erythrocytes with NO before transfusion could prevent pulmonary vasoconstriction, enhance erythrocyte deformability, and prolong erythrocyte survival after transfusion. Methods Ovine leukoreduced packed erythrocytes were treated before transfusion with either NO gas or a short-lived NO donor. Sheep were transfused with autologous packed erythrocytes, which were stored at 4°C for either 2 (“fresh blood”) or 40 days (“stored blood”). Pulmonary and systemic hemodynamic parameters were monitored before, during, and after transfusion. Transfused erythrocytes were labeled with biotin to measure their circulating lifespan. Erythrocyte deformability was assessed before and after NO treatment using a microfluidic device. Results NO treatment improved the deformability of stored erythrocytes and increased the number of stored erythrocytes circulating at 1 and 24 h after transfusion. NO treatment prevented transfusion-associated pulmonary hypertension (mean pulmonary arterial pressure at 30 min of 21 ± 1 vs. 15 ± 1 mmHg in control and NO–treated packed erythrocytes, P < 0.0001). Washing stored packed erythrocytes before transfusion did not prevent pulmonary hypertension. Conclusions NO treatment of stored packed erythrocytes before transfusion oxidizes cell-free oxyhemoglobin to methemoglobin, prevents subsequent NO scavenging in the pulmonary vasculature, and limits pulmonary hypertension. NO treatment increases erythrocyte deformability and erythrocyte survival after transfusion. NO treatment might provide a promising therapeutic approach to prevent pulmonary hypertension and extend erythrocyte survival.
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Gadilshina, R. S., and E. E. Bel’skaya. "Cases of alloimmunization with rh-antigen D in patients with uncomplicated transfusion history." Kazan medical journal 93, no. 2 (April 15, 2012): 347–48. http://dx.doi.org/10.17816/kmj2330.
Повний текст джерелаАнотація:
Aim. To attract the attention of practicing physicians to the problem of transfusion safety of erythrocyte-containing preparations to patients at risk for the emergence of post-transfusion complications. Methods. Gel technique, diagnostic panel of erythrocytes for screening and identification of alloimmune antibodies. Results. During the study of blood samples of patients identified were alloantibodies to the D antigen of the Rh-system and provided were recommendations for blood transfusions with individual selection. Conclusion. Antibodies to erythrocyte antigens of the Rh-system can be synthesized as a result of immunization due to an incompatible blood transfusion or incompatible pregnancies, as well as in cases of intravenous drug use, in the antigen D immunized donors.
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Feiner, John R., Michael A. Gropper, Pearl Toy, Jeremy Lieberman, Jenifer Twiford, and Richard B. Weiskopf. "A Clinical Trial to Detect Subclinical Transfusion-induced Lung Injury during Surgery." Anesthesiology 123, no. 1 (July 1, 2015): 126–35. http://dx.doi.org/10.1097/aln.0000000000000689.
Повний текст джерелаАнотація:
Abstract Background: Transfusion-related acute lung injury incidence remains the leading cause of posttransfusion mortality. The etiology may be related to leukocyte antibodies or biologically active compounds in transfused plasma, injuring susceptible recipient’s lungs. The authors have hypothesized that transfusion could have less severe effects that are not always appreciated clinically and have shown subtly decreased pulmonary oxygen gas transfer in healthy volunteers after transfusion of fresh and 21-day stored erythrocytes. In this study, the authors tested the same hypothesis in surgical patients. Methods: Ninety-one patients undergoing elective major spine surgery with anticipated need for erythrocyte transfusion were randomly allocated to receive their first transfusion of erythrocytes as cell salvage (CS), washed stored, or unwashed stored. Clinicians were not blinded to group assignment. Pulmonary gas transfer and mechanics were measured 5 min before and 30 min after erythrocyte transfusion. Results: The primary outcome variable, gas transfer, as assessed by change of Pao2/Fio2, with erythrocyte transfusion was not significant in any group (mean ± SD; CS: 9 ± 59; washed: 10 ± 26; and unwashed: 15 ± 1) and did not differ among groups (P = 0.92). Pulmonary dead space (VD/VT) decreased with CS transfusion (−0.01 ± 0.04; P = 0.034) but did not change with other erythrocytes; the change from before to after erythrocyte transfusion did not differ among groups (−0.01 to +0.01; P = 0.28). Conclusions: The authors did not find impaired gas exchange as assessed by Pao2/Fio2 with transfused erythrocytes that did or did not contain nonautologous plasma. This clinical trial did not support the hypothesis of erythrocyte transfusion-induced gas exchange deficit that had been found in healthy volunteers.
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Rofinda, Zelly Dia, Eryati Darwin, Ellyza Nasrul, and Irza Wahid. "Erythrocyte Antibody Due to Alloimmunization in Repeated Transfusion: A Meta-Analysis." Open Access Macedonian Journal of Medical Sciences 10, F (April 4, 2022): 257–62. http://dx.doi.org/10.3889/oamjms.2022.9035.
Повний текст джерелаАнотація:
BACKGROUND: Blood transfusion is one form of life-saving efforts to improve health. Each individual will experience a different transfusion reaction. Having a history of repeated transfusions increases the risk of alloimmunization leading to the development of erythrocyte alloantibodies. AIM: This study is a meta-analysis of various studies on erythrocyte antibodies due to alloimmunization in repeated transfusion. METHODS: Literatures were searched through the PubMed, DOAJ, and Google Scholar databases using the keywords “repeated transfusion,” “alloimmunization,” and “erythrocyte antibody” published in 2017 - 2021. All identified articles were then screened for relevance as well as duplication according to inclusion and exclusion criteria. Then, the articles were analyzed using software review manager 5.4 and software comprehensive meta-analysis (CMA) version 3. RESULTS: A total of seven articles were included in this study. Based on the analysis, we found that there was no association between alloimmunization in repeated transfusions with erythrocyte antibodies based on gender (pooled odds ratio 1.00 [95% CI 0.70 - 1.42]. CONCLUSION: Alloimmunization on repeated transfusion was not significantly associated with erythrocyte antibody based on gender.
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Yazer, Mark H., Philip C. Spinella, Leilani Doyle, Richard M. Kaufman, Robyn Dunn, John R. Hess, Luiz Amorim Filho, et al. "Transfusion of Uncrossmatched Group O Erythrocyte-containing Products Does Not Interfere with Most ABO Typings." Anesthesiology 132, no. 3 (March 1, 2020): 525–34. http://dx.doi.org/10.1097/aln.0000000000003069.
Повний текст джерелаАнотація:
Abstract Background Group O erythrocytes and/or whole blood are used for urgent transfusions in patients of unknown blood type. This study investigated the impact of transfusing increasing numbers of uncrossmatched type O products on the recipient’s first in-hospital ABO type. Methods This was a retrospective cohort study. Results of the first ABO type obtained in adult, non–type O recipients (i.e., types A, B, AB) after receiving at least one unit of uncrossmatched type O erythrocyte-containing product(s) for any bleeding etiology were analyzed along with the number of uncrossmatched type O erythrocyte-containing products administered in the prehospital and/or in hospital setting before the first type and screen sample was drawn. Results There were 10 institutions that contributed a total of 695 patient records. Among patients who received up to 10 uncrossmatched type O erythrocyte-containing products, the median A antigen agglutination strength in A and AB individuals on forward typing (i.e., testing the recipient’s erythrocytes for A and/or B antigens) was the maximum (4+), whereas the median B antigen agglutination strength among B and AB recipients of up to 10 units was 3 to 4+. The median agglutination strength on the reverse type (i.e., testing the recipient’s plasma for corresponding anti-A and -B antibodies) was very strong, between 3 and 4+, for recipients of up to 10 units of uncrossmatched erythrocyte-containing products. Overall, the ABO type of 665 of 695 (95.7%; 95% CI, 93.9 to 97.0%) of these patients could be accurately determined on the first type and screen sample obtained after transfusion of uncrossmatched type O erythrocyte-containing products. Conclusions The transfusion of smaller quantities of uncrossmatched type O erythrocyte-containing products, in particular up to 10 units, does not usually interfere with determining the recipient’s ABO type. The early collection of a type and screen sample is important. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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Shannon, Kevin M., Julian F. Keith, William C. Mentzer, Richard A. Ehrenkranz, Mark S. Brown, John A. Widness, Christine A. Gleason, et al. "Recombinant Human Erythropoietin Stimulates Erythropoiesis and Reduces Erythrocyte Transfusions in Very Low Birth Weight Preterm Infants." Pediatrics 95, no. 1 (January 1, 1995): 1–8. http://dx.doi.org/10.1542/peds.95.1.1.
Повний текст джерелаАнотація:
Design and methods. We hypothesized that treatment with recombinant human erythropoietin (r-HuEPO) would stimulate erythropoiesis and would thereby reduce the need for erythrocyte transfusions in preterm infants. We treated 157 preterm infants born at 26.9 ± 1.6 weeks of gestation who weighed 924 ± 183 g at birth with either subcutaneous r-HuEPO (100 U/kg/d, 5 days per week) or placebo for 6 weeks in a randomized, double-blind, controlled clinical trial. All patients received oral iron and were managed according to uniform conservative transfusion guidelines. Results. Treatment with r-HuEPO was associated with fewer erythrocyte transfusions (1.1 ± 1.5 per infant in the r-HuEPO group versus 1.6 ± 1.7 per infant in the placebo group; P = .046) and with a reduction in the volume of packed erythrocytes transfused (16.5 ± 23.0 mL versus 23.9 ± 25.7 mL per infant; P = .023). Overall, 43% of the infants in the r-HuEPO group and 31% of placebo-treated infants were transfusion-free during the study (P = .18). The volume of blood removed for laboratory tests and the need for respiratory support at the start of treatment had major effects on transfusion requirements independent of r-HuEPO. Reticulocyte counts were higher during treatment in the r-HuEPO group (P = .0001), and r-HuEPO-treated infants had higher hematocrit values at the end of the study (32% versus 27.3% in the placebo group; P = .0001). We found no differences in the incidence of major complications of prematurity between the treatment groups. Conclusion. We conclude that treatment with r-HuEPO at a weekly dose of 500 U/kg stimulates erythropoiesis, moderates the course of anemia, is associated with a reduction in erythrocyte transfusions, and appears safe in very low birth weight preterm infants who are receiving iron supplements. Conservative transfusion criteria, minimization of phlebotomy losses, and treatment with r-HuEPO are complementary strategies to reduce erythrocyte transfusions in these infants.
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Patel, Nishith N., Hua Lin, Ceri Jones, Graham Walkden, Paramita Ray, Philippa A. Sleeman, Gianni D. Angelini, and Gavin J. Murphy. "Interactions of Cardiopulmonary Bypass and Erythrocyte Transfusion in the Pathogenesis of Pulmonary Dysfunction in Swine." Anesthesiology 119, no. 2 (August 1, 2013): 365–78. http://dx.doi.org/10.1097/aln.0b013e31829419d3.
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Abstract Background: Allogeneic erythrocyte transfusion in cardiac surgical patients is associated with a fourfold increase in pulmonary complications. Our understanding of the processes underlying these observations is poor and there is no experimental model of transfusion-related acute lung injury that shows homology to cardiac surgical patients. Our objective was to develop a novel swine recovery model to determine how two clinical risk factors, allogenic erythrocyte transfusion and cardiopulmonary bypass, interact in the genesis of postcardiac surgery acute lung injury. Methods: Thirty-six pigs were infused with allogeneic 14- or 42-day-old erythrocytes or they underwent cardiopulmonary bypass with or without transfusion of 42-day erythrocyte. Controls received saline. All pigs were recovered and assessed for pulmonary dysfunction, inflammation, and endothelial activation at 24 h. Results: Transfusion of stored allogeneic erythrocytes in pigs compared with sham caused pulmonary dysfunction characterized by reduced lung compliance (mean difference −3.36 [95% CI, −5.31 to −1.42] ml/cm H2O), an increase in protein levels in bronchoalveolar lavage fluid, histological lung injury inflammation, and endothelial activation. Transfusion of blood stored for up to 42 days resulted in greater protein levels in bronchoalveolar lavage fluid, macrophage infiltration, platelet activation, and depletion of T-lymphocytes in recipient lungs versus 14-day-old blood. Transfusion interacted with cardiopulmonary bypass to increase lung injury in the absence of platelet activation. Conclusions: In this novel large animal model of allogeneic erythrocyte transfusion, pulmonary dysfunction occurs in the absence of any priming event, is increased when combined with other inflammatory stimuli, and is mediated by monocyte activation and T-lymphocyte depletion.
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Uezima, Cristina Lika, Ariane Moreira Barreto, Ruth Guinsburg, Akemi Kuroda Chiba, José Orlando Bordin, Melca Maria O. Barros, and Amélia Miyashiro N. dos Santos. "Reduction of exposure to blood donors in preterm infants submitted to red blood cell transfusions using pediatric satellite packs." Revista Paulista de Pediatria 31, no. 3 (September 2013): 285–92. http://dx.doi.org/10.1590/s0103-05822013000300003.
Повний текст джерелаАнотація:
OBJECTIVE: In preterm newborn infants transfused with erythrocytes stored up to 28 days, to compare the reduction of blood donor exposure in two groups of infants classified according to birth weight. METHODS: A prospective study was conducted with preterm infants with birth weight <1000g (Group 1) and 1000-1499g (Group 2), born between April, 2008 and December, 2009. Neonates submitted to exchange transfusions, emergency erythrocyte transfusion, or those who died in the first 24 hours of life were excluded. Transfusions were indicated according to the local guideline using pediatric transfusion satellite bags. Demographic and clinical data, besides number of transfusions and donors were assessed. . Logistic regression analysis was performed to determine factors associated with multiple transfusions. RESULTS: 30 and 48 neonates were included in Groups 1 and 2, respectively. The percentage of newborns with more than one erythrocyte transfusion (90 versus 11%), the median number of transfusions (3 versus 1) and the median of blood donors (2 versus 1) were higher in Group 1 (p<0.001), compared to Group 2. Among those with multiple transfusions, 14 (82%) and one (50%) presented 50% reduction in the number of blood donors, respectively in Groups 1 and 2. Factors associated with multiple transfusions were: birth weight <1000g (OR 11.91; 95%CI 2.14-66.27) and presence of arterial umbilical catheter (OR 8.59; 95%CI 1.94-38.13), adjusted for confounders. CONCLUSIONS: The efficacy of pediatrics satellites bags on blood donor reduction was higher in preterm infants with birth weight <1000g.
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Smeets, Michel WJ, Alexander PJ Vlaar, Herm Jan M. Brinkman, Jan J. Voorberg, and Peter L. Hordijk. "Platelet-Independent Adhesion of Red Blood Cells to Von Willebrand Factor." Blood 124, no. 21 (December 6, 2014): 2769. http://dx.doi.org/10.1182/blood.v124.21.2769.2769.
Повний текст джерелаАнотація:
Abstract Background/Objectives Red blood cell (RBC) transfusion can be lifesaving and is an essential therapy in conditions associated with tissue hypoxia due to anemia. However, recent clinical studies show that both the number of RBCs and the age of RBCs transfused are independent risk factors for an increase in transfusion related morbidity and mortality. It has been suggested that the so called “storage lesion” of RBCs, a reduction of quality of erythrocytes and changes in the erythrocyte concentrate storage medium, is the causal factor. Recently it has been shown that cold storage of erythrocytes induces microparticle formation. These erythrocyte microparticles are pro-coagulant and can cause thrombin formation. Another phenomenon of the storage lesion is the rapid and considerable loss of donor erythrocytes from the circulation of transfused patients. We wondered whether thrombin generated by transfused erythrocyte microparticles could contribute to red blood cell adherence to the vascular endothelium. Cytoadherence of red blood cells could contribute to the loss of circulating transfused red blood cells and vascular obstruction and could explain the observed transfusion associated complications in clinical practice. Methods/Results Employing FACS analysis and a microparticle analyzer we showed that erythrocyte cold storage indeed induces microparticle formation. We confirmed the pro-coagulant properties of these microparticles using a chromogenic substrate specific for thombin and a thrombin-anti-thrombin complex ELISA. To determine whether thrombin could induce adhesion of red blood cells to endothelial cells, we cultured human umbilical vein endothelial cells in micro-perfusion chambers and used live-imaging to define the adherence potential of the erythrocytes to endothelial cells at post-capillary flow rate. Thrombin stimulation of the endothelial cells did increase erythrocyte adhesion to endothelial cells. Moreover, the adhesion of erythrocytes followed a pattern resembling platelets binding to von Willebrand factor (VWF). By using live immunofluoresence imaging we confirmed that the erythrocytes did bind to VWF secreted from endothelial cells. Since erythrocyte-VWF interactions may be mediated by platelets, we used fluorescence cell sorting to remove platelets and erythrocyte-platelet complexes from erythrocyte concentrates. The purified erythrocytes did also bind to VWF secreted by endothelial cells and thereby we confirmed that erythrocytes can bind to VWF in a platelet-independent fashion. We further analyzed the specificity of the erythrocyte-VWF interaction by using different protein coatings in micro-perfusion chambers. Erythrocytes did bind to recombinant high molecular weight VWF multimers. Furthermore, they adhered more potently to VWF when compared to fibrinogen or fibrin but showed little binding to fibronectin, collagen type I, or subendothelial extra-cellular matrix proteins. Conclusion Our results suggest that transfusion of RBCs is able to induce endothelial binding of erythrocytes based on a VWF-erythrocyte interaction. We propose that passive infusion of cold stored erythrocyte derived microparticles promotes thrombin generation which subsequently activates endothelial cells and induces VWF secretion. This results in binding of red blood cells to endothelial cells in a platelet-independent fashion which requires the presence of VWF. Based on our results we hypothesize that binding of erythrocytes to VWF may occlude micro-capillaries thereby contributing to transfusion associated complications. Disclosures No relevant conflicts of interest to declare.
Дисертації з теми "Erythrocyte transfusion/methods"
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GAULTIER, JEAN-JACQUES. "Evaluation d'une nouvelle methode de recherche d'anticorps anti-erythrocytaires en phase solide : le couple capture-r/sami." Nancy 1, 1992. http://www.theses.fr/1992NAN11264.
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Baranova, Valentina. "Phenotyping erythrocyte antigens on ORTHO Vision Analyzer in comparison with gel cards." Thesis, Uppsala universitet, Institutionen för medicinsk cellbiologi, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-451505.
Повний текст джерелаАнотація:
Blood transfusion is a very common procedure. Before a blood transfusion it is important to find compatible blood for the patient. If the blood is incompatible with that of the patient a transfusion reaction may occur, which can be mortal. It is also important to avoid alloimmunisation. Alloimmunisation occurs when antibodies are produced against a specific antigen. These antibodies are called irregular antibodies and they can be produced after a transfusion, pregnancy, or transplantation. Alloimmunisation makes it harder to find compatible blood for patients in the future and it is a major concern for patients who require blood transfusions repeatedly. By phenotyping erythrocyte antigens, it is easier to find compatible blood for patients before a blood transfusion. Until now, a manual method has been used for phenotyping erythrocyte antigen at the Sundsvall County hospital and an automatization of this method was desired. For this study, 99 anonymised blood doner tests were used. The erythrocyte antigens M, Jka, Jkb, Fya, Fyb, S and s were phenotyped both manually and automated with ORTHO Vision Analyzer. A Clopper Pearson test was used to evaluate the accordance between the methods. A comparison was also made in regard totime and cost. The results showed a good accordance between the methods. The automated procedure using ORTHO Vision has several advantages over the manual procedure using gel cards. The risk of errors is reduced, there are fewer manual steps, it is faster and the personnel can do other tasks while the instrument is processing the tests.
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Oliveira, Carlos Augusto Cardim de. ""Prática de medicina baseada em evidências em um centro de tratamento intensivo pediátrico"." Universidade de São Paulo, 2003. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-13082005-173825/.
Повний текст джерелаАнотація:
Objetivos: Estimar a concordância entre as práticas e as evidências disponíveis em uma unidade de terapia intensiva pediátrica. Métodos: Estudo retrospectivo de todos os pacientes internados durante 2001. As práticas foram classificadas em adequadas ou não-adequadas de acordo com recomendações. Esperava-se para as práticas recomendadas 90% de concordância, para as contra-indicadas, discordância de até 10% e para aquelas onde havia incertezas, 50%. Resultados: Foram selecionadas 114 publicações e avaliadas 253/275 internações (92%). O uso foi considerado apropriado para albumina em 47,6% (IC 95% 39% 55%); dopamina <3mg/kg/min 87,9% (83% 92%); sedação e analgesia 88,6% (87% 90%); transfusões de concentrado de hemácias 95,2% (92% 97%); profiliaxia de úlcera de estresse 89,7% (88% 91%).Objectives: Estimate the concordance between the practices and the evidence available in a pediatric intensive care unit. Methods: Retrospective study of all admitted patients during 2001. The practices were classified as adequate or non-adequate according to recommendations. It was expected 90% concordance for the recommended practices, while for non-adequate practices, discordance until 10% and for those where there was doubt, 50%. Results: 114 publications were selected and 253/275 admissions (92%) were evaluated. Use was considered appropriate for albumin in 47.6% (IC 95% 39% 55%); dopamine <3mg/kg/min 87.9% (83% 92%); sedation and analgesia 88.6% (87% 90%); red blood cell transfusions 95.2% (92% 97%); stress ulcer prophylaxis 89.7% (88% 91%).
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Keir, Amy Kate. "Clinical practice of allogenic red blood cell transfusion and fluid bolus therapy in neonates." Thesis, 2018. http://hdl.handle.net/2440/117954.
Повний текст джерелаАнотація:
This thesis by publication comprises of seven chapters encompassing several aspects of allogenic red blood cell (RBC) transfusion practice, fluid bolus therapy and the use of these products utilised in both. The work aims to improve the evidence-base on which clinical and research decisions are made around both of these therapies and the products, namely RBCs and 0.9% sodium chloride, utilised within neonatal units. It includes two systematic reviews and meta-analyses to address uncertainties in neonatal transfusion practice, an in-vitro study designed to provide information to inform clinical transfusion practice and an observational, cross-sectional study to further understand the use of fluid bolus therapy in neonates. To place these studies in their broader context, an introductory chapter (Chapter 1) is provided. The first study (Chapter 2) provides contemporary data on blood usage in neonatal units. Without recent data on the use of blood products, it is challenging to design accurate clinical studies. Prior to this study, knowledge of neonatal transfusion practices was limited to local cohort or survey-based studies. This study found blood product use remains common in neonates born before 30 weeks' gestation. The second study (Chapter 3) provides, for the first time, a systematic review of the known published adverse effects and associations of neonatal allogenic RBC transfusion. The review did not find any significant differences in a range of clinical outcomes between neonates exposed to restrictive and liberal RBC transfusion practices. The predominance of nonrandomised and observational studies was highlighted in this relatively highly-transfused population group. Chapter 4 provides a systematic review of published studies examining washing RBCs prior to transfusion in neonates. It is possible that modification of RBCs prior to transfusion, through washing with 0.9% sodium chloride, may reduce adverse effects related to neonatal allogenic RBC transfusion. The review found insufficient evidence to support or refute the use of washed RBCs to prevent the development of significant neonatal morbidities or mortality. This review provided key data to support the development of a randomised study in this area. Transfusion guidelines advise against the co-infusion of RBCs with solutions other than 0.9% sodium chloride. This study (Chapter 5) evaluates the impact of co-infusion with dextrosecontaining fluids on markers of RBC quality in an in-vitro setting. The study found the invitro characteristics of RBCs co-infused with 0.9% sodium chloride or 10% dextrose were not adversely impacted, arguing against the recommendation not to co-infuse. These findings led to practice changes in several neonatal units in Australia and Canada. Intravenous fluid bolus therapy for suspected haemodynamically compromised neonates is an apparent common intervention in neonatal units. Despite this, the volume and type of fluid used, as well as the timing and indications for this practice are not well described or understood. The NeoBolus study (Chapter 6) provides a contemporary description of clinical practice in relation to the types and specific indications for use of fluid therapy, including blood products, in neonates with suspected haemodynamic compromise. The data generated will provide key information to develop a randomised study in the area. In summary, this work provides a number of insights into neonatal transfusion practice and fluid bolus therapy, key to improving the evidence-base and identifying future directions for research in these areas.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2018
Книги з теми "Erythrocyte transfusion/methods"
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McCarthy, Leo J. Controversies of Leukocyte Poor Blood. Amer Assn of Blood Banks, 1989.
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J, McCarthy Leo, Baldwin Michael L, and American Association of Blood Banks., eds. Controversies of leukocyte-poor blood and components. Arlington, Va: American Association of Blood Banks, 1989.
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