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Managing Crush Injuries on Arrival
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Sarvdeep Singh Dhatt, Deepak Neradi
Release of crushing force can cause sudden haemodynamic collapse and cardiac arrest due to reperfusion injury, which can be prevented by initiating resuscitation/monitoring with the patient still trapped. Basic life support should be provided at the earliest, and the patient should be transported to a definitive medical care facility as quickly as possible. Patients with crush injury should be monitored for basic observations (blood pressure, respiratory rate, heart rate, temperature, oxygen saturation). Urine output and continuous cardiac monitoring should be started as early as possible. Blood electrolytes and gases should be measured every 6 hrs. Hyperkalaemia, hypocalcaemia and oliguria are early signs which can precipitate arrhythmias and cardiac arrest. Venous bicarbonate < 17 mmol/L in presence of myoglobinuria is associated with the development of acute renal failure (ARF). Due to the high risk of hypothermia in crush victims, aggressive rewarming should be achieved with warm IV fluid administration, warm air blankets, warmers, bladder/peritoneal lavage, warm enemas, etc. Slow rewarming is associated with a sevenfold increase in mortality in trauma patients. Blood loss should be replaced by transfusion of whole blood or blood components in a 1:1:1 ratio of packed red blood cells:plasma:platelets. Various principles of management of crush injuries are depicted in Table 27.1.
Transfusion products
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
The transfusion of blood components, rather than whole blood, has several advantages, including the following: Optimal preservation of in vitro function of blood constituents; red cells maintain functional capacity best when refrigerated, the quality of plasma constituents is best preserved in the frozen state, and platelet storage is optimal when kept at room temperature with continuous agitationMore effective treatment by specific replacement of deficiency, and the avoidance and possibly harmful infusion of surplus constituentsEfficient utilization of blood donations and the provision of surplus plasma for the production of plasma derivatives or blood products
Concepts of Replacement Therapy: Blood Components, Blood Derivatives, and Medications
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
The transfusion of blood and blood components can be an integral part of patient care. However, there can be serious adverse effects associated with transfusion. One method of organizing these problems is to divide them into acute reactions, which occur during or within 24 hr of the transfusion, and delayed reactions, which occur days, or even years, following the transfusion.
Adverse transfusion reactions and what we can do
Published in Expert Review of Hematology, 2022
Yajie Wang, Quan Rao, Xiaofei Li
Transfusions of blood and blood components are generally safe but have natural risks. There are usually two different aspects. One is alloimmunization, the other is other immunological and inflammatory reactions [196]. In this review, we summarize the commonly encountered transfusion reactions from the aspects of mechanism, clinical characteristics and management. When an acute transfusion reaction is suspected, timely identification and immediate cessation are critical. As signs and symptoms (eg, fever, chills and dyspnea) are often overlapping and nonspecific, it is required to distinguish delayed responses or reactions. It is essential to diagnose correctly and provide appropriate treatments for ensuring the safety of any future transfusions. Various literatures have provided detailed guidance on this, which can be used as a reference for clinical staff [63,197,198]. The incidence of many transfusion-related adverse events is decreasing, but threats to transfusion safety are always emerging. Prevention requires strict adherence to blood transfusion indications, administration policies of restrictive blood transfusion, and avoidance of unnecessary blood transfusions. Many of the evidence-based recommendations need more verification in patients with the diverse risk factors. Newer donor policies and blood screening methods, new assay method, and electronic verification systems can decrease the incidence of serious transfusion reactions. It is also very important to report any suspicious reactions to the blood bank to facilitate further investigation of the cause and avoid similar adverse reactions in the future [199].
Progress in the use of plasma rich in growth factors in ophthalmology: from ocular surface to ocular fundus
Published in Expert Opinion on Biological Therapy, 2022
E Anitua, B de la Sen-Corcuera, G Orive, RM Sánchez-Ávila, P Heredia, F Muruzabal, J Merayo-Lloves
PRGF consists of a platelet enriched plasma free of leukocytes that contains an hemostatic fibrin and a pool of proteins and growth factors [41]. The preparation protocol accomplishes several steps including blood extraction, centrifugation, and separation of plasma fractions as it has been reported elsewhere [28,40,42]. Indeed, after blood centrifugation blood components are separated: the plasma is in the upper part, followed by a thin leukocyte layer (buffy coat) and the erythrocyte layer in the bottom. At the top of the plasma column there is a low concentration of platelets, whereas the bottom portion contains a higher concentration. Calcium-based activation catalyzes the coagulation pathways allowing both the release of the growth factors and the formation of a polymerized fibrin meshwork [28,40,42], being both processes temporarily linked [43]. Another remarkable feature of PRGF technology is being a leukocyte lacking formulation, reducing the pro-inflammatory response of white blood cells [44–47]. Interestingly, depending on the time elapsed after platelet activation, different formulations can be obtained with several therapeutic purposes: injectable PRGF (iPRGF), PRGF clot (cPRGF), PRGF membrane (mPRGF), PRGF eye drops or supernatant PRGF (ePRGF) as well as other temperature-dependent formulations such as is-ePRGF, is-mPRGF and lyo-ePRGF [28,40,48]. (Figure 1)
Hemostatic defects in massive transfusion: an update and treatment recommendations
Published in Expert Review of Hematology, 2021
Impairment of hemostasis is commonly treated with the transfusion of blood components (FFP, platelets and cryoprecipitate), but other options for treatment is to consider use of factor concentrates and fibrinogen concentrate. The use of coagulation factor concentrate-based therapy guided by point-of-care viscoelastic coagulation monitoring (ROTEM or TEG) appears promising (Figure 8). An ‘Early Coagulation Support (ECS) Protocol’ was developed by a network of Italian Trauma Centers to treat TIC in bleeding trauma patients and resulted in a significant decrease in blood product transfusion and a 10-day reduction in hospital length of stay compared to the standard MTP protocol which included only blood product resuscitation which was previously used. This protocol included prompt infusion of TXA, FC and RBC transfusions. No difference in mortality was identified, but overall costs for transfusion and coagulation support including point-of-care tests decreased by 23%. [121,122] With these emerging data regarding the potential benefit of factor concentrates early in treatment of TIC, there is great need for a large randomized clinical trial to determine the potential efficacy of factor concentrates vs. blood component transfusion for TIC.