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Blood Management for Patients with Placenta Accreta
Published in Robert M. Silver, Placenta Accreta Syndrome, 2017
Andra H. James, Evelyn Lockhart
Patient blood management is an evidence-based, multidisciplinary approach to optimizing the care of patients who might need transfusion.33 Patient blood management encompasses all aspects of patient evaluation and clinical management surrounding the transfusion decision-making process, including measures to avoid or minimize transfusion such as anemia management, cell salvage, and the use of hemostatic medication to reduce bleeding.34
Blood loss and blood transfusion
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Manual of Neuroanesthesia, 2017
The World Health Organization (WHO) recognized patient blood management in 2010 as the new standard of care.2 These protocols are being recommended for the perioperative management of blood products and adjuvant therapies to optimize patient outcome and minimize transfusion. Patient blood management is currently defined by the Society for the Advancement of Blood Management (available at http://www.sabm.org) as “the timely application of evidence based medical and surgical concepts designed to maintain haemoglobin, optimize haemostasis and minimise blood loss in an effort to improve patient outcome.” There is a paradigm shift from the previous transfusion-centric approach to a patient-centric approach, that is, primarily relying on the patient's blood rather than donor blood. This change has occurred due to an increasing gap between blood supply-to-demand ratio, escalating costs, concerns about product safety, adverse outcomes with transfusion, and questionable efficacy of transfusion. It is suggested to address the following three pillars of patient blood management (PBM)3 to minimize blood usage so that the risks of blood transfusion can be minimized while maximizing clinical outcome: First pillar: Optimize hematopoiesisSecond pillar: Minimize blood loss and bleedingThird pillar: Optimize tolerance of anemia
Ankylosing Spondylitis: Complications Related to Spine Surgery
Published in Barend J. van Royen, Ben A. C. Dijkmans, Ankylosing Spondylitis Diagnosis and Management, 2006
Infections: in our own experience we have had a high rate of deep wound infections after osteotomy surgery in patients with AS. Before 1998 we had 11.7% deep wound infections. There may be several explanations for this. Patients have an autoimmune disease, and use medication that is often immune suppressive. This combination makes them more susceptible to deep wound infections. Furthermore blood loss is generally large, and blood transfusions may have an autoimmune suppressive effect. Finally patients were originally treated postoperatively with a plaster of Paris thoracolumbo sacral orthosis (TLSO) which was applied directly postoperatively with the patient still under anesthesia. Although this is common practice in other fields of orthopedic surgery, such as foot and ankle surgery, the significant postoperative wound drainage into the cast of these patients may have created a favorable environment for bacterial growth resulting in an increased infection rate. Since 1998 we are employing a rigid blood management protocol and immune suppressive autologous blood transfusions have become very rare. Due to more extensive internal fixation direct postoperative immobilization in a plaster of Paris cast is no longer necessary. With this new postoperative regimen the infection rate has been reduced to 2.6%. Perioperatively patients should receive adequate antibiotics, based on the bacteria most frequently found in the hospital’s area. In our clinic patients currently receive an intravenous second generation cephalosporine at induction of anesthesia and during the first 24 hours postoperative. An extra dose of antibiotics is given after 2 L of blood loss or two hours of surgery. It is questionable whether longer postoperative antibiotics can prevent infections, and they may possibly have a detrimental effect by causing infections with resistant bacteria.
Acute myeloid leukemia: challenges for diagnosis and treatment in Latin America
Published in Hematology, 2023
Andrés Gómez-De León, Roberta Demichelis-Gómez, Abel da Costa-Neto, David Gómez-Almaguer, Eduardo Magalhães Rego
Transfusion support is key and the availability of plateletphereses can be challenging, as less than half of the blood supply in LA comes from altruistic donors [43]. Optimization of blood products through patient blood management programs is highly important [44]. Avoiding sibling and family directed donation becomes even more relevant, as the generation of anti-HLA donor-specific antibodies can become a barrier for haploidentical hematopoietic stem cell transplantation (HSCT) [45]. Thus, characteristics of the treatment center itself are of key importance and can improve or limit the capacity to deliver supportive care; induction mortality is inversely correlated with center specialization and experience [27,30,46]. ICU capacity and access, nursing, and quality management, establishment of outreach programs for timely referral to leukemia centers, and a multidisciplinary treatment team with continued education are all relevant factors that should be increasingly fostered and developed in our region [46]. Implementation of practices known to be successful is challenging but can likely save more lives worldwide than any diagnostic study or novel agent addition to the current standard management [41]. Furthermore, novel induction strategies such as early discharge and outpatient follow-up can decrease exposures, costs, and improve quality of life [47]. This strategy has been adopted successfully in the context of allogeneic HSCT in Mexico even in centers without a conventional transplant unit [48].
Managing blood supplies during natural disasters, humanitarian emergencies, and pandemics: lessons learned from COVID-19
Published in Expert Review of Hematology, 2023
Tayler A. Van Denakker, Arwa Z. Al-Riyami, Rita Feghali, Richard Gammon, Cynthia So-Osman, Elizabeth P. Crowe, Ruchika Goel, Herleen Rai, Aaron A.R. Tobian, Evan M. Bloch
Advances in blood management consequent to the pandemic, include growth and maturation of PBM programs, which encourage evidence-based transfusion practices thus reducing blood utilization. Second, blood centers and hospital transfusion services developed sophisticated lines of communication, which were important to the ongoing assessment of blood inventories, blood allocation, and resource sharing. Third, rapid adaptation to the growing threat enabled timely implementation of mitigation measures to ensure a safe donation experience for staff and donors alike (i.e. PPE measures, social distancing, separators between donations, etc.). Finally, there is unprecedented access to CCP at a time when alternative therapies for COVID-19 were lacking. New knowledge pertaining to the optimal use of CP allied with its practical implementation could be applied to future pandemics.
Prevalence of G6PD deficiency in Thai blood donors, the characteristics of G6PD deficient blood, and the efficacy of fluorescent spot test to screen for G6PD deficiency in a hospital blood bank setting
Published in Hematology, 2022
Phinyada Rojphoung, Thongbai Rungroung, Usanee Siriboonrit, Sasijit Vejbaesya, Parichart Permpikul, Janejira Kittivorapart
The prevalence of G6PD deficiency in this study was 7.59%. FST was demonstrated to be an effective and reliable method for G6PD deficiency screening among Thai blood donors in a hospital blood bank setting. Changes to the blood management policies at our center based on the findings of this study include: 1) G6PD deficient products will not be stored for more than 14 days, and 2) G6PD deficiency blood products will not be transfused to neonates for exchange transfusion or chronic transfusion dependent patients. To our knowledge, this is the first study to assess the in vitro quality of G6PD deficient RBC products in Thailand, which is a country with a high prevalence of moderate to mild G6PD enzyme deficiency.