Review of Blood Transfusion Strategies among Trauma Patients

Introduction: Trauma is the third most common cause of mortality worldwide and leading cause of death in the age group 1 to 44 years. Among those trauma patients, major hemorrhage is responsible for 30 to 40% of mortality, despite the fact that it could be preventable and reversible. The ideal resuscitation strategy for trauma patients remains a topic of ongoing debate. Transfusion services stress trauma centers with demands for strict accountability for individual blood component units and adherence to indications in a clinical field where research has been difficult and guidance opinion-based. New data suggest that the most severely injured patients arrive at the trauma center already coagulopathic and these patients benefit from prompt specific and corrective treatment. At present, no consensus has been reached on ideal fluid for early resuscitation and on the threshold for blood product transfusions. This review article provides a brief overview of recent advances in trauma induced hematological complications, role of pathologist in managing them and subsequent complicating issues. Thereby, covering the widest possible body of literature. Aims and objectives: In this review we address ongoing resuscitation strategies along with potential complications in management of the trauma patients. This review also assesses the still ongoing, controversial debate of the best fit treatment options. This research is clarifying trauma system requirements for new blood products and blood-product usage patterns, but the inability to obtain informed consent from severely injured patients remains an obstacle to further research. Methods: We considered systematic reviews identified through searches of Cochrane databases from inception to April 2015 and PubMed up to April 2015. Results and Conclusions: Polytrauma patients with severe shock from haemorrhage and massive tissue injury present major challenges for management and resuscitation. Many of the current recommendations for damage control resuscitation remain controversial. A lack of large, randomized, control trials leaves most recommendations at the level of consensus and expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients

The rise in preanalytical errors during COVID-19 pandemic

The COVID-19 pandemic has posed several challenges to clinical laboratories across the globe. Amidst the outbreak, errors occurring in the preanalytical phase of sample collection, transport and processing, can further lead to undesirable clinical consequences. Thus, this study was designed with the following objectives: (i) to determine and compare the blood specimen rejection rate of a clinical laboratory and (ii) to characterise and compare the types of preanalytical errors between the pre-pandemic and the pandemic phases. This retrospective study was carried out in a trauma-care hospital, presently converted to COVID-19 care centre. Data was collected from (i) pre-pandemic phase: 1st October 2019 to 23rd March 2020 and (ii) pandemic phase: 24th March to 31st October 2020. Blood specimen rejection rate was calculated as the proportion of blood collection tubes with preanalytical errors out of the total number received, expressed as percentage. Total of 107,716 blood specimens were screened of which 43,396 (40.3%) were received during the pandemic. The blood specimen rejection rate during the pandemic was significantly higher than the pre-pandemic phase (3.0% versus 1.1%; P < 0.001). Clotted samples were the commonest source of preanalytical errors in both phases. There was a significant increase in the improperly labelled samples (P < 0.001) and samples with insufficient volume (P < 0.001), whereas, a significant decline in samples with inadequate sample-anticoagulant ratio and haemolysed samples (P < 0.001). In the ongoing pandemic, preanalytical errors and resultant blood specimen rejection rate in the clinical laboratory have significantly increased due to changed logistics. The study highlights the need for corrective steps at various levels to reduce preanalytical errors in order to optimise patient care and resource utilisation

Influence of Blood Transfusion on the Clinical Course and Immediate Outcome of Trauma Patients: Retrospective Study in a Tertiary Trauma Care Centre in Northern India

Background: Red blood cell transfusion is a prominent faction of the standard protocol for management of trauma patients. Clinical research over the past two decades has linked RBC transfusion with increased odds of morbidity and mortality. We conducted a study to assess influence of transfusion on survival and the clinical course of trauma patients in a level I trauma care center. Methodology: Retrospective review of the blood bank registry was conducted (Jan-June 2012). 100 acutely injured trauma patients who received blood transfusion were selected and categorized based on the number of units transfused; group I (1-5 units) n= 40; group II (6-9 units) n=40 &amp; group III (&gt;10 units) n= 20. Study control were trauma patients who did not receive transfusion group IV (n= 40). The clinical course of the patients was followed via computerized patient record system maintained by our institution. Analysis was done to compare outcome (in hospital mortality, organ failure, infections, length of stay) between the study and control groups, also between groups based on units transfused. Results: Severity of injury was significantly higher in patients who received transfusion than those who did not (p&lt; 0.001). Transfusion was associated with high rate of infection (62%), organ failures (43%) and mortality (39%). Number of units transfused also correlated with injury severity (p&lt; 0.001). Incidence of renal failure (20%), liver failure (35%) was high in group II. Also 50% developed sepsis in group II compared to 13.6 % in group I, and 31.8 % in group III. (p&lt; 0.001). Highest mortality rate was observed in group II (67.5%), followed by 60% in group III and lowest in group IV 2.5% (p&lt; 0.001). Conclusion: We observed a surrogate relationship between severity of injury and transfusion requirements. Transfusion-related adversities may be more reflective of the confounding effect of severity of injury than RBC transfusion. Therefore evaluating the risks and benefits of blood transfusion in trauma management is recommended

Determinants of mortality in trauma patients following massive blood transfusion

AIM: This study was designed to find out the factors influencing mortality in trauma patients receiving massive blood transfusion (MBT). MATERIALS AND METHODS: Records of all patients admitted during December 2007 to November 2008 at a Level I Trauma Center emergency and who underwent massive transfusion (≥10 units of packed red cells in 24 h) were retrospectively analyzed. Death during the hospital stay was considered as the study outcome and various demographic, laboratory, and clinical parameters were included as its potential determinants. STATISTICAL ANALYSIS: Bivariate and multivariate logistic regression analyses were done to identify the risk factors associated with mortality. RESULTS: Of the 4054 transfused patients who were admitted to the trauma center during the study period, 71 (1.8%) patients underwent massive transfusion. Of this, there were 37 survivors and 34 nonsurvivors (48%). The median overall ISS was 27 (22–34). The patients who died had shorter mean length of hospital stay, shorter mean duration of intensive care unit (ICU) stay, and low admission Glasgow Coma Scale (GCS) compared to the survivors (P < 0.01). The mean prothrombin time (PT) and the mean activated partial thromboplastin time was significantly high (P < 0.01) among nonsurvivors. Total leukocyte count (TLC ≥ 10,000 cells/cubic mm), GCS ≤ 8, the presence of coagulopathy and major vascular surgery were the four independent determinants of mortality in multivariate logistic regression analysis. The FFP:PRBC (fresh frozen plasma:packed red cells) ratio and PC:PRBC (platelet concentrate:packed red cells) ratio calculated in our study was not statistically significant in correlation to the in hospital mortality. CONCLUSIONS: Overall mortality among the MBT patients was comparable with the studies in the literature. Mortality is not affected by the amount of packed red cells given in the first 12 h and the total number of packed red cells transfused. Prospective studies are required to further validate the determinants of mortality and establish guidelines for MBT

Determinants of mortality in trauma patients following massive blood transfusion

Aim : This study was designed to find out the factors influencing mortality in trauma patients receiving massive blood transfusion (MBT). Materials and Methods : Records of all patients admitted during December 2007 to November 2008 at a Level I Trauma Center emergency and who underwent massive transfusion (&#8805;10 units of packed red cells in 24 h) were retrospectively analyzed. Death during the hospital stay was considered as the study outcome and various demographic, laboratory, and clinical parameters were included as its potential determinants. Statistical Analysis : Bivariate and multivariate logistic regression analyses were done to identify the risk factors associated with mortality. Results : Of the 4054 transfused patients who were admitted to the trauma center during the study period, 71 (1.8&#x0025;) patients underwent massive transfusion. Of this, there were 37 survivors and 34 nonsurvivors (48&#x0025;). The median overall ISS was 27 (22-34). The patients who died had shorter mean length of hospital stay, shorter mean duration of intensive care unit (ICU) stay, and low admission Glasgow Coma Scale (GCS) compared to the survivors (P &lt; 0.01). The mean prothrombin time (PT) and the mean activated partial thromboplastin time was significantly high (P &lt; 0.01) among nonsurvivors. Total leukocyte count (TLC &#8805; 10,000 cells/cubic mm), GCS &#8804; 8, the presence of coagulopathy and major vascular surgery were the four independent determinants of mortality in multivariate logistic regression analysis. The FFP:PRBC (fresh frozen plasma:packed red cells) ratio and PC:PRBC (platelet concentrate:packed red cells) ratio calculated in our study was not statistically significant in correlation to the in hospital mortality. Conclusions : Overall mortality among the MBT patients was comparable with the studies in the literature. Mortality is not affected by the amount of packed red cells given in the first 12 h and the total number of packed red cells transfused. Prospective studies are required to further validate the determinants of mortality and establish guidelines for MBT

The Convalescent Plasma Craze! Where Does India Stand?

India becomes the country with second highest number of coronavirus disease 2019 (COVID-19) cases (59,03,932) as of September 2020. As the world debates various treatment options, the current pandemic has led to the resurgence of an ancient technique, namely convalescent plasma therapy. Although it has been in use from the late 19th century, it is an uncharted territory for most developing nations. In this article, we have discussed the pros and cons of convalescent plasma transfusion in COVID-19 patients. Articles discussed in this review have been obtained from search engines, namely PubMed, Scopus, and Embase. We have also expressed our viewpoint on the feasibility and logistical challenges of convalescent plasma use in India