Evaluating the appropriateness of blood component utilization in burns patients

Background: Blood transfusion is a common intervention in critically ill surgical patients, especially Burns patients. But transfusions have potentially life threatening risks. The aim of the study was to evaluate the appropriateness of various blood components, utilized in Burns patients.Methods: Burns patient who were admitted at Burns ward, Government Kilpauk Medical College, Chennai, India with age more than 16 years, with 15-40% Total body surface area burns and had survived treatment were included for a period of one year (September 2014-August 2015). New York State health guidelines for RBC transfusion in Burns, Baxter’s original Parkland formula and platelet transfusion thresholds given by AABB were used to categorize appropriate transfusions from inappropriate transfusions.Results: A total of 122 burns patients who fulfilled the inclusion criteria were followed. 85 patients received 308 red cell units of which 64% were appropriate. 114 patients were transfused with 441 fresh frozen plasma units of which 47% were appropriate. One patient was transfused with platelet concentrate and all patients, who had their platelet count more than 10,000/μL, were not transfused.Conclusions: In our study, 64% of red blood cell transfusions and 47% of FFP transfusions were appropriate. Successful outcome of burns patients purely depends on proper wound care, along with appropriate use of fluids and blood components

Prevalence of Rh Antigens among voluntary blood donors in Chennai, Tamil Nadu, India

Background: The Rh blood group system is the most polymorphic of the human blood groups and is the most clinically significant in transfusion medicine next to ABO system. The aim of the study was to find out the prevalence of 5 major types of Rh antigens in voluntary blood donors, to determine the Rh composition of the population in Chennai and to generate a database of donors for all future activities.Methods: This study was carried out over a period of 3 months from August 2015 to October 2015 on 100 healthy voluntary blood donors who attended the Department of Transfusion Medicine, The Tamil Nadu Dr. MGR Medical University, Guindy, Chennai Tamil Nadu, India. Determination of Rhesus antigens (Rh) was done by the Hemagglutination test using the conventional tube technique.Results: Our study on prevalence of Rh antigens among voluntary blood donors showed D-91%, C-84%, E-25%, c-67%, e-98% and ‘e’ (98%) was the most common antigen, followed by D (91%).Regarding predicted Rh phenotypes, DCe/DCe (R1R1) 35% was the most common predicted phenotype and dce/dce (rr) 7% was the most common predicted phenotype among Rh negatives. DcE/DcE (R2R2) 2% and dCe/dce (r’r) 2% were the rare predicted phenotypes observed in our study.Conclusions: This study helped us in establishing a database of donors for future preparation of indigenous cell panels and to provide antigen negative compatible blood to multi transfused patients with problems of alloimmunization

A contemporary comparison of the effect of shunt type in hypoplastic left heart syndrome on the hemodynamics and outcome at stage 2 reconstruction

ObjectiveWe compare the hemodynamics and perioperative course of shunt type in hypoplastic left heart syndrome at the time of stage 2 reconstruction and longer-term survival.MethodsWe retrospectively reviewed the echocardiograms, catheterizations, and hospital records of all patients who had a stage 1 reconstruction between January 2002 and May 2005 and performed a cross-sectional analysis of hospital survivors.ResultsOne hundred seventy-six patients with hypoplastic left heart syndrome and variants underwent a stage 1 reconstruction with either a right ventricle–pulmonary artery conduit (n = 62) or a modified Blalock–Taussig shunt (n = 114). The median duration of follow-up is 29.1 months (range, 0-57 months). By means of Kaplan–Meier analysis, there is no difference in survival at 3 years (right ventricle–pulmonary artery conduit: 73% [95% confidence limit, 59%–83%] vs modified Blalock–Taussig shunt: 69% [95% confidence limit, 59%–77%]; P = .6). One hundred twenty-four patients have undergone stage 2 reconstruction (78 modified Blalock–Taussig shunts and 46 right ventricle–pulmonary artery conduits). At the time of the stage 2 reconstruction, patients with right ventricle–pulmonary artery conduits were younger (153 days [range, 108–340 days]; modified Blalock–Taussig shunt, 176 days [range, 80–318 days]; P = .03), had lower systemic oxygen saturation (73% [range, 58%–85%] vs 77% [range, 57%–89%], P < .01), and had higher preoperative hemoglobin levels (15.8 g/dL [range, 13–21 g/dL] vs 14.8 g/dL [range, 12–19 g/dL], P < .01) compared with those of the modified Blalock–Taussig shunt group. By means of echocardiographic evaluation, there was a higher incidence of qualitative ventricular dysfunction in patients with right ventricle–pulmonary artery conduits (14/46 [31%] vs 9/73 [12%], P = .02). However, no difference was observed in common atrial pressure or the arteriovenous oxygen difference.ConclusionInterim analyses suggest no advantage of one shunt type over another. This report raises concern of late ventricular dysfunction and outcome in patients with a right ventricle–pulmonary artery conduit

Risk factors for hospital morbidity and mortality after the Norwood procedure: A report from the Pediatric Heart Network Single Ventricle Reconstruction trial

ObjectivesWe sought to identify risk factors for mortality and morbidity during the Norwood hospitalization in newborn infants with hypoplastic left heart syndrome and other single right ventricle anomalies enrolled in the Single Ventricle Reconstruction trial.MethodsPotential predictors for outcome included patient- and procedure-related variables and center volume and surgeon volume. Outcome variables occurring during the Norwood procedure and before hospital discharge or stage II procedure included mortality, end-organ complications, length of ventilation, and hospital length of stay. Univariate and multivariable Cox regression analyses were performed with bootstrapping to estimate reliability for mortality.ResultsAnalysis included 549 subjects prospectively enrolled from 15 centers; 30-day and hospital mortality were 11.5% (63/549) and 16.0% (88/549), respectively. Independent risk factors for both 30-day and hospital mortality included lower birth weight, genetic abnormality, extracorporeal membrane oxygenation (ECMO) and open sternum on the day of the Norwood procedure. In addition, longer duration of deep hypothermic circulatory arrest was a risk factor for 30-day mortality. Shunt type at the end of the Norwood procedure was not a significant risk factor for 30-day or hospital mortality. Independent risk factors for postoperative renal failure (n = 46), sepsis (n = 93), increased length of ventilation, and hospital length of stay among survivors included genetic abnormality, lower center/surgeon volume, open sternum, and post-Norwood operations.ConclusionsInnate patient factors, ECMO, open sternum, and lower center/surgeon volume are important risk factors for postoperative mortality and/or morbidity during the Norwood hospitalization

Longitudinal Assessment of Growth in Hypoplastic Left Heart Syndrome: Results From the Single Ventricle Reconstruction Trial

Background: We sought to characterize growth between birth and age 3 years in infants with hypoplastic left heart syndrome who underwent the Norwood procedure. Methods and Results: We performed a secondary analysis using the Single Ventricle Reconstruction Trial database after excluding patients 2 SD below normal). Failure to find consistent risk factors supports the strategy of tailoring nutritional therapies to patient‐ and stage‐specific targets. Clinical Trial Registration URL: http://clinicaltrials.gov/. Unique identifier: NCT00115934

Blood utilization practices at a tertiary care hospital- A Retrospective study

Aim: The aim of the study is to investigate the blood ordering pattern and transfusion practices thereby incorporating a blood ordering schedule which streamlines the use of blood and blood products for elective surgical procedures in future ,which can decrease the over ordering of blood. Materials &amp; methods: This study was conducted for a period of one year from January 2016 to December 2016 in those patients, who were scheduled for elective surgical procedures in our Govt. Royapettah Hospital. Total number of units reserved and cross matched and units issued were estimated for the calculation of C/T Ratio, Transfusion probability and Transfusion Index . Results: During the study, the hospital blood bank was requested to prepare 6013 units of Red blood cells for 2756 patients who underwent elective procedures. Blood crossmatched and transfusion patterns for surgeries performed in various departments. The overall C/T Ratio was 10.5, Transfusion Index was 0.2 and Transfusion Probability was 15.1% among various departments. Distribution of patients among Orthopedic department had the highest number of patients [30.4%(838)] Distribution of C/T Ratio among dental department had highest C/T Ratio of 12.8 and neurosurgery had lowest C/T Ratio of 5 conclusion: Before the implementation of an evidence-based blood ordering schedule at our hospital, we observed that a lot of blood was reserved for elective surgeries which were not being utilized. This ends up in burdening the blood bank personnel and also wasting the resources. The results showed that the C/T ratio for elective surgeries were very high

Evaluating the appropriateness of blood component utilization in burns patients

Background: Blood transfusion is a common intervention in critically ill surgical patients, especially Burns patients. But transfusions have potentially life threatening risks. The aim of the study was to evaluate the appropriateness of various blood components, utilized in Burns patients.Methods: Burns patient who were admitted at Burns ward, Government Kilpauk Medical College, Chennai, India with age more than 16 years, with 15-40% Total body surface area burns and had survived treatment were included for a period of one year (September 2014-August 2015). New York State health guidelines for RBC transfusion in Burns, Baxter’s original Parkland formula and platelet transfusion thresholds given by AABB were used to categorize appropriate transfusions from inappropriate transfusions.Results: A total of 122 burns patients who fulfilled the inclusion criteria were followed. 85 patients received 308 red cell units of which 64% were appropriate. 114 patients were transfused with 441 fresh frozen plasma units of which 47% were appropriate. One patient was transfused with platelet concentrate and all patients, who had their platelet count more than 10,000/μL, were not transfused.Conclusions: In our study, 64% of red blood cell transfusions and 47% of FFP transfusions were appropriate. Successful outcome of burns patients purely depends on proper wound care, along with appropriate use of fluids and blood components

Outcomes of the eighth international conference on pediatric mechanical circulatory support systems and pediatric cardiopulmonary perfusion

The Eighth International Conference on PediatricMechanical Circulatory Support Systems and Pediat-ric Cardiopulmonary Perfusion was held at the Gal-atasaray University, Istanbul, Turkey, June 13–16,2012 (Fig. 1).Atıf Akçevin, MD, was the local chair ofthe conference. The scientific co-chairs of the eighthevent were Atıf Akçevin, Tijen Alkan-Bozkaya,I˙hsan Bakır, Hakan Ceyran, Yves Durandy,Huriyet Ersayin-Kantas, Colleen E. Gruenwald,David Palanzo, Linda Pauliks, Kerem Pekkan, ChitraRavishankar, Eugen Sandica, Kyung Sun, RızaTürköz, Akif Ündar, Bonnie Weaver, and John L.Myers