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Melemenidis S, Nguyen KD, Baraceros-Pineda R, Barclay CK, Bautista J, Lau HD, Ashraf MR, Manjappa R, Dutt S, Soto LA, Katila N, Lau B, Viswanathan V, Yu AS, Surucu M, Skinner LB, Engleman EG, Loo BW, Pham TD. Rapid Sterilization of Clinical Apheresis Blood Products Using Ultra-High Dose Rate Radiation. Int J Mol Sci 2025; 26:2424. [PMID: 40141066 PMCID: PMC11942528 DOI: 10.3390/ijms26062424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2025] [Revised: 02/28/2025] [Accepted: 03/03/2025] [Indexed: 03/28/2025] Open
Abstract
Blood products, including apheresis platelets and plasma, are essential for medical use but pose risks of bacterial contamination and viral transmission. Platelets are prone to bacterial growth due to their storage conditions, while plasma requires extensive screening. This study explores rapid irradiation as an innovative pathogen reduction method. A clinical linear accelerator was configured to deliver ultra-high dose rate (6 kGy/min) irradiation to platelet and plasma components. Platelets spiked with Escherichia coli (E. coli; 10⁵ colony-forming units) were irradiated at 0.1-20 kGy, followed by bacterial growth and platelet count analysis. COVID-19 convalescent plasma (CCP) was irradiated at 25 kGy, and receptor-binding domain (RBD)-specific immunoglobulins (Ig) were assessed. Irradiation at 1 kGy reduced E. coli growth by 2.7-log without significant platelet loss, while 5 kGy achieved complete suppression. The estimated 6-log bacterial reduction dose (2.3 kGy) led to a 31% platelet count drop. Administering a 25 kGy virus-sterilizing dose to CCP resulted in a 9.2% decrease in RBD-specific IgG binding. This study demonstrates the proof-of-concept for rapid blood sterilization using a clinical linear accelerator. The method maintains platelet counts and CCP antibody binding at sterilizing doses, highlighting its potential as a point-of-care blood product sterilization solution.
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Affiliation(s)
- Stavros Melemenidis
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (M.R.A.); (R.M.); (S.D.); (L.A.S.); (N.K.); (B.L.); (V.V.); (A.S.Y.); (M.S.); (L.B.S.); (B.W.L.)
| | - Khoa D. Nguyen
- Stanford Blood Center, Stanford Health Care, Stanford, CA 94304, USA; (K.D.N.); (C.K.B.); (J.B.); (E.G.E.)
| | - Rosella Baraceros-Pineda
- Department of Health Policy, Center for Innovation to Implementation, Veterans Affairs Health Care, Palo Alto, CA 94304, USA;
| | - Cherie K. Barclay
- Stanford Blood Center, Stanford Health Care, Stanford, CA 94304, USA; (K.D.N.); (C.K.B.); (J.B.); (E.G.E.)
| | - Joanne Bautista
- Stanford Blood Center, Stanford Health Care, Stanford, CA 94304, USA; (K.D.N.); (C.K.B.); (J.B.); (E.G.E.)
| | - Hubert D. Lau
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - M. Ramish Ashraf
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (M.R.A.); (R.M.); (S.D.); (L.A.S.); (N.K.); (B.L.); (V.V.); (A.S.Y.); (M.S.); (L.B.S.); (B.W.L.)
| | - Rakesh Manjappa
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (M.R.A.); (R.M.); (S.D.); (L.A.S.); (N.K.); (B.L.); (V.V.); (A.S.Y.); (M.S.); (L.B.S.); (B.W.L.)
| | - Suparna Dutt
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (M.R.A.); (R.M.); (S.D.); (L.A.S.); (N.K.); (B.L.); (V.V.); (A.S.Y.); (M.S.); (L.B.S.); (B.W.L.)
| | - Luis A. Soto
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (M.R.A.); (R.M.); (S.D.); (L.A.S.); (N.K.); (B.L.); (V.V.); (A.S.Y.); (M.S.); (L.B.S.); (B.W.L.)
| | - Nikita Katila
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (M.R.A.); (R.M.); (S.D.); (L.A.S.); (N.K.); (B.L.); (V.V.); (A.S.Y.); (M.S.); (L.B.S.); (B.W.L.)
| | - Brianna Lau
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (M.R.A.); (R.M.); (S.D.); (L.A.S.); (N.K.); (B.L.); (V.V.); (A.S.Y.); (M.S.); (L.B.S.); (B.W.L.)
| | - Vignesh Viswanathan
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (M.R.A.); (R.M.); (S.D.); (L.A.S.); (N.K.); (B.L.); (V.V.); (A.S.Y.); (M.S.); (L.B.S.); (B.W.L.)
| | - Amy S. Yu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (M.R.A.); (R.M.); (S.D.); (L.A.S.); (N.K.); (B.L.); (V.V.); (A.S.Y.); (M.S.); (L.B.S.); (B.W.L.)
| | - Murat Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (M.R.A.); (R.M.); (S.D.); (L.A.S.); (N.K.); (B.L.); (V.V.); (A.S.Y.); (M.S.); (L.B.S.); (B.W.L.)
| | - Lawrie B. Skinner
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (M.R.A.); (R.M.); (S.D.); (L.A.S.); (N.K.); (B.L.); (V.V.); (A.S.Y.); (M.S.); (L.B.S.); (B.W.L.)
| | - Edgar G. Engleman
- Stanford Blood Center, Stanford Health Care, Stanford, CA 94304, USA; (K.D.N.); (C.K.B.); (J.B.); (E.G.E.)
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA;
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Division of Immunology & Rheumatology, Department of Internal Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Billy W. Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (M.R.A.); (R.M.); (S.D.); (L.A.S.); (N.K.); (B.L.); (V.V.); (A.S.Y.); (M.S.); (L.B.S.); (B.W.L.)
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Tho D. Pham
- Stanford Blood Center, Stanford Health Care, Stanford, CA 94304, USA; (K.D.N.); (C.K.B.); (J.B.); (E.G.E.)
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA;
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Park SM, Rodriguez J, Zhang Z, Miyata S. Review of Low Titer Group O Whole Blood (LTOWB) Transfusion in Initial Resuscitation of Pediatric Trauma Patients: Assessing Potential Benefits. J Pediatr Surg 2025; 60:161892. [PMID: 39332971 DOI: 10.1016/j.jpedsurg.2024.161892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 08/16/2024] [Accepted: 08/30/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND Hemorrhagic shock secondary to trauma is a leading cause of pediatric mortality in the United States. Timely intervention is crucial to prevent many of these deaths. Children and adults exhibit distinct responses to trauma due to varying blood volume ratios and injury patterns. Pediatric patients with hypotension face a heightened risk of shock, demanding a more assertive resuscitation. METHODS This study is a review of the literature on LTOWB transfusion in pediatric trauma. We conducted electronic database searches until December 2022, using keywords related to LTOWB and pediatric trauma resuscitation. Randomized/non-randomized, retrospective/prospective studies were considered, assessing serological safety, adverse reactions, clinical outcomes, and cost-effectiveness. RESULTS Six articles were ultimately reviewed. No adverse reactions related to hemolysis biomarkers were observed. Clinical outcomes exhibited no significant differences in mortality, hospital, or ventilator days between LTOWB and component therapy (CT). However, LTOWB transfusion resulted in faster resolution of base deficit, lower INR, and reduced requirement for additive plasma and platelet transfusions. In military and massive transfusion cases, LTOWB was associated with decreased mortality and lower transfusion volumes. One article suggested potential economic advantages. CONCLUSIONS LTOWB transfusion appears to be a promising option for pediatric trauma resuscitation, offering benefits in rapid administration and component balance. While some studies indicate potential advantages in clinical outcomes and cost-effectiveness, the current evidence is limited and requires further investigation. Future research should focus on large-scale studies to validate these findings, especially concerning economic benefits, and develop standardized protocols for LTOWB use in pediatric settings. LEVELS OF EVIDENCE Treatment Study, LEVEL III.
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Affiliation(s)
- Si-Min Park
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, 1465 S. Grand Blvd. St. Louis, MO 63104, USA.
| | - Joe Rodriguez
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, 1465 S. Grand Blvd. St. Louis, MO 63104, USA.
| | - Zidong Zhang
- Advanced HEAlth Data (AHEAD) Institute, Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, 1402 S Grand Blvd, St. Louis, MO 63104, USA.
| | - Shin Miyata
- Department of Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, 1465 S. Grand Blvd. St. Louis, MO 63104, USA; Department of Pediatric Surgery, Saint Louis University School of Medicine, 1402 S Grand Blvd, St. Louis, MO 63104, USA.
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Melemenidis S, Nguyen KD, Baraceros-Pineda R, Barclay CK, Bautista J, Lau H, Ashraf MR, Manjappa R, Dutt S, Soto LA, Katila N, Lau B, Visvanathan V, Yu AS, Surucu M, Skinner LB, Engleman EG, Loo BW, Pham TD. Rapid Sterilization of Clinical Apheresis Blood Products using Ultra-High Dose Rate Radiation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.12.14.628469. [PMID: 39713317 PMCID: PMC11661200 DOI: 10.1101/2024.12.14.628469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2024]
Abstract
BACKGROUND AND OBJECTIVES Apheresis platelets products and plasma are essential for medical interventions, but both still have inherent risks associated with contamination and viral transmission. Platelet products are vulnerable to bacterial contamination due to storage conditions, while plasma requires extensive screening to minimize virus transmission risks. Here we investigate rapid irradiation to sterilizing doses for bacteria and viruses as an innovative pathogen reduction technology. MATERIALS AND METHODS We configured a clinical linear accelerator to deliver ultra-high dose rate (6 kGy/min) irradiation to platelet and plasma blood components. Platelet aliquots spiked with 105 CFU of E.coli were irradiated with 0.1-20 kGy, followed by E.coli growth and platelet count assays. COVID Convalescent Plasma (CCP) aliquots were irradiated at a virus-sterilizing dose of 25 kGy and subsequently, RBD-specific antibody binding was assessed. RESULTS 1 kGy irradiation of bacteria-spiked platelets reduced E.coli growth by 2.7-log without significant change of platelet count, and 5 kGy or higher produced complete growth suppression. The estimated sterilization (6-log bacterial reduction) dose was 2.3 kGy, corresponding to 31% platelet count reduction. A 25 kGy virus sterilizing dose to CCP produced a 9.2% average drop of RBD-specific IgG binding. CONCLUSION This study shows proof-of-concept of a novel rapid blood sterilization technique using a clinical linear accelerator. Promising platelet counts and CCP antibody binding were maintained at bacteria and virus sterilizing doses, respectively. This represents a potential point-of-care blood product sterilization solution. If additional studies corroborate these findings, this may be a practical method for ensuring blood products safety.
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Affiliation(s)
- Stavros Melemenidis
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Khoa D. Nguyen
- Stanford Blood Center, Stanford Health Care, Stanford, California, USA
| | - Rosella Baraceros-Pineda
- Department of Health Policy, Center for Innovation to Implementation, Veterans Affairs Health Care, Palo Alto, California, USA
| | - Cherie K. Barclay
- Stanford Blood Center, Stanford Health Care, Stanford, California, USA
| | - Joanne Bautista
- Stanford Blood Center, Stanford Health Care, Stanford, California, USA
| | - Hubert Lau
- Department of Health Policy, Center for Innovation to Implementation, Veterans Affairs Health Care, Palo Alto, California, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - M. Ramish Ashraf
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Rakesh Manjappa
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Suparna Dutt
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Luis Armando Soto
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Nikita Katila
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Brianna Lau
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Vignesh Visvanathan
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Amy S. Yu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Murat Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Lawrie B. Skinner
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Edgar G. Engleman
- Stanford Blood Center, Stanford Health Care, Stanford, California, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
- Division of Immunology & Rheumatology, Department of Internal Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Billy W. Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Tho D. Pham
- Stanford Blood Center, Stanford Health Care, Stanford, California, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
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Vuoncino LH, Robles AJ, Barnes AC, Ross JT, Graeff LW, Anway TL, Vincent NT, Tippireddy N, Tanaka KM, Mays RJ, Callcut RA. Using microfluidic shear to assess transfusion requirements in trauma patients. Trauma Surg Acute Care Open 2024; 9:e001403. [PMID: 38974221 PMCID: PMC11227844 DOI: 10.1136/tsaco-2024-001403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/31/2024] [Indexed: 07/09/2024] Open
Abstract
Background Viscoelastic assays have widely been used for evaluating coagulopathies but lack the addition of shear stress important to in vivo clot formation. Stasys technology subjects whole blood to shear forces over factor-coated surfaces. Microclot formation is analyzed to determine clot area (CA) and platelet contractile forces (PCFs). We hypothesize the CA and PCF from this novel assay will provide information that correlates with trauma-induced coagulopathy and transfusion requirements. Methods Blood samples were collected on adult trauma patients from a single-institution prospective cohort study of high-level activations. Patient and injury characteristics, transfusion data, and outcomes were collected. Thromboelastography, coagulation studies, and Stasys assays were run on paired samples collected at admission. Stasys CA and PCFs were quantified as area under the curve calculations and maximum values. Normal ranges for Stasys assays were determined using healthy donors. Data were compared using Kruskal-Wallis tests and simple linear regression. Results From March 2021 to January 2023, 108 samples were obtained. Median age was 37.5 (IQR 27.5-52) years; patients were 77% male. 71% suffered blunt trauma, 26% had an Injury Severity Score of ≥25. An elevated international normalized ratio significantly correlated with decreased cumulative PCF (p=0.05), maximum PCF (p=0.05) and CA (p=0.02). Lower cumulative PCF significantly correlated with transfusion of any products at 6 and 24 hours (p=0.04 and p=0.05) as well as packed red blood cells (pRBCs) at 6 and 24 hours (p=0.04 and p=0.03). A decreased maximum PCF showed significant correlation with receiving any transfusion at 6 (p=0.04) and 24 hours (p=0.02) as well as transfusion of pRBCs, fresh frozen plasma, and platelets in the first 6 hours (p=0.03, p=0.03, p=0.03, respectively). Conclusions Assessing coagulopathy in real time remains challenging in trauma patients. In this pilot study, we demonstrated that microfluidic approaches incorporating shear stress could predict transfusion requirements at time of admission as well as requirements in the first 24 hours. Level of evidence Level II.
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Affiliation(s)
- Leslie H Vuoncino
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Anamaria J Robles
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Ashli C Barnes
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - James T Ross
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Leonardo W Graeff
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Taylor L Anway
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Nico T Vincent
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Nithya Tippireddy
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Kimi M Tanaka
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Randi J Mays
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Rachael A Callcut
- Department of Surgery, University of California Davis School of Medicine, Sacramento, California, USA
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Feinberg GJ, Tillman AC, Paiva ML, Emigh B, Lueckel SN, Hynes AM, Kheirbek T. Maintaining a whole blood-centered transfusion improves survival in hemorrhagic resuscitation. J Trauma Acute Care Surg 2024; 96:749-756. [PMID: 38146960 DOI: 10.1097/ta.0000000000004222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
BACKGROUND Whole blood (WB) transfusion has been shown to improve mortality in trauma resuscitation. The optimal ratio of packed red blood cells (pRBC) to WB in emergent transfusion has not been determined. We hypothesized that a low pRBC/WB transfusion ratio is associated with improved survival in trauma patients. METHODS We analyzed the 2021 Trauma Quality Improvement Program (TQIP) database to identify patients who underwent emergent surgery for hemorrhage control and were transfused within 4 hours of hospital arrival, excluding transfers or deaths in the emergency department. We stratified patients based on pRBC/WB ratios. The primary outcome was mortality at 24 hours. Logistic regression was performed to estimate odds of mortality among ratio groups compared with WB alone, adjusting for injury severity, time to intervention, and demographics. RESULTS Our cohort included 17,562 patients; of those, 13,678 patients had only pRBC transfused and were excluded. Fresh frozen plasma/pRBC ratio was balanced in all groups. Among those who received WB (n = 3,884), there was a significant increase in 24-hour mortality with higher pRBC/WB ratios (WB alone 5.2%, 1:1 10.9%, 2:1 11.8%, 3:1 14.9%, 4:1 20.9%, 5:1 34.1%, p = 0.0001). Using empirical cutpoint estimation, we identified a 3:1 ratio or less as an optimal cutoff point. Adjusted odds ratios of 24-hour mortality for 4:1 and 5:1 groups were 2.85 (95% confidence interval [CI], 1.19-6.81) and 2.89 (95% CI, 1.29-6.49), respectively. Adjusted hazard ratios of 24-hour mortality were 2.83 (95% CI, 1.18-6.77) for 3:1 ratio, 3.67 (95% CI, 1.57-8.57) for 4:1 ratio, and 1.97 (95% CI, 0.91-4.23) for 5:1 ratio. CONCLUSION Our analysis shows that higher pRBC/WB ratios at 4 hours diminished survival benefits of WB in trauma resuscitation. Further efforts should emphasize this relationship to optimize trauma resuscitation protocols. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Griffin J Feinberg
- From the Department of surgery (G.J.F., A.C.T., M.L.P., B.E., S.N.L., T.K.), Brown University, Alpert School of Medicine, Providence, Rhode Island; Department of Emergency Medicine (A.M.H.), and Department of Surgery (A.M.H.), University of New Mexico School of Medicine, Albuquerque, New Mexico
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Sheffield WP, Singh K, Beckett A, Devine DV. Prehospital Freeze-Dried Plasma in Trauma: A Critical Review. Transfus Med Rev 2024; 38:150807. [PMID: 38114340 DOI: 10.1016/j.tmrv.2023.150807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023]
Abstract
Major traumatic hemorrhage is now frequently treated by early hemostatic resuscitation on hospital arrival. Prehospital hemostatic resuscitation could therefore improve outcomes for bleeding trauma patients, but there are logistical challenges. Freeze-dried plasma (FDP) offers indisputable logistical advantages over conventional blood products, such as long shelf life, stability at ambient temperature, and rapid reconstitution without specialized equipment. We sought high level, randomized, controlled evidence of FDP clinical efficacy in trauma. A structured systematic search of MEDLINE/PubMed was carried out and identified 52 relevant English language publications. Three studies involving 607 patients met our criteria: Resuscitation with Blood Products in Patients with Trauma-related Hemorrhagic Shock receiving Prehospital Care (RePHILL, n = 501); Prehospital Lyophilized Plasma Transfusion for Trauma-Induced Coagulopathy in Patients at Risk for Hemorrhagic Shock (PREHO-PLYO, n = 150); and a pilot Australian trial (n = 25). RePHILL found no effect of FDP plus packed red blood cells (PRBC) concentrate transfusion versus saline on mortality. PREHO-PLYO found no effect of FDP versus saline on International Normalized Ratio (INR) at hospital arrival. The pilot trial found that study of PRBC versus PRBC plus FDP was feasible during long air transport times to an Australian trauma centre. Further research is required to determine under what conditions FDP might provide prehospital benefit to trauma patients.
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Affiliation(s)
- William P Sheffield
- Medical Affairs and Innovation, Canadian Blood Services, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Kanwal Singh
- Trauma Surgery, Critical Care Medicine and Acute Care Surgery, St. Michael's Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Beckett
- Trauma Surgery, Critical Care Medicine and Acute Care Surgery, St. Michael's Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Canadian Forces Health Services, Ottawa, Ontario, Canada
| | - Dana V Devine
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
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Lægreid IJ, Wilson T, Næss KH, Ernstsen SL, Schou V, Arsenovic MG. Whole blood transfusion and paroxysmal nocturnal haemoglobinuria meet again: Minor incompatibility, major trouble. Vox Sang 2022; 117:1323-1326. [PMID: 36102159 PMCID: PMC9826352 DOI: 10.1111/vox.13354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVES The field of transfusion medicine started out with whole blood transfusion to treat severe anaemia and other deficiencies, and then transitioned to component therapy, largely leaving the practice, and experiences, of whole blood transfusions behind. Currently, the field is circling back and whole blood is gaining ground as an alternative to massive transfusion protocols. MATERIALS AND METHODS Herein we describe a severely anaemic paroxysmal nocturnal haemoglobinuria (PNH) patient initially suspected of suffering from renal haemorrhage, receiving a standard low-titre group O whole blood transfusion during pre-hospital transportation. RESULTS Following the transfusion, the patient suffered a clinically unmistakable haemolytic transfusion reaction requiring supportive treatment in the intensive care unit. Clinical observations are consistent with an acute haemolytic reaction. The haemolysis was likely due to minor incompatibility between the plasma from the transfused whole blood and the patient's PNH red cells. Recovery was uneventful. CONCLUSION This revealed an unappreciated contraindication to minor incompatible whole blood transfusion, and prompted a discussion on the distinction between whole blood and erythrocyte concentrates, the different indications for use and the importance of emphasizing these differences. It also calls attention to patient groups where minor incompatibility can be of major importance.
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Affiliation(s)
- Ingvild Jenssen Lægreid
- Department of Laboratory Medicine, Division of Diagnostic servicesUniversity Hospital of North NorwayTromsøNorway
| | - Thomas Wilson
- Division of Prehospital servicesFinnmark Hospital TrustKirkenesNorway
| | | | - Siw Leiknes Ernstsen
- Department of Laboratory Medicine, Division of Diagnostic servicesUniversity Hospital of North NorwayTromsøNorway
| | - Vibeke Schou
- Department of Anesthesia and Intensive CareKirkenes Hospital, Finnmark Hospital TrustKirkenesNorway
| | - Mirjana Grujic Arsenovic
- Department of Laboratory Medicine, Division of Diagnostic servicesUniversity Hospital of North NorwayTromsøNorway
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