Coagulation and Transfusion Updates From 2021

Fabbro, Michael; Patel, Prakash A.; Henderson, Reney; Bolliger, Daniel; Tanaka, Kenichi A.; Mazzeffi, Michael

doi:10.1053/j.jvca.2022.03.042

Cited by 3 publications

(1 citation statement)

References 107 publications

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“…In addition to these concerns, blood operators may be faced with a question as to whether the emerging or re-emerging agent is blood-borne and capable of being transmitted by the transfusion of blood products [ 9 , 57 ]. A variety of variables may also create conditions that reduce the blood supply to support the healthcare system in general [ 72 , 73 ].…”

Section: How Blood Operators Can Prepare For the Next Pandemicmentioning

confidence: 99%

Lessons Learned from the COVID-19 Pandemic and How Blood Operators Can Prepare for the Next Pandemic

Drews

O’Brien

2022

Viruses

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Humans interact with virus-infected animal hosts, travel globally, and maintain social networks that allow for novel viruses to emerge and develop pandemic potential. There are key lessons-learned from the coronavirus diseases 2019 (COVID-19) pandemic that blood operators can apply to the next pandemic. Warning signals to the COVID-19 pandemic included outbreaks of Severe acute respiratory syndrome-related coronavirus-1 (SARS-CoV-1) and Middle East respiratory syndrome-related coronavirus (MERS-CoV) in the prior two decades. It will be critical to quickly determine whether there is a risk of blood-borne transmission of a new pandemic virus. Prior to the next pandemic blood operators should be prepared for changes in activities, policies, and procedures at all levels of the organization. Blood operators can utilize “Plan-Do-Study-Act” cycles spanning from: vigilance for emerging viruses, surveillance activities and studies, operational continuity, donor engagement and trust, and laboratory testing if required. Occupational health and donor safety issues will be key areas of focus even if the next pandemic virus is not transfusion transmitted. Blood operators may also be requested to engage in new activities such as the development of therapeutics or supporting public health surveillance activities. Activities such as scenario development, tabletop exercises, and drills will allow blood operators to prepare for the unknowns of the next pandemic.

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Section: How Blood Operators Can Prepare For the Next Pandemicmentioning

confidence: 99%

Lessons Learned from the COVID-19 Pandemic and How Blood Operators Can Prepare for the Next Pandemic

Drews

O’Brien

2022

Viruses

View full text Add to dashboard Cite

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Turbulence in surgical suction heads as detected by MRI

Hanekop¹,

Kollmeier²,

Frahm³

et al. 2023

J Extra Corpor Technol

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Background: Blood loss is common during surgical procedures, especially in open cardiac surgery. Allogenic blood transfusion is associated with increased morbidity and mortality. Blood conservation programs in cardiac surgery recommend re-transfusion of shed blood directly or after processing, as this decreases transfusion rates of allogenic blood. But aspiration of blood from the wound area is often associated with increased hemolysis, due to flow induced forces, mainly through development of turbulence. Methods: We evaluated magnetic resonance imaging (MRI) as a qualitative tool for detection of turbulence. MRI is sensitive to flow; this study uses velocity-compensated T1-weighted 3D MRI for turbulence detection in four geometrically different cardiotomy suction heads under comparable flow conditions (0-1250 mL/min). Results: Our standard control suction head Model A showed pronounced signs of turbulence at all flow rates measured, while turbulence was only detectable in our modified Models 1-3 at higher flow rates (Models 1 and 3) or not at all (Model 2). Conclusion: The comparison of flow performance of surgical suction heads with different geometries via acceleration-sensitized 3D MRI revealed significant differences in turbulence development between our standard control Model A and the modified alternatives (Models 1‑3). As flow conditions during measurement have been comparable, the specific geometry of the respective suction heads must have been the main factor responsible. The underlying mechanisms and causative factors can only be speculated about, but as other investigations have shown, hemolytic activity is positively associated with degree of turbulence. The turbulence data measured in this study correlate with data from other investigations about hemolysis induced by surgical suction heads. The experimental MRI technique used showed added value for further elucidating the underlying physical phenomena causing blood damage due to non-physiological flow.

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A single‐center, retrospective analysis to compare measurement of fibrinogen using the TEG6 analyzer to the Clauss measurement in children undergoing heart surgery

Gautam,

Tran,

Griffin

et al. 2023

Pediatric Anesthesia

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BackgroundNewer generation viscoelastic tests, TEG6s, offer point‐of‐care hemostatic therapy in adult patients. However, their efficacy in estimating fibrinogen levels in pediatric patients undergoing cardiac surgery is not well established.AimsThis study evaluates TEG6s for estimating fibrinogen levels in pediatric cardiac surgery patients and its predictive capability for post‐bypass hypofibrinogenemia.MethodsA single‐center, retrospective study on pediatric patients (under 18 years) who underwent cardiac surgery with cardiopulmonary bypass from August 2020 and November 2022. Blood samples for estimated whole blood functional fibrinogen level via TEG6s (Haemonetics Inc.) and concurrent laboratory‐measured plasma fibrinogen via von Clauss assay were collected at pre‐ and post‐cardiopulmonary bypass.ResultsPaired data for TEG6s estimated functional fibrinogen levels and plasma fibrinogen were analyzed for 432 pediatric patients pre‐bypass. It was observed that functional fibrinogen consistently overestimated plasma fibrinogen across all age groups with a mean difference of 138 mg/dL (95% confidence interval [CI]: 128–149 mg/dL). This positive bias in the pre‐bypass data was confirmed by Bland–Altman analysis. Post‐bypass, functional fibrinogen estimates were comparable to plasma fibrinogen in all patient groups with a mean difference of −6 mg/dL (95% CI: −20–8 mg/dL) except for neonates, where functional fibrinogen levels underestimated plasma fibrinogen with a mean difference of −38 mg/dL (95% CI: −64 to −12 mg/dL). The predictive accuracy of functional fibrinogen for detecting post‐bypass hypofibrinogenemia (plasma fibrinogen ≤250 mg/dL) demonstrated overall fair accuracy in all patients, indicated by an area under the curve of 0.73 (95% CI: 0.65–0.80) and good accuracy among infants, with an area under the curve of 0.80 (95% CI: 0.70–0.90). Similar performance was observed in predicting critical post‐bypass hypofibrinogenemia (plasma fibrinogen ≤200 mg/dL). Based on these analyses, optimal cutoffs for predicting post‐bypass hypofibrinogenemia were established as a functional fibrinogen level ≤270 mg/dL and MAFF ≤15 mm.ConclusionThis study demonstrates that whole blood functional fibrinogen, as estimated by TEG6s, tends to overestimate baseline plasma fibrinogen levels in pediatric age groups but aligns more accurately post‐cardiopulmonary bypass, particularly in neonates and infants, suggesting its potential as a point‐of‐care tool in pediatric cardiac surgery. However, the variability in TEG6s performance before and after bypass highlights the need for careful interpretation of its results in clinical decision‐making. Despite its contributions to understanding TEG6s in pediatric cardiac surgery, the study's design and inherent biases warrant cautious application of these findings in clinical settings.

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Coagulation and Transfusion Updates From 2021

Cited by 3 publications

References 107 publications

Lessons Learned from the COVID-19 Pandemic and How Blood Operators Can Prepare for the Next Pandemic

Lessons Learned from the COVID-19 Pandemic and How Blood Operators Can Prepare for the Next Pandemic

Turbulence in surgical suction heads as detected by MRI

A single‐center, retrospective analysis to compare measurement of fibrinogen using the TEG6 analyzer to the Clauss measurement in children undergoing heart surgery

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