Comparison of RBCs and FFP with whole blood during liver transplant surgery

Laine, E; Steadman, Randolph H.; Calhoun, Loni; Blackall, Douglas P.; Levin, Phillip M.; Braunfeld, Michelle; Nourmand, Hamid; Neelakanta, Gundappa; Ting, Lena H.; Gornbein, Jeffrey; Busuttil, Ronald W.; Petz, Lawrence D.

doi:10.1046/j.1537-2995.2003.00305.x

Cited by 33 publications

(27 citation statements)

References 9 publications

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“…A total of 19 comparator studies reported 22 outcomes of the effect of FFP on allogeneic transfusion requirements [22,23,30,35-37,39,41,43,44,47,49,50,64-69]. These requirements were reported as intraoperative, postoperative or total (studies in which the requirements were reported for the whole perioperative period).…”

Section: Resultsmentioning

confidence: 99%

Clinical effectiveness of fresh frozen plasma compared with fibrinogen concentrate: a systematic review

et al. 2011

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IntroductionHaemostatic therapy in surgical and/or massive trauma patients typically involves transfusion of fresh frozen plasma (FFP). Purified human fibrinogen concentrate may offer an alternative to FFP in some instances. In this systematic review, we investigated the current evidence for the use of FFP and fibrinogen concentrate in the perioperative or massive trauma setting.MethodsStudies reporting the outcome (blood loss, transfusion requirement, length of stay, survival and plasma fibrinogen level) of FFP or fibrinogen concentrate administration to patients in a perioperative or massive trauma setting were identified in electronic databases (1995 to 2010). Studies were included regardless of type, patient age, sample size or duration of patient follow-up. Studies of patients with congenital clotting factor deficiencies or other haematological disorders were excluded. Studies were assessed for eligibility, and data were extracted and tabulated.ResultsNinety-one eligible studies (70 FFP and 21 fibrinogen concentrate) reported outcomes of interest. Few were high-quality prospective studies. Evidence for the efficacy of FFP was inconsistent across all assessed outcomes. Overall, FFP showed a positive effect for 28% of outcomes and a negative effect for 22% of outcomes. There was limited evidence that FFP reduced mortality: 50% of outcomes associated FFP with reduced mortality (typically trauma and/or massive bleeding), and 20% were associated with increased mortality (typically surgical and/or nonmassive bleeding). Five studies reported the outcome of fibrinogen concentrate versus a comparator. The evidence was consistently positive (70% of all outcomes), with no negative effects reported (0% of all outcomes). Fibrinogen concentrate was compared directly with FFP in three high-quality studies and was found to be superior for > 50% of outcomes in terms of reducing blood loss, allogeneic transfusion requirements, length of intensive care unit and hospital stay and increasing plasma fibrinogen levels. We found no fibrinogen concentrate comparator studies in patients with haemorrhage due to massive trauma, although efficacy across all assessed outcomes was reported in a number of noncomparator trauma studies.ConclusionsThe weight of evidence does not appear to support the clinical effectiveness of FFP for surgical and/or massive trauma patients and suggests it can be detrimental. Perioperatively, fibrinogen concentrate was generally associated with improved outcome measures, although more high-quality, prospective studies are required before any definitive conclusions can be drawn.

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Section: Resultsmentioning

confidence: 99%

Clinical effectiveness of fresh frozen plasma compared with fibrinogen concentrate: a systematic review

et al. 2011

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“…However, the results of this study are still valuable for autologous transfusion and the many clinical settings, particularly in developing countries [35] where allogeneic whole blood is still mainly employed. Furthermore, the use of whole blood is gaining renewed interest in developed countries [36][37][38] because it has been shown that leukocyte depletion results in a considerably improved plasma quality in whole blood [39]. cells lose their deformability during storage has been consistently shown by indirect methods using filtration techniques [20] or the LORCA system [21].…”

Section: Discussionmentioning

confidence: 99%

Deformability of Red Blood Cells and Correlation with ATP Content during Storage as Leukocyte-Depleted Whole Blood

Karger

Lukow

Kretschmer³

2012

Transfus Med Hemother

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KeywordsATP content · Deformability · Quality · Red cell storage · Storage lesion · In vivo survival · Whole blood Summary Background: Storage duration of red cells has been associated with increased morbidity and mortality following transfusion. This association has been attributed to the loss of deformability of stored red cells leading to deterioration of microvascular perfusion. ATP content is considered a critical determinant of the deformability of stored red cells. Methods: ATP content and deformability were determined after storage for up to 49 days in 40 leukocyte-depleted whole blood units. Red cell deformability was determined using a laser-assisted optical rotational cell analyzer (LORCA ® ) employing shear stress (SS) ranging from 0.3 to 30 Pa. Deformability was expressed as the elongation index (EI). EI was correlated with ATP content. Results: ATP content decreased from 3.5 to 1.7 mol/g hemoglobin. EI increased from 0.03 to 0.05 at an SS of 0.

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“…The ratio of blood components used is also variable, and some authors have recently suggested that the use of whole blood would actually be more appropriate than RBC and fresh-frozen plasma (FFP) units for liver transplantation [27]. The variability can be partly attributed to a specific patient population or surgical techniques [11 ,21,24].…”

Section: Variability In Transfusion Practicesmentioning

confidence: 99%

Changing trends in transfusion practice in liver transplantation

Ozier

Tsou

2008

Current Opinion in Organ Transplantation

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Comparison of RBCs and FFP with whole blood during liver transplant surgery

Abstract: Whole blood, when compared with component therapy, is associated with fewer donor exposures yet provided equally effective replacement therapy for blood loss in liver transplantation patients.

Cited by 33 publications

References 9 publications

Clinical effectiveness of fresh frozen plasma compared with fibrinogen concentrate: a systematic review

Clinical effectiveness of fresh frozen plasma compared with fibrinogen concentrate: a systematic review

Deformability of Red Blood Cells and Correlation with ATP Content during Storage as Leukocyte-Depleted Whole Blood

Changing trends in transfusion practice in liver transplantation

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