The Experts below are selected from a list of 10752 Experts worldwide ranked by ideXlab platform
Yuan Xue - One of the best experts on this subject based on the ideXlab platform.
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Plasma Transfusion combined with chelating therapy alleviates fulminant Wilson's disease with a single Arg778Leu heterozygote mutation.
Annals of hepatology, 2019Co-Authors: Longgen Liu, Qing Gong, Juan Liu, Shen Hongyu, Hongyu Zhang, Yuan XueAbstract:Abstract Wilson's disease (WD), resulting from homozygote and compound heterozygote mutations in ATB7B, is an autosomal recessive disease. WD associated acute liver failure (ALF) is fatal, and a revised Wilson's disease prognostic index (RWPI) >11 is a reliable indication of liver transplantation (LT) or artificial liver support (ALS). We described a WD patient who initially presented with ALF and severe hemolytic anemia. A single heterozygote c.2333G>T mutation (p. Arg778Leu, R778L) in ATP7B was screened by whole exome sequencing and validated by Sanger sequencing. Rapid diagnostic criteria (ALP/TBIL 2.2) are suitable for early diagnosis. Although the RWPI amounted to 15, the patient recovered after intermittent Plasma Transfusion and subsequent chelating therapy without LT or ALS. In conclusion, WD patients with a single R778L heterozygote mutation can present with ALF as the initial clinical manifestation, and intermittent Plasma Transfusion combined with chelating therapy may alleviate fulminant WD without LT or ALS.
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Plasma Transfusion Combined with Chelating Therapy Alleviates Fulminant Wilson’s Disease with a Single Arg778Leu Heterozygote Mutation
Annals of Hepatology, 2018Co-Authors: Longgen Liu, Qing Gong, Juan Liu, Hongyu Zhang, Hongyu Shen, Yuan XueAbstract:Wilson’s disease (WD), resulting from homozygote and compound heterozygote mutations in ATB7B, is an autosomal recessive disease. WD associated acute liver failure (ALF) is fatal, and a revised Wilson’s disease prognostic index (RWPI) > 11 is a reliable indication of liver transplantation (LT) or artificial liver support (ALS). We described a WD patient who initially presented with ALF and severe hemolytic anemia. A single heterozygote c.2333G > T mutation (p. Arg778Leu, R778L) in ATP7B was screened by whole exome sequencing and validated by Sanger sequencing. Rapid diagnostic criteria (ALP/TBIL < 4 and AST/ALT > 2.2) are suitable for early diagnosis. Although the RWPI amounted to 15, the patient recovered after intermittent Plasma Transfusion and subsequent chelating therapy without LT or ALS. In conclusion, WD patients with a single R778L heterozygote mutation can present with ALF as the initial clinical manifestation, and intermittent Plasma Transfusion combined with chelating therapy may alleviate fulminant WD without LT or ALS.
Longgen Liu - One of the best experts on this subject based on the ideXlab platform.
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Plasma Transfusion combined with chelating therapy alleviates fulminant Wilson's disease with a single Arg778Leu heterozygote mutation.
Annals of hepatology, 2019Co-Authors: Longgen Liu, Qing Gong, Juan Liu, Shen Hongyu, Hongyu Zhang, Yuan XueAbstract:Abstract Wilson's disease (WD), resulting from homozygote and compound heterozygote mutations in ATB7B, is an autosomal recessive disease. WD associated acute liver failure (ALF) is fatal, and a revised Wilson's disease prognostic index (RWPI) >11 is a reliable indication of liver transplantation (LT) or artificial liver support (ALS). We described a WD patient who initially presented with ALF and severe hemolytic anemia. A single heterozygote c.2333G>T mutation (p. Arg778Leu, R778L) in ATP7B was screened by whole exome sequencing and validated by Sanger sequencing. Rapid diagnostic criteria (ALP/TBIL 2.2) are suitable for early diagnosis. Although the RWPI amounted to 15, the patient recovered after intermittent Plasma Transfusion and subsequent chelating therapy without LT or ALS. In conclusion, WD patients with a single R778L heterozygote mutation can present with ALF as the initial clinical manifestation, and intermittent Plasma Transfusion combined with chelating therapy may alleviate fulminant WD without LT or ALS.
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Plasma Transfusion Combined with Chelating Therapy Alleviates Fulminant Wilson’s Disease with a Single Arg778Leu Heterozygote Mutation
Annals of Hepatology, 2018Co-Authors: Longgen Liu, Qing Gong, Juan Liu, Hongyu Zhang, Hongyu Shen, Yuan XueAbstract:Wilson’s disease (WD), resulting from homozygote and compound heterozygote mutations in ATB7B, is an autosomal recessive disease. WD associated acute liver failure (ALF) is fatal, and a revised Wilson’s disease prognostic index (RWPI) > 11 is a reliable indication of liver transplantation (LT) or artificial liver support (ALS). We described a WD patient who initially presented with ALF and severe hemolytic anemia. A single heterozygote c.2333G > T mutation (p. Arg778Leu, R778L) in ATP7B was screened by whole exome sequencing and validated by Sanger sequencing. Rapid diagnostic criteria (ALP/TBIL < 4 and AST/ALT > 2.2) are suitable for early diagnosis. Although the RWPI amounted to 15, the patient recovered after intermittent Plasma Transfusion and subsequent chelating therapy without LT or ALS. In conclusion, WD patients with a single R778L heterozygote mutation can present with ALF as the initial clinical manifestation, and intermittent Plasma Transfusion combined with chelating therapy may alleviate fulminant WD without LT or ALS.
Simon J. Stanworth - One of the best experts on this subject based on the ideXlab platform.
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Prophylactic Plasma Transfusion for patients without inherited bleeding disorders or anticoagulant use undergoing non‐cardiac surgery or invasive procedures
The Cochrane database of systematic reviews, 2019Co-Authors: Jonathan Huber, Simon J. Stanworth, Carolyn Doree, Marialena Trivella, Susan J Brunskill, Sally Hopewell, Kirstin L Wilkinson, Patricia M Fortin, Lise J EstcourtAbstract:Background In the absence of bleeding, Plasma is commonly transfused to people prophylactically to prevent bleeding. In this context, it is transfused before operative or invasive procedures (such as liver biopsy or chest drainage tube insertion) in those considered at increased risk of bleeding, typically defined by abnormalities of laboratory tests of coagulation. As Plasma contains procoagulant factors, Plasma Transfusion may reduce perioperative bleeding risk. This outcome has clinical importance given that perioperative bleeding and blood Transfusion have been associated with increased morbidity and mortality. Plasma is expensive, and some countries have experienced issues with blood product shortages, donor pool reliability, and incomplete screening for transmissible infections. Thus, although the benefit of prophylactic Plasma Transfusion has not been well established, Plasma Transfusion does carry potentially life-threatening risks. Objectives To determine the clinical effectiveness and safety of prophylactic Plasma Transfusion for people with coagulation test abnormalities (in the absence of inherited bleeding disorders or use of anticoagulant medication) requiring non-cardiac surgery or invasive procedures. Search methods We searched for randomised controlled trials (RCTs), without language or publication status restrictions in: Cochrane Central Register of Controlled Trials (CENTRAL; 2017 Issue 7); Ovid MEDLINE (from 1946); Ovid Embase (from 1974); Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCOHost) (from 1937); PubMed (e-publications and in-process citations ahead of print only); Transfusion Evidence Library (from 1950); Latin American Caribbean Health Sciences Literature (LILACS) (from 1982); Web of Science: Conference Proceedings Citation Index-Science (CPCI-S) (Thomson Reuters, from 1990); ClinicalTrials.gov; and World Health Organization (WHO) International Clinical Trials Registry Search Platform (ICTRP) to 28 January 2019. Selection criteria We included RCTs comparing: prophylactic Plasma Transfusion to placebo, intravenous fluid, or no intervention; prophylactic Plasma Transfusion to alternative pro-haemostatic agents; or different haemostatic thresholds for prophylactic Plasma Transfusion. We included participants of any age, and we excluded trials incorporating individuals with previous active bleeding, with inherited bleeding disorders, or taking anticoagulant medication before enrolment. Data collection and analysis We used standard methodological procedures expected by Cochrane. Main results We included five trials in this review, all were conducted in high-income countries. Three additional trials are ongoing. One trial compared fresh frozen Plasma (FFP) Transfusion with no Transfusion given. One trial compared FFP or platelet Transfusion or both with neither FFP nor platelet Transfusion given. One trial compared FFP Transfusion with administration of alternative pro-haemostatic agents (factors II, IX, and X followed by VII). One trial compared the use of different Transfusion triggers using the international normalised ratio measurement. One trial compared the use of a thromboelastographic-guided Transfusion trigger using standard laboratory measurements of coagulation. Four trials enrolled only adults, whereas the fifth trial did not specify participant age. Four trials included only minor procedures that could be performed by the bedside. Only one trial included some participants undergoing major surgical operations. Two trials included only participants in intensive care. Two trials included only participants with liver disease. Three trials did not recruit sufficient participants to meet their pre-calculated sample size. Overall, the quality of evidence was low to very low across different outcomes according to GRADE methodology, due to risk of bias, indirectness, and imprecision. One trial was stopped after recruiting two participants, therefore this review's findings are based on the remaining four trials (234 participants). When Plasma Transfusion was compared with no Transfusion given, we are very uncertain whether there was a difference in 30-day mortality (1 trial comparing FFP or platelet Transfusion or both with neither FFP nor platelet Transfusion, 72 participants; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.13 to 1.10; very low-quality evidence). We are very uncertain whether there was a difference in major bleeding within 24 hours (1 trial comparing FFP Transfusion vs no Transfusion, 76 participants; RR 0.33, 95% CI 0.01 to 7.93; very low-quality evidence; 1 trial comparing FFP or platelet Transfusion or both with neither FFP nor platelet Transfusion, 72 participants; RR 1.59, 95% CI 0.28 to 8.93; very low-quality evidence). We are very uncertain whether there was a difference in the number of blood product Transfusions per person (1 trial, 76 participants; study authors reported no difference; very low-quality evidence) or in the number of people requiring Transfusion (1 trial comparing FFP or platelet Transfusion or both with neither FFP nor platelet Transfusion, 72 participants; study authors reported no blood Transfusion given; very low-quality evidence) or in the risk of Transfusion-related adverse events (acute lung injury) (1 trial, 76 participants; study authors reported no difference; very low-quality evidence). When Plasma Transfusion was compared with other pro-haemostatic agents, we are very uncertain whether there was a difference in major bleeding (1 trial; 21 participants; no events; very low-quality evidence) or in Transfusion-related adverse events (febrile or allergic reactions) (1 trial, 21 participants; RR 9.82, 95% CI 0.59 to 162.24; very low-quality evidence). When different triggers for FFP Transfusion were compared, the number of people requiring Transfusion may have been reduced (for overall blood products) when a thromboelastographic-guided Transfusion trigger was compared with standard laboratory tests (1 trial, 60 participants; RR 0.18, 95% CI 0.08 to 0.39; low-quality evidence). We are very uncertain whether there was a difference in major bleeding (1 trial, 60 participants; RR 0.33, 95% CI 0.01 to 7.87; very low-quality evidence) or in Transfusion-related adverse events (allergic reactions) (1 trial; 60 participants; RR 0.33, 95% CI 0.01 to 7.87; very low-quality evidence). Only one trial reported 30-day mortality. No trials reported procedure-related harmful events (excluding bleeding) or quality of life. Authors' conclusions Review findings show uncertainty for the utility and safety of prophylactic FFP use. This is due to predominantly very low-quality evidence that is available for its use over a range of clinically important outcomes, together with lack of confidence in the wider applicability of study findings, given the paucity or absence of study data in settings such as major body cavity surgery, extensive soft tissue surgery, orthopaedic surgery, or neurosurgery. Therefore, from the limited RCT evidence, we can neither support nor oppose the use of prophylactic FFP in clinical practice.
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prophylactic Plasma Transfusion for patients without inherited bleeding disorders or anticoagulant use undergoing non cardiac surgery or invasive procedures
Cochrane Database of Systematic Reviews, 2019Co-Authors: Jonathan Huber, Simon J. Stanworth, Carolyn Doree, Marialena Trivella, Susan J Brunskill, Sally Hopewell, Kirstin L Wilkinson, Patricia M Fortin, Lise J EstcourtAbstract:Background In the absence of bleeding, Plasma is commonly transfused to people prophylactically to prevent bleeding. In this context, it is transfused before operative or invasive procedures (such as liver biopsy or chest drainage tube insertion) in those considered at increased risk of bleeding, typically defined by abnormalities of laboratory tests of coagulation. As Plasma contains procoagulant factors, Plasma Transfusion may reduce perioperative bleeding risk. This outcome has clinical importance given that perioperative bleeding and blood Transfusion have been associated with increased morbidity and mortality. Plasma is expensive, and some countries have experienced issues with blood product shortages, donor pool reliability, and incomplete screening for transmissible infections. Thus, although the benefit of prophylactic Plasma Transfusion has not been well established, Plasma Transfusion does carry potentially life-threatening risks. Objectives To determine the clinical effectiveness and safety of prophylactic Plasma Transfusion for people with coagulation test abnormalities (in the absence of inherited bleeding disorders or use of anticoagulant medication) requiring non-cardiac surgery or invasive procedures. Search methods We searched for randomised controlled trials (RCTs), without language or publication status restrictions in: Cochrane Central Register of Controlled Trials (CENTRAL; 2017 Issue 7); Ovid MEDLINE (from 1946); Ovid Embase (from 1974); Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCOHost) (from 1937); PubMed (e-publications and in-process citations ahead of print only); Transfusion Evidence Library (from 1950); Latin American Caribbean Health Sciences Literature (LILACS) (from 1982); Web of Science: Conference Proceedings Citation Index-Science (CPCI-S) (Thomson Reuters, from 1990); ClinicalTrials.gov; and World Health Organization (WHO) International Clinical Trials Registry Search Platform (ICTRP) to 28 January 2019. Selection criteria We included RCTs comparing: prophylactic Plasma Transfusion to placebo, intravenous fluid, or no intervention; prophylactic Plasma Transfusion to alternative pro-haemostatic agents; or different haemostatic thresholds for prophylactic Plasma Transfusion. We included participants of any age, and we excluded trials incorporating individuals with previous active bleeding, with inherited bleeding disorders, or taking anticoagulant medication before enrolment. Data collection and analysis We used standard methodological procedures expected by Cochrane. Main results We included five trials in this review, all were conducted in high-income countries. Three additional trials are ongoing. One trial compared fresh frozen Plasma (FFP) Transfusion with no Transfusion given. One trial compared FFP or platelet Transfusion or both with neither FFP nor platelet Transfusion given. One trial compared FFP Transfusion with administration of alternative pro-haemostatic agents (factors II, IX, and X followed by VII). One trial compared the use of different Transfusion triggers using the international normalised ratio measurement. One trial compared the use of a thromboelastographic-guided Transfusion trigger using standard laboratory measurements of coagulation. Four trials enrolled only adults, whereas the fifth trial did not specify participant age. Four trials included only minor procedures that could be performed by the bedside. Only one trial included some participants undergoing major surgical operations. Two trials included only participants in intensive care. Two trials included only participants with liver disease. Three trials did not recruit sufficient participants to meet their pre-calculated sample size. Overall, the quality of evidence was low to very low across different outcomes according to GRADE methodology, due to risk of bias, indirectness, and imprecision. One trial was stopped after recruiting two participants, therefore this review's findings are based on the remaining four trials (234 participants). When Plasma Transfusion was compared with no Transfusion given, we are very uncertain whether there was a difference in 30-day mortality (1 trial comparing FFP or platelet Transfusion or both with neither FFP nor platelet Transfusion, 72 participants; risk ratio (RR) 0.38, 95% confidence interval (CI) 0.13 to 1.10; very low-quality evidence). We are very uncertain whether there was a difference in major bleeding within 24 hours (1 trial comparing FFP Transfusion vs no Transfusion, 76 participants; RR 0.33, 95% CI 0.01 to 7.93; very low-quality evidence; 1 trial comparing FFP or platelet Transfusion or both with neither FFP nor platelet Transfusion, 72 participants; RR 1.59, 95% CI 0.28 to 8.93; very low-quality evidence). We are very uncertain whether there was a difference in the number of blood product Transfusions per person (1 trial, 76 participants; study authors reported no difference; very low-quality evidence) or in the number of people requiring Transfusion (1 trial comparing FFP or platelet Transfusion or both with neither FFP nor platelet Transfusion, 72 participants; study authors reported no blood Transfusion given; very low-quality evidence) or in the risk of Transfusion-related adverse events (acute lung injury) (1 trial, 76 participants; study authors reported no difference; very low-quality evidence). When Plasma Transfusion was compared with other pro-haemostatic agents, we are very uncertain whether there was a difference in major bleeding (1 trial; 21 participants; no events; very low-quality evidence) or in Transfusion-related adverse events (febrile or allergic reactions) (1 trial, 21 participants; RR 9.82, 95% CI 0.59 to 162.24; very low-quality evidence). When different triggers for FFP Transfusion were compared, the number of people requiring Transfusion may have been reduced (for overall blood products) when a thromboelastographic-guided Transfusion trigger was compared with standard laboratory tests (1 trial, 60 participants; RR 0.18, 95% CI 0.08 to 0.39; low-quality evidence). We are very uncertain whether there was a difference in major bleeding (1 trial, 60 participants; RR 0.33, 95% CI 0.01 to 7.87; very low-quality evidence) or in Transfusion-related adverse events (allergic reactions) (1 trial; 60 participants; RR 0.33, 95% CI 0.01 to 7.87; very low-quality evidence). Only one trial reported 30-day mortality. No trials reported procedure-related harmful events (excluding bleeding) or quality of life. Authors' conclusions Review findings show uncertainty for the utility and safety of prophylactic FFP use. This is due to predominantly very low-quality evidence that is available for its use over a range of clinically important outcomes, together with lack of confidence in the wider applicability of study findings, given the paucity or absence of study data in settings such as major body cavity surgery, extensive soft tissue surgery, orthopaedic surgery, or neurosurgery. Therefore, from the limited RCT evidence, we can neither support nor oppose the use of prophylactic FFP in clinical practice.
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The Cochrane Library - Prophylactic Plasma Transfusion for patients undergoing non-cardiac surgery.
The Cochrane database of systematic reviews, 2017Co-Authors: Jonathan Huber, Simon J. Stanworth, Carolyn Doree, Marialena Trivella, Susan J Brunskill, Sally Hopewell, Kirstin L Wilkinson, Lise J EstcourtAbstract:This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the clinical effectiveness and safety of prophylactic Plasma Transfusion for people with confirmed or presumed coagulopathy requiring non-cardiac surgery.
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Factors influencing Plasma Transfusion practices in paediatric intensive care units around the world
Vox sanguinis, 2017Co-Authors: Oliver Karam, Marisa Tucci, Pierre Demaret, Alain Duhamel, Alison Shefler, Philip C. Spinella, Stéphane Leteurtre, Simon J. StanworthAbstract:Plasma Transfusions are a frequent treatment worldwide, but many studies have reported a wide variation in the indications to transfuse. Recently, an international paediatric study also showed wide variation in frequency in the use of Plasma Transfusions: 25% of the centres transfused Plasma to >5% of their patients, whereas another 25% transfused Plasma to <1% of their patients. The objective of this study was to explore the factors associated with different Plasma Transfusion practices in these centres. Online survey sent to the local investigators of the 101 participating centres, in February 2016. Four areas were explored: beliefs regarding Plasma Transfusion, patients' case-mix in each unit, unit's characteristics, and local blood product Transfusion policies and processes. The response rate was 82% (83/101). 43% of the respondents believed that Plasma Transfusions can arrest bleeding, whereas 27% believe that Plasma Transfusion can prevent bleeding. Centres with the highest Plasma Transfusion rate were more likely to think that hypovolaemia and mildly abnormal coagulation tests are appropriate indications for Plasma Transfusions (P = 0·02 and P = 0·04, respectively). Case-mix, centre characteristics or local Transfusion services were not identified as significant relevant factors. Factors influencing Plasma Transfusion practices reflect beliefs about indications and the efficacy of Transfusion in the prevention and management of bleeding as well as effects on coagulation tests. Educational and other initiatives to target these beliefs should be the focus of research. © 2017 International Society of Blood Transfusion.
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Plasma Transfusions prior to lumbar punctures and epidural catheters for people with abnormal coagulation
Cochrane Database of Systematic Reviews, 2017Co-Authors: Lise J Estcourt, Carolyn Doree, Marialena Trivella, Sally Hopewell, Michael Desborough, Simon J. StanworthAbstract:This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effect of different prophylactic Plasma Transfusion regimens prior to insertion of a lumbar puncture needle or epidural catheter in people with abnormal coagulation
John B Holcomb - One of the best experts on this subject based on the ideXlab platform.
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early Plasma Transfusion is associated with improved survival after isolated traumatic brain injury in patients with multifocal intracranial hemorrhage
Surgery, 2017Co-Authors: Ronald Chang, Lindley E. Folkerson, Duncan Sloan, Jeffrey S. Tomasek, Ryan S. Kitagawa, Charles E. Wade, Alex H Choi, John B HolcombAbstract:Background Plasma-based resuscitation improves outcomes in trauma patients with hemorrhagic shock, while large-animal and limited clinical data suggest that it also improves outcomes and is neuroprotective in the setting of combined hemorrhage and traumatic brain injury. However, the choice of initial resuscitation fluid, including the role of Plasma, is unclear for patients after isolated traumatic brain injury. Methods We reviewed adult trauma patients admitted from January 2011 to July 2015 with isolated traumatic brain injury. “Early Plasma” was defined as Transfusion of Plasma within 4 hours. Purposeful multiple logistic regression modeling was performed to analyze the relationship of early Plasma and inhospital survival. After testing for interaction, subgroup analysis was performed based on the pattern of brain injury on initial head computed tomography: epidural hematoma, intraparenchymal contusion, subarachnoid hemorrhage, subdural hematoma, or multifocal intracranial hemorrhage. Results Of the 633 isolated traumatic brain injury patients included, 178 (28%) who received early Plasma were injured more severely coagulopathic, hypoperfused, and hypotensive on admission. Survival was similar in the early Plasma versus no early Plasma groups (78% vs 84%, P = .08). After adjustment for covariates, early Plasma was not associated with improved survival (odds ratio 1.18, 95% confidence interval 0.71–1.96). On subgroup analysis, multifocal intracranial hemorrhage was the largest subgroup with 242 patients. Of these, 61 (25%) received Plasma within 4 hours. Within-group logistic regression analysis with adjustment for covariates found that early Plasma was associated with improved survival (odds ratio 3.34, 95% confidence interval 1.20–9.35). Conclusion Although early Plasma Transfusion was not associated with improved in-hospital survival for all isolated traumatic brain injury patients, early Plasma was associated with increased in-hospital survival in those with multifocal intracranial hemorrhage.
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Early Plasma Transfusion is associated with improved survival after isolated traumatic brain injury in patients with multifocal intracranial hemorrhage
Surgery, 2016Co-Authors: Ronald Chang, Lindley E. Folkerson, Duncan Sloan, Jeffrey S. Tomasek, Ryan S. Kitagawa, H. Alex Choi, Charles E. Wade, John B HolcombAbstract:Plasma-based resuscitation improves outcomes in trauma patients with hemorrhagic shock, while large-animal and limited clinical data suggest that it also improves outcomes and is neuroprotective in the setting of combined hemorrhage and traumatic brain injury. However, the choice of initial resuscitation fluid, including the role of Plasma, is unclear for patients after isolated traumatic brain injury. We reviewed adult trauma patients admitted from January 2011 to July 2015 with isolated traumatic brain injury. "Early Plasma" was defined as Transfusion of Plasma within 4 hours. Purposeful multiple logistic regression modeling was performed to analyze the relationship of early Plasma and inhospital survival. After testing for interaction, subgroup analysis was performed based on the pattern of brain injury on initial head computed tomography: epidural hematoma, intraparenchymal contusion, subarachnoid hemorrhage, subdural hematoma, or multifocal intracranial hemorrhage. Of the 633 isolated traumatic brain injury patients included, 178 (28%) who received early Plasma were injured more severely coagulopathic, hypoperfused, and hypotensive on admission. Survival was similar in the early Plasma versus no early Plasma groups (78% vs 84%, P = .08). After adjustment for covariates, early Plasma was not associated with improved survival (odds ratio 1.18, 95% confidence interval 0.71-1.96). On subgroup analysis, multifocal intracranial hemorrhage was the largest subgroup with 242 patients. Of these, 61 (25%) received Plasma within 4 hours. Within-group logistic regression analysis with adjustment for covariates found that early Plasma was associated with improved survival (odds ratio 3.34, 95% confidence interval 1.20-9.35). Although early Plasma Transfusion was not associated with improved in-hospital survival for all isolated traumatic brain injury patients, early Plasma was associated with increased in-hospital survival in those with multifocal intracranial hemorrhage. Copyright © 2016 Elsevier Inc. All rights reserved.
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impact of Plasma Transfusion in trauma patients who do not require massive Transfusion
Journal of The American College of Surgeons, 2010Co-Authors: Kenji Inaba, Bernardino C Branco, Peter Rhee, Lorne H Blackbourne, John B Holcomb, Pedro G R Teixeira, Ira A Shulman, Janice M Nelson, Demetrios DemetriadesAbstract:Background For trauma patients requiring massive blood Transfusion, aggressive Plasma usage has been demonstrated to confer a survival advantage. The aim of this study was to evaluate the impact of Plasma administration in nonmassively transfused patients. Study Design Trauma patients admitted to a Level I trauma center (2000–2005) requiring a nonmassive Transfusion ( Results The 1,716 patients (86.1% of 1,933 who received PRBC Transfusion) received a nonmassive Transfusion. After exclusion of 31 (1.8%) early deaths, 284 patients receiving Plasma were matched to patients who did not. There was no improvement in survival with Plasma Transfusion (17.3% versus 14.1%; p=0.30) irrespective of the Plasma-to-PRBC ratio achieved. However, the overall complication rate was significantly higher for patients receiving Plasma (26.8% versus 18.3%, odds ratio [OR] = 1.7; 95% CI, 1.1–2.4; p=0.016). As the volume of Plasma increased, an increase in complications was seen, reaching 37.5% for patients receiving >6 U. The ARDS rate specifically was also significantly higher in patients receiving Plasma (9.9% versus 3.5%, OR=3.0; 95% CI, 1.4–6.2; p=0.004]. Patients receiving >6 U Plasma had a 12-fold increase in ARDS, a 6-fold increase in multiple organ dysfunction syndrome, and a 4-fold increase in pneumonia and sepsis. Conclusions For nonmassively transfused trauma patients, Plasma administration was associated with a substantial increase in complications, in particular ARDS, with no improvement in survival. An increase in multiple organ dysfunction, pneumonia, and sepsis was likewise seen as increasing volumes of Plasma were transfused. The optimal trigger for initiation of a protocol for aggressive Plasma infusion warrants prospective evaluation.
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Impact of Plasma Transfusion in Trauma Patients Who Do Not Require Massive Transfusion
Journal of the American College of Surgeons, 2010Co-Authors: Kenji Inaba, Bernardino C Branco, Peter Rhee, Lorne H Blackbourne, John B Holcomb, Pedro G R Teixeira, Ira A Shulman, Janice M Nelson, Demetrios DemetriadesAbstract:For trauma patients requiring massive blood Transfusion, aggressive Plasma usage has been demonstrated to confer a survival advantage. The aim of this study was to evaluate the impact of Plasma administration in nonmassively transfused patients. Trauma patients admitted to a Level I trauma center (2000-2005) requiring a nonmassive Transfusion (<10 U packed RBC [PRBC] within 12 hours of admission) were identified retrospectively. Propensity scores were calculated to match and compare patients receiving Plasma in the first 12 hours with those who did not. The 1,716 patients (86.1% of 1,933 who received PRBC Transfusion) received a nonmassive Transfusion. After exclusion of 31 (1.8%) early deaths, 284 patients receiving Plasma were matched to patients who did not. There was no improvement in survival with Plasma Transfusion (17.3% versus 14.1%; p = 0.30) irrespective of the Plasma-to-PRBC ratio achieved. However, the overall complication rate was significantly higher for patients receiving Plasma (26.8% versus 18.3%, odds ratio [OR] = 1.7; 95% CI, 1.1-2.4; p = 0.016). As the volume of Plasma increased, an increase in complications was seen, reaching 37.5% for patients receiving >6 U. The ARDS rate specifically was also significantly higher in patients receiving Plasma (9.9% versus 3.5%, OR = 3.0; 95% CI, 1.4-6.2; p = 0.004]. Patients receiving >6 U Plasma had a 12-fold increase in ARDS, a 6-fold increase in multiple organ dysfunction syndrome, and a 4-fold increase in pneumonia and sepsis. For nonmassively transfused trauma patients, Plasma administration was associated with a substantial increase in complications, in particular ARDS, with no improvement in survival. An increase in multiple organ dysfunction, pneumonia, and sepsis was likewise seen as increasing volumes of Plasma were transfused. The optimal trigger for initiation of a protocol for aggressive Plasma infusion warrants prospective evaluation. Copyright (c) 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Oliver Karam - One of the best experts on this subject based on the ideXlab platform.
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Effects of Plasma Transfusions on antithrombin levels after paediatric liver transplantation
Vox sanguinis, 2018Co-Authors: Delphine Arni, Peter C. Rimensberger, Barbara E. Wildhaber, Valérie A. Mclin, Marc Ansari, Pierre Fontana, Oliver KaramAbstract:BACKGROUND AND OBJECTIVES Thrombotic complications affect 3-10% of patients after liver transplantation (LT), leading to potentially life-threatening complications. In the days following LT, antithrombin (AT) is decreased longer than pro-coagulant factors, thus favouring a pro-thrombotic profile. Plasma Transfusions are given empirically in some centres to correct AT levels following LT. We assessed the effect of Plasma Transfusion on AT levels after paediatric LT. MATERIALS AND METHODS Prospective single-centre observational study in 20 consecutive paediatric LT recipients over a 24-month period. Plasma was administered twice daily (10 ml/kg/dose) according to an existing protocol. AT levels were measured once daily, immediately prior to and one hour after the morning Plasma Transfusion. Sample size was calculated based on a non-inferiority hypothesis. RESULTS The median age and weight were 11.6 years (IQR 2.8; 14.7) and 40 kg (IQR 12.75; 44.8), respectively. We collected 85-paired blood samples. The median AT level prior to Plasma Transfusion was 58%. The median difference in AT levels before and after Plasma Transfusion was 4.2% (P = 0.001). Changes in AT levels after Plasma Transfusion were not correlated with baseline AT levels (R = 0.19) or patient weight (R = 0.18). CONCLUSION Plasma Transfusions only marginally increase AT levels in children after LT. Therefore, prophylactic Plasma Transfusions probably do not seem to confer an advantage in the routine management of paediatric LT patients. Randomized controlled trials are needed to identify the optimal anticoagulation strategy in this specific population.
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Factors influencing Plasma Transfusion practices in paediatric intensive care units around the world
Vox sanguinis, 2017Co-Authors: Oliver Karam, Marisa Tucci, Pierre Demaret, Alain Duhamel, Alison Shefler, Philip C. Spinella, Stéphane Leteurtre, Simon J. StanworthAbstract:Plasma Transfusions are a frequent treatment worldwide, but many studies have reported a wide variation in the indications to transfuse. Recently, an international paediatric study also showed wide variation in frequency in the use of Plasma Transfusions: 25% of the centres transfused Plasma to >5% of their patients, whereas another 25% transfused Plasma to <1% of their patients. The objective of this study was to explore the factors associated with different Plasma Transfusion practices in these centres. Online survey sent to the local investigators of the 101 participating centres, in February 2016. Four areas were explored: beliefs regarding Plasma Transfusion, patients' case-mix in each unit, unit's characteristics, and local blood product Transfusion policies and processes. The response rate was 82% (83/101). 43% of the respondents believed that Plasma Transfusions can arrest bleeding, whereas 27% believe that Plasma Transfusion can prevent bleeding. Centres with the highest Plasma Transfusion rate were more likely to think that hypovolaemia and mildly abnormal coagulation tests are appropriate indications for Plasma Transfusions (P = 0·02 and P = 0·04, respectively). Case-mix, centre characteristics or local Transfusion services were not identified as significant relevant factors. Factors influencing Plasma Transfusion practices reflect beliefs about indications and the efficacy of Transfusion in the prevention and management of bleeding as well as effects on coagulation tests. Educational and other initiatives to target these beliefs should be the focus of research. © 2017 International Society of Blood Transfusion.
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Performance of the PEdiatric Logistic Organ Dysfunction-2 score in critically ill children requiring Plasma Transfusions
Annals of intensive care, 2016Co-Authors: Oliver Karam, Marisa Tucci, Pierre Demaret, Alain Duhamel, Alison Shefler, Philip C. Spinella, Stéphane Leteurtre, Simon J. Stanworth, Warwick Butt, Carmel DelzoppoAbstract:Organ dysfunction scores, based on physiological parameters, have been created to describe organ failure. In a general pediatric intensive care unit (PICU) population, the PEdiatric Logistic Organ Dysfunction-2 score (PELOD-2) score had both a good discrimination and calibration, allowing to describe the clinical outcome of critically ill children throughout their stay. This score is increasingly used in clinical trials in specific subpopulation. Our objective was to assess the performance of the PELOD-2 score in a subpopulation of critically ill children requiring Plasma Transfusions. This was an ancillary study of a prospective observational study on Plasma Transfusions over a 6-week period, in 101 PICUs in 21 countries. All critically ill children who received at least one Plasma Transfusion during the observation period were included. PELOD-2 scores were measured on days 1, 2, 5, 8, and 12 after Plasma Transfusion. Performance of the score was assessed by the determination of the discrimination (area under the ROC curve: AUC) and the calibration (Hosmer–Lemeshow test). Four hundred and forty-three patients were enrolled in the study (median age and weight: 1 year and 9.1 kg, respectively). Observed mortality rate was 26.9 % (119/443). For PELOD-2 on day 1, the AUC was 0.76 (95 % CI 0.71–0.81) and the Hosmer–Lemeshow test was p = 0.76. The serial evaluation of the changes in the daily PELOD-2 scores from day 1 demonstrated a significant association with death, adjusted for the PELOD-2 score on day 1. In a subpopulation of critically ill children requiring Plasma Transfusion, the PELOD-2 score has a lower but acceptable discrimination than in an entire population. This score should therefore be used cautiously in this specific subpopulation.
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Performance of the pediatric logistic organ dysfunction-2 score in critically ill children requiring Plasma Transfusions
Annals of Intensive Care, 2016Co-Authors: Oliver Karam, Marisa Tucci, Pierre Demaret, Alain Duhamel, Alison Shefler, Philip C. Spinella, Simon J. Stanworth, Stéphane LeteurtreAbstract:BACKGROUND: Organ dysfunction scores, based on physiological parameters, have been created to describe organ failure. In a general pediatric intensive care unit (PICU) population, the PEdiatric Logistic Organ Dysfunction-2 score (PELOD-2) score had both a good discrimination and calibration, allowing to describe the clinical outcome of critically ill children throughout their stay. This score is increasingly used in clinical trials in specific subpopulation. Our objective was to assess the performance of the PELOD-2 score in a subpopulation of critically ill children requiring Plasma Transfusions. METHODS: This was an ancillary study of a prospective observational study on Plasma Transfusions over a 6-week period, in 101 PICUs in 21 countries. All critically ill children who received at least one Plasma Transfusion during the observation period were included. PELOD-2 scores were measured on days 1, 2, 5, 8, and 12 after Plasma Transfusion. Performance of the score was assessed by the determination of the discrimination (area under the ROC curve: AUC) and the calibration (Hosmer-Lemeshow test). RESULTS: Four hundred and forty-three patients were enrolled in the study (median age and weight: 1 year and 9.1 kg, respectively). Observed mortality rate was 26.9 % (119/443). For PELOD-2 on day 1, the AUC was 0.76 (95 % CI 0.71-0.81) and the Hosmer-Lemeshow test was p = 0.76. The serial evaluation of the changes in the daily PELOD-2 scores from day 1 demonstrated a significant association with death, adjusted for the PELOD-2 score on day 1. CONCLUSIONS: In a subpopulation of critically ill children requiring Plasma Transfusion, the PELOD-2 score has a lower but acceptable discrimination than in an entire population. This score should therefore be used cautiously in this specific subpopulation.
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Indications and Effects of Plasma Transfusions in Critically Ill Children
American journal of respiratory and critical care medicine, 2015Co-Authors: Oliver Karam, Pierre Demaret, Alison Shefler, Philip C. Spinella, Stéphane Leteurtre, Simon J. Stanworth, Marisa TucciAbstract:Plasma Transfusions are frequently prescribed for critically ill children, although their indications lack a strong evidence base. Plasma Transfusions are largely driven by physician conceptions of need, and these are poorly documented in pediatric intensive care patients. To identify patient characteristics and to characterize indications leading to Plasma Transfusions in critically ill children, and to assess the effect of Plasma Transfusions on coagulation tests. Point-prevalence study in 101 pediatric intensive care units in 21 countries, on 6 predefined weeks. All critically ill children admitted to a participating unit were included if they received at least one Plasma Transfusion. During the 6 study weeks, 13,192 children were eligible. Among these, 443 (3.4%) received at least one Plasma Transfusion and were included. The primary indications for Plasma Transfusion were critical bleeding in 22.3%, minor bleeding in 21.2%, planned surgery or procedure in 11.7%, and high risk of postoperative bleeding in 10.6%. No bleeding or planned procedures were reported in 34.1%. Before Plasma Transfusion, the median international normalized ratio (INR) and activated partial thromboplastin time (aPTT) values were 1.5 and 48, respectively. After Plasma Transfusion, the median INR and aPTT changes were -0.2 and -5, respectively. Plasma Transfusion significantly improved INR only in patients with a baseline INR greater than 2.5. One-third of transfused patients were not bleeding and had no planned procedure. In addition, in most patients, coagulation tests are not sensitive to increases in coagulation factors resulting from Plasma Transfusion. Studies assessing appropriate Plasma Transfusion strategies are urgently needed.