A comprehensive review of massive transfusion and major hemorrhage protocols: origins, core principles and practical implementation.

Until the beginning of the century, bleeding management was similar in elective surgeries or exsanguination scenarios: clotting tests were used to guide blood product orders and, while awaiting these results, an aggressive resuscitation with crystalloids was recommended. The high mortality rate in severe hemorrhages managed with this strategy endorsed the need for a special resuscitation plan. As a result, modifications were recommended to develop a new clinical approach to these patients, called "Damage Control Resuscitation".

Successful implementation of a patient blood management programme in a lower middle-income state.

Background And Objectives: Transfusions are common, but their use is decreasing in some countries as a result of increased risk awareness and the implementation of patient blood management (PBM), an evidence-based approach to optimize patient outcomes. This study aimed to detail the implementation of PBM in a Brazilian state and its impact on transfusion rates and associated costs.

Materials And Methods: The PBM implementation involved several strategies: medical education, haematology consultation services, provision of intravenous iron and other medications, establishment of PBM and perioperative anaemia clinics, cell salvage and acute normovolaemic haemodilution, anaemia reference laboratories and rotational thromboelastometry.

Prophylactic exchange transfusion in sickle cell disease pregnancy: a TAPS2 feasibility randomized controlled trial.

Serial prophylactic exchange blood transfusion (SPEBT) is increasingly used in sickle cell disease (SCD) pregnancy, despite a lack of robust evidence. The Transfusion Antenatally in Pregnant Women with Sickle Cell Disease (TAPS2) study assessed the feasibility and acceptability of conducting a definitive randomized controlled trial of SPEBT (intervention) vs standard care (control) in this population. Women aged ≥18 years with SCD, between 6+0 and 18+6 weeks of singleton gestation, were randomized 1:1 every 6 -10 weeks throughout pregnancy in 7 hospitals in England.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Anemia tolerance.

Anemia is a pathological condition in which the hemoglobin and red blood cell mass decrease; it is mainly defined by the concentration of hemoglobin in the blood. The World Health Organization guidelines establish specific values to define anemia in different population groups. Early detection of anemia can also be a valuable indicator of underlying medical conditions.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Assessment and management of postoperative anemia.

Postoperative anemia is a complex clinical issue that requires attention due to its ramifications on the patient's recovery and prognosis. Originating from multiple determinants, such as intraoperative blood loss, hemolysis, nutritional deficiencies, systemic inflammation and impact on the bone marrow, postoperative anemia has varied and often challenging presentations. Patients undergoing major surgical procedures, in particular, are susceptible to developing anemia due to the considerable associated blood loss.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Anemia tolerance mechanisms.

Understanding the physiological concepts of oxygen delivery is essential to discern the mechanisms that influence its increase, reduction or maintenance in the body. This text explores the different mechanisms that help maintain oxygen delivery even in the face of reduced hemoglobin levels. Adequate oxygen delivery ensures tissue and metabolic balance, which is crucial to avoid harmful consequences such as metabolic acidosis and cellular dysoxia.

Novel method for determining when a field-collected donor unit is sufficiently full.

Background: Whole blood (WB) collections can occur downrange for immediate administration. An important aspect of these collections is determining when the unit is sufficiently full. This project tested a novel method for determining when a field collection is complete.

Assessment of the need for routine intraoperative cell salvage in liver transplantation.

Purpose: This study aimed to assess the necessity of routine intraoperative cell salvage in liver transplantations.

Methods: A total of 327 liver transplants performed between 2014 and 2016 was included in the analysis. Patient data, including pre-transplant examinations, intraoperative red blood cell transfusions, and procedural information, were collected.

The use of social media as a tool for patient blood management and transfusion medicine education.

Background And Objectives: Transfusion is one of the most performed medical procedures. Wrong indications are common and are probably related to the scarcity of transfusion teaching during medical education. The development of a new way to improve transfusion education is paramount.

Subjective donor deferral as a tool for increased blood transfusion safety: A cross-sectional observational study.

Objectives: This study aims at evaluating whether subjective donor deferral (SDD) has the potential for increasing blood transfusion safety.

Background: Appropriate donor selection via clinical and serologic screening is necessary to prevent transfusion-transmissible infections (TTIs). One additional strategy adopted by some Brazilian blood transfusion centers (BTCs) is the rejection of a donation by the pre-donation interviewer based on subjective factors.

Prospective evaluation of immune haemolysis in liver transplantation.

Background: Immune haemolysis in liver transplant (LT) can occur due to autoantibodies and alloantibodies. The aim of this study was to evaluate the prevalence and risk factors for immune haemolysis in LT.

Methods: A total of 175 consecutive patients were included.

A blockage monoclonal antibody protocol as an alternative strategy to avoid anti-CD38 interference in immunohematological testing.

Background: As CD38 is expressed on red blood cells (RBCs), the plasma of patients on daratumumab (DARA) reacts with the panel cells of pretransfusion tests, masking underlying alloantibodies. The treatment of RBCs with dithiothreitol (DTT) is the most disseminated method to overcome DARA effect on immunohematological tests, but it hampers the identification of potentially harmful antibodies. Our goal was to validate a new strategy, the blockage monoclonal antibody protocol (BMAP), to mitigate the DARA interference on RBCs using anti-CD38 and antihuman globulin.

Renal involvement in paroxysmal nocturnal haemoglobinuria: a brief review of the literature.

Introduction: Paroxysmal Nocturnal Haemoglobinuria (PNH) is an acquired genetic disorder characterized by complement-mediated haemolysis, thrombosis and variable cytopenias. Renal involvement may occur and causes significant morbidity to these patients.

Objective: To review the literature about pathophysiology and provide recommendations on diagnosis and management of renal involvement in PNH.

Successful hematopoietic stem cell mobilization with vinorelbine and filgrastim in germ cell tumor.

Germ cell tumor (GCT) is the most frequent cancer in young men and is highly curable. Almost 80 % of patients with the disease in an advanced stage achieve a reliable response to cisplatin combination chemotherapy. For relapsing or refractory disease, autologous hematopoietic stem cell transplantation (HSCT) is an effective therapy.

Severe Acute Anemia After Liver Transplantation in an Elderly Jehovah's Witness Treated With High-dose Erythropoietin and Ferric Carboxymaltose: A Case Report.

Background: There is no standard treatment for patients with severe anemia who refuse blood transfusion or cannot receive red blood cells.

Case Report: After an orthotopic liver transplantation, an elderly Jehovah's Witness who refused blood transfusion presented with severe acute anemia with hemorrhagic shock. The calculated red blood cell loss was near 70%.