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Magic in a bottle? A Focused review of factor concentrates for the intraoperative treatment of acquired coagulopathy - Fibrinogen concentrate, prothrombin complex concentrate, and recombinant activated factor VII.
Best Pract Res Clin Anaesthesiol
December 2023
Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Goal-directed administration of blood components including red cells, platelets, plasma, and factor concentrates plays a critical role in the management of intraoperative coagulopathy. Increasingly commonly used, purified and recombinant factor concentrates are being recognized for their logistical advantages and potentially superior efficacy. Three- and four-factor prothrombin concentrates, fibrinogen concentrates and activated factor VII have an evolving evidence base relative to frozen plasma and cryoprecipitate.
View Article and Find Full Text PDFESAs in perioperative anemia management: Who, what, how and why?
Best Pract Res Clin Anaesthesiol
December 2023
Université d'Angers, Département Anesthésie Réanimation, CHU Angers, Angers, France; Université d'Angers, UMR CNRS 6015, Inserm U1083, Unité MitoVasc, Team Carme, Angers, France.
Preoperative anemia is frequent and is associated with poor patient outcomes and higher transfusion rates. Perioperative blood transfusion is also associated with poor outcomes. These observations justify efforts to increase hemoglobin levels in anemic patients before surgeries with a moderate to high bleeding risk.
View Article and Find Full Text PDFDoes patient blood management represent good value for money?
Best Pract Res Clin Anaesthesiol
December 2023
Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Australia; Department of Clinical Haematology, Monash Health, Melbourne, Australia. Electronic address:
Patient blood management is the umbrella term for a suite of initiatives designed to optimise blood product usage, minimise transfusion needs, and ensure appropriate and evidence-based transfusion practices. In this review we summarise published economic evaluations of patient blood management to determine whether they represent good value for money. We identified 54 economic evaluations of patient blood management, the majority of which had positive cost-effectiveness conclusions.
View Article and Find Full Text PDFPreoperative iron therapy: Where are we?
Best Pract Res Clin Anaesthesiol
December 2023
School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
Preoperative anemia affects one-third of patients undergoing major surgery and is associated with worse perioperative and postoperative outcomes; including length of hospital stay, allogeneic blood transfusion, morbidity, and mortality. Iron deficiency is the most common cause of anemia, and associative data suggests that preoperative correction of iron deficiency anemia could improve postoperative patient outcomes. However, data from randomized controlled trials (RCTs) do not appear to support the routine use of iron therapy to treat preoperative anemia.
View Article and Find Full Text PDFDoes one unit really matter? Immunological effects of transfusion after universal leucodepletion.
Best Pract Res Clin Anaesthesiol
December 2023
Department of Anesthesiology and Perioperative Medicine, The University of Texas, MD Anderson Cancer Center, USA; Anesthesiology and Surgical Oncology Research Group, USA. Electronic address:
Patients with cancer who receive allogeneic red blood cell transfusions are at risk of adverse reactions of varying severity. One of these reactions is immunomodulation, also known as transfusion-related immunomodulation. With the exact mechanism of transfusion related immunomodulation being unclear, storage lesions (both the cellular and cytokine component) are considered a major contributor.
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