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Background: Recent military experience reported casualties who receive > 10 units of packed red blood cells (PRBC) in 24 hours have 20% versus 65% mortality when the fresh-frozen plasma (FFP) to PRBC ratio was 1:1 versus 1:4, respectively. We hypothesize a similar improvement in mortality in civilian trauma patients that require massive transfusion and are treated with a FFP to PRBC ratio closer to 1:1., Methods: Four-year retrospective study of all trauma patients who underwent emergency surgery in an urban Level I Trauma Center. Patients were divided into two groups; those that received < or = 10 units or > 10 units of PRBC during and after initial surgical intervention. Only patients who received transfusion of both FFP and PRBC were included in the analysis. The primary research question was the impact of initial FFP:PRBC ratio on mortality. Other variables for analysis included patient age, gender, mechanism, and Injury Severity Scale score. Both univariate and multivariate analysis were used to assess the relationship between outcome and predictors., Results: A total of 2,746 patients underwent surgical intervention of which 1,985 (72.2%) received no transfusion. Of those that received transfusion, 626 (22.8%) received < or = 10 units of PRBC and 135 (4.9%) > 10 units of PRBC. Out of the 626 patients that received < or = 10 units of PRBC, 250 (39.9%) received FFP and 376 (60.1%) received no FFP. All the patients that received > 10 units PRBC received FFP. In univariate analysis, a significant difference in mortality was found in patients who received > 10 units of PRBC (26% vs. 87.5%) when FFP:PRBC ratio was 1:1 versus 1:4 (p = 0.0001). Multivariate analysis in the group of patients that received > 10 units of PRBC showed a FFP:PRBC ratio of 1:4 was consistent with increased risk of mortality (relative risk, 18.88; 95% CI, 6.32-56.36; p = 0.001), when compared with a ratio of 1:1. Patients who received < or = 10 units of PRBC had a trend toward increased mortality (21.2% vs.11.8%) when the FFP:PRBC ratio was 1:4 versus 1:1 (p: 0.06)., Conclusion: An FFP to PRBC ratio close to 1:1 confers a survival advantage in patients requiring massive transfusion.

Febrile nonhemolytic and allergic reactions are the most common transfusion reactions, but usually do not cause significant morbidity. In an attempt to prevent these reactions, US physicians prescribe acetaminophen or diphenhydramine premedication before more than 50% of blood component transfusions. Acetaminophen and diphenhydramine are effective therapies for fever and allergy, respectively, so their use in transfusion has some biologic rationale. However, these medications also have potential toxicity, particularly in ill patients, and in the studies performed to date, they have failed to prevent transfusion reactions. Whether the benefits of routine prophylaxis with acetaminophen and diphenhydramine outweigh their risks and cost requires reexamination, particularly in light of the low reaction rates reported at many institutions even when premedication is not prescribed.

Objective: Our objective was to quantify incremental risk associated with transfusion of packed red blood cells and other blood components on morbidity after coronary artery bypass grafting., Design: The study design was an observational cohort study., Setting: This investigation took place at a large tertiary care referral center., Patients: A total of 11,963 patients who underwent isolated coronary artery bypass from January 1, 1995, through July 1, 2002., Interventions: None., Measurements and Main Results: Among the 11,963 patients who underwent isolated coronary artery bypass grafting, 5,814 (48.6%) were transfused. Risk-adjusted probability of developing in-hospital mortality and morbidity as a function of red blood cell and blood-component transfusion was modeled using logistic regression. Transfusion of red blood cells was associated with a risk-adjusted increased risk for every postoperative morbid event: mortality (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.67-1.87; p<.0001), renal failure (OR, 2.06; 95% CI, 1.87-2.27; p<.0001), prolonged ventilatory support (OR, 1.79; 95% CI, 1.72-1.86; p<.0001), serious infection (OR, 1.76; 95% CI, 1.68-1.84; p<.0001), cardiac complications (OR, 1.55; 95% CI, 1.47-1.63; p<.0001), and neurologic events (OR, 1.37; 95% CI, 1.30-1.44; p<.0001)., Conclusions: Perioperative red blood cell transfusion is the single factor most reliably associated with increased risk of postoperative morbid events after isolated coronary artery bypass grafting. Each unit of red cells transfused is associated with incrementally increased risk for adverse outcome.

The study was conducted to assess the efficacy and tolerance of solvent-detergent (SD) plasma in neonates, in obstetric and gynaecological patients and in patients with liver disease in three large hospitals in Dublin during the period 1 April 2002 (when SD plasma was introduced) through 31 October 2003. Forty-one neonates received 67 transfusions of SD plasma at a mean dose +/- standard deviation of 18.4 +/- 13.2 mL kg(-1). Thirty-one (75.6%) patients had coagulopathy without haemorrhage (either disseminated intravascular coagulopathy or other coagulopathy); a further eight (19.5%) had clinical haemorrhage (excluding intraventricular haemorrhage), which complicated a coagulopathy. Thirty-eight obstetric and gynaecological patients received 57 SD plasma transfusions at a mean dose of 15.3 +/- 7.7 mL kg(-1). Thirty-six women (94.7%) had haemorrhage with mean blood loss per patient of 3345.8 +/- 2738.1 mL. Fifteen children with liver disease received 33 SD plasma transfusions at a mean volume of 38.0 +/- 41.5 mL kg(-1) body weight. Seventeen adult patients with severe end-stage liver disease were transfused with SD plasma either following liver transplantation or prior to other invasive procedures, at a mean dose of 10.2 +/- 3.4 mL kg(-1). There were statistically significant decreases in mean activated partial thromboplastin time and prothrombin time in neonates, in obstetric and gynaecological patients and in patients with liver disease. Complete correction of coagulation parameters was not achieved in any case in the liver transplant group. No adverse reactions were observed for SD plasma infusion. Use of SD plasma in critically ill neonates, in women with obstetric and gynaecological emergencies and in patients with liver disease appears safe, and improves laboratory indices of coagulopathy.

We present the results of the Joint Task Force on Rational Management of Life Threatening Haemorrhage (LTH) at Rigshospitalet, Copenhagen University Hospital. A standardised treatment algorithm for LTH due to trauma, surgery, or birth is presented. The key feature is balanced transfusion therapy with an "emergency transfusion package" (5 units of red blood cells plus 5 units of fresh-frozen plasma plus 2 units of platelets). The Blood Bank services, guides, monitors and delivers the emergency transfusion packages in accordance with the algorithm.

Bacterial contamination of blood components remains the highest infectious risk in blood transfusion, the risk is particularly high when it affects platelet concentrates (PC). In France, the residual risk of transfusion reaction due to bacterial contamination of PC has been decreasing slowly since 1994 but for all severity 1 case occurs with about 25,000 distributed PC and one death occurs with 200,000 distributed units. This reduction of the risk may be due to the measures which were implemented during the last 10 years in order to prevent contamination during donation. Improving strategies for reducing the risks of bacterial contamination is one of the priorities of the French National Blood Transfusion Service (l'Etablissement Français du sang - EFS). The main target remains PC. Bacterial detection or pathogens inactivation are now available and are able to reduce (for detection) or prevent (for inactivation) the occurrence of reaction due to bacterial contamination of PC. Up to now, the choice is in favour of bacterial detection. A national study was carried out in seven regional EFS at the end of 2004. It aims at confirming the feasibility of a systematic bacterial screening of PC before their delivery. The first conclusions show that this screening can be implemented with acceptable modifications in term of platelets availability. We can expect in a next future that new pathogens reduction technique and/or new detection systems will be available, certainly more efficient to prevent reaction due to bacterial contamination. Implementation of actual detection methods is probably a temporary solution.

Background and Objectives: Survival rates in patients transfused in 1993 and 2000 were compared in relation to diagnoses and surgical interventions., Materials and Methods: Blood centre and hospital records of all patients transfused from March to May in Orebro County in 1993 (n = 932) and 2000 (n = 990), were matched with the national register of deaths., Results: Relative risk of death within 1 year, adjusted for diagnoses, operations and other confounders in patients transfused in 2000 compared to 1993 was 0.78 (CI 0.66-0.91). Among those transfused 1993, 39% were alive after 7 years., Conclusion: The improved survival among those transfused in 2000 could not be accounted for by differences in ages or case-mix.

Transfusion of bacterially contaminated blood products remains an overlooked problem. However, the risk of receiving a bacterially contaminated unit is greater than the combined risk of HIV-1/2, HCV, HBV, and HTLV I/II [American Association of Blood Banks Bulletin, no. 294, 1996]. Topics covered in this article include: the current incidence, clinical presentation and outcome, effective methods of detection, and ways to reduce bacterial contamination of blood products. There is no one existing strategy that can completely eliminate the risk of bacterial contamination. It is inevitable that partial solutions or combinations of methods will be implemented in the near future., (Copyright 2001 Wiley-Liss, Inc.)

Objective: To receive and collate reports of death or major complications of transfusion of blood or components., Design: Haematologists were invited confidentially to report deaths and major complications after blood transfusion during October 1996 to September 1998., Setting: Hospitals in United Kingdom and Ireland., Subjects: Patients who died or experienced serious complications, as defined below, associated with transfusion of red cells, platelets, fresh frozen plasma, or cryoprecipitate., Main Outcome Measures: Death, "wrong" blood transfused to patient, acute and delayed transfusion reactions, transfusion related acute lung injury, transfusion associated graft versus host disease, post-transfusion purpura, and infection transmitted by transfusion. Circumstances relating to these cases and relative frequency of complications., Results: Over 24 months, 366 cases were reported, of which 191 (52%) were "wrong blood to patient" episodes. Analysis of these revealed multiple errors of identification, often beginning when blood was collected from the blood bank. There were 22 deaths from all causes, including three from ABO incompatibility. There were 12 infections: four bacterial (one fatal), seven viral, and one fatal case of malaria. During the second 12 months, 164/424 hospitals (39%) submitted a "nil to report" return., Conclusions: Transfusion is now extremely safe, but vigilance is needed to ensure correct identification of blood and patient. Staff education should include awareness of ABO incompatibility and bacterial contamination as causes of life threatening reactions to blood.