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Forex 1 unit prbc

Опубликовано в Forex vtb kitchen | Октябрь 2, 2012

forex 1 unit prbc

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To this end, we studied patients with a hematological malignancy in a stable clinical phase of their disease as these patients could be used as a model to study changes of plasma markers before and after blood transfusions. First, we demonstrated that prolonged storage significantly increased fHb concentrations and NO consumption within the pRBC storage medium, which was in line with previous reports [ 8 , 28 ].

Second, we were able to demonstrate for the first time that transfusion of 2 pRBC units significantly enhanced plasma fHb concentrations and NO consumption in patients. Third, the increase in post-transfusion fHb concentrations was most profound in patients with low pre-transfusion Hp levels and was absent in patients with highest Hp concentrations, irrespective of the number of transfused pRBCs, the storage duration of the transfused units, and the fHb concentrations within the storage medium.

To date, studies reporting on the postulated adverse effects of pRBC transfusion on patient outcome principally focused on the contribution of pRBC-related factors, with most attention being paid to the effect of storage duration. We could not confirm a correlation between prolonged storage and increased fHb levels or increased NO consumption in our patients.

Perhaps the uneven distribution of the storage duration of the pRBC units and the relatively small number of patients prevented us from finding such a relation. Interestingly, however, we were able to show an effect of pre-transfusion plasma Hp levels of the recipient on changes of fHb following transfusion. High plasma Hp levels prior to transfusion may improve the physiological buffer capacity of the recipient to increased plasma fHb concentrations.

One could even hypothesize that patients displaying increased Hp levels, such as patients with profound systemic inflammation [ 29 , 30 ], may be better protected against the potential adverse effects of transfused fHb. In contrast, patients undergoing complex cardiovascular surgery could be particularly sensitive to transfusion-induced, fHb-mediated NO consumption, as these patients frequently suffer Hp depletion during surgery [ 31 ].

Our data may be of significant importance for patients who require massive transfusion, such as critical care patients, trauma patients, or patients undergoing major aortic, cardiac, orthopedic, or gynecologic surgery [ 18 , 32 ]. Indeed, transfusion of pRBCs to treat anemia during cardiopulmonary bypass has been shown to be independently associated with increased urinary markers of intestinal damage, renal injury, and deterioration of kidney function compared with untreated anemic patients [ 33 , 34 ].

A similar independent association between pRBC transfusions and worse outcome was found in anemic critically ill patients [ 35 ]. Although the presented associations between the number of transfused pRBC units and increased levels of fHb and increased NO consumption do not imply causality, the results of the current study elicit an interesting dilemma regarding blood transfusions.

On the one hand, refraining from transfusing a seriously anemic patient might further impair blood oxygen-carrying capacity and tissue oxygenation, possibly causing tissue ischemia and organ failure. On the other hand, massive transfusion of pRBC units, containing high amounts of fHb, could significantly increase plasma fHb concentrations and NO consumption in the recipient.

This could hamper microcirculatory blood flow and may also ultimately lead to cellular damage and organ failure. As the beneficial effects of blood transfusions are undisputed, and safe alternatives to blood storage are still lacking, efforts should be made to minimize the unwanted effects of stored RBC transfusion.

If our results are confirmed by larger studies, the current study provides opportunities for the development of preventive or treatment strategies. Although we were able to demonstrate significant results, the relatively small patient population prevented correction for confounding variables such as disease severity. Future studies are therefore essential to provide additional insight into the causal relationships between transfusion of stored blood, increased plasma fHb concentrations and plasma NO consumption, decreased microcirculatory perfusion, and clinical outcome of the recipient.

Furthermore, we did not study the contribution of RBC microvesicles, known to be released during hemolysis and known to contain high concentrations of fHb, on post-transfusion fHb concentrations in the recipient [ 36 ]. In addition, the role of increased free nontransferrin-bound iron levels was not studied [ 37 ]. Lastly, we acknowledge the fact that we extrapolate data and results obtained in a specific patient group to other patient settings.

Notwithstanding, we consider that the results of this pilot study provide an important additional insight into the much-discussed relationship between stored blood transfusion and adverse outcome in patients, and therefore warrant additional investigation. Our data indicate that transfusion of 2 stored RBC units significantly increases plasma fHb concentrations and NO consumption in the recipient. These data are of interest in light of the ongoing debate and evaluation of the proposed negative association between pRBC transfusions and patient outcome, and may serve as a tool to improve patient morbidity and mortality after transfusion.

Transfusion of 2 pRBC units, in contrast to transfusion of 1 pRBC unit, significantly increases circulating fHb levels and plasma NO consumption in the recipient, irrespective of storage duration. High pre-transfusion plasma Hp levels may be protective as they are inversely related to post-transfusion fHb concentrations in the recipient.

Anesthesiology , Article PubMed Google Scholar. Crit Care Med , Wolfe LC: Oxidative injuries to the red cell membrane during conventional blood preservation. Semin Hematol , Crit Care Med , SS Circulation , Article Google Scholar. Zubair AC: Clinical impact of blood storage lesions. Am J Hematol , PubMed Google Scholar. Curr Opin Hematol , Transfusion , Nat Med , Adamson JW: New blood, old blood, or no blood? N Engl J Med , JAMA , Nat Med , 8: J Clin Invest , Kidney Int , Ann Intern Med , J Anal Toxicol , Am J Surg , Can J Anaesth , Arch Surg , Crit Care , R Vamvakas EC, Carven JH: Length of storage of transfused red cells and postoperative morbidity in patients undergoing coronary artery bypass graft surgery.

Blood , Oliviero S, Cortese R: The human haptoglobin gene promoter: interleukinresponsive elements interact with a DNA-binding protein induced by interleukin EMBO J , 8: Ann Surg , Anesth Analg , Download references. The authors wish to thank the nurses of the hematology and oncology ward for their excellent technical assistance in sample collection. Furthermore, the authors wish to thank the Annadal Foundation of the Maastricht University Medical Center for financially supporting this study.

Debyelaan 25, Maastricht, AZ, , , the Netherlands. Debyelaan 25, Maastricht, , the Netherlands. You can also search for this author in PubMed Google Scholar. Correspondence to Wim A Buurman. ICVW designed and performed the research, collected, analyzed, and interpreted data, and drafted and approved the manuscript.

NCJdW performed the research, interpreted data, and drafted and approved the manuscript. JTCS performed the research, analyzed and interpreted data, and drafted and approved the manuscript. EAMB interpreted data and drafted and approved the manuscript.

JET-S performed the research, analyzed and interpreted data, and drafted and approved the manuscript. MJJ drafted and approved the manuscript. WAB designed the study, interpreted data, and drafted and approved the manuscript. All authors have read and approved the manuscript for publication.

Reprints and Permissions. Vermeulen Windsant, I. Blood transfusions increase circulating plasma free hemoglobin levels and plasma nitric oxide consumption: a prospective observational pilot study. Crit Care 16, R95 Download citation. Received : 13 January Revised : 03 April Accepted : 25 May Published : 25 May Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Abstract Introduction The increasing number of reports on the relation between transfusion of stored red blood cells RBCs and adverse patient outcome has sparked an intense debate on the benefits and risks of blood transfusions. Conclusion These data suggest that RBC transfusion can significantly increase post-transfusion plasma fHb levels and plasma NO consumption in the recipient.

Introduction Transfusion of stored red blood cells RBCs is a common medical procedure, particularly in the context of critical care [ 1 ]. Materials and methods Patients Based on previous experiments, we calculated that inclusion of 22 patients would provide sufficient power 0. Blood sampling and sample processing Central venous blood was drawn from the venous line by an experienced nurse at six preset time points; pre-transfusion blood sample taken on the morning of transfusion in the context of routine patient care , 15 minutes after transfusion T15 of all pRBCs 1 or 2 units , 30 minutes after transfusion T30 , 60 minutes after transfusion T60 , minutes after transfusion T , and the morning after transfusion T Results Thirty patients were prospectively studied.

Table 1 Patient and packed red blood cell unit characteristics Full size table. Figure 1. Full size image. Figure 2. Figure 3. Discussion The relation between transfusion of stored blood and adverse outcome in patients is the subject of intense debate. Conclusion Our data indicate that transfusion of 2 stored RBC units significantly increases plasma fHb concentrations and NO consumption in the recipient. Acknowledgements The authors wish to thank the nurses of the hematology and oncology ward for their excellent technical assistance in sample collection.

View author publications. Additional information Competing interests The authors declare that they have no competing interests. Authors' contributions ICVW designed and performed the research, collected, analyzed, and interpreted data, and drafted and approved the manuscript. Rights and permissions Reprints and Permissions. About this article Cite this article Vermeulen Windsant, I. Copy to clipboard. The blood one donates, referred to as whole blood, has both the plasma and the red blood cell components.

This whole blood is not typically transfused unless the patient needs a massive amount of blood to counteract tremendous blood loss. Instead, packed red blood cells, which is whole blood minus the plasma portion, are typically given. Red blood cells are essential to good health and can be lost due to trauma gunshot wound, car accident , internal bleeding, or health problems such as significant anemia.

Red blood cells carry oxygen from the lungs to the tissues of the body. To determine if a blood transfusion should be given, a blood test called a complete blood count CBC is done. A person who needs red blood cells often feels weak and may feel out of breath with minimal activity. Prior to a needed transfusion, a patient may appear pale and feel fatigued. Whole blood is not typically transfused, instead, the component the patient needs is given.

The patient may receive plasma, or packed red blood cells, or if there is a need both may be given. After donated blood is collected, the components are separated in a centrifuge, then a small amount of an anticoagulant is added to keep the PBRCs from clotting. The blood is kept in a refrigerator and is good for approximately 42 days from the date of donation. PRBCs must be matched to the recipient , meaning that the blood type of the donor and the recipient must be compatible.

If the blood is not properly matched, the result can be a life-threatening reaction, so the match is typically double checked by lab staff and nursing staff at the minimum. Approximately 1 in 8 hospitalized patients needs a transfusion. The chances of needing a transfusion are higher when having surgery, and you may be told prior to the procedure that you will require blood.

Some patients prefer to avoid a transfusion when possible or have religious beliefs that forbid transfusions. For this reason, bloodless surgery, a group of techniques that help patients avoid or minimize the need for blood is often performed for these patients. Extensive testing is done to prevent tainted blood from reaching the blood supply. An initial screening is done to make sure the donor has no medical conditions or high-risk behaviors that make blood donation unwise.

The donor is also screened for current illnesses, such as having a cold or the flu or having an infection a risk for spreading an infection to the recipient. Once the blood has been collected, it is tested for infectious diseases, including hepatitis and HIV.

The blood supply in the United States is among the safest in the world, however, if you are in a country outside of the U. Abroad, you may have difficulty obtaining a blood transfusion limited supply , the supply may not be considered safe, or testing may not be adequate.

The number of units given in a PRBC transfusion can range anywhere from one unit for someone who is anemic, to forty or fifty for a critically ill patient who is hemorrhaging and will die without blood immediately. While it is true that donors are not compensated for donating their blood, aside from a token gift or a snack, blood is still quite costly.

These fees help pay for the staff that runs blood drives, the laboratory that processes the blood, transportation costs, blood bank technologists who match and issue the blood, and the nursing staff that gives the blood.

Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Transfusion of blood and blood products: indications and complications. Am Fam Physician.

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