Acute and Critical Care

Review Article

Trauma
Damage control strategy in bleeding trauma patients: Maru Kim, Hangjoo Cho; Acute Crit Care. 2020;35(4):237-241. Published online November 30, 2020; DOI: https://doi.org/10.4266/acc.2020.00941

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Hemorrhagic shock is a main cause of death in severe trauma patients. Bleeding trauma patients have coagulopathy on admission, which may even be aggravated by incorrectly directed resuscitation. The damage control strategy is a very urgent and essential aspect of management considering the acute coagulopathy of trauma and the physiological status of bleeding trauma patients. This strategy has gained popularity over the past several years. Patients in extremis cannot withstand prolonged definitive surgical repair. Therefore, an abbreviated operation, referred to as damage control surgery (DCS), is needed. In addition to DCS, the likelihood of survival should be maximized for patients in extremis by providing appropriate critical care, including permissive hypotension, hemostatic resuscitation, minimization of crystalloid use, early use of tranexamic acid, and avoidance of hypothermia and hypocalcemia. This review presents an overview of the evolving strategy of damage control in bleeding trauma patients.

Citations

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Current Approaches to the Treatment of Traumatic Shock (Review)
D. A. Ostapchenko, A. I. Gutnikov, L. A. Davydova
General Reanimatology.2021; 17(4): 65. CrossRef

Original Articles

Trauma
The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury: Young Hoon Park, Dong Hyun Ryu, Byung Kook Lee, Dong Hun Lee; Acute Crit Care. 2019;34(4):255-262. Published online November 29, 2019; DOI: https://doi.org/10.4266/acc.2019.00640

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Abstract PDF

Background
Exsanguination is a major cause of death in severe trauma patients. The purpose of this study was to analyze the prognostic impact of the initial lactate level for massive transfusion (MT) in severe trauma. We divided patients according to subgroups of traumatic brain injury (TBI) and non-TBI.
Methods
This single-institution retrospective study was conducted on patients who were admitted to hospital for severe trauma between January 2016 and December 2017. TBI was defined by a head Abbreviated Injury Scale ≥3. Receiver operating characteristic analysis was used to analyze the prognostic impact of the lactate level. Multivariate analyses were performed to evaluate the relationship between the MT and lactate level. The primary outcome was MT.
Results
Of the 553 patients, MT was performed in 62 patients (11.2%). The area under the curve (AUC) for the lactate level for predicting MT was 0.779 (95% confidence interval [CI], 0.742 to 0.813). The AUCs for lactate level in the TBI and non-TBI patients were 0.690 (95% CI, 0.627 to 0.747) and 0.842 (95% CI, 0.796 to 0.881), respectively. In multivariate analyses, the lactate level was independently associated with the MT (odds ratio [OR], 1.179; 95% CI, 1.070 to 1.299). The lactate level was independently associated with MT in non-TBI patients (OR, 1.469; 95% CI, 1.262 to 1.710), but not in TBI patients.
Conclusions
The initial lactate level may be a possible prognostic factor for MT in severe trauma. In TBI patients, however, the initial lactate level was not suitable for predicting MT.

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Association of initial lactate levels and red blood cell transfusion strategy with outcomes after severe trauma: a post hoc analysis of the RESTRIC trial
Yoshinori Kosaki, Takashi Hongo, Mineji Hayakawa, Daisuke Kudo, Shigeki Kushimoto, Takashi Tagami, Hiromichi Naito, Atsunori Nakao, Tetsuya Yumoto
World Journal of Emergency Surgery.2024;[Epub] CrossRef

Trauma
Risk factor, monitoring, and treatment for snakebite induced coagulopathy: a multicenter retrospective study: Yong Jun Jeon, Jong Wan Kim, SungGil Park, Dong Woo Shin; Acute Crit Care. 2019;34(4):269-275. Published online November 18, 2019; DOI: https://doi.org/10.4266/acc.2019.00591; Correction in: Acute Crit Care 2020;35(1):56

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Abstract PDF

Background
Snakebite can cause various complications, including coagulopathy. The clinical features of snakebite-associated coagulopathy differ from those of disseminated intravascular coagulation (DIC) caused by other diseases and its treatment is controversial.
Methods
We retrospectively reviewed the medical records of patients hospitalized for snakebite between January 2006 and September 2018.
Results
A total of 226 patients were hospitalized due to snakebite. Their median hospital stay was 4.0 days (interquartile range, 2.0 to 7.0 days). Five patients arrived at hospital with shock and one patient died. Twenty-one patients had overt DIC according to the International Society of Thrombosis and Hemostasis scoring system. Two patients developed major bleeding complications. Initial lower cholesterol level at presentation was associated with the development of overt DIC. International normalization ratio (INR) exceeding the laboratory’s measurement limit was recorded as late as 4 to 5 days after the bite. Higher antivenom doses (≥18,000 units) and transfusion of fresh frozen plasma (FFP) or cryoprecipitate did not affect prolonged INR duration or hospital stay in the overt DIC patients without bleeding.
Conclusions
Initial lower cholesterol level may be a risk factor for overt DIC following snakebite. Although patients lack apparent symptoms, the risk of coagulopathy should be assessed for at least 4 to 5 days following snakebite. Higher antivenom doses and transfusion of FFP or cryoprecipitate may be unbeneficial for coagulopathic patients without bleeding.

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A simple mortality risk prediction score for viper envenoming in India (VENOMS): A model development and validation study
Maya Gopalakrishnan, Suman Saurabh, Pramod Sagar, Chanaveerappa Bammigatti, Tarun Kumar Dutta, Nicholas R. Casewell
PLOS Neglected Tropical Diseases.2022; 16(2): e0010183. CrossRef
Attempt for a Recombinant Thrombomodulin Alpha Treatment in a Rat Disseminated Intravascular Coagulation Model Using Yamakagashi (Rhabdophis tigrinus) Venom
Akihiko Yamamoto, Takashi Ito, Toru Hifumi
Toxins.2022; 14(5): 322. CrossRef
Coagulopathy following Crotaliπae snakebites in northeast Florida
Satish Maharaj, Karan Seegobin, Simone Chang
Blood Coagulation & Fibrinolysis.2022; 33(4): 220. CrossRef
Unmasking the ties of snake bite poisoning and COVID-19
Anjuman Chander, Tanvir Samra, Sekar Loganathan, Varun Mahajan
Ain-Shams Journal of Anesthesiology.2022;[Epub] CrossRef
Venom induced consumption coagulopathy and performance of 20-min whole blood clotting test for its detection in viperid envenomation
Bayye Rajkumar, Kolar Vishwanath Vinod, Rakhee Kar, Premkumar Ramasubramani
Journal of the Royal College of Physicians of Edinburgh.2022; 52(3): 232. CrossRef
The effect of myocardial injury on the clinical course of snake envenomation in South Korea
J. M. Moon, Y. J. Koo, B. J. Chun, K. H. Park, Y. S. Cho, J. C. Kim, S. D. Lee, Y. R. Min, H. S. Park
Clinical Toxicology.2021; 59(4): 286. CrossRef

Review

Cardiology
Blood Transfusion Strategies in Patients Undergoing Extracorporeal Membrane Oxygenation: Hyoung Soo Kim, Sunghoon Park; Korean J Crit Care Med. 2017;32(1):22-28. Published online February 28, 2017; DOI: https://doi.org/10.4266/kjccm.2016.00983

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Abstract PDF

Extracorporeal membrane oxygenation (ECMO) is frequently associated with bleeding and coagulopathy complications, which may lead to the need for transfusion of multiple blood products. However, blood transfusions are known to increase morbidity and mortality, as well as hospital cost, in critically ill patients. In current practice, patients on ECMO receive a transfusion, on average, of 1-5 packed red blood cells (RBCs)/day, with platelet transfusion accounting for the largest portion of transfusion volume. Generally, adult patients require more transfusions than neonates or children, and patients receiving venovenous ECMO for respiratory failure tend to need smaller transfusion volumes compared to those receiving venoarterial ECMO for cardiac failure. Observation studies have reported that a higher transfusion volume was associated with increased mortality. To date, the evidence for transfusion in patients undergoing ECMO is limited; most knowledge on transfusion strategies was extrapolated from studies in critically ill patients. However, current data support a restrictive blood transfusion strategy for ECMO patients, and a low transfusion trigger seems to be safe and reasonable.

Citations

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Oxygenation During Venoarterial Extracorporeal Membrane Oxygenation: Physiology, Current Evidence, and a Pragmatic Approach to Oxygen Titration
Lavienraj Premraj, Alastair Brown, John F. Fraser, Vincent Pellegrino, David Pilcher, Aidan Burrell
Critical Care Medicine.2024; 52(4): 637. CrossRef
A Comprehensive Review of Extra Corporeal Membrane Oxygenation: The Lifeline in Critical Moments
Sindhu Geetha, Neeta Verma, Vivek Chakole
Cureus.2024;[Epub] CrossRef
Veno-arterial extracorporeal membrane oxygenation without allogeneic blood transfusion: An observational cohort study
Alison Grazioli, Michael Plazak, Siamak Dahi, Joseph Rabin, Ashley Menne, Mehrdad Ghoreishi, Bradley Taylor, Seth Perelman, Michael Mazzeffi
Perfusion.2023; 38(7): 1519. CrossRef
A value-based approach to optimize red blood cell transfusion in patients receiving extracorporeal membrane oxygenation
Yasuhiro Shudo, Nathalie Cheng, Hao He, Corinne Rosenberg, William Hiesinger, Eric Hadhazy, John Shepard, Purnima Krishna, Josh Resnik, Robyn Fong, Charles Hill, Joe L Hsu, Paul M Maggio, Sang-Ick Chang, Jack H Boyd, Y Joseph Woo
Perfusion.2023; 38(8): 1682. CrossRef
ECMO Retrieval Program: What Have We Learned So Far
Ihor Krasivskyi, Clara Großmann, Marit Dechow, Ilija Djordjevic, Borko Ivanov, Stephen Gerfer, Walid Bennour, Elmar Kuhn, Anton Sabashnikov, Navid Mader, Kaveh Eghbalzadeh, Thorsten Wahlers
Life.2023; 13(1): 157. CrossRef
Haematological Trends and Transfusion during Adult Extracorporeal Membrane Oxygenation: A Single Centre Study
Elliott T. Worku, April M. Win, Dinesh Parmar, Chris Anstey, Kiran Shekar
Journal of Clinical Medicine.2023; 12(7): 2629. CrossRef
Extracorporeal Membrane Oxygenation Patient Outcomes Following Restrictive Blood Transfusion Protocol
Jacob A. Braaten, Bridget S. Dillon, Jillian K. Wothe, Conner P. Olson, Elizabeth R. Lusczek, Kristiana J. Sather, Gregory J. Beilman, Melissa E. Brunsvold
Critical Care Explorations.2023; 5(12): e1020. CrossRef
Neonatal extra corporeal membrane oxygenation
Suneel Kumar Pooboni
Indian Journal of Thoracic and Cardiovascular Surgery.2021; 37(4): 411. CrossRef
Point-of-care testing of plasma free hemoglobin and hematocrit for mechanical circulatory support
Dong Ah Shin, Jung Chan Lee, Heean Shin, Young-Jae Cho, Hee Chan Kim
Scientific Reports.2021;[Epub] CrossRef
Systematic review and meta-analysis of the clinical effectiveness of point-of-care testing for anticoagulation management during ECMO
Federica Jiritano, Dario Fina, Roberto Lorusso, Hugo ten Cate, Mariusz Kowalewski, Matteo Matteucci, Raffaele Serra, Pasquale Mastroroberto, Giuseppe Filiberto Serraino
Journal of Clinical Anesthesia.2021; 73: 110330. CrossRef
Blood transfusion strategies and ECMO during the COVID-19 pandemic
David Koeckerling, Daniel Pan, N Lakmal Mudalige, Oluwatobiloba Oyefeso, Joseph Barker
The Lancet Respiratory Medicine.2020; 8(5): e40. CrossRef
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Frantzeska G. Frantzeskaki, Stavros Dimopoulos, Dimitrios Konstantonis, Pelagia Katsibri, Kostantinos Kostopanagiotou, Maria Theodorakopoulou, Chrysi Diakaki, Dimitrios Dougenis, Dimitrios Boumpas, Andreas Karabinis, Apostolos Armaganidis, Iraklis Tsangar
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Frontiers in Pediatrics.2020;[Epub] CrossRef

Original Article

Thoracic Surgery
Blood Conservation Strategy during Cardiac Valve Surgery in Jehovah’s Witnesses: a Comparative Study with Non-Jehovah’s Witnesses: Tae Sik Kim, Jong Hyun Lee, Chan-Young Na; Korean J Crit Care Med. 2016;31(2):101-110. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.101

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Abstract PDF

Background:
We compared the clinical outcomes of cardiac valve surgery in adult Jehovah’s Witness patients refusing blood transfusion to those in non-Jehovah’s Witness patients without any transfusion limitations.
Methods
From 2005 to 2014, 25 Jehovah’s Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery.
Results
The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups.
Conclusions
Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.

Citations

Citations to this article as recorded by

Optimising bloodless cardiovascular surgery for Jehovah’s Witnesses and beyond
Matti Jubouri, Fatemeh Hedayat, Sakina Abrar, Sophie L. Mellor, Louise J. Brown, Amer Harky
Coronary Artery Disease.2022; 33(1): 52. CrossRef
Outcomes of perioperative management in Jehovah's Witness patients undergoing surgeries with a risk of bleeding: a retrospective, single-center, observational study
Keum Young So, Sang Hun Kim
Medical Biological Science and Engineering.2022; 5(1): 6. CrossRef

Case Reports

Cardiology/Pediatric
Transfusion Associated Hyperkalemia and Cardiac Arrest in an Infant after Extracorporeal Membrane Oxygenation: Do Wan Kim, Kyeong Ryeol Cheon, Duck Cho, Kyo Seon Lee, Hwa Jin Cho, In Seok Jeong; Korean J Crit Care Med. 2015;30(2):132-134. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.132

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Abstract PDF

Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC) was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO) priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.

Citations

Citations to this article as recorded by

Transfusion-associated graft-versus-host disease, transfusion-associated hyperkalemia, and potassium filtration: advancing safety and sufficiency of the blood supply
Kenneth E. Nollet, Alain M. Ngoma, Hitoshi Ohto
Transfusion and Apheresis Science.2022; 61(2): 103408. CrossRef
Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients
Morgan Burke, Pranava Sinha, Naomi L. C. Luban, Nikki Gillum Posnack
Frontiers in Pediatrics.2021;[Epub] CrossRef
Double-filtered leukoreduction as a method for risk reduction of transfusion-associated graft-versus-host disease
Sejong Chun, Minh-Trang Thi Phan, Saetbyul Hong, Jehoon Yang, Yeup Yoon, Sangbin Han, Jungwon Kang, Mark H. Yazer, Jaehyun Kim, Duck Cho, Senthilnathan Palaniyandi
PLOS ONE.2020; 15(3): e0229724. CrossRef
Anticoagulation Therapy during Extracorporeal Membrane Oxygenator Support in Pediatric Patients
Hwa Jin Cho, Do Wan Kim, Gwan Sic Kim, In Seok Jeong
Chonnam Medical Journal.2017; 53(2): 110. CrossRef
Blood Transfusion Strategies in Patients Supported by Extracorporeal Membrane Oxygenation
Yoon Hee Kim
The Korean Journal of Critical Care Medicine.2015; 30(3): 139. CrossRef

Transfusion-Related Acute Lung Injury after Stored Packed Red Blood Cell Transfusion: A Case Report: Ho Hyun Kim, Dong Kyu Lee, Chan Yong Park, Jae Kyoon Ju, Jung Chul Kim; Korean J Crit Care Med. 2013;28(2):141-145.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.141

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Abstract PDF

Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortalities. Each type of blood product is likely to cause TRALI. Patients with TRALI present with dyspnea/respiratory distress and fever. The symptoms, signs and chest radiological findings in TRALI are similar to transfusion associated circulatory overload. Therefore, it is difficult to distinguish such from circulatory overloads. We report a case of TRALI in a 49-year-old woman after stored packed red blood cell transfusion. The patient developed hypoxemia and pulmonary edema after packed red blood cell transfusion during postoperative period. The patient completely recovered after an oxygen support for 3 days.

Citations

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A Case Report of Transfusion-Related Acute Lung Injury Induced in the Patient with HLA Antibody after Fresh Frozen Plasma Transfusion
Ki Sul Chang, Dae Won Jun, Youngil Kim, Hyunwoo Oh, Min Koo Kang, Junghoon Lee, Intae Moon
The Korean Journal of Blood Transfusion.2015; 26(3): 309. CrossRef

Review

Transfusion-related Acute Lung Injury: Miok Kim; Korean J Crit Care Med. 2012;27(1):1-4.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.1

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Abstract PDF

Transfusion-related acute lung injury (TRALI) is a significant cause of iatrogenic injuries in patients. It is also the major cause of transfusion-associated fatalities. Pathophysiologic mechanism is an implicated donor of HLA. Neutrophil antibodies and biologic response modifiers are accumulated in the stored blood products. Pulmonary endothelial activation of the host may be the response from these mediators. Treatment is supportive and will be subjected to other forms of ALL/ARDS. Diverting donors at high risk for alloimmunization may decrease the incidence of such cases.

Citations

Citations to this article as recorded by

Transfusion-related acute lung injury in a parturient diagnosed with myelodysplastic syndrome - A case report -
Tae-Yun Sung, Young Seok Jee, Seok-jin Lee, Hwang Ju You, Ki Soon Jeong, Po-Soon Kang
Anesthesia and Pain Medicine.2019; 14(1): 35. CrossRef
Correlation between Allergic Rhinitis Prevalence and Immune Responses of Children in Ulsan: A Case-control Study
Jiho Lee, Inbo Oh, Ahra Kim, Minho Kim, Chang sun Sim, Yangho Kim
Korean Journal of Environmental Health Sciences.2015; 41(4): 249. CrossRef
Transfusion-Related Acute Lung Injury after Stored Packed Red Blood Cell Transfusion - A Case Report -
Ho-Hyun Kim, Dong-Kyu Lee, Chan-Yong Park, Jae-Kyoon Ju, Jung-Chul Kim
Korean Journal of Critical Care Medicine.2013; 28(2): 141. CrossRef

Case Reports

A Case of Acute Lung Injury after Transfusion during Cesarean Section: A Case Report: Hee Jong Lee, Mi Ae Jeong, Ji Seon Jeong, Min Kyu Han, Jong Hun Jun; Korean J Crit Care Med. 2011;26(3):184-187.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.184

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Abstract PDF

Transfusion-related acute lung injury (TRALI) is a serious complication following the transfusion of blood products. TRALI is under-diagnosed and under-reported because of a lack of awareness. TRALI occurs within 6 hours of transfusion in the majority of cases and its presentation is similar to other forms of acute lung injury. We report on the case of a 34-year-old pregnant woman who suffered from TRALI after transfusion during Cesarean section.

Citations

Citations to this article as recorded by

Transfusion-related acute lung injury in a parturient diagnosed with myelodysplastic syndrome - A case report -
Tae-Yun Sung, Young Seok Jee, Seok-jin Lee, Hwang Ju You, Ki Soon Jeong, Po-Soon Kang
Anesthesia and Pain Medicine.2019; 14(1): 35. CrossRef
A Case Report of Transfusion-Related Acute Lung Injury Induced in the Patient with HLA Antibody after Fresh Frozen Plasma Transfusion
Ki Sul Chang, Dae Won Jun, Youngil Kim, Hyunwoo Oh, Min Koo Kang, Junghoon Lee, Intae Moon
The Korean Journal of Blood Transfusion.2015; 26(3): 309. CrossRef
Transfusion-Related Acute Lung Injury after Stored Packed Red Blood Cell Transfusion - A Case Report -
Ho-Hyun Kim, Dong-Kyu Lee, Chan-Yong Park, Jae-Kyoon Ju, Jung-Chul Kim
Korean Journal of Critical Care Medicine.2013; 28(2): 141. CrossRef
A case of transfusion-related acute lung injury induced by anti-human leukocyte antigen antibodies in acute leukemia
Sun Mi Jin, Moon Ju Jang, Ji Young Huh, Myoung Hee Park, Eun Young Song, Doyeun Oh
The Korean Journal of Hematology.2012; 47(4): 302. CrossRef

The Care of a Jehovah's Witness with Life-threatening Anemia Refusing Ventilator Care: A Case Report: Ji Hyeon Lee, So Ron Choi, Young Jhoon Chin, Soo Il Lee, Chan Jong Chung, Jong Hwan Lee, Seung Cheol Lee; Korean J Crit Care Med. 2010;25(1):52-55.; DOI: https://doi.org/10.4266/kjccm.2010.25.1.52

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Abstract PDF: Jehovah's Witnesses refuse the transfusion of blood and blood products, even when it can be lifesaving. Their religious conviction against receiving blood can create a difficult clinical dilemma, particularly in the life threatening situations. We report a case of a 42-year-old female Jehovah's Witness patient who had life-threatening anemia after postpartum hemorrhage. Despite severe anemia, she had a good postoperative recovery without complications.

Original Article

Quality Assessment of Blood Transfusion in Operating Room: Myoung Gil Chae, Byeung Ho Byeun, Dong Hee Kang, Hae Kyu Kim, Seong Wan Baik, Kyoo Sub Chung; Korean J Crit Care Med. 1998;13(2):234-238.

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Abstract PDF: BACKGOUND: Transfusion of red blood cells is a life saving measure in the management of a variety of surgical conditions. A guideline for blood transfusion during elective surgical procedure is necessary to reduce the risks of transfusion-associated complications, excessive blood bank workload, excessive blood request and overtransfusion, and the cost. From this, a program of quality assessment was adopted to improve blood transfusion practice and to establish the guideline for blood transfusion in elective surgery at Pusan National University Hospital.
METHODS
Fifty-six patients undergoing elective surgery was divided 2 groups. Transfusion (T) group was 18 persons. Non-transfusion (NT) group was 38 persons. The preoperative, pre-transfusion, postoperative, and post-transfusion hemoglobin (Hb), hematocrit, mean arterial blood pressure (MAP), heart rate (HR), average amount of transfused red blood cell units, allowable blood loss, and the amount of infused crystalloids and colloids was estimated for 9 months in Pusan National University Hospital.
RESULTS
There were no significant differences in Hb between T & NT group. Hb decreased significantly until postoperative 3rd day in NT group. Platelet count decreased in NT group on postop. 3rd day. There were no significant differences in MAP & HR. One-ninth of T group was overestimated blood loss & 18.4% of NT group was underestimated blood loss. One-third of transfusion patient were overtransfused & 36.2% of transfused RBC was unnecessary. Nearly 90% of patient was transfused packed RBC with FFP concurrently.
CONCLUSIONS
To minimize overtransfusion, transfusion based on intraoperative hematocrit is necessary. If possible, single use of packed RBC is recommended when the blood loss is below allowable blood loss. In massive bleeding above allowable blood loss, combined administration of FFP and packed RBC or transfusion of whole blood will be better.

Case Report

A Case of Severe Anemia Due to Anti Ce in Transfused Patient: Young Jae Kim, Kun Moo Lee, Soon Ho Jeong, Young Kyun Choe, Jin Woo Park, Chee Mahn Shin, Ju Yuel Park; Korean J Crit Care Med. 1998;13(1):101-104.

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Abstract PDF: Intraoperative massive bleeding requires fluid therapy and blood transfusion. But transfusion may elicit infection, hemolytic reaction, hemostatic disorder and other complication. Individuals often produce antibodies to the alleles which lack in ABO and Rh system. Such antibodies are responsible for the most serious reaction to transfusions. Antibodies may occur "naturally" or in response to sensitization from a previous transfusion or pregnancy. We report a case of severe anemic patient who had Anti Ce due to previous transfusion and was not transfused for several hours because of incompatible cross-matching. His Rh phenotype is revealed cDE.

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