Document Detail

Transfusion of the injured patient: proceed with caution.
MedLine Citation:
PMID:  15179127     Owner:  NLM     Status:  MEDLINE    
Transfusion of the injured patient with packed red blood cells (PRBCs) is a dynamic process requiring vigilance during the acute resuscitative and recovery phases postinjury. Although adverse events have been reported in 2% to 10% of injured patients, the advent of new detection techniques for viral pathogens has markedly decreased the risk of infectious transmission. However, transfusions are strongly associated with immunosuppression in the host, which may occur days after the initial injury and may lead to bacterial infections. Conversely, early transfusion of stored PRBCs, > 6 units in the first 12 h postinjury, contributes to an early state of hyperinflammation that is a strong, independent predictor of multiple organ failure (MOF) in those patients with intermediate injury severity scores. The roles of prestorage leukoreduction are also reviewed with respect to the promotion of both immunosuppression and hyperinflammation. We further summarize studies with hemoglobin substitutes, whose use may obviate many of the untoward events of transfusion and promise to lead to better outcomes for injured patients.
Christopher C Silliman; Ernest E Moore; Jeffrey L Johnson; Ricardo J Gonzalez; Walter L Biffl
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  Shock (Augusta, Ga.)     Volume:  21     ISSN:  1073-2322     ISO Abbreviation:  Shock     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-06-04     Completed Date:  2005-11-04     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  9421564     Medline TA:  Shock     Country:  United States    
Other Details:
Languages:  eng     Pagination:  291-9     Citation Subset:  IM    
Bonfils Blood Center, Denver Health Medical Center, Denver, Colorado 80230, USA.
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MeSH Terms
Erythrocyte Transfusion / adverse effects*,  methods*
Multiple Organ Failure / etiology
Risk Factors
Wounds and Injuries / immunology,  therapy*
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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