• Cardiovascular event
• Cardiovascular intensive care unit
• Mid-term prognosis
• Red blood cell transfusion

• intensive care unit
• outcomes
• platelet
• platelet transfusion
• sepsis
• thresholds

• Anemia
• Humans
• Intensive Care Units
• Organ Dysfunction Scores
• Platelet Transfusion
• Retrospective Studies
• Sepsis/therapy
• Thrombocytopenia/therapy

Transfusion of blood and blood components is a special type of tissue transplantation, a life-saving treatment. However, besides the benefits of blood product transfusions, there are also some undesirable side effects. In the present study, the frequency and type of transfusion reactions related to blood and blood components were investigated.

In this retrospective study, types and the time of occurrence of acute transfusion reaction (ATR), the types of blood and blood components used in our hospital between January 2018 and January 2020 were evaluated for hemovigilance using unit blood products application and side effect reporting forms.

During the 2-year period, 61,636 blood and/or blood components were used in 9334 patients, and 53 of the transfused patients developed ATR. In two patients, ATR developed 2 times and a total of 55 ATR developed. Of the patients who developed ATR, 18 were female and 35 were male, and their ages ranged from 1 month to 85 years. The frequency of ATR was 0.09%, and 47.3% of ATRs were allergic transfusion reactions, 41.8% were febrile non-hemolytic transfusion reactions (FNHTRs), 7.3% were hypotensive transfusion reactions, and 1.8% were transfusion-related lung injury. Fifty-five ATRs were found to be associated with 61.8% erythrocyte suspension, 30.9% with FFP, 5.5% with platelet suspension, and 1.8% with whole blood.

There are a limited number of studies evaluating transfusion reaction frequency and reaction types from our country. The most frequent ATR reported in our hospital were mild allergic reactions and FNHTR. The most common side effect of blood product type was erythrocyte suspension. It is important to monitor the transfused patients for undesired reactions during and after the transfusion to determine the frequency, type, risk factors, and safety precautions of the transfusion reactions.

• Acute transfusion reaction
• FNHTR
• allergic
• hemovigilance

We aimed to identify and represent factors associated with thrombocytopenia in intensive care unit, especially the pathogens and drugs related to severe and extremely thrombocytopenia. Then, we aim to compare the mortality of platelet transfusion and non-transfusion in patients with different degrees of thrombocytopenia.

We identified all thrombocytopenic patients in intensive care unit by using platelet-specific values and then extracted electronic health records from our Hospital Information System. Data were statistically analyzed with t test, chi-square test, and logistic regression.

We found that infections (32.7%) were the most frequent cause associated with thrombocytopenia, followed by sepsis shock (3.93%) and blood loss (2.99%). Meanwhile, antifungals (p = 0.002) and bacterial infection (p = 0.037) were associated with severe and extremely severe thrombocytopenia. Finally, we found that the mortality of platelet transfusion and non-transfusion in patients was statistically significant for patients with platelet counts between 30 and 49/nL (χ² = 9.719, p = 0.002).

Infection and sepsis emerged as two primary factors associated with thrombocytopenia in intensive care unit. Meanwhile, antifungals and bacterial infection were associated with platelet counts less than 49/nL. Finally, platelet transfusion may be associated with reduced mortality in patients with platelet counts between 30 and 49/nL.

• Thrombocytopenia
• etiology
• intensive care unit mortality
• prognosis

• anticoagulant therapy
• anticoagulation
• liver transplantation

Patients with malignant haematological disease and especially those who require intensive care have an increased risk of bleeding and thrombosis, but none of these data were obtained in ICU patients only. We assessed the incidence of bleeding and thrombotic complications, use of blood products and risk factors for bleeding in an adult population of ICU patients with haematological malignancies.

We screened all patients with acute leukaemia and myelodysplastic syndrome admitted to a university hospital ICU during 2008–2012. Bleeding in ICU was scored according to the WHO grading system, and risk factors were evaluated using unadjusted and adjusted analyses.

In total, 116 of 129 ICU patients were included; their median length of stay was 7 (IQR 2–16) days. Of these, 66 patients (57%) had at least one bleeding episode in ICU; they bled for 3 (2–6) days and most often from lower and upper airways and upper GI tract. Thirty-nine (59%) of the 66 patients had severe or debilitating (WHO grade 3 or 4) bleeding. The median platelet count on the day of grade 3 or 4 bleeding was 23 × 10⁹ per litre (IQR 13–39). Nine patients (8%) died in ICU following a bleeding episode; five of these had intra-cerebral haemorrhage. Platelet count on admission was associated with subsequent bleeding (adjusted odds ratio 1.18 (95% CI 1.03–1.35) for every 10 × 10⁹ per litre drop in platelet count, p = 0.016). Eleven of the 116 patients (9%) developed a clinically significant thrombosis in ICU, which was the cause of death in four patients. The median platelet count was 20 × 10⁹ per litre (15–48) at the time of thrombosis. The patients received a median of 6 units of red blood cells, 1 unit of fresh frozen plasma and 8 units of platelet concentrates in ICU.

Severe and debilitating bleeding complications were frequent in our ICU patients with haematological malignancies, but thrombosis also occurred in spite of low platelet counts. Platelet count on ICU admission was associated with subsequent bleeding.

The online version of this article (10.1186/s13613-017-0341-y) contains supplementary material, which is available to authorized users.

• Bleeding
• Haematology
• ICU
• Intensive care
• Leukaemia
• Myelodysplastic syndrome
• Sepsis
• Thrombosis
• Transfusion

• Blood transfusion
• Brain neoplasm
• Neurosurgery

Liver failure patients have traditionally been empirically transfused prior to invasive procedures. Blood transfusion is associated with immunologic and nonimmunologic reactions, increased risk of adverse outcomes and high costs. Scientific evidence supporting empirical transfusion is lacking, and the best approach for blood transfusion prior to invasive procedures in cirrhotic patients has not been established so far.

The aim of this study is to compare three transfusion strategies (routine coagulation test-guided – ordinary or restrictive, or thromboelastometry-guided) prior to central venous catheterization in critically ill patients with cirrhosis.

Design and setting: a double-blinded, parallel-group, single-center, randomized controlled clinical trial in a tertiary private hospital in São Paulo, Brazil. Inclusion criteria: adults (aged 18 years or older) admitted to the intensive care unit with cirrhosis and an indication for central venous line insertion. Patients will be randomly assigned to three groups for blood transfusion strategy prior to central venous catheterization: standard coagulation tests-based, thromboelastometry-based, or restrictive. The primary efficacy endpoint will be the proportion of patients transfused with any blood product prior to central venous catheterization. The primary safety endpoint will be the incidence of major bleeding. Secondary endpoints will be the proportion of transfusion of fresh frozen plasma, platelets and cryoprecipitate; infused volume of blood products; hemoglobin and hematocrit before and after the procedure; intensive care unit and hospital length of stay; 28-day and hospital mortality; incidence of minor bleeding; transfusion-related adverse reactions; and cost analysis.

This study will evaluate three strategies to guide blood transfusion prior to central venous line placement in severely ill patients with cirrhosis. We hypothesized that thromboelastometry-based and/or restrictive protocols are safe and would significantly reduce transfusion of blood products in this population, leading to a reduction in costs and transfusion-related adverse reactions. In this manner, this trial will add evidence in favor of reducing empirical transfusion in severely ill patients with coagulopathy.

ClinicalTrials.gov, identifier: NCT02311985. Retrospectively registered on 3 December 2014.

The online version of this article (doi:10.1186/s13063-017-1835-5) contains supplementary material, which is available to authorized users.

• Blood coagulation tests
• Blood transfusion
• Catheterization
• Central venous
• Clinical trial
• Critical care
• Hemostatic disorders
• Liver failure
• Thromboelastography
• Ultrasonography
• Vascular access devices

• Anemia
• Etiology
• Intensive Cardiac Care Unit (ICCU)
• Treatment

• Anemia/epidemiology
• Anemia/etiology
• Female
• Humans
• Intensive Care Units/statistics & numerical data
• Male

• Antineoplastic Agents/adverse effects
• Antineoplastic Agents/therapeutic use
• Evidence-Based Medicine
• Germany
• Hematology/standards
• Humans
• Medical Oncology/standards
• Neoplasms/complications
• Neoplasms/drug therapy
• Platelet Transfusion/standards
• Postoperative Hemorrhage/therapy
• Practice Guidelines as Topic
• Thrombocytopenia/chemically induced
• Thrombocytopenia/therapy
• Treatment Outcome

There is wide variation in the management of coagulation and blood transfusion practice in liver transplantation. The use of blood products intraoperatively is declining and transfusion free transplantations take place ever more frequently. Allogenic blood products have been shown to increase morbidity and mortality. Primary haemostasis, coagulation and fibrinolysis are altered by liver disease. This, combined with intraoperative disturbances of coagulation, increases the risk of bleeding. Meanwhile, the rebalancing of coagulation homeostasis can put patients at risk of hypercoagulability and thrombosis. The application of the principles of patient blood management to transplantation can reduce the risk of transfusion. This includes: preoperative recognition and treatment of anaemia, reduction of perioperative blood loss and the use of restrictive haemoglobin based transfusion triggers. The use of point of care coagulation monitoring using whole blood viscoelastic testing provides a picture of the complete coagulation process by which to guide and direct coagulation management. Pharmacological methods to reduce blood loss include the use of anti-fibrinolytic drugs to reduce fibrinolysis, and rarely, the use of recombinant factor VIIa. Factor concentrates are increasingly used; fibrinogen concentrates to improve clot strength and stability, and prothrombin complex concentrates to improve thrombin generation. Non-pharmacological methods to reduce blood loss include surgical utilisation of the piggyback technique and maintenance of a low central venous pressure. The use of intraoperative cell salvage and normovolaemic haemodilution reduces allogenic blood transfusion. Further research into methods of decreasing blood loss and alternatives to blood transfusion remains necessary to continue to improve outcomes after transplantation.

• Liver disease
• Transplantation
• Coagulation
• Transfusion
• Patient blood management
• Thromboelastography
• Cell salvage

• Blood Coagulation
• Blood Transfusion
• Elasticity
• End Stage Liver Disease/therapy
• Humans
• Liver Transplantation
• Platelet Transfusion
• Postoperative Complications
• Risk Factors
• Thrombelastography
• Treatment Outcome
• Viscosity