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Matthew A. Warner, Terence O'Keeffe, Premal Bhavsar, Rashmi Shringer, Carol Moore, Caryn Harper, Christopher J. Madden, Ravi Sarode, Larry M. Gentilello and Ramon Diaz-Arrastia

D espite evidence regarding the harmful effects of liberal transfusions in the critically ill, transfusion with packed RBCs remains controversial in the treatment of patients with TBI. In 1999, the TRICC trial, a multicenter, randomized controlled trial of 838 critically ill patients, was among the first to demonstrate that anemia is generally well tolerated in patients receiving intensive care. 14 The study showed that a restrictive transfusion strategy, with provision of packed RBCs when the HCT level decreased to less than 21% (hemoglobin < 7 g

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Laura B. Ngwenya, Catherine G. Suen, Phiroz E. Tarapore, Geoffrey T. Manley and Michael C. Huang

A restrictive transfusion protocol has yet to become standard of care in patients with traumatic brain injury (TBI). Blood transfusions are an integral part of health care. A transfusion of packed red blood cells (PRBCs) can be lifesaving in a hemodynamically unstable patient. Despite the lifesaving benefits of a transfusion, there are many risks. Blood transfusions are associated with morbidities, including fever, infection, thromboembolic events, multiple organ failure, and lung injury. 2 , 12 , 14 Transfusions are also associated with an increase in

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Mark A. Helfaer, Benjamin S. Carson, Carol S. James, Judy Gates, David Della-Lana and Craig Vander Kolk

I n healthy children, plasma erythropoietin levels fall in the 1st month of life, which is associated with a fall in hemoglobin and reticulocyte levels. In the 2nd month of life, plasma erythropoietin levels rise with a slow continuous increase in hemoglobin over subsequent months. 16 When erythropoietin is administered to premature infants in neonatal intensive care units (ICUs), the hematocrit level rises and transfusion requirements diminish. 15, 23 In addition, when erythropoietin is administered to adults, erythropoiesis increases and preoperative blood

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Rafael A. Vega, Camila Lyon, Jeannette F. Kierce, Gary W. Tye, Ann M. Ritter and Jennifer L. Rhodes

C raniosynostosis is characterized by the premature fusion of 1 or more cranial sutures resulting in head shape abnormalities. The goal of surgical remodeling of the cranial vault is to prevent or relieve elevated intracranial pressure (ICP) and to correct physical abnormalities of the craniofacial skeleton. Corrective surgical repair of craniosynostosis may require extensive removal or dislocation of calvarial bones at an early age (usually 2–3 months). Substantial intraoperative blood loss may be encountered and may require transfusion to replace lost

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Catherine O. Anglin, Jeffrey S. Spence, Matthew A. Warner, Christopher Paliotta, Caryn Harper, Carol Moore, Ravi Sarode, Christopher Madden and Ramon Diaz-Arrastia

intracranial hemorrhage can rapidly increase intracranial pressure, expose neural tissue to the toxic components of blood, and is associated with increased mortality in patients with severe TBI. 1 Other secondary complications associated with coagulopathy include cerebral ischemia, brain edema, delayed traumatic intracerebral hematoma, and ARDS. 7 The development of TBI-associated coagulopathy is also associated with a longer ICU stay and an almost 10-fold increased risk of death. 21 Transfusion of platelets or FFP could correct thrombocytopenia or coagulopathy

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Karén Matevosyan, Christopher Madden, Samuel L. Barnett, Joseph E. Beshay, Cynthia Rutherford and Ravindra Sarode

. Use of the INR is therefore inappropriate in other medical conditions in which clotting factors other than VKD factors are affected. 10 However, the INR is often (mis)used in clinical practice to assess hemostasis in patients not receiving warfarin therapy; thus, patients with mildly elevated INRs are reflexively transfused with FFP, usually perioperatively. In the past, less-sensitive thromboplastin reagents (ISI > 2.0) caused a prolonged PT only when factor VII was < 30%. With the older reagents, clinicians were accustomed to a PT value 1.5 times the normal

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Jeff Ehresman, Zach Pennington, Andrew Schilling, Ravi Medikonda, Sakibul Huq, Kevin R. Merkel, A. Karim Ahmed, Ethan Cottrill, Daniel Lubelski, Erick M. Westbroek, Salia Farrokh, Steven M. Frank and Daniel M. Sciubba

O f patients who undergo elective lumbar spine surgery annually in the United States, 1 approximately 17% of patients 2 will require allogeneic blood transfusion. Prior research has found allogeneic transfusion to be associated with higher complication rates, 2 , 3 , 33 including increases in the rates of surgical site infections, 4 thromboembolic events, 5 and kidney injuries. 6 Additionally, the use of allogeneic blood products is associated with significant increases in cost, reported to average between $526 per patient for anterior lumbar cases and

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Adil Harroud, Alexander G. Weil, Jean Turgeon, Claude Mercier and Louis Crevier

S agittal synostosis is the most common craniosynostosis, affecting approximately 1 of every 2000 newborns. 7 Surgical correction between 3 and 6 months of age has been shown to achieve the best results. One of the major challenges in this surgery is the associated high rate of packed red blood cell (PRBC) transfusion, with the majority of studies reporting rates between 50% and 100%. 1 , 2 , 4–6 , 9 PRBC transfusion carries rare but potentially serious adverse effects related to exposure to foreign antigens and blood-borne pathogens. 14 Increasing

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Andreea Seicean, Nima Alan, Sinziana Seicean, Duncan Neuhauser, Warren R. Selman and Nicholas C. Bambakidis

A nemia is a clinically significant finding that has been shown to compromise surgical outcome in many specialties. 5 , 16 , 24 , 27 Blood transfusion offers an immediate corrective measure in surgical candidates with anemia. 14 However, transfusion is perhaps a hazardous intervention. 19 Prior studies have examined anemia and blood transfusion in patients with traumatic brain injury 32 , 38 and subarachnoid hemorrhage, 23 , 25 , 28 , 31 , 35 but little is known about the role of anemia and transfusion as perioperative risk factors for patients who

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Thanh T. Nguyen, Sarah Hill, Thomas M. Austin, Gina M. Whitney, John C. Wellons III and Humphrey V. Lam

B lood transfusion is the most commonly performed medical procedure in health care in the US. 3 , 13 , 21 While the transfusion of blood products may be lifesaving for some patients, there is an abundance of compelling data implicating transfusions in increased morbidity and mortality in a variety of clinical settings. In critically ill children, blood transfusion is associated with increased mortality and prolonged ICU stay. 11 , 25 Among pediatric patients undergoing open cardiac procedures, blood transfusion has been associated with increased risks of