Blood product utilization in human upper-extremity transplantation: challenges, complications, considerations, and transfusion protocol conception

Jay S. Raval, Vijay S. Gorantla, Jaimie T. Shores, W. P.Andrew Lee, Raymond M. Planinsic, Marian A. Rollins-Raval, Gerald Brandacher, Karen E. King, Joseph E. Losee, Joseph E. Kiss

Research output: Research - peer-reviewArticle

  • 2 Citations

Abstract

BACKGROUND: Upper-extremity transplantation (UET) is a reality. Immunologic, functional, and graft survival outcomes have been encouraging. However, these complex reconstructions have unique considerations that pose distinct challenges. Transplant programs have reported morbidity and mortality due to significant intraoperative blood losses, but similar data are scant during other phases of recovery. We report experience from two centers on complete blood component demands and utilization with UET. STUDY DESIGN AND METHODS: Inpatient medical records of UET recipients from intraoperative (time from initiation of transplant surgery to exit from the operative suite) and postoperative (exit from the operative suite to discharge from the hospital) phases were retrospectively reviewed. RESULTS: Six patients received various UETs and mean (±SD) postoperative hospital stay was 46 (±14.4) days. Mean (±SD) intraoperative blood unit utilization was 14.8 (±10.2) red blood cells (RBCs), 10.5 (±11.8) plasma, 0.8 (±1.2) platelets (PLTs), and 0.3 (±0.8) cryoprecipitate units. Mean postoperative blood unit utilization was 9.3 (±10.4) RBCs, 5.3 (±6.7) plasma, 1.2 (±2.0) PLTs, and 0.7 (±1.6) cryoprecipitate units. Both intraoperative and postoperative blood utilization for unilateral versus bilateral transplant were different, but not significantly so. However, total inpatient blood use in bilateral transplants was significantly greater than in unilateral transplants. CONCLUSION: Substantial blood loss may occur in UET and require transfusion of many blood components, primarily RBCs and plasma. We propose an UET transfusion protocol and suggest that centers preparing to perform these transplants should actively engage the transfusion medicine service to ensure availability and access to appropriate blood components for the entire hospitalizations of these unique patients.

LanguageEnglish (US)
Pages606-612
Number of pages7
JournalTransfusion
Volume57
Issue number3
DOIs
StatePublished - Mar 1 2017

Fingerprint

Upper Extremity
Transplantation
Transplants
Erythrocytes
Inpatients
Blood Platelets
Blood Component Transfusion
Transfusion Medicine
Graft Survival
Medical Records
Length of Stay
Hospitalization
Morbidity
Mortality

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

Cite this

Blood product utilization in human upper-extremity transplantation : challenges, complications, considerations, and transfusion protocol conception. / Raval, Jay S.; Gorantla, Vijay S.; Shores, Jaimie T.; Lee, W. P.Andrew; Planinsic, Raymond M.; Rollins-Raval, Marian A.; Brandacher, Gerald; King, Karen E.; Losee, Joseph E.; Kiss, Joseph E.

In: Transfusion, Vol. 57, No. 3, 01.03.2017, p. 606-612.

Research output: Research - peer-reviewArticle

Raval, JS, Gorantla, VS, Shores, JT, Lee, WPA, Planinsic, RM, Rollins-Raval, MA, Brandacher, G, King, KE, Losee, JE & Kiss, JE 2017, 'Blood product utilization in human upper-extremity transplantation: challenges, complications, considerations, and transfusion protocol conception' Transfusion, vol 57, no. 3, pp. 606-612. DOI: 10.1111/trf.14009
Raval, Jay S. ; Gorantla, Vijay S. ; Shores, Jaimie T. ; Lee, W. P.Andrew ; Planinsic, Raymond M. ; Rollins-Raval, Marian A. ; Brandacher, Gerald ; King, Karen E. ; Losee, Joseph E. ; Kiss, Joseph E./ Blood product utilization in human upper-extremity transplantation : challenges, complications, considerations, and transfusion protocol conception. In: Transfusion. 2017 ; Vol. 57, No. 3. pp. 606-612
@article{2d73eb015dc24dad9357e2988c1a5326,
title = "Blood product utilization in human upper-extremity transplantation: challenges, complications, considerations, and transfusion protocol conception",
abstract = "BACKGROUND: Upper-extremity transplantation (UET) is a reality. Immunologic, functional, and graft survival outcomes have been encouraging. However, these complex reconstructions have unique considerations that pose distinct challenges. Transplant programs have reported morbidity and mortality due to significant intraoperative blood losses, but similar data are scant during other phases of recovery. We report experience from two centers on complete blood component demands and utilization with UET. STUDY DESIGN AND METHODS: Inpatient medical records of UET recipients from intraoperative (time from initiation of transplant surgery to exit from the operative suite) and postoperative (exit from the operative suite to discharge from the hospital) phases were retrospectively reviewed. RESULTS: Six patients received various UETs and mean (±SD) postoperative hospital stay was 46 (±14.4) days. Mean (±SD) intraoperative blood unit utilization was 14.8 (±10.2) red blood cells (RBCs), 10.5 (±11.8) plasma, 0.8 (±1.2) platelets (PLTs), and 0.3 (±0.8) cryoprecipitate units. Mean postoperative blood unit utilization was 9.3 (±10.4) RBCs, 5.3 (±6.7) plasma, 1.2 (±2.0) PLTs, and 0.7 (±1.6) cryoprecipitate units. Both intraoperative and postoperative blood utilization for unilateral versus bilateral transplant were different, but not significantly so. However, total inpatient blood use in bilateral transplants was significantly greater than in unilateral transplants. CONCLUSION: Substantial blood loss may occur in UET and require transfusion of many blood components, primarily RBCs and plasma. We propose an UET transfusion protocol and suggest that centers preparing to perform these transplants should actively engage the transfusion medicine service to ensure availability and access to appropriate blood components for the entire hospitalizations of these unique patients.",
author = "Raval, {Jay S.} and Gorantla, {Vijay S.} and Shores, {Jaimie T.} and Lee, {W. P.Andrew} and Planinsic, {Raymond M.} and Rollins-Raval, {Marian A.} and Gerald Brandacher and King, {Karen E.} and Losee, {Joseph E.} and Kiss, {Joseph E.}",
year = "2017",
month = "3",
doi = "10.1111/trf.14009",
volume = "57",
pages = "606--612",
journal = "Transfusion",
issn = "0041-1132",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Blood product utilization in human upper-extremity transplantation

T2 - Transfusion

AU - Raval,Jay S.

AU - Gorantla,Vijay S.

AU - Shores,Jaimie T.

AU - Lee,W. P.Andrew

AU - Planinsic,Raymond M.

AU - Rollins-Raval,Marian A.

AU - Brandacher,Gerald

AU - King,Karen E.

AU - Losee,Joseph E.

AU - Kiss,Joseph E.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - BACKGROUND: Upper-extremity transplantation (UET) is a reality. Immunologic, functional, and graft survival outcomes have been encouraging. However, these complex reconstructions have unique considerations that pose distinct challenges. Transplant programs have reported morbidity and mortality due to significant intraoperative blood losses, but similar data are scant during other phases of recovery. We report experience from two centers on complete blood component demands and utilization with UET. STUDY DESIGN AND METHODS: Inpatient medical records of UET recipients from intraoperative (time from initiation of transplant surgery to exit from the operative suite) and postoperative (exit from the operative suite to discharge from the hospital) phases were retrospectively reviewed. RESULTS: Six patients received various UETs and mean (±SD) postoperative hospital stay was 46 (±14.4) days. Mean (±SD) intraoperative blood unit utilization was 14.8 (±10.2) red blood cells (RBCs), 10.5 (±11.8) plasma, 0.8 (±1.2) platelets (PLTs), and 0.3 (±0.8) cryoprecipitate units. Mean postoperative blood unit utilization was 9.3 (±10.4) RBCs, 5.3 (±6.7) plasma, 1.2 (±2.0) PLTs, and 0.7 (±1.6) cryoprecipitate units. Both intraoperative and postoperative blood utilization for unilateral versus bilateral transplant were different, but not significantly so. However, total inpatient blood use in bilateral transplants was significantly greater than in unilateral transplants. CONCLUSION: Substantial blood loss may occur in UET and require transfusion of many blood components, primarily RBCs and plasma. We propose an UET transfusion protocol and suggest that centers preparing to perform these transplants should actively engage the transfusion medicine service to ensure availability and access to appropriate blood components for the entire hospitalizations of these unique patients.

AB - BACKGROUND: Upper-extremity transplantation (UET) is a reality. Immunologic, functional, and graft survival outcomes have been encouraging. However, these complex reconstructions have unique considerations that pose distinct challenges. Transplant programs have reported morbidity and mortality due to significant intraoperative blood losses, but similar data are scant during other phases of recovery. We report experience from two centers on complete blood component demands and utilization with UET. STUDY DESIGN AND METHODS: Inpatient medical records of UET recipients from intraoperative (time from initiation of transplant surgery to exit from the operative suite) and postoperative (exit from the operative suite to discharge from the hospital) phases were retrospectively reviewed. RESULTS: Six patients received various UETs and mean (±SD) postoperative hospital stay was 46 (±14.4) days. Mean (±SD) intraoperative blood unit utilization was 14.8 (±10.2) red blood cells (RBCs), 10.5 (±11.8) plasma, 0.8 (±1.2) platelets (PLTs), and 0.3 (±0.8) cryoprecipitate units. Mean postoperative blood unit utilization was 9.3 (±10.4) RBCs, 5.3 (±6.7) plasma, 1.2 (±2.0) PLTs, and 0.7 (±1.6) cryoprecipitate units. Both intraoperative and postoperative blood utilization for unilateral versus bilateral transplant were different, but not significantly so. However, total inpatient blood use in bilateral transplants was significantly greater than in unilateral transplants. CONCLUSION: Substantial blood loss may occur in UET and require transfusion of many blood components, primarily RBCs and plasma. We propose an UET transfusion protocol and suggest that centers preparing to perform these transplants should actively engage the transfusion medicine service to ensure availability and access to appropriate blood components for the entire hospitalizations of these unique patients.

UR - http://www.scopus.com/inward/record.url?scp=85015651009&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85015651009&partnerID=8YFLogxK

U2 - 10.1111/trf.14009

DO - 10.1111/trf.14009

M3 - Article

VL - 57

SP - 606

EP - 612

JO - Transfusion

JF - Transfusion

SN - 0041-1132

IS - 3

ER -