Monday, June 26, 2006

Blood Goes Round and Round......
A supplement to this month's Journal of Trauma titled Early Massive Trauma Transfusion: State of the Art has made for some interesting reading. The indications and risks for the use of whole blood as well as component therapy are presented very well and the discussions are entertaining and informative as well. One that is more of the former than the latter is as follows:
I think the last two talks amount to a damning criticism of the use of red cells. The product is difficult to handle, can easily be given to the wrong person, has technically difficult storage requirements and a complication rate when given on the order of one to 100 to one to several million, depending upon the complications. As it ages and becomes less effective, there are data showing that in the critically ill population this product doesn't deliver oxygen. In fact, it becomes so toxic or so ineffective at 42 days that it is simply thrown away. Furthermore, use of this product is independently associated with increased risk of infection, increased hospital stay, increased mortality, and with increased risk of multiple organ failure. So I only have one question for the speakers and the audience, and that is: Can a compassionate, caring, evidence-based physician in 2005 ever prescribe this product?

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