Methods of preserving platelets: cryopreservation as a reasonable option for its implementation in Argentina
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Abstract:
Platelets are one of the most widely used blood components in transfusion medicine, given their importance in the prevention of bleeding disorders in patients with multifactorial thrombocytopenia and Asian non-immunological etiology, as well as in the management of traumatic or blood-related surgical treatments. Given its extensive use and the constant demand for it to be used within the different procedures associated with medicine, it is the objective of both hemotherapy services and blood banks to ensure that blood product components are constantly available to meet such requirements. The main challenge with this resource is its short useful life (5–7 days) which limits its availability, especially in the Latin American context where the production of blood components as well as the resources allocated for this purpose by state entities to blood banks, are generally limited. Cryopreservation at –80°C using dimethylsulfoxide as a preservative solution is a technique used since the 1950s to prolong platelet survival, the improvement of which has been remarkable in recent years, thereby constituting an alternative solution to this problem.Keywords:
Hemotherapy
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Blood management
Patient Blood Management (PBM) is a multidimensional approach that seeks to optimize the use of blood and its components in patients. This matter emerged as a response to the need to reduce unnecessary exposure to blood transfusions and their potential risks. In the past, blood transfusion was often overused resulting in complications and high costs. The advent of Patient Blood Management has caused a paradigm shift, highlighting anemia prevention, bleeding control and maximizing the production of blood cells by the organism itself. Patient Blood Management guidelines include the early identification of anemia, strategies to minimize blood loss during surgery, intraoperative blood conservation techniques, preoperative hemoglobin optimization and evidence-based approaches to the rational use of blood transfusions. Aiming to improve clinical outcomes, decrease transfusion-related complications and reduce associated costs, this multidisciplinary approach counts on doctors, nurses, pharmacists and other healthcare professionals. Based on research and clinical evidence, Patient Blood Management continues to evolve thereby promoting safer, more effective patient-centered practices. Its implementation has proven beneficial in various medical contexts thereby contributing to improvements in the quality of care provided to patients. Our goal with this Consensus is to present readers with a broad and diverse view of Patient Blood Management so that they have the building blocks to implement this new technique.
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The preoperative clinical and laboratory evaluations of the patient is an essential step to ensure the safety and success of any surgical procedure. This assessment aims to identify any underlying medical conditions and risk factors and determine suitability for surgery. With this step, the medical team can adapt the care plan to meet each patient's specific needs, increasing the chances of a successful procedure. Good clinical assessment and comprehensive laboratory testing, when integrated into a Patient Blood Management approach, are invaluable in promoting safety of care, reducing transfusion risks, improving surgical outcomes, and optimizing resource utilization. This approach not only elevates the quality of care, but is also aligned with evidence-based practice and patient-centered principles, making it an essential component of the perioperative process.
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Managing coagulation disorders and potential bleeding risks, especially in the context of anticoagulant medications, is of immense value both clinically and prior to surgery. Coagulation disorders can lead to bleeding complications, affecting patient safety and surgical outcomes. The use of Patient Blood Management protocols offers a comprehensive, evidence-based approach that effectively addresses these challenges. The problem is to find a delicate balance between preventing thromboembolic events (blood clots) and reducing the risk of bleeding. Anticoagulant medications, although crucial to preventing clot formation, can increase the potential for bleeding during surgical procedures. Patient blood management protocols aim to optimize patient outcomes by minimizing blood loss and unnecessary transfusions.
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The management of major bleeding is a critical aspect of modern healthcare and it is imperative to emphasize the importance of applying Patient Blood Management (PBM) principles. Although transfusion support remains a vital component of bleeding control, treating severe bleeding goes beyond simply replacing lost blood. A more comprehensive, multidisciplinary approach is essential to optimize patient outcomes and minimize the risks associated with excessive transfusions.
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Anemia is a pathological condition in which the hemoglobin and red blood cell mass decrease; it is mainly defined by the concentration of hemoglobin in the blood. The World Health Organization guidelines establish specific values to define anemia in different population groups. Early detection of anemia can also be a valuable indicator of underlying medical conditions. Clinical studies have explored the relationship between perioperative anemia and morbidity, highlighting the need for more judicious therapeutic strategies, such as the use of Patient Blood Management, which aims to prevent and treat anemia in a personalized and effective way. Patient Blood Management emerges as a promising approach to dealing with anemia, recognizing that its correction through transfusion always carries risks and that personalized prevention and treatment can offer better outcomes for patients.
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Patient Blood Management (PBM) is a holistic approach to managing blood as a resource of each patient; it is a multimodal strategy that is implemented using a set of techniques that can be applied in individual cases. In fact, the overall result of the implementation of PBM cannot be fully appreciated or explained by simply summing up the effects of the individual strategies and techniques used, since they can only produce the expected ideal result if combined. Implementing a PBM program in healthcare offers several benefits including improved patient safety, better outcomes, cost savings, conservation of resources, evidence-based practice, transfusion alternatives, improved quality of care, compliance with accreditation standards, patient-centered care, and professional education and training.
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The current issue of Transfusion Medicine and Hemotherapy is intended to introduce our readers as well as blood banks and hospitals to the goals of patient blood management (PBM). Consistently, all comprehensive reviews and original articles published here might help in promoting the international exchange of knowledge with a variety of clinical disciplines and their scientific societies. The recently published World Health Assembly Resolution on availability, safety, and quality of blood products [1] urges the implementation of PBM programs in all 193 WHO member states ‘in order to ensure that regulatory control in the area of quality and safety of blood products across the entire transfusion chain meets internationally recognized standards’. For Germany, updated Cross-Sectional Guidelines [2] were published recently in English that widely reflect the current state of scientific knowledge in transfusion medicine covering both the pharmaceutical preparation and therapeutic application of cellular blood components and plasma derivatives. By applying the general principles of evidence-based medicine, these recommendations allow for facilitating the decision-making of physicians when blood transfusions are in the patient's best interest [3].
PBM is based on the timely application of medical and surgical concepts designed to maintain patient's hemoglobin concentration, optimize hemostasis, minimize blood loss, and reduce or even avoid blood transfusions and subsequent transfusion-associated adverse events. The main target of PBM is to improve the patient's outcome [4].
Further issues in regard to blood transfusion are more and more limited blood supply and concurrently increased blood requirements in a more and more aged population especially for hospitals of maximum medical care [5]. A special issue of Transfusion Medicine and Hemotherapy in 2010 has addressed future challenges in the European blood supply in consideration of this demographic development [overview in 6]. Safety of blood transfusion has increased dramatically with regard to viral transmission but this was associated with dramatically increased costs for laboratory tests including PCR testing. On the other hand, more unspecific adverse events such as transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), transfusion-related immunomodulation (TRIM), and subsequent nosocomial infections still are major risks when transfusing allogeneic blood and have come more and more to the fore during the last years [7, 8] as these transfusion-associated adverse events are associated with increased morbidity and mortality and hospital costs as well [8, 9, 10].
In principle, PBM is an interdisciplinary approach including and cross-linking several specialties such as transfusion medicine, hematology, hemostaseology, anesthesiology, intensive care medicine, and surgery [11]. Implementing concerted strategies starting with early detection and treatment of preoperative anemia, introducing blood-saving surgical techniques, early bleeding control by point-of-care coagulation monitoring and calculated goal-directed hemostatic interventions, re-transfusion of (washed) savaged or drained blood during and after surgery, and, last not least, strategies to increase patient's resistance to postoperative anemia, are the main pillows of PBM [7, 8, 9, 11, 12, 13, 14]. Inappropriate or unnecessary blood transfusion should strictly be avoided [7]. Furthermore, close communication and collaboration between the involved disciplines are essential for success in PBM or at least for improving patient's outcome.
Moreover, the interdisciplinary concept of PBM bears the big chance for all participating specialties to increase their personal knowledge by looking beyond one's own nose. In this spirit, PBM illustrates the fact that big issues can only be solved by interdisciplinary concepts and close collaboration. This special issue on PBM is intended to emphasize this concept and to animate all colleagues involved in the management of bleeding and blood transfusion to expand their networking in this field and to increase their efforts to improve the patient's outcome.
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Managing the patient's blood and hematopoietic system is like managing any of the other organs and organ systems during patient care. Specialists control the heart, kidneys, endocrine system, etc. and the patient's blood requires similar clinical treatment. The hematopoietic system and its circulatory products are fundamental for the healthy functioning of the human body. In simple terms, Patient Blood Management (PBM) is an organized, patient-centered approach in which the entire healthcare team coordinates efforts to improve outcomes by managing and preserving the patient's own blood. By reducing dependence on blood transfusions, PBM seeks to improve clinical outcomes, reduce the risks and costs associated with transfusions, and improve the safety and quality of patient care. Essentially, the concept of PBM is about the holistic management and preservation of the patient's own blood in the medical and surgical context.
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Autologous blood transfusion can be achieved through different techniques, including by the patient donating blood before surgery (pre-deposit), collecting blood from the patient immediately before the operation and replacing the volume with colloids or plasma expanders (acute normovolemic hemodilution) or through the salvage of lost blood, during or immediately after surgery, and its retransfusion after washing (intraoperative or postoperative recovery). We will focus on the two methods used intraoperatively that are of fundamental importance in the management and conservation of the patient's own blood.
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