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Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Hemostatic resuscitation with plasma and platelets in trauma
Pär I Johansson1, Roberto S Oliveri, Sisse R Ostrowski
1Section for Transfusion Medicine, Capital Region Blood Bank, Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Denmark.
Journal of Emergencies, Trauma, and Shock
|July 13, 2012
Summary
Proactive administration of plasma and platelets (PLT) in trauma patients with massive bleeding significantly reduces mortality. Higher ratios of plasma/PLT to red blood cells (RBC) improve survival in massively transfused patients.
Area of Science:
- Trauma and Emergency Medicine
- Hematology and Transfusion Medicine
Background:
- Hemorrhage is a leading cause of death in massively transfused trauma patients.
- Optimal management strategies for massive bleeding remain debated.
- Hemostatic resuscitation, involving early and sustained blood product administration, is a recent concept.
Purpose of the Study:
- To investigate the impact of proactive plasma and/or platelet (PLT) administration on survival in trauma patients with massive bleeding.
- To analyze the effect of blood product ratios on mortality in trauma patients.
Main Methods:
- A meta-analysis of 16 studies (3,663 patients) published between January 2005 and November 2010.
- Inclusion criteria: trauma patients receiving massive transfusion (≥10 RBCs/24h).
- Comparison of highest versus lowest ratios of plasma and/or PLT to RBC concentrates and their effect on 30-day mortality.
Main Results:
- The highest ratio of plasma and/or PLT to RBC was associated with significantly decreased mortality (OR: 0.49; P<0.0001).
- A substantial statistical heterogeneity (I(2) = 58%) was observed across the included studies.
- Patients receiving higher ratios of plasma/PLT to RBC showed improved survival outcomes.
Conclusions:
- Meta-analysis confirms significantly lower mortality in massively transfused trauma patients treated with higher fresh frozen plasma (FFP) and/or PLT ratios.
- Further randomized controlled trials are needed to establish optimal FFP: RBC and PLT: RBC ratios.
Related Concept Videos
01:05Introduction to Hemostasis
Hemostasis is a complex physiological process that prevents excessive bleeding when a blood vessel is injured. It's crucial for maintaining the integrity of the circulatory system, as it ensures that our blood remains fluid while still within the vascular network and yet clots to prevent blood loss upon vessel injury.
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized, and...
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized, and...
01:22Formation of the Platelet Plug
The platelet phase, the second stage of hemostasis, commences around 15-20 seconds after an injury. It follows and overlaps with the vascular phase, during which blood vessels constrict to minimize blood loss.
As the injured blood vessel contracts, endothelial cells undergo contraction, revealing collagen fibers in the basement membrane and underlying connective tissue. Furthermore, the plasma membrane of endothelial cells becomes adhesive, preparing the site for platelet adhesion. Platelets...
As the injured blood vessel contracts, endothelial cells undergo contraction, revealing collagen fibers in the basement membrane and underlying connective tissue. Furthermore, the plasma membrane of endothelial cells becomes adhesive, preparing the site for platelet adhesion. Platelets...
01:09Coagulation
The coagulation phase is a critical part of the body's process to prevent blood loss following injury to blood vessels. It involves chemical reactions that form a clot to seal the injured area. The clotting process begins shortly after injury, within 15-20 seconds for severe damage and 1-2 minutes for minor injuries.
During the coagulation phase, clotting factors, or procoagulants, play a vital role in initiating and progressing the coagulation cascade. This cascade is a series of reactions...
During the coagulation phase, clotting factors, or procoagulants, play a vital role in initiating and progressing the coagulation cascade. This cascade is a series of reactions...
01:20Extrinsic and Intrinsic Pathways of Hemostasis
Blood clotting or coagulation involves extrinsic and intrinsic pathways, which ultimately merge into the common pathway, forming a fibrin clot.
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which forms a...
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which forms a...
01:16Clot Retraction and Fibrinolysis
After a fibrin clot is formed, the next step is clot retraction, a vital process facilitated by platelet contractile proteins, such as actin and myosin. These proteins pull the fibrin strands closer together and condense the clot. This action reduces the size of the clot, creating a smaller, denser structure that effectively seals off the damaged vessel. Clot retraction consolidates the clot and helps with wound healing by bringing the edges of the damaged blood vessel closer together.
01:28Phases of Wound Repair
Following injury, the integrity of the injured tissues must be reestablished. For example, in skin tissue, wound repair involves coordination among resident skin cells, blood mononuclear cells, extracellular matrix, growth factors, and cytokines to complete the healing cascade.
Formation of Blood Clot
In case of deep injuries, trauma to blood vessels results in blood loss. In the meantime, phospholipids released from the ruptured endothelial cellular membrane are converted into arachidonic...
Formation of Blood Clot
In case of deep injuries, trauma to blood vessels results in blood loss. In the meantime, phospholipids released from the ruptured endothelial cellular membrane are converted into arachidonic...