20) I have published a detailed description of the presence of dehemoglobinized pRBCs
as the reason for the unusual retinal vessel whitening seen clinically (21); a clinicopathologic correlation of retinal hemorrhages with brain hemorrhages that has underpinned the use of the fundus as a diagnostic and prognostic aid for cerebral malaria (22); and, most recently, a detailed examination of the retinal pathology of CM.
Jehovah's Witnesses generally refuse transfusion of allogeneic and autologous whole blood, pRBCs, platelets, fresh frozen plasma, and white blood cells due to an interpretation by their governing body that use of whole blood or major blood components is prohibited by passages in the Old Testament.
This has been attributed to transfusions of racially mismatched pRBCs, resulting in increased alloantigen exposure (8).
The future direction for combat damage control resuscitation will likely include synthetic hemoglobin as a replacement for pRBCs, especially in far forward environments.
Aggressively replacing the lost clotting factors approaching a 1:1 ratio of FFP to pRBCs should be a goal in all abbreviated damage control operations and intensive care unit resuscitation of all severely injured patients undergoing a massive blood transfusion (>10 units of pRBCs in 24 hours) in the combat zone.
The effect of storage on PRBCs includes decreased levels of 2,3-diphosphoglycerate with a resultant increase in oxygen affinity and a decrease in the ability of hemoglobin to offload oxygen.
Two prospective studies (7,17) of outcomes in ICU patients showed a higher mortality rate in patients receiving PRBCs than in those not receiving PRBCs, even when adjusted for acuity and other factors.
Level IIb facilities have at least 20 units of PRBCs
but no other blood products available (Table 4).
2, serum bicarbonate level [less than or equal to]15 mEq/L, transfusion volume [less than or equal to]4000 mL of PRBCs
, total blood replacement [less than or equal to]5000 mL if both PRBCs
and whole blood were used, and total operating room fluid replacement including crystalloids, blood, and blood products [less than or equal to]12,000 mL.
Several studies have evaluated the concentrations of hemolysis markers, such as free hemoglobin (FHb) and lactate dehydrogenase (LDH) in PRBCs
and whole blood after microwave heating (4-7).
Low intake of fluids, loss of fluids because of vomiting and pyrexial sweating, cytokine and NO mediated arterial vasodilatation specifically organ specific release of NO, resistance to vasoactive hormones, cytopathic hypoxia leading to decreased ATP synthesis, cytoadherence of PRBCs
, etc all may contribute singly or in combination towards malarial ARF.
She received multiple transfusions of PRBCs
and platelets, and overcame Haemophilus influenzae sepsis.