评估低滴度 O 型全血在儿童和青少年中的安全性、止血效果和临床影响。
An assessment of the safety, hemostatic efficacy, and clinical impact of low-titer group O whole blood in children and adolescents.
机构信息
From the University of Texas at Houston (J.G, K.M., D.L., G.H., C.W, B.C.), Red Duke Trauma Institute, Houston, Texas; Tripler Army Medical Center (J.B.), Hawaii -Honolulu, Hawaii; Department of Pediatric Critical Care Medicine (K.B.), University of Texas at Houston, Houston Texas; University of Texas at Houston (C.C.), UT Physicians Pediatric Surgery, Houston, Texas.
出版信息
J Trauma Acute Care Surg. 2023 Oct 1;95(4):497-502. doi: 10.1097/TA.0000000000004035. Epub 2023 Jun 20.
BACKGROUND
Low-titer group O whole blood (LTOWB) use has been associated with improved survival and less blood transfusions in adult trauma patients. Its use in pediatric trauma has been shown to be safe when using leukoreduced, LTOWB with anti-A, anti-B antibody titers of <1:50. We set out to evaluate the safety, hemostatic potential, and impact on pediatric outcomes at a center using non-leukoreduced, LTOWB with anti-A, anti-B antibody titers of <1:200.
METHODS
Patients younger than 18 years, who received emergency-release, uncrossed matched blood, and presented to our trauma center from November 2017 to April 2021 were included. Patients were divided into those receiving any LTOWB and those receiving only RBC and or plasma (COMP). Primary outcome was 30-day survival.
RESULTS
One hundred sixty-four patients received emergency release blood products. Of these, 73 received at least one unit of LTOWB. The LTOWB group were younger (14 years vs. 13 years), more likely to be male (87% vs. 49%), and to have sustained penetrating trauma (44% vs. 23%); all p < 0.05. Low-titer group O whole blood patients received more blood than their COMP counterparts prior to arrival. Serial hemolysis panels (K+, bilirubin, LDH, haptoglobin) obtained at 24 hours, 48 hours, and 72 hours were similar between groups; all p > 0.05. There was no difference in survival by univariate analysis but after adjusting for inverse probability of treatment weights there was an observed association between WB administration and improved survival, with an odds ratio of 2.48 (1.15-5.47).
CONCLUSION
Non-leukoreduced, LTOWB in anti-A/anti-B antibody titers of <1:200 appear safe in children and adolescents. While patients receiving LTOWB had more evidence of shock, higher torso injury severity, and received more prehospital blood products, there may be a mortality benefit with whole blood. Larger, multicenter studies are needed.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
背景
低滴度 O 型全血（LTOWB）的使用与成人创伤患者的存活率提高和输血减少有关。在儿科创伤中，使用白细胞减少的、抗 A、抗 B 抗体滴度<1:50 的 LTOWB 是安全的。我们旨在评估在使用非白细胞减少的、抗 A、抗 B 抗体滴度<1:200 的 LTOWB 的中心的安全性、止血潜力和对儿科结果的影响。
方法
纳入 2017 年 11 月至 2021 年 4 月期间在我们的创伤中心接受急诊释放、未交叉匹配的血液且年龄小于 18 岁的患者。患者分为接受任何 LTOWB 和仅接受 RBC 和/或血浆（COMP）的患者。主要结局是 30 天生存率。
结果
164 名患者接受了急诊释放血液制品。其中，73 名患者至少接受了 1 单位的 LTOWB。LTOWB 组年龄较小（14 岁 vs. 13 岁），更可能为男性（87% vs. 49%），更可能遭受穿透性创伤（44% vs. 23%）；所有 p<0.05。LTOWB 组在到达之前接受的血液量多于 COMP 组。在 24 小时、48 小时和 72 小时获得的连续溶血谱（K+、胆红素、LDH、结合珠蛋白）在两组之间相似；所有 p>0.05。单因素分析无生存差异，但经治疗权重反概率调整后，发现 WB 给药与生存率提高之间存在关联，优势比为 2.48（1.15-5.47）。
结论
在抗 A/抗 B 抗体滴度<1:200 的情况下，非白细胞减少的、低滴度 O 型全血在儿童和青少年中似乎是安全的。尽管接受 LTOWB 的患者有更多休克的证据、更高的躯干损伤严重程度和接受了更多的院前血液制品，但全血可能有死亡率的益处。需要更大规模、多中心的研究。
证据水平
治疗/护理管理；IV 级。
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