Comparison of RBCs and FFP with whole blood during liver transplant surgery.
BACKGROUND
Component therapy has become the accepted standard of care in transfusion medicine. In instances of large blood loss, the transfusion of whole blood rather than the combination of RBCs and FFP is rational and may be preferred.


METHODS
In a controlled, prospective, randomized study of 33 patients undergoing orthotopic liver transplantation, the effectiveness of component therapy (RBCs and FFP) was compared with the use of whole blood. Coagulation tests (prothrombin time and activated partial thromboplastin time), clotting factor levels (FV, FVIII, fibrinogen), platelet counts, the number of donor exposures, and the total volume of blood transfused for the whole-blood group and the component-therapy group were compared at designated times before surgery, during surgery, and 24 hours after surgery.


RESULTS
There was a significant difference (p=0.015) in the median number of donor exposures for RBCs and FFP, with fewer occurring in the whole-blood group (n=14.5) compared with the component group (n=25). There was no significant difference between groups in coagulation profiles during any of the phases of surgery except for a mild decrease in fibrinogen levels in the whole-blood group at the conclusion of surgery. There were no differences between the groups in the median volume of blood component replacement, the median age of blood components, the patients' Hct or the number of RBC-containing components transfused.


CONCLUSIONS
Whole blood, when compared with component therapy, is associated with fewer donor exposures yet provided equally effective replacement therapy for blood loss in liver transplantation patients.
Laine
Edward
E
Department of Pathology and Laboratory Medicine, Division of Transfusion Medicine, UCLA School of Medicine, Los Angeles, California, USA.
Steadman
Randolph
R
Calhoun
Loni
L
Blackall
Douglas
D
Levin
Philip
P
Braunfeld
Michelle
M
Nourmand
Hamid
H
Neelakanta
Gundappa
G
Ting
Lena
L
Gornbein
Jeffrey
J
Busuttil
Ronald
R
Petz
Lawrence
L
D001777:Blood Coagulation; D001803:Blood Transfusion; D017707:Erythrocyte Transfusion; D005165:Factor V / Q000032:analysis; D005169:Factor VIII / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D006400:Hematocrit; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D010314:Partial Thromboplastin Time; D010949:Plasma; D017713:Platelet Transfusion; D011446:Prospective Studies; D011517:Prothrombin Time
D005165:Factor V; D005169:Factor VIII; D005340:Fibrinogen