title: Blood product utilization in human upper-extremity transplantation: challenges, complications, considerations, and transfusion protocol conception.
abstract: Upper-extremity transplantation (UET) is a reality. Immunologic, functional, and graft survival outcomes have been encouraging. However, these complex reconstructions have unique considerations that pose distinct challenges. Transplant programs have reported morbidity and mortality due to significant intraoperative blood losses, but similar data are scant during other phases of recovery. We report experience from two centers on complete blood component demands and utilization with UET.
  
  
  
  Inpatient medical records of UET recipients from intraoperative (time from initiation of transplant surgery to exit from the operative suite) and postoperative (exit from the operative suite to discharge from the hospital) phases were retrospectively reviewed.
  
  
  
  Six patients received various UETs and mean (±SD) postoperative hospital stay was 46 (±14.4) days. Mean (±SD) intraoperative blood unit utilization was 14.8 (±10.2) red blood cells (RBCs), 10.5 (±11.8) plasma, 0.8 (±1.2) platelets (PLTs), and 0.3 (±0.8) cryoprecipitate units. Mean postoperative blood unit utilization was 9.3 (±10.4) RBCs, 5.3 (±6.7) plasma, 1.2 (±2.0) PLTs, and 0.7 (±1.6) cryoprecipitate units. Both intraoperative and postoperative blood utilization for unilateral versus bilateral transplant were different, but not significantly so. However, total inpatient blood use in bilateral transplants was significantly greater than in unilateral transplants.
  
  
  
  Substantial blood loss may occur in UET and require transfusion of many blood components, primarily RBCs and plasma. We propose an UET transfusion protocol and suggest that centers preparing to perform these transplants should actively engage the transfusion medicine service to ensure availability and access to appropriate blood components for the entire hospitalizations of these unique patients.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Jay S
authors.initials: JS
authors.lastname: Raval
authors.affiliation: Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Vijay S
authors.initials: VS
authors.lastname: Gorantla
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jaimie T
authors.initials: JT
authors.lastname: Shores
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: W P Andrew
authors.initials: WP
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Raymond M
authors.initials: RM
authors.lastname: Planinsic
authors.affiliation: Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Marian A
authors.initials: MA
authors.lastname: Rollins-Raval
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Gerald
authors.initials: G
authors.lastname: Brandacher
authors.affiliation: Department of Pathology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Karen E
authors.initials: KE
authors.lastname: King
authors.affiliation: Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Losee
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.|The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Kiss
mesh_terms: D000328:Adult; D016913:Blood Component Transfusion; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D011182:Postoperative Care; D012189:Retrospective Studies; D034941:Upper Extremity / Q000601:surgery*