Transfusion and hematologic variables after fibrinogen or platelet transfusion in valve replacement surgery: preliminary data of purified lyophilized human fibrinogen concentrate versus conventional transfusion
Identifieur interne : 000C89 ( Istex/Corpus ); précédent : 000C88; suivant : 000C90Transfusion and hematologic variables after fibrinogen or platelet transfusion in valve replacement surgery: preliminary data of purified lyophilized human fibrinogen concentrate versus conventional transfusion
Auteurs : Kenichi A. Tanaka ; Katherine Egan ; Fania Szlam ; Satoru Ogawa ; John D. Roback ; Gautam Sreeram ; Robert A. Guyton ; Edward P. ChenSource :
- Transfusion [ 0041-1132 ] ; 2014-01.
Abstract
Platelet (PLT) and plasma transfusion remain the mainstay hemostatic therapy for perioperative bleeding. Several studies have indicated that acquired fibrinogen (FIB) deficiency can be the primary cause of bleeding after cardiac surgery. The aim of this study was to compare hematologic and transfusion profiles between the first‐line FIB replacement and PLT transfusion in post–cardiac surgical bleeding.
Url:
DOI: 10.1111/trf.12248
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<front><div type="abstract">Platelet (PLT) and plasma transfusion remain the mainstay hemostatic therapy for perioperative bleeding. Several studies have indicated that acquired fibrinogen (FIB) deficiency can be the primary cause of bleeding after cardiac surgery. The aim of this study was to compare hematologic and transfusion profiles between the first‐line FIB replacement and PLT transfusion in post–cardiac surgical bleeding.</div>
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<affiliation>Address reprint requests to: Kenichi A. Tanaka, MD, MSc, UPMC Presbyterian, C‐215, 200 Lothrop Street, Pittsburgh, PA 15213; e‐mail: tanakak@upmc.edu.</affiliation>
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<orgName>University of Pittsburgh Medical Center</orgName>
<address><settlement type="city">Pittsburgh</settlement>
<region>Pennsylvania</region>
</address>
</affiliation>
<affiliation><orgName>Department of Anesthesiology</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
<affiliation><orgName>Department of Pathology</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
<affiliation><orgName>Department of Surgery (Cardiothoracic)</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
</author>
<author xml:id="author-0003"><persName><forename type="first">Satoru</forename>
<surname>Ogawa</surname>
</persName>
<affiliation><orgName>Department of Anesthesiology</orgName>
<orgName>University of Pittsburgh Medical Center</orgName>
<address><settlement type="city">Pittsburgh</settlement>
<region>Pennsylvania</region>
</address>
</affiliation>
<affiliation><orgName>Department of Anesthesiology</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
<affiliation><orgName>Department of Pathology</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
<affiliation><orgName>Department of Surgery (Cardiothoracic)</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
</author>
<author xml:id="author-0004"><persName><forename type="first">John D.</forename>
<surname>Roback</surname>
</persName>
<affiliation><orgName>Department of Anesthesiology</orgName>
<orgName>University of Pittsburgh Medical Center</orgName>
<address><settlement type="city">Pittsburgh</settlement>
<region>Pennsylvania</region>
</address>
</affiliation>
<affiliation><orgName>Department of Anesthesiology</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
<affiliation><orgName>Department of Pathology</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
<affiliation><orgName>Department of Surgery (Cardiothoracic)</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
</author>
<author xml:id="author-0005"><persName><forename type="first">Gautam</forename>
<surname>Sreeram</surname>
</persName>
<affiliation><orgName>Department of Anesthesiology</orgName>
<orgName>University of Pittsburgh Medical Center</orgName>
<address><settlement type="city">Pittsburgh</settlement>
<region>Pennsylvania</region>
</address>
</affiliation>
<affiliation><orgName>Department of Anesthesiology</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
<affiliation><orgName>Department of Pathology</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
<affiliation><orgName>Department of Surgery (Cardiothoracic)</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
</author>
<author xml:id="author-0006"><persName><forename type="first">Robert A.</forename>
<surname>Guyton</surname>
</persName>
<affiliation><orgName>Department of Anesthesiology</orgName>
<orgName>University of Pittsburgh Medical Center</orgName>
<address><settlement type="city">Pittsburgh</settlement>
<region>Pennsylvania</region>
</address>
</affiliation>
<affiliation><orgName>Department of Anesthesiology</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
<affiliation><orgName>Department of Pathology</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
<affiliation><orgName>Department of Surgery (Cardiothoracic)</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
</author>
<author xml:id="author-0007"><persName><forename type="first">Edward P.</forename>
<surname>Chen</surname>
</persName>
<affiliation><orgName>Department of Anesthesiology</orgName>
<orgName>University of Pittsburgh Medical Center</orgName>
<address><settlement type="city">Pittsburgh</settlement>
<region>Pennsylvania</region>
</address>
</affiliation>
<affiliation><orgName>Department of Anesthesiology</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
<affiliation><orgName>Department of Pathology</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
<affiliation><orgName>Department of Surgery (Cardiothoracic)</orgName>
<orgName>Emory University School of Medicine</orgName>
<address><settlement type="city">Atlanta</settlement>
<region>Georgia</region>
</address>
</affiliation>
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<monogr><title level="j" type="main">Transfusion</title>
<title level="j" type="alt">TRANSFUSION</title>
<idno type="pISSN">0041-1132</idno>
<idno type="eISSN">1537-2995</idno>
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<profileDesc><abstract style="main">
Background
<p>Platelet (<hi rend="fc">PLT</hi>
) and plasma transfusion remain the mainstay hemostatic therapy for perioperative bleeding. Several studies have indicated that acquired fibrinogen (<hi rend="fc">FIB</hi>
) deficiency can be the primary cause of bleeding after cardiac surgery. The aim of this study was to compare hematologic and transfusion profiles between the first‐line <hi rend="fc">FIB</hi>
replacement and <hi rend="fc">PLT</hi>
transfusion in post–cardiac surgical bleeding.</p>
Study Design and Methods
<p>In this prospective, randomized, open‐label study, 20 adult patients who underwent valve replacement or repair and fulfilled preset visual bleeding scale were randomized to 4 g of <hi rend="fc">FIB</hi>
or 1 unit of apheresis <hi rend="fc">PLTs</hi>
. Primary endpoints included hemostatic condition in the surgical field and 24‐hour hemostatic product usage. Hematologic data, clinical outcome, and safety data were collected up to the 28th day postoperative visit.</p>
Results
<p>In patients who received the first‐line <hi rend="fc">FIB</hi>
concentrate (n = 10), the visual bleeding scale improved after intervention, and the incidence of <hi rend="fc">PLT</hi>
transfusion and total plasma donor exposure were lower compared to the <hi rend="fc">PLT</hi>
group (n = 10). Postintervention <hi rend="fc">FIB</hi>
level was statistically higher (209 mg/<hi rend="fc">dL</hi>
vs. 165 mg/<hi rend="fc">dL</hi>
) in the <hi rend="fc">FIB</hi>
group than in the <hi rend="fc">PLT</hi>
group, but <hi rend="fc">PLT</hi>
count and prothrombin were lower. There were no statistical differences in the postoperative blood loss and red blood cell transfusion between two groups.</p>
Conclusions
<p>Our preliminary data indicate that the primary <hi rend="fc">FIB</hi>
replacement may potentially reduce the incidence of <hi rend="fc">PLT</hi>
transfusion and the number of donor exposures. Plasma <hi rend="fc">FIB</hi>
level of 200 mg/<hi rend="fc">dL</hi>
is attainable with a single dose of 4 g, and this level seems to mitigate bleeding despite moderately decreased thrombin generation.</p>
</abstract>
<textClass><keywords rend="tocHeading1"><term>TRANSFUSION PRACTICE</term>
</keywords>
<keywords rend="articleCategory"><term>TRANSFUSION PRACTICE</term>
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<publicationMeta level="part" position="01101"><doi>10.1111/trf.2014.54.issue-1</doi>
<copyright ownership="thirdParty">Copyright © 2014 AABB</copyright>
<numberingGroup><numbering number="54" type="journalVolume">54</numbering>
<numbering type="journalIssue">1</numbering>
</numberingGroup>
<coverDate startDate="2014-01">January 2014</coverDate>
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<titleGroup><title type="tocHeading1">TRANSFUSION PRACTICE</title>
<title type="articleCategory">TRANSFUSION PRACTICE</title>
</titleGroup>
<copyright ownership="thirdParty">© 2013 American Association of Blood Banks</copyright>
<eventGroup><event agent="bestset" date="2013-04-30" type="xmlCreated"></event>
<event date="2013-01-02" type="manuscriptReceived"></event>
<event date="2013-03-31" type="manuscriptRevised"></event>
<event date="2013-04-01" type="manuscriptAccepted"></event>
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<correspondenceTo><i>Address reprint requests to:</i>
Kenichi A. Tanaka, MD, MSc, UPMC Presbyterian, C‐215, 200 Lothrop Street, Pittsburgh, PA 15213; e‐mail: <email>tanakak@upmc.edu</email>
.</correspondenceTo>
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<contentMeta><titleGroup><title type="short">Fibrinogen versus PLT Concentrate in Valve Replacement</title>
<title type="shortAuthors">Tanaka et al.</title>
<title type="main">Transfusion and hematologic variables after fibrinogen or platelet transfusion in valve replacement surgery: preliminary data of purified lyophilized human fibrinogen concentrate versus conventional transfusion</title>
</titleGroup>
<creators><creator affiliationRef="#trf12248-aff-0001 #trf12248-aff-0002 #trf12248-aff-1002 #trf12248-aff-0003" corresponding="yes" creatorRole="author" xml:id="trf12248-cr-0001"><personName><givenNames>Kenichi A.</givenNames>
<familyName>Tanaka</familyName>
</personName>
</creator>
<creator affiliationRef="#trf12248-aff-0001 #trf12248-aff-0002 #trf12248-aff-1002 #trf12248-aff-0003" creatorRole="author" xml:id="trf12248-cr-0002"><personName><givenNames>Katherine</givenNames>
<familyName>Egan</familyName>
</personName>
</creator>
<creator affiliationRef="#trf12248-aff-0001 #trf12248-aff-0002 #trf12248-aff-1002 #trf12248-aff-0003" creatorRole="author" xml:id="trf12248-cr-0003"><personName><givenNames>Fania</givenNames>
<familyName>Szlam</familyName>
</personName>
</creator>
<creator affiliationRef="#trf12248-aff-0001 #trf12248-aff-0002 #trf12248-aff-1002 #trf12248-aff-0003" creatorRole="author" xml:id="trf12248-cr-0004"><personName><givenNames>Satoru</givenNames>
<familyName>Ogawa</familyName>
</personName>
</creator>
<creator affiliationRef="#trf12248-aff-0001 #trf12248-aff-0002 #trf12248-aff-1002 #trf12248-aff-0003" creatorRole="author" xml:id="trf12248-cr-0005"><personName><givenNames>John D.</givenNames>
<familyName>Roback</familyName>
</personName>
</creator>
<creator affiliationRef="#trf12248-aff-0001 #trf12248-aff-0002 #trf12248-aff-1002 #trf12248-aff-0003" creatorRole="author" xml:id="trf12248-cr-0006"><personName><givenNames>Gautam</givenNames>
<familyName>Sreeram</familyName>
</personName>
</creator>
<creator affiliationRef="#trf12248-aff-0001 #trf12248-aff-0002 #trf12248-aff-1002 #trf12248-aff-0003" creatorRole="author" xml:id="trf12248-cr-0007"><personName><givenNames>Robert A.</givenNames>
<familyName>Guyton</familyName>
</personName>
</creator>
<creator affiliationRef="#trf12248-aff-0001 #trf12248-aff-0002 #trf12248-aff-1002 #trf12248-aff-0003" creatorRole="author" xml:id="trf12248-cr-0008"><personName><givenNames>Edward P.</givenNames>
<familyName>Chen</familyName>
</personName>
</creator>
</creators>
<affiliationGroup><affiliation xml:id="trf12248-aff-0001"><orgDiv>Department of Anesthesiology</orgDiv>
<orgName>University of Pittsburgh Medical Center</orgName>
<address><city>Pittsburgh</city>
<countryPart>Pennsylvania</countryPart>
</address>
</affiliation>
<affiliation xml:id="trf12248-aff-0002"><orgDiv>Department of Anesthesiology</orgDiv>
<orgName>Emory University School of Medicine</orgName>
<address><city>Atlanta</city>
<countryPart>Georgia</countryPart>
</address>
</affiliation>
<affiliation xml:id="trf12248-aff-1002"><orgDiv>Department of Pathology</orgDiv>
<orgName>Emory University School of Medicine</orgName>
<address><city>Atlanta</city>
<countryPart>Georgia</countryPart>
</address>
</affiliation>
<affiliation xml:id="trf12248-aff-0003"><orgDiv>Department of Surgery (Cardiothoracic)</orgDiv>
<orgName>Emory University School of Medicine</orgName>
<address><city>Atlanta</city>
<countryPart>Georgia</countryPart>
</address>
</affiliation>
</affiliationGroup>
<fundingInfo><fundingAgency>CSL Behring GmbH (Marburg, Germany)</fundingAgency>
</fundingInfo>
<fundingInfo><fundingAgency>ROTEM, Inc</fundingAgency>
</fundingInfo>
<abstractGroup><abstract type="main"><section xml:id="trf12248-sec-0017"><title type="main">Background</title>
<p>Platelet (<fc>PLT</fc>
) and plasma transfusion remain the mainstay hemostatic therapy for perioperative bleeding. Several studies have indicated that acquired fibrinogen (<fc>FIB</fc>
) deficiency can be the primary cause of bleeding after cardiac surgery. The aim of this study was to compare hematologic and transfusion profiles between the first‐line <fc>FIB</fc>
replacement and <fc>PLT</fc>
transfusion in post–cardiac surgical bleeding.</p>
</section>
<section xml:id="trf12248-sec-0018"><title type="main">Study Design and Methods</title>
<p>In this prospective, randomized, open‐label study, 20 adult patients who underwent valve replacement or repair and fulfilled preset visual bleeding scale were randomized to 4 g of <fc>FIB</fc>
or 1 unit of apheresis <fc>PLTs</fc>
. Primary endpoints included hemostatic condition in the surgical field and 24‐hour hemostatic product usage. Hematologic data, clinical outcome, and safety data were collected up to the 28th day postoperative visit.</p>
</section>
<section xml:id="trf12248-sec-0019"><title type="main">Results</title>
<p>In patients who received the first‐line <fc>FIB</fc>
concentrate (n = 10), the visual bleeding scale improved after intervention, and the incidence of <fc>PLT</fc>
transfusion and total plasma donor exposure were lower compared to the <fc>PLT</fc>
group (n = 10). Postintervention <fc>FIB</fc>
level was statistically higher (209 mg/<fc>dL</fc>
vs. 165 mg/<fc>dL</fc>
) in the <fc>FIB</fc>
group than in the <fc>PLT</fc>
group, but <fc>PLT</fc>
count and prothrombin were lower. There were no statistical differences in the postoperative blood loss and red blood cell transfusion between two groups.</p>
</section>
<section xml:id="trf12248-sec-0020"><title type="main">Conclusions</title>
<p>Our preliminary data indicate that the primary <fc>FIB</fc>
replacement may potentially reduce the incidence of <fc>PLT</fc>
transfusion and the number of donor exposures. Plasma <fc>FIB</fc>
level of 200 mg/<fc>dL</fc>
is attainable with a single dose of 4 g, and this level seems to mitigate bleeding despite moderately decreased thrombin generation.</p>
</section>
</abstract>
</abstractGroup>
</contentMeta>
<noteGroup><note numbered="no" xml:id="trf12248-note-1001">The study was supported by CSL Behring GmbH (Marburg, Germany).</note>
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<titleInfo type="abbreviated" lang="en"><title>Fibrinogen versus PLT Concentrate in Valve Replacement</title>
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<name type="personal"><namePart type="given">Kenichi A.</namePart>
<namePart type="family">Tanaka</namePart>
<affiliation>Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania</affiliation>
<affiliation>Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Pathology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Surgery (Cardiothoracic), Emory University School of Medicine, Georgia, Atlanta</affiliation>
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<name type="personal"><namePart type="given">Katherine</namePart>
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<affiliation>Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania</affiliation>
<affiliation>Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Pathology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Surgery (Cardiothoracic), Emory University School of Medicine, Georgia, Atlanta</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
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<name type="personal"><namePart type="given">Fania</namePart>
<namePart type="family">Szlam</namePart>
<affiliation>Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania</affiliation>
<affiliation>Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Pathology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Surgery (Cardiothoracic), Emory University School of Medicine, Georgia, Atlanta</affiliation>
<role><roleTerm type="text">author</roleTerm>
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</name>
<name type="personal"><namePart type="given">Satoru</namePart>
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<affiliation>Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania</affiliation>
<affiliation>Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Pathology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Surgery (Cardiothoracic), Emory University School of Medicine, Georgia, Atlanta</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">John D.</namePart>
<namePart type="family">Roback</namePart>
<affiliation>Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania</affiliation>
<affiliation>Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Pathology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Surgery (Cardiothoracic), Emory University School of Medicine, Georgia, Atlanta</affiliation>
<role><roleTerm type="text">author</roleTerm>
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</name>
<name type="personal"><namePart type="given">Gautam</namePart>
<namePart type="family">Sreeram</namePart>
<affiliation>Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania</affiliation>
<affiliation>Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Pathology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Surgery (Cardiothoracic), Emory University School of Medicine, Georgia, Atlanta</affiliation>
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</name>
<name type="personal"><namePart type="given">Robert A.</namePart>
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<affiliation>Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Pathology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Surgery (Cardiothoracic), Emory University School of Medicine, Georgia, Atlanta</affiliation>
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<name type="personal"><namePart type="given">Edward P.</namePart>
<namePart type="family">Chen</namePart>
<affiliation>Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania</affiliation>
<affiliation>Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Pathology, Emory University School of Medicine, Atlanta, Georgia</affiliation>
<affiliation>Department of Surgery (Cardiothoracic), Emory University School of Medicine, Georgia, Atlanta</affiliation>
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<abstract>Platelet (PLT) and plasma transfusion remain the mainstay hemostatic therapy for perioperative bleeding. Several studies have indicated that acquired fibrinogen (FIB) deficiency can be the primary cause of bleeding after cardiac surgery. The aim of this study was to compare hematologic and transfusion profiles between the first‐line FIB replacement and PLT transfusion in post–cardiac surgical bleeding.</abstract>
<abstract>In this prospective, randomized, open‐label study, 20 adult patients who underwent valve replacement or repair and fulfilled preset visual bleeding scale were randomized to 4 g of FIB or 1 unit of apheresis PLTs. Primary endpoints included hemostatic condition in the surgical field and 24‐hour hemostatic product usage. Hematologic data, clinical outcome, and safety data were collected up to the 28th day postoperative visit.</abstract>
<abstract>In patients who received the first‐line FIB concentrate (n = 10), the visual bleeding scale improved after intervention, and the incidence of PLT transfusion and total plasma donor exposure were lower compared to the PLT group (n = 10). Postintervention FIB level was statistically higher (209 mg/dL vs. 165 mg/dL) in the FIB group than in the PLT group, but PLT count and prothrombin were lower. There were no statistical differences in the postoperative blood loss and red blood cell transfusion between two groups.</abstract>
<abstract>Our preliminary data indicate that the primary FIB replacement may potentially reduce the incidence of PLT transfusion and the number of donor exposures. Plasma FIB level of 200 mg/dL is attainable with a single dose of 4 g, and this level seems to mitigate bleeding despite moderately decreased thrombin generation.</abstract>
<note type="funding">CSL Behring GmbH (Marburg, Germany)</note>
<note type="funding">ROTEM, Inc</note>
<relatedItem type="host"><titleInfo><title>Transfusion</title>
</titleInfo>
<titleInfo type="abbreviated"><title>Transfusion</title>
</titleInfo>
<genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre>
<subject><genre>article-category</genre>
<topic>TRANSFUSION PRACTICE</topic>
</subject>
<identifier type="ISSN">0041-1132</identifier>
<identifier type="eISSN">1537-2995</identifier>
<identifier type="DOI">10.1111/(ISSN)1537-2995</identifier>
<identifier type="PublisherID">TRF</identifier>
<part><date>2014</date>
<detail type="volume"><caption>vol.</caption>
<number>54</number>
</detail>
<detail type="issue"><caption>no.</caption>
<number>1</number>
</detail>
<extent unit="pages"><start>109</start>
<end>118</end>
<total>10</total>
</extent>
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<identifier type="istex">365102966A0074C951CFDCE8C21325E368A072A3</identifier>
<identifier type="ark">ark:/67375/WNG-MCWKQLPP-7</identifier>
<identifier type="DOI">10.1111/trf.12248</identifier>
<identifier type="ArticleID">TRF12248</identifier>
<accessCondition type="use and reproduction" contentType="copyright">Copyright © 2014 AABB© 2013 American Association of Blood Banks</accessCondition>
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