Experiences with frozen blood products in the Afghan theater (Aug 2006 Aug 2008)

Transcription

1 Experiences with frozen blood products in the Afghan theater (Aug 2006 Aug 2008) CCM Lelkens, SBB(ASCP) Cdr (MC) (Royal Netherlands Navy) CO NLD Military Blood Bank 1

2 Outline Introduction ISAF / OEF facts and figures Conclusions The way ahead Questions 2

3 Netherlands Blood Supply Only One (civilian) Organization is responsible for the Netherlands (national) Blood Supply 3

4 Netherlands Military Blood Supply Dependent upon the civilian organization: Recruitment and selection of donors Testing of donors Preparation of raw materials Production of standard, liquid red cells 4

5 Mandatory Tests on Volunteer, Allogeneic Donations performed by the civilian blood bank organization ABO, RH D Syphilis Hepatitis B sag Hepatitis C (NAT) Anti-Hepatitis C HIV 1 and 2 (NAT) Anti-HIV 1 and 2 Anti-HTLV I and II 5

6 MILITARY BLOOD COMPONENTS (Role 2 and 3 MTF s) O Platelets (25-50 U) 2 years at -80º C (*) AB Plasma (50-75 U) 7 years at -80º C (*) O Red Cells ( U) 10 years at -80º C (**) * + 6 hrs at 22 C after thawing / mixing ** + 14 days at 4 C after sterile thawing and washing 6

7 Outline Introduction ISAF / OEF facts and figures Conclusions The way ahead Questions 7

8 (Three) Two NLD Liquid-Frozen Blood Banks OEF / ISAF

9 NLD Blood Products ISAF / OEF Liquid-frozen blood bank module Afghanistan Bosnia Iraq Liberia Pakistan

10 Exposed to Danger 10

11 Type of Wounds / Problems Shrapnel Wounds (High Velocity) GSW Blast Injuries Time Delay (hypothermia! ) Mass Casualties with Massive Transfusion Needs 11

12 Coalition Military Fatalities By Year Year US Other Total Total (Nov 21) 12

13 Joint Combined (Medical) Effort 13

14 Joint Combined (Medical) Effort 14

15 aug-06 oct-06 dec-06 feb-07 apr-07 jun-07 aug-07 oct-07 dec-07 feb-08 apr-08 jun-08 aug-08 Blood usage by month and patients transfused EC DEC DFP DTC patients 15

16 Patients transfused with NLD products ( ) Nr of Patients Percentage F-RBC FFP F-Plt s L-RBC AFG UK CAN US NLD AUS Unk Total:

17 Massive Transfusions within 48 hrs RBC L-RBC F-RBC FFP F-PLT AFG NLD AFG AFG NLD AFG AFG AFG NLD AFG NLD AFG NLD 17

18 Red Cell Units transfused in Shelf life at time of transfusion DEC in AS3 EC in SAGM storage at 4 C (days) storage at 4 C (days) 41 Frozen RBC 46 Liquid RBC ± 30% < 2 days old ± 80% > 2 wks old 18

19 nr of units nr of units Frozen Platelets: Recovery and Plt Count <50% n=403, avg 70±12% 10 units<50%, 2 units <40% >=50%<60% >=60%<70% >=70%<80% >=80%<0% >=0% < n=403, avg 28±62 10^ Tc/Unit 10 units <200 10^ Tc/Unit >=200<250 >=250<300 >=300<350 >=350<400 >=400 TC recovery total process Plt Units Transfused: 403 TC content (10^/Unit) Recovery: 70 ± 12% Plt Count: 28 ± 62 x 10/U 1

20 FROZEN PLATELETS IN THE TEG Acceleration of clotting Fresh WB, in citrate, 200TC x 10 /L WB, filtered: 0 TC x 10 /L WB, filtered: 200 liquid TC x 10 /L WB, filtered: 200 frozen/thawed TC x10 /L 20

21 Outline Introduction ISAF / OEF facts and figures Conclusions The way ahead Questions 21

22 CONCLUSIONS Frozen blood products can provide safe, effective blood components on demand No walking blood bank required 22

23 Outline Introduction ISAF / OEF facts and figures Conclusions The way ahead Questions 23

24 Are we there yet..?? 24

25 ` Challenges and difficulties upstream. 25

26 I don't like you, because you are dangerous...! (Iceman vs. Maverick) Whole Blood works, but: Potentially Unsafe Unnecessary Fully tested components can do the job! 26

27 Goals / Improvements: Simpler, shorter (washing) procedures Prolonged post-wash shelf lives Blood bankers and clinicians: Fresh Whole Blood Frozen components Massive Transfusion Protocol needed! 27

28 QUESTIONS?? 28