ORCID Profile
0000-0003-1721-0541
Current Organisations
Newcastle University
,
University of Pittsburgh
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Publisher: Wiley
Date: 04-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2018
DOI: 10.1097/CCM.0000000000003192
Abstract: Little is known about platelet transfusions in pediatric critical illness. We sought to describe the epidemiology, indications, and outcomes of platelet transfusions among critically ill children. Prospective cohort study. Multicenter (82 PICUs), international (16 countries) from September 2016 to April 2017. Children ages 3 days to 16 years prescribed a platelet transfusion in the ICU during screening days. None. Over 6 weeks, 16,934 patients were eligible, and 559 received at least one platelet transfusion (prevalence, 3.3%). The indications for transfusion included prophylaxis (67%), minor bleeding (21%), and major bleeding (12%). Thirty-four percent of prophylactic platelet transfusions were prescribed when the platelet count was greater than or equal to 50 × 10 9 cells/L. The median (interquartile range) change in platelet count post transfusion was 48 × 10 9 cells/L (17–82 × 10 9 cells/L) for major bleeding, 42 × 10 9 cells/L (16–80 × 10 9 cells/L) for prophylactic transfusions to meet a defined threshold, 38 × 10 9 cells/L (17–72 × 10 9 cells/L) for minor bleeding, and 25 × 10 9 cells/L (10–47 × 10 9 cells/L) for prophylaxis in patients at risk of bleeding from a device. Overall ICU mortality was 25% but varied from 18% to 35% based on indication for transfusion. Upon adjusted analysis, total administered platelet dose was independently associated with increased ICU mortality (odds ratio for each additional 1 mL/kg platelets transfused, 1.002 95% CI, 1.001–1.003 p = 0.005). The majority of platelet transfusions are given as prophylaxis to nonbleeding children, and significant variation in platelet thresholds exists. Studies are needed to clarify appropriate indications, with focus on prophylactic transfusions.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2019
DOI: 10.1097/PCC.0000000000001987
Abstract: To describe the epidemiology of platelet transfusions in critically ill children with an underlying oncologic diagnosis and to examine effects of prophylactic versus therapeutic transfusions. Subgroup analysis of a prospective, observational study. Eighty-two PICUs in 16 countries. All children (3 d to 16 yr old) who received a platelet transfusion during one of the six predefined screening weeks and had received chemotherapy in the previous 6 months or had undergone hematopoietic stem cell transplantation in the last year. None. Of the 548 patients enrolled in the parent study, 237 (43%) had an underlying oncologic diagnosis. In this population, 71% (168/237) of transfusions were given prophylactically, and 59% (139/237) of transfusions were given at a total platelet count greater than 20 × 10 9 /L, higher than the current recommendations. Those with an underlying oncologic diagnosis were significantly older, and received less support including less mechanical ventilation, fewer medications that affect platelet function, and less use of extracorporeal life support than those without an underlying oncologic diagnosis. In this subpopulation, there were no statistically significant differences in median (interquartile range) platelet transfusion thresholds when comparing bleeding or nonbleeding patients (50 × 10 9 /L [10–50 × 10 9 /L] and 30 × 10 9 /L [10–50 × 10 9 /L], respectively [ p = 0.166]). The median (interquartile range) interval transfusion increment in children with an underlying oncologic diagnosis was 17 × 10 9 /L (6–52 × 10 9 /L). The presence of an underlying oncologic diagnosis was associated with a poor platelet increment response to platelet transfusion in this cohort (adjusted odds ratio, 0.46 95% CI, 0.22–0.95 p = 0.035). Children with an underlying oncologic diagnosis receive nearly half of platelet transfusions prescribed by pediatric intensivists. Over half of these transfusions are prescribed at total platelet count greater than current recommendations. Studies must be done to clarify appropriate indications for platelet transfusions in this vulnerable population.
Publisher: Wiley
Date: 17-04-2023
DOI: 10.1111/TRF.17328
Abstract: Cold‐stored platelets are increasingly being used to treat bleeding. Differences in manufacturing processes and storage solutions can affect platelet quality and may influence the shelf life of cold‐stored platelets. PAS‐E and PAS‐F are approved platelet additive solutions (PAS) in Europe and Australia, or the United States respectively. Comparative data are required to facilitate international transferability of laboratory and clinical data. Single apheresis platelets from matched donors ( n = 8) were collected using the Trima apheresis platform and resuspended in either 40% plasma/60% PAS‐E or 40% plasma/60% PAS‐F. In a secondary study, platelets in PAS‐F were supplemented with sodium citrate, to match the concentration in PAS‐E. Components were refrigerated (2–6°C) and tested over 21 days. Cold‐stored platelets in PAS‐F had a lower pH, a greater propensity to form visible (and micro‐) aggregates, and higher activation markers compared to PAS‐E. These differences were most pronounced during extended storage (14–21 days). While the functional capacity of cold‐stored platelets was similar, the PAS‐F group displayed minor improvements in ADP‐induced aggregation and TEG parameters (R‐time, angle). Supplementation of PAS‐F with 11 mM sodium citrate improved the platelet content, maintained the pH above specifications and prevented aggregate formation. In vitro parameters were similar during short‐term cold storage of platelets in PAS‐E and PAS‐F. Storage in PAS‐F beyond 14 days resulted in poorer metabolic and activation parameters. However, the functional capacity was maintained, or even enhanced. The presence of sodium citrate may be an important constituent in PAS for extended cold storage of platelets.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2019
DOI: 10.1097/PCC.0000000000001779
Abstract: To determine if transfusing ABO compatible platelets has a greater effect on incremental change in platelet count as compared to ABO incompatible platelets in critically ill children. Secondary analysis of a prospective, observational study. Transfusions were classified as either ABO compatible, major incompatibility, or minor incompatibility. The primary outcome was the incremental change in platelet count. Transfusion reactions were analyzed as a secondary outcome. Eighty-two PICUs in 16 countries. Children (3 d to 16 yr old) were enrolled if they received a platelet transfusion during one of the predefined screening weeks. None. Five-hundred three children were enrolled and had complete ABO information for both donor and recipient, as well as laboratory data. Three-hundred forty-two (68%) received ABO-identical platelets, 133 (26%) received platelets with major incompatibility, and 28 (6%) received platelets with minor incompatibility. Age, weight, proportion with mechanical ventilation or underlying oncologic diagnosis did not differ between the groups. After adjustment for transfusion dose, there was no difference in the incremental change in platelet count between the groups the median (interquartile range) change for ABO-identical transfusions was 28 × 10 9 cells/L (8–68 × 10 9 cells/L), for transfusions with major incompatibility 26 × 10 9 cells/L (7–74 × 10 9 cells/L), and for transfusions with minor incompatibility 54 × 10 9 cells/L (14–81 × 10 9 cells/L) ( p = 0.37). No differences in count increment between the groups were noted for bleeding ( p = 0.92) and nonbleeding patients ( p = 0.29). There were also no differences observed between the groups for any transfusion reaction ( p = 0.07). No differences were seen in the incremental change in platelet count nor in transfusion reactions when comparing major ABO incompatible platelet transfusions with ABO compatible transfusions in a large study of critically ill children. Studies in larger, prospectively enrolled cohorts should be performed to validate whether ABO matching for platelet transfusions in critically ill children is necessary.
Publisher: American Thoracic Society
Date: 15-06-2015
Publisher: Wiley
Date: 04-09-2013
DOI: 10.1002/PBC.24724
Publisher: Springer Science and Business Media LLC
Date: 29-07-2017
DOI: 10.1007/S00134-017-4895-9
Abstract: In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus moving away from the augmentation of coagulation factors (such as recombinant factor VIIa) and towards fibrinogen supplementation and administration of antifibrinolytics such as tranexamic acid. Novel diagnostic techniques need to be evaluated to determine whether an in idualised precision approach is superior to current empirical practice. The timing and efficacy of platelet transfusions remain in question, while new blood products need to be developed and evaluated, including whole blood variants, lyophilised products and novel red cell storage modalities. The current cornerstones of TBI management are intracranial pressure control, maintenance of cerebral perfusion pressure and avoidance of secondary insults (such as hypotension, hypoxaemia, hyperglycaemia and pyrexia). Therapeutic hypothermia and decompressive craniectomy are controversial therapies. Further research into these strategies should focus on identifying which subgroups of patients may benefit from these interventions. Prediction of the long-term outcome early after TBI remains challenging. Early magnetic resonance imaging has recently been evaluated for predicting the long-term outcome in mild and severe TBI. Novel biomarkers may also help in outcome prediction and may predict chronic neurological symptoms. For trauma in general, rehabilitation is complex and multidimensional, and the optimal timing for commencement of rehabilitation needs investigation. We propose priority areas for clinical trials in the next 10 years.
Publisher: Wiley
Date: 13-05-2019
DOI: 10.1111/VOX.12763
Publisher: Wiley
Date: 13-05-2019
DOI: 10.1111/VOX.12762
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2014
Location: United States of America
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United States of America
No related grants have been discovered for Philip Spinella.