Скачать с ютуб WSPF - "The Red Cell Storage Lesion: Rethinking Transfusions" by Dr. Allan Doctor for OPENPediatrics в хорошем качестве

WSPF - "The Red Cell Storage Lesion: Rethinking Transfusions" by Dr. Allan Doctor for OPENPediatrics

Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: [email protected] Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Welcome to World Shared Practices Forum. I'm Dr. Jeff Burns, chief of critical care at Boston Children's Hospital and Harvard Medical School. We're very privileged to have with us today Dr. Allan Doctor. Allan is the professor of Pediatrics and Biochemistry at the Washington University in Saint Louis, and he is chief of critical care at Saint Louis Children's Hospital. Allan, welcome. Thank you, Jeff. Allan, for at least a decade or more, you've been studying, thinking about, and writing about red cells. And I think around the world our colleagues are probably most curious to know, how do we interpret the recent literature on red cell transfusions? How should we be thinking about this issue today? Thanks, Jeff. We're actually going through a really exciting paradigm change in transfusion medicine. We used to think that the appropriate thing to do with a critically ill patient was to build the hemoglobin reserve so that patients under physiologic stress would be better able to deal with that stress. We're now beginning to understand that donor red cells can cause harm and if that harm can exceed the need of the patient, that we're actually hurting children by giving them blood. So what I'd like to do is I'll review some of that evidence, the literature that indicates the impact of transfusion on outcome and an approach to sort of recalibrating our therapy. Here are my disclosures. And specifically, Jeff, I'd like to review mounting body of evidence which requires us to question the appropriateness of current transfusion practice. And specifically, we'll question the use of red cell transfusions to maintain a pre-specified circulating red cell mass in the absence of other clinical information. But first I'd like to zoom out a bit and ask everybody to rethink red cells. In fact, this is a living tissue that functions as its own organ. And here's a few facts that might help reorient the thinking. There's about 20 to 30 trillion red cells that are circulating in the average adult. And that's about 7% of our body mass. They comprise easily a quarter of the cells in the human body. There's about 1.4 million red cells produced a second, 200 billion a day. They have a lifespan of 100 to 120 days. And we replace 1% of the circulating mass every day. We also produce about 250 kilos of red cells over a lifetime. So we, in an evolutionary sense, devote a considerable amount of energy to maintaining this as a healthy tissue.