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Existing transfusion practices may also limit its utility in clinical practice.
The preoperative haemoglobin cutoff value of 10 g dl−1 was set according to existing transfusion guidelines.
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Or were existing (restrictive) transfusion guidelines simply neglected?
Moreover, in Greece and other countries there are often insufficient quantities to cover existing blood transfusion needs.
Gonzalez and colleagues studied the existing trauma massive transfusion protocol at Memorial Hospital in Houston, which at that time required the infusion of six units of RBCs prior to use of plasma [ 7].
Therefore, in regard of the existing evidence of conventional transfusion strategies for general ICU patients (TRICC study), a more liberal transfusion regime has to be very cautiously evaluated in each patient and also balanced against ethical concerns because of blood product shortage [ 2, 5].
The analysis may be potentially underestimating the economic burden by not including hospitalization that may occur the day of or day after a RBC transfusion because this may be a result of the transfusion exacerbating a existing condition or producing a new condition.
Expanding the definition to include delayed TRALI (development of ALI 6 to 72 hours after transfusion regardless of existing risk factors) increases the incidence to 25% with an associated mortality of 40% [ 31].
Currently existing predictive models for massive blood transfusion in major trauma patients had limitations for sequential evaluation of patients and lack of dynamic parameters.
Such events could exacerbate existing shortfalls in blood supply and compromise transfusion safety, especially in developing countries.
It is therefore possible that several factors influenced the indication for transfusions at these neonatal units, such as phlebotomy blood loss, differences in the criteria employed for the indication of transfusions, the degree of compliance with existing protocols and other healthcare practices [ 33].
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