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1
Karkouti, Keyvan, Duminda N. Wijeysundera, Terrence M. Yau, Stuart A. McCluskey, Christopher T. Chan, Pui-Yuen Wong, Mark A. Crowther, Siroos Hozhabri, and W. Scott Beattie. "Advance Targeted Transfusion in Anemic Cardiac Surgical Patients for Kidney Protection." Anesthesiology 116, no. 3 (March 1, 2012): 613–21. http://dx.doi.org/10.1097/aln.0b013e3182475e39.
Повний текст джерелаАнотація:
Introduction : Acute kidney injury (AKI) is a serious complication of cardiac surgery, and preoperative anemia and perioperative erythrocyte transfusion are important risk factors. Prophylactic erythrocyte transfusion in anemic patients may, therefore, protect against AKI. Methods : In this unblinded, parallel-group, randomized pilot trial, 60 anemic patients (hemoglobin 10-12 g/dL) undergoing cardiac surgery with cardiopulmonary bypass were randomized (1:1) to prophylactic transfusion (2 units of erythrocytes transfused 1 to 2 days before surgery (n = 29) or standard of care (transfusions as indicated; n = 31). Between-group differences in severity of perioperative anemia, transfusion, and AKI (more than 25% drop in estimated glomerular filtration rate) were measured. The relationships between transfusion, iron levels, and AKI were also measured. Results : Perioperative anemia and erythrocyte transfusions were lower in the prophylactic transfusion group--median (25th, 75th percentiles) for nadir hemoglobin was 8.3 (7.9, 9.1) versus 7.6 (6.9, 8.2) g/dL (P = 0.0008) and for transfusion was 0 (0, 2) versus 2 (1, 4) units (P = 0.0002)--but between-group AKI rates were comparable (11 patients per group). In 35 patients with iron studies, perioperative transfusions were directly related to postoperative transferrin saturation (correlation coefficient 0.6; P = 0.0002), and high (more than 80%) transferrin saturation was associated with AKI (5/5 vs. 8/30; P = 0.005), implicating transfusion-related iron overload as a cause of AKI. Conclusions : In anemic patients, prophylactic erythrocyte transfusion reduces perioperative anemia and erythrocyte transfusions, and may reduce plasma iron levels. Adequately powered studies assessing the effect of this intervention on AKI are warranted.
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Muenster, Stefan, Arkadi Beloiartsev, Binglan Yu, E. Du, Sabia Abidi, Ming Dao, Gregor Fabry, et al. "Exposure of Stored Packed Erythrocytes to Nitric Oxide Prevents Transfusion-associated Pulmonary Hypertension." Anesthesiology 125, no. 5 (November 1, 2016): 952–63. http://dx.doi.org/10.1097/aln.0000000000001294.
Повний текст джерелаАнотація:
Abstract Background Transfusion of packed erythrocytes stored for a long duration is associated with increased pulmonary arterial pressure and vascular resistance. Prolonged storage decreases erythrocyte deformability, and older erythrocytes are rapidly removed from the circulation after transfusion. The authors studied whether treating stored packed ovine erythrocytes with NO before transfusion could prevent pulmonary vasoconstriction, enhance erythrocyte deformability, and prolong erythrocyte survival after transfusion. Methods Ovine leukoreduced packed erythrocytes were treated before transfusion with either NO gas or a short-lived NO donor. Sheep were transfused with autologous packed erythrocytes, which were stored at 4°C for either 2 (“fresh blood”) or 40 days (“stored blood”). Pulmonary and systemic hemodynamic parameters were monitored before, during, and after transfusion. Transfused erythrocytes were labeled with biotin to measure their circulating lifespan. Erythrocyte deformability was assessed before and after NO treatment using a microfluidic device. Results NO treatment improved the deformability of stored erythrocytes and increased the number of stored erythrocytes circulating at 1 and 24 h after transfusion. NO treatment prevented transfusion-associated pulmonary hypertension (mean pulmonary arterial pressure at 30 min of 21 ± 1 vs. 15 ± 1 mmHg in control and NO–treated packed erythrocytes, P < 0.0001). Washing stored packed erythrocytes before transfusion did not prevent pulmonary hypertension. Conclusions NO treatment of stored packed erythrocytes before transfusion oxidizes cell-free oxyhemoglobin to methemoglobin, prevents subsequent NO scavenging in the pulmonary vasculature, and limits pulmonary hypertension. NO treatment increases erythrocyte deformability and erythrocyte survival after transfusion. NO treatment might provide a promising therapeutic approach to prevent pulmonary hypertension and extend erythrocyte survival.
3
Gadilshina, R. S., and E. E. Bel’skaya. "Cases of alloimmunization with rh-antigen D in patients with uncomplicated transfusion history." Kazan medical journal 93, no. 2 (April 15, 2012): 347–48. http://dx.doi.org/10.17816/kmj2330.
Повний текст джерелаАнотація:
Aim. To attract the attention of practicing physicians to the problem of transfusion safety of erythrocyte-containing preparations to patients at risk for the emergence of post-transfusion complications. Methods. Gel technique, diagnostic panel of erythrocytes for screening and identification of alloimmune antibodies. Results. During the study of blood samples of patients identified were alloantibodies to the D antigen of the Rh-system and provided were recommendations for blood transfusions with individual selection. Conclusion. Antibodies to erythrocyte antigens of the Rh-system can be synthesized as a result of immunization due to an incompatible blood transfusion or incompatible pregnancies, as well as in cases of intravenous drug use, in the antigen D immunized donors.
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Feiner, John R., Michael A. Gropper, Pearl Toy, Jeremy Lieberman, Jenifer Twiford, and Richard B. Weiskopf. "A Clinical Trial to Detect Subclinical Transfusion-induced Lung Injury during Surgery." Anesthesiology 123, no. 1 (July 1, 2015): 126–35. http://dx.doi.org/10.1097/aln.0000000000000689.
Повний текст джерелаАнотація:
Abstract Background: Transfusion-related acute lung injury incidence remains the leading cause of posttransfusion mortality. The etiology may be related to leukocyte antibodies or biologically active compounds in transfused plasma, injuring susceptible recipient’s lungs. The authors have hypothesized that transfusion could have less severe effects that are not always appreciated clinically and have shown subtly decreased pulmonary oxygen gas transfer in healthy volunteers after transfusion of fresh and 21-day stored erythrocytes. In this study, the authors tested the same hypothesis in surgical patients. Methods: Ninety-one patients undergoing elective major spine surgery with anticipated need for erythrocyte transfusion were randomly allocated to receive their first transfusion of erythrocytes as cell salvage (CS), washed stored, or unwashed stored. Clinicians were not blinded to group assignment. Pulmonary gas transfer and mechanics were measured 5 min before and 30 min after erythrocyte transfusion. Results: The primary outcome variable, gas transfer, as assessed by change of Pao2/Fio2, with erythrocyte transfusion was not significant in any group (mean ± SD; CS: 9 ± 59; washed: 10 ± 26; and unwashed: 15 ± 1) and did not differ among groups (P = 0.92). Pulmonary dead space (VD/VT) decreased with CS transfusion (−0.01 ± 0.04; P = 0.034) but did not change with other erythrocytes; the change from before to after erythrocyte transfusion did not differ among groups (−0.01 to +0.01; P = 0.28). Conclusions: The authors did not find impaired gas exchange as assessed by Pao2/Fio2 with transfused erythrocytes that did or did not contain nonautologous plasma. This clinical trial did not support the hypothesis of erythrocyte transfusion-induced gas exchange deficit that had been found in healthy volunteers.
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Rofinda, Zelly Dia, Eryati Darwin, Ellyza Nasrul, and Irza Wahid. "Erythrocyte Antibody Due to Alloimmunization in Repeated Transfusion: A Meta-Analysis." Open Access Macedonian Journal of Medical Sciences 10, F (April 4, 2022): 257–62. http://dx.doi.org/10.3889/oamjms.2022.9035.
Повний текст джерелаАнотація:
BACKGROUND: Blood transfusion is one form of life-saving efforts to improve health. Each individual will experience a different transfusion reaction. Having a history of repeated transfusions increases the risk of alloimmunization leading to the development of erythrocyte alloantibodies. AIM: This study is a meta-analysis of various studies on erythrocyte antibodies due to alloimmunization in repeated transfusion. METHODS: Literatures were searched through the PubMed, DOAJ, and Google Scholar databases using the keywords “repeated transfusion,” “alloimmunization,” and “erythrocyte antibody” published in 2017 - 2021. All identified articles were then screened for relevance as well as duplication according to inclusion and exclusion criteria. Then, the articles were analyzed using software review manager 5.4 and software comprehensive meta-analysis (CMA) version 3. RESULTS: A total of seven articles were included in this study. Based on the analysis, we found that there was no association between alloimmunization in repeated transfusions with erythrocyte antibodies based on gender (pooled odds ratio 1.00 [95% CI 0.70 - 1.42]. CONCLUSION: Alloimmunization on repeated transfusion was not significantly associated with erythrocyte antibody based on gender.
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Yazer, Mark H., Philip C. Spinella, Leilani Doyle, Richard M. Kaufman, Robyn Dunn, John R. Hess, Luiz Amorim Filho, et al. "Transfusion of Uncrossmatched Group O Erythrocyte-containing Products Does Not Interfere with Most ABO Typings." Anesthesiology 132, no. 3 (March 1, 2020): 525–34. http://dx.doi.org/10.1097/aln.0000000000003069.
Повний текст джерелаАнотація:
Abstract Background Group O erythrocytes and/or whole blood are used for urgent transfusions in patients of unknown blood type. This study investigated the impact of transfusing increasing numbers of uncrossmatched type O products on the recipient’s first in-hospital ABO type. Methods This was a retrospective cohort study. Results of the first ABO type obtained in adult, non–type O recipients (i.e., types A, B, AB) after receiving at least one unit of uncrossmatched type O erythrocyte-containing product(s) for any bleeding etiology were analyzed along with the number of uncrossmatched type O erythrocyte-containing products administered in the prehospital and/or in hospital setting before the first type and screen sample was drawn. Results There were 10 institutions that contributed a total of 695 patient records. Among patients who received up to 10 uncrossmatched type O erythrocyte-containing products, the median A antigen agglutination strength in A and AB individuals on forward typing (i.e., testing the recipient’s erythrocytes for A and/or B antigens) was the maximum (4+), whereas the median B antigen agglutination strength among B and AB recipients of up to 10 units was 3 to 4+. The median agglutination strength on the reverse type (i.e., testing the recipient’s plasma for corresponding anti-A and -B antibodies) was very strong, between 3 and 4+, for recipients of up to 10 units of uncrossmatched erythrocyte-containing products. Overall, the ABO type of 665 of 695 (95.7%; 95% CI, 93.9 to 97.0%) of these patients could be accurately determined on the first type and screen sample obtained after transfusion of uncrossmatched type O erythrocyte-containing products. Conclusions The transfusion of smaller quantities of uncrossmatched type O erythrocyte-containing products, in particular up to 10 units, does not usually interfere with determining the recipient’s ABO type. The early collection of a type and screen sample is important. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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Shannon, Kevin M., Julian F. Keith, William C. Mentzer, Richard A. Ehrenkranz, Mark S. Brown, John A. Widness, Christine A. Gleason, et al. "Recombinant Human Erythropoietin Stimulates Erythropoiesis and Reduces Erythrocyte Transfusions in Very Low Birth Weight Preterm Infants." Pediatrics 95, no. 1 (January 1, 1995): 1–8. http://dx.doi.org/10.1542/peds.95.1.1.
Повний текст джерелаАнотація:
Design and methods. We hypothesized that treatment with recombinant human erythropoietin (r-HuEPO) would stimulate erythropoiesis and would thereby reduce the need for erythrocyte transfusions in preterm infants. We treated 157 preterm infants born at 26.9 ± 1.6 weeks of gestation who weighed 924 ± 183 g at birth with either subcutaneous r-HuEPO (100 U/kg/d, 5 days per week) or placebo for 6 weeks in a randomized, double-blind, controlled clinical trial. All patients received oral iron and were managed according to uniform conservative transfusion guidelines. Results. Treatment with r-HuEPO was associated with fewer erythrocyte transfusions (1.1 ± 1.5 per infant in the r-HuEPO group versus 1.6 ± 1.7 per infant in the placebo group; P = .046) and with a reduction in the volume of packed erythrocytes transfused (16.5 ± 23.0 mL versus 23.9 ± 25.7 mL per infant; P = .023). Overall, 43% of the infants in the r-HuEPO group and 31% of placebo-treated infants were transfusion-free during the study (P = .18). The volume of blood removed for laboratory tests and the need for respiratory support at the start of treatment had major effects on transfusion requirements independent of r-HuEPO. Reticulocyte counts were higher during treatment in the r-HuEPO group (P = .0001), and r-HuEPO-treated infants had higher hematocrit values at the end of the study (32% versus 27.3% in the placebo group; P = .0001). We found no differences in the incidence of major complications of prematurity between the treatment groups. Conclusion. We conclude that treatment with r-HuEPO at a weekly dose of 500 U/kg stimulates erythropoiesis, moderates the course of anemia, is associated with a reduction in erythrocyte transfusions, and appears safe in very low birth weight preterm infants who are receiving iron supplements. Conservative transfusion criteria, minimization of phlebotomy losses, and treatment with r-HuEPO are complementary strategies to reduce erythrocyte transfusions in these infants.
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Patel, Nishith N., Hua Lin, Ceri Jones, Graham Walkden, Paramita Ray, Philippa A. Sleeman, Gianni D. Angelini, and Gavin J. Murphy. "Interactions of Cardiopulmonary Bypass and Erythrocyte Transfusion in the Pathogenesis of Pulmonary Dysfunction in Swine." Anesthesiology 119, no. 2 (August 1, 2013): 365–78. http://dx.doi.org/10.1097/aln.0b013e31829419d3.
Повний текст джерелаАнотація:
Abstract Background: Allogeneic erythrocyte transfusion in cardiac surgical patients is associated with a fourfold increase in pulmonary complications. Our understanding of the processes underlying these observations is poor and there is no experimental model of transfusion-related acute lung injury that shows homology to cardiac surgical patients. Our objective was to develop a novel swine recovery model to determine how two clinical risk factors, allogenic erythrocyte transfusion and cardiopulmonary bypass, interact in the genesis of postcardiac surgery acute lung injury. Methods: Thirty-six pigs were infused with allogeneic 14- or 42-day-old erythrocytes or they underwent cardiopulmonary bypass with or without transfusion of 42-day erythrocyte. Controls received saline. All pigs were recovered and assessed for pulmonary dysfunction, inflammation, and endothelial activation at 24 h. Results: Transfusion of stored allogeneic erythrocytes in pigs compared with sham caused pulmonary dysfunction characterized by reduced lung compliance (mean difference −3.36 [95% CI, −5.31 to −1.42] ml/cm H2O), an increase in protein levels in bronchoalveolar lavage fluid, histological lung injury inflammation, and endothelial activation. Transfusion of blood stored for up to 42 days resulted in greater protein levels in bronchoalveolar lavage fluid, macrophage infiltration, platelet activation, and depletion of T-lymphocytes in recipient lungs versus 14-day-old blood. Transfusion interacted with cardiopulmonary bypass to increase lung injury in the absence of platelet activation. Conclusions: In this novel large animal model of allogeneic erythrocyte transfusion, pulmonary dysfunction occurs in the absence of any priming event, is increased when combined with other inflammatory stimuli, and is mediated by monocyte activation and T-lymphocyte depletion.
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Uezima, Cristina Lika, Ariane Moreira Barreto, Ruth Guinsburg, Akemi Kuroda Chiba, José Orlando Bordin, Melca Maria O. Barros, and Amélia Miyashiro N. dos Santos. "Reduction of exposure to blood donors in preterm infants submitted to red blood cell transfusions using pediatric satellite packs." Revista Paulista de Pediatria 31, no. 3 (September 2013): 285–92. http://dx.doi.org/10.1590/s0103-05822013000300003.
Повний текст джерелаАнотація:
OBJECTIVE: In preterm newborn infants transfused with erythrocytes stored up to 28 days, to compare the reduction of blood donor exposure in two groups of infants classified according to birth weight. METHODS: A prospective study was conducted with preterm infants with birth weight <1000g (Group 1) and 1000-1499g (Group 2), born between April, 2008 and December, 2009. Neonates submitted to exchange transfusions, emergency erythrocyte transfusion, or those who died in the first 24 hours of life were excluded. Transfusions were indicated according to the local guideline using pediatric transfusion satellite bags. Demographic and clinical data, besides number of transfusions and donors were assessed. . Logistic regression analysis was performed to determine factors associated with multiple transfusions. RESULTS: 30 and 48 neonates were included in Groups 1 and 2, respectively. The percentage of newborns with more than one erythrocyte transfusion (90 versus 11%), the median number of transfusions (3 versus 1) and the median of blood donors (2 versus 1) were higher in Group 1 (p<0.001), compared to Group 2. Among those with multiple transfusions, 14 (82%) and one (50%) presented 50% reduction in the number of blood donors, respectively in Groups 1 and 2. Factors associated with multiple transfusions were: birth weight <1000g (OR 11.91; 95%CI 2.14-66.27) and presence of arterial umbilical catheter (OR 8.59; 95%CI 1.94-38.13), adjusted for confounders. CONCLUSIONS: The efficacy of pediatrics satellites bags on blood donor reduction was higher in preterm infants with birth weight <1000g.
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Smeets, Michel WJ, Alexander PJ Vlaar, Herm Jan M. Brinkman, Jan J. Voorberg, and Peter L. Hordijk. "Platelet-Independent Adhesion of Red Blood Cells to Von Willebrand Factor." Blood 124, no. 21 (December 6, 2014): 2769. http://dx.doi.org/10.1182/blood.v124.21.2769.2769.
Повний текст джерелаАнотація:
Abstract Background/Objectives Red blood cell (RBC) transfusion can be lifesaving and is an essential therapy in conditions associated with tissue hypoxia due to anemia. However, recent clinical studies show that both the number of RBCs and the age of RBCs transfused are independent risk factors for an increase in transfusion related morbidity and mortality. It has been suggested that the so called “storage lesion” of RBCs, a reduction of quality of erythrocytes and changes in the erythrocyte concentrate storage medium, is the causal factor. Recently it has been shown that cold storage of erythrocytes induces microparticle formation. These erythrocyte microparticles are pro-coagulant and can cause thrombin formation. Another phenomenon of the storage lesion is the rapid and considerable loss of donor erythrocytes from the circulation of transfused patients. We wondered whether thrombin generated by transfused erythrocyte microparticles could contribute to red blood cell adherence to the vascular endothelium. Cytoadherence of red blood cells could contribute to the loss of circulating transfused red blood cells and vascular obstruction and could explain the observed transfusion associated complications in clinical practice. Methods/Results Employing FACS analysis and a microparticle analyzer we showed that erythrocyte cold storage indeed induces microparticle formation. We confirmed the pro-coagulant properties of these microparticles using a chromogenic substrate specific for thombin and a thrombin-anti-thrombin complex ELISA. To determine whether thrombin could induce adhesion of red blood cells to endothelial cells, we cultured human umbilical vein endothelial cells in micro-perfusion chambers and used live-imaging to define the adherence potential of the erythrocytes to endothelial cells at post-capillary flow rate. Thrombin stimulation of the endothelial cells did increase erythrocyte adhesion to endothelial cells. Moreover, the adhesion of erythrocytes followed a pattern resembling platelets binding to von Willebrand factor (VWF). By using live immunofluoresence imaging we confirmed that the erythrocytes did bind to VWF secreted from endothelial cells. Since erythrocyte-VWF interactions may be mediated by platelets, we used fluorescence cell sorting to remove platelets and erythrocyte-platelet complexes from erythrocyte concentrates. The purified erythrocytes did also bind to VWF secreted by endothelial cells and thereby we confirmed that erythrocytes can bind to VWF in a platelet-independent fashion. We further analyzed the specificity of the erythrocyte-VWF interaction by using different protein coatings in micro-perfusion chambers. Erythrocytes did bind to recombinant high molecular weight VWF multimers. Furthermore, they adhered more potently to VWF when compared to fibrinogen or fibrin but showed little binding to fibronectin, collagen type I, or subendothelial extra-cellular matrix proteins. Conclusion Our results suggest that transfusion of RBCs is able to induce endothelial binding of erythrocytes based on a VWF-erythrocyte interaction. We propose that passive infusion of cold stored erythrocyte derived microparticles promotes thrombin generation which subsequently activates endothelial cells and induces VWF secretion. This results in binding of red blood cells to endothelial cells in a platelet-independent fashion which requires the presence of VWF. Based on our results we hypothesize that binding of erythrocytes to VWF may occlude micro-capillaries thereby contributing to transfusion associated complications. Disclosures No relevant conflicts of interest to declare.
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Shehata, Nadine, Kumanan Wilson, C. David Mazer, George Tomlinson, David Streiner, Paul Hebert, and Gary Naglie. "Factors Affecting Perioperative Transfusion Decisions in Patients with Coronary Artery Disease Undergoing Coronary Artery Bypass Surgery." Anesthesiology 105, no. 1 (July 1, 2006): 19–27. http://dx.doi.org/10.1097/00000542-200607000-00008.
Повний текст джерелаАнотація:
Background A high proportion of patients having cardiac bypass surgery receive erythrocyte transfusions. Decisions about when to transfuse patients having surgery for coronary artery disease may impact on erythrocyte utilization and patient morbidity and mortality. There are no published data about the factors that influence physicians' decisions to transfuse erythrocytes to these patients. The objectives of this study were to determine the hemoglobin concentration for transfusion and the factors that influence physicians' perioperative transfusion decisions for coronary artery bypass patients. Methods The authors conducted a cross-sectional study using pretested, self-administered, mailed questionnaires sent in 2004 to all cardiac surgeons and anesthesiologists in Canada who participate in coronary artery bypass surgery. The questionnaire included four intraoperative and four postoperative vignettes. Factors assessed included patient age, sex, cardiac index, and myocardial ischemia. Results The response rates were 70% (345 of 489) for the intraoperative and 61% (297 of 489) for the postoperative case scenarios. The mean hemoglobin concentrations for transfusion were 7.0 g/dl for the intraoperative case scenarios and 7.2 g/dl for the postoperative case scenarios. Older age, the presence of myocardial ischemia, and a low cardiac index were factors that increased the hemoglobin concentration for transfusion (P < 0.0001). Physicians ranked myocardial ischemia as the most significant factor affecting their transfusion decisions. Conclusions Factors such as the presence of a low cardiac index, myocardial ischemia, and older age increase the hemoglobin concentrations at which physicians transfuse coronary bypass surgery patients. Future studies are required to elucidate whether transfusions based on these variables affect patient morbidity and mortality.
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Shimizu, Daisuke, Harumi Fujihara, Hiroki Shibata, Chiaki Yamada, Hiroyuki Furumaki, Hiroko Watanabe, Keiko Ishizuka, et al. "Difference In Erythrocyte Alloantibodies After Blood Transfusion In Patients With Hematological and Non-Hematological Diseases." Blood 122, no. 21 (November 15, 2013): 2404. http://dx.doi.org/10.1182/blood.v122.21.2404.2404.
Повний текст джерелаАнотація:
Abstract Introduction The incidence of irregular erythrocyte allo-antibodies (Abs) increases with the amount of previous erythrocyte transfusions. Blood transfusion has been one of the most important supportive cares in patients with hematological diseases. Therefore, patients with hematological diseases, such as leukemia and myelodysplastic syndrome, have often received considerable amounts of blood transfusion, and have a higher risk for alloimmunization against erythrocyte antigens. On the other hand, patients receiving chemotherapy and immunotherapy exhibit less antibody response than do patients with non-hematological diseases. Several authors reported that the frequency of irregular erythrocyte Abs was unexpectedly low in these patients (Schonewille et al., 2009). In this study, we retrospectively analyzed the frequency and the contents of Abs after blood transfusion in patients with hematological and non-hematological diseases. Materials and Methods We selected patients with hematological or non-hematological diseases, who were transfused in our hospital from 2000 to 2011. We analyzed the patients' profiles including gender, age, the number of blood units previously transfused, and category of transfused products. We also studied the frequencies of irregular erythrocyte Abs. If the same patient was tested more than once, it was counted as one case. If more than two antibodies were detected in the same blood sample, they were tallied separately. If a patient had different antibodies at different times, all of them were summarized. We compared antibody frequencies between the patients with hematological or non-hematological diseases. Statistical analysis was performed by chi-square test and F-test followed by Student's t-test. Results The numbers of patients with hematological or non-hematological diseases were 517 and 4,311 cases, respectively (Table 1). Gender was similar (male / female: 1.35 vs. 1.38, NS). Median age was 64 years (range: 15-93) vs. 75 years (2-82) (p< 0.001). The median amount of transfused erythrocytes was 18 units (2-358) and 8 units (1-182), respectively. Abs were detected in 24 (4.6%) and 129 cases (2.9%), respectively (p< 0.05). Frequently determined Abs were as follows: anti-E (63% vs. 34%), anti-Lea (13% vs. 23%), anti-C (4% vs. 5%), anti-Dia (4% vs. 5%), anti-Jka (4% vs. 6%), and anti-E+c Ab(4% vs. 8%, respectively) (Fig. 1). The amount of erythrocyte transfusions until determination of Abs was 19 units (10-100) and 14 units (2-84), respectively. Discussion The frequency of irregular erythrocyte Abs was significantly greater in patients with hematological diseases than in those with non-hematological diseases. The amount of erythrocyte transfusions was greater and age was younger in those with hematological diseases. Anti-E Ab, whose frequency is reportedly less in Japanese, was more frequently detected in those with hematological diseases, while non-Rh Abs were more frequently detected in those with non-hematological diseases. Analyses after the exclusion of perioperative transfusion showed that the amount of erythrocyte transfusion until determination of Abs was greater in those with hematological diseases. These results showed that irregular Abs were more frequently detected in patients with hematological diseases, but the Abs are poorly productive in these patients after the same amount of transfusion. Further studies will solve the detailed mechanisms. Disclosures: No relevant conflicts of interest to declare.
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Weiskopf, Richard B. "Efficacy of Acute Normovolemic Hemodilution Assessed as a Function of Fraction of Blood Volume Lost." Anesthesiology 94, no. 3 (March 1, 2001): 439–46. http://dx.doi.org/10.1097/00000542-200103000-00013.
Повний текст джерелаАнотація:
Background It has been recommended that intraoperative acute normovolemic hemodilution (ANH) be considered for patients expected to experience surgical blood loss of 20% or more of their blood volume. Previous mathematical analyses have not evaluated the potential efficacy of ANH in terms of fraction of blood volume lost. Since decrease of oxygen-carrying capacity is a function of erythrocyte loss relative to blood volume, the purpose of this analysis was to provide an assessment of ANH applicable to all blood volumes and to determine whether this recommendation is appropriate. Methods Equations were developed to describe the fractional blood volume loss (blood volume loss/blood volume; VReM/VBld) required to reduce hematocrit below a "trigger" hematocrit with maintenance of isovolemia. This is also the minimum fractional blood volume loss required for initial erythrocyte savings by any conservation technique. Equations were also developed to describe the fractional surgical blood volume loss for which ANH will obviate the need for transfusion of erythrocytes from any source other than those removed by ANH, and the fractional surgical blood volume loss required for ANH to save a defined volume of erythrocytes. Results Acute normovolemic hemodilution can extend the allowable fractional surgical blood loss before erythrocyte transfusion is required. The VRem/VBld required to initiate erythrocyte savings is approximately 0.5-0.9. The efficacy of ANH in terms of erythrocytes saved cannot be expressed as a function of the fractional blood volume lost alone. To save 1 unit of erythrocytes requires a fractional surgical blood loss of approximately 0.7-1.2 for the usual surgical patient when the transfusion trigger hematocrit is 0.18-0.21. Conclusions This analysis suggests that surgical blood loss should be 0.50 or more for ANH to begin to "save" erythrocytes and 0.70 or more of the patient's blood volume for ANH to save 1 unit erythrocytes, for the usual surgical patient with an initial hematocrit of 0.32-0.36 and a transfusion "trigger" hematocrit (the value at which transfusion is initiated) of 0.18-0.21.
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Karkouti, Keyvan, Duminda N. Wijeysundera, Terrence M. Yau, Stuart A. McCluskey, Christopher T. Chan, Pui-Yuen Wong, and W. Scott Beattie. "Influence of Erythrocyte Transfusion on the Risk of Acute Kidney Injury after Cardiac Surgery Differs in Anemic and Nonanemic Patients." Anesthesiology 115, no. 3 (September 1, 2011): 523–30. http://dx.doi.org/10.1097/aln.0b013e318229a7e8.
Повний текст джерелаАнотація:
Background Acute kidney injury (AKI) after cardiac surgery is a major health issue. Two important risk factors for AKI are preoperative anemia and perioperative erythrocyte transfusion, and elucidating their relationship may help in devising preventive strategies. Methods In this cohort study of 12,388 adults who underwent cardiac surgery with cardiopulmonary bypass and received three units or less of erythrocytes on the day of surgery, the authors used propensity score methods and conditional logistic regression to explore the relationship between preoperative anemia (hemoglobin less than 12.5 g/dL), erythrocyte transfusion on the day of surgery, and AKI (more than 50% decrease in estimated glomerular filtration rate from preoperative to postoperative day 3-4). Results AKI occurred in 4.1% of anemic patients (n = 94/2,287) and 1.6% of nonanemic patients (n = 162 of 10,101) (P < 0.0001). In the 2,113 propensity-score matched pairs, anemic patients had higher AKI rates than nonanemic patients (3.8% vs. 2.0%; P = 0.0007). AKI rates increased in direct proportion to the amount of erythrocytes transfused, and this increase was more pronounced in anemic patients: in anemic patients, the rate increased from 1.8% among those not transfused to 6.6% among those transfused three units (chi-square test for trend P < 0.0001), whereas in nonanemic patients, it increased from 1.7% among those not transfused to 3.2% among those transfused three units (chi-square test for trend P = 0.1). Conclusions Anemic patients presenting for cardiac surgery are more susceptible to transfusion-related AKI than nonanemic patients. Interventions that reduce perioperative transfusions may protect anemic patients against AKI.
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Bahovadinov, B. B., M. A. Kucher, A. Yu Tretyakova, G. S. Ashurova, and N. K. Ashuraliev. "Ways to develop the prophylaxis of post-transfusion hemolytic complications." Scientific Notes of the I. P. Pavlov St. Petersburg State Medical University 22, no. 4 (December 30, 2015): 90–95. http://dx.doi.org/10.24884/1607-4181-2015-22-4-90-95.
Повний текст джерелаАнотація:
Post-transfusion hemolytic complications (РНС) remain аn urgent рrоblem in medical practice despite the improvement of selecting methods of compatible blood transfusion for patients. The numbеr of РНС remains still high (1 in 6 000 - 29 000 transfusions). Aim: to analyze cases of РНС registered in health care facilities (HCF) in the Republic of Tajikistan. Method of investigation. Retrospective analysis of materials of national аnd regional committees оп investigation of РНС cases, histories fro hospital archives. During the period 1989-2014 in health facilities were registered 86 cases of РНС approximately 850 000 doses of red bооd cell transfusions containing blооd components, or 1 in 9418 doses of red blood cell-containing blood components. РНС reasons were: incompatibility of АВО blооd group system - 32 (37,3 %), antigen D of blооd group Rhesus factor system - 34 (39,53 %), according to minor blood group antigens of Rhesus factor and Kell blood group system (С, с, Е, е, К) - 16 (18,6 %). In 4 cases (4,6 %) the cases of РНС were hemolytic transfusions of erythrocyte-containing bags as а result of improper storage in domestic refrigeration without control of temperature storage. Causes of development 78 out of 86 РНС (90,69 %) were HCF doctors' mistakes, 8 (9,31 %) - mistakes of health personnel of health facilities departments of blood transfusion аnd regional blооd centers. Reducing the frequency of PHC is impossible without training physicians оn transfusion medicine, introduction of modern methods of phenotyping erythrocyte antigens of recipients and donors оn major transfusion significant blood group antigens the АВО system by direct and cross-over methods, Rhesus (С, с, Е, е), Kell (К) of patients requiring multiple transfusions, as well as to girls and women of childbearing age.
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Takeshita, Akihiro, Miwa Adachi, Dae Won Kim, Kyou Sup Han, So Yong Kwon, Hyun Ok Kim, Jang Soo Suh, et al. "Differences in Transfusion-Related Alloimmunity to Erythrocytes Between South Korea and Japan; Recent Results from the Third Cooperative International Study of Alloimmunity to Antigen Diversity in Asian Populations." Blood 124, no. 21 (December 6, 2014): 4295. http://dx.doi.org/10.1182/blood.v124.21.4295.4295.
Повний текст джерелаАнотація:
Abstract Backgrounds: Allo-immunization to blood cell antigens has been frequently reported among transfusion recipients with hematological diseases and cancer, as well as during pregnancy. The frequency of irregular erythrocyte antibodies (Abs) ranges from 1 to 2 % among hospitalized patients. However, the frequency varied according to the genetic diversity of the population. Several studies involving transfusion cases have been conducted in various countries including Japan (Watanabe et al, ASH 2009). However, there is currently little information about irregular erythrocyte Abs in many Asian populations. Here, we show updated data concerning variations of irregular erythrocyte Abs in patients with a history of blood transfusions between South Korea and Japan. Materials and Methods: In all, 21 institutions from South Korea and 59 from Japan participated in this study. We investigated methods employed for screening and identifying irregular erythrocyte Abs. The frequencies of irregular Abs to D, C, c, E, e, f, Ce, P1, M, N, S, s, Mia, Lea, Leb, Jka, Jkb, Jk3, Fya, Fyb, K, k, Kpa, Kpb, Jsa, Jsb, Dia, Dib, Lua, Lub, Xga and H were studied. If a case was analyzed multiple times, it was counted once. Multiple antibodies detected in the same patient were counted separately. The frequencies of irregular erythrocyte Abs on the basis of blood transfusion history were analyzed and compared between patients from South Korea and Japan. We partially selected irregular erythrocyte Abs detected in patients that were initially negative before receiving a transfusion. Among them, we compared the efficacy of detection methods between the indirect antiglobulin test (IAT) and the enzyme method at the first detection of the Abs. Results: In total, antibodies were detected in 16,438 patients (3,525 from South Korea; 12,913 from Japan). The female to male ratios of patients from the South Korean and Japanese institutions were 1.53 and 1.43, respectively. The number of patients with and without a history of previous transfusion was 1,146 and 2,100 in South Korea, 3,609 and 8,185 in Japan, respectively. Anti-E (1.4x, p<0.01 in South Korea; 1.7x, p<0.01 in Japan), anti-C (1.8x, p=0.05 and 2.3x, p<0.01, respectively) and anti-Jka (1.8x, p=0.01 and 5.8x, p<0.01, respectively) were frequently detected in patients who had received blood transfusions in either country. Anti-c was 1.8 times more frequently detected in patients who had received transfusions in South Korea, but there was no significant increase observed in patients who had received transfusions in Japan. Anti-D did not increase in patients who had received a transfusion in either country. Anti-c+E (2.1x in South Korea and 3.4x in Japan), anti-C+e (2.6x and 3.2x, respectively) and anti-E+Jka (9.2x and 6.3x, respectively) complex Abs increased in patients who had received a blood transfusion. Anti-E was newly detected in 341 patients after receiving a blood transfusion. In 40 cases, anti-E was detected earlier by the enzyme method than by the IAT method. In 147 cases, anti-E was detected only by the enzyme method; while in 4 cases detection was confirmed only by the IAT procedure. Anti-E was simultaneously detected in 154 cases by both methods. Conclusion: The data presented in this study was derived from a collaboration between South Korea and Japan on alloimmunity to erythrocyte antigens. The total number of positive cases was more than 16,000. Anti-E, anti-C, anti-Jka, anti-c+E and anti-C+e were frequently detected among patients with a history of previous blood transfusions. These results were similar between South Korean and Japanese patients. Anti-c was frequently detected in transfused patients from South Korea, but the number of positive cases did not change in Japanese patients who had undergone a transfusion. These observations might be explained by the ethnic difference in allo-immunity among patients or detection methods adopted in the various participating institutions. Further data, including details of the detection method, will be analyzed in future studies. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.
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Vlaar, Alexander P. J., Jorrit J. Hofstra, Marcel Levi, Willem Kulik, Rienk Nieuwland, Anton T. J. Tool, Marcus J. Schultz, Dirk de Korte, and Nicole P. Juffermans. "Supernatant of Aged Erythrocytes Causes Lung Inflammation and Coagulopathy in a “Two-Hit”In Vivo Syngeneic Transfusion Model." Anesthesiology 113, no. 1 (July 1, 2010): 92–103. http://dx.doi.org/10.1097/aln.0b013e3181de6f25.
Повний текст джерелаАнотація:
Background Transfusion of erythrocytes is associated with increased morbidity in certain patient groups. Storage time of erythrocytes may contribute to respiratory complications. Using a syngeneic in vivo transfusion model, we investigated whether transfusion of stored rat erythrocytes causes lung injury in healthy and in lipopolysaccharide-primed rats in a "two-hit" model of lung injury. Methods Rats were infused with aged rat erythrocytes (14 days of storage) and washed aged erythrocytes or supernatant of aged erythrocytes. Controls received fresh rat erythrocytes (0 days of storage) or saline. In the "two-hit" model of lung injury, lipopolysaccharide was used as a "first hit" before transfusion. Rat and control human erythrocyte products were analyzed for lysophosphatidylcholine accumulation. Results In healthy rats, transfusion of aged erythrocytes caused mild pulmonary inflammation but no coagulopathy. In lipopolysaccharide-pretreated rats, transfusion of aged erythrocytes augmented lung injury by inducing coagulopathy, both in the pulmonary and systemic compartment, when compared with transfusion with fresh erythrocytes. When transfused separately, supernatant of aged erythrocytes, but not washed aged erythrocytes, mediated coagulopathy in the "two-hit" model. Analysis of the supernatant of aged erythrocytes (rat and human) showed no lysophosphatidylcholine accumulation. Conclusions Transfusion of aged erythrocytes induces lung injury in healthy rats. In a "two-hit" model, injury induced by aged erythrocytes was characterized by coagulopathy and was abrogated by washing. Washing of aged erythrocytes may decrease pulmonary complications in patients with an inflammatory condition who are exposed to a blood transfusion.
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Gilliss, Brian M., Mark R. Looney, Michael A. Gropper, and David S. Warner. "Reducing Noninfectious Risks of Blood Transfusion." Anesthesiology 115, no. 3 (September 1, 2011): 635–49. http://dx.doi.org/10.1097/aln.0b013e31822a22d9.
Повний текст джерелаАнотація:
As screening for transfusion-associated infections has improved, noninfectious complications of transfusion now cause the majority of morbidity and mortality associated with transfusion in the United States. For example, transfusion-related acute lung injury, transfusion-associated circulatory overload, and hemolytic transfusion-reactions are the first, second, and third leading causes of death from transfusion, respectively. These complications and others are reviewed, and several controversial methods for prevention of noninfectious complications of transfusion are discussed, including universal leukoreduction of erythrocyte units, use of male-only plasma, and restriction of erythrocyte storage age.
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Johnson, Daniel J., Andrew V. Scott, Viachaslau M. Barodka, Sunhee Park, Jack O. Wasey, Paul M. Ness, Tom Gniadek, and Steven M. Frank. "Morbidity and Mortality after High-dose Transfusion." Anesthesiology 124, no. 2 (February 1, 2016): 387–95. http://dx.doi.org/10.1097/aln.0000000000000945.
Повний текст джерелаАнотація:
Abstract Background It is well recognized that increased transfusion volumes are associated with increased morbidity and mortality, but dose–response relations between high- and very-high-dose transfusion and clinical outcomes have not been described previously. In this study, the authors assessed (1) the dose–response relation over a wide range of transfusion volumes for morbidity and mortality and (2) other clinical predictors of adverse outcomes. Methods The authors retrospectively analyzed electronic medical records for 272,592 medical and surgical patients (excluding those with hematologic malignancies), 3,523 of whom received transfusion (10 or greater erythrocyte units throughout the hospital stay), to create dose–response curves for transfusion volumes and in-hospital morbidity and mortality. Prehospital comorbidities were assessed in a risk-adjusted manner to identify the correlation with clinical outcomes. Results For patients receiving high- or very-high-dose transfusion, infections and thrombotic events were four to five times more prevalent than renal, respiratory, and ischemic events. Mortality increased linearly over the entire dose range, with a 10% increase for each 10 units of erythrocytes transfused and 50% mortality after 50 erythrocyte units. Independent predictors of mortality were transfusion dose (odds ratio [OR], 1.037; 95% CI, 1.029 to 1.044), the Charlson comorbidity index (OR, 1.209; 95% CI, 1.141 to 1.276), and a history of congestive heart failure (OR, 1.482; 95% CI, 1.062 to 2.063). Conclusions Patients receiving high- or very-high-dose transfusion are at especially high risk for hospital-acquired infections and thrombotic events. Mortality increased linearly over the entire dose range and exceeded 50% after 50 erythrocyte units.
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Saevets, V. V., А. Р. Alekseeva, А. V. Taratonov, А. А. Muhin, and А. V. Chizhovskaja. "Analysis of economic efficiency of iron deficiency anemia therapy in patients with malignant tumors." Ural Medical Journal 20, no. 2 (July 19, 2021): 59–63. http://dx.doi.org/10.52420/2071-5943-2021-20-2-59-63.
Повний текст джерелаАнотація:
Introduction. Correction of iron deficiency anemia in patients with malignant neoplasms is an important aspect affecting the quality of life and the effectiveness of special treatments. At the same time, the therapy of comorbid conditions significantly increases the cost of treating cancer patients.The aim of the study was to conduct a comparative pharmacoeconomic analysis of the two most common methods for correcting iron deficiency anemia in cancer patients: transfusion of erythrocyte suspension and intravenous iron preparations using iron carboxymaltose as an example.Materials and methods. An observational, analytical, cohort study was carried out, which included 120 cancer patients. The patients underwent laboratory examination. The tests were assessed: a general blood test with an assessment of the morphological characteristics of erythrocytes, serum iron, ferritin, CRP, total protein. An analysis of the costs of iron deficiency anemia therapy was carried out, taking into account the procurement cost of drugs.Results. It is economically more profitable to use intravenous iron preparations in comparison with transfusion of erythrocyte suspension for the treatment of iron deficiency anemia in patients with malignant neoplasms. The cost of correcting iron deficiency anemia per patient was: when treated with carboxymaltosate iron (Ferinject): 7943.96 rubles, with transfusion of erythrocyte suspension: 16856.40 rubles.Conclusion. In the treatment of anemia in patients with malignant neoplasms with blood preparations (erythrocyte suspension), an improvement in hematological parameters is noted earlier and to a greater extent than with the use of iron preparation carboxymaltozate («Ferinject»). Nevertheless, the duration of the clinical effect when using erythrocyte suspension is lower than that of a parenteral iron preparation.
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Spahn, Donat R., Klaus F. Waschke, Thomas Standl, Johann Motsch, Léone Van Huynegem, Martin Welte, Hans Gombotz, et al. "Use of Perflubron Emulsion to Decrease Allogeneic Blood Transfusion in High-blood-loss Non-Cardiac Surgery." Anesthesiology 97, no. 6 (December 1, 2002): 1338–49. http://dx.doi.org/10.1097/00000542-200212000-00004.
Повний текст джерелаАнотація:
Background This single-blind randomized study in general surgery evaluated the efficacy of perflubron emulsion (PFC) as an artificial oxygen carrier being used to augment preoperative acute normovolemic hemodilution to reduce and avoid transfusion of both allogeneic erythrocytes and erythrocytes from preoperative autologous donation compared with standard of care. Methods Subjects (N = 492) with hemoglobin concentrations of 12-15 g/dl undergoing noncardiac surgical procedures with 20 ml/kg or greater expected blood loss were randomized into two groups. Control patients were transfused intraoperatively at a hemoglobin concentration less than 8.0 +/- 0.5 g/dl or at protocol-defined, physiologic triggers. PFC-treated patients first underwent acute normovolemic hemodilution to hemoglobin of 8.0 +/- 0.5 g/dl, followed by dosing with perflubron emulsion (1.8 g/kg). When hemoglobin reached less than 6.5 +/- 0.5 g/dl, an additional 0.9-g/kg dose was given. PFC patients were transfused at hemoglobin less than 5.5 +/- 0.5 g/dl or at predefined physiologic triggers. After surgery, hemoglobin was maintained at 8.5 +/- 0.5 g/dl or greater in all patients until discharge. Efficacy endpoints included the number of allogeneic and preoperative autologous donation units transfused and the percentage of subjects avoiding transfusion. Results Both groups had similar hemoglobin concentrations at screening (13.5 +/- 1.0 g/dl) and at discharge: 10.8 +/- 1.2 g/dl (PFC) and 11.1 +/- 1.3 g/dl (control). At 24 h, more patients in the PFC group avoided allogeneic and preoperative autologous donation erythrocyte transfusions (53% vs. 43%, < 0.05), and fewer erythrocytes were transfused (1.5 +/- 4.8 vs. 2.1 +/- 3.9 units; median, 0 vs. 1 unit; P = 0.013). By day of discharge, these differences were not significant in the intent-to-treat population, but overall there were less allogeneic and preoperative autologous donation erythrocyte transfusions in the PFC group (696 vs. 846 units). In the protocol-defined target population (n = 330 subjects with blood loss > or = 20 ml/kg), significantly greater avoidance of any erythrocyte transfusion was maintained through day of hospital discharge (26% vs. 16% in the PFC and control groups, respectively; P < 0.05), and there was also a significant reduction in the number of erythrocyte units transfused (3.4 +/- 2.9 vs. 4.9 +/- 2.4 units; median 2 vs. 4 units; P < 0.001). Adverse events rates were similar in the PFC (86%) and control (81%) groups; however, more serious adverse events were reported in the PFC group (32%) than in controls (21%; P < 0.05). Overall mortality was 3%, and the difference between groups (PFC, 4% vs. controls, 2%) was not statistically significant. Conclusions Augmented acute normovolemic hemodilution with PFC reduces transfusion needs in patients undergoing noncardiac surgical procedures with blood loss 20 ml/kg or greater.
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Engoren, Milo. "Does Erythrocyte Blood Transfusion Prevent Acute Kidney Injury?" Anesthesiology 113, no. 5 (November 1, 2010): 1126–33. http://dx.doi.org/10.1097/aln.0b013e181f70f56.
Повний текст джерелаАнотація:
Background Acute kidney injury is a common occurrence in intensive care unit patients with a reported incidence of 11-67% and is associated with an increased risk of death. In other patient populations, erythrocyte transfusion has been associated with increased risk of adverse outcomes including sepsis, multisystem organ dysfunction, and death. The purpose of this study was to determine the effect of erythrocyte transfusion on the development of acute kidney injury. Methods This was a retrospective analysis of prospectively collected data that used propensity matched transfused and nontransfused patients. Propensity matching was done using semiparsimonious logistic regression. McNemar test for nonindependent data sets was used to compare groups. Results Four hundred two patients from a trial on fluid management in patients with acute lung injury were matched. 38% of transfused patients had a rise in creatinine the day after transfusion compared with 33% of their nontransfused matches (P = 0.315). By day 7, creatinine had increased in 51% of transfused patients compared with 52% in nontransfused patients (P = 0.832). The incidences of renal risk, injury, and failure were 39 (19%), 27 (13%), and 11 (5%) in the transfused group and 38 (19%), 24 (12%), and 11 (5%) in the nontransfused group, P = 1.00, 0.785, and 1.00, respectively. Conclusions Transfusion of erythrocytes to patients with acute lung injury had no effect on the development of acute kidney injury.
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Boyarinov, G. A., I. S. Simutis, V. O. Nikolsky, A. V. Deryugina, L. V. Boyarinova, A. S. Gordetsov, and A. B. Kuznetsov. "The Role of Ozonized Erythrocytic Mass Transfusion in the Restoration of Myocardial Morphological Changes during Blood Loss (Experimental Study)." General Reanimatology 14, no. 3 (July 2, 2018): 27–35. http://dx.doi.org/10.15360/1813-9779-2018-3-27-35.
Повний текст джерелаАнотація:
Purpose.To evaluate the role of ozonized erythrocytic mass transfusion in the restoration of damages in the architectonics of myocardium microvasculature and cardiomyocytes in case of a severe blood loss.Materials and Methods. Two batches of experiments were conducted, 17 white outbred rats in each. The animals were anesthetized with thiopental sodium (25 mg/kg). Blood loss was caused by taking 3ml of blood from the tail artery of rats, which is 35% of the circulating blood volume. One hour after the blood loss, transfusion of autoerythrocytes with normal saline solution and Ringer’s solution infusion in 1:1 ratio was performed in the control batch. In the experimental batch, 3 ml of autoerythrocytes treated with ozonized saline solution with ozone concentration of 2 mg/l and 3 ml of Ringer’s solution (1:1 ratio) were administered to rats. Erythrocyte mass was prepared from 3 ml of the autoblood harvested from the animals 3 days before the experiment. On a post-transfusion day5, in both batches and in five intact animals, hearts were removed following the intraperitoneal thiopental sodium injection (100 mg/kg). The left ventricle wall specimen from each heart was removed for examination. Histologic sections were stained with hematoxylin and eosin. The preparations were visually examined and morphometric studies were performed using microvisor Vizo-103.Results.It has been established that administration of ozonized erythrocyte for severe blood loss correction limited the decrease in numbers of capillary profiles and their diameters, formation of mixed and hyaline thrombi fully or partially occluding microvascular lumens, major hemorrhages and reduction of variation of nuclear profiles, decreased perivascular, pericellular, perinuclear, and endonuclear edema of myocardial tissue, cardiomyocyte overcontruction zone, and their ruptures.Conclusion.The positive trends for microcirculation indices, vascularization density and myocardial edematization as prognostic markers in assessing potential posthypoxic rehabilitation of damaged tissues upon blood loss correction with ozonized erythrocyte mass might be explained by the antihypoxic, antioxidant, and detoxifying actions of ozone on erythrocytes and/or its metabolites (ozonides) in the body post-transfusion.
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So-Osman, Cynthia, Rob G. H. H. Nelissen, Ankie W. M. M. Koopman-van Gemert, Ewoud Kluyver, Ruud G. Pöll, Ron Onstenk, Joost A. Van Hilten, et al. "Patient Blood Management in Elective Total Hip- and Knee-replacement Surgery (Part 1)." Anesthesiology 120, no. 4 (April 1, 2014): 839–51. http://dx.doi.org/10.1097/aln.0000000000000134.
Повний текст джерелаАнотація:
Abstract Background: Patient blood management combines the use of several transfusion alternatives. Integrated use of erythropoietin, cell saver, and/or postoperative drain reinfusion devices on allogeneic erythrocyte use was evaluated using a restrictive transfusion threshold. Methods: In a factorial design, adult elective hip- and knee-surgery patients with hemoglobin levels 10 to 13 g/dl (n = 683) were randomized for erythropoietin or not, and subsequently for autologous reinfusion by cell saver or postoperative drain reinfusion devices or for no blood salvage device. Primary outcomes were mean allogeneic intra- and postoperative erythrocyte use and proportion of transfused patients (transfusion rate). Secondary outcome was cost-effectiveness. Results: With erythropoietin (n = 339), mean erythrocyte use was 0.50 units (U)/patient and transfusion rate 16% while without (n = 344), these were 0.71 U/patient and 26%, respectively. Consequently, erythropoietin resulted in a nonsignificant 29% mean erythrocyte reduction (ratio, 0.71; 95% CI, 0.42 to 1.13) and 50% reduction of transfused patients (odds ratio, 0.5; 95% CI, 0.35 to 0.75). Erythropoietin increased costs by €785 per patient (95% CI, 262 to 1,309), that is, €7,300 per avoided transfusion (95% CI, 1,900 to 24,000). With autologous reinfusion, mean erythrocyte use was 0.65 U/patient and transfusion rate was 19% with erythropoietin (n = 214) and 0.76 U/patient and 29% without (n = 206). Compared with controls, autologous blood reinfusion did not result in erythrocyte reduction and increased costs by €537 per patient (95% CI, 45 to 1,030). Conclusions: In hip- and knee-replacement patients (hemoglobin level, 10 to 13 g/dl), even with a restrictive transfusion trigger, erythropoietin significantly avoids transfusion, however, at unacceptably high costs. Autologous blood salvage devices were not effective.
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So-Osman, Cynthia, Rob G. H. H. Nelissen, Ankie W. M. M. Koopman-van Gemert, Ewoud Kluyver, Ruud G. Pöll, Ron Onstenk, Joost A. Van Hilten, et al. "Patient Blood Management in Elective Total Hip- and Knee-replacement Surgery (Part 2)." Anesthesiology 120, no. 4 (April 1, 2014): 852–60. http://dx.doi.org/10.1097/aln.0000000000000135.
Повний текст джерелаАнотація:
Abstract Background: Patient blood management is introduced as a new concept that involves the combined use of transfusion alternatives. In elective adult total hip- or knee-replacement surgery patients, the authors conducted a large randomized study on the integrated use of erythropoietin, cell saver, and/or postoperative drain reinfusion devices (DRAIN) to evaluate allogeneic erythrocyte use, while applying a restrictive transfusion threshold. Patients with a preoperative hemoglobin level greater than 13 g/dl were ineligible for erythropoietin and evaluated for the effect of autologous blood reinfusion. Methods: Patients were randomized between autologous reinfusion by cell saver or DRAIN or no blood salvage device. Primary outcomes were mean intra- and postoperative erythrocyte use and proportion of transfused patients (transfusion rate). Secondary outcome was cost-effectiveness. Results: In 1,759 evaluated total hip- and knee-replacement surgery patients, the mean erythrocyte use was 0.19 (SD, 0.9) erythrocyte units/patient in the autologous group (n = 1,061) and 0.22 (0.9) erythrocyte units/patient in the control group (n = 698) (P = 0.64). The transfusion rate was 7.7% in the autologous group compared with 8.3% in the control group (P = 0.19). No difference in erythrocyte use was found between cell saver and DRAIN groups. Costs were increased by €298 per patient (95% CI, 76 to 520). Conclusion: In patients with preoperative hemoglobin levels greater than 13 g/dl, autologous intra- and postoperative blood salvage devices were not effective as transfusion alternatives: use of these devices did not reduce erythrocyte use and increased costs.
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Engoren, Milo, and Cynthia Arslanian-Engoren. "Long-term Survival in the Intensive Care Unit After Erythrocyte Blood Transfusion." American Journal of Critical Care 18, no. 2 (March 1, 2009): 124–31. http://dx.doi.org/10.4037/ajcc2009193.
Повний текст джерелаАнотація:
Background Erythrocyte blood transfusions are commonly used in intensive care units, yet little is known about their effects on long-term survival. Objective To determine the effect of erythrocyte blood transfusion in intensive care units on long-term survival. Methods Retrospective analysis of a prospectively collected database of 2213 patients admitted January 27, 2001, to April 30, 2002, to the cardiac, burn, neurological-neurosurgical, and combined medical-surgical intensive care units in a tertiary care, university-affiliated, urban medical center. Further analysis was done on a case-control subgroup (n = 556) formed by matching scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II and propensity scores. Results Although transfusion was univariably associated with increased risk of death at all 3 times (0–30, 31–180, and >180 days after admission to the unit), multivariable adjustment with Cox modeling showed that transfusion had no association with mortality for the first 2 intervals (0–30 and 31–180 days), but was associated with a 25% lower risk of death (hazard ratio, 0.75; 95% confidence interval, 0.57–0.99; P = .04) in patients who survived at least 180 days after admission to the unit. In the case-control patients, after correction for APACHE II risk of death and propensity to receive a transfusion, transfusion had no association with mortality for the first 2 intervals, but was associated with 29% lowered risk of death (hazard ratio, 0.71; 95% confidence interval, 0.50–0.99; P=.046). Conclusion Blood transfusion was associated with a decreased risk of late (>180 days) death in intensive care patients.
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Lang, Elisabeth, Vitaly I. Pozdeev, Haifeng C. Xu, Prashant V. Shinde, Kristina Behnke, Junnat M. Hamdam, Erik Lehnert, et al. "Storage of Erythrocytes Induces Suicidal Erythrocyte Death." Cellular Physiology and Biochemistry 39, no. 2 (2016): 668–76. http://dx.doi.org/10.1159/000445657.
Повний текст джерелаАнотація:
Background/Aims: Similar to apoptosis of nucleated cells, red blood cells (RBC) can undergo suicidal cell death - called eryptosis. It is characterized by cell shrinkage and phosphatidylserine translocation. Eryptosis is triggered by an increase of intracellular calcium concentration due to activation of nonselective cation channels. The cation channels and consequently eryptosis are inhibited by erythropoietin. Eryptotic RBC are engulfed by macrophages and thus rapidly cleared from circulating blood. In this study, we explored whether storage of RBC influences the rate of eryptosis. Methods: Flow cytometry was employed to quantify phosphatidylserine exposing erythrocytes from annexin V binding and cytosolic Ca2+ activity from Fluo-3 fluorescence. Clearance of stored murine RBC was tested by injection of carboxyfluorescein succinimidyl ester (CFSE)-labelled erythrocytes. Results: Storage for 42 days significantly increased the percentage of phosphatidylserine exposing and haemolytic erythrocytes, an effect blunted by removal of extracellular calcium. Phosphatidylserine exposure could be inhibited by addition of erythropoietin. Upon transfusion, the clearance of murine CFSE-labelled RBC from circulating blood was significantly higher following storage for 10 days when compared to 2 days of storage. Conclusion: Storage of RBC triggers eryptosis by Ca2+ and erythropoietin sensitive mechanisms.
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Ağaçayak, Elif, Rezan Bugday, Nurullah Peker, Ugur Deger, Gönül Ölmez Kavak, Mehmet Siddik Evsen, and Talip Gul. "Factors Affecting ICU Stay and Length of Stay in the ICU in Patients with HELLP Syndrome in a Tertiary Referral Hospital." International Journal of Hypertension 2022 (April 18, 2022): 1–9. http://dx.doi.org/10.1155/2022/3366879.
Повний текст джерелаАнотація:
Objective. The study aimed to compare patients with HELLP syndrome who require intensive care and who do not require intensive care and evaluate the factors affecting the length of stay in the intensive care unit. Methods. Patients were divided into two groups as follows: requiring intensive care (group 1) and not requiring intensive care (group 2). The data of both groups were compared in terms of demographic characteristics, transfusion amounts, length of stay in the intensive care unit, maternal complications, and mortality. Results. 14032 births in a tertiary center between 2011 and 2018 were evaluated in this study. During the study period, 342 patients were diagnosed with HELLP, and 32 (9.4%) of these were followed up in the intensive care unit. The length of stay in the intensive care unit was determined as 8.1 (7.2) days on average. Fresh frozen plasma, erythrocyte suspension, apheresis, and random thrombocyte transfusion were observed to be significantly more in group 1 patients. In the regression analysis, the most effective factor was found to be erythrocyte suspension and the length of stay in the intensive care unit was significantly longer in patients who had erythrocyte suspension transfusion. The receiver operating characteristic curve showed that the area under the curve value for erythrocyte transfusion was 70.6%. When the cutoff value of erythrocyte suspension was 450 (95% CI: 365–681) ml, the sensitivity was 43.8% and the specificity was 91.6%. Conclusion. We think that physicians should be careful that maternal morbidity and mortality may increase as the need for erythrocyte suspension transfusion increases in patients with HELLP syndrome. Minimum transfusion to hemodynamically stable patients can be more suitable in terms of morbidity and mortality in managing patients with HELLP syndrome requiring erythrocyte suspension transfusion. Precautions and measures should be taken in this regard.
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Cruz, Roberto de Oliveira, Mariza Aparecida Mota, Fabiana Mendes Conti, Ricardo Antônio d'Almeida Pereira, Jose Mauro Kutner, Maria Giselda Aravechia, and Lilian Castilho. "Prevalence of erythrocyte alloimmunization in polytransfused patients." Einstein (São Paulo) 9, no. 2 (June 2011): 173–78. http://dx.doi.org/10.1590/s1679-45082011ao1777.
Повний текст джерелаАнотація:
Objective: To determine the incidence and the rate of red blood cell alloimmunization in polytransfused patients. Methods: A polytransfused patient was defined as having received at least 6 units of red cell concentrates during a 3-month period. The records of all patients (n = 12,904) who had received red blood cell units were examined retrospectively by searching the computer database at Hospital Israelita Albert Einstein in São Paulo, Brazil, over a 6-year period, between 2003 and 2009. Results: During this time, 77,049 red cell concentrate transfusions were performed in 12,904 patients. There were 3,044 polytransfused patients, 227 of whom (7.5%) presented with irregular erythrocyte antibodies. The prevalence of alloantibody specificity was: Anti-E>anti-D>anti-K>anti-C>anti-Dia>anti-c>anti-Jka>anti-S in 227 polytransfused patients. We found combinations of alloantibodies in 79 patients (34.8%), and the most common specificities were against the Rh and/or Kell systems. These antibodies show clinical significance, as they can cause delayed hemolytic transfusion reactions and perinatal hemolytic disease. About 20% of the patients showed an IgG autoantibody isolated or combined with alloantibodies. Interestingly, a high incidence of antibodies against low frequency antigens was detected in this study, mainly anti-Dia. Conclusion: Polytransfused patients have a high probability of developing alloantibodies whether alone or combined with autoantibodies and antibodies against low frequency antigens. Transfusion of red blood cells with a phenotype-compatible with RH (C, E, c), K, Fya, and Jka antigens is recommended for polytransfused patients in order to prevent alloimmunization and hemolytic transfusion reactions.
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Clifford, Leanne, Qing Jia, Arun Subramanian, Hemang Yadav, Darrell R. Schroeder, and Daryl J. Kor. "Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload." Anesthesiology 126, no. 3 (March 1, 2017): 409–18. http://dx.doi.org/10.1097/aln.0000000000001506.
Повний текст джерелаАнотація:
Abstract Background Transfusion-associated circulatory overload remains underappreciated in the perioperative environment. The authors aimed to characterize risk factors for perioperative transfusion-associated circulatory overload and better understand its impact on patient-important outcomes. Methods In this case–control study, 163 adults undergoing noncardiac surgery who developed perioperative transfusion-associated circulatory overload were matched with 726 transfused controls who did not develop respiratory complications. Univariate and multivariable logistic regression analyses were used to evaluate potential risk factors for transfusion-associated circulatory overload. The need for postoperative mechanical ventilation, lengths of intensive care unit and hospital stay, and mortality were compared. Results For this cohort, the mean age was 71 yr and 56% were men. Multivariable analysis revealed the following independent predictors of transfusion-associated circulatory overload: emergency surgery, chronic kidney disease, left ventricular dysfunction, previous β-adrenergic receptor antagonist use, isolated fresh frozen plasma transfusion (vs. isolated erythrocyte transfusion), mixed product transfusion (vs. isolated erythrocyte transfusion), and increasing intraoperative fluid administration. Patients who developed transfusion-associated circulatory overload were more likely to require postoperative mechanical ventilation (73 vs. 33%; P < 0.001) and experienced prolonged intensive care unit (11.1 vs. 6.5 days; P < 0.001) and hospital lengths of stay (19.9 vs. 9.6 days; P < 0.001). Survival was significantly reduced (P < 0.001) in transfusion recipients who developed transfusion-associated circulatory overload (1-yr survival 72 vs. 84%). Conclusions Perioperative transfusion-associated circulatory overload was associated with a protracted hospital course and increased mortality. Efforts to minimize the incidence of transfusion-associated circulatory overload should focus on the judicious use of intraoperative blood transfusions and nonsanguineous fluid therapies, particularly in patients with chronic kidney disease, left ventricular dysfunction, chronic β-blocker therapy, and those requiring emergency surgery.
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Nuttall, Gregory A., William C. Oliver, Paula J. Santrach, Sandra Bryant, Joseph A. Dearani, Hartzell V. Schaff, and Mark H. Ereth. "Efficacy of a Simple Intraoperative Transfusion Algorithm for Nonerythrocyte Component Utilization after Cardiopulmonary Bypass." Anesthesiology 94, no. 5 (May 1, 2001): 773–81. http://dx.doi.org/10.1097/00000542-200105000-00014.
Повний текст джерелаАнотація:
Background Abnormal bleeding after cardiopulmonary bypass (CPB) is a common complication of cardiac surgery, with important health and economic consequences. Coagulation test-based algorithms may reduce transfusion of non-erythrocyte allogeneic blood in patients with abnormal bleeding. Methods The authors performed a randomized prospective trial comparing allogeneic transfusion practices in 92 adult patients with abnormal bleeding after CPB. Patients with abnormal bleeding were randomized to one of two groups: a control group following individual anesthesiologist's transfusion practices and a protocol group using a transfusion algorithm guided by coagulation tests. Results Among 836 eligible patients having all types of elective cardiac surgery requiring CPB, 92 patients developed abnormal bleeding after CPB (incidence, 11%). The transfusion algorithm group received less allogeneic fresh frozen plasma in the operating room after CPB (median, 0 units; range, 0-7 units) than the control group (median, 3 units; range, 0-10 units) (P = 0.0002). The median number of platelet units transfused in the operating room after CPB was 4 (range, 0-12) in the algorithm group compared with 6 (range, 0-18) in the control group (P = 0.0001). Intensive care unit (ICU) mediastinal blood loss was significantly less in the algorithm group. Multivariate analysis demonstrated that transfusion algorithm use resulted in reduced ICU blood loss. The control group also had a significantly greater incidence of surgical reoperation of the mediastinum for bleeding (11.8% vs. 0%; P = 0.032). Conclusions Use of a coagulation test-based transfusion algorithm in cardiac surgery patients with abnormal bleeding after CPB reduced non-erythrocyte allogeneic transfusions in the operating room and ICU blood loss.
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Lenoir, Brigitte, Paul Merckx, Catherine Paugam-Burtz, Cyril Dauzac, Marie-Madeleine Agostini, Pierre Guigui, and Jean Mantz. "Individual Probability of Allogeneic Erythrocyte Transfusion in Elective Spine Surgery." Anesthesiology 110, no. 5 (May 1, 2009): 1050–60. http://dx.doi.org/10.1097/aln.0b013e31819df9e0.
Повний текст джерелаАнотація:
Background The aim of this study was to generate a score based on preoperative characteristics and predictive of the individual probability of allogeneic erythrocyte transfusion in patients undergoing elective thoracolumbar spine surgery. Methods Two hundred thirty consecutive patients were retrospectively included over a 15-month period (derivation set). Preoperative independent predictors of erythrocyte transfusion from the day of surgery until postoperative day 5 were determined by multivariable analysis, from which a model of individual probability of transfusion was derived and prospectively validated in 125 additional patients (validation set). Results Four preoperative independent predictors were associated with transfusion: age older than 50 yr (adjusted odds ratio = 4.9 [2-13.5]), preoperative hemoglobin level less than 12 g/dl (adjusted odds ratio = 6.9 [3.1-17.2]), fusion of more than two levels (adjusted odds ratio = 6.7 [3.1-15.2]), and transpedicular osteotomy (adjusted odds ratio = 19.9 [5.6-98.2]). A 0-4 score (0 = no risk, 4 = maximum risk) predictive of allogeneic transfusion was derived by weighting estimate parameters for each variable in a multivariable logistic regression model. Discriminating capacity of the score was 0.86 [0.81-0.92] in the receiver operating characteristics in the derivation sample and 0.83 [0.75-0.91] in the validation sample. The observed transfusion rates in the validation set and the individual probabilities of erythrocyte transfusion from the score were well correlated (y = 0.98x + 0.04; P < 0.0001), and the observed differences were not statistically different (goodness-of-fit chi-square, P = 0.125). The score was also correlated with the number of erythrocyte units transfused (Spearman rho = 0.61; P < 0.0001). Conclusion The Predictive Model of Transfusion in Spine Surgery may be useful in clinical practice to identify patients undergoing spine surgery at risk of massive bleeding and encourage erythrocyte-saving strategies in these patients.
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Fedorova, T. A., O. M. Borzykina, E. V. Strelnikova, K. G. Khamidulina, O. V. Rogachevskiy, A. V. Kozachenko, and T. Yu Ivanets. "Blood management in patients with uterine myoma and anemia in the perioperative period." Meditsinskiy sovet = Medical Council, no. 16 (October 6, 2022): 19–27. http://dx.doi.org/10.21518/2079-701x-2022-16-16-19-27.
Повний текст джерелаАнотація:
Introduction. In the structure of gynecological diseases, uterine myoma occupies one of the leading places and is accompanied by abnormal uterine bleeding, anemia, hemodynamic and hemostasiological disorders. Purpose. To optimize the management of the perioperative period in patients with uterine myoma and iron deficiency anemia (IDA) using methods of patient blood management (PBM). Materials and methods. The study group consisted of 94 patients with uterine myoma and IDA, who were examined and treated at the Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology. Of these, 74 patients made up the first, prospective group, who received IDA treatment with intravenous administration of ferric carboxymaltose during the perioperative period and during surgical treatment (laparoscopy / laparotomy and myomectomy), they underwent intraoperative autologous blood transfusion (IABT) using the cell salvage with Cell Saver 5+ apparatus. 20 women with myoma uterine and IDA constituted a comparison group (retrospective) who did not receive intravenous iron therapy in the perioperative period and did not undergo IABT. During surgical intervention (laparoscopy / laparotomy and myomectomy) or in the postoperative period, they received transfusion of donor erythrocyte-containing blood components according to indications. Results. All patients underwent surgical treatment in the amount of laparoscopy / laparotomy and myomectomy. During the operation, 74 patients of the main group underwent IABT in an average volume of 467.4 ± 327.8 ml. In the postoperative period, the patients of the main group continued to receive anemia therapy with intravenous administration of ferric carboxymaltose. And blood transfusions were not required in any patient of the main group. In patients of the second group, two (10 %) patients received donor erythrocyte suspension in an average volume of 358.2 ± 85.8 ml. Infectious and inflammatory complications: fever, inflammation of the postoperative suture, parametritis occurred in 6.8 % of women in the main group; in the comparison group – in 15 % of patients. Conclusions. Introduction into clinical practice of modern methods of blood management in patients with uterine myoma and IDA: the Infusion of intravenous high-dose ferric preparationsin the perioperative period, the use of Cell Saver devices for intra-operative autologous blood transfusion, helps to reduce the time of therapy, minimize transfusions of donor erythrocytes, reducing the frequency of infectious and inflammatory complications.
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Bryer, Emily Jane, and David H. Henry. "A retrospective analysis of venous thromboembolism trends in chemotherapy-induced anemia: Red blood cell transfusion versus erythrocyte stimulating agent (ESA) administration." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e14685-e14685. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e14685.
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e14685 Background: Anemia is a common and unfortunate consequence of chemotherapy; patients receiving a variety of chemotherapy regimens often develop chemotherapy–induced anemia (CIA), which contributes to poor outcomes including increased mortality. Prompt and effective treatment of CIA is essential to prevent fewer chemotherapy dose delays and reductions. Optimal therapy of CIA is controversial and involves the solitary and combined use of intravenous iron, red blood cell (RBC) transfusions, and erythropoietin stimulating agents (ESAs). Despite the baseline coagulopathies present in patients with malignancy, administration of both RBC transfusions and ESAs is associated with venous thromboembolism (VTE). It remains unknown whether the risk of VTE in patients with CIA is greater among patients who receive RBC transfusions or ESAs. Methods: A retrospective single-institution study analyzed 7360 patients with varying malignancies who developed CIA and received ESAs and RBC transfusion from 1998-2017. These patients were evaluated for subsequent development of VTE and categorized by prior receipt of RBC transfusion or ESA. Results: Among the 7360 patients with CIA, 5503 received either RBC transfusion or ESA and 1857 received both. Among all patients, 3466/7360 (47.1%) developed a VTE. The absolute risk of developing a VTE with receipt of a RBC transfusion was 0.38 compared to 0.19 with ESA. Patients with CIA who received RBC had twice the risk of developing a VTE compared with those who received ESA (p < 0.0001). Conclusions: While both RBC transfusion and ESA administration are independently associated with VTE, our data suggests a greater risk of VTE development with RBC transfusion as compared with ESA administration.[Table: see text]
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Duan, Lian, E. Wang, Guo-Huang Hu, Cheng-Liang Zhang, Si-Ni Liu, and Yan-Ying Duan. "Preoperative autologous platelet pheresis reduces allogeneic platelet use and improves the postoperative PaO2/FiO2 ratio in complex aortic surgery: a retrospective analysis." Interactive CardioVascular and Thoracic Surgery 31, no. 6 (November 1, 2020): 820–26. http://dx.doi.org/10.1093/icvts/ivaa200.
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Abstract OBJECTIVES An autologous platelet-rich plasma pheresis (aPP) strategy can harvest partial whole blood that is separated into erythrocytes, plasma and platelets, and can reduce blood loss and transfusion during cardiovascular surgery using cardiopulmonary bypass (CPB). However, the blood and organ conservation effects of this technique have not been confirmed in the context of complex aortic surgery. METHODS Perioperative records of 147 adult patients who underwent complex aortic surgery were analysed retrospectively. RESULTS All patients received regular blood conservation treatment, and 57 patients received aPP. Whether or not the participants were propensity matched, decreased platelet and cryoprecipitate transfusions were found in the aPP group (both P < 0.001), but there were non-significant differences in erythrocyte transfusion, Sequential Organ Failure Assessment scores and other outcomes when compared with the same parameters in the non-aPP group. The aPP group had a higher arterial oxygen partial pressure to inhaled oxygen concentration ratio on postoperative days 1, 2 and 7 than the non-aPP group (P < 0.001, P < 0.001 and P = 0.048, respectively). CONCLUSIONS The utilization of aPP was associated with a reduction in allogeneic platelet and cryoprecipitate transfusions as well as minor lung-protective effects during complex aortic surgery using CPB.
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Pinheiro de Almeida, Juliano, Jean-Louis Vincent, Filomena Regina Barbosa Gomes Galas, Elisangela Pinto Marinho de Almeida, Julia T. Fukushima, Eduardo A. Osawa, Fabricio Bergamin, et al. "Transfusion Requirements in Surgical Oncology Patients." Anesthesiology 122, no. 1 (January 1, 2015): 29–38. http://dx.doi.org/10.1097/aln.0000000000000511.
Повний текст джерелаАнотація:
Abstract Background: Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill patients, but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer. Methods: In a randomized, controlled, parallel-group, double-blind (patients and outcome assessors) superiority trial in the intensive care unit of a tertiary oncology hospital, the authors evaluated whether a restrictive strategy of erythrocyte transfusion (transfusion when hemoglobin concentration <7 g/dl) was superior to a liberal one (transfusion when hemoglobin concentration <9 g/dl) for reducing mortality and severe clinical complications among patients having major cancer surgery. All adult patients with cancer having major abdominal surgery who required postoperative intensive care were included and randomly allocated to treatment with the liberal or the restrictive erythrocyte transfusion strategy. The primary outcome was a composite endpoint of mortality and morbidity. Results: A total of 198 patients were included as follows: 101 in the restrictive group and 97 in the liberal group. The primary composite endpoint occurred in 19.6% (95% CI, 12.9 to 28.6%) of patients in the liberal-strategy group and in 35.6% (27.0 to 45.4%) of patients in the restrictive-strategy group (P = 0.012). Compared with the restrictive strategy, the liberal transfusion strategy was associated with an absolute risk reduction for the composite outcome of 16% (3.8 to 28.2%) and a number needed to treat of 6.2 (3.5 to 26.5). Conclusion: A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major postoperative complications in patients having major cancer surgery compared with a restrictive strategy.
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Glance, Laurent G., Andrew W. Dick, Dana B. Mukamel, Fergal J. Fleming, Raymond A. Zollo, Richard Wissler, Rabih Salloum, U. Wayne Meredith, and Turner M. Osler. "Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery." Anesthesiology 114, no. 2 (February 1, 2011): 283–92. http://dx.doi.org/10.1097/aln.0b013e3182054d06.
Повний текст джерелаАнотація:
Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.
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Haris, Muhammad, Najma Baseer, Yasar Mehmood Yousafzai, Sobia Haris, Usman Naeem, Rabail Rabail, Farah Deeba, and Muhammad Jehangir Khan. "Cytoskeletal changes in Erythrocytes during storage in banked blood." Rehman Journal of Health Sciences 2, no. 2 (February 9, 2021): 64–71. http://dx.doi.org/10.52442/rjhs.v2i2.74.
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Introduction: Erythrocytes have flexible, non-nucleated bi-concave shape with lipid bilayer cytoskeleton. Any alterations of erythrocyte shape make it susceptible to hemolysis. Blood for transfusion purpose is routinely stored in Citrate Phosphate Dextrose Adenine (CPDA-1) containing blood bags. During storage, blood undergoes an array of different morphological changes termed as “storage lesions” which makes it more fragile. This study was aimed to determine the structural and functional modifications in erythrocytes in CPDA-1 blood stored in local blood bank of KPK. Material & Methods: Blood from twenty healthy volunteer donors was taken and kept in CPDA-1 containing blood bags at Institute of Basic Medical Sciences (IBMS), Khyber Medical University (KMU). Hb-levels and Erythrocyte, Reticulocyte counts, Mechanical Fragility Index (MFI) and immunofluorescence staining for ankiyrin1 protein were performed on fresh blood samples. Samples for reticulocyte count was taken for 5 consecutive days while for the remaining parameters, blood was taken at 5 days interval till day 20th. The light and fluorescence micrographs were obtained accordingly and osmotic fragility tests were performed. Results: A significant mean reduction in erythrocyte counts and Hb-level was observed from day 0 to 20 (p=0.001), while MFI increased from day 0 to day 20 (12.88%±7.58 p=0.001). Reticulocyte count also decreased from day 0 up to day 5 (p=0.001). A weak association was observed between changes in MFI and erythrocyte morphology from day 0 to 20 (r=0.349), while the intensity and pattern of ankyrin1 protein expression appeared to change from day 10. Conclusion: Blood stored for a week has same properties as fresh blood, however, important structural alterations start to appear after the first week of storage and worsen with time. Therefore, to gain better transfusion results, blood stored for up to one week can safely be transfused.
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Akbaş, Türkay. "Long length of stay in the ICU associates with a high erythrocyte transfusion rate in critically ill patients." Journal of International Medical Research 47, no. 5 (March 12, 2019): 1948–57. http://dx.doi.org/10.1177/0300060519832458.
Повний текст джерелаАнотація:
Objective This study aimed to evaluate epidemiology and outcome among critically ill patients under a restrictive transfusion practice. Methods One hundred sixty-nine patients who were admitted to the intensive care unit (ICU) between March 2016 to December 2017 and remained in the ICU > 24 hours were retrospectively included. Results Hemoglobin levels on admission were <12 g/dL in 85% and <9 g/dL in 37.9% of patients. The median admission hemoglobin level was decreased on the last day of the ICU stay. Erythrocyte transfusion was required for 34% of patients. Transfused patients had high Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, more requirement for invasive mechanical ventilation, vasopressors, and dialysis, long ICU and hospital stays, low hemoglobin levels, and high hospital and ICU mortality rates. Multivariate analysis showed that the likelihood of transfusion increased from 6.6 to 25.8 fold when the ICU stay extended from ≥7 to ≥15 days. Age, vasopressor use, dialysis, and erythrocyte transfusion ≥5 units were predictors of mortality. Conclusion Patients receiving transfusion are severely ill and have more life support therapies. The number of erythrocyte units transfused, age, and organ support therapies are independent predictors of mortality.
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Weiskopf, Richard B., John Feiner, Harriet Hopf, Jeremy Lieberman, Heather E. Finlay, Cheng Quah, Joel H. Kramer, Alan Bostrom, and Pearl Toy. "Fresh Blood and Aged Stored Blood Are Equally Efficacious in Immediately Reversing Anemia-induced Brain Oxygenation Deficits in Humans." Anesthesiology 104, no. 5 (May 1, 2006): 911–20. http://dx.doi.org/10.1097/00000542-200605000-00005.
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Background Erythrocytes are transfused to treat or prevent imminent inadequate tissue oxygenation. 2,3-diphosphoglycerate concentration decreases and oxygen affinity of hemoglobin increases (P50 decreases) with blood storage, leading some to propose that erythrocytes stored for 14 or more days do not release sufficient oxygen to make their transfusion efficacious. The authors tested the hypothesis that erythrocytes stored for 3 weeks are as effective in supplying oxygen to human tissues as are erythrocytes stored for less than 5 h. Methods Nine healthy volunteers donated 2 units of blood more than 3 weeks before they were tested with a standard, computerized neuropsychological test (digit-symbol substitution test [DSST]) on 2 days, 1 week apart, before and after acute isovolemic reduction of their hemoglobin concentration to 7.4 and 5.5 g/dl. Volunteers randomly received autologous erythrocytes stored for either less than 5 h ("fresh") or 3 weeks ("stored") to return their hemoglobin concentration to 7.5 g/dl (double blinded). Erythrocytes of the alternate storage duration were transfused on the second experimental day. The DSST was repeated after transfusion. Results Acute anemia slowed DSST performance equivalently in both groups. Transfusion of stored erythrocytes with decreased P50 reversed the altered DSST (P < 0.001) to a time that did not differ from that at 7.4 g/dl hemoglobin during production of acute anemia (P = 0.88). The erythrocyte transfusion-induced DSST improvement did not differ between groups (P = 0.96). Conclusion Erythrocytes stored for 3 weeks are as efficacious as are erythrocytes stored for 3.5 h in reversing the neurocognitive deficit of acute anemia. Requiring fresh rather than stored erythrocytes for augmentation of oxygen delivery does not seem warranted.
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Barabasi, Ildiko, Cristina Stefanut, and Laurent Ognean. "Therapeutic efficacy and safety evaluation of erythrocyte concentrate used in dogs." Bulletin of University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca. Veterinary Medicine 73, no. 2 (November 30, 2016): 399. http://dx.doi.org/10.15835/buasvmcn-vm:12260.
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Therapeutic efficacy and safety evaluation of erythrocyte concentrate used in dogs 1Ildikó BARABÁSI, 1Cristina ȘTEFǍNUȚ, 1Laurenţ OGNEAN 1University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, 400037, Manastur street, no.3-5, Cluj-Napoca, Romania *Corresponding author: lognean@yahoo.com Keywords: dogs, erythrocyte concentrate, hematocrit, immune-mediated hemolytic anemia, transfusion therapy Introduction: The minimum dose of whole blood products as well as erythrocyte concentrate has been under a lot of debate, new equations for calculating the optimal dose being made up from a large variety of hematologists (Kisielewicz et al 2014; Helm and Knottenbelt, 2010; Gibson, 2007). Aim: The therapeutical efficacy of erythrocyte concentrates in dogs with different types of anemia by measuring the hematocrit level 6 hours after the transfusion and a complete blood count 5 days post-transfusion therapy. Materials and methods: Blood tests were performed with ADIVA hematological analyzer; the 6 hour post-transfusion hematocrit was determined by a micro hematocrit. On admission every patient received a routine blood test that included 40 hematological parameters and 21 biochemical parameters. In addition, a detailed examination of the blood smears was also performed by the ADIVA hematological analyzer with 26 parameters that mostly referred to red blood cell and white blood cell morphology. Blood typing was done using the RapidVet quick test kit. Patients received only type specific blood and to limit transfusion reaction occurrences, in addition, a crossmatch test was performed before every transfusion. Statistical analysis was accomplished with GraphPadInStat 3.0 and the graphical depiction of the obtained results was made using the Origin 8.5. graphics program. Results: Statistical analysis reveal that the total red blood cell count underwent very significant changes (p=0.0052) as well as the hemoglobin (p=0.0085). The hematocrit had an extremely significant evolution (p=0.0002). As far as the other hematological parameters are concerned, none underwent statistically significant evolutions from first day of transfusion (T0) until five days post-transfusion therapy (T5). Conclusion: The erythrocyte concentrate can be used safely even in critically ill or immune-suppressed patients and even in patients with an exaggerated immune response. A clear dosage of this blood product has not been set yet, every administration has to be tailored to the patient’s needs.
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Li, Zhen-Zhou, Xiao-Xiao Wang, Li Ma, Huan Wang, Jia-Ming Xu, Xiao-Fang Zhou, Yang Liu, and Jian-Rong Guo. "Influence of different erythrocyte storage times on the macrophage response in haemorrhagic shock mice." Journal of International Medical Research 48, no. 8 (August 2020): 030006052094787. http://dx.doi.org/10.1177/0300060520947872.
Повний текст джерелаАнотація:
Objective To investigate the characteristics of the macrophage response to transfusion of erythrocytes kept at different storage times in the mouse model of haemorrhagic shock. Methods Erythrocytes were isolated from mice and stored for 7, 21 or 35 days and samples injected intravenously into haemorrhagic shock mice. Changes in macrophages, inflammatory cytokines and T cell differentiation were assessed using flow cytometry or enzyme-linked immunosorbent assay (ELISA). In a second experiment, haemorrhagic shock mice were injected with 21D-erythrocytes and the expression of nuclear factor erythroid 2 p45-related factor 2 (Nrf2), arginine -1 (Arg-1) and inducible nitrous oxide (iNOS) determined. Results The proportion of M1-polarized macrophages was greatest in the 21D group while M2 macrophages tended to increase with the erythrocyte storage time. Levels of inflammatory cytokines and T helper 1 (Th1) cells increased in proportion to erythrocytes storage time. Most regulatory T cells (Treg) were found at 21D. Arg-1 expression was significantly increased in a group that received an heme oxygenase 1 (HO-1) agonist and significantly decreased in a group that received an HO-1 inhibitor but there were no differences in the expression of iNOS or Nrf2. Conclusion 21D storage time may be an important time point for erythrocyte storage and immunity response and Arg-1 may have a role in the macrophage response to erythrocyte infusion.
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Takeshita, Akihiro, Hiroko Watanabe, Harumi Fujihara, Chiaki Yamada, Machiko Oshida, Kimiko Yurugi, Yutaka Tomoda, et al. "Erythrocyte Alloimmunization Analyzed by Gender and Transfusion Status." Blood 116, no. 21 (November 19, 2010): 4407. http://dx.doi.org/10.1182/blood.v116.21.4407.4407.
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Abstract Abstract 4407 (Purpose) Prior investigations have looked for trends and patterns in post-transfusion erythrocyte alloantibody formation (e.g., Walker et al., Tormey et al., and Hoeltge et al.). While anti-E has consistently been one of the most frequently observed alloantibodies following transfusion, the relative frequency of other antibodies is variably reported. In fact, some authors have reported no relationship between transfusion and alloantibody prevalence (Coles et al. and Domen et al.). Different outcomes might be attributed to antibody detection methods, cohort size, and cohort composition by race (including differences in the racial composition of donor and patient populations). As yet, the significance of gender has not been explicitly investigated in a large cohort of transfused vs. non-transfused patients. This study reports gender differences in erythrocyte alloantibody formation in a nation where blood donor and patient populations are phenotypically similar and relatively homogeneous. (Methods) In response to an open invitation made in November, 2008, 25 Japanese institutions contributed data on 248,785 patients (male:female=1:1.19). Each institution reported results from the previous 3 years. Patients known to have been transfused were placed in the transfused group, whereas patients known not to have been transfused were placed in the non-transfused group. Patients for whom transfusion history was uncertain were excluded. Erythrocyte alloantibodies against D, C, c, E, e, f, Ce, P1, M, N, S, s, Mia, Lea, Leb, Jka, Jkb, Jk3, Fya, Fyb, K, k, Kpa, Kpb, Jsa, Jsb, Dia, Dib, Lua, Lub, Xga and H were analyzed. A patient investigated multiple times was counted as one case. Multiple antibodies in one patient were separately summarized. Antibody incidence was calculated as the percentage of patients in each group with the corresponding antibody. (Results) Erythrocyte antibodies were detected in 3,554 patients (1.43% of all patients, 1.32% of males and 1.52% of females). Including 655 patients with antibodies reported by four more institutions, a total of 4,219 patients with at least one antibody were analyzed. From these, anti-E was observed in 34.7% and 41.3% of male and female transfused patients vs. 8.0% and 21.9% in those not transfused, respectively. Anti-Dia was observed in 3.5% and 4.8% of male and female transfused patients vs. 2.7% and 2.8% in those not transfused. Jka was observed in 2.6% and 4.7% of male and female transfused patients vs. 0.4% and 0.1% in those not transfused. Anti-E+c was observed in 6.6% and 8.4% of male and female transfused patients vs. 0.4% and 2.3% in those not transfused. Emergence of anti-E, anti-Dia and anti-Jka following transfusion was significantly different between males and females (p<0.05, p<0.05 and p<0.01, respectively). (Conclusion) The frequencies of anti-E, anti-Dia, anti-Jka and others depend not only on transfusion history, but also gender. Discordance with other studies suggests that population genetics may also be relevant. These are especially important results in the emerging era of personalized medicine. Hematologists should continue large-scale investigations of transfusion-related alloimmunization to elucidate contributory factors and to optimize patient care. Disclosures: No relevant conflicts of interest to declare.
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Zeroual, Norddine, Cinderella Blin, Marine Saour, Hélène David, Safa Aouinti, Marie-Christine Picot, Pascal H. Colson, and Philippe Gaudard. "Restrictive Transfusion Strategy after Cardiac Surgery." Anesthesiology 134, no. 3 (January 21, 2021): 370–80. http://dx.doi.org/10.1097/aln.0000000000003682.
Повний текст джерелаАнотація:
Background Recent guidelines on transfusion in cardiac surgery suggest that hemoglobin might not be the only criterion to trigger transfusion. Central venous oxygen saturation (Svo2), which is related to the balance between tissue oxygen delivery and consumption, may help the decision process of transfusion. We designed a randomized study to test whether central Svo2–guided transfusion could reduce transfusion incidence after cardiac surgery. Methods This single center, single-blinded, randomized controlled trial was conducted on adult patients after cardiac surgery in the intensive care unit (ICU) of a tertiary university hospital. Patients were screened preoperatively and were assigned randomly to two study groups (control or Svo2) if they developed anemia (hemoglobin less than 9 g/dl), without active bleeding, during their ICU stay. Patients were transfused at each anemia episode during their ICU stay except the Svo2 patients who were transfused only if the pretransfusion central Svo2 was less than or equal to 65%. The primary outcome was the proportion of patients transfused in the ICU. The main secondary endpoints were (1) number of erythrocyte units transfused in the ICU and at study discharge, and (2) the proportion of patients transfused at study discharge. Results Among 484 screened patients, 100 were randomized, with 50 in each group. All control patients were transfused in the ICU with a total of 94 transfused erythrocyte units. In the Svo2 group, 34 (68%) patients were transfused (odds ratio, 0.031 [95% CI, 0 to 0.153]; P < 0.001 vs. controls), with a total of 65 erythrocyte units. At study discharge, eight patients of the Svo2 group remained nontransfused and the cumulative count of erythrocyte units was 96 in the Svo2 group and 126 in the control group. Conclusions A restrictive transfusion strategy adjusted with central Svo2 may allow a significant reduction in the incidence of transfusion. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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Hoehn, Richard S., Peter L. Jernigan, Alex L. Chang, Michael J. Edwards, Charles C. Caldwell, Erich Gulbins, and Timothy A. Pritts. "Acid Sphingomyelinase Inhibition Prevents Hemolysis During Erythrocyte Storage." Cellular Physiology and Biochemistry 39, no. 1 (2016): 331–40. http://dx.doi.org/10.1159/000445627.
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Background/Aims: During storage, units of human red blood cells (pRBCs) experience membrane destabilization and hemolysis which may cause harm to transfusion recipients. This study investigates whether inhibition of acid sphingomyelinase could stabilize erythrocyte membranes and prevent hemolysis during storage. Methods: Human and murine pRBCs were stored under standard blood banking conditions with and without the addition of amitriptyline, a known acid sphingomyelinase inhibitor. Hemoglobin was measured with an electronic hematology analyzer and flow cytometry was used to measure erythrocyte size, complexity, phosphatidylserine externalization, and band 3 protein expression. Results: Cell-free hemoglobin, a marker of hemolysis, increased during pRBC storage. Amitriptyline treatment decreased hemolysis in a dose-dependent manner. Standard pRBC storage led to loss of erythrocyte size and membrane complexity, increased phosphatidylserine externalization, and decreased band 3 protein integrity as determined by flow cytometry. Each of these changes was reduced by treatment with amitriptyline. Transfusion of amitriptyline-treated pRBCs resulted in decreased circulating free hemoglobin. Conclusion: Erythrocyte storage is associated with changes in cell size, complexity, membrane molecular composition, and increased hemolysis. Acid sphingomyelinase inhibition reduced these changes in a dose-dependent manner. Our data suggest a novel mechanism to attenuate the harmful effects after transfusion of aged blood products.
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Takeshita, Akihiro, Hiroko Watanabe, Dae Won Kim, Kyou Sup Han, So Yong Kwon, Jang Soo Suh, Chan Pui Ha Natalie, et al. "Allo-Immunity to Erythrocytes in Relation to Blood Transfusion and Pregnancy: Cooperative Study of Allo-Immunity to Antigen Diversity in Asian Populations." Blood 114, no. 22 (November 20, 2009): 3144. http://dx.doi.org/10.1182/blood.v114.22.3144.3144.
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Abstract Abstract 3144 Poster Board III-81 Purpose Allo-immunization to erythrocytes is an important issue with regard to blood transfusions, albeit perhaps less prominent than other possible adverse effects. Several studies including pregnant and transfused cases have been conducted in US and European counties. However, a sufficient international or interracial comparative study has not been performed yet. Asian populations contain a wide variety of genetics and circumstances. They may differ in immune responses to allo-antigens that are common among American and European populations. Because no confirmed nor detail information exists for many Asian populations, collaborative international study concerning these issues will improve blood transfusions and transplantations not only in Asia but also the world. (Method) Forty-eight institutes, including those in Japan (29), Korea (15), Hong Kong (1), Singapore (1), Malaysia (1) and Thailand (1), participated in this first cooperative study of Asian population examining allo-immunity to erythrocytes. The total number of independent cases included more than 866,000 patients. Ab screening methods adopted in these institutes included gel columns, beads columns, traditional tubes or some combination of these three. If a case was tested multiple times, we counted it as one case. Multiple antibodies detected during the study in one patient were separately analyzed. Patients with unconfirmed histories were excluded from the study. We analyzed and compared the frequencies of irregular antibodies (Abs) to erythrocyte antigens between patients of different gender, patients pregnant or not, and patients with and without previous blood transfusion. Results Abs were determined in 8,880 patients (male /female: 3,528 /5,482), including 1801 /2418 from Japan, 946 /1477 from Korea, 287 /688 from Malaysia, 214 /408 from Thailand, 237 /375 from Hong Kong, and 11 /15 from Singapore. Of note, anti-D Ab was more frequently detected in females (p<0.01), but varies among countries as follows; 0.6 /2.4 (male /female, %) in Japan, 1.7 /8.1 in Korea, and 8.0 /19.6 in Malaysia. It significantly increased in pregnant patients (4.8% in Japan, 35.9% in Korea, 34.0% in Malaysia), but did not increase in patients that had received blood transfusion. Other Abs including complex ones did not significantly increase in pregnant patients. Anti-D Ab was rare in other Asian counties. Anti-E Ab was 1.4 times more frequently detected in patients that had received blood transfusion. [Japan (2.4x), Thailand (3.1x) Hong Kong (1.3x) and Singapore (1.3x)]. Anti-Jka and -C Abs increased in patients that had received blood transfusion. Anti-Dia Ab increased 1.6 times more in Japan, but did not in Korea (0.5x). Anti-c+E complex Abs, increased in patients that had received blood transfusion in many Asian counties. However, other complex Abs such as Anti-Lea+Leb Abs did not. Conclusion Although there have been several previous reports on allo-immunity in pregnant and transfused cases, this is the first international collaborative study in allo-immunity to erythrocyte antigens in relation to gender, pregnancy and blood transfusion status in Asia. Anti-D Ab was frequently detected in pregnant female patients. Anti-E, -Jka and -C Abs were frequently detected in patients that had received blood transfusion. However, the frequency varies among Asian countries. These data will contribute to the international body of knowledge concerning allo-immunity, allowing for advancements in successful blood transfusion in Asia and the world. The number of cases might be small in the light of total Asian populations, therefore, we should continue and spread the study. Disclosures No relevant conflicts of interest to declare.
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Bryer, Emily, Michael Kallan, Ting-Shaun Chiu, Katerina Scheuba, and David H. Henry. "A 19-Year Retrospective Analysis of Venous Thromboembolism Trends in Chemotherapy-Induced Anemia: Red Blood Cell Transfusion Versus Erythrocyte Stimulating Agent Administration." Blood 134, Supplement_1 (November 13, 2019): 4944. http://dx.doi.org/10.1182/blood-2019-129316.
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Introduction: Anemia is a common and unfortunate consequence of chemotherapy; patients receiving a variety of chemotherapy regimens often develop chemotherapy-induced anemia (CIA), which contributes to poor outcomes including increased mortality. Prompt and effective treatment of CIA is essential to prevent fewer chemotherapy dose delays and reductions. Optimal therapy of CIA is controversial and involves the solitary and combined use of intravenous iron, red blood cell (RBC) transfusions, and erythropoietin stimulating agents (ESAs). Despite the baseline coagulopathies present in patients with malignancy, administration of both RBC transfusions and ESAs is independently associated with venous thromboembolism (VTE). It remains unknown whether the risk of VTE in patients with CIA is greater among patients who receive RBC transfusions or ESAs. Methods: A retrospective study analyzed 13,334 patients in the University of Pennsylvania Health System with malignancies of various type, stage, and histopathology who developed CIA between 1998-2017. Using multivariate Cox regression, we determined adjusted hazard ratios (and corresponding 95% confidence intervals) of VTE development after adjusting for RBC and ESA intervention (all during the 90 days following CIA diagnosis). Results: (Table 1) Among the 13,334 patients with CIA, 10,948 patients did not receive any therapy during the 90-day period for their anemia (neither RBC nor ESA), 1,892 received RBC transfusion, 368 received ESA, and 126 patients received both. Among all patients, 2,620 (19.7%) developed a VTE within the 90-day period. VTE risk following RBC transfusion (HR=2.18, 95% CI 1.98-2.39, p<0.001) was approximately four-fold the VTE risk following ESA administration (HR=0.55, 95% CI 0.42-0.72, p<0.001). Conclusion: While both RBC transfusion and ESA administration are associated with VTE, our data suggests a greater risk of VTE development with RBC transfusion as compared with ESA administration. Disclosures No relevant conflicts of interest to declare.
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Karkouti, Keyvan, Thérèse A. Stukel, W. Scott Beattie, Susie Elsaadany, Ping Li, Rachel Berger, and Duminda N. Wijeysundera. "Relationship of Erythrocyte Transfusion with Short- and Long-term Mortality in a Population-based Surgical Cohort." Anesthesiology 117, no. 6 (December 1, 2012): 1175–83. http://dx.doi.org/10.1097/aln.0b013e318271604e.
Повний текст джерелаАнотація:
Background When comparing transfused versus nontransfused patients, erythrocyte transfusion is consistently associated with increased mortality. Nonetheless, unmeasured confounding may unduly influence this comparison. This unmeasured risk may have less influence on comparisons of patients undergoing surgery at hospitals with differing transfusion rates. Methods Administrative databases were used to conduct a population-based cohort study of patients who underwent elective hip- or knee-replacement surgery from 1999 to 2008 in Ontario, Canada. The authors used Cox proportional-hazards models to determine the adjusted association of hospital-specific erythrocyte transfusion rates (i.e., comparing hospitals with differing transfusion rates) with postoperative mortality. For comparison, they also determined the adjusted association of patient receipt of transfusion (i.e., comparing transfused vs. nontransfused patients) with mortality. Results Of 162,190 patients, 23% (n=37,015) were transfused. Hospital-specific transfusion rates at the 66 included hospitals ranged from 10.3 to 57.9%. Compared with nontransfused patients, transfused patients experienced increased adjusted 30-day (hazard ratio 2.32; 95% CI, 1.91-2.83) and 1-yr mortality (hazard ratio 1.75; 95% CI, 1.60-1.91). However, when hospitals were categorized into quartiles based on hospital-specific transfusion rates, mortality rates were similar (highest transfusion quartile vs. lowest transfusion quartile: 30-day mortality, hazard ratio 1.11, 95% CI 0.82-1.50; 1-yr mortality, hazard ratio 1.02, 95% CI 0.82-1.26). Conclusions The association of transfusion with postoperative mortality differed significantly when comparing transfused versus nontransfused patients, as opposed to comparing hospitals with differing transfusion rates. This discrepancy raises questions about the true relationship between transfusion and mortality.
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Hourani, Layla, Christiane Weingart, and Barbara Kohn. "Alloimmunisation in transfused patients: serial cross-matching in a population of hospitalised cats." Journal of Feline Medicine and Surgery 19, no. 12 (January 19, 2017): 1231–37. http://dx.doi.org/10.1177/1098612x16688574.
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Objectives Cross-matching is currently recommended as part of pre-transfusion testing for repeat transfusions in cats 4 days after having received an initial transfusion. This prospective study determined when and if cats developed positive cross-match (CM) results after having been transfused with AB-compatible blood. Methods Donors were selected according to standard transfusion safety protocols. Twenty-one hospitalised anaemic recipients (blood type A: n = 20; blood type B: n = 1) received 1–4 (median 2) whole blood transfusions (WBTs) over 1–6 days (median 2) in 33 transfusion instances. The tube CM method, including major, minor and recipient control, was employed. Macroscopic and microscopic agglutination reactions were evaluated according to a predetermined scale. CM tests with a positive recipient control could not be evaluated. Results No signs of an acute transfusion reaction were observed. A total of 63 CMs were performed. In one cat with immune-mediated haemolytic anaemia the CM could not be evaluated (positive recipient control). The minor CM was negative in all cases. Fifteen of 20 cats had a negative major CM (MCM) 1–12 days (median 5) after their first transfusion. A positive MCM was observed in five cases after 2–10 days (median 5) post-first WBT. These five cats had received a total of 1–4 (median 2) WBTs. Cats with a negative MCM had received 1–3 (median 2) WBTs. In 51.5% (17/33) of transfusion instances, the cat’s haematocrit increased as expected, with cats with a positive MCM at 40% (4/10) vs 56.5% (13/23) if MCM was negative. Conclusions and relevance Twenty-five percent (5/20) of the feline recipients likely developed alloantibodies against erythrocyte antigens outside of the AB system as early as 2 days post-first WBT. This adds data to the recommendation to include cross-matching in pre-transfusion screening tests.
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Pashkova, I. A. "ALGORITHMS FOR SOLVING PROBLEMS OF PRE-TRANSFUSION IMMUNOHEMATOLOGICAL TESTING." Russian journal of hematology and transfusiology 64, no. 2 (October 4, 2019): 222–33. http://dx.doi.org/10.35754/0234-5730-2019-64-2-222-233.
Повний текст джерелаАнотація:
Introduction. Screening and identification of anti-erythrocyte alloimmune antibodies in recipients is an important and necessary step in their testing before blood transfusion.Aim. To formulate algorithms that could facilitate the process of pre-transfusion immunohematological testing.General findings. Such a testing allows the development of post-transfusion reactions and complications to be avoided. The presence of alloantibodies of various specificities and autoantibodies in the test blood may complicate pre-transfusion testing and require the use of additional methods (adsorption, elution, etc.). The author has proposed an effective system of algorithms for conducting immunohematological studies, which can be used to identify patients at risk of developing immune post-transfusion complications and ensure an individual selection of compatible donor blood-transfusion products.