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Xu X, Zhang Y, Gan J, Ye X, Yu X, Huang Y. Association Between Storage Time of Transfused Red Blood Cells and Infection After Clean-contaminated Surgery: A Retrospective Cohort Study. Ann Surg 2024; 280:253-260. [PMID: 37982526 DOI: 10.1097/sla.0000000000006155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE To investigate the association between the storage time of transfused red blood cells (RBCs) and risks of infections after clean-contaminated surgery. BACKGROUND Storage lesions of RBCs can aggravate transfusion-related immunomodulation. Very few randomized controlled trials have investigated the impacts of storage time on postoperative outcomes in noncardiac patients. METHODS We included adult patients who had undergone clean-contaminated surgery from 2014 to 2018 and received allogeneic RBC transfusion. In transfusion episode-level analysis, the exposure was the storage time of each transfusion episode. In patient-level analysis, the exposures were the mean, weighted mean, maximum storage time, and Scalar Age of Blood Index of RBCs transfused into each patient. The primary outcome was infections that developed after transfusions within postoperative day 30. RESULTS The 4046 patients were included who received 11604 transfusion episodes. Of these, 1025 (25.3%) patients developed postoperative infections. An increased storage time of transfused RBCs was not associated with increased odds of postoperative infections in either transfusion episode-level analysis [odds ratio (OR), 1.03 per 5 days, 95% CI, 0.95-1.11] or patient-level analysis (mean: OR, 1.02, 95% CI, 0.95-1.10; weighted mean: OR, 1.02, 95% CI, 0.95-1.10; maximum: OR, 1.06, 95% CI, 0.98-1.14; Scalar Age of Blood Index: OR, 0.99, 95% CI, 0.96-1.03), after adjusting 17 confounders. CONCLUSIONS Prolonged storage time of transfused RBCs was not associated with increased risks of infections after clean-contaminated surgery.
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Affiliation(s)
- Xiaohan Xu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Beijing, China
| | - Jia Gan
- Department of Blood Transfusion, Peking Union Medical College Hospital, Beijing, China
| | - Xiangyang Ye
- Department of Information Management, Peking Union Medical College Hospital, Beijing 100730, China
| | - Xuerong Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
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2
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Muche Y, Gelaw Y, Atnaf A, Getaneh Z. Blood Transfusion Complications and Associated Factors Among Blood-Transfused Adult Patients at Debre Markos Comprehensive Specialized Hospital, Ethiopia: A Cross Sectional Study. J Blood Med 2023; 14:389-398. [PMID: 37313438 PMCID: PMC10259606 DOI: 10.2147/jbm.s412002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/26/2023] [Indexed: 06/15/2023] Open
Abstract
Background Blood transfusion is the infusion of whole blood or its components into the veins of the patient to improve tissue oxygenation and maintain hemostasis. Besides its clinical use, it can pose a risk of transfusion complications with different factors. Purpose The aim of this study was to assess blood transfusion complications, and associated factors among transfused adult patients at Debre Markos Comprehensive Specialized Hospital, North West Ethiopia, 2022. Materials and Methods An institution-based cross-sectional study design was conducted on a total of 182 patients from March 20 to June 15, 2022. Patients were enrolled in the study using consecutive sampling method. The socio-demographic and clinical data were collected using a structured questionnaire and data extraction sheet, respectively. About 3 ml of anti-coagulated blood and 30 ml of urine samples were collected to assess transfusion complications. CBC and Coombs test were performed from blood and urinalysis from urine, respectively. Chi-square, Fisher's exact test, and binary logistic regression were done using SPSS version 25. P-values less than 0.05 are declared as statistically significant. Results An acute transfusion reaction (ATR) was encountered in 12 (6.6%) patients. It was 4.13, 7.78 and 3.96 times more likely to occur among patients with a previous history of transfusion, abortion, and transfused blood stored for more than 20 days compared to their counterparts, respectively. In addition, the odds of developing ATR increase by 2.07 as the number of transfused blood units increases by 1 unit. Conclusion The incidence of acute transfusion reactions was high. During transfusion, clinicians should closely monitor patients who had history of transfusion, abortion, transfused old blood and more than 1 unit.
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Affiliation(s)
- Yalew Muche
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Yemataw Gelaw
- Department of Hematology & Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aytenew Atnaf
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Zegeye Getaneh
- Department of Hematology & Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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3
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Islamzada E, Matthews K, Lamoureux E, Duffy SP, Scott MD, Ma H. Blood unit segments accurately represent the biophysical properties of red blood cells in blood bags but not hemolysis. Transfusion 2021; 62:448-456. [PMID: 34877683 DOI: 10.1111/trf.16757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/25/2021] [Accepted: 11/19/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The biophysical properties of red blood cells (RBCs) provide potential biomarkers for the quality of donated blood. Blood unit segments provide a simple and nondestructive way to sample RBCs in clinical studies of transfusion efficacy, but it is not known whether RBCs sampled from segments accurately represent the biophysical properties of RBCs in blood bags. STUDY DESIGN AND METHODS RBCs were sampled from blood bags and segments every two weeks during 8 weeks of storage at 4°C. RBC deformability was measured by deformability-based sorting using the microfluidic ratchet device in order to derive a rigidity score. Standard hematological parameters, including mean corpuscular volume (MCV), red cell distribution width (RDW), mean cell hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and hemolysis were measured at the same time points. RESULTS Deformability of RBCs stored in blood bags was retained over 4 weeks storage, but a progressive loss of deformability was observed at weeks 6 and 8. This trend was mirrored in blood unit segments with a strong correlation to the blood bag data. Strong correlations were also observed between blood bag and segment for MCV, MCHC, and MCH but not for hemolysis. CONCLUSION RBCs sampled from blood unit segments accurately represent the biophysical properties of RBCs in blood bags but not hemolysis. Blood unit segments provide a simple and nondestructive sample for measuring RBC biophysical properties in clinical studies.
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Affiliation(s)
- Emel Islamzada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerryn Matthews
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erik Lamoureux
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Simon P Duffy
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Institute of Technology, Vancouver, British Columbia, Canada
| | - Mark D Scott
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Blood Services, Vancouver, British Columbia, Canada
| | - Hongshen Ma
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada.,School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Prostate Centre, Vancouver General Hospital, Vancouver, British Columbia, Canada
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4
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Current Understanding of the Relationship between Blood Donor Variability and Blood Component Quality. Int J Mol Sci 2021; 22:ijms22083943. [PMID: 33920459 PMCID: PMC8069744 DOI: 10.3390/ijms22083943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022] Open
Abstract
While differences among donors has long challenged meeting quality standards for the production of blood components for transfusion, only recently has the molecular basis for many of these differences become understood. This review article will examine our current understanding of the molecular differences that impact the quality of red blood cells (RBC), platelets, and plasma components. Factors affecting RBC quality include cytoskeletal elements and membrane proteins associated with the oxidative response as well as known enzyme polymorphisms and hemoglobin variants. Donor age and health status may also be important. Platelet quality is impacted by variables that are less well understood, but that include platelet storage sensitive metabolic parameters, responsiveness to agonists accumulating in storage containers and factors affecting the maintenance of pH. An increased understanding of these variables can be used to improve the quality of blood components for transfusion by using donor management algorithms based on a donors individual molecular and genetic profile.
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5
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Old, older, the oldest: red blood cell storage and the potential harm of using older red blood cell concentrates. Curr Opin Anaesthesiol 2020; 33:234-239. [PMID: 31876784 DOI: 10.1097/aco.0000000000000824] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Over the last decades, clinical studies have suggested that transfusion of red blood cells (RBCs) might negatively impact patient outcomes. Even though large randomized clinical trials did not show differences in mortality when transfusing fresh versus standard-issue RBC units, data imply that RBCs at the very end of storage could elicit negative effects. RECENT FINDINGS Certain alterations of RBCs during cold storage -- such as an increase of potassium and lactate in the storage solution -- have been discovered a century ago. In recent years, proteomic and metabolomic studies have shed more light into pathophysiological changes of RBCs during storage and have helped to specify the definition of old blood. These advancements are now utilized to increase the quality of stored RBCs and devise therapeutic strategies (e.g. nitric oxide, haptoglobin, or reduction of the iron load) when transfusing old blood. SUMMARY Further research to improve the quality of RBC units and to study populations potentially at risk is warranted. Until the question whether transfusion of old blood is detrimental for specific patient populations has been answered, a deliberate use of RBC transfusion should be implemented.
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6
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Islamzada E, Matthews K, Guo Q, Santoso AT, Duffy SP, Scott MD, Ma H. Deformability based sorting of stored red blood cells reveals donor-dependent aging curves. LAB ON A CHIP 2020; 20:226-235. [PMID: 31796943 DOI: 10.1039/c9lc01058k] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A fundamental challenge in the transfusion of red blood cells (RBCs) is that a subset of donated RBC units may not provide optimal benefit to transfusion recipients. This variability stems from the inherent ability of donor RBCs to withstand the physical and chemical insults of cold storage, which ultimately dictate their survival in circulation. The loss of RBC deformability during cold storage is well-established and has been identified as a potential biomarker for the quality of donated RBCs. While RBC deformability has traditionally been indirectly inferred from rheological characteristics of the bulk suspension, there has been considerable interest in directly measuring the deformation of RBCs. Microfluidic technologies have enabled single cell measurement of RBC deformation but have not been able to consistently distinguish differences between RBCs between healthy donors. Using the microfluidic ratchet mechanism, we developed a method to sensitively and consistently analyze RBC deformability. We found that the aging curve of RBC deformability varies significantly across donors, but is consistent for each donor over multiple donations. Specifically, certain donors seem capable of providing RBCs that maintain their deformability during two weeks of cold storage in standard test tubes. The ability to distinguish between RBC units with different storage potential could provide a valuable opportunity to identify donors capable of providing RBCs that maintain their integrity, in order to reserve these units for sensitive transfusion recipients.
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Affiliation(s)
- Emel Islamzada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada and Centre for Blood Research, University of British Columbia, Canada
| | - Kerryn Matthews
- Centre for Blood Research, University of British Columbia, Canada and Department of Mechanical Engineering, University of British Columbia, Canada.
| | - Quan Guo
- Department of Mechanical Engineering, University of British Columbia, Canada.
| | - Aline T Santoso
- Centre for Blood Research, University of British Columbia, Canada and Department of Mechanical Engineering, University of British Columbia, Canada.
| | - Simon P Duffy
- Centre for Blood Research, University of British Columbia, Canada and Department of Mechanical Engineering, University of British Columbia, Canada. and British Columbia Institute of Technology, Canada
| | - Mark D Scott
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada and Centre for Blood Research, University of British Columbia, Canada and Canadian Blood Services, Canada
| | - Hongshen Ma
- Department of Pathology and Laboratory Medicine, University of British Columbia, Canada and Centre for Blood Research, University of British Columbia, Canada and Department of Mechanical Engineering, University of British Columbia, Canada. and School of Biomedical Engineering, University of British Columbia, Canada
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7
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Ng MSY, Hay K, Choy J, Middelburg RA, Tung JP, Fraser JF. Fresh frozen plasma and platelet concentrate storage duration not associated with in hospital mortality risk. Vox Sang 2019; 114:835-841. [PMID: 31452207 DOI: 10.1111/vox.12838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES To date, the effects of FFP and PC storage duration on mortality have only been studied in a few studies in limited patient subpopulations. The aim of the current study was to determine whether FFP and PC storage duration is associated with increased in hospital mortality risk across cardiac surgery, acute medicine, ICU and orthopaedic surgery patients. MATERIALS AND METHODS Two-stage individual patient data meta-analyses were performed to determine the effects of FFP and PC storage duration on in hospital mortality. Preset random effects models were used to determine pooled unadjusted and adjusted (adjusted for age, gender and units of product transfused) effect estimates. RESULTS The FFP storage duration analysis included 3625 patients across four studies. No significant association was observed between duration of storage and in hospital mortality in unadjusted analysis, but after adjusting for patient age, gender and units of product a small increased risk of in hospital mortality was observed for each additional month of storage (OR: 1·05, 95% CI: 1·01-1·08). This effect was no longer statistically significant when donor ABO blood group was incorporated into the random effects model on post hoc analyses. A total of 547 patients across five studies were incorporated in the PC storage duration analysis. No association was observed between PC storage duration and odds of in hospital morality (adjusted OR: 0·94, 95% CI: 0·79-1·11). CONCLUSIONS There is insufficient evidence to support shortening FFP or PC shelf life based on in hospital mortality.
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Affiliation(s)
- Monica Suet Ying Ng
- Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia.,Faculty of Medicine, Oral Health Centre, University of Queensland, Herston, QLD, Australia.,Research and Development, Australian Red Cross Blood Service, Kelvin Grove, QLD, Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Joleen Choy
- Faculty of Medicine, Oral Health Centre, University of Queensland, Herston, QLD, Australia.,Royal Brisbane & Women's Hospital, Herston, QLD, Australia
| | - Rutger A Middelburg
- Centre for Clinical Transfusion Research, Sanquin Research, Leiden, Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - John-Paul Tung
- Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia.,Faculty of Medicine, Oral Health Centre, University of Queensland, Herston, QLD, Australia.,Research and Development, Australian Red Cross Blood Service, Kelvin Grove, QLD, Australia
| | - John Francis Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia.,Faculty of Medicine, Oral Health Centre, University of Queensland, Herston, QLD, Australia
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8
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Loftus TJ, Brakenridge SC, Murphy TW, Nguyen LL, Moore FA, Efron PA, Mohr AM. Anemia and blood transfusion in elderly trauma patients. J Surg Res 2019; 229:288-293. [PMID: 29937004 DOI: 10.1016/j.jss.2018.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/06/2018] [Accepted: 04/12/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The natural history of postinjury among elderly trauma patients has not been well described. We hypothesized that elderly trauma patients would have lower admission hemoglobin (Hb) levels, higher transfusion rates, and worse outcomes than young trauma patients. METHODS We performed a propensity-matched retrospective cohort analysis comparing elderly (age ≥65 y) to young (age 18-64) trauma patients matched by sex, mechanism of injury, Injury Severity Score, base deficit, comorbidities, operative blood loss, and phlebotomy blood loss (n = 41/group). Outcomes included Hb trends, packed red blood cell (PRBC) transfusion, length of stay, and mortality. RESULTS Elderly patients had lower admission Hb (11.3 versus 10.2 g/dL, P = 0.012), received more PRBC transfusions within 24 h (3.6 versus 1.8 units, P = 0.046), and during admission (6.9 versus 4.3 units, P = 0.008). Despite receiving more PRBC transfusions and having similar operative and phlebotomy blood loss, elderly subjects had lower discharge Hb (9.0 versus 9.7 g/dL, P = 0.013). Elderly subjects had fewer ICU-free days (2.0 versus 6.0 d, P < 0.001) and higher in-hospital mortality (15% versus 0%, P = 0.026). CONCLUSIONS Elderly trauma patients had lower admission Hb, received more transfusions, and had persistently lower Hb on discharge when controlling for injury severity, comorbid conditions, and blood loss. Aging may have a negative impact on postinjury anemia.
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Affiliation(s)
- Tyler J Loftus
- Department of Surgery, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, Gainesville, Florida
| | - Scott C Brakenridge
- Department of Surgery, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, Gainesville, Florida
| | - Travis W Murphy
- Department of Surgery, University of Florida, Gainesville, Florida
| | - Linda L Nguyen
- University of Florida College of Medicine, Gainesville, Florida
| | - Frederick A Moore
- Department of Surgery, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, Gainesville, Florida
| | - Philip A Efron
- Department of Surgery, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, Gainesville, Florida
| | - Alicia M Mohr
- Department of Surgery, University of Florida, Gainesville, Florida; Sepsis and Critical Illness Research Center, Gainesville, Florida.
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9
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Ng MSY, David M, Middelburg RA, Ng ASY, Suen JY, Tung JP, Fraser JF. Transfusion of packed red blood cells at the end of shelf life is associated with increased risk of mortality - a pooled patient data analysis of 16 observational trials. Haematologica 2018; 103:1542-1548. [PMID: 29794148 PMCID: PMC6119129 DOI: 10.3324/haematol.2018.191932] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 02/22/2018] [Indexed: 12/13/2022] Open
Abstract
Observational studies address packed red blood cell effects at the end of shelf life and have larger sample sizes compared to randomized control trials. Meta-analyses combining data from observational studies have been complicated by differences in aggregate transfused packed red blood cell age and outcome reporting. This study abrogated these issues by taking a pooled patient data approach. Observational studies reporting packed red blood cell age and clinical outcomes were identified and patient-level data sets were sought from investigators. Odds ratios and 95% confidence intervals for binary outcomes were calculated for each study, with mean packed red blood cell age or maximum packed red blood cell age acting as independent variables. The relationship between mean packed red blood cell age and hospital length of stay for each paper was analyzed using zero-inflated Poisson regression. Random effects models combined paper-level effect estimates. Extremes analyses were completed by comparing patients transfused with mean packed red blood cell aged less than ten days to those transfused with mean packed red blood cell aged at least 30 days. sixteen datasets were available for pooled patient data analysis. Mean packed red blood cell age of at least 30 days was associated with an increased risk of in-hospital mortality compared to mean packed red blood cell of less than ten days (odds ratio: 3.25, 95% confidence interval: 1.27–8.29). Packed red blood cell age was not correlated to increased risks of nosocomial infection or prolonged length of hospital stay.
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Affiliation(s)
- Monica S Y Ng
- Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia .,Research and Development, Australian Red Cross Blood Service, Brisbane, Australia
| | - Michael David
- School of Medicine and Population Health, The University of Newcastle, Callaghan, Australia
| | - Rutger A Middelburg
- Centre for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
| | - Angela S Y Ng
- Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Jacky Y Suen
- Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - John-Paul Tung
- Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Research and Development, Australian Red Cross Blood Service, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia
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10
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Green RS, Erdogan M, Lacroix J, Hébert PC, Tinmouth AT, Sabri E, Zhang T, Fergusson DA, Turgeon AF. Age of transfused blood in critically ill adult trauma patients: a prespecified nested analysis of the Age of Blood Evaluation randomized trial. Transfusion 2018; 58:1846-1854. [PMID: 29672869 DOI: 10.1111/trf.14640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/02/2018] [Accepted: 03/02/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Blood transfusion is common in the resuscitation of patients with traumatic injury. However, the clinical impact of the length of storage of transfused blood is unclear in this population. STUDY DESIGN AND METHODS We undertook a prespecified nested analysis of 372 trauma victims of the 2510 critically ill patients from 64 centers treated as part of the Age of Blood Evaluation (ABLE) randomized controlled trial. Patients were randomized according to their trauma status to receive either a transfusion of fresh blood stored not more than 7 days or standard-issue blood. Our primary outcome was 90-day all-cause mortality. RESULTS Overall, 186 trauma patients received fresh blood and 186 received standard-issue blood. Adherence to transfusion protocol was 94% (915/971) for all fresh blood transfused and 100% (753/753) for all standard-issue blood transfused. Mean ± SD blood storage duration was 5.6 ± 3.8 days in the fresh group and 22.7 ± 8.4 days in the standard-issue group (p < 0.001). Ninety-day mortality in the fresh group was 21% (38/185), compared to 16% (29/184) in the standard-issue group, with an unadjusted absolute risk difference of 5% (95% confidence interval [CI], -3.1 to 12.6) and an adjusted absolute risk difference of 2% (95% CI, -3.5 to 6.8). CONCLUSION In critically ill trauma patients, transfusion of fresh blood did not decrease 90-day mortality or secondary outcomes, a finding similar to the overall population of the ABLE trial.
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Affiliation(s)
- Robert S Green
- Department of Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada.,Trauma Nova Scotia, NS Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Mete Erdogan
- Trauma Nova Scotia, NS Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Jacques Lacroix
- Department of Pediatrics, Division of Critical Care Medicine, Université de Montréal, Centre Hospitalier Universitaire (CHU) Sainte Justine
| | - Paul C Hébert
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Alan T Tinmouth
- Departments of Medicine and Laboratory Medicine & Pathology, University of Ottawa, Ottawa, Ontario, Canada
| | - Elham Sabri
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Tinghua Zhang
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alexis F Turgeon
- CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec City, Quebec, Canada.,Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Quebec, Canada
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11
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Ng MSY, Tung JP, Fraser JF. Platelet Storage Lesions: What More Do We Know Now? Transfus Med Rev 2018; 32:S0887-7963(17)30189-X. [PMID: 29751949 DOI: 10.1016/j.tmrv.2018.04.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 12/20/2022]
Abstract
Platelet concentrate (PC) transfusions are a lifesaving adjunct to control and prevent bleeding in cancer, hematologic, surgical, and trauma patients. Platelet concentrate availability and safety are limited by the development of platelet storage lesions (PSLs) and risk of bacterial contamination. Platelet storage lesions are a series of biochemical, structural, and functional changes that occur from blood collection to transfusion. Understanding of PSLs is key for devising interventions that prolong PC shelf life to improve PC access and wastage. This article will review advancements in clinical and mechanistic PSL research. In brief, exposure to artificial surfaces and high centrifugation forces during PC preparation initiate PSLs by causing platelet activation, fragmentation, and biochemical release. During room temperature storage, enhanced glycolysis and reduced mitochondrial function lead to glucose depletion, lactate accumulation, and product acidification. Impaired adenosine triphosphate generation reduces platelet capacity to perform energetically demanding processes such as hypotonic stress responses and activation/aggregation. Storage-induced alterations in platelet surface proteins such as thrombin receptors and glycoproteins decrease platelet aggregation. During storage, there is an accumulation of immunoactive proteins such as leukocyte-derive cytokines (tumor necrosis factor α, interleukin (IL) 1α, IL-6, IL-8) and soluble CD40 ligand which can participate in transfusion-related acute lung injury and nonhemolytic transfusion reactions. Storage-induced microparticles have been linked to enhanced platelet aggregation and immune system modulation. Clinically, stored PCs have been correlated with reduced corrected count increment, posttransfusion platelet recovery, and survival across multiple meta-analyses. Fresh PC transfusions have been associated with superior platelet function in vivo; however, these differences were abrogated after a period of circulation. There is currently insufficient evidence to discern the effect of PSLs on transfusion safety. Various bag and storage media changes have been proposed to reduce glycolysis and platelet activation during room temperature storage. Moreover, cryopreservation and cold storage have been proposed as potential methods to prolong PC shelf life by reducing platelet metabolism and bacterial proliferation. However, further work is required to elucidate and manage the PSLs specific to these storage protocols before its implementation in blood banks.
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Affiliation(s)
- Monica Suet Ying Ng
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia; Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia.
| | - John-Paul Tung
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia; Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia.
| | - John Francis Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.
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12
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Red Cell Storage Duration Does Not Affect Outcome after Massive Blood Transfusion in Trauma and Nontrauma Patients: A Retrospective Analysis of 305 Patients. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3718615. [PMID: 28589139 PMCID: PMC5446873 DOI: 10.1155/2017/3718615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/23/2017] [Accepted: 04/05/2017] [Indexed: 02/05/2023]
Abstract
Background Prolonged storage of packed red blood cells (PRBCs) may increase morbidity and mortality, and patients having massive transfusion might be especially susceptible. We therefore tested the hypothesis that prolonged storage increases mortality in patients receiving massive transfusion after trauma or nontrauma surgery. Secondarily, we considered the extent to which storage effects differ for trauma and nontrauma surgery. Methods We considered surgical patients given more than 10 units of PRBC within 24 hours and evaluated the relationship between mean PRBC storage duration and in-hospital mortality using multivariable logistic regression. Potential nonlinearities in the relationship were assessed via restricted cubic splines. The secondary hypothesis was evaluated by considering whether there was an interaction between the type of surgery (trauma versus nontrauma) and the effect of storage duration on outcomes. Results 305 patients were given a total of 8,046 units of PRBCs, with duration ranging from 8 to 36 days (mean ± SD: 22 ± 6 days). The odds ratio [95% confidence interval (CI)] for in-hospital mortality corresponding to a one-day in mean PRBC storage duration was 0.99 (0.95, 1.03, P = 0.77). The relationship did not differ for trauma and nontrauma patients (P = 0.75). Results were similar after adjusting for multiple potential confounders. Conclusions Mortality after massive blood transfusion was no worse in patients transfused with PRBC stored for long periods. Trauma and nontrauma patients did not differ in their susceptibility to prolonged PRBC storage.
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García-Roa M, del Carmen Vicente-Ayuso M, Bobes AM, Pedraza AC, González-Fernández A, Martín MP, Sáez I, Seghatchian J, Gutiérrez L. Red blood cell storage time and transfusion: current practice, concerns and future perspectives. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 15:222-231. [PMID: 28518049 PMCID: PMC5448828 DOI: 10.2450/2017.0345-16] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 12/24/2016] [Indexed: 12/25/2022]
Abstract
Red blood cells (RBCs) units are the most requested transfusion product worldwide. Indications for transfusion include symptomatic anaemia, acute sickle cell crisis, and acute blood loss of more than 30% of the blood volume, with the aim of restoring tissue oxygen delivery. However, stored RBCs from donors are not a qualitative equal product, and, in many ways, this is a matter of concern in the transfusion practice. Besides donor-to-donor variation, the storage time influences the RBC unit at the qualitative level, as RBCs age in the storage bag and are exposed to the so-called storage lesion. Several studies have shown that the storage lesion leads to post-transfusion enhanced clearance, plasma transferrin saturation, nitric oxide scavenging and/or immunomodulation with potential unwanted transfusion-related clinical outcomes, such as acute lung injury or higher mortality rate. While, to date, several studies have claimed the risk or deleterious effects of "old" vs "young" RBC transfusion regimes, it is still a matter of debate, and consideration should be taken of the clinical context. Transfusion-dependent patients may benefit from transfusion with "young" RBC units, as it assures longer inter-transfusion periods, while transfusion with "old" RBC units is not itself harmful. Unbiased Omics approaches are being applied to the characterisation of RBC through storage, to better understand the (patho)physiological role of microparticles (MPs) that are found naturally, and also on stored RBC units. Perhaps RBC storage time is not an accurate surrogate for RBC quality and there is a need to establish which parameters do indeed reflect optimal efficacy and safety. A better Omics characterisation of components of "young" and "old" RBC units, including MPs, donor and recipient, might lead to the development of new therapies, including the use of engineered RBCs or MPs as cell-based drug delivering tools, or cost-effective personalised transfusion strategies.
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Affiliation(s)
- María García-Roa
- Department of Hematology, “Instituto de Investigación Sanitaria San Carlos” (IdISSC), “Hospital Clínico San Carlos”, Madrid, Spain
| | - María del Carmen Vicente-Ayuso
- Department of Hematology, “Instituto de Investigación Sanitaria San Carlos” (IdISSC), “Hospital Clínico San Carlos”, Madrid, Spain
| | - Alejandro M. Bobes
- Department of Hematology, “Instituto de Investigación Sanitaria San Carlos” (IdISSC), “Hospital Clínico San Carlos”, Madrid, Spain
| | - Alexandra C. Pedraza
- Department of Hematology, “Instituto de Investigación Sanitaria San Carlos” (IdISSC), “Hospital Clínico San Carlos”, Madrid, Spain
| | - Ataúlfo González-Fernández
- Department of Hematology, “Instituto de Investigación Sanitaria San Carlos” (IdISSC), “Hospital Clínico San Carlos”, Madrid, Spain
| | - María Paz Martín
- Department of Hematology, “Instituto de Investigación Sanitaria San Carlos” (IdISSC), “Hospital Clínico San Carlos”, Madrid, Spain
| | - Isabel Sáez
- ”Servicio de Hematología y Hemoterapia”, “Hospital Clínico San Carlos”, Madrid, Spain
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement and DDR Strategy, London, United Kingdom
| | - Laura Gutiérrez
- Department of Hematology, “Instituto de Investigación Sanitaria San Carlos” (IdISSC), “Hospital Clínico San Carlos”, Madrid, Spain
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Gu J, Skals RK, Torp-Pedersen C, Lundbye-Christensen S, Jakobsen CJ, Bæch J, Petersen MS, Andreasen JJ. Storage time of intraoperative transfused allogeneic red blood cells is not associated with new-onset postoperative atrial fibrillation in cardiac surgery. PLoS One 2017; 12:e0172726. [PMID: 28225837 PMCID: PMC5321425 DOI: 10.1371/journal.pone.0172726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/08/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Allogeneic red blood cell (RBC) transfusion has been associated with new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Prolonged storage time of RBC may increase the risk. The primary aim of the study was to evaluate whether the storage time of RBC is associated with development of POAF. MATERIALS AND METHODS Pre-, per- and postoperative data were retrieved from the Western Denmark Heart Registry and local blood banks regarding patients who underwent coronary artery bypass surgery, valve surgery or combined procedures in Aalborg or Aarhus University Hospital during 2010-2014. Multiple logistic regression was used to determine the risk of POAF according to transfusion of RBC on the day of surgery. Furthermore, we determined trend in storage time of RBC according to risk of POAF using restricted cubic splines. Patients with a history of preoperative atrial fibrillation, patients who received transfusions preoperative and patients who died at the day of surgery were among excluded patients. RESULTS A total of 2,978 patients with a mean age of 66.4 years were included and 609 patients (21%) received RBC transfusion on the day of surgery. POAF developed in 752 patients (25%) and transfused patients were at an increased risk compared with non-transfused patients (adjusted Odds Ratios for patients receiving RBC: 1.37; 95% CI: 1.11-1.69, P-value = 0.004). However, RBC transfusion was not necessarily the cause of POAF and may only be a marker for development of POAF. There was no significant association between storage time of RBC and POAF. CONCLUSIONS In contrast to intraoperative allogeneic RBC transfusion in general, increased storage time of RBC is not associated with development of POAF in cardiac surgery.
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Affiliation(s)
- Jiwei Gu
- Department of Cardiovascular Surgery, Heart Centre of General Hospital, Ningxia Medical University, Yinchuan, Ningxia, PR China
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark
| | - Regitze Kuhr Skals
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Søren Lundbye-Christensen
- Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | | | - John Bæch
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jan Jesper Andreasen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
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Aung HH, Tung JP, Dean MM, Flower RL, Pecheniuk NM. Procoagulant role of microparticles in routine storage of packed red blood cells: potential risk for prothrombotic post-transfusion complications. Pathology 2017; 49:62-69. [DOI: 10.1016/j.pathol.2016.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 11/25/2022]
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16
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Focus on transfusion, bleeding and thrombosis. Intensive Care Med 2016; 42:1859-1861. [PMID: 27783112 DOI: 10.1007/s00134-016-4608-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
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17
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Something Old, Something New…Something Else to Consider in Blood Utilization*. Crit Care Med 2016; 44:1259-60. [DOI: 10.1097/ccm.0000000000001686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Does major surgery induce immune suppression and increase the risk of postoperative infection? Curr Opin Anaesthesiol 2016; 29:376-83. [DOI: 10.1097/aco.0000000000000331] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Farrugia A, Starr D. Where now for transfusion: the evolution of a paradigm and its logical progression. Transfusion 2016; 56 Suppl 2:S224-32. [PMID: 27100760 DOI: 10.1111/trf.13581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/12/2015] [Accepted: 02/15/2016] [Indexed: 12/27/2022]
Abstract
The development of transfusion over the past century and a half has been described as one of the blessings of modern medicine. But, in some ways, it is emerging as a decidedly mixed blessing, bringing epidemics as well as improved health. Given all the practice has been through, now is the right time to take a critical look at blood transfusion as it is practiced today, and whether it serves the individual patient as effectively as the interests of those who administer it.
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Affiliation(s)
- Albert Farrugia
- School of Surgery, QEII Medical Centre, The University of Western Australia (M509), Crawley, Australia.,Kedrion S.P.A, Lucca, Italy
| | - Douglas Starr
- College of Communication, Boston University, Boston, Massachusetts
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Subramaniam K, Spilsbury K, Ayonrinde OT, Latchmiah F, Mukhtar SA, Semmens JB, Leahy MF, Olynyk JK. Red blood cell transfusion is associated with further bleeding and fresh-frozen plasma with mortality in nonvariceal upper gastrointestinal bleeding. Transfusion 2015; 56:816-26. [PMID: 26718025 DOI: 10.1111/trf.13446] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 10/23/2015] [Accepted: 11/06/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Blood products are commonly transfused for patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). While concerns exist about further bleeding and mortality in subsets of patients receiving red blood cell (RBC) transfusion, the impact of non-RBC blood products has not previously been systematically investigated. The aim of the study was to investigate the associations between blood products transfusion, further bleeding, and mortality after acute NVUGIB. STUDY DESIGN AND METHODS A retrospective cohort study examined further bleeding and 30-day and 1-year mortality in adult patients who underwent gastroscopy for suspected acute NVUGIB between 2008 and 2010 in three tertiary hospitals in Western Australia. Survival analysis was performed. RESULTS A total of 2228 adults (63% male) with 2360 hospital admissions for NVUGIB met the inclusion criteria. Median age at presentation was 70 years (range, 19-99 years). Thirty-day mortality was 4.9% and 1-year mortality was 13.9%. Transfusion of 4 or more units of RBCs was associated with greater than 10 times the odds of further bleeding in patients with a hemoglobin level of more than 90 g/L (odds ratio, 11.9; 95% confidence interval [CI], 3.1-45.7; p ≤ 0.001), but was not associated with mortality. Administration of 5 or more units of fresh-frozen plasma (FFP) was associated with increased 30-day (hazard ratio, 2.8; 95% CI, 1.3-5.9; p = 0.008) and 1-year (hazard ratio, 2.6; 95% CI, 1.3-5.0; p = 0.005) mortality after adjusting for coagulopathy, comorbidity, Rockall score, and other covariates. CONCLUSION In this large, multicenter study of NVUGIB, RBC transfusion was associated with further bleeding but not mortality, while FFP transfusion was associated with increased mortality in a subset of patients.
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Affiliation(s)
- Kavitha Subramaniam
- Gastroenterology and Hepatology Unit, The Canberra Hospital.,Australian National University Medical School, Canberra, ACT, Australia
| | | | - Oyekoya T Ayonrinde
- Centre for Population Health Research.,Department of Gastroenterology, Fremantle Hospital.,School of Medicine and Pharmacology (Fremantle Hospital Campus), The University of Western Australia, Fremantle, WA, Australia.,Department of Gastroenterology and Hepatology, Fiona Stanley Hospital
| | - Faye Latchmiah
- Department of Gastroenterology, Fremantle Hospital.,Department of Gastroenterology and Hepatology, Fiona Stanley Hospital
| | | | | | - Michael F Leahy
- School of Medicine and Pharmacology (Fremantle Hospital Campus), The University of Western Australia, Fremantle, WA, Australia.,Department of Haematology, Royal Perth Hospital, Perth, WA, Australia
| | - John K Olynyk
- Department of Gastroenterology, Fremantle Hospital.,Department of Gastroenterology and Hepatology, Fiona Stanley Hospital.,Curtin Health Innovation Research Institute and School of Biomedical Sciences, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia.,School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA, Australia
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