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Hardy JF, Farmer SL, Auerbach M, Frank SM, Javidroozi M, Leahy MF, Meier J, Ozawa S, Shander A. Preoperative Intravenous Iron in Anemic Patients Undergoing Major Abdominal Surgery May Not PREVENTT Blood Transfusions But Still Contribute to the Objectives of Patient Blood Management. Anesth Analg 2021; 132:1174-1177. [PMID: 33723195 DOI: 10.1213/ane.0000000000005409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jean-François Hardy
- From the Department of Anesthesiology and Pain Medicine, University of Montreal, Montreal, Quebec, Canada.,Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA), Paris, France
| | - Shannon L Farmer
- Medical School and Division of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | | | - Steven M Frank
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Mazyar Javidroozi
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Health, Englewood, New Jersey
| | - Michael F Leahy
- Department of Haematology, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Jens Meier
- Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA), Paris, France.,Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Kepler University, Linz, Austria
| | | | - Aryeh Shander
- Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Health, Englewood, New Jersey.,Society for the Advancement of Blood Management (SABM), Englewood, New Jersey
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The Bleeding Post-op CT Patient: Coagulation Tests Versus Thromboelastography. DIFFICULT DECISIONS IN SURGERY: AN EVIDENCE-BASED APPROACH 2019. [DOI: 10.1007/978-3-030-04146-5_30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Patient Blood Management in the Intensive Care Unit. Transfus Med Rev 2017; 31:264-271. [DOI: 10.1016/j.tmrv.2017.07.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/14/2017] [Accepted: 07/25/2017] [Indexed: 01/28/2023]
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Stephens B, Sethna F, Crispin P. Postpartum obstetric red cell transfusion practice: A retrospective study in a tertiary obstetric centre. Aust N Z J Obstet Gynaecol 2017; 58:170-177. [DOI: 10.1111/ajo.12680] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/19/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Benjamin Stephens
- Centenary Hospital for Women and Children; Canberra Australian Capital Territory Australia
| | - Farah Sethna
- Centenary Hospital for Women and Children; Canberra Australian Capital Territory Australia
| | - Philip Crispin
- The Canberra Hospital; Canberra Australian Capital Territory Australia
- Australian National University; Canberra Australian Capital Territory Australia
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Calcaterra D, Renfro LA, Shander A. Navigating the Fine Line Between the Bad and Worse: The Issue Is Not the Number, and the Message Is Not "All or Nothing". J Cardiothorac Vasc Anesth 2016; 30:1159-62. [PMID: 27640892 DOI: 10.1053/j.jvca.2016.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Domenico Calcaterra
- Division of Cardiac Surgery, Hennepin County Medical Center and Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN
| | - Leslie A Renfro
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN
| | - Aryeh Shander
- Department of Anesthesiology, Englewood Hospital & Medical Center, Englewood, NJ
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Mayson E, Shand AW, Ford JB. Single‐unit transfusions in the obstetric setting: a qualitative study. Transfusion 2016; 56:1716-22. [DOI: 10.1111/trf.13603] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 02/19/2016] [Accepted: 03/01/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Eleni Mayson
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Royal North Shore HospitalSydney Australia
| | - Antonia W. Shand
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Royal North Shore HospitalSydney Australia
- Department of ObstetricsRoyal Hospital for WomenSydney Australia
| | - Jane B. Ford
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, Royal North Shore HospitalSydney Australia
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Abstract
PURPOSE OF REVIEW Anemia has been demonstrated to be detrimental in several populations such as high-surgical-risk patients, critically ill elderly, and cardiac patients. Red blood cell transfusion is the most commonly prescribed therapy for anemia. Despite being life-saving, it carries a risk that ranges from mild complications to death. The aim of this review is to discuss the risks of anemia and blood transfusion, and to describe recent developments in the strategies to reduce allogeneic blood transfusion. RECENT FINDINGS In the past decades, clinical studies comparing transfusion strategies in different populations were conducted. Despite the challenges imposed by the development of such studies, evidence-based medicine on transfusion medicine in critically ill patients is being created. Different results arising from these studies reflect population heterogeneity, specific circumstances, and difficulties in measuring the impact of anemia and transfusion in a clinical trial. SUMMARY An adequate judgment of a clinical condition associated with proper application of the available literature is the cornerstone in the management of transfusion in critical care. Apart from this individualized strategy, the institution of a patient blood management program allows goal-directed approach through preoperative recognition of anemia, surgical efforts to minimize blood loss, and continuous assessment of the coagulation status.
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Fischer DP, Zacharowski KD, Müller MM, Geisen C, Seifried E, Müller H, Meybohm P. Patient blood management implementation strategies and their effect on physicians' risk perception, clinical knowledge and perioperative practice - the frankfurt experience. Transfus Med Hemother 2015; 42:91-7. [PMID: 26019704 DOI: 10.1159/000380868] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/12/2015] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION A multicomponent, evidence-based and interdisciplinary Patient Blood Management (PBM) program was introduced at the University Hospital Frankfurt in July 2013. The implementation strategy included practical and tactical components aimed to increase knowledge on the risks of preoperative anemia, to standardize hemotherapy, and to facilitate PBM components. METHODS This article analyzes barriers to PBM implementation and outlines a strategy to introduce and manifest PBM. The effects in Frankfurt were measured in a before and after questionnaire study distributed among groups of physicians immediately before and 1 year after PBM implementation. RESULTS 142 clinicians completed the questionnaire in July 2013 and 101 clinicians in August 2014. Absolute certainty that the treatment of preoperative anemia favorably influences morbidity and mortality rose from 25 to 37%. Transfusion behavior seems to have been affected: In 2014, 56% of clinicians stated that they clinically reassess the patient and analyze hemoglobin following each single red blood cell unit compared to only 38% stating this in 2013. CONCLUSION These results show that our implementation strategy was effective in changing physicians' risk perception, attitude, and knowledge on PBM principles. Our experience highlights key success factors for the implementation of a comprehensive PBM program.
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Affiliation(s)
- Dania P Fischer
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/M., Germany
| | - Kai D Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/M., Germany
| | - Markus M Müller
- German Red Cross Blood Transfusion Service Baden-Wuerttemberg - Hessen, Institute of Transfusion Medicine and Immunohematology, Frankfurt/M., Germany
| | - Christof Geisen
- German Red Cross Blood Transfusion Service Baden-Wuerttemberg - Hessen, Institute of Transfusion Medicine and Immunohematology, Frankfurt/M., Germany
| | - Erhard Seifried
- German Red Cross Blood Transfusion Service Baden-Wuerttemberg - Hessen, Institute of Transfusion Medicine and Immunohematology, Frankfurt/M., Germany
| | - Heiko Müller
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/M., Germany
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/M., Germany
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Mikkola R, Heikkinen J, Lahtinen J, Paone R, Juvonen T, Biancari F. Does blood transfusion affect intermediate survival after coronary artery bypass surgery? Scand J Surg 2014; 102:110-6. [PMID: 23820687 DOI: 10.1177/1457496913482246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this study was to investigate the impact of transfusion of blood products on intermediate outcome after coronary artery bypass surgery. PATIENTS Complete data on perioperative blood transfusion in patients undergoing coronary artery bypass surgery were available from 2001 patients who were operated at our institution. RESULTS Transfusion of any blood product (relative risk = 1.678, 95% confidence interval = 1.087-2.590) was an independent predictor of all-cause mortality. The additive effect of each blood product on all-cause mortality (relative risk = 1.401, 95% confidence interval = 1.203-1.630) and cardiac mortality (relative risk = 1.553, 95% confidence interval = 1.273-1.895) was evident when the sum of each blood product was included in the regression models. However, when single blood products were included in the regression model, transfusion of fresh frozen plasma/Octaplas® was the only blood product associated with increased risk of all-cause mortality (relative risk = 1.692, 95% confidence interval = 1.222-2.344) and cardiac mortality (relative risk = 2.125, 95% confidence interval = 1.414-3.194). The effect of blood product transfusion was particularly evident during the first three postoperative months. Since follow-up was truncated at 3 months, transfusion of any blood product was a significant predictor of all-cause mortality (relative risk = 2.998, 95% confidence interval = 1.053-0.537). Analysis of patients who survived or had at least 3 months of potential follow-up showed that transfusion of any blood product was not associated with a significantly increased risk of intermediate all-cause mortality (relative risk = 1.430, 95% confidence interval = 0.880-2.323). CONCLUSIONS Transfusion of any blood product is associated with a significant risk of all-cause and cardiac mortality after coronary artery bypass surgery. Such a risk seems to be limited to the early postoperative period and diminishes later on. Among blood products, perioperative use of fresh frozen plasma or Octaplas seems to be the main determinant of mortality.
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Affiliation(s)
- R Mikkola
- Department of Surgery, Oulu University Hospital, Oulu, Finland
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Gombotz H, Rehak PH, Shander A, Hofmann A. The second Austrian benchmark study for blood use in elective surgery: results and practice change. Transfusion 2014; 54:2646-57. [DOI: 10.1111/trf.12687] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/27/2014] [Accepted: 02/27/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Hans Gombotz
- Department of Anesthesiology and Intensive Care; General Hospital Linz; Linz Austria
| | - Peter H. Rehak
- Department of Surgery; Medical University of Graz; Graz Austria
| | - Aryeh Shander
- Mount Sinai School of Medicine; New York New York
- Department of Anesthesiology and Critical Medicine; Englewood Hospital and Medical Center; Englewood New Jersey
| | - Axel Hofmann
- School of Surgery; Faculty of Medicine Dentistry and Health Sciences; University of Western Australia; Perth Australia
- Centre for Population Health Research; Curtin Health Innovation Research Institute; Curtin University; Perth Australia
- Institute of Anaesthesiology; University Hospital and University of Zurich; Zurich Switzerland
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Shander A, Hofmann A, Isbister J, Van Aken H. Patient blood management--the new frontier. Best Pract Res Clin Anaesthesiol 2014; 27:5-10. [PMID: 23590911 DOI: 10.1016/j.bpa.2013.01.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 01/23/2013] [Indexed: 01/12/2023]
Abstract
As one of the oldest and most common procedures in clinical practice, allogeneic blood transfusions face many issues including questionable safety and efficacy, increasing costs and limited supply. The need to provide effective care for a relatively small population of patients who could not be transfused for various reasons gave rise to 'bloodless medicine and surgery', which was subsequently proposed as a care strategy for all patients, with the goal of minimising the use of allogeneic blood components. The next evolution came from the shift from a 'product-centred' approach towards a 'patient-centred' approach, that is, a focus on patient outcome rather than use of blood components, which gave birth to 'patient blood management'. Defined as "the timely application of evidence-based medical and surgical concepts designed to maintain haemoglobin concentration, optimise haemostasis and minimise blood loss in an effort to improve patient outcome", patient blood management is expected to reshape the future of transfusion medicine and the way blood components are used in clinical practice.
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Affiliation(s)
- Aryeh Shander
- Department of Anesthesiology, Critical Care Medicine, Hyperbaric Medicine and Pain Management, Englewood Hospital and Medical Center, USA.
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Can Blood Transfusion Be Not Only Ineffective, But Also Injurious? Ann Thorac Surg 2014; 97:11-4. [DOI: 10.1016/j.athoracsur.2013.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 07/31/2013] [Accepted: 08/07/2013] [Indexed: 01/09/2023]
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Transfusion practice varies widely in cardiac surgery: Results from a national registry. J Thorac Cardiovasc Surg 2013; 147:1684-1690.e1. [PMID: 24332109 DOI: 10.1016/j.jtcvs.2013.10.051] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 10/06/2013] [Accepted: 10/29/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Evidence is accumulating of adverse outcomes associated with transfusion of blood components. If there are differences in perioperative transfusion rates in cardiac surgery, and what hospital factors may contribute, requires further investigation. METHODS Analysis of 42,743 adult patients who underwent 43,482 procedures from 2005 to 2011 at 25 Australian hospitals, according to the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database. Multiple logistic regression examined associations of patient and hospital characteristics with transfusion of ≥1 red blood cell (RBC) unit; platelet (PLT), fresh frozen plasma (FFP), and cryoprecipitate (CRYO) doses; and ≥5 RBC units, from surgery until hospital discharge. RESULTS Procedures included 24,222 (55%) isolated coronary artery bypass grafts, 7299 (17%) isolated valve, 4714 (11%) coronary artery bypass graft and valve, and 7247 (17%) other procedures. After adjustment for various patient and procedure characteristics, transfusion rates varied across hospitals for ≥1 RBC unit from 22% to 67%, ≥5 RBC units from 5% to 25%, ≥1 PLT dose from 11% to 39%, ≥1 FFP dose from 11% to 48% and ≥1 CRYO dose from 1% to 20%. Hospital characteristics, including state or territory, private versus public, and teaching versus nonteaching, were not associated with variation in transfusion rates. CONCLUSIONS Variation in transfusion of all components and large volume RBC was identified, even after adjustment for patient and procedural factors known to influence transfusion, and this was not explained by hospital characteristics.
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Shander A, Ozawa S, Gross I, Henry D. Erythropoiesis-stimulating agents: friends or foes? Transfusion 2013; 53:1867-72. [PMID: 24015936 DOI: 10.1111/trf.12328] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Ramakrishna H, Reidy C, Riha H, Sophocles A, Lane BJ, Patel PA, Andritsos M, Ghadimi K, Augoustides JGT. The year in cardiothoracic and vascular anesthesia: selected highlights from 2012. J Cardiothorac Vasc Anesth 2013; 27:86-91. [PMID: 23312777 DOI: 10.1053/j.jvca.2012.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Indexed: 11/11/2022]
Abstract
Cardiothoracic and vascular critical care has emerged as a subspecialty due to procedural breakthroughs, an aging population, and a multidisciplinary collaboration. This subspecialty now has a dedicated professional society, recently published guidelines, and plans for standardized certification. This paradigm shift represents a major collaboration opportunity for our specialty. The rise of evidence-based perioperative practice has produced a culture of large trials in our specialty to search for solutions to the challenging outcome questions. Besides the growth in the development of evidence, the consensus conference format and postpublication peer review have both emerged as effective processes for identifying the most relevant high-quality evidence. The quest for best perioperative practice has highlighted the importance of teamwork at all phases of care with respect to transitions in care, blood component transfusion, and research misconduct. The emergence of ultrasound as a standard for central vascular access also has been emphasized in recent multisociety guidelines. There also has been a paradigm shift in the management of patients with coronary artery disease. Recent guidelines have emphasized the roles of the cardiac anesthesiologist and the interventional cardiologist as part of the heart team approach. Major recent trials in comparative effectiveness have challenged the advantages of percutaneous coronary intervention, off-pump coronary artery bypass surgery, and intra-aortic balloon counterpulsation. The year 2012 has witnessed the emergence of new paradigms of care in our specialty with the emphasis on teamwork, safety, and quality. These processes will further improve perioperative outcome.
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Partridge J, Harari D, Gossage J, Dhesi J. Anaemia in the older surgical patient: a review of prevalence, causes, implications and management. J R Soc Med 2013; 106:269-77. [PMID: 23759887 DOI: 10.1177/0141076813479580] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This review provides the clinician with a summary of the causes, implications and potential treatments for the management of anaemia in the older surgical patient. The prevalence of anaemia increases with age and is frequently identified in older surgical patients. Anaemia is associated with increased postoperative morbidity and mortality. Allogenic blood transfusion is commonly used to treat anaemia but involves inherent risks and may worsen outcomes. Various strategies for the correction of pre- and postoperative anaemia have evolved. These include correction of nutritional deficiencies and the use of intravenous iron and erythropoesis stimulating therapy. Clear differences exist between the elective and emergency surgical populations and the translation of research findings into these individual clinical settings requires more work. This should lead to a standardized approach to the management of this frequently encountered clinical scenario.
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