1
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Jia L, Wang Y, Zhang W, Lin Y, Chen F, Wan Y, Fu X. Optimisation and Effect Analysis of the Blood Collection Method in Pre-Deposit Autotransfusion Patients Undergoing Thoracotomy Surgery. J Multidiscip Healthc 2023; 16:2793-2798. [PMID: 37753340 PMCID: PMC10518258 DOI: 10.2147/jmdh.s424470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
Background and Purpose To explore the feasibility of the modified blood collection method in pre-deposit autotransfusion in patients undergoing thoracotomy surgery. Methods This double-blinded randomised controlled trial enrolled 92 patients from the cardiothoracic surgery department from February 2019 to October 2020. Results Compared with the conventional blood collection method, the modified blood collection method avoided blood overflow from the oblique plane of the needle (χ2 = 61.986, P < 0.01) and reduced the diameter of the bruising area after 24 hours (χ2 = 24.611, P < 0.01). Furthermore, due to optimising the blood collection method, diastolic blood pressure reduced slightly before and after blood collection (t = 2.036, P < 0.05), and patients in the test group had less pain (based on the numerical rating score) (t = 5.556, P < 0.01). Meanwhile, the time required to collect 400 mL of blood was shortened (t = 17.744, p < 0.01). Conclusion An improved blood collection method can enhance the blood donation experience, avoid blood spillage, lessen pain and reduce adverse reactions. This may be of great significance in ensuring blood quality and the safety of subsequent transfusions. Clinical Trials Registration ClinicalTrials.gov Identifier: NCT05539846.
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Affiliation(s)
- Limin Jia
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 317000, People’s Republic of China
| | - Yanfeng Wang
- Department of Geriatrics, Taizhou Central Hospital (Taizhou University Hospital) of Zhejiang, Taizhou, Zhejiang, 318000, People’s Republic of China
| | - Wenyuan Zhang
- Department of ICU, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 317000, People’s Republic of China
| | - Yulian Lin
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 317000, People’s Republic of China
| | - Fang Chen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 317000, People’s Republic of China
| | - Yixiao Wan
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 317000, People’s Republic of China
| | - Xin Fu
- Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, 317000, People’s Republic of China
- Department of Radiology, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, Zhejiang, 318000, People’s Republic of China
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2
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Abstract
BACKGROUND Blood transfusion is frequently used as an indicator of severe maternal morbidity during pregnancy. However, few studies have examined its validity in population perinatal databases. METHODS We linked a perinatal database from British Columbia, Canada, with the province's Central Transfusion Registry for 2004-2015 deliveries. Using the Central Transfusion Registry records for red blood cell transfusion as the gold standard, we calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the perinatal database variable for red blood cell transfusion, overall and by transfusion risk factor status. We used multivariable logistic regression to examine whether outcome misclassification altered the odds ratios for different transfusion risk factors. RESULTS Among 473,688 deliveries, 4,033 (8.5 per 1,000) had a red blood cell transfusion according to the Central Transfusion Registry. The sensitivity of the perinatal database transfusion variable was 72.3 [95% confidence interval (CI) = 72.2, 72.4]. Sensitivity differed according to the presence of many transfusion risk factors (e.g., 84.9% vs. 72.2% in deliveries with versus without uterine rupture). Odds ratios associated with some transfusion risk factors were exaggerated when the perinatal database transfusion variable was used to define the outcome instead of the Central Transfusion Registry variable, but 95% confidence intervals for these estimates overlapped. CONCLUSION Blood transfusion was documented with reasonable sensitivity in this large population perinatal database. However, validity varied according to risk factor status. Our findings enable researchers to better account for outcome misclassification in studies of obstetrical transfusion risk factors.
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3
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Shah A, Oczkowski S, Aubron C, Vlaar AP, Dionne JC. Transfusion in critical care: Past, present and future. Transfus Med 2020; 30:418-432. [PMID: 33207388 DOI: 10.1111/tme.12738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/27/2020] [Indexed: 01/28/2023]
Abstract
Anaemia and coagulopathy are common in critically ill patients and are associated with poor outcomes, including increased risk of mortality, myocardial infarction, failure to be liberated from mechanical ventilation and poor physical recovery. Transfusion of blood and blood products remains the corner stone of anaemia and coagulopathy treatment in critical care. However, determining when the benefits of transfusion outweigh the risks of anaemia may be challenging in some critically ill patients. Therefore, the European Society of Intensive Care Medicine prioritised the development of a clinical practice guideline to address anaemia and coagulopathy in non-bleeding critically ill patients. The aims of this article are to: (1) review the evolution of transfusion practice in critical care and the direction for future developments in this important area of transfusion medicine and (2) to provide a brief synopsis of the guideline development process and recommendations in a format designed for busy clinicians and blood bank staff. These clinical practice guidelines provide recommendations to clinicians on how best to manage non-bleeding critically ill patients at the bedside. More research is needed on alternative transfusion targets, use of transfusions in special populations (e.g., acute neurological injury, acute coronary syndromes), use of anaemia prevention strategies and point-of-care interventions to guide transfusion strategies.
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Affiliation(s)
- Akshay Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Adult Intensive Care Unit, John Radcliffe Hospital, Oxford, UK
| | - Simon Oczkowski
- Department of Medicine, McMaster University, Hamilton, Canada.,Guidelines in Intensive Care, Development and Evaluation (GUIDE) Group, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Cecile Aubron
- Department of Intensive Care Medicine, Centre Hospitalier Regional et Universitaire de Brest, Université de Bretagne Occidentale, Brest, France
| | - Alexander P Vlaar
- Department of Intensive Care Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Joanna C Dionne
- Department of Medicine, McMaster University, Hamilton, Canada.,Guidelines in Intensive Care, Development and Evaluation (GUIDE) Group, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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4
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Lasica M, Sparrow RL, Tacey M, Pollock WE, Wood EM, McQuilten ZK. Haematological features, transfusion management and outcomes of massive obstetric haemorrhage: findings from the Australian and New Zealand Massive Transfusion Registry. Br J Haematol 2020; 190:618-628. [PMID: 32064584 DOI: 10.1111/bjh.16524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/13/2020] [Indexed: 12/17/2022]
Abstract
Massive obstetric haemorrhage (MOH) is a leading cause of maternal morbidity and mortality world-wide. Using the Australian and New Zealand Massive Transfusion Registry, we performed a bi-national cohort study of MOH defined as bleeding at ≥20 weeks' gestation or postpartum requiring ≥5 red blood cells (RBC) units within 4 h. Between 2008 and 2015, we identified 249 cases of MOH cases from 19 sites. Predominant causes of MOH were uterine atony (22%), placenta praevia (20%) and obstetric trauma (19%). Intensive care unit admission and/or hysterectomy occurred in 44% and 29% of cases, respectively. There were three deaths. Hypofibrinogenaemia (<2 g/l) occurred in 52% of cases in the first 24 h after massive transfusion commenced; of these cases, 74% received cryoprecipitate. Median values of other haemostatic tests were within accepted limits. Plasma, platelets or cryoprecipitate were transfused in 88%, 66% and 57% of cases, respectively. By multivariate regression, transfusion of ≥6 RBC units before the first cryoprecipitate (odds ratio [OR] 3·5, 95% CI: 1·7-7·2), placenta praevia (OR 7·2, 95% CI: 2·0-26·4) and emergency caesarean section (OR 4·9, 95% CI: 2·0-11·7) were independently associated with increased risk of hysterectomy. These findings confirm MOH as a major cause of maternal morbidity and mortality and indicate areas for practice improvement.
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Affiliation(s)
- Masa Lasica
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia.,Australian Red Cross Blood Service, Melbourne, Vic, Australia.,Department of Haematology, Eastern Health, Melbourne, Vic, Australia.,Department of Haematology, St Vincent's Hospital, Melbourne, Vic, Australia
| | - Rosemary L Sparrow
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Mark Tacey
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Wendy E Pollock
- Maternal Critical Care, Melbourne, Vic, Australia.,School of Nursing and Midwifery, La Trobe University, Melbourne, Vic, Australia.,Department of Nursing, The University of Melbourne, Melbourne, Vic, Australia
| | - Erica M Wood
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia.,Department of Haematology, Monash Health, Melbourne, Vic, Australia
| | - Zoe K McQuilten
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia.,Australia and New Zealand Intensive Care Research Centre (ANZIC-RC), Melbourne, Vic, Australia
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5
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Patterson JA, Francis S, Ford JB. Assessing the Accuracy of Reporting of Maternal Red Blood Cell Transfusion at Birth Reported in Routinely Collected Hospital Data. Matern Child Health J 2017; 20:1878-85. [PMID: 27013516 DOI: 10.1007/s10995-016-1992-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Hospital administrative data collections have been used to describe transfusion practice, particularly in relation to the maternity population. Knowledge of the accuracy of this data is important in order to interpret the results of such studies. The aim of this study was to compare the accuracy of reporting of red cell transfusion around childbirth within hospital data with data submitted by hospital blood banks. Methods Linked hospital and birth data from New South Wales, Australia, between June 2006 and December 2010 were used to identify blood transfusions occurring at delivery. This reporting was compared with the gold standard of blood pack level information submitted by hospital blood banks, and sensitivity, specificity, and positive and negative predictive values calculated. Reporting related to quantity and timing of transfusion were also considered. Results Data were available for 235,796 births, with blood bank data identifying that 2.0 % of received a blood transfusion. Overall the sensitivity of hospital data for identifying transfusion was 84.8 % (95 % CI 83.7 %, 85.8 %) with specificity 99.9 % (99.9 %, 99.9 %). Sensitivity was better for births involving a postpartum haemorrhage [Sn 90.9 % (89.9 %, 91.9 %)], and poorer for births in regional hospitals [Sn 78.8 % (76.0 %, 81.5 %)]. Almost all (96 %) transfusions of 10 or more units were identified in hospital data, and there was no difference in reporting depending on whether the transfusion was on the baby's date of birth or not. Discussion The reliability of hospital reporting of transfusion in maternity patients is high, however with some underreporting of cases.
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Affiliation(s)
- Jillian A Patterson
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, c/- University Dept of O&G, Building 52, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Sally Francis
- NSW Clinical Excellence Commission, Sydney, NSW, Australia
| | - Jane B Ford
- Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, c/- University Dept of O&G, Building 52, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
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6
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McQuilten ZK, Bailey M, Cameron PA, Stanworth SJ, Venardos K, Wood EM, Cooper DJ. Fibrinogen concentration and use of fibrinogen supplementation with cryoprecipitate in patients with critical bleeding receiving massive transfusion: a bi-national cohort study. Br J Haematol 2017; 179:131-141. [PMID: 28653339 DOI: 10.1111/bjh.14804] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/01/2017] [Indexed: 02/06/2023]
Abstract
We aimed to compare hypofibrinogenaemia prevalence in major bleeding patients across all clinical contexts, fibrinogen supplementation practice, and explore the relationship between fibrinogen concentrations and mortality. This cohort study included all adult patients from 20 hospitals across Australia and New Zealand who received massive transfusion between April 2011 and October 2015. Of 3566 patients, 2829 (79%) had fibrinogen concentration recorded, with a median first and lowest concentration of 2·0 g/l (interquartile range [IQR] 1·5-2·7) and 1·8 g/l (IQR 1·3-2·4), respectively. Liver transplant (1·7 g/l, IQR 1·2-2·1), trauma (1·8, IQR 1·3-2·5) and vascular surgery (1·9 g/l, IQR 1·4-2·5) had lower concentrations. Total median fibrinogen dose administered from all products was 7·3 g (IQR 3·3-13·0). Overall, 1732 (61%) received cryoprecipitate and 9 (<1%) fibrinogen concentrate. Time to cryoprecipitate issue in those with initial fibrinogen concentration <1 g/l was 2·5 h (IQR 1·2-4·3 h). After adjustment, initial fibrinogen concentration had a U-shaped association with in-hospital mortality [adjusted odds ratios: fibrinogen <1 g/l, 2·31 (95% confidence interval (CI) 1·48-3·60); 1-1·9 g/l, 1·29 (95% CI 0·99-1·67) and >4 g/l, 2·03 (95% CI 1·35-3·04), 2-4 g/l reference category]. The findings indicate areas for practice improvement including timely administration of cryoprecipitate, which is the most common source of concentrated fibrinogen in Australia and New Zealand.
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Affiliation(s)
- Zoe K McQuilten
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Monash Health, Melbourne, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter A Cameron
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Simon J Stanworth
- NHS Blood and Transplant/Oxford University Hospitals NHS Trust, John Radcliffe Hospital, and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Kylie Venardos
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Erica M Wood
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Monash Health, Melbourne, Australia
| | - D James Cooper
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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7
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Green L, Tan J, Grist C, Kaur M, MacCallum P. Aetiology and outcome of massive transfusion in two large London teaching hospitals over a 3-year period (2012-2014). Transfus Med 2017; 27 Suppl 5:342-347. [DOI: 10.1111/tme.12434] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/14/2017] [Accepted: 05/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
- L. Green
- Department of Haematology; Barts Health NHS Trust; London UK
- Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
- NHS Blood and Transplant; London UK
| | - J. Tan
- Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - C. Grist
- Department of Haematology; Barts Health NHS Trust; London UK
| | - M. Kaur
- Department of Haematology; Barts Health NHS Trust; London UK
| | - P. MacCallum
- Department of Haematology; Barts Health NHS Trust; London UK
- Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
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8
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Oldroyd JC, Venardos KM, Aoki NJ, Zatta AJ, McQuilten ZK, Phillips LE, Andrianopoulos N, Cooper DJ, Cameron PA, Isbister JP, Wood EM. Improving outcomes for hospital patients with critical bleeding requiring massive transfusion: the Australian and New Zealand Massive Transfusion Registry study methodology. BMC Res Notes 2016; 9:457. [PMID: 27716381 PMCID: PMC5052932 DOI: 10.1186/s13104-016-2261-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 09/27/2016] [Indexed: 12/28/2022] Open
Abstract
Background The Australian and New Zealand (ANZ) Massive Transfusion (MT) Registry (MTR) has been established to improve the quality of care of patients with critical bleeding (CB) requiring MT (≥ 5 units red blood cells (RBC) over 4 h). The MTR is providing data to: (1) improve the evidence base for transfusion practice by systematically collecting data on transfusion practice and clinical outcomes; (2) monitor variations in practice and provide an opportunity for benchmarking, and feedback on practice/blood product use; (3) inform blood supply planning, inventory management and development of future clinical trials; and (4) measure and enhance translation of evidence into policy and patient blood management guidelines. The MTR commenced in 2011. At each participating site, all eligible patients aged ≥18 years with CB from any clinical context receiving MT are included using a waived consent model. Patient information and clinical coding, transfusion history, and laboratory test results are extracted for each patient’s hospital admission at the episode level. Results Thirty-two hospitals have enrolled and 3566 MT patients have been identified across Australia and New Zealand between 2011 and 2015. The majority of CB contexts are surgical, followed by trauma and gastrointestinal haemorrhage. Validation studies have verified that the definition of MT used in the registry correctly identifies 94 % of CB events, and that the median time of transfusion for the majority of fresh products is the ‘product event issue time’ from the hospital blood bank plus 20 min. Data linkage between the MTR and mortality databases in Australia and New Zealand will allow comparisons of risk-adjusted mortality estimates across different bleeding contexts, and between countries. Data extracts will be examined to determine if there are differences in patient outcomes according to transfusion practice. The ratios of blood components (e.g. FFP:RBC) used in different types of critical bleeding will also be investigated. Conclusions The MTR is generating data with the potential to have an impact on management and policy decision-making in CB and MT and provide benchmarking and monitoring tools for immediate application.
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Affiliation(s)
- J C Oldroyd
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, 3004, Australia.
| | - K M Venardos
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, 3004, Australia
| | - N J Aoki
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, 3004, Australia
| | - A J Zatta
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, 3004, Australia
| | - Z K McQuilten
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, 3004, Australia.,Centre of Research Excellence for Patient Blood Management in Critical Illness and Trauma, Monash University, Clayton, VIC, 3004, Australia
| | - L E Phillips
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, 3004, Australia
| | - N Andrianopoulos
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, 3004, Australia
| | - D J Cooper
- Centre of Research Excellence for Patient Blood Management in Critical Illness and Trauma, Monash University, Clayton, VIC, 3004, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, 3004, Australia
| | - P A Cameron
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, 3004, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, 3004, Australia
| | - J P Isbister
- Department of Haematology, University of Sydney, Royal North Shore Hospital, St Leonard, Sydney, NSW, 2065, Australia
| | - E M Wood
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, 3004, Australia
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9
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Shah A, Roy NB, McKechnie S, Doree C, Fisher SA, Stanworth SJ. Iron supplementation to treat anaemia in adult critical care patients: a systematic review and meta-analysis. Crit Care 2016; 20:306. [PMID: 27681259 PMCID: PMC5041556 DOI: 10.1186/s13054-016-1486-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/13/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Anaemia affects 60-80 % of patients admitted to intensive care units (ICUs). Allogeneic red blood cell (RBC) transfusions remain the mainstay of treatment for anaemia but are associated with risks and are costly. Our objective was to assess the efficacy and safety of iron supplementation by any route, in anaemic patients in adult ICUs. METHODS Electronic databases (CENTRAL, MEDLINE, EMBASE) were searched through March 2016 for randomized controlled trials (RCT)s comparing iron by any route with placebo/no iron. Primary outcomes were red blood cell transfusions and mean haemoglobin concentration. Secondary outcomes included mortality, infection, ICU and hospital length of stay, mean difference (MD) in iron biomarkers, health-related quality of life and adverse events. RESULTS Five RCTs recruiting 665 patients met the inclusion criteria; intravenous iron was tested in four of the RCTs. There was no difference in allogeneic RBC transfusion requirements (relative risk 0.87, 95 % confidence interval (CI) 0.70 to 1.07, p = 0.18, five trials) or mean number of RBC units transfused (MD -0.45, 95 % CI -1.34 to 0.43, p = 0.32, two trials) in patients receiving or not receiving iron. Similarly, there was no difference between groups in haemoglobin at short-term (up to 10 days) (MD -0.25, 95 % CI -0.79 to 0.28, p = 0.35, three trials) or mid-term follow up (last measured time point in hospital or end of trial) (MD 0.21, 95 % CI -0.13 to 0.55, p = 0.23, three trials). There was no difference in secondary outcomes of mortality, in-hospital infection, or length of stay. Risk of bias was generally low although three trials had high risk of attrition bias; only one trial had low risk of bias across all domains. CONCLUSION Iron supplementation does not reduce RBC transfusion requirements in critically ill adults, but there is considerable heterogeneity between trials in study design, nature of interventions, and outcomes. Well-designed trials are needed to investigate the optimal iron dosing regimens and strategies to identify which patients are most likely to benefit from iron, together with patient-focused outcomes. TRIAL REGISTRATION PROSPERO International prospective register of systematic reviews CRD42015016627 . Registered 2 March 2015.
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Affiliation(s)
- Akshay Shah
- Nuffield Department of Anaesthetics, Level 2 John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Noémi B. Roy
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Stuart McKechnie
- Nuffield Department of Anaesthetics, Level 2 John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Carolyn Doree
- Systematic Review Initiative, NHS Blood & Transplant, Oxford, UK
| | - Sheila A. Fisher
- Systematic Review Initiative, NHS Blood & Transplant, Oxford, UK
| | - Simon J. Stanworth
- NHS Blood and Transplant, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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10
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Boutin A, Chassé M, Shemilt M, Lauzier F, Moore L, Zarychanski R, Griesdale D, Desjardins P, Lacroix J, Fergusson D, Turgeon AF. Red Blood Cell Transfusion in Patients With Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Transfus Med Rev 2015; 30:15-24. [PMID: 26409622 DOI: 10.1016/j.tmrv.2015.08.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/14/2015] [Accepted: 08/15/2015] [Indexed: 01/23/2023]
Abstract
Our objectives were to evaluate the frequency of red blood cell (RBC) transfusion in patients with traumatic brain injury (TBI) as well as potential determinants and outcomes associated with RBC transfusion in this population. We conducted a systematic review of cohort studies and randomized trials of patients with TBI. We searched Medline, Embase, the Cochrane Library, and BIOSIS databases from their inception up to April 2015. We selected studies of adult patients with acute TBI reporting data on RBC transfusions. Cumulative incidences of transfusion were pooled using random-effect models with a DerSimonian approach. To evaluate the association between RBC transfusion and potential determinants or clinical outcomes, we pooled risk ratios or mean differences with random-effect models and the Mantel-Haenszel method. We identified 24 eligible studies (17414 patients). After pooling data from 23 studies (7524 patients), approximately 36% (95% confidence interval [CI], 28-44; I(2) = 98%) of patients received RBC transfusion at some point during their hospital stay. Hemoglobin thresholds for transfusion were rarely available (reported in 9 studies) and varied from 6 to 10 g/dL. Glasgow Coma Scale scores at admission were lower in patients who were transfused than those who were not (3 cohort studies; 1371 patients; mean difference of 1.38 points [95% CI, 0.86-1.89]; I(2) = 12%). Mortality was not significantly different among transfused and nontransfused patients in univariate and multivariate meta-analyses. Hospital length of stay was longer among patients receiving RBC transfusion compared to those who did not (3 studies; n = 455; mean difference, 9.58 days [95% CI, 3.94-15.22]; I(2) = 74%). Results should be considered cautiously due to the high heterogeneity and high risk of confounding from the observational nature of included studies. Red blood cell transfusion is frequent in patients with TBI, and transfusion practices varied widely between studies. Current published data highlight the lack of clinical evidence guiding transfusion strategies in TBI.
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Affiliation(s)
- Amélie Boutin
- CHU de Québec-Université Laval Research Center (Hôpital de l'Enfant-Jésus), Population Health and Optimal Health Practices Research Unit, Université Laval, Quebec City, QC, Canada; Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, Canada
| | - Michaël Chassé
- CHU de Québec-Université Laval Research Center (Hôpital de l'Enfant-Jésus), Population Health and Optimal Health Practices Research Unit, Université Laval, Quebec City, QC, Canada; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Michèle Shemilt
- CHU de Québec-Université Laval Research Center (Hôpital de l'Enfant-Jésus), Population Health and Optimal Health Practices Research Unit, Université Laval, Quebec City, QC, Canada
| | - François Lauzier
- CHU de Québec-Université Laval Research Center (Hôpital de l'Enfant-Jésus), Population Health and Optimal Health Practices Research Unit, Université Laval, Quebec City, QC, Canada; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, QC, Canada; Department of Medicine, Université Laval, Quebec City, QC, Canada
| | - Lynne Moore
- CHU de Québec-Université Laval Research Center (Hôpital de l'Enfant-Jésus), Population Health and Optimal Health Practices Research Unit, Université Laval, Quebec City, QC, Canada; Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, Sections of Critical Care Medicine and of Haematology & Medical Oncology, University of Manitoba, Winnipeg, MB, Canada
| | - Donald Griesdale
- Department of Anesthesia, University of British Columbia, Vancouver, BC, Canada
| | - Philippe Desjardins
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Jacques Lacroix
- Department of Pediatrics, Critical Care Medicine, Université de Montréal, Montreal, QC, Canada
| | - Dean Fergusson
- Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alexis F Turgeon
- CHU de Québec-Université Laval Research Center (Hôpital de l'Enfant-Jésus), Population Health and Optimal Health Practices Research Unit, Université Laval, Quebec City, QC, Canada; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, QC, Canada.
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McQuilten ZK, Andrianopoulos N, van de Watering L, Aubron C, Phillips L, Bellomo R, Pilcher D, Cameron P, Reid CM, Cole-Sinclair MF, Newcomb A, Smith J, McNeil JJ, Wood EM. Introduction of universal prestorage leukodepletion of blood components, and outcomes in transfused cardiac surgery patients. J Thorac Cardiovasc Surg 2015; 150:216-22. [DOI: 10.1016/j.jtcvs.2015.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 02/15/2015] [Accepted: 03/11/2015] [Indexed: 11/25/2022]
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Zatta AJ, McQuilten ZK, Mitra B, Roxby DJ, Sinha R, Whitehead S, Dunkley S, Kelleher S, Hurn C, Cameron PA, Isbister JP, Wood EM, Phillips LE. Elucidating the clinical characteristics of patients captured using different definitions of massive transfusion. Vox Sang 2014; 107:60-70. [PMID: 24697251 DOI: 10.1111/vox.12121] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 11/05/2013] [Accepted: 11/06/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The type and clinical characteristics of patients identified with commonly used definitions of massive transfusion (MT) are largely unknown. The objective of this study was to define the clinical characteristics of patients meeting different definitions of MT for the purpose of patient recruitment in observational studies. MATERIALS AND METHODS Data were extracted on all patients who received red blood cell (RBC) transfusions in 2010 at three tertiary Australian hospitals. MT patients were identified according to three definitions: ≥10 units RBC in 24 h (10/24 h), ≥6 units RBC in 6 h (6/6 h) and ≥5 units RBC in 4 h (5/4 h). Clinical coding data were used to assign bleeding context. Data on in-hospital mortality were also extracted. RESULTS Five hundred and forty-two patients met at least one MT definition, with 236 (44%) included by all definitions. The most inclusive definition was 5/4 h (508 patients, 94%) followed by 6/6 h (455 patients, 84%) and 10/24 h (251 patients, 46%). Importantly, 40-55% of most types of critical bleeding events and 82% of all obstetric haemorrhage cases were excluded by the 10/24 h definition. Patients who met both the 5/4 h and 10/24 h definitions were transfused more RBCs (19 vs. 8 median total RBC units; P < 0·001), had longer ventilation time (120 vs. 55 h; P < 0·001), median ICU (149 vs. 99 h; P < 0·001) and hospital length of stay (23 vs. 18 h; P = 0·006) and had a higher in-hospital mortality rate (23·3% vs. 16·4%; P = 0·050). CONCLUSION The 5/4 h MT definition was the most inclusive, but combination with the 10/24 h definition appeared to identify a clinically important patient cohort.
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Affiliation(s)
- A J Zatta
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia
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Thompson PA, May D, Choong PF, Tacey M, Liew D, Cole-Sinclair MF. Predicting blood loss and transfusion requirement in patients undergoing surgery for musculoskeletal tumors. Transfusion 2014; 54:1469-77. [DOI: 10.1111/trf.12532] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 10/18/2013] [Accepted: 10/19/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Philip A. Thompson
- Department of Hematology; St Vincent's Hospital, Melbourne; Victoria Australia
| | - Deborah May
- Department of Orthopedic Surgery; St Vincent's Hospital, Melbourne; Victoria Australia
| | - Peter F. Choong
- Department of Orthopedic Surgery; St Vincent's Hospital, Melbourne; Victoria Australia
- Department of Surgery; University of Melbourne; Parkville Victoria Australia
| | - Mark Tacey
- Collaborative Centre for Clinical Epidemiology, Biostatistics and Health Services Research; Parkville Victoria Australia
| | - Danny Liew
- Collaborative Centre for Clinical Epidemiology, Biostatistics and Health Services Research; Parkville Victoria Australia
- Department of Clinical Epidemiology; University of Melbourne; Parkville Victoria Australia
| | - Merrole F. Cole-Sinclair
- Department of Hematology; St Vincent's Hospital, Melbourne; Victoria Australia
- Department of Pathology; University of Melbourne; Parkville Victoria Australia
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Py JY, Daurat G. La place de l’informatique dans l’activité transfusionnelle et son évolution – Panorama 2013. Transfus Clin Biol 2013; 20:243-8. [DOI: 10.1016/j.tracli.2013.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/27/2013] [Indexed: 11/15/2022]
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Grann AF, Erichsen R, Nielsen AG, Frøslev T, Thomsen RW. Existing data sources for clinical epidemiology: The clinical laboratory information system (LABKA) research database at Aarhus University, Denmark. Clin Epidemiol 2011; 3:133-8. [PMID: 21487452 PMCID: PMC3072155 DOI: 10.2147/clep.s17901] [Citation(s) in RCA: 161] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Indexed: 11/23/2022] Open
Abstract
This paper provides an introduction to the clinical laboratory information system (LABKA) research database in Northern and Central Denmark. The database contains millions of stored laboratory test results for patients living in the two Danish regions, encompassing 1.8 million residents, or one-third of the country’s population. More than 1700 different types of blood test analyses are available. Therefore, the LABKA research database represents an incredible source for studies involving blood test analyses. By record linkage of different Danish registries with the LABKA research database, it is possible to examine a large number of biomarkers as predictors of disease risk and prognosis and as markers of disease severity, and to evaluate medical treatments regarding effectiveness and possible side effects. Large epidemiological studies using routinely stored blood test results for individual patients can be performed because it is possible to link the laboratory data to high-quality individual clinical patient data in Denmark.
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Affiliation(s)
- Anne Fia Grann
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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