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da Silva RL, Benites BD, Leite F, Soriano S, Alves SDOC, Rizzo SRCP, Rabello G, Junior DML. Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Preoperative Clinical and Laboratory Assessment of the Patient. Hematol Transfus Cell Ther 2024; 46 Suppl 1:S12-S16. [PMID: 38521627 PMCID: PMC11069059 DOI: 10.1016/j.htct.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/18/2024] [Indexed: 03/25/2024] Open
Abstract
The preoperative clinical and laboratory evaluations of the patient is an essential step to ensure the safety and success of any surgical procedure. This assessment aims to identify any underlying medical conditions and risk factors and determine suitability for surgery. With this step, the medical team can adapt the care plan to meet each patient's specific needs, increasing the chances of a successful procedure. Good clinical assessment and comprehensive laboratory testing, when integrated into a Patient Blood Management approach, are invaluable in promoting safety of care, reducing transfusion risks, improving surgical outcomes, and optimizing resource utilization. This approach not only elevates the quality of care, but is also aligned with evidence-based practice and patient-centered principles, making it an essential component of the perioperative process.
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Affiliation(s)
- Roberto Luiz da Silva
- Instituto Brasileiro de Controle do Câncer (IBCC), São Paulo, SP, Brazil; Hospital São Camilo Pompéia, São Paulo, SP, Brazil
| | - Bruno Deltreggia Benites
- Centro de Hematologia e Hemoterapia da Universidade Estadual de Campinas(Hemocentro UNICAMP), Campinas, SP, Brazil
| | - Flavia Leite
- Hemocentro de Ribeirão Preto, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Selma Soriano
- Fundação HEMOPA Hemocentro Coordenador do Estado do Pará, Belém, PA, Brazil
| | | | | | - Guilherme Rabello
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Incor - HCFMUSP), São Paulo, SP, Brazil.
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2
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Song KH, Choi ES, Kim HY, Ahn KH, Kim HJ. Patient blood management to minimize transfusions during the postpartum period. Obstet Gynecol Sci 2023; 66:484-497. [PMID: 37551109 PMCID: PMC10663398 DOI: 10.5468/ogs.22288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/11/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023] Open
Abstract
Patient blood management is an evidence-based concept that seeks to minimize blood loss by maintaining adequate hemoglobin levels and optimizing hemostasis during surgery. Since the coronavirus disease 2019 pandemic, patient blood management has gained significance due to fewer blood donations and reduced amounts of blood stored for transfusion. Recently, the prevalence of postpartum hemorrhage (PPH), as well as the frequency of PPH-associated transfusions, has steadily increased. Therefore, proper blood transfusion is required to minimize PPH-associated complications while saving the patient's life. Several guidelines have attempted to apply this concept to minimize anemia during pregnancy and bleeding during delivery, prevent bleeding after delivery, and optimize recovery methods from anemia. This study systematically reviewed various guidelines to determine blood loss management in pregnant women.
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Affiliation(s)
- Kwan Heup Song
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Seoul,
Korea
| | - Eun Saem Choi
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Ho Yeon Kim
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Seoul,
Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Hai Joong Kim
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Seoul,
Korea
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3
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Mendez E, Puig G, Barquero M, Leon A, Bellafont J, Colomina MJ. Enhanced recovery after surgery: a narrative review on patient blood management recommendations. Minerva Anestesiol 2023; 89:906-913. [PMID: 37307032 DOI: 10.23736/s0375-9393.23.17389-5] [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: 06/13/2023]
Abstract
This review aims to analyze and document the presence of patient blood management (PBM) recommendations in enhanced recovery after surgery (ERAS) guidelines. The aim of ERAS programs is to improve outcomes and optimize patient recovery by reducing the stress response to surgery. PBM programs pursue the objective of improving outcomes by boosting and conserving the patient's own blood. From the early development of ERAS, there was little attention paid to the three pillars of perioperative blood management. Preoperative anemia is an important risk factor in perioperative outcomes and should be diagnosed and treated. Bleeding and unnecessary transfusions should be avoided. We analyzed clinical guidelines for scheduled surgery in adults published by the ERAS Society between 2018 and 2022. The guidelines selected were searched for recommendations related to the three pillars of PBM. We selected 15 ERAS guidelines in programmed surgery in adults. Until 2018, none of the ERAS guidelines analyzed included any recommendations related to pillars I and III of PBM. In 2019, recommendations related to the three pillars of PBM were introduced in the ERAS clinical guidelines for colorectal surgery, gynecology/oncology surgery, and lung resection surgery. However, many ERAS guidelines for surgeries with a high risk of bleeding, such as cardiac surgery, contain no clear recommendations on the management of preoperative anemia. This review shows that the ERAS guidelines published to date make very few recommendations related to PBM. The authors emphasize the need to include the most efficient PBM recommendations in ERAS clinical guidelines, given improved outcomes with a good perioperative management of blood transfusion.
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Affiliation(s)
- Esther Mendez
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain -
| | - Guillermo Puig
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain
| | - Marta Barquero
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain
| | - Ariadna Leon
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain
| | - Javier Bellafont
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain
| | - Maria J Colomina
- Department of Anesthesiology and Intensive Care, Bellvitge University Hospital, L'Hospitalet de LLobregat, Barcelona, Spain
- Department of Anesthesiology and Intensive Care, University of Barcelona, Barcelona, Spain
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Ahmed A. Pro: Can We Use Artificial Intelligence-Derived Algorithms to Guide Patient Blood Management Decision-Making? J Cardiothorac Vasc Anesth 2023; 37:2141-2144. [PMID: 37365072 DOI: 10.1053/j.jvca.2023.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/12/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Aamer Ahmed
- Department of Anaesthesia and Critical Care, University Hospitals of Leicester National Health Services Trust, Leicester, UK; Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
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5
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Kelly S, Sharpe S, Culliton M, Higgins MF, Fitzgerald J. The effect of clinician education on blood transfusion practice in obstetrics: completing the audit cycle. Ir J Med Sci 2022; 192:765-771. [PMID: 35665474 DOI: 10.1007/s11845-022-03032-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/11/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND With blood products being a limited and expensive resource within the healthcare system, there is an ever-increasing emphasis on judicial and appropriate use. AIMS To evaluate whether implementing contemporary society recommendations on restrictive transfusion policies would reduce inappropriate use of red blood cell transfusions, by evaluating the effect of a staff educational campaign. METHODS An audit of peri-partum red cell concentrate (RCC) transfusion practice within a tertiary obstetric unit was undertaken, covering a 1-year period (2015), examining data related to transfusion prescribing practices. Subsequently, an educational programme was held for clinical and laboratory staff which aimed to bring practice in line with society guidelines. A repeat audit covering another 1-year period (2018) was undertaken. RESULTS The number of RCC units of transfused reduced by 49% between 2015 and 2018 (426 to 218). The number of patients receiving transfusion dropped from 166 in 2018 (1.8% of births) to 119 in 2015 (1.5% of births). Among stable patients who were transfused, the proportion receiving a single unit increased from 6.9 to 53.9%. (p < 0.001). Haematological reassessment between units rose from 13.8 to 80.4% (p < 0.001). Written consent documentation improved (68% in 2018 vs. 38% in 2015) (p < 0.001). CONCLUSIONS The implementation of guidelines has resulted in substantial reduction in RCC transfusions between 2015 and 2018. Fewer women received a blood transfusion, and those who did received fewer units. There is a higher proportion of patients being reassessed between units and receiving single unit transfusions. Recording of consent has improved.
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Affiliation(s)
- Shane Kelly
- University College Dublin School of Medicine, Dublin, Republic of Ireland
| | - Simon Sharpe
- University College Dublin School of Medicine, Dublin, Republic of Ireland
| | - Marie Culliton
- Medical Science, National Maternity Hospital, Dublin, Republic of Ireland
| | - Mary F Higgins
- UCD Peri-Natal Research Centre, University College Dublin Obstetrics and Gynecology, Dublin, Republic of Ireland
| | - Joan Fitzgerald
- Haematology, National Maternity Hospital and Saint Vincent's University Hospital, Holles Street, Dublin 2, Dublin, D02 YH21, Republic of Ireland.
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Shander A, Hardy JF, Ozawa S, Farmer SL, Hofmann A, Frank SM, Kor DJ, Faraoni D, Freedman J. A Global Definition of Patient Blood Management. Anesth Analg 2022; 135:476-488. [PMID: 35147598 DOI: 10.1213/ane.0000000000005873] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
While patient blood management (PBM) initiatives are increasingly adopted across the globe as part of standard of care, there is need for a clear and widely accepted definition of PBM. To address this, an expert group representing PBM organizations, from the International Foundation for Patient Blood Management (IFPBM), the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA), the Society for the Advancement of Patient Blood Management (SABM), the Western Australia Patient Blood Management (WAPBM) Group, and OnTrac (Ontario Nurse Transfusion Coordinators) convened and developed this definition: "Patient blood management is a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood, while promoting patient safety and empowerment." The definition emphasizes the critical role of informed choice. PBM involves the timely, multidisciplinary application of evidence-based medical and surgical concepts aimed at screening for, diagnosing and appropriately treating anemia, minimizing surgical, procedural, and iatrogenic blood losses, managing coagulopathic bleeding throughout the care and supporting the patient while appropriate treatment is initiated. We believe that having a common definition for PBM will assist all those involved including PBM organizations, hospital administrators, individual clinicians and policy makers to focus on the appropriate issues when discussing and implementing PBM. The proposed definition is expected to continue to evolve, making this endeavor a work in progress.
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Affiliation(s)
- Aryeh Shander
- From the Department of Anesthesiology, Critical Care and Hyperbaric Medicine, Englewood Health, Englewood, New Jersey.,Society for the Advancement of Patient Blood Management (SABM), Mount Royal, New Jersey
| | - Jean-Francois Hardy
- Department of Anaesthesiology and Pain Medicine, Université de Montréal, Montréal, Quebec, Canada.,Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA), Paris, France
| | - Sherri Ozawa
- Society for the Advancement of Patient Blood Management (SABM), Mount Royal, New Jersey.,Institute for Patient Blood Management and Bloodless Medicine and Surgery, Englewood Health, Englewood, New Jersey
| | - Shannon L Farmer
- Medical School and Division of Surgery, Faculty of Medicine and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Department of Haematology, Royal Perth Hospital, Perth, Western Australia, Australia.,International Foundation for Patient Blood Management, Basel, Switzerland.,The Western Australia Patient Blood Management Group, The University of Western Australia, Perth, Western Australia, Australia
| | - Axel Hofmann
- Medical School and Division of Surgery, Faculty of Medicine and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia.,International Foundation for Patient Blood Management, Basel, Switzerland.,Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Steven M Frank
- Department of Anesthesiology, Critical Care Medicine, Johns Hopkins Health System Patient Blood Management Program, The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
| | - Daryl J Kor
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Michigan.,Patient Blood Management Program, Mayo Clinic, Rochester, Michigan
| | - David Faraoni
- Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA), Paris, France.,Department of Anesthesiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Freedman
- Ontario Nurse Transfusion Coordinators Program (ONTraC), Ontario, Canada.,The Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Neef V, Piekarski F, Choorapoikayil S, Helmer P, Zacharowski K, Meybohm P, Raimann FJ. Physician's Subjective Increase in Awareness towards Perioperative Anaemia, Patient's Blood Resource, and Transfusion after the Implementation of Patient Blood Management: A Nationwide Multicentre Survey. Acta Haematol 2021; 145:38-45. [PMID: 34464953 DOI: 10.1159/000517607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/28/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Patient blood management (PBM) is a clinical and multidisciplinary, 3-pillar concept. The aim of this study was to detect the subjective increase in physician's awareness towards perioperative anaemia, patient's blood resource, and transfusion after the implementation of PBM in German hospitals. MATERIAL AND METHODS A survey among 56 hospitals from the German PBM Network group was conducted from October 27 to December 19, 2020. An electronic questionnaire with 28 questions was sent to the local PBM coordinator for the distribution at the hospital level. For assessment of the physician's subjective increase in awareness, numeric rating scales (0 [no increase] - 10 [maximum increase]) were used. RESULTS In total, 404 clinicians from 56 hospitals completed the survey. The mean (±standard deviation) time of an existing PBM program was 4.8 (±2.2) years. The physician's subjective increase in awareness towards anaemia (8.2 [±2.0]), patient's blood resource (7.6 [±2.5]), and transfusion (8.1 [±1.9]) was the highest in physicians from hospitals with ≥21 implemented PBM measures. In addition, a subjective increase in awareness towards anaemia (6.6 [±3.3]), patient's blood resource (7.0 [±3.3]), and transfusion (6.6 [±3.4]) was the highest in physicians with daily PBM contact. CONCLUSION Results suggest that physician's awareness towards perioperative anaemia, patient's blood resource, and transfusion has increased, depending on the hospital's number of implemented PBM measures and physician's PBM contact in everyday clinical practice.
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Affiliation(s)
- Vanessa Neef
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Florian Piekarski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Suma Choorapoikayil
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Philipp Helmer
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Florian J Raimann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
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8
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Pre-operative anaemia and myocardial injury after noncardiac surgery: A retrospective study. Eur J Anaesthesiol 2021; 38:582-590. [PMID: 33399380 DOI: 10.1097/eja.0000000000001421] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pre-operative anaemia is associated with adverse outcomes of noncardiac surgery, but its association with myocardial injury after noncardiac surgery (MINS) has not been fully investigated. OBJECTIVE The association between pre-operative anaemia and MINS. DESIGN A single-centre retrospective cohort study. SETTING Tertiary care referral centre. PATIENTS Patients with measured cardiac troponin (cTn) I levels after noncardiac surgery. INTERVENTIONS Patients were separated according to pre-operative anaemia (haemoglobin <13 g dl-1 in men and <12 g dl-1 in women). Anaemia was further stratified into mild and moderate-to-severe at a haemoglobin level threshold of 11 g dl-1. MAIN OUTCOME MEASURES The primary outcome was MINS, defined as a peak cTn I level more than 99th percentile of the upper reference limit within 30 postoperative days. RESULTS Data from a total of 35 170 patients were collected, including 22 062 (62.7%) patients in the normal group and 13 108 (37.3%) in the anaemia group. After propensity score matching, 11919 sets of patients were generated, and the incidence of MINS was significantly associated with anaemia [14.5 vs. 21.0%, odds ratio (OR) 1.57, 95% confidence interval (CI) 1.47 to 1.68, P < 0.001]. For the entire population, multivariable analysis showed a graded association between anaemia severity and MINS (OR 1.32, 95% CI 1.22 to 1.43, P < 0.001 for mild anaemia and OR 1.80, 95% CI 1.66 to 1.94, P < 0.001 for moderate-to-severe anaemia compared with the normal group) and a significantly higher incidence of MINS for moderate-to-severe anaemia than mild anaemia (18.6 vs. 28.6%, OR 1.37, 95% CI 1.25 to 1.50, P < 0.001). The estimated threshold for pre-operative haemoglobin associated with MINS was 12.2 g dl-1, with an area under the curve of 0.622. CONCLUSIONS Pre-operative anaemia was independently associated with MINS, suggesting that MINS may be related to the association between anaemia and postoperative mortality. TRIAL REGISTRATION SMC 2019-08-048.
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Shin HJ, Kim JH, Park Y, Ahn KH, Jung JS, Park JH. Effect of patient blood management system and feedback programme on appropriateness of transfusion: An experience of Asia's first Bloodless Medicine Center on a hospital basis. Transfus Med 2020; 31:55-62. [PMID: 33368693 DOI: 10.1111/tme.12754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/17/2020] [Accepted: 12/17/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patient blood management (PBM) programmes minimise red blood cell (RBC) transfusion and improve patient outcomes worldwide. This study evaluated the effect of a multidisciplinary, collaborative PBM programme on the appropriateness of RBC transfusion in medical and surgical departments at a hospital level. METHODS/MATERIALS In 2018, the revised PBM programme was launched at the Korea University Anam Hospital, a tertiary hospital with 1048 hospital beds and the first Asian institution where a new computer PBM programme was implemented. Monthly RBC usage and adequacy were analysed from January 2018 to December 2019. The trend of adequacy over time was assessed. RESULTS A total of 2 201 021 patients were hospitalised and visited an outpatient clinic. The number of RBC units transfused per 10 000 patients decreased from 139.8 for 2018 to 137.3 for 2019. The proportion of patients with Hb <7 g/dL receiving RBC transfusion increased significantly: 29.1%, 34.5%, 40.4% and 40.6% for periods 1, 2, 3 and 4, respectively (p < 0.001). The appropriateness of RBC transfusion significantly increased for medical (35.2%, 41.5%, 49.6% and 74.3% for periods 1, 2, 3 and 4, respectively [p < 0.001]) and surgical (37.8%, 33.3%, 45.5% and 71.1% for periods 1, 2, 3 and 4, respectively [p < 0.001]) departments. CONCLUSION Implementation of a PBM programme through a multidisciplinary clinical community approach increased the appropriateness of RBC transfusion in medical and surgical departments. Therefore, expanding publicity and PBM education to health care providers is important to maintain the appropriateness of blood transfusion.
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Affiliation(s)
- Hyeon Ju Shin
- Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Jong Hun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yujin Park
- Bloodless Medicine Center, Korea University Anam Hospital, Seoul, South Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, South Korea
| | - Jae Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Jong Hoon Park
- Department of Orthopedic Surgery, Korea University College of Medicine, Seoul, South Korea
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Mitterecker A, Hofmann A, Trentino KM, Lloyd A, Leahy MF, Schwarzbauer K, Tschoellitsch T, Böck C, Hochreiter S, Meier J. Machine learning-based prediction of transfusion. Transfusion 2020; 60:1977-1986. [PMID: 32596877 PMCID: PMC7540018 DOI: 10.1111/trf.15935] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/10/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022]
Abstract
Background The ability to predict transfusions arising during hospital admission might enable economized blood supply management and might furthermore increase patient safety by ensuring a sufficient stock of red blood cells (RBCs) for a specific patient. We therefore investigated the precision of four different machine learning–based prediction algorithms to predict transfusion, massive transfusion, and the number of transfusions in patients admitted to a hospital. Study Design and Methods This was a retrospective, observational study in three adult tertiary care hospitals in Western Australia between January 2008 and June 2017. Primary outcome measures for the classification tasks were the area under the curve for the receiver operating characteristics curve, the F1 score, and the average precision of the four machine learning algorithms used: neural networks (NNs), logistic regression (LR), random forests (RFs), and gradient boosting (GB) trees. Results Using our four predictive models, transfusion of at least 1 unit of RBCs could be predicted rather accurately (sensitivity for NN, LR, RF, and GB: 0.898, 0.894, 0.584, and 0.872, respectively; specificity: 0.958, 0.966, 0.964, 0.965). Using the four methods for prediction of massive transfusion was less successful (sensitivity for NN, LR, RF, and GB: 0.780, 0.721, 0.002, and 0.797, respectively; specificity: 0.994, 0.995, 0.993, 0.995). As a consequence, prediction of the total number of packed RBCs transfused was also rather inaccurate. Conclusion This study demonstrates that the necessity for intrahospital transfusion can be forecasted reliably, however the amount of RBC units transfused during a hospital stay is more difficult to predict.
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Affiliation(s)
| | - Axel Hofmann
- Department of Anesthesiology and Critical Care Medicine, University and University Hospital, Zürich, Switzerland
| | - Kevin M Trentino
- Data and Digital Innovation, East Metropolitan Health Service, Perth, Australia
| | - Adam Lloyd
- Data and Digital Innovation, East Metropolitan Health Service, Perth, Australia
| | - Michael F Leahy
- Department of Haematology, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, Australia
| | - Karin Schwarzbauer
- Institute for Machine Learning, Johannes Kepler University, Linz, Austria
| | - Thomas Tschoellitsch
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH and Johannes Kepler University, Linz, Austria
| | - Carl Böck
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH and Johannes Kepler University, Linz, Austria
| | - Sepp Hochreiter
- Institute for Machine Learning, Johannes Kepler University, Linz, Austria
| | - Jens Meier
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital GmbH and Johannes Kepler University, Linz, Austria
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11
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Meybohm P, Straub N, Füllenbach C, Judd L, Kleinerüschkamp A, Taeuber I, Zacharowski K, Choorapoikayil S. Health economics of Patient Blood Management: a cost-benefit analysis based on a meta-analysis. Vox Sang 2019; 115:182-188. [PMID: 31823382 DOI: 10.1111/vox.12873] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/18/2019] [Accepted: 11/14/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Patient Blood Management (PBM) is the timely application of evidence-based medical and surgical concepts designed to improve haemoglobin concentration, optimize haemostasis and minimize blood loss in an effort to improve patient outcomes. The focus of this cost-benefit analysis is to analyse the economic benefit of widespread implementation of a multimodal PBM programme. MATERIALS AND METHODS Based on a recent meta-analysis including 17 studies (>235 000 patients) comparing PBM with control care and data from the University Hospital Frankfurt, a cost-benefit analysis was performed. Outcome data were red blood cell (RBC) transfusion rate, number of transfused RBC units, and length of hospital stay (LOS). Costs were considered for the following three PBM interventions as examples: anaemia management including therapy of iron deficiency, use of cell salvage and tranexamic acid. For sensitivity analysis, a Monte Carlo simulation was performed. RESULTS Iron supplementation was applied in 3·1%, cell salvage in 65% and tranexamic acid in 89% of the PBM patients. In total, applying these three PBM interventions costs €129·04 per patient. However, PBM was associated with a reduction in transfusion rate, transfused RBC units per patient, and LOS which yielded to mean savings of €150·64 per patient. Thus, the overall benefit of PBM implementation was €21·60 per patient. In the Monte Carlo simulation, the cost savings on the outcome side exceeded the PBM costs in approximately 2/3 of all repetitions and the total benefit was €1 878 000 in 100·000 simulated patients. CONCLUSION Resources to implement a multimodal PBM concept optimizing patient care and safety can be cost-effectively.
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Affiliation(s)
- Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt/Main, Germany.,Department of Anaesthesiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Niels Straub
- Institute of Market Research, Statistics and Prognosis, Munich, Germany
| | - Christoph Füllenbach
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Leonie Judd
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Adina Kleinerüschkamp
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Isabel Taeuber
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Suma Choorapoikayil
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt/Main, Germany
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12
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Langi Sasongko P, Rolink M, Hurk K, Kraaij M, Janssen M. Past, present, and future: a qualitative and literature study identifying historical trends, drivers, and transformational factors for the future demand of blood supply in the Netherlands. Transfusion 2019; 59:3413-3423. [DOI: 10.1111/trf.15525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Praiseldy Langi Sasongko
- Department of Donor Medicine Research Transfusion Technology Assessment, Sanquin Research Amsterdam The Netherlands
- Department of Donor Medicine Research Donor Studies, Sanquin Research Amsterdam The Netherlands
| | - Marlon Rolink
- Department of Donor Medicine Research Transfusion Technology Assessment, Sanquin Research Amsterdam The Netherlands
| | - Katja Hurk
- Department of Donor Medicine Research Donor Studies, Sanquin Research Amsterdam The Netherlands
| | - Marian Kraaij
- Department of Transfusion Medicine and Donor Affairs Sanquin Blood Bank Amsterdam The Netherlands
| | - Mart Janssen
- Department of Donor Medicine Research Transfusion Technology Assessment, Sanquin Research Amsterdam The Netherlands
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Faulds J, Whately-Smith C, Clarke K. Transfusion requirement and length of stay of anaemic surgical patients associated with a patient blood management service: a single-Centre retrospective study. Transfus Med 2019; 29:311-318. [PMID: 31327171 DOI: 10.1111/tme.12617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 05/08/2019] [Accepted: 06/28/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess the value of patient blood management (PBM) in the detection and management of preoperative anaemia before elective surgery. BACKGROUND PBM is recognised as the standard of care, with diagnosis and management of preoperative anaemia being the key components of PBM. No formal assessment of the value of PBM anaemia screening and correction before scheduled surgery had been made at our hospital. METHODS We conducted a retrospective study in a tertiary-care, academic hospital of consecutive records of elective surgery (n = 25 641). We excluded minor surgeries. We identified anaemic patients who had been assessed by PBM or not (non-PBM). We calculated transfusion incidence and hospital length of stay (LOS) across all surgical specialities. RESULTS During the 1-year study period, 15 245 patients were eligible for inclusion; 311 patients (2·0%) were transfused, and 83·3% of transfusions were in anaemic patients. Transfusion incidence was 9·2% in anaemic PBM-assessed patients and 17·4% in non-PBM patients. For haemoglobin (Hb) <100 g L-1 , the transfusion incidence was 22·1% [95% confidence interval (CI) 15·5-30·6%] in PBM and 40·0% (95% CI 35·1-45·0%) in non-PBM patients, and for Hb 100-119 g L-1 , it was 4·7% (95% CI 2·8-7·5%) and 7·9% (95% CI 6·3-9·8%), respectively. Overall mean LOS was 2·1 days [standard deviation (SD) 6·0]. Mean LOS with Hb <100 g L-1 was 6·7 days (SD 14·8) in PBM-assessed patients and 12·4 days (SD 19·5) in non-PBM patients and was 3·1 (SD 5·2) and 6·2 (SD 9·5) days, respectively, for Hb 100-119 g L-1 . CONCLUSION Anaemic elective surgery patients assessed by patient blood management (PBM) had a markedly lower transfusion risk and shorter LOS than anaemic patients not assessed by PBM.
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Affiliation(s)
- J Faulds
- Patient Blood Management, Royal Cornwall Hospital NHS Trust, Cornwall, UK
| | | | - K Clarke
- Department of Haematology, Royal Cornwall Hospital NHS Trust, Cornwall, UK
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Sultan P, Bampoe S, Shah R, Guo N, Estes J, Stave C, Goodnough LT, Halpern S, Butwick AJ. Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221:19-29.e3. [PMID: 30578747 DOI: 10.1016/j.ajog.2018.12.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/15/2018] [Accepted: 12/08/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To perform a systematic review of randomized trials comparing oral vs intravenous (IV) iron therapy to treat postpartum anemia. DATA SOURCES Data sources were as follows: PubMed (1972-2017); Cochrane Central Register of Controlled Trials, CENTRAL (1972-2017); CINAHL (1972-2017); Web of Science; Excerpta Medica Database, and EMBASE (1972-2017). STUDY ELIGIBILITY CRITERIA We included randomized trials comparing oral vs IV iron monotherapy to treat postpartum anemia (classified as a hemoglobin <12 g/dL). STUDY APPRAISAL AND SYNTHESIS METHODS Study quality was assessed with the Cochrane risk of bias assessment tool. The primary outcome was hemoglobin concentration at 6 weeks postpartum. Secondary outcomes included hemoglobin concentration at 1-5 weeks postpartum, ferritin concentration at 1-6 weeks postpartum, and maternal adverse outcomes. For meta-analysis, mean differences and odds ratios using a random effects model were calculated. Risk of heterogeneity was reported as I2. RESULTS A total of 15 randomized trials met our inclusion criteria (n = 1001 and 1 181 women receiving oral iron and IV iron, respectively); 4 studies reported data for our primary outcome. We observed higher postpartum week 6 hemoglobin concentrations in the IV iron group compared to the oral iron group (mean difference, 0.9 g/dL; 95% confidence interval (CI), 0.4-1.3; P = .0003). Compared to oral iron, women receiving IV iron had higher hemoglobin concentrations at postpartum weeks 1, 2, and 3; higher ferritin concentrations at postpartum weeks 1, 2, 4, and 6; an increased likelihood of skin flushing (odds ratio [OR], 6.95; 95% CI, 1.56-31.03; P = .01; I2 = 0%); and a decreased likelihood of constipation (OR, 0.08; 95% CI, 0.03-0.21; P < .00001, I2 = 27%) and dyspepsia (OR, 0.07; 95% confidence interval, 0.01-0.42; P = .004; I2 = 0%). The reported event rate for anaphylaxis among women receiving IV iron was 0.6%. CONCLUSION In this systematic review, among women with postpartum anemia, hemoglobin concentrations at 6 weeks postpartum were almost 1 g/dL higher in women who received IV iron compared to oral iron. The safety profile of IV iron was also reassuring. Given the weaker hemoglobin response and higher risk of gastrointestinal side effects with oral iron use, our findings suggest that IV iron be considered as a viable treatment option for postpartum iron deficiency anemia.
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The efficacy of pre-operative preparation with intravenous iron and/or erythropoietin in anaemic patients undergoing orthopaedic surgery: An observational study. Eur J Anaesthesiol 2019; 35:289-297. [PMID: 29303906 DOI: 10.1097/eja.0000000000000752] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pre-operative anaemia and transfusion are common among patients undergoing elective orthopaedic surgery. Application of 'patient blood management' might be the most effective way to reduce both anaemia and transfusion. Pre-operative administration of iron and/or erythropoietin (EPO) is one of the cornerstones of the first pillar of patient blood management, but in a daily clinical setting, efficacy and long-term safety of this measure have not been analysed thoroughly to date. OBJECTIVE To investigate the influence of pre-operative preparation (PREP) of patients with iron and/or EPO on peri-operative transfusion needs and long-term survival. DESIGN Single-centre, retrospective study. SETTING Anaesthesia department, University hospital. INTERVENTIONS Pre-operative preparation with iron and/or EPO versus no preparation. METHODS After approval of our local ethics committee, data of 5518 patients who received total hip or total knee replacement between 2008 and 2014 were included. Patients receiving iron and/or EPO were included in the PREP group, whereas patients without iron and/or EPO were included in the no preparation group. From the full data set, a bias-reduced subset of 662 patients was obtained by means of propensity score-matching to compare peri-operative red blood cell utilisation and long-term survival of patients between groups. RESULTS Patients in the PREP group needed a lower number of units of red blood cells than patients in the no preparation group (0.2 ± 0.8 vs. 0.5 ± 1.3, P < 0.001), had a lower transfusion rate (12 vs. 24%, P < 0.05) and had a similar haemoglobin concentration (10.7 ± 1.3 vs. 10.6 ± 1.1 g dl, not significant) at discharge. No differences in long-term survival were observed between the two study groups. CONCLUSION PREP of patients with iron and/or EPO in orthopaedic patients can be considered highly effective in terms of transfusion reduction, without influencing long-term survival.
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Hu W, Meng H, Hu Q, Feng L, Qu X. Blood donation from 2006 to 2015 in Zhejiang Province, China: annual consecutive cross-sectional studies. BMJ Open 2019; 9:e023514. [PMID: 31110081 PMCID: PMC6530455 DOI: 10.1136/bmjopen-2018-023514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To describe the basic demographical characteristics of whole blood donors in Zhejiang Province, China, from 2006 to 2015 and to examine the trends in individual characteristics associated with blood donation and the relationship between weight and donation. DESIGN Cross-sectional study comparing characteristics of blood donors and annual donations for the period 2006 to 2015. SETTING Urban and rural communities in Zhejiang, China (11 cities, 89 districts or counties and 1379 townships). PARTICIPANTS 3 226 571 volunteer blood donors. OUTCOME MEASURES Volume of each whole blood donation and donation frequency. All data were collected by trained staff and entered into a standardised electronic information system. RESULTS The number of blood donations generally trended up in Zhejiang Province from 2006 to 2015. Donors were predominately males aged 18 to 25 years, but this major donor age group shifted to the 26 to 45 year range by 2015. The rate of repeated blood donation was 30.8 per cent. The blood volume per donation concentrated in 200 mL and 400 mL categories has been gradually shifted to 300 mL and 400 mL. Approximately one-third of donors had a college education. The average weight of donors increased over time for both men and women. Both the blood volume of each donation and donation frequency were proportional to weight. CONCLUSIONS The trend of voluntary non-remunerated blood donation in Zhejiang province is positive. However, given the expected growth in demand for whole blood, more research is needed to increase both the donor pool and the rate of repeated donation. The relationship between body weight and blood donation warrants further study because while improving nutritional status is associated with higher average donation volume and more frequent donations, overnutrition may lead to poorer quality of donated blood. Blood donation may present a unique opportunity for health education and body weight management to monitor and improve population health.
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Affiliation(s)
- Wei Hu
- Blood Center of Zhejiang Province, Hangzhou, China
- Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Hongdao Meng
- School of Ageing Studies, University of South Florida, Tampa, Florida, USA
| | - Qiuyue Hu
- Blood Center of Zhejiang Province, Hangzhou, China
| | - Lijuan Feng
- School of Ageing Studies, University of South Florida, Tampa, Florida, USA
| | - Xianguo Qu
- The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, China
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Kwak DK, Jang CY, Kim DH, Rhyu SH, Hwang JH, Yoo JH. Topical tranexamic acid in elderly patients with femoral neck fractures treated with hemiarthroplasty: efficacy and safety? - a case-control study. BMC Musculoskelet Disord 2019; 20:228. [PMID: 31101040 PMCID: PMC6525434 DOI: 10.1186/s12891-019-2615-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background Perioperative blood management is an important issue in the treatment of elderly patients at an increased risk of postoperative complications. Accordingly, tranexamic acid (TXA) is widely administered to reduce blood loss and transfusion requirements. In this case-control study, the effect of topical TXA on the outcomes of elderly patients with femoral neck fractures after hemiarthroplasty was evaluated. Methods This study enrolled elderly patients (age ≥ 70 years) who underwent cementless bipolar hemiarthroplasty for femoral neck fractures between January 2015 and January 2017. The study group comprised 72 patients who received TXA via topical administration during surgery. After propensity matching, the control group comprised 72 patients who did not receive topical TXA. The perioperative and postoperative parameters of the two groups were compared. Results The estimated blood loss, vacuum tube drainage, and total transfusion volume were significantly lower in the study group than the control (p = 0.024, 0.003, and 0.019, respectively). Despite a lack of significant intergroup differences in the lengths of ICU and hospital stays; rates of ICU admission, venous thromboembolism, delirium, and readmission; and rates of in-hospital and 1-year mortality, the incidence of postoperative medical complications was significantly lower in the study group (p = 0.003). Conclusion Topical TXA administration appears to be a simple and effective option for reducing blood loss, transfusion requirements, and medical complications after hemiarthroplasty in elderly patients with femoral neck fractures.
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Affiliation(s)
- Dae-Kyung Kwak
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 14068, South Korea
| | - Chul-Young Jang
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 14068, South Korea
| | - Dae-Hwan Kim
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 14068, South Korea
| | - Sang-Hyun Rhyu
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 14068, South Korea
| | - Ji-Hyo Hwang
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Je-Hyun Yoo
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang, 14068, South Korea.
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Khan KS, Moore P, Wilson M, Hooper R, Allard S, Wrench I, Roberts T, McLoughlin C, Beresford L, Geoghegan J, Daniels J, Catling S, Clark VA, Ayuk P, Robson S, Gao-Smith F, Hogg M, Jackson L, Lanz D, Dodds J. A randomised controlled trial and economic evaluation of intraoperative cell salvage during caesarean section in women at risk of haemorrhage: the SALVO (cell SALVage in Obstetrics) trial. Health Technol Assess 2019; 22:1-88. [PMID: 29318985 DOI: 10.3310/hta22020] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Caesarean section is associated with blood loss and maternal morbidity. Excessive blood loss requires transfusion of donor (allogeneic) blood, which is a finite resource. Cell salvage returns blood lost during surgery to the mother. It may avoid the need for donor blood transfusion, but reliable evidence of its effects is lacking. OBJECTIVES To determine if routine use of cell salvage during caesarean section in mothers at risk of haemorrhage reduces the rates of blood transfusion and postpartum maternal morbidity, and is cost-effective, in comparison with standard practice without routine salvage use. DESIGN Individually randomised controlled, multicentre trial with cost-effectiveness analysis. Treatment was not blinded. SETTING A total of 26 UK obstetric units. PARTICIPANTS Out of 3054 women recruited between June 2013 and April 2016, we randomly assigned 3028 women at risk of haemorrhage to cell salvage or routine care. Randomisation was stratified using random permuted blocks of variable sizes. Of these, 1672 had emergency and 1356 had elective caesareans. We excluded women for whom cell salvage or donor blood transfusion was contraindicated. INTERVENTIONS Cell salvage (intervention) versus routine care without salvage (control). In the intervention group, salvage was set up in 95.6% of the women and, of these, 50.8% had salvaged blood returned. In the control group, 3.9% had salvage deployed. MAIN OUTCOME MEASURES Primary - donor blood transfusion. Secondary - units of donor blood transfused, time to mobilisation, length of hospitalisation, mean fall in haemoglobin, fetomaternal haemorrhage (FMH) measured by Kleihauer-Betke test, and maternal fatigue. Analyses were adjusted for stratification factors and other factors that were believed to be prognostic a priori. Cost-effectiveness outcomes - costs of resources and service provision taking the UK NHS perspective. RESULTS We analysed 1498 and 1492 participants in the intervention and control groups, respectively. Overall, the transfusion rate was 2.5% in the intervention group and 3.5% in the control group [adjusted odds ratio (OR) 0.65, 95% confidence interval (CI) 0.42 to 1.01; p = 0.056]. In a planned subgroup analysis, the transfusion rate was 3.0% in the intervention group and 4.6% in the control group among emergency caesareans (adjusted OR 0.58, 95% CI 0.34 to 0.99), whereas it was 1.8% in the intervention group and 2.2% in the control group among elective caesareans (adjusted OR 0.83, 95% CI 0.38 to 1.83) (interaction p = 0.46, suggesting that the difference in effect between subgroups was not statistically significant). Secondary outcomes did not differ between groups, except for FMH, which was higher under salvage in rhesus D (RhD)-negative women with RhD-positive babies (25.6% vs. 10.5%, adjusted OR 5.63, 95% CI 1.43 to 22.14; p = 0.013). No case of amniotic fluid embolism was observed. The additional cost of routine cell salvage during caesarean was estimated, on average, at £8110 per donor blood transfusion avoided. CONCLUSIONS The modest evidence for an effect of routine use of cell salvage during caesarean section on rates of donor blood transfusion was associated with increased FMH, which emphasises the need for adherence to guidance on anti-D prophylaxis. We are unable to comment on long-term antibody sensitisation effects. Based on the findings of this trial, cell salvage is unlikely to be considered cost-effective. FUTURE WORK Research into risk of alloimmunisation among women exposed to cell salvage is needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN66118656. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Khalid S Khan
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Philip Moore
- Selwyn Crawford Department of Anaesthetics, Birmingham Women's Hospital, Birmingham, UK
| | - Matthew Wilson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Richard Hooper
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | | | - Ian Wrench
- Anaesthetics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Tracy Roberts
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | | | - Lee Beresford
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - James Geoghegan
- Selwyn Crawford Department of Anaesthetics, Birmingham Women's Hospital, Birmingham, UK
| | - Jane Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Sue Catling
- Department of Anaesthetics, Singleton Hospital, Swansea, UK
| | - Vicki A Clark
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Paul Ayuk
- Women's Services, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Stephen Robson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Fang Gao-Smith
- Perioperative, Critical Care and Trauma Trials Group, University of Birmingham, Birmingham, UK
| | - Matthew Hogg
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Louise Jackson
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Doris Lanz
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Julie Dodds
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Secular trends in the distribution of allogeneic blood components in Taiwan. J Formos Med Assoc 2019; 118:1369-1374. [PMID: 30928185 DOI: 10.1016/j.jfma.2019.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 11/20/2022] Open
Abstract
Recent blood distribution profiles for transfusions in Taiwan have not been comprehensively documented. This study aimed to analyze trends in red blood cell (RBC), platelet, and plasma distribution rates, and compares these profiles with those in other countries. The distribution rates of RBC, platelets, and plasma in Taiwan during 2015 were 47.6, 11.1, and 26.8 units per 1000 population, respectively. At least 1.5 and 2.5-fold higher platelet and plasma distribution rates were observed than other selected countries. During 2007-2015, there was no significant change in RBC distribution. However, we observed a significant increase of 0.20 (95% CI: 0.11-0.30) adult doses of platelets, and a significant decrease of 1.69 (95% CI: 1.45-1.93) units of plasma per 1000 population per annum. Seven other countries showed a general significant decreasing trend of RBC distributions. Higher blood distribution rates were observed in Taiwan. Therefore, the adoption of patient blood management is essential.
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McLoughlin C, Roberts TE, Jackson LJ, Moore P, Wilson M, Hooper R, Allard S, Wrench I, Beresford L, Geoghegan J, Daniels J, Catling S, Clark VA, Ayuk P, Robson S, Gao-Smith F, Hogg M, Lanz D, Dodds J, Khan KS. Cost-effectiveness of cell salvage and donor blood transfusion during caesarean section: results from a randomised controlled trial. BMJ Open 2019; 9:e022352. [PMID: 30782867 PMCID: PMC6398743 DOI: 10.1136/bmjopen-2018-022352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To evaluate the cost-effectiveness of routine use of cell salvage during caesarean section in mothers at risk of haemorrhage compared with current standard of care. DESIGN Model-based cost-effectiveness evaluation alongside a multicentre randomised controlled trial. Three main analyses were carried out on the trial data: (1) based on the intention-to-treat principle; (2) based on the per-protocol principle; (3) only participants who underwent an emergency caesarean section. SETTING 26 obstetric units in the UK. PARTICIPANTS 3028 women at risk of haemorrhage recruited between June 2013 and April 2016. INTERVENTIONS Cell salvage (intervention) versus routine care without salvage (control). PRIMARY OUTCOME MEASURES Cost-effectiveness based on incremental cost per donor blood transfusion avoided. RESULTS In the intention-to-treat analysis, the mean difference in total costs between cell salvage and standard care was £83. The estimated incremental cost-effectiveness ratio (ICER) was £8110 per donor blood transfusion avoided. For the per-protocol analysis, the mean difference in total costs was £92 and the ICER was £8252. In the emergency caesarean section analysis, the mean difference in total costs was £55 and the ICER was £13 713 per donor blood transfusion avoided. This ICER is driven by the increased probability that these patients would require a higher level of postoperative care and additional surgeries. The results of these analyses were shown to be robust for the majority of deterministic sensitivity analyses. CONCLUSIONS The results of the economic evaluation suggest that while routine cell salvage is a marginally more effective strategy than standard care in avoiding a donor blood transfusion, there is uncertainty in relation to whether it is a less or more costly strategy. The lack of long-term data on the health and quality of life of patients in both arms of the trial means that further research is needed to fully understand the cost implications of both strategies. TRIAL REGISTRATION NUMBER ISRCTN66118656.
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Affiliation(s)
| | - Tracy E Roberts
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | | | - Philip Moore
- Selwyn Crawford Department of Anaesthetics, Birmingham Women's Hospital, Birmingham, UK
| | - Matthew Wilson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Richard Hooper
- Pragmatic Clinical Trials Unit, Centre for Primary Care & Public Health, Queen Mary University of London, London, UK
| | - Shubha Allard
- Haematology, Barts Health NHS Trust and NHS Blood and Transplant, London, UK
| | - Ian Wrench
- Departmentof Anaesthesia (Northern General Hospital), SheffieldTeaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Lee Beresford
- Pragmatic Clinical Trials Unit, Centre for Primary Care & Public Health, Queen Mary University of London, London, UK
| | - James Geoghegan
- Selwyn Crawford Department of Anaesthetics, Birmingham Women's Hospital, Birmingham, UK
| | - Jane Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Sue Catling
- Department of Obstetrics, Singleton Hospital, Swansea, UK
| | - Vicki A Clark
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Paul Ayuk
- Women's Services, RoyalVictoria Infirmary, Newcastle upon Tyne, UK
| | - Stephen Robson
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Fang Gao-Smith
- Perioperative, Critical Care and Trauma Trials Group, University of Birmingham, Birmingham, UK
| | - Matthew Hogg
- Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Doris Lanz
- Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Julie Dodds
- Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Khalid S Khan
- Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Jegasothy E, Patterson J, Randall D, Nippita TA, Simpson JM, Irving DO, Ford JB. Assessing the effect of risk factors on rates of obstetric transfusion over time using two methodological approaches. BMC Med Res Methodol 2018; 18:139. [PMID: 30445917 PMCID: PMC6240252 DOI: 10.1186/s12874-018-0595-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/30/2018] [Indexed: 11/22/2022] Open
Abstract
Background While red blood cell transfusion rates have declined in most Australian medical specialties, obstetric transfusion rates have instead been increasing. Obstetric transfusions are mostly linked to postpartum haemorrhage, the rates of which have also increased over time. This study used two methodological approaches to investigate recent trends in obstetric transfusion in New South Wales (NSW) and the extent to which this was influenced by changing maternal and pregnancy characteristics. Methods Linked birth and hospital records were used to examine rates of red blood cell transfusion in the postpartum period for mothers giving birth in NSW hospitals from 2005 to 2015. Logistic regression models were run to examine the contribution of maternal and pregnancy risk factors to changing rates of transfusion. Risk factors were divided into “pre-pregnancy” and “pregnancy related”. Crude and adjusted estimates of the effect of year of birth on obstetric transfusion rates were compared to assess the effect of risk factors on rates over time using two approaches. The first compared actual and predicted odds ratios of transfusion for each year. The second compared the observed increase in transfusion rate with that predicted after controlling for the risk factors. Results Among 935,659 births, the rate of obstetric transfusion rose from 13 per 1000 births in 2005 to 17 in 2011, and remained stable until 2015. From 2005 to 2015, postpartum haemorrhage increased from 74 to 114 per 1000 births. Compared with the rate in 2005, the available maternal and pregnancy characteristics only partially explained the change in rate of transfusion by 2015 (Method 1, crude odds ratio 1.39 (95% CI 1.25, 1.56); adjusted odds ratio 1.29 (95% CI 1.15, 1.45)). After adjustment for maternal and pregnancy characteristics, obstetric transfusion incidence was predicted to increase by 10.3%, but a 38.7% increase was observed (Method 2). Conclusion Rates of obstetric transfusion have stabilised after a period of increase. The trend could not be fully explained by measured maternal and pregnancy characteristics with either of the two approaches. Further investigation of rates and maternal and clinical risk factors will help to inform and improve obstetric blood product use. Electronic supplementary material The online version of this article (10.1186/s12874-018-0595-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Edward Jegasothy
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia. .,Biostatistics Training Program, New South Wales Ministry of Health, North Sydney, NSW, Australia. .,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Jillian Patterson
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
| | - Deborah Randall
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
| | - Tanya A Nippita
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia.,Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Judy M Simpson
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - David O Irving
- Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - Jane B Ford
- Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, St Leonards, NSW, Australia
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Kor DJ, Juffermans NP. Transfusion in Critical Care. Transfus Med Rev 2018; 31:203-204. [PMID: 28939103 DOI: 10.1016/j.tmrv.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Daryl J Kor
- Department of Anesthesiology/Division of Critical Care Medicine, Anesthesia Clinical Research Unit (ACRU).
| | - Nicole P Juffermans
- Academic Medical Center, Amsterdam, the Netherlands; Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology
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Bloch EM, Ingram C, Hull J, Fawcus S, Anthony J, Green-Thompson R, Crookes RL, Ngcobo S, V Creel D, Courtney L, Bellairs GRM, Murphy EL. Risk factors for peripartum blood transfusion in South Africa: a case-control study. Transfusion 2018; 58:2149-2156. [PMID: 29989178 PMCID: PMC6167140 DOI: 10.1111/trf.14772] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/29/2018] [Accepted: 03/30/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Obstetric hemorrhage (OH) and access to peripartum blood transfusion remains a global health challenge. The rates of peripartum transfusion in South Africa exceed those in high-income countries despite comparable rates of OH. We sought to evaluate factors associated with peripartum transfusion. STUDY DESIGN AND METHODS A case-control study was conducted at four large South African hospitals. Transfused peripartum women (cases) and nontransfused controls were stratum matched 1:2 by hospital and delivery date. Data on obstetric, transfusion, and human immunodeficiency virus (HIV) history were abstracted from medical records. Blood was obtained for laboratory evaluation. We calculated unadjusted and adjusted odds ratios (ORs) for transfusion using logistic regression. RESULTS A total of 1200 transfused cases and 2434 controls were evaluated. Antepartum hemorrhage (OR, 197.95; 95% confidence interval [CI], 104.27-375.78), hemorrhage with vaginal delivery (OR, 136.46; 95% CI, 75.87-245.18), prenatal anemia (OR, 22.76; 95% CI, 12.34-41.93 for prenatal hemoglobin level < 7 g/dL), and failed access to prenatal care (OR, 6.71; 95% CI, 4.32-10.42) were the major risk factors for transfusion. Platelet (PLT) count (ORs, 4.10, 2.66, and 1.77 for ≤50 × 109 , 51 × 109 -100 × 109 , and 101 × 109 -150 × 109 cells/L, respectively), HIV infection (OR, 1.29; 95% CI, 1.02-1.62), and admitting hospital (twofold variation) were also associated with transfusion. Mode of delivery, race, age category, gravidity, parity, gestational age, and birthweight were not independently associated with transfusion. CONCLUSION Major risk factors of peripartum transfusion in South Africa, namely, prenatal anemia and access to prenatal care, may be amenable to intervention. HIV infection and moderately low PLT count are novel risk factors that merit further investigation.
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Affiliation(s)
- Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Blood Systems Research Institute, San Francisco, California
| | - Charlotte Ingram
- South African National Blood Service, Johannesburg, South Africa
- South African Bone Marrow Registry, Cape Town, South Africa
| | - Jennifer Hull
- Department of Obstetrics and Gynecology, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Susan Fawcus
- Department of Obstetrics and Gynecology, Mowbray Maternity Hospital
| | - John Anthony
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, Cape Town, South Africa
| | | | - Robert L Crookes
- South African National Blood Service, Johannesburg, South Africa
- Cryo-Save, Pretoria, South Africa
| | - Solomuzi Ngcobo
- South African National Blood Service, Johannesburg, South Africa
| | | | | | | | - Edward L Murphy
- Blood Systems Research Institute, San Francisco, California
- Departments of Laboratory Medicine and Epidemiology/Biostatistics, University of California San Francisco, San Francisco, California
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Affiliation(s)
- H A Doughty
- Academic Department of Military, Anaesthesia and Critical Care, Birmingham, UK.
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Vaena MMDV, Alves LA. Assessment of the knowledge and perceptions of Brazilian medical residents on transfusion medicine. Hematol Transfus Cell Ther 2018; 41:37-43. [PMID: 30793103 PMCID: PMC6371233 DOI: 10.1016/j.htct.2018.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/07/2018] [Indexed: 11/18/2022] Open
Abstract
Background Medical education has a major social impact because it ultimately influences the quality and safety of the health service offered to the population. Several studies have acknowledged the relationship between medical knowledge on transfusion medicine and the proper use of this therapy. The rational use of blood has become a worldwide concern. In this context, the aim of the present study was to evaluate medical residents' knowledge on transfusion medicine in hospitals located in Rio de Janeiro, Brazil, and their training during their medical education. Methods One hundred and six residents from eight medical specialties of four hospitals participated. A questionnaire developed by the Biomedical Excellence for Safer Transfusion (BEST) group was applied to evaluate the participants' medical knowledge. Another questionnaire was also applied to evaluate participant profiles regarding frequency of transfusion prescriptions, self-perceived knowledge and relevance of the subject. Results The mean number of correct answers to the questionnaire on knowledge about transfusion practices was 43.5% (range: 15-80%). A relationship between training during medical residency and the obtained result was observed (p-value = 0.0007). Most residents (73%) did not receive training in transfusion medicine during their graduation or residency and 93% would like to receive additional training. Conclusion A clear deficit in the knowledge of transfusion medicine was verified, indicating the need for change in the teaching of this specialty. This result is similar to some developed countries.
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Morgan PN, Coleman PL, Martinez-Garduno CM, Gunaratne AW, McInnes E, Middleton S. Implementation of a patient blood management program in an Australian private hospital orthopedic unit. J Blood Med 2018; 9:83-90. [PMID: 29950914 PMCID: PMC6014436 DOI: 10.2147/jbm.s157571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Preoperative anemia in surgical patients has been linked to increased rates of allogeneic blood transfusion (ABT) and associated adverse patient outcomes such as prolonged ventilation in intensive care, increased length of hospital stay, and infections. We conducted a multifaceted implementation for orthopedic surgeons to improve preoperative patient assessment of anemia and iron deficiency to reduce perioperative blood transfusions. Materials and methods Using a before-and-after study design of independent samples, we recruited a convenience sample of surgeons who performed primary total hip arthroplasty at 1 Australian private hospital. Our implementation intervention consisted of: executive support, interactive education, and peer-to-peer support to encourage adherence to the National Blood Authority’s Patient Blood Management Program (PBMP) guidelines. We also used monthly reminders, e-learning access, and posters. Pre and post medical record audits evaluated preoperative blood tests, preoperative anemia, and number of blood units transfused between day of surgery until discharge. The primary outcome was an increase in the proportion of patients with preoperative blood tests undertaken prior to total hip arthroplasty surgery as recommended by the PBMP guidelines. Results Audits from 239 pre- and 263 postimplementation patients from 3 surgeons were conducted. Our primary outcome showed a significantly increased proportion of patients who had all the required preoperative tests postimplementation (0% to 94.6%; P<0.0001). Administration of ABT significantly decreased (pre: 9.2%, n=22; post: 2.3%, n=6; P=0.001) as well as the standard 2 blood units transfused (pre: 73%, n=16; post: 17%, n=1; P=0.022). The time between preoperative tests and day of surgery increased from 16 to 20 days (P<0.0001), allowing more time for physician’s review of test results. Conclusion Our results demonstrated successful implementation of a targeted PBMP to improve preoperative assessment to diagnose and treat anemia and/or iron deficiency prior to orthopedic surgery. This avoided unnecessary ABT and therefore mitigated potential risk to the patient.
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Affiliation(s)
- Paul N Morgan
- Quality Improvement Unit, The Mater Private Hospital (Sydney), St. Vincent's Health Australia, North Sydney, NSW, Australia
| | | | - Cintia Mayel Martinez-Garduno
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and the Australian Catholic University School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia
| | - Anoja W Gunaratne
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and the Australian Catholic University School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and the Australian Catholic University School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and the Australian Catholic University School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia
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Sherliker L, Pendry K, Hockley B. Patient blood management: how is implementation going?: A report comparing the 2015 survey with the 2013 survey of PBM in England. Transfus Med 2018; 28:92-97. [DOI: 10.1111/tme.12527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 11/27/2022]
Affiliation(s)
- L. Sherliker
- NHS Blood & Transplant; Oxford Blood Centre; Oxford UK
| | - K. Pendry
- NHS Blood and Transplant; Manchester Blood Centre; Manchester UK
| | - B. Hockley
- NHS Blood and Transplant; Sheffield Blood Centre; Sheffield UK
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de Las Nieves Lopez MA, Matas Cobos AM, Sarria Gonzalez F, Dominguez Lomeña MJ, Palomo Hernandez AM, Gil Gines E, Serna Juan S, Ampuero Ampuero J, Marin Fernandez A, Vazquez de la Villa A. Red blood cell transfusion after a global strategy for early detection and treatment of iron deficiency anemia: three-year results of a prospective observational study. Transfusion 2018; 58:1399-1407. [PMID: 29582437 DOI: 10.1111/trf.14582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/30/2018] [Accepted: 01/30/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anemia is the main indication for red blood cell (RBC) transfusion and iron deficiency is the most prevalent, preventable, and treatable cause of anemia worldwide. We aimed to assess the impact of iron deficiency anemia (IDA) on RBC transfusion by means of a program for prevention, early detection, and treatment. STUDY DESIGN AND METHODS A prospective observational study was conducted starting in 2014 after an intervention in clinical practice in Melilla, a peripheral city isolated by 207 km sea distance to nearest continental Spain. Recommendations were proposed for first-step diagnosis of iron deficiency in the laboratory, oral iron prevention and treatment in primary care, and intravenous iron complexes and RBC transfusion for hospital management. Reduction in RBC use for years 2014 to 2016 was the primary outcome, with the period 2010 to 2013 considered as baseline performance for statistical analysis. RESULTS Compared to baseline, there was a significant (p < 0.05) increase in mean (±SD) yearly reference population (79,748 ± 3265 vs. 85,376 ± 781), ferritin assays (6980 ± 997 vs. 11,794 ± 1567), admissions (6768 ± 239 vs. 7629 ± 191), and subjects exposed to iron therapy (3975 ± 0.0 vs. 4667 ± 21 for oral, 54 ± 7 vs. 257 ± 109 for sucrose, and 128 ± 9 vs.176 ± 15 for carboxymaltose iron). Mean yearly number of RBC units transfused decreased (1622 ± 112 vs. 1434 ± 44; p = 0.043), with a mean reduction of 11.6% from baseline, or 21.4% when estimated by units transfused per 1000 admissions. CONCLUSIONS Management of IDA is a target to avoid RBC transfusion, and awareness of this health problem should be among the first pillars for any patient blood management program.
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Affiliation(s)
| | | | | | | | | | | | - Salvador Serna Juan
- Instituto de Gestión Sanitaria (INGESA), Area Sanitaria de Mellilla, Melilla, Spain
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Lee H, Yuh YJ. A Paradigm Shift: Perioperative Iron and Erythropoietin Therapy for Patient Blood Management. ACTA ACUST UNITED AC 2018. [DOI: 10.7599/hmr.2018.38.1.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Hyesun Lee
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Young Jin Yuh
- Department of Internal Medicine, Inje University Paik Hospital, Seoul, Korea
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Khan KS, Moore PAS, Wilson MJ, Hooper R, Allard S, Wrench I, Beresford L, Roberts TE, McLoughlin C, Geoghegan J, Daniels JP, Catling S, Clark VA, Ayuk P, Robson S, Gao-Smith F, Hogg M, Lanz D, Dodds J. Cell salvage and donor blood transfusion during cesarean section: A pragmatic, multicentre randomised controlled trial (SALVO). PLoS Med 2017; 14:e1002471. [PMID: 29261655 PMCID: PMC5736174 DOI: 10.1371/journal.pmed.1002471] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/13/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Excessive haemorrhage at cesarean section requires donor (allogeneic) blood transfusion. Cell salvage may reduce this requirement. METHODS AND FINDINGS We conducted a pragmatic randomised controlled trial (at 26 obstetric units; participants recruited from 4 June 2013 to 17 April 2016) of routine cell salvage use (intervention) versus current standard of care without routine salvage use (control) in cesarean section among women at risk of haemorrhage. Randomisation was stratified, using random permuted blocks of variable sizes. In an intention-to-treat analysis, we used multivariable models, adjusting for stratification variables and prognostic factors identified a priori, to compare rates of donor blood transfusion (primary outcome) and fetomaternal haemorrhage ≥2 ml in RhD-negative women with RhD-positive babies (a secondary outcome) between groups. Among 3,028 women randomised (2,990 analysed), 95.6% of 1,498 assigned to intervention had cell salvage deployed (50.8% had salvaged blood returned; mean 259.9 ml) versus 3.9% of 1,492 assigned to control. Donor blood transfusion rate was 3.5% in the control group versus 2.5% in the intervention group (adjusted odds ratio [OR] 0.65, 95% confidence interval [CI] 0.42 to 1.01, p = 0.056; adjusted risk difference -1.03, 95% CI -2.13 to 0.06). In a planned subgroup analysis, the transfusion rate was 4.6% in women assigned to control versus 3.0% in the intervention group among emergency cesareans (adjusted OR 0.58, 95% CI 0.34 to 0.99), whereas it was 2.2% versus 1.8% among elective cesareans (adjusted OR 0.83, 95% CI 0.38 to 1.83) (interaction p = 0.46). No case of amniotic fluid embolism was observed. The rate of fetomaternal haemorrhage was higher with the intervention (10.5% in the control group versus 25.6% in the intervention group, adjusted OR 5.63, 95% CI 1.43 to 22.14, p = 0.013). We are unable to comment on long-term antibody sensitisation effects. CONCLUSIONS The overall reduction observed in donor blood transfusion associated with the routine use of cell salvage during cesarean section was not statistically significant. TRIAL REGISTRATION This trial was prospectively registered on ISRCTN as trial number 66118656 and can be viewed on http://www.isrctn.com/ISRCTN66118656.
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Affiliation(s)
- Khalid S. Khan
- Women’s Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | | | - Matthew J. Wilson
- School of Health and Related Research, University of Sheffield, United Kingdom
| | - Richard Hooper
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary University of London, United Kingdom
| | | | - Ian Wrench
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Lee Beresford
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary University of London, United Kingdom
| | - Tracy E. Roberts
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Carol McLoughlin
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, United Kingdom
| | | | - Jane P. Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, United Kingdom
| | | | - Vicki A. Clark
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Paul Ayuk
- Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom
| | - Stephen Robson
- Institute of Cellular Medicine, Newcastle University, United Kingdom
| | - Fang Gao-Smith
- Peri-operative, Critical Care and Trauma Trials Group, University of Birmingham, United Kingdom
| | - Matthew Hogg
- Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Doris Lanz
- Women’s Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Julie Dodds
- Women’s Health Research Unit, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
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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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Filipescu D, Bănăţeanu R, Beuran M, Burcoş T, Corneci D, Cristian D, Diculescu M, Dobrotă A, Droc G, Isacoff D, Goşa D, Grinţescu I, Lupu A, Mirea L, Posea C, Stanca O, Ştefan M, Tomescu D, Tudor C, Ungureanu D, Mircescu G. Perioperative Patient Blood Management Programme. Multidisciplinary recommendations from the Patient Blood Management Initiative Group. Rom J Anaesth Intensive Care 2017; 24:139-157. [PMID: 29090267 DOI: 10.21454/rjaic.7518.242.fil] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Patients with untreated anaemia or iron deficiency who undergo surgical procedures have an increased risk for mortality and morbidity. Patient Blood Management programmes address this issue worldwide and try to improve patient outcomes through a complex set of measures targeting anaemia correction, minimisation of bleeding and improvement of anaemia tolerance, in all phases of perioperative care. The Patient Blood Management Initiative Group is a multidisciplinary team of physicians from specialties including anaesthesiology, nephrology, surgery, orthopaedics, haematology, gastroenterology and transfusion medicine. The team has elaborated ten recommendations, divided into five categories, in order to implement a Patient Blood Management programme in Romania, using the most recent and relevant evidence. The document was discussed during three meetings which took place during October 2016 and May 2017 and the result was modified and updated via e-mail.
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Muñoz M, Peña-Rosas JP, Robinson S, Milman N, Holzgreve W, Breymann C, Goffinet F, Nizard J, Christory F, Samama CM, Hardy JF. Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement. Transfus Med 2017; 28:22-39. [DOI: 10.1111/tme.12443] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 05/30/2017] [Accepted: 06/18/2017] [Indexed: 01/06/2023]
Affiliation(s)
- M. Muñoz
- Perioperative Transfusion Medicine, Department of Surgical Specialties, Biochemisty and Inmunology; University of Málaga; Málaga Spain
| | - J. P. Peña-Rosas
- Evidence and Programme Guidance, Department of Nutrition for Health and Development; World Health Organization; Geneva Switzerland
| | - S. Robinson
- Guy's and St Thomas' NHS Foundation Trust; Clinical Lead for Transfusion and Obstetric Haematology; London UK
| | - N. Milman
- Departments of Clinical Biochemistry and Obstetrics, Naestved Hospital; University of Copenhagen; Naestved Denmark
| | - W. Holzgreve
- FIGO Representative, Professor of Gynaecology and Obstetrics; Medical Director and CEO, University Hospital Bonn; Bonn Germany
| | - C. Breymann
- Obstetric Research - Feto Maternal Haematology Research Unit; University Hospital Zurich; Zurich Switzerland
| | - F. Goffinet
- Department of Obstetrics and Gynecology, Port-Royal Maternity; Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique des Hôpitaux de Paris; Paris France
| | - J. Nizard
- Department of Obstetrics and Gynecology, Groupe Hospitalier Pitié Salpêtrière; Université Pierre et Marie Curie-Paris 6; Paris France
| | - F. Christory
- Network for the Advancement of Patient Blood Management; Haemostasis and Thrombosis (NATA); Paris France
| | - C.-M. Samama
- NATA Chair, Professor of Anaesthesiology, Department of Anaesthesiology; Centre Hospitalier de l'Universite de Montréal; Montreal QC Canada
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Abstract
Anemia is a common and often ignored condition in surgical patients. Anemia is usually multifactorial and iron deficiency and inflammation are commonly involved. An exacerbating factor in surgical patients is iatrogenic blood loss. Anemia has been repeatedly shown to be an independent predictor of worse outcomes. Patient blood management (PBM) provides a multimodality framework for prevention and management of anemia and related risk factors. The key strategies in PBM include support of hematopoiesis and improving hemoglobin level, optimizing coagulation and hemostasis, use of interdisciplinary blood conservation modalities, and patient-centered decision making throughout the course of care.
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Affiliation(s)
- Aryeh Shander
- Department of Anesthesiology and Critical Care Medicine, Englewood Hospital and Medical Center, TeamHealth Research Institute, 350 Engle Street, Englewood, NJ 07631, USA.
| | - Gregg P Lobel
- Department of Anesthesiology and Critical Care Medicine, Englewood Hospital and Medical Center, TeamHealth Research Institute, 350 Engle Street, Englewood, NJ 07631, USA
| | - Mazyar Javidroozi
- Department of Anesthesiology and Critical Care Medicine, Englewood Hospital and Medical Center, TeamHealth Research Institute, 350 Engle Street, Englewood, NJ 07631, USA
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Schneidewind L, Kranz J, Schlager D, Barski D, Mühlsteadt S, Grabbert M, Queissert F, Frank T, Pelzer AE. Mulitcenter study on antibiotic prophylaxis, infectious complications and risk assessment in TUR-P. Cent European J Urol 2017; 70:112-117. [PMID: 28461999 PMCID: PMC5407338 DOI: 10.5173/ceju.2017.941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/18/2016] [Accepted: 01/09/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Transurethral resection of the prostate is one of the most frequent urological procedures. Urinary tract infections represent major sequelae, but data about antibiotic prophylaxis in TUR-P are controversial and outdated. MATERIAL AND METHODS We conducted a retrospective multicentre study of TUR-P in ten German hospitals. Primary endpoints were epidemiological and outcome data of TUR-P. Secondary endpoints were the identification of factors associated with febrile UTIs and sepsis after TUR-P. RESULTS We included 444 patients with a median age of 71.0 years. Nearly every patient (93.5%) received some kind of antibiotic prophylaxis. Complication rates were 4.9% for febrile UTIs and 2.3% sepsis. Significant risk factors associated with febrile UTIs were pre-existing risk factors for UTIs (p = 0.035) and a duration of catheterization of more than three days (p <0.0001). Significant risk factors for sepsis were duration of surgery of more than 60 minutes (p = 0.030) and again a duration of catheterization of more than three days (p <0.0001). Interestingly, 50.8% of the cases had evidence of chronic prostatitis in their histological specimen. This evidence of chronic prostatitis was significantly associated with febrile UTIs (p = 0.019) and sepsis (p = 0.018). CONCLUSIONS Duration of catheterization is one of the major risk factors for infectious complications after TUR-P. Antibiotic prophylaxis in TUR-P needs prospective investigation. These future studies should also address chronic prostatitis a priori.
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Affiliation(s)
- Laila Schneidewind
- University of the Saarland Medical Center, Institute of Virology, Homburg, Germany
- equal author contribution
| | - Jennifer Kranz
- St.-Antonius-Hospital, Department of Urology and Paediatric Urology, Eschweiler, Germany
- equal author contribution
| | - Daniel Schlager
- University of Freiburg Medical Center, Department of Urology, Freiburg (Brsg.), Germany
| | - Dimitri Barski
- Lukas Hospital Neuss, Department of Urology, Neuss, Germany
| | - Sandra Mühlsteadt
- Martin Luther University Halle-Wittenberg, Department of Urology, Halle, Germany
| | - Markus Grabbert
- Ludwig Maximilians University, Department of Urology, Munich, Germany
| | - Fabian Queissert
- University of Muenster Medical Center, Department of Urology, Muenster, Germany
| | - Tanja Frank
- RoMed Hospital Rosenheim, Department of Urology, Rosenheim, Germany
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Gombotz H, Schreier G, Neubauer S, Kastner P, Hofmann A. Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study. BMJ Open 2016; 6:e012210. [PMID: 27965248 PMCID: PMC5168603 DOI: 10.1136/bmjopen-2016-012210] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES A post hoc gender comparison of transfusion-related modifiable risk factors among patients undergoing elective surgery. SETTINGS 23 Austrian centres randomly selected and stratified by region and level of care. PARTICIPANTS We consecutively enrolled in total 6530 patients (3465 women and 3065 men); 1491 underwent coronary artery bypass graft (CABG) surgery, 2570 primary unilateral total hip replacement (THR) and 2469 primary unilateral total knee replacement (TKR). MAIN OUTCOME MEASURES Primary outcome measures were the number of allogeneic and autologous red blood cell (RBC) units transfused (postoperative day 5 included) and differences in intraoperative and postoperative transfusion rate between men and women. Secondary outcomes included perioperative blood loss in transfused and non-transfused patients, volume of RBCs transfused, perioperative haemoglobin values and circulating red blood volume on postoperative day 5. RESULTS In all surgical groups, the transfusion rate was significantly higher in women than in men (CABG 81 vs 49%, THR 46 vs 24% and TKR 37 vs 23%). In transfused patients, the absolute blood loss was higher among men in all surgical categories while the relative blood loss was higher among women in the CABG group (52.8 vs 47.8%) but comparable in orthopaedic surgery. The relative RBC volume transfused was significantly higher among women in all categories (CABG 40.0 vs 22.3; TKR 25.2 vs 20.2; THR 26.4 vs 20.8%). On postoperative day 5, the relative haemoglobin values and the relative circulating RBC volume were higher in women in all surgical categories. CONCLUSIONS The higher transfusion rate and volume in women when compared with men in elective surgery can be explained by clinicians applying the same absolute transfusion thresholds irrespective of a patient's gender. This, together with the common use of a liberal transfusion strategy, leads to further overtransfusion in women.
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Affiliation(s)
- Hans Gombotz
- Department of Anaesthesiology and Intensive Care,General Hospital Linz, Vienna, Austria
- AIT Austrian Institute of Technology GmbH 8020, Graz, Austria
| | - Günter Schreier
- AIT Austrian Institute of Technology GmbH 8020, Graz, Austria
| | - Sandra Neubauer
- AIT Austrian Institute of Technology GmbH 8020, Graz, Austria
| | - Peter Kastner
- AIT Austrian Institute of Technology GmbH 8020, Graz, Austria
| | - Axel Hofmann
- Department of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, School of Surgery, Dentistry and Health Sciences, University of Western Australia, Western Australia, Australia
- Faculty of Health Sciences, Curtin University, Western Australia, Australia
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Butwick AJ, Walsh EM, Kuzniewicz M, Li SX, Escobar GJ. Patterns and predictors of severe postpartum anemia after Cesarean section. Transfusion 2016; 57:36-44. [PMID: 27618767 DOI: 10.1111/trf.13815] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Postpartum anemia is associated with maternal and perinatal morbidity. Population-level data may inform guideline development for postpartum anemia screening. Our objectives were to evaluate the associations between potential predictors (predelivery anemia and postpartum hemorrhage [PPH]) with severe postpartum anemia after Cesarean section. STUDY DESIGN AND METHODS Data were collected from 70,939 hospitalizations for Cesarean section performed at Kaiser Permanente Northern California facilities between 2005 and 2013. Severe postpartum anemia was defined as a hemoglobin (Hb) level of less than 8 g/dL before hospital discharge. Using multivariable logistic regression, we assessed the associations between predelivery anemia and PPH with severe postpartum anemia. Distributions of these characteristics among women with severe postpartum anemia were evaluated. RESULTS The overall rate of severe postpartum anemia was 7.3% (95% confidence interval [CI], 7.1%-7.4%). Severe postpartum anemia was strongly associated with a predelivery Hb level between 10 and 10.9 g/dL (adjusted odds ratio [aOR], 5.4; 95% CI, 4.89-5.91), predelivery Hb level of less than 10 g/dL (aOR, 30.6; 95% CI, 27.21-34.6), and PPH (aOR, 8.45; 95% CI, 7.8-9.16). The proportions of women with severe postpartum anemia were highest for those experiencing PPH but no predelivery anemia (12.2%; 95% CI, 11.0%-13.6%) and those who did not incur PPH nor predelivery anemia (10.7%; 95% CI, 9.6%-12.0%). CONCLUSIONS Our findings suggest that PPH and predelivery anemia are strong independent risk factors for severe postpartum anemia. Optimization of patients' Hb before delivery may reduce the incidence of severe anemia after Cesarean section.
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Affiliation(s)
- Alexander J Butwick
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Eileen M Walsh
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Michael Kuzniewicz
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Sherian X Li
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Gabriel J Escobar
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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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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Weiskopf RB. What is innovation? Transfusion 2016; 56 Suppl 1:S3-5. [DOI: 10.1111/trf.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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