Adverse Effects Of Blood Transfusion Research Articles

Incidence of acute transfusion reactions and associated factors among adult blood-transfused patients at Jimma University Medical Center, southwest Ethiopia: A cross-sectional study.

Acute transfusion reaction is mainly related to the infusion of blood or blood products resulting at any time within a day of the intervention. It ranges from a non-specific febrile episode to a life-threatening intravascular hemolysis. The severity of the reaction and the degree of morbidity are usually related to the degree of ABO incompatibility and the volume of blood transfused. Therefore, this study aimed to determine the incidence of acute transfusion reactions and its associated factors in Jimma University Medical Center, southwest Ethiopia. Institution-based cross-sectional study was conducted from 1 October to December 30, 2020. A total of 384 transfused patients were followed in this study. Socio-demographic and clinical data were collected through a structured questionnaire. Baseline measurement and 24-hour periodic vital signs monitoring were conducted after each transfusion. Four milliliters of venous blood were drawn after transfusion intervention from each distrusted patient for complete blood count, blood group phenotype, direct antihuman globulin test (DAT), and crossmatching. Data were entered into Epi data version 3.1 and analyzed using Statistical Package for Social Science software (SPSS) version 20. Descriptive statistics, and bivariable and multivariable logistic regression were employed to test the association between independent and dependent variables. A P value ≤ .05 was considered to indicate statistical significance. Acute transfusion reactions were diagnosed in 5.7% of patients, with most of these reactions were febrile nonhemolytic reactions (63.6%) followed by allergic (36.4%) reactions with mild clinical manifestations (27.3%). Transfusion history, transfused blood that was kept for more than 13 days, abortion history, and number of transfused units (≥3 units of blood/blood component) have 3.3, 3.85, 4.2, and 3.9 times greater odds, respectively, besides their significant association with the incidence of acute transfusion reactions. Patients with a history of previous transfusion, abortion, multi-unit transfusion, and patients transfused with blood stored for ≥14 days should be closely monitored. Starting a hemovigilance system of monitoring, collecting, and evaluating data on adverse effects of blood transfusion locally and nationally will decrease the occurrence of acute transfusion reactions.

Trends in Transfusion-Transmissible Infections Among Blood Donors at the National Blood Transfusion Service, Guyana

Aim: The most adverse effect of blood transfusion is the acquisition of transfusion-transmissible infections (TTIs), which poses a serious threat in developing countries. This study aims to identify the trends of transfusion-transmissible infections among blood donors.Materials and Methods: This study was a laboratory-based retrospective study conducted using blood donors’ records from January 2015 to December 2018, collected at the National Blood Transfusion Service, Guyana (NBTS). Analysis of data was performed using the Statistical Package for the Social Sciences (SPSS) version 22.0 software and the results were presented in tables and graphs. Chi-square and logistic regression were used to identify trends and influencing factors.Results: A total of 39,308 blood donors were included in this study, of whom 2,418 (6.2%) donors tested positive to at least one pathogen. Among those donors, 4.4% were coinfected with at least one of the sixteen dual infection combinations. The overall seroprevalence of HIV, HTLV, syphilis, HBV, HCV, Chagas, microfilaria, and malaria was 0.8%, 0.8%, 0.6%, 1.5%, 1.3%, 1.2%, 0.0%, and 0.0%, respectively. Trends of transfusion-transmissible infections showed an overall increase from the lowest prevalence, 5.1%, in 2015 to 7% in 2016, followed by decreases in 2017 (6.8%) and 2018 (5.8%).Conclusions: Even though 98.6% of the donor population are volunteers, this study has shown that a significant percentage of blood donors harbour transfusion-transmissible infections. Stringent screening and preventive measures are very important to ensure the safety of the transfusion recipient.

Is It Beneficial to Optimize Vital Signs Before Embolization for Pelvic Fractures? A Dilemma Between Resuscitation and Hemostasis.

Adequate resuscitation and definitive hemostasis are both important in the management of hemorrhage related to pelvic fracture. The goal of this study was to analyze the relationship between the amount of blood transfused before transcatheter arterial embolization (TAE) and the clinical outcome later in the disease course. Patients with pelvic fractures who underwent TAE for hemostasis from January 2018 to December 2019 were studied. The characteristics of patients who received blood transfusions of >2 U (1000mL) and ≤2 U before TAE were compared. The mortality rate, blood transfusion-related complications, and length of stay were compared between these two groups. Among the 75 studied patients, 39 (52.0%) received blood transfusions of ≤2 U before TAE, and the other 36 (48.0%) patients received blood transfusions of >2 U before TAE. The incidence rates of systemic inflammatory response syndrome, sepsis, and coagulopathy were significantly higher in the >2 U group (97.2% vs 81.1%, P = .027; 50.0% vs 27.0%, P = .045; and 44.4% vs 5.4%, P < .01, respectively). After nonsurvivors were excluded, the >2 U group had a significantly higher proportion (43.8% vs 14.7%, P < .001) of prolonged intensive care unit (ICU) length of stay (7days or more) and a longer hospital length of stay (33.8 ± 15.1 vs 21.9 ± 94.0, P < .01) than the ≤2 U group. Pre-TAE blood transfusion >2 U serves as an independent risk factor for prolonged ICU length of stay and increased hospital length of stay. Early hemostasis for pelvic fracture-related hemorrhage is suggested to prevent pre-TAE blood transfusion-associated adverse effects of blood transfusion.

Developing clinical performance indicators for pre-hospital blood transfusion: The Thames Valley Air Ambulance approach.

In this article, we describe how we developed and validated key performance indicators (KPIs) for pre-hospital blood transfusion and offer suggestions for other organisations wishing to develop performance metrics. KPIs are metrics that compare actual care against an ideal structure, process or outcome standard. An increasing number of UK-based pre-hospital critical care services now carry blood components to enable pre-hospital blood transfusion. A working group of pre-hospital physicians and paramedics was formed to create and validate performance indicators that reflected a high-quality pre-hospital transfusion. This was performed by literature searching and reviewing consensus documents that guide the best practice and then adjusting the indicators as the process evolved. Throughout the year, the performance against the domains was monitored monthly and outputs communicated within the clinical staff of the organisation; at the end of the year, the domains were amended. The final list of performance indicators was as follows: (a) rationale for transfusion documented in the notes; (b) rationale for transfusion in line with Thames Valley Air Ambulance blood transfusion guideline; (c) aggressive management of hypothermia; (d) tranexamic acid administered within an hour of injury; (e) evidence of bleeding in hospital; (f) monitoring of adverse effects of blood transfusion; (g) overall-was the use of blood justified; and (h) no units wasted this month. This study has shown that it is feasible to devise and implement clinical performance indicators for pre-hospital blood transfusion and that their use has increased the focus on this important area.

The Necessity of Clinical Rh Phenotypic Serological Detection and Homotypic Infusion in Patients with Repeated Blood Transfusion.

BackgroundThis study analyzed the distribution of Rh serological phenotype in people living in Hangzhou, China, and assessed the necessity of its routine clinical detection and homotypic infusion.Material/MethodsBlood donors and patients who might need blood transfusion were enrolled into the study, and ABO and 5 major Rh serological antigens (C, c, D, E, and e) were routinely detected. The consistent ABO and Rh serological phenotype blood was transfused between the blood donors and recipients. Irregular antibodies were screened and identified in patients before the blood transfusion. Then, the transfusion adverse effects were monitored and compared with the previous data in the hospital.ResultsThe phenotypic frequencies of Rh blood groups were D>C>E>c>e. The CCDee was the most common phenotype and CcdEe was the least common. The detection rate of unexpected antibodies gradually increased, while the unexpected antibodies slowly decreased in the Rh system. There was a correlation between the isotypic infusion of 5 Rh antigens and the detection rate of antibodies in the Rh system (R=0.845). The adverse effects of blood transfusion declined from 19.95% in 2011 with just homotypic ABO infusion to 3.098% in 2019 with the transfusion of homotypic ABO and the 5 major Rh serological antigens.ConclusionsThe consistency of the transfusion with ABO and 5 significant Rh serological antigens could prevent and decrease the high frequency production of isoantibodies, which is of vital importance in reducing the incidence rate of adverse effects in patients receiving transfusions.

Clearance and phenotype of extracellular vesicles after red blood cell transfusion in a human endotoxemia model

BackgroundIn the critically ill, extracellular vesicles (EV) from red blood cells (RBC) have been related to adverse effects of blood transfusion. Stored RBC units contain high concentrations of RBC- EVs, thereby increasing the concentration of EVs in the circulation after transfusion. The mechanisms underlying the clearance of donor RBC-EVs after transfusion are unknown. This study investigates whether membrane markers that are associated with clearance of RBCs are also implicated in clearance of RBC-EVs in human endotoxemic recipients of a transfusion. MethodsSix volunteers were injected with Escherichia coli lipopolysaccharide, and after two hours transfused with an autologous RBC unit donated 35 days earlier. Samples were collected from the RBC unit and the volunteers before and after transfusion. RBC-EVs were labeled with (anti) glycophorin A, combined with (anti) CD44, CD47, CD55, CD59, CD147, or lactadherin to detect phosphatidylserine (PS) and analyzed on a A50 Micro flow cytometer. ResultsIn the RBC unit, RBC-EVs solely exposed PS (7.8%). Before transfusion, circulating RBC-EVs mainly exposed PS (22%) and CD59 (9.1%), the expression of the other membrane markers was much lower. After transfusion, the concentration of RBC- EVs increased 2.4-fold in two hours. Thereafter, the EV concentration decreased towards baseline levels. The fraction of EVs positive for all tested membrane markers decreased after transfusion. ConclusionBesides a minor fraction of PS-exposing EVs, RBC-EVs produced during storage do not expose detectable levels of RBC membrane markers that are associated with clearance, which is in contrast to the EVs produced by the circulating RBCs.

Safety and efficacy of intraoperative cell salvage in off-pump coronary artery bypass grafting

Objectives Cell salvage and retransfusion of autologous blood has been shown to reduce the requirement for homologous blood transfusion during cardiac surgery. The adverse effects of blood transfusion are well-documented. Different techniques have been developed in the past to reduce homologous blood transfusion requirement. We evaluated the advantages of cell saver processed red blood cells which were to be used as autologous blood transfusion intra operatively and tried to avoid allogenic blood transfusion. We studied the safety and efficacy of this technique and determined the effects on haematological parameters, clotting parameters, homologous blood transfusion requirements, blood loss and postoperative parameters.

The Case for a Conservative Approach to Blood Transfusion Management in Cardiac Surgery.

Limiting blood transfusion in cardiac operations is a well-meaning goal of perioperative care. Potential benefits include decreasing morbidity and limiting procedural costs. It is difficult to identify transfusion as the cause of adverse outcomes. The need for transfusion may identify a sicker patient population at greater risk for a worse outcome that may or may not be related to the transfusion. We reviewed the indications for and adverse effects of blood transfusion in patients undergoing cardiac procedures to provide a balanced approach to management of blood resources in this population. We reviewed current literature, including systematic reviews and practice guidelines, to synthesize a practice management plan in patients having cardiac operations. Several prospective randomized studies and large population cohort studies compared a postoperative restrictive transfusion policy to a more liberal policy and found very little difference in outcomes but decreased costs with a restrictive policy. Evidence-based practice guidelines and implementation standards provide robust intervention plans that can limit harmful effects of transfusion and provide safe and effective procedure outcomes. A restrictive transfusion policy seems to be safe and effective but does not necessarily provide better outcome in most patient cohorts. The implications of these findings suggest that many discretionary transfusions could be avoided. A subset of high-risk patients could undoubtedly benefit from a more liberal transfusion policy, but the definition of high risk is ill defined.

Transfusion Medicine: Time for a Change: Patient Blood Management and the Ontario ONTraC Program

Despite increasing recognition of the potential adverse effects of blood transfusion there is evidence that the procedure is over-utilized and often inappropriately and unnecessarily administered. Patient Blood Management (PBM) is a recent world-wide initiative to optimize transfusion therapy by employing preoperative and perioperative maneuvers and alternatives to avoid unnecessary blood transfusion. These approaches are, however, not restricted to the surgical setting, but may be applied whenever transfusion is contemplated. A key component of PBM is the appropriate management of anemia, a prime determinant of transfusion. Another is tolerance of anemia through the use of restrictive transfusion thresholds for transfusion and of a single unit at a time policy. Among a number of options at surgery, antifibrinolytics have proven effective at reducing blood loss and transfusion. Burgeoning literature demonstrates that PBM (also known as Blood Conservation or as ‘Bloodless Medicine/Surgery’) is costeffective while improving patient outcomes and conserving the blood supply. Data from the ONTraC program in Ontario are described herein to illustrate the effectiveness of PBM approaches

Allogeneic versus autologous blood transfusion and survival after radical prostatectomy (CME)

Potential adverse effects of blood transfusion (BT) remain controversial, especially for clinical outcomes after curative cancer surgery. Some postulate that immune modulation after allogeneic BT predisposes to recurrence and death, but autologous superiority is not established. This study assessed whether BT is associated with long-term prostate cancer recurrence and survival with a large single-institutional radical prostatectomy (RP) database. Between 1994 and 2012, a total of 11,680 patients had RP with available outcome and transfusion data. A total of 7443 (64%) had complete covariate data. Clinical variables associated with biochemical recurrence-free survival (BRFS), cancer-specific survival (CSS), and overall survival (OS) were identified with Cox proportional hazards models for three groups: no BT (reference, 27.7%, n = 2061), autologous BT only (68.8%, n = 5124), and any allogeneic BT (with or without autologous, 3.5%, n = 258). Median (range) follow-up was 6 (1-18) years. Kaplan-Meier analysis showed significantly decreased OS (but not BRFS or PCSS) in the allogeneic group versus autologous and no BT groups (p = 0.006). With univariate analysis, any allogeneic BT had a hazard ratio (HR) of 2.29 (range, 1.52-3.46; p < 0.0001) for OS, whereas autologous BT was not significant (HR, 1.04 [range, 0.82-1.32], p = 0.752). In multivariable models, neither autologous nor allogeneic BT was independently associated with BRFS, CSS, or OS, and a dose response was not observed for allogeneic units and BRFS. Although allogeneic but not autologous BT was associated with decreased long-term OS, after adjustment for confounding clinical variables, BT was not independently associated with OS, BRFS, or CSS regardless of transfusion type. Notably, no association was observed between allogeneic BT and cancer recurrence. Observed differences in OS may reflect confounding.

Transfusion transmissible infections in blood donors: A 7-year study in central Gujarat

<b>Context:</b> One of the major adverse effects of blood transfusion is transfusion transmissible infections (TTIs). Serological testing can help to reduce, but not eliminate occurrences of TTIs. Study of TTIs in different blood donor groups help to find safe blood for patients. <b>Aims:</b> The aim of this study was to determine the prevalence and trends in TTIs in voluntary and replacement blood donors. <b>Settings and Design:</b> Voluntary and replacement blood donors were studied for TTIs over the duration of 7 years. TTIs were documented with particulates like gender and type of donation (voluntary or replacement). <b>Materials and Methods:</b> Blood donation taken after predonation examination. Tests for TTIs carried out from donated blood and results were documented. <b>Statistical Analysis Used:</b> Data entered into Microsoft Excel sheets and studied for prevalence, trend, and odds ratio. <b>Results:</b> Total blood units taken during the period from 2007 to 2013 were 15,368. 93.1% were male donors and 6.9% were female donors. Prevalence of TTIs was 0.72%. Human immunodeficiency virus, hepatitis B surface antigen, hepatitis C virus, and syphilis were detected in 0.14%, 0.38%, 0.06%, and 0.14% of donors, respectively. No female donors had TTI. TTIs in voluntary donors (VDs) and replacement donors were 0.64% and 1.15%. <b>Conclusions:</b> Outcome of the study shows increasing trend for total blood donation, voluntary donations, and female blood donors. All TTIs were reducing except syphilis. To provide safe blood to patients, blood donation from VDs and female donors should be encouraged.

Prevalence of acute blood transfusion reactions in Mazandaran Heart Center, Sari, Iran, 2010-2012.

ABSTRACTIntroduction:Although blood transfusion is life saving for patients, it is responsible for a series of complications and exposes the patients to a variety of risks. Therefore knowing different adverse effects of blood transfusion represents a great issue in managing recipient patients.Aim:The aim of the present work was to study the prevalence of blood transfusion complications among patients in the Mazandaran Heart Center, Sari, Iran, during a period of 2 years.Material and Methods:A retrospective review of all reported and evaluated acute transfusion reactions during a 2 years period in Mazandaran Heart Center was performed. Associated clinical signs and symptoms were evaluated.Results:In 9193 transfused blood products, there was 34 (0.4%) acute transfusion reactions. The commonest were discomfort and restlessness(0.16%), dyspnea(0.16%), rigors (0.13%), fever (0.08%), chest pain(0.06%), rash or urticaria (0.04%), nausea and vomiting(0.03%), palpitation(0.03%), hypertension(0.03%)flashing(0.02%), hypotension(0.02%).Conclusion:Acute transfusion reaction is seen in %0.4 of transfused patients therefore, we recommend a well-structured program for monitoring adverse reactions associated with blood transfusion and blood product administration (Hemovigilance program).

Perioperative Complications in the Cancer Patient: A Robust Prognostic Factor

As surgeons, we grew up learning about postoperative complications in the forum known as the Morbidity and Mortality (M&M) conference. We learned that certain genre of complications, such as intra-abdominal infections, myocardial ischemia, pneumonia, and deep venous thrombosis, portend especially detrimental outcomes for our surgical patients. The concept of the M&M conference developed from the seminal work of Dr. Ernest Amory Codman who, in the early 1900s working at Massachusetts General Hospital, recognized that in order to learn from our mistakes and improve patient care we had to discuss unsuccessful outcomes, quantify and catalogue these misadventures, and follow the course of our patients. These tenets espoused by Codman were not embraced by his fellow Boston physicians and he was invited to remove himself from the environment of the medical staff and hospital! Codman’s early endeavors into developing databases and reporting outcomes served, however, as the basis for the quality initiatives first developed by the American College of Surgeons (ACS) during the infancy of that organization in the second decade of the twentieth century. Subsequently, the creation of risk-adjusted instruments, such as the Veterans Administration (VA)initiated National Surgical Quality Improvement Program (NSQIP) launched in the early 1990s and the ACS–NSQIP promulgated to all hospitals more recently, has provided analytic tools not only to evaluate the consequences of surgical complications during the immediate postoperative period but to assess the ultimate effects of these events on the entire course of an illnesses, such as cancer. As an important derivative from the ACS–NSQIP, the Surgical Risk Calculator recently has been launched to facilitate the computation of the likelihood of 30-day outcomes for a large number of surgical procedures given the presence of preoperative comorbidities. The late Shukri Khuri, working with his VA colleagues using the VA-NSQIP database, showed that the 30-day complication rate is a robust factor in determining both short(30-day) and long-term survivals for all patients undergoing eight common operations. Although not directed previously to cancer patients, Khuri’s work suggested that the ‘‘inflammatory response’’ resulting from postoperative complications was a detrimental factor in determining long-term survival and was independent of patients’ preoperative risks. The importance of this work had obvious implications for patients with malignancy. The prognosis of cancer is dependent on adequate staging of patients. More recently, molecular markers along with anatomical staging have been added to the taxonomy of outcomes of cancer patients. Unfortunately, the role of comorbidities, although championed by some, continues to be unrecognized as a major factor in the outcomes of cancer patients. Along with this, we have generally failed to understand the importance of the postoperative complication on the future of our cancer patient. Perhaps complicated outcomes are associated with other factors. The adverse effect of blood transfusion has been delineated as a reason for reduced survival in cancer patients, perhaps as a consequence of reduced immunocompetence resulting from transfusion. Obviously patients with postoperative complications may have an increased This is an editorial to the article available at doi: 10.1245/s10434013-3267-0.

Inhibition of lysophosphatidic acid increase by prestorage whole blood leukoreduction in autologous CPDA‐1 whole blood

Lysophosphatidylcholine (LPC) has been implicated in the onset of transfusion-related acute lung injury (TRALI). In plasma, LPC is converted to lysophosphatidic acid (LPA) by autotaxin (ATX). The effect of leukoreduction in the accumulation of these bioactive lipids and ATX in human autologous blood has not been fully investigated. The accumulation of choline-containing phospholipids (LPC, sphingomyelin [SM], and phosphatidylcholine [PC]), LPA, and ATX during the storage of autologous blood and the changes caused by leukoreduction were investigated. A total of 26 orthopedic patients were enrolled. Autologous blood was collected as whole blood and, after leukoreduction, preserved refrigerated until use. Prestorage leukoreduced (LR) and non-LR autologous blood samples were analyzed. The time-dependent changes and the effect of the filtration were compared. A time-dependent and significant increase in the levels of LPA was observed in both non-LR and LR samples. The concentration of LPA was significantly reduced in LR compared to non-LR samples. The concentration of LPC was higher in LR compared to non-LR samples. The levels of PC, SM, and ATX were not affected by either the storage period or the leukoreduction. Leukoreduction of autologous whole blood effectively reduced the accumulation of LPA. On the other hand, prestorage leukoreduction resulted in an increased concentration of LPC, without significantly affecting ATX. Further studies are necessary to confirm the role of LPA in the pathogenesis of adverse effects of blood transfusion, especially TRALI.

Transfusion-Related Acute Lung Injury Following Upper Extremity Replantation

OZET Transfusion-related acute lung injury (TRALI) is a common adverse effect of blood transfusion that is often underrecognised and underreported. We would like to report a case of TRALI after the replantation and transfusion of blood components in a male patient who had sustained a complete amputation of the right upper extremity. The level of amputation was just proximal to the humeral condyles. Replantation was performed 5 hours after the accident and 36 units of blood products were transfused intraoperatively. Subsequently, during the early postoperative period, TRALI was revealed. In this case report, the circumstances of this injury and preventive measures are discussed to understand and recognise this condition in order to reduce the morbidity and mortality of TRALI. It is important to distinguish TRALI from other causes of pulmonary oedema because early diagnosis and management are associated with a favourable outcome.

Blood transfusion and cancer surgery outcomes: A continued reason for concern

The adverse effects of blood transfusion after cancer surgery have been recently challenged in older anemic persons or those with substantial intraoperative blood loss. We hypothesized that intraoperative blood transfusions continue to adversely impact short-term cancer surgery outcomes regardless of age or preoperative hematocrit levels. Using the 2005 to 2008 American College of Surgeons National Surgical Quality Improvement Program, we identified 38,926 patients who underwent cancer surgery. Pre-, intra-, and postoperative factors were compared by units of blood transfusion a patient received. Stratified multivariable analyses, by age and hematocrit level, were performed to assess the impact of blood transfusion on operative outcomes, adjusting for covariates. Fourteen percent of patients received an intraoperative blood transfusion. Of those, >60% received only 1 to 2 units of blood. Receipt of intraoperative blood transfusion was associated with higher rates of 30-day operative mortality, major complications, total number of complications, and prolonged length of stay across age groups and in persons with low to normal hematocrit levels. The present study shows that intraoperative blood transfusion adversely impacts short-term operative cancer surgery outcomes across all age groups and in those with low to normal hematocrit levels. These findings provide insightful implications on the patterns of blood transfusion during cancer surgery that deserve further investigation.

Impact of Blood Product Transfusion on Short and Long-Term Survival After Cardiac Surgery: More Evidence

Despite the proven benefits in hemorrhagic shock, blood transfusions have been linked to increased morbidity and mortality. The short-term adverse effects of blood transfusion in cardiac surgical patients are well documented but there are very few studies that adequately assess the long-term survival. This study was undertaken to evaluate the effects of transfusion on both short-term and long-term survival after cardiac surgery. Data from 5,342 patients who underwent a cardiac surgical procedure from January 2002 to December 2005 at our institution were reviewed. The effect of transfusion of packed red blood cells (PRBC) and other blood products was tested in a 2-level approach of transfusion (any) versus no transfusion, and also a 4-level approach of transfusion (PRBC, other blood products, and both blood and blood products) versus no transfusion. Long-term survival data of these patients were obtained. Cox proportional hazard models, Kaplan-Meier survival plots, and hazard functions were used to compare the groups. A total of 3,013 of the 5,342 study patients (56.4%) received transfusion during or within 72 hours of their cardiac surgery. Median time to death was significantly lower for patients who received transfusions; 1.15 years for PRC and 0.83 years for any transfusion, compared with 4.68 years in the non-transfused group. The overall 30-day mortality was 1.7%, but in patients who received transfusions (3.6%) was significantly higher than the non-transfused group (0.3%, p<0.001). The 1-year mortality (overall 3.9%) in the transfused group (7.3%, p<0.001) was also significantly higher than that in the non-transfused group (1.3%). The 5-year mortality rate in the transfused group was more than double that in the non-transfused group (16% vs 7%). After correction for comorbidities and other factors, transfusion was still associated with a 66% increase in mortality. This study suggests that blood or blood product transfusion during or after cardiac surgery is associated with increased short-term and long-term mortality. It reinforces the need for prospective randomized controlled studies for evaluation of restrictive transfusion triggers and objective clinical indicators for transfusion in the cardiac surgical patient population.

Blood Transfusion and Cancer Surgery Outcomes: A Continued Reason for Concern

Background The adverse effects of blood transfusion after cancer surgery have been recently challenged in older anemic persons or those with substantial intraoperative blood loss. We hypothesized that intraoperative blood transfusions continue to adversely impact short-term cancer surgery outcomes regardless of age or preoperative hematocrit levels. Methods Using the 2005 to 2008 American College of Surgeons National Surgical Quality Improvement Program, we identified 38,926 patients who underwent cancer surgery. Pre-, intra-, and postoperative factors were compared by units of blood transfusion a patient received. Stratified multivariable analyses, by age and hematocrit level, were performed to assess the impact of blood transfusion on operative outcomes, adjusting for covariates. Results Fourteen percent of patients received an intraoperative blood transfusion. Of those, >60% received only 1 to 2 units of blood. Receipt of intraoperative blood transfusion was associated with higher rates of 30-day operative mortality, major complications, total number of complications, and prolonged length of stay across age groups and in persons with low to normal hematocrit levels. Conclusion The present study shows that intraoperative blood transfusion adversely impacts short-term operative cancer surgery outcomes across all age groups and in those with low to normal hematocrit levels. These findings provide insightful implications on the patterns of blood transfusion during cancer surgery that deserve further investigation.

Association Between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

Background: The impact of intraoperative erythrocyte transfusiononoutcomesofanemicpatientsundergoingnoncardiacsurgeryhasnotbeenwellcharacterized.Theobjective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severeanemia(hematocritlessthan30%)whoareexposedto one or two units of erythrocytes intraoperatively. Methods: Thiswasaretrospectiveanalysisoftheassociationof blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results: Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03–1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48–2.09), sepsis (OR, 1.43; 95% CI, 1.21–1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32–2.38), and wound complications (OR, 1.87; 95% CI, 1.47–2.37). Conclusions: Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

Human red blood cell aging: correlative changes in surface charge and cell properties

Red blood cells (RBCs) during microcirculation, aging and storage, lose N-acetylneuraminic acid (NANA) and other biomaterials thereby altering cell structures, some properties and functions. Such cell damage very likely underlies the serious adverse effects of blood transfusion. However, a controversy has remained since 1961–1977 as to whether with aging, the RBCs, suffering loss of NANA, do have a decreased charge density. Any correlation between the changes in the cell properties with cell aging is also not clear. Therefore, to remove the ambiguity and uncertainty, we carried out multiparameteric studies on Percoll fractions of blood of 38 volunteers (lightest-young-Y-RBCs, densest-old-O-RBCs, two middle fractions).We found that there were striking differences between the properties of Y-RBCs and O-RBCs. The ζ-potential of Y-RBCs decreased gradually with aging. Studies in parallel on RBC fractions incubated with both positively charged quantum dots and Sambucus Nigra-fluorescein isothiocyanate (FITC) along with their ζ-potentials provide for the first time direct visual evidence about the lesser amount of charge density and NANA on O-RBCs, and a collinear decrease in their respective ζ-potentials. Close correlation was found between the surface charge on an aging RBC and its structure and functions, from the cell morphology, the membrane deformability to the intracellular Hb structure and oxidation ability. This quantitative approach not only clarifies the picture but also has implications in biology and medicine.