Allogeneic Blood Transfusion Group Research Articles

Postoperative long‑term outcomes of acute normovolemic hemodilution in pancreatic cancer: A propensity score matching analysis.

Acute normovolemic hemodilution (ANH) is a useful intraoperative blood conservation technique. However, the impact on long-term outcomes in pancreatic ductal adenocarcinoma (PDAC) remains unclear. The present study investigated the impact of ANH on long-term outcomes in patients with PDAC undergoing radical surgery. Data from 155 resectable PDAC cases were collected. Patients were categorized according to whether or not they had received intraoperative allogeneic blood transfusion (ABT) or ANH. Postoperative complications, recurrence-free survival (RFS) and disease-specific survival (DSS), before and after propensity score matching (PSM), were compared among patients who did and did not receive ANH. A total of 44 patients (28.4%) were included in the ANH group and 30 patients (19.4%) were included in the ABT group; 81 (52.3%) patients, comprising the standard management (STD) group, received neither ANH nor ABT. The ABT group had the worst prognosis among them. Before PSM, ANH was significantly associated with decreased RFS (P=0.043) and DSS (P=0.029) compared with the STD group before applying Bonferroni correction; however, no significant difference was observed after applying Bonferroni correction. Cox regression analysis identified ANH as an independent prognostic factor for RFS [relative risk (RR), 1.696; P=0.019] and DSS (RR, 1.876; P=0.009). After PSM, the ANH group exhibited less favorable RFS [median survival time (MST), 12.1 vs. 18.1 months; P=0.097] and DSS (MST, 32.1 vs. 50.5 months; P=0.097) compared with the STD group; however, these differences were not statistically significant. In conclusion, while ANH was not as harmful as ABT, it exhibited potentially more negative effects on long-term postoperative outcomes in PDAC than STD.

Intraoperative cell-salvaged autologous blood transfusion is safe in metastatic spine tumour surgery: early outcomes of prospective clinical study.

Allogeneic blood transfusion (ABT) is current standard of blood replenishment despite known complications. Salvaged blood transfusion (SBT) addresses majority of such complications. Surgeons remain reluctant to employ SBT in metastatic spine tumour surgery (MSTS), despite ample laboratory evidence. This prompted us to conduct a prospective clinical study to ascertain safety of intraoperative cell salvage (IOCS), in MSTS. Our prospective study included 73 patients who underwent MSTS from 2014 to 2017. Demographics, tumour histology and burden, clinical findings, modified Tokuhashi score, operative and blood transfusion (BT) details were recorded. Patients were divided based on BT type: no blood transfusion (NBT) and SBT/ABT. Primary outcomes assessed were overall survival (OS), and tumour progression was evaluated using RECIST (v1.1) employing follow-up radiological investigations at 6, 12 and 24months, classifying patients with non-progressive and progressive disease. Seventy-three patients [39:34(M/F)] had mean age of 61 years. Overall median follow-up and survival were 26 and 12 months, respectively. All three groups were comparable for demographics and tumour characteristics. Overall median blood loss was 500mL, and BT was 1000mL. Twenty-six (35.6%) patients received SBT, 27 (37.0%) ABT and 20 (27.4%) NBT. Females had lower OS and higher risk of tumour progression. SBT had better OS and reduced risk of tumour progression than ABT group. Total blood loss was not associated with tumour progression. Infective complications other than SSI were significantly (p = 0.027) higher in ABT than NBT/SBT groups. Patients of SBT had OS and tumour progression better than ABT/NBT groups. This is the first prospective study to report of SBT in comparison with control groups in MSTS.

Risk factors for blood transfusion in adolescent patients with scoliosis undergoing scoliosis surgery: a study of 722 cases in a single center

BackgroundTo assess the risk factors for blood transfusion in a great number of adolescent cases with different types of scoliosis who received scoliosis surgery.MethodsData of patients who were diagnosed as scoliosis and received one-stage posterior correction and spinal fusion from January 2014 to December 2017 were prospectively collected and retrospectively analyzed. Patients’ demographic characteristics, segments of spinal fusion, Cobb angle of the major curve,osteotomy pattern, preoperative and postoperative levels of hemoglobin, and allogeneic blood transfusion (ABT) were recorded and analyzed.ResultsIn this study, 722 cases with adolescent scoliosis were included, of whom 32.8% (237/722) received ABT. Risk factors included diagnosis: neurofibromatosis (OR = 5.592), syndromic (OR = 3.029),osteotomy: Ponte osteotomy (OR = 5.997), hemivertebrae resection (OR = 29.171), pedicle subtraction osteotomy (PSO)(OR = 8.712), vertebral column resection (VCR)(OR = 32.265);fusion segments (OR = 1.224) and intraoperative blood loss (OR = 1.004). In the subgroup analysis of cases with idiopathic scoliosis, Ponte osteotomy (OR = 6.086), length of segments of spinal fusion (OR = 1.293), and intraoperative blood loss (OR = 1.001) were found as risk factors for ABT. Results of receiver operating characteristic (ROC) curve analysis revealed that length of segments of spinal fusion equal to 11.5 vertebrae was the best cutoff value for cases with idiopathic scoliosis who did not receive osteotomy in both ABT group and non-ABT group. In the subgroup analysis of congenital scoliosis, Ponte osteotomy (OR = 5.087), hemivertebra resection (OR = 5.457), PSO (OR = 4.055), VCR (OR = 6.940), and intraoperative blood loss (OR = 1.004) were risk factors for ABT.ConclusionsMethod of diagnosis, osteotomy pattern, segments of spinal fusion, and intraoperative blood loss were risk factors for ABT in cases with adolescent scoliosis. In cases with idiopathic scoliosis, Ponte osteotomy and segments of spinal fusion longer than 11.5 vertebrae were risk factors for ABT. In cases with congenital scoliosis, osteotomy pattern was the main risk factor for ABT.Level of evidenceLevel III.

Survival analysis of intraoperative blood salvage for patients with malignancy disease: A PRISMA-compliant systematic review and meta-analysis.

Background:Intraoperative blood salvage as a blood-saving strategy has been widely used in surgery. Considering its theoretic risk of malignant tumor cells being reinfused and the corresponding blood metastases, the safety of intraoperative blood salvage in cancer surgery remains controversial.Methods:Following the Preferred Reporting Items for Systemic Review and Meta-Analysis (PRISMA), we searched the Cochrane Library, MEDLINE and EMBASE to November 2017. We included only studies comparing intraoperative blood salvage with allogeneic blood transfusion.Results:This meta-analysis included 9 studies with 4354 patients with 1346 patients in the intraoperative blood salvage group and 3008 patients in the allogeneic blood transfusion group. There were no significant differences in the 5-year overall survival outcome (odds ratio [OR] 1.12; 95% confidence interval [CI], 0.80–1.58), 5-year disease-free survival outcome (OR 1.08; 95% CI 0.86–1.35), or 5-year recurrence rate (OR 0.86; 95% CI 0.71–1.05) between the 2 study groups. Subgroup analysis also showed no significant differences in the 5-year overall survival outcome (OR 0.97; 95% CI 0.57–1.67) of hepatocellular carcinoma patients in liver transplantation.Conclusions:For patients with malignant disease, intraoperative blood salvage did not increase the tumor recurrence rate and had comparable survival outcomes with allogeneic blood transfusion.

The impact of perioperative allogeneic blood transfusion on prognosis of hepatocellular carcinoma after radical hepatectomy: A systematic review and meta-analysis of cohort studies.

This meta-analysis aims to clarify the clinical impacts of allogeneic blood transfusion (ABT) on hepatectomy outcome in hepatocellular carcinoma (HCC) patients. A systematic literature search was performed for relevant articles in international and Chinese databases up to May 2018. Random- or fixed-effect meta-analysis was used to pool the effect estimates. Publication bias was assessed by Egger's and Peters's test. Heterogeneity was assessed using the I statistic. The strength of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation system. A total of 29 studies met the eligibility criteria. Meta-analysis showed HCC patients in ABT group had lower survival rate at 1, 3, 5, and 10 years after radical hepatectomy than those in no blood transfusion (NBT) group (RR = 0.9, 95%CI: 0.87-0.93, P < .05; RR = 0.83, 95%CI: 0.77-0.89, P < .05; RR = 0.7, 95%CI: 0.65-0.74, P < .05; RR = 0.64, 95%CI: 0.54-0.75, P < .05). Similar results were observed in disease-free survival (DFS) (respectively: RR = 0.86, 95%CI: 0.82-0.91, P < .05; RR = 0.77, 95%CI: 0.67-0.79, P < .05; RR = 0.71, 95%CI: 0.64-0.79, P < .05; RR = 0.62, 95%CI: 0.48-0.8, P < .05). Cancer recurrence rate was higher for the patients in ABT group at 1 and 3 years (RR = 1.5, 95%CI: 1-2.24, P < .05; RR = 1.27, 95%CI: 1.09-1.49, P < .05, respectively), but not statistically significant at 5years (RR = 1.08, 95%CI: 0.98-1.19, P = .512). The HCC patients in ABT group increased postoperative complications occurrence compared with those in NBT group (RR = 1.87, 95%CI: 1.42-2.45, P < .05). This meta-analysis demonstrated that ABT was associated with adverse clinical outcomes for HCC patients undergoing radical hepatectomy, including poor survival, DFS, and complications. Surgeons should reduce blood loss during hepatectomy and avoid perioperative allogenic blood transfusion.

Effect of allogeneic blood transfusion on levels of IL-6 and sIL-R2 in peripheral blood of children with acute lymphocytic leukemia.

Effect of allogeneic blood transfusion on the expression of interleukin-6 (IL-6) and soluble interleukin-2 receptor (sIL-2R) in peripheral blood of children with acute lymphoblastic leukemia (ALL) was investigated. A total of 91 ALL children admitted to Nanfang Hospital from June 2014 to January 2017 were selected as the study group. Patients were randomly divided into allogeneic blood transfusion group (n=38) and non-transfusion group (n=53). In addition, a total of 64 healthy children were also selected from June 2014 to January 2017 as the control group. Patients in allogeneic blood transfusion group were transfused with red blood cell suspension and machine-collected platelets, while patients in non-transfusion group were not treated with blood transfusion. Peripheral venous blood was collected before and at 4, 8 and 12 weeks after blood transfusion to prepare serum. Serum IL-6 and sIL-2R levels were measured by enzyme-linked immunosorbent assay (ELISA). Before transfusion, serum levels of IL-6 and sIL-2R were significantly lower in the study group than those in control group (p<0.05), and no significant differences in serum levels of IL-6 and sIL-2R were found between the allogeneic blood transfusion and non-transfusion group. After transfusion, serum levels of IL-6 and sIL-2R were stable for 12 weeks in the non-transfusion group, while IL-6 and sIL-2R levels were significantly increased in the allogeneic blood transfusion group. The results showed that serum level of IL-6 and sIL-2R was increased in ALL patients with allogeneic blood transfusion, which resulted in reduced antibody production and decreased cellular immunity. The patients had low immunity, and attention should be paid on the pathogen infection prevention.

Comparison of effects of allogeneic blood transfusion and hemodiluted autotransfusion on cellular immune function in patients undergoing cesarean section

Objective To compare the effects of allogeneic blood transfusion and hemodiluted autotransfusion on cellular immune function in the patients undergoing cesarean section. Methods Sixty patients, aged 20-35 yr, weighing 50-80 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective cesarean section, were randomly divided into 2 groups(n = 30 each)using a random number table: hemodiluted autotransfusion group(group HAT)and allogeneic blood transfusion group(group ABT). Both groups received epidural anesthesia.The radial artery was cannulated after epidural anesthesia, and the autologous blood was collected in group HAT.The autologous blood transfusion timing: intraoperative blood loss was expected to exceed 20% of blood volume.For the patients in whom intraoperative blood loss was not expected to exceed 20% of blood volume, bleeding was stopped, and autologous blood was infused intravenously after peritoneum closure.The allogeneic blood transfusion timing: when hemoglobin 1.5 times of the normal value, the fresh frozen plasma 100-400 ml was infused intravenously; when platelet count<50×109/L, platelets 10-40 U were infused intravenously.When entering the operating room(T0), on 1st day after operation(T1), and on 5th day after operation(T2), blood samples were collected to detect the levels of T lymphocyte subsets CD3+ , CD4+ and CD8+ (using FACScan flow cytometer), and serum interleukin-2(IL-2)and IL-6 concentrations(by enzyme-linked immunosorbent assay). CD4+ /CD8+ ratio was calculated. Results Compared with the values at T0, the levels of CD3+ and CD4+ , CD4+ /CD8+ ratio, and serum IL-2 concentrations were significantly decreased, and the serum IL-6 concentrations were increased at T1, 2 in group ABT, and at T1 in group HAT(P<0.05). Compared with group ABT, the CD3+ and CD4+ levels, CD4+ /CD8+ ratio and serum IL-6 concentrations were significantly increased at T1, and the serum IL-2 concentrations were increased at T1, 2 in group HAT(P<0.05). Conclusion Compared with allogeneic transfusion, hemodiluted autotransfusion has less inhibitory effect on cellular immune function in the patients undergoing cesarean section. Key words: Blood transfusion, autologous; Blood component transfusion; Cesarean section; Immunity, cellular

Effect of autologous blood withdrawal-reinfusion on pulmonary function in patients undergoing spinal surgery

Objective To evaluate the effect of autologous blood withdrawal-reinfusion on pulmonary function in the patients undergoing spinal surgery.Methods Forty patients of both sexes,aged 28-64 yr,with body mass index 20-25 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective spinal surgery under general anesthesia,were randomly divided into 2 groups (n =20 each):allogeneic blood transfusion group (group A) and autologous blood withdrawal-reinfusion group (group B).Anesthesia was induced with iv midazolam,sufentanil,propofol and rocuronium,and maintained with propofol,remifentanil and cisatracurium.Patients were tracheally intubated and mechanically ventilated.Patients received transfusion of allogeneic blood in group A,while patients received transfusion of intraoperative salvaged blood in group B.Immediately before blood transfusion (T0,baseline),and at l,6 and 24 h after the last transfusion during operation (T1-3),blood samples were collected from the radial artery for blood gas analysis and for measurement of serum pulmonary surfactant-associated protein A (SP-A) level.Oxygenation index (OI) and respiratory index (RI) were calculated.Adverse effects of blood transfusion and respiratory complications within 72 h after operation were also recorded.Results No significant differences were found in all the parameters mentioned above at each time point between the two groups,and these parameters were all within the normal range.Compared with the baseline values at T0,OI was significantly decreased and RI was increased at T1,2,and the serum SP-A level was decreased at T2,3 in the two groups.Compared with the value at T1,RI was significantly decreased at T3,the serum SP-A level was decreased at T2-3,and no significant changes were found in OI in the two groups.No adverse effects of blood transfusion were found in the two groups.There were no respiratory complications within 72 h after operation in group A,one case developed respiratory complications within 72 h after operation in group B,and no differences were found between the two groups.Conclusion Autologous blood withdrawal-reinfusion exerts no effect on pulmonary function in the patients undergoing spinal surgery. Key words: Blood transfusion, autologous; Respiratory function tests; Blood loss, surgical

Predicting the need for blood transfusions in elderly patients with pertrochanteric femoral fractures

ObjectiveThe need exists for perioperative blood management measures aimed at improving patient outcomes and reducing the risks of allogeneic blood transfusion (ABT). Our study aim is to discuss an algorithm to predict the need for perioperative blood transfusion in old patients with pertrochanteric femoral fractures. MethodsWe retrospectively analysed the data from 220 elderly patients with pertrochanteric femoral fractures with regard to the probability of receiving an ABT within 72h after surgery. The patients were divided into ABT and non-ABT groups. A univariate analysis was used to compare between-group differences with regard to 13 variables. A logistic regression analysis and a probability algorithm to predict the need for an ABT based on independent predictors were used. ResultsThe non-ABT group included 131 patients (55 males and 76 females), with an average age of 77.2±6.8 years; the ABT group included 89 patients (29 males and 60 females), with an average age of 79.7±6.6 years. The total volume of transfused blood was 276 Units; the actual average blood transfusion was 3.1±1.47 Units. Significant between-group differences (P<0.05) were observed with regard to age, duration of operation, haemoglobin (Hb) at admission, intra-operative blood loss, type of fracture and type of anaesthesia. The mean volume of transfused blood in the proximal femoral nail anti-rotation (PFNA) and Gamma3 group was larger than that of the dynamic hip screw (DHS) group (P<0.05). A logistic regression analysis revealed that patients with pertrochanteric femoral fractures who were elderly (>81 years), had lower Hb levels at admission (≤124g/L), longer duration of operations (t>85min), underwent intramedullary fixation (Gamma3 and PFNA) and had more intra-operative blood loss were more likely to need an ABT. This regression model predicted 74.1% of the transfused cases. ConclusionsAn algorithm was devised to predict and manage the need for an ABT within 72h after surgery in patients with pertrochanteric femoral fractures. A reasonable transfusion program might reduce the complications caused by anaemia and effectively avoid the risks associated with ABTs.

Utility and cost of low‐vacuum reinfusion drains in patients undergoing surgery for subcapital hip fracture repair. A before and after cohort study

Postoperative blood loss may be a risk factor for allogeneic blood transfusion (ABT) in patients undergoing subcapital hip fracture (SHF) repair. We investigated the utility and costs of using a low-vacuum reinfusion drain (Bellovac ABT) within a blood management protocol for reducing ABT requirements in consecutive SHF. The blood management protocol consisted of the application of a restrictive transfusion trigger (Hb<8g/dl), the peri-operative administration of IV iron sucrose (3×200mg/48h)±recombinant erythropoietin (1×40000IU sc) and the use of Bellovac ABT (Group 2, n=117). An immediate previous SHF series managed without Bellovac ABT served as control (Group 1, n=138). Overall, 72 out of 255 (28%) received at least one ABT unit (2·1±1·0 U/transfused patient) without differences between groups. However, in the subgroup of patients with admission Hb<13g/dl, the use of Bellovac ABT reduced postoperative ABT rates (16% vs. 46%, for groups 2 and 1, respectively; P=0·001), although only 3 were reinfused, and was cost-saving. The use of Bellovac ABT also resulted in fewer wound bleeding complications, but there were no differences in Hb at postoperative days 7 and 30 between groups. In SHF patients with admission Hb<13g/dl and managed with peri-operative IV iron±recombinant erythropoietin plus restrictive transfusion indication, the use of Bellovac ABT was associated with reduced ABT requirements, without increasing postoperative complications, and cost-savings.

Development of internal fixation for treatment of instable pertrochanteric hip fractures

The need exists for perioperative blood management measures aimed at improving patient outcomes and reducing the risks of allogeneic blood transfusion (ABT). Our study aim is to discuss an algorithm to predict the need for perioperative blood transfusion in old patients with pertrochanteric femoral fractures.We retrospectively analysed the data from 220 elderly patients with pertrochanteric femoral fractures with regard to the probability of receiving an ABT within 72 h after surgery. The patients were divided into ABT and non-ABT groups. A univariate analysis was used to compare between-group differences with regard to 13 variables. A logistic regression analysis and a probability algorithm to predict the need for an ABT based on independent predictors were used.The non-ABT group included 131 patients (55 males and 76 females), with an average age of 77.2 ± 6.8 years; the ABT group included 89 patients (29 males and 60 females), with an average age of 79.7 ± 6.6 years. The total volume of transfused blood was 276 Units; the actual average blood transfusion was 3.1 ± 1.47 Units. Significant between-group differences (P < 0.05) were observed with regard to age, duration of operation, haemoglobin (Hb) at admission, intra-operative blood loss, type of fracture and type of anaesthesia. The mean volume of transfused blood in the proximal femoral nail anti-rotation (PFNA) and Gamma3 group was larger than that of the dynamic hip screw (DHS) group (P < 0.05). A logistic regression analysis revealed that patients with pertrochanteric femoral fractures who were elderly (>81 years), had lower Hb levels at admission (≤124 g/L), longer duration of operations (t > 85 min), underwent intramedullary fixation (Gamma3 and PFNA) and had more intra-operative blood loss were more likely to need an ABT. This regression model predicted 74.1% of the transfused cases.An algorithm was devised to predict and manage the need for an ABT within 72 h after surgery in patients with pertrochanteric femoral fractures. A reasonable transfusion program might reduce the complications caused by anaemia and effectively avoid the risks associated with ABTs.

Effect of blood transfusion on survival in a mouse bacterial peritonitis model

Allogeneic blood transfusions can result in alloimmunization or immunosuppression. A previous study demonstrated a deleterious effect of allogeneic blood transfusion on tumor growth in mice that was dependent, in part, on the dose of tumor cells with which the host animal was inoculated. The current study examined the effect of a similar allogeneic blood transfusion protocol on survival in a mouse bacterial peritonitis model. C57Bl/6J mice were transfused with 0.2 mL of heparinized fresh whole blood from C57Bl/6J (syngeneic) or Balb/c (allogeneic) mice. Transfusions were given on Days -10 and -7. On Day 0, mice were injected intraperitoneally with 10(7) Escherichia coli. Survival at Day 7 was 61 percent in the allogeneic blood transfusion group and 55 percent in the syngeneic blood transfusion group (p = 0.52). Experiments using different strains of mice, different transfusion protocols, and different doses of bacteria also failed to demonstrate an effect of allogeneic blood transfusion on survival. The results demonstrate that blood transfusion does not influence survival after a septic challenge with bacteria. The data obtained in the present study, together with those obtained in the tumor model, suggest that the mechanisms by which the allogeneic blood transfusion impedes host defense against bacterial infections is different from the mechanisms involved in tumor growth.