Effect Of Allogeneic Blood Transfusion Research Articles

Does perioperative allogeneic blood transfusion worsen the prognosis of patients with hepatocellular carcinoma? A meta-analysis of propensity score-matched studies.

Allogeneic blood transfusion is required in a part of liver resection. The effect of allogeneic blood transfusion on the prognosis of patients with hepatocellular carcinoma (HCC) remains controversial. To investigate whether perioperative allogeneic blood transfusion (PBT) affects the long-term prognosis of patients with HCC, we conducted a meta-analysis that included only propensity score-matched (PSM) studies. The Cochrane Library, Embase, PubMed, and Web of Science databases were systematically searched to identify PSM studies that compared the long-term outcomes of allogeneic blood transfusion in resected HCC patients. Overall survival (OS) and recurrence-free survival (RFS) rates were calculated. This meta-analysis included 9 PSM studies with 12 datasets involving 2476 patients. Lower OS and RFS in HCC patients receiving allogeneic blood transfusion were observed than those in patients not receiving blood transfusion (OS: hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.10-1.64; p < 0.01; RFS: HR, 1.29; 95% CI, 1.07-1.56; p < 0.01). Subgroup analysis revealed that among patients with BCLC A HCC, those receiving allogeneic blood transfusion had lower OS and RFS (OS: HR, 2.27; 95% CI, 1.61-3.21; RFS: HR, 2.11; 95% CI, 1.30-3.41). OS and RFS were similar in both groups of patients with BCLC B and C HCC. The receipt of perioperative allogeneic blood transfusion is associated with a decrease in OS and RFS. These results seem to be reliable for patients in BCLC stage A. But more high-quality research is needed to confirm this conclusion.

Real-World Presentation and Prognostic Effect of Allogeneic Blood Transfusion during the Intensive Induction Phase in Pediatric Acute Lymphoblastic Leukemia.

Purpose: To determine associations between allogeneic blood transfusion (ABT) during the intensive induction phase of therapy and prognostic effect in a real-world cohort of pediatric patients with acute lymphoblastic leukemia (ALL). Methods: A total of 749 pediatric patients who were diagnosed with ALL were enrolled in this study by using a single-center retrospective cohort study method from February 2008 to May 2022. Results: Among the ABT patients, 711 (94.9%) children were transfused with packed red blood cells (PRBCs), 434 (57.9%) with single-donor platelets (SDPs), and 196 (26.2%) with fresh frozen plasma (FFP). Our multivariate analysis demonstrated that FFP transfusion was the unique independent factor that affected both relapse-free survival (RFS) and overall survival (OS). The transfusion of FFP was significantly associated with higher age (p < 0.001), being more likely to receive SCCLG-ALL-2016 protocol (p < 0.001), higher proportion of more than 25 blood product transfusions, more PRBC transfusion (p < 0.001), and higher D33-MRD-positive rates (p = 0.013). Generalized additive models and threshold effect analysis using piece-wise linear regression were applied to identify the cut-off value of 25 mL/kg for average FFP transfusion. K-M survival analysis further confirmed that average FFP transfusion > 25 mL/kg was an independent adverse indicator of inferior outcome in terms of RFS (p = 0.027) and OS (p = 0.033). Conclusions: In blood products, only FFP supplement is closely related to the prognosis of childhood ALL. During the intensive induction phase, the indications of FFP transfusion should be strictly grasped, and the total amount of FFP should be controlled and kept below 25 mL/kg.

Effect of allogeneic blood transfusion on neutrophil functional activity and lymphocyte cytotoxicity in recipient rabbits

The relevance of this paper is that transfusion of allogeneic blood to recipient animals is always associated with immunological risks. In this regard, the purpose of this study was to assess the state of phagocytic activity of blood neutrophils by indicators of phagocytic index, phagocytic number, and oxygen-dependent bactericidal activity, as well as to establish changes in antibody-dependent cytotoxic activity of lymphocytes in recipient rabbits during allogeneic whole blood transfusion. Modelling of blood transfusions was performed on five clinically healthy rabbits by intravenous administration of whole blood at the rate of 5.5 ml/kg of body weight. Blood samples were taken from animals on Days 3, 7, and 23 after blood transfusion. Neutrophil populations were obtained from blood samples by centrifugation on a double density gradient of 1.077 and 1.093 Ficoll-Verografin. The absorption activity of phagocytes was determined in a microscopic test. To investigate the oxygen-dependent bactericidal activity of neutrophils, a spontaneous test with nitroblue tetrazolium was performed. Antibody-dependent cytotoxic activity of lymphocytes was investigated by colorimetric method. It was found that after the transfusion of whole blood, the phagocytic activity of neutrophils increases with a simultaneous decrease in their absorption capacity. On Days 3 and 7, the results of the spontaneous test with nitroblue tetrazolium decreased. This indicates inactivation of the oxygen-dependent bactericidal activity of neutrophil granulocytes during the first phase of post-transfusion immunological reactions. On Day 23, there was an increase in the values of the indicators of the spontaneous test with nitroblue tetrazolium, which indicates the activation of the bactericidal properties of phagocytes. It was found that on Day 3, the antibody-dependent cytotoxic activity of lymphocytes significantly decreased relative to the initial state, and on Days 7 and 23, it increased. An increase in the antibody-dependent cytotoxic activity of lymphocytes should be associated with the active synthesis of antibodies of the late phase of the immune response. Consequently, transfusion of allogeneic blood causes an immune response in recipient rabbits, without causing immediate and long-term transfusion reactions (changes in heart rate, respiratory rate, body temperature). The obtained results are of practical value both for scientists and practising doctors who use transfusion of whole blood and its components to animals with acute anaemia, impaired functional activity of blood coagulation factors, parasitic, and oncological diseases

Investigation of Changes in Exosomes Profile During Storage Period of Erythrocyte Suspensions

This study aimed to investigate the relationship of exosomes in erythrocyte suspension (ES) with leukoreduction and storage period. In this study, we expected to obtain new information about the immunomodulatory effect of allogeneic blood transfusion. Whole blood from healthy donors (10) were transferred to two separate blood bags by an equal amount converted into ES. One of the bags was passed through the leukocyte filter to obtain reduced leukocyte and non-reduced ESs and divided into four equal blood bags. Flow cytometry was used to identify and quantify exosomes in the samples on the 0th, 14th, 28th, and 42nd days at 4 °C. The exosomes were first coated with anti-CD9 antibodies with carboxylates beads and exosome volumes were determined by BCA Protein Assay to determine the amount of exosome-containing samples to be bound by beads and investigated by flow cytometry. Exosomes which were derived from Th, NK, NK-T cells were not detected in our study. There were no significant differences in exosome profiles between NL-ES and LR-ES groups. Statistically significant results (in comparison with the 0th day) were found as below. Exosomes that were derived from; T lymphocytes, decrease in LR-ES groups at 42nd-day samples (P < 0.05). Tc lymphocytes, decrease in NL-ES groups at 14th day and 42nd-day samples (P < 0.05). B lymphocytes, a decrease in NL-ES groups at the sample of 28th and 42nd-days (P < 0.05). MDSC and G-MDSC, decrease in both NL-ES groups and LR-ES groups at the sample of 14th, 28th, and 42nd-days (P < 0.05). Our results suggest that exosomes in erythrocyte suspensions are not affected by the leukoreduction procedure. Exosomes which can freely pass from leukocyte filters may be the main cause of the insufficiency of leukoreduction to prevent TRIM.

Prognostic impact of blood transfusion in patients with metastatic non-small cell lung cancer receiving chemotherapy

PurposeTo investigate the prognostic effects of Allogeneic Blood Transfusion (ABT) in patients with metastatic Non-Small Cell Lung Cancer (NSCLC) receiving Chemotherapy (CT) in the first-line treatment, comparing untransfused patients to those receiving blood transfusion during treatment period or before treatment period. MethodsThis was a retrospective study of 433 patients with metastatic NSCLC receiving CT in the first-line treatment. Patients were categorized into 3 groups according to the transfusion strategy as follows; group-U(Untransfused patients, n = 303), group-B(patients receiving transfusion Before treatment period, n = 43), and group-D(patients receiving transfusion During treatment period, n = 87). ResultsThere were 433 patients in the analysis, consisting of 388 (89.6%) males, with a median age of 60 years(range, 21–92). The median Overall Survival(mOS) according to the ABT was 14 months for group-U, 9 months for group-B, and 7 months for group-D (p < 0.001). In subgroup analysis, patients with squamous cell carcinoma subtype, mOS was 11 months for group-U, 12 months for group-B, and 9 month for group-D (p = 0.074) The corresponding mOS durations for adenocarcinoma subtype were 21 months, 7 months, and 6 months (p < 0.001). Performing ABT during treatment period was found to be a negative independent factor related to OS (HR 1.50 for progression-free survival, 95% CI 1.15–1.97, HR 1.36 for OS, 95% CI 1.04–1.80). ConclusionOur results demonstrated that ABT was significantly associated with earlier progression and shorter survival in patients with metastatic NSCLC, especially in adenocarcinoma histology, hence suggesting that transfusion strategy in this group should remain limited, and its benefit should outweigh the risk of progression.

Allogeneic blood transfusion in 163 children with acute lymphocytic leukemia (a STROBE-compliant article).

Little research has been done about the effects of allogeneic blood transfusion (ABT) on the recurrence and prognosis in the cases with childhood acute lymphocytic leukemia (cALL). In order to provide a basis for clinical safe blood transfusion, the data of 163 cases with cALL were retrospectively analyzed to explore the issue.The data of 163 cases with cALL between 2006 and 2011 were retrospectively analyzed. According to the frequency of blood transfusion, the 163 cases were divided into 4 groups including non-transfusion group, 1 to 10-time transfusion group, 11 to 25-time transfusion group, and >25-time transfusion group. Survival rates were compared with Log-Rank test. Cox regression analysis was used in the effects of risk factors on recurrence and death.ABT was performed in 152 cases with cALL (93.25%). In low-risk and intermediate-and-high risk cALL, the survival rate significantly decreased in all transfusion groups compared with that in non-transfusion group (all P < .01). Cox regression analysis showed that >25-time transfusion was an independent prognosis index of recurrence (odds ratio [OR] = 3.015, 95% confidence interval [CI]: 1.368–6.646) and death (OR = 3.979, 95% CI: 1.930–8.207) in cALL.Frequency of ABT appears to affect the recurrence and death in cALL. We should be careful with blood transfusion and avoid unnecessary blood transfusion as far as possible in the cases with cALL.

Intraoperative cell salvage with autologous transfusion in liver transplantation.

Liver transplant (LT) is the primary treatment for patients with end-stage liver disease. About 25000 LTs are performed annually in the world. The potential for intraoperative bleeding is quite variable. However, massive bleeding is common and requires blood transfusion. Allogeneic blood transfusion has an immunosuppressive effect and an impact on recipient survival, in addition to the risk of transmission of viral infections and transfusion errors, among others. Techniques to prevent excessive bleeding or to use autologous blood have been proposed to minimize the negative effects of allogeneic blood transfusion. Intraoperative reinfusion of autologous blood is possible through previous self-donation or blood collected during the operation. However, LT does not normally allow autologous transfusion by prior self-donation. Hence, using autologous blood collected intraoperatively is the most feasible option. The use of intraoperative blood salvage autotransfusion (IBSA) minimizes the perioperative use of allogeneic blood, preventing negative transfusion effects without negatively impacting other clinical outcomes. The use of IBSA in patients with cancer is still a matter of debate due to the theoretical risk of reinfusion of tumor cells. However, studies have demonstrated the safety of IBSA in several surgical procedures, including LT for hepatocellular carcinoma. Considering the literature available to date, we can state that IBSA should be routinely used in LT, both in patients with cancer and in patients with benign diseases.

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

Perioperative blood conservation strategies for major spine surgery.

Orthopedic surgery, especially spine and spinal deformity surgery, may be associated with high perioperative blood loss. In order to reduce the risk of excessive blood loss and unnecessary blood transfusions, strategies such as Patient Blood Management including goal-directed coagulation management have been developed. Adverse effects of allogeneic blood transfusions have been shown for most surgical fields including orthopedic surgery. Several efforts have been made to increase the preoperative red blood cell (RBC) mass, to reduce the intraoperative blood loss, and to use restrictive transfusion triggers in order to minimize or avoid RBC transfusions. Measures to reduce intraoperative blood loss include new surgical techniques, use of cell salvage where possible, bedside coagulation management with point-of-care devices, substitution of coagulation factors, antifibrinolytic agents, and desmopressin, induced hypotension, and avoidance of hypothermia. Blood conservation in spinal surgery is a multidisciplinary approach and the efficacy of most single measures has been shown. Cost-effectiveness and the benefits of long-term patient outcomes are the subjects of current and future research.

Tracking Syngeneic Leukocytes after Transfusion of Non-leukoreduced Blood in a Murine Model

Objective: Several Western European countries and Canada have introduced white blood cell reduction as a universal standard to prevent potential adverse effects of allogeneic blood transfusions. However, there is an ongoing controversy regarding its appropriateness in other countries such as North America. We were interested in the whereabouts of leukocytes following whole blood transfusion in mice to evaluate their potential sites of (adverse) action. Materials and methods: Wildtype C57BL/6 were transfused with non-leukoreduced blood from enhanced green fluorescent protein transgenic C57BL/6-Tg(CAGEGFP) 1 Osb/J mice. Cells were tracked on day 3 and day 5 after transfusion by flow cytometry. Results: Enhanced green fluorescent protein-labeled leukocytes were found in the blood circulation, the myocardium, bone marrow and lung tissue up until day 5, but not in the kidney, the liver or the spleen. Myeloperoxidase activity in the lungs was significantly higher on day 5 when compared to control animals (0.09 ± 0.01% vs. 0.26 ± 0.08%, p=0.047). There was no increase in cytokines. Conclusion: Syngeneic white blood cells survive in the recipient of non-leukoreduced red blood cell units. They circulate in the blood stream and can be found in the bone marrow and the lungs up to five days after transfusion.

Tranexamic Acid in total joint arthroplasty: efficacy and safety.

Despite improvements in surgical and anesthetic techniques, total joint arthroplasty (TJA) is still associated with substantial blood loss and postoperative anemia (1). A considerable portion of patients with postoperative anemia require blood transfusion, which has been shown to negatively affect the outcome of TJA and predisposes patients to development of surgical site infection and periprosthetic joint infection (2,3). Various blood conservation strategies have been developed to reduce the need for allogeneic blood transfusion in patients undergoing TJA (3). Administration of tranexamic acid (TA) is one of the most effective (4). TA is a synthetic lysine derivative drug that binds to plasminogen and prevents the interaction of plasminogen and fibrin, eventually leading to dissolution of fibrin clots (5). There is level I evidence supporting the need for allogeneic transfusion in primary total hip and total knee arthroplasties, and the efficacy of TA in particular for reducing blood loss (6,7). TA is also effective in reducing the need for blood transfusion in bilateral TJA and revision surgeries (4). Moreover, when TA is used, other blood conservation strategies are rendered unnecessary (4). The drug can be used intravenously in a weight-based manner (10-20 mg/kg), or administered 1gm intravenously at the start of surgery and 1gm intravenously at the end of surgery, or up to 3 hours after the first dose. TA can also be applied topically to the surgical site to provide hemostasis, or it can be injected intra-articularly (1g in 50 cc saline). Although oral administration of TA (25 mg/kg, maximum 2g, two hours preoperatively) has also been reported to be effective, it is not routinely used in TJA patients and intravenous and topical methods are preferred (4). Despite the proven efficacy of the use of TA in TJA, there are still some concerns about the development of venous thromboembolism (VTE) after TA is used. Since VTE following TJA is relatively rare, the majority of studies that evaluated the efficacy of TA are underpowered for evaluation of its safety. In a recent study by Poeran et al. using a large national database including 872,416 patients who had total hip or knee arthroplasty, the authors suggested that TA is effective in reducing the need for blood transfusions while not increasing the risk of VTE and renal complications (8). However, it is still advised that patients with cardiac stents and previous thromboembolic events including ischemic stroke not be administered TA. TA can also cause gastrointestinal disturbance and its dose needs to be adjusted in patients with renal impairment (5). In conclusion, administration of TA in TJA patient is a cost-effective blood conservation strategy and there is strong evidence to support the efficacy and safety of the drug in reducing blood loss and transfusion in TJA patients. Given the adverse effects of allogeneic blood transfusion on the outcome of TJA, administration of TA should be considered in patients with no contraindication for its use.

Allogeneic blood transfusion and the prognosis of gastric cancer patients: Systematic review and meta-analysis

Background: Perioperative allogeneic blood transfusion (ABT) may be a deleterious predictor on the prognosis of gastric cancer (GC) for subjects who had undergone curative surgeries. In this article we proposed to figure out the effect of ABT with a systematic review and meta-analysis. Methods: Relevant articles were identified by searching Pubmed and Embase to March 2014. A random-effects model or fixed-effects model was used to calculate pooled odds ratios (ORs). Sensitivity analysis, meta-regression, stratified analysis, dose–response meta-analysis were conducted, and publication bias tested. Results: Eighteen studies (9120 GC patients) were included, of which 36.3% received transfusions. ABT was associated with increased all-cause mortality (OR, 2.17; 95% confidence interval [CI], 1.72–2.74; p < 0.001; I2 = 75%). Sensitivity analysis showed significant changes in ORs while meta-regression had little influence on ORs. Galbraith plot revealed the OR reduced to 2.10 (95% CI, 1.86–2.37; p < 0.001) with tau2 reduced to 0.00 and I2 reduced to 0%. Results of stratified analysis were robust and consistent. Dose–response meta-analysis revealed that all-cause mortality was significantly lower in patients transfused with ≤800 mL of blood than those transfused with >800 mL (OR, 0.58; 95% CI, 0.37–0.92; p = 0.02; I2 = 54%). ABT was also associated with increased cancer-related mortality (OR, 2.57, p = 0.011) and recurrence (OR, 1.52, p = 0.017). Conclusions: In GC patients undergoing curative surgeries, ABTs are associated with a worse prognosis, including all-cause mortality, cancer-related mortality and recurrence. Patient blood management should be investigated further to minimize use of ABT.

The abandoned controversy surrounding universal white blood cell reduction.

The abandoned controversy surrounding universal white blood cell reduction.

Effect of allogeneic blood transfusion on clinical outcomes of patients undergoing colorectal cancer surgery: a meta-analysis

Objective To evaluate the effects of allogeneic blood transfusion(ABT)on long-term prognosis in colorectal cancer(CRC)patients undergoing surgery.Methods PubMed,EMbase,The Cochrane Library and China Biology Medicine disc(CBMdisc)were searched for studies on the correlation between ABT and clinical outcomes of colorectal cancer patients,and relevant articles were also retrieved from references.All the searches were done from inception to March,2014.Two reviewers independently screened the literature,extracted the data and evaluated the quality of the data.Then the meta-analysis was performed by using Stata12.0software.Results Finally 8studies involving 5 479 patients were included.The results of metaanalysis showed that,compared with non-transfusion group,the transfusion group had significantly increased risks of overall survival(by 21%,HR=1.21;95% CI:1.09-1.33;P0.001)and disease-specific survival(by 47%,HR=1.47;95% CI:1.17-1.84;P=0.001);whereas the risks of disease free survival,local recurrence or distant metastasis were not significantly different between the 2groups.Conclusion ABT can increase the risks of overall survival and disease-specific survival in CRC patients undergoing surgery;therefore,it is of great clinical significance to take active perioperative blood conservation strategies to decrease ABT rate.

Effects of Allogeneic Blood Transfusion in Patients with Stage II Colon Cancer

The aim of the present study was to determine whether allogeneic red blood cell transfusions showed a deleterious effect and what might be preoperative risk factors for blood transfusion in patients with TNM stage II colon cancer. Total 470 patients who fulfilled inclusion criteria were selected for a further 10-year follow-up study. We found that there were statistical significance between non-transfused and transfused group in mortality (P=0.018), local recurrence (P=0.000) and distant metastasis (P=0.040). Local recurrence and distant metastasis between 1 to 3 units and more than 3 units group did not show any significant differences. There was no difference in survival rate between non-transfused and 1 to 3 units group (log rank =0.031, P=0.860). The difference between different blood transfusion volume in transfused patients was found (78.77% vs 63.83%, P=0.006). Meanwhile, the significant difference of survival rate was existed between non-transfused group and more than 3 units group (84.83% vs 63.83%, P=0.002 ). Univariate analysis showed the following 3 variables to be associated with an increased risk of allogeneic blood transfusions: preoperative CEA level (P<0.05), location of tumor (P<0.01) and diameter of tumor (P<0.01). Multivariate analysis revealed that location of tumor and diameter of tumor are two independent factors for requirement of perioperative transfusions. Therefore, allogeneic transfusion increase the postoperative tumor mortality, local recurrence and distant metastasis in patients with stage II colon cancer. The postoperative tumor mortality, local recurrence and distant metastasis were not associated with the blood transfusion volume. The blood transfusion volume was associated with the survival rate. Location of tumor and diameter of tumor were the independent preoperative risk factors for blood transfusion.

Blood Transfusions and Prognosis in Colorectal Cancer

Perioperative blood transfusions may adversely affect survival in patients with colorectal malignancy, although definite proof of a causal relationship has never been reported. We report the long-term outcomes of a randomized controlled trial performed between 1986 and 1991 to compare the effects of allogeneic blood transfusions and an autologous blood transfusion program in colorectal cancer patients. All 475 randomized patients operated upon for colorectal cancer were tracked via a national computerized record-linkage system to investigate survival and cause of death. Kaplan-Meier survival curves were constructed and multivariate Cox regression analysis was performed to study 20 years' overall survival. Colorectal cancer-specific survival was analyzed over the 10-year time period after surgery. The overall survival percentage at 20 years after surgery was worse in the autologous group (21%) compared to the allogeneic group (28%) (P = 0.041; log-rank test). Cox regression, allowing for tumor stage, age, and sex, resulted in a hazard ratio (autologous vs allogeneic group) for overall mortality of 1.24 (95% confidence interval 1.00-1.54; P = 0.051). Colorectal cancer-specific survival at 10 years for the whole study group was 48% and 60% for the autologous and allogeneic group, respectively (P = 0.020; log-rank test). The adjusted hazard ratio was 1.39 (95 confidence interval 1.05-1.83; P = 0.045). At long-term follow-up colorectal cancer patients did not benefit from autologous transfusion compared with standard allogeneic transfusion. On the contrary, the overall and colorectal cancer-specific survival rates were worse in the patients in the autologous transfusion group.

Effects of Allogeneic Red Blood Cell Transfusions on Clinical Outcomes in Patients Undergoing Colorectal Cancer Surgery

To determine the effect of allogeneic blood transfusion (ABT) on clinical outcomes in patients with colorectal cancer undergoing surgery. Perioperative ABTs may be associated with adverse clinical outcomes. Systematic review of the literature with odds ratio (OR) and incidence rate ratio (IRR) meta-analyses of predefined clinical outcomes based on a MEDLINE search. In total, 20,795 colorectal cancer (CRC) patients observed for more than 59.2 ± 26.1 months (108,838 patient years) were included, of which 58.8% were transfused. ABT was associated with increased all-cause mortality OR = 1.72 (95% confidence interval [CI] 1.55-1.91, P < 0.001); I(2) = 23.3% (0-51.1) and IRR = 1.31 (1.23-1.39, P < 0.001), I(2) = 0.0% (0-37.0). ABT was also associated with increased ORs (95% CI, P) for cancer-related mortality of 1.71 (1.43-2.05, P <0.001), combined recurrence-metastasis-death 1.66 (1.41-1.97, P < 0.001), postoperative infection 3.27 (2.05-5.20, P < 0.001), and surgical reintervention 4.08 (2.18-7.62, <0.001). IRR (95% CI, P) was 1.45 (1.26-1.66, <0.001) for cancer-related mortality and 1.32 (1.19-1.46, <0.001) for recurrence-metastasis-death. Mean length of hospital stay was significantly longer in transfused compared with nontransfused patients (17.8 ± 4.8 vs 13.9 ± 4.7 days, P = 0.005). In patients with colorectal cancer (CRC) undergoing surgery, ABTs are associated with adverse clinical outcomes, including increased mortality. Measures aimed at limiting the use of ABTs should be investigated further.

Do Perioperative Blood Transfusions Influence Prognosis of Gastric Cancer Patients? Analysis of 927 Patients and Interactions with Splenectomy

This study was to assess the influence of perioperative blood transfusions on the prognosis of patients undergoing a potentially curative resection for gastric cancer and to investigate the interaction between transfusions and splenectomy. Between January 1990 and December 2005, 927 patients from 6 Italian tertiary referral centers underwent curative resections for gastric cancer. Clinical and pathologic variables were prospectively collected. The influence of perioperative blood transfusions on survival were evaluated by univariate and multivariate analysis. Moreover, the influence of splenectomy both in transfused and nontransfused patients undergoing total gastrectomy was also evaluated. The overall 5-year survival was 54.6%. The 5-year survival rate in transfused patients (n=327) was 50.6% compared with 56.6% in nontransfused patients (n=600) (P=.094). In the subgroup of patients who underwent total gastrectomy with spleen preservation (n=209), 5-year survival rate was 46% and 51.4% in transfused and nontransfused patients, respectively (P=.418); those who underwent total gastrectomy with splenectomy (n=199) presented a 5-year survival rate of 45% in transfused group compared with 39.1% in nontransfused patients (P=.571). Our study indicates a slightly, but not significantly, negative effect of allogeneic blood transfusion on prognosis of gastric cancer patients. In the subgroup of patients who underwent total gastrectomy, splenectomy seems to invert this mild effect, with a positive influence on overall survival.

Laboratory characteristics and clinical utility of post-operative cell salvage: washed or unwashed blood transfusion?

The development of complex surgical procedures for the treatment of a number of diseases has increased the demand for allogeneic blood. In hospitals, up to 50% of transfused blood units are used in the surgical setting and up to 60% of all transfusions are given to patients over 65 years old, an age group of patients who are excluded from altruistic blood donation in some countries1,2. The demand for allogeneic blood often exceeds the supply. The safety of allogeneic blood transfusion (ABT) in developed countries has improved dramatically, especially as a result of more restrictive criteria for donor selection and increased analytical screening of donated blood which have led to a decrease in the rate of transfusion-transmitted infections. However, “clerical mistakes” or administration of “wrong blood” are still too frequent (1/15,000-20,000 units)3,4. Liberal transfusion protocols (pre-transfusion haemoglobin [Hb] concentration > 9-10 g/dL) should, therefore, be avoided to further reduce the risk of infection and other complications such as incompatible haemolytic reactions, Graft-versus-Host Disease, metabolic disorders, Transfusion-Related Acute Lung Injury, and transfusion related immuno-modulation3,4. As for immuno-modulation, the results of three extensive studies involving more than 22,000 patients undergoing orthopaedic surgery strongly suggest that peri-operative ABT is associated with an increase in the risk of post-operative infection5–7. Overall concerns about the adverse effects of ABT have prompted the review of transfusion practices and the search for transfusion alternatives, such as pre-operative autologous blood donation, haemodilution, peri-operative cell salvage, recombinant human erythropoietin (rHuEPO) and iron, or anti-fibrinolytic administration8. The ultimate objective is to minimise exposure to ABT and, therefore, ABT-associated risks. The main objective of this review is to provide updated evidence on the quality, safety and efficacy of postoperatively salvaged shed blood (PSB) after major surgery. However, the results of a systematic review indicate that reinfusion of unwashed filtered PSB after cardiac surgery produces only a marginal benefit9 and can also cause significant adverse effects, so its use is not recommended10. We, therefore, shall focus mainly on the use of PSB in orthopaedic surgery, especially lower limb joint replacement.