Effect Of Red Blood Cell Transfusion Research Articles

Impact of red blood cell transfusion and hemoglobin threshold on 1-year mortality among surgical sepsis survivors: A propensity score matching study

Despite the fact that red blood cell (RBC) transfusion is commonly applied in surgical intensive care unit (ICU), the effect of RBC transfusion on long-term outcomes remains undetermined. We aimed to explore the association between RBC transfusion and the long-term prognosis of surgical sepsis survivors. This retrospective study was conducted on adult sepsis patients admitted to a tertiary surgical ICU center in China. Patients were divided into transfusion and non-transfusion groups based on the presence of RBC transfusion. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW)were performed to balance the potential confounders. A total of 1421 surgical sepsis survivors were enrolled, including 403 transfused patients and 1018 non-transfused patients. There was a significant difference in 1-year mortality between the two groups (23.1​% vs 12.7​%, HR: 1.539, 95​% confidence interval [CI]: 1.030-2.299, P​<​0.001). After PSM and IPTW, transfused patients still showed significantly increased 1-year mortality risks compared to non-transfused individuals (PSM: 23.6​% vs 15.9​%, HR 1.606, 95​% CI 1.036-2.488​P​=​0.034; IPTW: 20.1​% vs 12.9​%, HR 1.600, 95​% CI 1.040-2.462​P​=​0.032). Among patients with nadir hemoglobin below 70​g/L, 1-year mortality risks in both groups were similar (HR 1.461, 95​% CI 0.909-2.348, P​=​0.118). However, among patients with nadir hemoglobin above 70​g/L, RBC transfusion was correlated with increased 1-year mortality risk (HR 1.556, 95​% CI 1.020-2.374, P​=​0.040). For surgical sepsis survivors, RBC transfusion during ICU stay was associated with increased 1-year mortality, especially when patients show hemoglobin levels above 70​g/L.

Blood transfusion had no influence on the 5-year biochemical recurrence after robot-assisted radical prostatectomy: a retrospective study

BackgroundAlthough red blood cells (RBC) transfusion is known to be significantly associated with biochemical recurrence in patients undergoing open prostatectomy, its influence on biochemical recurrence after robot-assisted laparoscopic radical prostatectomy remains unclear. Therefore, this study aimed to validate the effect of RBC transfusion on the 5-year biochemical recurrence in patients undergoing robot-assisted laparoscopic radical prostatectomy.MethodsThis study retrospectively analyzed the medical records of patients who underwent robot-assisted laparoscopic radical prostatectomy at single tertiary academic hospital between October 2007 and December 2014. Univariate and multivariate Cox proportional hazard regression analysis was performed to identify any potential variables associated with 5-year biochemical recurrence.ResultsA total of 1311 patients were included in the final analysis. Of these, 30 patients (2.3%) were transfused with RBC either during robot-assisted laparoscopic radical prostatectomy or during their hospital stay, which corresponded to 5-year biochemical recurrence of 15.7%. Multivariate Cox proportional hazard regression analysis showed that RBC transfusion had no influence on the 5-year biochemical recurrence. Variables including pathologic T stage (Hazard ratio [HR] 3.5, 95% confidence interval [CI] 2.4–5.1 p < 0.001), N stage (HR 2.3, 95% CI 1.5–3.7, p < 0.001), Gleason score (HR 2.4, 95% CI 1.8–3.2, p < 0.001), and surgical margin (HR 2.0, 95% CI 1.5–2.8, p < 0.001) were independently associated with the 5-year biochemical recurrence.ConclusionsRBC transfusion had no significant influence on the 5-year biochemical recurrence in patients undergoing robot-assisted laparoscopic radical prostatectomy.

Cardiorespiratory monitoring of red blood cell transfusions in preterm infants

Clinical improvement after red blood cell (RBC) transfusions in preterm infants remains debated. This study aims to investigate the effect of RBC transfusion on the occurrence of desaturations and hypoxia, and other cardiorespiratory outcomes in preterm infants. In this longitudinal observational study, prospectively stored cardiorespiratory parameters of preterm infants who received at least one RBC transfusion between July 2016 and June 2017 were retrospectively analyzed. Sixty infants with 112 RBC transfusions, median GA of 26.7 weeks, were included. The number of desaturations and area < 80% SpO2 limit, as a measure of the hypoxic burden, were calculated in 24 h before and after RBC transfusion. A mixed effects model was used to account for repeated measurements. Overall, the mean (SE) number of desaturations per hour decreased from 3.28 (0.55) to 2.25 (0.38; p < 0.001), and area < 80% SpO2 limit decreased from 0.14 (0.04) to 0.08 (0.02) %/s (p = 0.02). These outcomes were stratified for the number of desaturations in 24 h prior to RBC transfusion. The largest effect was observed in the group with the highest mean number of desaturations (≥ 6) prior to RBC transfusion, with a decrease from 7.50 (0.66) to 4.26 (0.38) (p < 0.001) in the number of desaturations and 0.46 (0.13) to 0.20 (0.06) in the area < 80% SpO2. Perfusion index increased significantly after RBC transfusion (p < 0.001). No other significant effects of RBC transfusion on cardiorespiratory data were observed.Conclusions: RBC transfusions in preterm newborns could help decrease the incidence of desaturations and the area < 80% SpO2 as a measure of the hypoxic burden. The higher the number of desaturations prior to the RBC transfusion, the larger the effect observed.What is Known:•Red blood cell transfusions potentially prevent hypoxia in anemic preterm infants by increasing the circulatory hemoglobin concentration and improving tissue oxygenation.•There is not a predefined hemoglobin concentration cut-off for the occurrence of symptomatic anemia in preterm infants.What is New:•Oxygen desaturations and hypoxia in anemic preterm infants can be improved by RBC transfusions, especially if more desaturations have occurred before transfusion.•Cardiorespiratory monitor data may help identify infants who will benefit most from red blood cell transfusions.

Red Blood Transfusion Does Not Increase Risk for Venous or Arterial Thrombosis

Introduction: Previous observational studies in patients with cancer, subarachnoid hemorrhage, or undergoing surgery suggested an association between red blood cell (RBC) transfusion and an increased risk for arterial and venous thrombosis, findings warranting further evaluation. Methods: The risk of thrombosis in all hospitalized patients was assessed in patients admitted to 12 hospitals located across the United States in New Haven, Pittsburgh, Milwaukee, and San Francisco using the Recipient Database from the NHLBI Recipient Epidemiology and Donor Evaluation Study-III. All patients admitted between January 2013 and September 2015 were included in analyses. A thrombosis event was defined as an admission with an ICD-9 code of arterial or venous thrombosis as a primary or secondary diagnosis and administration of a therapeutic dose of an anticoagulant or antiplatelet agent during that admission. The timing of the thrombosis was based upon medication administration time. Timing of transfusion was based upon release of RBC from the blood bank. Patients using anticoagulant medications at home or with a history of thrombosis diagnostic code were excluded. Encounters with a thrombotic event within the first 24 hours after admission were also excluded as thrombosis was likely the etiology of the admission. A proportional hazards regression model was used to evaluate the effect of transfusion on the risk of thrombosis with transfusion treated as a time-varying predictor. Discharge without thrombosis, in-hospital thrombosis and death were considered competing risks. Estimates were adjusted for age, sex, hospital, medical comorbidities, and surgical procedures. Results: Of 657,412 inpatient admissions, 67,176 (10.2%) received at least one RBC transfusion; median age was 58 and 53.6% were women. Two percent (12,927) of patients experienced a thrombosis. Of these, 2,587 developed thrombosis after a RBC transfusion. In a univariable analysis, many surgical procedures were associated with a risk of thrombosis including cardiac surgery [Hazard Ratio (HR)=3.25 (3.05-3.47)] and vascular surgery, HR=1.90 (1.82-1.99). Comorbidities were also associated with thrombosis including heart arrhythmias HR=1.60 (1.54-1.66), hypertension HR=1.31 (1.26-1.37), anemia HR=1.32 (1.17-1.49), and metastatic cancer HR=1.36 (1.28-1.45). In unadjusted analyses, RBC transfusion was associated with an increased risk of thrombosis [HR=1.3 (95% CI 1.25-1.36)] (Table 1). The risk of thrombosis increased with the number of RBC units transfused. However, after adjustment for surgical procedures, age, sex, hospital, and comorbidities, no effect of RBC transfusion on risk of thrombosis was found [HR 0.98 (95% CI: 0.94-1.03)] (Table 1). Conclusions: In univariate analyses there are multiple risks for venous and arterial thrombosis, including many surgical procedures and medical comorbidities, as well as RBC transfusion. However, after adjustment for these multiple risk factors, RBC transfusion was not associated with a risk for arterial or venous thrombosis. Thus, this study of all patients admitted to 12 hospitals in the US did not identify RBC transfusion as an independent risk factor for thrombosis. The REDS-III database contains detailed information about comorbidities, medications, and timing of transfusion which allowed us to carefully define a thrombotic episode and its temporal relationship to RBC transfusion, and adjust for confounders that may not have been available in other datasets. Our findings do not rule out the possibility of a patient subset where RBC transfusion increases risk for thrombosis, such as patients with an underlying genetic hypercoagulable risk, but they do indicate that RBC transfusion does not appear to be an important risk factor for thrombosis in most patients. As such, receiving a blood transfusion should not influence decisions about venous thrombosis prophylaxis in hospitalized patients. Disclosures Mast:Novo Nordisk: Research Funding.

The occurrence and impact of blood transfusion in cardiogenic shock patients supported by an Impella device: a retrospective study

Abstract Background Cardiogenic shock (CS) patients are frequently supported by mechanical devices, such as the Impella. The use of these devices is associated with device-related complications, such as hemolysis and bleeding, which may necessitate blood transfusion. Blood transfusion has been associated with worse clinical outcome. Information on the occurrence and impact of blood transfusion in these patients is scarce. Purpose To assess the incidences of hemolysis, bleeding and red blood cell (RBC) transfusion in CS patients receiving Impella support, to identify patients at risk for RBC transfusion and to assess mortality in transfused and non-transfused patients. Methods We performed a single center retrospective cohort study between August 2006 and April 2019, collecting data on all patients supported by an Impella device (type 2.5, CP or 5.0) for more than 24 hours. Patient baseline characteristics, clinical course and outcomes were compared between patients transfused with RBCs and non-transfused patients. Multivariate logistic regression analysis was used to identify factors associated with RBC transfusion. Correlations between patient characteristics and the number of units of RBCs administered were tested using the Spearman's Rank correlation coefficient. Results We included 122 CS patients who received Impella support for longer than 24 hours. Seventy-eight percent was male and the median age was 60.0 years. Transfused patients had a longer support duration compared with non-transfused patients (respectively; 97 (52–173) hours versus 51 (39–76) hours, p&amp;lt;0.001). Of all included patients, 68% received RBC transfusion. Transfused patients received a median of 1.5 (0.6–2.8) units of RBCs per day. The incidence of hemolysis was 10% in transfused patients and 11% in non-transfused patients (p=NS). Bleeding occurred in 61% of the transfused patients and 11% of the non-transfused patients (p&amp;lt;0.001). Higher age, lower hemoglobin level prior to Impella implant and longer support duration increased the odds of receiving RBC transfusion. The 30-day mortality was similar in transfused and non-transfused patients, respectively 58% and 42% (p=NS) (Figure 1. Kaplan-Meier Curve showing 30-day mortality of transfused and non-transfused patients). Conclusion RBC transfusion was required in more than two-third of the CS patients who received Impella support for longer than 24 hours. Higher age, lower hemoglobin level prior to implant and longer support duration were independent risk factors for RBC transfusion. In contrast to previous studies, transfusion was not associated with 30-day mortality. Future research should focus on the effects of RBC transfusion on morbidity and mortality and investigate the optimal transfusion criteria and aims. Funding Acknowledgement Type of funding source: None

The effect of red blood cell transfusion on plasma hepcidin and growth differentiation factor 15 in gastric cancer patients: a prospective study.

Hepcidin and growth differentiation factor 15 (GDF-15) have been reported to be highly expressed in various cancers. Serum hepcidin and GDF-15 levels were demonstrated to be potential prognostic markers in cancers. This study aims to evaluate the effect of red blood cell (RBC) transfusion on plasma hepcidin and GDF-15 in gastric cancer patients. In this prospective study, 40 patients with gastric cancer were eligible for this study. Peripheral blood samples were obtained before and within 24 h after RBC transfusion. A routine blood test was performed before transfusion and within 24 h post-transfusion. Plasma hepcidin, GDF-15, interleukin 6 (IL-6) and erythropoietin were determined by ELISA. In patients with metastasis, plasma hepcidin (P=0.02), and GDF-15 (P=0.01) levels were higher than without metastasis. Plasma hepcidin was increased after RBC transfusion (P=0.001), while plasma erythropoietin was decreased after transfusion (P=0.03). However, RBC transfusion did not affect plasma GDF-15 (P=0.32) and IL-6 (P=0.12). The effect of RBC transfusion on variables did not differ between metastatic and non-metastatic patients. The mean percentage change of hepcidin in transfusion volume 4 unit (U) was more than 2 U. RBC transfusion could increase plasma hepcidin and have no effect on plasma GDF-15 in gastric patients.

Effect of red blood cell transfusion on cerebral tissue oxygenation in premature infants

Objective To analyze the changes in cerebral oxygen saturation (CrSO2) and cerebral fractional oxygen extraction ratio (CFOE) before, during and after red blood cell (RBC) transfusion in premature infants, and to explore the effect of RBC transfusion on the cerebral tissue oxygenation in premature infants. Methods The preterm infants with gestational age<37 weeks who were treated with RBC transfusion were selected from September 2017 to March 2018 in Neonatal Department of Children′s Hospital of Fudan University.Near-infrared spectroscopy (NIRS) was applied to continuously monitor CrSO2 from 2 h before RBC transfusion to 24 h after RBC transfusion.Transcuta-neous arterial oxygen saturation (TcSaO2), heart rate (HR) and blood pressure (BP) were synchronously measured by using multi-function monitor.CFOE could be calculated based on the monitored TcSaO2. Results A total of 71 cases were included in the study, 39 males and 32 females, with a medium gestational age of 29 (24-37) weeks, a mean birth weight of 2 195 (710-3 950) g, 17 cases in moderate anemia group and 54 cases in severe anemia group.Compared with the data 2 h before transfusion, CrSO2 increased (t=9.536, P<0.001), while CFOE decreased (t=-8.688, P<0.001) during transfusion in the whole study population.The CrSO2 at 2 h before blood transfusion, during blood transfusion, 2, 6, 12 and 24 h after transfusion were 0.579±0.037, 0.591±0.032, 0.599±0.035, 0.596±0.035, 0.595±0.027, 0.585±0.022, respectively in moderate anemia group and were 0.571±0.038, 0.592±0.039, 0.605±0.038, 0.603±0.035, 0.596±0.032, 0.596±0.032, respectively in severe anemia group.The CFOE at 2 h before blood transfusion, during blood transfusion, 2, 6, 12 and 24 h after transfusion were 0.40±0.04, 0.38±0.03, 0.37±0.04, 0.38±0.04, 0.38±0.03, 0.38±0.03, respectively in moderate anemia group and were 0.42±0.04, 0.39±0.04, 0.38±0.04, 0.38±0.04, 0.39±0.03, 0.39±0.03, respectively in severe anemia group.CrSO2 increased (t=3.874, P<0.05), while CFOE decreased (t=-4.091, P<0.05) at 2 h after transfusion in moderate anemia group.In severe anemia group, CrSO2 significantly increased (t=9.221, P<0.001), while CFOE significantly decreased (t=-8.583, P<0.001) during transfusion, and this effect lasted until 2 h after transfusion (t=5.926, -5.556, P<0.001). Compared with the data 2 h before transfusion, CrSO2 was significantly increased (t=6.894, P<0.001), while CFOE was significantly decreased (t=-8.536, P<0.001) at 24 h after transfusion in severe anemia group.However, there was no signi-ficant difference in CrSO2 and CFOE between the 24 h after transfusion and 2 h before in the moderate anemia group. Conclusions RBC transfusion improves cerebral tissue oxygenation, and severe anemia group benefit more from blood transfusion.Cerebral oxygenation monitoring with NIRS monitor may provide new insights for the clinical management of RBC transfusion in preterm infants. Key words: Infant, premature; Blood transfusion; Spectroscopy, near-infrared; Brain; Oxygen

The effect of red blood cell transfusion on iron metabolism in critically ill patients.

Anemia of inflammation (AI) has a high prevalence in critically ill patients. In AI, iron metabolism is altered, as high levels of inflammation-induced hepcidin reduce the amount of iron available for erythropoiesis. AI is treated with red blood cell (RBC) transfusions. The effect of RBC transfusion on iron metabolism during inflammatory processes in adults is unknown. We investigated the effect of RBC transfusion on iron metabolism in critically ill patients. In a prospective cohort study in 61 critically ill patients who received 1 RBC unit, levels of iron variables were determined before, directly after, and 24 hours after transfusion in septic and nonseptic patients. Serum iron levels were low and increased after transfusion (p = 0.02). However, RBC transfusion had no effect on transferrin saturation (p = 0.14) and ferritin levels (p = 0.74). Hepcidin levels increased after RBC transfusion (p = 0.01), while interleukin-6 levels decreased (p = 0.03). In septic patients, RBC transfusion induced a decrease in haptoglobin levels compared to baseline, which did not occur in nonseptic patients (p = 0.01). The effect of RBC transfusion on other iron variables did not differ between septic and nonseptic patients. Transfusion of a RBC unit transiently increases serum iron levels in intensive care unit patients. The increase in hepcidin levels after transfusion can further decrease iron release from intracellular storage making it available for erythropoiesis. RBC transfusion is associated with a decrease in haptoglobin levels in septic compared to nonseptic patients, but did not affect other markers of hemolysis.

The Prospective Evaluation of the Net Effect of Red Blood Cell Transfusions in Routine Provision of Palliative Care.

Red Blood Cell (RBC) transfusions are commonly used in palliative care. RBCs are a finite resource, transfusions carry risks, and the net effect (benefits and harms) is poorly defined for people with life-limiting illnesses. To examine the indications and effects of RBC transfusion in palliative care patients. This international, multisite, prospective consecutive cohort study. Palliative care patients undergoing RBC transfusion. Target symptoms (fatigue, breathlessness, generalized weakness, or dizziness) were assessed before transfusion and at day 7 by treating clinicians, using National Cancer Center Institute Common Terminology Criteria for Adverse Events. Assessment of harms was made at day 2. One hundred and one transfusions with day 7 follow-up were collected. Median age was 72.0 (interquartile range 61.5-83.0) years, 58% men, and mean Australia-modified Karnofsky Performance Status (AKPS) of 48 (standard deviation [SD] 17). A mean 2.1 (SD 0.6) unit was tranfused. The target symptoms were fatigue (61%), breathlessness (16%), generalized weakness (12%), dizziness (6%), or other (5%). Forty-nine percent of transfusions improved the primary target symptom, and 78% of transfusions improved at least one of the target symptoms. Harms were infrequent and mild. An AKPS of 40%-50% was associated with higher chances of symptomatic benefit in the target symptom; however, no other predictors of response were identified. In the largest prospective consecutive case series to date, clinicians generally reported benefit, with minimal harms. Ongoing work is required to define the optimal patient- and clinician-reported hematological and functional outcome measures to optimize the use of donor blood and to minimize transfusion-associated risk.

Perioperative red blood cell transfusion in orofacial surgery.

In the field of orofacial surgery, a red blood cell transfusion (RBCT) is occasionally required during double jaw and oral cancer surgery. However, the question remains whether the effect of RBCT during the perioperative period is beneficial or harmful. The answer to this question remains challenging. In the field of orofacial surgery, transfusion is performed for the purpose of oxygen transfer to hypoxic tissues and plasma volume expansion when there is bleeding. However, there are various risks, such as infectious complications (viral and bacterial), transfusion-related acute lung injury, ABO and non-ABO associated hemolytic transfusion reactions, febrile non-hemolytic transfusion reactions, transfusion associated graft-versus-host disease, transfusion associated circulatory overload, and hypersensitivity transfusion reaction including anaphylaxis and transfusion-related immune-modulation. Many studies and guidelines have suggested RBCT is considered when hemoglobin levels recorded are 7 g/dL for general patients and 8-9 g/dL for patients with cardiovascular disease or hemodynamically unstable patients. However, RBCT is occasionally an essential treatment during surgeries and it is often required in emergency cases. We need to comprehensively consider postoperative bleeding, different clinical situations, the level of intra- and postoperative patient monitoring, and various problems that may arise from a transfusion, in the perspective of patient safety. Since orofacial surgery has an especially high risk of bleeding due to the complex structures involved and the extensive vascular distribution, measures to prevent bleeding should be taken and the conditions for a transfusion should be optimized and appropriate in order to promote patient safety.

Effect of RBC Transfusion on T Lymphocyte Subsets of Patients with Hematologic Malignancies

To explore the effect of red blood cell(RBC) transfusion on T lymphocyte subsets in the patients with hematologic malignancies. The patients admitted in department of hematology of the second hospital of Shanxi Medical University from September 2013 to September 2014 acconuted for 144 cases had been diagnosed with hematologic malignancies and needed RBC transfusions according to clinical transfusion creteria (Hb level<70 g/L). All the patients were in rest period after chemotherapy, furthermore they did not administrate immunomodulatory drugs. The T lymphocyte subsets in these patients were detected by flow cytometry before and within 1 month after RBC transfusion, and the effect of RBC transfusion on T lymphocyte subsets was analysed. Compared with those before red blood transfusion, the CD3+ cells, CD3+CD4+ cells, CD3+CD8+ cells of the patients with hematologic malignancies increased within 10 days after transfusion of red blood cells with statistical significance (P<0.05), while the CD3+CD8+ cells of 59 patients with hematologic malignancies raised within 10 days to 30 days after red blood transfusion when compared with that before blood cell transfusion. However,CD3+CD4+,Th/Ts of these patients were decreased significantly(P<0.05) as compared with those before transfusion. Hematological malignancies of AML, ALL, MDS and MM showed different changes of T lymphocyte subsets before and after red blood cell transfusion. T lymphocyte subsets are affected by red blood cell transfusion for the patients with hematologic malignancies. At the begining of red blood cells transfusion the cellular immune function is slightly enhanced or unchanged. As the immune response carring out, the inhibited cells are dominant and the cellular immune function is suppressed.

Transfusion interventions in critical bleeding requiring massive transfusion: a systematic review.

Critical bleeding (CB) requiring massive transfusion (MT) can occur in a variety of clinical contexts and is associated with substantial mortality and morbidity. In 2011, the Australian National Blood Authority (NBA) published patient blood management guidelines for CB and MT, which found limited high-quality evidence from which only 2 recommendations could be made. The aim of this systematic review (SR) was to update these guidelines and identify evidence gaps still to be addressed. A comprehensive search was performed for randomized controlled trials (RCTs) and SRs using MeSH index and free text terms in MEDLINE, the Cochrane Library (Issue 11, 2012), EMBASE, CINHAL, PUBMED, and the Transfusion Evidence Library up to July 15, 2014. The evidence was grouped according to 4 questions based on the original guideline relating to transfusion interventions: (1) effect of dose, timing, and ratio of red blood cells (RBCs) to component therapy on patient outcomes; (2) effect of RBC transfusion on patient outcomes; (3) effect of fresh frozen plasma, platelet, cryoprecipitate, fibrinogen concentrate, and prothrombin complex concentrate on patient outcomes; and (4) effect of recombinant activated factor VII (rFVIIa) on patient outcomes. From this search, 19 studies were identified: 6 RCTs and 13 SRs. Two of the RCTs were pilot/feasibility studies, 3 were investigating rFVIIa, and 1 compared restrictive versus liberal RBC transfusion in upper gastrointestinal hemorrhage. Overall, limited new evidence was identified and substantial evidence gaps remain, particularly with regard to the effect of component therapies, including ratio of RBC to component therapies, on patient outcomes. Clinical trials to address these questions are required.

Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients.

Forward This document aims to summarize the current literature guiding the use of red cell transfusion in critically ill patients and provides recommendations to support clinicians in their day-to-day practice. Critically ill patients differ in their age, diagnosis, co-morbidities, and severity of illness. These factors influence their tolerance of anaemia and alter the risk to benefit ratio of transfusion. The optimal management for an individual may not fall clearly within our recommendations and each decision requires a synthesis of the available evidence and the clinical judgment of the treating physician. This guideline relates to the use of red cells to manage anaemia during critical illness when major haemorrhage is not present. A previous British Committee for Standards in Haematology (BCSH) guideline has been published on massive haemorrhage (Stainsby et al, 2006), but this is a rapidly changing field. We recommend readers consult recent guidelines specifically addressing the management of major haemorrhage for evidence-based guidance. A subsequent BCSH guideline will specifically cover the use of plasma components in critically ill patients.

Challenges of anemia correction during radiotherapy and chemoradiation

The effect of radiotherapy depends on optimal tumour oxygenation, as tumour hypoxia impairs the production of radiation-induced cytotoxic free radicals resulting in less tumour cell kill. The range of haemoglobin levels optimal for tumour oxygenation is 12–14 g/dl in women and 13–15 g/dl in men. It appears reasonable to elevate the haemoglobin level in anaemic cancer patients into this optimal range. This may be achieved with red blood cell transfusions (RBCT) or erythropoiesis stimulating agents (ESAs). However, RBCT have had negligible or even negative effect on patient outcome, possibly because RBCT induce immunosuppression or result in haemoglobin levels too high for optimal tumour oxygenation. Several randomized trials have demonstrated that patients irradiated for head-and-neck cancer had worse outcomes with ESAs than the control group. However, in the majority of these trials, over-treatment with ESAs resulted in haemoglobin levels above the optimal range. Tumour oxygenation is impaired by inappropriately high haemoglobin levels due to increased blood viscosity and decreased tumour cell perfusion. This concept is supported by the findings of prospective studies in cervix cancer and esophageal cancer patients. In these studies the ESA administration was withheld at a haemoglobin level of 14 g/dl resulting in a positive effect of ESAs on treatment outcome. In summary, the effect of RBCT and particularly of ESAs during radiotherapy remains unclear. Further randomized trials are required. Until such trials are available, one should follow the ASCO and ESMO guidelines that are very conservative regarding the administration of ESAs during radiotherapy and chemoradiation.

Red blood cell transfusion improves microdialysis-assessed interstitial lactate/pyruvate ratio in critically ill septic patients

Even though red blood cell (RBC) transfusion is a common intervention in the critical care setting, there is a paucity of data regarding its impact on tissue metabolism. The aim of this study was to explore the effect of RBC transfusion on microdialysis-assessed interstitial fluid metabolic parameters in septic patients.

The effect of RBC transfusions on cytokine gene expression after cardiac surgery in patients developing post-operative multiple organ failure

To determine the effect of red blood cell (RBC) transfusions during cardiac surgery on cytokine gene expression (GE) in relation to multiple organ failure (MOF) development after systemic inflammatory response syndrome (SIRS). RBC transfusion in cardiac surgery patients is dose-dependently associated with post-operative MOF, possibly acting as a second hit after cardiopulmonary bypass. For this observational study, 29 patients divided into four groups of cardiac surgery patients were selected from a randomised controlled trial (RCT). Group 1: no-RBC, no-MOF (N = 8); group 2: MOF, no-RBC (N = 7); group 3: RBC, no-MOF (N = 6); group 4: RBC and MOF (N = 8). Selection was based on age, gender, number of (leukocyte-depleted) RBC transfusions, type and duration of surgery. A 114 cytokine GE array was applied to blood samples withdrawn before and 24 h after surgery. Expression of selected genes was confirmed with reverse transcriptase real time-polymerase chain reaction (RT-PCR). Nineteen of the 39 detectable genes showed a significant change in GE after surgery. Confirmed by RT-PCR, transfused MOF patients exhibit significantly less downregulation of CD40 ligand than control patients. Patients who would develop MOF show significantly larger increases in GE of transforming growth factor-α (TGF-α), tumour necrosis factor (TNF)-superfamily members 10 and 13B (TNFsf10/13B). When tested at 24 h after surgery, cytokine GE in peripheral blood leucocytes showed no significant differences between those transfused and those not transfused. Some alterations were seen in those developing MOF compared to those who did not, but the findings offer no role of leukocyte depleted (LD) RBC transfusion in the development of MOF.

Red blood cell transfusion is an independent risk factor for cardiovascular complications in adult patients undergoing cardiac surgery: a propensity score-matched analysis

Red blood cell (RBC) transfusion is associated with a higher occurrence of clinical complications after cardiac surgery. However, the cause-effect relationship is confounded by other risk factors for worse outcomes as advanced age, valve or combined procedure, high EuroSCORE, redo surgery, longer bypass time and previous anemia. The objective of this study was to evaluate the effect of RBC transfusion in a propensity score-matched case-control analysis.

The Clinical Effects of Red Blood Cell Transfusions: An Overview of the Randomized Controlled Trials Evidence Base

No up-to-date overview of randomized controlled trials (RCTs) in red blood cell (RBC) transfusion exists. This systematic review examines the quantity and quality of the evidence for the clinical effects of RBC transfusion. One hundred forty-two eligible RCTs were identified through searches of The Cochrane Library (issue 4, 2009), MEDLINE (1950 to November 2009), EMBASE (1974 to November 2009), and other relevant sources. After data extraction and methodological quality assessment, trials were grouped by clinical specialty and type of RBC transfusion. Data analysis was predominantly descriptive. The 142 RCTs covered 11 specialties and 10 types of RBC transfusion. The number of included patients varied widely across the RCTs (median, 57; IQ range, 27-167). Most trials were single center comparing 2 parallel study arms. Overall, the reporting of methodological assessment was poor, although it improved markedly from 2001. Clinical areas with few trials are highlighted. Comparison with a study of RBC use in clinical practice highlighted a lack of correlation between the size of the evidence base for a given clinical specialty and the proportion of total RBC use by that clinical specialty. The gaps in the evidence base and the poor methodology of trials particularly in the past do not provide a strong evidence base for the use of RBC transfusions, but they indicate important targets for future research.

Transfusion practice in hip arthroplasty – a nationwide study

The optimal transfusion strategy in hip arthroplasty remains controversial despite existing guidelines. The aim of this study was to evaluate the transfusion practice in patients undergoing primary total hip arthroplasty (THA) or revision total hip arthroplasty (RTHA) in Denmark. We performed a retrospective cohort study of all patients undergoing THA or RTHA in Denmark in 2008. Primary outcomes were intercentre variation in red blood cell (RBC) transfusion rates and the timing of transfusion related to surgery. Six thousand nine hundred thirty-two THA patients and 1132 RTHA patients were included for analysis of which 1674 (24%) THA and 689 (61%) RTHA patients received RBC transfusion. Of these, 47% of THA and 73% of RTHA patients received transfusion on the day of surgery. Transfusion rates between centres varied from 7 to 71% and between 26 and 85% in THA and RTHA patients, respectively. Patients receiving RBC transfusion had longer length of stay and for THA patients an increased odds-ratio (5·5) of death within 90 days. Despite established guidelines, RBC transfusion practice in hip arthroplasty remains highly variable between Danish hospitals. The effect of RBC transfusion on outcome after hip arthroplasty should be established in prospective randomized controlled trials.

Gender Influences Cerebral Oxygenation After Red Blood Cell Transfusion in Patients with Severe Traumatic Brain Injury

Important differences with respect to gender exist in the prognosis and mortality of traumatic brain injury (TBI) patients. The objective of this study was to assess the role of gender as an independent factor in cerebral oxygenation variations following red blood cell transfusion (RBCT). This retrospective analysis of a prospective study was conducted on patients with severe TBI. Hemoglobin levels were measured at baseline and 6 h after transfusion. Brain tissue oxygen pressure (PbrO(2)), cerebral perfusion pressure (CPP), intracranial pressure (ICP), and mean arterial pressure (MAP) were measured at baseline, at the end of RBCT and at 1, 2, 3, 4, 5, and 6 h after transfusion. After the patients were stratified into two groups according to gender, the effect of RBCT on PbrO(2) (cerebral oxygenation) was analyzed using a multivariate analysis of variance with repeated measures (MANOVA). The MANOVA was repeated after adjusting for all covariables with baseline differences between groups. At baseline, we found differences in age (P = 0.01), weight (P = 0.03), MAP (P = 0.01), ISS (P = 0.05), and CCP (P = 0.01) between the groups. After adjusting for these co-variables, we observed that gender and age were related to the increase in PbrO(2) (P = 0.05 and P = 0.04, respectively). Our results suggest that the effect of RBCT on cerebral oxygenation, as measured by PbrO(2), is greater in women than in men.