Impact Of Blood Transfusion Research Articles

Transfusions of packed red blood cells in surgery for liver cancer: predictor of impaired overall survival but not recurrence-free survival – impact of blood transfusions in liver surgery

BackgroundLiver surgery remains a cornerstone of potentially curative multimodal treatments for primary malignancies of the liver and hepatic metastases. Improving perioperative safety is a prerequisite in this context. Perioperative blood transfusions negatively influence postoperative recovery. This study aimed to identify risk factors for perioperative packed red blood cell (PRBC) transfusion and to elucidate its effect on postoperative outcomes. MethodsThis was an observational study of a prospective data collection. A monocentric, retrospective analysis of 1118 hepatectomies at the University Hospital Carl Gustav Carus between 2013 and 2020 was conducted to compare postoperative short- and long-term outcomes in patients undergoing curative intended liver resection of hepatic primary or secondary malignancies. The outcomes were compared between 356 patients (31.8%) who received PRBC transfusions during surgery or within 7 days after surgery and 762 patients (68.2%) who did not receive PRBC transfusions. ResultsPreoperative anemia could be observed in 45.0% of the whole cohort: 65.7% in the PRBC transfusion group and 35.3% in the nontransfused group. Postoperative complications were significantly more common in the PRBC transfusion group in association with prolonged lengths of hospital stay and increased 30-day mortality than in the nontransfused group. After adjustment for possible confounders, preexisting kidney failure, preoperative hemoglobin and albumin levels outside of the reference range, intraoperative plasma transfusions, and overall surgery time were recognized as negative predictors for perioperative PRBC transfusions. PRBC transfusion increased the risk of death by approximately 38.8% (hazard ratio, 1.388; 95% CI, 1.027-1.876; P = .033), whereas no influence on recurrence-free survival (RFS) was observed. ConclusionPRBC transfusions were associated with postoperative morbidity and mortality after curative-intended surgery for liver cancers and represented an independent poor prognostic indicator for overall survival but not for RFS.

The Impact of Blood Transfusion on Pediatric Severe Malaria Cases with HIV Co Infection A Review

Pediatric severe malaria cases complicated by HIV co-infection present a formidable healthcare challenge, necessitating a nuanced and comprehensive approach to treatment. This review critically examines the efficacy of blood transfusion as a therapeutic intervention in managing severe malaria among pediatric patients co-infected with HIV. We delve into the current state of knowledge, discussing the immunological complexities, potential interactions with antiretroviral therapy, and the inherent challenges associated with this dual burden of disease. Despite the complexities, blood transfusion remains a vital element in addressing severe anemia in pediatric malaria. This review synthesizes existing literature, identifies gaps in knowledge, and proposes avenues for future research to enhance our understanding and optimize treatment strategies for this vulnerable population.

The Impact of Blood Transfusion in Developing Postoperative Delirium in Patients with Hip Fracture Surgery.

Many studies have been conducted to explore the risk factors associated with postoperative delirium (POD) in order to understand its underlying causes and develop prevention strategies, especially for hip fracture surgery. However, the relationship between blood transfusion and POD has been heatedly debated. The purpose of this study was to evaluate the risk factors of POD and the relationship between blood transfusions and the occurrence of POD in hip fracture surgery through big data analysis. Medical data (including medication history, clinical and laboratory findings, and perioperative variables) were acquired from the clinical data warehouse (CDW) of the five hospitals of Hallym University Medical Center and were compared between patients without POD and with POD. The occurrence of POD was 18.7% (228 of 2398 patients). The risk factors of POD included old age (OR 4.38, 95% CI 2.77-6.91; p < 0.001), American Society of Anesthesiology physical status > 2 (OR 1.84 95% CI 1.4-2.42; p < 0.001), dementia (OR 1.99, 95% CI 1.53-2.6; p < 0.001), steroid (OR 0.53 95% CI 0.34-0.82; p < 0.001), Antihistamine (OR 1.53 95% CI 1.19-1.96; p < 0.001), and postoperative erythrocyte sedimentation rate (mm/h) (OR 0.97 95% CI 0.97-0.98; p < 0.001) in multivariate logistic regression analysis. The postoperative transfusion (OR 2.53, 95% CI 1.88-3.41; p < 0.001) had a significant effect on the incidence of POD. big data analytics using a CDW was a good option to identify the risk factors of POD and to prevent POD in hip fracture surgery.

Abstract 4207: Systematic review and meta-analysis of cancer incidence after blood transfusion in the general population

Abstract Background: The impact of blood transfusion on cancer survival and mortality has been widely studied. However, few studies have investigated its relationship with cancer incidence. This is the first systematic review and meta-analysis evaluating the correlation between blood transfusion and cancer incidence. Methods: Five studies were identified through Pubmed, Embase, and Cochrane library. Four cohort studies and one case-control study (N = 3,048,906) were included. Over seventy percent were female (N =2,167,580), and about thirty-one percent (N = 956,522) were transfused. Meta-analysis was conducted between blood transfusion and cancer incidence. Subgroup analyses were performed by cancer types, follow-up period, and units of transfused blood. We pooled available risk estimates, which were adjusted for confounding factors, including age and sex, were pooled. Results: Overall cancer risk increased statistically significantly in people who received transfusion compared to the population that did not (1.70, 95% CI, 1.30 to 2.10). The result was consistent regardless of time intervals from transfusion or units of transfused blood. Cancer incidences in all solid tumors, except breast, thyroid, and uterine cancer, were higher in blood transfusion recipients (Table 1). The elevated risk of stomach, bladder, and kidney cancer was sustained for up to fifteen years. Furthermore, lung cancer, liver cancer, and non-Hodgkin lymphoma risk remained high among the blood transfusions group even after fifteen years. The three types of cancer with the highest incidence following transfusion were leukemia, stomach cancer, and liver cancer. Conclusions: Blood transfusion increases the risk of cancer in transfusion recipients. The impact of blood transfusion on cancer development varies depending on the cancer type and the time from transfusion. Further prospective studies are warranted to validate the findings and investigate the underlying mechanism. The pooled risk of cancer according to cancer types, units of transfusion, and time from transfusion Risk* (95% CI) Total &amp;lt; 5 yrs 5-15 yrs ≧ 15 yrs All cancer types 1.70 (1.30 - 2.10) 1.89 (1.13 - 2.65) 1.18 (0.97 - 1.40) 1.10 (1.06 - 1.14) Leukemia 2.79 (2.00 - 3.57) 4.07 (2.72 - 5.42) 1.15 (1.04 - 1.27) 0.91 (0.66 - 1.16) Non Hodgkin lymphoma 1.94 (1.49 - 2.40) 2.66 (1.82 - 3.50) 1.43 (0.89 - 1.98) 1.23 (1.00 - 1.46) Stomach 2.37 (1.70 - 3.04) 2.37 (1.70 - 3.04) 1.13 (1.03 - 1.23) 1.17 (0.91 - 1.43) Liver 2.25 (1.67 - 2.84) 2.80 (1.80 - 3.80) 1.67 (1.48 - 1.86) 2.54 (1.85 - 3.23) Colon 2.34 (1.62 - 3.05) 3.49 (1.90 - 5.08) 1.02 (0.96 - 1.08) 1.05 (0.90 - 1.20) Pancreas 1.85 (1.36 - 2.34) 2.37 (1.50 - 3.24) 1.19 (0.72 - 1.66) 1.28 (0.97 - 1.59) Rectum 1.40 (1.06 - 1.75) 1.71 (1.04 - 2.39) 0.98 (0.91 - 1.05) 1.00 (0.81 - 1.19) Lung 1.49 (1.21 - 1.77) 1.71 (1.18 - 2.23) 1.24 (1.17 - 1.30) 1.27 (1.09 - 1.45) Kidney 2.27 (1.63 - 2.90) 3.30 (1.89 - 4.17) 1.15 (1.03 - 1.27) 1.39 (0.70 - 2.08) Bladder 1.40 (1.12 - 1.68) 1.56 (1.06 - 2.06) 1.19 (1.11 - 1.27) 1.35 (0.15 - 2.54) Breast 0.96 (0.84 - 1.09) 1.06 (0.91 - 1.22) 0.95 (0.90 - 1.00) 1.12 (1.03 - 1.21) Uterus 1.02 (0.84 - 1.19) 1.13 (0.85 - 1.25) 0.81 (0.46 - 1.16) 1.00 (0.78 - 1.22) Thyroid 1.16 (0.91 - 1.41) 1.32 (0.87 - 1.77) 0.92 (0.70 - 1.14) 1.12 (0.64 - 1.78) 1-2 units ≧ 3 units All cancer types 1.53 (1.15 - 1.90) 1.93 (1.39 - 2.48) *Risk is pooled from odds ratio, hazard ratio, relative risk, and standardized incidence ratio.Abbreviations: CI=Confidence Interval Citation Format: Youjin Oh, Soowon Lee, Sebin Bok, Chan Mi Jung, Ilene Hong, Liam Chung, Jeeyeon Lee, Young Kwang Chae. Systematic review and meta-analysis of cancer incidence after blood transfusion in the general population. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4207.

Impact of Blood Transfusion on Postoperative Infection and Hospital Stay after Isolated Coronary Artery Bypass Surgery

Objective: The blood transfusion during cardiac surgeries has been demonstrated to be increased in length of hospital stay. The aim of current study was to characterize the post-operative complication. Methodology: A descriptive study was conducted at Cardiac Centre Bahawalpur from 1st February 2020 to 30th March, 2021 all patients were divided into two groups. who underwent cardiac surgery during this period Group A (No blood transfusion). Group B (low transfusion 1-2 units) Results: A total of 176 patients, 122 (69.3%) were male and 54 (30.7%) female. in our study there were 1(1%) in Group A while 5(6.6%) in Group B were found with post-operative infection with statistically significant p-value 0.049. Similarly, hospital stay in group A was 5.8 ± 1.3 while in Group B was 6.9 ± 0.3 showing insignificant p-value 0.067. Conclusion: A restrictive transfusion policy while considering RCC transfusion seems more useful and patients who require blood should receive the number of transfusions as minimum as possible. Keywords: RCC Red Cell Concentrates Transfusion, CABG Cardiac Artery Bypass Graft, LOH Length of Hospital Stay, restrictive blood transfusion.

Наиболее значимые постнатальные факторы, влияющие на течение различных форм ретинопатии недоношенных

Purpose.To evaluate the most significant factors affecting the course of ROP. Material and methods. From 2009 to 2018, we examined 4120 children with ROP. The examination of children was carried out as part of a neonatal screening to detect ROP using standard diagnostic methods. Results. Against the background of prolonged oxygen therapy in children with broncho-pulmonary dysplasia (BPD), severe forms of ROP developed in 9.7% of cases, which is significantly lower than similar indicators in the pathology departments of premature and newborns. Among children with severe apnea, the onset of different-sized hemorrhages, mainly preretinal located in various parts of the fundus, mostly at the ends of the vascular arcades is observed in 70.4% of cases. In 25.9% of children with severe ROP, partial hemophthalmus appears. During blood transfusions in children with severe forms of ROP, the transition of the disease to a more severe stage was reduced in 64.0%, caliber and tortuosity of the retinal vessels increased in 79.8%, retinal edema and exudative manifestations intensified in 39,3%, hemorrhagic changes rose in 49,4%, extraretinal proliferation increased in 50.6%. Against the background of adenoviral epidemic keratoconjunctivitis (AEK) in children with severe forms of ROP, the exudation in the vitreous body sharply increased in 34.7%, retinal detachment developed in 4.1% of cases, even though the children had already undergone laser coagulation of the retina at the time of infection, fresh hemorrhages mainly at the ends of the vascular arcades appeared in 57.1%. Conclusions. Prolonged oxygen therapy under BPD reduces the severity of the ROP. The impact of blood transfusions is observed only in severe forms of ROP. Frequent episodes of apnea contribute to the development of intraocular hemorrhages during ROP. The course of adenoviral AEK exacerbates the course of severe forms of ROP. Key words: retinopathy of prematurity, blood transfusion, apnea, broncho-pulmonary dysplasia, adenoviral epidemic keratoconjunctivitis, risk factors of retinopathy of prematurity

The impact of blood Transfusion on T Helper Cells and Cytokines in Transfusion-Refractory Patients: a Prospective Study.

Red blood cell (RBC) transfusion can increase patients' hemoglobin levels and improve hypoxia. The factors affecting the transfusion efficacy include immune and nonimmune factors. The objective of this study was to explore the impact ofbloodtransfusiononT helper(Th) cell ratios and levels of serum cytokines in RBC transfusion-refractory patients. In thisprospectivestudy, anemic patients receiving RBC transfusion were enrolled. Peripheral venous blood samples were extracted from patients before RBC transfusion and within 24h after transfusion. Th cell ratios and levels of serum cytokines were detected byflow cytometry. Differences in Th cell ratios and levels of serum cytokines (IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ) between pretransfusion and posttransfusion were compared. A total of 47 patients agreed to participate in this study. They were grouped according to incremental Hb levels, 20 (42.55%) patients were divided into the RBC transfusion refractory group, while 27 (57.45%) patients were in the validity group. The expected Hb increment was defined by a panel of Chinese experts. In RBC transfusion-refractory patients, Th1 and Th2 cell ratios increased while levels of serum IL-2 and IL-10 decreased after transfusion. In RBC transfusion validity patients, there were no significant changes in Th cell ratios or levels of serum cytokines between pretransfusion and posttransfusion. We found that Th1 and Th2 cell ratios increased while serum IL-2 and IL-10 levels decreased after transfusion in RBC-refractory patients.

Impact of blood transfusion on survival after nephrectomy for localized or locally advanced renal cancer.

Several studies have reported blood transfusion were associated with a decrease of survival after oncological surgery. For kidney cancer, the effect of blood transfusion is still debated. The objective of this study was to determine the effect of blood transfusion after oncological nephrectomy on overall, specific and recurrence-free survival in a retrospective cohort of localized or locally advanced kidney cancer. We performed a monocentric retrospective analysis of all patients managed by surgery for localized or locally advanced renal cancer between January 2000 and December 2016. We compared overall and specific survival and recurrence-free survival between two groups: patients transfused and not transfused. Demographic, surgical and tumor characteristics were compared. Survival analyses were performed using univariate Cox regression and multivariate Cox proportional regression test. We included 382 patients in this study: 320 (83.8%) were not transfused and 62 (16.2%) were transfused. Transfused patients were significantly older (P=0.001) and had a lower pre-operative hemoglobin level (P=0.008). Operative and oncological characteristics were also different between both groups. In univariate analysis, we showed that blood transfusion was associated with lower overall survival (P<0.001), specific survival (P<0.001), and recurrence-free survival (P<0.001). In multivariate analysis, we found that blood transfusion was not associated with overall survival, or specific survival, but it was associated with lower recurrence-free survival (HR: 1.967, CI95% [1.024-3.780], P=0.042). Perioperative blood transfusion is an independent risk factor that increases tumor recurrence among patients treated with nephrectomy for renal cancer.

Prognostic Value of Intraoperative Blood Transfusion in Patients with Adenocarcinoma of the Esophagogastric Junction

Background and objectives: Adenocarcinoma of the esophagogastric junction (AEG) has a complicated surgical anatomy, due to which it sometimes induces excessive intraoperative blood loss that necessitates intraoperative blood transfusion (BTF). However, few reports have focused on the impact of BTF on the survival outcomes of patients with AEG. We aimed to evaluate the impact of BTF on AEG prognosis. Materials andMethods: We included 63 patients who underwent surgical resection for AEG at our hospital between January 2010 and September 2020. Clinicopathological characteristics and survival outcomes were compared between patients with (n = 12) and without (n = 51) BTF. Multivariate analysis was performed to identify the independent prognostic factors for overall survival. Results: None of the patients who underwent minimally invasive surgery received BTF. Patients who received BTF had a significantly worse 5-year survival rate than those who did not (67.8% vs. 28.3%, p = 0.001). BTF was an independent risk factor for overall survival (hazard ratio: 3.90, 95% confidence interval 1.30–11.7), even after patients who underwent minimally invasive surgery were excluded. Conclusions: BTF adversely affected the survival outcomes of patients with AEG who underwent curative surgery. To avoid BTF, surgeons should strive to minimize intraoperative bleeding.

TCT-396 Occurrence and Impact of Blood Transfusions in Patients With Cardiogenic Shock Receiving Impella Support

TCT-396 Occurrence and Impact of Blood Transfusions in Patients With Cardiogenic Shock Receiving Impella Support

Blood transfusions and hip fracture mortality - A retrospective cohort study

BackgroundHip fractures are associated with serious morbidity and mortality. Low haemoglobin at presentation has been shown to be associated with increased mortality in hip fracture patients. This comorbid patient group commonly receives packed red cell blood transfusions during their hospital admission, the impact of which is less clear. Aims and objectivesWe aim to assess the rate, appropriateness and impact of blood transfusions on one-year mortality in hip fracture patients. We also aim to assess the impact of patients taking anticoagulant medications at presentation on the rates of blood transfusions in this patient group. MethodsA retrospective cohort study of 324 consecutive hip fracture patients. Data was collected from the national hip fracture database, electronic patient records and PACS. Results75 patients received a blood transfusion. Receiving a blood transfusion increased absolute risk of one-year mortality by 2.466 (p < 0.05). Adjusted for age, sex, comorbidities, residence prior to admission and time from presentation to surgery increased the risk of one-year mortality was 2.790 (p < 0.05).28% of patients who went on to receive a transfusion had a haemoglobin of less than 100 g/L at presentation. 94.6% of transfused patients had a pre-transfusion haemoglobin of less than 90 g/L. There was no increased risk of requiring a blood transfusion if anticoagulant medication was being taken at presentation. ConclusionReceiving a blood transfusion during an admission for hip fracture carried an increased risk of one-year mortality of almost two and a half times. With appropriate preoperative optimisation, taking an anticoagulant medication at presentation did not increase the risk of requiring a transfusion. Most blood transfusions were administered appropriately using thresholds. Just over a quarter of patients who received a transfusion had an admission haemoglobin of less than 100 g/L, showing it as a poor predictor of blood transfusion requirement during admission.

Response to Measles, Mumps and Rubella (MMR) Vaccine in Transfusion-Dependent Patients.

Measles, mumps and rubella (MMR) still determine significant morbidity and mortality, although a highly effective vaccine is available. Postponing the MMR vaccination until 6 months after the last red blood cell (RBC) transfusion is recommended, but this delay is incompatible with chronic transfusions. The present study aimed at investigating the impact of blood transfusions on the immunogenicity of the MMR vaccine. In this observational study, a group of 45 transfusion- dependent (TD) patients was compared to 24 non-transfusion-dependent (NTD) patients. Immunity to measles was achieved in 35 (78%) TD and 21 (88%) NTD subjects (p = 0.7), to mumps in 36 (80%) TD and 21 (88%) NTD subjects (p = 0.99), and to rubella in 40 (89%) TD and 23 (96%) NTD subjects (p = 0.99). No significant difference was observed in the number of non-immune individuals or those with doubtful protection between the two groups (p > 0.05). The mean IgG value, assayed in 50 pre-storage leukoreduced RBC units, was 0.075 ± 0.064 mg/mL, ten times lower than the level assumed in blood units and considered detrimental to the immune response in TD patients. This work shows a favorable response to MMR vaccination in TD and NTDT patients and paves the way for further larger studies assessing the impact of chronic transfusions on vaccine response.

Blood transfusions may adversely affect survival outcomes of patients with lung cancer: a systematic review and meta-analysis.

BackgroundDespite common use in clinical practice, the impact of blood transfusions on prognosis among patients with lung cancer remains unclear. The purpose of the current study is to perform an updated systematic review and meta-analysis to evaluate the influence of blood transfusions on survival outcomes of lung cancer patients.MethodsWe searched PubMed, Embase, Cochrane Library, and Ovid MEDLINE for publications illustrating the association between blood transfusions and prognosis among people with lung cancer from inception to November 2019. Overall survival (OS) and disease-free survival (DFS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using the random-effects model. Study heterogeneity was evaluated with the I2 test. Publication bias was explored via funnel plot and trim-and-fill analyses.ResultsWe included 23 cohort studies with 12,175 patients (3,027 cases and 9,148 controls) for meta-analysis. Among these records, 22 studies investigated the effect of perioperative transfusions, while one examined that of transfusions during chemotherapy. Two studies suggested the possible dose-dependent effect in accordance with the number of transfused units. In pooled analyses, blood transfusions deleteriously influenced both OS (HR=1.35, 95% CI: 1.14–1.61, P<0.001, I2=0%) and DFS (HR=1.46, 95% CI: 1.15–1.86, P=0.001, I2=0%) of people with lung cancer. No evidence of significant publication bias was detected in funnel plot and trim-and-fill analyses (OS: HR=1.26, 95% CI: 1.07–1.49, P=0.006; DFS: HR=1.35, 95% CI: 1.08–1.69, P=0.008).ConclusionsBlood transfusions were associated with decreased survival of patients with lung cancer.

The effect of red blood cell transfusion on peripheral tissue oxygen delivery and consumption in septic patients.

The impact of blood transfusion on tissue oxygen delivery (DO2) and tissue oxygen consumption (VO2) is a subject of current clinical studies. The primary objective of this observational study is to evaluate and measure the parameters involved in determining DO2 and VO2, in early phase of septic patients. A secondary objective of this study is to assess the potential benefit of blood transfusion on tissue metabolism by serial measurements of lactic acid (Ac. Lac.). A group of 29 patients were studied, each patient received between one to three units of fresh packed red blood cells (pRBC). Clinical and paraclinical criteria for sepsis as well as the plasma value of haemoglobin (Hb) below 10g/dL represented the inclusion criteria in this study. We evaluated Hb, haematocrit (HCT), arterial blood oxigen saturation (SAO2), central venous oxygen saturation (SCVO2), parameters which are involved in determination of DO2 and VO2, before and after the transfusion of one unit of pRBC. Values of Ac. Lac. were also assessed in order to determine the type of metabolism (aerobic or anaerobic). SCVO2, SAO2, Hb, HCT and Ac. Lac. were determined using Epoc blood analyser. The cardiac output (CO) and systemic vascular resistance (SVR) were monitored during blood transfusion, using Vigileo monitor (Edward's Life Science, PreSep catheter kit). SAO2 was also monitored by pulse-oximetry. Changes in Hb, HCT and SCVO2 before and after pRBC transfusion (which further determine VO2) were statistically significant (P<0.001). A statistically significant increase (P<0.001) was obtained in Ac. Lac. values, before and after pRBC transfusion. SAO2 and CO directly involved in producing DO2, were clinically monitored during blood transfusion and the results remained constant. Results obtained in this clinical study show an increase in DO2 in critically ill septic patients and also an increase in oxygen tissue uptake which is similar to VO2, clearly pointing out the benefit of pRBC transfusion. The benefits of pRBC transfusion on tissue metabolism in critically ill septic patients remain elusive because of lactic acid values increase during and after transfusion. Based on our findings we recommend that Hb values used as a single trigger for pRBC transfusion should be further studied and that additional parameters such as SCVO2 and lactic acid should be considered as possible triggers for transfusion. Values of Hb and HCT should never be neglected.

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

Impact of Blood Transfusion in Free Flap Breast Reconstruction Using Propensity Score Matching.

Microvascular thrombosis has been associated with cytokine release and inflammatory syndromes which can occur as a result of blood transfusions. This phenomenon could potentially lead to complications in breast free flap reconstruction. The aim of this study was to evaluate the impact of perioperative blood transfusion in free flap breast reconstruction using large population analysis. The American College of Surgeons National Quality Improvement Program database was queried for delayed free flap breast reconstructions performed in 2016. The study population was divided based on perioperative blood transfusion within 24 hours of the start of the operation. Propensity score matching analysis was used to ensure homogeneity between the two study groups. Primary outcome was unplanned return to the operating room (OR) within 30 days. Secondary outcomes were readmission and complications. A total of 1,256 patients were identified. Out of those, 91 patients received a perioperative blood transfusion. All the patients received only one unit of PRBC within the first 24 hours. Those patients were matched with similar patients who did not receive a transfusion on a ratio of 1:3 (273 patients). Patients who received a transfusion had a significantly higher incidence of reoperation (42 vs. 10%, p < 0.001). Patients who received a transfusion were more likely to return to the OR after 48 hours from the initial operation (13 vs. 5%, p = 0.001). All returns to the OR were due to flap-related complications. Perioperative blood transfusion increased the incidence of wound dehiscence (9 vs. 2%, p = 0.041) but had no protective effect on the development of other postoperative complications. Perioperative blood transfusion in free flap breast reconstruction is associated with an increased probability of flap-related complications and subsequent return to the OR without decreasing the probability of developing other systemic postoperative complications.

Abstract 5791: Blood transfusions may adversely affect survival outcomes of patients with lung cancer: A systematic review and meta-analysis

Abstract Background: Lung cancer has the highest mortality rate among tumor entities in the United States. Patients with lung cancer may require transfusions due to blood loss during surgery or bone marrow suppression caused by chemoradiation. Despite common use in practice, however, the impact of blood transfusions on prognosis among patients with lung cancer remains unclear. There have been long-standing concerns on the associated risk, including possible contamination by undetected malignant cells. The concept of transfusion-related immunomodulation (TRIM) has also been highlighted, which hypothesizes that transfusions may suppress the anti-tumor immune surveillance and promote growth of cancer cells. In spite of these concerns, scholarly efforts elucidating the relationship between transfusions and cancer recurrence have focused primarily on other cancers such as colorectal cancer. We thus performed an updated systematic review and meta-analysis to evaluate the influence of blood transfusions on survival outcomes of lung cancer patients. Methods: We searched PubMed, Embase, Cochrane Library, and Ovid MEDLINE for publications illustrating the association between blood transfusions and prognosis among people with lung cancer from inception to 11/28/2019. Overall survival (OS) and disease-free survival (DFS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using the random-effects model. Study heterogeneity was evaluated with the I2 test. Publication bias was explored via funnel plot and trim-and-fill analyses. Results: We identified 843 citations initially and four studies were added after reviewing references of the searched articles. By assessing titles and abstracts, we excluded 393 duplicates and 414 irrelevant articles. 16 studies were removed given that they were review or correspondence articles or lacked the outcome of interest. As a result, 24 cohort studies with 13,036 patients (3,098 cases and 9,938 controls) were included for meta-analysis. Among these records, 23 studies investigated the effect of perioperative transfusions, while one examined that of transfusions during chemotherapy. Two studies suggested the possible dose-dependent effect in accordance with the number of transfused units. In pooled analyses, blood transfusions deleteriously influenced both OS (HR=1.36, 95% CI=1.14-1.62, P=0.0005, I2=0%) and DFS (HR=1.46, 95% CI=1.16-1.84, P=0.0013, I2=0%) of people with lung cancer. No evidence of significant publication bias was detected in funnel plot and trim-and-fill analyses (OS: HR=1.26, 95% CI=1.07-1.48, P=0.0052; DFS: HR=1.36, 95% CI=1.10-1.69, P=0.0053). Conclusion: Blood transfusions were associated with decreased survival of lung cancer patients. Citation Format: Sukjoo Cho, Jonghanne Park, Misuk Lee, Dongyup Lee, Horyun Choi, Gahyun Gim, Leeseul Kim, Cyra Y. Kang, Young Kwang Chae. Blood transfusions may adversely affect survival outcomes of patients with lung cancer: A systematic review and meta-analysis [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5791.

Intra-Operative Transfusions are Associated with Worse Outcomes after Lung Transplantation

Purpose Peri-operative blood transfusions are associated with increased pulmonary morbidity and mortality. The impact of blood transfusions during lung transplantation surgery is largely unknown. We investigated the impact of intra-operative blood transfusions on acute rejection, post-transplant lung function and mortality in lung transplant recipients. Methods A retrospective review was conducted on 274 adult patients who underwent bilateral lung transplantation from January 2012 to June 2018. Intra-operative transfusions of red blood cells (RBC), fresh frozen plasma (FFP), platelets and cryoprecipitate were analysed. Logistic regression was used to determine variables predicting higher blood product use. Kaplan-Meier and Cox proportional hazard models were used to analyse time-to-first rejection/death and all-cause mortality. Results 149 men and 125 women (median age 55, range 18 to 69) required a median number of 2 units of red blood cells (range, 0 to 22 units), 2 units of fresh frozen plasma (range, 0 to 10 units), 1 unit of platelets (range, 0 to 4 units) and 2 units of cryoprecipitate (range, 0 to 16 units). Female patients (p 0.001), longer CPB time (p 0.024) and lower pre-operative haemoglobin (p 0.001) predicted greater RBC use. Greater transfusions of all blood products were significantly associated with prolonged hospital stays, ICU stays and ventilation time. Mortality risk was not significantly different for any transfusion product. Time-to-first A3 or higher rejection and the number of rejections in the first year post-transplant were not significantly related to increased blood product use. However, increased cryoprecipitate transfusion was associated with greater severity of rejections. Post-transplant predicted forced expiratory volume in 1 second at 3 months, 6 months and 12 months was significantly worse if patients received more intra-operative blood products. Conclusion Increased intra-operative blood transfusions in lung transplant recipients did not significantly increase risk of lung rejection or mortality. However, increased blood transfusions were associated with prolonged hospital stay, ICU stay and ventilation time. Higher volumes of all blood products were also show significantly worse lung function up to 1 year post-transplant.

Impact of Blood Transfusion on Troponin I Levels and Outcomes after Cardiac Surgery: A Cohort Study.

ObjectivesIncreased cardiac troponin I (TI) has been suggested to be a sensitive indicator of intraoperative myocardial injury. We investigated the association of transfusion on TI levels post-surgery and outcomes in patients undergoing elective cardiac surgeries.MethodsWe conducted a retrospective review of 542 patients. Patients were divided into two groups based on TI levels at 24 hours (TI24) (> 6.5 µg/L vs. ≤ 6.5 µg/L). The impact of transfusion on TI levels was estimated using logistic regression and adjusted for using a multivariable model that included aortic cross-clamp time and preoperative ejection fraction. The effect of TI on the clinical outcomes was examined.ResultsRed blood cell (RBC) transfusion was found to be associated with high TI levels (odds ratio (OR) = 2.33, p = 0.007, 95% confidence interval (CI): 1.30–4.30). A trend was observed when aortic cross-clamp time and preoperative ejection fraction were adjusted for (OR = 2.06, p = 0.080, 95% CI: 0.90–4.70). An association was found between aortic cross-clamp time and high TI levels in the multivariable model (OR = 1.01, p = 0.028, 95% CI: 1.00–1.02). Elevated TI levels was associated with higher mortality (OR = 4.15, p = 0.017, 95% CI: 1.29–13.08), renal failure (OR = 2.99, p = 0.004, 95% CI: 1.41–6.32), and increased length of stay in-hospital (OR = 4.50, p = 0.020, 95% CI: 0.69–8.30).ConclusionsRBC transfusion is associated with increased TI24 post-cardiac surgery and worse outcomes, albeit a confounding effect cannot be excluded. Larger studies are required to confirm these findings.

Impact of Blood Transfusion on Haematopoietic Stem Cell Transplantation Outcome

Impact of Blood Transfusion on Haematopoietic Stem Cell Transplantation Outcome