Incidence Of Transfusion Research Articles

Comparison of intravenous versus topical tranexamic acid in primary total hip arthroplasty: a systematic review and meta-analysis of tenrandomized trials.

Aim: The optimal management approach for tranexamic acid(TXA)in primary total hip arthroplasty (THA) is still controversial. This meta-analysis aimed to evaluate the efficacy and safety of intravenous versus topical TXAduringTHA. Materials & methods: PubMed, Google Scholar, Embaseand the Cochrane library were searched for all randomized controlled trials comparing topical and intravenous TXA (iTXA)following primary THA. The primary outcome consisted of blood loss including total blood loss, intraoperative blood lossand hidden blood loss (HBL), hemoglobin (Hb) level of postoperative day 1, maximum Hb dropand transfusion incidence. The second outcome included drainage volume, complicationsand length of stay. Extracted data were statistically analyzed with the Stata11.0. Results: A total of ten randomized controlled trials containing 1295 patients were included in the study. A similar effect of transfusion rate, total blood loss, Hb level of postoperative day 1, drainage volume, deep vein thrombosis eventsand wound complications appeared in the two routes. Intraoperative blood loss (weighted mean difference [WMD]= -12.687, 95% CI: -22.291, -3.083; p=0.010), HBL (WMD =14.276, 95% CI: 9.936, 19.459; p<0.001) and maximum Hb drop (WMD =-0.400, 95% CI: -0.577, -0.222; p<0.001) were significantly reduced in the intravenous group compared with topical group. Conclusion: The present result indicated comparable safety and transfusion rate for intravenous and topical TXA in primary THA, while the intravenous approach demonstrated a smaller intraoperative blood loss, HBL and maximum Hb drop.

Outcomes of audit on blood requisition and utilization in obstetrics and gynaecology setting: Aminu Kano Teaching Hospital, Kano, Nigeria

Background: Indications for transfusion in obstetrics may be emergent as well as non-emergent: the keystone of transfusion practice is that it should be appropriate, that is, not given when not required and not missed when requiredObjectives: To identify key areas where there is a need to change policy so as to prevent unnecessary blood transfusion, to formulate strategies for appropriate preoperative blood requisition and to change clinicians’ approach regarding blood component utilization.Results: The mean age was 30.04 years (SD ± 8.08) and ranged from 16 to 70 years. The incidence of blood transfusion among all admissions was 418 out of 3078 (13.6%). The mean pre-transfusion PCV for patients who received blood transfusion was 23.06 ± 6.1% compared to 34.2 ± 4.54% obtained in the non-transfused patients. Only 59.8% of blood was utilized while 40.2% of blood was not needed.Conclusion: Current practice at O&amp;G department, AKTH appears to be generally inconsistent with the guidelines. This indicates inefficient transfusion practice when comparing with the standard.

BLOOD AND COAGULATION PRODUCT DISPOSAL IN THE MODERN ERA - A SURVEY AND REVIEW OF CURRENT PRACTICE

Introduction Perioperative transfusion is associated with reduced with reduced survival1 and increased morbidity and mortality2 Several studies report poor adoption of guidelines and wide variation in clinical practice3. However, the influence of simple practical factors is disregarded, as for instance which blood products are available in which time for the transfusing physician? We hypothesize that local practical issues are a relevant cofounder of transfusion decisions. Methods With kind endorsement of EACTAIC, the link to a web-based survey was sent via newsletter to all EACTAIC-Members via the monthly newsletter in November 2020. Results The Newsletter was opened by 429 active members. We collected 66 survey responses, with 51 complete surveys, resulting in a response rate of 11.9% 72% of participants report having a local algorithm for the use of blood products and coagulation factors. Several factors were reported as having an influence on the local transfusion algorithm (Figure 1) and on transfusion practice (Figure 2). 86% of respondents report ROTEM®/TEG® available, 76% haemoglobin tests, 24% quick measurements and 22% Thrombocyte function tests. 6% of the respondents have no point of care test available. A majority of respondents report the possibility to receive more than 10 labile blood products delivered at once (64%). Packed red blood cells are available with a median time delay of 10-15 minutes (Figure 3). For platelets, a median time between ordering and delivery of 15-20 minutes was reported (Figure 4). Discussion The data of our survey reveals wide variability in the logistics of perioperative transfusion and significant subjective influence of these logistic factors. The time to delivery of labile blood products was the most mentioned factor. To our knowledge, this is the first study to evaluate logistic factors with influence on transfusion practice. The principal limitation of our survey is the low response rate. In many situations, the transfusing physician has the consequences of a delayed or omitted transfusion directly in sight, while the consequences of unnecessary transfusions remain diffuse. Those subjective benefits of transfusion might lead to a risk-aversive behavior, as is known from economy and sociology 4. In combination with (perceived) long delivery times, this might be a contributing factor for transfusion incidence. The adaption of institutional processes therefore bear potential benefits for better adherence to transfusion guidelines. In conclusion, transfusion logistics show wide variation across different institutions and are a significant subjective contributor to the individual transfusion behaviour.

Blood transfusion incidence in primary Total Knee Arthroplasty of Unilateral vs Bilateral group with a high prevalence of low hemoglobin concentration: A Retrospective Observational Study

Background: Blood transfusion is one of the major concerns following Total Knee Arthroplasty. We assessed the incidence rate of blood transfusion (packed red cells) in our geographical group based on age, gender, preoperative Haemoglobin and following both unilateral and bilateral primary TKA done either in single-stage or sequentially after a week. Materials and Methods: This was a retrospective observational study that included 200 patients who underwent primary TKA unilateral, bilateral done in single-stage and sequential from June 2015 to May 2016. Two doses of parenteral Tranexamic acid and periarticular cocktail injection was given. Transfusion was indicated with postoperative Hgb below 8 g/dl associated with or without clinical signs of tissue hypoperfusion. Results: The study group was 200 patients with the age group of 50-81 years, of which 154 (77%) were female and 46 (23%) were male and had a mean preoperative Hgb level of 12.6 g/dl. 88 (44%) unilateral, 40 (20%) bilateral and 72 (36%) sequential TKA were performed and 7 (7.95%), 12 (30%) and 26 (36%) patients received blood transfusion respectively. Among the transfused 45 patients, 38 patients were bilateral group, of which 30 (66.6%) patients had a preoperative Hgb level of 10–12 g/dl, indicating a high incidence of transfusion in bilateral cases compared to unilateral and with preoperative Hgb levels of 10–12g/dl which was statistically significant with p-value &lt;0.05. Conclusion: In our study, age and gender were not the major factors for blood transfusion, but low preoperative Hgb levels and bilateral single stage and sequential TKA showed a significantly higher incidence of blood transfusion. Keywords: total knee arthroplasty, blood transfusion, preoperative Hgb

Effect of Granulocyte Colony-Stimulating Factor Combined with Erythropoietin on Chronic Granulocytic Leukemia with Anemia and Its Effect on Nutritional Status

Objective: To investigate the clinical effect of granulocyte colony-stimulating factor combined with erythropoietin on chronic granulocytic leukemia with anemia and its effect on nutritional status. Methods: 60 patients of chronic granulocytic leukemia of our hospital with anemia induced by maintenance chemotherapy were randomly divided into two groups. Patients in the control group received routine treatment, while patients in the observation group received basal treatment with granulocyte colony-stimulating factor and erythropoietin. The nutritional status before and after treatment as well as the immune function and the incidence of blood transfusion and adverse events were compared between the two groups. Results: There was no significant difference in hemoglobin, hematocrit, nutritional status and immune function between the two groups before treatment (P&gt;0.05). Those after treatment were significantly higher than that before treatment (P&lt;0.05). After treatment, the percentage of CD4* cells in the control group was significantly higher than that before treatment (P&lt;0.05), but the percentage of CD8* cells and CD47/CD8* cells did not change significantly (P&gt;0.05). After treatment, the concentrations of IgA, IgM and IgG in the observation group were significantly higher than those before treatment (P&lt;0.05), but only the concentrations of IgA and IgM in the control group were significantly higher than those in the observation group after treatment (P&lt;0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group. Conclusion: Granulocyte colony-stimulating factor combined with erythropoietin can effectively correct anemia, improve nutritional status and improve immune function in patients with chronic myelogenous leukemia.

Intravenous Tranexamic Acid is Associated With a Clinically Significant Reduction in Blood Loss in Craniosynostosis Surgery.

Blood loss is a potential cause of morbidity and mortality in craniosynostosis surgery. Recent reports have suggested that the use of tranexamic acid (TXA), an antifibrinolytic agent, mitigates this blood loss. A retrospective cohort study of patients undergoing craniosynostosis surgery at a tertiary craniofacial hospital in Sydney was undertaken. Primary outcomes were blood loss and transfusion requirements. Two groups were compared: those who received intravenous prophylactic TXA and those who underwent surgery without TXA. Statistical analysis was performed with Student t test and the Mann-Whitney U test for nonparametric results. We identified 206 patients who underwent craniosynostosis surgery over an 8 year period; 78 control patients and 128 patients that received TXA. Tranexamic acid was found to result in a weight-adjusted calculated blood loss mean difference of 9.6 ml/kg across all procedures (P = 0.0332 95% confidence interval 0.7734-18.4266). The actual blood loss reduction achieved with TXA was 6.7 ml/kg in spring cranioplasties, compared to 15.2 ml/kg in fronto-orbital remodeling procedures. There was a statistically and clinically significant reduction in postoperative transfusion incidence, with transfusions required in 27% of controls and 6% of TXA patients (P < 0.0001). The number needed to treat to prevent giving a unit of blood postoperatively was 4.8. There were no incidences of TXA-specific complications. This study found that TXA is a safe and effective method of decreasing blood loss and transfusion requirements in patients undergoing craniosynostosis surgery. The clinical benefit of TXA is particularly evident in the more invasive craniosynostosis surgeries.

A 20-cm cut umbilical cord milking may not benefit the preterm infants < 30 week's gestation: A randomized clinical trial

To evaluate whether a shorter length (20cm) of C-UCM has potential benefits, compared to immediate cord clamping (ICC), in very preterm babies. Inborn preterm infants less than 30 weeks of gestational age (GA) were randomly assigned to the 20-cm C-UMC and ICC groups. The primary outcome was the need for packed red blood cell (pRBC) transfusion before the 21st day of life. The secondary outcomes were short- and long-term outcomes related to premature birth. Seventy-six neonates were randomized to the two groups. GA were 27.2±1.8 and 27.5±1.7 weeks (p=0.389) and birth weights were 987±269 and 1023±313g (p=0.601) in the 20-cm C-UCM and ICC groups, respectively. There was no significant difference between the groups in terms of the need for pRBC transfusion before the 21st day of life (59.4% versus 71.8%, adjusted odds ratio [aOR] 0.311, 95% confidence interval [CI] 0.090-1.079). An increased prevalence of late-onset sepsis was observed in the 20-cm C-UCM group compared to the ICC group (21.6% versus 5.1%, aOR 5.434, 95% CI 1.033-23.580). The mortality rates were 13.5% and 2.6% in the 20-cm C-UCM and ICC groups, respectively (aOR 5.339, 95% CI 0.563-50.626). The neurodevelopmental outcomes at 2 years of corrected age between the groups were also not statistically significant. A 20-cm C-UCM showed no effect on reducing the incidence of pRBC transfusion in preterm babies with GA less than 30 weeks compared with ICC in this small-scale randomized controlled trial.

The combined effect of anti-D and non-D Rh antibodies in maternal alloimmunization

Objective:This study aims to investigate the distribution of antibodies that cause hemolytic disease of the fetus and newborn (HDFN) and compare the clinical outcomes of pregnancies affected by anti-D and anti-D combined with non-D Rh alloimmunization.Materials and Methods:We retrospectively searched and obtained the perinatal and neonatal data of patients with anti-D antibodies and anti-D combined with non-D Rh antibodies (anti-c, -C, -e, -E, and -Kell) from October 2015 to December 2018 at the University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital. Univariate and multiple logistic regression analyses and adjusted odds ratios with their confidence intervals were used to define independent risk factors for non-D antibody positive.Results:The severe fetal hydrops rate was significantly higher in the anti-D combined non-D group (3/25, 12%) than in the anti-D group (1/128, 0.08%, p<0.001). The intrauterine transfusion (IUT) requirement in the anti-D combined non-D group (16/25, 64%) tended to be significantly higher than that in the anti-D group (5/128, 7.46%, p<0.001). The incidence of neonatal exchange transfusion, top-up transfusion, and postnatal phototherapy frequency in the anti-D combined non-D group was significantly higher than in the anti-D group.Conclusion:Anti-D combined with another non-D Rh alloantibody resulted in significantly higher HDFN rates than the anti-D alloimmunized pregnancies. Also, anti-D in association with non-D Rh antibodies resulted in more severe HDFN requiring more invasive treatment procedures, including IUT, neonatal exchange transfusion, or top-up transfusion.

Development and validation of a novel predictive model and web calculator for evaluating transfusion risk after spinal fusion for spinal tuberculosis: a retrospective cohort study

ObjectivesThe incidence and adverse events of postoperative blood transfusion in spinal tuberculosis (TB) have attracted increasing attention. Our purpose was to develop a prediction model to evaluate blood transfusion risk after spinal fusion (SF) for spinal TB.MethodsNomogram and machine learning algorithms, support vector machine (SVM), decision tree (DT), multilayer perceptron (MLP), Naive Bayesian (NB), k-nearest neighbors (K-NN) and random forest (RF), were constructed to identified predictors of blood transfusion from all spinal TB cases treated by SF in our department between May 2010 and April 2020. The prediction performance of the models was evaluated by 10-fold cross-validation. We calculated the average AUC and the maximum AUC, then demonstrated the ROC curve with maximum AUC.ResultsThe collected cohort ultimately was consisted of 152 patients, where 56 required allogeneic blood transfusions. The predictors were surgical duration, preoperative Hb, preoperative ABL, preoperative MCHC, number of fused vertebrae, IBL, and anticoagulant history. We obtained the average AUC of nomogram (0.75), SVM (0.62), k-NM (0.65), DT (0.56), NB (0.74), MLP (0.56) and RF (0.72). An interactive web calculator based on this model has been provided (https://drwenleli.shinyapps.io/STTapp/).ConclusionsWe confirmed seven independent risk factors affecting blood transfusion and diagramed them with the nomogram and web calculator.

Renal outcomes of laparoscopic versus open surgery in patients with rectal cancer: a propensity score analysis

BackgroundA laparoscopic approach is widely used in abdominal surgery. Although several studies have compared surgical and oncological outcomes between laparoscopic surgery (LS) and open surgery (OS) in rectal cancer patients, there have been few studies on postoperative renal outcomes. MethodsWe conducted a retrospective cohort study involving 1,633 patients who underwent rectal cancer surgery between 2003 and 2017. Postoperative acute kidney injury (AKI) was diagnosed according to the serum creatinine criteria of the Kidney Disease: Improving Global Outcomes classification.ResultsAmong the 1,633 patients, 1,072 (65.6%) underwent LS. After matching propensity scores, 395 patients were included in each group. The incidence of postoperative AKI in the LS group was significantly lower than in the OS group (9.9% vs. 15.9%; p = 0.01). Operation time, estimated blood loss, and incidence of transfusion in the LS group were significantly lower than those in the OS group. Cox proportional hazard models revealed that LS was associated with decreased risk of postoperative AKI (hazard ratio [HR], 0.599; 95% confidence interval [CI], 0.402–0.893; p = 0.01) and postoperative transfusion was associated with increased risk of AKI (HR, 2.495; 95% CI, 1.529–4.072; p < 0.001). In the subgroup analysis, the incidence of postoperative AKI in patients with middle or high rectal cancer who underwent LS was much lower than in those who underwent OS (HR, 0.373; 95% CI, 0.197–0.705; p = 0.002). ConclusionThis study showed that LS may have a favorable effect on the development of postoperative AKI in patients with rectal cancer.

Trends and safety of robot-assisted partial nephrectomy during the initial 2-year period after government approval in Japan: A nationwide database study from 2016 to 2018.

To evaluate the trends and safety of robot-assisted partial nephrectomy during the initial 2-year period after government approval for this type of procedure in April 2016. This nationwide retrospective study included 3722 received robot-assisted partial nephrectomy cases carried out from April 2016 to March 2018 in 124 participating institutions. The institutions were divided into lower- and higher-volume institutions according to the median of 19 robot-assisted partial nephrectomy cases during the study period. Surgical outcomes between 616 cases from lower-volume institutions and 3106 cases from higher-volume institutions were compared using propensity score matching. During the study period, both the number of robot-assisted partial nephrectomy surgeries and the number of institutions in which the surgery was carried out steadily increased. Overall, the median anesthesia time was 217min, the median postoperative length of stay was 9days, and the proportion of blood transfusions, complications and readmissions were 0.8%, 5.1% and 1.0%, respectively. There were no significant differences in anesthesia time, incidence of blood transfusions, and complication rates between the lower-volume and higher-volume institutions. However, a slightly, but significantly, longer postoperative length of stay and a lower incidence of readmission were observed in lower-volume institutions both before and after propensity score matching. Robot-assisted partial nephrectomy has become widespread during the initial 2-year period after government approval with an acceptable safety profile, regardless of the institutional caseloads. This technique has become a standard of care for stage1 renal cancer patients in Japan.

Évolution et facteurs de risque de transfusion et d’accident thrombo-embolique après arthroplastie primaire et de révision de prothèses totales de hanche et de genou : analyse d’une base nationale sur 736061 cas

BackgroundOver the last years, new transfusion guidelines and pharmaceuticals have been introduced in primary and revision total hip and knee arthroplasty (P-THA, P-TKA, R-THA, R-TKA). In the US, a substantial decrease in transfusions has been observed in recent years. Little data exists on the subject in Europe. In this context we aimed to analyze: 1) Is there also a significant decrease in blood transfusion for these procedures in Germany? 2) Which patient and hospital related factors are associated with the risk of blood transfusion? 3) Is there a trend in complications, especially venous thromboembolism and stroke events that can be linked to tranexamic acid use? HypothesisThere is a significant trend in decreasing blood transfusions in hip and knee arthroplasty. MethodsUsing nationwide healthcare insurance data for inpatient hospital treatment, 736,061 cases treated between January 2011 and December 2017 were included (318,997 P-THAs, 43,780 R-THAs, 338,641 P-TKAs, 34,643 R-TKAs). Multivariable logistic regression was used to model the odds of transfusion as a function of the year of surgery. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated. ResultsIn each cohort the odds of transfusion decreased over time (2017 vs. 2011 (reference): P-THA: OR 0.42 (95%CI 0.39–0.45), P-TKA: OR 0.41 (95%CI 0.37–0.46), R-THA: OR 0.52 (95%CI 0.47–0.58), R-TKA: OR 0.53 (95%CI 0.46–0.61). Patient-related risk factors for blood transfusion included older age, female gender, lower Bodu Mass Index, comorbidities such as renal failure, cardiac arrhythmia, congestive heart failure, valvular disease, coagulopathy, depression, and antithrombotic medication prior to surgery. Venous thromboembolism or stroke events did not increase over the study period. DiscussionThe incidence of blood transfusions in primary and revision TKA and THA decreased over the study period. This may be due to new transfusion guidelines and the introduction of novel pharmaceuticals such as tranexamic acid. A further improved patient blood management and a focus on vulnerable patient groups might lead to a further future reduction of transfusions, especially in R-THA. Level of EvidenceIII; comparative observational Study.

Incidence, trends and risk factors for obstetric massive blood transfusion in China from 2012 to 2019: an observational study

ObjectivesThis study aims to use the high-quality national monitoring data from the China’s National Maternal Near Miss Surveillance System (NMNMSS) to ascertain the incidence, trends and risk factors of obstetric...

MDS-138: Management of Acute Hemolytic Events in Paroxysmal Nocturnal Hemoglobinuria Patients Taking Pegcetacoplan

Context: Acute hemolytic events occurred in completed paroxysmal nocturnal hemoglobinuria (PNH) studies during the pegcetacoplan clinical development program. As part of the long-term extension study, we aim to better understand how to manage acute hemolytic events through dose adjustments in patients treated with the C3 inhibitor pegcetacoplan, recently approved by the FDA. Objective: Establish the long-term safety and efficacy of pegcetacoplan dose adjustments in patients with PNH. Design: This is a multicenter, open-label, nonrandomized extension study (NCT03531255) in PNH patients treated with pegcetacoplan who have previously completed a pegcetacoplan study. Study participants who experience an acute hemolytic event will be offered the opportunity to receive either intensive subcutaneous (SC) or intravenous (IV) pegcetacoplan as an acute treatment. Patients must have lactate dehydrogenase (LDH) >2 times the upper limit of normal and the presence of at least one new or worsening sign or symptom of hemolysis (e.g., decrease in hemoglobin, hemoglobinuria, fatigue), warranting acute intervention in the opinion of the investigator. Interventions: In patients with a steady-state pegcetacoplan dose of 1080 mg SC twice weekly, a loading dose of 1080 mg IV once or 1080 mg SC every 24 hours for 3 doses, followed by an increase in the maintenance dose to 1080 mg SC every 3 days would be used. In patients at steady-state on a pegcetacoplan dose of 1080 mg SC every 3 days, a loading dose of 1080 mg IV once or 1080 mg SC every 24 hours for 3 doses, followed by an increase in the maintenance dose to 1080 mg SC 3 times weekly would be used. Main Outcome Measures: Main outcome measures include incidence and severity of treatment-emergent adverse events, thromboembolic events, hemoglobin level, LDH level, and red blood cell transfusions. Results: Results will be presented upon study completion, estimated in 2022.

Establishment and Verification of a Perioperative Blood Transfusion Model After Posterior Lumbar Interbody Fusion: A Retrospective Study Based on Data From a Local Hospital.

Objective: We aimed to analyze the related risk factors for blood transfusion and establish a blood transfusion risk model during the per-ioperative period of posterior lumbar interbody fusion (PLIF). It could provide a reference for clinical prevention and reduction of the risk of blood transfusion during the peri-operative period.Methods: We retrospectively analyzed 4,378 patients who underwent PLIF in our hospital. According to whether they were transfused blood or not, patients were divided into the non-blood transfusion group and the blood transfusion group. We collected variables of each patient, including age, sex, BMI, current medical history, past medical history, surgical indications, surgical information, and preoperative routine blood testing. We randomly divide the whole population into training group and test group according to the ratio of 4:1. We used the multivariate regression analyses get the independent predictors in the training set. The nomogram was established based on these independent predictors. Then, we used the AUC, calibration curve and DCA to evaluate the nomogram. Finally, we verified the performance of the nomogram in the validation set.Results: Three or more lumbar fusion segments, preoperative low hemoglobin, with hypertension, lower BMI, and elder people were risk factors for blood transfusion. For the training and validation sets, the AUCs of the nomogram were 0.881 (95% CI: 0.865–0.903) and 0.890 (95% CI: 0.773–0.905), respectively. The calibration curve shows that the nomogram is highly consistent with the actual observed results. The DCA shows that the nomogram has good clinical application value. The AUC of the nomogram is significantly larger than the AUCs of independent risk factors in the training and validation set.Conclusion: Three or more lumbar fusion segments, preoperative low hemoglobin, with hypertension, lower BMI, and elder people are associated with blood transfusion during the peri-operative period. Based on these factors, we established a blood transfusion nomogram and verified that it can be used to assess the risk of blood transfusion after PLIF. It could help clinicians to make clinical decisions and reduce the incidence of peri-operative blood transfusion.

Acute hypervolemic hemodilution combined with controlled hypotension to minimize blood loss during operations of spine fusion: remifentanil versus magnesium sulfate

BackgroundBlood loss is one of the major problems during operations of spine fusion. Several blood-conservative measures were applied to reduce the incidence of blood loss—among them, acute hypervolemic hemodilution (AHH) and controlled hypotension (CH). This study was designed to detect the effect of combination of AHH with CH induced by remifentanil versus magnesium sulfate on the volume of blood loss, allogeneic blood transfusion, hemodynamics, coagulation, and electrolytes during operations for spine fusion which are risky operations with high incidence of blood loss and blood transfusion. Sixty patients scheduled for posterior fusion of the spine were randomly allocated into three groups of 20 patients each (group I (AHH), group II (AHH combined with remifentanil-based CH), and group III (AHH combined with magnesium sulfate-based CH)). Estimated blood loss and total volume of packed red blood cells (PRBCS) transfused were recorded. Arterial blood pressure (ABP) and heart rate (HR) measures were recorded. Blood samples were obtained for the detection of hemoglobin (Hb) and hematocrit (HCT).ResultsEstimated blood loss, percentage blood loss, and intraoperative RBC transfusion units were significantly high in group I in relation to group II and group III (Table 2). Cardiac output was significantly higher in group I in relation to group II and group III at 10, 15, 30, 45, and 60 min after start of AHH. MBP and HR results were significantly high in group I in comparison with group II and group III at 30, 45, 60, and 90 min and 2 and 3 h after start of study drugs. CVP results were significantly high in group I in relation to group II and group III at 15, 30, 45, 60, and 90 min after start of AHH. PTT was significantly increased in the three study groups in comparison with baseline inside each group after AHH.ConclusionCombination of AHH with CH induced by remifentanil or magnesium sulfate was associated with reduction in estimated blood loss, and total volume of PRBCS transfused. There was no significant difference between hemodynamic parameters with the use of remifentanil or magnesium sulfate except that SBP, DBP, and MBP results were significantly high with magnesium sulfate at 15 min after drug infusion. There was significant increase in PT and PTT after AHH that was not reflected by significant blood oozing from the operative field, or by difficulty in hemostasis.

Prevalence of iron deficiency and red blood cell transfusions in surgical patients.

Background and ObjectivesWhile iron deficiency (ID) is the most common cause of anaemia, little is known about the prevalence and type of ID in preoperative surgical patients. The aims of the present study were to investigate the prevalence and types of ID in a large cohort of surgical patients, and how these are related to perioperative blood use after correction for confounders such as haemoglobin level.Materials and MethodsData were retrospectively extracted from electronic case records of all patients who underwent elective surgery between September 2016 and November 2017 (n = 2711). Iron parameters, haemoglobin and details of perioperative red cell transfusions were collected.ResultsOf 2711 patients, 618 (22.8%) were iron deficient (= transferrin saturation [TSAT] < 16%) preoperatively, 173 (6.4% of the cohort) had an absolute iron deficiency (AID; TSAT < 16% and ferritin < 30 μg/L) and 445 (16.4%) had functional/mixed ID (TSAT < 16% and ferritin ≥ 30 μg/L). Corrected for Hb level, iron‐deficient patients received significantly more red cell units than patients without ID (p = 0.026). AID was not associated with a significantly higher incidence of transfusions (7.5% of patients transfused; p = 0.12 after correction for Hb) than patients without ID, whereas patients with functional/mixed deficiency did receive significantly more transfusions (6.1%; p = 0.021) as compared to patients without ID (1.7%).ConclusionPreoperative ID, in particular the functional/mixed type, was associated with a higher risk of receiving perioperative red cell transfusions as compared to patients without ID. Adequately treating ID might, therefore, reduce the need for perioperative red cell transfusions.

Impact of Clopidogrel Stop Interval on Major Adverse Bleeding Events in Cardiac Surgery

BackgroundMajor societal guidelines recommend a 5-day stop interval before cardiac surgery for patients with acute coronary syndrome receiving clopidogrel. Yet, many such patients present with high acuity, generating surgeon inclination toward use of shorter stop intervals. Thus, this study aimed to determine the impact of the duration and timing of the interval of clopidogrel cessation on adverse bleeding events. MethodsPatients who underwent cardiac surgery between 2009 and 2016 at a tertiary-care centre were included in this retrospective cohort study. Multivariable logistic regression models adjusted for clopidogrel stop interval, age, urgency of procedure, and procedure type were used to quantify the effect of clinically relevant baseline demographic characteristics on incidence of massive transfusion as well as hemorrhagic complication outcomes. ResultsA total of 5748 patients underwent cardiac surgery. In this cohort, 1743 patients (30.3%) received clopidogrel preoperatively, and 884 (50.7%) of these patients discontinued clopidogrel 5 days before presenting to the operating room. The administration of clopidogrel 1-2 days before surgery (odds ratio 1.97; 95% confidence interval: 1.18 to 3.29) was an independent predictor for massive transfusions and hemorrhagic complications (odds ratio 1.85; 95% confidence interval: 1.01 to 3.37). The 3-4 day group did not have an increased risk of major bleeding complications. The risk for both massive transfusions and hemorrhagic complications also increased with the urgency and complexity of surgery. ConclusionA clopidogrel stop interval of 3-4 days preoperatively was not associated with an increased risk for major bleeding complications.

Impact of Chronic Lymphocytic Leukemia on Outcomes and Readmissions After Cardiac Operations

BackgroundOutcomes of cardiac operations in patients with chronic lymphocytic leukemia (CLL) have been examined in limited series. The present study aimed to assess the impact of CLL on clinical outcomes and resource utilization after cardiac operations in a nationally representative cohort. MethodsAll adult patients undergoing elective coronary artery bypass grafting, valve repair, or valve replacement were identified utilizing the 2010 to 2017 Nationwide Readmissions Database. Patients were stratified by history of CLL. Incidence of in-hospital mortality, perioperative complications, blood transfusions, and readmission within 90 days were examined. We subsequently performed 3:1 nearest neighbor matching between CLL and non-CLL patients for all primary and secondary outcomes of interest. ResultsOf an estimated 1,250,882 patients undergoing cardiac operations, 0.23% had a diagnosis of CLL. Among 11,237 propensity matched patients, those with CLL had similar rates of in-hospital mortality (3.8% vs 2.6%; P = .08) and perioperative complications (33.4% vs 33.6%; P = .92) compared with their non-CLL counterparts. Although the incidence of infection was comparable (8.5% vs 9.4%; P = .38), CLL patients did require blood transfusions more frequently (33.7% vs 28.4%; P = .003) than others. Furthermore, CLL patients were more likely to be readmitted with respiratory etiologies contributing significantly to rehospitalization. ConclusionsPatients with CLL generally have similar outcomes after cardiac operations but may more commonly require blood transfusion. Blood-conserving interventions may be considered in this at-risk population to improve outcomes. Furthermore, interventions to mitigate readmission deserve further exploration.

Withdrawal: “Effect of single preoperative ferric carboxymaltose injection on perioperative transfusion in patients undergoing total hip arthroplasty: A retrospective analysis” Hyun‐Jung Shin, Hun‐Taek Lee, Hyo‐Seok Na

Despite ongoing efforts to reduce perioperative transfusion, there is still high chance of transfusion in total hip arthroplasty (THA). We investigated the requirement of red blood cell (RBC) transfusion according to the administration of single preoperative ferric carboxymaltose (FCM) in patients undergoing THA. This retrospective study included the patients undergoing unilateral THA from November 2014 to July 2018, who received FCM (FCM group) at 2 weeks prior to the surgery or who did not (Non-FCM group). A propensity-score matching method was used to balance the two groups for analysis. The primary endpoint was to evaluate if there was any difference in requirement of RBC transfusion between the two groups. This study included 1,032 cases of THA for final analysis, and the cases were divided into the FCM group (n = 568) and Non-FCM group (n = 464). Propensity matching produced 389 patients in each group. In the FCM group, the amount (0.4 vs. 0.6 units) and incidence (21% vs. 31%) of RBC transfusion was significantly lower compared with the Non-FCM group (P = 0.035 and P = 0.003, respectively). Single preoperative FCM administration without any other supplementation could reduce the requirement of RBC transfusion in patients undergoing THA. This study suggests that single preoperative FCM administration can be recommended as a simple and easy patient blood management strategy in addition to other methods for reducing the RBC transfusion in THA.