Increased Blood Transfusion Requirements Research Articles

Concomitant severe traumatic brain injury is not associated with increased red blood cell transfusion volumes in patients with pelvic fractures: A retrospective observational study

IntroductionTraumatic brain injury (TBI)-associated coagulopathy significantly influences survival outcomes in patients with multiple injuries. Severe TBI can potentially affect systemic hemostasis due to coagulopathy; however, there is limited evidence regarding whether the risk of hemorrhage increases in patients with pelvic fractures complicated with TBI. Therefore, through multivariable analysis, we aimed to examine the association between severe TBI and increased blood transfusion requirements in patients with pelvic fractures. Materials and methodsThis retrospective observational study was conducted at a tertiary care facility in Japan. Patients aged 16 years or older with pelvic fractures who were admitted to our intensive care unit between April 2014 and December 2021 were included in the analysis. The patients were categorized into no to mild and severe TBI groups according to whether the Head Abbreviated Injury Scale (AIS) score was 3 or higher. The primary outcome was the number of red blood cell (RBC) units transfused within 24 h after arrival at the hospital. The primary outcome was analyzed using univariable and multivariable linear regression analyses. The covariates used for the multivariable linear regression analysis were age, sex, antithrombotic therapy, mechanism of injury, Pelvic AIS score, and extravasation on contrast-enhanced computed tomography on admission. ResultsWe identified 315 eligible patients (221 and 94 in the no to mild and severe TBI groups, respectively). In the univariable analysis, the RBC transfusion volume within 24 h after arrival was significantly higher in the severe TBI group than in the no to mild TBI group (2.53-unit increase; 95 % confidence interval [CI]: 0.46–4.61). However, in the multivariable analysis, no statistically significant association was detected between severe TBI and the RBC transfusion volume within 24 h after arrival at the hospital (0.87-unit increase; 95 % CI: −1.11–2.85). ConclusionsConcomitant severe TBI was not associated with increased RBC transfusion volumes in patients with pelvic fractures on multivariable analysis.

Incidence of admission ionised hypocalcaemia in paediatric major trauma: protocol for a systematic review and meta-analysis

IntroductionHypocalcaemia forms part of the ‘diamond of death’ in major trauma, alongside hypothermia, acidosis and coagulopathy. In adults, admission hypocalcaemia prior to transfusion is associated with increased mortality, increased blood...

The nature and timing of coagulation dysfunction in a cohort of trauma patients in the Australian pre-hospital setting

BackgroundAcute Traumatic Coagulopathy (ATC) is a complex pathological process that is associated with patient mortality and increased blood transfusion requirements. It is evident on hospital arrival, but there is a paucity of information about the nature of ATC and the characteristics of patients that develop ATC in the pre-hospital setting. The objective of this study was to describe the nature and timing of coagulation dysfunction in a cohort of injured patients and to report on patient and pre-hospital factors associated with the development of ATC in the field. MethodsThis was a prospective observational study of a convenience sample of trauma patients. Patients had blood taken during the pre-hospital phase of care and evaluated for derangements in Conventional Coagulation Assays (CCA) and Rotational Thromboelastometry (ROTEM). Associations between coagulation derangement and pre-hospital factors and patient outcomes were evaluated. ResultsA total of 216 patients who had either a complete CCA or ROTEM were included in the analysis. One hundred and eighty (83 %) of patients were male, with a median injury severity score of 17 [interquartile range (IQR) 10–27] and median age of 34 years [IQR = 25.0–52.0]. Hypofibrinogenemia was the predominant abnormality seen, (CCA Hypofibrinogenemia: 51/193, 26 %; ROTEM hypofibrinogenemia: 65/204, 32 %). Increased CCA derangement, the presence of ROTEM coagulopathy, worsening INR, worsening FibTEM and decreasing fibrinogen concentration, were all associated with both mortality and early massive transfusion. ConclusionClinically significant, multifaceted coagulopathy develops early in the clinical course, with hypofibrinogenemia being the predominant coagulopathy. In keeping with the ED literature, pre-hospital coagulation dysfunction was associated with mortality and early massive transfusion. Further work is required to identify strategies to identify and guide the pre-hospital management of the coagulation dysfunction seen in trauma.

Hemoglobin Drop and the Need for Transfusion in Primary Knee Arthroplasty.

BackgroundBlood loss is still a serious adverse effect of total knee replacement (TKR), resulting in Hemoglobin drop and a higher need for blood transfusions. Multiple modalities are used to reduce intra-operative blood loss and hemoglobin drop for this procedure, such as placing a drain intraoperatively and Tranexamic acid (TXA) administration. This study aimed to investigate factors associated with hemoglobin loss and blood transfusion increased demand.Patients and methodsWe retrospectively looked at 223 patients who underwent primary unilateral or staged bilateral knee arthroplasty by a single surgeon from January 2013 until April 2018 in Salmaniya Medical Complex (SMC), Bahrain. We looked into patients' demographics such as age, gender, preoperative hemoglobin and hematocrit, postoperative hemoglobin and hematocrit, drain insertion intra-operatively, and the administration of Intravenous tranexamic acid intra-operatively. Eighty-three patients had a drain inserted intra-operatively, and sixty-nine patients received intra-venous Tranexamic acid during the procedure.ResultsOut of 223 patients, 152 patients were included after applying exclusion criteria. The mean hemoglobin (Hb) loss in patients who had a drain inserted was 2.186 g/dL, while patients who received tranexamic acid had a mean of 1.609 g/dL. Multivariable regression analysis revealed that increased blood transfusion requirements postoperatively were significantly associated with reduced pre-operative Hemoglobin levels (p-value .004). Univariable analysis of the hemoglobin drop showed that the use of TXA would reduce Hb loss while a drain would increase Hb drop (p-value .003 and .002, respectively). Moreover, univariable analysis of blood transfusion requirements showed reduced pre-operative Hb, and placing a drain would increase blood transfusion demand (p-value <.001, .044 respectively), while administration of tranexamic acid would reduce blood transfusion demand (p-value 0.05).ConclusionReducing the need for blood transfusion following primary total knee arthroplasty can be achieved by maintaining preoperative hemoglobin levels, administering tranexamic acid intra-operatively, and avoiding placing an intra-articular drain.

Platelet dysfunction after trauma: From mechanisms to targeted treatment.

Platelet dysfunction after trauma: From mechanisms to targeted treatment.

Vascular access complications in patients undergoing veno-arterial ecmo and their impact on survival in patients with refractory cardiogenic shock: A retrospective 8-year study.

Introduction:Veno-arterial extracorporeal membrane oxygenation (ECMO) is well-recognized treatment modality for patients with refractory cardiogenic shock. Uncomplicated cannulation is a prerequisite and basis for achieving a successful outcome in ECMO. Vascular access is obtained either by surgical cut-down. Common vascular access complications are bleeding and limb ischemia.Objective:To evaluate cannulation technique, the incidence of vascular complications, and their impact on the outcome.Methods:A retrospective data analysis conducted on 95 patients receiving ECMO from 2013 to 2020 was done. The patients were divided into two groups: no vascular access complications (non-VAC group) and vascular access complications (VAC group). The groups were compared related to the hospital and ICU stays and blood transfusion.Results:The patients in both groups were demographically and clinically comparable. The Non-VAC group had 75 patients, whereas the VAC group had a total of 20 patients. The main complication observed in the VAC group was bleeding from the cannulation site which required more blood transfusion than the non-VAC group (6.8 ± 1.02 vs 4.2 ± 1.26). Limb ischemia was another complication seen in the VAC group (4.2%, n = 4). Two patients had delayed bleeding after decannulation. The overall average length of stay in the hospital was statistically similar in both the groups (22 days in the VAC group vs 18 days in the non-VAC group), but the average ICU stay was more in the VAC group compared to the non-VAC group (18 days vs 12.06 days).Conclusion:Bleeding and limb ischemia are the important vascular access site complications, which increase blood transfusion requirements, ICU stay, and overall hospital stay.

Re-visiting Drain Use in Operative Liver Trauma: A Retrospective Analysis

Despite the liver being one of the most frequently injured abdominal organs in trauma patients, clinical management strategies differ between trauma surgeons. Few studies have critically evaluated current practice patterns in the operative management of liver trauma. Historical studies recommended against the use of drains but there has not been a modern investigation of this issue. The objective of this study was to analyze outcomes associated with intra-operative drain use for liver trauma. A retrospective chart review of all adult trauma patients presenting to a Level I trauma center from 2012 to 2018 was performed. Patients who underwent operative management of liver trauma were divided into groups based on whether an intra-abdominal drain was utilized and differences in outcomes between the groups were analyzed. The primary endpoint evaluated was post-operative intra-abdominal abscesses. Univariate and multivariate analyses were performed. 184 patients with operative management of liver trauma were included in the study. Closed suction drains were utilized in 26.1% of post-operative patients. Rate of intra-abdominal abscesses was significantly higher in the drain group (35.4% versus 8.8%, P < 0.001). Drains were more commonly used in patients receiving more units of PRBCs (median, 9 units [IQR 4-20] versus median 5.5 units, [IQR 2-14], P=0.03). Drain use was found to be an independent risk factor for post-operative intra-abdominal abscess on multivariate analysis (OR 4.9, 95% CI 1.7-14, P=0.003). The results of this study support previous conclusions that drain placement for operative liver trauma is associated with increased risks of infectious complications. Drains were used in patients with more severe liver injury, intra-operative bile leaks, penetrating trauma, and increased blood transfusion requirements. Future studies should focus on the development of specific guidelines for the use of drains in liver trauma.

Preoperative ferritin and hemoglobin levels are lower in patients with a history of COVID-19 but blood loss and transfusion requirements are not increased.

IntroductionA history of COVID-19 (Coronavirus Disease 2019), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may have an impact on hemoglobin and ferritin levels predisposing patients to increased blood transfusion requirements following total joint arthroplasty (TJA). The current study compares ferritin levels, hemoglobin levels, and transfusion rates between SARS-CoV-2 IgG positive and SARS-CoV-2 IgG negative TJA patients.Materials and methodsPreoperative ferritin levels, pre- and postoperative hemoglobin levels, postoperative change in hemoglobin, and transfusion rates of 385 consecutive SARS-CoV-2 IgG positive patients undergoing TJA were compared to those of 5156 consecutive SARS-CoV-2 IgG negative patients undergoing TJA.ResultsPreoperative hemoglobin levels were significantly lower in SARS-CoV-2 IgG positive patients [13.3 g/dL (range 8.9–17.7 g/dL)] compared to 13.5 g/dl (7.3–18.3 g/dL; p value 0.03). Ferritin levels were significantly lower in SARS-CoV-2 IgG positive patients (mean of 106.1 ng/ml (2.1–871.3.3 ng/ml) vs. 123.7 ng/ml (1.4–1985 ng/ml) (p value 0.02)). Hemoglobin on postoperative day (POD) one, after four–six weeks, and transfusion rates did not differ between the two groups.ConclusionAlthough preoperative hemoglobin and ferritin levels are lower in SARS-CoV2 IgG positive patients, there was no difference in hemoglobin on POD one, recovery of hemoglobin levels at four—six weeks postoperatively, and transfusion rates after surgery. Routine ferritin testing prior to TJA is not recommended in SARS-CoV-2 IgG positive patients.

Hypocalcemia in trauma patients: A systematic review.

During hemorrhagic shock and subsequent resuscitation, pathways reliant upon calcium such as platelet function, intrinsic and extrinsic hemostasis, and cardiac contractility are disrupted. The objective of this systematic review was to examine current literature for associations between pretransfusion, admission ionized hypocalcemia, and composite outcomes including mortality, blood transfusion requirements, and coagulopathy in adult trauma patients. This review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. We searched Ovid MEDLINE and grey literature from database inception till May 3, 2020. Case series and reports were excluded. Reference lists of appraised studies were also screened for articles that the aforementioned databases might not have captured. The Newcastle-Ottawa Scale was used to assess study quality. A total of 585 abstracts were screened through database searching and alternative sources. Six unique full-text studies were reviewed, of which three were excluded. Admission ionized hypocalcemia was present in up to 56.2% of the population in studies included in this review. Admission ionized hypocalcemia was also associated with increased mortality in all three studies, with increased blood transfusion requirements in two studies, and with coagulopathy in one study. Hypocalcemia is a common finding in shocked trauma patients. While an association between admission ionized hypocalcemia and mortality, blood transfusion requirements, and coagulopathy has been identified, further prospective trials are essential to corroborating this association. Systematic review, level III.

A prehabilitation protocol to reduce blood transfusion requirement in head and neck microvascular reconstructive surgery

Introduction The surgical management of head and neck tumours and osteonecrosis of the mandible, often involves reconstructive surgery with free tissue transfer. There is evidence that blood transfusion increases rates of, cancer recurrence, treatment associated morbidity and prolonged hospital stay, with additional cost. This project was designed to identify the risk factors associated with increased blood transfusion requirement, and to develop a prehabilitation protocol to reduce blood transfusion requirement.

Blood loss management in major elective orthopaedic surgery

Blood loss is anticipated with all surgical procedures. Within the field of elective orthopaedic surgery it is especially important to reduce bleeding to maintain a patient's haemodynamic balance and ensure a clear surgical field. Complex reconstructive arthroplasty and spinal procedures can be complicated by significant intraoperative blood loss (IBL) and result in the need for allogenic blood transfusion. Patients with higher rates of IBL have increased blood transfusion requirements, resulting in a higher risk of mortality and significant postoperative morbidity. The aim of this review is to outline strategies to manage IBL for both paediatric and adult patients undergoing major elective orthopaedic surgery, and to evaluate the available evidence regarding their efficacy in managing IBL and reducing the need for perioperative allogenic transfusion.

44 Inhalation Injury Does Not Increase Blood Transfusion Requirements Following Burn Injury in Adults

Patients with major burns receive numerous red blood cell (RBC) transfusions for many indications, but it is not known whether an accompanying inhalation injury (INHI) influences the amount of blood transfused. The purpose of this study was to examine the effect of INHI on RBC transfusion in burned adults. This was a secondary analysis of a multi-center prospective randomized controlled trial that compared a liberal and restrictive blood transfusion threshold in adults with burns ≥ 20% TBSA. We compared 25 response variables between patients with and without INHI but here focus on the total number of RBC transfusions per patient (nRBC), the number of RBC transfusions per day (RBC/day), and the number of RBC transfusions/%TBSA burn (RBC/%). Generalized estimating equations (GEE) were used to account for clustering by facility. P values for response variable tests were adjusted for multiple comparisons. Multiple regression with GEE was used to identify variables that determined RBC/day. Values are shown as mean ± SD or median [25th,75th Q] as appropriate. Of 345 patients (age 42.9 +/- 16.8 years, %TBSA burn 38.0 +/- 17.6, 20.9% female, and admission APACHE 18.4 +/- 8.1) there were 78 (23%) with INHI. The table compares patients with and without INHI. The regression found that %TBSA burn (p<0.001), age (p=0.004), and requiring at least one day of mechanical ventilation(MV) (p < 0.0001) were significant determinants of RBC/day whereas INHI (p=0.251), and presence of at least one blood stream infection (p=0.107) were not. While patients with INHI tended to get more blood transfusions, this appears to have been determined by burn extent and requiring MV rather than the INHI itself. Presence of an INHI does not independently increase the need for RBC transfusions following a major burn injury. Table a P-values were not adjusted for multiple testing. Table a P-values were not adjusted for multiple testing.

A Systematic Review and Meta-Analysis Comparing Liver Resection with the Rf-Based Device Habib™-4X with the Clamp-Crush Technique.

Liver cancer is the sixth most common cancer and third most common cause of cancer-related mortality. Presently, indications for liver resections for liver cancers are widening, but the response is varied owing to the multitude of factors including excess intraoperative bleeding, increased blood transfusion requirement, post-hepatectomy liver failure and morbidity. The advent of the radiofrequency energy-based bipolar device Habib™-4X has made bloodless hepatic resection possible. The radiofrequency-generated coagulative necrosis on normal liver parenchyma provides a firm underpinning for the bloodless liver resection. This meta-analysis was undertaken to analyse the available data on the clinical effectiveness or outcomes of liver resection with Habib™-4X in comparison to the clamp-crush technique. The RF-assisted device Habib™-4X is considered a safe and feasible modality for liver resection compared to the clamp-crush technique owing to the multitude of benefits and mounting clinical evidence supporting its role as a superior liver resection device. The most intriguing advantage of the RF-device is its ability to induce systemic and local immunomodulatory changes that further expand the boundaries of survival outcomes following liver resection.

Ushering a New Era in the Management of Hepatitis C in Children with Hematological Disorders.

Transfusion-transmitted hepatitis C is a major concern among thalassemia patients. Our aim isto estimate the prevalence of Hepatitis C infection among thalassemia patients and to assess the treatment response, adverse effects of Peg-interferon based regimen and the new direct-acting antiviral drugs. Patients with thalassemia receiving regular blood transfusions with positive anti HCV antibodies during a period from January 2012 to June 2017 were analyzed. Serial HCV viral load and genotype and liver function tests were performed. Peg interferon and Ribavirin were used in patients diagnosed before January 2016 and patients diagnosed after January 2016 were started on the combination of Ledipasvir/Sofosbuvir. Thirty-two patients aged between 2 and 28years were analyzed. Genotype 1 was the predominant type. Twenty-one patients were initiated on Peg Interferon with Ribavirin, and 14 achieved sustained virological response. All of them had increased blood transfusion requirements with significant compliance issues. Alleleven patients started on Ledipasvir and Sofosbuvir including 4 undergoing hematopoietic stem cell transplantation and 7 interferon failures showed sustained viral clearance with good compliance. Ledipasvir/Sofosbuvir combination can be safelyused inthalassemia patients and in young children. The cost of therapy is less compared to peg interferon based regimen with good compliance and superior efficacy.

A Clinical Study on the Initial Assessment of Arterial Lactate and Base Deficit as Predictors of Outcome in Trauma Patients.

Background:Trauma is a leading cause of mortality in India. Outcomes can be improved by early recognition of hemorrhagic shock and expedited management. At present, we rely on traditional vital signs, which are not sensitive measures. Point of care biochemical markers have been emerging as prognostic markers in trauma, but have not been studied in Indian setting.Aims:This study aims to study the association between arterial lactate and base deficit (BD) at emergency department (ED) admission and 24 h outcome in trauma patients at risk of hemodynamic compromise.Materials and Methods:This was a prospective observational study on 100 trauma patients at risk of hemodynamic compromise in tertiary care center ED. Arterial blood gas analysis at admission and 24 h outcomes were noted and statistically analyzed.Results:Arterial lactate ≥4 mmol/L (sensitivity 100% and specificity 85.9%), BD ≥12 mEq/L (sensitivity 87.5% and specificity 82.6%) had more sensitivity than vital signs for predicting 24 h mortality. Higher lactate and BD were associated with increased blood transfusion requirement. Best cutoff values for predicting transfusion were lactate ≥2.9 mmol/L (sensitivity 65.2% and specificity 90.7%), BD ≥8 mEq/L (sensitivity 78.3% and specificity 75.9%). BD-based classification was comparable to ATLS classification in predicting mortality and determining transfusion requirements. Patients with higher arterial lactate and BD were found to have higher 24 h Intensive Care Unit (ICU) admission.Conclusion:Emergency admission arterial lactate and Base Deficit are useful predictors of mortality, need for blood transfusion and ICU admission at 24 h. It can be used to triage, identify shock early, assess transfusion requirement, and prognosticate trauma patients.

Increased Blood Transfusion Requirements with Pharmacologic Venous Thromboembolism Prophylaxis During IBD Exacerbation: 2016 ACG Category Award (IBD)

Introduction: In-patients with an inflammatory bowel disease (IBD) exacerbation are at increased risk for venous thromboembolism (VTE). Guidelines recommend pharmacologic VTE prophylaxis (PVTEP) with anticoagulants. Guideline compliance is compromised by fear that PVTEP may worsen bleeding or anemia, and by limited observational data. Our goal was to define the bleeding risks of PVTEP of IBD in-patients. Methods: We conducted a retrospective chart review of 4 hospitals of the Northshore-LIJ Health System from 01/2011 and 06/2015. Those admitted with IBD as their primary diagnosis were included, as were those with bleeding, abdominal pain, or diarrhea as the primary diagnosis and IBD as a secondary diagnosis. Demographic data, IBD type Crohn's disease (CD) or Ulcerative Colitis (UC), admission hemoglobin (Hgb), and use of anti-platelet therapy were recorded. Inpatient use of warfarin, enoxaparin, heparin, or xarelto qualified as PVTEP. Severe disease activity was defined by any inpatient use of corticosteroid or biologic therapy. Our primary outcome was packed red blood cell (PRBC) transfusion events, used as a surrogate marker for bleeding. Separate generalized linear mixed models for binary clustered data were used to examine the probability of transfusion related to PVTEP. Results: 717 patients, (49.5% UC, 53.4% female), met inclusion criteria totaling 891 admissions. Overall 60% of admissions involved PVTEP, and 46.5% of admissions met criteria for severe disease activity. The unadjusted risk of any PRBC transfusion with severe disease was greater with PVTEP vs. no PVTEP, 18.6% vs. 11.2%, OR 1.82 (95% CI 1.04-3.17), but not for non-severe disease, 7.4% vs. 9.42%, OR 0.77 (95% CI 0.38-1.54).In the multivariable model, the adjusted risk of transfusion was increased by PVTEP, OR 2.80 (95% CI 1.61-4.88, p < 0.0003), severe disease activity, OR 2.63 (95% CI 1.57-4.41, p < 0.0002), decreased admission Hgb, OR 1.96 (95% CI 1.72-2.27, p < 0.0001), and anti-platelet therapy OR 2.36 (95% CI 1.23-4.52, p < 0.0098) but not disease type (CD vs UC), OR 0.78 (95%CI 0.46-1.30). Conclusion: In a large inpatient IBD population PVTEP increased transfusion requirement, especially among those with severe IBD activity. While bleeding and transfusion are not desirable outcomes, the aim of PVTEP is to prevent the morbidity and mortality of VTE in this high risk population. Our data provides an important guide to inform patient management, as is available for other therapies used for active IBD.

Blood transfusion: In the air tonight?

The use of prehospital blood transfusion (PBT) in air medical transport has become more widespread. However, the effect of PBT remains unknown. The aim of this study was to examine the impact of PBT on 24-hour and overall in-hospital mortality. This is a retrospective cohort study of all trauma patients carried by air medical transport from the scene to a Level I trauma center from 2007 to 2013. We excluded patients who died on the helipad or in the emergency department. Primary outcomes measured were 24-hour and overall in-hospital mortality. Multivariable logistic regressions using all available patient data or the propensity score (for receiving PBT)-matched patient data were performed to study the effect of PBT on these outcomes. Of the 5,581 patients included in the study, 231 (4%) received PBT. Multivariable regression analyses did not show evidence of PBT effect on 24-hour in-hospital mortality (odds ratio [OR], 1.22; 95% confidence interval [CI], 0.61-2.44) and on overall in-hospital mortality (OR, 1.20; 95% CI, 0.55-1.79). In addition, using 1:1 propensity score-matched data, the analysis did not show evidence of PBT effect on 24-hour in-hospital mortality (OR, 1.04; 95% CI, 0.54-1.98) and on overall in-hospital mortality (OR, 1.05; 95% CI, 0.56-1.96). Factors associated with increased 24-hour mortality were advanced age, penetrating injury, increased blood transfusion requirement in the first 24 hours, and decreased Glasgow Coma Scale (GCS) score (p < 0.05). These factors were also associated with overall mortality, in addition to increased Injury Severity Score (ISS) (p < 0.05). This is the largest study to date of trauma patients who received PBT and were transported from the scene by air medical transport. Our results show no effect of PBT on 24-hour and overall in-hospital mortality. Previous studies also suggest no benefit of PBT, which is counterintuitive to damage-control resuscitation. Prospective data on PBT are needed to assess risk, cost, and benefit. Therapeutic study, level III.

The Relationship Between Preoperative Hemoglobin Concentration, Use of Hospital Resources, and Outcomes in Cardiac Surgery.

Preoperative anemia is an established risk factor associated with adverse perioperative outcomes after cardiac surgery. However, limited information exists regarding the relationship between preoperative hemoglobin concentration and outcomes. The aim of this study was to investigate how outcomes are affected by preoperative hemoglobin concentration in a cohort of patients undergoing cardiac surgery. A retrospective, observational cohort study. A single-center tertiary referral hospital. The study comprised 1,972 adult patients undergoing elective and nonelective cardiac surgery. The independent relationship of preoperative hemoglobin concentration was explored on blood transfusion rates, return to the operating room for bleeding and/or cardiac tamponade, postoperative intensive care unit (ICU) and in-hospital length of stay, and mortality. The overall prevalence of anemia was 32% (629/1,972 patients). For every 1-unit increase in hemoglobin (g/dL), blood transfusion requirements were reduced by 11%, 8%, and 3% for red blood cell units, platelet pools, and fresh frozen plasma units, respectively (adjusted incident rate ratio 0.89 [95% CI 0.87-0.91], 0.92 [0.88-0.97], and 0.97 [0.96-0.99]). For each 1-unit increase in hemoglobin (g/dL), the probability (over time) of discharge from the ICU and hospital increased (adjusted hazard ratio estimates 1.04 [1.00-1.08] and 1.12 [1.12-1.16], respectively). A lower preoperative hemoglobin concentration resulted in increased use of hospital resources after cardiac surgery. Each g/dL unit fall in preoperative hemoglobin concentration resulted in increased blood transfusion requirements and increased postoperative ICU and hospital length of stay.

Abdominal compartment syndrome in trauma patients: New insights for predicting outcomes.

Context:Abdominal compartment syndrome (ACS) is associated with high morbidity and mortality among trauma patients. Several clinical and laboratory findings have been suggested as markers for ACS, and these may point to different types of ACS and complications.Aims:This study aims to identify the strength of association of clinical and laboratory variables with specific adverse outcomes in trauma patients with ACS.Settings and Design:A 5-year retrospective chart review was conducted at three Level I Trauma Centers in the City of Chicago, IL, USA.Subjects and Methods:A complete set of demographic, pre-, intra- and post-operative variables were collected from 28 patient charts.Statistical Analysis:Pearson's correlation coefficient was used to determine the strength of association between 29 studied variables and eight end outcomes.Results:Thirty-day mortality was associated strongly with the finding of an initial intra-abdominal pressure >20 mmHg and moderately with blunt injury mechanism. A lactic acid >5 mmol/L on admission was moderately associated with increased blood transfusion requirements and with acute renal failure during the hospitalization. Developing ACS within 48 h of admission was moderately associated with increased length of stay in the Intensive Care Unit (ICU), more ventilator days, and longer hospital stay. Initial operative intervention lasting more than 2 h was moderately associated with risk of developing multi-organ failure. Hemoglobin level <10 g/dL on admission, ongoing mechanical ventilation, and ICU stay >7 days were moderately associated with a disposition to long-term support facility.Conclusions:Clinical and lab variables can predict specific adverse outcomes in trauma patients with ACS. These findings may be used to guide patient management, improve resource utilization, and build capacity within trauma centers.

The use of clamped drainage to reduce blood loss in total hip arthroplasty.

BackgroundDrainage is a routine practice used to reduce hematoma and blood loss following total hip arthroplasty. The aim of this study was to assess the effect of clamped drainage on blood loss and wound healing after total hip arthroplasty.MethodsA prospective cohort of 44 patients with hip osteoarthritis or femur head necrosis undergoing total hip arthroplasty was randomized equally into two groups: 6-h postoperative clamped or non-clamped suction tube drainage. Body mass index, gender distribution, preoperative hemoglobin, hip pathology, and affected side were comparable between the two groups. Blood loss, hemoglobin levels, and wound healing complications were recorded and compared between groups.ResultsThe drainage blood loss and calculated blood loss volumes were higher for the non-clamped group. About 100 mL more blood loss was noticed in the non-clamped group. There was no significant difference in adverse events or need for transfusion.ConclusionsThe present study showed a statistically significant reduction in postoperative drainage amount between clamped and unclamped drainage groups, but this difference was not large enough to warrant increased blood transfusion requirements in patients with unclamped drainage. Further studies are essential to define the critical period of clamping that is compatible with the dual objectives of reduced blood loss and lack of wound complications from hematoma.