Indications For Red Cell Transfusion Research Articles

Perioperative transfusion of red cell products in patients operated at general surgical units of National Hospital of Sri Lanka

Indications for red cell transfusion among general surgical patients have changed over time. Despite a scarcity in evidence, many international guidelines advocate a restrictive transfusion protocol.Objectives: To describe the red cell transfusion practices including transfusion thresholds in general surgical wards of a tertiary hospital in Sri Lanka.Methods: A descriptive cross-sectional study was done in all general surgical units of the National Hospital of Sri Lanka, Colombo. All patients transfused with red cell products for a 3-month period from 1/5/2017-1/8/2017 were included in the study. Indications for transfusion, haemoglobin at transfusion and the number of units transfused was the primary data recorded.Results: A total of 196 patients were included in the study. Most transfusions 79.08% (n=155) were for elective reasons. Most elective transfusions were to facilitate chronic extremity wound healing (52.2%, n=81). Most emergency transfusions were for intraoperative bleeding (31.7%, n=13). The majority (73.5%, n=114) of elective transfusions occurred at a Hb of 7-10 g/dL. The mean number of RBC units transfused in elective circumstances for a Hb of 7-10 g/dL was 1.59. A pre-transfusion blood picture was not available in over 85% (n=132) of elective transfusions. Only a single febrile non-haemolytic transfusion reaction was reported.Conclusions: The study revealed substantial divergence of red cell transfusion thresholds in perioperative practice when compared with international guidelines, nonadherence to rational practice such as obtaining a blood picture prior to elective transfusion and therefore the need to formulate local guidelines. It also highlighted the transfusion burden of diabetic foot disease.

Diagnosis, management and prevention of Pediatric Acute Hemolytic Anemia: Egyptian adapted evidence-based clinical practice guidelines

BackgroundAcute hemolytic anemia (AHA) is a common emergency in pediatric emergency departments, hence the need to adapt pre-existing high-quality practice guidelines for the diagnosis, management, and prevention of AHA to be available for national use.MethodsThe guideline panel used the adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to be used in low-resource countries.ResultsThe guideline provided approach to a child with AHA: laboratory diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency, autoimmune hemolytic anemia (AIHA), and hemolytic uremic syndrome (HUS); treatment of AHA including indications for red cell transfusion, medical treatment, plasma exchange, and indications of antibiotic in HUS; how to avoid further episodes of hemolysis; and when to refer to a hematologist. Implementation tools included a checklist for history and examination, lists of differential diagnoses, flow charts for the diagnosis of AHA, and a list of medications and food to be avoided in patients with G6PD deficiency.ConclusionThis adapted guideline will aid decision-making related to the diagnosis, management, and prevention of AHA.

Red Cell Transfusion Practices in Neonatal Intensive Care Unit: An Experience from Tertiary Care Centre.

Red cells are the most often transfused blood components during the neonatal period. The aim of the present study was to obtain information regarding the relationship of red cell transfusion with clinical outcomes and to evaluate red cell transfusion practices in neonatal centre of a tertiary care centre. The clinical history, blood componentdetails and laboratory parameters were evaluated with clinical outcomes. The neonates requiring transfusion of red cells were then followed up in the Blood bank for various laboratory parameters. Clinical parameters and clinical outcome were noted from case files. During the study period, 291 neonates were admitted in NICU. 2 neonates were excluded as they were congenitally malformed. Out of 289 admitted neonates, 61 neonates (21.1%) received blood and blood component transfusions. Out of 61 neonates, 20 received red cell transfusions. Mean donor exposure of red cells was 1.2. The mean volume of transfused red cell was 39.6ml with mean age of red cells was 3.6days. The mean pre- and post-transfusion Hct was 25.3 and 30.4%, respectively. The most common indication for red cell transfusion was low haemoglobin. There was a significant increase in lactate level and decrease in base excess in transfused neonates. However, no statistically significant correlations were found between transfusions and neonatal weight gain, apnoea, respiratory support and mortality. Transfusion of red cells has significant effect on laboratory parameters as compared to clinical parameters such as weight gain, episodes of apnoea and respiratory support.

Update on Indications for Red cell transfusion

The first successful blood transfusion in human took place in the early 19th century. However, blood transfusion became an established clinical practice only in the 20th century as the need to treat large numbers of war casualties during the First and Second World Wars propelled the improvement in transfusion‐related knowledge and technology, resulting in safer and more effective blood collection and transfusion. The benefits of blood (or red cell) transfusion were first recognized and demonstrated in patients with massive haemorrhage and haemorrhagic shock. In such patients, securing haemostasis remains the most important therapeutic goal. Red cell transfusion also helps to quickly restore arterial oxygen content, and together with other measures such as fluid resuscitation, it helps to restore oxygen delivery to tissues. For patients with non‐haemorrhagic isovolaemic anaemia or non‐massive bleed who are haemodynamically stable, there may be differences in their tolerance of anaemia due to variations in their ability to recruit physiological reserves depending on their age and comorbidities. Therefore, decision to transfuse red cells in these patients should not be based purely on their haemoglobin (Hb), but should also depend on their clinical assessment. As the randomized controlled trial on Transfusion Requirements in Critical Care was first published in the late 1990s, more randomized controlled trials were conducted, showing non‐inferiority of a restrictive transfusion strategy compared to a liberal strategy in most clinical settings despite a significantly lower transfusion requirement. However, a safe Hb threshold for red cell transfusion in high‐risk patients such as those with acute coronary syndrome remains unknown, and larger randomized controlled trials are needed.

PTH-147 A More Restrictive Transfusion Policy for Upper Gastrointestinal Haemorrhage Would Save Resources Without Compromising Clinical Outcome

Introduction Upper GI bleeding (UGIB) is the most common indication for transfusion in England, comprising 14% of all transfusions. 1 Evidence has demonstrated a restrictive as opposed to liberal transfusion policy improves clinical outcome. 2 In addition to the known clinical benefits, our aim was to asssess whether a more restrictive transfusion policy would save significant resources. Methods We conducted a prospective audit of consecutive patients presenting to the Royal Devon and Exeter hospital with UGIB during a 9 week period from 7.12.12. The case notes and laboratory data were reviewed. Unstable patients, those with evidence of massive UGIB and those not receiving blood transfusion were excluded. Liberal transfusion was defined as haemoglobin >80 g/L pre-transfusion or a post transfusion haemoglobin >90 g/L. We calculated the number of additional units transfused beyond these parameters. Results 79 patients presented with an UGIB. 42 patients received a total of 170 units of red blood cells. 7 patients were transfused 1 unit, 33 patients were transfused 2 units, and 28 patients received ≥3 units. 30/42 were transfused in a liberal manner, resulting in the potentially unnecessary use of 68 additional units at a cost of £8,302. Conclusion A significant number of patients received transfusions according to our definition of a liberal transfusion strategy, usually receiving several units at a time. A restrictive transfusion policy has been proven to be safe and would also result in significant cost savings. References 1 Wallis JP, Wells AW, Chapman CE. Changing indications for red cell transfusion from 2000 to 2004 in the North of England. Transfus Med . 2006; 16 :411–417. 2 Villanueva C, Colomo A, Bosch A, Concepcion M, Hernandez-Gea V, Aracil C Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med . 2013; 368 :11–21. Disclosure of Interest None Declared

Inpatient management of sickle cell pain: A ‘snapshot’ of current practice

The Sickle Cell Disease Clinical Research Network (SCDCRN) designed the PROACTIVE Feasibility Study (ClinicalTrials.gov NCT00951808) to determine whether elevated serum levels of secretory phospholipase A2 (sPLA2) during hospitalization for pain would permit preemptive therapy of sickle cell acute chest syndrome (ACS) by blood transfusion. While PROACTIVE was not designed to assess pain management and was terminated early due to inadequate patient accrual, collection of clinical data allowed a "snapshot" of current care by expert providers. Nearly half the patients admitted for pain were taking hydroxyurea; hydroxyurea did not affect length of stay. Providers commonly administered parenteral opioid analgesia, usually morphine or hydromorphone, to adults and children, generally by patient-controlled analgesia (PCA). Adult providers were more likely to prescribe hydromorphone and did so at substantially higher morphine equivalent doses than were given to adults receiving morphine; the latter received doses similar to children who received either medication. All subjects treated with PCA received higher daily doses of opioids than those treated by time-contingent dosing. Physicians often restricted intravenous fluids to less than a maintenance rate and underutilized incentive spirometry, which reduces ACS in patients hospitalized for pain.

Changing indications for red cell transfusion

Changing indications for red cell transfusion

Changing indications for red cell transfusion from 2000 to 2004 in the North of England

Falling donor numbers and the threat of transfusion-transmitted variant Creutzfeldt-Jakob disease may lead to shortages in the national blood supply. Knowledge of current patterns of transfusion and trends in usage will help predict future change in blood use. Our previous survey identified medical indications as the major reason for transfusion, but detailed information within this category was limited. We performed prospective surveys of indications for red cell transfusion for two 14-day periods in 2004 in the North of England, concentrating on medical reasons for transfusion. Data were obtained for transfusion indications of 9003 units, which accounted for over 99% of red cell issues from the regional blood centre during the study. In 2004, medical patients received 62% (5558 units) of all transfused units, surgical patients 33% (3001 units) and Obstetric & Gynaecology patients 5% (444 units). These figures compare with 52, 41 and 6% for Medicine, Surgery, and Obstetrics & Gynaecology in 1999/2000. The three largest uses of blood within the medical category were for patients with primary haematological disorders (18.2% of all transfused blood), for management of gastrointestinal haemorrhage (13.8%) and for patients with nonhaematological malignancies (8.8%). There has been a significant reduction in use of blood for surgical indications over the last 5 years, but an absolute increase in use of blood for medical indications. Lower transfusion triggers, education, use of cell salvage, the increasing price of a unit of red cells and changing population demographics may all have contributed to the reduction in surgical blood use. Promotion of good transfusion practice and alternatives to allogeneic transfusion should now focus on medical and surgical use of blood transfusion.

Indications for red cell transfusion.

Indications for red cell transfusion.

Indications for red cell transfusion in sickle cell disease

Transfusion of red blood cells is an important therapeutic method employed in the care of people with sickle cell disease (SCD). There are several clinical situations in which patients with SCD clearly need red cell transfusion (RCT). In other situations, the indication for RCT is doubtful, controversial, or ill-advised. RCT is used on either an episodic or chronic basis in the management of SCD. Episodic transfusions are usually applied in a patient who has already developed a serious complication of SCD or are used to reduce the chances for the development of a complication. Chronic transfusion therapy is often used to prevent the recurrence of a major complication such as a stroke. Recently, chronic transfusion has been applied to patients with evidence of cerebrovascular disease to prevent the first occurrence of stroke.

Indications for red cell transfusion in sickle cell disease

Transfusion of red blood cells is an important therapeutic method employed in the care of people with sickle cell disease (SCD). There are several clinical situations in which patients with SCD clearly need red cell transfusion (RCT). In other situations, the indication for RCT is doubtful, controversial, or III-advised. RCT is used on either an episodic or chronic basis in the management of SCD. Episodic transfusions are usually applied in a patient who has already developed a serious complication of SCD or are used to reduce the chances for the development of a complication. Chronic transfusion therapy is often used to prevent the recurrence of a major complication such as a stroke. Recently, chronic transfusion has been applied to patients with evidence of cerebrovascular disease to prevent the first occurrence of stroke.

Perioperative haemotherapy: I. Indications for blood component transfusion.

The practice of transfusion medicine has undergone substantial change over the last decade. Much of the impetus for the change has come from the isolation of human immunodeficiency virus (HIV) and the linkage of HIV transmission to blood transfusion. The purpose of this paper is to collate and review the literature relating to the indications for blood transfusion and provide recommendations for the appropriate utilization of blood products. Peer-reviewed and published studies and reviews relating to aspects of clinical blood transfusion were identified through computer searches and searching of the bibliographies of identified articles. Emphasis was placed on the literature published within the last decade and particularly in the years 1985-91. Material was chosen which was of proved clinical importance and in which findings were consistent among different investigators or different centres. Less emphasis was placed on material reporting new findings of uncertain clinical relevance or findings that were not consistent with majority reports. It is concluded that the only indication for red cell transfusion is to increase the oxygen carrying capacity of the blood and that an adjustment downwards in the haemoglobin concentration at which blood is transfused (transfusion trigger) from the traditional level of 100 g.L-1 is supported by the physiological and clinical data. Perioperative haemoglobin concentrations of 80 g.L-1 are acceptable in otherwise healthy young patients. The transfusion trigger should be adjusted upwards from this in medically compromised patients and in the elderly (greater than 60 yr). Fresh frozen plasma (FFP) is only indicated when there are documented deficiencies of coagulation factors. Platelet concentrates (PC) are indicated for the treatment of clinical coagulopathy resulting from thrombocytopaenia or platelet dysfunction. Routine or prophylactic administration of either FFP or PC after cardiopulmonary bypass or during resuscitation from haemorrhage is not indicated.

A Commentary on Three Consensus Development Conferences on Transfusion Medicine

Summary The panel's conclusions were specific, stating that the available evidence does not support the use of a single criterion such as 10 g/30% and that there is no evidence that mild to moderate anemia contributes to perioperative morbidity. Due to the risk of disease transmission and immune changes, homologous transfusion should be minimized. A variety of promising alternatives to homologous transfusion are being developed and will decrease the use of homologous blood products. “However, in the foreseeable future homologous blood transfusion will continue to be the therapeutic mainstay… Future research is necessary to define the best indications for red cell transfusion and the safest methods of blood conservation and delivery.”