Packed Red Cell Transfusion Research Articles

Effect of epinephrine-mixed fascia iliaca compartment block on bleeding in total hip arthroplasty: A single-center retrospective study.

Fascia iliaca compartment block (FICB) reduces opioid consumption and pain scores after total hip arthroplasty (THA), and has recently been widely applied. We investigated whether FICB could also reduce postoperative bleeding. One hundred and fifteen consecutive patients who underwent elective THA under general anesthesia over 5 months were retrospectively analyzed. They were divided into 2 groups: the FICB group received an epinephrine-mixed FICB procedure and the control group did not receive any block. Using the hematocrit measured at 4 different time points (preoperative and 1, 24, and 48 hours after surgery), the estimated blood loss (EBL) was calculated for 3 different time periods (0-1, 1-24, 24-48 hours after surgery). EBL at 1 to 24 hours (226 vs 398 mL, P = .008) was significantly lower in the FICB group than in the control group. Additionally, the number of packed red cell (PRC) units transfused per patient over 48 hours was 0.38 units in the FICB group, which was significantly lower than the 0.70 units used in the control group (P = .040). Epinephrine-mixed FICB in THA has the potential to reduce postoperative bleeding in the first 24 hours after surgery as well as reduce PRC transfusion requirements.

Predictors and pathways of in-hospital mortality in active vascular contrast extravasation detected on abdominopelvic CT

ObjectivesThis study aimed to identify factors influencing in-hospital mortality in adult patients with active vascular contrast extravasation (AVCE) on abdominopelvic computed tomography (CT).MethodsAll consecutive patients with AVCE detected on CT between January 2019 and May 2022 were retrospectively included. Their data were compared through uni- and multivariable analyses between patients with and without in-hospital mortality. Path analysis was utilized to clarify the relationships among factors affecting mortality.ResultsThere were 272 patients (60.2 ± 19.4 years, 150 men) included, of whom 70 experienced in-hospital mortality. Multivariable analysis revealed nonsurgery, chronic kidney disease (CKD) stage 4–5 or dialysis, prolonged partial thromboplastin time (PTT), minimum AVCE length > 8 mm, and a lower rate of packed red cell (PRC) transfusion were identified as independent predictors of in-hospital mortality (p = 0.005–0.048). Path analysis demonstrated direct influences of CKD4-5 or dialysis, prolonged PTT, and minimum AVCE length on mortality (coefficients 0.525–0.616; p = 0.009 to < 0.001). PRC transfusion impacted mortality through nonsurgery (coefficient 0.798, p = 0.003) and intensive care unit (ICU) admission (coefficients 0.025, p = 0.016), leading to subsequent death. Three AVCE spaces (free, loose, and tight) defined on CT were not directly associated with in-hospital mortality.ConclusionIn adults with AVCE on CT, AVCE size had a direct independent influence on mortality, highlighting the critical role of radiologists in detecting and characterizing this finding. Additionally, CKD4-5 or dialysis and prolonged PTT also directly influenced mortality, while the lower rate of PRC transfusion impacted mortality through nonsurgery and ICU admission.Clinical relevance statementIn patients with active vascular contrast extravasation (AVCE) on abdominopelvic CT, larger AVCE directly increased in-hospital mortality. Radiologists’ detection and characterization of this finding is crucial, along with recognizing factors like CKD4-5, dialysis, and prolonged PTT to improve patient outcomes.Key PointsSeveral factors independently predicted in-hospital mortality in patients with abdominopelvic AVCE.Extravasation length > 8 mm was the only imaging marker predictive of in-hospital mortality.Non-imaging factors correlated with in-hospital mortality, and PRC transfusion impacted mortality through nonsurgery and ICU admission pathways.Graphical

PROFILE OF INCOMPATIBLE REACTIONS TO PACKED RED CELL TRANSFUSION IN PATIENTS WITH CHRONIC KIDNEY DISEASE AT SANGLAH HOSPITAL

Background: Since the prevalence of chronic renal failure disease has increased. Packed Red Cell (PRC) transfusions were a common way to replace the kidneys' function in filtration. However, the reaction caused was not widely reported. Purpose: To assess the profile of incompatible reactions in PRC transfusions of chronic kidney disease patients at Sanglah Hospital, Denpasar. Method: A descriptive observational study with a cross-sectional design was employed to identify incompatibility reactions in 210 patients using medical records from July–December 2021 at Sanglah Hospital in Denpasar. Sample determination using saturated sampling techniques and data analysis were carried out descriptively. Result: Incompatible reactions in patients with chronic renal failure at Sanglah Hospital Denpasar still affected 57 people (27.14%) out of 210 people with chronic renal failure. This condition could increase fatalities in various health services if not appropriately handled. Incompatible reactions could occur, and the higher risk was in patients of the male sex who were elderly (45–65 years), had blood type O, had hemoglobin (Hb) levels ranging from 6.1–9.0 g/dL, and had conducted PRC transfusions above three pouches with a frequency of more than three times. Conclusion: People with chronic kidney failure still had a high chance of having an incompatible reaction after a PRC transfusion. Many different things caused these reactions. Incompatibility reactions in people with chronic kidney failure should happen less often in the future if they were evaluated and found early.

An Audit on Transfusion error in 16 years of blood transfusion practice at a Teaching Hospital in North Eastern Malaysia

Clinical demand for blood transfusion is endless, and patients are exposed to the risk of transfusion error at any point along the transfusion chain which lead to incorrect blood component transfused (IBCT) if the standard transfusion practices have not complied. This study aimed to determine the prevalence, sources, and causes of error among IBCT in Hospital USM. This retrospective study involved all packed red cell (PC) transfusion and reported IBCT in Transfusion Medicine Units, Hospital USM from January 2005 to December 2020. The recipient and transfusion data of IBCT were collected from the medical record and laboratory information system (MyTransfusi). A total of 193 697 PC transfusions were documented, and 14 IBCT were reported within 16 years of transfusion services. The incidence of IBCT was 1 in 13 836 of PC transfusion. Most of the IBCT contributed by ward error (64.3%). The major cause of error was patient miss identification (85.7%) either in patient sampling, blood component issuing and administration. Most ABO incompatibility IBCT (3 out of 5) end up with severe morbidity or mortality related to an acute haemolytic transfusion reaction. Most of the errors occurred in the wards. Patient misidentification is a major cause of IBCT, and it is preventable. Thus, preventive measures should emphasize on positive patient identification at every step of transfusion chain.

Adjunctive Topical Tranexamic Acid for Blood Salvage Does Not Reduce Postoperative Blood Loss Compared with Placebo in Patients Who Undergo Palliative Decompressive Spinal Metastasis Surgery: A Randomized Controlled Trial.

Randomized controlled trial. To evaluate the efficacy of adjunctive topical tranexamic acid (tTXA) in reducing postoperative blood loss and packed red cell (PRC) transfusion in patients who underwent palliative decompressive spinal metastasis surgery for malignant epidural spinal cord compression. Palliative decompressive spinal metastasis surgery is associated with massive postoperative blood loss and increased transfusion rate. tTXA reduces blood loss in traumatic or degenerative spinal surgery; however, the role of topical TXA in decompressive spinal metastasis surgery remains controversial. A total of 65 patients who underwent palliative decompressive thoracolumbar spinal metastasis surgery were included in this study. In 33 patients, 1 g of tTXA (20 mL) was soaked in an absorbable gelatin sponge and placed lateral to the decompressive site. The remaining 32 patients in the control group received the same procedures with normal saline at the same volume, instead of TXA. All of the patients received standard 1 g intravenous TXA, just before initiating the operation. The primary outcome was postoperative blood loss, and the secondary outcomes were postoperative PRC transfusion and complications. No differences were found in postoperative blood loss between tTXA and placebo group (P50 778 mL [IQR 347, 1,122 mL] versus P50 490 mL [IQR 295, 920 mL]; P = 0.238). The number of patients requiring postoperative PRC transfusion were quite similar in tTXA and placebo groups (PRC transfusion in 15 patients [45.45%] versus 16 patients [50%]; P = 0.585). No complications related to TXA and absorbable gelatin sponge were observed. We do not recommend tTXA as an adjunctive treatment for patients undergoing decompressive spinal metastasis surgery since it does not provide additional benefit to prophylactic intravenous TXA in postoperative blood loss and transfusion rate.Level of Evidence: 2.

The Glasgow Outcome Scale-Extended Pediatric Scores of Intracranial Bleeding Patients with Acquired Prothrombin Complex Deficiency Post Craniotomy and Duraplasty

Introduction: Surgical evacuation of intracranial bleeding in pediatric patients due to acquired prothrombin complex deficiency (APCD) is a life-saving surgery when conservative treatment insufficient and impending brain herniation. This study aimed to evaluate the Glasgow outcome scale-extended pediatric (GOS-ePed) score of the pediatric intracranial bleeding patients with APCD after craniotomy and duraplasty. Method: This was a retrospective study in the last 5 years of our experience. All of the pediatric patients with intracranial bleeding due to APCD who needed surgery were investigated. The data were collected from medical records after their parents have given their written informed concern and approved by the Ethics Review Committee, Faculty of Medicine, Universitas Kristen Indonesia. The inclusion criteria were patients who operated on by craniotomy and duraplasty. The patient with a second disease was excluded. Blood tests include hemoglobin, prothrombin time, activated prothrombin time, and platelets were investigated before and after intravenous vitamin K injection, transfusion packed red cells (PRCs), and fresh frozen plasma (FFP) administration. The Glasgow coma scale (GCS) pre- and postoperatively was evaluated using a modified GCS for infants and children. The outcome was evaluated by the GOS-ePed score. All data were analyzed with the normality test and paired t test. Results: There were 5 patients age between 37 and 60 days, and all patients did not get vitamin K prophylaxis after birth. The blood tests of all patients revealed anemia, prothrombin, and activated prothrombin time increased, but platelets were normal. All these values returned to normal after vitamin K injection, transfusion of PRCs, and FFP. The paired t tests were p < 0.05. The GCS of all patients before surgery was 8 or below. After surgery, the GCS of 4 patients was increased become 12 and 15. One patient did not change significantly. The GOS-ePed score showed 4 patients (80%) had upper or lower good recovery, and 1 patient (20%) was in a vegetative state. Conclusions: The GOS-ePed score of the pediatric intracranial bleeding with APCD after craniotomy and duraplasty was mostly in upper or lower good recovery.

Comparison of Early Clinical Outcomes between Intermittent Vascular Inflow Occlusion versus Intermittent Selective Hepatic Vascular Exclusion in Hepatic Resections for Cholangiocarcinoma Patients: A Prospective Randomized Controlled Trial Study

Background: There were reported benefits of selective hepatic vascular exclusion (SHVE) in reducing intraoperative blood loss (IBL), intraoperative packed red cell (PRC) transfusion, and perioperative complications over intermittent Pringle maneuver (IPM) in hepatectomies. However, there was lack of data regarding the use of SHVE in comparison with IPM in hepatectomies for cholangiocarcinoma (CCA) patients. Objective: To compare IBL, intraoperative PRC transfusion, total operative time (TOT), and perioperative complications between SHVE and IPM. Materials and Methods: Between October 2018 and September 2019, forty eligible CCA patients participated in the study. They were randomly allocated to the SHVE group (n=20) or the IPM group (n=20). Data regarding patient demographics, tumor characteristics, and the objectives of the study were gathered and analyzed with intention-to-treat principle. Results: The median IBL (range) 923.5 (101 to 4,979) versus 1,109 (413 to 5,305) ml; p=0.2, median intraoperative PRC transfusion (range) 112.5 (0 to 1,745) versus 296 (0 to 1,500) ml; p=0.22, and median TOT (range) 390 minute (220 to 915) versus 320 (240 to 930) minutes; p=0.55 between SHVE and IPM were not significantly different. There was no statistical difference in perioperative complications between SHVE and IPM. Conclusion: Routine use of SHVE during hepatectomies in CCA patients showed no significant difference in outcomes regarding the objectives of the study. Keywords: Selective hepatic vascular exclusion (SHVE), Hepatic vascular exclusion with preservation of caval flow (HVEPV), Hepatic resection, Cholangiocarcinoma, Intraoperative blood loss, Perioperative complications

Estimation of surgical blood loss and transfusion requirements in orthopaedic soft tissue tumor surgery: associated factors

Background: Over half of soft tissue tumor surgeries require intraoperative packed red cell (PRC) transfusion. Several factors that can be identified in the preoperative period have been associated with surgical bleeding and transfusion in soft tissue tumor surgery. This study aimed to determine factors associated with surgical blood loss and intraoperative PRC transfusion. Methods: A retrospective cohort was analyzed on 84 records of orthopedic soft tissue tumor surgery during 2014-2018. Data were analyzed by linear regression and multivariate analysis. Results: Most commonly found malignant tumor in this study was rhabdomyosarcoma (20 . 2 % ). Preop hemoglobin of 11.5 g/dL (p=0.013) and tumor size of =5 cm (p<0.001) are the two significant predictors for intraoperative transfusion. Conclusion: tumor size and preoperative Hb value were predictors of the probability of requiring intraoperative PRC transfusion.

Erythrocyte alloantibodies in chronic kidney disease patients receiving packed red cell transfusions in Sanglah General Hospital, Denpasar

Introduction: In Chronic kidney disease (CKD) patients, as the consequences of the pathogenesis, anemia due to the failure of erythropoietin production requires Packed Red Cell (PRC) transfusion. The presence of alloantibodies in CKD patients who routinely require transfusion in Bali has never been evaluated. This study aims to determine the erythrocyte alloantibodies of CKD patients who received PRC transfusions in Sanglah Hospital.Methods: This study was a cross sectional descriptive study in adult CKD patients with history of PRC transfusion more than twice.Results: A total of 50 patients with Chronic Kidney Disease consisting of 31 men and 19 women, mostly 46-65 years old (60%) and the most blood group were blood group O (44%). There were 3 patients with positive antibody screening and identification results, 2 male patients (66.67%) and 1 female (33.33%). Two patients 46-65 years (66.67%) while 1 person 18-45 years (33.33%), with 2 person with blood group A (66.67%) and one person with blood group O (33.37% ). These three patients presented multiple alloantibodies in the form of anti-K, anti-Kpa, anti-LuaConclusion: From  the CKD patients who received PRC transfusions in Sanglah Hospital, ±6% formed alloantibodies. All of the alloantibodies formed were multiple alloantibodies, in the form of anti-K, anti-Kpa and Lua.

Hubungan jenis packed red cell (PRC) yang ditransfusikan dengan reaksi transfusi febrile non haemolytic transfusion reaction (FNHTR)

Background: One of the components of blood cells are often used for transfusions is Packed Red Cell (PRC). Blood components transfusion may continues with rapid or delayed transfusion ractions. The most transfusion reactions was fever (55%) or febrile non haemolytic transfusion reaction (FNHTRs). The cause of these events is associated with allogenic leucocytes (the ability to differentiate self cells and non-self cells based on the human leukocyte antigen (HLA) on the cell surface) and release of proinflammatory cytokines such as IL-1, IL-6, IL-8, TNFα, Cell-free DNA (cfDNA), histone and the duration of blood storage. Methods: Cross-sectional study on 41.177 patients who received a PRC transfusion with the FNHTR transfusion reaction in Hospital Blood Bank Dr. Kariadi Semarang, during January 2017 to July 2018. Pearson Chi Square test for expected frequency more than 5. The Kolmogorov smirnov and Shapiro-wilk test were used to evaluate normality of the data. Mann-Whitney test to analyze the difference, p &lt; 0,05 was considered as significant.Results: The incidence of FNHTR was lower in patients who received leukodepleted PRC (11 patients) than non leukodepleted PRC (124 patients). There were differences in body temperature in the incidence of FNHTR between the two groups 38.10 C (38-39) VS 38.40 C (38 – 39.2) with p = 0,046.Conclusions:There were relationship between the incidence of FNHTR with the transfusion with leukodepleted PRC and non leukodepleted PRC.

Profile of alanine aminotransferase and hepatic iron accumulation in thalassemic patients with or without anti-hepatitis C virus

Background Repeated blood transfusions in thalassemic patientscause iron accumulation in tissues and might impair organ func-tion. Other peril of blood transfusion is hepatitis C virus infection.Objectives This study aimed to find out the proportion of increasedalanine aminotransferase (ALT), increased transferrin saturation(TS), and positive anti hepatitis C virus (anti-HCV) among thalas-semic patients and to get the profile of ALT among thalassemicpatients who have increased TS and positive anti-HCV.Methods This cross-sectional descriptive study was conductedon β- and β-HbE-thalassemic patients at the Thalassemia Outpa-tient Clinic, Department of Child Health, Medical School, Univer-sity of Indonesia–Cipto Mangunkusumo Hospital in May 2002.Results Subjects were 57 homozygous β-thalassemic and 33 β-HbE-thalassemic patients. No one had regular desferoxamine orhistory of splenectomy. Proportions of increased ALT, TS, and posi-tive anti-HCV were 76%, 78%, and 6%, respectively. Duration ofillness, total volume of packed red cell (PRC) transfusions, TS level,and positive anti-HCV seemed to have role in the increased pro-portion of subjects with increased ALT, whereas duration of illnessand total volume of PRC seemed to have role in the increased TS.Conclusion Factors that seem to have a role in the increasedproportion of subjects who had increased ALT and TS were (1)duration of illness, total volume of PRC transfusion, TS, and posi-tive anti-HCV; 2) duration of illness and total volume of PRC trans-fusion, respectively

Impact of pretransplant red cell transfusion on outcome after allogeneic stem cell transplantation in adult patients with severe aplastic anemia.

The aim of this study was to evaluate the impact of pretransplant transfusion of packed red cells (PRCs) on outcome after allogeneic stem cell transplantation (SCT) in severe aplastic anemia (SAA). A total of 221 adult SAA patients receiving allogeneic SCT were analyzed. The patients were divided into two groups according to the amount of pretransplant transfusion before SCT: the low transfusion group (⩽32 PRC units, n=164) and the high transfusion group (>32 PRC units, n=57). The incidence of engraftment failure was not different between the two groups. The incidence of acute GvHD (grades II-IV) was higher in the high transfusion group than in the low transfusion group (P=0.04), and the incidences of chronic extensive GVHD were not significantly different (P=0.136). The high transfusion group had higher 5-year transplant-related mortality (TRM) (24.8% vs 6.8%, P<0.001) and lower overall survival (OS) (72.3% vs 91.9%, P<0.001) than those in the low transfusion group. Multivariate analysis revealed that the high transfusion group and unrelated donor type were independent prognostic factors affecting OS. These results indicate that a history of higher pretransplant transfusion of PRCs was associated with increased TRM and decreased OS, suggesting that iron overload had a negative impact on outcome after SCT in SAA.

A multivariate analysis to assess the effect of packed red cell transfusion and the unit age of transfused red cells on postoperative complications in patients undergoing cardiac surgeries.

Background:Transfusion of blood components and age of transfused packed red cells (PRCs) are independent risk factors for morbidity and mortality in cardiac surgeries.Materials and Methods:We retrospectively examined data of patients undergoing cardiac surgery at our institute from January 1, 2012 to September 30, 2012. Details of transfusion (autologous and allogenic), postoperative length of stay (PLOS), postoperative complications were recorded along with other relevant details. The analysis was done in two stages, in the first both transfused and nontransfused individuals and in the second only transfused individuals were considered. Age of transfused red cells as a cause of morbidity was analyzed only in the second stage.Results:Of the 762 patients included in the study, 613 (80.4%) were males and 149 (19.6%) were females. Multivariate analysis revealed that factors like the number and age of transfused PRCs and age of the patient had significant bearing upon the morbidity. Morbidity was significantly higher in the patients transfused with allogenic PRCs when compared with the patients not receiving any transfusion irrespective of the age of transfused PRCs. Transfusion of PRC of over 21 days was associated with higher postoperative complications, but not with in-hospital mortality.Conclusion:In patients undergoing cardiac surgery, allogenic blood transfusion increases morbidity. The age of PRCs transfused has a significant bearing on morbidity, but not on in-hospital mortality. Blood transfusion services will therefore have to weigh the risks and benefits of providing blood older than 21 days in cardiac surgeries.

Sa1882 Exploring Predictors of in-Hospital Mortality in Dieulafoy's Lesions of the Stomach and Intestine

Introduction: Dieulafoy's lesions (DL) are a rare and often unrecognized cause of obscure, and sometimes significant upper gastrointestinal (GI) hemorrhage. There are currently no population-based studies evaluating mortality risk associated with the locality of DL. We used a national database to assess the association between in-hospital mortality and demographic, co-morbidities and intervention variables, among patients with DL of the stomach and intestine. Methods: Using National Inpatient Sample (NIS) data between January 2004 and December 2009, simple and multiple logistic regression analyses were conducted to assess the effect of the various covariates onmortality. Demographic covariates explored in this analysis included gender, age, race/ethnicity, income, and type of insurance. Co-morbidities of interest include atrial fibrillation (AFIB), coronary heart disease (CAD), congestive heart failure (CHF), acute renal failure (ARF), chronic kidney disease (CKD), end stage renal disease (ESRD) and coagulopathies (COAG). Additionally, the Charlson-Deyo Index (CDI) was used to measure the burden of co-morbidities. Interventions include packed red cell transfusion (PCT), endoscopic control of gastric hemorrhage (EGD), small bowel endoscopy (SBE) and intensive level of care (ICU). Results: We identified 4,652 patients with a primary diagnosis of DL, out of which 88% were located in the stomach and 12% were found in the small and large intestine. The overall percentage mortality of DL is around 3%. There was no significant difference in mortality between DL of the stomach and intestine. When compared to 2004, there is a significant decrease in mortality from year to year. Multiple logistic regression, modeling mortality as the outcome variable, was statistically significant for patients with age greater than 85, odds ratio (OR) =5.30 and patients with ARF OR= 4.21. About 1,335 patients or 29% of the total population had small bowel endoscopy and was found to be associated with an OR=1.78. About 70% or 3290 patients had EGD and 60% or 2786 patients had PCT. About 6% of the patients had ICU level of care, as defined by the use of mechanical ventilation (6%), central venous catheterization (13%) and hemodialysis (3%). If patient had ICU level of care, it was associated with OR=16.8 of death. Coagulopathies were not found to be significantly associated with death. Conclusion: This is the first population-based study that explored factors associated with in-hospital mortality for DL. Among demographic variables, only age greater than 85 was associated with significantly higher mortality. Disparity in care was not a factor since gender, race/ethnicity, income and type of insurance had no bearing on mortality. Mortality however, was significantly associated with the development of ARF and if the patient was admitted to ICU level of care.

Risk Factors Associated with Mortality in Hospitalized Patients with Gastroduodenal Angioectasia Using Data from the National Inpatient Sample

Purpose: To assess the association between mortality and demographic variables, co-morbidities and intervention, among patients with hemorrhagic gastroduodenal angioectasia (GDA). Methods: Using National Inpatient Sample (NIS) data between January, 2000 and December, 2009, simple and multiple logistic regression analyses were conducted to assess the effect of the various covariates on mortality. Demographic covariates included age, race/ethnicity, income, and gender. Co-morbidities included the presence of hypovolemia, congestive heart failure (CHF), acute renal failure (ARF), chronic kidney disease (CKD), COPD, von Willebrand disease, coronary artery disease and valvular disease. The Charlson-Deyo Index (CDI) was also used in the analysis. Intervention options including packed red cell transfusion (PCT), endoscopic control of gastric hemorrhage (ECGH), hemodialysis (HD), central venous catheterization (CVC) and mechanical ventilation (MV), which were also included in the analysis. Results: We identified 30,239 patients with a primary diagnosis of GDA, out of which 97% resulted in blood loss and a percentage mortality of 1%. Univariate odds ratio are represented in the graph attached. Multiple logistic regression modeling showed that significant mortality is associated with age greater than 85 odds ratio (OR)=2.41, lowest income status OR 1.59; CDI of 3-4 OR 1.58, CDI ≥ 5 or more comorbidities OR 2.41. Significant mortality was seen with patients with ARF OR 2.59, HD OR 2.33, CVC OR 4.58 and MV OR 23.177. Intervening with ECGH OR 0.67 and PCT OR 0.73 significantly reduced mortality. Conclusion: This is the first study to show risk factors for mortality in patients hospitalized with GDA. Factors significantly associated with increased mortality with hemorrhagic GDA include advanced age, lowest income level, ARF, hemodialysis, CVC placement and mechanical ventilation. There was no association with mortality from aortic stenosis and Von Willebrand disease. Protective factors included transfusion and inpatient endoscopic control of gastric hemorrhage.Figure: Graph of univariate odds ratio of variables associated with mortality.

Factors Associated with Mortality in Patients with Intestinal Angioectasia (IA) and Blood Loss using a Population-based Inpatient Sample

Purpose: To assess the association between mortality and demographic, comorbidities, and inpatient intervention among patients with hemorrhagic intestinal angioectasia. Methods: Using the National Inpatient Sample data between 2000 and 2009, logistic regression (univariate and multivariate) analysis were conducted to assess the association of the following variables on mortality. Demographic covariates included age, race/ethnicity, income, and gender. Comorbidities included the presence of hypovolemia, congestive heart failure (CHF), aortic stenosis (AS), valvular insufficiencies (VI), acute renal failure (ARF), chronic kidney disease (CKD), COPD, and von Willebrand disease. The Charlson-Deyo Index (CDI) and interventions such as packed red cell transfusion (PCT), endoscopy, surgical resection, hemodialysis (HD), central venous catheterization (CVC), and mechanical ventilation (MV) were included in the analysis. Results: We identified 32,238 patients with a primary diagnosis of IA. Multiple logistic regression modeling showed that significant mortality is associated with age range 75-84 years (odds ratio [OR] 1.93) age >85 years (OR 2.96). CDI score range 3-4 (OR 1.64) and CDI score >5 (OR 2.88). Increased mortality is seen with ARF (OR 2.72), CHF (OR 1.33), AS (OR 2.85), VI (OR 3.74), hypovolemia (OR 1.85), and coagulopathies (OR 2.25). Interventions such as HD (OR 1.88), CVC (OR 2.64), MV (OR 19.1), and surgical resections (small bowel OR 1.34, colon OR 3.6, and combined OR 8.28) were associated with increased mortality. The patients who received endoscopy (small bowel, colonoscopy, or both) had lower mortality when compared with those who did not receive endoscopy (OR 0.68, OR 0.50, and OR 0.40, respectively). This trend was also realized among patients who received PCT (OR 0.71). Conclusion: This is the first study to show risk factors for mortality in hospitalized patients diagnosed with IA and blood loss. This study also showed that patients with AS and IA were at increased risk for mortality. Other factors for increased mortality in IA include advanced age, male gender, increased CDI score, ARF, CHF, coagulopathies, and hypovolemia. This trend was also noted in patients who had HD, CVC placement, mechanical ventilation, and surgical resection. Protective factors included PCT and inpatient endoscopy.Figure: Graph of univariate odds ratio of variables associated with mortality.

The effect of retrograde autologous priming on intraoperative blood product transfusion in coronary artery bypass grafting

Retrograde autologous priming (RAP) of the cardiopulmonary bypass (CPB) circuit could reduce the degree of haemodilution associated with priming with acellular solutions. However, there is no strong evidence to prove that the practice of RAP reduced intraoperative packed red cell (PRC) or blood product transfusion. To evaluate the effect of RAP on intraoperative PRC usage in coronary artery bypass grafting (CABG). This study is a prospective, observational study on patients who underwent first-time, isolated CABG using CPB between April 2012 and July 2012. Two groups of patients were identified: 1. Non-RAP group (n=128) and 2. RAP group (n=73). The primary outcome for the study was the amount of PRC and blood product usage between the induction of anaesthesia and the cessation of CPB. Use of PRC and blood products in the operating room was comparable in both groups. Univariate logistic regression showed that RAP was not an independent predictor of PRC or blood product transfusion (p=0.43). Multivariate logistic regression showed that CPB time, preoperative haemoglobin (Hb) levels and creatinine clearance were independent predictors of blood product transfusion. Practising RAP with mean volumes of 300 ml does not necessarily reduce PRC and other blood product transfusion requirements during CABG. In our practice, RAP was performed, aiming at displacing CPB circuit prime volume with which the perfusionist felt comfortable and dictated by haemodynamic parameters prior to commencing CPB. We presume this is the case in many units around the world. This practice, in our opinion, is not enough to achieve the benefits of RAP, if any, in the form of a reduction of packed red cell transfusion requirements. The true advantages of RAP in cardiac surgery need to be studied in a prospective, randomized, controlled trial.

255 Survey on Threshold for Packed Red Cell Transfusion in Neonatal Units Across the UK

AimNeonatal blood-product transfusion practices and policies vary widely among different institutions. The aim of this survey was to evaluate the threshold for packed red cell (PRC) transfusion for non-haemolytic neonatal...

Neuroborreliosis in patient with aplastic anaemia secondary to therapy with ticlopidine

Aplastic anaemia is a rare but potentially fatal complication of treatment with ticlopidine. We present a 55-year-old male with aplastic anaemia which developed after 45 days of the therapy with 200 mg ticlopidine to prevent coronary thrombosis. The treatment with ticlopidine was withdrawn and broad spectrum antibiotics as well as transfusion of packed red cells, platelets and G-CSF were administered. Two weeks after the onset of the disease, the number of white blood cells dropped to 0.5 x 10(9)/l, along with drop of both haemoglobin concentration and the number of platelets. At that time, weakness of facial muscles due to bilateral facial nerve paralysis with Bell's phenomenon and after that weakness of muscles of both legs and signs of polyradiculoneuritis were developed. Western blot analysis of blood and liquor showed a high concentration of IgG and IgM antibodies against Borrelia burgdorferi. The treatment with cephtriaxone resulted in normalization of body temperature and gradual recovery of neurological findings. Blood picture became normal two months after the onset of the disease. The treatment with ticlopidine may result in different haematological complications such as agranulocytosis/ granulocytopaenia, thrombotic trombocytopenic purpura and rarely aplastic anaemia. Due to these complications blood pictures in patients on this therapy should be closely followed up and in case of complications, the treatment with ticlopidine has to be stopped and introduce the therapeutic procedures depending on the sort of the complications and clinical presentation.

Effect of blood transfusions on oxidative stress in preterm infants

Objective: To confirm the increase in non-transferrin bound iron (NTBI) after packed red cell (PRC) transfusion and to evaluate the association with increased oxidative stress in preterm infants. Method: Twenty...