Blood Management Research Articles

Current concepts in the use of cell salvage in obstetrics.

The worldwide leading cause of maternal death is severe maternal hemorrhage. Maternal hemorrhage can be profound leading to an entire loss of blood volume. In the past two decades, Patient Blood Management has evolved to improve patient's care and safety. In surgeries with increased blood loss exceeding 500 ml, the use of cell salvage is strongly recommended in order to preserve the patient's own blood volume and to minimize the need for allogeneic red blood cell (RBC) transfusion. In this review, recent evidence and controversies of the use of cell salvage in obstetrics are discussed. Numerous medical societies as well as national and international guidelines recommend the use of cell salvage during maternal hemorrhage. Intraoperative cell salvage is a strategy to maintain the patient's own blood volume and decrease the need for allogeneic RBC transfusion. Historically, cell salvage has been avoided in the obstetric population due to concerns of iatrogenic amniotic fluid embolism (AFE) or induction of maternal alloimmunization. However, no definite case of AFE has been reported so far. Cell salvage is strongly recommended and cost-effective in patients with predictably high rates of blood loss and RBC transfusion, such as women with placenta accreta spectrum disorder. However, in order to ensure sufficient practical experience in a multiprofessional obstetric setting, liberal use of cell salvage appears advisable.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: History and scenario of patient blood management in the world and in Brazil

Patient Blood Management (PBM) is a multidimensional approach that seeks to optimize the use of blood and its components in patients. This matter emerged as a response to the need to reduce unnecessary exposure to blood transfusions and their potential risks. In the past, blood transfusion was often overused resulting in complications and high costs. The advent of Patient Blood Management has caused a paradigm shift, highlighting anemia prevention, bleeding control and maximizing the production of blood cells by the organism itself. Patient Blood Management guidelines include the early identification of anemia, strategies to minimize blood loss during surgery, intraoperative blood conservation techniques, preoperative hemoglobin optimization and evidence-based approaches to the rational use of blood transfusions. Aiming to improve clinical outcomes, decrease transfusion-related complications and reduce associated costs, this multidisciplinary approach counts on doctors, nurses, pharmacists and other healthcare professionals. Based on research and clinical evidence, Patient Blood Management continues to evolve thereby promoting safer, more effective patient-centered practices. Its implementation has proven beneficial in various medical contexts thereby contributing to improvements in the quality of care provided to patients. Our goal with this Consensus is to present readers with a broad and diverse view of Patient Blood Management so that they have the building blocks to implement this new technique.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Preoperative Phase – Preoperative management of the patient's anemia

Managing anemia before surgery is extremely important as it is a clinical condition that can significantly increase surgical risk and affect patient outcomes. Anemia is characterized by a reduction in the number of red blood cells or hemoglobin levels leading to a lower oxygen-carrying capacity of the blood. Proper treatment requires a multifaceted approach to ensure patients are in the best possible condition for surgery and to minimize potential complications. The challenge is recognizing anemia early and implementing a timely intervention to correct it. Anemic patients are more susceptible to surgical complications such as increased infection rates, slower wound healing and increased risk of cardiovascular events during and after surgery. Additionally, anemia can exacerbate existing medical conditions, causing greater strain on organs and organ systems. To correct anemia and optimize patient outcomes, several essential measures must be taken with the most common being identifying and correcting iron deficiency.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Definition of Patient Blood Management

Managing the patient's blood and hematopoietic system is like managing any of the other organs and organ systems during patient care. Specialists control the heart, kidneys, endocrine system, etc. and the patient's blood requires similar clinical treatment. The hematopoietic system and its circulatory products are fundamental for the healthy functioning of the human body. In simple terms, Patient Blood Management (PBM) is an organized, patient-centered approach in which the entire healthcare team coordinates efforts to improve outcomes by managing and preserving the patient's own blood. By reducing dependence on blood transfusions, PBM seeks to improve clinical outcomes, reduce the risks and costs associated with transfusions, and improve the safety and quality of patient care. Essentially, the concept of PBM is about the holistic management and preservation of the patient's own blood in the medical and surgical context.

Blood Management: A Current Opportunity in Perioperative Medicine.

The purpose of this viewpoint is to provide awareness of the current opportunities to enhance a high-value care approach to blood product transfusion. It provides a historical context to the evolution of blood management, as well as of the patient safety and high-value care movement. Leveraging current technology for enhanced education, as well as clinical decision support, is also discussed.

Digital Transformation In Blood Banking: The Story Of E-Raktkosh

The E-raktkosh initiative, launched by the Government of India, is a pioneering effort in the field of healthcare and technology. This paper explores the inception, objectives, and recent advancements of the E-raktkosh project, shedding light on its impact on blood management in India. By harnessing the power of digitalization, E-raktkosh has revolutionized the way blood is collected, stored, and distributed across the nation, ensuring efficient and safe access to this life-saving resource. This paper delves into the significance of E-raktkosh in addressing blood shortage challenges, enhancing transparency, and saving countless lives.

Does Patient Blood Management Affect Outcomes in Metastatic Spine Tumour Surgery? A Review of Current Concepts.

Narrative review. The spine is the most common site of metastases, associated with decreased quality of life. Increase in metastatic spine tumour surgery (MSTS) has caused us to focus on the management of blood, as blood loss is a significant morbidity in these patients. However, blood transfusion is also not without its own risks, and hence this led to blood conservation strategies and implementation of a concept of patient blood management (PBM) in clinical practise focusing on these patients. A narrative review was conducted and all studies that were related to blood management in metastatic spine disease as well as PBM surrounding this condition were included. A total of 64 studies were included in this review. We discussed a new concept of patient blood management in patients undergoing MSTS, with stratification to pre-operative and intra-operative factors, as well as anaesthesia and surgical considerations. The studies show that PBM and reduction in blood transfusion allows for reduced readmission rates, lower risks associated with blood transfusion, and lower morbidity for patients undergoing MSTS. Through this review, we highlight various pre-operative and intra-operative methods in the surgical and anaesthesia domains that can help with PBM. It is an important concept with the significant amount of blood loss expected from MSTS. Not applicable.

Has the frequency of ABO RhD blood groups in Australian blood donors changed as a result of the removal of the variant Creutzfeldt-Jakob disease-based deferral?

Until 25 July 2022, Australians who had spent more than 6 months in the United Kingdom or territories between 1980 and 1996 were deferred from blood donation due to the risk of variant Creutzfeldt-Jakob disease. Removal of this geography-based donor deferral on RhD-negative blood availability has not been reported. All donors who donated at least once from 25 July 2022 to 25 July 2023 were included. UK donor status, first-time donor and ABO RhD data were extracted from the National Blood Management System. Data from 566,447 blood donors with a valid ABO RhD result were analysed. Of these, 34,560 were new or returning lapsed donors following removal of the UK donor deferral. The median age [range] in years for all donors was 43 [75] with UK donors being older 53 [70]. There was a higher prevalence of RhD-negative status in UK donors (20.2%) compared with first-time blood donors (15.7%). UK donors were generally older, female and more likely to be RhD-negative. Although UK donors provided a boost to RhD-negative blood collections, the overall prevalence of ABO RhD blood groups in the total Australian blood donor panel remained similar to previous estimates.

Ten Years of Experience on the Effectiveness and Efficiency of the Cleanfield Device in Cardiothoracic Surgery

AbstractThe process of blood management and treatment from the surgical field to produce concentrated red blood cells (RBC) is crucial in the context of cardiothoracic surgery and in other branch of surgery. The role of autotransfusion reservoir is not well described in the literature in terms of superiority suction for hemolysis prevention. In this context, we presented a ten-year single-center retrospective analysis on suction, filtering, and blood collection from surgical field through the use of the Cleanfield Autotransfusion Reservoir (Eurosets SRL, Medolla, Italy) in terms of performance, effectiveness, and safety. From January 2013 to January 2023 were collected and analyzed the consecutive uses of Cleanfield Autotransfusion Reservoir in a single cardiothoracic surgery center Anthea Hospital Gvm Care & Research, Bari, Italy. For single procedure, the number of cleanfield disposable used, the relative maximum blood volume filtered and collected, the suction pressure from devices through vacuum meter and the electronic suction pressure measurements in the devices for suctions and the presence and the incidence of adverse events during the use (implosion, clot formation, inability to cell saver use, inability to suction during the use) were analyzed. 5202 Cleanfield disposable autotransfusion reservoir were analyzed for blood volume suction, filtering and collection on 5199 cardiac surgery procedures, the maximum blood volume filtered and collected was 1997 ± 123 ml, the mean suction pressure measured from the device with vacuum meter during suction use was 38 ± 3 mmHg, the mean suction pressure measured in the device during suction use was 38 ± 2 mmHg, no presence of adverse event was reported for implosion, clot formation, inability to cell saver use, and inability to suction during the use. In our retrospective report, the use of Cleanfield autotransfusion reservoir (Eurosets SRL, Medolla Italy) in cardiothoracic surgery context was safe and effective for blood volume suction, filtering, and collection.

A Comprehensive Patient Blood Management Program During Cardiopulmonary Bypass in Patients Over 60 Years of Age.

There is currently no consensus on the most appropriate blood transfusion strategy for older adults undergoing cardiovascular surgery. We aimed to investigate the potential benefits of the patient blood management (PBM) program specifically for advanced age patients, and to evaluate the relationship of age and PBM in cardiovascular surgery. We collected data from patients over 60 years old who underwent on-pump cardiovascular surgery. We compared transfusion and clinical outcomes between the pre-PBM and post-PBM groups using a propensity score matching method. Then, we conducted a subgroup analysis within the original cohort, specifically focusing on patients aged of 75 and above with multivariable adjusted models. Data of 9703 older adults were analyzed. Red blood cell (RBC) transfusion rates during cardiopulmonary bypass (CPB) (31.6% vs 13.1%, P<0.001), during the operation (50.8% vs 39.0%, P<0.001) and after the operation (5.6% vs 3.1%, P<0.001) were significantly reduced, and mortality and the risk of some adverse events were also reduced after the PBM. Subgroup analysis showed that there was no interaction between age and PBM, and advanced age (over age 75) did not modify the effect of PBM program in reducing RBC transfusion (Pinteraction=0.245), on mortality (Pinteration=0.829) and on certain complications. The comprehensive PBM program could reduce RBC transfusion without adverse outcomes in older patients undergoing CPB. Even patients over age 75 may benefit from a more stringent transfusion indication. Comprehensive blood conservation measures should be applied to optimize the blood management for older patients.

Patient blood management, past, present and future

Patient blood management, past, present and future

Economics of patient blood management in the United States: a narrative review

Economics of patient blood management in the United States: a narrative review

Comparative Analysis of Anterior and Posterior Approaches in Hip Replacement Surgery: Enhancing Patient Efficiency

Hip replacement surgery, a significant orthopaedic intervention, is commonly undertaken to address hip pain stemming from aging or injury, particularly among elderly patients. The primary objective of this surgical procedure is to restore the patient's quality of life to its pre-operative state, enabling them to resume normal daily activities. Typically, the posterior approach has been the conventional surgical method for hip replacement, widely practiced both in Indonesia and globally. This evolving trend has sparked interest in comparing the effectiveness and outcomes of the anterior and posterior approaches, particularly concerning critical factors such as operating time, length of hospital stays, need for transfusion, and postoperative mobilization time. In pursuit of a comprehensive understanding, a study was conducted, focusing on patients who underwent hip replacement surgery at Siloam Kupang Hospital. The anterior approach was considered as the case group, while the posterior approach served as the control group. Surprisingly, the study did not identify any statistically significant differences in operating time and transfusion requirements between hip replacement surgeries utilizing the anterior approach and those employing the posterior approach. This suggests that, from a procedural standpoint, both approaches are comparable in terms of efficiency and blood management. However, when assessing postoperative outcomes, distinct trends emerged. The anterior approach demonstrated a notable advantage in terms of faster mobilization times, implying a quicker recovery and the potential for patients to regain their mobility sooner. On the other hand, the posterior approach exhibited a shorter hospital stay, suggesting a streamlined postoperative course. These findings contribute valuable insights to the ongoing discourse within the orthopaedic community regarding the merits of the anterior and posterior approaches in hip replacement surgery. As medical practices continue to evolve, such comparative studies play a pivotal role in refining surgical techniques and optimizing patient outcomes in the realm of orthopaedic interventions.

Perioperative Plasma in Addition to Red Blood Cell Transfusions Is Associated With Increased Venous Thromboembolism Risk Postoperatively.

Perioperative red blood cell (RBC) transfusions increase venous thromboembolic (VTE) events. Although a previous study found that plasma resuscitation after trauma was associated with increased VTE, the risk associated with additional perioperative plasma is unknown. A US claims and EHR database (TriNetX Diamond Network) was queried. We compared surgical patients who received perioperative plasma and RBC to patients who received perioperative RBC but not plasma. Subanalyses included (1) all surgeries (n = 48,580) and (2) cardiovascular surgeries (n = 38,918). Propensity score matching was performed for age at surgery, ethnicity, race, sex, overweight and obesity, type 2 diabetes, disorders of lipoprotein metabolism, essential hypertension, neoplasms, nicotine dependence, coagulopathies, sepsis, chronic kidney disease, liver disease, nonsteroidal anti-inflammatory analgesics, platelet aggregation inhibitors, anticoagulants, hemoglobin level, outpatient service utilization, and inpatient services; surgery type was included for "all surgeries" analyses. Outcomes included 30-day mortality, postoperative VTE, pulmonary embolism (PE), and disseminated intravascular coagulation (DIC). After matching the surgical cohorts, compared to only RBC, plasma + RBC was associated with higher risk of postoperative mortality (4.52% vs 3.32%, risk ratio [RR]: 1.36 [95% confidence interval, 1.24-1.49]), VTE (3.92% vs 2.70%, RR: 1.36 [1.24-1.49]), PE (1.94% vs 1.33%, RR: 1.46 [1.26-1.68]), and DIC (0.96% vs 0.35%, RR: 2.75 [2.15-3.53]). Among perioperative cardiovascular patients, adding plasma to RBC transfusion was associated with similar increased risk. When compared with perioperative RBC transfusion, adding plasma was associated with increased 30-day postoperative mortality, VTE, PE, and DIC risk among surgical and cardiovascular surgical patients. Reducing unnecessary plasma transfusion should be a focus of patient blood management to improve overall value in health care.

Changes in Practices After Implementation of a Patient Blood Management Program in French Surgical Departments: The National Multicenter Observational PERIOPES Study.

Patient blood management (PBM) is an evidence-based approach recommended to improve patient outcomes. Change in practices is often challenging. We report here data from French surgical departments before and after a standardized implementation of a PBM program. This was a national, multicenter, observational study in surgical centers ("expert" centers with an already established protocol for preoperative anemia or "pilot" centers). Data from consecutive surgical patients of different specialties were retrieved before and after the implementation of a PBM program. Primary outcome variables (preoperative anemia treatment rates, transfusion rates, and length of hospital stay) before and after the implementation of a PBM program were analyzed with segmented regression adjusted on confounders (American Society of Anesthesiologists [ASA] scores and centers). A total of 1618 patients (ASA physical status III and IV, 38% in the first period and 45% in the second period) were included in expert (N = 454) or pilot (N = 1164) centers during the first period (January 2017-August 2022) and 1542 (N = 440 and N = 1102, respectively) during the second period (January 2020-February 2023). After implementation of the PBM program, the rate of preoperative anemia treatment increased (odds ratio, 2.37; 95% confidence interval [CI], 1.20-4.74; P = .0136) and length of hospital stay in days decreased (estimate, -0.11; 95% CI, -0.21 to -0.02; P = .0186). Transfusion rate significantly decreased only in expert centers (odds ratio, 0.17; 95% CI, 0.03-0.88; P = .0354). PBM practices in various surgical specialties improved significantly after the implementation of a PBM program. However, too many patients with preoperative anemia remained untreated.

Impact of Intraoperative Allogeneic Platelet Transfusion on Healthcare-Associated Infections in Cardiac Surgery: Insights From a Large Single-Center Cohort Study

ObjectivesDespite significant improvement in patient blood management-cardiac surgery remains a high hemorrhagic risk procedure. Platelet transfusion is commonly used to treat thrombocytopenia-induced perioperative bleeding. Allogeneic platelet transfusion may induce transfusion-related immunomodulation. However, its association with postoperative healthcare-associated infections is still a matter of debate. Our objective was to evaluate the impact of allogeneic platelet transfusion during cardiac surgery on postoperative HAI incidence. DesignRetrospective cohort study SettingTertiary referral academic center ParticipantsPatients undergoing cardiac surgery from 2012 to 2018. InterventionsNone Measurements and Main ResultsIntraoperative platelet transfusion was defined as exposure in a causal model. The primary outcome was the incidence of healthcare-associated infections-comprised of bloodstream infection-hospital-acquired pneumonia and surgical-site infection. Among 7662 included patients, 528 (6.8%) were exposed to intraoperative platelet transfusion and 329 (4.3%) developed 454 postoperative infections. Bloodstream infection affected 106 (1.4%) patients, hospital-acquired pneumonia 174 (2.3%) and surgical-site infection 148 (1.9%). Intraoperative platelet transfusion was associated with an increased risk of bloodstream infection after adjustment by multivariable logistic regression (OR 2.85; 95%CI (1.40-5.8); p=0.004; n=7662), propensity score matching (OR 3.95; 95%CI (1.57-12.0), p=0.007; n=766) and propensity score overlap weighting (OR 3.04; 95%CI (1.51-6.1), p=0.002; n=7762). Surgical-site infection and hospital-acquired pneumonia were not significantly increased by platelet transfusion. ConclusionsOur results suggest that intraoperative allogeneic platelet transfusion is a risk factor for bloodstream infection after cardiac surgery. These results support the development of patient blood management strategies aiming at minimizing perioperative platelet transfusion in cardiac surgery.

Preoperative hypocoagulative state is an independent risk factor for wound complications and infection in gender-affirming bottom surgeries

BackgroundBottom gender affirmation surgery (GAS) involves the risks of bleeding and associated complications. Effective preoperative blood management is paramount across surgical disciplines with international normalized ratio (INR)≤1.5 advised prior to certain surgeries. This study aimed to examine the proportion of patients who were hypocoagulative before they underwent bottom GAS and assess the influence of hypocoagulability on their 30-day post-operative outcomes. MethodA retrospective study on female-to-male (FtM) and male-to-female (MtF) bottom GAS was performed based on American college of surgeons national surgical quality improvement program (ACS-NSQIP) database from 2005 to 2021. Patients with hypocoagulation were identified when PTT> 60 s, PT > 30 s, and/or INR> 2. Multivariable logistic regression was used to compare the 30-day perioperative outcomes between patients with hypocoagulation and controls. ResultsIn this study, 380 patients (182 FtM, 198 MtF) with hypocoagulation and 1176 controls (886 FtM, 310 MtF) were included. Mortality and organ system complications were infrequent in both groups. Patients with hypocoagulation had higher wound complication rates (13.68% vs. 2.64%, aOR 2.858, p < 0.01), especially wound dehiscence (10.00% vs. 0.60%, aOR 4.424, p < 0.01) and organ space infection rates (2.11% vs. 0.26%, aOR 12.77, p < 0.01). Additionally, patients with hypocoagulation had higher sepsis (0.79% vs. 0.09%, aOR 15.508, p = 0.04) and readmission rates (4.74% vs. 2.47%, aOR 1.919, p = 0.03), but lower rates of discharge not to home (7.92% vs. 25.38%, aOR 0.324, p < 0.01). ConclusionPreoperative hypocoagulative state is observed in approximately a quarter of the patients undergoing bottom GAS and is an independent risk factor for increased risks of 30-day wound complications and infections. Therefore, meticulous monitoring of preoperative hemostasis and implementing hemostasis control before surgery may be necessary. Thus, it may be advisable to discontinue oral anticoagulants before the surgery.

Relationship Between Blood Group and Obesity Reduction Through Diet Among Adults of Urban Bihar

ABO blood system is not only important for determining the lifestyle diseases, blood transfusion and exchange but it has also been found to be highly relevant to genetic marker of obesity. Recent studies are trying to explore the relation between blood grouping and obesity, and blood group diets and management of obesity. But still there are limited studies related to reduction of weight from blood group diets. The aim of this study is to examine the association of blood groups and weight reduction through a Moderate-Fat, Balanced Nutrient Reduction Diets among overweight and obese adults. A longitudinal study was conducted over 175 overweight and obese adults (&gt;18 years and &lt;60 years of age) of urban Bihar. A planned diet regime was followed by participants for a period of six months, and their anthropometric measurements were used for statistical analysis. There were substantial decreases in weight, BMI and waist circumference across different blood groups resulted through moderate-fat balanced nutrient reduction diet plan in both genders. For all blood groups, BMI reduction was at least 3.78 kg/m2 through the program, and the program was most effective for blood group O positive participants.

Iatrogenic blood loss from phlebotomy during adult extracorporeal membrane oxygenation: A retrospective cohort study.

Adult extracorporeal membrane oxygenation (ECMO) patients are at high risk for allogeneic blood transfusion. Few studies have characterized iatrogenic blood loss from phlebotomy in adult ECMO patients. We hypothesized that iatrogenic phlebotomy would be a significant source of blood loss during ECMO. Adults who had their entire ECMO run at our medical center between 2020 and 2022 were included. Average daily phlebotomy volume and total phlebotomy volume during ECMO were estimated based on the total number of laboratory tests that were processed. In addition, the crude and adjusted association between total phlebotomy volume during ECMO and RBC transfusion during ECMO was evaluated using linear regression and Loess curve analysis. A total of 161 patients who underwent 162 ECMO runs were included. Of the 162 ECMO runs, 88 (54.3%) were veno-arterial and 74 (45.7%) were veno-venous ECMO. Median duration of ECMO was 5 days [25th, 75th percentile = 2, 11]. Median daily phlebotomy volume was 130 mLs [25th, 75th percentile = 94, 170] and median total phlebotomy volume during ECMO was 579 mLs [25th, 75th percentile = 238, 1314]. There was a significant crude and adjusted association between total phlebotomy volume and RBC transfusion during ECMO (beta coefficient = 0.0023 and 0.0024 respectively, both p < .001) based on linear regression analysis. Phlebotomy for laboratory testing is a significant source of blood loss during ECMO in adults. Comprehensive patient blood management for adult ECMO patients should include strategies to reduce laboratory testing and/or phlebotomy volume during ECMO.

The risk factors for perioperative blood transfusion in open liver resection, a retrospective cohort study

Purpose: Liver resection is the current treatment for hepatic neoplasms but may be associated with intraoperative hemorrhage and the need for blood transfusions. The aim of this study is to identify the risk factors for predicting the requirement of a perioperative blood transfusion in open liver resection. Methods: A total of 808 consecutive patients who had undergone elective open liver resection from 2006 to 2017 were retrospectively reviewed using the database. Baseline characteristics and intra-operative data were collected. Perioperative blood transfusion was defined as the transfusion of allogenic packed red cells during surgery and the 48 hours following surgery. An analysis of logistic regression was used to determine the independent risk factors for blood transfusion in open liver resection. Results: Three hundred and seventy-seven patients (46.7%) received perioperative packed red cell transfusions. The independent risk factors associated with perioperative blood transfusion included ASA classification&gt;2, preoperative anemia (Hb&lt;12 g/dL for women, Hb&lt;13 g/dL for men), thrombocytopenia (platelet count&lt;100×103/mm3), albumin&lt;3.5 g/dL, largest tumor size&gt;4 cm., major liver resection, and surgeon experience performing&lt;50 cases of major open liver resection. Conclusion: Preoperative risk factors may be utilized to assess and predict patients who require perioperative blood transfusions following liver resection. Modifiable risk factors may also be treated prior to surgery. Furthermore, patient blood management and methods to minimize blood loss and blood transfusions during surgery should be implemented in patients who require high-risk transfusions.