Reduce Blood Transfusion Research Articles

Efficacy of Different Interventions to Reduce Pre- or Perioperative Blood Transfusion Rate in Patients with Colorectal Cancer: A Network Meta-Analysis of Randomized Controlled Trials.

Background: The high proportion of blood transfusions before and during surgery carries unnecessary risk and results in poor prognosis in colorectal cancer patients. Different pharmacological interventions (i.e., iron supplement or recombinant erythropoietin) to reduce blood transfusion rates have shown inconclusive results. Methods: This network meta-analysis (NMA) consisted of randomized controlled trials (RCTs) comparing the efficacy of different pharmacologic interventions (i.e., iron supplementation or recombinant erythropoietin) to reduce the blood transfusion rate. NMA statistics were conducted using the frequentist model. Results: Seven RCTs (688 participants) were included in this study. The NMA demonstrated that the combination of high-dose recombinant human erythropoietin and oral iron supplements was associated with the least probability of receiving a blood transfusion [odds ratio = 0.24, 95% confidence intervals (95% CIs): 0.08 to 0.73] and best reduced the amount of blood transfused if blood transfusion was necessary (mean difference = −2.62 U, 95% CI: −3.55 to −1.70 U) when compared to the placebo/control group. None of the investigated interventions were associated with any significantly different dropout rate compared to the placebo/control group. Conclusions: The combination of high-dose recombinant human erythropoietin and oral iron supplements might be considered as a choice for reducing the rate of blood transfusion in patients with colorectal cancer. However, future large-scale RCT with long-term follow-up should be warranted to approve the long-term safety.

P132. How does the Mazor X stealth edition compare with the Mazor X for robot-assisted spine surgery? A multicenter, propensity matched analysis of 2,800 screws and 372 patients

<h3>BACKGROUND CONTEXT</h3> Robot-assisted spine surgery continues to rapidly develop as evidenced by the growing literature in the last few years. Numerous reports demonstrate excellent pedicle screw accuracy and early studies have explored the impact of robot-assisted spine surgery on reducing radiation exposure, length of hospital stay, operative time, and perioperative complications in comparison to conventional freehand technique. Recently, the Mazor X Stealth Edition was introduced in 2018. This robotic system integrates Medtronic's Stealth navigation technology into the Mazor X platform. It is unclear what the impact of these advancements have made on clinical outcomes. <h3>PURPOSE</h3> This is the first study to compare the outcomes and complications between the most recent iterations of the Mazor Robot systems: Mazor X and the Mazor X Stealth Edition. <h3>STUDY DESIGN/SETTING</h3> Multicenter cohort. <h3>PATIENT SAMPLE</h3> Among four different institutions, we included adult (≥18 years old) patients who underwent robot-assisted spine surgery with either the Mazor X or Stealth platforms. <h3>OUTCOME MEASURES</h3> Primary outcomes included robot time per screw, robot abandonment, screw accuracy, radiation exposure and 90-day reoperation rate. <h3>METHODS</h3> A propensity-score matching algorithm based on perioperative factors (eg, demographics, comorbidities, primary diagnosis, prior spine surgery, pelvic fixation, instrumented levels, number of planned robot screws) was employed to control for the potential selection bias between the two robotic systems. The minimum follow-up was 90 days after surgery. Chi-square/fisher exact test and t-test/ANOVA were used for categorical and continuous variables, respectively. <h3>RESULTS</h3> A total of 372 adult patients were included in this study (Stealth: 186, X: 186). The mean number of instrumented levels was 4.3. The mean number of planned robot screws was 7.8. Similar total operative time (Stealth: 197 minutes vs X: 211, p=0.591) and robot time per screw (Stealth: 6.1 minutes/screw vs X: 6.1 minutes/screw, p=0.930) occurred between cohorts. However, Stealth achieved a significantly lower robot abandonment rate (Stealth: 0% vs X: 2.2%, p=0.044). The screw accuracy for both robots was excellent (Stealth: 99.6% vs X: 99.1%, p=0.120). Stealth achieved significantly shorter radiation time than X (Stealth: 7.2 seconds/screw vs X: 10.4 seconds/screw, p<0.001). Furthermore, a lower blood transfusion rate was observed for Stealth than X (Stealth: 4.3% vs X: 10.8%, p=0.018). Non-robot related complications such as dura tear, motor/sensory deficits, return to the OR during same admission, and LOS was similar between robots (p>0.05). The 90-day reoperation rates were low and similar between robot cohorts. <h3>CONCLUSIONS</h3> In this multicenter study, both robot systems achieved excellent screw accuracy and low robot time per screw. However, Stealth achieved significantly less radiation exposure, lower robot abandonment rates, and reduced blood transfusion rates than Mazor X. Other factors including LOS, and 90-day reoperation rates were similar. <h3>FDA DEVICE/DRUG STATUS</h3> Medtronic Mazor X and Mazor X stealth are FDA approved in the US.

SHORT VS LONG PROXIMAL FEMORAL NAIL IN UNSTABLE INTERTROCHANTERIC FRACTURES OF FEMUR

BACKGROUND; The current methods of treatment of Inter Trochanteric fractures of femur are either DHS plating for a stable Intertrochanteric fracture or a Proximal Femoral Nail for an unstable IT fracture. There are increased surgical demands and complications associated with Unstable IT fractures. Fracture patterns like –Posteromedial large separate fragment, Basi cervical pattern, Reverse obliquity pattern, Displaced and/or avulsed greater trochanter, Lateral wall fractures pose challenges before operating surgeon. Failure to reduce the fracture before internal xation and failure to hold the reduction till denitive xation are the most frequent causes of poor results irrespective of the implant used for xation. . Present surgeon's usual preference is towards long PFN. There is an added advantage of increased stability due to splinting of the whole length of femur with the use of long PFN. However there are times where short PFN is preferred over long one when there is a mismatch of curvature between the nail and the femur. However, there is no pre-established treatment choice protocol in choosing long nail or short nail for trochanteric fractures, but many surgeons are reluctant to use short proximal femoral nails biased by literature showing more fracture rates with short PFN usage and with a belief that long nails can avoid stress risers in the diaphysis and make peri- prosthetic fracture rates acceptable. Some of the drawbacks of long PFN include increased operative duration, reaming of the medullary canal distally, unavailability of distal locking jig, leading to prolongation of distal locking time and exposing the surgical team to more radiation. Stacking the above facts the study tried to verify these in the practical scenario. The study was conducted at the department of orthopaedics Andhra Medical College Visakhapatnam Andhra Pradesh. Salvage procedures like Dimon osteotomy and Sarmiento osteotomy were not entertained in the present study.This effectively limits the study to cephalomedullary xation of un stable per trochanteric fractures with short and long Proximal Femoral Nail. METHODS: Study design: Hospital Based Comparative study. Study period: October 2017 to September 2019. Sample size: 30 (N=30, Short PFN-15, Long PFN-15) The study population was randomly divided into 2 groups with 15 patients in each group. Group S (odd): The patients who were operated with Short Proximal Femoral Nail. Group L (even): The patients who were operated with Long Proximal Femoral Nail. RESULTS Thirty cases of unstable inter-trochanteric fractures treated with reduction and internal xation with long or short proximal femoral nail were studied. In the present study minimum age was 29 years and maximum age was 75 years. Majority of the patients were between 51 to 70 years of age. Mean age for long PFN was 52.83 +/- 10.33 SD years, (Range 29-70). Mean age for short PFN was 58.16 +/- 13.94 SD years, (Range 35-75). In the present study males predominate females with a male to female ratio of 3:2. CONCLUSION We conclude that both short and long nails appear acceptable for use in unstable inter-trochanteric fractures. A reduction in operative duration and reduction in blood loss, which translates into a reduced blood transfusion requirement more importantly signicant reduction in image intensier exposures seen with short PFN makes it a surgeon friendly implant. We prefer long PFN for xation of unstable trochanteric fractures with osteoporosis so as to splint the whole femur.

Impact of Deferred Cord Clamping on Mortality and Severe Neurologic Injury in Twins Born at

To determine whether deferred cord clamping (DCC) compared with early cord clamping (ECC) was associated with reduction in death and/or severe neurologic injury among twins born at <30weeks of gestation. We performed a retrospective cohort study including all liveborn twins of <30weeks admitted to a tertiary-level neonatal intensive care unit (NICU) in Canada between 2015 and 2018 using the Canadian Neonatal/Preterm Birth Network database. We compared DCC ≥30seconds vs ECC <30seconds. Our primary outcome was a composite of death and/or severe neurologic injury (severe intraventricular hemorrhage grade III/IV and/or periventricular leukomalacia). Secondary outcomes included neonatal morbidity and health care utilization outcomes. We calculated aORs and β coefficients for categorical and continuous variables, along with 95% CI. Models were fitted with generalized estimated equations accounting for twin correlation. We included 1597 twins (DCC, 624 [39.1%]; ECC, 973 [60.9%]). Death/severe neurologic injury occurred in 17.8% (n=111) of twins who received DCC and in 21.7% (n=211) of those who received ECC. The rate of death/severe neurologic injury did not differ significantly between the DCC and ECC groups (aOR 1.07; 95% CI, 0.78-1.47). DCC was associated with reduced blood transfusions (adjusted β coefficient, -0.49; 95% CI, -0.86 to -0.12) and NICU length of stay (adjusted β coefficient, -4.17; 95% CI, -8.15 to -0.19). The primary composite outcome of death and/or severe neurologic injury did not differ between twins born at <30weeks of gestation who received DCC and those who received ECC, but DCC was associated with some benefits.

Phase 2 study of danicopan in patients with paroxysmal nocturnal hemoglobinuria with an inadequate response to eculizumab

AbstractParoxysmal nocturnal hemoglobinuria (PNH) is characterized by uncontrolled terminal complement activation and subsequent intravascular hemolysis (IVH). C5 inhibitors prevent membrane attack complex formation, but patients may experience extravascular hemolysis (EVH) and continue to require blood transfusions. Danicopan, an oral proximal complement inhibitor of alternative pathway factor D (FD), is designed to control IVH and EVH. In a phase 2 dose-finding trial, eculizumab-treated transfusion-dependent patients with PNH (n = 12) received danicopan, 100 to 200 mg thrice daily, in addition to their eculizumab regimen for 24 weeks. End points included hemoglobin (Hgb) change vs baseline at week 24 (primary), reduction in blood transfusions, and patient-reported outcomes. Safety, tolerability, and pharmacokinetics/pharmacodynamics were measured. Twelve patients received ≥1 danicopan dose; 1 patients discontinued from a serious adverse event deemed unlikely related to danicopan. Eleven patients completed the 24-week treatment period. Addition of danicopan resulted in a mean Hgb increase of 2.4 g/dL at week 24. In the 24 weeks prior to danicopan, 10 patients received 31 transfusions (50 units) compared with 1 transfusion (2 units) in 1 patient during the 24-week treatment period. Mean Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue score increased by 11 points from baseline to week 24. The most common adverse events were headache, cough, and nasopharyngitis. Addition of danicopan, a first-in-class FD inhibitor, led to a meaningful improvement in Hgb and reduced transfusion requirements in patients with PNH who were transfusion-dependent on eculizumab. These benefits were associated with improvement of FACIT-Fatigue. This trial was registered at www.clinicaltrials.gov as #NCT03472885.

Preoperative anemia management program reduces blood transfusion in elective cardiac surgical patients, improving outcomes and decreasing hospital length of stay.

Anemia is an independent risk factor for hospitalization, readmission, prolonged length of stay (LOS), diminished quality of life, and mortality. A multidisciplinary program was implemented to manage anemia preoperatively as a patient blood management (PBM) initiative. From March 2016 to August 2018, 240 patients were screened for anemia during their preoperative cardiovascular visit. About 52/240 (22%) were found to be anemic and met out inclusion criteria. Also, 45/52 (87%) had iron deficiency anemia and 7 (13%) had anemia without iron deficiency. A similar historical cohort of patients undergoing elective cardiovascular surgery with hemoglobin (Hb) < 12 g/dl from September 2014 to February /2016 (n=52) served as control group. The primary outcome was perioperative red blood cell (RBC) transfusion. Secondary outcomes were date-of-surgery Hb, intensive care unit (ICU) and hospital LOS, complication rates, and transfusion cost. The two most common treatments were IV iron ± folate (n=36/45; 80%) and oral iron (n=9/45; 20%). As compared to historical patients, study patients had significantly higher day-of-surgery Hb (10.6 ± 1.4 vs. 9.8 ± 1.3g/dl, p < .001), lower utilization of RBC transfusion (0.86 ± 1.4 vs. 2.78 ± 2.4, p < .001), fewer days in the ICU (2.1 ± 2.0 vs. 4.0 ± 3.5, p=.002), and shorter total LOS (6.9 ± 4.8 vs. 12.9 ± 6.8, p < .0001). Study patients also showed lower overall complication rates (p < .0001). Analysis of RBC acquisition cost and transfusion cost also showed significant saving of 69% ($293 vs. $945 and $656 vs. $2116, respectively). When corrected for type of procedures and surgeon, our pilot anemia program in elective cardiovascular surgeries showed higher day-of-surgery Hb and significant reduction in RBC transfusion rates, ICU and hospital LOS, and overall complication rates.

Impact of COVID-19 and lockdown regarding blood transfusion.

BackgroundThe outbreak of a SARS‐CoV‐2 resulted in a massive afflux of patients in hospital and intensive care units with many challenges. Blood transfusion was one of them regarding both blood banks (safety, collection, and stocks) and consumption (usual care and unknown specific demand of COVID‐19 patients). The risk of mismatch was sufficient to plan blood transfusion restrictions if stocks became limited.Study design and methodsAnalyses of blood transfusion in a tertiary hospital and blood collection in the referring blood bank between February 24 and May 31, 2020.ResultsWithdrawal of elective surgery and non‐urgent care and admission of 2291 COVID‐19 patients reduced global activity by 33% but transfusion by 17% only. Only 237 (10.3) % of COVID‐19 patients required blood transfusion, including 45 (2.0%) with acute bleeding. Lockdown and cancellation of mobile collection resulted in an 11% reduction in blood donation compared to 2019. The ratio of reduction in blood transfusion to blood donation remained positive and stocks were slightly enhanced.DiscussionReduction of admissions due to SARS‐CoV‐2 pandemic results only in a moderate decrease of blood transfusion. Incompressible blood transfusions concern urgent surgery, acute bleeding (including some patients with COVID‐19, especially under high anticoagulation), or are supportive for chemotherapy‐induced aplasia or chronic anemia. Lockdown results in a decrease of blood donation by cancellation of mobile donation but with little impact on a short period by mobilization of usual donors. No mismatch between demand and donation was evidenced and no planned restriction to blood transfusion was necessary.

Ayurvedic Add-on Therapy for β-Thalassemia Major Cases on Quality of Life

Blood transfusions which were suggested as treatment for beta thalassemia major cases brought down the quality of life by several means like splenomegaly, growth retardation, poor appetite, low hemoglobin (Hb), increased serum ferritin level, etc. In present study the group of 79 patients which were selected were having such symptoms arouse due to repeated conventional blood transfusion. the patient was given Amlavetas (Garcinia pedunculata Roxb. ex Buch. Ham) dry fruit pulp (5 g) once daily in the early morning on an empty stomach regularly for 6 months without imposing any restriction to their regular food and other medicines for his existing comorbidities. Objective parameters such as Hb (g%), body weight (Kg), loss of appetite serum ferritin (ng/dl), and frequency of blood transfusion were assessed which ultimately help to understand the QoL of the subjects. The Hb percentage after 3rd month and 6th month was 6.94 ± 1.57 g% and 6.99 ± 1.52 g% which were significant when compared with baseline values (6.42 ± 1.37 g%, P &lt; 0.001). The serum ferritin was significantly increased (P &lt; 0.005) in the follow up visits when compared with baseline value 3112.13 ± 2801.20 ng/dl. The gain in body weight, increase in appetite and reduced blood transfusion rate indicates the quality of life, revealed by the improvement of his blood parameters including the serum ferritin level. Amlavetas fruit pulps can be a potential iron chelating as well as erythropoiesis Ayurvedic intervention to normalize iron metabolism, relieve thalassemia symptoms, and increase BT intervals with better life expectancy.

Sucrosomial® Iron Supplementation during Perioperative Period in General Surgery

Anemia frequently occurs in patients undergoing general surgery and in particular for gastrointestinal surgery [1]. The impact of anemia and iron deficiency on abdominal surgery outcomes is well known [1-3] and new preoperative strategies are nowadays considered to improve patient conditions during the perioperative period. Iron supplementation is often administered intravenously, since conventional oral iron therapies are usually less effective [4]. Since Sucrosomial iron, an innovative oral iron formulation where iron is conveyed into a matrix of phospholipids and sucrester, appears to be effective in improving Hb levels and reducing blood transfusion during the perioperative period (5), we aim to determine whether oral Sucrosomial® Iron supplementation enables better results in terms of recovery, length of hospital stay and need of blood transfusions in anemic patients undergoing major elective gastrointestinal surgery.Data from patients scheduled for major gastrointestinal surgery were prospectively collected between October 2016 and July 2017. Supplementation with oral Sucrosomial Iron (1 capsule/day) for 2 to 3 weeks prior to surgery, was recommended to patients, scheduled for colorectal surgery (right and left hemicolectomy, segmental colonic resection or anterior rectal resection) or gastric surgery (total or subtotal gastrectomy), that showed levels of hemoglobin < 13 g/dL for women and < 14 g/dL for men during preoperative visit. The level of hemoglobin was evaluated one week before surgery, during the preoperative follow up visit, and one day after surgery. Moreover, blood transfusion needs and length of hospital stay were also evaluated. Thirty-five patients have been currently enrolled, however 4 patients were excluded due to intraoperative findings of advanced neoplastic disease and 3 due to post-operative anastomotic bleeding. To date, the post-operative results from 10 patients are available and have been analyzed in terms of hemoglobin values, blood transfusions and hospital stay. These preliminary results were compared to an equivalent historical population of 82 patients extrapolated from a pool of patients, who underwent major elective gastrointestinal surgery in 2015. Thus, patients that received palliative intervention and those with hemorrhagic post-operative complications were excluded. The two populations were not pair-matched. This comparable group of patients from 2015 was chosen in order to evaluate the difference in hemoglobin drop recorded after surgery and evaluate a possible preoperative protocol implementation that includes sucrosomial iron supplementation.Preliminary results from patients supplemented with Sucrosomial® iron showed that average hemoglobin levels one week prior to surgery (preOP) were 11.5 ± 1.72 g/dL, which were maintained after surgery (postOP, 11.3 ± 1.45 g/dL). These results showed a smaller decrease in the expected post-operative hemoglobin drop compared to an equivalent and not supplemented population from 2015 (0.2 g/dL vs 1.9 g/dL). Moreover, average blood transfusions decrease of 2 folds to 0.20 ± 0.03 units/patient in patients supplemented with Sucrosomial iron, compare to 2015 patients (0.41 ± 0.07 units/patient). Finally, mean hospital stay appears to be longer in the Sucrosomial iron group, however this result was biased by 2 patients whose longer hospitalization was not due to anemia.Preliminary results show that supplementation with Sucrosomial® iron allows an improvement in perioperative Hb levels and a decrease in blood transfusion compared to a comparable historical population. Thus these finding appear to confirm previous results on Sucrosomial® iron in patients undergoing elective surgery (5). However, these are preliminary results and data collected from all patients still need to be analyzed. Moreover, confirmation on a larger cohort of patients is need.1. Hallet J, et al. Transfus Med Rev. 2014 Oct;28(4):205-11. Review.2. Hogan M, et al. Eur J Cardiothorac Surg. 2015 Feb;47(2):218-26. Review.3. Yohanathan L, et al. J Gastrointest Surg. 2016 Jun;20(6):1106-22.4. Garrido-Martín et al. Interact Cardiovasc Thorac Surg. 2012 Dec;15(6):1013-85. Scardino M. et al. Expert Review of Hematology. 2016;9:1-42. [Display omitted] DisclosuresPera:Pharmanutra S.p.A.: Employment. Tarantino:Pharmanutra S.p.A.: Employment.

Is there a difference between navigated and non-navigated robot cohorts in robot-assisted spine surgery? A multicenter, propensity-matched analysis of 2,800 screws and 372 patients

Robot-assisted spine surgery continues to rapidly develop as evidenced by the growing literature in recent years. In addition to demonstrating excellent pedicle screw accuracy, early studies have explored the impact of robot-assisted spine surgery on reducing radiation time, length of hospital stay, operative time, and perioperative complications in comparison to conventional freehand technique. Recently, the Mazor X Stealth Edition was introduced in 2018. This robotic system integrates Medtronic's Stealth navigation technology into the Mazor X platform, which was introduced in 2016. It is unclear what the impact of these advancements have made on clinical outcomes. To compare the outcomes and complications between the most recent iterations of the Mazor Robot systems: Mazor X and Mazor X Stealth Edition. Multicenter cohort PATIENT SAMPLE: Among four different institutions, we included adult (≥18 years old) patients who underwent robot-assisted spine surgery with either the Mazor X (non-navigated robot) or Stealth (navigated robot) platforms. Primary outcomes included robot time per screw, fluoroscopic radiation time, screw accuracy, robot abandonment, and clinical outcomes with a minimum 90 day follow up. A one-to-one propensity-score matching algorithm based on perioperative factors (e.g. demographics, comorbidities, primary diagnosis, open vs. percutaneous instrumentation, prior spine surgery, instrumented levels, pelvic fixation, interbody fusion, number of planned robot screws) was employed to control for the potential selection bias between the two robotic systems. Chi-square/fisher exact test and t-test/ANOVA were used for categorical and continuous variables, respectively. From a total of 646 patients, a total of 372 adult patients were included in this study (X: 186, Stealth: 186) after propensity score matching. The mean number of instrumented levels was 4.3. The mean number of planned robot screws was 7.8. Similar total operative time and robot time per screw occurred between cohorts (p>0.05). However, Stealth achieved significantly shorter fluoroscopic radiation time per screw (Stealth: 7.2 seconds vs. X: 10.4 seconds, p<.001) than X. The screw accuracy for both robots was excellent (Stealth: 99.6% vs. X: 99.1%, p=0.120). In addition, Stealth achieved a significantly lower robot abandonment rate (Stealth: 0% vs. X: 2.2%, p=0.044). Furthermore, a lower blood transfusion rate was observed for Stealth than X (Stealth: 4.3% vs. X: 10.8%, p=0.018). Non-robot related complications such as dura tear, motor/sensory deficits, return to the operating room during same admission, and length of stay was similar between robots (p>0.05). The 90-day complication rates were low and similar between robot cohorts (Stealth: 5.4% vs. X: 3.8%, p=0.456). In this multicenter study, both robot systems achieved excellent screw accuracy and low robot time per screw. However, using Stealth led to significantly less fluoroscopic radiation time, lower robot abandonment rates, and reduced blood transfusion rates than Mazor X. Other factors including length of stay, and 90-day complications were similar.

Prevalence of Preoperative Iron Deficiency Anemia: A Case Series Among Patients Undergoing Radical Cystectomy.

Anemia occurs in a significant group of patients with bladder cancer before radical cystectomy. Iron deficiency is a readily identifiable cause of anemia, which can be treated before surgery. The proportion of patients with bladder cancer with iron deficiency anemia is unknown. Laboratory and clinical outcomes were collected on 47 consecutive patients presenting for radical cystectomy. Iron studies found 30% of patients had iron deficiency anemia. These findings present an opportunity to treat anemia before surgery, to reduce blood transfusions during radical cystectomy.

Effectiveness of pre-operative anaemia screening and increased Tranexamic acid dose policies on outcomes following unilateral primary, elective total hip or knee replacement: a statistical analysis plan for an interrupted time series and regression discontinuity study.

Perioperative blood transfusion is associated with poorer postoperative outcomes following hip and knee replacement surgery. Evidence for the effectiveness of some measures aimed at reducing blood transfusions in this setting are limited and often rely on weak pre-post study designs. Quasi-experimental study designs such as interrupted time series (ITS) and regression discontinuity design (RDD) address many of the weaknesses of the pre-post study design. In addition, a priori publication of statistical analysis plans for such studies increases their transparency and likely validity, as readers are able to distinguish between pre-planned and exploratory analyses. As such, this article, written prospective of any analysis, provides the statistical analysis plan for an ITS and RDD study based on a data set of 20,772 primary elective hip and knee replacement patients in a single English NHS Trust. The primary aim is to evaluate the impact of a preoperative anaemia optimisation service on perioperative blood transfusion (within 7 days of surgery) using both ITS and RDD methods. A secondary aim is to evaluate the impact of a policy of increased tranexamic acid dose given at the time of surgery, using ITS methods.

340 Pre-operative Screening and Treatment of Iron Deficiency Anaemia in Upper GI Cancer Surgery

Abstract Introduction NICE guidelines recommend intravenous iron for patients with iron deficiency anaemia (IDA) before major elective surgery to reduce blood transfusion rate. The aim of this audit was to assess pre-operative screening for anaemia and treatment of IDA in patients undergoing Upper GI (UGI) cancer surgery. Method A retrospective audit of all patients who underwent UGI cancer surgery in year 2019 at a tertiary centre. Data were collected from electronic records. Results Pre-operative haemoglobin level was performed in 110/111 (99.1%) patients. 43 (39.1%) patients were found to be anaemic using the WHO definition and 9/43 (20.9%) were severely anaemic (Hb &amp;lt; 100g/L). All anaemic patients had iron status checked and 26/43 (60.5%) patients were diagnosed with IDA. 17/43 (39.5%) anaemic patients received treatment, including IV iron (n = 8), blood transfusion (n = 3), oral iron (n = 3), and both IV iron and blood transfusion (n = 3). Anaemic patients (n = 17) who received treatment had a significant improvement in anaemia (P = 0.005). Conclusions This audit has demonstrated good pre-operative anaemia and IDA screening; however anaemic patients are not adequately treated, and IV iron is not routinely offered. Pre-operative anaemia treatment is effective in improving haemoglobin level. We have implemented a new anaemia treatment pathway and MDT proforma to improve the quality of care.

Effectiveness of pre-operative anaemia screening and increased Tranexamic acid dose policies on outcomes following unilateral primary, elective total hip or knee replacement: a statistical analysis plan for an interrupted time series and regression discontinuity study

Perioperative blood transfusion is associated with poorer postoperative outcomes following hip and knee replacement surgery. Evidence for the effectiveness of some measures aimed at reducing blood transfusions in this setting are limited and often rely on weak pre-post study designs. Quasi-experimental study designs such as interrupted time series (ITS) and regression discontinuity design (RDD) address many of the weaknesses of the pre-post study design. In addition, a priori publication of statistical analysis plans for such studies increases their transparency and likely validity, as readers are able to distinguish between pre-planned and exploratory analyses. As such, this article, written prospective of any analysis, provides the statistical analysis plan for an ITS and RDD study based on a data set of 20,772 primary elective hip and knee replacement patients in a single English NHS Trust. The primary aim is to evaluate the impact of a preoperative anaemia optimisation service on perioperative blood transfusion (within 7 days of surgery) using both ITS and RDD methods. A secondary aim is to evaluate the impact of a policy of increased tranexamic acid dose given at the time of surgery, using ITS methods.

Intravenous Iron Replacement in Patients with Left Ventricular Assist Devices

<h3>Purpose</h3> In patients supported by LVADs, iron deficiency is a common cause of anemia (IDA) and its associated morbidity. The clinical benefits of intravenous (IV) iron replacement in heart failure are well described, but there are fewer data supporting IDA treatment in LVAD patients. This study assessed the clinical and financial impact of IV ferric carboxymaltose (FCM) in an outpatient LVAD population through evaluation of anemia, blood transfusion requirements, readmissions, and insurance reimbursement. <h3>Methods</h3> This was a single-center prospective observational study of LVAD patients with IDA (ferritin <100 ng/mL or 100-300 ng/mL with Tsat <20%). Outpatients received FCM 750 mg x 2 doses given 1 week apart. The primary endpoint was the resolution of anemia at 1, 3, and 6 months. Blood transfusion requirements and readmissions were assessed pre- and post-FCM therapy. Financial analysis included the comparison of drug-specific reimbursement to drug acquisition cost. <h3>Results</h3> Eighty patients received FCM therapy. Baseline data are shown in Table 1. On average, patients were 19 months post-implant, 16% had experienced a gastrointestinal bleed within the last 3 months, and mean baseline Hgb was 9.9 g/dL. At 1 month, mean Hgb significantly improved (12.0±1.9 g/dL vs 9.9±1.4, p<0.0001), and this was maintained at 3 months (12.1±2.0, p<0.0001) and 6 months (12.2±2.1, p<0.0001) (Figure 1). When comparing the 3- and 6-month periods pre- and post-FCM, blood transfusion requirements and hospital admissions were both significantly reduced (Table 3). The majority of patients were covered by Medicare (67.5%) or a commercial payor (18.2%) with drug reimbursement to cost ratios of 0.81 and 1.97, respectively. <h3>Conclusion</h3> This prospective evaluation of IV iron replacement with 2 doses of FCM in a large cohort of LVAD patients demonstrated a resolution of anemia and subsequent reduction in blood transfusion and readmission requirements. In a mixed payor patient population, drug reimbursement supports utilization of FCM for this indication.

Impact of autologous platelet rich plasma use on postoperative acute kidney injury in type A acute aortic dissection repair: a retrospective cohort analysis

BackgroundPerioperative coagulopathy and blood transfusion are common in patients undergoing Stanford type A acute aortic dissection (AAD) repair. The autologous platelet-rich plasmapheresis (aPRP) technique is a blood conservation approach to reduce blood transfusions and morbidity in patients at high risk of bleeding. The purpose of this study was to analyze the effect of aPRP on outcomes, especially in postoperative acute kidney injury (post-AKI), in patients undergoing AAD surgery.MethodsSix hundred sixty patients were divided into aPRP and non-aPRP groups according to aPRP use. The primary endpoint was the difference in the incidence of post-AKI between two groups. The secondary endpoints were risk factors for post-AKI and to assess clinical outcomes. The risk factors associated with post-AKI were calculated, and all outcomes were adjusted by propensity-score matching analysis.ResultsA total of 272 patients (41.2%) received aPRP, whereas 388 were in the non-aPRP group. Compared to non-aPRP group, the occurrence of post-AKI increased by 14.1% (p = 0.002) and 11.1% (p = 0.010) with and without propensity adjustment in the aPRP group, respectively. The aPRP group required fewer intraoperative transfusions (p < 0.05) and shortened the duration of mechanical ventilation (p < 0.05) than those in the non-aPRP group. Multiple regression analyses showed that aPRP (odds ratio: 1.729, 95% confidence interval: 1.225–2.440; p < 0.001) was one of the independent risk factors for post-AKI.ConclusionsThe use of aPRP significantly reduced intraoperative blood transfusions and decreased postoperative mortality-adjusted mechanical ventilation. However, aPRP use was independently associated with an increased hazard of post-AKI after adjusting for confounding factors.

Tranexamic acid and reduction of blood transfusion in lower limb trauma surgery: a randomized controlled study.

Introduction: Post-operative blood loss in lower limb trauma fractures increases morbidity. Very few studies have evaluated the efficacy of Tranexamic Acid (TXA) in reducing blood loss and the consequent requirement of blood transfusion in the Indian population. Methods: This was a randomized controlled study of 100 patients with lower limb trauma. Fifty patients were given 1 g of TXA before surgery, and 50 patients were not given TXA. The requirement of blood transfusion, fall in Hb, the number of days admitted in the hospital after surgery were recorded, and evidence of deep vein thrombosis (DVT) was monitored. Results: Baseline demographics between the groups were comparable. The required blood transfusion and fall in Hb in patients receiving intra-operative TXA were significantly lower than those not given TXA (p < 0.0001). There was no significant difference in the length of hospital stay between the two groups (p = 0.6). There was no significant difference in the incidence of DVT in both groups. Discussion: TXA helps reduce the morbidity of trauma patients by reducing the requirement for blood transfusion. Its use is safe in lower limb trauma surgery and lowers the cost of therapy to the patient.

How does tranexamic acid affect blood transfusion and bleeding amount in pelvis-acetabulum fractures treated with open reduction and internal fixation?

This study aimed to investigate intravenous tranexamic acid's (TA) effect on blood loss and transfusion ratios in pelvis-acetabulum fractures treated with open reduction and internal fixation. Patients who underwent open reduction and internal fixation due to pelvis-acetabulum fractures between January 2017 and January 2019 constituted this study's target population. After applying inclusion and exclusion criteria, patients were divided into two groups: Those who were perioperatively given 15 mg/kg TA (i.e., Group 1) and those who were not (i.e., Group 2). Data including age, gender, mechanism of injury, fracture type, presence or absence of additional injuries, the time interval between admission and surgery, incision site, pre-operative and post-operative hemoglobin levels, intraoperative estimated blood loss (EBL), number of blood units transfused, and complications were recorded. Two groups were compared regarding these parameters. The study cohort included 58 patients. There were 30 patients in Group 1 and 28 patients in Group 2. Our analysis revealed that the number of blood units transfused was significantly higher in Group 2 than Group 1 (p=0.016). However, there was no significant difference between the two groups regarding intraoperative EBL, pre-operative and post-operative hemoglobin levels, and the time interval between admission and surgery. Administration of intravenous TA reduces blood transfusion requirement in patients with pelvis-acetabulum fractures treated with open reduction and internal fixation. This approach can prevent potential blood transfusion-related complications.

Real-world results of the implementation of preoperative anaemia clinic with intravenous iron therapy for treating iron-deficiency anaemia: a propensity-matched case-control study.

BackgroundPreoperative anaemia is associated with blood transfusion and longer hospital length of stay. Preoperative iron deficiency anaemia (IDA) can be treated with oral or intravenous (IV) iron. IV iron can raise haemoglobin faster compared with oral iron. However, its ability to reduce blood transfusion and length of stay in clinical trials is inconclusive. This study aims to compare blood transfusion and hospital length of stay between anemic patients who received preoperative IV iron versus standard care, after implementation of a protocol in 2017 to screen patients for preoperative IDA, and its treatment with IV iron.MethodsRetrospective before-after cohort study comparing 89 patients who received IV iron preoperatively in 2017, with historic patients who received oral iron therapy (selected by propensity score matching (PSM) from historic cohort of 7,542 patients who underwent surgery in 2016). Propensity score was calculated using ASA status, age, gender, surgical discipline, surgical risk and preoperative haemoglobin concentration. Both 1:1 and 1:2 matching were performed as sensitivity analysis.ResultsAfter PSM, there was no statistically significant difference in distribution of preoperative clinical variables. There was no significant difference in proportion of cases requiring transfusion nor a difference in average units transfused per patient. IV iron cohort stayed in hospital on average 8.0 days compared to non-IV iron cohort 14.1–15.1 days (P=0.006, P=0.013 respectively). Average time from IV iron therapy to surgery was 10.5 days.ConclusionsPreoperative IV iron therapy for patients with IDA undergoing elective surgery may not reduce perioperative blood transfusion, but this could be due to the short time between therapy and surgery. Implementation of IV iron therapy may reduce hospital length of stay compared to standard care for anemic patients, although this may be enhanced by concomitant improvement in perioperative care.

Study protocol for a multicentre, 2×2 factorial, randomised, controlled trial evaluating the interest of intravenous iron and tranexamic acid to reduce blood transfusion in hip fracture patients (the HiFIT study)

IntroductionBlood transfusion and anaemia are frequent and are associated with poor outcomes in patients with hip fracture (HF). We hypothesised that preoperative intravenous iron and tranexamic acid (TXA) may reduce...