Effects of massive transfusion on oxygen availability

Auler, José Otávio Costa; Bonetti, E.; Hueb, Alexandre Ciappina; Gallas, Filomena Regina Barbosa Gomes; Carmona, Maria José Carvalho

doi:10.1590/s1516-31801998000200006

Cited by 6 publications

(4 citation statements)

References 19 publications

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“…Blood loss would likely have no deleterious effects if a 1:1 simultaneous replacement with fully compatible fresh whole blood were possible. As it stands, the current process of large‐volume resuscitation leads to marked physiologic perturbations—including acid‐base and electrolyte abnormalities, tissue edema, hemostasis impairment, immune and inflammatory system modulation—that have been linked to end‐organ ischemia and dysfunction 33 ‐39 …”

Section: Discussionmentioning

confidence: 99%

The independent association of massive blood loss with mortality in cardiac surgery

et al. 2004

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Section: Discussionmentioning

confidence: 99%

The independent association of massive blood loss with mortality in cardiac surgery

et al. 2004

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“…At least three reports in the literature, both from cardiac surgery as well as from critical care, show that the systemic blood P 50 decreases after transfusion. [19][20][21] Gastric tonometry is a method to measure of acid production in the wall of the stomach. It has been implicated as a measurement technique to assess gut ischemia as well, and the gut mucosa is a sensitive indicator of shock.…”

Section: Oxygen Carrying Capacitymentioning

confidence: 99%

Transfusion of Blood Products Affects Outcome in Cardiac Surgery

Spiess

2004

Semin Cardiothorac Vasc Anesth

127

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There remains controversy as to when patients undergoing cardiac surgery should receive a transfusion and whether a low hematocrit and its treatment with a transfusion of red cells influences outcome. The data related to this controversy are reviewed. Although the risk of known viral transmission is currently low, stored red cells do not function normally, and each unit contains activated inflammatory cells and mediators. These changes cause limited oxygen release, impaired microcirculatory flow, and immune suppression. A number of studies have observed decreased survival associated with transfusions in trauma, coronary artery bypass grafting, and intensive care unit patients. Studies that show an adverse outcome associated with low hematocrit are not definitive, because they fail to distinguish between the impact of low hematocrit per se and the possible adverse effects of transfusion, for what the low hematocrit may simply be a surrogate. The observation that a low hematocrit is associated with an adverse outcome does not necessarily prove that "treatment" of the anemia with a red cell transfusion will improve the outcome. Stored platelets contain a highly activated mixture of platelets with storage lesions and inflammatory mediators. Two retrospective post hoc multifactorial analyses suggest that platelet transfusions are associated with substantial increased morbidity and mortality. Clearly, large prospective studies are required to define the proper trigger for blood product transfusion to balance the adverse effects of anemia and platelet deficiency or dysfunction with the adverse effects of transfusion of blood products on morbidity and mortality associated with cardiac surgery and anesthesia.

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“…Cell‐to‐cell interactions through fibrin cross‐linking lead to microaggregate formations that increase both in number and in number of cells per microaggreagte over the length of storage 15 . These factors combined with decreased oxygen binding and release lead to some fascinating and counterintuitive events seen with transfusion of RBCs 15‐22 . In articles just beginning to be appreciated, it has been demonstrated that patients transfused either during heart surgery or in the critical care units have worse P 50 values after transfusion of RBC units 16‐20 .…”

Section: Red Cell Transfusionsmentioning

confidence: 99%

“…These factors combined with decreased oxygen binding and release lead to some fascinating and counterintuitive events seen with transfusion of RBCs 15‐22 . In articles just beginning to be appreciated, it has been demonstrated that patients transfused either during heart surgery or in the critical care units have worse P 50 values after transfusion of RBC units 16‐20 . The gastric wall pH as measured by gastric tonometry has shown that patients transfused with RBCs acutely have worsened gut mucosal oxygen supply than before transfusion.…”

Section: Red Cell Transfusionsmentioning

confidence: 99%