Correlation between red blood cell transfusion volume and mortality in patients with massive blood transfusion: A large multicenter retrospective study

Yang, Jiangcun; Sun, Yang; Xu, Cuixiang; Dang, Qian-Li; Li, Ling; Xu, Yan; Song, Yuyan; Zhang, Pengcheng

doi:10.3892/etm.2014.2068

Cited by 28 publications

(21 citation statements)

References 12 publications

(14 reference statements)

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“…[11][12][13] Furthermore, there are only limited descriptions of UMT that are not restricted to specific patient groups. [13][14][15][16] To better understand the current status of largevolume blood transfusion, we undertook a retrospective analysis of patients receiving 20 or more RBC units during 2 consecutive days at 11 hospitals in six nations. Our aim was to characterize the blood requirements of these patients, identify their underlying diagnostic categories, and report short-term patient survival rates according to increasing blood use.…”

Section: Discussionmentioning

confidence: 99%

Survival after ultramassive transfusion: a review of 1360 cases

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Survival after ultramassive transfusion: a review of 1360 cases

et al. 2015

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“…In revision cardiac surgery, specifically, George and coworkers found that revision sternotomy heart transplant recipients had increased blood product usage and that increased transfusion of products was independently associated with short‐ and long‐term mortality. Many other observational studies have reported the increased morbidity and mortality associated with incremental amounts of blood transfusion . Although the results of observational studies must be interpreted with caution, the 2011 Update to the Society of Thoracic Surgeons and Society of Cardiovascular Anesthesiologists Blood Conservation Guidelines noted that transfusing beyond the recommended guidelines only increases risk and cost for cardiac surgery patients …”

Section: Discussionmentioning

confidence: 99%

“…Many other observational studies have reported the increased morbidity and mortality associated with incremental amounts of blood transfusion. 4,12,13 Although the results of observational studies must be interpreted with caution, the 2011 Update to the Society of Thoracic Surgeons and Society of Cardiovascular Anesthesiologists Blood Conservation Guidelines noted that transfusing beyond the recommended guidelines only increases risk and cost for cardiac surgery patients. 14 Surgeons also approach revision sternotomy cases differently from primary cases.…”

Section: Discussionmentioning

confidence: 99%

Blood utilization in revision versus first‐time cardiac surgery: an update in the era of patient blood management

Hensley¹,

Kostibas²,

Yang³

et al. 2017

Transfusion

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BACKGROUND Relative to first‐time (primary) cardiac surgery, revision cardiac surgery is associated with increased transfusion requirements, but studies comparing these cohorts were performed before patient blood management (PBM) and blood conservation measures were commonplace. The current study was performed as an update to determine if this finding is still evident in the PBM era. STUDY DESIGN AND METHODS Primary and revision cardiac surgery cases were compared in a retrospective database analysis at a single tertiary care referral center. Two groups of patients were assessed: 1) those having isolated coronary artery bypass (CAB) or valve surgery and 2) all other cardiac surgeries. Intraoperative and whole hospital transfusion requirements were assessed for the four major blood components. RESULTS Compared to the primary cardiac surgery patients, the revision surgery patients required approximately twofold more transfused units intraoperatively (p < 0.0001) and approximately two‐ to threefold more transfused units for the whole hospital stay (p < 0.0001). Intraoperative massive transfusion (>10 red blood cell [RBC] units) was substantially more frequent with revision versus primary cardiac surgery (2.6% vs. 0.1% [p < 0.0001] for isolated CAB or valve and 6.1% vs. 1.9% [p < 0.0001] for all other cardiac surgeries). Revision surgery was an independent risk factor for both moderate (6‐10 RBC units) and massive intraoperative transfusion. CONCLUSIONS In the era of PBM, with restrictive transfusion strategies and a variety of methods for blood conservation, revision cardiac surgery patients continue to have substantially greater transfusion requirements relative to primary cardiac surgery patients. This difference in transfusion requirement was greater than what has been previously reported in the pre‐PBM era.

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“…These data have been replicated in a 600-patient cohort in domestic trauma [ 38 ] as well as in other large clinical studies [ 39 , 40 ]. However, there is also a clear association between high-volume blood component therapy and adverse events linked to each of the three components [ 41 - 43 ]. Hence, the optimal ratio for such a massive transfusion protocol has yet to be determined.…”

Section: Red Blood Cell Transfusion Strategies: Premise and Datamentioning

confidence: 99%

Restrictive and liberal red cell transfusion strategies in adult patients: reconciling clinical data with best practice

et al. 2015

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Red blood cell (RBC) transfusion guidelines correctly promote a general restrictive transfusion approach for anemic hospitalized patients. Such recommendations have been derived from evaluation of specific patient populations, and it is important to recognize that engaging a strict guideline approach has the potential to incur harm if the clinician fails to provide a comprehensive review of the patient’s physiological status in determining the benefit and risks of transfusion. We reviewed the data in support of a restrictive or a more liberal RBC transfusion practice, and examined the quality of the datasets and manner of their interpretation to provide better context by which a physician can make a sound decision regarding RBC transfusion therapy. Reviewed studies included PubMed-cited (1974 to 2013) prospective randomized clinical trials, prospective subset analyses of randomized studies, nonrandomized controlled trials, observational case series, consecutive and nonconsecutive case series, and review articles. Prospective randomized clinical trials were acknowledged and emphasized as the best-quality evidence. The results of the analysis support that restrictive RBC transfusion practices appear safe in the hospitalized populations studied, although patients with acute coronary syndromes, traumatic brain injury and patients at risk for brain or spinal cord ischemia were not well represented in the reviewed studies. The lack of quality data regarding the purported adverse effects of RBC transfusion at best suggests that restrictive strategies are no worse than liberal strategies under the studied protocol conditions, and RBC transfusion therapy in the majority of instances represents a marker for greater severity of illness. The conclusion is that in the majority of clinical settings a restrictive RBC transfusion strategy is cost-effective, reduces the risk of adverse events specific to transfusion, and introduces no harm. In anemic patients with ongoing hemorrhage, with risk of significant bleeding, or with concurrent ischemic brain, spinal cord, or myocardium, the optimal hemoglobin transfusion trigger remains unknown. Broad-based adherence to guideline approaches of therapy must respect the individual patient condition as interpreted by comprehensive clinical review.

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Correlation between red blood cell transfusion volume and mortality in patients with massive blood transfusion: A large multicenter retrospective study

Cited by 28 publications

References 12 publications

Survival after ultramassive transfusion: a review of 1360 cases

Survival after ultramassive transfusion: a review of 1360 cases

Blood utilization in revision versus first‐time cardiac surgery: an update in the era of patient blood management

Restrictive and liberal red cell transfusion strategies in adult patients: reconciling clinical data with best practice

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