Evidence Base for Restrictive Transfusion Triggers in High-Risk Patients

Spahn, Donat R.; Spahn, G.; Stein, Philipp

doi:10.1159/000381509

Cited by 37 publications

(25 citation statements)

References 35 publications

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“…Among nonobstetric, nonbleeding (“stable”) anemic patients, liberal transfusion approaches do not reduce rates of mortality or morbidity compared with restrictive approaches. 65,66 Furthermore, evidence suggests that adopting a restrictive transfusion approach either within single institutions or health care systems can decrease the number of RBCs transfused per patient and potentially improve patient outcomes (by reducing mortality rate and length of hospital stay). 67–70 These results have not been confirmed in the obstetric setting.…”

Section: Discussionmentioning

confidence: 99%

National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review

Shaylor

Weiniger

Austin

et al. 2017

Anesthesia &Amp; Analgesia

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In developed countries, rates of postpartum hemorrhage (PPH) requiring transfusion have been increasing. As a result, anesthesiologists are being increasingly called upon to assist with the management of patients with severe PPH. First responders, including anesthesiologists, may adopt Patient Blood Management (PBM) recommendations of national societies or other agencies. However, it is unclear whether national and international obstetric societies’ PPH guidelines account for contemporary PBM practices. We performed a qualitative review of PBM recommendations published by the following national obstetric societies and international groups: the American College of Obstetricians and Gynecologists; The Royal College of Obstetricians and Gynecologists, United Kingdom; The Royal Australian and New Zealand College of Obstetricians and Gynecologists; The Society of Obstetricians and Gynecologists of Canada; an interdisciplinary group of experts from Austria, Germany, and Switzerland; an international multidisciplinary consensus group; and the French College of Gynaecologists and Obstetricians. We also reviewed a PPH bundle, published by The National Partnership for Maternal Safety. On the basis of our review, we identified important differences in national and international societies’ recommendations for transfusion and PBM. In the light of PBM advances in the nonobstetric setting, obstetric societies should determine the applicability of these recommendations in the obstetric setting. Partnerships among medical, obstetric, and anesthetic societies may also help standardize transfusion and PBM guidelines in obstetrics.

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Section: Discussionmentioning

confidence: 99%

National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review

Shaylor

Weiniger

Austin

et al. 2017

Anesthesia &Amp; Analgesia

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“…This includes preoperative anemia treatment, [3][4][5][6][7] reduction of perioperative RBC loss, 6-10 and restrictive transfusion triggers. 6,7,[11][12][13] In addition to such medical measures, structural changes within an organization may help to reinforce the adequate use of allogeneic blood products in medical situations where there is evidence of patient benefit rather than harm. One such modality is an intelligent blood product ordering system providing real-time clinical decision support.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a patient blood management monitoring and feedback program significantly reduces transfusions and costs

et al. 2015

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“…Further research is needed to define the role of intravenous iron in LT. Surgical and anaesthetic strategies to minimize haemoglobin drop (including autologous transfusion) should be implemented and will be discussed further in this article. Clear transfusion triggers reflecting the emerging evidence for the safety and benefits of restrictive policies, even in high-risk patients, should be applied [34] . In a transplant centre with exceptionally low transfusion rates, a trigger Hb of 60 g/L has been used successfully [35] .…”

Section: Patient Blood Managementmentioning

confidence: 99%

Reducing transfusion requirements in liver transplantation

Donohue

Mallett

2015

WJT

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Liver transplantation (LT) was historically associated with massive blood loss and transfusion. Over the past two decades transfusion requirements have reduced dramatically and increasingly transfusionfree transplantation is a reality. Both bleeding and transfusion are associated with adverse outcomes in LT. Minimising bleeding and reducing unnecessary transfusions are therefore key goals in the perioperative period. As the understanding of the causes of bleeding has evolved so too have techniques to minimize or reduce the impact of blood loss. Surgical "piggyback" techniques, anaesthetic low central venous pressure and haemodilution strategies and the use of autologous cell salvage, point of care monitoring and targeted correction of coagulopathy, particularly through use of factor concentrates, have all contributed to declining reliance on allogenic blood products. Pre-emptive management of preoperative anaemia and adoption of more restrictive transfusion thresholds is increasingly common as patient blood management (PBM) gains momentum. Despite progress, increasing use of marginal grafts and transplantation of sicker recipients will continue to present new challenges in bleeding and transfusion management. Variation in practice across different centres and within the literature demonstrates the current lack of clear transfusion guidance. In this article we summarise the causes and predictors of bleeding and present the evidence for a variety of PBM strategies in LT. Core tip: Liver transplantation (LT) was historically associated with massive blood loss. Many factors have contributed to the decline in bleeding and transfusion in the past two decades including refinement of surgical techniques, anaesthetic management and the use of point of care guided goal-directed haemostatic therapies. Increasing awareness of the adverse associations of allogenic transfusion has driven the quest for transfusion-free transplantation. Increasing use of marginal grafts and transplantation of sicker recipients will continue to challenge perioperative care and transfusion practice. Inter-institutional variability suggests a current lack of clear guidance and limited application of the principles of patient blood management to LT.

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Evidence Base for Restrictive Transfusion Triggers in High-Risk Patients

Cited by 37 publications

References 35 publications

National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review

National and International Guidelines for Patient Blood Management in Obstetrics: A Qualitative Review

Implementation of a patient blood management monitoring and feedback program significantly reduces transfusions and costs

Reducing transfusion requirements in liver transplantation

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