Red Blood Cell Transfusion Thresholds in Critically Ill Patients

Chacko, Jose; Brar, Gagan

doi:10.5005/jp-journals-10071-23248

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…However, blood transfusion is expensive and not an innocuous treatment. Transfusions are associated with pulmonary complications, sepsis, thromboembolic events, and mortality [ 24 , 25 , 26 , 27 ]. However, RBC transfusion may be harmful even in the geriatric age group, where anemia is tolerated less, in patients with cardiovascular disease, cancer, or in patients receiving beta-blocker therapy [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, existing studies have reported that some subsets of patients may benefit from RBCs to maintain higher hemoglobin concentrations and that future research should focus on these clinical contexts [ 31 ]. A recent study stated that a threshold value of 7 g/dL for RBC transfusion in critically ill patients in the intensive care unit is generally reliable [ 26 ]. The authors believe that a cut-off Hb value, determined as a general recommendation, can be decisive in this regard.…”

Section: Discussionmentioning

confidence: 99%

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Association between Anemia and New-Onset Atrial Fibrillation in Critically Ill Patients in the Intensive Care Unit: A Retrospective Cohort Analysis

Sertçakacılar

Yıldız

2022

Clinics and Practice

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New-onset atrial fibrillation (NOAF) is one of the leading causes of morbidity and mortality, especially in older patients in the intensive care unit (ICU). Although many comorbidities are associated with NOAF, the effect of anemia on the onset of atrial fibrillation is still unknown. This study aimed to test the hypothesis that anemia is associated with an increased risk of developing NOAF in critically ill patients in intensive care. We performed a retrospective analysis of critically ill patients who underwent routine hemoglobin and electrocardiography monitoring in the ICU. Receiver operating characteristics analysis determined the hemoglobin (Hb) value that triggered NOAF formation. Bivariate correlation was used to determine the relationship between anemia and NOAF. The incidence of NOAF was 9.9% in the total population, and 12.8% in the patient group with anemia. Analysis of 1931 patients revealed a negative association between anemia and the development of NOAF in the ICU. The stimulatory Hb cut-off value for the formation of NOAF was determined as 9.64 g/dL. Anemia is associated with the development of NOAF in critically ill patients in intensive care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association between Anemia and New-Onset Atrial Fibrillation in Critically Ill Patients in the Intensive Care Unit: A Retrospective Cohort Analysis

Sertçakacılar

Yıldız

2022

Clinics and Practice

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“…Other studies have shown that transfusion of red blood cells may increase the mortality rate of critically ill patients. 28,29 Anemia associated with sepsis is not always true anemia, and sometimes it may be caused by blood dilution related to fluid load. 30,31 Therefore, after occurrence of sepsis, even if the HC is reduced, clinicians need to determine whether a blood transfusion is required on the basis of the condition of children.…”

Section: Discussionmentioning

confidence: 99%

A significant decrease in hemoglobin concentrations may predict occurrence of necrotizing enterocolitis in preterm infants with late-onset sepsis

et al. 2020

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Objective This study aimed to examine the clinical value of a decrease in hemoglobin concentration (HC) after the onset of sepsis for predicting occurrence of necrotizing enterocolitis (NEC) in preterm infants with late-onset sepsis. Methods We performed a retrospective cohort study between January 2015 and January 2020. Premature neonates (gestational age <37 weeks) with late-onset sepsis (age >3 days) were enrolled. According to the degree of reduction in HC, neonates were divided into the non-decrease group, mild decrease group, and severe decrease group. Demographic data, perinatal conditions, blood cell count analysis, blood culture, and treatment measures were compared. Results Eighty premature infants with sepsis were studied. The mortality rate and incidence of NEC were significantly higher in the severe decrease group than in the non-decrease and mild decrease groups. Significant differences were observed in the decrease in HC, red blood cell transfusion, and ventilator application between the NEC and non-NEC groups. A significant decrease in HC was an independent risk factor for NEC in preterm infants with sepsis. Conclusion A significant decrease in HC is an independent risk factor for NEC and may predict the occurrence of NEC in preterm infants with sepsis.

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Generating real-world evidence compatible with evidence from randomized controlled trials: a novel observational study design applicable to surgical transfusion research

Wang

et al. 2022

BMC Med Res Methodol

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Background Numerous observational studies have revealed an increased risk of death and complications with transfusion, but this observation has not been confirmed in randomized controlled trials (RCTs). The “transfusion kills patients” paradox persists in real-world observational studies despite application of analytic methods such as propensity-score matching. We propose a new design to address this long-term existing issue, which if left unresolved, will be deleterious to the healthy generation of evidence that supports optimized transfusion practice. Methods In the new design, we stress three aspects for reconciling observational studies and RCTs on transfusion safety: (1) re-definition of the study population according to a stable hemoglobin range (gray zone of transfusion decision; 7.5–9.5 g/dL in this study); (2) selection of comparison groups according to a trigger value (last hemoglobin measurement before transfusion; nadir during hospital stay for control); (3) dealing with patient heterogeneity according to standardized mean difference (SMD) values. We applied the new design to hospitalized older patients (aged ≥60 years) undergoing general surgery at four academic/teaching hospitals. Four datasets were analyzed: a base population before (Base Match−) and after (Base Match+) propensity-score matching to simulate previous observational studies; a study population before (Study Match−) and after (Study Match+) propensity-score matching to demonstrate effects of our design. Results Of 6141 older patients, 662 (10.78%) were transfused and showed high heterogeneity compared with those not receiving transfusion, particularly regarding preoperative hemoglobin (mean: 11.0 vs. 13.5 g/dL) and intraoperative bleeding (≥500 mL: 37.9% vs. 2.1%). Patient heterogeneity was reduced with the new design; SMD of the two variables was reduced from approximately 100% (Base Match−) to 0% (Study Match+). Transfusion was related to a higher risk of death and complications in Base Match− (odds ratio [OR], 95% confidence interval [CI]: 2.68, 1.86–3.86) and Base Match+ (2.24, 1.43–3.49), but not in Study Match− (0.77, 0.32–1.86) or Study Match+ (0.66, 0.23–1.89). Conclusions We show how choice of study population and analysis could affect real-world study findings. Our results following the new design are in accordance with relevant RCTs, highlighting its value in accelerating the pace of transfusion evidence generation and generalization.

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Red Blood Cell Transfusion Thresholds in Critically Ill Patients

Cited by 4 publications

References 21 publications

Association between Anemia and New-Onset Atrial Fibrillation in Critically Ill Patients in the Intensive Care Unit: A Retrospective Cohort Analysis

Association between Anemia and New-Onset Atrial Fibrillation in Critically Ill Patients in the Intensive Care Unit: A Retrospective Cohort Analysis

A significant decrease in hemoglobin concentrations may predict occurrence of necrotizing enterocolitis in preterm infants with late-onset sepsis

Generating real-world evidence compatible with evidence from randomized controlled trials: a novel observational study design applicable to surgical transfusion research

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