Relationship between transfusion volume and outcomes in children undergoing noncardiac surgery

Goobie, Susan M.; DiNardo, James A.; Faraoni, David

doi:10.1111/trf.13732

Cited by 53 publications

(42 citation statements)

References 31 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Minhas et al performed an analysis of the ACS NSQIP pediatric database including 1,691 patients with idiopathic scoliosis and observed that transfusion was only associated with an increased incidence of complication when transfusion volumes > 20 mL/kg were given . However, it is important to keep in mind that the indication for transfusion also significantly influences outcome and that transfusion of large volumes of blood products are usually required in the presence of massive bleeding, while small volumes are used to increase the hemoglobin in the context of anemia . If RBC transfusion can be used to treat anemia, this option should never be considered as the first line since alternatives exist.…”

Section: Discussionmentioning

confidence: 99%

Preoperative anemia increases the risk of red blood cell transfusion and prolonged hospital length of stay in children undergoing spine arthrodesis surgery

et al. 2018

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Preoperative anemia is an important modifiable risk factor for red blood cell (RBC) transfusion in a variety of surgical populations. The primary objective of this study was to examine the association between preoperative anemia and i) transfusion of RBCs within 72 hours of surgery and ii) postoperative clinical outcomes in children undergoing spine arthrodesis surgery. STUDY DESIGN AND METHODS:We assembled a retrospective cohort of children included in the American College of Surgeons National Quality Improvement Program Pediatric database who underwent spine arthrodesis surgery from 2012 to 2016. Anemia was defined using age-and sex-specific hematocrit thresholds. Data collected included demographic and surgical characteristics, RBC transfusion within 72 hours, and 30-day postoperative outcomes (postoperative mechanical ventilation, infection, readmission, hospital length of stay, mortality). Multivariable logistic regression analyses were used to identify independent predictors of RBC transfusion and postoperative outcomes. RESULTS:We included 9,095 patients in the analysis.Preoperative anemia was present in 14% (n = 1,233) of the population and 67% (n = 6,135) of patients were transfused. Our multivariable logistic regression showed anemia, surgical time > 350 minutes, > 7 vertebral levels fused, neuromuscular disease, and cerebral palsy were all independent predictors of RBC transfusion. Preoperative anemia was also associated with prolonged hospital LOS (adjusted OR: 1.31, 95%CI: 1.11-1.54, p = 0.002). CONCLUSIONS:In this study of 9,095 children undergoing spine surgery, preoperative anemia was associated with an increased risk of RBC transfusion and prolonged LOS. Further studies are needed to determine if treatment of preoperative anemia can effectively reduce intraoperative RBC transfusion.

show abstract

Section: Discussionmentioning

confidence: 99%

Preoperative anemia increases the risk of red blood cell transfusion and prolonged hospital length of stay in children undergoing spine arthrodesis surgery

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…Recently, several studies have shown that longer storage of RBCs was associated with increased risks of infection, renal dysfunction, respiratory failure, multiple organ dysfunction syndrome, deep vein thrombosis, and mortality. In addition, adverse clinical outcomes were more common especially in critically ill patients [11-13]. A study by Cholette et al found that transfusion of washed RBCs and platelets during cardiac surgery reduced postoperative inflammation and number of transfusions [14].…”

Section: Introductionmentioning

confidence: 99%

Induction of Pluripotent Stem Cell-Derived Cardiomyocyte Toxicity by Supernatant of Long Term-Stored Red Blood Cells in Vitro

Fan

Sun

et al. 2018

Cell Physiol Biochem

View full text Add to dashboard Cite

Background/Aims: Preserved red blood cells (RBCs) in vitro undergo a series of morphological, functional and metabolic changes during storage. RBC metabolites accumulate over time during storage, the toxicity of the supernatants of RBCs (SSRBCs) on tissue cells is largely unknown. Here, we aimed to study cardiomyocyte toxicity by supernatant of long term-stored RBCs in vitro and to discover elements involved in the mechanism. Methods: Using human-induced pluripotent stem cell-derived cardiomyocytes (hiPS-CMs) and real-time cell analyzing (RTCA), we analyzed the cardiotoxicity of d0, d14 and d35 SSRBCs. To analyze the cardiotoxicity of potassium (K) and lactic acid (LA) in SSRBCs, solutions containing the same concentrations of K and LA were respectively prepared and co-cultured with hiPS-CMs. Immunofluorescence and Gene Expression Array of hiPS-CMs were performed to evaluate the effects of d35 K and d35 SSRBCs. Results: The beating of hiPS-CM was stopped by d14, d35 SSRBCs, or d35 K solution. Beating resumed within 48 hours in the presence of d14 SSRBC or d35 K but not d35 SSRBC; d0, d14 and d35 LA solution had no effect on beating patterns. At 48h after treatment, the immunofluorescence results showed that the integrity of the filament and sarcomere were intact. Gene Expression Array results found 14 differentially expressed genes which were likely to play an important role in the cytotoxic effect. Conclusion: Our results demonstrated cardiomyocyte toxicity by long term-stored SSRBCs in vitro. Besides high K-induced cardiotoxicity, there must be other unknown components in long term-stored SSRBCs that are cytotoxic to hiPS-CMs.

show abstract

“…Transfusion‐related acute lung injury, transfusion‐related acute circulatory overload, and hemolytic transfusion reactions are the main culprits with mortality rates as high as 15%‐30%. Allogeneic red blood cell transfusion is associated with an increased incidence of 30‐day mortality and complications in children . In order to decrease the risks associated with transfusion of blood products, a concerted effort must be made by all hospitals and health care workers to avoid unnecessary and inappropriate transfusions as well as over‐transfusion.…”

Section: Introductionmentioning

confidence: 99%

“…Allogeneic red blood cell transfusion is associated with an increased incidence of 30-day mortality and complications in children. 15,30 In order to decrease the risks associated with transfusion of blood products, a concerted effort must be made by all hospitals and health care workers to avoid unnecessary and inappropriate transfusions as well as over-transfusion. Management of critical pediatric bleeding using massive hemorrhage guidelines complements Massive Transfusion Protocols (MTP) 23 Neonates, infants, and children are physiologically distinct from adults.…”

mentioning

confidence: 99%

Society for the advancement of blood management administrative and clinical standards for patient blood management programs. 4th edition (pediatric version)

Goobie¹,

Gallagher²,

Gross

et al. 2019

Pediatric Anesthesia

Self Cite

View full text Add to dashboard Cite

Summary Patient Blood Management is the timely application of evidence‐based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss to improve patient outcomes. Conceptually similar to a “bundle” strategy, it is designed to improve clinical care using comprehensive evidence‐based treatment strategies to manage patients with potential or ongoing critical bleeding, bleeding diathesis, critical anemia, and/ or a coagulopathy. Patient Blood Management includes multimodal strategies to screen, diagnose and properly treat anemia, coagulopathies and minimize bleeding, using goal‐directed therapy and leverages a patient's physiologic ability to adapt to anemia while definitive treatment is undertaken. Allogeneic blood component transfusion is one traditional therapeutic modality out of many for managing blood loss and anemia and, while it may be the best choice in certain situations, other effective and more appropriate options are available and should be used in conjunction or alone. Therefore, comprehensive Patient Blood Management is the new standard of care to prevent and manage anemia and optimize hemostasis and has been recommended by the World Health Organization, the American Society of Anesthesiologists, the European Society of Anaesthesiology and the Australian National Blood Authority. While there is a plethora of expert consensus and good practice guidelines published for blood component transfusion from multiple professional organizations and societies, there remains a need for more comprehensive and broader standards of patient medical management to proactively reduce the risk of exposure to allogeneic transfusions. In 2010, the Society for Advancement of Blood Management published the first comprehensive standards to address the administrative and clinical components of an effective, patient‐centered Patient Blood Management program. Recognizing the need to reduce inappropriate transfusions, some professional organizations have placed their emphasis on transfusion guidelines. In contrast, the focus of the Society for Advancement of Blood Management Standard is on the centrality of the patient and the full spectrum of therapeutic strategies needed to improve clinical outcomes in patients at risk for blood loss or anemia, thereby reducing avoidable transfusions as well. The Standards are meant not to replace, but to complement transfusion guidelines by more completely addressing the need for a multi‐modal clinical approach with the goal to improve patient outcomes. Compared to adult programs, Pediatric Patient Blood Management programs are currently not commonly accepted as standard of care for pediatric patients. This is partly due to the fact that, until recently, there was a paucity of robust evidence‐based literature and expert consensus guidelines on pediatric PBM. Managing pediatric bleeding and blood product transfusion presents a unique set of challenges. The main goal of transfusion is to correct or avoid imminent inadequate oxygen c...

show abstract

Relationship between transfusion volume and outcomes in children undergoing noncardiac surgery

Cited by 53 publications

References 31 publications

Preoperative anemia increases the risk of red blood cell transfusion and prolonged hospital length of stay in children undergoing spine arthrodesis surgery

Preoperative anemia increases the risk of red blood cell transfusion and prolonged hospital length of stay in children undergoing spine arthrodesis surgery

Induction of Pluripotent Stem Cell-Derived Cardiomyocyte Toxicity by Supernatant of Long Term-Stored Red Blood Cells in Vitro

Society for the advancement of blood management administrative and clinical standards for patient blood management programs. 4th edition (pediatric version)

Contact Info

Product

Resources

About