Risks of Transfusion

Squires, Jerry E.

doi:10.1097/smj.0b013e31823213b6

Cited by 63 publications

(48 citation statements)

References 35 publications

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“…Research has shown that smoking directly leads to alterations in platelet membranes and causes impairment of their natural function [13,35,38], therefore it seemed plausible to us that there would be an association between smoking and blood loss after spinal surgery. Should that be the case, it would be a modifiable risk factor that potentially could help patients avoid the neurologic compli cations of bleeding after spine surgery (such as development of a compressive hematoma), and the known deleterious effects of transfusions [15,16,20,32,40,42,43,45,52]. Our results suggest that smoking is strongly associated with increased surgical blood loss and perioperative transfusions in patients undergoing lumbar spine surgery.…”

Section: Discussionmentioning

confidence: 67%

“…The increased blood loss may lead to transfusion use during the perioperative setting that can carry associated morbidity. Transfusions of even one unit of blood in surgical patients are associated with increased risk of wound complications, postoperative infections, renal dysfunction, pulmonary complications, systemic sepsis, composite morbidity, and postoperative length of stay [6,10,12,16,21,29,32,33,43]. The risks of transfusion must be balanced with the need to maintain appropriate levels of perfusion to end-organs and the spinal cord.…”

Section: Introductionmentioning

confidence: 99%

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Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

McCunniff

Young

Ahmadinia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Little is known about the association between smoking and intraoperative blood loss and perioperative transfusion use in patients undergoing spinal surgery. However, we found that although many of the common complications and deleterious effects of smoking on surgical patients had been well documented, the aspect of blood loss seemingly had been overlooked despite data reported in nonorthopaedic sources to suggest a possible connection. Questions/Purposes We asked: (1) Is smoking associated with increased estimated blood loss during surgery in patients undergoing lumbar spine surgery? (2) Is smoking associated with increased perioperative transfusion usage?Methods Between 2005 and 2009, 581 lumbar decompression procedures (with or without fusion) were performed at one academic spine center. Of those, 559 (96%) had sufficient chart documentation to categorize patients by smoking status, necessary intra-and postoperative data to allow analysis with respect to bleeding and transfusion-related endpoints, and who did not meet exclusion criteria. Exclusion criteria included: patients whose smoking status did not fit in our two categories, patients with underlying coagulopathy, patients receiving anticoagulants (including aspirin and platelet inhibitors), history of hepatic disease, history of platelet disorder or other blood dyscrasias, and patient or family history of any other known bleeding disorder. Smoking history in packs per day was obtained for all subjects. We defined someone as a smoker if the patient reported smoking up until the day of their surgical procedure; nonsmokers were patients who quit smoking at least 6 weeks before surgery or had no history of smoking. We used a binomial grouping for whether patients did or did not receive a transfusion perioperatively. Age, sex, number of levels of discectomies, number of levels decompressed, number of levels fused, and use of instrumentation were recorded. The same approaches were used for transfusions in all patients regardless of smoking history; decisions were made in consultation between the surgeon and the anesthesia team. Absolute indications for transfusion postoperatively were: a hemoglobin less than 7 g/dL, continued symptoms of dizziness, tachycardia, decreased exertional tolerance, or hypotension that failed to respond to fluid resuscitation. Multiple linear regression analyses correcting for the above variables were performed to determine associations with intraoperative blood loss, while logistic regression was used to analyze perioperative transfusion use.

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Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

McCunniff

Young

Ahmadinia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…[58][59][60] In addition, plasma and other blood products are expensive and carry infection risks. 61 A smallvolume, simple, durable, portable drug that improves blood pressure and survival is needed to treat hemorrhagic shock in the tactical environment, and hydroxocobalamin may be a potential candidate based on our study results.…”

Section: Discussionmentioning

confidence: 99%

A Prospective, Randomized Trial of Intravenous Hydroxocobalamin Versus Whole Blood Transfusion Compared to No Treatment for Class III Hemorrhagic Shock Resuscitation in a Prehospital Swine Model

Bebarta

Garrett

Boudreau

et al. 2015

Academic Emergency Medicine

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Objectives: The objective was to compare systolic blood pressure (sBP) over time in swine that have had 30% of their blood volume removed (Class III shock) and treated with intravenous (IV) whole blood or IV hydroxocobalamin, compared to nontreated control animals.Methods: Thirty swine (45 to 55 kg) were anesthetized, intubated, and instrumented with continuous femoral and pulmonary artery pressure monitoring. Animals were hemorrhaged a total of 20 mL/kg over a 20-minute period. Five minutes after hemorrhage, animals were randomly assigned to receive 150 mg/ kg IV hydroxocobalamin solubilized in 180 mL of saline, 500 mL of whole blood, or no treatment. Animals were monitored for 60 minutes thereafter. A sample size of 10 animals per group was determined based on a power of 80% and an alpha of 0.05 to detect an effect size of at least a 0.25 difference (>1 standard deviation) in mean sBP between groups. sBP values were analyzed using repeated-measures analysis of variance (RANOVA). Secondary outcome data were analyzed using repeated-measures multivariate analysis of variance (RMANOVA).Results: There were no significant differences between hemodynamic parameters of IV hydroxocobalamin versus whole blood versus control group at baseline (MANOVA; Wilks' lambda; p = 0.868) or immediately posthemorrhage (mean sBP = 47 mm Hg vs. 41 mm Hg vs. 37 mm Hg; mean arterial pressure = 39 mm Hg vs. 28 mm Hg vs. 34 mm Hg; mean serum lactate = 1.2 mmol/L vs. 1.4 mmol/L vs. 1.4 mmol/L; MANOVA; Wilks' lambda; p = 0.348). The outcome RANOVA model detected a significant difference by time between groups (p < 0.001). Specifically, 10 minutes after treatment, treated animals showed a significant increase in mean sBP compared to nontreated animals (mean sBP = 76.3 mm Hg vs. 85.7 mm Hg vs. 51.1 mm Hg; p < 0.001). RMANOVA modeling of the secondary data detected a significant difference in mean arterial pressure, heart rate, and serum lactate (p < 0.001). Similar to sBP, 10 minutes after treatment, treated animals showed a significant increase in mean arterial pressure compared to nontreated animals (mean arterial pressure = 67.7 mm Hg vs. 61.4 mm Hg vs. 40.5 mm Hg). By 10 minutes, mean heart rate was significantly slower in treated animals compared to nontreated animals (mean heart rate = 97.3 beats/min vs. 95.2 beats/min vs. 129.5 beats/min; p < 0.05). Serum lactate, an early predictor of shock, continued to rise in the control group, whereas it did not in treated animals. Thirty minutes after treatment, serum lactate values of treated animals were significantly lower compared to nontreated animals (p < 0.05). This trend continued throughout the 60-minute observation period such that 60-minute values for lactate were 1.4 mmol/L versus 1.1 mmol/L versus 3.8 mmol/L. IV hydroxocobalamin produced a statistically significant increase in systemic vascular resistance compared to control, but not whole blood, with a concomitant decrease in cardiac output.

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“…Ker so simptomi sistemski in pogosto nespecifični, je ključno vodilo podatek o nedavno prejeti krvi oz. krvnih komponentah (30).…”

Section: Obravnava In Zdravljenje Respiratornih Transfuzijskih Reakcijunclassified

Respiracijske transfuzijske reakcije

Marić¹,

Mlakar

Bricl³

2017

SlovMedJour

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IzvlečekTransfuzijske reakcije niso pogoste, vendar kljub temu verjetno pogostejše, kot jih ocenjujemo na splošno, saj je prepoznavanje in poročanje o transfuzijskih reakcijah še vedno pomanjkljivo. Čla-nek opisuje najpogostejše respiracijske transfuzijske reakcije, patofiziologijo le-teh, klinično sliko in zdravljenje. Med primarnimi transfuzijskimi reakcijami so najpomembnejše: s transfuzijo povezana akutna okvara pljuč oz. TRALI, s transfuzijo povezana volumska preobremenitev oz. TACO ter s transfuzijo povezana dispneja oz. TAD. Pri TRALI pride do aktiviranja imunskega sistema, katerega posledica je povečana prepustnost bazalne membrane v pljučnih mešičkih, kar vodi v nekardiogeni pljučni edem. Zdravljenje je podporno z dodajanjem kisika, tekočin ob hipotenziji, v hujših primerih dihalne odpovedi tudi mehansko predihavanje. Klinična slika TACO je kardiogeni pljučni edem, do katerega pride zaradi volumske obremenitve pri predisponiranih osebah, ki so: dojenčki, starostniki, bolniki s srčnim popuščanjem, anemijo in bolniki s pozitivno tekočinsko bilanco. TACO zdravimo po načelih zdravljenja kardiogenega pljučnega edema z dodajanjem kisika, diuretiki, po potrebi pa tudi z neinvazivnim ali invazivnim mehanskim predihavanjem. Pri TAD pa gre za etiološko nepojasnjeno dispnejo, ki se pojavi po transfuziji in je ne moremo opredeliti kot TACO ali TRALI, prav tako pa je ne pojasnijo bolnikove kronične bolezni. Ponavadi je TAD blaga reakcija. Čeprav transfuzijske reakcije niso zelo pogoste, je znanje o prepoznavanju, zdravljenju in preprečevanju respiracijskih transfuzijskih reakcij nujno potrebno, da se preprečijo resne posledice pri bolnikih. AbstractRespiratory transfusion-related reactions are not very frequent, partly also because recognition and reporting transfusion reactions is still underemphasized. This article describes the most important respiratory transfusion reactions, their pathophysiology, clinical picture and treatment strategies. Respiratory transfusion related reactions can be primary or secondary. The most important primary transfusion-related reactions are TRALI -transfusion-related acute lung injury, TACO -transfusion-associated circulatory overload, and TAD -transfusion-associated dyspnea. TRALI is immuneassociated injury of alveolar basal membrane, which becomes highly permeable and causes noncardiogenic pulmonary edema. Treatment of TRALI is mainly supportive with oxygen, fluids (in case of hypotension) and in cases of severe acute respiratory failure also mechanic ventilation. TACO is caused by volume overload in predisposed individuals, such as patients with heart failure, the elderly, infants, patients with anemia and patients with positive fluid balance. Clinical picture is that of a typical pulmonary cardiogenic edema, and the therapy is classical: oxygen and diuretics, and in severe cases also non-invasive or invasive mechanical ventilation. TAD is usually a mild reaction of unknown cause and cannot be classified as TACO or TRALI, nor can it be ascribed to patient's preexisting diseases. ...

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Risks of Transfusion

Cited by 63 publications

References 35 publications

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

A Prospective, Randomized Trial of Intravenous Hydroxocobalamin Versus Whole Blood Transfusion Compared to No Treatment for Class III Hemorrhagic Shock Resuscitation in a Prehospital Swine Model

Respiracijske transfuzijske reakcije

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