Risks of transfusion: outcome focus

The objective of this paper is to introduce clinicians and health care professionals to the concept of patient blood management (PBM) and to explain the difference between PBM and the concept of "appropriate use" of blood products. The five reasons why modern health systems need to shift from product-focused transfusion practice to PBM are also presented. These are: the aging population with a leveraged demand for blood products opposed to a shrinking donor base; the growing awareness that transfusion is a complex service involving many different cost centers within a hospital and representing a multiple of the blood product cost; the continuous effort to protect blood pools from known, new, or re-emerging pathogens while facing uncertainty over their potentially long silent carrier states; the emerging evidence that transfusion is an independent risk factor for adverse outcomes; and finally, a lack of evidence for benefit of transfusion for the vast majority of recipients. The Oncologist 2011;16(suppl 3):3-11

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“…Does transfusion do what it is intended to do-improve outcomes or prevent adverse outcomes [59]? Level I evidence to support this is scant.…”

Section: Questionable Efficacy Of Transfusionsmentioning

confidence: 99%

Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management

2011

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“…Based on these findings, we reasoned that the inability of banked blood to improve oxygen delivery might relate to a deficiency in SNO-Hb. Specifically, we hypothesized that the impaired vasoregulation associated with administration of banked blood (10,22,(50)(51)(52) results, at least partly, from losses in RBC-derived NO bioactivity. As an initial test of this idea, we screened samples of expired blood (Ͼ42 days of storage) and found them to be markedly depleted in SNO-Hb and deficient in hypoxic vasodilatory activity (data not shown).…”

mentioning

confidence: 99%

S -nitrosohemoglobin deficiency: A mechanism for loss of physiological activity in banked blood

Reynolds

Ahearn

Angelo

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

257

227

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RBCs distribute oxygen to tissues, but, paradoxically, blood transfusion does not always improve oxygen delivery and is associated with ischemic events. We hypothesized that storage of blood would result in loss of NO bioactivity, impairing RBC vasodilation and thus compromising blood flow, and that repleting NO bioactivity would restore RBC function. We report that S-nitrosohemoglobin (SNO-Hb) concentrations declined rapidly after storage of fresh venous blood and that hypoxic vasodilation by banked RBCs correlated strongly with the amounts of SNO-Hb (r 2 ‫؍‬ 0.90; P < 0.0005). Renitrosylation of banked blood during storage increased the SNO-Hb content and restored its vasodilatory activity. In addition, canine coronary blood flow was greater during infusion of renitrosylated RBCs than during infusion of S-nitrosothiol-depleted RBCs, and this difference in coronary flow was accentuated by hypoxemia (P < 0.001). Our findings indicate that NO bioactivity is depleted in banked blood, impairing the vasodilatory response to hypoxia, and they suggest that SNO-Hb repletion may improve transfusion efficacy.blood preservation ͉ blood transfusion ͉ erythrocytes ͉ hypoxic vasodilation ͉ S-nitrosylation

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“…L'intérêt pour la conservation périopératoire du sang demeure d'actualité, bien que les risques d'infection virale du sang allogène, ainsi que les autres risques explicites sévères -y compris les réactions hémoly-tiques importantes, les lésions pulmonaires aiguës liées à la transfusion et la contamination bactérienne -soient minimes. 1 3 Parmi les modalités utilisées pour la conservation périopératoire du sang, citons :…”

Section: The Gauntletunclassified

“…1,2 Proponents of perioperative blood conservation argue that minimizing allogeneic blood transfusion remains an important objective because allogeneic blood is expensive, is often in short supply, and may, owing to its immunomodulatory effects, increase morbidity and mortality. 3 Some of the modalities employed for perioperative blood conservation include:…”

mentioning

confidence: 99%

Perioperative blood conservation — The experts, the elephants, the clinicians, and the gauntlet

Karkouti

McCluskey

2007

Can J Anesth/J Can Anesth

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Risks of transfusion: outcome focus

Abstract: ABBREVIATIONS: CABG = coronary artery bypass graft; CHF = congestive heart failure; ICU = intensive care unit; MI(s) = myocardial infarction(s); vCJD = variant Creutzfeldt-Jacob disease.

Cited by 62 publications

References 61 publications

Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management

Five Drivers Shifting the Paradigm from Product-Focused Transfusion Practice to Patient Blood Management

S -nitrosohemoglobin deficiency: A mechanism for loss of physiological activity in banked blood

Perioperative blood conservation — The experts, the elephants, the clinicians, and the gauntlet

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