Role of Blood Transfusion in Organ System Failure Following Major Abdominal Surgery

Abstract

Using multivariate probit analysis, the data of 565 patients who underwent major abdominal surgery were retrospectively analyzed, and the etiologic role of blood transfusion in organ system failure (OSF), which includes respiratory failure, gastrointestinal stress bleeding, renal failure, nonobstructive, nonhepatitic jaundice, and coagulopathy, was studied. Apart from the amount of blood transfusion, the following factors were included in the analysis as possible contributors to OSF: age, preoperative hematocrit, organ failure risk (diffuse peritonitis, obstructive cholangitis, liver cirrhosis, terminal cancer, and hemorrhagic shock), operative time, blood loss, and postoperative highest hematocrit. The results showed that, except for preoperative hematocrit, all the factors are statistically significant contributors, blood transfusion being the most significant. There was no statistically significant interaction between blood transfusion and organ failure risk. It is concluded that blood transfusion is an important, independent factor contributing to OSF, and its contribution cannot be attributed to the underlying conditions that require blood transfusion.

Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction?

“…It is possible that, among recipients of multiple transfusions, allogeneic transfusion may exercise other deleterious effects that have not yet been recognized or defined, probably because of the confounding effect of the association between transfusion and illness severity (which becomes extremely strong in patients receiving multiple transfusions). Associations between allogeneic transfusion and various adverse clinical outcomes (eg, prolonged mechanical ventilation, 102,103 impaired wound healing, 104 or multiorgan failure [105][106][107] ) have been reported from retrospective cohort studies, but it remains uncertain whether these associations reflect true relationships because it has been impossible to separate the effects of the allogeneic transfusions from the effects of confounding factors.…”

What would Karl Landsteiner do? The ABO blood group and stem cell transplantation

“…33 Surgical patients receiving allogeneic transfusions develop impaired cellular immunity [34][35][36][37][38] associated with increases in postoperative bacterial infections, [39][40][41][42] cancer recurrence, 43,44 multiorgan failure, [45][46][47][48][49][50] and poorer wound healing. [51][52][53] Could ABO nonidentical transfusions cause impaired cellular immune function, infection, and multiorgan failure, but by a different mechanism than that causing hemolysis?…”

Transfusion Timing and Postoperative Septic Complications After Gastric Cancer Surgery

“…5 Clinical evidence of a relationship between transfusion-induced immunosuppression and development of postoperative septic complications has been reported in many series 6,7,[19][20][21][22][23][24] concerning head and neck, cardiac, orthopedic, and elective and emergency abdominal surgery.…”