The hazards of blood transfusion in historical perspective

Alter, Harvey J.; Klein, Harvey G.

doi:10.1182/blood-2008-07-077370

Cited by 287 publications

(213 citation statements)

References 86 publications

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“…Although blood products are extremely safe in terms of viral transmission, transfusion reactions, albeit rare, may occur. 83 In addition to classical transfusion reactions, more recently recognized complications such as transfusion-related acute lung injury may occur and should be considered when blood products are administered prophylactically. Evidence from cardiac surgery has clearly indicated that transfusion of blood products is associated with increased morbidity and mortality, 84 and we have recently demonstrated that the same is true in liver transplantation.…”

Section: Therapeutic Implicationsmentioning

confidence: 99%

Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences

Lisman

Porte

2010

Blood

545

541

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Patients with liver disease frequently acquire a complex disorder of hemostasis secondary to their disease. Routine laboratory tests such as the prothrombin time and the platelet count are frequently abnormal and point to a hypocoagulable state. With more sophisticated laboratory tests it has been shown that patients with liver disease may be in hemostatic balance as a result of concomitant changes in both pro-and antihemostatic pathways. Clinically, this rebalanced hemostatic system is reflected by the large proportion of patients with liver disease who can undergo major surgery without any requirement for blood product transfusion. However, the hemostatic balance in the patient with liver disease is relatively unstable as evidenced by the occurrence of both bleeding and thrombotic complications in a significant proportion of patients. Although it is still common practice to prophylactically correct hemostatic abnormalities in patients with liver disease before invasive procedures by administration of blood products guided by the prothrombin time and platelet count, we believe that this policy is not evidence-based. In this article, we will provide arguments against the traditional concept that patients with liver failure have a hemostasis-related bleeding tendency. Consequences of these new insights for hemostatic management will be discussed. (Blood. 2010;116(6):878-885)

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Section: Therapeutic Implicationsmentioning

confidence: 99%

Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences

Lisman

Porte

2010

Blood

545

541

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“…Although the majority of these complications are historical, some can be life threatening. [16][17][18] These risks, together with the cost for collection, storage and processing of donor blood, have led to alternative methods of blood conservation.…”

Section: Cost Analysismentioning

confidence: 99%

Clinical efficacy and cost effectiveness of intraoperative cell salvage in pelvic trauma surgery

Odak

Raza

Shah

et al. 2013

annals

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INTRODUCTION Pelvic acetabular injuries are associated with significant blood loss. This is compounded by multiple surgical interventions including definitive fracture fixation, which put patients at further risk of postoperative transfusion. We use intraoperative cell salvage routinely as a blood conservation strategy to address this issue. This is a prospective evaluation of the clinical efficacy and cost effectiveness of using intraoperative cell salvage in patients with pelvic acetabular injuries. METHODS Data were collected prospectively for all the patients who underwent pelvic acetabular fracture fixation at our institution. A total of 30 patients (25 men, 5 women) with a mean age of 41 years (range: 31-79 years) were assessed over a period of 10 months. RESULTS The mean preoperative and postoperative haemoglobin levels were 11.8g/dl and 9.9g/dl respectively. The mean intraoperative blood loss was 1,232.5ml (range: 150-2,693ml). The mean amount of blood salvaged and retransfused through a cell saver was 388ml. Of the 30 patients, 14 (47%) required transfusion after surgery and 26 units of blood were transfused. In terms of cost effectiveness, a total of £2,572 in 30 patients or £86 per patient were saved. CONCLUSIONS We found intraoperative cell salvage to be clinically efficacious and cost effective in patients with pelvic acetabular injuries.

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“…Estimation skills can be improved by simple education (11). Unnecessary transfusion of blood products should be avoided because of potential risks associated with the procedure, side effects, and the limited availability of blood units (12). Inter-professional training is potentially effective in the prevention of errors and thereby patient safety can be improved (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Can Interprofessional Simulation Training Influence the Frequency of Blood Transfusions After Birth?

Egenberg

Øian

Bru

et al. 2016

Obstetric Anesthesia Digest

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Objective. To investigate whether inter-professional simulation training influenced the rate of red blood cell (RBC) transfusions after birth. Design. Two cohorts were compared retrospectively using a pre-post design. Setting. Norwegian university hospital with 4800 deliveries annually. Population. Women with estimated blood loss >500 mL within 24 h after birth in 2009 and 2011. Methods. In 2010, all maternity staff attended a 6-h, scenario-based training on emergency obstetrics including postpartum hemorrhage, using a birthing simulator. The simulation focused on prevention, identification, and treatment of postpartum hemorrhage and on communication and leadership. Debrief immediately after the scenarios involved reflection and self-assessment. Main outcome measures. The frequency of women receiving RBC transfusions as a marker for blood loss. Secondary outcome was the frequency of surgical procedures in the management of postpartum hemorrhage. Results. In 2009, 111/534 (20.8%) women with estimated blood loss >500 mL after birth received RBC transfusions vs. 67/546 (12.3%) in 2011 (p < 0.01). The adjusted odds ratio for women receiving RBC transfusions in 2011 vs. 2009 was 0.53 (95% CI 0.38-0.74). Parity, oxytocin augmentation, duration of second stage, episiotomy, operative vaginal delivery, and sphincter injury were included in the final model. The odds ratio was stable in all combinations of possible confounders. We observed a significant reduction in the frequencies of curettage (p < 0.01) and uterine artery embolizations (p = 0.01). Conclusion. We found a significant reduction in RBC transfusions after birth, which might be associated with mandatory simulation training. A causal link cannot be documented because of complex interactions of several variables.Abbreviations: CS, cesarean section; Hgb, hemoglobin; PPH, postpartum hemorrhage; RBC, red blood cell. Key MessageWe examined whether inter-professional simulation training could influence the rate of red blood cell transfusions after birth and observed a significant reduction in red blood cell transfusions, curettages, and uterine artery embolization after introduction of mandatory simulation training on management of postpartum hemorrhage.

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The hazards of blood transfusion in historical perspective

Cited by 287 publications

References 86 publications

Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences

Rebalanced hemostasis in patients with liver disease: evidence and clinical consequences

Clinical efficacy and cost effectiveness of intraoperative cell salvage in pelvic trauma surgery

Can Interprofessional Simulation Training Influence the Frequency of Blood Transfusions After Birth?

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