The <scp>N</scp>ational <scp>H</scp>eart, <scp>L</scp>ung, and <scp>B</scp>lood <scp>I</scp>nstitute <scp>R</scp>ecipient <scp>E</scp>pidemiology and <scp>D</scp>onor <scp>E</scp>valuation <scp>S</scp>tudy (<scp>REDS</scp>‐<scp>III</scp>): a research program striving to improve blood donor and transfusion recipient outcomes

Kleinman, Steven; Busch, Michael P.; Murphy, Edward L.; Shan, Hua; Ness, Paul M.; Glynn, Simone A.

doi:10.1111/trf.12468

Cited by 90 publications

(93 citation statements)

References 65 publications

(94 reference statements)

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“…REDS-III is a consortium of four hubs, each consisting of a blood center and two to four affiliated hospitals, a single central laboratory (Blood Systems Research Institute, San Francisco, CA), and a data coordinating center (RTI International, Raleigh, NC). 9 Data were collected retrospectively and were restricted to the inpatient electronic data at each hospital. The data set consisted of detailed blood component information, patient demographics, and clinical and laboratory data from the blood bank and electronic health records (EHRs) from October 1, 2010, to September 30, 2011, for all adult patients transfused with plasma.…”

Section: Methodsmentioning

confidence: 99%

A multicenter study of plasma use in the United States

et al. 2014

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Background Detailed information regarding plasma use in the United States is needed to identify opportunities for practice improvement and design of clinical trials of plasma therapy. Study Design and Methods Ten US hospitals collected detailed medical information from the electronic health records for 1 year (2010-2011) for all adult patients transfused with plasma. Results A total of 72,167 units of plasma were transfused in 19,596 doses to 9269 patients. The median dose of plasma was 2 units (interquartile range, 2-4; range 1-72); 15% of doses were 1 unit, and 45% were 2 units. When adjusted by patient body weight (kg), the median dose was 7.3 mL/kg (interquartile range, 5.5-12.0). The median pretransfusion international normalized ratio (INR) was 1.9 (25%-75% interquartile range, 1.6-2.6). A total of 22.5% of plasma transfusions were given to patients with an INR of less than 1.6 and 48.5% for an INR of 2.0 or more. The median posttransfusion INR was 1.6 (interquartile range, 1.4-2.0). Only 42% of plasma transfusions resulted in a posttransfusion INR of less than 1.6. Correction of INR increased as the plasma dose increased from 1 to 4 units (p < 0.001). There was no difference in the INR response to different types of plasma. The most common issue locations were general ward (38%) and intensive care unit (ICU; 42%). Conclusion This large database describing plasma utilization in the United States provides evidence for both inadequate dosing and unnecessary transfusion. Measures to improve plasma transfusion practice and clinical trials should be directed at patients on medical and surgical wards and in the ICU where plasma is most commonly used.

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Section: Methodsmentioning

confidence: 99%

A multicenter study of plasma use in the United States

et al. 2014

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“…71 Hypoxia inducible factor [HIF]-1-alpha, is involved in iron homeostasis by increasing erythropoietin, and suppressing hepcidin expression in the liver under conditions of hypoxia. Men who were carriers of the HIF-1α P-582-S polymorphism (affecting 25-30% of reported subjects) were found to have higher hemoglobin and ferritin levels than individuals homozygous for the wild-type allele.…”

Section: Genetic Assessment Of Iron Status In Blood Donorsmentioning

confidence: 99%

Laboratory and Genetic Assessment of Iron Deficiency in Blood Donors

Kiss

2015

Clinics in Laboratory Medicine

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Synopsis Over 9 million individuals donate blood annually in the US. Between 200 to 250 mg of iron is removed with each whole blood donation, reflecting losses from the hemoglobin in red blood cells. This amount represents approximately 25% of the average iron stores in men and almost 75% of the iron stores in women. Replenishment of iron stores takes many months, leading to a high rate of iron depletion, especially in frequent blood donors (e. g., more than 2 times per year). In large epidemiologic studies, donation frequency, female gender, and younger age (reflecting menstrual status), are particularly associated with iron depletion. Currently, a minimum capillary hemoglobin of 12.5 gm/dl is the sole requirement for donor qualification in the US as far as iron levels are concerned, yet it is known that hemoglobin level is a poor surrogate for low iron. In an effort to better identify and prevent iron deficiency, blood collection centers are now considering various strategies to manage donor iron loss, including changes in acceptable hemoglobin level, donation interval, donation frequency, testing of iron status, and iron supplementation. This chapter highlights laboratory and genetic tests to assess the iron status of blood donors and their applicability as screening tests for blood donation.

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“…However, the frequency and impact of non-infectious complications such as transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) have been increasingly described and appreciated 6–14 . Indeed, TACO has been identified as a major area of interest for national research networks such as the National Heart Lung and Blood Institute-funded Recipient Epidemiology and Donor Evaluation Survey III research network 15 .…”

Section: Introductionmentioning

confidence: 99%

Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload

et al. 2017

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Background Transfusion-associated circulatory overload remains underappreciated in the perioperative environment. The authors aimed to characterize risk factors for perioperative transfusion-associated circulatory overload and better understand its impact on patient-important outcomes. Methods In this case–control study, 163 adults undergoing noncardiac surgery who developed perioperative transfusion-associated circulatory overload were matched with 726 transfused controls who did not develop respiratory complications. Univariate and multivariable logistic regression analyses were used to evaluate potential risk factors for transfusion-associated circulatory overload. The need for postoperative mechanical ventilation, lengths of intensive care unit and hospital stay, and mortality were compared. Results For this cohort, the mean age was 71 yr and 56% were men. Multivariable analysis revealed the following independent predictors of transfusion-associated circulatory overload: emergency surgery, chronic kidney disease, left ventricular dysfunction, previous β-adrenergic receptor antagonist use, isolated fresh frozen plasma transfusion (vs. isolated erythrocyte transfusion), mixed product transfusion (vs. isolated erythrocyte transfusion), and increasing intraoperative fluid administration. Patients who developed transfusion-associated circulatory overload were more likely to require postoperative mechanical ventilation (73 vs. 33%; P < 0.001) and experienced prolonged intensive care unit (11.1 vs. 6.5 days; P < 0.001) and hospital lengths of stay (19.9 vs. 9.6 days; P < 0.001). Survival was significantly reduced (P < 0.001) in transfusion recipients who developed transfusion-associated circulatory overload (1-yr survival 72 vs. 84%). Conclusions Perioperative transfusion-associated circulatory overload was associated with a protracted hospital course and increased mortality. Efforts to minimize the incidence of transfusion-associated circulatory overload should focus on the judicious use of intraoperative blood transfusions and nonsanguineous fluid therapies, particularly in patients with chronic kidney disease, left ventricular dysfunction, chronic β-blocker therapy, and those requiring emergency surgery.

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The National Heart, Lung, and Blood Institute Recipient Epidemiology and Donor Evaluation Study (REDS‐III): a research program striving to improve blood donor and transfusion recipient outcomes

Cited by 90 publications

References 65 publications

A multicenter study of plasma use in the United States

A multicenter study of plasma use in the United States

Laboratory and Genetic Assessment of Iron Deficiency in Blood Donors

Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload

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