The use of a blood conservation device to reduce red blood cell transfusion requirements: a before and after study

Abstract

IntroductionAnaemia and the associated need for packed red blood cell (PRBC) transfusions are common in patients admitted to the intensive care unit (ICU). Among many causes, blood losses from repeated diagnostic tests are contributory.MethodsThis is a before and after study in a medical ICU of a university hospital. We used a closed blood conservation device (Venous Arterial blood Management Protection, VAMP, Edwards Lifesciences, Irvine, CA, USA) to decrease PRBC transfusion requirements. We included all adult (≥18 years) patients admitted to the ICU with indwelling arterial catheters, who were expected to stay more than 24 hours and were not admitted for active gastrointestinal or any other bleeding. We collected data for six months without VAMP (control group) immediately followed by nine months (active group) with VAMP. A restrictive transfusion strategy in which clinicians were strongly discouraged from any routine transfusions when haemoglobin (Hb) levels were above 7.5 g/dL was adopted during both periods.ResultsEighty (mean age 61.6 years, 49 male) and 170 patients (mean age 60.5 years, 101 male) were included in the control and active groups respectively. The groups were comparable for age, gender, Acute Physiology and Chronic Health Evaluation (APACHE) II score, need for renal replacement therapy, length of stay, and Hb levels on discharge and at transfusion. The control group had higher Hb levels on admission (12.4 ± 2.5 vs. 11.58 ± 2.8 gm/dL, P = 0.02). Use of a blood conservation device was significantly associated with decreased requirements for PRBC transfusion (control group 0.131 unit vs. active group 0.068 unit PRBC/patient/day, P = 0.02) on multiple linear regression analysis. The control group also had a greater decline in Hb levels (2.13 ± 2.32 vs. 1.44 ± 2.08 gm/dL, P = 0.02) at discharge.ConclusionsThe use of a blood conservation device is associated with 1) reduced PRBC transfusion requirements and 2) a smaller decrease in Hb levels in the ICU.

Anemia in Critical Illness

“…Such waste can be eliminated by returning this blood to the patient, either via three-way stopcock or a commercially available blood-sampling system. Using such a closed system decreases blood loss (109,112) and one before-and-after study also showed reduced amount of blood transfusions (0.07 vs. 0.13 units/patient/day; P ¼ 0.02), and even reduced hospital mortality (30 vs. 53%; P ¼ 0.001) (113).…”

Transfusion de concentrés globulaires en réanimation : moins, c’est mieux !

“…La première étape d'une stratégie d'épargne transfusionnelle est probablement de réduire le vampirisme médical lié aux prélèvements sanguins. Outre une prescription raisonnée des examens biologiques, l'utilisation d'un système de réinjection de la purge sur la ligne artérielle ou de tubes d'examens à volume réduit ou de tubes pédiatriques peuvent permettre de diminuer la spoliation sanguine voire de diminuer le recours à la transfusion de CGR [88][89][90][91]. L'utilisation d'EPO, souvent associée à une supplémenta-tion martiale, a été proposée afin de limiter le recours à la transfusion de CGR en réanimation, sur la base des excellents résultats obtenus chez les patients insuffisants rénaux et d'observations expérimentales d'inhibition de l'apoptose des progéniteurs érythroïdes obtenus chez des patients de réanimation [10].…”

Iatrogenic anemia/Twenty-five million liters of blood into the sewer: reply

“…However, the reported effects of blood reduction strategies on transfusion requirements were different between these studies; only Mukhopadhyay et al [9] reported a significant reduction in the amount of transfused packed cells following reduction of iatrogenic blood loss.…”