Studies on intravenous transfusion of thymus cells and lymphnode cells. II. Influences of transfused thymus cells and lymphnode cells on the thymus and lymphnode.
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Animals↗
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Studies on intravenous transfusion of thymus cells and lymphnode cells. 3. Influences of transfused thymus cells and lymphnode cells on the bone marrow.
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Animals↗
Studies on intravenous transfusion of thymus cells and lymphnode cells. IV. Influences of intraperitoneal transfusion of thymus cells and lymphnode cells and of extracts from both cells and intraperitoneal insertion of diffusion chambers with both cells.
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Animals↗
[Precautions taken at the Centre de Transfusion Sanguine de Marseille to avoid transfusion errors].
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Blood Banks↗
[Experience in using machine processed files in transfusion at the Centre de Transfusion Sanguine de Nantes].
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Blood Banks↗
[Recent problems in blood transfusion (2)--transfusion of blood components (author's transl)].
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Blood Banks↗
[Transfusion of recuperated blood in total knee arthroplasty].
PURPOSE OF THE STUDY: Autologous blood transfusion is not a routine procedure in knee replacement surgery. Several authors have proposed recovering blood shed during the procedure to limit the need for homologous transfusions. The purpose of this retrospective study was to analyze the amount of blood recovered and reinfused with a blood conservation system (MI, USA) and its effect on hemoglobin level five days after surgery in 405 consecutive patients undergoing total knee arthroplasty. MATERIAL AND METHODS: Preoperative intravascular blood volume and hemoglobin level were used to calculate the quantity of hemoglobin transfused expressed in g/dl at time t 0 of transfusion then at day 1 and day 5 postop. Autologous blood transfusion was not programmed for any of these patients. Twenty patients were given homologous blood transfusions and were excluded from the analysis of data on recovered shed blood but were included in the analysis of risk of homologous transfusion. The analysis thus included 385 patients who did not require homologous blood transfusion. Shed blood was reinfused in 337 patients; no transfusion was performed for 48 patients whose drainage produced an insufficient volume. The same analysis was performed for three sub-groups of patients: 205 patients whose transfusion volume was less than 10% of their intravascular volume, 132 patients whose transfusion volume was greater than 10% of their intravascular volume, and 50 transfused patients who weighed less than 70 kg. RESULTS: Mean transfusion volume was 516 ml (range 100-1440 ml), accounting for 59% of the drainage volume over 24 hours and 32% of total estimated blood loss. On the average, the whole blood shed and reinfused contained 60.60 g hemoglobin and increased serum hemoglobin by 0.97 g/dl at day 5 postop (with a wide range: 0.18-2.74 g/dl). Mean transfusion volume, based on hemoglobin equivalent packed cell units, corresponding to 10% of the mean intravascular volume was taken as the threshold of transfusion efficacy. Among the 132 patients whose transfusion volume was greater than 10% of the intra-vascular volume, hemoglobin level at day 5 postop increased 1.32 g/dl on the average. Among the 205 patients whose transfusion volume was less than 10% of the intravascular volume, hemoglobin level on day 5 postop increased 0.74 g/dl on the average. In patients weighing less than 70 kg, transfusion increased hemoglobin level on day 5 postop 1.23 g/dl on the average. The probability of transfusion of more than 10% of the intravascular volume was 0.66 +/- 0.1 in patients weighing less than 70 kg and 0.33 +/- 0.05 for the entire population (p<0.001). The fall in mean hemoglobin level from day 0 to day 5 was 3.46 g/dl in transfused patients and 4.16 g/dl in non-transfused patients (p<0.0001). Reinfusion of shed blood allowed 80 more patients (20% of the 405 patients in this series) to maintain their hemoglobin level above 9 g/dl on day 5 postop. The probability of homologous blood transfusion for serum hemoglobin<8 g/dl was 0.5 +/- 0.08. Applying this probability in a situation without recovery of shed blood, the total number of homologous blood transfusions would have increased from 4.9% to 10.7% (p<0.01). DISCUSSION: Patient follow-up confirmed the absence of specific problems. Mean transfusion volume was 516 ml with a 59% (mean) reinfusion/drainage ratio, in line with data reported in the literature. The efficacy of the blood conservation system was unpredictable due to the wide range of blood volume transfused, and consequently of hemoglobin transfused, related to wide interindividual variability for total blood loss and drainage volume. Since the mean volume of reinfused blood contained the same quantity of hemoglobin as one packed red cell units, it would appear reasonable to take 10% of theoretical intravascular volume as a threshold above which the transfusion method becomes efficacious. CONCLUSION: Considerable interindividual variability in total blood loss and total drainage volume compromises the overall efficacy of blood conservation systems. Increase in hemoglobin level on day 5 postop was vary variable in this series of reinfused knee arthroplasty patients (range 0.18 - 2.74 g/dl) with a mean of 0.97 g/dl which corresponds to one packed red cell unit. The probability that the transfused volume would be greater than 10% of the theoretical intravascular volume was 0.66 +/- 0.1 in patients weighing less than 70 kg versus 0.33 +/- 0.05 for the entire population (p<0.001). This finding would suggest that a blood conservation system should be used routinely in patients weighing less than 70 kg. Conversely, the use of the system as a routine measure for all knee arthroplasty patients with the aim of limiting the risk of homologous blood transfusion to a minimum would divide the risk by two and also avoid the risk of viral contamination and identification errors.
Aged↗
Quantifying risk of transfusion in children undergoing spine surgery.
BACKGROUND CONTEXT: The risks and costs of transfusion are a great concern in the area of pediatric spine surgery, because it is a blood-intensive procedure with a high risk for transfusion. Therefore, determining the predictors of transfusion in this patient population is an important first step and has the potential to improve upon the current approaches to reducing transfusion rates. In this study, we reveal several predictors of transfusion in a pediatric patient population undergoing spine surgery. In turn, we present a general rule of thumb ("rule of two's") for gauging transfusion risk, thus enhancing the surgeon's approach to avoiding transfusion in certain clinical scenarios. PURPOSE: This study was conducted to determine the main factors of transfusion in a population of pediatric patients undergoing scoliosis surgery. The goal was to present an algorithm for quantifying the true risk of transfusion for various patient groups that would highlight patients "at high risk" for transfusion. This is especially important in light of the various risks associated with undergoing a transfusion, as well as the costs involved in maintaining and disposing of exogenous blood materials. STUDY DESIGN/SETTING: This is a retrospective review of a group of children who underwent scoliosis surgery between 1988 and 1995 at an academic institution. PATIENT SAMPLE: A total of 290 patients were analyzed in this study, of which 63 were transfused and 227 were not. OUTCOME MEASURES: No outcomes measures were used in this study. METHODS: A retrospective review of 290 patients presenting to our institution for scoliosis surgery was conducted, with a focus on socioclinical data related to transfusion risk. Univariate analysis and logistic regression were used to quantify the determinants of transfusion risk. RESULTS: Univariate analysis identified many factors that were associated with the risk of transfusion. However, it is clear that several of these factors are dependent on each other, obscuring the true issues driving transfusion need. We used multivariate analysis to control for the various univariate predictors of transfusion. Our logistic regression model suggested that the type of scoliosis (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.07 to 3.82), degree of curvature (OR, 1.012/degree curve; 95% CI, 1.01 to 1.03), and use of erythropoietin (OR, 0.29; 95% CI, 0.14 to 0.62) were the main determinants of transfusion risk for our population. CONCLUSIONS: The main risk factors of transfusion were used to formulate a simple algorithm, which can be used to quantify transfusion risk and to guide efforts to avoid transfusion in children undergoing spinal surgery. Given a 10% baseline risk for transfusion, our "rule of two's" indicates that each risk factor approximately doubles the chance of transfusion, whereas the administration of recombinant human erythropoietin roughly halves the risk of transfusion.
Adolescent↗
Number needed to treat and cost of recombinant human erythropoietin to avoid one transfusion-related adverse event in critically ill patients.
OBJECTIVE: To calculate the absolute risk reduction of transfusion-related adverse events, the number of patients needed to treat, and cost to avoid one transfusion-related adverse event by using erythropoietin in critically ill patients DESIGN: Number needed to treat with sensitivity analysis. SETTING: Teaching hospital. PATIENTS: Hypothetical cohort of critically ill patients who were candidates to receive erythropoietin. INTERVENTIONS: Using vs. not using erythropoietin to reduce the need for packed red blood cell transfusions. MEASUREMENTS AND MAIN RESULTS: We used published estimates of known transfusion risks: transfusion-related acute lung injury, transfusion-related errors, hepatitis B and C, human immunodeficiency virus, human T-cell lymphotropic virus, and bacterial contamination, stratified by severity. Based on the estimated risk and frequency of transfusions with and without erythropoietin, we calculated the absolute risk reduction of transfusion-related adverse events, the number needed to treat, and cost to avoid one transfusion-related adverse event by using erythropoietin. The estimated incidence of transfusion-related adverse event was 318 permillion units transfused for all transfusion-related adverse events, 58 per million for serious transfusion-related adverse events, and 21 per million for likely fatal transfusion-related adverse events. The routine use of erythropoietin resulted in an absolute risk reduction of 191 per million for all transfusion-related adverse events, 35 per million for serious transfusion-related adverse events, and 12 per million for likely fatal transfusion-related adverse events. The number needed to treat was 5,246 to avoid one transfusion-related adverse event, 28,785 to avoid a serious transfusion-related adverse event, and 81,000 for a likely fatal transfusion-related adverse event. The total cost was $4,700,000 to avoid one transfusion-related adverse event, $25,600,000 to avoid one serious transfusion-related adverse event, and $71,800,000 to avoid a likely fatal transfusion-related adverse event. The magnitude of these results withstood extensive sensitivity analysis. CONCLUSIONS: From the perspective of avoidance of adverse events, erythropoietin does not appear to be an efficient use of limited resources for routine use in critically ill patients.
Bacterial Infections↗
The transfusion effect.
Pretransplant Transfusion 1. With cyclosporine, cadaver kidney donor transplant recipients who had no transfusions (392 patients) had a 66% one-year graft survival rate compared with 77% for those who had transfusions (2916 patients, p less than 0.001). Without cyclosporine, the comparable figures were 57% for those without transfusions (234 patients) compared with 64% for those who had transfusions (2761 patients, p less than 0.05). Thus, the transfusion effect remains a significant factor in transplantation even with the advent of cyclosporine. 2. With cyclosporine, whole blood transfusions effectively increased the survival rate to 96% for one year with more than five transfusions in 26 patients. 3. The transfusion effect was most apparent in patients ages 16 to 40. Older patients had a high survival rate without transfusions. 4. The transfusion effect acted independently from cyclosporine and HLA-B,DR matching. Thus, when all three factors were maximized, there was an 89% one-year survival rate (118 patients) compared with 49% survival when all three factors were at their worst. 5. In transplants performed in 1982 and 1983, the transfusion effect had almost disappeared because the nontransfused patients had a high survival rate. However, in transplants performed in 1984 and 1985, there was a transfusion effect, although not as strong as it was earlier. 6. Second cadaver grafts were improved by intervening transfusions given after rejection of a first graft. Interestingly, more than 10 transfusions yielded a one-year graft survival rate of 69% in 183 patients. 7. The related donor transplant survival rate was significantly influenced by the number of transfusions both in cyclosporine-treated and conventionally treated patients. Peroperative Transfusions at Surgery 8. Peroperative transfusions were most effective in regrafted patients (55% one-year survival rate without and 61% with peroperative transfusions). In first grafts, particularly in males, they were slightly deleterious. These relationships were the same in cyclosporine-treated patients. 9. Peroperative transfusions were beneficial to regrafted patients regardless of their presensitization status, sex, or whether they had rejected their first grafts rapidly or slowly. 10. Second graft survival increased to 77% at one year in 107 patients by adding peroperative transfusions to more than 10 intervening transfusions. 11. One or two units of blood were equivalent, as were the various types of blood products. Whole blood was the most effective, although the numbers of cases available for analysis were small.(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗
Transfusion practices among patients who did and did not predonate autologous blood before elective cardiac surgery.
BACKGROUND: Preoperative autologous blood donation is commonly used to reduce exposure to allogeneic transfusions among patients undergoing elective cardiac surgery. However, this technique is associated with an overall increase in transfusions (allogeneic or autologous). The authors assessed the impact of transfusion decision-making on the effectiveness of preoperative autologous donation in reducing the frequency of allogeneic transfusions, and its impact on the increased transfusion rate associated with preoperative autologous donation in cardiac surgery. METHODS: This retrospective analysis compared transfusion practices among 176 patients who predonated autologous blood before elective cardiac surgery and 176 matched cardiac surgery patients who did not predonate blood. The impact of decision-making on transfusion exposure was determined using multivariate analyses to account for major perioperative interventions and complications. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for exposure to allogeneic blood transfusion or any transfusion, before and after exclusion of transfusions not conforming with selected transfusion criteria. RESULTS: Exposure to allogeneic transfusion was more likely among patients who did not predonate blood than among those who did predonate blood (OR 14.0, 95% CI 5.8-33.8). This finding was still true after exclusion of transfusions not meeting the transfusion criteria (OR 19.3, 95% CI 6.7-55.7). The autologous blood donors were more likely than the nondonors to receive any transfusion (OR 10.8, 95% CI 5.7-20.3). However, this association was substantially attenuated after exclusion of transfusions not meeting the transfusion criteria (OR 1.9, 95% CI 1.1-3.2). INTERPRETATION: Patients who predonated blood before elective cardiac surgery were at lower risk of receiving allogeneic transfusions than the nondonors. This was not because of a deliberate withholding of allogeneic transfusions from autologous donors. However, more liberal transfusion criteria for autologous blood were largely responsible for the increased transfusion rate among the autologous donors.
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Allogeneic blood transfusion as a risk factor for the subsequent development of non-Hodgkin's lymphoma.
In summary, it is impossible to reconcile the contradictory results of the studies of the association between previous blood transfusion and subsequent development of NHL (Figs 1 and 2). Most of the studies were of high quality, and the authors discussed the possible sources of bias that might have generated a spurious association or concealed a true relationship. Although recall bias, detection bias, and allogeneic blood transfusions given because of the onset of NHL could be responsible for the reported positive associations, these explanations were considered by the investigators, and they seem unlikely. Multiple comparisons may account for the association between transfusion history and NHL in individual studies, but they are less likely to explain the association noted in all the positive studies considered together. Random misclassification and Berkson's bias might explain some of the null results, but they are unlikely to account for disagreements of the magnitude shown in Figures 1 and 2. Alexander discussed the superior quality of the design of the case-control study of Adami et al but was unable to explain the disagreements among the reported studies (Figs 1 and 2). He concluded that there is no proof that allogeneic blood transfusion does not increase the risk of NHL; one can, however, be reassured that the evidence so far points to--at worst--a doubling of risk, and--at best--no increase in risk after a previous transfusion. Along these lines, Figure 1 shows the results of the 3 cohort studies, which were remarkably consistent in reporting a 2-fold increase in the risk of developing NHL after a blood transfusion; and Figure 2 shows the results of the 6 case-control studies, which usually observed no increased risk. If allogeneic blood transfusion does have an immunosuppressive effect, this effect is probably transient and weak, compared with the severity of the immunosuppression encountered in the posttransplantation situation. Immune impairment may be the common determinant for the increased risk of NHL observed in transplanted and transfused patients, and--if this were the case--the difference in the duration and intensity of the immunosuppressive state would be logically congruent with the observed patterns of lymphoma development: that is, the risk of NHL is increased 20- to 120-fold in the transplanted patients, as compared with only 2-fold in the previously transfused patients. The association between allogeneic blood transfusion and subsequent development of NHL is biologically plausible, whether the mechanism is transfusion-associated immunosuppression, transmission of oncogenic viruses, or viral activation in a setting of transfusion-associated immunosuppression. Also, if allogeneic blood transfusion is a risk factor for the subsequent development of NHL, the increased use of allogeneic blood transfusion since the 1950s might account, at least in part, for the increase in the incidence of NHL over the last half of this century. Blood transfusions are commonly used worldwide, and--based on at least some studies--they show a weak association with NHL (i.e., at worst, a doubling of risk; Fig 1). Common exposures that have a weak association with NHL are more likely to account for the current epidemic of NHL in the elderly, compared with rare exposures that increase the risk of NHL by manyfold. However, no evidence regarding a causal relationship between history of an allogeneic blood transfusion and the subsequent development of NHL has been presented. The available studies are observational, and they cannot determine whether any increase in risk, observed in association with allogeneic blood transfusion, is due to the transfusion itself or to other factors occurring in association with the transfusion. In conclusion, allogeneic blood transfusion from healthy donors may be associated with a small increase in the risk of development of NHL after the transfusion. This hypothesis is biologically plausible and is
Case-Control Studies↗
[Perioperative transfusion of erythrocyte concentrates during elective surgery: introduction of a protocol for indications].
PURPOSE: The aim of this paper is, first, to know the actual situation of the perioperatory red cell transfusion for elective surgery in our hospital. In a second phase and prospectively, we tested guidelines for red cell perioperatory transfusion in order to observe the change of transfusions. Then, we compared the results between the basal and postintervention periods. PATIENTS AND METHODS: We performed an aleatory assay with two periods, basal and interventionist. Basal period: 151 patients undergoing elective surgery with perioperatory blood requested and general anesthesia. Intervention period: We applied a transfusion guidelines protocol for perioperatory red cell transfusion from the Hospital's Transfusion Committee, also a questionnaire to evaluate the medical indication; We studied 164 patients with clinical features like the basal period. Study/results variables: preoperative blood request, perioperatively transfusion, number of packed red-cell units transfused, crossmatch--to--transfusion ratio, haemoglobin level pre and posttransfusion. RESULTS: No significant drop of the cross match-transfusion ratio was observed after intervention. There is a slight reduction of the crossmatch--to--transfusion ratio, although these value is high (4.48), due to an increase of the transfusion keeping the percentage of appropriate transfusions. The most frequent reason (53%) of inadequate transfusion is the active bleeding. CONCLUSIONS: 1) The transfusional activity of the Marina Alta Hospital supposes approximately 17% of the request and 6% of the global transfusion. 2) The introduction of a protocol of perioperative transfusion instructions suppose a small decrease of the crossmatch--to--transfusion ratio, without statistical significance. This slight reduction is due to an increase of transfusion in the post-intervention period, since in this period there is a group of older age patients and with greater percentage of associated pathology. 3) The rate of appropriate transfusions in both periods is similar. 4) The preoperative request of red cells is inappropriate. 5) The most frequent reason of inappropriate transfusion is active bleeding.
Adolescent↗
Clinical experience of blood transfusion in renal transplantation.
A positive effect on survival of renal grafts of pretransplant blood transfusions have been reported from several centers. The aim of this study was to study if the described graft-protecting effect of blood transfusion was present in the Gothenburg material of transplanted patients, and if this effect could be achieved by deliberately transfusing previously non-transfused patients with two units of leukocyte-reduced blood. The effect on graft survival (GS) of the number and timing of transfusions to recipients, transfusions to the cadaveric donors, HLA-A, B matching, lymphocytotoxic antibodies and pretransplant hemodialysis was also studied. The study includes 844 recipients of primary renal grafts from living related and cadaveric donors (LRD, CD) and 70 patients waiting for transplantation. In the retrospective part of the study the GS of previously transfused and non-transfused non-transfused patients was compared. In the prospective part of the study a protocol with two deliberate transfusions (DT) to previously non-transfused patients was introduced. The GS of the DT group was compared to that for patients transfused for strictly medical reasons (MT) and non-transfused patients (NT). Survival of patients and grafts was calculated according to the life table method. In the retrospective part of study one year GS in LRD transplantation was 86.6% for transfused and 38.4% for non-transfused patients (P less than 0.01). In the first period one year GS in CD transplantation was 62.1% for transfused and 35.1% for non-transfused patients (P less than 0.01). The corresponding figures in the second period were 68.1% and 39.5%, respectively (P less than 0.001). In transfused recipients receiving kidneys from transfused and non-transfused cadaveric donors, the GS was 76.3% and 55.4%, respectively (P less than 0.05). In the prospective part of study the one year GS after LRD transplantation was 85.0% in both the DT and MT groups. In CD transplantation the one year GS was 73.4% and 75.7% of the DT and MT groups, respectively. The GS of each of these two groups was significantly better than that of 20.8% for the NT group (P less than 0.01). Lymphocytotoxic antibodies were detected in 5.0% of the DT group and 23.0% of the MT group (P less than 0.001). Foreign HLA-B series antigens had a negative influence on GS in the first period of the retrospective CD study. Later, no influence on GS was noted of HLA-A, B matching. Hemodialysis prior to transplantation did not influence GS.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
Triggers for prophylactic use of platelet transfusions and optimal platelet dosing in thrombocytopenic dogs and cats.
Prophylactic platelet transfusions are frequently given to human patients with hypoproliferative thrombocytopenia. For several decades, the most common transfusion trigger was 20,000/microL, but the trend is now to use 10,000/microL in the absence of other risk factors for bleeding. This trigger seems to reduce the number of transfusions without increasing the risk of severe bleeding. Most studies involved in establishing platelet transfusion policies have involved patients with acute leukemia, with fewer studies involving patients undergoing hematopoietic stem cell transplantation or aggressive chemotherapy for other cancers and patients with aplastic anemia. In the presence of other risk factors for spontaneous bleeding, 20,000/microL is still considered an appropriate trigger. The trigger for prophylactic transfusion before surgery has not undergone the same recent scrutiny as has the trigger for spontaneous bleeding. The recommendation remains to raise the platelet count to 50,000 to 100,000/microL if possible, although it is recognized that surgery and other invasive procedures have been performed at lower platelet counts without major bleeding. Prophylactic transfusion is not used in disorders of platelet consumption and destruction to prevent spontaneous bleeding but is used before surgery. Because of the comparative lack of experience with platelet transfusion in veterinary medicine, it is difficult to make generalizations for dogs and cats. Using the guidelines established for therapeutic and prophylactic transfusion of human patients is a reasonable starting point, however. A therapeutic transfusion policy is suggested in the veterinary setting provided that the patient can be closely observed for critical bleeding and a prompt transfusion can be given. This policy should ultimately reduce the overall number of platelet transfusions given to hospital patients. If an animal cannot be closely observed or the ability to transfuse on demand is limited, prophylactic transfusion is recommended. The triggers for initiating a platelet transfusion in dogs are extrapolated from human data; these values are lower by 50% for cats. Because of the imprecision of platelet counting at low values, platelet counts must always be interpreted in conjunction with clinical signs of hemorrhage. If platelet-rich plasma or platelet concentrate is available, a dose of 1 platelet unit per 10 kg is recommended, although resources may dictate a smaller dose. This will raise the recipient platelet count by a maximum of about 40,000/microL. Assuming a trigger of 10,000/microL, a transfusion will probably be required approximately every 3 days. It must be remembered that the frequency of platelet transfusions may be greater in the presence of factors accelerating platelet loss or destruction. If fresh whole blood is used, a rule of thumb is to transfuse 10 mL/kg, which will raise the recipient platelet count by a maximum of approximately 10,000/microL. Daily transfusions or transfusions every other day will probably be required.
Animals↗
Regional blood flow alterations after bovine fumaryl beta beta-crosslinked hemoglobin transfusion and nitric oxide synthase inhibition.
OBJECTIVES: a) To determine whether isovolemic exchange transfusion with cell-free, bovine fumaryl beta beta-crosslinked hemoglobin results in a different pattern of regional blood flow distribution than transfusion with a poor oxygen-carrying, colloidal solution. b) Because of potential nitric oxide scavenging by plasma-based hemoglobin, to determine whether blood flow differences are reduced after nitric oxide synthase inhibition. DESIGN: A prospective, randomized design with repeated blood flow measurements within groups. SETTING: Experimental physiology laboratory in a university medical center. SUBJECTS: Pentobarbital-anesthetized female cats. INTERVENTIONS: Three groups of eight cats were studied: a) a control group with no transfusion (hematocrit of 32%); b) an anemia group in which exchange transfusion with an albumin-containing solution reduced hematocrit to 18% over a 40- to 50-min period; and c) a group in which cell-free hemoglobin was exchanged transfused to reduce hematocrit to 18%, without a proportional reduction in oxygen-carrying capacity. Bovine hemoglobin was covalently crosslinked intramolecularly between the 81-lysine residues on the beta-subunits to stabilize the tetramer. Regional blood flow was measured by the radiolabeled microsphere technique before transfusion and at 10, 100, and 180 mins from the start of transfusion. At 190 mins, N omega-nitro-L-arginine methyl ester (L-NAME; 10mg/kg) was infused to inhibit nitric oxide synthase and blood flow was measured 30 mins later. MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure was unchanged in the control and albumin-transfused groups. However, mean arterial pressure increased rapidly in the hemoglobin-transfused group. With hemoglobin transfusion, there were marked reductions in blood flow to the intestines, kidneys and adrenal glands. Administration of L-NAME after hemoglobin transfusion failed to increase arterial pressure or cause further reductions in intestinal, renal, or adrenal blood flow. Administration of L-NAME to the control and albumin-transfused groups increased arterial pressure and reduced intestinal, renal, and adrenal blood flows to values attained with hemoglobin transfusion. In contrast, in skeletal muscle and left ventricle, blood flow rates increased in the albumin-transfused group and were greater than those values found in the control group and hemoglobin-transfused group. The greater flow in the albumin-transfused group persisted after L-NAME administration. There was no difference in renal sodium, potassium, or osmolar excretion, or in urine flow between groups. CONCLUSIONS: Transfusion with cell-free, bovine crosslinked hemoglobin in cats can selective reductions in blood flow in the intestines, kidneys, and adrenal glands without evidence of renal dysfunction by a mechanism consistent with nitric oxide scavenging. In skeletal and cardiac muscle, the increase in blood flow persisted after nitric oxide inhibition in the albumin group relative to the hemoglobin-transfused group at equivalent hematocrit values. This finding is consistent with compensatory vasoconstriction with hemoglobin transfusion due to improved oxygenation by this oxygen carrier.
Animals↗
A model for predicting transfusion requirements in head and neck surgery.
INTRODUCTION: Although allogeneic blood transfusions have allowed surgeons increased latitude in resecting advanced cancers, they can cause significant morbidity or even death in rare instances. Potential side effects may include transmission of infection and immunosuppression leading to an increased risk of cancer recurrence. Because patients have become more reluctant to receive transfusions, they frequently request preoperative autologous blood donation (PABD). In practice, however, only 50% or less of the donated blood is ultimately transfused while the remainder is discarded. PURPOSE: The purpose of this study was to develop a transfusion prediction and risk assessment (TPRA) model for predicting the need for perioperative blood transfusions in patients undergoing major head and neck oncologic surgical procedures. By knowing the probability for blood transfusion, the physician and patient can make an educated decision regarding the need for PABD. PATIENTS AND METHODS: Over a 4-year period, 436 patients underwent major head and neck surgical procedures for neoplasms of the upper aerodigestive tract, the thyroid gland, and the salivary glands. Data obtained prospectively on each patient included age and gender, the TNM stage, primary disease site, type of prior treatment, estimated intraoperative blood loss, duration of surgery, transfusion requirements, preoperative and postoperative hemoglobin and hematocrit levels, type of procedure and method of reconstruction. These variables were examined singly and in combination both for descriptive purposes and to evaluate their interrelationships. In order to develop the TPRA model, only the 12 variables available prior to the surgical procedure were examined. Variables associated with transfusion need were evaluated further in a multivariate analysis. The logistic regression model allowed a linear expression of patient characteristics to be related to a function of the probability of transfusion need. Analyses of association between categorical variables and transfusion status were based on chi-squared, Fisher's Exact, and Mann-Whitney U tests. RESULTS: Overall, 51 (11.7%) patients required blood transfusions. The median number of units transfused was 2.0 (range, 1 to 13 U). Univariate analysis demonstrated a higher probability for blood replacement in patients with oropharyngeal or hypopharyngeal primary tumor sites, a preoperative hemoglobin level below normal, prior chemotherapy, composite resection, flap reconstruction, between 50 and 59 years of age, and T3 or T4 tumor stage. Logistic regression analysis demonstrated that the need for flap reconstruction, a preoperative hemoglobin below the normal level, and T3 or T4 primary stage were the three factors most significantly associated with the need for transfusion (P < .03). Based on eight combinations of these three variables, transfusion risk predictions were obtained. The TPRA model predicted that patients with a normal hemoglobin level who did not require flap reconstruction and did not have either a T3 or T4 primary stage tumor had the lowest probability (.02) for requiring blood transfusion. Patients at highest risk (.65) were those with less than a normal hemoglobin level, who required flap reconstruction, and had T3 or T4 primary tumor stage. Based on the TPRA model, an algorithm was developed which could serve as a guideline for preoperative transfusion planning. CONCLUSION: By using the TPRA model to change guidelines for preoperative transfusion planning, costs can theoretically be reduced by 50% without significantly increasing the risk of exposing patients to allogeneic blood transfusion. If the TPRA model proves accurate in a follow-up study to test its validity, it may have clinical utility for aiding the surgeon in more cost-effective transfusion planning.
Adolescent↗
Allergic transfusion reactions: an evaluation of 273 consecutive reactions.
CONTEXT: Allergic reaction to transfusion is common. However, the review of a large series of allergic transfusion reactions has not been performed. OBJECTIVE: To review a large series of allergic transfusion reactions. DESIGN: A retrospective review of all reported and evaluated transfusion reactions during a 9-year period at 1 institution was performed. Associated clinical signs and symptoms were evaluated. SETTING: Large, tertiary-care teaching hospital. RESULTS: A total of 1613 adverse reactions to transfusion were evaluated. Allergic transfusion reactions accounted for 17% (273 of 1613) of the transfusion reactions. Severe allergic reactions (anaphylaxis, anaphylactoid signs and symptoms, and/or hypotension) were observed in 21 patients (7.7% of allergic reactions, or 1.3% of all transfusion reactions). Serum tryptase, a marker for anaphylaxis, was measured in 1 patient and determined to be borderline elevated. Five patients experienced allergic transfusion reactions to autologous red cell transfusions. One patient experienced hives during the transfusion of a major ABO mismatched red blood cell. A wide variety of skin manifestations were observed, but 26 (9.5%) patients did not have skin manifestations. Allergic transfusion reactions were estimated to occur in approximately 1 in 4124 blood components transfused, or 1 in 2338 transfusion episodes. Severe allergic reactions occurred in approximately 1 in 30,281 transfusions. No deaths directly attributable to transfusion were observed in this patient group. CONCLUSIONS: The clinical presentation of allergic transfusion reactions was quite variable, and the pathophysiology remains unclear. Recommendations for clinical evaluation and therapy remain problematic and often empirical.
Acute Disease↗