High Volume Intraoperative Transfusion is Associated with Decreased Early Survival in Recipients of Ventricular Assist Devices
S. ForestYu XiaJonathan LeffUlrich P. JordeSingh NairLeticia NolascoOmar SaeedDaniel B. SimsSnehal R. PatelWilliam JakobleffJulia ShinS. MurthyS. ScheininDaniel J. Goldstein
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Transfusion of blood or any blood product presents a significant risk to the recipient. Over 10% of all recipients suffer from some kind of adverse reaction. It is important to determine whether the expected benefits of transfusion outweigh the risks associated with a transfusion. Judicious and rational use of blood and blood products reduces these risks. Common complications associated with the use of a particular blood product have been described with the product.
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Despite increasing popularity and multiple postulated benefits, less invasive (LIS) left ventricular assist device (LVAD) implantation has not been sufficiently compared with standard full sternotomy (FS). We report the outcomes of a propensity score analysis designed to compare LIS and FS LVAD implantation, with perioperative blood product use, adverse event rates, and mortality as primary objective. From September 2010 to August 2016, 159 consecutive patients received a Medtronic HVAD or Abbott HeartMate 3 LVAD via a FS or LIS approach. Outcomes were analyzed using proportional hazard Cox regression, with risk adjustment based on a LIS approach propensity score model computed from demographics, risk factors, and operative covariates. Seventy-five patients were matched and compared (HVAD 83% [n = 62]; LIS approach 43% [n = 32]; mean age 60 ± 12 years; 89% [n = 67] male; 48% [n = 36] ischemic cardiomyopathy [ICMP]; 37% [n = 28]). Patient groups were comparable with regard to preoperative patient characteristics. Less invasive LVAD implantation was successful in all patients with no intraoperative conversions. In-hospital mortality was 16% in both groups, despite 37% Interagency Registry for Mechanically Assisted Circulatory Support Level I patients. Overall, 28% of the LIS patients did not receive any blood products intraoperatively, whereas, in the FS group, only two patients (5%) did not require the administration of blood products ( p = 0.000). This was also a significant finding in the overall perioperative phase in which seven LIS patients (22%) who not receive any blood products versus two FS patients (5%; p = 0.033). Otherwise, outcomes were comparable. Less invasive LVAD implantation is a feasible, safe, and reduces blood product use.
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Ischemic Cardiomyopathy
Destination therapy
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To summarize the experience of blood transfusion during orthotopic liver transplantation (OLT).The clinic data and blood transfusion of 28 patients during OLT were analyzed.The total blood volume of transfusion was 9 517 +/- 7 680 ml averagely for the 28 patients in general during OLT, including that of an infant (920 ml), massive blood transfusion in 2 cases (28740 ml and 38580 ml respectively). The transfusion volume of patients with anemia or/and thrombcytopenia before the operation was not more than that of patients with normal blood routine.In general, 5 000 - 10 000 ml is reserved for receptor of OLT before the operation. We should take measures to deal with massive blood transfusion. The preparative blood volume for receptor of OLT can not depend on the result of blood routine.
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A 46-year-old man with a continuous flow left ventricular-assist device implanted as destination therapy 2 years ago (CF-LVAD; HeartMate II, Thoratec Corporation, Pleasanton, CA, USA) presented with syncope, low flow device alarms, and several brief device stoppage events. The patient had been off anticoagulation (warfarin, International Normalized Ratio goal of 2.0–2.5) and anti-platelet agent (aspirin, 81 mg daily) for 5 months due to a large …
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The ageing population in developed countries, including Australia, is putting increasing demands on blood transfusion services. With a falling donor pool there is likely to be a shortage of blood and blood products in the next 20 to 30 years unless there are significant changes in medical practice. The National Health and Medical Research Council/Australasian Society of Blood Transfusion Clinical Practice Guidelines on the Use of Blood Components from 2001 are being redeveloped by the National Health and Medical Research Council/Australian and New Zealand Society of Blood Transfusion as evidence-based patient-focused Patient Blood Management guidelines with the aim of improving patient outcomes by reducing inappropriate blood and blood product use and targeting therapies for improving the management of anaemia and coagulopathies.
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The author studied upon the clinical cases with more than 200ml. of blood loss in operation without blood transfusion and devised a formula with which the permitted quantity of blood loss can be calculated, in other words, how much blood loss a patient can tolerate without risk during operation and postoperative course. Furthermore, the author discussed control of the postoperative hypovolemia, safety limit of hemodilution, and recovery from it upon the above cases and came to the following conclusions.1) In the early stage after operation, approximately 10% decrease of the total blood volume was found because of functional decrease of the extracellular fluid. As it is difficult to prevent the decrease of the total blood volume even with blood transfusion, it is reasonable to put a landmark around 10% decrease of the total blood volume when surgeons control the hypovolemia after non blood transfusion operation.2) When plasma expander of more than 1.2 times of volume of total blood loss and fluid of 5.0ml/kg/hr were given intravenously in non blood transfusion operation, decrease of the total blood volume was 8% on the average if total blood loss remained within permitted quantity regardless of age and bleeding speed during operation.3) It was established that normal blood constituent was lowered up to 30% without any trouble in both operative and postoperative course.4) During a few days after non blood transfusion operation, the data suggesting low production and accelerating destruction of red blood cells were obtained. Red blood cell volume showed decrease due to blood loss and this was followed by further slight decrease as postoperative course progressed.5) At the beginning of the second postoperative week, production of the red blood cell became remarkably active and the greater was the dilution the faster was the production of red blood cell. The most cases recovered from anemia to normal value at the time of discharge from the hospital.6) From the above data, the author devised the formula which was supposed to be reasonable pathophysiologically.Y=V (1-b/Z)Y: permitted quantity of blood lossV: total blood volumeZ: preoperative hematocritb: possible hematocrit by dilution
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Accurately predicting the demand for blood transfusions is crucial for blood banks. Given the potential for emergency situations, it is imperative that blood banks maintain a sufficient inventory of blood products. In this study, we examined the use of perioperative transfusions in patients undergoing elective kidney transplants.Data on all complement-dependent cytotoxicity-crossmatched assays between 2013 and 2022 were collected. We excluded repeated assays and patients who did not undergo kidney transplantation. Transfusion records and transfusion adverse reactions were reviewed retrospectively.In total, 30 patients underwent elective kidney transplantation from 2013 to 2022. The mean age of the patients was 48.1±9.7 years. The male-to-female ratio was 1.5:1. Four patients received transfusions intraoperatively, whereas eight patients were transfused postoperatively. The postoperative hemoglobin level of the transfusion group (n=9, 8.9±1.3) was significantly lower than that of the nontransfusion group (n=21, 10.4±1.2). The most commonly transfused blood product intraoperatively was leuko-reduced filtered red blood cells, followed by fresh frozen plasma. When the study period was divided into two halves based on the time of operation, the first half showed a higher number of significant transfusions.In most elective kidney transplant cases, surgery was conducted without the need for blood transfusion. The timing of transfusion, when necessary, shifted from during the operation to after the operation. The implementation of patient blood management, coupled with advancements in surgical techniques, appears to have impacted the pattern of perioperative transfusion.
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