Recent trends in perioperative blood transfusion during elective kidney transplantation
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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.Keywords:
Blood product
Elective surgery
Objective To study the relationship between perioperative transfusion and postoperative infection.Methods 567 cases of perioperative transfusion from 1992 to 2007 were analysed.According to the blood components it was divided into whole blood transfusion group,frozen plasma group,and concentrated red cell group.The relation of the blood category and quantities with postoperative infection was analysed.The results were compared with non-transfusion group of 856 cases.Results The postoperative infection rate of whole blood transfusion group was 12.4%,the infection rate of frozen plasma transfusion was 7.3%,and that of red cell transfusion was 5.6%.There was significant difference among them(P0.05).Conclusion There is a close correlation between perioperative transfusion and postoperative infection.The infection rate by whole blood or plasma transfusion is high and by component transfusion is comparatively low.
Fresh frozen plasma
Infection rate
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Objective To investigate the relationship between perioperative blood transfusion and postoperative wound infection in patients with oral squamous cell carcinoma(OSCC). Methods 753 patients with OSCC in T2 stage were retrospectively analysed. Results Postoperative wound infection rates of patients with perioperative blood transfusion and patients without perioperative blood transfusion were 8.4% and 3.9%,respectively,and there was a significant statistical difference between the two groups (P0.05). Postoperative wound infection rate was increased with the amount of blood transfusion. Conclusion Postoperative wound infection rate of patients with perioperative blood transfusion is significantly higher than that of patients without perioperative blood transfusion. Perioperative blood transfusion should be applied properly.
Wound infection
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Objective: To study the effects of allogeneic blood transfusion on polarized Th cell in gastric carcinoma patients during perioperative time. Methods: Thirty patients undergoing gastric carcinectomy were randomly divided into three groups with 10 patients in each group: group A received no allogeneic blood; group B received leukodepleted blood; group C received allogeneic whole blood during perioperative time. The polarized rates of Th cell were measured by flow cytometry. Results: The counts of Th1 in group A decreased significantly on the 2nd postoperation, but returned to the baseline levels on the 5th postoperative day. The Th1 counts and Th1/Th2 ratio decreased significantly in group B and group C after blood transfusion(P0.05). The Th2 counts increased significantly in group B and C postoperative time. On the 10th postoperative day the Th1?Th2 cell counts and Th1/Th2 ratio returned to preoperative level in group B, but remained low in group C. As compared with that in group A, the Th1 cell counts, Th1/Th2 ratio reduced and Th2 cell counts increased markedly in group C than in group B(P0.05). Conclusion: Perioperative blood transfusion contributes to the immunosuppression, which is more serious after whole blood transfusion than leukodepleted blood. In perioperative period component blood transfusion is superior to whole blood transfusion. The Th cells polarized to Th2 cells may be one of the causes of immunosuppression in patients received allogeneic blood transfusion.
Immunosuppression
Group B
Group A
Blood cell
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Cancer surgery
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The association between perioperative blood transfusion and the prognosis of patients with gastric cancer is still unclear.A total of 1581 patients with gastric cancer who underwent curative gastrectomy from 2000 to 2008 were evaluated. Perioperative blood transfusion was defined as the transfusion of packed red blood cells within seven days before surgery, during surgery, or within the postoperative hospitalization period. The association between perioperative blood transfusion and prognosis was evaluated using univariate and multivariate Cox regression analyses.Of 1581 patients, 298 patients (19%) received perioperative blood transfusion. Perioperative blood transfusion correlated with older age (P < 0.001); larger tumor size (P < 0.001); and more advanced stage (P < 0.001). Five-year survival rate was 40% in patients who had perioperative blood transfusion and 55% patients who did not have perioperative blood transfusion, and the difference was statistically significant (P < 0.001). Multivariate analysis showed that perioperative blood transfusion was defined as independent prognostic factor. Perioperative blood transfusion was associated with worse outcomes in patients with stage III (P < 0.001).Perioperative blood transfusion independently correlated with poorer prognosis in patients with gastric cancer.
Surgical oncology
Univariate analysis
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Objective To discuss the safety and effect of transfusion plan guided by Peri- operative transfusion trigger score( POTTS) in perioperative patients. Methods 84 perioperative patients were randomly divided in to the observation group( n = 42) and the control group( n = 42),the transfusion plan of the observation group were guided by POTTS,and the control group was guided by Journal of Clinical Transfusion technical specification( 2000),then the perioperative blood transfusion rate,amount of blood transfusion,complications,mortality,blood transfusion costs,hospital stay,postoperative drainage,postoperative suture removal time were contrasted between the two groups. Results The perioperative blood transfusion rate and amount of blood transfusion were significantly lower in the observation group than the control group( P 0. 01),there was no severe complication and death in the two groups; blood transfusion costs in the observation group was significantly lower than the control group( P 0. 01),hospital stay and postoperative suture removal time were significantly less than the control group( P 0. 01),but no significantly difference in postoperative drainage( P 0. 05).Conclusions POTTS is safe and effective in guidance of transfusion plan in perioperative patients,it can avoid unnecessary blood transfusions,save blood resource,reduce blood transfusion costs,shorten hospital stay,and is worthy of promotion.
Blood product
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Abstract Purpose : The purpose is to identify risk factors for perioperative blood transfusion in patients undergoing hysterectomy for benign disease. Methods : This study is a retrospective chart review including all the patients who underwent hysterectomy for benign disease between January 1 st 2018 and December 31 st 2019. Patients who received perioperative blood transfusion were identified and compared to those who did not. The following risk factors for blood transfusion were analyzed: route of hysterectomy, BMI, presence of adhesions, history of cesarean section, uterine weight. Descriptive statistics was used to analyze the data. Results : A total of 517 patients were identified and included in the study. Forty-seven patients (9.09 %) received a perioperative blood transfusion. The abdominal hysterectomy route (TAH) was a significant risk factor for receiving blood transfusion (p=0.012). Other identified risk factors for blood transfusion included: Body mass index above 33.0 (p=0.002), and uterine weight (p=0.002). There was no association between the presence of pelvic adhesions (p=0.91) or a personal history of cesarean section (p=0.89) and receiving perioperative blood transfusion. When analyzing only the patients who underwent TLH, the presence of pelvic adhesion was found as a risk factor for perioperative blood transfusion (p=0.024) Conclusion : The abdominal hysterectomy route, the presence of a large uterus, and obesity are risk factors for receiving a blood transfusion. Early identification of the patient at risk of requiring perioperative blood transfusion provides better patient counseling and surgical preparation.
Abdominal hysterectomy
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The decision to perform intraoperative blood transfusion is subject to a variety of clinical and laboratory factors. This study examined variation in haemoglobin (Hb) triggers and overall utilization of intraoperative blood transfusion, as well the impact of transfusion on perioperative outcomes.The study included all patients who underwent pancreatic, hepatic or colorectal resection between 2010 and 2013 at Johns Hopkins Hospital, Baltimore, Maryland. Data on Hb levels that triggered an intraoperative or postoperative transfusion and overall perioperative blood utilization were obtained and analysed.Intraoperative transfusion was employed in 437 (15·6 per cent) of the 2806 patients identified. Older patients (odds ratio (OR) 1·68), patients with multiple co-morbidities (Charlson co-morbidity score 4 or above; OR 1·66) and those with a lower preoperative Hb level (OR 4·95) were at increased risk of intraoperative blood transfusion (all P < 0·001). The Hb level employed to trigger transfusion varied by sex, race and service (all P < 0·001). A total of 105 patients (24·0 per cent of patients transfused) had an intraoperative transfusion with a liberal Hb trigger (10 g/dl or more); the majority of these patients (78; 74·3 per cent) did not require any additional postoperative transfusion. Patients who received an intraoperative transfusion were at greater risk of perioperative complications (OR 1·55; P = 0·002), although patients transfused with a restrictive Hb trigger (less than 10 g/dl) showed no increased risk of perioperative morbidity compared with those transfused with a liberal Hb trigger (OR 1·22; P = 0·514).Use of perioperative blood transfusion varies among surgeons and type of operation. Nearly one in four patients received a blood transfusion with a liberal intraoperative transfusion Hb trigger of 10 g/dl or more. Intraoperative blood transfusion was associated with higher risk of perioperative morbidity.
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