The impact of blood conservation techniques on transfusion requirements for posterior scoliosis corrections: Do we need a routine cross-match for the operation?

Acute mesenteric ischemia (AMI) continues to carry high morbidity and mortality. Endovascular strategies have been increasingly used in the management of AMI. The purpose of this study was to evaluate the impact of endovascular therapy on outcomes of patients with AMI. The National Surgical Quality Improvement Program database was queried to identify all patients requiring emergency surgical intervention for AMI. Demographics, clinical data, interventions, and outcomes were extracted. Patients were compared according to treatment (endovascular versus hybrid versus open revascularization). Over the six-year study period, a total of 439 patients were found to have AMI [27 (6.2%) endovascular, 23 (5.2%) hybrid, and 389 (88.6%) open revascularization]. A total of 16 (59.3%) patients in the endovascular group avoided laparotomy. There was a trend toward lower transfusion requirements (intraoperative transfusion: 3.7% for endovascular vs 17.4% for hybrid vs 19.3% for open, adjusted. P = 0.127) and complications in particular pneumonia (22.2% vs 39.1% vs 27.8%, respectively, Adj. P = 0.392) and sepsis (25.9% vs 21.7% vs 35.5%, adjusted P = 0.260). Endovascular therapy was associated with a 2.5-fold decrease in the risk of death [odds ratio, 95% confidence interval: 0.4 (0.2, 0.9), adjusted P = 0.018]. In this analysis of morbidity and mortality, endovascular therapy was associated with decreased need for laparotomy and a trend toward lower transfusion requirements and complications, in particular pneumonia and sepsis. Endovascular first therapy was associated with a 2.5-fold decrease in the risk of death. Further prospective evaluation of these results is warranted.

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Predictors of transfusion requirements for cardiac surgical procedures at a blood conservation center

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(03)01345-6 ◽

2004 ◽

Vol 77 (2) ◽

pp. 626-634 ◽

Cited By ~ 85

Author(s):

David M. Moskowitz ◽

James J. Klein ◽

Aryeh Shander ◽

Katherine M. Cousineau ◽

Richard S. Goldweit ◽

...

Keyword(s):

Surgical Procedures ◽

Cardiac Surgical Procedures ◽

Blood Conservation ◽

Transfusion Requirements

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Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice. Procrit Study Group.

Journal of Clinical Oncology ◽

10.1200/jco.1997.15.3.1218 ◽

1997 ◽

Vol 15 (3) ◽

pp. 1218-1234 ◽

Cited By ~ 522

Author(s):

J Glaspy ◽

R Bukowski ◽

D Steinberg ◽

C Taylor ◽

S Tchekmedyian ◽

...

Keyword(s):

Quality Of Life ◽

Functional Status ◽

Cancer Patients ◽

Hemoglobin Level ◽

Activity Level ◽

Epoetin Alfa ◽

Open Label ◽

Transfusion Requirements ◽

The Impact

PURPOSE To study the impact of Procrit (epoetin alfa; Amgen Inc, Thousand Oaks, CA) on quality of life, transfusion requirements, and hemoglobin in anemic cancer patients receiving chemotherapy. PATIENTS AND METHODS More than 500 community-based oncologists enrolled 2,342 patients with malignancies undergoing cytotoxic chemotherapy in an open-label study. Patients were treated with epoetin alfa 150 U/kg three times weekly, which could be doubled if the therapuetic response was judged inadequate. Total treatment was up to 4 months. RESULTS Of the 2,342 patients enrolled, data were available for 2,030 patients. Of the 2,030, 1,047 patients completed all 4 months of epoetin alfa therapy. Epoetin alfa was associated with significant increases in mean self-rated scores for energy level, activity level, and overall quality of life; these improvements correlated with the magnitude of the hemoglobin increase and were independent of tumor response. In addition, epoetin alfa was associated with a significant increase in mean hemoglobin and with a significant decrease in the proportion of patients requiring transfusions (baseline to final value, P < .001). Epoetin alfa was well tolerated. CONCLUSION Epoetin alfa is effective in improving the functional status and quality of life in anemic cancer patients receiving chemotherapy, as well as increasing hemoglobin level and decreasing transfusion requirements. Improvement in functional status can be attributed to an increase in hemoglobin level, demonstrating that quality of life in this group of patients can be improved by aggressively treating anemia. Further studies will be required to define the optimal doses and schedules for epoetin alfa.

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The effect of intravenous iron on erythropoiesis in older people with hip fracture

Age and Ageing ◽

10.1093/ageing/afz049 ◽

2019 ◽

Vol 48 (5) ◽

pp. 751-755 ◽

Cited By ~ 4

Author(s):

I K Moppett ◽

M Rowlands ◽

A M Mannings ◽

T C Marufu ◽

O Sahota ◽

...

Keyword(s):

Hip Fracture ◽

Older People ◽

Reticulocyte Count ◽

Controlled Trial ◽

Intervention Group ◽

Haemoglobin Concentration ◽

Intravenous Iron ◽

Good Evidence ◽

Transfusion Requirements ◽

The Impact

Abstract Background anaemia following hip fracture is common and associated with worse outcomes. Intravenous iron is a potential non-transfusion treatment for this anaemia and has been found to reduce transfusion rates in previous observational studies. There is good evidence for its use in elective surgical populations. Objective to examine the impact of intravenous iron on erythropoiesis following hip fracture. Design two-centre, assessor-blinded, randomised, controlled trial of patients with primary hip fracture and no contra-indications to intravenous iron. Method the intervention group received three doses of 200 mg iron sucrose over 30 min (Venofer, Vifor Pharma, Bagshot Park, UK) on three separate days. Primary outcome was reticulocyte count at day 7 after randomisation. Secondary outcomes included haemoglobin concentration, complications and discharge destination. Eighty participants were randomised. Results there was a statistically significantly greater absolute final reticulocyte count in the iron group (89.4 (78.9–101.3) × 109 cells l−1 (n = 39) vs. the control (72.2 (63.9–86.4)) × 109 cells l−1 (n = 41); P = 0.019; (mean (95% confidence intervals) of log-transformed data). There were no differences in final haemoglobin concentration (99.9 (95.7–104.2) vs. 102.0 (98.7–105.3) P = 0.454) or transfusion requirements in the first week (11 (28%) vs. 12 (29%); P = 0.899). Functional and safety outcomes were not different between the groups. Conclusions although intravenous iron does stimulate erythropoiesis following hip fracture in older people, the effect is too small and too late to affect transfusion rates. Trial Registry Numbers: ISRCTN:76424792; EuDRACT: 2011-003233-34.

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Evaluation of Enteral Versus Parenteral Feeding As Nutritional Support In Allogeneic Hematopoietic Stem Cell Transplantation

Blood ◽

10.1182/blood.v118.21.4576.4576 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4576-4576

Author(s):

Richard Lemal ◽

Romain Guièze ◽

Cécile Moluçon-Chabrot ◽

Eric Hermet ◽

Aurélie Ravinet ◽

...

Keyword(s):

Stem Cell ◽

Median Duration ◽

Nutritional Support ◽

Conflicts Of Interest ◽

Conditioning Regimen ◽

Hematopoietic Stem ◽

Early Outcome ◽

Transfusion Requirements ◽

Significant Difference ◽

The Impact

Abstract Abstract 4576 Introduction Allo-HSCT procedure is associated with a frequent and potentially severe malnutrition which could highly participate to the transplant-related morbidity (TRM). Optimal nutritional management is still poorly known while both enteral nutrition (EN) and parenteral nutrition (PN) are effective. We proposed to retrospectively evaluate the impact of EN versus PN as nutritional support on early outcome of allo-HSCT. Patients and methods We retrospectively analyzed all the successive patients who needed a nutritional support during their first allo-HSCT in our center from January 2009 to October 2010, excepting whose who had a progressive disease at time of transplant. Datas were compared in an intent to treat analysis according the EN or PN initial nutritional support strategy. Results We analysed early outcome of 56 successive patients. Twenty of them received a myeloablative conditioning regimen and 36 a reduced intensity one. A total of 28 agreed to receive EN via a nasogastric feeding tube and the remaining 28 received PN. No significant difference in terms of age, diagnosis, disease status at transplant, conditioning regimens, stem cell source, GVHD nor antifungal secondary prophylaxis could be observed between the EN and PN groups. We found a lower median duration of fever in EN (2[0–8] vs. 5[0–17] (days); p=0.0026) and a lower need for antifungal therapy in EN group (7/28 vs. 17/28; p=0.0069), with a lower median duration of intravenous antifungal use (0 day [0–99] in EN vs. 7 days [0–93] in PN; p=0.00034) while incidence of bacteriemiae was not different. We observed a lower rate of replacement of central veinous catheter in EN group (3/28 in EN vs. 9/28 in PN; p=0.05) and a lower rate of transfer to ICU in the EN group (2/28 in EN vs. 8/28 in PN, p=0.036) but early death rate (<100 days) was the same in each group (4/28 vs. 4/28, p=NS). Median neutropenia and thrombopenia duration and median transfusion requirements were not significantly different. Fourteen patients in EN group and 18 in PN group presented a grade 3–4 oral mucositis (p=NS). Grade III-IV GVHD incidence was comparable in both groups (4/28 vs. 8/28; p=0.19). Conclusion Compared with PN, EN directly decreases the infectious risk, particularly the fungal risk, and its complications in allo-HSCT, without influencing hematopoietic toxicity nor GVHD incidence. Based on these encouraging results, we are now conducting a prospective, multicentric and randomized trial to confirm EN benefice in allo-HSCT. Disclosures: No relevant conflicts of interest to declare.

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Enhanced Recovery Protocol Reduces Transfusion Requirements and Hospital Stay in Patients Undergoing an Elective Arthroplasty Procedure

Advances in Orthopedic Surgery ◽

10.1155/2016/9846910 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Kirsten Juliette de Burlet ◽

James Widnall ◽

Cefin Barton ◽

Veera Gudimetla ◽

Stephen Duckett

Keyword(s):

Length Of Stay ◽

Enhanced Recovery ◽

Transfusion Rate ◽

Transfusion Requirements ◽

Total Knee ◽

Enhanced Recovery Protocol ◽

Knee Arthroplasty Surgery ◽

The Impact ◽

Arthroplasty Surgery ◽

Arthroplasty Procedure

Background. Enhanced recovery (ER) for elective total hip or total knee replacement has become common practice. The aim of this study is to evaluate the impact of ER on transfusion rates and incidence of venous thromboembolism (VTE). Methods. A comprehensive review was undertaken of all patients who underwent primary hip or knee arthroplasty surgery electively between January 2011 and December 2013 at our institution. ER was implemented in August 2012, thus creating two cohorts: the traditional protocol (TP) group and the ER group. Outcome measurements of length of stay, postoperative transfusion, thromboembolic complications, and number of readmissions were assessed. Main Findings. 1262 patients were included. The TP group contained a total of 632 patients and the ER group contained 630 patients. Postoperative transfusion rate in the ER group was reduced with 45% (P≤0.05). There was no statistical difference in postoperative VTE complications. The length of stay was reduced from 5.5 days to 4.8 days (P<0.05). Conclusions. There was no difference in the number of readmissions. ER has contributed to a significant decrease in transfusions after elective arthroplasty surgery, with no increase in the incidence of thromboembolic events. Furthermore, it has significantly reduced inpatient length of stay.

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Measuring trade-offs that matter: assessing the impact of a new electronic cross-match policy on the turnaround time and the cross-match workload efficiency

Transfusion ◽

10.1111/trf.12725 ◽

2014 ◽

Vol 54 (12) ◽

pp. 3075-3079 ◽

Cited By ~ 4

Author(s):

David M. Lin ◽

Dennis Goldfinger ◽

Qun Lu ◽

Bridget Wallace ◽

Dawn Kosaka-Nguyen ◽

...

Keyword(s):

Turnaround Time ◽

Trade Offs ◽

The Cross ◽

The Impact ◽

Cross Match

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Blood Conservation in Neurosurgery: Erythropoietin and Autologous Donation

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2014.14 ◽

2014 ◽

Vol 41 (5) ◽

pp. 583-589 ◽

Cited By ~ 8

Author(s):

Alexander McGirr ◽

Katerina Pavenski ◽

Bhanu Sharma ◽

Michael D. Cusimano

Keyword(s):

Significant Proportion ◽

International Classification Of Diseases ◽

Recombinant Erythropoietin ◽

Blood Conservation ◽

Retrospective Case ◽

Transfusion Requirements ◽

Classification Of Diseases ◽

Matching Criteria ◽

The Cost ◽

Rbc Transfusion

AbstractBackgroundNeurosurgery may involve significant blood loss and frequently requires allogeneic red blood cell (RBC) transfusion. Preoperative recombinant erythropoietin (EPO) may be used to improve erythroid status and recovery, and used either alone or in combination with preoperative autologous donation (PAD) it may reduce exposure to allogeneic RBC. We wished to study the use of EPO with and without PAD and the risk of RBC transfusion in neurosurgery.MethodsUsing a retrospective case-control design, 57 patients who received EPO preoperatively were matched 2:1 for age, sex, year of surgery, and International Classification of Diseases code most responsible for surgery (three were excluded because of stringent matching criteria, leaving 54 cases and 108 comparison subjects). Thirty-two cases participated in PAD. Medical and anesthetic records as well as laboratory investigations were reviewed and extracted.ResultsAllogeneic RBC exposure was identical for EPO cases and comparison subjects (18.5%). Concomitant PAD and EPO did not reduce allogeneic RBC exposure (21.9%), and resulted in a greater number of RBC units transfused. Last recorded hemoglobin levels suggested that autologous RBCs were not more liberally used. Patients who engaged in PAD and EPO suffered from iatrogenic anemia. A significant proportion (58.6%) of the autologous RBCs was ultimately not used and discarded.ConclusionFurther research is needed to determine the efficacy of EPO in neurological surgery. PAD does not appear to reduce the risk of allogeneic RBC transfusion, despite concomitant EPO. Indeed, PAD resulted in iatrogenic anemia and increased transfusion requirements. The cost-effectiveness of blood conservation efforts in neurosurgery deserves additional research.

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