Red Blood Cell Transfusion Practices in the Neurointensive Care Unit: A Narrative Review

AbstractAnemia is common in neurointensive care unit (NICU) patients and is one of the common causes of systemic insults to the brain. Though the recent literature favors restrictive blood transfusion practices over liberal transfusion to correct anemia in the general ICU, whether a similar practice can be adopted in NICU patients is doubtful due to lack of strong evidence. Impairment of cerebral autoregulation and cardiac function following acute brain injury affects the body's compensatory mechanism to anemia and renders the brain susceptible to anemic hypoxia at different hemoglobin (Hb) thresholds. Hence, red blood cell transfusion (RBCT) practice based on a single Hb threshold value might be inappropriate. On the other hand, allogenic RBCT has its own risks, both in short and in long run, leading to adverse outcomes. Thus, instead of relying only on arbitrary Hb values, a better way to decide the need for RBCT in NICU patients is to target parameters based on systemic and regional cerebral oxygenation. This approach will help us to individualize RBCT practices. In this narrative review, based on the available literature, authors have discussed the impact of anemia and blood transfusion on the immediate and late neurological outcomes and the current role of regional brain monitoring in guiding blood transfusion practices. In the end, authors have tried to update on the current RBCT practices in neurosurgical and neuromedical patients admitted to the NICU.

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Red blood cell transfusion induces abnormal HIF-1α response to cytokine storm after adult cardiac surgery

Scientific Reports ◽

10.1038/s41598-021-01695-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Emma Viikinkoski ◽

Juho Jalkanen ◽

Jarmo Gunn ◽

Tuija Vasankari ◽

Joonas Lehto ◽

...

Keyword(s):

Cardiac Surgery ◽

Blood Transfusion ◽

Blood Cell ◽

Red Blood Cell ◽

Adverse Outcomes ◽

Red Blood Cell Transfusion ◽

Clinical Trial Registration ◽

Packed Red Blood Cells ◽

The Impact ◽

Adult Cardiac Surgery

AbstractPatients undergoing cardiac surgery develop a marked postoperative systemic inflammatory response. Blood transfusion may contribute to disruption of homeostasis in these patients. We sought to evaluate the impact of blood transfusion on serum interleukin-6 (IL-6), hypoxia induced factor-1 alpha (HIF-1α) levels as well as adverse outcomes in patients undergoing adult cardiac surgery. We prospectively enrolled 282 patients undergoing adult cardiac surgery. Serum IL-6 and HIF-1α levels were measured preoperatively and on the first postoperative day. Packed red blood cells were transfused in 26.3% of patients (mean 2.93 ± 3.05 units) by the time of postoperative sampling. Postoperative IL-6 levels increased over 30-fold and were similar in both groups (p = 0.115), whilst HIF-1α levels (0.377 pg/mL vs. 0.784 pg/mL, p = 0.002) decreased significantly in patients who received red blood cell transfusion. Moreover, greater decrease in HIF-1α levels predicted worse in-hospital and 3mo adverse outcome. Red blood cell transfusion was associated with higher risk of major adverse outcomes (stroke, pneumonia, all-cause mortality) during the index hospitalization. Red blood cell transfusion induces blunting of postoperative HIF-1 α response and is associated with higher risk of adverse thrombotic and pulmonary adverse events after cardiac surgery. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT03444259.

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Faculty Opinions recommendation of How low should we go: A systematic review and meta-analysis of the impact of restrictive red blood cell transfusion strategies in oncology.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726269386.793518644 ◽

2016 ◽

Author(s):

Davide Cattano

Keyword(s):

Systematic Review ◽

Blood Cell ◽

Red Blood Cell ◽

Meta Analysis ◽

Red Blood Cell Transfusion ◽

The Impact

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Intraoperative Anemia and Single Red Blood Cell Transfusion During Cardiac Surgery: An Assessment of Postoperative Outcome Including Patients Refusing Blood Transfusion

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2015.10.021 ◽

2016 ◽

Vol 30 (2) ◽

pp. 363-372 ◽

Cited By ~ 9

Author(s):

Esther K. Hogervorst ◽

Peter M.J. Rosseel ◽

Leo M.G. van de Watering ◽

Anneke Brand ◽

M. Bentala ◽

...

Keyword(s):

Cardiac Surgery ◽

Blood Transfusion ◽

Blood Cell ◽

Red Blood Cell ◽

Postoperative Outcome ◽

Red Blood Cell Transfusion

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Sex based analysis of the impact of red blood cell transfusion and vascular or bleeding complications related to TAVI – The TRITAVI-Women Study

International Journal of Cardiology ◽

10.1016/j.ijcard.2021.02.066 ◽

2021 ◽

Author(s):

Tania Rodriguez-Gabella ◽

Marco Zimarino ◽

Marco Barbanti ◽

Luca Testa ◽

Davide Capodanno ◽

...

Keyword(s):

Blood Cell ◽

Red Blood Cell ◽

Red Blood Cell Transfusion ◽

Bleeding Complications ◽

The Impact

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BLOOD TRANSFUSION IN CARDIAC SURGERY- NEED TO FOLLOW BASICS!

PERSPECTIVES IN MEDICAL RESEARCH - 2 ◽

10.47799/pimr.0703.01 ◽

2020 ◽

Vol 7 (3) ◽

Keyword(s):

Cardiac Surgery ◽

Blood Transfusion ◽

Blood Cell ◽

Red Blood Cell ◽

Red Blood Cell Transfusion ◽

Transfusion Strategy ◽

Transfusion Threshold ◽

Restrictive Transfusion ◽

Conflicting Evidence ◽

American Society

More and more data is coming in recent times about hazards of blood transfusion. In a landmark TRICC1 trial Euvolemic patients in the intensive care unit (ICU) with Hb<9 g/dl were randomized to a restrictive transfusion strategy for transfusion of PRBCs (transfused if Hb<7 g/dl to maintain Hb between 7 and 9 g/dl) or a liberal strategy (transfused if Hb<10 g/dl to maintain Hb 10-12 g/dl). Mortality was similar in both groups, indicating that liberal transfusions were not beneficial. An Updated Report by the American Society of AnaesthesiologistsTask Force on Perioperative Blood Management tells us restrictive red blood cell transfusion strategy may be safely used to reduce transfusion administration. It further states that The determination of whether hemoglobin concentrations between 6 and 10 g/dl justify or require red blood cell transfusion should be based on potential or actual on going bleeding (rate and magnitude), intravascular volume status, signs of organ ischemia, and adequacy of cardiopulmonary reserve. Should we extrapolate these guidelines in Cardiac surgery? TRACS2 trial concluded that among patients undergoing cardiac surgery, the use of a restrictive perioperative transfusion strategy compared with a more liberal strategy resulted in noninferior rates of the combined outcome of 30-day all-cause mortality and severe morbidity.They advocated use of restrictive strategy, but 5 years later, the authors 3concluded that A restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care costs. With this conflicting evidence, by which way anaesthesiologist to go?

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A SARS-CoV-2-pandémia hatása a vérkészítmény-felhasználásra a Pécsi Tudományegyetemen

Orvosi Hetilap ◽

10.1556/650.2021.32334 ◽

2021 ◽

Vol 162 (43) ◽

pp. 1717-1723

Author(s):

Sándor Pál ◽

Barbara Réger ◽

Tamás Kiss ◽

Hussain Alizadeh ◽

András Vereczkei ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Cell ◽

Red Blood Cell ◽

Blood Product ◽

Patient Blood Management ◽

Blood Products ◽

Blood Management ◽

Number Of Patients ◽

Willingness To Donate ◽

The Impact

Összefoglaló. Bevezetés: A COVID–19-világjárvány betegellátásra gyakorolt hatása hazánkban is jelentős. A vérellátást nehezítette a járványügyi intézkedések következményeként a véradási események elmaradása, a csökkent véradási hajlandóság, továbbá a nehezen megítélhető vérkészítményigény . A „Patient Blood Management” irányelveinek az orvosi gyakorlatban történő egyre szélesebb körű alkalmazása elősegíti az optimális vérkészítmény-felhasználást a transzfúziók lehetőség szerinti elkerülésével. Célkitűzés és módszer: Vizsgálatunk célja a Pécsi Tudományegyetem Klinikai Központjának Janus Pannonius Klinikai Tömbjében a vérkészítmény-felhasználás változásainak felmérése volt a 2020. év első öt hónapjában. Eredmények: A járványügyi intézkedéseket követő időszakban szignifikánsan csökkent a hospitalizált betegeknek (34,08%), a transzfúziót igénylő betegeknek (39,69%) és a felhasznált vörösvérsejt-készítményeknek (46,41%) a száma, valamint az egy betegre jutó felhasznált vörösvérsejt-koncentrátum átlaga (2,61-ről 1,97-re) is. Közel 30%-os arányban csökkent a felhasznált friss fagyasztott plazma egységeinek és a thrombocytakoncentrátumoknak a száma is. Következtetés: A szigorú korlátozások életbe léptetését követően a nehézségek ellenére sikerült elegendő mennyiségű vérkészítményt biztosítani a betegeknek. Az Országos Vérellátó Szolgálat Pécsi Regionális Vérellátó Központja munkatársainak és a klinikusok erőfeszítéseinek köszönhetően a vérkészítményigény és -kínálat között új egyensúly alakult ki, mely megfelelő ellátást biztosított a feltétlenül szükséges transzfúziók kivitelezéséhez. Orv Hetil. 2021; 162(43): 1717–1723. Summary. Introduction: The impact of COVID–19 pandemic on patient care is pronounced also in Hungary. Blood supply was hindered by the reduction of public blood donation events, the reduced willingness to donate, and the difficult predictability of blood product demand as a result of the epidemiological regulations. The wider application of Patient Blood Management guidelines in the medical practice will promote optimal blood product utilization by avoiding transfusions where possible. Objective and method: The aim of our study was to assess the changes in the usage of blood products in the first five months of 2020 at the Clinical Center of the University of Pécs, Janus Pannonius Clinical Building. Results: In the period following the epidemiological measures, we found reduction in the number of hospitalized patients (34.08%), in the number of patients requiring transfusion (39.69%) and in the number of red blood cell products used (46.41%). The number of transfused red blood cell concentrates per patient was also significantly reduced (from 2.61 to 1.97) in this period. The number of transfused fresh frozen plasma units and platelet concentrates also decreased by approximately 30%. Conclusion: After the implementation of the strict restrictions, despite the difficulties, it was possible to provide patients with sufficient blood products. Due to the efforts of both the Regional Blood Transfusion Center of Pécs of the Hungarian National Blood Transfusion Service and of the clinicians, a new balance was established between the demand and the supply of blood products, which provided adequate care for the necessary transfusions. Orv Hetil. 2021; 162(43): 1717–1723.

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Allogeneic Leukocyte-Reduced Red Blood Cell Transfusion Is Associated with Postoperative Infectious Complications and Cancer Recurrence after Colon Cancer Resection

Digestive Surgery ◽

10.1159/000498865 ◽

2019 ◽

Vol 37 (2) ◽

pp. 163-170 ◽

Cited By ~ 1

Author(s):

Andrew-Paul Deeb ◽

Christopher T. Aquina ◽

John R.T. Monson ◽

Neil Blumberg ◽

Adan Z. Becerra ◽

...

Keyword(s):

Colon Cancer ◽

Blood Cell ◽

Red Blood Cell ◽

Cancer Recurrence ◽

Infectious Complications ◽

Oncologic Outcomes ◽

Red Blood Cell Transfusion ◽

Elective Resection ◽

Increased Risk ◽

The Impact

Background/Aims: Transfusion rates in colon cancer surgery are traditionally very high. Allogeneic red blood cell (RBC) transfusions are reported to induce immunomodulation that contributes to infectious morbidity and adverse oncologic outcomes. In an effort to attenuate these effects, the study institution implemented a universal leukocyte reduction protocol. The purpose of this study was to examine the impact of leukocyte-reduced (LR) transfusions on postoperative infectious complications, recurrence-free survival, and overall survival (OS). Methods: In a retrospective study, patients with stage I–III adenocarcinoma of the colon from 2003 to 2010 who underwent elective resection were studied. The primary outcome measures were postoperative infectious complications and recurrence-free and OS in patients that received a transfusion. Bivariate and multivariable regression analyses were performed for each endpoint. Results: Of 294 patients, 66 (22%) received a LR RBC transfusion. After adjustment, transfusion of LR RBCs was found to be independently associated with increased infectious complications (OR 3.10, 95% CI 1.24–7.73), increased odds of cancer recurrence (hazard ratio [HR] 3.74, 95% CI 1.94–7.21), and reduced OS when ≥3 units were administered (HR 2.24, 95% CI 1.12–4.48). Conclusion: Transfusion of LR RBCs is associated with an increased risk of infectious complications and worsened survival after elective surgery for colon cancer, irrespective of leukocyte reduction.

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The Impact of Perioperative Packed Red Blood Cell Transfusion on Survival in Epithelial Ovarian Cancer

International Journal of Gynecological Cancer ◽

10.1097/01.igc.0000436089.03581.6b ◽

2013 ◽

Vol 23 (9) ◽

pp. 1612-1619 ◽

Cited By ~ 16

Author(s):

Lindsay L. Morgenstern Warner ◽

Sean C. Dowdy ◽

Janice R. Martin ◽

Maureen A. Lemens ◽

Michaela E. McGree ◽

...

Keyword(s):

Ovarian Cancer ◽

Propensity Score ◽

Blood Cell ◽

Epithelial Ovarian Cancer ◽

Propensity Score Matching ◽

Red Blood Cell ◽

Red Blood Cell Transfusion ◽

Improvement Program ◽

Estimated Blood Loss ◽

The Impact

ObjectivePerioperative packed red blood cell transfusion (PRBCT) has been implicated as a negative prognostic marker in surgical oncology. There is a paucity of evidence on the impact of PRBCT on outcomes in epithelial ovarian cancer (EOC). We assessed whether PRBCT is an independent risk factor of recurrence and death from EOC.MethodsPerioperative patient characteristics and process-of-care variables (defined by the National Surgical Quality Improvement Program) were retrospectively abstracted from 587 women who underwent primary EOC staging between January 2, 2003, and December 29, 2008. Associations with receipt of PRBCT were evaluated using univariate logistic regression models. The associations between receipt of PRBCT and disease-free survival and overall survival were evaluated using multivariable Cox proportional hazards models and using propensity score matching and stratification, respectively.ResultsThe rate of PRBCT was 77.0%. The mean ± SD units transfused was 4.1 ± 3.1 U. In the univariate analysis, receipt of PRBCT was significantly associated with older age, advanced stage (≥IIIA), undergoing splenectomy, higher surgical complexity, serous histologic diagnosis, greater estimated blood loss, longer operating time, the presence of residual disease, and lower preoperative albumin and hemoglobin. Perioperative packed red blood cell transfusion was not associated with an increased risk for recurrence or death, in an analysis adjusting for other risk factors in a multivariable model or in an analysis using propensity score matching or stratification to control for differences between the patients with and without PRBCT.ConclusionsPerioperative packed red blood cell transfusion does not seem to be directly associated with recurrence and death in EOC. However, lower preoperative hemoglobin was associated with a higher risk for recurrence. The need for PRBCT seems to be a stronger prognostic indicator than the receipt of PRBCT.

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