Red Blood Cell Transfusion and its Relationship with Pedicle Thrombosis in Microvascular Free Flaps

2021 ◽  
Author(s):  
Carlos Eduardo Torres Fuentes ◽  
Iván Enrique Rodríguez Mantilla ◽  
Diego Nicolás Guerrero Cáceres ◽  
Diego Felipe Camargo Gonzalez
Keyword(s):  
Blood Cell ◽  
Free Flap ◽  
Red Blood Cell ◽  
Cox Regression ◽  
Free Flaps ◽  
Perioperative Period ◽  
Red Blood Cell Transfusion ◽  
Flap Survival ◽  
Increased Risk ◽  
The Relationship

Abstract Background Free flaps have become a highly valuable tool for complex reconstructive surgeries. The requirement of red blood cell transfusion (RBCT) during the perioperative period is common and its effect on the free flap survival is debatable. The aim of this study was to determine the relationship between perioperative RBCT and vascular pedicle thrombosis (VPT). Methods For this study 302 free flaps performed between January 2006 and December 2019 were retrospectively analyzed. It included their characteristics from before, during, and after the surgical procedure. The incidence of VPT and flap survival were calculated based on Kaplan Meier's method and the relationship between VPT and perioperative variables were analyzed by Cox regression models. Results The transfusion group was represented by 62 flaps (20.5%) and no transfusion by 240 flaps. The overall transfusion requirement was 20.5% and the cumulative incidence of VPT was 9.11%. A statistically significant relationship was not demonstrated between flap survival and transfusion status (HR = 1.73 IC 95%: 0.5 to 3.96; p = 0.192) (p = 0.192) independently from the number of units transfused, the preoperative diagnosis of anemia, and the type of flap used and did not establish an increased risk of VPT. Conclusions This study did not demonstrate an association between RBCT during preoperative period and the risk for VPT or microvascular free flap survival rate on postoperative follow up.

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

2019 ◽  
Vol 37 (2) ◽  
pp. 163-170 ◽  
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.

scholarly journals RhD Immunization Despite Adequate Immunoprophylaxis: Role of Fc Gamma Receptor Gene Polymorphisms

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 759-759
Author(s):  
Tamara C Stegmann ◽  
Sietse Q Nagelkerke ◽  
Dian van Winkelhorst ◽  
Taco W Kuijpers ◽  
Gestur Vidarsson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Genetic Variation ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Potential Risk ◽  
Caesarian Section ◽  
Red Blood Cell Transfusion ◽  
Control Group ◽  
Increased Risk ◽  
Potential Risk Factors

Abstract Introduction: One of the most effective immunological interventions in clinical medicine is the prevention of hemolytic disease of the newborn by prophylactic Rh immune globulin (Rh-Ig) therapy. The administration of ante- and postnatal Rh-Ig has reduced the risk of RhD immunization in the Netherlands from 17% to a mere 0.31%, yet its mechanism of action is still unknown. To gain more insight into the possible working mechanism of the Rh-Ig prophylaxis we analyzed potential risk factors and genotyped all known IgG-Fc receptor (protein FcγR, gene FCGR) variants known to date, on a cohort of Dutch women who failed Rh-Ig prophylaxis and developed anti-D antibodies. Adequate Rh-Ig immunoprophylaxis was defined as an antenatal and postnatal prophylaxis of 1,000 IU (200 µg) in both current and previous pregnancies, according to the Dutch guidelines. Material and Methods: Between 1999 and 2013 we identified 274 women who produced anti-D antibodies. Through a structured questionnaire we collected information about Rh-Ig prophylaxis and additional clinical data for potential risk factors. In 122 cases, adequate Rh-Ig prophylaxis was given, and clinical risk factors for fetal maternal hemorrhage (FMH) could be collected. Their clinical circumstances were compared to a control group of 339 randomly selected pregnant women. The Rh-Ig therapy failure of 57 of those women could not be explained through our risk factor analysis. From these 57 cases, DNA was obtained, and used for the FcγR-specific multiplex ligation-dependent probe amplification (MLPA) assay, identifying both single nucleotide polymorphisms and copy number variations in the FCGR locus. The results were compared to a control group of 200 healthy donors. Results: A history of red blood cell transfusion (p=0.05) and caesarean section (p<0.0001) were identified to be independent risk factors for RhD immunization. All other described risk factors for FMH such as miscarriage, termination of pregnancy, or invasive diagnostic procedures, requiring an additional Rh-Ig dose according to the guidelines, were not found to increase the risk of immunoprophylaxis failure. RhD-immunization due to caesarian section or red blood cell transfusion accounted for 53% of our cohort, suggesting an alternative explanation for the production of Rh-Ig alloantibodies in the remaining 47% of the cases - despite adequate amount of prophylaxis given in current and previous pregnancies. We therefore postulate the existence of a genetic variation that puts women at increased risk for RhD immunization during pregnancy. To test this hypothesis we analyzed the genetic variation in the FCGR locus and found a significantly (p=0.02) increased prevalence of the FCGR2 -ORF, expressing a functional copy of the activating FcγRIIc, which is otherwise a pseudogene. Strikingly, the prevalence of the 2B.4-promotor haplotype of the FCGR2B gene, associated with a 1.5 fold increase of the inhibitory FcγRIIb, was strongly (p=0.0001) increased. Conclusion: Caesarian section and red blood cell transfusion are risk factors that increase RhD immunization during pregnancies, accounting for about half failed Rh-Ig prophylactic cases. Genetic variation in the FCGR-gene might be a possible explanation for increased immunization risk. In our cohort we encountered a significantly increased frequency of individuals expressing FcγRIIc, along with a polymorphism encoding for a higher expression of the inhibitory receptor FcγRIIb, suggesting these genes to influence immune responses to RBC in a manner previously unrecognized. Disclosures No relevant conflicts of interest to declare.

scholarly journals Prognostic Association Between Perioperative Red Blood Cell Transfusion and Postoperative Cardiac Surgery Outcomes

2021 ◽  
Vol 8 ◽  
Author(s):  
Yanxiu Li ◽  
Iokfai Cheang ◽  
Zhongwen Zhang ◽  
Xiangrong Zuo ◽  
Quan Cao ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Medical Information ◽  
Red Blood Cell Transfusion ◽  
Multivariable Logistic Regression Analysis ◽  
Inhospital Mortality ◽  
Increased Risk ◽  
Worse Prognosis

Objective: To investigate the correlation between red blood cell transfusion and clinical outcome in patients after cardiac surgery.Methods: Demographic, clinical characteristics, treatment with/without transfusion, and outcomes of patients after cardiac surgery from the Medical Information Mart for Intensive Care—III database were collected. Patients were divided into two groups according to perioperative transfusion. A multivariable logistic regression analysis was utilized to adjust for the effect of red blood cell transfusion on outcomes for baseline and covariates and to determine its association with outcomes.Results: In total, 6,752 patients who underwent cardiac surgery were enrolled for the analysis. Among them, 2,760 (40.9%) patients received a perioperative transfusion. Compared with patients without red blood cell transfusion, transfused patients demonstrated worse outcomes in inhospital mortality, 1-year mortality, and all-cause mortality. Adjusting odds ratios (ORs) for the significant characteristic, patients with perioperative transfusion remained significantly associated with an increased risk of inhospital mortality [OR = 2.8, 95% confidence interval (CI) 1.5–5.1, P = 0.001], 1-year mortality (OR = 2.0, 95% CI 1.4–2.7, P &lt; 0.001), and long-term mortality (OR = 2.2, 95% CI 1.8–2.8, P &lt; 0.001).Conclusion: Perioperative red blood cell transfusion is associated with a worse prognosis of cardiac surgery patients. Optimal perioperative management and restricted transfusion strategy might be considered in selected patients.

scholarly journals Maintenance treatment of patients with myelodysplastic syndromes using recombinant human granulocyte colony-stimulating factor

Blood ◽  
1990 ◽  
Vol 76 (1) ◽  
pp. 36-43 ◽  
Author(s):  
RS Negrin ◽  
DH Haeuber ◽  
A Nagler ◽  
Y Kobayashi ◽  
J Sklar ◽  
...  
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Myelodysplastic Syndromes ◽  
Red Blood Cell Transfusion ◽  
Granulocyte Colony Stimulating Factor ◽  
Risk Of Infection ◽  
Colony Stimulating Factor ◽  
Transfusion Requirements ◽  
Increased Risk ◽  
Stimulating Factor

Myelodysplastic syndromes (MDS) are characterized by chronic refractory cytopenias resulting in increased risk of infection, bleeding, and conversion to acute leukemia. In an effort to improve these cytopenias we have treated 18 patients over a 6- to 8-week period with increasing daily subcutaneous doses of recombinant human granulocyte colony- stimulating factor (G-CSF). Sixteen patients responded with improvement in neutrophil counts. On cessation of treatment these counts returned to baseline values over a 2- to 4-week period. To maintain these improved blood counts 11 patients were treated with G-CSF for more prolonged periods. Ten patients again responded with an increase in total leukocyte counts (1.6- to 6.4-fold) and absolute neutrophil counts (ANC) (3.6- to 16.3-fold), with responses persisting for 3 to 16 months. A significantly decreased risk of developing bacterial infections was noted during periods with ANC greater than 1,500/mm3 as compared with periods of time with ANC less than 1,500/mm3. Two anemic patients had a greater than 20% rise in hematocrit over the study period, and 2 additional patients had a decrease in red blood cell transfusion requirements during G-CSF treatment. Bone marrow myeloid maturation improved in 7 of 9 maintenance phase patients. Three patients progressed to acute myeloid leukemia during treatment. The drug was generally well-tolerated and no severe toxicities were noted. These data demonstrated that G-CSF administered to MDS patients by daily subcutaneous administration was well-tolerated and effective in causing persistent improvement of the neutrophil levels and marrow myeloid maturation. These effects were associated with a decreased risk of infection and, in some patients, with decreased red blood cell transfusion requirements.

scholarly journals A 19-Year Retrospective Analysis of Venous Thromboembolism Trends in Chemotherapy-Induced Anemia: Red Blood Cell Transfusion Versus Erythrocyte Stimulating Agent Administration

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4944-4944
Author(s):  
Emily Bryer ◽  
Michael Kallan ◽  
Ting-Shaun Chiu ◽  
Katerina Scheuba ◽  
David H. Henry
Keyword(s):  
Venous Thromboembolism ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Cox Regression ◽  
Conflicts Of Interest ◽  
Intravenous Iron ◽  
Red Blood Cell Transfusion ◽  
Chemotherapy Patients ◽  
Poor Outcomes ◽  
Rbc Transfusion

Introduction: Anemia is a common and unfortunate consequence of chemotherapy; patients receiving a variety of chemotherapy regimens often develop chemotherapy-induced anemia (CIA), which contributes to poor outcomes including increased mortality. Prompt and effective treatment of CIA is essential to prevent fewer chemotherapy dose delays and reductions. Optimal therapy of CIA is controversial and involves the solitary and combined use of intravenous iron, red blood cell (RBC) transfusions, and erythropoietin stimulating agents (ESAs). Despite the baseline coagulopathies present in patients with malignancy, administration of both RBC transfusions and ESAs is independently associated with venous thromboembolism (VTE). It remains unknown whether the risk of VTE in patients with CIA is greater among patients who receive RBC transfusions or ESAs. Methods: A retrospective study analyzed 13,334 patients in the University of Pennsylvania Health System with malignancies of various type, stage, and histopathology who developed CIA between 1998-2017. Using multivariate Cox regression, we determined adjusted hazard ratios (and corresponding 95% confidence intervals) of VTE development after adjusting for RBC and ESA intervention (all during the 90 days following CIA diagnosis). Results: (Table 1) Among the 13,334 patients with CIA, 10,948 patients did not receive any therapy during the 90-day period for their anemia (neither RBC nor ESA), 1,892 received RBC transfusion, 368 received ESA, and 126 patients received both. Among all patients, 2,620 (19.7%) developed a VTE within the 90-day period. VTE risk following RBC transfusion (HR=2.18, 95% CI 1.98-2.39, p<0.001) was approximately four-fold the VTE risk following ESA administration (HR=0.55, 95% CI 0.42-0.72, p<0.001). Conclusion: While both RBC transfusion and ESA administration are associated with VTE, our data suggests a greater risk of VTE development with RBC transfusion as compared with ESA administration. Disclosures No relevant conflicts of interest to declare.

Maintenance treatment of patients with myelodysplastic syndromes using recombinant human granulocyte colony-stimulating factor

Blood ◽  
1990 ◽  
Vol 76 (1) ◽  
pp. 36-43 ◽  
Author(s):  
RS Negrin ◽  
DH Haeuber ◽  
A Nagler ◽  
Y Kobayashi ◽  
J Sklar ◽  
...  
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Myelodysplastic Syndromes ◽  
Red Blood Cell Transfusion ◽  
Granulocyte Colony Stimulating Factor ◽  
Risk Of Infection ◽  
Colony Stimulating Factor ◽  
Transfusion Requirements ◽  
Increased Risk ◽  
Stimulating Factor

Abstract Myelodysplastic syndromes (MDS) are characterized by chronic refractory cytopenias resulting in increased risk of infection, bleeding, and conversion to acute leukemia. In an effort to improve these cytopenias we have treated 18 patients over a 6- to 8-week period with increasing daily subcutaneous doses of recombinant human granulocyte colony- stimulating factor (G-CSF). Sixteen patients responded with improvement in neutrophil counts. On cessation of treatment these counts returned to baseline values over a 2- to 4-week period. To maintain these improved blood counts 11 patients were treated with G-CSF for more prolonged periods. Ten patients again responded with an increase in total leukocyte counts (1.6- to 6.4-fold) and absolute neutrophil counts (ANC) (3.6- to 16.3-fold), with responses persisting for 3 to 16 months. A significantly decreased risk of developing bacterial infections was noted during periods with ANC greater than 1,500/mm3 as compared with periods of time with ANC less than 1,500/mm3. Two anemic patients had a greater than 20% rise in hematocrit over the study period, and 2 additional patients had a decrease in red blood cell transfusion requirements during G-CSF treatment. Bone marrow myeloid maturation improved in 7 of 9 maintenance phase patients. Three patients progressed to acute myeloid leukemia during treatment. The drug was generally well-tolerated and no severe toxicities were noted. These data demonstrated that G-CSF administered to MDS patients by daily subcutaneous administration was well-tolerated and effective in causing persistent improvement of the neutrophil levels and marrow myeloid maturation. These effects were associated with a decreased risk of infection and, in some patients, with decreased red blood cell transfusion requirements.

scholarly journals Sexual Dimorphism in Hematocrit Response Following Red Blood Cell Transfusion of Critically Ill Surgical Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Fredric M. Pieracci ◽  
Carlton C. Barnett ◽  
Nicole Townsend ◽  
Ernest E. Moore ◽  
Jeffery Johnson ◽  
...  
Keyword(s):  
Immune Response ◽  
Sexual Dimorphism ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Red Blood Cell Transfusion ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
The Relationship

The change in hematocrit (ΔHct) following packed red blood cell (pRBCs) transfusion is a clinically relevant measurement of transfusion efficacy that is influenced by post-transfusion hemolysis. Sexual dimorphism has been observed in critical illness and may be related to gender-specific differences in immune response. We investigated the relationship between both donor and recipient gender and ΔHct in an analysis of all pRBCs transfusions in our surgical intensive care unit (2006–2009). The relationship between both donor and recipient gender and ΔHct (% points) was assessed using both univariate and multivariable analysis. A total of 575 units of pRBCs were given to 342 patients; 289 (49.9%) donors were male. By univariate analysis, ΔHct was significantly greater for female as compared to male recipients (3.81% versus 2.82%, resp., ). No association was observed between donor gender and ΔHct, which was 3.02% following receipt of female blood versus 3.23% following receipt of male blood (). By multivariable analysis, recipient gender remained associated significantly with ΔHct (). In conclusion, recipient gender is independently associated with ΔHct following pRBCs transfusion. This association does not appear related to either demographic or anthropomorphic factors, raising the possibility of gender-related differences in recipient immune response to transfusion.

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