Iron studies and red cell transfusion in cardiothoracic and orthopaedic surgical patients: a retrospective audit at a tertiary hospital

Abstract Three observations led us to investigate whether infusion of ABO non-identical platelets might impair, rather than improve hemostasis. (1) Exposure of platelets to immune complexes or platelet specific antibody can interfere with platelet function in vitro (Thromb Haemost76: 774, 1996). (2) In surgical patients receiving similar numbers of platelet transfusions, those receiving ABO non-identical platelets require 50% more red cell transfusions (Transfusion41: 790, 2001). (3) Patients with acute leukemia receiving prophylactic platelet transfusions typically are reported with serious bleeding at a rate of 15–20%, yet the bleeding rate in patients receiving only ABO identical platelets is below 5% (BMC Blood Disorders4: 6, 2004). In this study, the number of red cell transfusions and clinical outcomes during March 2002-Feb 2003 for all surgical patients of blood groups B and AB (B/AB) who received platelet transfusions were compared with patients of blood groups O and A (O/A). Recipients of blood groups B/AB would not be expected to experience excess bleeding, as measured by red cell transfusions, compared with patients of blood groups O/A. However, because of the lower prevalence of blood groups B/AB in the donor blood supply B/AB recipients may more frequently receive ABO mismatched platelet transfusions. O/A surgical patients (n=281) who received platelet transfusions required a mean of 13 ± 13 (SD) red cell transfusions as compared with B/AB patients (n=54), who required 19 ± 25 red cells (p =0.0086). O/A patients also had shorter length of stay, mean = 25 ± 34 days as compared with B/AB patients at 36 ± 59 days (p =0.064). Rates of mortality and nosocomial infections were not statistically significantly different. O/A patients received a mean of 14 ± 19 units of whole blood platelets during and after surgery, compared with 16 ± 16 units for B/AB patients (p =0.47). O/A patients received a mean of 3.3 ± 6.2 ABO non-identical platelets in contrast with B/AB patients who received 7.5 ± 11 (p = 0.0001). Both groups received similar numbers of ABO identical platelets: 11 ± 16 (O/A) versus 9 ± 12 (B/AB) (p =0.35). All but two patients received only ABO identical FFP and both groups received similar total amounts of FFP (mean of 9 units versus 11 units). While O/A patients received similar mean amounts of cryoprecipitate (6 units) to B/AB patients (8 units), the B/AB patients received significantly more ABO non-identical cryoprecipitate (mean = 4.2 vs. 2.3 units; p = 0.02). To study the effects of ABO incompatible plasma on platelet function, we measured PFA-100 (epinephrine cartridge) closure times in reconstituted whole blood exposing group A platelets to either group A or O plasma. In four of seven instances, closure times for A platelets exposed to O plasma were prolonged by more than 50 seconds, compared with A platelets exposed to allogeneic A plasma. These preliminary results support previous observations that exposure to ABO non-identical platelet transfusions is associated with increased red cell transfusions. One possible mechanism is impaired platelet function caused by antibody or immune complex binding. We speculate that transfusion of ABO mismatched platelets, FFP and/or cryoprecipitate may in some instances exacerbate bleeding, rather than correcting defects in hemostasis. Though further investigation is needed before suggesting changes in clinical practice these findings raise the possibility that use of ABO identical blood components might reduce red cell transfusion needs in bleeding surgical patients.

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Predictors and reasons for inappropriate hospitalization days for surgical patients in a tertiary hospital in Wuhan, China: a retrospective study

BMC Health Services Research ◽

10.1186/s12913-021-06845-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hao Li ◽

Hongbing Tao ◽

Gang Li

Keyword(s):

Health Care ◽

Health Care Providers ◽

Average Frequency ◽

Tertiary Hospital ◽

Surgical Patients ◽

Health Providers ◽

Care Providers ◽

Binary Logistic Regression Model ◽

Cross Sectional ◽

Retrospective Audit

Abstract Background Inappropriate hospitalization day (IHD) is recognized as an important indication of the excessive demand for health-care services, especially for surgical patients. We aim to examine the degree of IHDs, predictors associated with higher incidences of IHDs, and reasons for each IHD in different periods of hospitalization. Methods A total of 4586 hospital days from 408 cases were evaluated by a cross-sectional and retrospective audit program carried out in a tertiary hospital with 5613 beds and 9623 faculty in Wuhan, China. This study used the revised Chinese version of the Appropriateness Evaluation Protocol (C-AEP) to assess IHDs, and the Delay Tool to ascertain each reason for IHDs. A binary logistic regression model was performed to examine the predictors of higher incidences of IHDs. Results The average frequency of IHDs was 23.24 %, and a total of 322 cases (78.92 %) were reported to have experienced at least one IHD. The multivariate analysis showed that patients at the age of 60–69 with respect to under 50, and with overlength of stay were predictors of higher incidences of preoperative IHDs, while admission from outpatient, multiple diagnosis, higher surgical incision level, and overlength of stay were predictors of higher incidence of postoperative IHDs. The most frequent reasons related to health providers for IHDs were doctor’s conservative views of patient management and delays in inspection, prescription, appointment, or result report. Patient factors gave rise to nearly a quarter of postoperative IHDs. Conclusions Findings from this study indicate that measures including paying more attention to the construction of MDT for diagnosis and treatment in general surgery, reducing laboratory turnaround time, dispelling distrust among health-care providers and patients, setting stricter discharge standards and, providing integrated out-of-hospital services could be adopted accordingly to improve the inappropriateness of hospital stays.

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The Effects of Acidosis and Hypothermia on Blood Transfusion Requirements following Factor VII Administration

Anaesthesia and Intensive Care ◽

10.1177/0310057x0703500405 ◽

2007 ◽

Vol 35 (4) ◽

pp. 494-497 ◽

Cited By ~ 11

Author(s):

K. Hall ◽

P. Forrest ◽

C. Sawyer

Keyword(s):

Blood Transfusion ◽

Rescue Therapy ◽

Surgical Patients ◽

Factor Vii ◽

Red Cell ◽

Recombinant Activated Factor Vii ◽

Activated Factor Vii ◽

Rfviia Administration ◽

Transfusion Requirements ◽

Red Cell Transfusion

While there is laboratory evidence that the activity of recombinant activated factor VII (rFVIIa) is reduced by the presence of acidosis and hypothermia, there is limited clinical data to support this observation. Recombinant FVIIa may be used as rescue therapy in surgical patients who have bleeding that is refractory to conventional therapy. However, these patients are also frequently acidotic and hypothermic at the time the drug is administered. In this retrospective study, the records of 38 adult surgical patients who received rFVIIa intraoperatively or within six hours postoperatively were reviewed. The requirements for red cell transfusion in the two hours following the administration of rFVIIa and the need for repeated doses of rFVIIa were recorded. The relationship between red cell transfusion and pH and temperature of the patient at the time of rFVIIa administration was assessed by multiple regression analysis. The major finding was an inverse relationship between the degree of acidosis at the time of rFVIIa administration and the requirement for either subsequent blood transfusion or repeat dosing of rFVIIa (P=0.003 and P <0.001 respectively). For patients with apH <7.2 vs. pH >7.2, the odds ratio for receiving two or more packs of red blood cells within two hours of rFVIIa administration was 15:1. This effect was not observed for hypothermia. The implication of this study is that rFVIIa may be less effective when administered to severely acidotic patients. Further studies are required to examine whether this is related to the acidosis directly, or is secondary to other intraoperative variables affecting acidosis. The clinical utility of rFVIIa in acidotic patients also requires further investigation.

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Recurrent fetal hydrops with maternal M alloimmunisation: not a benign condition

BMJ Case Reports ◽

10.1136/bcr-2019-230552 ◽

2019 ◽

Vol 12 (7) ◽

pp. e230552 ◽

Cited By ~ 1

Author(s):

Michelle Yu ◽

Kathryn Graham ◽

Leonardo Pasalic ◽

Thushari Indika Alahakoon

Keyword(s):

Neonatal Intensive Care ◽

Tertiary Hospital ◽

Red Cell ◽

Fetal Hydrops ◽

Haemolytic Disease ◽

Benign Condition ◽

First Case ◽

Placental Disease ◽

Clinically Significant ◽

Red Cell Transfusion

Haemolytic disease of the fetus and newborn (HDFN) is associated with red cell antibodies. Anti-M usually results in a mild haemolysis and is rarely clinically significant. There is no established consensus on management of pregnancies with anti-M. A case of recurrent HDFN with maternal M alloimmunisation was identified at a tertiary hospital in Australia. We collected the patient and neonate’s clinical and pathological data and interpreted the case with available literature. This is the first case in literature of recurrent fetal hydrops in the setting of M alloimmunisation. Neonate was delivered in a poor condition, intubated and admitted to the neonatal intensive care unit for ionotropic support, red cell transfusion and plasma transfusion for coagulopathy. Direct Coombs test was positive, confirming HDFN. Although anti-M rarely causes HDFN, accurate history, fetal surveillance and monitoring is essential for identification of fetal anaemia. Concurrent placental disease may increase fetal risk from anti-M antibodies.

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Variation in Transfusion Rates amongst Canadian Academic and Community Medical Centers.

Blood ◽

10.1182/blood.v104.11.2709.2709 ◽

2004 ◽

Vol 104 (11) ◽

pp. 2709-2709

Author(s):

Brian Hutton ◽

Dean Fergusson ◽

Paul C. Hebert ◽

Alan Tinmouth ◽

Lauralyn McIntyre ◽

...

Keyword(s):

Cardiac Surgery ◽

Hip Fracture ◽

Critically Ill ◽

Median Number ◽

Transfusion Practice ◽

Fracture Repair ◽

Surgical Patients ◽

Trauma Patients ◽

Red Cell ◽

Red Cell Transfusion

Abstract Purpose: Few recent studies have examined approaches to transfusion practice in high-risk patients. We therefore documented practice variation following repair of hip fracture or cardiac surgery, as well as those requiring intensive care following a surgical intervention or multiple trauma. Methods: We documented rates of red cell transfusion in 41,568 patients admitted to 11 hospitals across Canada between August 1998 and August 2000 as part of a retrospective observational cohort study. Adjusted odds of transfusion, median number of transfusions per patient and median number of transfusions per patient day were compared across sites. We also compared mean nadir hemoglobin concentrations from center to center in the subgroup of 7,552 patients that received red cells. Results: The overall rate of red cell transfusion was 38.7 %, and ranged from 23.8% to 51.9% across centers among the 41,568 peri-operative and critically ill patients. Women were more likely to be transfused (43.7% versus 35.3%, p<0.0001), with higher rates of transfusion in 8 of 11 centers. Following adjustment for the effects of age, gender, severity of illness and the presence of twelve different comorbidities, the odds of transfusion ranged from 0.44 to 1.53 overall, from 0.42 to 1.22 in patients undergoing a hip fracture repair, from 0.72 to 3.17 in cardiac surgical patients undergoing cardiac surgery, and from 0.27 to 1.11 in critically ill and trauma patients (figure 1). Examination of both median number of units transfused and median number of units transfused per patient day also revealed between-site variation (figure 2). In the 7,552 transfused patients, the mean adjusted nadir hemoglobin was 74.0±4.83g/L overall, and ranged from 66.9±1.7g/L to 84.5±1.6g/L across centers. Similar differences among centers were observed amongst hip fracture patients (71.2±2.9g/L to 82.8±1.7g/L), cardiac surgical patients (65.7±1.1g/L to 77.3±1.0g/L) and critically ill and trauma patients (66.1±3.04g/L to 87.5±2.5g/L). Conclusions: We noted significant differences in the rates of red cell transfusion and nadir hemoglobin concentrations in various surgical and critical care settings. Such variation provides the impetus for investigators to explore its potential causes, and furthermore to attempt to define optimal transfusion practice in a variety of clinical settings by conducting randomized controlled trials.

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An association of ABO non-identical platelet and cryoprecipitate transfusions with altered red cell transfusion needs in surgical patients

Vox Sanguinis ◽

10.1111/j.1423-0410.2010.01464.x ◽

2011 ◽

Vol 101 (1) ◽

pp. 55-60 ◽

Cited By ~ 26

Author(s):

Majed A. Refaai ◽

Lawrence B. Fialkow ◽

Joanna M. Heal ◽

Kelly F. Henrichs ◽

Sherry L. Spinelli ◽

...

Keyword(s):

Surgical Patients ◽

Red Cell ◽

Red Cell Transfusion

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Predictors And Reasons of Inappropriate Hospitalizations For Surgical Patients in A Tertiary Hospital in Wuhan, China: A Retrospective Study

10.21203/rs.3.rs-418318/v1 ◽

2021 ◽

Author(s):

Hao Li ◽

Hongbing Tao ◽

Gang Li

Keyword(s):

Healthcare Services ◽

Tertiary Hospital ◽

Surgical Patients ◽

Cross Sectional ◽

Surgical Incision ◽

Quality Improvement Process ◽

Retrospective Audit ◽

Hospital Days ◽

Audit Program ◽

Multiple Diagnosis

Abstract Background The first step in every quality improvement process is the identification the problem and its extent. We aim to analyze the frequency and its associated factors of inappropriate hospitalization for a tertiary hospital in Wuhan and ascertain the specific reasons for each IHDs to provide evidence for further reduction of inappropriate hospital days.Results A total of 4586 days of hospital stay from 408 cases were evaluated by A cross-sectional and retrospective audit program carried out in a third-level teaching hospital with 5613 beds and 9623 faculty in Wuhan, China. 320 cases (78.43%) were reported to have experience at least one IHD and 1053 hospital days (23.31%) were found to be inappropriate. Predictors of higher levels of inappropriateness with surgery were patients at the age of 60-69(OR=2.328, 95% CI=1.359-3.989) before the surgery, and use of ventilators(OR=2.127, 95%CI=1.116-2.839), admission from outpatient(OR=5.724, 95%CI=1.579-20.744), multiple diagnosis(OR=1.604, 95%CI=1.059-2.432), and higher surgical incision level(OR=2.152, 95%CI=1.391-3.327) after surgery. The main causes of inappropriateness were medical factors that were related to the healthcare services providers, however, the patient factors gave rise to nearly a quarter of IHDs after surgery.Conclusions The prevalence of IHDs was 23.31% in this tertiary hospital in Wuhan. Findings from this study indicate that the characteristics of surgical patients from different phases(preoperative/postoperative) are supposed to be taken into account to develop efficient and feasible interventions for IHD reduction.

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