An update on mortality and morbidity in patients with very low postoperative hemoglobin levels who decline blood transfusion (CME)

Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

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Transfusion: Morbidity and Mortality

Anaesthesia and Intensive Care ◽

10.1177/0310057x9302100107 ◽

1993 ◽

Vol 21 (1) ◽

pp. 15-19 ◽

Cited By ~ 34

Author(s):

M. D. Nicholls

Keyword(s):

Blood Transfusion ◽

Public Awareness ◽

Autologous Blood ◽

Critical Evaluation ◽

Volume Overload ◽

Autologous Blood Transfusion ◽

Transfusion Therapy ◽

Mortality And Morbidity ◽

Morbidity Data ◽

Surveillance Programs

Homologous, and to a significantly lesser extent, autologous blood transfusion is associated with definable and potentially serious risk. The increasing professional and public awareness has led to a critical evaluation of transfusion practices and a change in transfusion philosophy towards optimising transfusion therapy for individual patients. This involves the provision of the safest blood and the minimisation of homologous blood exposure. Autologous blood transfusion is not without risk as misidentification of patient or unit, bacterial contamination and volume overload can occur; consequently, the indications for the transfusion of autologous blood, as per homologous units, must be appropriate to the clinical circumstances. Appropriate transfusion criteria are being developed and lower haemoglobin levels are becoming accepted. Transfusion-related mortality and morbidity data is infrequently reported. Ongoing transfusion surveillance programs have reported adverse reactions in 3.5% of transfusion episodes and fatalities have resulted from ABO-incompatible acute haemolytic transfusion reactions, most commonly with group O recipients of group A or B red cells. A significant number of such deaths are attributable to misidentification of patient or units and are preventable by obsessional attention to clerical details. The risks should be considered in the evaluation of the risk-benefit equation and in the resultant decision to administer blood.

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Be your own donor: An insight into the technique of Autologous blood transfusion

CODS Journal of Dentistry ◽

10.5005/cods-3-2-28 ◽

2011 ◽

Vol 3 (2) ◽

pp. 28-30

Author(s):

Rajendra Desai ◽

Johnathan Theodore ◽

Shubhalakshmi LNU ◽

Kiran V. Nesvi

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Autologous Blood ◽

Maxillofacial Surgery ◽

Major Influence ◽

Oral And Maxillofacial Surgery ◽

Autologous Blood Transfusion ◽

Mortality And Morbidity ◽

Insight Into

Abstract Blood loss has a major influence on mortality and morbidity after surgery. Homologous transfusion has long been in use. With the awareness of associated complications such as risk of transmission of hepatitis and HIV associated with use of homologous transfusion, autologous blood transfusion has gained importance. This paper is an attempt to review the method of autologous blood transfusion, as well as its application in oral and maxillofacial surgery.

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SP1.1.8Optimising anaemic patients for colorectal cancer surgery: implementation of day-case iron infusion pathway and closed loop audit of anaemia management

British Journal of Surgery ◽

10.1093/bjs/znab361.005 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Francesca Malcolm ◽

Furqaan Kaji ◽

Lisa Shelswell ◽

William Speake ◽

Sarah Liptrot ◽

...

Keyword(s):

Colorectal Cancer ◽

Blood Transfusion ◽

Patient Group ◽

Secondary Outcome ◽

Day Case ◽

Colorectal Cancer Surgery ◽

Anaemic Patient ◽

Mortality And Morbidity ◽

Anaemia Management ◽

Iv Iron

Abstract Aims Pre-operative anaemia is associated with increased mortality and morbidity in patients undergoing colorectal cancer (CRC) surgery. NICE recommends screening for and treating anaemia in this patient group. Our local guidelines reflect this and advocate the use of pre-operative IV iron provided to patients in the day-case unit. Through 2 audit cycles we assessed whether anaemic CRC patients were prescribed pre-operative iron infusion. Secondary outcome was the requirement of post-operative blood transfusion. Methods Data was collected between June-August 2019 (cycle 1) and January-February 2020 (cycle 2) for patients undergoing elective CRC surgery. Data collected included haemoglobin levels pre and post-operatively, pre-operative iron infusion and post-operative blood transfusion rates. Between the cycles education regarding anaemia management and further publicity of the iron infusion pathway took place within the department. Results In cycle 1 27.5% (11/40) of patients were anaemic; 18% (2/11) of these patients received appropriate iron infusion pre-operatively. In cycle 2 45.4% (20/44) of patients were anaemic; 60% (12/20) received iron infusion. 45% (5/11) of anaemic patients in cycle 1 had post-operative transfusion; none of these patients had pre-operative IV iron. In cycle 2 20% (4/20) of anaemic patient required post-operative transfusion; 3 out of 4 of these patients had not received pre-operative IV iron. Conclusions We have demonstrated how education and improved awareness of local services can increase rate of IV iron prescription and reduce the need for post-operative transfusion in anaemic CRC patients. However these is still room for improvement in management of anaemia within this patient group.

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Obstetric haematology

10.1093/med/9780198713333.003.0048 ◽

2016 ◽

Author(s):

Sapna Ladani ◽

Beverley J. Hunt ◽

Sue Pavord

Keyword(s):

Iron Deficiency ◽

Blood Transfusion ◽

Early Recognition ◽

Bleeding Disorders ◽

Significant Morbidity ◽

Cell Disease ◽

Mortality And Morbidity ◽

Treatment Morbidity ◽

Haematological Disorders ◽

In Pregnancy

This chapter aims to cover aspects of haematology of pregnancy, delivery, and postpartum that are not addressed in other chapters. Obstetric haematology is a vast and complex area, the importance of which has promoted the development of this as a unique subspecialty. Thrombosis and bleeding, anaemia, haemoglobinopathies, and microangiopathies still account for significant morbidity and mortality in pregnancy, despite improvements in recognition, prevention, and management. Anaemia, due to iron deficiency, is highly prevalent in the pregnant population, but with early recognition and treatment, morbidity and need for unnecessary blood transfusion can be avoided. The management of women with thrombocytopenias and inherited bleeding disorders can be complex because of the haemostatic challenges of pregnancy. Pregnancies in women with haematological disorders need to be carefully managed to reduce mortality and morbidity in the mother and fetus. This chapter addresses the management of anaemia, haemoglobinopathies (mainly sickle cell disease), thrombocytopenia, microangiopathies, and the inherited bleeding disorders.

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Faculty Opinions recommendation of An update on mortality and morbidity in patients with very low postoperative hemoglobin levels who decline blood transfusion (CME).

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

10.3410/f.718278615.793491126 ◽

2014 ◽

Author(s):

Davide Cattano

Keyword(s):

Blood Transfusion ◽

Mortality And Morbidity

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Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion

Transfusion ◽

10.1046/j.1537-2995.2002.00123.x ◽

2002 ◽

Vol 42 (7) ◽

pp. 812-818 ◽

Cited By ~ 328

Author(s):

Jeffrey L. Carson ◽

Helaine Noveck ◽

Jesse A. Berlin ◽

Steven A. Gould

Keyword(s):

Blood Transfusion ◽

Mortality And Morbidity

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Seroprevalence and Related Risk Factors of HBsAg, Anti–HCV and Anti–HIV Antibody Among Pregnant Women of Rural India

Annals of Clinical Chemistry and Laboratory Medicine ◽

10.3126/acclm.v1i2.12956 ◽

2015 ◽

Vol 1 (2) ◽

pp. 3-7

Author(s):

Seema Dayal ◽

Amit Singh ◽

Vineet Chaturvedi ◽

Asha Pathak ◽

Vinay Gupta ◽

...

Keyword(s):

Risk Factors ◽

Blood Transfusion ◽

Pregnant Women ◽

Viral Infections ◽

Economic Status ◽

Medical Science ◽

Safe Motherhood ◽

Mortality And Morbidity ◽

Hcv Antibody ◽

Associated Risk Factors

BACKGROUND: Vertical transmission is also mode of transmission of HBV, HCV and HIV. Viral infections may cause abortion, ectopic pregnancies and HBV, HCV also causes hepatitis, cirrhosis. ‘Janani Sureksha Yojana’ (safe motherhood program) is a scheme in which pregnant women are benefited if they deliver in government medical facility. Antenatal screening for HBV, HCV and HIV should be done so as to provide appropriate antiviral therapy. The aim of study was to detect the frequency of HBsAg, HCV antibody, HIV antibody and their correlation with risk factors.METHODS: Present study was conducted in central laboratory of Rural Institute of Medical Science and Research Saifai, Etawah (Uttar Pradesh) on pregnant women from 1 January to 31 December 2014.RESULTS: Out of 7867 women, 2.07% were positive for HBsAg, 0.43% and 0.13% for HCV antibody and HIV antibody, respectively. The age group with maximum seropositivity was in 21-30 year (76.44%) and parity with maximum seropositivity was 3-4 children (42.30%). Seropositivity was high among low socio economic status (77.40%). Among the associated risk factors Obstetric and Gynaecology surgeries (46.15%) and blood transfusion (20%) were prominent. These associated risk factors were found more among HBsAg seropositive females (86.66%) and (84.61%) respectively.CONCLUSIONS: The prevalence of HBsAg positive (2.07%) was more. Obstetric and Gynaecology surgery, blood transfusion were major risk factors. So, screening for HBsAg, HCV antibody, HIV antibody should be mandatory for pregnant women to reduce mortality and morbidity.

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Evaluation of Maternal Hemorrhage in Placenta Accreta

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2016.88 ◽

2016 ◽

Vol 22 (1) ◽

Author(s):

Elif Ağaçayak ◽

Senem Yaman Tunç ◽

Bircan Alan ◽

Serdar Başaranoğlu ◽

Fatih Mehmet Fındık ◽

...

Keyword(s):

Blood Transfusion ◽

Length Of Stay ◽

Maternal Mortality ◽

Placenta Accreta ◽

Multidisciplinary Care ◽

Mortality And Morbidity ◽

Factors Affecting ◽

Transfusion Requirements ◽

Maternal Mortality And Morbidity ◽

Parity Number

Objective: The aim of the present study is to provide a retrospective evaluation of placenta accreta cases to identify the factors affecting the blood transfusion requirement, which stands as one of the most important causes of maternal mortality and morbidity. study desıgn: A total of 110 patients who presented to the outpatient clinic of gynaecology and obstetrics of the Faculty of Medicine of Dicle University and were diagnosed with placental attachment before or during a caesarean section (C-section) between January 2006 and June 2015 were included in this study. The patients’ data were collected from the hospital’s records. Results: During the study period, 21674 births were realised and 110 (1/200) of these patients exhibited placenta accreta. 86 of these 110 patients (78,2%) received at least one unit of blood. The group of patients that had received blood transfusion exhibited significantly higher values in age, parity, number of C-sections, length of stay (p = 0.003, 0.004, 0.024, 0.000, respectively). Multiple logistical regression analysis led to the identification of a significant association between the length of stay and the blood transfusion requirements (OR 95% Cl 2.005(1.213-3.314) p= 0.007). Conclusion: Patients of advanced age as well as grand multiparous patients and patients with a history of multiple repeat caesarean deliveries should be evaluated more carefully during pregnancy. These patients should be referred to hospitals that provide multidisciplinary care and management before the delivery or even at the early stages of pregnancy in an effort to decrease maternal mortality and morbidity rates.

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