scholarly journals Red Blood Cell Transfusion in the Emergency Department: An Observational Cross-Sectional Multicenter Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2475
Author(s):  
Olivier Peyrony ◽  
Danaé Gamelon ◽  
Romain Brune ◽  
Anthony Chauvin ◽  
Daniel Aiham Ghazali ◽  
...  
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Cross Sectional Study ◽  
Red Blood Cell Transfusion ◽  
Cross Sectional ◽  
Acute Bleeding ◽  
History Of ◽  
Rbc Transfusion

Background: We aimed to describe red blood cell (RBC) transfusions in the emergency department (ED) with a particular focus on the hemoglobin (Hb) level thresholds that are used in this setting. Methods: This was a cross-sectional study of 12 EDs including all adult patients that received RBC transfusion in January and February 2018. Descriptive statistics were reported. Logistic regression was performed to assess variables that were independently associated with a pre-transfusion Hb level ≥ 8 g/dL. Results: During the study period, 529 patients received RBC transfusion. The median age was 74 (59–85) years. The patients had a history of cancer or hematological disease in 185 (35.2%) cases. Acute bleeding was observed in the ED for 242 (44.7%) patients, among which 145 (59.9%) were gastrointestinal. Anemia was chronic in 191 (40.2%) cases, mostly due to vitamin or iron deficiency or to malignancy with transfusion support. Pre-transfusion Hb level was 6.9 (6.0–7.8) g/dL. The transfusion motive was not notified in the medical chart in 206 (38.9%) cases. In the multivariable logistic regression, variables that were associated with a higher pre-transfusion Hb level (≥8 g/dL) were a history of coronary artery disease (OR: 2.09; 95% CI: 1.29–3.41), the presence of acute bleeding (OR: 2.44; 95% CI: 1.53–3.94), and older age (OR: 1.02/year; 95% CI: 1.01–1.04). Conclusion: RBC transfusion in the ED was an everyday concern and involved patients with heterogeneous medical situations and severity. Pre-transfusion Hb level was rather restrictive. Almost half of transfusions were provided because of acute bleeding which was associated with a higher Hb threshold.

scholarly journals Red Blood Cell Transfusion and the Use of Intravenous Iron in Iron Deficient Patients Presenting to the Emergency Department

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 1-2
Author(s):  
Arvand Barghi ◽  
Robert Balshaw ◽  
Emily Rimmer ◽  
Murdoch Leeies ◽  
Allan Garland ◽  
...  
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Iron Deficiency ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Hemoglobin Concentration ◽  
Factors Associated ◽  
Iv Iron ◽  
Iron Parameters ◽  
Rbc Transfusion

Background: Red blood cell (RBC) transfusions are often used to treat patients with iron deficiency who present to the emergency department (ED) with symptomatic anemia. Intravenous (IV) iron is the preferred treatment in this setting, as it has been shown to increase hemoglobin concentration rapidly and durably. We aim to determine the incidence of iron deficiency anemia (IDA) and the management of these patients in the ED setting. Objectives: To evaluate the incidence of IDA, the frequency of RBC transfusion and iron supplementation, and factors associated with RBC transfusion. Study Design: Retrospective cohort study of all adult patients presenting to the St Boniface Hospital (Winnipeg, CAN) ED from January 2014 to January 2019. Methods: We used electronic data from the Emergency Department Information System (EDIS) and Laboratory Information Services (LIS) databases to identify patients presenting with IDA, defined as anemia (hemoglobin <120 g/L) with either a transferrin saturation less than 20% or ferritin less than 30 umol/L, or mean corpuscular volume (MCV) of < 75 fL. A ferritin greater than 100 umol was used to exclude IDA, regardless of MCV. We extracted patient demographics, diagnoses, markers of iron storage, RBC transfusion and use of IV iron. Multivariate logistic regression analysis was used to evaluate factors associated with RBC transfusion. Results: Of 39222 patients, 17945 (45%) were anemic. Of the anemic patients, iron parameters were ordered in 1848 (10.3%) patients, and IDA was present in 910 (5.1 %). In the IDA population, 95 patients (10.4 %) received 1 RBC unit, and 197 patients (21.6 %) received 2 or more units. Oral iron and IV iron were prescribed for 64 (7 %) and 14 (1.5 %) patients, respectively. Our logistic regression model demonstrated that hemoglobin concentration was the main determinant of whether patients received RBC transfusion. Other variables including patient age, cardiac symptoms, heart rate, blood pressure, and CTAS score were not associated with increased likelihood of receiving RBC transfusion. Conclusion: Iron parameters were infrequently ordered in the evaluation of anemia in the ED, with limited use of oral and IV iron. The decision to transfuse RBCs was primarily influenced by hemoglobin concentration, but not other surrogates of hemodynamic instability. An interventional study to improve education and access to oral and IV iron is planned to reduce unnecessary RBC transfusions and their associated risks in patients with IDA. Disclosures No relevant conflicts of interest to declare.

scholarly journals Factors associated with red blood cell transfusion among hospitalized patients: a cross-sectional study

2021 ◽  
Vol 22 (12) ◽  
pp. 1060-1064
Author(s):  
Peiwen Zhang ◽  
Dandan Xu ◽  
Xinhan Zhang ◽  
Mengyin Wu ◽  
Xuecheng Yao ◽  
...  
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Cross Sectional Study ◽  
Hospitalized Patients ◽  
Red Blood Cell Transfusion ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated

scholarly journals Doctors’ practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Temitope Adedayo ◽  
Don O'Mahony ◽  
Oluakyode Adeleke ◽  
Sikhumbuzo Mabunda
Keyword(s):  
Mixed Methods ◽  
Focus Group ◽  
Blood Transfusion ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Transfusion Practice ◽  
Mixed Methods Study ◽  
Red Blood Cell Transfusion ◽  
Cross Sectional ◽  
Rbc Transfusion

Background: Unnecessary blood transfusion exposes recipients to potential harms.Aim: The aim of this study was to describe blood transfusion practice and explore doctors’ attitudes towards transfusion.Setting: A hospital providing level 1 and 2 services.Methods: A mixed-methods study design was used. In the cross-sectional descriptive component, a sample was taken from patients transfused over a 2-month period. Blood use was categorised as for medical anaemia or haemorrhage, and appropriate or not. The qualitative component comprised a purposeful sample for focus group and individual semi-structured interviews.Results: Of 239 patients sampled, 62% were transfused for medical anaemia and 38% for haemorrhage. In the medical anaemia group, compliance with age-appropriate transfusion thresholds was 69%. In medical anaemia and haemorrhage, 114 (77%) and 85 (93.4%) of recipients had orders for ≥ 2 red blood cell (RBC) units, respectively. In adults ≥ 18 years old with medical anaemia, 47.1% of orders would have resulted in a haemoglobin (Hb) 8 g/dL. Six doctors participated in focus group and eleven in individual interviews. There was a lack of awareness of institutional transfusion guidelines, disagreement on appropriate RBC transfusion thresholds and comments that more than one RBC unit should always be transfused. Factors informing decisions to transfuse included advice from senior colleagues, relieving symptoms of anaemia and high product costs.Conclusion: Most orders were for two or more units. In medical anaemia, doctors’ compliance with RBC transfusion thresholds was reasonable; however, almost half of the orders would have resulted in overtransfusion. The attitudes of doctors sampled suggest that their transfusion practice is influenced more by institutional values than formal guidelines.

Red Blood Cell Transfusion Practices

ICU Director ◽  
2012 ◽  
Vol 4 (1) ◽  
pp. 11-14
Author(s):  
Edwin Annan ◽  
Kristin G. Fless ◽  
Nirav Jasani ◽  
Frantz Pierre-Louis ◽  
Fariborz Rezai ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Cell ◽  
Red Blood Cell ◽  
High Intensity ◽  
Retrospective Chart Review ◽  
Red Blood Cell Transfusion ◽  
Icu Length Of Stay ◽  
Staffing Model ◽  
One Year ◽  
Rbc Transfusion

Background and Objectives. High-intensity ICU staffing model is associated with quality and outcome improvements. Restrictive red blood cell (RBC) transfusion strategies have been shown to have equivalent mortality to a more liberal strategy in the ICU. We examined the effect of high-intensity staffing on pretransfusion hemoglobin levels, RBC transfusion rates and length of ICU stay. Materials and Methods. The study was a retrospective chart review (n = 196) of all patients admitted to the adult medical/surgical ICU for more than 24 hours one year prior to and after institution of the high-intensity staffing model. Results. Matched for demographics and diagnosis, RBC transfusion rates pre- versus postinstitution of the high-intensity staffing model was 42% versus 27%, respectively, and pretransfusion hemoglobin levels were lower (8.94 to 7.39 g/dL). Length of stay was 4.1 days pre–high-intensity staffing and 4.0 days post–high-intensity staffing. Conclusions. High-intensity ICU staffing resulted in fewer RBC transfusions and lower transfusion thresholds. This restrictive RBC transfusion strategy had no adverse effects on patient ICU length of stay.

scholarly journals Durable Red Blood Cell Transfusion Independence in a Patient with an MDS/MPN Overlap Syndrome Following Discontinuation of Iron Chelation Therapy

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Harpreet Kochhar ◽  
Chantal S. Leger ◽  
Heather A. Leitch
Keyword(s):  
Blood Cell ◽  
Iron Overload ◽  
Red Blood Cell ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
Red Blood Cell Transfusion ◽  
Favorable Effect ◽  
Iron Chelation Therapy ◽  
Transfusion Independence ◽  
Rbc Transfusion

Background. Hematologic improvement (HI) occurs in some patients with acquired anemias and transfusional iron overload receiving iron chelation therapy (ICT) but there is little information on transfusion status after stopping chelation.Case Report. A patient with low IPSS risk RARS-T evolved to myelofibrosis developed a regular red blood cell (RBC) transfusion requirement. There was no response to a six-month course of study medication or to erythropoietin for three months. At 27 months of transfusion dependence, she started deferasirox and within 6 weeks became RBC transfusion independent, with the hemoglobin normalizing by 10 weeks of chelation. After 12 months of chelation, deferasirox was stopped; she remains RBC transfusion independent with a normal hemoglobin 17 months later. We report the patient’s course in detail and review the literature on HI with chelation.Discussion. There are reports of transfusion independence with ICT, but that transfusion independence may be sustained long term after stopping chelation deserves emphasis. This observation suggests that reduction of iron overload may have a lasting favorable effect on bone marrow failure in at least some patients with acquired anemias.

A retrospective analysis of venous thromboembolism trends in chemotherapy-induced anemia: Red blood cell transfusion versus erythrocyte stimulating agent (ESA) administration.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14685-e14685
Author(s):  
Emily Jane Bryer ◽  
David H. Henry
Keyword(s):  
Venous Thromboembolism ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Absolute Risk ◽  
Subsequent Development ◽  
Intravenous Iron ◽  
Red Blood Cell Transfusion ◽  
Chemotherapy Patients ◽  
Poor Outcomes ◽  
Rbc Transfusion

e14685 Background: 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 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 single-institution study analyzed 7360 patients with varying malignancies who developed CIA and received ESAs and RBC transfusion from 1998-2017. These patients were evaluated for subsequent development of VTE and categorized by prior receipt of RBC transfusion or ESA. Results: Among the 7360 patients with CIA, 5503 received either RBC transfusion or ESA and 1857 received both. Among all patients, 3466/7360 (47.1%) developed a VTE. The absolute risk of developing a VTE with receipt of a RBC transfusion was 0.38 compared to 0.19 with ESA. Patients with CIA who received RBC had twice the risk of developing a VTE compared with those who received ESA (p < 0.0001). Conclusions: While both RBC transfusion and ESA administration are independently associated with VTE, our data suggests a greater risk of VTE development with RBC transfusion as compared with ESA administration.[Table: see text]

scholarly journals Uterine prolapse and associated factors among reproductive age women in Dawro zone, southwest Ethiopia: a community based cross sectional study

2020 ◽  
Author(s):  
Abebe Sorsa Badacho ◽  
Mengistu Auro Lelu ◽  
Zegeye Gelan
Keyword(s):  
Logistic Regression ◽  
Uterine Prolapse ◽  
Cross Sectional Study ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Cross Sectional ◽  
First Marriage ◽  
Age At First Marriage ◽  
Assisted Delivery ◽  
History Of

Abstract Background: Uterine Prolapse is an important but one of the most neglected public health problems causing maternal morbidity and mortality among women of reproductive age in developing countries including Ethiopia. However, yet few data are available with respect to uterine prolapse. The objective of this study was to assess the prevalence of, and factors associated with uterine prolapse among women of reproductive age.Methods: A community based cross-sectional study was conducted in Loma Woreda, Dawro southwest Ethiopia, from November to December 2019. A total of 422 randomly selected women of reproductive age were participated in the study. Data were collected by face-to-face interview with pre-structured questionnaire and clinical diagnoses were carried out. Epi data 3.2.1 and SPSS version 24 were used for data entry, processing and analysis. Binary Logistic regression was used to find out the association between dependent and independent variables. Variables with P-value less than 0.25 in bivariate logistic regression were further examined using multivariate logistic regression to investigate an association between dependent variable and independent variables. Results: The mean age of the respondents was 35.4 years (±7.994 SD). This study identified that the prevalence of symptomatic and anatomical uterine prolapse was 6.6 %(28) and 5.9%(25) respectively. The prevalence of anatomical prolapse was used as a reference when determining the associated factors. Age at first marriage (AOR: 0.25, 95%CI (0.07, 0.89), place of delivery (AOR: 3.33, 95%CI (1.21, 9.13), birth attendant assisted delivery (AOR 0.21; 95%CI (0.06, 0.71) and history of abortion (AOR: 2.94, 95%CI (1.08, 7.97) were found to have significantly and independently associated with prevalence of uterine prolapse. Conclusion: Uterine prolapse is common among women of reproductive age group age at first marriage, place of delivery, birth attendant assisted delivery, and history of abortion were found to be independent predictors of prevalence of uterine prolapse.

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