The efficacy and safety of intraoperative acute normovolaemic haemodilution in complex spine surgery in a private surgical facility in Ghana

Objectives: To assess the safety and clinical benefits of intraoperative acute normovolaemic haemodilution (ANH) incomplex spine surgery. Design: Prospective comparative cohort studySetting: A private orthopaedic hospital in GhanaPatients: Seventy-six patients who underwent complex spine deformity surgeryInterventions: Patients were randomly assigned to two groups. 45 patients to the acute normovolaemic haemodilution(ANH) or Group 1 and 31patients to the non-ANH or Group 2. Following anesthetic administration and before incision, autologous blood was collected from patients in Group1 and was reinfused during/shortly after surgery while patients in Group2 were transfused with compatible allogeneic blood intraoperatively.Main Outcome Measures: Changes in haemodynamic parameters and incidence of allogeneic transfusions and related complications.Results: The mean age (years), gender ratio, deformity size and aetiology, fusion levels, and operative times were similar in both groups. Blood loss (ml) of patients in groups 1 and 2 were 1583ml± 830.48 vs 1623ml ± 681.34, p=0.82, respectively. The rate of allogeneic blood transfusion in groups 1 and 2 were 71% vs 80.65%, p=0.88, respectively. Haemoglobin levels (g/dL) in groups 1 and 2 were comparable in both groups at Post-operative Day (POD) 0 and POD 1. Incidence of minor allogeneic transfusion reaction was 1/45 vs 1/31, p=0.80, group-1 and group-2, respectively.Conclusion: Acute normovolaemic haemodilution can be safely performed in complex spine surgery in underserved regions. However, its use does not obviate allogeneic transfusion in patients with complex spine deformities in whom large volumes of blood loss is expected.

Impact of RBC Transfusion on Peripheral Capillary Oxygen Saturation and Partial Pressure of Arterial Oxygen

Objectives RBCs are known to undergo deleterious changes during storage, known as storage lesions, which have been shown to result in decreased oxygen-carrying capacity. However, there is inadequate literature describing the effects of stored RBC allogeneic transfusion on oxygen parameters in vivo. The oxygen standard parameters were retrospectively assessed before and after RBC transfusion. Methods Patients who received 1 RBC transfusion were assessed for hemoglobin (Hb) levels, peripheral capillary oxygen saturation (Spo2), and partial pressure of arterial oxygen (Pao2) from 12 hours before and 24 hours after transfusion. Results In total, 78 patients who were monitored by Spo2 and 28 patients monitored by Pao2 were included in this analysis. Following RBC transfusion, Hb levels increased significantly (P < .001); however, there was a significant decrease in both Spo2 and Pao2 within 24 hours after transfusion (P = .04 and P = .003, respectively), indicating lower tissue oxygenation and lower soluble oxygen level. Conclusions This single-center, retrospective study revealed evidence of significantly decreased oxygenation and tissue perfusion after single-unit RBC transfusion, despite corrected Hb levels.

The Effects of Allogeneic Blood Transfusion in Hepatic Resection

Background Hepatectomy has a high risk of perioperative bleeding due to the underlying disease. Here, we investigated the postoperative impact of allogeneic blood transfusion during hepatectomy. Methods The surgical outcomes in 385 patients who underwent hepatic resection for hepatocellular carcinoma were retrospectively reviewed. The association of allogeneic blood transfusion with surgical outcomes and remnant liver regeneration data was analyzed. Results Eighty-six patients (24.0%) received an allogeneic blood transfusion and 272 patients (76.0%) did not. After propensity score matching, the incidence rates of postoperative complication (Clavien-Dindo grade >IIIA), posthepatectomy liver failure, and massive ascites were significantly higher for the group that received a blood transfusion than for the group that did not receive blood transfusion ( P < .001, P = .001, and <.001, respectively). Postoperative measures of total bilirubin, albumin, platelet count, prothrombin time, aspartate aminotransferase, and alanine aminotransferase were significantly more favorable in patients without blood transfusion until day 7 after surgery. There were no correlations in the remnant liver regeneration at 7 days, and 1, 2, 5, and 12 months postoperatively between the 2 groups ( P = .585, .383, .507, .261, and .430, respectively). Regarding prognosis, there was no significant difference in overall and recurrence-free survival between the 2 groups ( P = .065 and .166, respectively). Conclusion Allogeneic transfusion during hepatectomy strongly affected remnant liver function in the early postoperative period; however, this was not related to the remnant liver regeneration volume. Despite that the allogeneic transfusion resulted in poorer postoperative laboratory test results and increased postoperative complication and mortality rates, it had no effect on the long-term prognosis.

Effect of ulinastatin on post-operative blood loss and allogeneic transfusion in patients receiving cardiac surgery with cardiopulmonary bypass: a prospective randomized controlled study with 10-year follow-up

Background: Major bleeding and allogeneic transfusion leads to negative outcomes in patients receiving cardiac surgery with cardiopulmonary bypass (CPB). Ulinastatin, a urine trypsin inhibitor, relieves systemic inflammation and improves coagulation profiles with however sparse evidence of its effects on blood loss and allogeneic transfusion in this specific population. Methods: In this prospective randomized controlled trial, 426 consecutive patients receiving open heart surgery with CPB were randomly assigned into three groups to receive ulinastatin (group U, n=142), tranexamic acid (group T, n=143) or normal saline (group C, n=141). The primary outcome was the total volume of post-operative bleeding and the secondary outcome included the volume and exposure of allogeneic transfusion, the incidence of stroke, post-operative myocardial infarction, renal failure, respiratory failure and all-cause mortality. A ten-year follow-up was carried on to evaluate long-term safety.Results: Compared with placebo, ulinastatin significantly reduced the volume of post-operative blood loss within 24 hours (688.39±393.55ml vs 854.33±434.03ml MD -165.95ml, 95%CI -262.88ml to -69.01ml, p<0.001) and the volume of allogeneic erythrocyte transfusion (2.57±3.15 unit vs 3.73±4.21 unit, MD-1.16 unit, 95%CI -2.06 units to -0.26 units, p=0.002). The bleeding and transfusion outcomes were comparable between the ulinastatin group and the tranexamic acid group. In-hospital outcomes and 10-year follow-up showed no statistical difference in mortality and major morbidity among groups. Conclusions: Ulinastatin reduced post-operative blood loss and allogeneic erythrocyte transfusion in heart surgery with CPB. The mortality and major morbidity was comparable among the groups shown by the 10-year follow-up. Trial registration: The trial was retrospectively registered on February 2, 2010. Trial registration number: https://www.clinicaltrials.gov. Identifier: NCT01060189.

Effect of ulinastatin on post-operative blood loss and allogeneic transfusion in patients receiving cardiac surgery with cardiopulmonary bypass: a prospective randomized controlled study with 10-year follow-up

Background: Major bleeding and allogeneic transfusion leads to negative outcomes in patients receiving cardiac surgery with cardiopulmonary bypass (CPB). Ulinastatin, a urine trypsin inhibitor, relieves systemic inflammation and improves coagulation profiles with however sparse evidence of its effects on blood loss and allogeneic transfusion in this specific population.Methods: In this prospective randomized controlled trial, 426 consecutive patients receiving open heart surgery with CPB were randomly assigned into three groups to receive ulinastatin (group U, n=142), tranexamic acid (group T, n=143) or normal saline (group C, n=141). The primary outcome was the total volume of post-operative bleeding and the secondary outcome included the volume and exposure of allogeneic transfusion, the incidence of stroke, post-operative myocardial infarction, renal failure, respiratory failure and all-cause mortality. A ten-year follow-up was carried on to evaluate long-term outcomes.Results: Compared with placebo, ulinastatin significantly reduced the total volume of post-operative blood loss (801.7±460.14ml vs 1016.67±529.08ml, MD -214.98ml, p<0.001) and the volume of allogeneic erythrocyte transfusion (2.57±3.15 unit vs 3.73±4.21 unit, MD-1.16 unit, p=0.002). The bleeding and transfusion outcomes were comparable between the ulinastatin group and the tranexamic acid group. In-hospital outcomes and 10-year follow-up showed no statistical difference in mortality and major morbidity among groups.Conclusion: Ulinastatin reduced post-operative blood loss and allogeneic erythrocyte transfusion in open heart surgery with CPB. The mortality and major morbidity was comparable among the groups shown by the 10-year follow-up.Trial registration: The trial was retrospectively registered on February 2, 2010. Trial registration number: https://www.clinicaltrials.gov. Identifier: NCT01060189.