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Journal of Cardiothoracic and Vascular... Feb 2018
Review
Topics: Adult; Advisory Committees; Anesthesia, Cardiac Procedures; Blood Transfusion; Cardiac Surgical Procedures; Europe; Humans; Practice Guidelines as Topic
PubMed: 29029990
DOI: 10.1053/j.jvca.2017.06.026 -
Archives of Pathology & Laboratory... May 2007We provide an overview of the principles of blood management: the appropriate use of blood and blood components, with a goal of minimizing their use. (Review)
Review
CONTEXT
We provide an overview of the principles of blood management: the appropriate use of blood and blood components, with a goal of minimizing their use.
OBJECTIVE
To review the strategies that exploit combinations of surgical and medical techniques, technologic devices, and pharmaceuticals, along with an interdisciplinary team approach that combines specialists who are expert at minimizing allogeneic blood transfusion.
DATA SOURCES
A search on Medline and PubMed for the terms English and humans used in articles published within the last 20 years.
CONCLUSIONS
Blood management is most successful when multidisciplinary, proactive programs are in place so that these strategies can be individualized to specific patients.
Topics: Blood Component Transfusion; Blood Loss, Surgical; Blood Transfusion; Blood Transfusion, Autologous; Erythropoietin; Hemostatics; Humans; Intraoperative Care; Postoperative Hemorrhage; Preoperative Care
PubMed: 17488154
DOI: 10.5858/2007-131-695-BM -
Anaesthesia Jan 2015Allogeneic red cell transfusion is a commonly used treatment to improve the oxygen carrying capacity of blood during the peri-operative period. Increasing arterial... (Review)
Review
Allogeneic red cell transfusion is a commonly used treatment to improve the oxygen carrying capacity of blood during the peri-operative period. Increasing arterial oxygen content by increasing haemoglobin does not necessarily increase tissue oxygen delivery or uptake. Although the evidence-base for red cell transfusion practice is incomplete, randomised studies across a range of clinical settings, including surgery, consistently support the restrictive use of red cells, with no evidence of benefit for maintaining patients at higher haemoglobin thresholds (liberal strategy). A recent meta-analysis of 7593 patients concluded that a restrictive transfusion strategy was associated with a reduced risk of healthcare-associated infections (pneumonia, mediastinitis, wound infection, sepsis) when compared with a liberal transfusion strategy. The degree to which the optimal haemoglobin concentration or transfusion trigger should be modified for patients with additional specific risk factors (e.g. ischaemic heart disease), remains less clear and requires further research. Although most clinical practice guidelines recommend restrictive use of red cells, and many blood transfusion services have seen marked falls in overall usage of red cells, the use of other blood components such as fresh frozen plasma, platelets, and cryoprecipitate has risen. In clinical practice, administration of fresh frozen plasma is usually guided by laboratory tests of coagulation, mainly prothrombin time, international normalised ratio and activated partial thromboplastin time, but the predictive value of these tests to predict bleeding is poor.
Topics: Anemia; Blood Component Transfusion; Blood Transfusion; Erythrocyte Transfusion; Humans; Platelet Transfusion; Preoperative Care
PubMed: 25440390
DOI: 10.1111/anae.12893 -
Transfusion Jun 2017Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of...
Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals.
BACKGROUND
Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes.
STUDY DESIGN AND METHODS
This was a retrospective study of 605,046 patients admitted to four major adult tertiary-care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused; single-unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity-based costs of transfusion; in-hospital mortality; length of stay; 28-day all-cause emergency readmissions; and hospital-acquired complications.
RESULTS
Comparing final year with baseline, units of RBCs, FFP, and platelets transfused per admission decreased 41% (p < 0.001), representing a saving of AU$18,507,092 (US$18,078,258) and between AU$80 million and AU$100 million (US$78 million and US$97 million) estimated activity-based savings. Mean pretransfusion hemoglobin levels decreased 7.9 g/dL to 7.3 g/dL (p < 0.001), and anemic elective surgery admissions decreased 20.8% to 14.4% (p = 0.001). Single-unit RBC transfusions increased from 33.3% to 63.7% (p < 0.001). There were risk-adjusted reductions in hospital mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.67-0.77; p < 0.001), length of stay (incidence rate ratio, 0.85; 95% CI, 0.84-0.87; p < 0.001), hospital-acquired infections (OR, 0.79; 95% CI, 0.73-0.86; p < 0.001), and acute myocardial infarction-stroke (OR, 0.69; 95% CI, 0.58-0.82; p < 0.001). All-cause emergency readmissions increased (OR, 1.06; 95% CI, 1.02-1.10; p = 0.001).
CONCLUSION
Implementation of a unique, jurisdiction-wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product-related cost savings.
Topics: Adult; Australia; Blood Transfusion; Erythrocyte Transfusion; Hospital Mortality; Hospitals; Humans; Length of Stay; Retrospective Studies
PubMed: 28150313
DOI: 10.1111/trf.14006 -
British Journal of Anaesthesia Feb 2022Transfusion support is an essential element of modern emergency healthcare. Blood services together with hospital transfusion teams are required to prepare for, and...
Transfusion support is an essential element of modern emergency healthcare. Blood services together with hospital transfusion teams are required to prepare for, and respond to, mass casualty events as part of wider healthcare emergency planning. Preparedness is a constant collaborative process that actively identifies and manages potential risks, to prevent such events becoming a 'disaster'. The aim of transfusion support during incidents is to provide sufficient and timely supply of blood components and diagnostic services, whilst maintaining support to other patients not involved in the event.
Topics: Blood Component Transfusion; Blood Transfusion; Cooperative Behavior; Disaster Planning; Emergency Medical Services; Humans; Mass Casualty Incidents; Patient Care Team
PubMed: 34503826
DOI: 10.1016/j.bja.2021.07.027 -
British Journal of Haematology Nov 2022Home care is a healthcare alternative to hospitalisation. Different types of procedures are performed at home care services, such as home transfusion of blood products.... (Review)
Review
Home care is a healthcare alternative to hospitalisation. Different types of procedures are performed at home care services, such as home transfusion of blood products. However, home blood transfusion is not fully implemented and there is a great lack of knowledge about it. The aims of this study were thus to assess the safety and effectiveness of home blood transfusions and patient acceptance and satisfaction. A systematic literature review was conducted in the main biomedical databases. We included all studies that covered patients who had received a home blood transfusion, regardless of their baseline diagnosis. The literature search yielded 290 studies, 14 of which were included in this study as they met the predefined criteria. The main patient profile of a home-transfusion recipient was a person with anaemia associated with other diseases. Overall incidence of severe adverse events was 0.05%. No studies evaluated the effectiveness of home versus hospital transfusions. One study showed that 51% of patients would be willing to receive home transfusions. Home blood transfusion appears to be a feasible, safe, and well-accepted procedure. Existing studies are of low quality, however, and this is an important limitation when it comes to drawing definitive benefit-risk conclusions.
Topics: Humans; Blood Transfusion; Anemia
PubMed: 35778372
DOI: 10.1111/bjh.18344 -
British Medical Journal (Clinical... Jul 1985
Topics: Blood Transfusion; Blood Transfusion, Autologous; Hemodilution; Hospitals; Humans; Surgical Procedures, Operative; United Kingdom
PubMed: 3926134
DOI: 10.1136/bmj.291.6490.234 -
British Journal of Sports Medicine Feb 2004This article reviews the history, technique, effects, side effects, and detection of blood boosting. It also considers whether or not this particular performance... (Review)
Review
This article reviews the history, technique, effects, side effects, and detection of blood boosting. It also considers whether or not this particular performance enhancement technique is a thing of the past or a continuing form of abuse among athletes.
Topics: Blood Transfusion; Cryopreservation; Doping in Sports; Erythrocyte Transfusion; Humans; Sports; Substance Abuse Detection; Transfusion Reaction
PubMed: 14751959
DOI: 10.1136/bjsm.2003.007195 -
Transfusion Jun 2012Blood for transfusion is stored for up to 42 days. Older blood develops lesions and accumulates potentially injurious substances. Some studies report increasing toxicity... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Blood for transfusion is stored for up to 42 days. Older blood develops lesions and accumulates potentially injurious substances. Some studies report increasing toxicity as blood ages. We assessed the safety of transfused older versus newer stored blood.
STUDY DESIGN AND METHODS
PubMed, Scopus, and Embase were searched using terms new and old and red blood cell and storage through May 6, 2011, for observational and randomized controlled studies comparing outcomes using transfused blood having longer and shorter storage times. Death was the outcome of interest.
RESULTS
Twenty-one studies were identified, predominantly in cardiac surgery (n=6) and trauma (n=6) patients, including 409,966 patients. A test for heterogeneity of these studies' results was not significant for mortality (I(2)=3.7%, p=0.41). Older blood was associated with a significantly increased risk of death (odds ratio, 1.16; 95% confidence interval [CI], 1.07-1.24). Using available mortality data, 97 (95% CI, 63-199) patients need to be treated with only new blood to save one life. Subgroup analysis of these trials indicated that the increased risk was not restricted to a particular type of patient, size of trial, or amount of blood transfused.
CONCLUSION
Based on available data, use of older stored blood is associated with a significantly increased risk of death.
Topics: Algorithms; Blood Preservation; Blood Safety; Blood Transfusion; Death; Erythrocyte Transfusion; Humans; Randomized Controlled Trials as Topic; Risk Factors; Transfusion Reaction
PubMed: 22188419
DOI: 10.1111/j.1537-2995.2011.03466.x -
Medicine May 2020This study aimed to investigate blood transfusion rates and spectrum of diseases in hospitalized neonates treated with blood transfusion in China to provide supporting... (Observational Study)
Observational Study
This study aimed to investigate blood transfusion rates and spectrum of diseases in hospitalized neonates treated with blood transfusion in China to provide supporting data for future studies on neonatal blood transfusion.Data on hospitalized neonates were obtained from more than 100 experts from the Department of Neonatology of 55 hospitals in China between January 1, 2012 and December 31, 2016, using a standardized survey. A statistical analysis was conducted to evaluate the data collected, including the blood transfusion rates, blood component transfused, spectrum of diseases, and spectrum of major diseases.Between 2012 and 2016, 541,128 neonates were hospitalized in the 55 hospitals surveyed. There were 70,433 neonates who received blood transfusion, with an average transfusion rate of 13.02%. The rates of red blood cell transfusion, platelet transfusion, and plasma transfusion were 9.44%, 0.66%, and 4.77%, respectively. The neonatal blood transfusion rate was 17.99% in Northeast China, 9.74% in Northwest China, and between 10.60% and 16.22% in other regions. The neonatal blood transfusion rate was 12.3% in general hospitals and 13.8% in women and children's hospitals. The top 10 diseases identified in hospitalized neonates treated by blood transfusion were, in rank order, as follows:prematurity,pneumonia, hyperbilirubinemia, bacterial sepsis, respiratory distress syndrome, anemia, hemolytic disease, asphyxia, hemorrhage, and necrotizing enterocolitis.The neonatal blood transfusion rate in China is 13.03%.The rank order in the disease spectrum of the hospitalized neonates and that in hospitalized neonates treated with blood transfusion are different.
Topics: Blood Component Transfusion; Blood Transfusion; China; Hospitals, General; Hospitals, Maternity; Humans; Infant, Newborn; Infant, Newborn, Diseases; Residence Characteristics
PubMed: 32358367
DOI: 10.1097/MD.0000000000019961