The Effect of Antifibrinolytic Prophylaxis on Postoperative Outcomes in Patients Undergoing Cardiac Operations

Antifibrinolytic agents such as aprotinin and epsilon aminocaproic acid limit postoperative bleeding and blood transfusion in patients undergoing cardiac operations using cardiopulmonary bypass (CPB). Recent evidence suggests that these agents have adverse side effects that influence operative mortality and morbidity. We studied postoperative bleeding, transfusion rates, and operative outcomes in our patients in order to assess the efficacy of these agents during cardiac operations requiring CPB. We reviewed records of 520 patients undergoing a variety of cardiac operations between January 2005 and May 2009. We measured multiple variables including pre-operative risk factors, antifibrinolytic agent used, and outcomes of operation, such as measures of bleeding and blood transfusion, as well as serious operative morbidity and mortality. Postoperative bleeding rates varied significantly between patients receiving aprotinin and those receiving aminocaproic acid (P < 0.05). There was an associated 12% decrease in operative site bleeding in aprotinin-treated patients compared with aminocaproic acid. There was no significant difference in the transfusion rates of packed red blood cells between patients receiving aminocaproic acid or aprotinin (P > 0.05), though individuals in the aprotinin group did receive FFP more frequently than patients in the aminocaproic acid group (P < 0.05). There was no significant difference in morbidity and mortality rates between patients in either drug group (P > 0.05). Our study shows that aprotinin is more effective at controlling operative site bleeding than aminocaproic acid. Reduced operative site bleeding did not portend better outcome or differences in transfusion requirements. Aminocaproic acid remains a safe and cost-effective option for antifibrinolytic prophylaxis because of unavailability of aprotinin.     

How does transfusion-associated graft-versus-host disease compare to hematopoietic cell transplantation-associated graft-versus-host disease?

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare life-threatening complication of blood transfusion caused by donor T cells that escape rejection by the recipient immune system. These donor T cells drive recipient tissue damage in response to host antigens. On the other hand, GVHD occurring after allogeneic hematopoietic cell transplantation (HCT-GVHD) is also caused by donor T cells, but its pathophysiology is more complex and differs due to the effects of tissue damage caused by pre?HCT conditioning and profound immunosuppression. Both TA-GVHD and HCT-GVHD can be fatal; however, mortality is higher with TA-GVHD due to the paucity of treatment options. Here, we compare and summarize the presentation, diagnosis, pathophysiology, prevention, and treatment of TA-GVHD and HCT-GVHD.     

Transfusional iron overload in patients with myelodysplastic syndromes: A 10-year retrospective survey from a French general hospital

We retrospectively assessed the characteristics of 165 MDS patients from our institution having received at least 20 RBC units. In the vast majority of them various comorbidities (range: 1–6 per patient) were registered including mainly cardiovascular disorders. Serum ferritin was over 1000 μg/L in about half of tested individuals. A chelator agent was initiated in 43.6% of patients (mainly low-risk MDS). Transformation in AML occurred in 46 cases (27.8%). Overall, 112 patients died during follow up. The cause of death was documented in 65 cases and included mainly MDS or AML resistance to therapy. There was a context of bacterial or fungal-related sepsis in 35.3% of cases. We noticed a correlation between survival and number of RBC transfusions. Median OS from the 20th RBC unit was significantly prolonged among the chelated subgroup. Consequences of transfusional iron overload and chelation need to be clarified in MDS patients.     

56例临床输血不良反应原因分析

目的:分析临床输血过程中发生输血不良反应的原因,探讨有效的预防措施。方法:回顾2012—2014年输注由我站提供的血液制品后发生输血不良反应患者56例,分析输血不良反应发生的原因。结果:21615人次输血中,发生不良反应56例,发生率为0.3%,其中非溶血性发热反应为32例,占57.1%,过敏反应为24例,占42.9%,未发现其他输血不良反应。结论:临床上应加强对输血全过程的监管,遵循合理科学用血原则,采用新的输血技术,大力提倡自身输血,确保临床输血的安全性。     

An audit to estimate the quality of practices followed during bedside blood transfusion in a tertiary care hospital and role of continuous medical education in it

Blood transfusion is an integral component of the health Service system and it becomes imperative that its benefits, risks as well as prospective and viable alternatives of this common medical intervention are explained explicitly to the patients. Appropriate compliance to bedside blood transfusion practices can also help in avoiding adverse transfusion outcomes. At the same time, it is also crucial to document a patient's valid consent based on their decision after evaluation of the risk to benefit ratio. This audit aims to assess the compliance and adherence to bedside blood transfusion practices in a tertiary care hospital and role of Continuous Medical education (CME) on it. The study involved collection of data for blood transfusion services and practices in two periods, for adults and children, who received transfusion from the month of June 2021 to October 2021 and a re-audit beginning from November 2021 to February 2022 following few CMEs in between involving doctors and nurses. A total of 3240 transfusion procedures were assessed in this duration. In them 1500 (46.3%) took place before CME and remaining 1740 (53.7%) procedures took place after CME. There were statistically significant differences between pre-CME and post-CME bedside transfusion practices. During CME/training session, pre-training and post training knowledge has been evaluated by test which also showed statistically significant difference in knowledge of transfusion medicine & bedside transfusion practices. Our study recommends that there is a need of frequent audit on bedside transfusion practices to check the quality and standards associated with it and also points out the need of continuous medical education on this issue.     

Anemia,red blood cell transfusions,and necrotizing enterocolitis

In the past 15 years, multiple clinical studies have identified a temporal association between red blood cell (RBC) transfusions and necrotizing enterocolitis (NEC). With some variability, most of these studies indicate that up to one-third of all cases of NEC involving very low-birth weight infants may occur within 24–48 h after receiving a RBC transfusion. There is also evidence that the risk of such transfusion-associated NEC may be higher in infants transfused with the greatest severity of anemia. In this article, we summarize the clinical evidence pertaining to these issues; specifically, the contribution of RBC transfusions, and the contribution of severity of underlying anemia, to the pathogenesis of a type of NEC potentially termed, “transfusion/anemia-associated NEC.”     

门诊输液室护理管理缺陷分析及对策

门诊输液室常存在护理管理缺陷,本研究分别从患者的识别、健康教育、医务人员、患者等因素对这些缺陷进行分析,提出了制作座号牌,制定健康教育宣传单,实行量化管理、弹性排班、对输液室护士进行急救理论及技能的培训等针对性的防范措施。通过这些措施提高了门诊输液室的护理质量,减少了医疗纠纷的发生。