Length of survival after perioperative transfusion

To describe the post-transfusion survival of an entire, geographically defined population, we observed all residents of a US county who underwent perioperative transfusion before and after the introduction of a large autologous transfusion programme. We enrolled 444 and 1540 county residents, transfused in 1981 and in 1986–88, respectively. Complete follow-up (until death or for 5 years) was available on 1960 patients (98.8%). Of patients transfused in 1986–88, 67.6% were alive at 5 years, having survived for a mean (± SE) period of 46.15 (±0.575) months. The survival statistics were 66.2% and 46.09 (±1.047) months, respectively, for patients transfused in 1981 ( P  =0.8424). Transfusion in 1986–88 vs. 1981 (with 615 [40%] vs. six [1.3%] patients receiving some autologous blood) did not have an effect on survival ( P  =0.3892), following adjustment for age, gender, transfusion dose, receipt of a single-unit transfusion and transfusing surgical service. We conclude that the survival of an entire, geographically defined transfused population is substantially longer than that reported previously for patients referred to tertiary-care medical centres. The aggregate 5-year survival of patients transfused in 1981 and in 1986–88 does not differ, despite differences in patient case-mix and in perioperative transfusion practice, particularly as it relates to autologous blood usage.     

One year period prevalence of blood transfusion

Transfusion practice is reported to differ considerably between countries. Comparisons often rely on transfusion rates, incidence ‐ or prevalence rates. In this paper, the one‐year period prevalence rate (1‐YPPR) of transfusion of red cells (RBC) is presented. Transfusion data, demographic data and patient data were retrospectively combined to calculate sex and diagnosis specific and age standardized 1‐YPPR s of RBC transfusion for the complete population in a Danish county. During the calendar year of 2006, 4427 patients received RBC transfusion in Funen County. The crude 1‐YPPR of RBC transfusion was 9.2/1000 citizens. Most of the transfused patients had a main diagnosis of neoplasm (22% of recipients), diseases of the circulatory system (15%), the digestive system (15%), injuries (13%) and diseases of the blood (8%). Age standardization reversed the relation between sex specific 1‐YPPRs, yielding a statistically significantly higher 1‐YPPR in males (6.8/1000) vs. females (6.3/1000). The method for calculating a diagnosis specific 1‐YPPR of transfusion of RBC is presented and proposed as an option for comparison of transfusion practice with other transfusion centres. The crude and the diagnosis specific 1‐YPPR s are found to increase with age. Thus, age standardization of crude prevalence rates is necessary for meaningful comparisons between populations.     

Transfusion practice in the intensive care unit: a 10‐year analysis

BACKGROUND: Clinical guidelines recommend a restrictive transfusion strategy in nonhemorrhaging critically ill patients. STUDY DESIGN AND METHODS: We conducted a retrospective observational study of 3533 single‐admission patients, without evidence of acute coronary syndromes, hemorrhage, or hemoglobinopathy admitted to the medical intensive care unit (MICU) of a large, academic medical center. RESULTS: MICU admission hemoglobin (Hb) level did not change significantly over the study period. The proportion of transfused patients decreased from 31.0% in 1997 to 1998 to 18.0% in 2006 to 2007 (p < 0.001). Among patients receiving transfusion, the mean pretransfusion Hb level decreased over time from 7.9 ± 1.3 to 7.3 ± 1.3 g/dL (p < 0.001). These changes in practice were not accounted for by differences in patient characteristics. The mean nadir Hb level in nontransfused patients decreased from 11.2 ± 2.2 g/dL in 1997 to 1999 to 10.4 ± 2.3 g/dL in 2006 to 2007 (p < 0.001). The mean number of units per patient transfused decreased during this time from 4.3 ± 4.7 to 3.0 ± 3.8 units (p < 0.001). The proportion of transfused patients who were transfused at a Hb level of less than 7.0 g/dL increased by an estimated absolute increment of 3.2% (95% CI, 2.1%‐4.3%) per interval (p < 0.001), and the proportion of single‐unit transfusions during the first transfusion episode increased by 1.4% per interval (95% CI, 0.2 to 2.6%; p = 0.03) from 40.2% in 1997 to 1998 to 53.1% in 2006 to 2007. CONCLUSIONS: Between 1997 and 2007, important and sustained changes have occurred in our MICU physician transfusion practices, with overall reductions in the proportion of patients transfused, mean pretransfusion Hb level, and nadir Hb level in patients who were not transfused.     

Pre-operative predeposit autologous donation in children presenting for elective surgery: a review

Predeposit Autologous blood donation (PAD) in children decreases the life-time complications associated with allogeneic blood. These complications include transmission of known or unknown pathogens and alloimmunization against future blood transfusions, organ transplants and pregnancies. In view of the potential long term benefits of PAD should it be considered a component of paediatric blood conservation programs. This paper reviews the literature to explore the risk of benefit analysis of adopting PAD in paediatric practice.     

Berkeley Moynihan – early transfusionist and blood transfusion recipient

Lord Sir Berkeley Moynihan (1865–1936) was a surgeon at the General Infirmary in Leeds (Yorkshire) from 1893, rising during his career to be one of the foremost surgeons in the UK whose reputation reached its pinnacle at the outbreak of the First World War (WW1). He was the only surgeon after Lister to be made a Baronet. In a letter to The Lancet in 1918, he claimed to have used blood transfusion on some of his patients during the 10‐year period prior to that date. If true, this statement would make him the first surgeon in England to routinely use transfusion prior to WW1. This review investigates this claim using currently available evidence from Moynihan's personal records and publications, as well as published information from his colleagues.     

自身输血在产科的应用

随机选择30例孕妇进行自身输血研究。分娩前1～6天采血150～350ml,分娩当日或术中回输。结果:采血过程无严重副反应,采血后孕妇和胎儿生命体征无异常,产后或术后母婴健康。血回输后产妇血液指标的增高程度,试验组较对照组稍高。认为孕妇自身输血安全、有效,值得在我国提倡。