Impact of Blood Transfusions on Recurrence and Survival After Rectal Cancer Surgery

Purpose This study was designed to determine whether type or number of blood units transfused affected short-term and long-term outcome in patients undergoing surgery for rectal cancer. The number of perioperative blood units is associated with postoperative mortality and overall survival by some authors. In addition, allogenic perioperative blood transfusion has been postulated to produce host immunosuppression and has been reported to result in adverse outcome in patients with colorectal cancer. Autologous blood transfusion might improve results compared with allogenic transfusion. Methods Clinical outcome for 597 patients undergoing surgery for rectal cancer was analyzed according to their transfusion status. Results for type (autologous or allogenic) and number of blood units transfused were recorded. Results Blood transfusion was associated with increased postoperative mortality at 60 days. Patients who received > 3 units had a postoperative mortality of 6 percent compared with 1 percent for patients who received 1 to 3 units and 0 percent for patients who did not require transfusions. No difference was found between patients who received autologous or allogenic blood. Blood transfusions were also associated with impaired overall survival in a univariate analysis, but this finding was not confirmed in the multivariate analysis. The number or type of blood units transfused did not influence oncologic results. Local recurrence rates, distant metastases rates, and disease-free survival were not influenced by transfusion in our patients. Conclusions Increased numbers of blood units were associated with postoperative mortality. However, there is no reason, with respect to cancer recurrence or disease-free survival, to use a program of transfusion with autologous blood in patients undergoing surgery for rectal cancer. Reprints are not available.     

Prevalence and Classification of Anemia in Elective Orthopedic Surgery Patients: Implications for Blood Conservation Programs

We audited 281 consecutive orthopedic patients scheduled for surgery for whom blood type/cross-matching was requested over a 6-month period. One hundred and sixty-two patients predonated autologous blood at University Hospitals of Cleveland, and 34 (21%) of these were anemic [hematocrit (Hct) less than or equal to 39%] at initial donation. Twelve (35%) of these 34 anemic autologous blood donors subsequently received homologous blood. In contrast, 18 (15%) of 128 nonanemic autologous blood donors received homologous blood (p = 0.05). In 119 patients who did not donate autologous blood, 39 (33%) were anemic at admission. Of these, 22 (56%) received homologous blood. In the 80 remaining nonanemic patients, 33 (41%) received homologous blood (p = 0.119). Analysis of discharge Hct indicates that 31 (12%) of 263 evaluable patients were possibly transfused inappropriately. The anemias of a cohort of 30 autologous donors were analyzed: 5 had rheumatoid arthritis without iron deficiency. Nine (30%) others had evidence of iron deficiency. Sixteen (53%) had an unclassified anemia of chronic disease. We conclude: (1) the high rates of homologous blood exposure indicate a need for innovative blood conservation strategies in anemic autologous blood donors; (2) the prevalence of anemia and the high rates of homologous blood exposure in anemic patients who did not donate autologous blood demonstrate a need for early recognition and treatment in order to procure autologous blood and reduce homologous blood exposure; (3) the presence of inappropriate autologous and homologous transfusions demonstrates a need for more effective physician education programs that emphasize 'no blood transfusion' as an alternative to enhance blood conservation effectiveness.     

Preoperative autologous blood donation by elderly patients undergoing orthopaedic surgery

BACKGROUND AND OBJECTIVES: To assess the feasibility of a programme of predeposit in elderly patients undergoing elective orthopaedic surgery. PATIENTS AND METHODS: We retrospectively studied 789 elderly patient candidates (> 65 years of age) for orthopaedic surgery (total hip and knee replacement and spinal surgery), who were undergoing a programme of preoperative autologous blood donation (PABD) in our city hospital between January 1990 and December 1998. RESULTS: Six hundred and eighty-eight patients (87.2%) were transfused with autologous blood; 128 (16.2%) also received allogeneic blood. Hip arthroplasty revision was characterized by the greatest blood consumption. The predeposit programme was discontinued in 96 patients (12.2%) because of the following complications: the onset of anaemia (11.0%); vasovagal reactions (0.5%); lack of venous access (0.4%); or cardiac complications (0.2%). No episodes of reaction to autologous transfusion were recorded. CONCLUSIONS: Our study confirms the feasibility of PABD in elderly patients undergoing elective orthopaedic surgery.     

Red Blood Cell Transfusions for Total Hip Replacement in a Regional Hospital: A Six-Year Analysis

To evaluate changes in the need for homologous blood and to assess the impact of autologous blood transfusion, red cell transfusions in unilateral total hip replacement surgery, performed electively in the period 1986–1991, were studied in a regional hospital. Transfusion data, perioperative blood loss and postoperative haemoglobin concentration of 495 patients were analysed. From 1986 to 1991, the percentage of patients not transfused with homologous blood increased from 18.5 to 45.5%. After the introduction of an autologous blood transfusion programme in 1987, 116 of 430 patients (27.0%) donated autologous blood. No increase in the percentage of autologous donors was observed during the study. Most common reasons for nonparticipation were the patient's age, doctors' underordering and logistic limitations. 81.9% of autologous donors had total hip replacement surgery without homologous transfusions. Mean blood loss reduced significantly from 1,373 ± 781 ml in 1986 to 958 ± 582 ml in 1991 (p < 0.001). Transfusion requirement in the nonautologous patients fell from 2.6 ± 1.8 units in 1986 to 1.4 ± 1.4 units per patient in 1989 and increased thereafter to 2.2 ± 2.1 units in 1991 (p < 0.01) and showed a strong correlation with blood loss (r = 0.58; p < 0.001). No changes in postoperative haemoglobin concentration were observed throughout the study. In conclusion, collection of autologous blood is effective, albeit still underutilized, to reduce homologous blood requirement. The close correlation between blood loss and transfusion requirement accentuates the role of surgical practice in the reduction of homologous transfusions.     

Predeposit self-transfusion (PDS) in a hepatobiliopancreatic surgery (HBPS) unit: preliminary data

Hepatobiliary pancreatic surgery (HBPS) has high morbility and mortality and frequently requires blood transfusion. Allogeneic transfusion may cause adverse sequelae. Predeposit self-transfusiÓn (PDS) minimizes allogeneic blood transfusion and avoids most adverse reactions. We present the preliminary data of our PDS experience (with recombinant human erythropoieting, r-HuEPO) in HBPS during the first year. We studied our first-year HBPS-PDS program by a retrospective review of the case histories and transfusion records in our Blood Bank. Sex, weight, underlying disease, packed red cell units (PRCUs) requested, drawn, and transfused, and hospital and ICU stays were analyzed. Nine patients were admitted in the PDS program. Of desired blood units, 83% was obtained, successfully in 77.8% of patients, and 63.2% were transfused with autologous blood transfusion. Only three patients needed allogeneic blood (33.3%). All complications occurred in patients who received allogeneic units. Also, we found stays were three times longer in those patients. PDS could be a valid and safe alternative for patients undergoing elective HBPS because it decreases allogeneic blood requirements, reduces overall complications, and also reduces hospital and ICU stays.     

Do perioperative blood transfusions affect the postoperative recurrence rate in Crohn disease?]

The influence of perioperative blood transfusion on postoperative recurrence rate was investigated in 109 patients with Crohn's disease after primary surgery. 52 of the 109 patients had received transfusions during the perioperative period. The symptomatic recurrence rate 5 years after surgery was 31% in transfused and 33% in non-transfused patients (p = 0.99). The reoperation rates were 10% (transfused) and 12% (non-transfused) after 5 years respectively (p = 0.70). Therefore, the finding of decreased postoperative recurrence rates in patients who received perioperative blood transfusions cannot be supported by our results.     

Effectiveness of preoperatively obtained autologous platelet concentrates in open heart surgery

BACKGROUND: Autologous blood components have been widely introduced in open heart surgery. However, the effectiveness of autologous platelet products remains controversial. METHODS: Autologous platelet concentrates (PC) were collected from patients (n = 35) scheduled for primary valvular heart surgery 1 to 3 days before the operation and were transfused immediately after cardiopulmonary bypass. Blood loss and platelet-related factors were compared with the control patients who had no PC (n=35). RESULTS: There were no serious complications in harvesting, preservation, and transfusion of autologous PC. The maximal platelet aggregation response significantly improved after its transfusion and tended to be higher with autologous PC stored 1 day than with ones stored 2-3 days. Activation of coagulation and fibrinolytic factors did not significantly differ between the groups. Postoperative blood loss was significantly less in autologous PC group, and seemed to have a negative correlation with platelet aggregation response. CONCLUSIONS: Autologous PC can be safely prepared and are clinically effective in reduction of postoperative blood loss in open heart surgery.     

Erythrokinetic Studies in Thalassaemia

Erythrocyte survival studies were performed in a group of thalassaemic patients. The survival and sites of destruction of autologous and normal donor cells were determined. These studies were repeated in patients who had undergone splenectomy. The life span of the autologous red cells was found to be invariably shortened with some evidence of splenic sequestration. On the other hand, the life span of the donor cells was normal or decreased after repeated blood transfusions.
Following surgery, there was no noticeable improvement in the survival of the patient's abnormal cells, while transfused red cells now survived normally.     

Predictors of blood loss during total hip replacement surgery

Objective. To determine total blood loss and transfusion requirements during primary total hip replacement (THR) surgery; and, to identify predictors of increased blood loss. Methods. This was a prospective cohort study of 295 consecutive patients undergoing primary THR at α 700-bed teaching hospital in Boston, Massachusetts. The main outcome measures were the total blood loss, which was defined (in units) as the initial hematocrit minus final hematocrit divided by 3 plus the number of units transfused, and the number of autologous and homologous units of blood transfused. Results. The mean total blood loss was 3.6 units, and the mean total units transfused was 2.1. Univariate predictors of greater total blood loss (at P < 0.05) included being male, receiving general anesthesia, and higher American Society of Anesthesiologists (ASA) class. In multiple linear regression models which controlled for demographic and clinical variables (age, race, marital status, education, smoking history, obesity, underlying disease, payor status, cemented prosthesis, comorbidity, and season of operation), being male, receiving general anesthesia, and having an ASA score of 3 predicted greater total blood loss. Conclusion. Preoperative characteristics can help determine which patients should donate either more or less than the customary 2 units of blood.     

Preoperative autologous blood donation in primary total knee arthroplasty: a single-centre experience on 214 consecutive patients

BACKGROUND AND OBJECTIVES: Although preoperative autologous blood donation (PABD) is a widespread practice in elective orthopedic surgery, it is controversial whether this procedure avoids allogeneic blood transfusions in patients undergoing total knee arthroplasty (TKA). PATIENTS AND METHODS: We performed a retrospective study on 214 consecutive patients undergoing PABD before elective primary TKA. RESULTS: Thirty-eight patients (17.8%) were transfused with autologous red blood cells (RBC), while four of them (10.5% of those requiring transfusions, 1.9% of all patients) also received allogeneic RBC. The transfused patients were, in most cases, female and had significantly lower basal and preoperative haemoglobin levels. CONCLUSIONS: Based on the results of this study, PABD is not necessary in most patients undergoing TKA, although older female patients with low basal haemoglobin levels could benefit from a predeposit programme and/or erythropoietin support in order to reduce the risk of exposure to allogeneic blood.     

Autologous Blood Donation Elective Surgery in Children

Studies were made on 59 children (cardiac 42, orthopaedic 13, miscellaneous 4) scheduled for autologous blood donation before elective surgery. The donor-patients' ages ranged from 3 to 15 years (mean 9.9 years) and their weights from 13 to 70 kg (mean 34 kg). All patients received 50–100 mg of oral iron sulphate per day. As a rule, about 10% of intravascular blood volume was drawn once a week. Before surgery, an average of 720 ml of autologous blood per patient was prepared. Two patients failed to donate autologous blood because of anxiety about the procedure; however, none of the donors was deferred due anaemia assoicated with the phlebotomy. Of the 53 patients undergoing surgery and participating in autologous predonation, 50 (94%) were able to avoid homologous blood transfusion. 600 ml of homologous blood were transfused to each of 2 orthopaedic patients and 400 ml to 1 cardiac patient. We conclude that a predeposit autologous transfusion programme is logistically possible in small children when the patients are cooperative.     

The influence of perioperative blood transfusion on intrahepatic recurrence after curative resection of hepatocellular carcinoma

OBJECTIVE: This study retrospectively evaluated the association between perioperative blood transfusion and intrahepatic recurrence in patients with hepatocellular carcinoma (HCC) who had undergone curative hepatic resections. METHODS: Hepatic resection was performed with curative intent in 195 patients with primary HCC between 1985 and 1996. Patients who had received perioperative blood transfusion (transfused group: n = 117) and those who had no perioperative blood transfusion (nontransfused group: n = 78) were compared in terms of conventional prognostic variables and cancer-free survival by the univariate and multivariate analyses. RESULTS: The 1-, 3-, and 5-yr cancer-free survival rates in the nontransfused and transfused groups were 83.4% and 67.9%, 43.0% and 36.7%, and 23.1% and 24.6%, respectively (p = 0.175). Multivariate analysis of prognostic factors in all patients revealed that vascular invasion, tumor size (> or =5 cm), and Child's class were independent factors for intrahepatic recurrence. Further analyses in various stratified groups showed that perioperative blood transfusion was an independent predictor of prognosis in HCC patients with portal vein invasion (RR: 2.8, p = 0.0038). The 1-, 3-, and 5-yr survival rates in the nontransfused and transfused groups with portal vein invasion were 71.9% and 41.6%, 54.5% and 10.9%, and 26% and 0%, respectively (p = 0.0003). CONCLUSIONS: We conclude that perioperative blood transfusions enhance the risk of intrahepatic recurrence of HCC in patients with portal vein invasion. As well, the more difficult surgery and the increased manipulation of the liver that occur in these cases create a greater possibility of tumor dissemination.     

Blood Product Utilization in Hip and Knee Arthroplasty: Effect of Gender and Autologous Blood on Transfusion Practice

Analysis of total blood product support for a 1-year cohort of patients undergoing hip or knee total joint arthroplasty showed significant differences in transfusion therapy between patients who predeposited autologous blood and those who did not. In primary joint arthroplasty, 51% of nonpredepositing patients undergoing hip replacement and 28% of nonpredepositing patients undergoing knee replacement required red cell transfusions. In revision procedures, 58–61% were transfused. Predepositors requiring only autologous blood received less blood per patient than nonpredepositors; however, 73–87% of primary and 86–88% of revision arthroplasty patients were transfused. Predepositors receiving supplemental allogeneic blood used a volume of red cells comparable to nonpredepositing patients, which was significantly greater than the red cell requirement of predepositors using only autologous blood. Moreover, regardless of predeposit status, the extent of red cell replacement differed between men and women. Male patients presented with significantly higher hematocrits and were less likely to be transfused than females undergoing the same procedure. However, once the transfusion-decision was made, the average amount of red cells given for each procedure did not show gender-related variation. Despite differences in admission and lowest observed hematocrits, all patients were discharged with hematocrits in the same range, suggesting that men were replaced with relatively less blood than women. These differences in transfusion practice relating to gender and predeposit status could not be associated with identifiable changes in clinical outcome which might provide rationale for the observed differences in practice.     

Preoperative autologous plateletpheresis in patients undergoing open heart surgery

Blood conservation is an important aspect of care provided to the patients undergoing cardiac operations with cardiopulmonary bypass (CPB). It is even more important in patients with anticipated prolonged CPB, redo cardiac surgery, patients having negative blood group and in patients undergoing emergency cardiac surgery. In prolonged CPB the blood is subjected to more destruction of important coagulation factors, in redo surgery the separation of adhesions leads to increased bleeding and difficulty in achieving the haemostasis and in patients with negative blood group and emergency operations, the availability of sufficient blood can be a problem. Harvesting the autologous platelet rich plasma (PRP) can be a useful method of blood conservation in these patients. The above four categories of patients were prospectively studied, using either autologous whole blood donation or autologous platelet rich plasma (PRP) harvest in the immediate pre-bypass period. Forty two patients were included in the study and randomly divided into two equal groups of 21 each, control group (Group I) in which one unit of whole blood was withdrawn, and PRP group (Group II) where autologous plateletpheresis was utilised. After reversal of heparin, autologous whole blood was transfused in the control group and autologous PRP was transfused in the PRP group. The chest tube drainage and the requirement of homologous blood and blood products were recorded. Average PRP harvest was 643.33 +/- 133.51 mL in PRP group and the mean whole blood donation was 333.75 +/- 79.58 mL in the control group. Demographic, preoperative and intra operative data showed no statistically significant differences between the two groups. The PRP group patients drained 26.44% less (p<0.001) and required 38.5% less homologous blood and blood products (p<0.05), in the postoperative period. Haemoglobin levels on day zero (day of operation) and day three were statistically not different between the two groups. We conclude that autologous plateletpheresis is a better method of blood conservation in terms of better haemostasis, and less requirement of blood and blood products in the postoperative period as compared with the autologous whole blood donation. This technique can be especially useful in the above-mentioned categories of patients.     

心内直视手术中输自体血临床研究

１９８９～１９９３年的４年中，共进行心内直视手术时输自体血１７５５例（其中成人１５５５例，儿童２００例），共放出自体血１０５万ｍｌ，平均每例放血６００ｍｌ。患者年龄最小生后６２天，最大７４岁，体重最轻４．５ｋｇ，最重９８ｋｓ。本文推道了临床情况放血方法及一系列临床科研工作。此项工作培养了干部，节约了库血，减轻了患者经济负担和减少手术后肝炎发生的危险，应广为宣传应用。     

Risk factors for massive blood loss during liver resection for hepatocellular carcinoma in patients with cirrhosis

BACKGROUND/AIMS: Liver resection for hepatocellular carcinoma in patients with cirrhosis carries risk of major hemorrhage and sometimes requires blood transfusion. We investigated risk factors for massive blood loss during liver resection and indications for storing blood for autologous intraoperative transfusion. METHODOLOGY: We analyzed clinical records of 100 patients with cirrhosis who underwent liver resection for hepatocellular carcinoma. Autologous blood was stored preoperatively for 19 patients. RESULTS: Intraoperative blood loss ranged from 5 to 3000 mL (mean, 640). Liver resection was performed without transfusion in 67 patients and with autologous blood storage in 17 patients not receiving homologous blood. In the other 16 patients, homologous blood was transfused. Univariate analysis identified youth, large tumors (> 4cm), major hepatectomy, portal tumor involvement, hepatic vein involvement, and prolonged operation time as risk factors for massive blood loss; multivariate analysis identified portal involvement and hepatic vein involvement as independent risk factors. Blood loss exceeded 1000 mL in the 4 transfused group B patients and 3 of the 4 patients had hepatic vein involvement. CONCLUSIONS: Portal involvement and hepatic vein involvement were risk factors for massive blood loss during liver resection for hepatocellular carcinoma in patients with cirrhosis. Autologous blood storage is indicated in patients with such risk factors.     

Blood transfusion is associated with increased resource utilisation, morbidity and mortality in cardiac surgery

The purpose of the present investigation was to examine the impact of blood transfusion on resource utilisation, morbidity and mortality in patients undergoing coronary artery bypass graft (CABG) surgery at a major university hospital. The resources we examined are time to extubation, intensive care unit length of stay (ICULOS) and postoperative length of stay (PLOS). We further examined the impact of number of units of packed red blood cells (PRBCs) transfused during PLOS. This is a retrospective observational study and includes 1746 consecutive male and female patients undergoing primary CABG (on- and off-pump) at our institution. Of these, 1067 patients received blood transfusions, while 677 did not. The data regarding the demography, blood transfusion, resource utilisation, morbidity and mortality were collected from the records of patients undergoing CABG over a period of three years. The mean time to extubation following surgery was 8.0 h for the transfused group and 4.3 h for the nontransfused group ( P 相似文献   

Systematic Pre-Deposit Autologous Blood Provision for Elective Surgery: An Important Contribution to Hospital Blood Supply

From the 8th of September 1987 to the 31st of July 1988 all patients scheduled for major elective orthopaedic surgery were systematically offered the facility of pre-deposit autologous blood storage. Of 251 patients, 204 (81%) were eligible to pre-donate, and of these only 9 declined to do so. 72% of the participants required only autologous blood at operation, 23% required some additional homologous blood. During the study period, autologous blood accounted for 10% of all blood transfused in the district, making a significant contribution to the local blood supply.     

Allogeneic blood transfusion does not increase the risk of wound infection in total knee arthroplasty

Background and Objective Allogeneic blood transfusion has been reported to increase the risk of postoperative infection in arthroplasty though the results are inconclusive. Data from a previous clinical trial on antibiotic prophylaxis in knee arthroplasty were analysed to gain further insight into the relationship between wound infection and both blood transfusion and the storage time of transfused RBCs. Materials and Methods A total of 910 consecutive patients undergoing primary knee arthroplasty were prospectively followed for 12 months after surgery. The main outcome was wound infection, either superficial or deep‐tissue. Possible predictors for wound infection included the patient’s age and sex, preoperative physical status, time under leg ischaemia, postoperative fluid drainage, and the number and length of storage of transfused RBCs. Results Deep tissue infection was diagnosed in 28 (3%) patients, superficial infection in 25 (2·7%) and cellulitis in eight (0·8%) patients. Transfusion of at least one blood unit had been given to 22 (36%) of the 61 patients who later developed wound infection and 313 (36%) of those who did not (P > 0·05). Patients who developed wound infection had a significantly poorer physical status and longer time of leg ischaemia. There was no significant difference between both groups of patients in either the amount or the length of storage of transfused RBC units. Conclusion This study failed to find any association between the incidence of wound infection after knee arthroplasty and allogeneic transfusion.     

Effect of intravenous proton pump inhibitor regimens and timing of endoscopy on clinical outcomes of peptic ulcer bleeding

Background and Aim: The most effective schedule of proton pump inhibitor (PPI) administration and the optimal timing of endoscopy in acute peptic ulcer bleeding remain uncertain. The aim of this study was to determine the most efficient PPI regimen and optimal timing of endoscopy. Methods: Consecutive patients with suspected bleeding peptic ulcers were enrolled and randomized to receive either a standard regimen or a high‐dose intensive intravenous regimen. Only patients with bleeding peptic ulcers diagnosed at initial endoscopy continued the study. High‐risk patients received endoscopic hemostasis. The primary outcome measure of recurrent bleeding was compared between the two dosage regimens and between early and late endoscopy. Secondary outcome measures compared included need for endoscopic treatment, blood transfusion, hospital stay, surgery and mortality. Results: A total of 875 patients completed the study. Recurrent bleeding occurred in 11.0% in the standard regimen group, statistically higher than that in the intensive regimen group (6.4%, P = 0.02). Mean units of blood transfused and duration of hospital stay were also higher in the standard regimen group (P < 0.001 for each compared to intensive regimen group). However, no significant differences were noted between the two groups in the need for endoscopic hemostasis, need for surgery, and mortality. Recurrence of bleeding was similar between the early and late endoscopy groups. Units of blood transfused and length of hospital stay were both significantly reduced with early endoscopy. Conclusion: High‐dose PPI infusion is more efficacious in reducing rebleeding rate, blood transfusion requirements and hospital stay. Early endoscopy is safe and more effective than late endoscopy.