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.     

Autotransfusion

The risk of contracting certain disorders following a blood transfusion is currently becoming worrisome not only for physicians who are aware of this problem, but also for patients who, with increased media attention on AIDS, are more afraid of this potential risk than of the surgical or anesthetic risks. In fact, hepatitis constitute the major risk involved in homologous transfusion since some 60,000 cases are reported each year in France. Prevention of transmission of disease by blood transfusion is based on decreasing homologous transfusions and especially by saving blood. Indeed, when surgery is planned, units of the patient's blood can be obtained in the weeks prior to it to be used during the operation or the immediate follow-up period. In case of emergency surgery, blood is collected preoperatively making it possible to obtain hemodilution during surgery and an autotransfusion if necessary at the conclusion of the procedure. Finally, there are methods to recover blood at the actual site of the surgical procedure.     

Effect of erythropoietin therapy in cardiac surgery using autologous blood transfusion

Autologous blood transfusion in cardiac surgery is currently widely practiced to avoid homologous blood transfusion. To assess the benefit of recombinant human erythropoietin (rhEPO), the authors studied 72 patients (53 men, 19 women) who underwent elective cardiac surgery over a 15-month period and agreed to this protocol. Of these, 47 had coronary artery bypass grafting, 19 had valve replacement, and 6 had other procedures. Each patient was scheduled to preserve more than 800 mL of autologous blood preoperatively. They received rhEPO (100 to 40 U/kg) IV 3 times weekly during a 2 to 3-week preoperative period. During surgery, an autotransfusion system was also applied. During the preoperative period, 49 patients (68.1%) increased their hemoglobin by more than 1.0 g/dL, and 66 patients (91.7%) had their operation without homologous blood transfusion. This is a significantly high incidence compared with the group who had neither preoperative preservation nor rhEPO (55 of 109 patients; 50.5%). The authors conclude that rhEPO is effective in preserving autologous blood safely before elective surgery, and most elective cardiac surgery can be done without homologous blood transfusion by preoperatively preserving autologous blood with the aid of rhEPO and employing intraoperative autotransfusion.     

Hepatitis GB virus C genome in the serum of aplastic anaemia patients receiving frequent blood transfusions

GB virus C (GBV-C) RNA was detected in five of 18 patients with aplastic anaemia who had received blood transfusions, whereas it was not detected in eight patients who had not received any transfusions. Antibody against hepatitis C virus (anti-HCV) was detected in nine patients in the transfusion group, compared with one of eight who had not received any transfusions. Therefore, the route of transmission of both GBV-C and HCV in these patients appeared to have been multiple blood transfusion. Since all of the GBV-C RNA-positive patients harboured anti-HCV, GBV-C seems to frequently superinfect with HCV. Neither GBV-C nor HCV is likely to have been a causative agent of the anaemia in the cases examined.     

心脏介入术并发急性心包填塞的临床分析

【】 目的 总结心脏介入术中并发急性心包填塞的防治体会。方法 回顾性分析6例心脏介入术中发生急性心包填塞患者的发病特点、发生原因及处理措施。结果 二尖瓣球囊扩张术(PBMV)中1例为房间隔穿刺位置过高致右心房穿孔而发生急性心包填塞,经紧急心外科手术救治成功,1例为送入穿刺鞘致心房穿孔所致,超声引导下心包穿刺置管引流48h后痊愈;冠状动脉介入治疗术(PCI)中1例为反复推送导丝穿破高度狭窄钙化的左前降支所致, 经紧急心外科手术救治成功,1例为急性前壁心肌梗死PCI时发生,经对症治疗及置管引流48小时后痊愈;射频消融术(RFCA)中1例为放置左上肺静脉电极导管时不慎将左心耳穿破所致,行猪尾导管引流、输血、升压等措施后心包填塞症状缓解;心脏永久性起搏器植入术中1例为电极损伤冠状静脉所致,行超声下猪尾导管心包穿刺引流及输血等治疗后,病情稳定。结论：急性心包填塞是心脏介入术的严重并发症,积极预防、及时发现、果断处理是防治的关键措施。     

Does preoperative clopidogrel increase bleeding after coronary bypass surgery?

Antiplatelet therapy has been demonstrated to reduce the risk of cardiac events in patients presenting with acute coronary syndrome, yet all effective therapies also increase the risk of bleeding. This study aimed to test the hypothesis that patients undergoing coronary artery bypass grafting, who received clopidogrel within 5 days before surgery, have worse bleeding outcomes and blood transfusion requirements than those who stopped clopidogrel >5 days earlier. We recruited 342 patients who underwent on-pump elective coronary artery bypass grafting between January 2004 and December 2008. Of these, 191 stopped taking clopidogrel >5 days earlier, and 151 stopped ≤5 days before surgery. Postoperative drainage after 8 and 12 h and the total drainage were similar in both groups. There was no significant difference in the amount of blood products used. There was no reexploration in either group. It was concluded that preoperative clopidogrel exposure does not increase the risk of hemostatic reoperation or the requirements for blood and blood product transfusion during and after coronary artery bypass grafting.     

Evidence of prior hepatitis B and hepatitis A virus infections in an ambulatory geriatric population

Ninety-five randomly selected patients attending an ambulatory geriatric medical clinic were tested for the presence in their sera of hepatitis B surface antigen and of antibody to hepatitis B and A viruses. Such evidence of past hepatitis infection was correlated with current liver function and history of having received blood transfusions. The results showed that 94% of patients had antibody to hepatitis A virus, and 32% had antibody to hepatitis B virus. Patients with abnormal liver function tests, or those with a history of blood transfusions were no more likely to have hepatitis B antibody than patients with normal liver function tests or those with no history of transfusion.     

Blood management and radical retropubic prostatectomy: Quebec experience

One of the concerns of patients undergoing radical retropubic prostatectomy (RRP) is the risk of intraoperative bleeding and the subsequent need of blood products. Patients can presently consider pre-operative autologuous blood donation (PAD) prior to elective urological oncology surgery to decrease the risk of allogenic transfusion. We reviewed the medical charts of 141 patients that had a RRP in the CHUQ-Pavillon H?tel-Dieu de Québec in 1996 for prostate cancer. The average and median blood loss were respectively 804 cc and 650 cc, but more than 75% of patients lost less than 1,000 ml. Allogeneic transfusion was required in 11 (7.8%) patients. PAD was done in 45.4 %. The clinical characteristics of patients with PAD were similar to the patients who did not bank blood. The need for allogeneic transfusion was reduced to 3% (2/64) in the patients with PAD compared to 11.7% for the 77 patients without PAD. The average blood loss was higher in the 11 patients that received allogenic blood (1641 cc vs 734 cc, p < 0.01), but their average preoperative Hb was lower (127.9 vs 141.9, p < 0.01). These results suggest that there may be other effective methods in preventing the need for allogenic blood transfusion in RRP.     

Feasibility of a Predeposit Autologous Blood Donation Program in Colorectal Cancer Patients: Results from a Randomized Clinical Study

The hematologic and transfusion data of a multicenter randomized trial investigating the effect of blood transfusions on the 5-year survival were used to study the feasibility of an autologous blood donation program in colorectal cancer patients. Three hundred and ten patients were randomized for autologous blood transfusions (predeposition of 2 units) or homologous blood transfusions, and transfusion rules were standardized. The Hb level in the patients who donated blood decreased by 20.1 +/- 1.3 g/l (mean +/- SEM) preoperatively and 4.5 +/- 1.8 g/l postoperatively, and in controls 3.7 +/- 1.1 g/l and 16.5 +/- 1.9 g/l (significantly different between the two groups, both pre- and postoperatively: p less than 0.01). Because blood loss and number of transfusions were similar in both groups, this indicated that either preoperative or postoperative erythropoiesis is stronger in patients who had donated blood. Twenty-three percent of the autologous patients and 61% of the homologous patients were exposed to homologous blood. The effectiveness of the procedure differed per tumor localization. In patients with a right-sided colon carcinoma, 22% of the control patients needed homologous blood, compared to 10% of the autologous patients. In patients with other colon carcinomas, this was 52 and 16%, respectively, and in patients with a rectal carcinoma 85 and 41%. We conclude that predeposition of 2 units of blood for colorectal cancer surgery is feasible and useful to prevent homologous blood usage in a significant number of patients with left colon carcinoma or rectal carcinoma.     

Prospective controlled study of posttransfusion hepatitis after cardiac surgery in a large referral hospital in India

ABSTRACT— We studied the risk of post-transfusion hepatitis (PTH) in recipients of blood collected from voluntary donors screened for HBsAg. Two hundred and fifty patients without any previous history of liver disease or transfusion were followed up for 12 months subsequent to cardiac surgery. Thirty-five of them had closed-heart surgery without receiving transfusion and served as controls. The remaining 215 patients received single-point transfusions (mean 4 ± 2.4 units). None of the controls and 15 (6.9%) blood recipients developed PTH. Three (20%) patients had hepatitis-B-virus-induced hepatitis while the remainder (80%) had non A, non B (NANB) hepatitis. The number of units of blood transfused and surrogate markers for development of PTH (donor alanine aminotransferase, anti-HBc and anti-HBs antibody) were not associated with the occurrence of PTH (p>0.05). Nine (60%) of the 15 patients developing PTH were asymptomatic. All the patients recovered from the PTH, except one who died of fulminant hepatitis. At the end of 1 year of follow-up, none of the patients had evidence of chronic hepatitis. Only three (25%) of the patients with NANB-PTH developed anti-hepatitis C virus (HCV) antibody during the follow-up. We conclude that the incidence of PTH in India is similar to other parts of the world and NANB virus was the major cause of the PTH. The absence of chronicity and lack of seroconversion to anti-HCV antibody in the majority of the patients after 1 year of follow-up may suggest the possibility of a NANB virus other than HCV as the major cause of PTH in India.     

心脏瓣膜手术患者围手术期用血情况分析

目的:分析心脏瓣膜手术患者围手术期临床用血情况和影响因素,为心外科手术合理备血、用血提供参考依据。方法:回顾性调查2017年,在本院行心脏瓣膜手术患者的临床病历资料。分析成分血的使用情况以及对影响输血的相关因素,如:性别、年龄、血型、BMI、体外循环时间、手术方式、住院天数等进行统计分析。结果:通过对心脏瓣膜手术患者在围手术期的输血情况分析,结果显示:不同血型、BMI、体外循环时间与平均输血量比较,差异无统计学意义(P>0.05);平均输血量与性别、年龄有显著相关性(P<0.05),女性患者输注量多于男性患者,60岁以上老人平均输血量大。结论:性别、年龄与平均输血量有显著相关性,我们应掌握心脏瓣膜病围手术期输血的特点和规律,为临床手术合理备血、围手术期合理用血提供理论依据,做到合理有效用血,在节约血液资源的同时,可以缩短住院周期,节省医疗费用。     

Erythropoietin in Jehova's witness heart surgery

The patients, reported here, needed open heart surgery, but religion obliged them to refuse blood transfusion. Three of the four patients suffered from obstructive coronary diseases and one from mitral valvular disease, prevalently stenosis. All of them refused blood transfusions. One of the three patients presented, was refused by an other Cardiovascular Surgery Center because of his low blood values (Haemoglobin 9.2--Haematocrit 26.7). All these patients had been treated with subcutaneous injection of epoetin alfa 10,000 U twice a week and ferrous sulphate 525 mg three time a day per os, for three weeks before operation. Haemoglobin, haematocrit and reticulocytes values were controlled in pre, postoperative and at discharge. With this treatment the authors found haemoglobin and haematocrit values so increased to allow surgery without blood transfusion during and in the post operative period.     

Advantages and limits of programmed autologous transfusion in cardiovascular surgery. Apropos of 524 patients]

Between October 1987 and July 1989, 544 patients, candidates for cardiovascular surgery, were included in a trial of programmed autologous autotransfusion. Five hundred and twenty four patients underwent one or several (maximum 4) blood donation sessions in the 3 weeks before surgery with no complications. Overall, 57% of patients benefited from homologous blood transfusion, thereby avoiding all risk of contamination. It was in the group of patients able to undergo 3 or 4 preoperative blood donations that we observed the smallest number of homologous transfusions (30%). Programmed autologous transfusion would seem to be a very useful technique for cardiac surgery, allowing a reduction in health care costs without additional patient risk. In order to improve on this method, it may be useful to associate a peroperative technique of blood recuperation in patients in whom the transfusion needs are likely to exceed the possibilities of preoperative blood donation alone.     

Transfusion and the risk of hepatitis

Hepatitis is an inevitable risk of blood transfusion. Data concerning the frequency of the disease much deviate from each other, conditioned by epidemiological and clinico-diagnostic differences. From 1979 to 1981 in 273,476 transfusions in the counties of Magdeburg and Erfurt altogether 57 diseases of hepatitis were recognized by the organs of hygiene, which were in temporary connection (6 months) with transfusions. Thus the risk of hepatitis of notified diseases per transfusion unit was 0.02%. 6.1% of all hepatitic affection were in a temporary connection with transfusions, 7.6% were in a temporary connection (6 months) with hospitalization without transfusion. The necessity of repeated clinical examinations of the recipients of blood and blood preparations, the immediate duty of notification to the blood transfusion service when donors and recipients fall ill is emphasized. When individual donations are given the causality of transfusion and hepatitis is not to be proved. The use of the notion transfusion hepatitis which is to be proved by tradition, nowadays, however, done too inconsiderately deviates from other chains of infection and necessary measures.     

Patients' perceptions of blood transfusion risks in Karachi, Pakistan.

OBJECTIVE: To evaluate the understanding of and attitudes toward risks of blood transfusions among transfusion recipients in Karachi. METHODS: One hundred forty-one transfusion recipients from 13 major Karachi hospitals were interviewed. Indications for transfusion were obtained by reviewing the patients' medical records. RESULTS: The most common indications for transfusion were surgical complications (n = 77, 55%), anemia (n = 34, 24%), and generalized weakness (n = 15, 11%). Most recipients (n = 103, 80%) had never heard of viral hepatitis, and 44 (31%) had never heard of acquired immunodeficiency syndrome (AIDS). Ninety-four recipients (66%) believed that generalized weakness was a valid indication for blood transfusion. Sixty-nine recipients (49%) were not willing to pay an increased price for blood that was screened for blood-borne pathogens. CONCLUSIONS: Blood recipients in Karachi are unaware of the risks of transfusions, and the reasons given by the ordering physician for many of the transfusions were not consistent with international guidelines. Steps to educate the public about the risks of transfusions and practitioners about the indications for transfusion could prevent blood-borne virus transmission in Karachi.     

Frozen Blood and Transfusion-Transmitted Hepatitis C Virus

The purpose of the present study was to evaluate the impact of frozen red cell transfusion on the transmission of hepatitis C virus (HCV) before the introduction of blood donor screening. Anti-HCV antibodies were detected in 59 patients with sickle-cell disease who required chronic transfusions and had exclusively received frozen red blood cells (RBC). The files were reviewed for clinical signs of chronic hepatitis C. Anti-HCV antibodies were detected in 2 adult patients; both also had clinical evidence of HCV infection. No other patient showed signs of acute or chronic HCV hepatitis. In a control group of 28 patients who had received nonfrozen RBC transfusions, the prevalence of anti-HCV antibodies was 25%. So, our study seems to indicate that the use of frozen RBC had reduced the risk of HCV contamination.     

Preoperative autologous blood donation for cardiac surgery in children

Preoperative autologous blood donation has been shown to reduce homologous blood transfusion in cardiac operations, but there have been few reports of its use in children. Of 50 children aged 6 months to 5 years (weight, 6.1-14.8 kg) undergoing primary cardiac surgery for simple anomalies, 23 donated autologous blood before surgery, the other 27 were age and weight-matched controls. Two donations of 10 mL x kg(-1) each were collected via the femoral vein under mild general anesthesia 12 +/- 5 and 19 +/- 7 days preoperatively. No complications related to autologous blood collection were observed. Homologous blood use was significantly less in the group given autologous blood (4.3%) compared to the control group (44.4%). There was no significant difference in hemoglobin levels between groups before, during or after the operation. Preoperative autologous blood donation appears to be safe and effective in reducing homologous transfusions, even in children weighing less than 15 kg.     

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。     

The effect of preoperative blood transfusion on morbidity and survival in colorectal malignancy.

BACKGROUND/AIMS: It is believed that blood transfusions adversely affect colorectal cancer surgery. However, intra- and postoperative blood transfusions represent urgent interventions, and immeasurable confounding factors may affect the shortand long-term outcome. Therefore, we compared colorectal cancer patients who had received preoperative blood transfusion with patients who did not receive transfusions with regard to postoperative complications and long-term outcome. METHODS: The records of 333 patients who were operated for colorectal malignancy between 1980 and 1995 were evaluated. RESULTS: Sixty-one patients (18.3%) received preoperative blood transfusions. Wound infection rate was higher (14.2% vs 1.9%) in the no-transfusion group. Disease-free survival was not different between the groups (p=0.134). Cumulative survival was adversely affected in the preoperative transfusion group (p=0.012). However, preoperative blood transfusion did not emerge to be an independent factor for wound infection or for death on follow-up when the confounding factors were corrected. CONCLUSION: Preoperative transfusion during surgery for colorectal malignancy does not result in an increase in postoperative complications, long-term failure or death rates.     

Prospective controlled study of post-transfusion hepatitis after cardiac surgery in a large referral hospital in India.

We studied the risk of post-transfusion hepatitis (PTH) in recipients of blood collected from voluntary donors screened for HBsAg. Two hundred and fifty patients without any previous history of liver disease or transfusion were followed up for 12 months subsequent to cardiac surgery. Thirty-five of them had closed-heart surgery without receiving transfusion and served as controls. The remaining 215 patients received single-point transfusions (mean 4 +/- 2.4 units). None of the controls and 15 (6.9%) blood recipients developed PTH. Three (20%) patients had hepatitis-B-virus-induced hepatitis while the remainder (80%) had non A, non B (NANB) hepatitis. The number of units of blood transfused and surrogate markers for development of PTH (donor alanine aminotransferase, anti-HBc and anti-HBs antibody) were not associated with the occurrence of PTH (p greater than 0.05). Nine (60%) of the 15 patients developing PTH were asymptomatic. All the patients recovered from the PTH, except one who died of fulminant hepatitis. At the end of 1 year of follow-up, none of the patients had evidence of chronic hepatitis. Only three (25%) of the patients with NANB-PTH developed anti-hepatitis C virus (HCV) antibody during the follow-up. We conclude that the incidence of PTH in India is similar to other parts of the world and NANB virus was the major cause of the PTH. The absence of chronicity and lack of seroconversion to anti-HCV antibody in the majority of the patients after 1 year of follow-up may suggest the possibility of a NANB virus other than HCV as the major cause of PTH in India.