1
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Melnyk V, Xu W, Ryan JP, Karim HT, Chan EG, Mahajan A, Subramaniam K. Utilization of machine learning to model the effect of blood product transfusion on short-term lung transplant outcomes. Clin Transplant 2023:e14961. [PMID: 36912861 DOI: 10.1111/ctr.14961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 11/29/2022] [Accepted: 03/01/2023] [Indexed: 03/14/2023]
Abstract
The objective of this study was to identify the relationship between blood product transfusion and short-term morbidity and mortality following lung transplantation utilizing machine learning. Preoperative recipient characterstics, procedural variables, perioperative blood product transfusions, and donor charactersitics were included in the model. The primary composite outcome was occurrence on any of the following six endpoints: mortality during index hospitalization; primary graft dysfunction at 72 h post-transplant or the need for postoperative circulatory support; neurological complications (seizure, stroke, or major encephalopathy); perioperative acute coronary syndrome or cardiac arrest; and renal dysfunction requiring renal replacement therapy. The cohort included 369 patients, with the composite outcome occurring in 125 cases (33.9%). Elastic net regression analysis identified 11 significant predictors of composite morbidity: higher packed red blood cell, platelet, cryoprecipitate and plasma volume from the critical period, preoperative functional dependence, any preoperative blood transfusion, VV ECMO bridge to transplant, and antifibrinolytic therapy were associated with higher risk of morbidity. Preoperative steroids, taller height, and primary chest closure were protective against composite morbidity.
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Affiliation(s)
- Vladyslav Melnyk
- Department of Anesthesiology, University of Alberta - Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Wen Xu
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - John P Ryan
- Division of Lung Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ernest G Chan
- Division of Lung Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Aman Mahajan
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kathirvel Subramaniam
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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2
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Massive intraoperative red blood cell transfusion during lung transplantation is strongly associated with 90-day mortality. Anaesth Crit Care Pain Med 2022; 41:101118. [DOI: 10.1016/j.accpm.2022.101118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/30/2022] [Accepted: 04/24/2022] [Indexed: 11/23/2022]
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3
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Loor G, Mattar A, Schaheen L, Bremner RM. Surgical Complications of Lung Transplantation. Thorac Surg Clin 2022; 32:197-209. [PMID: 35512938 DOI: 10.1016/j.thorsurg.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lung transplantation is a life-saving intervention and the most effective therapy for select patients with irreversible lung disease. Despite the effectiveness of lung transplantation, it is a major operation with several opportunities for complications. For example, recipient and donor factors, technical issues, early postoperative events, and immunology can all contribute to potential complications. This article highlights some of the key surgery-related complications that can undermine a successful lung transplantation. The authors offer their expert opinion and experience to help practitioners avoid such complications and recognize and treat them early should they occur.
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Affiliation(s)
- Gabriel Loor
- Department of Surgery and Baylor Lung Institute, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX 77030, USA; Division of Cardiothoracic Transplantation and Circulatory Support, Texas Heart Institute, 6720 Bertner Avenue Suite C355K, Houston, TX 77030, USA.
| | - Aladdein Mattar
- Department of Surgery and Baylor Lung Institute, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston, TX 77030, USA
| | - Lara Schaheen
- Norton Thoracic Institute, St. Joseph's Medical Center, 500 W Thomas Rd Ste 500, Phoenix, AZ 85013, USA; Creighton University School of Medicine-Phoenix Regional Campus, 350 W. Thomas Rd, Phoenix, AZ 85013, USA
| | - Ross M Bremner
- Norton Thoracic Institute, St. Joseph's Medical Center, 500 W Thomas Rd Ste 500, Phoenix, AZ 85013, USA; Creighton University School of Medicine-Phoenix Regional Campus, 350 W. Thomas Rd, Phoenix, AZ 85013, USA
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4
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Fernandez-Trujillo L, Sanabria F, Bautista DF, Velazquez M, Cujiño I, Tafur E, Arboleda D, Zuñiga-Restrepo V, Martinez W. First Lung Transplantation in Jehovah's Witness Patient in Latin America. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2020; 13:1179547620940737. [PMID: 32733126 PMCID: PMC7370336 DOI: 10.1177/1179547620940737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/28/2020] [Indexed: 11/17/2022]
Abstract
Lung transplantation is a life-saving alternative for patients with end-stage lung disease. The procedure itself has a high risk of bleeding. Jehovah’s Witness patients refuse to accept blood products due to religious beliefs. A 48-year-old Jehovah’s Witness woman presented with an 8-year history of cough, dyspnea along with progressive worsening of her functional class and quality of life. A diagnosis of autoimmune interstitial lung disease was made, for which cyclophosphamide was administered without improvement of symptoms, and the patient was accepted as a transplant candidate. Transplantation was performed without complications, nor blood products requirement, intraoperative cell salvage was performed, and pharmacological agents were used preoperatively for bleeding prevention. The patient only developed anemia after administration of immunosuppressor therapy, which was treated with erythropoietin in the outpatient setting.
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Affiliation(s)
- Liliana Fernandez-Trujillo
- Department of Internal Medicine, Pulmonology Service, Interventional Pulmonology, Fundación Valle del Lili, Cali, Colombia.,Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Fernando Sanabria
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Department of Internal Medicine, Pulmonology Service, Fundación Valle del Lili, Cali, Colombia
| | - Diego F Bautista
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Department of Critical Care Medicine, Fundación Valle del Lili, Cali, Colombia
| | - Mauricio Velazquez
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Department of Surgery, Thoracic Surgery Service, Fundación Valle del Lili, Cali, Colombia
| | - Indira Cujiño
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Department of Anesthesiology, Fundación Valle del Lili, Cali, Colombia
| | - Eric Tafur
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Daniel Arboleda
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | | | - Willian Martinez
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Department of Internal Medicine, Pulmonology Service, Fundación Valle del Lili, Cali, Colombia
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Seay T, Guinn N, Maisonave Y, Fuller M, Poisson J, Pollak A, Bryner B, Haney J, Klapper J, Hartwig M, Bottiger B. The Association of Increased FFP:RBC Transfusion Ratio to Primary Graft Dysfunction in Bleeding Lung Transplantation Patients. J Cardiothorac Vasc Anesth 2020; 34:3024-3032. [PMID: 32622711 DOI: 10.1053/j.jvca.2020.05.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/17/2020] [Accepted: 05/29/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Lung transplantation is associated with a significant risk of needed transfusion. Although algorithm-based transfusion strategies that promote a high fresh frozen plasma:red blood cells (FFP:RBC) ratio have reduced overall blood product requirements in other populations, large-volume transfusions have been linked to primary graft dysfunction (PGD) in lung transplantation, particularly use of platelets and plasma. The authors hypothesized that in lung transplant recipients requiring large-volume transfusions, a higher FFP:RBC ratio would be associated with increased PGD severity at 72 hours. DESIGN Observational retrospective review. SETTING Single tertiary academic center. PARTICIPANTS Adult patients undergoing bilateral or single orthotopic lung transplantation and receiving >4 U PRBC in the first 72 hours from February 2014 to March 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patient demographics, operative characteristics, blood transfusions, and outcomes including PGD scores and length of stay were collected. Eighty-nine patients received >4U PRBC, had available 72-hour PGD data, and were included in the study. These patients were grouped into a high-ratio (>1:2 units of FFP:RBC, N = 38) or low-ratio group (<1:2 units of FFP:RBC, N = 51). Patients in the high-ratio group received more transfusions and factor concentrates and had significantly longer case length. The high-ratio group had a higher rate of severe PGD at 72 hours (60.5% v 23.5%, p = 0.0013) and longer hospital length of stay (40 v 32 days, p = 0.0273). CONCLUSIONS In bleeding lung transplantation patients at high risk for PGD, a high FFP:RBC transfusion ratio was associated with worsened 72-hour PGD scores when compared with the low-ratio cohort.
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Affiliation(s)
- Theresa Seay
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
| | - Nicole Guinn
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Yasmin Maisonave
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Matt Fuller
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Jessica Poisson
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Angela Pollak
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Ben Bryner
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - John Haney
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Jacob Klapper
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Matthew Hartwig
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Brandi Bottiger
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC
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Adelmann D, Koch S, Menger J, Opfermann P, Jaksch P, Hoetzenecker K, Kurz M, Mouhieddine M, Steinlechner B. Risk factors for early bleeding complications after lung transplantation – a retrospective cohort study. Transpl Int 2019; 32:1313-1321. [DOI: 10.1111/tri.13491] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/19/2019] [Accepted: 08/07/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Dieter Adelmann
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine Department of Anesthesia, Intensive Care Medicine and Pain Medicine Medical University of Vienna Wien Austria
- Department of Anesthesia and Perioperative Care University of California San Francisco CA USA
| | - Stefan Koch
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine Department of Anesthesia, Intensive Care Medicine and Pain Medicine Medical University of Vienna Wien Austria
| | - Johannes Menger
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine Department of Anesthesia, Intensive Care Medicine and Pain Medicine Medical University of Vienna Wien Austria
| | - Philipp Opfermann
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine Department of Anesthesia, Intensive Care Medicine and Pain Medicine Medical University of Vienna Wien Austria
| | - Peter Jaksch
- Division of Thoracic Surgery Department of Surgery Medical University of Vienna Wien Austria
| | - Konrad Hoetzenecker
- Division of Thoracic Surgery Department of Surgery Medical University of Vienna Wien Austria
| | - Martin Kurz
- Department of Blood Group Serology and Transfusion Medicine Medical University of Vienna Wien Austria
| | - Mohammed Mouhieddine
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine Department of Anesthesia, Intensive Care Medicine and Pain Medicine Medical University of Vienna Wien Austria
| | - Barbara Steinlechner
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine Department of Anesthesia, Intensive Care Medicine and Pain Medicine Medical University of Vienna Wien Austria
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7
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Pena JJ, Bottiger BA, Miltiades AN. Perioperative Management of Bleeding and Transfusion for Lung Transplantation. Semin Cardiothorac Vasc Anesth 2019; 24:74-83. [DOI: 10.1177/1089253219869030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Perioperative allogeneic blood product transfusion is common in lung transplantation and has various implications on the short- and long-term outcomes of lung recipients. This review summarizes the effect of transfusion on outcomes including primary graft dysfunction, chronic lung allograft dysfunction, and all-cause mortality. We outline known risk factors for increased transfusion requirement in lung transplantation and present current evidence regarding the effect of hemostatic agents including antifibrinolytics, recombinant factor VII, and prothrombin complex concentrates. Finally, we highlight the roles of point-of-care coagulation testing and goal-directed transfusion strategies in reducing transfusion requirements in lung transplantation.
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8
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Cernak V, Oude Lansink-Hartgring A, van den Heuvel ER, Verschuuren EAM, van der Bij W, Scheeren TWL, Engels GE, de Geus AF, Erasmus ME, de Vries AJ. Incidence of Massive Transfusion and Overall Transfusion Requirements During Lung Transplantation Over a 25-Year Period. J Cardiothorac Vasc Anesth 2019; 33:2478-2486. [PMID: 31147209 DOI: 10.1053/j.jvca.2019.03.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/12/2019] [Accepted: 03/26/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To establish the incidence of massive transfusion and overall transfusion requirements during lung transplantation, changes over time, and association with outcome in relation to patient complexity. DESIGN Retrospective cohort study. SETTING University hospital. PARTICIPANTS All 514 adult patients who underwent transplantation from 1990 until 2015. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patient records and transfusion data, divided into 5-year intervals, were analyzed. The incidence of massive transfusion (>10 units of red blood cells [RBCs] in 24 h) was 27% and did not change over time, whereas the median (interquartile range) transfusion requirement in the whole cohort decreased from 8 (5-12) to 3 (0-10) RBCs (p < 0.001). In patients transplanted from the intensive care unit, the incidence of massive transfusion increased over time from 25% to 54% (p = 0.04) and median transfusion requirements from 4.5 (3-8.5) units to 14.5 (5-26) units of RBCs (p = 0.03). Multivariable analysis showed that circulatory support, pulmonary hypertension, re-transplantation, cystic fibrosis, Eisenmenger syndrome, bilateral transplantation, and low body mass index were associated with massive transfusion. Patients with massive transfusion had more primary graft dysfunction grade III at 0, 24, 48, and 72 hours (p < 0.001), higher 30-day mortality (13% v 4%; p < 0.001), and lower 5-year survival (hazard ratio 3.67 [95% confidence interval 1.72-7.85]; p < 0.001). CONCLUSION The incidence of massive transfusion did not change over time, whereas transfusion requirements in the whole cohort decreased. In patients transplanted from the intensive care unit, massive transfusion and transfusion requirements increased. Massive transfusion was associated with poor outcome.
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Affiliation(s)
- Vladimir Cernak
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | | | - Edwin R van den Heuvel
- Department of Mathematics and Computer Science, Technical University Eindhoven, Eindhoven, The Netherlands
| | - Erik A M Verschuuren
- Department of Pulmonary Diseases and Lung Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wim van der Bij
- Department of Pulmonary Diseases and Lung Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas W L Scheeren
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Arian F de Geus
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel E Erasmus
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrianus J de Vries
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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9
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Oechslin P, Zalunardo MP, Inci I, Schlaepfer M, Grande B. Established and potential predictors of blood loss during lung transplant surgery. J Thorac Dis 2018; 10:3845-3848. [PMID: 30069385 DOI: 10.21037/jtd.2018.05.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lung transplantation is an established therapeutic procedure for end stage lung diseases. Its success may be impaired by perioperative complications. Intraoperative blood loss and the resulting blood transfusion are among the most common complications. The various factors contributing to increased blood loss during lung transplantation are only scarcely investigated and not yet completely understood. This is in sharp contrast to other surgical fields, as in orthopedic surgery, liver transplantation and cardiac surgery the contributors to blood loss are well identified. This narrative review article aims to highlight the acknowledged factors influencing blood loss in lung transplantation (such as double vs. single lung transplant) and to discuss potential factors that may be of interest for further research or helpful to develop strategies targeting risk factors in order to minimize blood loss during lung transplantation and finally improve patient outcome.
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Affiliation(s)
- Pascal Oechslin
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Marco P Zalunardo
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Ilhan Inci
- Departement of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Martin Schlaepfer
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Bastian Grande
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.,Simulation Center, University Hospital Zurich, Zurich, Switzerland
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10
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Extracorporeal Circulation During Lung Transplantation Procedures: A Meta-Analysis. ASAIO J 2018; 63:551-561. [PMID: 28257296 DOI: 10.1097/mat.0000000000000549] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Extracorporeal circulation (ECC) is an invaluable tool in lung transplantation (lutx). More than the past years, an increasing number of centers changed their standard for intraoperative ECC from cardiopulmonary bypass (CPB) to extracorporeal membrane oxygenation (ECMO) - with differing results. This meta-analysis reviews the existing evidence. An online literature research on Medline, Embase, and PubMed has been performed. Two persons independently judged the papers using the ACROBAT-NRSI tool of the Cochrane collaboration. Meta-analyses and meta-regressions were used to determine whether veno-arterial ECMO (VA-ECMO) resulted in better outcomes compared with CPB. Six papers - all observational studies without randomization - were included in the analysis. All were considered to have serious bias caused by heparinization as co-intervention. Forest plots showed a beneficial trend of ECMO regarding blood transfusions (packed red blood cells (RBCs) with an average mean difference of -0.46 units [95% CI = -3.72, 2.80], fresh-frozen plasma with an average mean difference of -0.65 units [95% CI = -1.56, 0.25], platelets with an average mean difference of -1.72 units [95% CI = -3.67, 0.23]). Duration of ventilator support with an average mean difference of -2.86 days [95% CI = -11.43, 5.71] and intensive care unit (ICU) length of stay with an average mean difference of -4.79 days [95% CI = -8.17, -1.41] were shorter in ECMO patients. Extracorporeal membrane oxygenation treatment tended to be superior regarding 3 month mortality (odds ratio = 0.46, 95% CI = 0.21-1.02) and 1 year mortality (odds ratio = 0.65, 95% CI = 0.37-1.13). However, only the ICU length of stay reached statistical significance. Meta-regression analyses showed that heterogeneity across studies (sex, year of ECMO implementation, and underlying disease) influenced differences. These data indicate a benefit of the intraoperative use of ECMO as compared with CPB during lung transplant procedures regarding short-term outcome (ICU stay). There was no statistically significant effect regarding blood transfusion needs or long-term outcome. The superiority of ECMO in lutx patients remains to be determined in larger multi-center randomized trials.
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11
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Raval JS, Gorantla VS, Shores JT, Lee WPA, Planinsic RM, Rollins-Raval MA, Brandacher G, King KE, Losee JE, Kiss JE. Blood product utilization in human upper-extremity transplantation: challenges, complications, considerations, and transfusion protocol conception. Transfusion 2017; 57:606-612. [PMID: 28297082 DOI: 10.1111/trf.14009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 11/06/2016] [Accepted: 11/06/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Upper-extremity transplantation (UET) is a reality. Immunologic, functional, and graft survival outcomes have been encouraging. However, these complex reconstructions have unique considerations that pose distinct challenges. Transplant programs have reported morbidity and mortality due to significant intraoperative blood losses, but similar data are scant during other phases of recovery. We report experience from two centers on complete blood component demands and utilization with UET. STUDY DESIGN AND METHODS Inpatient medical records of UET recipients from intraoperative (time from initiation of transplant surgery to exit from the operative suite) and postoperative (exit from the operative suite to discharge from the hospital) phases were retrospectively reviewed. RESULTS Six patients received various UETs and mean (±SD) postoperative hospital stay was 46 (±14.4) days. Mean (±SD) intraoperative blood unit utilization was 14.8 (±10.2) red blood cells (RBCs), 10.5 (±11.8) plasma, 0.8 (±1.2) platelets (PLTs), and 0.3 (±0.8) cryoprecipitate units. Mean postoperative blood unit utilization was 9.3 (±10.4) RBCs, 5.3 (±6.7) plasma, 1.2 (±2.0) PLTs, and 0.7 (±1.6) cryoprecipitate units. Both intraoperative and postoperative blood utilization for unilateral versus bilateral transplant were different, but not significantly so. However, total inpatient blood use in bilateral transplants was significantly greater than in unilateral transplants. CONCLUSION Substantial blood loss may occur in UET and require transfusion of many blood components, primarily RBCs and plasma. We propose an UET transfusion protocol and suggest that centers preparing to perform these transplants should actively engage the transfusion medicine service to ensure availability and access to appropriate blood components for the entire hospitalizations of these unique patients.
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Affiliation(s)
- Jay S Raval
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Vijay S Gorantla
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jaimie T Shores
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - W P Andrew Lee
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Raymond M Planinsic
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marian A Rollins-Raval
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Karen E King
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Joseph E Losee
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joseph E Kiss
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
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12
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Ong LP, Sachdeva A, Ramesh BC, Muse H, Wallace K, Parry G, Clark SC. Lung Transplant With Cardiopulmonary Bypass: Impact of Blood Transfusion on Rejection, Function, and Late Mortality. Ann Thorac Surg 2016; 101:512-9. [DOI: 10.1016/j.athoracsur.2015.07.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 07/16/2015] [Accepted: 07/20/2015] [Indexed: 11/29/2022]
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13
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Ong LP, Thompson E, Sachdeva A, Ramesh B, Muse H, Wallace K, Parry G, Clark SC. Allogeneic blood transfusion in bilateral lung transplantation: impact on early function and mortality. Eur J Cardiothorac Surg 2015; 49:668-74; discussion 674. [DOI: 10.1093/ejcts/ezv155] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/12/2015] [Indexed: 01/09/2023] Open
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Yamashita M, Miyata S, Takeuchi S, Inoue H. Separation method of blood constituents using dielectrophoresis and flow-induced shear force. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:4462-5. [PMID: 24110724 DOI: 10.1109/embc.2013.6610537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Platelet Rich Plasma (PRP) contains many cytokines for treatment skin diseases. The final goal of this study is to develop the dielectrophoretic PRP purification system enriching the platelets in a label-free manner from whole blood solution. In this study, we characterized dielectrophoretic properties of red blood cell, white blood cell, and platelet for the fundamental study. Moreover, purification of PRP was performed to eliminate red and white blood cells using dielectrophoretic and flow-induced shear force.
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15
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Burdett C, Butt T, Lordan J, Dark JH, Clark SC. Comparison of single lung transplant with and without the use of cardiopulmonary bypass. Interact Cardiovasc Thorac Surg 2012; 15:432-6; discussion 436. [PMID: 22714587 DOI: 10.1093/icvts/ivs264] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Many centres avoid using cardiopulmonary bypass (CPB) for lung transplant due to concerns over aggravated lung reperfusion injury and excessive blood loss. We reviewed our 23-years' experience of single lung transplantation. METHODS A retrospective review of single lung transplants at our institution (1987-2010), examining differences in allograft function and postoperative complications between CPB and non-bypass (non-CPB) cases. RESULTS Two hundred and fifty-nine single lung transplants were undertaken. Fifty-three (20.5%) with CPB. There was no difference demographically between the two groups. No difference existed in preoperative PO(2)/FiO(2). At 1 and 24 h, the postoperative PO(2)/FiO(2) ratio was no different (mean 2.95 and 3.24 in non-CPB cases; 3.53 and 3.75 in CPB patients, P = 0.18 and P = 0.34, respectively). Extubation time was not influenced by the use of CPB. Postoperative blood loss was greater in the CPB group. The usage of fresh frozen plasma and platelets was similar (P = 0.64 and 0.41, respectively). More blood was transfused during postoperative care of CPB patients (P = 0.02). CONCLUSIONS Fears of poor postoperative lung function after CPB appear unfounded. We could detect no difference in function or extubation time. Although the use of CPB increases postoperative bleeding and the need for transfusion, it may be used safely to facilitate lung transplantation.
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Triulzi DJ, Griffith BP. The above letter was sent to Drs. Triulzi and Griffith, who offer the following reply. Transfusion 2009. [DOI: 10.1111/j.1537-2995.1998.tb05650.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mason DP, Little SG, Nowicki ER, Batizy LH, Murthy SC, McNeill AM, Budev MM, Mehta AC, Pettersson GB, Blackstone EH. Temporal Pattern of Transfusion and Its Relation to Rejection After Lung Transplantation. J Heart Lung Transplant 2009; 28:558-63. [DOI: 10.1016/j.healun.2009.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 03/05/2009] [Accepted: 03/05/2009] [Indexed: 11/30/2022] Open
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Pommer MS, Zhang Y, Keerthi N, Chen D, Thomson JA, Meinhart CD, Soh HT. Dielectrophoretic separation of platelets from diluted whole blood in microfluidic channels. Electrophoresis 2008; 29:1213-8. [DOI: 10.1002/elps.200700607] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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McDonald CP. Bacterial risk reduction by improved donor arm disinfection, diversion and bacterial screening. Transfus Med 2007; 16:381-96. [PMID: 17163869 DOI: 10.1111/j.1365-3148.2006.00697.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Interventions of improved donor arm disinfection, diversion and bacterial screening have been implemented by blood services and shown to have substantial benefit. The major source of bacterial contamination is donor arm derived. Blood services are now introducing best practice donor arm disinfection techniques. Diversion has been shown to substantially reduce bacterial contamination in the order of 40-88%. Diversion, together with improved donor arm disinfection, has shown to improve the percentage of reduction in contamination from 47% to 77%. Residual contamination levels after the Introduction of diversion and improved donor arm disinfection may be in the order of 30-40%. Numerous countries have now implemented screen testing programmes for platelet concentrates, which are the major source of bacterial transfusion transmission. Pathogen reduction systems have been developed and are under development. At present, concerns remain with these systems regarding cost, process control, ability to inactivate high titres of viruses, killing of bacterial spores, product damage, genotoxicity and mutagenicity. The interventions of diversion, improved donor arm disinfection and bacterial screen testing are currently available, As such they can be implemented now to increase blood safety with no associated patient risk.
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Affiliation(s)
- C P McDonald
- National Bacteriology Laboratory, National Blood Service, Colindale, London, UK.
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Platelet Storage and Transfusion. Platelets 2007. [DOI: 10.1016/b978-012369367-9/50831-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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22
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Dalibon N, Geffroy A, Moutafis M, Vinatier I, Bonnette P, Stern M, Loirat P, Bisson A, Fischler M. Use of cardiopulmonary bypass for lung transplantation: a 10-year experience. J Cardiothorac Vasc Anesth 2006; 20:668-72. [PMID: 17023286 DOI: 10.1053/j.jvca.2006.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The use of cardiopulmonary bypass (CPB) for lung transplantation (LTx) has been reported previously. This study reports the authors' experience of planned and unplanned use of cardiopulmonary bypass for LTx. DESIGN Case series. SETTING A university teaching hospital. PARTICIPANTS Patients undergoing LTx. INTERVENTIONS A retrospective analysis of the charts of all patients having undergone LTx over the last 10 years. MEASUREMENTS AND MAIN RESULTS Among 140 LTx, 23 (16%) were performed with the use of CPB. CPB was planned in 11 cases and unplanned in the 12 other cases. The use of CPB is associated with a longer period of postoperative mechanical ventilation, more pulmonary edema, more blood transfusion requirement, and an increase in postoperative mortality at 48 hours and 1 month. Surgical difficulties related to the dissection of the native left lung and acute right ventricular failure are the main reasons for unscheduled use of CPB. CONCLUSION Scheduled and unscheduled CPB for LTx are associated with an increased mortality at 1 month and 1 year.
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Affiliation(s)
- Nicolas Dalibon
- Department of Anesthesiology, Hôpital Foch, Suresnes, France
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Abstract
As solid organ transplantation becomes increasingly common and complex, the demands on the transfusion service expand. Transplant recipients present unique challenges not only because of product availability but also because of specialized blood components, serologic problems, and immunologic effects of transfusion on the allograft and the recipient. Solid organ transplant recipients receive immunosuppressive agents that make them more susceptible to infectious or immunologic complications of transfusion such as cytomegalovirus infection and graft-versus-host disease. Other immunologic consequences of transfusion such as alloimmunization may also be severe, resulting in acute or chronic graft rejection. The transfusion specialist must recommend the optimal approach to reducing the risk of these complications in organ transplant recipients.
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Affiliation(s)
- Darrell J Triulzi
- Department of Pathology, University of Pittsburgh, Pennsylvania, USA.
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de Boer WJ, Hepkema BG, Loef BG, van der Bij W, Verschuuren EAM, de Vries HJ, Lems SPM, Ebels T. Survival benefit of cardiopulmonary bypass support in bilateral lung transplantation for emphysema patients. Transplantation 2002; 73:1621-7. [PMID: 12042650 DOI: 10.1097/00007890-200205270-00017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study is designed to examine a possible association of cardiopulmonary bypass (CPB) support and outcome of lung transplantation in a well-balanced group of emphysema patients. METHODS We performed a retrospective analysis of 62 consecutive primary bilateral lung transplantations for emphysema. Risk factors for their possible association with patient survival were analyzed by multivariate logistic regression. RESULTS The use of CPB support was associated with improved survival (odds ratio=0.25; P=0.038). The actuarial survival at 1 year was 97% for patients treated with CPB and 77% for patients treated without CPB support. In 28 patients (45%), 2 human leukocyte antigen (HLA)-DR mismatches between donor and recipient occurred, whereas 34 patients had 0 or 1 HLA-DR mismatches. The use of CPB support in the group with two HLA-DR mismatches was associated with improved survival (odds ratio=0.06; P=0.020). This association was not present in the group with 0 or 1 HLA-DR mismatches. CONCLUSIONS These results demonstrate a significant survival benefit of CPB support during bilateral lung transplantation in emphysema patients. The difference in survival benefit of CPB support between the patients with 0 or 1 HLA-DR mismatches and the patients with 2 HLA-DR mismatches indicates that the immunosuppressive effect of CPB support might be responsible for this survival benefit. The underlying immunological mechanism might be important in the future treatment of organ transplantation.
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Affiliation(s)
- Willem J de Boer
- Department of Cardiothoracic Surgery, University Hospital Groningen, 9700 RB Groningen, The Netherlands. W.J.de.Boer@ thorax.azg.nl
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Depcik-Smith ND, Hay SN, Brecher ME. Bacterial contamination of blood products: factors, options, and insights. J Clin Apher 2002; 16:192-201. [PMID: 11835416 DOI: 10.1002/jca.10004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Transfusion of bacterially contaminated blood products remains an overlooked problem. However, the risk of receiving a bacterially contaminated unit is greater than the combined risk of HIV-1/2, HCV, HBV, and HTLV I/II [American Association of Blood Banks Bulletin, no. 294, 1996]. Topics covered in this article include: the current incidence, clinical presentation and outcome, effective methods of detection, and ways to reduce bacterial contamination of blood products. There is no one existing strategy that can completely eliminate the risk of bacterial contamination. It is inevitable that partial solutions or combinations of methods will be implemented in the near future.
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Affiliation(s)
- N D Depcik-Smith
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
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Titlestad K, Kristensen T, Jorgensen J, Georgsen J. Monitoring transfusion practice--a computerized procedure. Transfus Med 2002; 12:25-34. [PMID: 11967134 DOI: 10.1046/j.1365-3148.2002.00352.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As the description of transfusion practice over time requires the handling of massive amounts of data, and because the majority of records have until now been paper-based, little is known about the epidemiology of blood transfusion. Furthermore, most previous studies have collected data manually from patient records or from computerized registers created solely for study purposes. We describe a procedure for monitoring transfusion practices based exclusively upon the collection of data from the existing computerized registers. During the calendar years 1997 and 1998, more than 750 000 data records were collected from the blood transfusion registers, diagnosis and procedure registers, and clinical biochemistry registers at two university hospitals. Linking of the data required a unique and consistent identification of all data records. This was made possible by the national Personal Identification Number. In this way more than 98% of all transfusions could be identified and approximately 95% (77 950) could be connected to a principal diagnosis. The described procedure creates new opportunities for studies of transfusion practices both on a large scale and in richness of detail, and we propose to establish a network where transfusion practices data are available and comparable for individual departments, hospitals, whole regions, and possibly nations.
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Affiliation(s)
- K Titlestad
- Department of Clinical Immunology, Odense University Hospital, Denmark.
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Abstract
Transfusion-associated bacterial sepsis is a persistent problem in transfusion medicine, posing a greater threat than the combined risks of receiving a blood product contaminated with HIV-1 or 2, hepatitis C virus (HCV), hepatitis B virus (HBV), and human T-cell lymphtrophic virus (HTVL) -I or -II. This article provides a brief overview of the current incidence, clinical presentation, associated blood products and organisms, and the most feasible and effective methods available to reduce the potential risk of transfusion-associated sepsis. Because bacterial contamination of blood products is the most frequent cause of transfusion-transmitted infectious disease, and as no single existing strategy can completely eliminate its risk, it is important that clinical suspicion be high, and any partial solutions additively be implemented.
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Affiliation(s)
- F C Reading
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Ledent E, Semple JW, Berlin G. White Blood Cell Subsets in Buffy Coat-Derived Platelet Concentrates: The Effect of Pre- and Poststorage Filtration. Vox Sang 2000. [DOI: 10.1046/j.1423-0410.2000.7940235.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Roth VR, Arduino MJ, Nobiletti J, Holt SC, Carson LA, Wolf CF, Lenes BA, Allison PM, Jarvis WR. Transfusion-related sepsis due to Serratia liquefaciens in the United States. Transfusion 2000; 40:931-5. [PMID: 10960519 DOI: 10.1046/j.1537-2995.2000.40080931.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Severe, often fatal, transfusion reactions due to bacterial contamination of blood components continue to occur. Serratia liquefaciens, an unusual human pathogen, is a recently recognized potential cause of transfusion-related sepsis. CASE REPORTS Five episodes of transfusion-related sepsis and endotoxic shock due to S. liquefaciens were reported to the CDC from July 1992 through January 1999. One episode has been described. The remaining four, all fatal, are described here: three associated with RBC transfusion and one associated with transfusion of platelets. In each instance, the source of contamination could not be found. The implicated units tended to be older (mean RBC age 28 days), and visual discoloration was noted in each RBC unit, although usually in retrospect. CONCLUSION S. liquefaciens is an increasingly recognized cause of transfusion-related sepsis and is associated with a high mortality rate. S. liquefaciens can contaminate both RBCs and platelets, but the mechanism(s) of contamination remain unknown. Increased attention to pretransfusion visual inspection may avert the transfusion of some S. liquefaciens-contaminated RBC units. However, more sensitive rapid diagnostic tests are needed to further reduce the risk of transfusion-related sepsis and endotoxic shock.
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Affiliation(s)
- V R Roth
- Hospital Infections Program, CDC, Atlanta, Georgia 30333, USA.
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