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Putot A, Zeller M, Perrin S, Beer JC, Ravisy J, Guenancia C, Robert R, Manckoundia P, Cottin Y. Blood Transfusion in Elderly Patients with Acute Myocardial Infarction: Data from the RICO Survey. Am J Med 2018; 131:422-429.e4. [PMID: 29030059 DOI: 10.1016/j.amjmed.2017.09.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Red blood cell transfusion benefit during acute myocardial infarction remains unclear in the elderly. We aimed to assess the transfusion impact on 1-year mortality in acute myocardial infarction patients aged ≥65 years, according to their age and hemoglobin nadir. METHODS We included 3316 consecutive patients with acute myocardial infarction aged ≥65 years from the "obseRvatoire des Infarctus de Côte d'Or" (RICO) survey. They were categorized according to their hemoglobin nadir (≤8, >8 to ≤10, and >10 g/dL) and age (<80 or ≥80 years). RESULTS A total of 1906 patients (57%) were 65-79 years old, and 1410 (43%) were aged ≥80 years, of whom 103 (5%) and 145 (10%) patients received red blood cell transfusion, respectively (P < .001). In Cox regression analysis, transfusion was associated with increased 1-year mortality for hemoglobin nadir >10 g/dL but no significant effect for hemoglobin nadir between 8 and 10 g/dL. When hemoglobin nadir was ≤8 g/dL, transfusion did not influence 1-year mortality for younger patients (65-79 years). However, for older patients (≥80 years), transfusion was associated with lower mortality (hazard ratio 0.43 [95% confidence interval, 0.22-0.86], P = .016). CONCLUSION Among older patients with acute myocardial infarction, the effect of transfusion was largely dependent on hemoglobin threshold and age. Transfusion was associated with increased 1-year mortality when hemoglobin nadir was >10 g/dL. However, in patients aged ≥80 years with hemoglobin nadir <8 g/dL, transfusion was associated with a 50% reduction in 1-year mortality.
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Affiliation(s)
- Alain Putot
- Médecine interne gériatrie, Pôle Personnes Âgées, Centre Hospitalier Universitaire, Dijon, France
| | - Marianne Zeller
- Laboratoire Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), Université de Bourgogne Franche-Comté, Dijon, France.
| | - Sophie Perrin
- Médecine interne gériatrie, Pôle Personnes Âgées, Centre Hospitalier Universitaire, Dijon, France
| | - Jean-Claude Beer
- Service de Cardiologie, Centre Hospitalier Universitaire, Dijon, France
| | - Jack Ravisy
- Service de Cardiologie, Clinique de Fontaine, Fontaine les Dijon, France
| | - Charles Guenancia
- Service de Cardiologie, Centre Hospitalier Universitaire, Dijon, France
| | - Raphaël Robert
- Service de Cardiologie, Centre Hospitalier Universitaire, Dijon, France
| | - Patrick Manckoundia
- Médecine interne gériatrie, Pôle Personnes Âgées, Centre Hospitalier Universitaire, Dijon, France; Institut National de la Santé et de la Recherche Médicale U1093 Cognition Action Plasticité, Université de Bourgogne Franche-Comté, Dijon, France
| | - Yves Cottin
- Laboratoire Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), Université de Bourgogne Franche-Comté, Dijon, France; Service de Cardiologie, Centre Hospitalier Universitaire, Dijon, France
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da Silveira Cavalcante L, Feng Q, Chin-Yee I, Acker JP, Holovati JL. Effect of liposome-treated red blood cells in an anemic rat model. J Liposome Res 2016; 27:56-63. [DOI: 10.3109/08982104.2016.1149867] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Luciana da Silveira Cavalcante
- Canadian Blood Services Center for Innovation, Edmonton, AB, Canada,
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada,
| | - Qingping Feng
- Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada, and
| | - Ian Chin-Yee
- Department of Medicine Division of Hematology, University of Western Ontario, London, ON, Canada
| | - Jason P. Acker
- Canadian Blood Services Center for Innovation, Edmonton, AB, Canada,
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada,
| | - Jelena L. Holovati
- Canadian Blood Services Center for Innovation, Edmonton, AB, Canada,
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada,
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Hsia CC, Mahon JL, Seitelbach M, Chia J, Zou G, Chin-Yee IH. Use of n-of-1 (single patient) trials to assess the effect of age of transfused blood on health-related quality of life in transfusion-dependent patients. Transfusion 2016; 56:1192-200. [PMID: 26840915 DOI: 10.1111/trf.13484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/21/2015] [Accepted: 11/17/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The impact of age of red blood cells on health-related quality of life (HRQL) in patients who require chronic transfusions is not known. We assessed this using n-of-1 trials in patient populations where large randomized trials have not been done to date. STUDY DESIGN AND METHODS Chronically transfusion-dependent adult patients were randomly assigned over time to four fresh (<7 days of storage) and four standard-issue (up to 42 days of storage) blood transfusions in prospective double-blinded multicrossover studies (n-of-1 trials). HRQL questionnaires were completed before and at 24 hours after each transfusion. Hemoglobin (Hb) levels were measured before each subsequent transfusion. RESULTS Twenty transfusion-dependent patients were enrolled, of whom nine (five myelodysplastic syndromes, two myelofibrosis, one β-thalassemia major, one Diamond-Blackfan anemia) completed at least six transfusions. Mean ages of fresh and standard-issue blood transfused were 4.0 and 23.2 days, respectively. There were no significant differences in the effect of standard and fresh blood on follow-up Hb levels or the eight HRQL dimensions assessed in all analyses. CONCLUSIONS In chronically transfused patients, there were no significant differences in HRQL or Hb levels between fresh versus standard blood. While larger trials are needed, these results support current practices in hospital blood transfusion laboratories using a first-in, first-out model of blood utilization for these transfusion-dependent patients. Use of n-of-1 trials to determine the benefits of transfusions in single patients appears to be feasible.
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Affiliation(s)
- Cyrus C Hsia
- Department of Medicine, Division of Hematology, Western University, London Health Sciences Centre, London, Ontario.,Department of Medicine, Western University, London Health Sciences Centre, London, Ontario
| | - Jeffrey L Mahon
- Department of Medicine, Western University, London Health Sciences Centre, London, Ontario.,Department of Epidemiology & Biostatistics, Western University, London Health Sciences Centre, London, Ontario
| | - Maayan Seitelbach
- Department of Medicine, Western University, London Health Sciences Centre, London, Ontario
| | - Justin Chia
- Department of Medicine, Western University, London Health Sciences Centre, London, Ontario.,Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Guangyong Zou
- Department of Epidemiology & Biostatistics, Western University, London Health Sciences Centre, London, Ontario
| | - Ian H Chin-Yee
- Department of Medicine, Division of Hematology, Western University, London Health Sciences Centre, London, Ontario.,Department of Medicine, Western University, London Health Sciences Centre, London, Ontario
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Pavenski K, Saidenberg E, Lavoie M, Tokessy M, Branch DR. Red blood cell storage lesions and related transfusion issues: a Canadian Blood Services research and development symposium. Transfus Med Rev 2011; 26:68-84. [PMID: 21871777 DOI: 10.1016/j.tmrv.2011.07.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
For centuries, man has been trying to figure out how to revive sick and traumatized individuals using fluids of various types, even from animals. In the 17th century, it was determined that blood was the best fluid to use and, in the early 1900s, after the discovery of the ABO blood groups, human blood was found to provide significant benefit for patients with shock and/or anemia. In the 1950s and 1960s, various ways to obtain, process, and store human blood were developed. It soon became apparent that storage of human blood for transfusion was problematic because red cells, as they aged in vitro, underwent a multitude of physicochemical changes that greatly affected their shelf life, the so-called storage lesion. More recently, the question has arisen as to the potential detrimental effects of the storage lesion and suggestions that older blood may induce increased morbidity and even mortality despite its acceptable in vivo survival. To address this issue of the efficacy and safety of transfusion of aged stored blood, a number of controlled clinical trials have been instituted to determine if older blood is significantly detrimental compared with fresher blood in transfusion recipients.
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Affiliation(s)
- Katerina Pavenski
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, ON, Canada
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Effect of haemoglobin concentration on the clinical outcomes in patients with acute myocardial infarction and the factors related to haemoglobin. BMC Res Notes 2011; 4:142. [PMID: 21600038 PMCID: PMC3114763 DOI: 10.1186/1756-0500-4-142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Accepted: 05/22/2011] [Indexed: 11/23/2022] Open
Abstract
Background The impact of haemoglobin concentrations on clinical outcomes is still a controversial issue. To determine the association between haemoglobin concentrations on admission and clinical outcomes and the related factors, this study was performed in a Chinese hospital. Findings We conducted a retrospective study on 1394 Chinese patients with acute myocardial infarction. Patients were categorized according to the haemoglobin concentration on admission, and data were evaluated to determine whether there was an association between the haemoglobin concentrations on admission and 30-day in-hospital MACEs (major cardiovascular events). Patients with hemoglobin values between 141 and 150 g/L were used as the reference, the MACEs increased as hemoglobin concentrations fell below 140 g/L or rose > 150 g/L, with an adjusted OR (odds ratio) of 5.96[95% CI (confidence interval) 2.00 to 17.68, p = 0.0013], 4.39(1.37 to 14.08, p = 0.0128), 3.99(1.46 to 10.92, p = 0.0071), 3.19(1.27 to 8.05, p = 0.0139), 2.37(0.94 to 6.01, p = 0.0687), 2.11(0.66 to 6.74, p = 0.2065), 2.01(0.60 to 6.68, p = 0.2559) in patients with haemoglobin concentrations <100 g/L, 101-110 g/L, 111-120 g/L, 121-130 g/L, 131-140 g/L, 151-160 g/L, and >160 g/L respectively. Partial correlation analysis showed that age, albumin and creatinine were significantly associated with hemoglobin concentration. Conclusions Our results demonstrated that haemoglobin concentration affected MACEs in patients with acute myocardial infarction, and that haemoglobin concentration was associated with age, albumin and creatinine.
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McFarland J, Sarode R. ASH 2010 meeting report-Top 10 clinically oriented abstracts in transfusion medicine. Am J Hematol 2011. [DOI: 10.1002/ajh.21983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Erythropoietin is equally effective as fresh-blood transfusion at reducing infarct size in anemic rats. Crit Care Med 2010; 38:2215-21. [PMID: 20693887 DOI: 10.1097/ccm.0b013e3181f17d6e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We recently demonstrated that transfusion of anemic animals up to 100 g/L hemoglobin with fresh blood protects the heart from ischemic injuries following myocardial infarction. Erythropoietin has cardioprotective effects independent of its erythropoietic activity. The objective of this study was to compare the cardioprotective effects of erythropoietin treatment to fresh-blood transfusion in anemic rats after acute myocardial infarction. DESIGN Randomized animal study. SETTING University laboratory. SUBJECTS Male Sprague-Dawley rats weighing 200-300 g. INTERVENTION Myocardial infarction was induced by coronary artery ligation in 76 rats, 55 of which were anemic (80-90 g/L) and 21 of which had normal hemoglobin levels. Animals were randomized to erythropoietin (2000 units/kg), fresh-blood transfusion to 100 g/L hemoglobin, or saline-treatment groups immediately following myocardial infarction. MEASUREMENTS AND MAIN RESULTS At 24 hrs after myocardial infarction, cardiac function and infarct size were determined. Myocardial apoptosis was determined by caspase-3 activity and terminal deoxynucleotidyl transferase d-UTP nick end labeling (TUNEL) assay. Infarct size was significantly decreased in anemic rats treated with erythropoietin or blood transfusion compared to those in the saline-treatment group. Cardiac function, as measured by maximal positive and minimal negative first derivatives of left ventricular pressure, was better preserved in the normal hemoglobin groups and the erythropoietin- or transfusion-treated anemic animals compared to saline-treated anemic animals. Myocardial caspase-3 activity and TUNEL-positive nuclei were significantly increased in anemic rats but were decreased by erythropoietin treatment or red blood cell transfusion. CONCLUSIONS Erythropoietin treatment is equally effective as fresh-blood transfusion in anemic rats after acute myocardial infarction at reducing infarct size, myocardial apoptosis, and improving cardiac function.
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