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Davidow EB, Montgomery H, Mensing M. The influence of leukoreduction on the acute transfusion-related complication rate in 455 dogs receiving 730 packed RBCs: 2014-2017. J Vet Emerg Crit Care (San Antonio) 2022; 32:479-490. [PMID: 35043550 DOI: 10.1111/vec.13175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/22/2020] [Accepted: 07/25/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the influence of prestorage leukoreduction of packed RBCs (pRBCs) on acute transfusion-related complication rate in dogs. SETTING Two private referral hospitals. DESIGN Retrospective case study. ANIMALS Four hundred and fifty-five dogs receiving nonleukoreduced (nLR) or leukoreduced (LR) pRBC between January 1, 2014 and July 31, 2017. MEASUREMENTS AND MAIN RESULTS Transfusions were retrospectively reviewed to record data about the patient, donor, unit, transfusion event, acute complications, hospital discharge, and cause of death. Of 730 transfusion events in 455 dogs, 288 used LR pRBC and 442 used nLR pRBC. There was a 18.9% (138/730) overall complication rate. Seven (0.96%) complications were life-threatening. The most common complications were pyrexia (5.6%), gastrointestinal signs (4.9%), and hemolysis with no other signs (4.1%). Pyrexia with no other clinical signs, consistent with a febrile nonhemolytic transfusion reaction (FNHTR), occurred in 3.2% of transfusion events. There was a significant (P = 0.03) decrease in the rate of FNHTR with LR pRBC (1%) versus nLR pRBC (4.5%). Use of LR pRBC did not decrease in-hospital mortality. The odds of any complication, hemolysis only, FNHTR, and more severe complications increased with pRBC age. Leukoreduction did not decrease the impact of pRBC age on these complications. Use of older pRBC did not increase the incidence of life-threatening complications or mortality. Dogs receiving pRBC for blood loss were more likely to have gastrointestinal and more severe complications than those dogs that had hemolysis. The effect of pRBC unit age on complications was not influenced by the underlying reason for transfusion. Dogs that received a previous transfusion were more likely to have respiratory complications. CONCLUSION In this study, the use of LR pRBC was associated with a decreased rate of FNHTR but no other complications. Unit age was associated with the incidence of hemolysis, FNHTR, and complication severity but not the rate of life-threatening complications or mortality.
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Affiliation(s)
| | - Heather Montgomery
- ACCES Blood Bank, BluePearl Veterinary Partners, Seattle, Washington, USA
| | - Michelle Mensing
- ACCES Blood Bank, BluePearl Veterinary Partners, Seattle, Washington, USA
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2
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Flatman LK, Fergusson DA, Lacroix J, Ducruet T, Papenburg J, Fontela PS. Association between the length of storage of transfused leukoreduced red blood cell units and hospital-acquired infections in critically ill children: A secondary analysis of the TRIPICU study. Transfus Med 2021; 31:467-473. [PMID: 34585466 DOI: 10.1111/tme.12824] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/08/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Evaluate the association between leukoreduced red blood cell (RBC) storage length and hospital-acquired infection (HAI) incidence rate in critically ill children. BACKGROUND RBC transfusions are common in critically ill children. Despite their benefits, observational studies suggest an association between them and HAIs. One possible mechanism for increased HAI is transfusion-related immunomodulation due to bioactive substances' release as transfused blood ages. METHODS In this secondary analysis of the 'Transfusion Requirement in Paediatric Intensive Care Units' (TRIPICU) study, we analysed a subset of 257 participants that received only one pre-storage leukoreduced RBC transfusion. RBC storage length was classified as 1) transfusion of 'fresh' RBCs (≤10 days), 2) transfusion of 'stored' RBCs (21-34 days), and 3) transfusion of 'long-stored' RBCs (≥35 days). All were compared to a 'golden' period (11-20 days), representing the time between 'fresh' and 'stored'. We used quasi-Poisson multivariable regression models to estimate the HAI incidence rate ratio (IRR) and corresponding 95% confidence interval (CI). RESULTS We found that the association between the length of storage time of leukoreduced RBCs and HAIs was not significant in the 'fresh' group (IRR 1.23; 95% CI 0.55, 2.78) and the 'stored' group (IRR 1.61; 95% CI 0.63, 4.13) when compared to the 'golden' period. However, we observed a statistically significant association between the 'long-stored' group and an increase in the HAI incidence rate (IRR 3.66; 95% CI 1.22, 10.98). CONCLUSION Transfusion of leukoreduced RBC units stored for ≥35 days is associated with increased HAI incidence rate in haemodynamically stable, critically ill children.
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Affiliation(s)
- Leah K Flatman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Thierry Ducruet
- Unité de recherche clinique appliquée (URCA), Université de Montréal, Centre de Recherche, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Jesse Papenburg
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Division of Pediatric Infectious Diseases, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Patricia S Fontela
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Division of Pediatric Critical Care Medicine, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
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3
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Saadah NH, Wood EM, Bailey MJ, Cooper DJ, French CJ, Haysom HE, Sparrow RL, Wellard CJ, McQuilten ZK. Age of red blood cells is not associated with in-hospital mortality in massively transfused patients. J Trauma Acute Care Surg 2021; 91:279-286. [PMID: 34108423 DOI: 10.1097/ta.0000000000003192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies comparing mortality following massive transfusion (MT) with fresher versus longer-stored red blood cells (RBCs) have focused on trauma patients. The Australian and New Zealand Massive Transfusion Registry collects data on all adult MT cases (≥5 RBCs within 4 hours, any bleeding context, ≥18 years) at participating hospitals. METHODS Years 2007 to 2018 data from 29 hospitals were analyzed to quantify the association between mortality and RBC storage time in adult MT cases. We ran three logistic regression models separately on each of seven bleeding contexts, with in-hospital mortality as the outcome and, in turn, (1) mean storage time (STmean) quartiles, (2) proportion of RBCs ≥30 days old (propOLD), and (3) scalar age of blood index as predictors. RESULTS A total of 8,685 adult MT cases involving transfusion of 126,622 RBCs were analyzed with Australian and New Zealand data analyzed separately. Mean storage times for these cases were (by quartile in ascending order) as follows: Australia, 12.5 days (range, 3.1-15.5 days), 17.7 (15.5-19.9), 22.3 (19.9-24.9), and 29.8 (24.9-41.7); New Zealand, 11.3 days (3.6-13.7), 15.3 (13.7-16.8), 18.7 (16.8-20.7), and 24.5 (20.7-35.6). The odds ratios comparing in-hospital mortality for each quartile with that of the control first quartile (freshest blood), proportion of longer-stored (≥30 days) RBCs, and scalar age of blood index were not statistically significant across all bleeding contexts. CONCLUSION We find no correlation between in-hospital mortality and storage time of transfused RBCs in a large cohort of adult MT patients representing all bleeding contexts. These results are consistent with those of recent large multicenter trials. LEVEL OF EVIDENCE Epidemiologic, level III; Therapeutic, level IV.
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Affiliation(s)
- Nicholas H Saadah
- From the Transfusion Research Unit (N.H.S., E.M.W., H.E.H., R.L.S., C.J.W., Z.K.M.), Public Health and Preventive Medicine, Monash University; Department of Haematology (E.M.W., Z.K.M.), Monash Health; Australian and New Zealand Intensive Care Research Centre (M.J.B., D.J.C., C.J.F., Z.K.M.), Public Health and Preventive Medicine, Monash University; and Department of Intensive Care (C.J.F., Z.K.M.), Western Health, Melbourne, Australia
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4
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Mack J, Kahn SR, Tinmouth A, Fergusson D, Hébert PC, Lacroix J. Volume-dependent effect of stored red blood cells: A secondary analysis of the Age of Blood Evaluation trial. Transfusion 2020; 60:1929-1939. [PMID: 32856734 DOI: 10.1111/trf.15933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND An increased risk of complications, including death, has been associated with stored red blood cell (RBC) units in observational studies but not in randomized trials. We aimed to evaluate for volume-dependent effects attributable to length of RBC storage in a secondary analysis of the Age of Blood Evaluation (ABLE) trial. STUDY DESIGN AND METHODS In the 2510 critically ill adults from the ABLE trial randomized to receive RBC units stored not more than 7 days or the oldest compatible RBC units, we estimated the hazard ratio (HR) for death by intensive care unit (ICU) and hospital discharge and by days 28, 90, and 180, within subgroups defined by the number of RBC units received. Extended Cox proportional hazards regression was used to model the HR. RESULTS A volume-dependent effect of storage age on survival was present for death by 90 and 180 days, but not earlier endpoints. The HR for death by 90 days was 0.55 (95% confidence interval [CI], 0.11-0.98, fresh vs standard) after transfusion of 6 RBC units but 1.45 (95% CI, 1.06-1.98) after transfusion of 1 RBC unit. CONCLUSION In this exploratory analysis, volume-dependent effects related to RBC storage were documented in the ABLE trial. The harms associated with small volumes of fresh RBC units and large volumes of older RBC units should be further explored.
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Affiliation(s)
- Johnathan Mack
- Department of Medicine, Ottawa General Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Susan R Kahn
- Department of Medicine and Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Alan Tinmouth
- Department of Medicine, Ottawa General Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean Fergusson
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul C Hébert
- Division of Critical Care, Centre Hospitalier Universitaire de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
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5
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Wang C, Le Ray I, Lee B, Wikman A, Reilly M. Association of blood group and red blood cell transfusion with the incidence of antepartum, peripartum and postpartum venous thromboembolism. Sci Rep 2019; 9:13535. [PMID: 31537816 PMCID: PMC6753067 DOI: 10.1038/s41598-019-49566-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/23/2019] [Indexed: 11/12/2022] Open
Abstract
The increased risk of venous thromboembolism (VTE) associated with pregnancy is well-known and prophylaxis guidelines consider a number of risk factors. Although non-O blood group and red blood cell (RBC) transfusion are known to be associated with VTE risk, their contribution to pregnancy-associated VTE has received little attention. This study was conducted in a population-based cohort of 1,000,997 deliveries to women with no prior history of VTE or thrombophilia. The independent contributions of ABO blood type and RBC transfusion to the risks of antepartum, peripartum and postpartum VTE are reported as odds ratios adjusted for risk factors that are considered in current prophylaxis guidelines and other potential confounders. Compared with type O, A and B blood types have higher risk of antepartum and postpartum VTE, with odds ratios between 1.4 and 1.8. Transfusion around delivery has the largest increased risks and a dose-response effect, with adjusted odds ratios from 2.60 (1.71–3.97) for 1–2 units to 3.55 (1.32–9.55) for more than 5 units. ABO blood type and RBC transfusion were found to be independent risk factors for pregnancy-associated VTE. Further research is required to understand the underlying mechanisms and to conduct a risk-benefit assessment of the small volumes of RBCs transfused around delivery.
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Affiliation(s)
- Chen Wang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Isabelle Le Ray
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Brian Lee
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, USA
| | - Agneta Wikman
- Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Reilly
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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6
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Roubinian N, Kleinman S, Murphy EL, Glynn SA, Edgren G. Methodological considerations for linked blood donor-component-recipient analyses in transfusion medicine research. ACTA ACUST UNITED AC 2019; 15:185-193. [PMID: 32368251 DOI: 10.1111/voxs.12518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In recent years, there has been a concerted effort to improve our understanding of the quality and effectiveness of transfused blood components. The expanding use of large datasets built from electronic health records allows the investigation of potential benefits or adverse outcomes associated with transfusion therapy. Together with data collected on blood donors and components, these datasets permit an evaluation of associations between donor or blood component factors and transfusion recipient outcomes. Large linked donor-component recipient datasets provide the power to study exposures relevant to transfusion efficacy and safety, many of which would not otherwise be amenable to study for practical or sample size reasons. Analyses of these large blood banking-transfusion medicine datasets allow for characterization of the populations under study and provide an evidence base for future clinical studies. Knowledge generated from linked analyses have the potential to change the way donors are selected and how components are processed, stored and allocated. However, unrecognized confounding and biased statistical methods continue to be limitations in the study of transfusion exposures and patient outcomes. Results of observational studies of blood donor demographics, storage age, and transfusion practice have been conflicting. This review will summarize statistical and methodological challenges in the analysis of linked blood donor, component, and transfusion recipient outcomes.
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Affiliation(s)
- Nareg Roubinian
- Kaiser Permanente Northern California Division of Research, Oakland, California.,Vitalant Research Institute, San Francisco, California.,University of California, San Francisco, San Francisco, California
| | | | - Edward L Murphy
- University of California, San Francisco, San Francisco, California.,Vitalant Research Institute, San Francisco, California
| | - Simone A Glynn
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Gustaf Edgren
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Södersjukhuset, Stockholm, Sweden
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7
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Noninfectious transfusion-associated adverse events and their mitigation strategies. Blood 2019; 133:1831-1839. [PMID: 30808635 DOI: 10.1182/blood-2018-10-833988] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/26/2018] [Indexed: 01/28/2023] Open
Abstract
Blood transfusions are life-saving therapies; however, they can result in adverse events that can be infectious or, more commonly, noninfectious. The most common noninfectious reactions include febrile nonhemolytic transfusion reactions, allergic transfusion reactions, transfusion-associated circulatory overload, transfusion-related acute lung injury, and acute and delayed hemolytic transfusion reactions. These reactions can be asymptomatic, mild, or potentially fatal. There are several new methodologies to diagnose, treat, and prevent these reactions. Hemovigilance systems for monitoring transfusion events have been developed and demonstrated decreases in some adverse events, such as hemolytic transfusion reactions. Now vein-to-vein databases are being created to study the interactions of the donor, product, and patient factors in the role of adverse outcomes. This article reviews the definition, pathophysiology, management, and mitigation strategies, including the role of the donor, product, and patient, of the most common noninfectious transfusion-associated adverse events. Prevention strategies, such as leukoreduction, plasma reduction, additive solutions, and patient blood management programs, are actively being used to enhance transfusion safety. Understanding the incidence, pathophysiology, and current management strategies will help to create innovative products and continually hone in on best transfusion practices that suit individualized patient needs.
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8
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9
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Tucci M, Lacroix J, Fergusson D, Doctor A, Hébert P, Berg RA, Caro J, Josephson CD, Leteurtre S, Menon K, Schechtman K, Steiner ME, Turgeon AF, Clayton L, Bockelmann T, Spinella PC. The age of blood in pediatric intensive care units (ABC PICU): study protocol for a randomized controlled trial. Trials 2018; 19:404. [PMID: 30055634 PMCID: PMC6064163 DOI: 10.1186/s13063-018-2809-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/16/2018] [Indexed: 02/02/2023] Open
Abstract
Background The “Age of Blood in Children in Pediatric Intensive Care Unit” (ABC PICU) study is a randomized controlled trial (RCT) that aims to determine if red blood cell (RBC) unit storage age affects outcomes in critically ill children. While RBCs can be stored for up to 42 days in additive solutions, their efficacy and safety after long-term storage have been challenged. Preclinical and clinical observational evidence suggests loss of efficacy and lack of safety of older RBC units, especially in more vulnerable populations such as critically ill children. Because there is a belief that shorter storage will improve outcomes, some physicians and institutions systematically transfuse fresh RBCs to children. Conversely, the standard practice of blood banks is to deliver the oldest available RBC unit (first-in, first-out policy) in order to decrease wastage. Methods/design The ABC PICU study, is a double-blind superiority trial comparing the development of “New or Progressive Multiple Organ Dysfunction Syndrome” (NPMODS) in 1538 critically ill children randomized to either transfusion with RBCs stored for ≤ 7 days or to standard-issue RBCs (oldest in inventory). Patients are being recruited from 52 centers in the US, Canada, France, Italy, and Israel. Discussion The ABC PICU study should have significant implications for blood procurement services. A relative risk reduction of 33% is postulated in the short-storage arm. If a difference is found, this will indicate that fresher RBCs do improve outcomes in the pediatric intensive care unit population and would justify that use in critically ill children. If no difference is found, this will reassure clinicians and transfusion medicine specialists regarding the safety of the current system of allocating the oldest RBC unit in inventory and will discourage clinicians from preferentially requesting fresher blood for critically ill children. Trial registration ClinicalTrials.gov, ID: NCT01977547. Registered on 6 November 2013. Electronic supplementary material The online version of this article (10.1186/s13063-018-2809-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marisa Tucci
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada. .,Sainte-Justine Hospital, 3175 Côte Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
| | - Jacques Lacroix
- From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Dean Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Allan Doctor
- Division of Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA
| | - Paul Hébert
- Division of Critical Care Medicine, Department of Medicine, Montreal University Health Center, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Robert A Berg
- Division of Pediatric Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Faculty of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jaime Caro
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Evidera, Boston, MA, USA
| | - Cassandra D Josephson
- Departments of Pathology and Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Stéphane Leteurtre
- University of Lille, CHU Lille, EA 2694 - Santé Publique : épidémiologie et qualité des soins, F-59000, Lille, France
| | - Kusum Menon
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kenneth Schechtman
- Clinical Epidemiology Program, St. Louis Children's Hospital, Faculty of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie E Steiner
- Division of Pediatric Hematology-Oncology and Division of Pulmonary and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Alexis F Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, and CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Unit, Université Laval, Québec City, QC, Canada
| | - Lucy Clayton
- From the Clinical Research Unit, Research Center, Sainte-Justine Hospital, Université de Montréal, Montréal, QC, Canada
| | - Tina Bockelmann
- Division of Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA
| | - Philip C Spinella
- Division of Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA
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10
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Ng MSY, David M, Middelburg RA, Ng ASY, Suen JY, Tung JP, Fraser JF. Transfusion of packed red blood cells at the end of shelf life is associated with increased risk of mortality - a pooled patient data analysis of 16 observational trials. Haematologica 2018; 103:1542-1548. [PMID: 29794148 PMCID: PMC6119129 DOI: 10.3324/haematol.2018.191932] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 02/22/2018] [Indexed: 12/13/2022] Open
Abstract
Observational studies address packed red blood cell effects at the end of shelf life and have larger sample sizes compared to randomized control trials. Meta-analyses combining data from observational studies have been complicated by differences in aggregate transfused packed red blood cell age and outcome reporting. This study abrogated these issues by taking a pooled patient data approach. Observational studies reporting packed red blood cell age and clinical outcomes were identified and patient-level data sets were sought from investigators. Odds ratios and 95% confidence intervals for binary outcomes were calculated for each study, with mean packed red blood cell age or maximum packed red blood cell age acting as independent variables. The relationship between mean packed red blood cell age and hospital length of stay for each paper was analyzed using zero-inflated Poisson regression. Random effects models combined paper-level effect estimates. Extremes analyses were completed by comparing patients transfused with mean packed red blood cell aged less than ten days to those transfused with mean packed red blood cell aged at least 30 days. sixteen datasets were available for pooled patient data analysis. Mean packed red blood cell age of at least 30 days was associated with an increased risk of in-hospital mortality compared to mean packed red blood cell of less than ten days (odds ratio: 3.25, 95% confidence interval: 1.27–8.29). Packed red blood cell age was not correlated to increased risks of nosocomial infection or prolonged length of hospital stay.
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Affiliation(s)
- Monica S Y Ng
- Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia .,Research and Development, Australian Red Cross Blood Service, Brisbane, Australia
| | - Michael David
- School of Medicine and Population Health, The University of Newcastle, Callaghan, Australia
| | - Rutger A Middelburg
- Centre for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
| | - Angela S Y Ng
- Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Jacky Y Suen
- Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - John-Paul Tung
- Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia.,Research and Development, Australian Red Cross Blood Service, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia
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11
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Gultawatvichai P, Tavares MF, DiQuattro PJ, Cheves TC, Sweeney JD. Hemolysis in In-Date RBC Concentrates. Am J Clin Pathol 2017; 149:35-41. [PMID: 29267842 DOI: 10.1093/ajcp/aqx120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Hemolysis is one of the most prominent changes that occur during the liquid storage of RBCs in additive solution (AS), but most studies have measured hemolysis only on day 42. METHODS Prestorage leukoreduced RBCs in AS-1 and AS-3 were studied, one group on day 42 and a second group between day 0 and day 40. Each product was sampled for direct measurement of supernatant hemoglobin and hematocrit. RESULTS Ninety day 42 and 218 day 7 to day 39 RBCs showed a mean ± SD supernatant hemoglobin of 75 ± 100 vs 25.5 ± 16 mg/dL respectively (P < .01). Supernatant hemoglobin correlated weakly with storage age (r = 0.2, P < .01) but more strongly with hematocrit (r = 0.4, P < .01). CONCLUSIONS There are minimal differences in supernatant hemoglobin until the final days of liquid storage when some high hematocrit RBCs show excessive hemolysis.
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12
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Biagini S, Dale CS, Real JM, Moreira ES, Carvalho CRR, Schettino GPP, Wendel S, Azevedo LCP. Short-term effects of stored homologous red blood cell transfusion on cardiorespiratory function and inflammation: an experimental study in a hypovolemia model. ACTA ACUST UNITED AC 2017; 51:e6258. [PMID: 29185590 PMCID: PMC5685056 DOI: 10.1590/1414-431x20176258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 08/11/2017] [Indexed: 01/08/2023]
Abstract
The pathophysiological mechanisms associated with the effects of red blood cell (RBC) transfusion on cardiopulmonary function and inflammation are unclear. We developed an experimental model of homologous 14-days stored RBC transfusion in hypovolemic swine to evaluate the short-term effects of transfusion on cardiopulmonary system and inflammation. Sixteen healthy male anesthetized swine (68±3.3 kg) were submitted to controlled hemorrhage (25% of blood volume). Two units of non-filtered RBC from each animal were stored under blood bank conditions for 14 days. After 30 min of hypovolemia, the control group (n=8) received an infusion of lactated Ringer's solution (three times the removed volume). The transfusion group (n=8) received two units of homologous 14-days stored RBC and lactated Ringer's solution in a volume that was three times the difference between blood removed and blood transfusion infused. Both groups were followed up for 6 h after resuscitation with collection of hemodynamic and respiratory data. Cytokines and RNA expression were measured in plasma and lung tissue. Stored RBC transfusion significantly increased mixed oxygen venous saturation and arterial oxygen content. Transfusion was not associated with alterations on pulmonary function. Pulmonary concentrations of cytokines were not different between groups. Gene expression for lung cytokines demonstrated a 2-fold increase in mRNA level for inducible nitric oxide synthase and a 0.5-fold decrease in mRNA content for IL-21 in the transfused group. Thus, stored homologous RBC transfusion in a hypovolemia model improved cardiovascular parameters but did not induce significant effects on microcirculation, pulmonary inflammation and respiratory function up to 6 h after transfusion.
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Affiliation(s)
- S Biagini
- Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, SP, Brasil
| | - C S Dale
- Laboratorio de Neuromodulação e Dor Experimental, Departamento de Anatomia, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J M Real
- Associação TUCCA para Crianças e Adolescentes com Câncer, Departamento de Oncologia Pediátrica, Hospital Santa Marcelina, São Paulo, Brasil.,Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil.,Hospital do Servidor Público Estadual de São Paulo (IAMSPE), São Paulo, SP, Brasil
| | - E S Moreira
- Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, SP, Brasil.,Evidências - Kantar Health, São Paulo, SP, Brasil
| | - C R R Carvalho
- Departamento de Cardiopneumologia, Instituto do Coração, Universidade de São Paulo, São Paulo, SP, Brasil
| | - G P P Schettino
- Departamento de Cardiopneumologia, Instituto do Coração, Universidade de São Paulo, São Paulo, SP, Brasil.,Hospital Municipal da Vila Santa Catarina, Sociedade Beneficente Israelita Albert Einstein, São Paulo, SP, Brasil
| | - S Wendel
- Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, SP, Brasil.,Banco de Sangue, Hospital Sirio-Libanes, São Paulo, SP, Brasil
| | - L C P Azevedo
- Instituto de Ensino e Pesquisa, Hospital Sírio-Libanês, São Paulo, SP, Brasil.,Disciplina de Emergências Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
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13
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Edgren G, Hjalgrim H. Epidemiology of donors and recipients: lessons from the SCANDAT database. Transfus Med 2017; 29 Suppl 1:6-12. [PMID: 29148106 DOI: 10.1111/tme.12487] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/04/2017] [Accepted: 10/16/2017] [Indexed: 02/03/2023]
Abstract
With the development of several 'vein-to-vein' databases, which capture data on the entire donor-recipient continuum and link this data to health outcomes, there has been an increasing number of studies investigating the health effects of all aspects of the practice of transfusion medicine. The Scandinavian Donations and Transfusions (SCANDAT) database is one of several such databases, which includes all electronically available data on blood donors, donations and transfusions since the late 1960s in Sweden and the early 1980s in Denmark. The SCANDAT database has been used to characterise disease occurrence among blood donors and transfused patients, as well as to investigate possible health effects of blood donations, aspects of transfusion care and possible transfusion transmission of disease. Recent publications include studies on recipient mortality associated with the storage lesion, studies on the effects of donor demographics on patient mortality and health effects of frequent blood donation. Although this research approach is clearly very powerful, the appropriate analysis of such real-world data is complex and requires close methodological attention. The purpose of this review is to present some of the research conducted within the SCANDAT collaboration. We hope more international collaboration may help improve our understanding of the important remaining questions about donor and recipient health.
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Affiliation(s)
- G Edgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Hematology Center, Karolinska University Hospital, Stockholm, Sweden
| | - H Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
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14
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Cybulska P, Goss C, Tew WP, Parameswaran R, Sonoda Y. Indications for and complications of transfusion and the management of gynecologic malignancies. Gynecol Oncol 2017; 146:416-426. [PMID: 28528916 PMCID: PMC5527999 DOI: 10.1016/j.ygyno.2017.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/01/2017] [Accepted: 05/08/2017] [Indexed: 02/06/2023]
Abstract
Anemia, which is highly prevalent in oncology patients, is one of the most established negative prognostic factors for several gynecologic malignancies. Multiple factors can cause or contribute to the development of anemia in patients with gynecologic cancers; these factors include blood loss (during surgery or directly from the tumor), renal impairment (caused by platinum-based chemotherapy), and marrow dysfunction (from metastases, chemotherapy, and/or radiation therapy). Several peri- and intra-operative strategies can be used to optimize patient management and minimize blood loss related to surgery. Blood transfusions are routinely employed as corrective measures against anemia; however, blood transfusions are one of the most overused healthcare interventions. There are safe and effective evidence-based blood transfusion strategies used in other patient populations that warrant further investigation in the surgical oncology setting. Blood is a valuable healthcare resource, and clinicians can learn to use it more judiciously through knowledge of the potential risks and complications of blood interventions, as well as the ability to properly identify the patients most likely to benefit from such interventions.
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Affiliation(s)
- Paulina Cybulska
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cheryl Goss
- Hematology and Coagulation Laboratory Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William P Tew
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Rekha Parameswaran
- Transfusion Medicine Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Hematology Service, Department of Medicine, Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
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15
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Edgren G, Ullum H, Rostgaard K, Erikstrup C, Sartipy U, Holzmann MJ, Nyrén O, Hjalgrim H. Association of Donor Age and Sex With Survival of Patients Receiving Transfusions. JAMA Intern Med 2017; 177:854-860. [PMID: 28437543 PMCID: PMC5540056 DOI: 10.1001/jamainternmed.2017.0890] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Following animal model data indicating the possible rejuvenating effects of blood from young donors, there have been at least 2 observational studies conducted with humans that have investigated whether donor age affects patient outcomes. Results, however, have been conflicting. OBJECTIVE To study the association of donor age and sex with survival of patients receiving transfusions. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study based on the Scandinavian Donations and Transfusions database, with nationwide data, was conducted for all patients from Sweden and Denmark who received at least 1 red blood cell transfusion of autologous blood or blood from unknown donors between January 1, 2003, and December 31, 2012. Patients were followed up from the first transfusion until death, emigration, or end of follow-up. Data analysis was performed from September 15 to November 15, 2016. EXPOSURES The number of transfusions from blood donors of different age and sex. Exposure was treated time dependently throughout follow-up. MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) for death and adjusted cumulative mortality differences, both estimated using Cox proportional hazards regression. RESULTS Results of a crude analysis including 968 264 transfusion recipients (550 257 women and 418 007 men; median age at first transfusion, 73.0 years [interquartile range, 59.8-82.4 years]) showed a U-shaped association between age of the blood donor and recipient mortality, with a nadir in recipients for the most common donor age group (40-49 years) and significant and increasing HRs among recipients of blood from donors of successively more extreme age groups (<20 years: HR, 1.12; 95% CI, 1.10-1.14; ≥70 years: HR, 1.25; 95% CI, 1.08-1.44). Higher mortality was also noted among recipients of blood from female donors (HR, 1.07; 95% CI, 1.07-1.07). Adjustments for number of transfusions with a linear term attenuated the associations, but the increased mortality for recipients of blood from young, old, and female donors was not eliminated. Closer examination of the association between number of transfusions and mortality revealed a nonlinear pattern. After adjustments to accommodate nonlinearity, donor age and sex were no longer associated with patient mortality. CONCLUSIONS AND RELEVANCE Donor age and sex were not associated with patient survival and need not be considered in blood allocation. Any comparison between common and less common categories of transfusions will inevitably be confounded by the number of transfusions, which drives the probability of receiving the less common blood components. Previous positive findings regarding donor age and sex are most likely explained by residual confounding.
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Affiliation(s)
- Gustaf Edgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden2Hematology Center, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Ullum
- Department of Clinical Immunology, the Blood Bank, Rigshospitalet, Copenhagen, Denmark
| | - Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Ulrik Sartipy
- Section of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden7Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Martin J Holzmann
- Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden9Department of Internal Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Olof Nyrén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark10Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
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16
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Red Cell Storage Duration Does Not Affect Outcome after Massive Blood Transfusion in Trauma and Nontrauma Patients: A Retrospective Analysis of 305 Patients. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3718615. [PMID: 28589139 PMCID: PMC5446873 DOI: 10.1155/2017/3718615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/23/2017] [Accepted: 04/05/2017] [Indexed: 02/05/2023]
Abstract
Background Prolonged storage of packed red blood cells (PRBCs) may increase morbidity and mortality, and patients having massive transfusion might be especially susceptible. We therefore tested the hypothesis that prolonged storage increases mortality in patients receiving massive transfusion after trauma or nontrauma surgery. Secondarily, we considered the extent to which storage effects differ for trauma and nontrauma surgery. Methods We considered surgical patients given more than 10 units of PRBC within 24 hours and evaluated the relationship between mean PRBC storage duration and in-hospital mortality using multivariable logistic regression. Potential nonlinearities in the relationship were assessed via restricted cubic splines. The secondary hypothesis was evaluated by considering whether there was an interaction between the type of surgery (trauma versus nontrauma) and the effect of storage duration on outcomes. Results 305 patients were given a total of 8,046 units of PRBCs, with duration ranging from 8 to 36 days (mean ± SD: 22 ± 6 days). The odds ratio [95% confidence interval (CI)] for in-hospital mortality corresponding to a one-day in mean PRBC storage duration was 0.99 (0.95, 1.03, P = 0.77). The relationship did not differ for trauma and nontrauma patients (P = 0.75). Results were similar after adjusting for multiple potential confounders. Conclusions Mortality after massive blood transfusion was no worse in patients transfused with PRBC stored for long periods. Trauma and nontrauma patients did not differ in their susceptibility to prolonged PRBC storage.
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17
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Baek JH, Yalamanoglu A, Gao Y, Guenster R, Spahn DR, Schaer DJ, Buehler PW. Iron accelerates hemoglobin oxidation increasing mortality in vascular diseased guinea pigs following transfusion of stored blood. JCI Insight 2017; 2:93577. [PMID: 28469086 DOI: 10.1172/jci.insight.93577] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/04/2017] [Indexed: 12/20/2022] Open
Abstract
Non-transferrin-bound iron (NTBI) and free hemoglobin (Hb) accumulate in circulation following stored RBC transfusions. This study investigated transfusion, vascular disease, and mortality in guinea pigs after stored RBC transfusion alone and following cotransfusion with apo-transferrin (apo-Tf) and haptoglobin (Hp). The effects of RBC exchange transfusion dose (1, 3, and 9 units), storage period (14 days), and mortality were evaluated in guinea pigs with a vascular disease phenotype. Seven-day mortality and the interaction between iron and Hb as cocontributors to adverse outcome were studied. Concentrations of iron and free Hb were greatest after transfusion with 9 units of stored RBCs compared with fresh RBCs or stored RBCs at 1- and 3-unit volumes. Nine units of stored RBCs led to mortality in vascular diseased animals, but not normal animals. One and 3 units of stored RBCs did not cause a mortality effect, suggesting the concomitant relevance of NTBI and Hb on outcome. Cotransfusion with apo-Tf or Hp restored survival to 100% following 9-unit RBC transfusions in vascular diseased animals. Our data suggest that increases in plasma NTBI and Hb contribute to vascular disease-associated mortality through iron-enhanced Hb oxidation and enhanced tissue injury.
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Affiliation(s)
| | | | - Yamei Gao
- Division of Viral Products, Center of Biologics Evaluation and Research (CBER), FDA, Silver Spring, Maryland, USA
| | - Ricardo Guenster
- Institute of Anesthesiology, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anesthesiology, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Dominik J Schaer
- Division of Internal Medicine, University of Zurich, Zurich, Switzerland
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18
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Chai-Adisaksopha C, Alexander PE, Guyatt G, Crowther MA, Heddle NM, Devereaux PJ, Ellis M, Roxby D, Sessler DI, Eikelboom JW. Mortality outcomes in patients transfused with fresher versus older red blood cells: a meta-analysis. Vox Sang 2017; 112:268-278. [PMID: 28220494 DOI: 10.1111/vox.12495] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/03/2017] [Accepted: 01/06/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Among transfused patients, the effect of the duration of red blood cell storage on mortality remains unclear. This study aims to compare the mortality of patients who were transfused with fresher versus older red blood cells. METHODS We performed an updated systematic search in the CENTRAL, MEDLINE, EMBASE and CINAHL databases, from January 2015 to October 2016. RCTs of hospitalized patients of any age comparing transfusion of fresher versus older red blood cells were eligible. We used a random-effects model to calculate pooled risk ratios (RRs) with corresponding 95% confidence interval (CI). RESULTS We identified 14 randomized trials that enrolled 26 374 participants. All-cause mortality occurred in 1219 of 9531 (12·8%) patients who received a transfusion of fresher red blood cells and 1810 of 16 843 (10·7%) in those who received older red blood cells (RR: 1·04, 95% CI: 0·98-1·12, P = 0·90, I2 = 0%, high certainty for ruling out benefit of fresh blood, moderate certainty for ruling out harm of fresh blood). In six studies, in-hospital death occurred in 691 of 7479 (9·2%) patients receiving fresher red cells and 1291 of 14 757 (8·8%) receiving older red cells (RR: 1·06, 95% CI: 0·97-1·15, P = 0·81, I2 = 0%, high certainty for ruling out benefit of fresh blood, moderate certainty for ruling out harm of fresh blood). CONCLUSION Transfusion of fresher red blood cells does not reduce overall or in-hospital mortality when compared with older red blood cells. Our results support the practice of transfusing patients with the oldest red blood cells available in the blood bank.
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Affiliation(s)
- C Chai-Adisaksopha
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - P E Alexander
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - G Guyatt
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - M A Crowther
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - N M Heddle
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.,McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.,Centre for Innovation Canadian Blood Services, Hamilton, ON, Canada
| | - P J Devereaux
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | - M Ellis
- Meir Medical Centre Kfar Saba and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Roxby
- SA Pathology Transfusion Service, Flinders Medical Centre and Flinders University, Adelaide, SA, Australia
| | - D I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - J W Eikelboom
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada.,Thrombosis & Atherosclerosis Research Institute, Hamilton, ON, Canada
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19
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Age of Transfused Blood Impacts Perioperative Outcomes Among Patients Who Undergo Major Gastrointestinal Surgery. Ann Surg 2017; 265:103-110. [DOI: 10.1097/sla.0000000000001647] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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20
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Parmar N, Pendergrast J, Lieberman L, Lin Y, Callum J, Cserti-Gazdewich C. The association of fever with transfusion-associated circulatory overload. Vox Sang 2016; 112:70-78. [DOI: 10.1111/vox.12473] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 12/19/2022]
Affiliation(s)
- N. Parmar
- Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]); Laboratory Medicine Program (LMP); University Health Network (UHN); Toronto ON Canada
| | - J. Pendergrast
- Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]); Laboratory Medicine Program (LMP); University Health Network (UHN); Toronto ON Canada
- Department of Medical Oncology & Hematology (DMOH); University Health Network (UHN); Toronto ON Canada
- Department of Laboratory Medicine - Pathobiology (LMP); Faculty of Medicine; University of Toronto; Toronto ON Canada
- Department of Medicine - Division of Hematology; Faculty of Medicine; University of Toronto; Toronto ON Canada
- Quality, Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Collaborative; Toronto ON Canada
| | - L. Lieberman
- Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]); Laboratory Medicine Program (LMP); University Health Network (UHN); Toronto ON Canada
- Department of Laboratory Medicine - Pathobiology (LMP); Faculty of Medicine; University of Toronto; Toronto ON Canada
- Quality, Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Collaborative; Toronto ON Canada
| | - Y. Lin
- Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]); Laboratory Medicine Program (LMP); University Health Network (UHN); Toronto ON Canada
- Department of Laboratory Medicine - Pathobiology (LMP); Faculty of Medicine; University of Toronto; Toronto ON Canada
- Quality, Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Collaborative; Toronto ON Canada
- Department of Clinical Pathology; Blood & Tissue Bank Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - J. Callum
- Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]); Laboratory Medicine Program (LMP); University Health Network (UHN); Toronto ON Canada
- Department of Laboratory Medicine - Pathobiology (LMP); Faculty of Medicine; University of Toronto; Toronto ON Canada
- Quality, Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Collaborative; Toronto ON Canada
- Department of Clinical Pathology; Blood & Tissue Bank Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - C. Cserti-Gazdewich
- Department of Laboratory Hematology (Blood Transfusion Laboratory [BTL]); Laboratory Medicine Program (LMP); University Health Network (UHN); Toronto ON Canada
- Department of Medical Oncology & Hematology (DMOH); University Health Network (UHN); Toronto ON Canada
- Department of Laboratory Medicine - Pathobiology (LMP); Faculty of Medicine; University of Toronto; Toronto ON Canada
- Department of Medicine - Division of Hematology; Faculty of Medicine; University of Toronto; Toronto ON Canada
- Quality, Utilization, Efficacy, & Safety of Transfusion (QUEST) Research Collaborative; Toronto ON Canada
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21
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Edgren G, Rostgaard K, Hjalgrim H. Methodological challenges in observational transfusion research: lessons learned from the Scandinavian Donations and Transfusions (SCANDAT) database. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- G. Edgren
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
- Hematology Centre; Karolinska University Hospital; Stockholm Sweden
| | - K. Rostgaard
- Department of Epidemiology Research; Statens Serum Institut; Copenhagen Denmark
| | - H. Hjalgrim
- Department of Epidemiology Research; Statens Serum Institut; Copenhagen Denmark
- Department of Hematology; Copenhagen University Hospital; Copenhagen Denmark
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22
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McEntire MC, Wardrop KJ, Davis WC. Comparison of established and novel methods for the detection and enumeration of microparticles in canine stored erythrocyte concentrates for transfusion. Vet Clin Pathol 2016; 46:54-63. [DOI: 10.1111/vcp.12434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Meredeth C. McEntire
- Veterinary Clinical Sciences Washington State University College of Veterinary Medicine Pullman WA USA
| | - K. Jane Wardrop
- Veterinary Clinical Sciences Washington State University College of Veterinary Medicine Pullman WA USA
| | - William C. Davis
- Veterinary Microbiology and Pathology Washington State University College of Veterinary Medicine Pullman WA USA
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23
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Parviz Y, Hsia C, Alemayehu M, Wall S, Bagur R, AbuRomeh N, Chin-Yee I, Lavi S. The effect of fresh versus standard blood transfusion on microvascular endothelial function. Am Heart J 2016; 181:156-161. [PMID: 27823688 DOI: 10.1016/j.ahj.2016.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/16/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The duration of red blood cell (RBC) storage may have a negative impact on endothelial nitric oxide bioavailability. We tested the hypothesis that transfused fresh blood will have a more favorable effect on microvascular endothelial function as compared to older standard issue blood. METHODS Participants requiring chronic RBC transfusions were enrolled in a crossover design study to receive fresh (<7 days of storage) or standard (up to 42 days of storage) blood on 2 separate visits. Endothelial function was assessed by reactive hyperemia peripheral arterial tonometry that was measured before and after transfusions. For each participant, the difference between endothelial function pretransfusion and posttransfusion was assessed in relation to blood storage time. RESULTS Twenty-one patients (71 ± 16 years, 52% females) were enrolled. Mean age of fresh blood was 5.5 days (±1.0), and that of standard blood was 24.5 days (±7.9 days). The pretransfusion hemoglobin was 83.1 ± 2.5 g/L; and posttransfusion, 98.9 ± 2.6 g/L. An average of 2 U of packed RBCs was transfused. Microvascular endothelial function decreased more frequently after transfusion of standard blood compared to fresh blood. Standard issue blood transfusion was associated with decrease in reactive hyperemia peripheral arterial tonometry index (-0.25 ± 0.63) compared to fresh blood (+0.03 ± 0.49); P = .026. CONCLUSION Transfusions of standard issue blood are associated with less favorable effect on microvascular endothelial function as compared to fresh blood.
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Affiliation(s)
- Yasir Parviz
- Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Cyrus Hsia
- Division of Hematology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Mistre Alemayehu
- Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Sabrina Wall
- Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Rodrigo Bagur
- Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Nour AbuRomeh
- Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Ian Chin-Yee
- Division of Hematology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Shahar Lavi
- Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada.
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24
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Saytashev I, Glenn R, Murashova GA, Osseiran S, Spence D, Evans CL, Dantus M. Multiphoton excited hemoglobin fluorescence and third harmonic generation for non-invasive microscopy of stored blood. BIOMEDICAL OPTICS EXPRESS 2016; 7:3449-3460. [PMID: 27699111 PMCID: PMC5030023 DOI: 10.1364/boe.7.003449] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/20/2016] [Accepted: 08/08/2016] [Indexed: 05/18/2023]
Abstract
Red blood cells (RBC) in two-photon excited fluorescence (TPEF) microscopy usually appear as dark disks because of their low fluorescent signal. Here we use 15fs 800nm pulses for TPEF, 45fs 1060nm pulses for three-photon excited fluorescence, and third harmonic generation (THG) imaging. We find sufficient fluorescent signal that we attribute to hemoglobin fluorescence after comparing time and wavelength resolved spectra of other expected RBC endogenous fluorophores: NADH, FAD, biliverdin, and bilirubin. We find that both TPEF and THG microscopy can be used to examine erythrocyte morphology non-invasively without breaching a blood storage bag.
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Affiliation(s)
- Ilyas Saytashev
- Department of Chemistry, Michigan State University, 578 S Shaw Ln., East Lansing, MI 48824, USA
| | - Rachel Glenn
- Department of Chemistry, Michigan State University, 578 S Shaw Ln., East Lansing, MI 48824, USA
| | - Gabrielle A. Murashova
- Department of Chemistry, Michigan State University, 578 S Shaw Ln., East Lansing, MI 48824, USA
| | - Sam Osseiran
- Harvard-MIT Division of Health Sciences and Technology, 77 Massachusetts Avenue E25-519, Cambridge, MA 02139, USA
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA
| | - Dana Spence
- Department of Chemistry, Michigan State University, 578 S Shaw Ln., East Lansing, MI 48824, USA
| | - Conor L. Evans
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA
| | - Marcos Dantus
- Department of Chemistry, Michigan State University, 578 S Shaw Ln., East Lansing, MI 48824, USA
- Department of Physics and Astronomy, Michigan State University, 567 Wilson Rd., East Lansing, MI 48824, USA
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25
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van Hoeven LR, Hooftman BH, Janssen MP, de Bruijne MC, de Vooght KMK, Kemper P, Koopman MMW. Protocol for a national blood transfusion data warehouse from donor to recipient. BMJ Open 2016; 6:e010962. [PMID: 27491665 PMCID: PMC4985976 DOI: 10.1136/bmjopen-2015-010962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Blood transfusion has health-related, economical and safety implications. In order to optimise the transfusion chain, comprehensive research data are needed. The Dutch Transfusion Data warehouse (DTD) project aims to establish a data warehouse where data from donors and transfusion recipients are linked. This paper describes the design of the data warehouse, challenges and illustrative applications. STUDY DESIGN AND METHODS Quantitative data on blood donors (eg, age, blood group, antibodies) and products (type of product, processing, storage time) are obtained from the national blood bank. These are linked to data on the transfusion recipients (eg, transfusions administered, patient diagnosis, surgical procedures, laboratory parameters), which are extracted from hospital electronic health records. APPLICATIONS Expected scientific contributions are illustrated for 4 applications: determine risk factors, predict blood use, benchmark blood use and optimise process efficiency. For each application, examples of research questions are given and analyses planned. CONCLUSIONS The DTD project aims to build a national, continuously updated transfusion data warehouse. These data have a wide range of applications, on the donor/production side, recipient studies on blood usage and benchmarking and donor-recipient studies, which ultimately can contribute to the efficiency and safety of blood transfusion.
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Affiliation(s)
- Loan R van Hoeven
- Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Babette H Hooftman
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Mart P Janssen
- Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Karen M K de Vooght
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Kemper
- Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, The Netherlands
| | - Maria M W Koopman
- Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The Netherlands
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Bjursten H, Dardashti A, Björk J, Wierup P, Algotsson L, Ederoth P. Transfusion of sex-mismatched and non–leukocyte-depleted red blood cells in cardiac surgery increases mortality. J Thorac Cardiovasc Surg 2016; 152:223-232.e1. [DOI: 10.1016/j.jtcvs.2015.12.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 11/30/2022]
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Poisson JL, Tuma CW, Shulman IA. Inventory management strategies that reduce the age of red blood cell components at the time of transfusion. Transfusion 2016; 56:1758-62. [PMID: 27184727 DOI: 10.1111/trf.13639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 03/29/2016] [Accepted: 04/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND There has been interest concerning patient outcomes when older red blood cell (RBC) components are utilized. Inventory management is key to maintaining a stock of fresher RBCs for general transfusion needs. We have altered our practice for RBC management to reduce RBC age at the time of transfusion. STUDY DESIGN AND METHODS Retrospective review of RBC age at time of transfusion at a tertiary care hospital with active trauma service was performed. The baseline nonirradiated RBC inventory was decreased from 12 to 15 days of stock to 7 to 10 days of stock, with request made to the blood supplier for fresher RBCs, specified at 75% of RBCs less than 14 days old. The age of RBCs at time of receipt and at time of transfusion was tracked on a monthly basis for the next 12 months. RESULTS The mean age of RBCs at transfusion was decreased by 9 days on average for the year. Significant decreases in the mean age of RBCs at transfusion were seen in the second half of the year, with 4 of 6 months seeing a mean age of less than 20 days. There were no documented incidences of hospital blood shortages after the reduction in inventory; no surgery was canceled or delayed because of inventory. CONCLUSION Inventory age depends on active management, combined with vendor cooperation to receive fresher components. Reducing the age of RBC components transfused is possible without experiencing blood component shortages. Longer periods of observation may allow for further adjustment of stocking levels on a seasonal basis.
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Affiliation(s)
- Jessica L Poisson
- Department of Pathology, Keck School of Medicine, University of Southern California; and the Transfusion Service, LAC+USC Medical Center, Los Angeles, California
| | - Christopher W Tuma
- Department of Pathology, Keck School of Medicine, University of Southern California; and the Transfusion Service, LAC+USC Medical Center, Los Angeles, California
| | - Ira A Shulman
- Department of Pathology, Keck School of Medicine, University of Southern California; and the Transfusion Service, LAC+USC Medical Center, Los Angeles, California
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Tzounakas VL, Kriebardis AG, Papassideri IS, Antonelou MH. Donor-variation effect on red blood cell storage lesion: A close relationship emerges. Proteomics Clin Appl 2016; 10:791-804. [PMID: 27095294 DOI: 10.1002/prca.201500128] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/24/2016] [Accepted: 04/11/2016] [Indexed: 12/20/2022]
Abstract
Although the molecular pathways leading to the progressive deterioration of stored red blood cells (RBC storage lesion) and the clinical relevance of storage-induced changes remain uncertain, substantial donor-specific variability in RBC performance during storage, and posttransfusion has been established ("donor-variation effect"). In-bag hemolysis and numerous properties of the RBC units that may affect transfusion efficacy have proved to be strongly donor-specific. Donor-variation effect may lead to the production of highly unequal blood labile products even when similar storage strategy and duration are applied. Genetic, undiagnosed/subclinical medical conditions and lifestyle factors that affect RBC characteristics at baseline, including RBC lifespan, energy metabolism, and sensitivity to oxidative stress, are all likely to influence the storage capacity of individual donors' cells, although not evident by the donor's health or hematological status at blood donation. Consequently, baseline characteristics of the donors, such as membrane peroxiredoxin-2 and serum uric acid concentration, have been proposed as candidate biomarkers of storage quality. This review article focuses on specific factors that might contribute to the donor-variation effect and emphasizes the emerging need for using omics-based technologies in association with in vitro and in vivo transfusion models and clinical trials to discover biomarkers of storage quality and posttransfusion recovery in donor blood.
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Affiliation(s)
- Vassilis L Tzounakas
- Department of Cell Biology and Biophysics, Faculty of Biology, NKUA, Athens, Greece
| | - Anastasios G Kriebardis
- Department of Medical Laboratories, Faculty of Health and Caring Professions, Technological and Educational Institute of Athens, Greece
| | | | - Marianna H Antonelou
- Department of Cell Biology and Biophysics, Faculty of Biology, NKUA, Athens, Greece
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29
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Desmarets M, Bardiaux L, Benzenine E, Dussaucy A, Binda D, Tiberghien P, Quantin C, Monnet E. Effect of storage time and donor sex of transfused red blood cells on 1-year survival in patients undergoing cardiac surgery: an observational study. Transfusion 2016; 56:1213-22. [DOI: 10.1111/trf.13537] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 01/10/2016] [Accepted: 01/12/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Maxime Desmarets
- Centre d'Investigation Clinique, INSERM CIC 1431; University Hospital of Besançon; Besançon France
| | - Laurent Bardiaux
- Etablissement Français du Sang (EFS) Pyrénées Méditerranée; Toulouse, France
| | - Eric Benzenine
- Service de Biostatistiques et Informatique Médicale (DIM), University Hospital of Dijon; Dijon, France
| | - Alain Dussaucy
- Département d'Information Médicale; University Hospital of Besançon
| | - Delphine Binda
- Centre d'Investigation Clinique, INSERM CIC 1431; University Hospital of Besançon; Besançon France
| | - Pierre Tiberghien
- UMR 1098, INSERM, Université de Franche-Comté, Etablissement Français du Sang; Besançon, France
| | - Catherine Quantin
- Service de Biostatistiques et Informatique Médicale (DIM), University Hospital of Dijon; Dijon, France
- Centre d'Investigation Clinique, INSERM CIC 1432, University Hospital of Dijon
- UMR 1181, Biostatistiques, biomathématiques, pharmacoépidémiologie et maladies infectieuses (BP2PHI), INSERM Université de Bourgogne; Dijon France
| | - Elisabeth Monnet
- Centre d'Investigation Clinique, INSERM CIC 1431; University Hospital of Besançon; Besançon France
- EA 4266, Agents Pathogènes et Inflammation, Université de Franche-Comté; Besançon France
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Risbano MG, Kanias T, Triulzi D, Donadee C, Barge S, Badlam J, Jain S, Belanger AM, Kim-Shapiro DB, Gladwin MT. Effects of Aged Stored Autologous Red Blood Cells on Human Endothelial Function. Am J Respir Crit Care Med 2016. [PMID: 26222884 DOI: 10.1164/rccm.201501-0145oc] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RATIONALE A major abnormality that characterizes the red cell "storage lesion" is increased hemolysis and reduced red cell lifespan after infusion. Low levels of intravascular hemolysis after transfusion of aged stored red cells disrupt nitric oxide (NO) bioavailabity, via accelerated NO scavenging reaction with cell-free plasma hemoglobin. The degree of intravascular hemolysis post-transfusion and effects on endothelial-dependent vasodilation responses to acetylcholine have not been fully characterized in humans. OBJECTIVES To evaluate the effects of blood aged to the limits of Food and Drug Administration-approved storage time on the human microcirculation and endothelial function. METHODS Eighteen healthy individuals donated 1 U of leukopheresed red cells, divided and autologously transfused into the forearm brachial artery 5 and 42 days after blood donation. Blood samples were obtained from stored blood bag supernatants and the antecubital vein of the infusion arm. Forearm blood flow measurements were performed using strain-gauge plethysmography during transfusion, followed by testing of endothelium-dependent blood flow with increasing doses of intraarterial acetylcholine. MEASUREMENTS AND MAIN RESULTS We demonstrate that aged stored blood has higher levels of arginase-1 and cell-free plasma hemoglobin. Compared with 5-day blood, the transfusion of 42-day packed red cells decreases acetylcholine-dependent forearm blood flows. Intravascular venous levels of arginase-1 and cell-free plasma hemoglobin increase immediately after red cell transfusion, with more significant increases observed after infusion of 42-day-old blood. CONCLUSIONS We demonstrate that the transfusion of blood at the limits of Food and Drug Administration-approved storage has a significant effect on the forearm circulation and impairs endothelial function. Clinical trial registered with www.clinicaltrials.gov (NCT 01137656).
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Affiliation(s)
- Michael G Risbano
- 1 Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,2 Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute
| | - Tamir Kanias
- 2 Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute
| | | | - Chenell Donadee
- 4 Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Suchitra Barge
- 1 Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jessica Badlam
- 5 Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver, Colorado
| | - Shilpa Jain
- 6 Division of Hematology/Oncology, Women and Children's Hospital of Buffalo, Buffalo, New York; and
| | - Andrea M Belanger
- 7 Department of Physics, Wake Forest University, Winston Salem, North Carolina
| | | | - Mark T Gladwin
- 1 Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,2 Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute
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Remy KE, Sun J, Wang D, Welsh J, Solomon SB, Klein HG, Natanson C, Cortés-Puch I. Transfusion of recently donated (fresh) red blood cells (RBCs) does not improve survival in comparison with current practice, while safety of the oldest stored units is yet to be established: a meta-analysis. Vox Sang 2016; 111:43-54. [PMID: 26848822 DOI: 10.1111/vox.12380] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/16/2015] [Accepted: 12/26/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Preclinical studies generated the hypothesis that older stored red blood cells (RBCs) can increase transfusion risks. To examine the most updated and complete clinical evidence and compare results between two trial designs, we assessed both observational studies and randomized controlled trials (RCTs) studying the effect of RBC storage age on mortality. MATERIALS AND METHODS Five databases were searched through December 2014 for studies comparing mortality using transfused RBCs having longer and shorter storage times. RESULTS Analysis of six RCTs found no significant differences in survival comparing current practice (average storage age of 2 to 3 weeks) to transfusion of 1- to 10-day-old RBCs (OR 0·91, 95% CI 0·77-1·07). RBC storage age was lower in RCTs vs. observational studies (P = 0·01). The 31 observational studies found an increased risk of death (OR 1·13, 95% CI 1·03-1·24) (P = 0·01) with increasing age of RBCs, a different mortality effect than RCTs (P = 0·02). CONCLUSION RCTs established that transfusion of 1- to 10-day-old stored RBCs is not superior to current practice. The apparent discrepancy in mortality between analyses of RCTs and observational studies may in part relate to differences in hypotheses tested and ages of stored RBCs studied. Further trials investigating 1- to 10-day-old stored RBC benefits would seem of lower priority than studies to determine whether 4- to 6-week stored units have safety and efficacy equivalent to the 2- to 3-week-old stored RBCs commonly transfused today.
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Affiliation(s)
- K E Remy
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, MD, USA
| | - J Sun
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, MD, USA
| | - D Wang
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, MD, USA
| | - J Welsh
- NIH Library, NIH, Bethesda, MD, USA
| | - S B Solomon
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, MD, USA
| | - H G Klein
- Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, MD, USA
| | - C Natanson
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, MD, USA
| | - I Cortés-Puch
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, MD, USA
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Bordbar A, Johansson PI, Paglia G, Harrison SJ, Wichuk K, Magnusdottir M, Valgeirsdottir S, Gybel-Brask M, Ostrowski SR, Palsson S, Rolfsson O, Sigurjónsson OE, Hansen MB, Gudmundsson S, Palsson BO. Identified metabolic signature for assessing red blood cell unit quality is associated with endothelial damage markers and clinical outcomes. Transfusion 2016; 56:852-62. [PMID: 26749434 DOI: 10.1111/trf.13460] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/03/2015] [Accepted: 11/10/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND There has been interest in determining whether older red blood cell (RBC) units have negative clinical effects. Numerous observational studies have shown that older RBC units are an independent factor for patient mortality. However, recently published randomized clinical trials have shown no difference of clinical outcome for patients receiving old or fresh RBCs. An overlooked but essential issue in assessing RBC unit quality and ultimately designing the necessary clinical trials is a metric for what constitutes an old or fresh RBC unit. STUDY DESIGN AND METHODS Twenty RBC units were profiled using quantitative metabolomics over 42 days of storage in SAGM with 3- to 4-day time intervals. Metabolic pathway usage during storage was assessed using systems biology methods. The detected time intervals of the metabolic states were compared to clinical outcomes. RESULTS Using multivariate statistics, we identified a nonlinear decay process exhibiting three distinct metabolic states (Days 0-10, 10-17, and 17-42). Hematologic variables traditionally measured in the transfusion setting (e.g., pH, hemolysis, RBC indices) did not distinguish these three states. Systemic changes in pathway usage occurred between the three states, with key pathways changing in both magnitude and direction. Finally, an association was found between the time periods of the metabolic states with the clinical outcomes of more than 280,000 patients in the country of Denmark transfused over the past 15 years and endothelial damage markers in healthy volunteers undergoing autologous transfusions. CONCLUSION The state of RBC metabolism may be a better indicator of cellular quality than traditional hematologic variables.
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Affiliation(s)
| | - Pär I Johansson
- Section for Transfusion Medicine, Capital Region Blood Bank, Rigshopitalet, University of Copenhagen, Copenhagen, Denmark
| | - Giuseppe Paglia
- Center for Systems Biology, University of Iceland, Reykjavik, Iceland
| | - Scott J Harrison
- Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Lyngby, Denmark
| | - Kristine Wichuk
- Center for Systems Biology, University of Iceland, Reykjavik, Iceland
| | | | | | - Mikkel Gybel-Brask
- Section for Transfusion Medicine, Capital Region Blood Bank, Rigshopitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sisse R Ostrowski
- Section for Transfusion Medicine, Capital Region Blood Bank, Rigshopitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sirus Palsson
- Sinopia Biosciences, San Diego, California.,Center for Systems Biology, University of Iceland, Reykjavik, Iceland
| | - Ottar Rolfsson
- Center for Systems Biology, University of Iceland, Reykjavik, Iceland
| | - Olafur E Sigurjónsson
- Blood Bank, Landspitali-University Hospital.,School of Science and Engineering, Reykjavik University, Reykjavik, Iceland
| | - Morten B Hansen
- Section for Transfusion Medicine, Capital Region Blood Bank, Rigshopitalet, University of Copenhagen, Copenhagen, Denmark
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Effect of Intraoperative Red Blood Cell Transfusion on Postoperative Complications After Open Radical Cystectomy: Old Versus Fresh Stored Blood. Clin Genitourin Cancer 2015; 13:581-7. [PMID: 26165733 DOI: 10.1016/j.clgc.2015.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 11/22/2022]
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Cortés-Puch I, Remy KE, Solomon SB, Sun J, Wang D, Al-Hamad M, Kelly SM, Sinchar D, Bellavia L, Kanias T, Popovsky MA, Kim-Shapiro DB, Klein HG, Natanson C. In a canine pneumonia model of exchange transfusion, altering the age but not the volume of older red blood cells markedly alters outcome. Transfusion 2015; 55:2564-75. [PMID: 26469998 PMCID: PMC4644122 DOI: 10.1111/trf.13275] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/29/2015] [Accepted: 06/30/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Massive exchange transfusion of 42-day-old red blood cells (RBCs) in a canine model of Staphylococcus aureus pneumonia resulted in in vivo hemolysis with increases in cell-free hemoglobin (CFH), transferrin-bound iron (TBI), non-transferrin-bound iron (NTBI), and mortality. We have previously shown that washing 42-day-old RBCs before transfusion significantly decreased NTBI levels and mortality, but washing 7-day-old RBCs increased mortality and CFH levels. We now report the results of altering volume, washing, and age of RBCs. STUDY DESIGN AND METHODS Two-year-old purpose-bred infected beagles were transfused with increasing volumes (5-10, 20-40, or 60-80 mL/kg) of either 42- or 7-day-old RBCs (n = 36) or 80 mL/kg of either unwashed or washed RBCs with increasing storage age (14, 21, 28, or 35 days; n = 40). RESULTS All volumes transfused (5-80 mL/kg) of 42-day-old RBCs resulted in alike (i.e., not significantly different) increases in TBI during transfusion as well as in CFH, lung injury, and mortality rates after transfusion. Transfusion of 80 mL/kg RBCs stored for 14, 21, 28, and 35 days resulted in increased CFH and NTBI in between levels found at 7 and 42 days of storage. However, washing RBCs of intermediate ages (14-35 days) does not alter NTBI and CFH levels or mortality rates. CONCLUSIONS Preclinical data suggest that any volume of 42-day-old blood potentially increases risks during established infection. In contrast, even massive volumes of 7-day-old blood result in minimal CFH and NTBI levels and risks. In contrast to the extremes of storage, washing blood stored for intermediate ages does not alter risks of transfusion or NTBI and CFH clearance.
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Affiliation(s)
- Irene Cortés-Puch
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland, USA
| | - Kenneth E. Remy
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland, USA
| | - Steven B. Solomon
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland, USA
| | - Junfeng Sun
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland, USA
| | - Dong Wang
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland, USA
| | - Mariam Al-Hamad
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland, USA
| | - Seth M. Kelly
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland, USA
| | - Derek Sinchar
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, 15213
| | - Landon Bellavia
- Department of Physics and the Translational Science Center, Wake Forest University, Winston-Salem, NC 27109
| | - Tamir Kanias
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, 15213
| | | | - Daniel B. Kim-Shapiro
- Department of Physics and the Translational Science Center, Wake Forest University, Winston-Salem, NC 27109
| | - Harvey G. Klein
- Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, Maryland, USA
| | - Charles Natanson
- Critical Care Medicine Department, Clinical Center, NIH, Bethesda, Maryland, USA
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Triulzi DJ. A trial is a trial is a trial: the need for an evidence-based clinical approach for evaluation of stored red cell. Transfus Med 2015; 25:293-4. [PMID: 26462872 DOI: 10.1111/tme.12255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 11/26/2022]
Affiliation(s)
- D J Triulzi
- Institute for Transfusion Medicine, Centralized Transfusion Service, Pittsburgh, Pennsylvania, USA
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Ahluwalia BS, McCourt P, Oteiza A, Wilkinson JS, Huser TR, Hellesø OG. Squeezing red blood cells on an optical waveguide to monitor cell deformability during blood storage. Analyst 2015; 140:223-9. [PMID: 25408950 DOI: 10.1039/c4an01181c] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Red blood cells squeeze through micro-capillaries as part of blood circulation in the body. The deformability of red blood cells is thus critical for blood circulation. In this work, we report a method to optically squeeze red blood cells using the evanescent field present on top of a planar waveguide chip. The optical forces from a narrow waveguide are used to squeeze red blood cells to a size comparable to the waveguide width. Optical forces and pressure distributions on the cells are numerically computed to explain the squeezing process. The proposed technique is used to quantify the loss of blood deformability that occurs during blood storage lesion. Squeezing red blood cells using waveguides is a sensitive technique and works simultaneously on several cells, making the method suitable for monitoring stored blood.
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Effects of packed red blood cell storage duration on post-transfusion clinical outcomes: a meta-analysis and systematic review. Intensive Care Med 2015; 41:2087-97. [DOI: 10.1007/s00134-015-4078-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/22/2015] [Indexed: 12/31/2022]
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39
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Chin-Yee IH, Chin-Yee BH, Pereira A. Clinical trials and the age of blood: ABLE but still wanting. Transfus Med 2015; 25:349-50. [DOI: 10.1111/tme.12252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
Affiliation(s)
- I. H. Chin-Yee
- Division of Hematology, Department of Medicine, Schulich School of Medicine; Western University; London Canada
| | - B. H. Chin-Yee
- Faculty of Medicine; University of Toronto; Toronto Canada
| | - A. Pereira
- Service of Hemotherapy and Hemostasis; Hospital Clínic; Barcelona Spain
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Abstract
BACKGROUND Well-characterized biochemical, structural, and physiological changes occur when red blood cells (RBCs) are stored for a period of time and are collectively called the storage lesion. METHODS Key study results are summarized and contrasted and new data from recently completed randomized controlled trials will be discussed. RESULTS It is unclear whether in vitro changes to RBCs that occur during storage are clinically relevant. The clinical effects of RBC storage have been the focus of observational studies in recent years. However, these studies lack any consensus, possibly because of methodological limitations. CONCLUSIONS The clinical significance of storing RBCs is controversial, although new data from randomized controlled trials of neonates and patients undergoing cardiac surgery suggest that the duration of RBC storage is not associated with adverse clinical outcomes in these patient populations.
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Affiliation(s)
- Lirong Qu
- Department of Pathology, Institute for Transfusion Medicine, Pittsburgh, PA 15213, USA.
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41
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Patterson JA, Irving DO, Isbister JP, Morris JM, Mayson E, Roberts CL, Ford JB. Age of blood and adverse outcomes in a maternity population. Transfusion 2015; 55:2730-7. [PMID: 26177784 DOI: 10.1111/trf.13230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/01/2015] [Accepted: 06/04/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND In recent times there has been debate around whether longer storage time of blood is associated with increased rates of adverse outcomes after transfusion. It is unclear whether results focused on cardiac or critically ill patients apply to a maternity population. This study investigates whether older blood is associated with increased morbidity and readmission in women undergoing obstetric transfusion. STUDY DESIGN AND METHODS Women giving birth in hospitals in New South Wales, Australia, between July 2006 and December 2010 were included in the study population if they had received between 1 and 4 red blood cell units during the birth admission. Information on women's characteristics, transfusions, and outcomes were obtained from five routinely collected data sets including blood collection, birth, and hospitalization data. Generalized propensity score methods were used to determine the effect of age of blood on rates of severe morbidity and readmission, independent of confounding factors. RESULTS Transfusion data were available for 2990 women, with a median age of blood transfused of 20 days (interquartile range, 14-27 days). There were no differences in the maximum age of blood transfused between women with and without severe morbidity (21 [14-28] days vs. 22 [15-30] days) and in women readmitted or not (22 [14-28] days vs. 22 [16-30] days). After potential confounding factors were considered, no relationship was found between the age of blood transfused and rates of severe morbidity and readmission. CONCLUSION Among women receiving low-volume transfusions during a birth admission, there was no evidence of increased rates of adverse outcomes after transfusion with older blood.
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Affiliation(s)
- Jillian A Patterson
- Clinical and Population Perinatal Health, Kolling Institute, University of Sydney, Sydney
| | - David O Irving
- Research and Development, Australian Red Cross Blood Service, Melbourne
| | - James P Isbister
- Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Jonathan M Morris
- Clinical and Population Perinatal Health, Kolling Institute, University of Sydney, Sydney
| | - Eleni Mayson
- Clinical and Population Perinatal Health, Kolling Institute, University of Sydney, Sydney
| | - Christine L Roberts
- Clinical and Population Perinatal Health, Kolling Institute, University of Sydney, Sydney
| | - Jane B Ford
- Clinical and Population Perinatal Health, Kolling Institute, University of Sydney, Sydney
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42
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Kleinman S, Glynn SA. Database research in transfusion medicine: The power of large numbers. Transfusion 2015; 55:1591-5. [DOI: 10.1111/trf.13139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 01/03/2023]
Affiliation(s)
| | - Simone A. Glynn
- Blood Epidemiology and Clinical Therapeutics Branch, Division of Blood Diseases and Resources; National Heart, Lung, and Blood Institute, National Institutes of Health; Bethesda MD
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43
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Hunt BJ, Allard S, Keeling D, Norfolk D, Stanworth SJ, Pendry K. A practical guideline for the haematological management of major haemorrhage. Br J Haematol 2015; 170:788-803. [PMID: 26147359 DOI: 10.1111/bjh.13580] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Beverley J Hunt
- Department of Haematology, GSTT, St Thomas' Hospital, London, UK
| | - Shubha Allard
- Department of Haematology, Royal London Hospital, London, UK
| | - David Keeling
- Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals, Churchill Hospital, Oxford, UK
| | - Derek Norfolk
- Department of Haematology, Leeds Hospital, Leeds, UK
| | - Simon J Stanworth
- NHSBT/Department of Haematology, John Radcliffe Hospital, Oxford, UK
| | - Kate Pendry
- Patients' Clinical Team, NHSBT, Manchester, UK
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Abstract
PURPOSE OF REVIEW This article will analyze and evaluate the current evidence regarding the use of older, longer-stored red blood cells (RBCs) for transfusion in pediatric patients and will examine some of the postulated mechanisms of injury related to prolonged refrigerated storage of RBCs and studies reporting clinical outcomes. RECENT FINDINGS Three randomized controlled trials and seven observational studies have been conducted entirely in pediatric patients. The outcomes, mortality and morbidity in critically ill patients and children undergoing cardiac surgery, and necrotizing enterocolitis in premature infants, have been inconsistent. However, many of these studies have been confounded by study design, mixed patient populations, red cell preparation, and other factors. SUMMARY Further exploration into the possible deleterious effects of older, longer-stored RBC transfusions on mortality and morbidity in different pediatric populations is merited. Understanding the potential mechanisms of injury should help explain the clinical findings.
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45
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Steiner ME, Ness PM, Assmann SF, Triulzi DJ, Sloan SR, Delaney M, Granger S, Bennett-Guerrero E, Blajchman MA, Scavo V, Carson JL, Levy JH, Whitman G, D'Andrea P, Pulkrabek S, Ortel TL, Bornikova L, Raife T, Puca KE, Kaufman RM, Nuttall GA, Young PP, Youssef S, Engelman R, Greilich PE, Miles R, Josephson CD, Bracey A, Cooke R, McCullough J, Hunsaker R, Uhl L, McFarland JG, Park Y, Cushing MM, Klodell CT, Karanam R, Roberts PR, Dyke C, Hod EA, Stowell CP. Effects of red-cell storage duration on patients undergoing cardiac surgery. N Engl J Med 2015; 372:1419-29. [PMID: 25853746 PMCID: PMC5442442 DOI: 10.1056/nejmoa1414219] [Citation(s) in RCA: 334] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Some observational studies have reported that transfusion of red-cell units that have been stored for more than 2 to 3 weeks is associated with serious, even fatal, adverse events. Patients undergoing cardiac surgery may be especially vulnerable to the adverse effects of transfusion. METHODS We conducted a randomized trial at multiple sites from 2010 to 2014. Participants 12 years of age or older who were undergoing complex cardiac surgery and were likely to undergo transfusion of red cells were randomly assigned to receive leukocyte-reduced red cells stored for 10 days or less (shorter-term storage group) or for 21 days or more (longer-term storage group) for all intraoperative and postoperative transfusions. The primary outcome was the change in Multiple Organ Dysfunction Score (MODS; range, 0 to 24, with higher scores indicating more severe organ dysfunction) from the preoperative score to the highest composite score through day 7 or the time of death or discharge. RESULTS The median storage time of red-cell units provided to the 1098 participants who received red-cell transfusion was 7 days in the shorter-term storage group and 28 days in the longer-term storage group. The mean change in MODS was an increase of 8.5 and 8.7 points, respectively (95% confidence interval for the difference, -0.6 to 0.3; P=0.44). The 7-day mortality was 2.8% in the shorter-term storage group and 2.0% in the longer-term storage group (P=0.43); 28-day mortality was 4.4% and 5.3%, respectively (P=0.57). Adverse events did not differ significantly between groups except that hyperbilirubinemia was more common in the longer-term storage group. CONCLUSIONS The duration of red-cell storage was not associated with significant differences in the change in MODS. We did not find that the transfusion of red cells stored for 10 days or less was superior to the transfusion of red cells stored for 21 days or more among patients 12 years of age or older who were undergoing complex cardiac surgery. (Funded by the National Heart, Lung, and Blood Institute; RECESS ClinicalTrials.gov number, NCT00991341.).
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Affiliation(s)
- Marie E Steiner
- From Fairview-University Medical Center, Minneapolis (M.E.S., S.P., J.M.), and Mayo Clinic, Rochester (G.A.N.) - both in Minnesota; Johns Hopkins University (P.M.N., G.W.) and University of Maryland (R.C.) - both in Baltimore; New England Research Institutes, Data Coordinating Center, Watertown (S.F.A., S.G.), Boston Children's Hospital (S.R.S.), Massachusetts General Hospital (L.B., C.P.S.), Brigham and Women's Hospital (R.M.K.), Tufts University (R.E.), St. Elizabeth's Medical Center (R.H.), and Beth Israel Deaconess Medical Center (L.U.), Boston, and Baystate Medical Center, Springfield (R.E.) - all in Massachusetts; University of Pittsburgh and University of Pittsburgh-Mercy Hospital, Pittsburgh (D.J.T., P.D.); Puget Sound Blood Center and University of Washington (M.D.) and Swedish Medical Center (S.Y.) - all in Seattle; Duke University, Durham (E.B.-G., J.H.L., T.L.O.), and University of North Carolina, Chapel Hill (Y.P.) - both in North Carolina; McMaster University, Hamilton, ON, Canada (M.A.B.); Indiana-Ohio Heart and St. Joseph Hospital (V.S.) - both in Fort Wayne, IN; Rutgers Robert Wood Johnson Medical School, New Brunswick (J.L.C.), and Newark Beth Israel Medical Center, Newark (R.K.) - both in New Jersey; University of Iowa, Iowa City (T.R.); Aurora St. Luke's Medical Center (K.E.P.) and Froedert Memorial Lutheran Hospital (J.G.M.), Milwaukee, and Aspirus Heart and Vascular Institute, Wausau (R.M.) - all in Wisconsin; Vanderbilt University, Nashville (P.P.Y.); University of Texas Southwestern Medical Center, Dallas (P.E.G.); Children's Healthcare of Atlanta, Emory University, and Emory University Hospital, Atlanta (C.D.J.); St. Luke's-Texas Heart Institute, Houston (A.B.); Weill Cornell Medical College (M.M.C.) and Columbia University Medical Center (E.A.H.) - both in New York; University of Florida, Gainesville (C.T.K.); University of Oklahoma, Oklahoma City (P.R.R.); and University of North Dakota School of Medicine and Health Sciences, Fargo (C.D.)
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Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*. Anesthesiology 2015; 122:241-75. [PMID: 25545654 DOI: 10.1097/aln.0000000000000463] [Citation(s) in RCA: 442] [Impact Index Per Article: 49.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract
The American Society of Anesthesiologists Committee on Standards and Practice Parameters and the Task Force on Perioperative Blood Management presents an updated report of the Practice Guidelines for Perioperative Blood Management.
Supplemental Digital Content is available in the text.
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47
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Orlov D, Karkouti K. The pathophysiology and consequences of red blood cell storage. Anaesthesia 2015; 70 Suppl 1:29-37, e9-12. [PMID: 25440392 DOI: 10.1111/anae.12891] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2014] [Indexed: 12/17/2022]
Abstract
Red cell transfusion therapy is a common treatment modality in contemporary medical practice. Although blood collection and administration is safer and more efficient than ever before, red cells undergo multiple metabolic and structural changes during storage that may compromise their functionality and viability following transfusion. The clinical relevance of these changes is a hotly debated topic that continues to be a matter of intense investigation. In the current review, we begin with an in-depth overview of the pathophysiological mechanisms underlying red cell storage, with a focus on altered metabolism, oxidative stress and red cell membrane damage. We proceed to review the current state of evidence on the clinical relevance and consequences of the red cell storage lesion, while discussing the strengths and limitations of clinical studies.
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Affiliation(s)
- D Orlov
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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48
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Chassé M, McIntyre L, Tinmouth A, Acker J, English SW, Knoll G, Forster A, Shehata N, Wilson K, van Walraven C, Ducharme R, Fergusson DA. Clinical effects of blood donor characteristics in transfusion recipients: protocol of a framework to study the blood donor-recipient continuum. BMJ Open 2015; 5:e007412. [PMID: 25600255 PMCID: PMC4305074 DOI: 10.1136/bmjopen-2014-007412] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION When used appropriately, transfusion of red blood cells (RBCs) is a necessary life-saving therapy. However, RBC transfusions have been associated with negative outcomes such as infection and organ damage. Seeking explanations for the beneficial and deleterious effects of RBC transfusions is necessary to ensure the safe and optimal use of this precious resource. This study will create a framework to analyse the influence of blood donor characteristics on recipient outcomes. METHODS AND ANALYSIS We will conduct a multisite, longitudinal cohort study using blood donor data routinely collected by Canadian Blood Services, and recipient data from health administrative databases. Our project will include a thorough validation of primary data, the linkage of various databases into one large longitudinal database, an in-depth epidemiological analysis and a careful interpretation and dissemination of the results to assist the decision-making process of clinicians, researchers and policymakers in transfusion medicine. Our primary donor characteristic will be age of blood donors and our secondary donor characteristics will be donor-recipient blood group compatibility and blood donor sex. Our primary recipient outcome will be a statistically appropriate survival analysis post-RBC transfusion up to a maximum of 8 years. Our secondary recipient outcomes will include 1-year, 2-year and 5-year mortality; hospital and intensive care unit length of stay; rehospitalisation; new cancer and cancer recurrence rate; infection rate; new occurrence of myocardial infarctions and need for haemodialysis. ETHICS AND DISSEMINATION Our results will help determine whether we need to tailor transfusion based on donor characteristics, and perhaps this will improve patient outcome. Our results will be customised to target the different stakeholders involved with blood transfusions and will include presentations, peer-reviewed publications and the use of the dissemination network of blood supply organisations. We obtained approval from the Research Ethics boards and privacy offices of all involved institutions.
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Affiliation(s)
- Michaël Chassé
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lauralyn McIntyre
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alan Tinmouth
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jason Acker
- Centre for Innovation, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Shane W English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
| | - Greg Knoll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Nadine Shehata
- Department of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Carl van Walraven
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robin Ducharme
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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49
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Edgren G, Rostgaard K, Vasan SK, Wikman A, Norda R, Pedersen OB, Erikstrup C, Nielsen KR, Titlestad K, Ullum H, Melbye M, Nyrén O, Hjalgrim H. The new Scandinavian Donations and Transfusions database (SCANDAT2): a blood safety resource with added versatility. Transfusion 2015; 55:1600-6. [DOI: 10.1111/trf.12986] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/01/2014] [Accepted: 11/12/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Gustaf Edgren
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
- Hematology Centre; Karolinska University Hospital; Stockholm Sweden
| | - Klaus Rostgaard
- Department of Epidemiology Research; Statens Serum Institut; Copenhagen Denmark
| | - Senthil K. Vasan
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Agneta Wikman
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital; Stockholm Sweden
| | - Rut Norda
- Department of Immunology, Genetics and Pathology; Uppsala University; Uppsala Sweden
| | | | - Christian Erikstrup
- Department of Clinical Immunology; Aarhus University Hospital; Aarhus Denmark
| | - Kaspar René Nielsen
- Department of Clinical Immunology; Aalborg University Hospital; Aalborg Denmark
| | - Kjell Titlestad
- Department of Clinical Immunology; Odense University Hospital; Odense Denmark
| | - Henrik Ullum
- Department of Clinical Immunology; the Blood Bank; Rigshospitalet; University Hospital of Copenhagen; Copenhagen Denmark
| | - Mads Melbye
- Department of Epidemiology Research; Statens Serum Institut; Copenhagen Denmark
- Department of Clinical Medicine; Copenhagen University; Copenhagen Denmark
- Department of Medicine; Stanford School of Medicine; Stanford California
| | - Olof Nyrén
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Henrik Hjalgrim
- Department of Epidemiology Research; Statens Serum Institut; Copenhagen Denmark
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50
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Grasas A, Pereira A, Bosch MA, Ortiz P, Puig L. Feasibility of reducing the maximum shelf life of red blood cells stored in additive solution: a dynamic simulation study involving a large regional blood system. Vox Sang 2014; 108:233-42. [DOI: 10.1111/vox.12224] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/17/2014] [Accepted: 10/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. Grasas
- Department of Economics and Business; Universitat Pompeu Fabra; Barcelona Spain
| | - A. Pereira
- Service of Hemotherapy and Hemostasis; Hospital Clínic; Barcelona Spain
| | | | - P. Ortiz
- Banc de Sang I Teixits; Barcelona Spain
| | - L. Puig
- Banc de Sang I Teixits; Barcelona Spain
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