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Lee HR. Predictors of Red Blood Cell Transfusion in Elderly COVID-19 Patients in Korea. Ann Lab Med 2022; 42:659-667. [PMID: 35765874 PMCID: PMC9277048 DOI: 10.3343/alm.2022.42.6.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/20/2022] [Accepted: 06/17/2022] [Indexed: 01/28/2023] Open
Abstract
Background Patients who experience clinical deterioration from coronavirus disease (COVID-19) require blood transfusion support. We analyzed blood component usage in COVID-19 patients and identified the predictors of red blood cell (RBC) transfusion in elderly (≥65 years) patients. Methods Blood component usage in 882 COVID-19 patients hospitalized between January 24, 2020 and April 30, 2021 was analyzed. Elderly patients were categorized into transfused and non-transfused groups according to their RBC transfusion history; their demographic and clinical characteristics, disease severity, and outcomes were compared. Associations were determined using multiple logistic regression. Results The overall transfusion rate was 8.3% (73/882), and the transfusion rate was 2.7% (14/524) in patients aged <65 years and 16.5% (59/358) in those aged ≥65 years. Among the 358 elderly patients, 344 patients, including 50 who received transfusion and 294 who did not, were enrolled for the analysis. The prevalence of diabetes mellitus (DM), white blood cell count, absolute neutrophil count, and neutrophil-to-lymphocyte ratio (NLR) on admission were significantly higher in the transfused group, whereas Hb and platelet counts were significantly lower. Disease severity in the transfused group was relatively high on admission and increased thereafter. DM, intensive care unit entrance on admission, Hb, platelet count, and NLR on admission were independently associated with RBC transfusion. Conclusions This study presents transfusion rates in COVID-19 patients according to age groups and predictors of RBC transfusion in elderly patients. The results provide a basis for developing a strategy for the medical treatment of infectious diseases emerging during pandemics.
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Affiliation(s)
- Hye Ryun Lee
- Department of Laboratory Medicine, National Medical Center, Seoul, Korea
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Sanz C, Faúndez A, García A, Rodríguez M, Coromoto Jaramillo A, Pereira A. Clinical characteristics and indications for blood transfusion in patients with SARS-CoV-2 infection. Medicina Clínica (English Edition) 2022; 159:230-233. [PMID: 36065233 PMCID: PMC9435025 DOI: 10.1016/j.medcle.2021.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/21/2021] [Indexed: 01/28/2023]
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Vasiljević-jovanović B, Milenković M, Mijović L, Bukumirić Z, Šantrić-milićević M, Božanić M, Milutinović V, Zdravković M. Evaluation of the Use of Blood Products in ICU Hospitalized COVID-19 Patients. Surgeries 2021; 2:391-8. [DOI: 10.3390/surgeries2040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The COVID-19 pandemic tested the public health system’s readiness for crises and highlighted the importance of knowing the demand for blood products and the maintenance of the blood supply chain. The aim of this study was to evaluate blood product usage in a series of patients that were hospitalized due to COVID-19 and to analyze their demographics and clinical characteristics. (2) Methods: In this retrospective cohort study, we analyzed data from transfused COVID-19 patients that were treated in the University Hospital Medical Center Bezanijska Kosa in Belgrade, Serbia during the second wave of the epidemic. (3) Results: This study included 90 patients. The median age of the patients was 72 (range 23–95) years. The median time of hospitalization was 23 days (range 3–73 days). In intensive care units (ICUs) the median time of hospitalization was 9 days (range 0–73). One or more comorbidities were observed in 86 individuals (95.6%). The total number of transfused red blood cell concetrates (RBC) was 304 (139 in ICU, 165 in other wards), with a mean of 3 units/patient (range 1–14). Comorbidities, severity of illness and hospital duration in the ICU were statistically significant predictors of higher RBC use. (4) Conclusion: Knowledge of the transfusion profile of COVID-19 patients allowed better management of the hospital’s blood stocks during the COVID-19 pandemic.
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Sanz C, Faúndez A, García A, Rodríguez M, Coromoto Jaramillo A, Pereira A. Clinical characteristics and indications for blood transfusion in patients with SARS-CoV-2 infection. Med Clin (Barc) 2021; 159:230-233. [PMID: 34417021 PMCID: PMC8318729 DOI: 10.1016/j.medcli.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 01/28/2023]
Abstract
Background There are few data on the clinical characteristics of COVID-19 patients who require blood transfusion. We aimed to investigate the clinical characteristics and indication for transfusion in COVID-19 patients seen during the epidemic's first wave. Material and methods Cross-sectional study that included all consecutive COVID-19 patients admitted to the Hospital Clínic of Barcelona, Spain, from mid-March to mid-May 2020. Results A total of 80 patients received 354 RBC units, 116 plasma units, and 48 platelet units. Median age was 71 years (IQR: 62–76), and 59 (74%) were males. In total, 138 of the 261 transfusion episodes that involved RBCs (59%) were related to spontaneous (n = 94) or procedure-related (n = 44) bleeding. Spontaneous bleeding was more frequent in the retroperitoneal space and the gastrointestinal apparatus. Tracheostomy with endotracheal intubation, surgical interventions, and cannulation of femoral vessels were the main procedures behind non-spontaneous bleeding. Most patients (91%) were on anticoagulants, mostly intermediate- or full-dose heparin. Conclusion Anticoagulation-related bleeding was a leading cause of blood transfusion in COVID-19 patients during the epidemic's first-wave.
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Affiliation(s)
- Cristina Sanz
- Blood Bank and Transfusion Service, Hospital Clínic, Barcelona, Spain.
| | - Annabel Faúndez
- Blood Bank and Transfusion Service, Hospital Clínic, Barcelona, Spain
| | - Anna García
- Blood Bank and Transfusion Service, Hospital Clínic, Barcelona, Spain
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Langi Sasongko P, van den Hurk K, van Kraaij M, Rouwette EAJA, Marchau VAWJ, Janssen MP. Not a crystal ball: Mapping opportunities and threats for the future demand of red blood cells in the Netherlands using a scenario approach. Transfusion 2021; 61:2356-2367. [PMID: 34058022 DOI: 10.1111/trf.16532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND As Western blood transfusion practices are changing, there is interest and need in anticipating the future demand of blood products and how a blood establishment can actively prepare for various long-term developments. This article provides an overview of how a scenario approach was used to prioritize key categories of drivers for the future demand of red blood cells and the organizational implications thereof for Sanquin, the Dutch national blood establishment. STUDY DESIGN AND METHODS Based on previously identified drivers from interviews and a literature review (Step 1), we conducted scenario sessions and a survey to rank a list of drivers ("themes") with its related opportunities and threats (Step 2), to identify mitigating measures per theme through focus groups (Step 3). RESULTS In Step 2, 10 themes were found that were classified in terms of importance and uncertainty. These were plotted on a two-dimensional graph with an ellipse to indicate the interquartile ranges per theme. Experts rated the top three most important themes to be the blood supply organization, precision medicine, and red blood cell replacements. In Step 3, focus groups identified specific mitigating measures per theme. These measures had parallel ideas, such as the need for an innovative mentality, internal and external communication and collaboration, and building Sanquin's reputation and trust with the public. CONCLUSION Having identified the most important themes with suggestions for mitigating measures, Sanquin can take steps to become adaptive and proactive. Other blood establishments may also use a scenario approach to create contextualized long-term strategies.
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Affiliation(s)
- Praiseldy Langi Sasongko
- Department of Donor Medicine Research, Transfusion Technology Assessment, Sanquin Research, Amsterdam, The Netherlands.,Department of Donor Medicine Research, Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Katja van den Hurk
- Department of Donor Medicine Research, Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Marian van Kraaij
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Mart P Janssen
- Department of Donor Medicine Research, Transfusion Technology Assessment, Sanquin Research, Amsterdam, The Netherlands
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Grandone E, Tiscia G, Pesavento R, De Laurenzo A, Ceccato D, Sartori MT, Mirabella L, Cinnella G, Mastroianno M, Dalfino L, Colaizzo D, Vettor R, Intrieri M, Ostuni A, Margaglione M. Use of low-molecular weight heparin, transfusion and mortality in COVID-19 patients not requiring ventilation. J Thromb Thrombolysis 2021; 52:772-778. [PMID: 33844150 PMCID: PMC8040353 DOI: 10.1007/s11239-021-02429-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 01/08/2023]
Abstract
It is still debated whether prophylactic doses of low-molecular- weight heparin (LMWH) are always effective in preventing Venous Thromboembolism (VTE) and mortality in COVID-19. Furthermore, there is paucity of data for those patients not requiring ventilation. We explored mortality and the safety/efficacy profile of LMWH in a cohort of Italian patients with COVID-19 who did not undergo ventilation. From the initial cohort of 422 patients, 264 were enrolled. Most (n = 156, 87.7%) received standard LMWH prophylaxis during hospitalization, with no significant difference between medical wards and Intensive Care Unit (ICU). Major or not major but clinically relevant hemorrhages were recorded in 13 (4.9%) patients: twelve in those taking prophylactic LMWH and one in a patient taking oral anticoagulants (p: n.s.). Thirty-nine patients (14.8%) with median age 75 years. were transfused. Hemoglobin (Hb) at admission was significantly lower in transfused patients and Hb at admission inversely correlated with the number of red blood cells units transfused (p < 0.001). In-hospital mortality occurred in 76 (28.8%) patients, 46 (24.3%) of whom admitted to medical wards. Furthermore, Hb levels at admittance were significantly lower in fatalities (g/dl 12.3; IQR 2.4 vs. 13.3; IQR 2.8; Mann–Whitney U-test; p = 0.001). After the exclusion of patients treated by LMWH intermediate or therapeutic doses (n = 32), the logistic regression showed that prophylaxis significantly and independently reduced mortality (OR 0.31, 95% CI 0.13–0.85). Present data show that COVID-19 patients who do not require ventilation benefit from prophylactic doses of LMWH.
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Affiliation(s)
- Elvira Grandone
- Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. "Casa Sollievo della Sofferenza", Viale Cappuccini, S. Giovanni Rotondo, 71013, Foggia, Italy.
- Ob/Gyn Department of The First I.M. Sechenov Moscow State Medical University, Moscow, Russia.
| | - Giovanni Tiscia
- Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. "Casa Sollievo della Sofferenza", Viale Cappuccini, S. Giovanni Rotondo, 71013, Foggia, Italy
| | | | - Antonio De Laurenzo
- Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. "Casa Sollievo della Sofferenza", Viale Cappuccini, S. Giovanni Rotondo, 71013, Foggia, Italy
| | - Davide Ceccato
- Department of Internal Medicine, University of Padua, Padua, Italy
| | | | - Lucia Mirabella
- Department of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy
| | - Gilda Cinnella
- Department of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy
| | - Mario Mastroianno
- Scientific Direction, Fondazione I.R.C.C.S. "Casa Sollievo Della Sofferenza", S. Giovanni Rotondo, Foggia, Italy
| | - Lidia Dalfino
- Anesthesia and Intensive Care Unit, University of Bari, Bari, Italy
| | - Donatella Colaizzo
- Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. "Casa Sollievo della Sofferenza", Viale Cappuccini, S. Giovanni Rotondo, 71013, Foggia, Italy
| | - Roberto Vettor
- Department of Internal Medicine, University of Padua, Padua, Italy
| | - Mariano Intrieri
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Angelo Ostuni
- Immunohematology and Transfusion Medicine Service, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, University of Bari "Aldo Moro", and Struttura Regionale Coordinamento Puglia, Bari, Italy
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Grandone E, Pesavento R, Tiscia G, De Laurenzo A, Ceccato D, Sartori MT, Mirabella L, Cinnella G, Mastroianno M, Dalfino L, Colaizzo D, Vettor R, Ostuni A, Margaglione M. Mortality and Transfusion Requirements in COVID-19 Hospitalized Italian Patients According to Severity of the Disease. J Clin Med 2021; 10:E242. [PMID: 33440831 DOI: 10.3390/jcm10020242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/30/2020] [Accepted: 01/08/2021] [Indexed: 12/15/2022] Open
Abstract
There is paucity of data on the transfusion need and its impact on the overall mortality in patients with COVID-19. We explored mortality in hospitalized patients with COVID-19 who required transfusions. Information on clinical variables and in-hospital mortality were obtained from medical records of 422 patients admitted to medical wards or the Intensive Care Unit (ICU). In-hospital mortality occurred in 147 (34.8%) patients, 94 (63.9%) of whom were admitted to the ICU. The median fatalities age was 77 years (IQR 14). Overall, 100 patients (60 males) received transfusion during hospitalization. The overall mortality was significantly and independently associated with age, ICU admission, Chronic Kidney Disease (CKD), and the number of transfused Red Blood Cell (RBC) units. Specifically, CKD was associated with mortality in patients admitted to medical wards, whereas the number of transfused RBC units predicted mortality in those admitted to the ICU. Transfusion strongly interacted with the admission to ICU (OR: 9.9; 95% CI: 2.5–40.0). In patients with COVID-19, age is one of the strongest risk factors in predicting mortality independently of the disease’s severity. CKD confers a higher risk of mortality in patients admitted to medical wards. In those admitted to the ICU, the more RBC units are transfused, the more mortality increases.
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