To Optimize Perioperative Patient Blood Management_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WEIXin-guang ,  GUANYu-long

Department of Extracorporeal Circulation, State Key Laboratory of Cardiovascular Diseas, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R.China;

Corresponding author：

GUANYu-long, Email: guanyulong@yahoo.com

Keywords：

Transfusion; Safe; Threshold; Infection

DOI：

10.7507/1007-4848.20160090

Video：

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The limitation of resource of blood and risk of transfusion-transmitted infections contribute to development and generalization of restrictive transfusion strategy. However, advanced evidences of clinical trials indicated a restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care costs. It is time to optimize patient blood management but not free-transfusion and increase of risk of patients. The duration of red-cell storage was not associated with significant differences in the mortality and morbidity of patients. Three new pathogen-reduction technologies and pharmaceutical intervenes may provide safe of transfusion and improvement of outcomes.

Citation： WEIXin-guang, GUANYu-long. To Optimize Perioperative Patient Blood Management. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(4): 390-395. doi: 10.7507/1007-4848.20160090 Copy

1.	Corwin HL. Blood conservation in the critically ill patient. Anesthesiol Clin North America, 2005, 23(2): viii 363-372.
2.	Zilberg MD, Stern LS, Wiederkehr DP, et al. Anemia, transfusions and hospital outcomes among critically ill patients on prolonged acute mechanical ventilation: a retrospective cohort study. Crit Care, 2008, 12(2):R60.
3.	Vincent JL, Baron JF, Reinhart K. Anemia and blood transfusion in critically ill patients. JAMA, 2002, 288:1499-1507.
4.	Corwin HL, Surgenor SD, Gettinger A. Transfusion practice in the critically ill. Crit Care Med, 2003, 31(suppl 12): S668-S671.
5.	VincentJL, PiagnerelliM. Transfusion in the intensive care unit. Crit Care Med, 2006, 34(suppl 5): S96-S101.
6.	Beattie WS, Karkouti K, Wijeysundera DN, et al. Risk associated with preoperative anemia in noncardiac surgery. Anesthesiology, 2009, 110: 574-581.
7.	Carson JL, Duff RM, Berlin JA, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet, 1996, 348: 1055-1060.
8.	Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet, 2011, 378(9800): 1396-1407.
9.	Goodnough LT, Levy JH, Murphy MF. Concepts of blood transfusion in adults. Lancet, 2013, 381(9880):1845-1854.
10.	Dodd RY. Current risk for transfusion transmitted infections. Curr Opin Hematol, 2007, 14: 671-676.
11.	Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood, 2009, 113(15): 3406-3417.
12.	Triulzi DJ. Transfusion-related acute lung injury: current concepts for the clinician. Anesth Analg, 2009, 108(3): 770-776.
13.	Vamvakas EC. Pneumonia as a complication of blood product transfusion in the critically ill: transfusion-related immunomodulation (TRIM). Crit Care Med, 2006, 34(5 Suppl): S151-S159.
14.	Bhaskar B, Dulhunty J, Mullany DV, et al. Impact of blood product transfusion on short and long-term survival after cardiac surgery: more evidence. Ann Thorac Surg, 2012, 94(2): 460-467.
15.	Shaw RE, Johnson CK, Ferrari G, et al. Balancing the benefits and risks of blood transfusions in patients undergoing cardiac surgery: a propensity-matched analysis. Interact Cardiovasc Thorac Surg, 2013, 17(1): 96-102.
16.	Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on perioperative blood transfusion and adjuvant therapies. Anesthesiol, 2006, 105(1):198-208.
17.	Ferraris VA, Brown JR, Despotis GJ, et al. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg, 2011, 91(3): 944-982.
18.	Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Intern Med, 2012, 157(1):49-58.
19.	廖刃, 刘进. 华西围术期输血指征评分——以临床需求为目标的输血评分. 中国胸心血管外科临床杂志, 2014, 21 (2): 145-146.
20.	高歌, 胡盛寿, 郑哲, 等. 双联抗血小板治疗对冠状动脉旁路移植术后出血及输血的影响. 中国胸心血管外科临床杂志, 2010, 17(1): 1-5.
21.	Addison J, Gerrard R, Harris A. Strategies to avoid unnecessary transfusions. Nurs Times, 2014, 110(40): 22-25.
22.	Shander A, Van Aken H, Colomina MJ, et al. Patient blood management in Europe. Br J Anaesth, 2012, 109(1): 55-68.
23.	Whitmore E, Gerrard R, Coffey K. Gaining informed consent for blood transfusion. Nurs Times, 2014, 110(36): 12-14.
24.	Holst LB, Haase N, Wetterslev J, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med, 2014, 371(15): 1381-1391.
25.	Hébert PC, Carson JL. Transfusion threshold of 7 g per deciliter--the new normal. N Engl J Med, 2014, 371(15): 1459-1461.
26.	Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med, 2013, 368(1): 11-21.
27.	Hébert PC, Yetisir E, Martin C, et al. Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med, 2001, 29(2): 227-234.
28.	Carson JL, Brooks MM, Abbott JD, et al. Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. Am Heart J, 2013, 165(6): 964-971.
29.	Murphy GJ, Pike K, Rogers CA, et al. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med, 2015, 372(11): 997-1008.
30.	Hogervorst E, Rosseel P, van der Bom J. Tolerance of intraoperative hemoglobin decrease during cardiac surgery. Transfusion, 2014, 54(10 Pt 2): 2696-2704.
31.	Klein HG. How safe is blood, really? Biologicals, 2010, 38(1): 100-104.
32.	Ho J, Sibbald WJ, Chin-Yee IH. Effects of storage on efficacy of red cell transfusion: when is it not safe? Crit Care Med, 2003, 31(suppl 12): S687-S697.
33.	Vandromme MJ, McGwin G Jr, Weinberg JA. Blood transfusion in the critically ill: does storage age matter? Scand J Trauma Resusc Emerg Med, 2009, 17: 35.
34.	Zubair AC. Clinical impact of blood storage lesions. Am J Hematol, 2010, 85(2): 117-122.
35.	Min JJ, Bae JY, Kim TK, et al. Association between red blood cell storage duration and clinical outcome in patients undergoing off-pump coronary artery bypass surgery: a retrospective study. BMC Anesthesiol, 2014, 14: 95.
36.	Fergusson DA, Hébert P, Hogan DL, et al. Effect of fresh red blood cell transfusions on clinical outcomes in premature, very low-birth-weight infants: the ARIPI randomized trial. JAMA, 2012, 308(14): 1443-1451.
37.	Steiner ME, Ness PM, Assmann SF, et al. Effects of red-cell storage duration on patients undergoing cardiac surgery. N Engl J Med, 2015, 372(15): 1419-1429.
38.	Lacroix J, Hébert PC, Fergusson DA, et al. Age of transfused blood in critically ill adults. N Engl J Med, 2015, 372(15): 1410-1418.
39.	Sarnack MJ, Tighiouart H, Manjunath G, et al. Anemia as a risk factor for cardiovascular disease in The Atherosclerosis Risk in Communities (ARIC) study. J Am Coll Cardiol, 2002, 40(1):27-33.
40.	Snyder EL, Stramer SL, Benjamin RJ. The safety of the blood supply-time to raise the bar. N Engl J Med, 2015, 372(20): 1882-1885.
41.	Weltert L, Rondinelli B, Bello R, et al. A single dose of erythropoietin reduces perioperative transfusions in cardiac surgery: results of a prospective single-blind randomized controlled trial. Transfusion, 2015, 55(7): 1644-1654.

1. Corwin HL. Blood conservation in the critically ill patient. Anesthesiol Clin North America, 2005, 23(2): viii 363-372.
2. Zilberg MD, Stern LS, Wiederkehr DP, et al. Anemia, transfusions and hospital outcomes among critically ill patients on prolonged acute mechanical ventilation: a retrospective cohort study. Crit Care, 2008, 12(2):R60.
3. Vincent JL, Baron JF, Reinhart K. Anemia and blood transfusion in critically ill patients. JAMA, 2002, 288:1499-1507.
4. Corwin HL, Surgenor SD, Gettinger A. Transfusion practice in the critically ill. Crit Care Med, 2003, 31(suppl 12): S668-S671.
5. VincentJL, PiagnerelliM. Transfusion in the intensive care unit. Crit Care Med, 2006, 34(suppl 5): S96-S101.
6. Beattie WS, Karkouti K, Wijeysundera DN, et al. Risk associated with preoperative anemia in noncardiac surgery. Anesthesiology, 2009, 110: 574-581.
7. Carson JL, Duff RM, Berlin JA, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet, 1996, 348: 1055-1060.
8. Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet, 2011, 378(9800): 1396-1407.
9. Goodnough LT, Levy JH, Murphy MF. Concepts of blood transfusion in adults. Lancet, 2013, 381(9880):1845-1854.
10. Dodd RY. Current risk for transfusion transmitted infections. Curr Opin Hematol, 2007, 14: 671-676.
11. Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood, 2009, 113(15): 3406-3417.
12. Triulzi DJ. Transfusion-related acute lung injury: current concepts for the clinician. Anesth Analg, 2009, 108(3): 770-776.
13. Vamvakas EC. Pneumonia as a complication of blood product transfusion in the critically ill: transfusion-related immunomodulation (TRIM). Crit Care Med, 2006, 34(5 Suppl): S151-S159.
14. Bhaskar B, Dulhunty J, Mullany DV, et al. Impact of blood product transfusion on short and long-term survival after cardiac surgery: more evidence. Ann Thorac Surg, 2012, 94(2): 460-467.
15. Shaw RE, Johnson CK, Ferrari G, et al. Balancing the benefits and risks of blood transfusions in patients undergoing cardiac surgery: a propensity-matched analysis. Interact Cardiovasc Thorac Surg, 2013, 17(1): 96-102.
16. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on perioperative blood transfusion and adjuvant therapies. Anesthesiol, 2006, 105(1):198-208.
17. Ferraris VA, Brown JR, Despotis GJ, et al. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg, 2011, 91(3): 944-982.
18. Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Intern Med, 2012, 157(1):49-58.
19. 廖刃, 刘进. 华西围术期输血指征评分——以临床需求为目标的输血评分. 中国胸心血管外科临床杂志, 2014, 21 (2): 145-146.
20. 高歌, 胡盛寿, 郑哲, 等. 双联抗血小板治疗对冠状动脉旁路移植术后出血及输血的影响. 中国胸心血管外科临床杂志, 2010, 17(1): 1-5.
21. Addison J, Gerrard R, Harris A. Strategies to avoid unnecessary transfusions. Nurs Times, 2014, 110(40): 22-25.
22. Shander A, Van Aken H, Colomina MJ, et al. Patient blood management in Europe. Br J Anaesth, 2012, 109(1): 55-68.
23. Whitmore E, Gerrard R, Coffey K. Gaining informed consent for blood transfusion. Nurs Times, 2014, 110(36): 12-14.
24. Holst LB, Haase N, Wetterslev J, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med, 2014, 371(15): 1381-1391.
25. Hébert PC, Carson JL. Transfusion threshold of 7 g per deciliter--the new normal. N Engl J Med, 2014, 371(15): 1459-1461.
26. Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med, 2013, 368(1): 11-21.
27. Hébert PC, Yetisir E, Martin C, et al. Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med, 2001, 29(2): 227-234.
28. Carson JL, Brooks MM, Abbott JD, et al. Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. Am Heart J, 2013, 165(6): 964-971.
29. Murphy GJ, Pike K, Rogers CA, et al. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med, 2015, 372(11): 997-1008.
30. Hogervorst E, Rosseel P, van der Bom J. Tolerance of intraoperative hemoglobin decrease during cardiac surgery. Transfusion, 2014, 54(10 Pt 2): 2696-2704.
31. Klein HG. How safe is blood, really? Biologicals, 2010, 38(1): 100-104.
32. Ho J, Sibbald WJ, Chin-Yee IH. Effects of storage on efficacy of red cell transfusion: when is it not safe? Crit Care Med, 2003, 31(suppl 12): S687-S697.
33. Vandromme MJ, McGwin G Jr, Weinberg JA. Blood transfusion in the critically ill: does storage age matter? Scand J Trauma Resusc Emerg Med, 2009, 17: 35.
34. Zubair AC. Clinical impact of blood storage lesions. Am J Hematol, 2010, 85(2): 117-122.
35. Min JJ, Bae JY, Kim TK, et al. Association between red blood cell storage duration and clinical outcome in patients undergoing off-pump coronary artery bypass surgery: a retrospective study. BMC Anesthesiol, 2014, 14: 95.
36. Fergusson DA, Hébert P, Hogan DL, et al. Effect of fresh red blood cell transfusions on clinical outcomes in premature, very low-birth-weight infants: the ARIPI randomized trial. JAMA, 2012, 308(14): 1443-1451.
37. Steiner ME, Ness PM, Assmann SF, et al. Effects of red-cell storage duration on patients undergoing cardiac surgery. N Engl J Med, 2015, 372(15): 1419-1429.
38. Lacroix J, Hébert PC, Fergusson DA, et al. Age of transfused blood in critically ill adults. N Engl J Med, 2015, 372(15): 1410-1418.
39. Sarnack MJ, Tighiouart H, Manjunath G, et al. Anemia as a risk factor for cardiovascular disease in The Atherosclerosis Risk in Communities (ARIC) study. J Am Coll Cardiol, 2002, 40(1):27-33.
40. Snyder EL, Stramer SL, Benjamin RJ. The safety of the blood supply-time to raise the bar. N Engl J Med, 2015, 372(20): 1882-1885.
41. Weltert L, Rondinelli B, Bello R, et al. A single dose of erythropoietin reduces perioperative transfusions in cardiac surgery: results of a prospective single-blind randomized controlled trial. Transfusion, 2015, 55(7): 1644-1654.

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