ObjectiveTo study the effectiveness of simplified blood management in cardiovascular surgery, minimize the need for blood transfusions and decrease the medical care costs. MethodsFrom March 2010 to May 2013, the simplified blood management was applied in 655 patients who underwent cardiovascular surgery in the department of cardiac surgery, Guangdong General Hospital. There were 316 males and 339 females with their age of 13-78 (45.0±13.8) years. The techniques of simplified blood management consisted of preoperative strategies, intraoperative strategies, and postoperative strategies. ResultsThere were 437 patients (66.7%) avoiding red cell transfusion in cardiac surgery. Of the 437 patients, 403 (61.5%) without any blood products transfusion, 29 had transfusion of plasma transfusion, 3 of plasma and cryoprecipitation, one of plasma and platelet, and one of platelet only. Two patients died within 30 days postoperative with 0.5% mortality rate:one died of multiple organ failure, one died of cardiac arrest. The procedures and special etiologies of 437 patients avoiding red cell transfusion included mitral valve replacement in 86 patients, double valve (aortic and mitral) replacement in 75 patients, aortic valve replacement in 51 patients, mitral valve replacement plus modified Maze procedure in 41 patients, atrial septal defect repair in 41 patients, mitral valve repair in 38 patients, double valve replacement plus modified Maze procedure in 25 patients, re-do operation in 23 patients, ventricular septal defect repair in 18 patients, coronary artery bypass grafting plus valve replacement in 10 patients, myxoma excision in 8 patients, subacute bacterial endocarditis in 8 patients, pericardium dissection in 5 patients, off-pump coronary artery bypass grafting in 4 patients, Bentall procedure in 4 patients. Of 65 patients with cardiac surgery history, 23 (35.4%) were free from red cell transfusion in the second operation. ConclusionSimplified blood management is of benefit to reduce the blood transfusion safely and effectively, no using additional expensive medication and medical devices and therefore without increasing hospital costs. The technique is suitable to any institute and patient. It is worthwhile to be used widely in clinical practice. Cell salvage system is not necessary.
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.
ObjectiveTo systematically review the characteristics of adverse transfusion reaction in Grade Three Class-A hospitals in China, and to provide scientific evidence for related control and prevention work. MethodsSuch databases as the PubMed, EMbase, The Cochrane Library (Issue 11, 2014), CNKI, VIP, WanFang Data and CBM were searched for studies investigating the characteristics of adverse transfusion reaction with ≥6 months observation time in Grade Three Class-A hospitals in China up to November 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed by using the R 3.1.1 software. ResultsSeventy-two studies involving 1 660 472 cases of blood transfusion were included. The results of pooled analysis showed that the total number of adverse transfusion reaction rate was 0.58% (95%CI 0.48 to 0.69). Sub-group analysis shows that the blood transfusion adverse reaction rates in the eastern, central and western regions were 0.42% (95%CI 0.31 to 0.55), 0.55% (95%CI 0.41 to 0.70), 0.56% (95%CI 0.43 to 0.70), respectively; and there were statistical differences between regions (P<0.05). Different types of adverse transfusion reaction rates were 38.85% (95%CI 34.27 to 43.53) for non hemolytic febrile reaction and 55.67% (95%CI 50.79 to 60.50) for allergic. The adverse reactions incidence of different kinds of blood products transfusion occurred were 0.41% (95%CI 0.32 to 0.50) in red blood cell, 0.57% (95%CI 0.43 to 0.72) in plasma, 1.00% (95%CI 0.73 to 1.30) in platelet. The incidence of adverse reaction of platelet transfusion was significantly higher than that of red blood cell and plasma (P<0.05). ConclusionThere is a big gap between domestic and foreign blood transfusion adverse reaction reports, therefore comprehensive measures should be taken for further prevention and control.
ObjectiveTo study the expression of cytokine-induced neutrophil chemoattractant-1(CINC-1)in rats with transfusion-related acute lung injury(TRALI),explore its possible role in the pathogenesis of TRALI. MethodsSixty Sprague-Dawley rats were randomly divided into a normal control group with sham operation,a positive control group with ALI induced by intravenous infusion of lipopolysaccharide(5 mg/kg),and a TRALI group treated by intraperitoneal injection of LPS 2h before the transfusion of human plasma (1mL),a LPS control group treated by intraperitoneal injection of LPS 2h before the transfusion of normal saline(1mL).The reverse transcription-polymerase chain (RT-PCR)was used to detect CINC-1 mRNA.The level of CINC-1 in lung tissue homogenate was measured by ELISA.Morphological changes of the lung tissue were observed under light microscope.Myeloperoxidase (MPO)in lung homogenate and wet lung weight to dry lung weight ratio (W/D)were observed.The number of cells and the percentage of polymorphonuclear neutrophil (PMN)in Bronchoalveolar lavage fluid (BALF)were also compared. ResultsCompared with the normal control group and the LPS control group,the expression of CINC-1 protein and CINC-1 mRNA were increased significantly in lung of the positive control group and the TRALI group(P<0.05).The number of cells and the percentage of PMN in BALF of the TRALI group [(310.63±76.67)×106/L and (33.57±11.51)%] were significantly higher than those in BALF of the normal control group [(101.36±63.83)×106/L and (9.87±3.56)%](P<0.05).Tissue water content and MPO activity in the TRALI group were significantly higher than those in the normal control group (P<0.05). ConclusionExpression of CINC-1 protein and CINC-1 mRNA are increased in the rat lung with TRALI and PMN infiltration in lung tissue,which suggests CINC-1 participate in the process of the PMN and endothelial cell adhesion and may play an important role in the pathogeneses of TRALI.
Anemia and coagulopathy are frequently presented in critically ill patients on the intensive care unit. Scientific use of blood products assist the treatment of critically ill patients. However, life-threatening adverse effects are also a risk. In 2020, the European Society of Critical Care Medicine (ESICM) published a clinical practice guideline on transfusion strategies for non-bleeding critically ill adults in an attempt to resolve the transfusion strategy problems of relevant critically ill patients. This paper interprets the key contents in order to assist Chinese clinicians for better understanding and using of the guideline.