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Objective: Thoracic spinal stenosis (TSS) surgeries necessitate a substantial amount of allogeneic blood resources. However, the efficacy of preoperative autologous blood donation (PABD) in TSS surgery has not been clearly evaluated. Therefore, we aimed to evaluate the efficacy of PABD for TSS surgery. Methods: This study is a retrospective study. Totally 397 patients who underwent TSS surgeries at our institution from January 2019 to June 2023 were included. Propensity score matching (PSM) was used to make the PABD and Non‐PABD groups comparable at baseline. Regarding outcome measures, the incidence and amount of allogeneic blood transfusion, changes in postoperative hemoglobin and hematocrit levels, occurrence of postoperative complications, medical costs, drainage time, length of hospital stay, and postoperative neurological function were analyzed. The outcomes were compared between the matched PABD (n = 79) and Non‐PABD (n = 79) groups. Univariate analysis methods were used for statistical analysis, including independent samples t‐test, Wilcoxon rank‐sum test, and chi‐square test. Results: The incidence of allogeneic blood transfusion (8.9% vs. 25.3%, p = 0.006) and volume of intraoperative red blood cell (RBC) transfusion (10.12 ± 54.52 vs. 122.78 ± 275.00 mL, p < 0.001) in the PABD group were significantly lower than those in the Non‐PABD group. The PABD group had significantly higher average postoperative hemoglobin and hematocrit levels than the Non‐PABD group at 1, 3, and 5 days after surgery (p < 0.05). Similarly, the PABD group exhibited a smaller reduction in hemoglobin and hematocrit levels compared with the Non‐PABD group on 1, 3, and 5 days postoperatively. There were no significant intergroup differences in terms of transfusion‐related complications, medical expenses, neurological function, length of hospital stay, or drainage time. Notably, PABD was an independent protective factor of allogeneic transfusion in the multivariate regression analysis (OR = 0.334, 95%CI = 0.051–0.966). Conclusions: PABD can effectively reduce the incidence of allogeneic blood transfusion and amount of allogeneic blood in TSS surgeries with safety. It also significantly improved the postoperative hemoglobin and hematocrit levels. Under the premise of clear indications, PABD is worth promoting for the surgical treatment of TSS. [ABSTRACT FROM AUTHOR]

• Staged autotransfusion during ECMO decannulation effectively maintains Hb levels. • This approach reduces allogeneic RBC transfusion needs and lowers transfusion cost. • No significant differences in adverse events between groups. • No significant differences in decannulation success rates between groups. Clinical blood resources are scarce and autologous blood transfusion for extracorporeal membrane oxygenation (ECMO) withdrawal is less studied. To assess the use of staged autotransfusion during ECMO decannulation. The study included ECMO withdrawal patients. Patients in the autologous transfusion group underwent staged transfusion during ECMO withdrawal, while those in the control group received 2.0 units of allogeneic packed red blood cells (RBCs) to increase hemoglobin (Hb). Parameters such as Hb, hematocrit (Hct), adverse events, decannulation success rate, volume of allogeneic RBC transfusions, and transfusion costs were compared. A total of 82 Chinese patients were enrolled, with a mean age of 46 years, 27 were female, and the top three primary diagnoses were cardiac arrest, acute myocarditis, and severe pneumonia. There were 41 individuals in the autologous blood transfusion group and 41 in the control group. No significant differences were observed in Hb, Hct, adverse events, and the success rate for decannulation between the two groups (all P > 0.05). Compared with the control group, the volume of allogeneic RBC transfusions [0 (0∼1.50) U vs. 3.5 (1.88∼40) U, P < 0.001] and the total cost [130 (130∼390) Chinese Yuan (CNY) vs. 910 (487.50, 1040) CNY, P = 0.002] were lower in the autologous transfusion group. In comparison with allogeneic RBC transfusion, staged autotransfusion during ECMO decannulation not only effectively maintained Hb levels but also reduced the requirement for allogeneic RBC transfusions. In addition, this approach decreased the associated costs and did not increase the risk of clinical adverse events. [ABSTRACT FROM AUTHOR]

Objective Thoracic spinal stenosis (TSS) surgeries necessitate a substantial amount of allogeneic blood resources. However, the efficacy of preoperative autologous blood donation (PABD) in TSS surgery has not been clearly evaluated. Therefore, we aimed to evaluate the efficacy of PABD for TSS surgery. Methods This study is a retrospective study. Totally 397 patients who underwent TSS surgeries at our institution from January 2019 to June 2023 were included. Propensity score matching (PSM) was used to make the PABD and Non‐PABD groups comparable at baseline. Regarding outcome measures, the incidence and amount of allogeneic blood transfusion, changes in postoperative hemoglobin and hematocrit levels, occurrence of postoperative complications, medical costs, drainage time, length of hospital stay, and postoperative neurological function were analyzed. The outcomes were compared between the matched PABD (n = 79) and Non‐PABD (n = 79) groups. Univariate analysis methods were used for statistical analysis, including independent samples t‐test, Wilcoxon rank‐sum test, and chi‐square test. Results The incidence of allogeneic blood transfusion (8.9% vs. 25.3%, p = 0.006) and volume of intraoperative red blood cell (RBC) transfusion (10.12 ± 54.52 vs. 122.78 ± 275.00 mL, p

Objective Total hip arthroplasty (THA) remains the primary treatment option for femoral neck fractures in elderly patients. This study aims to explore the risk factors associated with allogeneic blood transfusion after surgery and to develop a dynamic prediction model to predict post‐operative blood transfusion requirements. This will provide more accurate guidance for perioperative humoral management and rational allocation of medical resources. Methods We retrospectively analyzed data from 829 patients who underwent total hip arthroplasty for femoral neck fractures at three third‐class hospitals between January 2017 and August 2023. Patient data from one hospital were used for model development, whereas data from the other two hospitals were used for external validation. Logistic regression analysis was used to screen the characteristic subsets related to blood transfusion. Various machine learning algorithms, including logistic regression, SVA (support vector machine), K‐NN (k‐nearest neighbors), MLP (multilayer perceptron), naive Bayes, decision tree, random forest, and gradient boosting, were used to process the data and construct prediction models. A 10‐fold cross‐validation algorithm facilitated the comparison of the predictive performance of the models, resulting in the selection of the best‐performing model for the development of an open‐source computing program. Results BMI (body mass index), surgical duration, IBL (intraoperative blood loss), anticoagulant history, utilization rate of tranexamic acid, Pre‐Hb, and Pre‐ALB were included in the model as well as independent risk factors. The average area under curve (AUC) values for each model were as follows: logistic regression (0.98); SVA (0.91); k‐NN (0.87) MLP, (0.96); naive Bayes (0.97); decision tree (0.87); random forest (0.96); and gradient boosting (0.97). A web calculator based on the best model is available at: (https://nomo99.shinyapps.io/dynnomapp/). Conclusion Utilizing a computer algorithm, a prediction model with a high discrimination accuracy (AUC > 0.5) was developed. The logistic regression model demonstrated superior differentiation and reliability, thereby successfully passing external validation. The model's strong generalizability and applicability have significant implications for clinicians, aiding in the identification of patients at high risk for postoperative blood transfusion.

Objective: Total hip arthroplasty (THA) remains the primary treatment option for femoral neck fractures in elderly patients. This study aims to explore the risk factors associated with allogeneic blood transfusion after surgery and to develop a dynamic prediction model to predict post‐operative blood transfusion requirements. This will provide more accurate guidance for perioperative humoral management and rational allocation of medical resources. Methods: We retrospectively analyzed data from 829 patients who underwent total hip arthroplasty for femoral neck fractures at three third‐class hospitals between January 2017 and August 2023. Patient data from one hospital were used for model development, whereas data from the other two hospitals were used for external validation. Logistic regression analysis was used to screen the characteristic subsets related to blood transfusion. Various machine learning algorithms, including logistic regression, SVA (support vector machine), K‐NN (k‐nearest neighbors), MLP (multilayer perceptron), naive Bayes, decision tree, random forest, and gradient boosting, were used to process the data and construct prediction models. A 10‐fold cross‐validation algorithm facilitated the comparison of the predictive performance of the models, resulting in the selection of the best‐performing model for the development of an open‐source computing program. Results: BMI (body mass index), surgical duration, IBL (intraoperative blood loss), anticoagulant history, utilization rate of tranexamic acid, Pre‐Hb, and Pre‐ALB were included in the model as well as independent risk factors. The average area under curve (AUC) values for each model were as follows: logistic regression (0.98); SVA (0.91); k‐NN (0.87) MLP, (0.96); naive Bayes (0.97); decision tree (0.87); random forest (0.96); and gradient boosting (0.97). A web calculator based on the best model is available at: (https://nomo99.shinyapps.io/dynnomapp/). Conclusion: Utilizing a computer algorithm, a prediction model with a high discrimination accuracy (AUC > 0.5) was developed. The logistic regression model demonstrated superior differentiation and reliability, thereby successfully passing external validation. The model's strong generalizability and applicability have significant implications for clinicians, aiding in the identification of patients at high risk for postoperative blood transfusion. [ABSTRACT FROM AUTHOR]

Background: Delayed extubation and transfer to the intensive care unit (ICU) in children undergoing major scoliosis surgery may increase postoperative complications, prolong hospital stay, and increase medical expenses; however, whether a child will require delayed extubation or transfer to the ICU after scoliosis orthopedic surgery is not fully understood. In this study, we reviewed the risk factors for delayed extubation and transfer to the ICU after scoliosis orthopedic surgery in children. Method: The electronic medical records of pediatric patients (≤ 18 years) who underwent posterior spinal fusion surgery between January 2018 and November 2021 were reviewed and analyzed. Patient characteristics (age, sex, body mass index, American Society of Anesthesiologists, ASA, grade, preoperative lung function, and congenital heart disease), preoperative Cobb angle, scoliosis type, correction rate, vertebral fusion segments, pedicle screws, surgical osteotomy, intraoperative bleeding, intraoperative allogeneic transfusion, intraoperative hemoglobin changes, intraoperative mean arterial pressure changes, intraoperative tidal volume (ml/kg predicted body weight), surgical time, postoperative extubation, and transfer to the ICU were collected. The primary outcomes were delayed extubation and transfer to the ICU. Multivariate logistic regression models were used to determine the risk factors for delayed extubation and ICU transfer. Results: A total of 246 children who satisfied the inclusion criteria were enrolled in this study, of whom 23 (9.3%) had delayed extubation and 81 (32.9%) were transferred to the ICU after surgery. High ASA grade (odds ratio [OR] 5.42; 95% confidence interval [CI] 1.49–19.78; p = 0.010), high Cobb angle (OR 1.04; 95% CI 1.02–1.07; p < 0.001), moderate to severe pulmonary dysfunction (OR 10.9; 95% CI 2.00–59.08; p = 0.006) and prolonged surgical time (OR 1.01; 95% CI 1.00–1.03; p = 0.040) were risk factors for delayed extubation. A high Cobb angle (OR 1.02; 95% CI 1.01–1.04; p = 0.004), high intraoperative bleeding volume (OR 1.06; 95% CI 1.03–1.10; p = 0.001), allogeneic transfusion (OR 3.30; 95% CI 1.24–8.83; p = 0.017) and neuromuscular scoliosis (OR 5.38; 95% CI 1.59–18.25; p = 0.007) were risk factors for transfer to the ICU. A high Cobb angle was a risk factor for both delayed extubation and ICU transfer. Age, sex, body mass index, number of vertebral fusion segments, correction rate, and intraoperative tidal volume were not associated with delayed postoperative extubation and ICU transfer. Conclusion: The most common risk factor for delayed extubation and ICU transfer in pediatric patients who underwent posterior spinal fusion was a high Cobb angle. Determining risk factors for a poor prognosis may help optimize perioperative respiratory management strategies and planning of postoperative care for children undergoing complicated spinal surgery. [ABSTRACT FROM AUTHOR]

Researching how the immune system reacts to stimuli such as blood transfusion of alloantigens on models of different species of laboratory animals, in particular rabbits, is important for understanding the mechanisms through which post-transfusion reactions develop. In this study, we identified the absolute and relative contents of white blood cells in blood of the recipient rabbits, and also their subpopulations after allogenic transfusion of packed red blood cells (pRBCs). Allogeneic transfusion of pRBCs without leukoreduction was conducted once, in the calculation of 5.5 mL/kg of body mass of the experimental animals. The material for the studies were samples of blood serum, collected from 5 rabbits on the 3rd, 7th, and 23rd days after pRBC administration. Allogeneic transfusion of pRBCs to the recipient rabbits caused development of leukocytosis in their blood: compared with the initial condition, the absolute content of leukocytes in the blood of the experimental animals increased 27.0% on the 3rd day after transfusion, equaling 8.94 109/L; 40.1% on the 7th day, accounting for 9.86 109/L; and 34.1% on the 23rd day, measuring 9.44 109/L. Leukocytosis resulted from increased content of granulocytes in the blood compared with the initial state: the absolute content of granulocytes surged 66.9% on the 3rd day after transfusion, measuring 4.54 109/L, 2.21-fold on the 7th day, equaling 6.02 109/L, and 1.87-fold on the 23rd day, equaling 5.08 109/L. Allogeneic transfusion of pRBCs to the recipient rabbits caused decrease in the relative content of Т-lymphocytes and increase in the content of В-lymphocytes in their blood. Compared with the initial condition, the relative content of Т-lymphocytes in the blood of the experimental animals declined 20.6% on the 3rd day of the study, accounting for 58.0%; 30.1% on the 7th day, equaling 51.0%; and 25.8% on the 23rd day, equaling 54.2%. Compared with the initial state, the relative content of В-lymphocytes spiked 94.7% on the 3rd day of the study, measuring 22.2%, 2.23-fold on the 7th day, accounting for 25.4%, and 2.51-fold on the 23rd day, equaling 28.6%.

Researching how the immune system reacts to stimuli such as blood transfusion of alloantigens on models of different species of laboratory animals, in particular rabbits, is important for understanding the mechanisms through which post-transfusion reactions develop. In this study, we identified the absolute and relative contents of white blood cells in blood of the recipient rabbits, and also their subpopulations after allogenic transfusion of packed red blood cells (pRBCs). Allogeneic transfusion of pRBCs without leukoreduction was conducted once, in the calculation of 5.5 mL/kg of body mass of the experimental animals. The material for the studies were samples of blood serum, collected from 5 rabbits on the 3rd, 7th, and 23rd days after pRBC administration. Allogeneic transfusion of pRBCs to the recipient rabbits caused development of leukocytosis in their blood: compared with the initial condition, the absolute content of leukocytes in the blood of the experimental animals increased 27.0% on the 3rd day after transfusion, equaling 8.94 109/L; 40.1% on the 7th day, accounting for 9.86 109/L; and 34.1% on the 23rd day, measuring 9.44 109/L. Leukocytosis resulted from increased content of granulocytes in the blood compared with the initial state: the absolute content of granulocytes surged 66.9% on the 3rd day after transfusion, measuring 4.54 109/L, 2.21-fold on the 7th day, equaling 6.02 109/L, and 1.87-fold on the 23rd day, equaling 5.08 109/L. Allogeneic transfusion of pRBCs to the recipient rabbits caused decrease in the relative content of Т-lymphocytes and increase in the content of В-lymphocytes in their blood. Compared with the initial condition, the relative content of Т-lymphocytes in the blood of the experimental animals declined 20.6% on the 3rd day of the study, accounting for 58.0%; 30.1% on the 7th day, equaling 51.0%; and 25.8% on the 23rd day, equaling 54.2%. Compared with the initial state, the relative content of В-lymphocytes spiked 94.7% on the 3rd day of the study, measuring 22.2%, 2.23-fold on the 7th day, accounting for 25.4%, and 2.51-fold on the 23rd day, equaling 28.6%. [ABSTRACT FROM AUTHOR]

Objective To study the effect of perioperative allogeneic blood transfusion on patients with oral squamous cell carcinoma (OSCC) after first-stage free flap transplantation. Methods A total of 306 OSCC patients who accepted primary repair and reconstruction using free flap admitted to our affiliation from January 2010 to January 2019 were selected as the research objects and retrospectively analyzed. According to their clinical data, they were divided into three groups: no transfusion group (n=98), 1-2 U transfusion group (n=131) and 3 + U transfusion group (n=77), respectively. The incidence of complications including flap infection, blood circulation disorder and hematoma in the three groups were compared. The five-year survival rate of the three groups was calculated by Kaplan-Meier analysis, and the relative risk of death was analyzed by Cox regression. Results There was no statistically significant difference among the three groups of patients (P>0.05) regarding such baseline data as embracing gender, age, primary location, degree of differentiation, adjuvant radiotherapy and chemotherapy. The complication rate of patients with 3 + U transfusion (25.97%) was significantly higher than that of no transfusion (6.12%) and 1-2 U transfusion (10.86%) (P

Objective: To investigate the effects of autotransfusion and allogeneic transfusion on coagulation function, cellular immune function and nerve injury markers in patients with traumatic brain injury(TBI) undergoing craniotomy. Methods: The clinical data of 120 patients with TBI who underwent craniotomy in our hospital from April 2019 to May 2022 were retrospectively analyzed. Patients were divided into allogeneic transfusion group(n=58, allogeneic transfusion) and autotransfusion group(n=62, autotransfusion) according to different blood transfusion methods. Clinical indexes, cellular immune function, coagulation function, nerve injury markers and incidence of adverse reactions in the two groups were observed. Results: There were no significant differences in operation bleeding volume, blood transfusion and proportion of blood products containing coagulation components in the two groups(P＞0.05). CD3+, CD4+,CD4+/CD8+in the autotransfusion group were higher than those in the allogeneic transfusion group at discharge, and CD8+was lower than that in the allogeneic transfusion group(P＜0.05). There were no significant differences in prothrombin time(PT), thrombin time(TT) and fibrinogen(FIB), activated partial thrombin time(APTT) in the two groups at discharge(P＞0.05). The levels of S100 calc-binding protein B(S100B), glial fibrillary acid protein(GFAP) and neuron-specific enolase(NSE) in the autotransfusion group were lower than those in the allogeneic transfusion group at discharge(P＜0.05). There was no difference in the incidence of adverse reactions between the two groups(P＞0.05). Conclusion: Autotransfusion is used in patients with TBI undergoing craniotomy has little impact on the coagulation function of patients, and can also improve the cellular immune function of the body, and reduce the level of nerve injury markers. [ABSTRACT FROM AUTHOR]

Background: The allogeneic transfusion-related immunomodulation (TRIM) may be responsible for an increase in survival of renal transplants but in contrast it could increase the rate of bacterial infections or the recurrence rate of tumors post-operatively. Objective: This review focuses in the implications of perioperative allogeneic transfusions on the immune-inflammatory response of surgical transfused patients. Results: ABTs modify immune functions in recipients including decrease of the number of lymphocytes; decrease the CD4 cells; decrease the CD4/CD8 T-cell ratio; decrease NK cells; and decrease the lymphocyte response to mitogens. TRIM effects may be mediated by allogeneic white cells present in blood products; soluble peptides present in transfused plasma; and/or biologic mediators released into the supernatant of blood units. A recent systematic review and meta-analysis including 36 clinical observational studies (n = 174,036) concluded that perioperative ABTs not only decreased overall survival and reduced colorectal cancer-specific survival. Furthermore ABTs increased the rate of infectious, cardiac, pulmonary and anastomotic complications in colorectal cancer patients undergoing surgery. Conclusions: It has been demonstrated by laboratory tests that TRIM is associated with transfusion recipient immune alterations but its influence in colorectal cancer recurrence after resection remains controversial though may exist. Surgical techniques reducing intraoperative blood loss have limited the number of ABTs perioperatively, however increase in mortality continues to be reported in literature after ABT in colorectal cancer surgery. Poor survival associated to TRIM in colorectal cancer might be due to higher number of allogeneic transfused units and/or prolonged length of blood storage.

Background and ObjectiveLiposuction is an effective treatment for fat disposition in lymphedema. Blood transfusion has been seldom investigated in lymphedema liposuction surgery. The purpose of the study was to analyze clinical factors associated with blood transfusion in liposuction surgery of lymphedema patients and compare the autologous and allogeneic transfusion patterns.MethodsA total of 1,187 cases of liposuction due to lymphedema were recruited. Demographic, laboratory tests and operation information were collected. Patients were divided into a transfusion and a non-transfusion group. Different transfusion patterns were compared and analyzed.ResultsBetween the two groups, there is a significant difference in postoperative hemoglobin levels, and as well as gender, age, surgery duration, body weight change, intraoperative transfusion volume and blood loss, hospital length of stay, and surgical site distribution. There is a significant difference in the comparison of hospital stay length, autologous transfusion volume, combined allogeneic volume, operative blood loss, intraoperative transfusion volume, and change in hemoglobin levels between predonation and acute normovolemic hemodilution (ANH) transfusion. In comparison with the allogeneic transfusion-only patients, the mean allogeneic transfusion volume in either ANH group, predonated transfusion group, or mixed group is statistically lower. Allogeneic transfusion volume in the predonated-only group is significantly lower than that of either the ANH-only group or the mixing ANH with predonation group. Ordinary least squares regression analysis suggests that autologous transfusion in the ANH-only mode is statistically associated with allogeneic transfusion.ConclusionsThis study described the blood transfusion in lymphedema liposuction surgery and compared autologous and allogeneic transfusion patterns in these patients. Autologous transfusion can reduce the transfusion volume of allogeneic blood and might be a beneficial mode of transfusion in these patients.

PurposeTo compare the effect of allogeneic transfusion and acute normovolemic hemodilution (ANH) autologous transfusion in patients undergoing cesarean section.MethodsPatients who underwent cesarean section and received blood transfusion therapy from February 2019 to July 2021 in our hospital were observed and divided into the allogeneic group (n = 55) who received allogeneic transfusion therapy and the autologous group (n = 55) who received ANH autologous transfusion therapy according to the mode of transfusion. Observations included vital signs [heart rate (HR), mean arterial pressure (MAP), stroke volume variation (SVV)], blood routine [red blood cells (RBC), platelets (PLT), hematocrit (HCT), hemoglobin (Hb)], T-cell subsets (CD4+, CD8+, CD4+/CD8+), immunoglobulins (IgA, IgM, IgG), inflammatory factors [C-reactive protein (CRP), tumor necrosis factor (TNF)-α, interleukin (IL)-6], and adverse effects were counted in both groups.ResultsThere was no statistical significance in the intra-group and inter-group comparisons of HR, MAP, and SVV between the two groups before transfusion and transfusion for 10 min (P > 0.05). 5d after operation, the RBC, PLT, HCT, and Hb of the allogeneic group were lower than those before operation, and the autologous group was higher than that of the allogeneic group (P < 0.05). 5d after operation, the CRP, TNF-α, and IL-6 of the allogeneic group were higher than those before operation, and the autologous group was lower than that of the allogeneic group (P < 0.05). 5d after operation, the CD4+, CD4+/CD8+ of the allogeneic group were lower than before operation, and the CD8+ was higher than before operation. The CD4+ and CD4+/CD8+ of the autologous group were higher than that of the allogeneic group, and CD8+ was lower than that of the allogeneic group (P < 0.05). 5d after operation, the IgA, IgG, and IgM of the allogeneic group were lower than those before operation, and the autologous group was higher than that of the allogeneic group (P < 0.05). During blood transfusion, there was no significant difference in the adverse reaction rate between the two groups (P > 0.05).ConclusionBoth allogeneic transfusion and ANH autologous transfusion have little effect on the vital signs of patients undergoing cesarean section, but ANH autologous transfusion is more helpful to the stability of blood routine, T-cell subsets, immunoglobulin, and inflammation levels after surgery, which is a safe and effective way of blood transfusion.

Objectives: To assess the safety and clinical benefits of intraoperative acute normovolaemic haemodilution (ANH) in complex spine surgery. Design: Prospective comparative cohort study Setting: A private orthopaedic hospital in Ghana Patients: Seventy-six patients who underwent complex spine deformity surgery Interventions: Patients were randomly assigned to two groups. 45 patients to the acute normovolaemic haemodilution (ANH) or Group 1 and 31patients to the non-ANH or Group 2. Following anesthetic administration and before incision, autologous blood was collected from patients in Group1 and was reinfused during/shortly after surgery while patients in Group2 were transfused with compatible allogeneic blood intraoperatively. Main Outcome Measures: Changes in haemodynamic parameters and incidence of allogeneic transfusions and related complications. Results: The mean age (years), gender ratio, deformity size and aetiology, fusion levels, and operative times were similar in both groups. Blood loss (ml) of patients in groups 1 and 2 were 1583ml± 830.48 vs 1623ml ± 681.34, p=0.82, respectively. The rate of allogeneic blood transfusion in groups 1 and 2 were 71% vs 80.65%, p=0.88, respectively. Haemoglobin levels (g/dL) in groups 1 and 2 were comparable in both groups at Post-operative Day (POD) 0 and POD 1. Incidence of minor allogeneic transfusion reaction was 1/45 vs 1/31, p=0.80, group-1 and group-2, respectively. Conclusion: Acute normovolaemic haemodilution can be safely performed in complex spine surgery in underserved regions. However, its use does not obviate allogeneic transfusion in patients with complex spine deformities in whom large volumes of blood loss is expected. [ABSTRACT FROM AUTHOR]

Abstract Background Platelets (PLTs) are usually stored for up to 5 days prior to transfusion, although in some blood services the storage period is extended to 7 days. During storage, changes occur in both PLT and storage medium, which may lead to PLT activation and dysfunction. The clinical significance of these changes remains uncertain. Methods We performed a systematic review to assess the association between PLT storage time and clinical or transfusion outcomes in patients receiving allogeneic PLT transfusion. We searched studies published in English between January 2000 and July 2017 identified from MEDLINE, Embase, PubMed and the Cochrane Libraries. Results Of the 18 studies identified, five included 4719 critically ill patients (trauma, post-cardiac surgery and a heterogeneous population of critically ill patients) and 13 included 8569 haematology patients. The five studies in critically ill patients were retrospective and did not find any association between PLT storage time when PLTs were stored for up to 5 days and mortality. There was also no association between older PLTs and sepsis in the two largest studies (n = 4008 patients). Of the 13 studies in haematology patients, seven analysed prolonged storage time up to 6.5 or 7 days. Administration of fresh PLTs (less than 2 or 3 days) was associated with a significant increase in corrected count increment (CCI) compared to older PLTs in seven of the eight studies analysing this outcome. One single centre retrospective study found an increase in bleeding events in patients receiving older PLTs. Conclusions PLT storage time does not appear to be associated with clinical outcomes, including bleeding, sepsis or mortality, in critically ill patients or haematology patients. The freshest PLTs (less than 3 days) were associated with a better CCI, although there was no impact on bleeding events, questioning the clinical significance of this association. However, there is an absence of evidence to draw definitive conclusions, especially in critically ill patients.

In terms of complications due to allogeneic blood transfusions, it is necessary to use the latter only in accordance with the strict indications elaborated specifically for each component. When indications for the use of red blood cell-containing media are substantiated, it is essential to take into account not only laboratory data and transfusion trigger compliance, but also the clinical picture of hemic hypoxia. While prescribing fresh frozen plasma, one should be based on laboratory coagulogram readings.

Yi Li,* Pengbin Yin,* Houchen Lv, Yutong Meng, Licheng Zhang, Peifu Tang Department of Orthopedics, General Hospital of Chinese PLA, Beijing, People’s Republic of China *These authors contributed equally to this work Purpose: The debate is still ongoing on the effectiveness and safety of erythropoietin (EPO) treatment in orthopedic surgeries. Specifically, previous studies have not compared the dynamic change of hemoglobin (Hb) levels between different transfusion methods. Besides, complications or side effects of this alternative have not been quantitatively analyzed. We conducted a meta-analysis and systemic review to evaluate the efficacy of EPO on Hb levels observed during the whole perioperative period as well as the volume of allogeneic blood transfusion (ABT), the risk of venous thromboembolism, and application frequency of ABT in hip and knee surgery.Materials and methods: PubMed, Embase, Web of Science, and the Cochrane library were systematically searched from inception to November 2017. The data from randomized controlled trials were extracted and the risk of bias assessed using Cochrane’s Collaboration’s tool.Results: Twenty-five randomized controlled trials involving 4,159 patients were included in this meta-analysis. EPO could reduce exposure to allogeneic blood transfused (odds ratio [OR] =0.42, P=0.001) and reduce the average volume of allogeneic blood transfused (OR = -0.28, P=0.002). When EPO and preoperative autologous blood donation (PABD) were compared, the use of EPO was associated with lower exposure to ABT (OR =0.48, P=0.03), but no significant decrease in the average volume of allogeneic blood transfused (OR = -0.23, P=0.32). The use of EPO was associated with a higher level of Hb with or without use of PABD at all the 4 time points (preoperation, 24–48 hours postoperation, 3–5 days postoperation, discharge of last observation) (P

Objective: To investigate the effect of acute normovolemic hemodilution (ANH) autotransfusion and allogeneic transfusion on T cell subsets, liver and kidney function and inflammatory factors levels in patients undergoing cesarean section. Methods: The clinical data of 128 cases of cesarean section in our hospital from July 2016 to August 2019 were analyzed retrospectively. According to the different ways of blood transfusion, the patients were divided into group A (n=64, allogeneic blood transfusion) and group B (n=64, Anh autotransfusion). The blood routine indexes [hemoglobin (Hb), hematocrit (HCT), platelet (PLT), red blood cell (RBC], T cell subsets, inflammatory factors [interleukin-6 (IL-6), C-reactive protein (CRP) and tumor necrosis factor-α(TNF-α)] and indexes of liver and kidney function [aspartate transaminase (AST), Alanine aminotransferase (ALT), Creatinine (CR), Urea nitrogen （BUN）] were compared between the two groups. Results: Hb, HCT, PLT and RBC in group A decreased 5 days after operation (P<0.05), the Hb, HCT, PLT and RBC in group B were higher than those in group A(P<0.05). There was no significant difference in AST, ALT, Cr and BUN between the two groups (P>0.05). CD4+/CD8+, CD4+ decreased and CD8+ increased in group A (P<0.05); CD4+/CD8+ and CD4+ in group B were higher than those in group A, but CD8+ was lower than that in group A (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). The levels of CRP, IL-6 and TNF-αin group B were lower than those in group A (P<0.05). Conclusion: ANH autotransfusion has no significant effect on T cell subsets, inflammatory reaction, liver and kidney function and blood routine in patients undergoing cesarean section, and it is safe. [ABSTRACT FROM AUTHOR]

To investigate the effects of storage autotransfusion and allogeneic blood transfusion on inflammatory response and T lymphocyte subsets in elderly patients undergoing Department of cerebral surgery. 150 elderly patients undergoing brain surgery in our hospital from March 2017 to October 2019 were selected, they were divided into control group (n = 75, allogeneic blood transfusion) and study group (n = 75, storage autotransfusion) according to the method of random number table. The perioperative indexes of the two groups were compared, the changes of inflammatory factors [Interleukin-6 (IL-6), tumor necrosis factor - 琢 (TNF-琢), C-reactive protein (CRP)] and T-lymphocyte subsets were compared between the two groups before and 5d after operation, the adverse reactions of blood transfusion were recorded in two groups. There was no significant difference in preoperative hospitalization time and hemoglobin between the two groups (P > 0.05). The postoperative hospitalization time of the study group was shorter than that of the control group, the amount of intraoperative blood loss and intraoperative blood transfusion was less than that of the control group, and the postoperative hemoglobin was more than that of the control group (P < 0.05). The levels of IL-6, CRP and TNF-琢in the study group were higher than those in the control group (P < 0.05). CD3+, CD4+/CD8+, CD4+ were decreased in the two groups 5d after operation, but the study group were higher than those of the control group, CD8+ were increased, but the study group were lower than that of the control group (P < 0.05). The incidence of adverse reactions in the study group was lower than that in the control group (P < 0.05). Compared with the allogeneic transfusion, the storage autotransfusion can reduce the immunosuppression and inflammatory stress, reduce the incidence of adverse reactions, and save valuable blood resources. [ABSTRACT FROM AUTHOR]

Autologous blood withdrawal before instituting cardiopulmonary bypass (CPB) protects the platelets, preserve red cell mass and reduce allogeneic transfusion requirements. Ideal condition for autologous blood donation is elective cardiac surgery where there is a high probability of blood transfusion. The purpose of this study was to assess the role of preoperative autologous blood donation in cardiac surgeries. Out of 150 patients registered, 50 cases were excluded on the basis of hemoglobin content ( [J Med Allied Sci 2017; 7(1.000): 48-54]

A Patient Blood Management programme was established at the University Hospital of Zurich, along with a monitoring and feedback programme, at the beginning of 2014 with a first analysis reported in 2015. Our study aimed to investigate the further impact of this Patient Blood Management monitoring and feedback programme on transfusion requirements and related costs. We included adult patients discharged between 2012 and 2017. A total of 213,882 patients underwent analysis: 66,659 patients in the baseline period (2012-2013); 35,309 patients in the year after the introduction of the Patient Blood Management monitoring and feedback programme (2014) and 111,914 patients in the continued sustainability period (2015-2017). The introduction of the Patient Blood Management monitoring and feedback programme reduced allogeneic blood product transfusions by 35%, from 825 units per 1000 hospital discharges in 2012 to 536 units in 2017. The most sustained effect was an approximately 40% reduction in red blood cell transfusions, from 535 per 1000 discharges to 319 units. Fewer patients were transfused in the periods after the introduction of the Patient Blood Management monitoring and feedback programme (6251 (9.4%) vs. 2932 (8.3%) vs. 8196 (7.3%); p < 0.001). Compared with 2012, the yearly OR for being exposed to any blood transfusion declined steadily after the introduction of the Patient Blood Management monitoring and feedback programme to 0.64 (95%CI 0.61-0.68; p < 0.001) in 2017. For patients requiring extracorporeal membrane oxygenation, transfusion requirements were also sustainably reduced. This reduction in allogeneic blood transfusions led to savings of 12,713,754 Swiss francs (£ 9,497,000 sterling; EUR 11,100,000; US$ 12,440,000) in blood product acquisition costs over 4 years. In-hospital mortality was not affected by the programme. The Patient Blood Management monitoring and feedback programme sustainably reduced transfusion requirements and related costs, without affecting in-hospital mortality. [ABSTRACT FROM AUTHOR]

Background: Allogeneic transfusions are commonly used for substantial blood loss in total knee arthroplasty (TKA), but have been associated with adverse effects and increased costs. The purpose of this study is to provide a detailed description of (1) trends of allogeneic blood transfusion; (2) risk factors and adverse events; and (3) discharge disposition, length-of-stay (LOS), and cost/charge analysis for primary TKA patients who received an allogeneic blood transfusion from 2009-2013.Methods: A cohort of 3,217,056 primary TKA patients was identified from the National Inpatient Sample database from 2009-2013. Demographic, clinical, economic, and discharge data were analyzed for patients who received allogeneic blood products, and for those who did not receive any type of blood transfusion. Other parameters analyzed include risk factors, adverse events, discharge disposition, and costs/charges.Results: There was a significant decline in use of allogeneic transfusion from 2009-2013 incidence (13.9%-7.3%; P < .001). All comorbidities examined were associated with significantly increased risk of receiving allogeneic transfusion with exception of patients with AIDS, metastatic cancer, and peptic ulcer disease. Allogeneic transfusion was associated with worse outcomes during hospitalization. Patients also had a greater likelihood of discharge to short-term care, greater LOS, and greater median costs/charges. Among TKA patients who received an allogeneic transfusion, costs varied based on hospital ownership and characteristics, primary-payer, region, and bed-size.Conclusion: Given the poor outcomes and higher costs associated with allogeneic transfusions, efforts must be undertaken to minimize this risky practice. With the projected increase in demand for TKAs, orthopedists must understand effective blood management strategies. [ABSTRACT FROM AUTHOR]

Background: Securing future blood supply is a major issue of transfusion safety. In this prospective 10-year longitudinal study we enrolled all blood donation services and hospitals of the federal state Mecklenburg-Western Pomerania. Methods and Results: From 2005 to 2015 (time period with major demographic effects), whole blood donation numbers declined by 18%. In male donors this paralleled the demographic change, while donation rates of females declined 12.4% more than expected from demography. In parallel, red cell transfusion rates/1,000 population decreased from 2005 to 2015 from 56 to 51 (-8.4%), primarily due to less transfusions in patients >60 years. However, the transfusion demand declined much less than blood donation numbers: -13.5% versus -18%, and the population >65 years (highest transfusion demand) will further increase. The key question is whether the decline in transfusion demand observed over the previous years will further continue, hereby compensating for reduced blood donation numbers due to the demographic change. The population structure of Mecklenburg-Western Pomerania reflects all Eastern German federal states, while the Western German federal states will reach similar ratios of age groups 18-64 years / ≥65 years about 10 years later. Conclusions: Regular monitoring of age- and sex-specific donation and transfusion data is urgently required to allow transfusion services strategic planning for securing future blood supply. [ABSTRACT FROM AUTHOR]

Autologous blood withdrawal before instituting cardiopulmonary bypass (CPB) protects the platelets, preserve red cell mass and reduce allogeneic transfusion requirements. Ideal condition for autologous blood donation is elective cardiac surgery where there is a high probability of blood transfusion. The purpose of this study was to assess the role of preoperative autologous blood donation in cardiac surgeries. Out of 150 patients registered, 50 cases were excluded on the basis of hemoglobin content (<11 gm/dl) and age group (pediatric group); therefore, the study was conducted on 100 cardiac surgery patients. We collected 13% to 15% of patient's estimated blood volume in bags containing either heparin or citrate phosphate dextrose (CPD) and stored at room temperature. This was later returned to the patient through a peripheral vein after the bypass. In most of the cases 1-2 units (1 unit=450 ml) were withdrawn and re-administered to the patients. This study showed that there was 10% decrease in banked blood requirements. We conclude that autologous pre-donation is a promising alternative in reducing the harmful effects of allogeneic blood transfusion in elective cardiac surgery. It improves the recovery profile and decreases the transfusion related morbidity. [ABSTRACT FROM AUTHOR]

To evaluate the effect of autologous whole blood (AWB) collection on intraoperative/postoperative allogeneic blood transfusion rate in complex aortic surgery with hypothermic circulatory arrest. This retrospective study included adults who underwent aortic surgery with hypothermic circulatory arrest at a single institution between 2014 and 2019. Out of 509 cases (414 patients), 110 (22%) received the AWB protocol. We performed propensity-score matching, including 35 preoperative and procedural variables, which resulted in 95 well-matched pairs, to compare outcomes in patients who received AWB protocol versus those who did not. Study outcomes were percentage of patients who received transfusion of allogeneic blood products intraoperatively and postoperatively. Mean volume of collected autologous blood was 826 ± 263 mL. Intraoperatively, fewer AWB patients received red blood cell concentrate (33% vs 49%; P =.02), plasma (35% vs 62%; P =.0002), platelets (61% vs 81%; P =.003), and cryoprecipitate (43% vs 56%; P =.08) compared with non-AWB patients. During the entire hospital stay, the differences in transfusion rate between the 2 groups were: red blood cells (58% vs 62%; P =.6), plasma (49% vs 66%; P =.01), platelets (72% vs 82%; P =.09), and cryoprecipitate (56% vs 63%; P =.3). Pre-pump autologous blood collection may reduce the need for intraoperative transfusion of allogenic non–red-cell blood products in patients undergoing complex aortic surgery with hypothermic circulatory arrest. A larger study is needed to clarify the influence of this association on patient outcomes and resource utilization. The role of the autologous whole blood collection protocol in aortic surgery with the use of hypothermic circulatory arrest is undetermined. We undertook this retrospective study to examine the effect of the autologous blood collection on allogeneic blood transfusions intraoperatively and for the entire hospital stay. We identified 509 cases during a 4-year period, and applied the propensity score matching which resulted in 95 patients in each group. We found lower transfusion rate for red blood cell concentrate, plasma, platelets, and cryoprecipitate intraoperatively. For the entire hospital stay, fewer patients received plasma. [Display omitted] [ABSTRACT FROM AUTHOR]

Background Postoperative blood loss may be a risk factor for allogeneic blood transfusion ( ABT) in patients undergoing subcapital hip fracture ( SHF) repair. We investigated the utility and costs of using a low-vacuum reinfusion drain (Bellovac ABT) within a blood management protocol for reducing ABT requirements in consecutive SHF. Methods The blood management protocol consisted of the application of a restrictive transfusion trigger (Hb < 8 g/dl), the peri-operative administration of IV iron sucrose (3 × 200 mg/48 h) ± recombinant erythropoietin (1 × 40 000 IU sc) and the use of Bellovac ABT (Group 2, n = 117). An immediate previous SHF series managed without Bellovac ABT served as control (Group 1, n = 138). Results Overall, 72 out of 255 (28%) received at least one ABT unit (2·1 ± 1·0 U/transfused patient) without differences between groups. However, in the subgroup of patients with admission Hb < 13 g/dl, the use of Bellovac ABT reduced postoperative ABT rates (16% vs. 46%, for groups 2 and 1, respectively; P = 0·001), although only 3 were reinfused, and was cost-saving. The use of Bellovac ABT also resulted in fewer wound bleeding complications, but there were no differences in Hb at postoperative days 7 and 30 between groups. Conclusions In SHF patients with admission Hb < 13 g/dl and managed with peri-operative IV iron ± recombinant erythropoietin plus restrictive transfusion indication, the use of Bellovac ABT was associated with reduced ABT requirements, without increasing postoperative complications, and cost-savings. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether or not there was a significant difference between the methods of centrifugation (CF) and multiple-pass hemoconcentration (MPH) of the residual cardiopulmonary-bypass volume in relation to biochemical measurements and patient outcomes. Design: Prospective, randomized, and controlled. Setting: Conducted at a western Canadian tertiary care hospital. Participants: Consisted of 61 consecutive male and female patients from ages 40 to 80 who were scheduled for cardiac surgery with cardiopulmonary bypass. Interventions: Either the centrifugation or multiple-pass hemoconcentration method was used to process the residual blood from the cardiopulmonary bypass circuit. Results: The 12-hour postoperative levels of serum hemoglobin were not significantly different in the centrifugation group as compared to the multiple-pass hemoconcentration group. However, the serum levels of total protein and albumin were significantly higher in the multiple-pass hemoconcentration group as compared to the centrifugation group. Additionally, after 12-hours postoperatively, the serum fibrinogen and platelet counts were significantly higher in the multiple-pass hemoconcentration group as compared to those of the centrifugation group. The allogeneic product transfusion index and the chest-tube blood drainage indices were lower in the multiple-pass hemoconcentration group as compared to the centrifugation group. Conclusion: Although the CF method provided a product in a shorter turnaround time, with consistent clearance of heparin, the MPH method trended towards enhanced biochemical and clinical patient outcomes over the 12-hour postoperative period. [Copyright &y& Elsevier]

Abstract: Background and objectives: Spinal surgery has been shown to have a high blood transfusion requirement. Preoperative autologous blood donation (PABD) is a strategy to reduce the allogeneic transfusions in this subset of patients. Material and methods: We retrospectively reviewed transfusion outcome of patients undergoing elective major spinal surgery from 2005 to 2011, and included in the PABD program. Transfusion outcome was compared with a group of patients that did not enter in the program during the same period. Results: A total of 148 patients were included in the program during the analyzed period. Patients in the PABD program benefited from reduced exposure to allogeneic blood (Odds Ratio: 0.077, 95% confidence interval 0.043–0.140). However, 12.16% (n =18) of these patients received also allogeneic blood (total 40 red blood cell units). Univariate analysis showed the following parameters as significantly predictors of transfusion: inclusion in the program (p <0.000), number of levels fused (Odds Ratio: 1.143, p =0.010), and number of autologous red blood cells donated (Odds Ratio: 1.906, p <0.000). Conclusions: The preoperative autologous blood donation program designed in our hospital was effective for reducing allogeneic transfusion in mostly young patients under major elective spinal surgery. However and as expected, their inclusion in the program increased the risk to be transfused. [Copyright &y& Elsevier]

Background: Preoperative donation of autologous blood has been widely used to minimize the potential risk of allogeneic transfusions in total knee arthroplasty. A previous study from our center revealed that preoperative autologous donation reduces the allogeneic blood exposure for anemic patients but has no effect for non-anemic patients. Questions/Purposes: The current study investigates the impact of a targeted blood donation protocol on overall transfusion rates and the incidence of allogeneic blood transfusions. Methods: Prospectively, 372 patients undergoing 425 unilateral primary knee replacements were preoperatively screened by the Blood Preservation Center between 2009 and 2012. Anemic patients with a hemoglobin level less than 13.5 g/dL were advised to donate blood, while non-anemic patients did not donate. Results: Non-anemic patients who did not donate blood required allogeneic blood transfusions in 5.9% of the patients. The overall rate of allogeneic transfusion was significantly lower for anemic patients who donated autologous blood (group A, 9%) than those who did not donate (group B, 33%; p < 0.001). Donating autologous blood did increase the overall transfusion rate of anemic patients to 0.84 per patient in group A compared to 0.41 per patient in group B ( p < 0.001). Conclusion: This investigation confirms that abandoning preoperative autologous blood donation for non-anemic patients does not increase allogeneic blood transfusion rates but significantly lowers overall transfusion rates. [ABSTRACT FROM AUTHOR]

Abstract: Background: Mediastinitis, a serious complication after cardiac surgery, increases morbidity, mortality, and cost of care. Accumulating evidence implicates blood transfusions in the development of mediastinitis. Objectives: We conducted a systematic review to evaluate the association between allogeneic blood transfusion and mediastinitis in adult cardiac surgery patients. Results: After a search of Medline, PubMed, Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, and the Institute for Scientific Information''s Web of Knowledge (1990-2010) for relevant studies, 7 (3 prospective cohort and 4 retrospective reviews) met our inclusion/exclusion criteria. Between 20% and 80.2% of patients received blood transfusions, with an incidence of mediastinitis ranging from 0.1% to 2.3%. Five studies demonstrated an independent association between red blood cell transfusion and mediastinitis. Two studies identified a dose-response relationship. Conclusion: The findings of this systematic review suggest that allogeneic red blood cell transfusions are associated with an increased risk of mediastinitis in patients undergoing cardiac surgery. Individual risks and benefits should be assessed in each patient before a red blood cell transfusion. [Copyright &y& Elsevier]

Background: In aortic surgery bleeding complications can be fatal. Therefore, rotational thromboelastometry(ROTEMTM)based coagulation management was introduced. Methods: After 5 cases of acute type A aortic dissection and aortic arch replacement had been treated based on ROTEM findings (ROTEM group; RG), 5 cases without ROTEM were matched as control group (CG). CG treatment was based on conventional tests and clinical findings. Blood component and coagulation factor requirements, ventilation time, duration of stay at intensive care unit (ICU), hospitalization, and thrombotic or bleeding incidents as well as transfusion-associated costs were compared. Results: Administration of blood products and coagulation factor concentrates, ventilation time, ICU length of stay, and hospitalization tended to be lower in RG. Postoperative plasma transfusion (p = 0.038), recognized incidents (p = 0.048), and resulting costs on coagulation treatment (p = 0.049) were significantly reduced. Conclusion: Our data suggest that ROTEM-based coagulation management can reduce transfusion requirements and corresponding costs in patients with aortic arch replacement. These data has to be confirmed by prospective randomized trials. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article discusses a multimodal blood avoidance protocol for total joint arthroplasty. It notes that 50% of patients subjected to total joint arthroplasty tend to receive an allogenic transfusion. Intraoperative techniques that can limit blood loss are explored which include acute normovolemic hemodilution, hypotensive anesthesia and tissue hemostasis. Drain usage as well as continuous passive motion (CPM) are cited as procedures that can be used to preserve blood following the surgery.

The article presents a retrospective case-control study on the efficiency of intraoperative cell salvage systems. The study examined 54 pediatric patients undergoing posterior spinal fusion (PSF) for idiopathic scoliosis in which data such as body mass index and perioperative transfusions were obtained. It states that regression analysis was used between allogeneic transfusion and chosen covariates. The results of the study affirm the efficiency of cell saver use during PSF.

Background Preoperative anaemia is a major risk factor for allogeneic blood transfusion (ABT) in patients undergoing hip fracture repair. We investigated the efficacy of preoperative recombinant human erythropoietin (rHuEPO) administration for reducing ABT requirements in a series of consecutive hip fracture patients presenting with haemoglobin (Hb) between 10 g/dl and 13 g/dl. Methods The blood conservation protocol consisted of the application of a restrictive transfusion trigger (Hb < 8 g/dl) and the perioperative administration of intravenous iron sucrose (3 × 200 mg/48 h) (group 1, n = 115). Additionally, some patients received preoperative rHuEPO (40 000 IU sc) on admission to the orthopaedic ward (group 2, n = 81). Results Overall, 103 of 196 patients (52·5%) received at least one ABT unit (2·1 ± 1·0 U/patient). However, there were significant differences in perioperative ABT rates between groups (60% vs. 42%, for groups 1 and 2, respectively; P = 0·013). Postoperative Hb on postoperative days 7 and 30 was higher in group 2 than in group 1. In addition, in group 2, Hb levels were higher on postoperative day 30 than on admission (12·7 ± 1·0 g/dl vs. 11·9 ± 0·8 g/dl, respectively; P = 0·030). Administration of rHuEPO did not increase postoperative complications or 30-day mortality rate. Only three mild intravenous iron adverse effects were witnessed. Conclusions In anaemic hip fracture patients managed with perioperative intravenous iron and restrictive transfusion protocol, preoperative administration of rHuEPO is associated with reduced ABT requirements. However, appropriate training, education and awareness are needed to avoid protocol violations and to limit further exposure to ABT and ABT-related risks. [ABSTRACT FROM AUTHOR]

Background. Hereditary haemochromatosis is the most common inherited disorder in white persons with prevalence of about 1 in 200. Therapeutic phlebotomy is an effective treatment for the disease and prevents its sequele. In addition to their altruism, patients with hereditary haemochromatosis have also medical and monetary incentives for blood donation. Current guidelines do not allow haemochromatosis patients to donate blood. About two thirds of patients are eligible as blood donors and about two thirds of therapeutically drawn blood is suitable for transfusion. Therapeutically drawn blood could increase the blood supply by 1.5 to 30%.Conclusions. The number of states that already accept patients with hereditary haemochromatosis as blood donors is increasing. To avoid monetary incentives they offer free phlebotomies for all patients with hereditary haemochromatosis. There have been no reports about higher incidence of transfusion reactions. In Slovenia the number of therapeutic phlebotomy is increasing. We should evaluate the possibilities for recruitment of haemochromatosis patients as blood donors also in our country. It is necessary to modify regulatory restrictions and to ensure that there is no other incentives than altruism for blood donation.

The safety of allogeneic blood and blood products in relation to infection risk is paramount, even though absolute safety is an ideal that clearly cannot be attained. In countries with developed healthcare systems and with effective and well-managed national transfusion services, any residual infection risk is generally much lower than the risk of non-infectious adverse events. The number of infectious agents known to be transmitted by transfusion is not insignificant, but at the same time only a proportion of these present a significant universal threat. It is therefore important to understand and attempt to quantify the residual infectious risks associated with transfusion. These risks generally fall into two categories: the risk of infection because of the failure to identify infection in a donation from a recently infected donor and the risk of infection from a ‘new’ infectious agent or from one that donations are not routinely screened for. Both of these scenarios are ‘real’ in the sense that these are the threats faced every day by transfusion services. The mitigation of such threats is by ensuring that there are effective donor screening and deferral procedures in place, that the screening performed is carried out to the highest possible standards in terms of sensitivity and reliability, and finally that the transfusion service actively monitors ‘new’ or emerging infectious threats so that action can be taken if the safety of the blood supply is likely to be compromised, as well as maintaining hemovigilance of adverse events in recipients of transfusions. [ABSTRACT FROM AUTHOR]

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Abstract: Background: Unilateral total knee replacement (TKR) can result in a substantial blood loss and 30–50% of these patients receive allogeneic blood transfusion (ABT), this transfusion rate may be even higher among anaemic patients. Patients and methods: We assessed the requirements for ABT in 156 consecutive patients undergoing surgery for primary TKR, who received iron ferrous sulphate (256mg/day; 80mg of Fe2+), vitamin C (1000mg/day) and folic acid (5mg/day) during the 30–45days preceding surgery, and who were transfused if Hb <80g/L and/or clinical signs/symptoms of acute anaemia/hypoxemia (Group 2). A previous series of 156 TKR patients serves as a control group (Group 1). Results: Compared to those in Group 1, patients in Group 2 presented a lower transfusion rate (5.8% vs. 32%, for Group 2 and Group 1, respectively; p <0.01), and a lower transfusion index (1.78±0.44 vs. 2.22±0.65 units per transfused patient, respectively; p <0.05). After patient''s stratification according to a preoperative Hb above or below 130g/L, the differences in transfusion rate remained significant, although 19% of patients from Group 2 still needed ABT if their preoperative Hb <130g/L. Conclusion: This protocol seems to be effective for avoiding ABT in non-anaemic TKR patients, whereas for anaemic patients another blood saving strategy, such us preoperative erythropoietin administration or postoperative blood salvage, should be added to further increase its effectiveness. [Copyright &y& Elsevier]

Introduction Requirements for allogeneic blood transfusion (ABT) after total knee replacement (TKR) are still high (30–50%), and salvage of unwashed filtered postoperative shed blood (USB) may represent an alternative to ABT. We evaluated that patients are more likely to benefit of USB reinfusion after TKR. Patients and Methods Data from 581 consecutive primary TKR, managed with (reinfusion group, n= 382) or without (control group, n= 199) reinfusion of USB, were retrospectively reviewed. Results Patients from reinfusion group received 119 ± 88 ml of red blood cells from USB, without clinically relevant incidents, and showed a lower ABT rate (30.6% vs. 8·4%, for control and reinfusion groups, respectively; P = 0·001) (transfusion trigger, haemoglobin [Hb] < 9 g/dl). Differences in ABT rate between groups were significant for all preoperative Hb levels, except for Hb ≤ 12 g/dl. A lower transfusion threshold (Hb < 8 g/dl) might have further decreased ABT rate (14·6% vs. 5·2%, respectively; P < 0·001), with differences being significant for preoperative Hb between 12 and 15 g/dl. There were no differences with respect to postoperative infection rate, but patients from reinfusion group had a shorter length of hospital stay (11 ± 4 vs. 13 ± 4 days, respectively; P= 0·001). Conclusions Return of USB after TKR seems to reduce the need for ABT, especially in patients with preoperative Hb between 12 and 15 g/dl. There is little benefit of USB reinfusion for patients with preoperative Hb > 15 g/dl, whereas patients with preoperative Hb < 12 g/dl would probably benefit from the combination of USB with some other blood-saving method. [ABSTRACT FROM AUTHOR]

In unilateral total knee replacement (TKR), perioperative blood loss, low transfusion thresholds and short hospital stay result in patients being discharged with low haemoglobin (Hb). We assessed the effects of perioperative administration of intravenous iron, with or without erythropoietin, plus a restrictive transfusion threshold (Hb <80 g L-1) both on transfusion rate and recovery from post-operative anaemia. TRK patients received iron sucrose (2 × 200 mg per 48 h, iv) (Group IVI, n = 129). Patients with admission Hb < 130 g L-1, also received erythropoietin (1 × 40 000 IU, sc) (Group EPO, n = 19). Perioperative clinical and laboratory data were obtained. Mean Hb loss was 36 g L-1, but only seven patients were transfused (5%). Pre-operatively, 66 (45%) patients did not have enough stored iron to compensate Hb loss. At post-operative day 30, only 15% were anaemic, 70% of Hb loss and 92% of pre-operative Hb were recovered and ferritin increased by 73 μg L-1 (P < 0.01), although erythropoietic response was higher in patients receiving erythropoietin (P < 0.05). No adverse effects of iron sucrose or erythropoietin were witnessed. This protocol seems to reduce allogeneic blood transfusion rate and may hasten the recovery from post-operative anaemia in TKR patients, without depleting iron stores. Further studies are needed to ascertain which patients may benefit of extended intravenous iron and/or erythropoietin administration. [ABSTRACT FROM AUTHOR]

Several recent studies have shown differences in blood loss and allogeneic transfusion requirements between on-pump and off-pump coronary artery bypass grafting (CABG). Recently a new concept, the mini-extracorporeal circulation, was introduced to minimize the side effects of extracorporeal circulation. Therefore, there are no data comparing the three techniques with special emphasis to blood loss and transfusion requirements. Two hundred and eighty-five patients undergoing first-time coronary artery bypass grafting were retrospectively matched for number of grafts, age and sex. Ninety-five patients underwent surgery with the off-pump CABG (OPCAB) technique, 97 patients using conventional CABG with cold cardioplegia (CCABG) and 93 patients with the mini-extracorporeal circuit with warm blood cardioplegia (MCABG). Blood loss for the CCABG group with a mean loss of 819 ± 557 mL and the OPCAB group with a mean loss of 870 ± 768 mL was significant different compared to the MCABG group with a mean loss of 679 ± 290 mL. The use of units red blood cell units was significantly higher for CCABG group and OPCAB group compared to the MCABG group. On the day of operation the use of platelet concentrate was significantly higher for the CCABG group compared to MCABG group. As a consequence of improvements of several components of the mini heart lung machine, significantly less blood products are needed in MCABG patients. The expected reduced need for transfusion when the pump was completely avoided could not be confirmed in this single retrospective cohort study. [ABSTRACT FROM AUTHOR]

Salvage and return of unwashed filtered shed blood (USB) after unilateral total knee replacement (TKR) is a blood-saving method frequently used to avoid allogeneic blood transfusion (ABT). However, the use of USB is controversial, as it may impair hemostasis when retransfused. We report on 1-month follow-up of fibrinolytic activity in TKR patients who received either ABT, USB or no transfusion. One hundred and six consecutive TKR patients entered the study: 88 received no transfusion (group 1), five received ABT (group 2), and 13 received USB (group 3). Blood samples were obtained on day of surgery and postoperative days 1, 7 and 30, and assayed for blood counts, C-reactive protein (CRP), and D-dimers. Demographic and clinical data were also collected. There were no differences in demographic data or postoperative infection rate between groups, but length of hospital stay was longer in group 2 ( P < 0.05). Postoperative levels of D-dimers increased on day 1, and remained elevated on day 30 in all groups, but on day 1 they were higher in group 3 ( P < 0.05). There were no differences in perioperative levels of CRP between groups, and they correlated with D-dimers both preoperatively and on day 30. Taken together, these data suggest that surgery for TKR induced an activation of coagulation and fibrinolysis. This situation lasts at least as late as 30 days after surgery, and is not modified by transfusion, except for a transitory induction of fibrinolysis by USB return in the early postoperative period. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Although often life-saving, blood transfusions are associated with significant risk to the patient and escalating costs to the blood system and hospital. Transfusions are often given unnecessarily. Blood conservation represents the use of alternatives to transfusion. The ONTraC program attempts to enhance transfusion practice outside the blood transfusion laboratory, promote blood conservation in surgery patients, and reduce allogeneic red cell use. Methods: In the first such large scale program, funding was obtained from the Ontario MOHLTC for a Transfusion Coordinator in 23 Ontario hospitals selected based on blood utilization and geography. At specific time periods, detailed anonymized information was collected in a defined number of all consecutive patients admitted for the three designated surgical procedures: knee arthroplasty (N =approximately 1200 at each time point), abdominal aortic aneurysm (AAA; N =300 at each time) and coronary artery bypass graft (CABG) surgery (N =300 at each time point). Results: Considerable inter-institutional variation was observed in the proportion of patients and amount of blood transfused. At the 12 month analysis, most, although not all, hospitals had decreased use of allogeneic blood and there was an overall 24% reduction in blood use in patients undergoing knee surgery, 14% in AAA and 23% in CABG. In addition to reduction in proportion of patients transfused, transfused patients received fewer units of allogeneic blood. Patients who did not receive allogeneic transfusions had significantly lower postoperative infection rates (p <0.05) and length of stay (p <0.0001); multivariate analysis showed that allogeneic transfusion was an independent predictor of increased length of stay. Eighteen-month analysis indicates even greater reduction in allogeneic transfusion. The main measures of blood conservation employed were preoperative autologous donation and education, with recent increasing use of erythropoietin and the cell saver. These measures have been demonstrated to be very effective in avoiding allogeneic transfusion. Conclusions: The ONTraC have become leaders locally, nationally and internationally in blood conservation. The reduction in allogeneic transfusion associated with the implementation of the ONTraC program represents important savings in costs associated with blood components, hospital stay and work in transfusion laboratories and nursing units, as well as enhancing patient satisfaction and safety. [Copyright &y& Elsevier]

The effect of closed-suction drainage with red-cell reinfusion on patients receiving low molecular weight heparin (LMWH) prophylaxis after total knee arthroplasty (TKA) has not been previously studied. Therefore, our goals were to determine the effect of reinfusion drains and LMWH on allogeneic transfusions and wound complications after TKA by comparing patients treated with and without drains. Overall, transfusion rates were lower in the drain group (40% vs 15%, P=.04). Patients with reinfusion drains had a significantly higher rate of allogeneic transfusion (15.8%) than those predonating autologous blood and no drain (5.4%, P=.0003). The drain group had lower rates of wound complications ( P=not significant). We were unable to demonstrate the efficacy of red-cell reinfusion as a substitute for autologous donation in TKA. [ABSTRACT FROM AUTHOR]

Introduction In patients undergoing total knee replacement (TKR), most of the measured blood loss occurs during the postoperative period, and 30-50% of these patients receive allogeneic blood transfusion (ABT). For this reason, the salvage and return of unwashed filtered shed blood (USB) from postoperative drainage may represent an alternative to ABT in these patients. We have, therefore, evaluated the clinical utility of USB return in TKR patients, with a special focus on patients with mild anaemia. Materials and methods Data from 200 TKR patients (group 2) receiving USB within the first 6 postoperative hours (Consta Vac CBC II, Sryker) were prospectively collected. A retrospective series of 100 TRK patients served as the control group (group 1). Results USB return was possible in 162 patients who received a mean of 0.98 ± 0.4 U/pte, without any clinically relevant incident. Return of USB decreased both the percentage of patients with ABT (48% vs 11%, for groups 1 and 2, respectively; p<0.01) and the ABT units/patient index (1.31 ± 1.27 vs 0.29 ±0.87 units/patient, respectively; p < 0.01). A transfusion protocol was not established, but there was no difference between groups with respect to either perioperative Hb levels or overall transfusion index, indicating that the transfusion criteria were uniform. However, for the subgroups of patients who needed ABT, the preoperative Hb level was 1 g/dL lower in those receiving USB (13.4± 1.4 vs 12.4± 1.2 g/dL; p<0.05). There was no difference in the postoperative complication rate, and patients in group 2 recovered the ability to walk 1 day earlier, and their hospital stay was 3 days shorter than in group 1 (p < 0.01). Conclusions Return of USB after TKR seems to shorten the hospital stay and effectively reduce postoperative requirements for ABT, especially in patients with preoperative Hb > 13 g/dL. For patients with preoperative Hb ⩽13 g/dL, although the return of USB also decreased the requirements for ABT, a further reduction will probably be obtained with the addition of another blood-saving method. [ABSTRACT FROM AUTHOR]

Introduction An important percentage of patients affected by hip fracture require the administration of allogenic blood transfusion (ABT) to avoid the risks of perioperative acute anaemia. However, concerns about ABT risks have led to the search for alternatives, especially in elective orthopaedic surgery. Materials and methods We have prospectively investigated the effect of preoperative intravenous 200-300 mg (group 2; n=20) iron sucrose on ABT requirements and postoperative morbid-mortality in patients undergoing surgery for displaced subcapital hip fracture (DSHF) repair. A previous series of 57 DSHF patients served as the control group (group 1). All patients were older than 65 years, were operated on the 3rd day after admission to the hospital, by the same medical team, and using the same implant. Age, gender, ASA classification, surgical procedure, perioperative haemoglobin, requirements for ABT, postoperative infection, length of hospital stay (LOS) and 30-day mortality rate were examined. Results No adverse reactions to the iron administration were observed. The iron group had a lower transfusion rate (15% vs 36.8%), lower transfusion index (0.26 vs 0.77 units per patient), lower 30d mortality rate (0 vs 19.3%), shorter LOS (11.9 vs 14.1 days), as well as a trend to a lower postoperative infection rate (15% vs 33%). Conclusion Preoperative parenteral iron administration could be a safe and effective way to reduce the ABT requirements in DSHF patients. This reduction in the ABT requirements is accompanied by a reduction in the morbid-mortality rate and LOS. A large, randomised, controlled trial to confirm these results is warranted. [ABSTRACT FROM AUTHOR]

Patients undergoing surgery for hip fracture (HF) often receive perioperative allogeneic blood transfusions (ABT) to avoid anaemia. However, concerns about the adverse effects of ABT have prompted the review of transfusion practice and the search for a safer treatment of perioperative anaemia.We prospectively investigated the effect of a blood-saving protocol of perioperative iron sucrose (3 × 200 mg/48 h, intravenously) plus erythropoietin (1 × 40 000 IU, subcutaneously) if admission haemoglobin level< 130 g/l, on transfusion requirements and postoperative morbid-mortality in patients with HF (group 2;n= 83). A parallel series of 41 HF patients admitted to another surgical unit within the same hospital served as the control group (group 1). Perioperative blood samples were taken for haematimetric, iron metabolism and inflammatory parameter determination.This blood-saving protocol reduced the number of transfused patients (P < 0·001), the number of transfused units (P < 0·0001), increased the reticulocyte count and improved iron metabolism. In addition, the blood-saving protocol also reduced the rate of postoperative infections (P = 0·016), but not the 30-day mortality rate or the mean length of hospital stay.The blood-saving protocol implemented seems to reduce ABT requirements in patients with HF, and is associated with a lower postoperative morbidity. The possible mechanisms involved in these effects are discussed. [ABSTRACT FROM AUTHOR]

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