Investigation On The Status Of Red Blood Cell Transfusion In Five Hospitals Of China And A Case-control Study On Relevant Factors Of Red Blood Cell Transfusion

Chapter ⅠInvestigation on the status of red blood cell transfusion in five hospitals of China Background:Red blood cell transfusion has been widely used in clinical practice to maintain tissue oxygen supply.There are relatively few cross-sectional studies on red blood cell transfusion in China.Objective:The purpose of this study was to study the clinical background features,frequency of red blood cell transfusion,and indications of red blood cell transfusion of five top-ranking hospitals from different regions in China to investigate the current status of red blood cell transfusion in China.Methods:The number of hospitalized patients,surgical patients,and red blood cell transfusiond patients in 2013 in each hospital were collected,and the red blood cell transfusion rates among the hospitals were compared.To study the main diagnosis,the red blood cell transfusion rate of surgical patients and non-surgical patients,the type of red blood cell products transfused,the amount of transfusion and the hemoglobin threshold before transfusion among the 1000 randomly selected red blood cell transfued patients in each hospital,.Results:The average blood transfusion rate of each hospital is 4.7%.This study included 5050 patients undergoing red blood cell transfusion therapy in 5 hospitals throughout 2013.The most common comorbidity suffered by patients is solid tumors(80.2%)and Hypertension(18.7%).The average Hb level in admission is 100 129g/L,and the average Hb level in admission is significantly lower for medical patients(82 ±24g/Lvs.110 ± 27g/L,p<0.001).Similarly,hemoglobin thresholds before transfusion is significantly higher in surgical patients than in medical patients(101±30g/Lvs.63±16g/L,p<0.001).Conclusion:Red blood cell transfusrd patients in China included in the study had lower blood hemoglobin thresholds before transfusion than similar patients in the United States,and non-surgical patients had a large gap in haemoglobin thresholds.Chapter ⅡA case-control study on relevant factors of red blood cell transfusionBackground:Case-control studies of patients with red blood cell transfusions and aim to investigate the relevant about clinical factors are very rare.Comparing the clinical features associated with red blood cell transfusions between different patients is a key step in managing transfusion therapy.At present,the case information of red blood cell transfusion patients has been paid enough attention.In recent years,various hospitals have applied more extensive and in-depth applications to patient blood management.Objective:To evaluate the clinical factors related to red blood cell transfusion among the top 6 major red cell transfusion patients diagnosed in 5 hospitals in China.Methods:The top 6 diagnoses leading to red blood cell transfusion therapy among all investigators were identified and the control group was screened.Pre-transfusion hemoglobin thresholds and other transfusion-related clinical features were evaluated.We used logistic regression to assess independent risk factors related to red blood cell transfusion.Risk factors assessed included age,gender,basic diagnosis,cardiovascular disease,hospital and pre-transfusion hemoglobin levels.Results:From the 5050 patients who received red blood cell transfusions,we selected top 6 diagnostic groups:orthopedic surgery(case/control:312/216);general surgery(case/control:367/332);solid tumor(case/control:230/232),gastrointestinal bleeding(case/control:212/221),cardiovascular disease(case/control:87/77)and hematological malignancies(case/control:100/101).Multiple regression analysis showed that pre－transfusion hemoglobin level was an important factor related to the patient’s red blood cell transfusion.The pre-transfusion hemoglobin level is an independent risk factor affecting red blood cell transfusion(p<0.05).The pre-transfusion hemoglobin level of non-surgical patients,the main diagnosis of the patient,the hospital and the age over 75 years have a significant effect on the probability of red blood cell transfusion(p<0.05).The non-surgical patients with hematological malignancies(Odds Ratio(OR):0.4,95%confidence interval(CI):0.2-0.6,p<0.05)and gastrointestinal bleeding(OR:0.5,95%CI:0.3-0.7,p<0.01)had lower red blood cell transfusion probability than non-surgical patients with solid tumors,the difference was statistically significant;the non-surgical patients with cardiovascular disease(OR:2.5,95%CI:1.2-4.9,p<0.01)is an independent risk factor that affects the patient’s red blood cell transfusion.Conclusion:For all patients,pre-transfusion hemoglobin level is the most important factor associated with red blood cell transfusion.Different hospitals have different clinical habits of red blood cell transfusion.This study provides clinical evidence for future Chinese patient blood management.