| Irrationality of Allogeneic Red Blood Cell Transfusion in Intraoperative Cell Salvage Patients:a Retrospective AnalysisBackground and objective:Although intraoperative cell salvage(ICS)has been widely used to reduce the demand for allogeneic blood transfusion,patients who use ICS approach still have not completely avoided chances of allogeneic blood transfusion.This study aims to investigate the rate of allogeneic red blood cell(RBC)transfusion in patients receiving ICS,and to evaluate irrationality of allogeneic RBC transfusion and identify its risk factors.Methods:Medical records of all patients associated with intraoperative cell salvage approach from January 2013 to July 2014 were retrospectively reviewed.Theoretical hemoglobin level after reinfusion of salvaged red blood cells at the end of operations was estimated.Irrational transfusion was defined as still initiating allogeneic transfusion with theoretical hemoglobin above 100g/L.The clinical variables,including the surgical department,gender,age,body weight,ratio of estimated blood loss to estimated blood volume(EBL/EBV),salvaged blood volume and preoperative hemoglobin were subsequently compared between patients who received irrational transfusion and those who did not.Logistic regression was performed to identify the risk factors for irrationality of allogeneic RBC transfusion in these patients.Results:Of 1487 patients with ICS approach in this study,the rate of allogeneic RBC transfusion was 31.4%(467/1487),and the rate of irrationally allogeneic RBC transfusion was 26.0%(341/1313),Patients with irrational transfusion were younger(t=4.656,P<0.001),with lower body weight(t=3.910,P<0.001)and slightly lower preoperative HGB level(t=2.822,P=0.005),but had significantly larger salvaged blood volume(U=-10.926,P<0.001)and higher ratio of blood loss to EBV(U=-17.067,P<0.001),disregarding preoperative anemia or not(U=-1.396,P=0.163).The independent risk factors leading to the irrational allogeneic RBC transfusion included the patient preoperative hemoglobin(OR=1.975,P=0.005)and EBL/EBV%(OR=5.392,P<0.001).Conclusions:The irrationality of allogeneic RBC transfusion existed in ICS patients,which may be associated with the patient preoperative hemoglobin and the ratio of estimated blood loss to EBV.Determining HGB levels is required before transfusion to avoid unnecessary blood transfusion.Doctors should keep knowledge in blood management updated and improve their awareness of rational transfusion for better patient care.Retrospective analysis of blood management in scoliosis patients undergoing deformity correction surgeriesBackground and objective:It is reported that reducing perioperative allogeneic red blood cell transfusion rate requires a multimodal blood conservation techniques.The aim was to compare the blood conservation techniques(tranexamic acid and postoperative erythropoietin)and their effect on estimated blood loss,postoperative hemoglobin and perioperative transfusion rate and volume,and to investigate the independent risk factors of allogeneic transfusion in scoliosis patients undergoing deformity correction surgeries using intraoperative cell salvage over the past 6 years.Methods:We retrospectively reviewed medical records of scoliosis patients undergoing deformity correction surgeries using intraoperative cell salvage from December 2013 to January 2014 and from December 2019 to January 2020 in Peking Union Medical College Hospital.The clinical characteristics and perioperative blood conservation techniques of patients were compared between the 2013-year group and the 2019-year group.The estimated blood loss and perioperative blood transfusion of patients were compared between the tranexamic acid group and the non-tranexamic acid group.The clinical characteristics of patients were compared between the transfusion group and the non-transfusion group and the risk factors of receiving allogeneic blood transfusion in ICS patients undergoing deformity correction surgeries for scoliosis were identified by logistic regression.Results:There was no statistically significant difference in demographics,estimated blood loss,allogeneic transfusion and postoperative recovery between the 2013-year group(n=37 cases)and the 2019-year group(n=40 cases).There was statistically significant difference only in intraoperative use ratio of tranexamic acid(<0.001).Tranexamic acid was not used in 2013,while most patients(77.5%)received intraoperative tranexamic acid in 2019.The postoperative use of erythropoietin also increased(21.6%→37.5%).Under circumstance that the ratio of EBL/EBV was roughly the same(P=0.983)between the two groups,the intraoperative allogeneic blood transfusion rate(43.2%→32.5%),the perioperative allogeneic blood transfusion rate(48.6%→42.5%),the intraoperative allogeneic blood transfusion volume(221.6ml±304.7ml→172.5ml±285.5ml),perioperative allogeneic blood transfusion volume(275.7 ml±398.2 ml→242.5 ml±336.6 ml),the level of hemoglobin on POD1(109.9±18.1g/L→103.8±16.2g/L)in the 2019-year group was less than that in the 2013-year group.There was no significant difference in the demographics,estimated blood loss and the perioperative allogeneic transfusion rate between the tranexamic acid group(n=31 cases)and the non-tranexamic acid group(n=37 cases).Gender(OR=4.075,P=0.037),EBL/EBV%(continuous variable,OR=1.170,P=0.001),and EBL/EBV%(classification variable,OR=6.380,P=0.011)were independent risk factors leading to intraoperative allogeneic blood transfusion in these patients.Conclusion:During the past six years,the blood loss of deformity correction surgeries for scoliosis patients has not changed significantly.Doctors have been employing with combined different conservation techniques,and gradually accepting lower hemoglobin levels on the first day after operation,thus leading to a slight decrease in rate and volume of intraoperative and perioperative allogeneic blood transfusion.The role of intraoperative cell salvage in saving allogeneic transfusion was not taken into full consideration by doctors. |
PDF Full Text Request