Blood component transfusion increases the risk of death in children with traumatic brain injury

Acker, Shannon N.; Partrick, David A.; Ross, John; Nadlonek, Nicole A.; Bronsert, Michael; Bensard, Denis D.

doi:10.1097/ta.0000000000000095

Cited by 33 publications

(26 citation statements)

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“…R ed blood cell (RBC) transfusion in critically ill patients is known to be associated with increased risks of nosocomial infection, suggesting a relationship between RBC transfusion and impaired host defense, although a causal link between RBC transfusion and immune function has not been clearly established. [1][2][3][4][5][6][7] Acquired suppression of innate (e.g., monocyte) and adaptive (e.g., lymphocyte) immune function are increasingly recognized as complications of critical illness and are independently associated with increased risks of adverse outcomes. [8][9][10][11][12][13] Immune function in the intensive care unit (ICU) can be measured by quantifying the ability of immune cells to produce cytokines in response to ex vivo stimulation.…”

mentioning

confidence: 99%

Red blood cell transfusion and immune function in critically ill children: a prospective observational study

et al. 2014

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mentioning

confidence: 99%

Red blood cell transfusion and immune function in critically ill children: a prospective observational study

et al. 2014

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“…Bu tezi destekler şekilde travmatik beyin hasarlı hastalarda eritrosit transfüzyonunun mortaliteyi arttırdığı gösterilmiştir. 11 Rouette ve ark.…”

Section: Discussionunclassified

“…Hastaların eritrosit transfüzyonu sırasında bir hastada ateş olması dışında transfüzyonla ilgili bir yan etki gözlenmedi. 11 travmatik beyin hasarı olan çocuklarda bizim çalışmamızdaki sonuca benzer olarak mortaliteyi etkilemeyen hemoglobin eşik değeri olarak 8,0 g/dL sonucunu bulmuşlardır. Daha düşük hemoglobin düzeyi değerlerinde eritrosit transfüzyonu yapılması hastaları transfüzyonun yol açacağı olumsuz etkilerden koruyacaktır.…”

Section: Bulgularunclassified

Relationship of Hemoglobin Concentration at Admission and Need for Erythroyte Transfusion During Hospitalization with Mortality in Pediatric Critical Care Patients

Arslanköylü¹,

Akbas²,

Alakaya³

et al. 2017

cayd

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Amaç: Bu çalışmanın amacı çocuk yoğun bakım ünitesine yatış sırasındaki hemoglobin düzeyi ve izlem sırasında eritrosit transfüzyonu gereksinimi ile mortalite arasındaki ilişkinin araştırılmasıdır. Yöntemler: Bu ileriye yönelik çalışmaya on iki yataklı çocuk yoğun bakım ünitesine bir yıl süreyle kabul edilen toplam 260 hasta dahil edilmiştir. Hastaların demografik özellikleri, yatış nedenleri, yatış süreleri, mekanik ventilatör gereksinimi ve mekanik ventilatörde kalma süreleri, pediyatrik mortalite riski III ve pediyatrik lojistik organ disfonksiyon skorları, yatış anındaki tam kan sayımı değerleri ile transfüze edilme durumları kayıt edildi. Bulgular: Çalışmaya alınan hastalardan 34 olgu eksitus oldu. Çalışmamızda kaba mortalite oranı %13 idi. Eksitus olan hastaların ortalama hemoglobin düzeyleri (10,55±2,45 g/dL) sağ kalan hastaların değerlerine (11,58±2,15 g/dL) göre daha düşük bulundu (p=0,011). Transfüzyon uygulanan hastaların mortalite oranı transfüze edilmeyen hastalara göre anlamlı olarak yüksek bulundu (%40,2 vs. %1,6; p<0,001). Sonuç: Çalışmamızda kritik çocuk hastalarda çocuk yoğun bakım ünitesine başvuru sırasında anemi varlığı ve/veya takip sırasında transfüzyon gereksinimi artmış mortalite riski ile ilişkili bulunmuştur. Anahtar Kelimeler: Çocuk yoğun bakım, anemi, transfüzyon, mortaliteIntroductıon: This study aimed to investigate the relationship of hemoglobin concentration at admission to pediatric intensive care unit and erythrocyte transfusion during hospitalization with mortality. Methods: In this prospective study, we included 260 patients who were admitted to a 12-bed pediatric intensive care unit in a one-year period. Demographic characteristics, admission etiologies, length of stay in the pediatric intensive care unit, mechanical ventilation rates, pediatric risk of mortality III and pediatric logistic organ dysfunction scores, complete blood count on admission and erythrocyte transfusion during hospitalization were recorded prospectively. Results: Of the 260 cases, 34 were exitus. The mortality rate was 13%. The mean hemoglobin concentration of patients who were exitus was lower than that of patients who survived (10.55±2.45 g/dL vs. 10.55±2.45 g/dL, p=0.011). Although platelet levels were lower in patients who were exitus than in survivors, the difference was not statistically significant (320.352±181.731/mm 3 vs. 352.231±174,129/mm 3 p=0.325). The mortality rate in transfused patients was higher than in patients who were not transfused. (40.2% vs. 1.6%, p<0.001). Conclusion: Hemoglobin concentration at admission in patients who die in pediatric intensive care unit is significantly lower than in those who survive. In this study, increased mortality risk in patients admitted to pediatric intensive care unit was found to be associated with the presence of anemia and need for erythrocyte transfusion.

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“…The threshold for RBC transfusion in patients with TBI is controversial, and the optimal transfusion trigger is unknown [9]. In a recent retrospective review of 635 patients with isolated, severe TBI (Glasgow Coma Scale 3–8), the association between Hb levels and mortality was assessed [10].…”

Section: Traumatic Brain Injurymentioning

confidence: 99%

“…A recent retrospective study reviewed outcomes in 1607 pediatric patients with TBI, of which 178 received RBC transfusion [9]. The authors demonstrated that RBC transfusions in these patients were associated with poor outcomes and increased mortality.…”

Section: Traumatic Brain Injurymentioning

confidence: 99%

Red blood cell transfusion in neurosurgical patients

Gruenbaum

Ruskin

2014

Current Opinion in Anaesthesiology

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Purpose of review Anemia is common in neurosurgical patients, and is associated with secondary brain injury. Although recent studies in critically ill patients have shifted practice toward more restrictive red blood cell (RBC) transfusion strategies, the evidence for restrictive versus liberal transfusion strategies in neurosurgical patients has been controversial. In this article, we review recent studies that highlight issues in RBC transfusion in neurosurgical patients. Recent findings Recent observational, retrospective studies in patients with traumatic brain injury, subarachnoid hemorrhage, and intracranial hemorrhage have demonstrated that prolonged anemia and RBC transfusions were associated with worsened outcomes. Anemia in patients with ischemic stroke was associated with increased ICU length of stay and longer mechanical ventilation requirements, but mortality and functional outcomes did not improve with RBC transfusion. In elective craniotomy, perioperative anemia was associated with increased hospital length of stay but no difference in 30-day morbidity or mortality. Summary There is a lack of definitive evidence to guide RBC transfusion practices in neurosurgical patients. Large randomized control trials are needed to better assess when and how aggressively to transfuse RBCs in neurosurgical patients.

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Blood component transfusion increases the risk of death in children with traumatic brain injury

Abstract: Epidemiologic study, level III. Therapeutic study, level IV.

Cited by 33 publications

References 26 publications

Red blood cell transfusion and immune function in critically ill children: a prospective observational study

Red blood cell transfusion and immune function in critically ill children: a prospective observational study

Relationship of Hemoglobin Concentration at Admission and Need for Erythroyte Transfusion During Hospitalization with Mortality in Pediatric Critical Care Patients

Red blood cell transfusion in neurosurgical patients

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