Patient blood management to reduce surgical risk

Clevenger, Ben; Mallett, Susan; Klein, A. A.; Richards, Toby

doi:10.1002/bjs.9898

Cited by 123 publications

(93 citation statements)

References 85 publications

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“…Given these risks, comprehensive PBM programs have been used increasingly to help reduce RBC transfusion . PBM is endorsed by the American Association of Blood Banks Advancing Transfusion and Cellular Therapies Worldwide (AABB) and is described as the use of evidence‐based strategies to optimize the care of patients who might require transfusion.…”

Section: Discussionmentioning

confidence: 99%

Five‐year trends in perioperative red blood cell transfusion from index cases in five surgical specialties: 2011 to 2015

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Five‐year trends in perioperative red blood cell transfusion from index cases in five surgical specialties: 2011 to 2015

et al. 2018

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“…9 This allows for appropriate and focussed use of PBM strategies, which may include medication and techniques that can be expensive, or may result in harmful side-effects, and should be therefore be reserved for those at higher risk of transfusion. Scoring systems to predict general mortality and morbidity are widely used in cardiac surgery and critical care, such as the EuroSCORE 10 and the recently published ARCTIC score 11 .…”

Section: Patient Blood Management (Pbm) Is An Increasingly Important mentioning

confidence: 99%

The ACTA PORT-score for predicting perioperative risk of blood transfusion for adult cardiac surgery

Klein

Collier

Yeates

et al. 2017

British Journal of Anaesthesia

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Objective: To derive a simple and accurate scoring system to predict risk of transfusion for patients undergoing cardiac surgery Design: Retrospective analysis of data collected from the ACTA National Audit; for the derivation dataset, we included data from 20,036 patients, which we then externally validated using a further group of 1,047 patients. Methods:We identified independent risk factors associated with transfusion by performing univariate analysis, followed by logistic regression. We then simplified the score to aninteger-based system and tested it using AUC characteristic statistic. A Hosmer-Lemeshow goodness-of-fit test was applied. Finally, the scoring system was applied to the external validation dataset and the same statistical methods applied to test the accuracy of the ACTA-PORT score.Results: Several factors were shown to be independently associated with risk of transfusion.These included age, gender, body surface area, logistic EuroSCORE, preoperative haemoglobin and creatinine, and type of surgery. In our primary dataset, the score accurately predicted risk of perioperative transfusion in cardiac patients with an AUC of 0.76. The external validation confirmed the accuracy of the scoring method with an AUC of 0.84 and good agreement across all scores with a minor tendency to under-estimate transfusion risk in very high-risk patients. Conclusion:The ACTA-PORT score is a reliable, validated tool for predicting the risk of transfusion for patients undergoing cardiac surgery. This score will allow clinicians to easily identify patients at increased risk for transfusion and apply patient blood management strategies appropriately, with the potential to reduce perioperative morbidity and mortality.

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“…Increased appreciation of the adverse effects of anemia in the perioperative period together with awareness of the risks of blood transfusion have led to the pre-operative use of intravenous iron preparations as part of patient blood management protocols 2–4 . Critically ill patients in intensive care units are also exposed to acute iron loading (defined here as an increase in intracellular iron concentration in response to iron administration) in the form of blood transfusions as well as oral and parenteral iron treatment 5, 6 .…”

Section: Introductionmentioning

confidence: 99%

Iron Loading Exaggerates the Inflammatory Response to the Toll-like Receptor 4 Ligand Lipopolysaccharide by Altering Mitochondrial Homeostasis

et al. 2017

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Background Perioperative and critically ill patients are often exposed to iron (in the form of parenteral-iron administration or blood transfusion) and inflammatory stimuli, but the effects of iron loading on the inflammatory response are unclear. Recent data suggest that mitochondrial reactive oxygen species have an important role in the innate immune response and that increased mitochondrial reactive oxygen species production is a result of dysfunctional mitochondria. We tested the hypothesis that increased intracellular iron potentiates lipopolysaccharide-induced inflammation by increasing mitochondrial reactive oxygen species levels. Methods Murine macrophage cells were incubated with iron and then stimulated with lipopolysaccharide. C57BL/6 wild-type mice were intraperitoneally injected with iron and then with lipopolysaccharide. Markers of inflammation and mitochondrial superoxide production were examined. Mitochondrial homeostasis (the balance between mitochondrial biogenesis and destruction) was assessed, as were mitochondrial mass and the proportion of nonfunctional to total mitochondria. Results Iron loading of mice and cells potentiated the inflammatory response to lipopolysaccharide. Iron loading increased mitochondrial superoxide production. Treatment with MitoTEMPO, a mitochondria-specific antioxidant, blunted the proinflammatory effects of iron loading. Iron loading increased mitochondrial mass in cells treated with lipopolysaccharide and increased the proportion of nonfunctional mitochondria. Iron loading also altered mitochondrial homeostasis to favor increased production of mitochondria. Conclusions Acute iron loading potentiates the inflammatory response to lipopolysaccharide, at least in part by disrupting mitochondrial homeostasis and increasing the production of mitochondrial superoxide. Improved understanding of iron homeostasis in the context of acute inflammation may yield innovative therapeutic approaches in perioperative and critically ill patients.

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Patient blood management to reduce surgical risk

Cited by 123 publications

References 85 publications

Five‐year trends in perioperative red blood cell transfusion from index cases in five surgical specialties: 2011 to 2015

Five‐year trends in perioperative red blood cell transfusion from index cases in five surgical specialties: 2011 to 2015

The ACTA PORT-score for predicting perioperative risk of blood transfusion for adult cardiac surgery

Iron Loading Exaggerates the Inflammatory Response to the Toll-like Receptor 4 Ligand Lipopolysaccharide by Altering Mitochondrial Homeostasis

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