Perioperative Red Blood Cell Transfusion: Harmful or Beneficial to the Patient?

Abstract

SummaryAlthough the transfusion of red blood cells (RBCs) is safer than ever regarding infections, it is still associated with several adverse reactions and therefore should only be used on the basis of evidence-based triggers. However, prevention of RBC transfusion and subsequent substitution of blood losses with acellular solutions will inevitably result in dilutional anemia. Acute dilutional anemia can be compensated by the body over a wide range of hemoglobin concentrations without a critical restriction of tissue oxygenation. On the other hand, chronic anemia is known to be a potent cause of morbidity and mortality. As a consequence, the impact of perioperative anemia on mortality is difficult to describe, because anemia, as well as the transfusion of RBCs, can influence the clinical outcome. The resulting 'Gordian knot' cannot be cut easily, and this circumstance forces clinical physicians to make a daily trade-off between transfusion-associated and anemia-associated risks. This review focuses on the physiology of oxygen transport, the hazards of acute anemia, the hazards of RBC transfusion, and the literature putting these problems into perspective.

Thirty-Day Outcomes after Surgery for Primary Sarcomas of the Extremities: An Analysis of the NSQIP Database

“…Another potential risk factor identified in our study is the increased risk of intra-and postoperative bleeding requiring transfusion in LE cases (OR 4.643, 95% CI: 3.048-7.060). Journal of Oncology Although the association between perioperative blood transfusions and postoperative infections is still under scrutiny, there is some evidence to suggest that immunomodulation after allogenic blood transfusion increases the patient's susceptibility to infection [30,31]. is is particularly concerning in patients with malignancy who are already in an immunocompromised state.…”

Predictors of Intraoperative Blood Transfusion in Free Tissue Transfer

“…While the risk for transmitted infections has decreased over the decades, emerging and potentially unknown pathogens still pose a serious problem. [1][2][3][4] Also, immunogenic and allergic reactions can occur due to blood transfusions. 5 In addition, RBCT has been shown to be associated with several other adverse events, ranging from flap failure to recurrence of cancer and even an increased mortality rate.…”

“…[6][7][8][9][10][11] Therefore, a careful balance between the potential dangers of anemia and RBCT has to be found to optimize care. 2 To achieve this goal, preoperative evaluation and the prediction of the need for RBCT can help optimize the preoperative status of patients undergoing free tissue transfer, thus reducing the need for RBCT. While there are already several studies concerned with the impact and prediction of RBCT in the field of reconstructive microsurgery, they are mainly focused on breast and head and neck reconstruction.…”

Patient Blood Management: Clinical Hemotherapy and Hemostasis Management in Perioperative Settings

“…Safety of blood transfusion has increased dramatically with regard to viral transmission but this was associated with dramatically increased costs for laboratory tests including PCR testing. On the other hand, more unspecific adverse events such as transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), transfusion-related immunomodulation (TRIM), and subsequent nosocomial infections still are major risks when transfusing allogeneic blood and have come more and more to the fore during the last years [7,8] as these transfusion-associated adverse events are associated with increased morbidity and mortality and hospital costs as well [8][9][10].…”

“…Implementing concerted strategies starting with early detection and treatment of preoperative anemia, introducing blood-saving surgical techniques, early bleeding control by point-of-care coagulation monitoring and calculated goal-directed hemostatic interventions, re-transfusion of (washed) savaged or drained blood during and after surgery, and, last not least, strategies to increase patient's resistance to postoperative anemia, are the main pillows of PBM [7][8][9][11][12][13][14]. Inappropriate or unnecessary blood transfusion should strictly be avoided [7]. Furthermore, close communication and collaboration between the involved disciplines are essential for success in PBM or at least for improving patient's outcome.…”