Red blood cell transfusion and skeletal muscle tissue oxygenation in anaemic haematologic outpatients

Podbregar, Matej; Gavric, Ana Ursula; Podbregar, Eva; Možina, Hugon; Stefanović, S

doi:10.1515/raon-2015-0046

Cited by 12 publications

(7 citation statements)

References 25 publications

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“…rPOEF result is in agreement with literature [5, 15, 19, 45], where a 0.13% significant decrease in the abdomen was found, for example, comparable to ours. Conversely, a lot of studies highlighted a significant increase in StO 2 peripheral level [17–21, 25, 46–48], which is also in accordance with our study. For instance, peripheral StO 2 increased by 17% in infants [17] and by 1.6% in patients undergoing transfusion during aortic or spinal surgery [46].…”

Section: Discussionsupporting

confidence: 93%

“…These results are consistent with ours. Our results are also strengthened by several studies highlighting a significant increase in cerebral StO 2 [17–21, 25, 46–48]. In Reference [17], cerebral regional StO 2 measured by CW-NIRS increased by 17% in infants and by 4.2% in patients undergoing transfusion during aortic or spinal surgery [46].…”

Section: Discussionsupporting

confidence: 78%

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Hybrid diffuse optical appraisal of peripheral and cerebral changes in critically ill patients receiving red blood cell transfusion

Tagliabue,

Rey-Perez,

Esposito

et al. 2024

Preprint

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Background: Red blood cells transfusions (RBCT) are utilized to restore normal values of hemoglobin concentration and hematocrit percentage in anemic patients. As expected, RBCT often leads to local and global alteration of blood flow (BF) and blood/tissue oxygenation which could have local deleterious consequences. This complicates its use and its dosage and there is no consensus on liberal versus restrictive RBCT in critically ill patients. Blood gas sampling is utilized to bring objectivity to RBCT which is a reliable systemic measure. However, it is also hypothesized that the knowledge about the dynamic response of selected organs could improve RBCT outcomes. We carried out a study using non-invasive hybrid diffuse optics (DO) to assess the RBCT effect on the brain and a peripheral muscle by evaluating microvascular BF, oxygen extraction fraction (OEF) and microvascular oxy-, deoxy- and total hemoglobin concentrations ([HbO2], [Hhb], [HbT]) in critically ill patients. We explored the DO's ability to identify RBCT-induced significant alterations and to provide a quantitative description. Methods: Critically ill anemic patients undergoing RBCT were recruited and monitored by hybrid DO. Blood gas samples were extracted to obtain arterial total hemoglobin concentration (Hgb) and hematocrit value. Optical signals, such as BF, OEF, metabolic rate of oxygen extraction (MRO2), [HbO2], [Hhb] and [HbT] were simultaneously measured at the cerebral and the peripheral tissues. The changes in these variables were investigated characterizing the distributions of the cerebral and of the peripheral post-RBCT variables. Results: Fourteen out of fifteen recruited subjects were included. After RBCT, Hgb and hematocrit significantly increased (p<0.001). OEF significantly decreased both at peripheral and cerebral level (p<0.001, p<0.001). A significant increase was found in MRO2 (p=0.03, p<0.001), [HbT] (p=0.01, p<0.0001) and [HbO2] (p=0.008, p<0.0001) at both levels. BF significantly decreased only at the peripheral level (p<0.001). No change was encountered in [Hhb] (p>0.05). No statistical difference was found between cerebral and peripheral signals post-RBCT (p>0.05) apart from MRO2 (p=0.03, higher at peripheral tissue). Conclusions: Hybrid DO detected tissue oxygenation improvement after RBCT, enabling a thorough examination. The potential for DO to quantify and alert changes of concern deserves further investigation.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 78%

Hybrid diffuse optical appraisal of peripheral and cerebral changes in critically ill patients receiving red blood cell transfusion

Tagliabue,

Rey-Perez,

Esposito

et al. 2024

Preprint

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“… 34 In anaemic patients, erythrocyte transfusions improved maximum skeletal muscle tissue oxygen. 35 In addition, fatigue in patients with anaemia could promote loss of muscle mass and strength, although adjustment for the CIS Score, reflecting fatigue, did not change our results.…”

Section: Discussionmentioning

confidence: 52%

Decreased haemoglobin levels are associated with lower muscle mass and strength in kidney transplant recipients

Vinke

Wouters

Stam

et al. 2022

J cachexia sarcopenia muscle

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Background Post-transplant anaemia and reduced muscle mass and strength are highly prevalent in kidney transplant recipients (KTRs). Decreased haemoglobin levels, a marker of anaemia, could adversely affect muscle mass and strength through multiple mechanisms, among others, through diminished tissue oxygenation. We aimed to investigate the association between haemoglobin levels with muscle mass and strength in KTRs. Methods We included stable KTRs from the TransplantLines Biobank and Cohort study with a functional graft ≥1 year post-transplantation. Muscle mass was assessed using 24 h urinary creatinine excretion rate (CER) and bioelectrical impedance analysis (BIA). Muscle strength was assessed with a handgrip strength test using a dynamometer and, in a subgroup (n = 290), with the five-times sit-to-stand (FTSTS) test. We used multivariable linear and logistic regression analyses to investigate the associations of haemoglobin levels with muscle mass and strength. ResultsIn 871 included KTRs [median age 58 (interquartile range (IQR), 48-66)] years; 60% men; eGFR 51 ± 18 mL/min/1.73 m 2 ) who were 3.5 (1.0-10.2) years post-transplantation, the mean serum haemoglobin level was 13.9 ± 1.8 g/dL in men and 12.8 ± 1.5 g/dL in women. Lower haemoglobin levels were independently associated with a lower CER (std. β = 0.07, P = 0.01), BIA-derived skeletal muscle mass (std. β = 0.22, P < 0.001), handgrip strength (std. β = 0.15, P < 0.001), and worse FTSTS test scores (std. β = À0.17, P = 0.02). KTRs in the lowest age-specific and sex-specific quartile of haemoglobin levels had an increased risk of being in the worst age-specific and sex-specific quartile of CER (fully adjusted OR, 2.09; 95% CI 1.15-3.77; P = 0.02), handgrip strength (fully adjusted OR, 3.30; 95% CI 1.95-5.59; P < 0.001), and FTSTS test score (fully adjusted OR, 7.21; 95% CI 2.59-20.05; P < 0.001). Conclusions Low haemoglobin levels are strongly associated with decreased muscle mass and strength in KTRs. Future investigation will need to investigate whether maintaining higher haemoglobin levels may improve muscle mass and strength in KTRs.

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“…However, StO2 during the perioperative period in cardiac surgery is lower in patients who develop certain postoperative complications (34). The resting skeletal muscle StO2 in patients with chronic anemia is lower than StO2 in controls and the storage time of red blood cells influences the change of StO2 after transfusion (35).…”

Section: Nirs For Evaluation Of Skeletal Muscle Tissue Oxygenation Inmentioning

confidence: 99%

How I use skeletal muscle Near Infrared Spectroscopy to non-invasively assess hemodynamic status of the critically ill

Podbregar¹

2017

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The major goal of hemodynamic treatment is to reach adequate flow. Near infrared spectroscopy (NIRS) allows non-invasive assessment of skeletal muscle tissue oxygenation during rest and also during vascular occlusion test (VOT). VOT allows estimation of tissue oxygen extraction capability, which could be preserved (i.e. hypovolemic, obstructive and cardiogenic shock) or inappropriate (i.e. sepsis/ septic shock). By using ultrasound to estimate cardiac output, arterial hemoglobin oxygen saturation, skeletal muscle NIRS, arterial lactate and hemoglobin, therapeutic goals in critically ill patients with preserved oxygen extraction capability can easily be targeted. Current controversies of NIRS technology and approach to patients with impaired oxygen extraction are discussed as well.

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Red blood cell transfusion and skeletal muscle tissue oxygenation in anaemic haematologic outpatients

Cited by 12 publications

References 25 publications

Hybrid diffuse optical appraisal of peripheral and cerebral changes in critically ill patients receiving red blood cell transfusion

Hybrid diffuse optical appraisal of peripheral and cerebral changes in critically ill patients receiving red blood cell transfusion

Decreased haemoglobin levels are associated with lower muscle mass and strength in kidney transplant recipients

How I use skeletal muscle Near Infrared Spectroscopy to non-invasively assess hemodynamic status of the critically ill

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