Transfusions in patients undergoing cardiac surgery with autologous blood

Abstract

705CAN J ANESTH 2000 / 47: 7 / pp [705][706][707][708][709][710][711] Purpose: Determinants of allogeneic blood use in cardiac surgery include preoperative factors such as female sex, age, body weight, hematocrit and red cell volume. We verified if these variables also predicted the need for allogeneic transfusions when autologous blood is predonated.Methods: Demographic and intraoperative variables, hemoglobin concentrations and transfusion requirements in patients undergoing cardiopulmonary bypass with autologous blood predonation were reviewed. Multivariate logistic regression and RECPAM tree-growing analyses were applied to identify the preoperative predictors of allogeneic transfusion in these patients.Results: Data from 230 patients included in our autologous blood program between 1995 and 1998 were analysed. Patients undergoing complex/reoperative surgical procedures and patients over age 64yr with a low red cell volume (<2070ml) undergoing simple procedures were more likely to require allogeneic red cells. Younger patients with a low red cell volume undergoing simple procedures carried an intermediate risk. Allogeneic transfusion was avoided in 95% of patients undergoing simple procedures when red cell volume $ 2070ml.Conclusions: In our institution, complex/reoperative surgery, low red cell volume and increased age are the main factors associated with the need for allogeneic red cell transfusion despite autologous blood predonation. Knowledge of the factors that limit the effectiveness of predonation with respect to allogeneic blood exposure should help clinicians decide which cardiac surgical patients should be included in autologous blood programs.Objectif : Parmi les déterminants de l'utilisation de sang allogénique en cardiochirurgie, on retrouve des facteurs préopératoires comme le sexe féminin, l'âge, la masse corporelle, l'hématocrite et le volume globulaire. Nous avons voulu vérifier si ces variables prédisaient aussi le besoin de transfusions allogéniques dans les cas d'un don autologue préopératoire. Méthode : Les variables démographiques et peropératoires, les concentrations d'hémoglobine et les conditions de transfusion ont été révisées chez des patients qui subissent une circulation extracorporelle avec du sang autologue prélevé avant l'opération. Des analyses de régression logistique multifactorielle et de partition et amalgamation récursive ont été appliquées pour identifier les facteurs prédictifs préopératoires de transfusion allogénique chez ces patients. Résultats : Des données sur 230 patients admis dans notre programme de sang autologue entre 1995 et 1998 ont été analysées. Les patients qui subissent une intervention chirurgicale complexe ou une réopération et ceux qui ont plus de 64 ans, présentent un faible volume globulaire, <2070 ml), et subissent une intervention simple ont davantage besoin de globules rouges allogéniques. Les jeunes patients qui présentent un faible volume globulaire et subissent une opération simple sont moyennement à risque. La transfusion allogénique a été ...

Comparison of early period results of blood use in open heart surgery

“…[13] The present study demonstrated that the need for ABT was significantly reduced in the autologous transfusion group that underwent ANH.…”

Review of the clinical practice literature on patient characteristics associated with perioperative allogeneic red blood cell transfusion

“…[14][15][16][17]19,20,[22][23][24][25][26]28,[30][31][32][33][34]36,[38][39][40][41][42][43] This was followed by increasing age, which was found to be associated with a higher transfusion rate in 20 studies. 15,18,21,[23][24][25][26][27][28][29][30][31][32][33][38][39][40][41][42][43] Female gender and body size were also related to RBC transfusion in 15 studies 16,18,20,21,[24][25][26][29][30][31][32]36,[...…”

“…27 Fourteen studies determined transfusion requirements in patients who had either elective or emergency cardiac surgery. [12][13][14]17,19,20,[22][23][24]29,31,35,36,38 Twelve studies examined patients who had both primary and reoperative surgery, 12,13,15,16,22,24,31,35,36,38,39,42 whereas 2 studies focused only on patients undergoing reoperative cardiac surgery. 21,34 Twelve studies were prospective cohort studies, [12][13][14]18,21,[25][26][27][28][29][30]43 and 3 were randomized controlled trials.…”

“…Twenty studies examined transfusion requirements in patients undergoing myocardial revascularization surgery only, 12,14,[18][19][20][21][22][23][24][28][29][30][31][32][33]38,[40][41][42][43] whereas 10 studies examined patients that underwent coronary artery bypass grafting and/or valve surgery. 13,[15][16][17]25,26,34,36,37,39 One study examined patients who underwent valve replacement only, 35 and another study focused on patients undergoing surgery of the ascending aorta or aortic arch. 27 Fourteen studies determined transfusion requirements in patients who had either elective or emergency cardiac surgery.…”

Modifiable Risk Factors associated with Post-Operative Bleeding and transfusion requirements in Cardiac Surgery

“…Aminocaproic acid and Tranexamic acid have frequent use too. 19 The Commonly used and avoiding Preoperative associated factors leading to postoperative bleeding are Clopidogrel which should be stopped five days before the surgery, Ticagrelor which should be stopped three days before the operation, Heparin for acute coronary syndromes, low molecular weight heparin and patients on Warfarin or novel oral anticoagulants as these factors are not analyzed in our study.…”