Variability on red blood cell transfusion practices among Brazilian neonatal intensive care units

Santos, Amélia Miyashiro Nunes dos; Guinsburg, Ruth; Procianoy, Renato S.; Sadeck, Lílian S. R.; Netto, Abimael Aranha; Rugolo, Lígia Maria Suppo de Souza; Luz, Jorge Hecker; Bomfim, Olga; Martinez, Francisco Eduardo; Almeida, Maria Fernanda Branco de

doi:10.1111/j.1537-2995.2009.02373.x

Cited by 27 publications

(28 citation statements)

References 30 publications

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“…(20–24) This lack of a universal approach stems from limited knowledge of the cellular and molecular biology of erythropoiesis during the perinatal period, an incomplete understanding of infant physiological/adaptive responses to anaemia, and contrary/controversial transfusion practice guidelines as based on results of randomized clinical trials and expert opinions. Generally, RBC transfusions are given to maintain a level of blood hemoglobin or HCT believed to be optimal for each neonate's clinical condition.…”

Section: Rbc Transfusions To Treat the Anaemia Of Prematuritymentioning

confidence: 99%

Anaemia of prematurity: Pathophysiology and treatment

Strauss¹

2010

Blood Reviews

163

117

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Most infants with birth weight <1.0 kg are given multiple red blood cell (RBC) transfusions within the first few weeks of life. The anaemia of prematurity is caused by untimely birth occuring before placental iron transport and fetal erythropoiesis are complete, by phlebotomy blood losses taken for laboratory testing, by low plasma levels of erythropoietin due to both diminished production and accelerated catabolism, by rapid body growth and need for commensurate increase in red cell volume/ mass, and by disorders causing RBC losses due to bleeding and/or hemolysis. RBC transfusions are the mainstay of therapy with recombinant human erythropoietin largely unused because it fails to substantially diminish RBC transfusion needs -despite exerting substantial erythropoietic effects on neonatal marrow.

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Section: Rbc Transfusions To Treat the Anaemia Of Prematuritymentioning

confidence: 99%

Anaemia of prematurity: Pathophysiology and treatment

Strauss¹

2010

Blood Reviews

163

117

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“…These regulations also include a hemovigilance system that requires notification of unexpected adverse effects of blood transfusion and measures to protect recipients 15,16 . Although these regulations exist, there are few published data describing the use of blood in Brazil 17‐19 . Our goals in this study are to describe the blood utilization patterns and recipient survival at the Central Institute at Hospital das Clinicas (HC) in São Paulo.…”

mentioning

confidence: 99%

Blood transfusion utilization and recipient survival at Hospital das Clinicas in São Paulo, Brazil

et al. 2011

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Background The characteristics of blood recipients including diagnoses associated with transfusion and post-transfusion survival are unreported in Brazil. The goals of this analysis were: 1) to describe blood utilization according to clinical diagnoses and patient characteristics at a large public hospital, Hospital das Clinicas (HC), a tertiary teaching hospital and trauma center in the city of Sao Paulo; 2) to determine the factors associated with survival of blood recipients. Methods A retrospective cross-sectional analysis was conducted on all inpatients in 2004. Data came from three sources were merged: HC electronic admission files, blood issue files, and the national death registry. The first two files consist of data about patient characteristics, clinical diagnosis, and transfusion information. Analyses comparing transfused and non-transfused patients were conducted. The third file was used to determine survival status of recipients up to three years after last transfusion. Logistic regression was conducted among transfused patients to examine survival curves and characteristics associated with follow up patient survival. Results In 2004, 30,779 patients were admitted to HC, with 3,835 (12.4%) transfused. These patients had 10,479 transfusions episodes, consisting of 39,561 transfused components; 16,748 (42%) red cells, 15,828 (40%) platelets and 6,190 (16%) plasma. The median number of components transfused was 3 (range 1 – 656) per patient admission. Mortality during hospitalization was dramatically different for patients whose admissions included transfusion or not (24% vs. 4%). After 1 year, 56% of transfusion recipients were alive. The multivariable model of factors associated with mortality following transfusion showed that the most significant factors in descending order were hospital ward, increasing age, increasing number of components transfused, and type of components received. Conclusion Ward and transfusion are markers of underlying medical conditions and are associated with the probability of survival. Platelet transfusions are common and likely reflect the types of patients treated at HC. This comprehensive blood utilization study, first of its kind in Brazil can help in developing transfusion policy analyses in South America.

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“…Indications for transfusion procedures are often based on objective and subjective criteria, such as "trigger" variables, semiotic criteria, the hospital itself, professional experience, medical conditions and low hemoglobin levels, often without associated clinical symptoms. (11,(22)(23)(24) Hemoglobin levels were actually used as a trigger variable for the indication of transfusions for years, however the optimal hemoglobin levels vary considerably from one patient to another depending on multiple variables such as age, chronic diseases (especially coronary artery disease), current diagnosis, cause of anemia and anemia tolerance. (15,25,26) There are studies that clearly demonstrate the good tolerability that some patients with low hemoglobin levels have of anemia and the effectiveness of blood conservation strategies and autologous red blood cell production stimulating procedures, which maximize the final hematocrit without RBCT.…”

Section: Discussionmentioning

confidence: 99%

Fatores preditivos da transfusão de concentrado de hemácias em pacientes submetidos a cirurgias eletivas do aparelho digestivo: uma análise interinstitucional

Jorge

Silva

Júnior

et al. 2010

Rev. Bras. Hematol. Hemoter.

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Variability on red blood cell transfusion practices among Brazilian neonatal intensive care units

Abstract: The need of RBC transfusions in very-low-birth-weight preterm infants was associated with clinical conditions and birth center. The distribution of the number of transfusions during hospital stay may be used as a measure of neonatal care quality.

Cited by 27 publications

References 30 publications

Anaemia of prematurity: Pathophysiology and treatment

Anaemia of prematurity: Pathophysiology and treatment

Blood transfusion utilization and recipient survival at Hospital das Clinicas in São Paulo, Brazil

Fatores preditivos da transfusão de concentrado de hemácias em pacientes submetidos a cirurgias eletivas do aparelho digestivo: uma análise interinstitucional

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