Red Blood Cell Transfusion Requirements Before and After Implementation of a Perioperative Patient Blood Management Program in Adult Patients Undergoing Cardiac Surgery. A Before and After Observational Study.

OBJECTIVES: Anemia and transfusion are common in cardiac surgery patients, and are associated with significant morbidity and mortality. Multiple perioperative interventions have been described to reduce blood transfusion, but are rarely combined altogether. The aim of this study was to compare the incidence of red blood cell (RBC) transfusion in adult patients undergoing cardiac surgery before and after the implementation of a perioperative patient blood management (PBM) program. DESIGN: Before-and-after observational study. SETTING: Single-center French university teaching hospital. PARTICIPANTS: Adult patients scheduled for cardiac surgery. INTERVENTIONS: Perioperative patient blood management program including pre-, intra-, and postoperative interventions aimed at identifying and correcting anemia, minimizing blood loss during surgery, and optimizing coagulation. MEASUREMENTS AND MAIN RESULTS: Four hundred thirty-four patients were included in the study from January 2021 to July 2022. The incidence of perioperative RBC transfusion (intraoperatively and during the first 2 postoperative days) was significantly reduced from 43% (90/213) in the pre-PBM period to 27% (60/221) in the post-PBM period (p < 0.001). The application of a PBM program was associated with a reduction in perioperative RBC transfusion by multivariate analysis (odds ratio 0.55, 95% CI 0.36-0.85, p = 0.007), and was associated with a reduction in the median number of RBC units transfused within transfused patients (p = 0.025). These effects persisted at day 30 after surgery (p = 0.029). CONCLUSION: A perioperative PBM program in adult patients undergoing cardiac surgery was associated with a significant reduction in perioperative RBC transfusion, which persisted at day 30.

Clinical value of CEA for detection of distant metastases in newly diagnosed breast cancer: comparison with CA 15-3.

The aim of the study is to investigate the clinical value of CEA (carcinoembryonic antigen) for detection of distant metastases (DM) in newly diagnosed breast cancer. This retrospective study focuses on a population of 929 patients with locally advanced breast cancer (n=521) or metastatic breast cancer (n=408) diagnosed at the CGFL (Centre Georges Francois Leclerc) from 1998 to 2014. These patients underwent a measurement of CA 15-3, a measurement of CEA and an assessment of extension before any treatment. The initial concentrations of CEA are correlated with conventional prognostic factors. The cut-off value of CEA was determined and verified on two independents subpopulations determined in drawing lots. The ROC curve shows an AUC of 0.82 (p<0.0001). At the threshold of 6.7 µg/L, CEA before treatment has a predictive value on the existence of DM independently of the CA 15-3 and other prognostic factors. The combination of CEA and CA 15-3 increases significantly the predictive value of CA 15-3 on the whole population (sensitivity increased by 9%) and on tumors expressing hormonal receptors. Concerning the only CEA the rate of false negative is of 52% and depends on the number and the type of the metastatic localization. Among the 28 patients without DM and a CEA > 6.7 µg/L, 15 have developed DM and 2 a new cancer. Thirteen will die of cancer. In conclusion, these facts confirm the independently predictive value of CEA before treatment on the existence of DM and its complementarity with CA 15-3 during the assessment of extension by imagery.