Blood consumption and clinical prognosis in patients with massive blood transfusion: a retrospective analysis / 中国输血杂志

ABSTRACT

【Objective】 To investigate the incidence of clinical massive blood transfusion in hospitals, the proportion of departments conducted massive blood transfusion and the current situation of component transfusion, so as to provide a theoretical basis for medical decision-making and further research on massive blood transfusion. 【Methods】 The basic clinical data and transfusion of blood components were retrospectively collected from 489 patients (514 occasions) who received massive blood transfusion at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from Jan. 1 2014 to Dec. 31 2018. 【Results】 The incidence of massive blood transfusion during the 5-year period was 1.2/1 000 inpatients (95%CI 1.1-1.3), and the 30-day all-cause mortality was 21.88%; in the departments where massive blood transfusion occurred, the mortality rate was the highest in the trauma emergency department (60%), followed by intensive care unit (56.25%) and other surgery department (46.67%), while there was no death in the obstetric department. All patients received red blood cells [median 14 U (11.5-19.13)] and plasma [median 1 600 mL (1 200-2 200)], of which 47% received platelet [median 0 U (0-10)] and 32.68% received cryoprecipitate [0 U (0-10)]. The results of logistics regression analysis of all-cause mortality risk showed that compared with the youth group, the risk of all-cause death at 30 days of elderly patients over 65 years old (65 80 years old OR=7.563, 95%CI=[1.587, 36.049], P<0.05) and 24-hour RBC infusion volume greater than 18 U (18≤RBC<27 OR=2.948 95%CI=[1.592, 5.462], P<0.05; RBC≥28 OR=3.992, 95%CI=[1.178, 13.536], P<0.05) was higher. 【Conclusion】 A dynamic definition should be included in massive transfusion studies. If only a 24-hour RBC infusion volume ≥18 U was used as the mass transfusion definition, about 68% of cases would be lost. The mortality rate of patients with massive blood transfusion was higher, and the incidence of massive blood transfusion was higher in the departments of cardiac surgery, general surgery and orthopedics surgery. More attention should be paid to the increasing number of female patients with massive blood transfusion. In addition, the risk of 30-day all-cause death was highest in elderly patients over 65 years of age and those with a 24-hour erythrocyte transfusion level of ≥18 U.