Subject(s)
Humans , Male , Female , Middle Aged , Aged , Critical Care , Aftercare , Blood Component Transfusion , Coronavirus Infections/therapy , Plasma , Severity of Illness Index , Case-Control StudiesABSTRACT
Background: The optimal blood management after cardiac surgery remains controversial. Moreover, blood transfusions may have an impact on long-term outcomes. Objective: The aim of this study is to characterize the impact of liberal red blood cell transfusions on Health-Related Quality of life (HRQoL) after cardiac surgery. Methods: We studied a cohort of 205 consecutive patients after ICU discharge. Baseline characteristics and clinical data were recorded, and HRQoL was assessed using the EuroQoL-5D instrument, applied 6 months after ICU discharge. A specific question regarding the improvement in the quality of life after the surgical intervention was added to the HRQoL questionnaire. Risk factors related to impaired quality of life were identified using univariate comparisons and multivariate regression techniques. Results: The median (interquartile range, IQR) of transfused red blood cells was 3 (1-4). Among 205 patients, 178 were studied 6 months after discharge. Impairment in at least one dimension of the EuroQoL-5D questionnaire was observed in 120 patients, with an overall score of 0.8 (IQR 0.61-1). The number of red blood cell transfusions was related to an impaired HRQoL (OR 1.17 per additional unit, 95% confidence interval 1.03-1.36, p=0.03), a trend to lower visual analog scale score (coefficient −0.75 per additional unit, 95% confidence interval −1.61 to 0.1, p=0.09) and an absence of improvement in HRQoL after surgery compared to the previous status (OR 1.13, 95% confidence interval 1.03-1.25, p=0.01). Conclusions: Liberal red blood cell transfusions increase the risk of impaired HRQoL after cardiac surgery
Antecedentes: El manejo óptimo de la sangre después de cirugía cardíaca sigue siendo controvertido. Objetivo: Analizar el impacto de la transfusión liberal de concentrado de hematíes (CdH) sobre la calidad de vida relacionada con la salud (CVRS) después de la cirugía cardíaca. Métodos: Se estudió una cohorte de 205 pacientes consecutivos. Se registraron las características basales y los datos clínicos, y se evaluó la CVRS utilizando el EuroQoL-5D, 6 meses después del alta de la UCI. Se añadió una pregunta específica sobre la mejoría de la CVRS tras la cirugía cardiaca. Los factores de riesgo relacionados con la alteración de la CVRS se identificaron mediante el uso de comparaciones univariadas y técnicas de regresión multivariante. Resultados: La mediana (rango intercuartílico [IQR]) de los CdH transfundidos fue de 3 (1-4). De 205 pacientes, 178 fueron estudiados 6 meses después del alta, 120 pacientes (67%) mostraron deficiencias en alguna dimensión del cuestionario EuroQoL-5D, con un puntaje general de 0,8 (IQR: 0,61-1). El número de transfusiones de CdH se relacionó con una CVRS deteriorada (OR: 1,17 por unidad adicional; intervalo de confianza del 95%: 1,03-1,36; p=0,03), menor escala analógica visual (coeficiente: −0,75 por unidad adicional, intervalo de confianza del 95%: −1,61-0,1; p=0,09) y una ausencia de mejoría en la CVRS después de la cirugía en comparación con el estado previo (OR: 1,13; intervalo de confianza del 95%: 1,03-1,25; p=0,01). Conclusión: La transfusión liberal de CdH aumenta el riesgo de deterioro de la CVRS después de la cirugía cardíaca
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Erythrocyte Transfusion/adverse effects , Quality of Life , Cardiac Surgical Procedures , Erythrocyte Transfusion/methods , Risk Factors , Cohort Studies , Multivariate Analysis , Confidence IntervalsABSTRACT
BACKGROUND: The optimal blood management after cardiac surgery remains controversial. Moreover, blood transfusions may have an impact on long-term outcomes. OBJECTIVE: The aim of this study is to characterize the impact of liberal red blood cell transfusions on Health-Related Quality of life (HRQoL) after cardiac surgery. METHODS: We studied a cohort of 205 consecutive patients after ICU discharge. Baseline characteristics and clinical data were recorded, and HRQoL was assessed using the EuroQoL-5D instrument, applied 6 months after ICU discharge. A specific question regarding the improvement in the quality of life after the surgical intervention was added to the HRQoL questionnaire. Risk factors related to impaired quality of life were identified using univariate comparisons and multivariate regression techniques. RESULTS: The median (interquartile range, IQR) of transfused red blood cells was 3 (1-4). Among 205 patients, 178 were studied 6 months after discharge. Impairment in at least one dimension of the EuroQoL-5D questionnaire was observed in 120 patients, with an overall score of 0.8 (IQR 0.61-1). The number of red blood cell transfusions was related to an impaired HRQoL (OR 1.17 per additional unit, 95% confidence interval 1.03-1.36, p=0.03), a trend to lower visual analog scale score (coefficient -0.75 per additional unit, 95% confidence interval -1.61 to 0.1, p=0.09) and an absence of improvement in HRQoL after surgery compared to the previous status (OR 1.13, 95% confidence interval 1.03-1.25, p=0.01). CONCLUSIONS: Liberal red blood cell transfusions increase the risk of impaired HRQoL after cardiac surgery.
Subject(s)
Cardiac Surgical Procedures , Erythrocyte Transfusion/adverse effects , Quality of Life , Aged , Erythrocyte Transfusion/methods , Erythrocyte Transfusion/statistics & numerical data , Female , Humans , Male , Postoperative Period , Prospective Studies , Regression Analysis , Risk Factors , Surveys and Questionnaires , Time FactorsABSTRACT
PURPOSE: Thrombopheresis procedures have been recently expanded with the development or different programmes. Taking into account that this reasonably safe procedure is not devoid of complications, it would be desirable to select those individuals with lower risk of suffering adverse side effects as donors. The thrombopheresis procedures performed in our hospital between 1986 and 1997 were analysed in order to establish the useful guidelines for such selection. MATERIAL AND METHODS: All the thrombopheresis procedures performed in the Asturias Central Hospital blood bank in the 1986-1987 period were analysed. The first procedure per donor, along with all data referred to adverse effects appearing during thrombopheresis, were collected. Sex, age, body, weight, blood cells count (before and after thrombopheresis) and serum calcium levels (before and after thrombopheresis) were taken as variables with predictive value for adverse effects. With regard to the procedure, the model of cell separator, the duration of the procedure, the amount and type of anticoagulant solution and the prophylactic use of calcium ions were assessed. RESULTS: A total number of 1,024 thrombophereses were analysed. Some types of adverse effect were seen in 259 instances (25.3%). Of these, 70.3%, were mild, 29.3% moderate and 0.4% severe. The commonest adverse effect was perioral paraesthesia. Of the different variables studied, female sex and low weight acquired predictive value with respect to the occurrence of adverse effects. Prophylactic administration of calcium did not prevent the appearance of complications. CONCLUSIONS: The thrombopheresis procedures may present adverse side effects in a high percentage of cases, which, although mostly mild, require specialised personnel for identification and management. Males weighing over 70 kg are less prone to suffer such effects. Oral administration of calcium before the apheresis does not prevent the adverse reactions.
Subject(s)
Plateletpheresis/adverse effects , Adult , Blood Cell Count , Female , Humans , Male , Middle Aged , Patient Selection , Risk FactorsSubject(s)
Purpura, Thrombotic Thrombocytopenic/therapy , Adrenal Cortex Hormones/therapeutic use , Adult , Blood Transfusion , Child , Combined Modality Therapy , Hemolytic-Uremic Syndrome/mortality , Hemolytic-Uremic Syndrome/physiopathology , Hemolytic-Uremic Syndrome/therapy , Humans , Immunosuppressive Agents/therapeutic use , Plasma , Plasma Exchange , Plasmapheresis , Platelet Aggregation , Platelet Aggregation Inhibitors/therapeutic use , Prognosis , Purpura, Thrombotic Thrombocytopenic/classification , Purpura, Thrombotic Thrombocytopenic/mortality , Purpura, Thrombotic Thrombocytopenic/physiopathology , Salvage Therapy , SplenectomyABSTRACT
PURPOSE: Transfusion is not devoid of adverse effects; therefore every transfusional procedure must be indicated correctly. With this in mind in 1991 transfusion guidelines were published by our Hospital Transfusion Committee. Four years later, a retrospective audit was performed. MATERIAL AND METHODS: We have evaluated all blood component orders (order is a transfusion request) during one month, classifying them as appropriate or inappropriate according to the transfusion guidelines. The evaluation was performed 24 hours after transfusion. The results obtained were compared with the ones obtained before the published transfusion guidelines. RESULTS: 481 transfusion orders were studied. 87 percent (420/481) were considered appropriate according to the transfusion guidelines. These 481 orders referred to the transfusion of 1178 units to 293 patients. 12 percent of the transfused units was considered as inappropriate. 16 percent of the patients (48/239) had at least on inappropriate transfusion procedure. The comparison with the data obtained in 1991 showed a significant increase of the appropriate transfusion orders (74 versus 87 percent). The use of fresh frozen plasma showed the greatest incidence in inappropriate use, mainly in haemorrhagic disorders without factor deficit. The patients with haemoglobin levels between 70 and 100 g/L without signs of hypoxia were the most important cause of inappropriate use of red cell concentrates. And the patients with platelet levels > 20 x 10(9)/L were the major cause of inappropriate use of platelet concentrates. CONCLUSION: Transfusion guidelines knowledge improves the use of blood components.
