The Impact of Erythrocyte Suspension Transfusion on Clinical Outcomes in Critical Care Settings

Year 2019, Volume: 6 Issue: 3, 123 - 128, 31.12.2019

Gürhan Taşkın , Ramazan Öcal

Abstract

In this study,
potential risks related to erythrocyte suspension (ES) transfusion in intensive
care patients and the impacts on clinical results of the transfusion are aimed
to be investigated. 259 patients who were hospitalized for more than 24 hours
in intensive care unit (ICU) were included in the study. Demographic findings
related to the patients, APACHE II scores, length of ICU stay, overall ICU
mortality, culture results, causes of anemia in patients who are applied transfusion
and levels of Hemoglobin (Hgb) and Hematocrit (Hct) with Hgb and Hct levels of
post-transfusion and  complications
related to transfusion were recorded. Of the 259 cases included in the study,
78 (30.1%) were received transfusion and the mean Hgb threshold for transfusion
was 7.35±1.00 gr/dL. In the transfusion group; chronic renal failure (p=0.007)
and sepsis (p=0.001) were found significantly frequent and APACHE II score was
higher (p=0.001). ICU length of stay (23.84±21.89 vs. 12.70±9.68) was also significantly
longer in the transfusion group (p<0.001). Nosocomial pathogen-related
infections were also significantly more frequent in the transfusion group
(28.2%, p=0.043). Transfusion itself had a close relationship with mortality
(37.2% vs. 22.7%, p=0.016). Mortality rates were found to be significantly
higher in patients with transfusion-related complications (p=0.048),
concomitant malignancy (p=0.020) and nasocomial pathogen-related infections
(p=0.048). In addition to ES transfusion that is life saving, patients’ needs
should be carefully assessed considering its potential risks. Strategy of
restrictive transfusion that has lower mortality rates is one of the most
attention grabbing results.

Keywords

Erythrocyte Suspension, Hemoglobin, Intensive Care, Mortality, Transfusion

Yoğun Bakımda Eritrosit Transfüzyonunun Klinik Sonlanımlar Üzerine Etkisi

Abstract

Bu araştırma ile yoğun bakım hastalarında
eritrosit süspansiyonu (ES) transfüzyona ait potansiyel riskler ve
transfüzyonun klinik sonuçlar üzerine etkilerinin araştırılması amaçlanmıştır.
Yoğun Bakım Ünitesinde (YBÜ) 24 saatten uzun süre yatarak tedavi gören 259
hasta araştırmaya dâhil edilmiştir. Bu hastalara ait demografik veriler, APACHE
II skorları, yoğun bakım yatış süreleri, mortalite, kültür üreme sonuçları,
transfüzyon uygulanan hastaların anemi nedenleri ve Hemoglobin (Hgb) ve
Hematokrit (Hct) düzeyleri ile transfüzyon sonrası Hgb ve Hct düzeyleri ve transfüzyona
ait komplikasyonlar değerlendirildi. Araştırmaya dahil edilen 259 olgudan 78
(%30.1)’ne transfüzyon yapıldığı ve ortalama transfüzyon eşik hemoglobin
değerinin 7.35±1.00 gr/dL olduğu saptandı. Transfüzyon grubunda kronik böbrek
yetmezliği (p=0.007), sepsis (p=0.001) anlamlı oranda sık ve APACHE II skoru
daha yüksek saptandı (p=0.001). YBÜ yatış süresi de transfüzyon grubunda
(23.84±21.89 karşın 9.68±12.70 gün) anlamlı derecede uzundu (p<0.001).
Nazokomiyal enfeksiyonlar transfüzyon grubunda %28.2 ile anlamlı derecede daha
sıktı (p=0.043). Diğer yandan transfüzyonunun kendisi de mortalite (%37.2
karşın %22.7, p=0.016) ile yakın ilişkiye sahipti. Transfüzyon ile ilişkili
komplikasyon izlenenlerde (p=0.048), eşlik eden malignite varlığında (p=0.020) ve
nazokomiyal enfeksiyon gelişenlerde (p=0.048) mortalite oranı anlamlı düzeyde
sık saptandı. ES transfüzyonunun hayat kurtarıcı olmasının yanı sıra potansiyel
risklerin göz önünde bulundurularak hastaların ihtiyaçlarının titizlikle
seçilmesi gerekmektedir. Kısıtlı transfüzyon stratejisinin daha düşük mortalite
oranlarına sahip olması ise en dikkat çekici sonuçlarımızdan biridir.

Keywords

Eritrosit Süspansiyonu, Hemoglobin, Mortalite, Transfüzyon, Yoğun Bakım

References

• 1. FAO, WHO. World declaration and plan of action for nutrition: International Conference on Nutrition, Rome, December, 1992.
• 2. United Nations Children's Fund, United Nations University, World Health Organization. Iron deficiency anaemia: assessment, prevention, and control: a guide for programme managers. WHO, Geneva, 2001.
• 3. Carson JL, Stanworth SJ, Roubinian N, et al. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2016;12(10):CD002042.
• 4. Nguyen BV, Bota DP, Melot C, Vincent JL. Time course of hemoglobin concentrations in nonbleeding intensive care unit patients. Crit care Med. 2003;31(2):406-10.
• 5. Vincent JL, Baron JF, Reinhart K, et al. Anemia and blood transfusion in critically ill patients. JAMA. 2002;288(12):1499-507.
• 6. Sakr Y, Vincent JL. Should red cell transfusion be individualized? Yes. Intensive Care Med. 2015;41(11):1973-6.
• 7. Rohde JM, Dimcheff DE, Blumberg N, et al. Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. JAMA. 2014;311(13):1317-26.
• 8. Remy KE, Hall MW, Cholette J, et al. Mechanisms of red blood cell transfusion-related immunomodulation. Transfusion. 2018;58(3):804-15.
• 9. Vincent JL, Jaschinski U, Wittebole X, et al. Worldwide audit of blood transfusion practice in critically ill patients. Crit Care. 2018;22(1):102.
• 10. Docherty AB, Walsh TS. Anemia and blood transfusion in the critically ill patient with cardiovascular disease. Critical Care. 2017;21:61.
• 11. Vincent JL, Sakr Y, Sprung C, Harboe S, Damas P. Are blood transfusions associated with greater mortality rates? Results of the Sepsis Occurrence in Acutely Ill Patients study. Anesthesiology. 2008;108(1):31-9.
• 12. Corwin HL, Gettinger A, Pearl RG, et al. The CRIT study: anemia and blood transfusion in the critically ill–current clinical practice in the United States. Crit Care Med. 2004;32(1):39-52.
• 13. Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Trials Group. N Engl J Med. 1999;340(6):409-17.
• 14. Leal-Noval SR, Muñoz-Gómez M, Jiménez-Sánchez M, et al. Red blood cell transfusion in non-bleeding critically ill patients with moderate anemia: is there a benefit? Intensive Care Med. 2013;39(3):445-53.
• 15. Surial B, Burkhart A, Terliesner N, Morgenthaler M, BaÈ chli E. Adherence to transfusion guidelines: are we prepared for the Smarter Medicine or Choosing Wisely initiative? Swiss Med Wkly. 2015;145:1-8.
• 16. Lannan KL, Sahler J, Spinelli SL, Phipps RP, Blumberg N. Transfusion immunomodulation-the case for leukoreduced and (perhaps) washed transfusions. Blood Cells Mol Dis. 2013;50(1):61-8.
• 17. Horvath KA, Acker MA, Chang H, et al. Blood transfusion and infection after cardiac surgery. Ann Thorac Surg. 2013;95(6):2194-201.
• 18. Hajjar LA, Vincent JL, Galas FR, et al. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA. 2010;304(14):1559-67.
• 19. Dupuis C, Garrouste-Orgeas M, Bailly S, et al. Effect of Transfusion on Mortality and Other Adverse Events Among Critically Ill Septic Patients: An Observational Study Using a Marginal Structural Cox Model. Crit Care Med. 2017;45(12):1972-80.