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

【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.

Analysis of high risk factors and establishment of risk score model for postpartum massive blood transfusion / 中国输血杂志

【Objective】 To screen the risk factors of severe postpartum hemorrhage that can be found at 32 weeks of pregnancy through univariate and multivariate analysis and establish the risk prediction diagram. 【Methods】 A retrospective analysis was performed on pregnant women who gave birth and received blood transfusion in Women's Hospital of Nanjing Medical University from 2019 to 2021. According to the blood transfusion volume during and after operation, the patients were divided into low/moderate transfusion group (transfusion volume <2 000 mL) and massive-transfusion group (transfusion volume ≥2 000 mL), and the basic information of puerperal, single high risk factor, measures of operation and use of blood preparations were recorded. The differences of physiological and pathological factors between the low/moderate transfusion group and the massive transfusion group were analyzed by univariate analysis. Multivariate analysis and nomogram were performed on the statistically significant factors to calculate the consumption of blood components and hemostatic measures in the massive transfusion group. 【Results】 There were significant differences in age, number of pregnancies, advanced age at first delivery, history of abortion, scar uterus, pernicious placenta previa, placenta accreta, eclampsia/pre-eclampsia and acquired coagulopathy between the low/moderate transfusion group (n=930) and the massive transfusion group (n=108) (P<0.05), among which the number of pregnancies, advanced age for the first delivery, pernicious placenta previa, placenta accreta, and eclampsia/pre-eclampsia were independent risk factors for severe postpartum hemorrhage at 32 weeks of gestation. The scores of risk factors for massive blood transfusion from high to low were placenta accreta, primiparity at advanced age, eclampsia/pre-eclampsia, pernicious placenta previa, number of pregnancies≥4 and scar uterus. 【Conclusion】 The possibility of severe postpartum hemorrhage can be accurately evaluated in the third trimester (around 32 weeks) by univariate analysis, multivariate analysis and nomogram drawing. Among the puerpera underwent blood transfusion, the risk factors for massive hemorrhage included pregnancies ≥4 times, primiparity at advanced age, pernicious placenta previa, placenta accreta, and eclampsia/pre-eclampsia. The model based on these factors has a good prediction effect on massive hemorrhage.

Predictive value of preoperative liver function for perioperative massive blood transfusion in patients undergoing ascending aorta surgery / 中国输血杂志

【Objective】 To explore the predictive value of preoperative liver function for massive blood transfusion (MBT) in patients undergoing ascending aorta surgery. 【Methods】 Data from 238 patients undergoing ascending aorta surgery in the Department of Cardiovascular Surgery at The Affiliated Lihuili Hospital of Ningbo University were collected. Preoperative liver function tests were performed for all patients. Based on the perioperative transfusion volumes of red blood cell suspension, patients were divided into the MBT group, non-MBT group, and no blood transfusion (NBT) group. Clinical data during the perioperative period were compared among different groups. Receiver operating characteristic curve (ROC curve) analysis was used to assess the predictive value of liver function indicators for MBT and determine cut-off values. 【Results】 Compared with the non-MBT group and NBT group, the MBT group showed statistically significant differences in preoperative levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), direct bilirubin (DBIL), and serum albumin (SA) (P28.50 U/L, ALT >40.00 U/L, SA ≤34.55 g/L, and DBIL >4.25 μmol/L, there was a significant increase in the transfusion volume of various blood components and the incidence of MBT. 【Conclusion】 Preoperative liver function indicators (AST, ALT, SA, DBIL) have a moderate predictive value for MBT in patients undergoing ascending aorta surgery.

Electrolyte changes induced by massive transfusion in patients undergoing cardiac surgery / 中国输血杂志

【Objective】 To investigate the effect of electrolyte concentration on transfusion related complications in patients undergoing cardiac surgery after short-term massive transfusion (MT). 【Methods】 Seventy-six cases of adult cardiac surgery in our hospital from January 2018 to December 2019 were collected. According to their perioperative blood transfusion units, they were divided into the massive blood transfusion group (red blood cell units≥ 10 U/ person) and the control group[red blood cell units (0~1)U/ person]. The concentrations of Na+ , K+ and Ca2+ ions in serum were detected by ISE (ion selective electrode method) and NM-BAPTA before and after intraoperative blood transfusion. The changes of Na+ , K+ and Ca2+ ions in serum before and after intraoperative blood transfusion were analyzed and compared through T-test. 【Results】 There were 38 patients in the MT group and 38 in the control group, and the demographic variables and types of surgeries (number) of patients in the two groups were comparable (P>0.05). The serum K+ , Ca2+ and Na+ before operation were similar (P>0.05), and within the normal range. The mean values of serum K+ , Ca2+ and Na+ (mmol/l) in the massive blood transfusion group and the control after operation (blood transfusion) were 4.25±0.44 vs 4.01±0.53, 2.31±0.12 vs 2.45±0.43, 140.82±2.31 vs 146.44±4.35 (P<0.05). In the control, the serum K+ , and Ca2+ were slightly lower than those before operation, while the Na+ was slightly higher (all P>0.05), and all were within the normal range. 【Conclusion】 Patients undergoing cardiac surgery are prone to suffer electrolyte disorders after massive blood transfusion. Electrolyte concentration should be monitored in time during and after perioperative blood transfusion.

Analysis of perioperative blood transfusion and the influencing factors of mass-transfusion in patients underwent heart transplantation / 中国输血杂志

【Objective】 To provide references for clinical prediction of blood preparation and blood consumption, as well as the influencing factors of mass-transfusion by analyzing the perioperative blood transfusion in patients underwent heart transplantation. 【Methods】 The blood transfusions of 44 patients with heart transplantation completed in the Department of Cardiac Surgery of our hospital from March 2014 to January 2022 were retrospectively collected. Patient information included age, gender, preoperative diagnosis, relevant medical history, history of cardiac surgery, and history of antithrombotic medication. The risk factors of perioperative red blood cell transfusion in patients with heart transplantation were analyzed by univariate analysis method and multivariate logistic regression method. 【Results】 All 44(100%) heart transplant patients received blood components: the average transfusion units of red blood cells was 3.75(0, 7.5) U (72.73%), plasma 1 140 (597.5, 1782.5) mL (97.73%), cryoprecipitate 10(9.5±10) U(88.64%), platelets 1(1, 1.25) therapeutic amount (86.36%). The rate of massive transfusion of red blood cells was 45.45% (20/44). The univariate analysis found that there were significant differences in preoperative use of antithrombotic drugs, blood loss, and cardiopulmonary bypass time between the red blood cell transfusion group≤4 U (n=24) and the red blood cell transfusion group >4 U (n=20) (P<0.05). Multivariate Logistic regression analysis showed that preoperative antithrombotic drug treatment (n=15) was OR 5.900, 95%CI 1.313~26.521(P<0.05) and cardiopulmonary bypass time was OR 1.024, 95%CI 1.000~1.049(P<0.05). 【Conclusion】 The perioperative transfusion rate of blood components in cardiac transplant patients was high. The preoperative use of antithrombotic drugs, and prolonged cardiopulmonary bypass are risk factors for massive red blood cell transfusion.

Influencing factors of perioperative red blood cell transfusion in patients underwent lung transplantation / 中国输血杂志

【Objective】 To explore the influencing factors of perioperative red blood cell transfusion in patients underwent lung transplantation, so as to provide reference for perioperative blood management (PBM) of lung transplantation patients. 【Methods】 The clinical data of 173 lung transplant patients completed in China-Japan Friendship Hospital from March 2017 to June 2019 were retrospectively analyzed. The patients were divided into two groups according to perioperative red blood cell transfusion volume: large blood transfusion group (transfusion red blood cell volume ≥6 U, n=66) and non-large blood transfusion group (red blood cell transfusion volume <6 U, n=107). The basic information, preoperative laboratory test results, and surgical status of the two groups were statistically analyzed.The clinical data of the two groups were analyzed by univariate analysis. The factors of P<0.15 were included in the binary logistic regression analysis, and the independent influencing factors of perioperative massive blood transfusion in patients with lung transplantation were found. 【Results】 Univariate analysis of clinical data of the two groups of patients (large blood transfusion group vs. non-large blood transfusion group) showed that the differences of smoking history ratio [44(66.7%) vs 87(81.3%)], BMI(20.8±4.5 vs 22.5±4.0)(P<0.05), preoperative Hb [124(111, 138.8) vs 138(126, 149)], preoperative Hct [37.9(34.8, 42.5) vs 41.3(37.9, 44.6)], surgery duration(327.9±107.7 vs 238.4±77.0), intraoperative blood loss(1 108.6±1342.0 vs 341.8±270.8) and single lung transplantation [28(42.4%) vs 84(78.5%)] (P<0.01) were statistically significant. Logistic regression analysis showed that intraoperative blood loss (OR=1.001, P<0.05), surgery duration (OR=1.006, P<0.05), preoperative Hb (OR=0.973, P<0.01), lung transplantation type(single or double lung transplantation)( OR=0.247, P<0.05) and extracorporeal membrane oxygenation (ECMO) (OR=0.187, P<0.01) were independent factors influencing red blood cell transfusion during lung transplantation. 【Conclusion】 Intraoperative blood loss and surgery duration are risk factors for massive blood transfusion during the perioperative period. And the use of ECMO, preoperative Hb, single lung transplantation (compared to double lung transplantation) are protective factors for perioperative massive blood transfusion.

Effects of massive blood transfusion on inflammatory factors, islet B cell function, MODS incidence and mortality in patients with severe traumatic hemorrhage / 中国输血杂志

【Objective】 To explore the effect of massive blood transfusion on inflammatory factors, islet B cell function, incidence and mortality of multiple organ dysfunction syndrome (MODS) in patients with severe traumatic hemorrhage. 【Methods】 214 traumatic hemorrhage patients who received blood transfusion and were hospitalized in the Third People′s Hospital of Xingtai from January 2015 to June 2019 were enrolled and divided into the routine blood transfusion group (n=118) and massive blood transfusion group (n=96) according to the amount and method of blood transfusion. The changes of the inflammatory factors such as TNF α and IL-6, the functional indexes of Islet B cells such as HOMA-B and Δ INS30 / Δ GLU30, and the incidence and mortality of MODS in two groups 3 d after blood transfusion were observed. 【Results】 The level of TNF α(ng/L), IL-6(ng/L), HOMA-B and Δ INS30 / Δ GLU30 were (64.21±8.41) vs (30.75±5.26), (216.52±17.99) vs (152.45±16.26) (58.55±10.23) vs (103.47±17.48) and (2.95±0.69) vs (5.87±1.30) in the massive transfusion group and routine transfusion group, respectively (P<0.01). The incidence of MODS was 63.54%(61/96) vs 40.07%(52/118)(P<0.01) while the mortality of MODS was 46.88%(40/118) vs 33.90% (P>0.05). 【Conclusion】 The massive blood transfusion could increase the incidence of MODS in patients with severe traumatic hemorrhage by promoting inflammatory reaction and dysfunction of islet B cells.

To guide the preparation of blood before liver transplantation: the establishment of multiple regression equation based on R language / 中国输血杂志

【Objective】 To establish the multiple regression equation based on R language in order to guide scientific and reasonable blood preparation for clinicians before liver transplantation. 【Methods】 Basic clinical information, including gender, age and disease types, of 183 liver transplant patients were collected, and results of preoperative blood routine(MCV, MCHC, Hct, RBC, Hb and Plt), prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT), fibrinogen(FIB), international normalized ratio(INR) and D dimer and antithrombin Ⅲ(AT Ⅲ), operation time, as well as intraoperative transfusion volume of red blood cells, plasma, cryoprecipitates and platelets were analyzed using R language analysis.The correlation between blood component transfusion volume and analysis factors was calculated by generalized linear function, and the regression equation for predicting blood preparation was obtained by Poisson regression analysis. 【Results】 Intraoperative transfusion rates of RBC, plasma, platelets and cryoprecipitates in liver transplantation patients were 85.79%(8.35±8.78 U), 100%(1 083±742.80 mL), 18.58%(0.26±0.60 treatment dose), and 12.02%(2.49±7.51 U), respectively. According to the analysis factors with good correlation, the prediction equations for the volume of each blood component were as follows: RBC: 3.348+ 1.276×Time-0.02×Hct-0.16×RBC-0.006×Hb, plasma: 6.901+ 0.826 ×Time-0.003×Hb, platelets: -1.275+ 1.866×Time-0.013 Hb+ 0.025×TT, and cryoprecipitates: -7.183+ 2.888×Time + 0.067×MCV+ 0.029×TT. 【Conclusion】 It is of great clinical significance to use R language to carry out multivariate regression analysis and establish the prediction regression equation of blood preparation before liver transplantation, which can provide scientific, reasonable and sufficient blood supply in operation.

Study on application of massive blood transfusion program in massive hemorrhage and early stage of coagulopathy / 重庆医学

Objective To study the effect of massive blood transfusion program(MTP) in early massive blood transfusion and preventing coagulopathy.Methods Fifty cases of massive blood transfusion were clinically collected and performed the statistical analysis and processing before and after intervention according to the blood transfusion scheme of MTP.The statistical comparison was performed by using the data before and after intervention.Results PLT was decreased with the increase of transfusing of RBC.After transfusing 15 U of RBC,the PT test,INR and APTT were increased significant(P＜0.05).After transfusing 20 U of RBC,the Fib was decreased significant(P＜0.05).The MTP had statistical difference between before and after intervention(P＜0.01).Conclusion The MTP application has an important significance to prevent the occurrence of coagulopathy and evaluate the coagulation status.

Analysis on the factors influencing the serum potassium concentration changes before and after massive blood transfusion and transfusion hyperkalemia occurred / 中国医学装备

Objective: To study the changes of blood transfusion and blood potassium concentration and the occurrence of hyperkalemia after transfusion factors influence. Methods: In our hospital from 2010 April to select the diagnosis and treatment of -2012 in April 132 cases of non crush injury patients, these patients were randomly divided into two groups, the control group without blood transfusion therapy group, the observation group for massive transfusion treatment group, changes of serum potassium were compared between the two groups before and after transfusion, and to analyze the related effect factors. Results:The serum potassium levels showed no significant difference between the two groups of patients before and after blood transfusion, operation process, but the postoperative within 12h, observation of blood potassium level group were significantly higher than that in control group, the difference is significant, with statistical significance (t=1.562, P<0.05), in addition to 12h after operation, blood potassium levels between the two groups no significant difference. Conclusion: The clinical blood transfusion is not the main cause of hyperkalemia in patients with, but there are still some patients in massive transfusion potassium increased, therefore, in the process of transfusion, or to close monitoring and observation of the serum potassium level, but also to pay attention to changes in renal function, has ruled out the elevation of serum potassium results in impaired renal function because, in order to reduce the incidence of complications.

Prediction of Massive Blood Transfusion at Emergency Department in Non-trauma Patients / 대한수혈학회지

BACKGROUND: Many patients received transfusion in emergency department because of blood loss. There are few studies on massive transfusion for non-traumatic patients. This study investigated mortality and risk factor for non-traumatic bleeding patients who received transfusion. METHODS: Non-trauma patients who received transfusion at the emergency department for 3 years from March 2009 to February 2011 were enrolled. The patients who are younger than 15 years, trauma patients, and transfused FFP or platelet alone are excluded. Medical records was investigated retrospectively. We investigated predictive factors for MT on non-trauma patients and predictive factors for mortality on MT patients. RESULTS: Among 1655 non-trauma patients, 150 patients (9.24%) received MT. The age of MT group was younger than that of non-MT group and systolic bloor pressure, diastolic blood pressure, mean arterial pressure were significantly lower. Base excess, pH, lactate levels were significantly different between MT and non-MT group. Intensive care unit length of stay was longer, mortality of 24 hours was higher and survival discharge was lower than non-MT group. Mortality rate of MT group was 20.7% which was significantly higher than non-MT group's 9.3%. FFP:RBC ratio was higher in MT group than non-MT group. Among the MT group, non-survival group used higher FFP:RBC ratio product than survival group. On multivariate analysis, sBP, MAP, lactate, pH, BE were significant as predictors of MT. CONCLUSION: For non-trauma patients in emergency department, if sBP, MAP, lactate, pH, BE are abnormal, massive transfusion could be expected. Like trauma patients, basic scoring system that can predict MT would be necessary and useful.

The emergency treatment and prevention of complications for 87 patients with severe traumatic shock / 中国基层医药

Objective To explore the treatment of patients with severe traumatic shock first-aid and the preventive measure of the complications caused by a large number of fast blood transfusion during surgery.Methods Retrospective analysis of 87 patients with severe traumatic shock and rapid blood transfusion given to a large number of patients for emergency medical treatment, while the load cycle, bleeding, body temperature, serum potassium, and other indicators were observed, effects and complieations of treatment and effective prevention measures were summarized.Results 87 patients after aggressive surgical treatment,the success rate was 81.61% (71/87) ;surgery circulatory overload caused massive blood transfusion, bleeding tendency,low body temperature,low blood potassium disorders such specific complications.Conclusion Patients with severe traumatic shock should be taken promptly and effective first aid treatment and.the complication caused by massive blood transfusion during surgery,and it could reduce mortality and complications.

Mortality and the factors related to the death in surgical patients with massive blood transfusion

Background: Massive Blood Transfusion is common in surgery, which can save many lives. However, massive blood transfusion in a short time together with other disorders can cause serious side effects and death. Objective: Investigation on the factors related to mortality in surgical patients after massive blood transfusion. Subject and Method: A descriptive study was carried out on 90 patients of massive blood transfusion in Viet Duc hospital. Results: There were 38 cases of death among the 90 patients of massive blood transfusion (42%), in which 97.7% died within 2 to 24 days of hospitalization (caused by multi organ failure). There are no correlation between the deaths, with the units of blood transfused, hypothermia, anemia (Hb) and with platelet counts, APTT, PT, fibrinogen changes, 3 risk factors that correlated significantly with mortality are BE, DIC and age of patients. Conclusion: Acidosis (pH, BE) and hemostasis status should be closely monitored and corrected early to reduce the risks of mortality.

A Case of Acute Renal Failure due to Massive Blood Loss during Gastrectomy / 대한마취과학회지

Often anesthesiologists are experienced to performe the inevitable blood transfusion during massive blood loss. Red blood cells are transfused primarily to increase transport of oxygen to tissues. An increase in the circulating red cell mass produces an increase in oxygen uptake in the lungs and a corresponding probable increase in oxygen delivery to tissues. However, tissue hypoxia may develop from infusion of stored blood due to leftward shift in the oxygen dissociation curve especially massive transfusion. And dilutional thrombocytopenia is probably the most likely cause of a hemorrhagic diathesis in a patient who has received multiple units of bank blood. The deposited fibrin may severely alter the microcirculation and lead to ischemic necrosis in various organs, particulary the kidney, especially derranged hemodynamic conditions are exist. A case ofacute renal failure due to massive blood loss during gastrectomy was reviewed.