ObjectiveTo review the perioperative blood management (PBM) of total knee arthroplasty (TKA) and total hip arthroplasty (THA).MethodsRecent researches on PBM for TKA and THA were comprehensively read and summarized. Then the advantages and disadvantages of various measures together with the clinical experience of West China Hospital of Sichuan University were evaluated from three aspects, including optimizing hematopoiesis, reducing blood loss and blood transfusion, which could provide a basis for clinical selection.ResultsThere are many PBM methods in TKA and THA, among which the optimization of hematopoiesis mainly includes the application of perioperative iron and erythropoietin. Measures to reduce bleeding include the use of tourniquet, intraoperative controlled hypotension, and perioperative antifibrinolytic agents. Autologous blood transfusion includes preoperative autologous blood donation, hemodilution and cell salvage. Allogeneic blood transfusion is the ultimate treatment for anemia. The application of erythropoietin combined with iron therapy for blood mobilization before surgery together with intraoperative controlled hypotension for bleeding control and the multiple use of tranexamic acid can achieve satisfactory clinical results.ConclusionIn the perioperative period of TKA and THA, single or multiple use of different blood management measures should be considered carefully according to the physical and economic conditions of patients individually, so as to reduce the blood loss and allogeneic blood transfusion optimally, and finally accelerate the recovery of patients.
Red blood cell (RBC) transfusions are frequently used in cardiac surgery. A minority of patients assume most of the blood products transfusion during and after cardiac operations. Observational analysis of transfusion in patients undergoing cardiac surgery has uniformly demonstrated that RBC transfusion is associated with a significantly increasing risk of all-cause mortality and other serious adverse outcomes. In addition, it is an established fact that such patients can tolerate relatively low hemoglubin (Hb) levels. Consequently, it becomes widely accepted that appropriate limitation of transfusions could confer a substantial benefit to patients and decrease the use of limited resource. As a result, a restrictive threshold for blood transfusion is likely to be favored under most circumstances. However, an increasing amount of data differing from the observational analysis shows that clinical outcomes in patients who received transfusions with restrictive thresholds for Hb level are not superior to those with liberal thresholds. It has created a new uncertainty regarding the use of a restrictive threshold for transfusion during the perioperative period of cardiac surgery.
ObjectiveTo systematically evaluate the risk factors for perioperative blood transfusion in patients undergoing coronary artery bypass grafting (CABG).MethodsPubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang and VIP Database were electronically searched to collect case-control and cohort studies about the risk factors for perioperative blood transfusion in patients undergoing CABG from inception to February 2020. Two reviewers screened and evaluated the literatures according to the inclusion and exclusion criteria, and meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 26 articles were collected, involving 84 661 patients. The results of meta-analysis showed that age (OR=1.06, 95%CI 1.03 to 1.08, P<0.001), age≥70 years (OR=2.14, 95%CI 1.77 to 2.59, P<0.001), female (OR=1.85, 95%CI 1.55 to 2.22, P<0.001), body mass index (OR=0.94, 95%CI 0.90 to 0.98, P=0.003), weight (OR=0.95, 95%CI 0.93 to 0.96, P<0.001), body surface area (OR=0.19, 95%CI 0.10 to 0.39, P<0.001), smoking (OR=0.80, 95%CI 0.69 to 0.93, P=0.003), diabetes (OR=1.15, 95%CI 1.09 to 1.20, P<0.000 01), chronic heart failure (OR=1.59, 95%CI 1.26 to 1.99, P<0.001), number of diseased coronary arteries (OR=1.17, 95%CI 1.01 to 1.35, P=0.030), reoperation (OR=2.12, 95%CI 1.79 to 2.51, P<0.001), preoperative hemoglobin level (OR=0.60, 95%CI 0.43 to 0.84, P=0.003), preoperative ejection fraction <35% (OR=2.57, 95%CI 1.24 to 5.34, P=0.010), emergency surgery (OR=4.09, 95%CI 2.52 to 6.63, P<0.001), urgent operation (OR=2.28, 95%CI 1.25 to 4.17, P=0.007), intra-aortic balloon pump (OR=3.86, 95%CI 3.35 to 4.44, P<0.001), cardiopulmonary bypass (OR=4.24, 95%CI 2.95 to 6.10, P<0.001), cardiopulmonary bypass time (OR=1.01, 95%CI 1.01 to 1.01, P<0.000 01) and minimum hemoglobin during cardiopulmonary bypass (OR=0.42, 95%CI 0.23 to 0.77, P=0.005) were the risk factors for perioperative blood transfusion in patients undergoing CABG.ConclusionCurrent evidence shows that age, age≥70 years, female, body mass index, weight, body surface area, smoking, diabetes, chronic heart failure, number of diseased coronary arteries, reoperation, preoperative hemoglobin level, preoperative ejection fraction<35%, emergency surgery, urgent operation, intra-aortic balloon pump, cardiopulmonary bypass, cardiopulmonary bypass time and minimum hemoglobin during cardiopulmonary bypass are risk factors for perioperative blood transfusion in patients who undergo CABG. Medical staff should formulate and improve the relevant perioperative blood management measures according to the above risk factors, in order to reduce the perioperative blood utilization rate and improve the clinical prognosis of patients.
目的:分析输血反应类型,分布及概率。方法:回顾性分析我院2008年11月至2009年4月各类输血事件,收集输血不良反应回报单,进行统计分析。结果:在共计8996人次输血中,发生输血不良反应47人次,其中输注血浆引起的输血不良反应率为0.68％,输注红细胞悬液的不良反应率为0.30％,总的输血不良反应率0.98％,不同血液制品输血不良反应发生率具显著性差异(Plt;0.05)。其中主要表现为过敏反应,占63％,其次为发热反应.结论:如何提高临床科室科学合理用血水平的方法需进一步探讨。
ObjectiveTo explore modified methods and outcomes of collection of donor blood from donation after citizen death (DCD). MethodThe clinicopathologic data of 26 DCD donors underwent phase Ⅰ clinical trials and 6 patients who received donor blood by modified collection technique from May 2020 to November 2021 in the West China Hospital of Sichuan University were collected retrospectively. ResultsCompared with the data of 26 DCD donors at phase Ⅰ clinical trials, after the modified collection technique, the blood collection volume, the concentrated red blood cells following filtration, centrifugation, and the amount of concentrated red blood cell/kg body mass were more (P<0.05). In addition, compared with the components of stored red blood cell suspension, the pH value, sodium and chloride ions concentrations of the red blood cell suspension obtained after modified collection technique were higher (P<0.05), the potassium ion concentration was <1 mmol/L, and the lactic acid concentration of none of blood was >15 mmol/L. ConclusionThe adoption of the modified collection technique increases the amount of donor red blood collected, and its biochemical and electrolyte indicators are more in line with physiological requirements than those of stored blood.
ObjectivesTo systematically review the efficacy and safety of tranexamic acid (TXA) in reducing blood transfusion and total blood loss in patients undergoing orthopaedic trauma surgery.MethodsA systematic literature search was performed using PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases. A search for grey literature was also performed in American Academy of Orthopaedic Surgeons (AAOS) and Orthopaedic Trauma Association (OTA). The search time was up to June 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias, then meta-analysis was performed by using RevMan 5.3 and Stata 14.0 softwares.ResultsA total of 10 studies were included, including 936 patients. The pooled results indicated that TXA group was superior to the control group in blood transfusion (RR=0.75, 95%CI 0.63 to 0.89, P=0.001), the total blood loss (MD=–157.61, 95%CI –250.09 to –65.13, P=0.000 8) and the wound complications (RR=0.24, 95%CI 0.10 to 0.58, P=0.002). There was no significant difference in risk of thromboembolic events (RR=1.25, 95%CI 0.78 to 2.00, P=0.36) and the mortality (RR=0.81, 95%CI 0.40 to 1.66, P=0.57) between TXA and control group.ConclusionsTXA can effectively reduce blood transfusion, total blood loss and wound complications in patients undergoing orthopedic trauma surgery. Furthermore, TXA does not significantly increase the incidence of thromboembolic events and mortality. Due to the limited quality of included studies, more high quality studies are required to verify the above conclusions.
The limitation of resource of blood and risk of transfusion-transmitted infections contribute to development and generalization of restrictive transfusion strategy. However, advanced evidences of clinical trials indicated a restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care costs. It is time to optimize patient blood management but not free-transfusion and increase of risk of patients. The duration of red-cell storage was not associated with significant differences in the mortality and morbidity of patients. Three new pathogen-reduction technologies and pharmaceutical intervenes may provide safe of transfusion and improvement of outcomes.