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Thread: Blood transfusion is associated with infection and increased resource utilization

  1. #1
    Managing Editor Jan B. Wade's Avatar
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    Blood transfusion is associated with infection and increased resource utilization

    Blood transfusion is associated with infection and increased resource utilization in combat casualties.

    The National Naval Medical Center, Department of General Surgery, 8901 Wisconsin Avenue, Bethesda, MD 20889-5600, USA.
    Combat casualty care has made significant advances in recent years, including administration of blood products in far-forward locations. However, recent studies have shown blood transfusion to be a significant risk factor for infection and increased resource utilization in critically injured patients. We therefore sought to investigate the incidence of blood transfusion and its association with infection and resource utilization in combat casualties. Prospective data were collected and retrospectively reviewed on 210 critically injured patients admitted to the USNS Comfort over a 7-week period during the 2003 assault phase of Operation Iraqi Freedom. Patients were stratified by age, gender, and injury severity score (ISS). Multivariate regression analyses were used to assess blood transfusion and hematocrit (HCT) as independent risk factors for infection and intensive care unit (ICU) admission controlling for age, gender, and ISS. The study cohort had a mean age of 30 +/- 2 years, a mean ISS of 14 +/- 3, 84 per cent were male, and 88 per cent sustained penetrating trauma. Blood transfusion was required in 44 per cent (n = 93) of the study cohort. Transfused patients had a higher ISS (18 +/- 4 vs. 10 +/- 3, P < 0.01), a higher pulse rate (105 +/- 4 vs. 93 +/- 3, P < 0.0001), and a lower admission HCT (27 +/- 1 vs. 33 +/- 2, P < 0.0001) compared with patients not transfused. Patients receiving blood transfusion had an increased infection rate (69% vs. 18%, P < 0.0001), ICU admission rate (52% vs. 21%, P < 0.0001), and ICU length of stay (6.7 +/- 2.1 days vs. 1.4 +/- 0.5 days, P < 0.0001) compared with nontransfused patients. However, there was no significant difference in mortality between transfused and nontransfused patients. Multivariate binomial regression analysis identified blood transfusion and HCT as independent risk factors for infection (P < 0.01) and blood transfusion as an independent risk factor for ICU admission (P < 0.05). Combat casualties have a high incidence of blood transfusion. Blood transfusion is an independent risk factor for infection and increased resource utilization. Therefore, consideration should be given to the use of alternative blood substitutes and recombinant human erythropoietin in the treatment and management of combat casualties.
    PMID: 16875084 [PubMed - in process]
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  3. #2
    Physician
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    Blood transfusion is associated with infection and increases resource utilization

    This abstract of the article (American Surgeon, July 2006) on blood transfusion as a significant risk factor for infection and increased resource use is only one of the many studies showing that allogeneic blood is not at all safe despite substantial advances in blood safety.

    Please look in the Journal of Pediatrics, February 2003 issue the article "Pediatric Red Blood Cell Transfusions Increase Resource Use" by Allyson Goodman, Murray Pollack, Kantilal Patel and Naomi Luban from the George Washington Univ School of Medicine. Five pediatric ICUs participated in the study and among 240 children, 131 were transfused and 109 were not. After controlling for the effects of other variables, transfusion was associated with significant increase in days of oxygen use, days of mechanical ventilation, days of vasoactive agent infusions and an increase in PICU and hospital lengths of stay.

    In a multicenter, randomized controlled clinical trial in adults, a restrictive RBC transfusion strategy resulted in a lower hospital mortality rate than that of a liberal transfusion strategy. This suggested that a restrictive transfusion practice was as effective or superior to liberal transfusion in critically-ill patients, except those with acute myocardial injury or unstable angina ( Hebert PC et al. New England Journal of Medicine 1999; 340:409-17)

    The results of yet another study Blood Transfusion and Pulmonary Lipid Peroxidation in Ventilated Premature Babies by Keith Collard et al. Pediatric Pulmonology 39: 257-261(2005) indicate that babies receiving blood transfusions show greater incidence of pulmonary oxidative stress and poor clinical outcome.

    The June 2005 issue of Anesthesiology clinics of North America has been devoted to Issues in Transfusion Medicine. Lawrence Goodnough discussed very well risks of blood transfusion.

    The website NATA > Welcome to the Network for Advancement of Transfusion Alternatives provides more information on this topic.

    A. Gapay, MD
    Angelina A. Gapay, MD

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