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Transfusion therapy in injured children
Published in David E. Wesson, Bindi Naik-Mathuria, Pediatric Trauma, 2017
The practice of transfusion medicine has evolved over the years as we develop a deeper understanding of the effects of anemia, how particular patients tolerate anemia, coagulation, and the risks associated with transfusion. At first, the utility of transfusion was limited by both our understanding of the ABO system and red blood cell (RBC) antigens, leading to both acute and delayed hemolytic transfusion reactions. In addition, blood was collected from unscreened donors and carried a much greater risk for the development of transfusion-transmitted infections including hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and human T-cell lymphotropic virus. Today, our knowledge of these systems and enhanced testing methods for infection allow us to transfuse patients more safely. However, emerging infections such as West Nile virus, Zika virus, and the risk of prion disease still threaten our blood supply. Transfusion of blood products is also still associated with a number of adverse reactions including acute and delayed hemolysis, transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), and transfusion-related immunomodulation. Clinicians should therefore remain mindful that transfusion is not without risk and should only occur in the appropriate setting.
Outcomes and prognostic factors of cytoreductive surgery and perioperative intraperitoneal chemotherapy in high-volume peritoneal carcinomatosis
Published in International Journal of Hyperthermia, 2022
Lee S. Kyang, Suzannah L. Dewhurst, Valerie A. See, Nayef A. Alzahrani, David L. Morris
Increased blood transfusion (>8 units) decreased the OS (HR 1.77, 95%CI = 1.03–3.03, p = 0.038) and DFS (HR 2.11, 95%CI = 1.03–4.31, p = 0.042) by approximately one-half- and two-fold, respectively. This may be explained by transfusion-related immune modulation (TRIM), which is a result of the inflammatory and immunosuppressive nature of blood products. They blunt the recipients’ innate immunity that regulates local tumor control, thereby promoting growth of malignant tumors [38]. A study involving patients with mesothelioma and PMP treated with CRS/PIC demonstrated that blood transfusion is an independent prognostic factor for worse OS and DFS. There is a dose-dependent effect such that even low amounts of transfusion (1 U-2U) affect survival outcomes following CRS/PIC [39].
Adverse transfusion reactions and what we can do
Published in Expert Review of Hematology, 2022
Yajie Wang, Quan Rao, Xiaofei Li
Evidence has indicated that transfusion-related immunomodulation (TRIM) is a complicated set of biological immune responses to blood transfusion leading to immunosuppression. The mechanisms of TRIM are immunosuppressive and pro-inflammatory effects, including the presence of apoptotic cells and residual leukocytes, the repression of interleukin-2 (IL-2) production, the release of immunosuppressive prostaglandins, an increase of suppressor T-cell activity, the presence of metabolite-active growth factor-loaded transfer particles and extracellular vesicles, as well as free hemoglobin or extracellular vesicles bound to hemoglobin [156,157]. Actually, the immunosuppressive effect of allogenic blood transfusions was therapeutically exploited to reduce organ rejection in early renal transplant recipients and improve immediate graft survival [158]. The immune dysregulation results from TRIM is the potential cause of postoperative infection, hindered wound healing, and acute kidney injury in patients undergoing cardiac surgery. It may also display as increased hospital stay, increased demand for inotropic drugs, multiple organ failure, or death. In general, the negative consequences of TRIM include increasing susceptibility to infection, reducing tumor defense ability, and enhancing allogeneic immunity to transfused antigens [50]. Data suggest that pre-storage leukoreduction of blood products can reduce the inflammatory cytokines caused by leukocytes in stored blood components [159]. Leukoreduction may be helpful in largely mitigating proinflammatory responses after RBC transfusion [156]. A recent study also found that leukofiltration could effectively decrease the effects of TRIM in patients with cardiac surgery [160]. However, another research pointed out that leukoreduction could not reduce immunosuppression of blood transfusion, but leukoreduction and γ-irradiation (LRγ) decreased the immunosuppressive effects in the recipients [161]. Overall, how to reduce the negative impact associated with immune dysregulations in TRIM requires large and more research to confirm.
Anesthesia management and outcomes of gynecologic oncology surgery
Published in Postgraduate Medicine, 2023
Hicret Yeniay, Bahar Kuvaki, Sule Ozbilgin, Hasan Bahadır Saatli, Hikmet Tunç Timur
In our study, the postoperative transfusion rates were higher in deceased patients. Geist et al. [22] assessed the correlation between perioperative erythrocyte transfusion, morbidity, and oncologic outcomes in a study that included patients with stage IIIC-IV epithelial ovarian cancer receiving neoadjuvant chemotherapy and interval debulking surgery. They reported that perioperative blood transfusions were administered to 50.4% of the patients. They administered more perioperative blood transfusions to patients with preoperative anemia and predicted high blood loss. More transfusions were performed in patients who underwent moderate and highly complicated surgeries than in those who underwent surgery with minor complications. While a correlation was observed between preoperative erythrocyte transfusion and intraabdominal infection, no correlations were observed with wound site complications or venous/pulmonary thromboembolism. When investigated according to age and stage, no significant difference was observed in terms of survival between patients who received preoperative erythrocyte transfusions and those who did not. A differential diagnosis of anemia should be made for patients with preoperative anemia, and elective surgery should be delayed until the anemia is treated. In our study, the preoperative anemia rate was 8.7%, and the preoperative blood transfusion rate was 3.8%. Our hospital does not have a protocol for patients with preoperative anemia, and the patients often undergo transfusion to increase their hemoglobin levels. Although our preoperative transfusion rate was low, the transfusion rate before elective surgery should be zero. The transfusion of blood or blood products reduces the rate of assisting cytotoxic T cells (transfusion-related immune modulation) [23,24], and patients undergoing blood transfusions may have increased rates of tumor recurrence, perioperative infection, and mortality. In our hospital, anesthesiologists decide whether to perform transfusions according to the amount of hemorrhage, hypotension, and intraoperative hemoglobin levels. However, the records used in this study lacked data regarding the reasons for blood transfusion. Moreover, standard monitoring, rather than advanced hemodynamic monitoring, was performed for patients during anesthesia. Perioperative hypothermia, which is frequently encountered in patients under general anesthesia and often neglected despite its preventable role in perioperative hemorrhage, is a primary risk factor of morbidity and mortality [3]. In the present study, the incidence of hypothermia was 38.6% and was associated with reduced survival.The Turkish Society of Anesthesia and Reanimation performed studies on this topic in Turkey and attempted to increase awareness during a ‘Meeting for Patient Blood Management Awareness’ in Izmir, Turkey in 2017.