Restrictive transfusion strategy after cardiac surgery.
Zeroual and colleagues report the results of a single-centre, single-blinded randomised controlled study of cardiac surgery patients comparing two strategies for transfusion of red blood cells. The control group followed a standard regime with transfusion of red blood cells if the haemoglobin level fell < 9 g/dL. In the intervention group, transfusion of red blood […]
Liberal versus restrictive red blood cell transfusion thresholds in hematopoietic cell transplantation: a randomized, open label, phase III, noninferiority trial.
This trial is a non-inferiority RCT comparing the effect of a liberal versus restrictive transfusion strategy on health-related quality of life (HRQOL) in patients undergoing haematopoietic stem cell (HCT) transplant. The study focuses on HRQOL since multiple transfusion trials have already examined and shown no difference between a liberal versus restrictive transfusion strategy on mortality […]
Variation in red cell transfusion practice in the intensive care unit – An international survey.
This study aimed to explore the variation in transfusion practice amongst critical care physicians using a cross-sectional online survey of critical care providers identified through the European Society of Intensive Care Medicine (ESICM). Participants were presented with four clinical scenarios in which each patient had a haemoglobin of 7.3 g/dL and one of the following four […]
Preterm neonates benefit from low prophylactic platelet transfusion threshold despite varying risk of bleeding or death.
The Platelets for Neonatal Thrombocytopenia (PlaNeT-2) trial, a multicentre randomised clinical trial, found an unexpected overall benefit of a prophylactic platelet transfusion threshold of 25 x 10^9/L compared to 50 x 10^9/L for major bleeding and/or mortality within 28 days of randomization in preterm neonates (7% absolute risk reduction). To assess if there was heterogeneity of treatment effect and […]
Association of timing of plasma transfusion with adverse maternal outcomes in women with persistent postpartum hemorrhage.
Early plasma transfusion is believed to improve maternal outcomes in postpartum haemorrhage (PPH) because it could theoretically prevent or treat coagulopathy occurring among women treated for persistent PPH. However, as with other areas of PPH, studies evaluating the effect of plasma transfusion on outcomes of women with severe PPH are scarce. This study is an […]
Four years’ experience of a ROTEM((R))-guided algorithm for treatment of coagulopathy in obstetric haemorrhage.
This important study by McNamara et al. reports on four years of observational data from a large UK hospital and tertiary referral unit, following the introduction of a rotational thromboelastometry-guided algorithm for treatment of coagulopathy in major obstetric haemorrhage. This was compared to a matched cohort from the year prior when a “shock pack” was […]
Transfusion practice in the non-bleeding critically ill: an international online survey-the TRACE survey.
In order to elucidate whether data from transfusion trials has impacted current intensive care transfusion management, de Bruin and colleagues performed an online, anonymous, worldwide survey among ICU physicians, evaluating red blood cell, platelet and plasma transfusion practices. Of 725 completed surveys, a hospital transfusion protocol was available in 53%, with only 29% using ICU-specific […]
Association of blood component ratios with 24-hour mortality in injured children receiving massive transfusion.
While the incidence of paediatric trauma requiring massive transfusion is lower than the incidence in adults, little is known regarding the optimal transfusion strategy in the paediatric population. Although optimal ratios for red blood cell, plasma and platelet transfusion have been extensively discussed in the literature, only a limited number of studies can be found […]
Impact of a Patient Blood Management monitoring and feedback programme on allogeneic blood transfusions and related costs.
While Patient Blood Management (PBM) is becoming a new standard worldwide with evidence-based and expert consensus guidelines to promote the three PBM pillars, measuring the performance of these efforts remains a challenge. PBM programmes need to measure transfusion reductions and patient-specific outcomes, and report these to drive change. Here is one such impactful report supporting […]
Intra-operative red blood cell transfusion and mortality after cardiac surgery.
Many studies have shown an association between transfusion and adverse events, including short- and long-term mortality, in cardiac surgery. In this study, the authors aimed to investigate this association in patients undergoing isolated coronary artery bypass graft surgery (CABG) or combined CABG and aortic valve replacement (AVR). They found that intraoperative red blood cell (RBC) […]
Multimodal patient blood management program based on a three-pillar strategy: a systematic review and meta-analysis.
This systematic review and meta-analysis focused on the implementation of a comprehensive PBM approach. Studies included had to address at least one recognised PBM modality per pillar. Data for 235,779 surgical patients were included (100,886 in the pre-PBM group and 134,893 in the PBM group). The combined PBM measures led to improved clinical outcomes through a reduction of […]
Randomized trial of platelet-transfusion thresholds in neonates.
In this multicentre trial, infants born at less than 34 weeks of gestation and in whom severe thrombocytopenia was detected were randomised to receive a platelet transfusion at a platelet count threshold of 50 000/µL (high-threshold group) versus a threshold of 25 000/µL (low-threshold group). Preterm infants became eligible for randomisation provided there was no further major bleeding. […]
Six-month outcomes after restrictive or liberal transfusion for cardiac surgery.
In this follow-up article to the TRICS III trial, the authors report the clinical outcomes of moderate- to high-risk patients undergoing cardiac surgery with cardiopulmonary bypass at 6 months after the operation. The authors report on the original primary outcomes (death from any cause, myocardial infarction, stroke or renal failure with dialysis) and on secondary outcomes […]
Association of perioperative red blood cell transfusions with venous thromboembolism in a North American registry.
An association between red blood cell (RBC) transfusion and increased incidence of perioperative complications has been highlighted in a large number of prospective and restrospective studies. In the study published in JAMA Surgery by Ruchika Goel and her group, the authors looked at a potential association between perioperative RBC transfusion and the incidence of postoperative […]
Contemporary risk factors and outcomes of transfusion-associated circulatory overload.
Recently, a joint working group of members of the International Haemovigilance Network, the International Society of Blood Transfusion and AABB concluded that it is too early to develop a consensus on TACO, its definition, its reporting criteria and its risk factors. This was due to the fact that currently, insufficient published research was available to […]