From the Literature


Published: Nov 2019

Transfusion of red blood cells, fresh frozen plasma, or platelets is associated with mortality and infection after cardiac surgery in a dose-dependent manner.
Ming Y, Liu J, Zhang F, et al.
Anesth Analg 2019; Nov 5 [Epub ahead of print].
Pub Med
NATA rating :


J. M. Cholette


The authors sought to determine whether transfusion of platelets or fresh frozen plasma, in addition to RBCs, is associated with an increased risk of mortality and infection after cardiac surgery. Patients who underwent valve surgery and/or coronary artery bypass grafting at 2 centres performing cardiac surgery were retrospectively studied.

After stratifying patients based on propensity score matching, rates of mortality and infection between patients who received RBCs, FFP or platelets were compared with subjects not receiving these blood products. Outcomes were compared between patients who received any of the 3 blood products and patients who received no transfusions at all. Multivariable logistic regression was used to assess associations between transfusion and outcomes.

Of 8238 patients,109 (1.3%) died, 812 (9.9%) experienced infection, and 4937 (59.9%) received at least one type of blood product. Transfusion of any blood type was associated with higher rates of mortality (2.0% vs. 0.18%; P < 0.01) and infection (13.3% vs. 4.8%; P < 0.01). Each of the 3 blood products was independently associated with an increase in mortality per unit transfused (RBC, OR 1.18, 95% [CI], 1.14-1.22; FFP, OR 1.24, 95% CI, 1.18-1.30; platelets, OR 1.12, 95% CI, 0.07-1.18).

Transfusing 3 units of any of the 3 blood products was associated with a dose-dependent increase in the incidence of mortality (OR 1.88, 95% CI, 1.70-2.08) and infection (OR 1.50, 95% CI, 1.43-1.57). Transfusion of RBCs, FFP, or platelets is an independent risk factor of mortality and infection, and combination of the 3 blood products is associated with adverse outcomes in a dose-dependent manner after cardiac surgery.

– Jill M. Cholette (SABM reviewer)