Clinical nursing value of predictive nursing in reducing complications of pregnant women undergoing short-term massive blood transfusion during cesarean section

BACKGROUND Cesarean hemorrhage is one of the serious complications,and short-term massive blood transfusion can easily cause postoperative infection and physical stress response.However,predictive nursing intervention has important clinical significance for it.AIM To explore the effect of predictive nursing intervention on the stress response and complications of women undergoing short-term mass blood transfusion during cesarean section(CS).METHODS A clinical medical record of 100 pregnant women undergoing rapid mass blood transfusion during sections from June 2019 to June 2021.According to the different nursing methods,patients divided into control group(n=50)and observation group(n=50).Among them,the control group implemented routine nursing,and the observation group implemented predictive nursing intervention based on the control group.Moreover,compared the differences in stress res-ponse,complications,and pain scores before and after the nursing of pregnant women undergoing rapid mass blood transfusion during CS.RESULTS The anxiety and depression scores of pregnant women in the two groups were significantly improved after nursing,and the psychological stress response of the observation group was significantly lower than that of the control group(P<0.05).The heart rate and mean arterial pressure(MAP)of the observation group during delivery were lower than those of the control group,and the MAP at the end of delivery was lower than that of the control group(P<0.05).Moreover,different pain scores improved significantly in both groups,with the observation group considerably less than the control group(P<0.05).After nursing,complications such as skin rash,urinary retention,chills,diarrhea,and anaphylactic shock in the observation group were 18%,which significantly higher than in the control group(4%)(P<0.05).CONCLUSION Predictive nursing intervention can effectively relieve the pain,reduce the incidence of complications,improve mood and stress response,and serve as a reference value for the nursing of women undergoing rapid mass transfusion during CS.

Survey on Blood Transfusion Practices among Medical and Paramedical Staff in the Pediatric Unit of the Mohammed VI University Hospital in Marrakesh, Morocco

Blood transfusion is a complex activity, involving many actors. As a high-risk activity, it necessitates the implementation of specific methods for effective control. The safety of blood transfusion is significantly influenced by the beliefs of healthcare workers and organizational factors, constituting two major considerations. We conducted a cross-sectional, descriptive, and analytical survey to examine the knowledge and practices related to transfusion among the medical and paramedical staff at the Pediatric Department (Mother-Child) of CHU Mohammed VI from September 1, 2022, to December 31, 2022. Among the 135 staff members interviewed, only 41% had received training in blood transfusion. A majority (65.2%) of the staff noted that a mismatch in cross-matching led to transfusion complications. Two-thirds (66.7%) identified chills as the primary clinical sign of potential accidents. Regarding elements to monitor during a reaction, hemolysis (78.5%) and temperature (76.3%) were most commonly mentioned. Surprisingly, more than half (53.3%) of the personnel interviewed did not conduct post-transfusion monitoring. This survey highlighted significant deficiencies in knowledge and practices related to transfusion. To address these issues, we recommend implementing guidelines and providing tailored training for the staff, aiming to rectify these deficiencies and enhance overall practices.

The impact of chemotherapy-naïve open radical cystectomy delay and perioperative transfusion on the recurrence-free survival: A perioperative parameters-based nomogram

Objective: To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.Methods: Patients who underwent open RC and ileal conduit between January 1996 to December 2016 were split into developing (n=948) and validating (n=237) cohorts. The time to radical cystectomy (TTC) was defined as the interval between the onset of symptoms and RC. The regression coefficients of the independent predictors obtained by Cox regression were used to construct the nomogram. Discrimination, validation, and clinical usefulness in the validation cohort were assessed by the area under the curve, the calibration plot, and decision curve analysis.Results: In the developing dataset, the 1-, 5-, and 10-year RFS were 83.0%, 47.2%, and 44.4%, respectively. On multivariate analysis, independent predictors were TTC (hazards ratio [HR] 1.07, 95% confidence interval [CI] 1.05-1.08, p<0.001), PBT (one unit: HR 1.40, 95% CI 1.03-1.90, p=0.03;two or more units: HR 1.72, 95% CI 1.29-2.29, p<0.001), bilateral hydronephrosis (HR 1.54, 95% CI 1.21-1.97, p<0.001), squamous cell carcinoma (HR 0.60, 95% CI 0.45-0.81, p=0.001), pT3-T4 (HR 1.77, 95% CI 1.41-2.22, p<0.001), lymph node status (HR 1.53, 95% CI 1.21-1.95, p<0.001), and lymphovascular invasion (HR 1.28, 95% CI 1.01-1.62, p=0.044). The areas under the curve in the validation dataset were 79.3%, 69.6%, and 76.2%, for 1-, 5-, and 10-year RFS, respectively. Calibration plots showed considerable correspondence between predicted and actual survival probabilities. The decision curve analysis revealed a better net benefit of the nomogram.Conclusion: A nomogram with good discrimination, validation, and clinical utility was constructed utilizing TTC and PBT in addition to standard pathological criteria.

Paradigm shift in transfusion practices during early COVID-19 pandemic:A single center retrospective study

BACKGROUND The advent of coronavirus disease 2019(COVID-19)unveiled the worst national blood crisis that the United States had witnessed in over a decade.With the pandemic influencing the different stages of the acquisition of blood products outside the hospital setting,we aimed to explore the possible barriers contributing to the shortage of blood products within the medical community.the COVID era and pre-COVID era.METHODS We conducted a retrospective cross-sectional study on hospitalized patients distinguishing the pattern of blood transfusion during the COVID and pre-COVID era in a community hospital.Data was tabulated to include the number of red blood cell(RBC)transfusions and if transfusions met restrictive blood transfusion criteria as per institutional guidelines.Chi-square was applied to test the statistical association between qualitative variables.Unpaired t test and Mann Whitney U test were applied respectively to test the mean difference of quantitative variables.RESULTS A total of 208 patients were included in the study,of which 108 were during COVID era and 100 were during pre-COVID era.The leading reason for admission in both the COVID era and pre-COVID era transfused patients was shortness of breath(53.7%and 36%P=0.001),followed by gastrointestinal bleeding(25.9%and 21%P=0.001).There was a higher percentage of RBC transfusions in the intensive care unit in the COVID-era group than in the pre-COVID era group(38.9%vs 22%,P=0.008).The restrictive transfusion criteria were met in 62%vs 79%in the COVID and pre-COVID eras,respectively(P=0.008).CONCLUSION The COVID-era group received RBC transfusions with less stringent adherence to restrictive blood transfusion practices in comparison to pre-COVID era group.

The Impact of Blood Transfusion on the Efficiency of Stem Cell Transplants

Background: While blood product transfusion is essential for managing hematologic deficits in Allogenic Hematopoietic stem cell transplant (AHSCT) recipients, it has risks including infectious disease transmission, alloimmunization, and transfusion reactions. These risks have sparked an ongoing debate regarding the overall impact of transfusions on patient outcomes. Thus, this study aimed to evaluate the impact of Red Blood Cells (RBCs) and/or platelet transfusion on the infection incidence and overall survival in AHSCT patients. Methods: We performed a retrospective analysis of clinical and laboratory data of sixty adult patients with primary malignant hematological disorder who had undergone AHSCT. Participants’ data were categorized into two groups;Group 1 (low transfusion group) consisted of patients receiving 10 units. Quantitative data were expressed as mean ± SD. The t-test of significance and Chi-square (χ2) test were used, with p ≤ 0.05 considered significant. Result: A total of 60 patients’ data was included. In Group 1, out of 30 patients, 13 (43.33%) developed infections. In contrast, Group 2 had 21 (70%) out of 30 patients develop infections. Group 1 had a higher survival rate (57.8%) than Group 2 (transfusion > 10 units) (46.2%) with a chi-square value = 23.56, and p-value Conclusion: The volume of blood product transfusions has a considerable impact on patient outcomes, particularly infection and survival rates. Additional long-term prospective studies and larger randomized controlled trials are needed to strengthen the evidence for determining transfusion protocols for these patients.

The Effect of the Direct Anti-Human Globulin Test on the Clinical Outcome of Patients Receiving Blood Transfusion

Objective:To study the effect of the direct anti-human globulin test on the clinical efficacy of blood transfusion patients.Methods:52 transfused patients were selected for this study,of which 26 cases with positive direct anti-human globulin tests were included in the positive group,and another 26 cases with negative direct anti-human globulin tests were included in the negative group.The apparent efficacy of the patients in the two groups after blood transfusion was compared.Results:After blood transfusion,the apparent efficacy of the negative group was significantly higher,P<0.05;in the positive group,the proportion of the predominantly multi-antibody group was the highest;after blood transfusion,the post-transfusion apparent efficacy of the simple IgG group was higher than that of the multi-antibody group,P<0.05;comparing the intensity of the different antibodies resulted in the 1+group,and the 3+to 4+groups were significantly lower after blood transfusion,P<0.05.Conclusion:The use of the direct antiglobulin test in transfused patients showed that patients with positive results would have better clinical efficacy.Direct anti-human globulin tests will have an impact on the clinical efficacy of blood transfusion in patients with positive results,so it is very important to carry out a direct anti-human globulin test on blood transfusion patients.

First platelet transfusion refractoriness in a patient with acute myelocytic leukemia: A case report

BACKGROUND Platelet transfusion is of great significance in the treatment of thrombocytopenia caused by myelosuppression during intensive chemotherapy in patients with acute leukemia.In recent years,with platelet transfusion increasing,ineffective platelet transfusion has become increasingly prominent.Generally speaking,platelet antibodies can be produced after repeated transfusion,thus rendering subsequent platelet transfusion ineffective.We report a case of first platelet transfusion refractoriness(PTR)in a patient with acute myelocytic leukemia(AML).Due to the rarity of such cases in clinical practice,there have been no relevant case reports so far.CASE SUMMARY A 51-year-old female patient attended the hospital due to throat pain and abnormal blood cells for 4 d.Her diagnosis was acute myelocytic leukemia[M2 type Fms related receptor tyrosine kinase 3,Isocitrate Dehydrogenase 1,Nucleophosmin 1,Neuroblastoma RAS viral oncogene homolog(+)high-risk group].She was treated with"IA"(IDA 10 mg day 1-3 and Ara-C 0.2 g day 1-5)chemotherapy.When her condition improved,the patient was discharged from the hospital,instructed to take medicine as prescribed by the doctor after discharge,and returned to the hospital for further chemotherapy on time.CONCLUSION We report a rare case of first platelet transfusion failure in a patient with AML during induction chemotherapy,which may be related to the production of platelet antibodies induced by antibiotics and excessive tumor load.This also suggests that we should consider the influence of antibiotics when the rare situation of first platelet transfusion failure occurs in patients with AML.When platelet antibodies are produced,immunoglobulins can be used to block antibodies,thereby reducing platelet destruction.For patients with PTR,both immune and non-immune factors need to be considered and combined in clinical practice along with individualized treatment to effectively solve the problem.

The Place of Blood Transfusion in the Management of Obstetric Emergencies in the Gynaecology and Obstetrics Department of the Reference Health Center of Fana (Mali)

This is a prospective and descriptive study carried out at the gynecology and obstetrics department of the reference health center of Fana from 01 May 2019 to 30 November or 7 months. The main objective was to study the role of blood transfusion in the management of obstetric emergencies. During the study period we recorded 434 cases of obstetric emergencies of which 116 cases required an emergency blood transfusion or 26.73%. The most frequently found indications for blood transfusion are hemorrhages of the immediate postpartum 46.6% followed by severe malaria on pregnancy 27.6%. Blood remains the most prescribed and available Labile blood product in the department. Maternal prognosis was improved in 92.2%.

Blood typing and transfusion therapy in a patient with A2 subtype acute myeloid leukemia M2:A case report

BACKGROUND Acute myeloid leukemia(AML)is one of the most common types of leukemia in adults.However,AML is relatively rare in the population overall,accounting for only about 1 percent of all cancers.Treatment for AML can be very effective for some patients,yet it leaves others with serious and even life-threatening side effects.Chemotherapy is still the primary treatment for most AML,but over time,leukemia cells become resistant to chemotherapy drugs.In addition,stem cell transplantation,targeted therapy,and immunotherapy are currently available.At the same time,with the progression of the disease,the patient may have corresponding complications,such as coagulation dysfunction,anemia,granulocytopenia,and repeated infection,so transfusion supportive therapy will be involved in the overall treatment regime.To date,few articles have reported on blood transfusion treatment options for patients with ABO subtypes AML-M2.Blood transfusion therapy is an important supportive treatment for AML-M2,and accurate determination of patients'blood type is one of the most important steps in the treatment process.In this study,we explored blood typing and supportive treatment strategies for a patient with A2 subtype AML-M2 to provide the basis for treatment for all patients.CASE SUMMARY In order to determine the blood type of the patient,serological and molecular biological methods were used for reference tests,and the genetic background was studied to determine the patient's final blood type and select the appropriate blood products for infusion treatment.According to the results obtained by serological and molecular biological methods,the blood type of the patient was A2 subtype;the genotype was A02/001;the irregular antibody screening was negative,and anti-A1 was found in the plasma.According to the overall treatment plan,active anti-infection,elevated cells,component blood transfusion support,and other rescue and supportive treatments were given,and the patient successfully passed the stage of myelosuppression after chemotherapy.Re-examination of bone marrow smears showed that AL was in complete remission of bone marrow signs,and minimal residual leukemia lesions suggested no cells with obvious abnormal immunophenotype(residual leukemia cells<10-4).CONCLUSION The infusion of patients with A2 subtype AML-M2 with A irradiated platelets and O washing red blood cells can meet the needs of clinical treatment.

Frequency of Transfusions and Risk Factor for Bleeding Risk to Guide a Blood-Sparing Program during Hip Arthroplasty in Gabon

Background: Hip arthroplasty is a surgery with a high risk of bleeding. The main objective of this study was to research risk factors for bleeding and transfusion in patients undergoing hip arthroplasty in order to guide a blood-saving program. Method: Retrospective, monocentric, descriptive and analytical study carried out from June 2011 to June 2021 at the Omar Bongo Ondimba army training hospital. The variables studied were demographic characteristics, biological variables, transfusion data, anesthetic and intraoperative data. The primary outcome was intraoperative or postoperative transfusion. A univariate and multivariate analysis was conducted to identify the factors associated with the occurrence of a transfusion. Results: Of the 276 patients included, 179 benefited from Total Hip Prosthesis (THP) and 97 from Intermediate Hip Prosthesis (IHP). Spinal anesthesia was performed in 67.4% of patients. The ASA 2 score predominated (65.9%). The transfusion incidence was 56.9% (157/276). Tranexamic acid was used in 16.3% (45/276) of patients. The average bleeding was 528 ± 405 ml. Preoperative anemia (OR = 0.78, 95% CI [0.66 - 0.91]) and total hip prosthesis (OR = 2.02 95% CI [1.11 - 3.67]) were predictors of bleeding and transfusion to be significant. The average serum hemoglobin predictive of a transfusion was 11.6 ± 1.8. ASA score and operative time were not found as risk factors for bleeding and transfusion. Conclusion: The incidence of transfusion is high. Preoperative anemia remains a major but modifiable risk factor unlike the choice of implant. The implementation of a patient blood management protocol could reduce this transfusion incidence.

Machine Learning for Detecting Blood Transfusion Needs Using Biosignals

Adequate oxygen in red blood cells carrying through the body to the heart and brain is important to maintain life.For those patients requiring blood,blood transfusion is a common procedure in which donated blood or blood components are given through an intravenous line.However,detecting the need for blood transfusion is time-consuming and sometimes not easily diagnosed,such as internal bleeding.This study considered physiological signals such as electrocardiogram(ECG),photoplethysmogram(PPG),blood pressure,oxygen saturation(SpO2),and respiration,and proposed the machine learning model to detect the need for blood transfusion accurately.For the model,this study extracted 14 features from the physiological signals and used an ensemble approach combining extreme gradient boosting and random forest.The model was evaluated by a stratified five-fold crossvalidation:the detection accuracy and area under the receiver operating characteristics were 92.7%and 0.977,respectively.

Assessment of Unmet Transfusion Needs in the Management of Immediate Postpartum Haemorrhage at the Kalaban Coro Reference Health Centre (MALI)

The aim was to assess transfusion needs in the management of immediate postpartum haemorrhage. Materials and Methods: this was a prospective, descriptive, analytical study from 01 January 2018 to 31 October 2018 in the gynecology and obstetrics department of the reference health center of Kalaban-Coro (Mali). Results: During the study period we recorded 32 cases of transfusion of the immediate postpartum out of 109 cases of hemorrhage or 29.35%;for a total of 2425 deliveries or a frequency of 1.31%. The main indications for blood transfusion were: postpartum haemorrhage due to tearing of the soft parts in 21.9%;retroplacental hematoma in 18.6%;uterine rupture in 12.5%;and placenta previa covering hemorrhagic in 12.5%. More than half of the transfused were evacuees, or 62.5%. Unmet transfusion requirements were 59.4%. The blood products requested were: whole blood in 99% of cases and fresh frozen plasma in only 1% of cases. Conclusion: the need for labile blood products remains a reality in obstetrics. The permanent availability of labile blood products improves the prognosis of immediate postpartum haemorrhages.

Is peri-transplant blood transfusion associated with worse transplant outcomes?A retrospective study

BACKGROUND Blood transfusion is common during the peri-transplantation period.The incidence of immunological reactions to blood transfusion after kidney transplantation and their consequences on graft outcomes have not been extensively studied.AIM To examine the risk of graft rejection and loss in patients who received blood transfusion in the immediate peri-transplantation period.METHODS We conducted a single-center retrospective cohort study of 105 kidney recipients,among them 54 patients received leukodepleted blood transfusion at our center between January 2017 and March 2020.RESULTS This study included 105 kidney recipients,of which 80%kidneys were from living-related donors,14%from living-unrelated donors,and 6%from deceased donors.Living-related donors were mostly first-degree relatives(74.5%),while the rest were second-degree relatives.The patients were divided into transfusion(n=54)and non-transfusion(n=51)groups.The average hemoglobin level at which blood transfusion was commenced was 7.4±0.9 mg/dL.There were no differences between the groups in terms of rejection rates,graft loss,or death.During the study period,there was no significant difference in creatinine level progression between the two groups.Delayed graft function was higher in the transfusion group;however,this finding was not statistically significant.A high number of transfused packed red blood cells was significantly associated with increased creatinine levels at the end of the study.CONCLUSION Leukodepleted blood transfusion was not associated with a higher risk of rejection,graft loss,or death in kidney transplant recipients.

Impact of perioperative blood transfusion on oncological outcomes in ampullary carcinoma patients underwent pancreaticoduodenectomy

BACKGROUND The effect of perioperative blood transfusion(PBT)on the prognosis of ampullary carcinoma(AC)is still debated.AIM To explore the impact of PBT on short-term safety and long-term survival in AC patients who underwent pancreaticoduodenectomy.METHODS A total of 257 patients with AC who underwent pancreaticoduodenectomy between 1998 and 2020 in the Cancer Hospital,Chinese Academy of Medical Sciences,were retrospectively analyzed.We used Cox proportional hazard regression to identify prognostic factors of overall survival(OS)and recurrencefree survival(RFS)and the Kaplan-Meier method to analyze survival information.RESULTS A total of 144(56%)of 257 patients received PBT.The PBT group and nonperioperative blood transfusion group showed no significant differences in demographics.Patients who received transfusion had a comparable incidence of postoperative complications with patients who did not.Univariable and multivariable Cox proportional hazard regression analyses indicated that transfusion was not an independent predictor of OS or RFS.We performed Kaplan-Meier analysis according to subgroups of T stage,and subgroup analysis indicated that PBT might be associated with worse OS(P<0.05)but not RFS in AC of stage T1.CONCLUSION We found that PBT might be associated with decreased OS in early AC,but more validation is needed.The reasonable use of transfusion might be helpful to improve OS.

Risk factors for blood transfusion and its prognostic implications in curative gastrectomy for gastric cancer

BACKGROUND Gastric cancer(GC)is still a prevalent neoplasm around the world and its main treatment modality is surgical resection.The need for perioperative blood transfusions is frequent,and there is a long-lasting debate regarding its impact on survival.AIM To evaluate the factors related to the risk of receiving red blood cell(RBC)transfusion and its influence on surgical and survival outcomes of patients with GC.METHODS Patients who underwent curative resection for primary gastric adenocarcinoma at our Institute between 2009 and 2021 were retrospectively evaluated.Clinicopathological and surgical characteristics data were collected.The patients were divided into transfusion and non-transfusion groups for analysis.RESULTS A total of 718 patients were included,and 189(26.3%)patients received perioperative RBC transfusion(23 intraoperatively,133 postoperatively,and 33 in both periods).Patients in the RBC transfusions group were older(P<0.001),and had morecomorbidities(P=0.014),American Society of Anesthesiologists classification III/IV(P<0.001),and lower preoperative hemoglobin(P<0.001)and albumin levels(P<0.001).Larger tumors(P<0.001)and advanced tumor node metastasis stage(P<0.001)were also associated with the RBCtransfusion group.The rates of postoperative complications(POC)and 30-d and 90-d mortalitywere significantly higher in the RBC transfusion group than in the non-transfusion group.Lowerhemoglobin and albumin levels,total gastrectomy,open surgery,and the occurrence of POC werefactors associated with the RBC transfusion.Survival analysis demonstrated that the RBCtransfusions group had worse disease-free survival(DFS)and overall survival(OS)compared withpatients who did not receive transfusion(P<0.001 for both).In multivariate analysis,RBCtransfusion,major POC,pT3/T4 category,pN+,D1 lymphadenectomy,and total gastrectomywere independent risk factors related to worse DFS and OS.CONCLUSIONPerioperative RBC transfusion is associated with worse clinical conditions and more advancedtumors.Further,it is an independent factor related to worse survival in the curative intentgastrectomy setting.

Successful Treatment of Severe Heparin-induced Thrombocytopenia with Intravenous Immunoglobulin, Platelet Transfusion and Rivaroxaban: A Case Report

Heparin-induced thrombocytopenia(HIT) is a relatively infrequent complication of heparin administration. HIT can cause devastating thrombosis, making it one of the most serious adverse drug reactions encountered in clinical practice. We successfully treated a case of severe HIT presenting with thrombosis and life-threatening bleeding complications with intravenous immunoglobulin(IVIG), platelet transfusion and oral anticoagulant Rivaroxaban. In this case, we considered that IVIG played the most important role by preventing further thrombosis, increasing the platelet count, and ensuring the efficacy of Rivaroxaban. We therefore suggest that IVIG might be the optimal treatment for patients with this urgent condition.

Blood loss,predictors of bleeding,transfusion practice and strategies of blood cell salvaging during liver transplantation

Blood loss during liver transplantation (OLTx) is a common consequence of pre-existing abnormalities of the hemostatic system,portal hypertension with multiple collateral vessels,portal vein thrombosis,previous abdominal surgery,splenomegaly,and poor "functional" recovery of the new liver.The intrinsic coagulopathic features of end stage cirrhosis along with surgical technical difficulties make transfusion-free liver transplantation a major challenge,and,despite the improvements in understanding of intraoperative coagulation profiles and strategies to control blood loss,the requirements for blood or blood products remains high.The impact of blood transfusion has been shown to be significant and independent of other well-known predictors of posttransplant-outcome.Negative effects on immunomodulation and an increased risk of postoperative complications and mortality have been repeatedly demonstrated.Isovolemic hemodilution,the extensive utilization of thromboelastogram and the use of autotransfusion devices are among the commonly adopted procedures to limit the amount of blood transfusion.The use of intraoperative blood salvage and autologous blood transfusion should still be considered an important method to reduce the need for allogenic blood and the associated complications.In this article we report on the common preoperative and intraoperative factors contributing to blood loss,intraoperative transfusion practices,anesthesiologic and surgical strategies to prevent blood loss,and on intraoperative blood salvaging techniques and autologous blood transfusion.Even though the advances in surgical technique and anesthetic management,as well as a better understanding of the risk factors,have resulted in a steady decrease in intraoperative bleeding,most patients still bleed extensively.Blood transfusion therapy is still a critical feature during OLTx and various studies have shown a large variability in the use of blood products among different centers and even among individual anesthesiologists within the same center.Unfortunately,despite the large number of OLTx performed each year,there is still paucity of large randomized,multicentre,and controlled studies which indicate how to prevent bleeding,the transfusion needs and thresholds,and the "evidence based" perioperative strategies to reduce the amount of transfusion.

Long-lasting discussion: Adverse effects of intraoperative blood loss and allogeneic transfusion on prognosis of patients with gastric cancer

Gastrectomy with radical lymph node dissection is the most promising treatment avenue for patients with gastric cancer. However, this procedure sometimes induces excessive intraoperative blood loss and requires perioperative allogeneic blood transfusion. There are lasting discussions and controversies about whether intraoperative blood loss or perioperative blood transfusion has adverse effects on the prognosis in patients with gastric cancer. We reviewed laboratory and clinical evidence of these associations in patients with gastric cancer. A large amount of clinical evidence supports the correlation between excessive intraoperative blood loss and adverse effects on the prognosis. The laboratory evidence revealed three possible causes of such adverse effects: anti-tumor immunosuppression, unfavorable postoperative conditions, and peritoneal recurrence by spillage of cancer cells into the pelvis. Several systematic reviews and meta-analyses have suggested the adverse effects of perioperative blood transfusions on prognostic parameters such as all-cause mortality, recurrence, and postoperative complications. There are two possible causes of adverse effects of blood transfusions on the prognosis: Anti-tumor immunosuppression and patient-related confounding factors (e.g., preoperative anemia). These factors are associated with a worse prognosis and higher requirement for perioperative blood transfusions. Surgeons should make efforts to minimize intraoperative blood loss and transfusions during gastric cancer surgery to improve patients’ prognosis.

Effect of Point-of-care Hemoglobin/Hematocrit Devices and Autologous Blood Salvage on Reduction of Perioperative Allogeneic Blood Transfusion

Objective To evaluate the effect of point-of-care hemoglobin/hematocrit(POC HGB/HCT) devices and intraoperative blood salvage on the amount of perioperative allogeneic blood transfusion and blood conservation in clinical practice. Methods A total of 46 378 medical records of 22 selected hospitals were reviewed. The volume of allogeneic red blood cell and plasma, number of patients transfused, number of intraoperative autologous blood salvage, total volume of autologous blood transfusion, and amount of surgery in the year of 2011 and 2013 were tracked. Paired t-test was used in intra-group comparison, while t-test of two isolated samples carried out in inter-group comparison. P<0.05 was defined as statistically significant difference. Results In the hospitals where POC HGB/HCT device was used(n=9), the average allogeneic blood transfusion volume per 100 surgical cases in 2013 was significantly lower than that in 2011(39.86±20.20 vs. 30.49±17.50 Units, t=3.522, P=0.008). In the hospitals without POC HGB/HCT meter, the index was not significantly different between 2013 and 2011. The average allogeneic blood transfusion volume was significantly reduced in 2013 than in 2011 in the hospitals where intraoperative autologous blood salvage ratio [autologous transfusion volume/(autologous transfusion volume+allogeneic transfusion volume)] was increased(n=12, t=2.290, P=0.042). No significant difference of the above index was found in the hospitals whose autologous transfusion ratio did not grow. Conclusion Intraoperative usage of POC HGB/HCT devices and increasing autologous transfusion ratio could reduce perioperative allogeneic blood transfusion.

Intraoperative cell salvage with autologous transfusion in liver transplantation

Liver transplant(LT) is the primary treatment for patients with end-stage liver disease. About 25000 LTs are performed annually in the world. The potential for intraoperative bleeding is quite variable. However, massive bleeding is common and requires blood transfusion. Allogeneic blood transfusion has an immunosuppressive effect and an impact on recipient survival, in addition to the risk of transmission of viral infections and transfusion errors, among others.Techniques to prevent excessive bleeding or to use autologous blood have been proposed to minimize the negative effects of allogeneic blood transfusion.Intraoperative reinfusion of autologous blood is possible through previous selfdonation or blood collected during the operation. However, LT does not normally allow autologous transfusion by prior self-donation. Hence, using autologous blood collected intraoperatively is the most feasible option. The use of intraoperative blood salvage autotransfusion(IBSA) minimizes the perioperative use of allogeneic blood, preventing negative transfusion effects without negatively impacting other clinical outcomes. The use of IBSA in patients with cancer is still a matter of debate due to the theoretical risk of reinfusion of tumor cells. However, studies have demonstrated the safety of IBSA in several surgical procedures, including LT for hepatocellular carcinoma. Considering the literature available to date, we can state that IBSA should be routinely used in LT, both in patients with cancer and in patients with benign diseases.