Effect of packed red blood cell transfusion on the prognosis of patients with upper gastrointestinal bleeding:a retrospective analysis of eICU-CRD v2.0 multicenter critically ill patients database

Background:The effects of packed red blood cell(PRBC)transfusion on the prognosis of patients with upper gastrointestinal bleeding(UGIB),particularly on the 30-day mortality rate,are unclear.This study aimed to determine the prognostic influence of PRBC transfusion in patients with UGIB with different hemoglobin(Hb)levels.Methods:The subjects in this study were selected from the Philips Electronic ICU Collaborative Research Database Version 2.0 multi-center critically ill patient database from January 2014 to December 2015.A total of 4689 patients were included in this study.The Hb levels were divided into 3 groups:Hb<6 g/dL(Group 1),6 g/dL≤Hb<8 g/dL(Group 2),and Hb≥8 g/dL(Group 3).Based on the ad-ministration of PRBC transfusion,each group was subdivided into PRBC and non-PRBC groups.Results:A total of 4689 patients were enrolled in the study,including 825,2195,and 1669 patients in Groups 1,2,and 3,respectively.Furthermore,the PRBC and non-PRBC groups consisted of 1847 and 2842 patients,respectively.There was no significant difference in the 30-day mortality rate between Group 1 and Group 2 or between the PRBC and non-PRBC subgroups.In Group 3,the 30-day mor-tality rate of patients who received transfusion was higher than that of patients who did not(13.29%vs 9.14%,P=0.029).For the PRBC group,the difference in 30-day mortality rate was not statistically significant among the 3 groups,whereas for the non-PRBC group,the 30-day mortality rate in Group 3 was the lowest,and there was a significant difference among the 3 groups(P=0.003).There was no significant difference in the subgroup analysis of bleeding at different sites and etiologies.Conclusion:Packed red blood cell transfusion does not improve prognosis or reduce mortality in patients with UGIB but may increase mortality in patients with Hb levels greater than 8 g/dL.

Use of donor-specific red blood cell transfusions for patients undergoing liver transplantation during the COVID-19 pandemic

Background:Increased risks have been found for patients undergoing liver transplantation due to the blood supply shortage following the ongoing coronavirus disease 2019(COVID-19)pandemic.Hence,exploring a method to alleviate this dilemma is urgent.This phase I,nonrandomized,prospective trial aimed to evaluate the safety and feasibility of using donor-specific red blood cell transfusion(DRBCT)as an urgent measurement to alleviate the blood supply shortage in deceased donor liver transplantation(DDLT).Methods:The outcomes of 26 patients who received DRBCT and 37 patients in the control group who only received 3rd party packed red blood cells(pRBCs)transfusion between May 2020 and January 2021 were compared.Results:Patients receiving DRBCT did not develop transfusion-related complications,and the incidence of postoperative infection was similar to that in the control group(23.1%vs.18.9%,P=0.688).Because the patients received the red blood cells from organ donors,the median volume of intraoperative allogeneic red blood cell transfusion from blood bank was 4.0 U(IQR 1.1-8.0 U)in the DRBCT group,which is significantly lower than that(7.5 U,IQR 4.0-10.0 U)in the control group(P=0.018).The peak aspartate aminotransferase(AST)level was significantly lower in the DRBCT group than in the control group(P=0.008)and so were the AST levels in the first two days after the operation(P=0.006 and P=0.033).Conclusions:DRBCT is a safe and effective procedure to lower the need for blood supply and is associated with a reduction in AST levels after transplantation.DRBCT is beneficial to patients receiving life-saving transplantation without sufficient blood supply during the COVID-19 pandemic.

Analysis of Factors Influencing the Effect of Red Blood Cell Suspension Infusion in Children

Objective: The related factors of no improvement of hypoxia and ineffective infusion were analyzed to provide new ideas, clinical observation and evaluation pathway for RBC transfusion in clinical children. Methods: Retrospective analysis from January 2020 to December 2020, Guangzhou women and children’s medical center hospital in the emergency observation room of 249 children under 1 month to 18 years of blood cell suspension infusion, analyze the clinical effect of red blood cell infusion and children gender, age, fever after transfusion, disease type, delay transfusion. The possible influencing factors were analyzed by logistic regression. Results: Invalid transfusion was associated with the type of transfusion product (P = 0.032), logistic regression analysis showed that patients infused with washed RBC suspension were 3.231 times more likely to not achieve the expected effect than those infused with RBC suspension (P = 0.025). Failure transfusion was associated with the type of transfusion products. In ineffective transfusion was closely related to post-transfusion fever (P P P = 0.031). Logistic regression analysis showed that fever after transfusion was a risk factor for no improvement of hypoxia (OR = 5.809, P = 0.001), and the improvement of hypoxia in adolescent children was 10.744 times higher than that of infants (0 - 3 years old). Late transfusion hypoxia improvement was 4.212 times more likely to achieve no effect than timely transfusion. If ineffective infusion of red blood cells is considered and hypoxia after transfusion is not improved, univariate suggests a close correlation with fever after transfusion (P = 0.002), logistic regression analysis showed that fever after transfusion was an independent risk factor (OR = 7.258, P = 0.002). Conclusion: There was no correlation between the ineffective transfusion of red blood cells and the type of disease affected in the child. Infusion of red cell suspension has an advantage over the wash red cell infusion. Ineffective RBC transfusion and no improvement in hypoxia after transfusion were closely related to post-transfusion fever, with no difference between children in all age groups. Red blood cell infusion in pediatric clinical treatment activities should pay attention to adolescent children, especially female children to give more attention, and give timely red blood cell infusion as much as possible.