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.

Severe hyperkalemia following blood transfusions:Is there a link?

Patients with gastrointestinal bleeding often require large volume blood transfusion. Among the various side effects of blood transfusion,the increase of potassium levels is a serious one which is often overlooked. We report a case of severe hyperkalemia in a patient with gastric bleeding after large volume transfusion of packed red blood cells. The patient had hyperkalemia at baseline associated with his receiving medication as well as acute renal failure following hypovolemia. The baseline hyperkalemia was further aggravated after massive transfusions of packed red blood cells in a short period of time. The associated pathogenetic mechanisms resulting in the increase of potassium levels are presented. A number of risk factors which increase the risk of hyperkalemia after blood transfusion are discussed. Moreover,appropriate management strategies for the prevention of blood transfusion associated hyperkalemia are also presented. Physicians should always keep in mind the possibility of hyperkalemia in cases of blood transfusion.

Development of necrotizing enterocolitis after blood transfusion in very premature neonates

Background Prior studies report conflicting evidence on the association between packed red blood cell(PRBC)transfu-sions and necrotizing enterocolitis(NEC),especially in early weeks of life where transfusions are frequent and spontaneous intestinal perforation can mimic NEC.The primary objective of this study was to evaluate the association between PRBC transfusions and NEC after day of life(DOL)14 in very premature neonates.Methods A retrospective cohort analysis of very premature neonates was conducted to investigate association between PRBC transfusions and NEC after DOL 14.Primary endpoints were PRBC transfusions after DOL 14 until the date of NEC diagnosis,discharge,or death.Wilcoxon ranked-sum and Fisher's exact tests,Cox proportional hazards regression,and Kaplan-Meier curves were used to analyze data.Results Of 549 premature neonates,186(34%)received transfusions after DOL 14 and nine(2%)developed NEC(median DOL=38;interquartile range=32-46).Of the nine with NEC after DOL 14,all were previously transfused(P<0.001);therefore,hazard of NEC could not be estimated.Post hoc analysis of patients from DOL 10 onward included five additional patients who developed NEC between DOL 10 and DOL 14,and the hazard of NEC increased by a factor of nearly six after PRBC transfusion(hazard ratio=5.76,95%confidence interval=1.02-32.7;P=0.048).Conclusions Transfusions were strongly associated with NEC after DOL 14.Prospective studies are needed to determine if restrictive transfusion practices can decrease incidence of NEC after DOL 14.