Mortality, increased blood transfusion

Chatterjee S, Wetterslev J, Sharma A, lichstein E, Mukherjee D. Association of blood transfusion with increased mortality in myocardial infarction a meta-analysis and diversity-adjusted study sequential analysis. JAMA Intern Med 2013 173(2) 132-9. 

Hydroxyurea reduced the frequency of hospitalizations and the incidences of pain, acute chest syndrome, and blood transfusions by almost 50% in a landmark trial in adult SCD patients with moderate to severe disease. Hemoglobin and HbF concentrations increased, and hemolysis decreased.22 A follow-up study demonstrated a 40% reduction in mortality over a 9-year period in patients continuing to receive hydroxyurea.23 Not all patients responded equally, so hydroxyurea may not be the answer for all patients. 

Recurrent episodes are common approximately 50% in one study, and are associated with mortality. Options for management of recurrence include observation, chronic transfusion, and splenectomy. Observation is common in adults because they tend to have milder episodes. Increased risk of invasive infection after splenectomy is a concern in young children. Chronic transfusion may allow delaying splenectomy and temporarily restore splenic function, but it is associated with its own risks. Splenectomy is probably indicated, even after a single sequestration crisis, if that event is life-threatening. Splenectomy should be considered after repetitive episodes, even if they are less serious. For children less than 2 years of age, chronic blood transfusions have been recommended to prevent sequestration and to delay splenectomy until the age of 2, when the risk of postsplenectomy septicemia is less. Finally, splenectomy should also be considered for patients with chronic hypersplenism. " ... 

The answer ts3[IVA2fl. Recommended treatment for rattlesnake bites includes immobilization to reduce spread of the venom, blood transfusion and fluids to treat shcxTc, atKl administration of drugs to control the intense pain (e.g., meperidine) and anxiety (diphenhydramine). Antibiotics are used to control secondary infections. Corticosteroids are not recommended because they have been associated with increased mortality and they may alter parameters of the crwnplete blood count and serum chemistry that ate used to assess prognose. 

An important overall approach for treatment of sepsis is goal-directed therapy. Mortality can be reduced by early placement and use of a central venous catheter, increased fluid volume administration, dobutamine therapy if needed, and red blood cell transfusion, to achieve specific physiologic goals in the first 6 hours. Evidence-based treatment recommendations for sepsis and septic shock from the Surviving Sepsis campaign are presented in Table 45-3. 

Other issues that must be considered with blood product administration include monitoring for transfusion-related reactions and attention to appropriate warming, particularly when large volumes are given to pediatric patients, because hypothermia is associated with increased fluid requirements and mortality." ... 

Human herpesvirus 8 (HHV-8) is endemic in Uganda, so researchers evaluated mortality after transfusion of HHV-8 antibody-positive blood [159 J. They identified an increased risk of mortality when HHV-8 seropositive blood stored 4days or less was transfused (aHR 1.92,95% Cl=1.21-3.05). 

---