Transfusion associated mortality

Leukocyte contamination has been associated with increased transfusion associated mortality as a result of transfusion-related immune modulation, with cancer growth and impaired immunity against infections as suspected consequences. However, in two randomized studies, cancer growth was not found to be influenced by transfusion of leukodepleted and non-depleted erythrocytes [25 ]. The association with postoperative infections and leukocyte-containing transfusions could not be confirmed in a meta-analysis [26 ]. 

Epoetin Alfa [Erythropoietin/ EPO] (Epogen/ Procrit) [Recombinant Human Erythropoietin] WARNING Use lowest dose possible may be associated w/1 CV, thromboembolic events /or mortality D/C if Hgb >12 g/dL Uses CRF associated anemia zidovudine Rx in HIV-infected pts, CA chemo -1- transfusions associated w/ surgery Action Induces ery-thropoiesis Dose Adul Peds. 50-150 Units/kg IV/SQ 3x/wk adjust dose q4-6wk PRN Surgery 300 Units/kg/d x 10 d before to 4 d after -I dose if Hct 36% or Hgb, T > 12 g/dL or Hgb t >1 g/dL in 2-wk pmod hold dose if Hgb >12 g/dL Caution [C, +] Contra Uncontrolled HTN Disp Inj SE HTN, HA, fatigue, fever, tach, NA Interactions None noted EMS Monitor ECG for hypokalemia (peaked T waves) t risk of CV thrombotic events OD May cause HA, dizziness, SOB and polycythemia symptomatic and supportive... 

Buskell Z, et al. Long-term mortality and morbidity of transfusion-associated non-A, non-B, and type C hepatitis A National Heart, Lung, and Blood Institute collaborative study. Hepatology 2001 33 455-63. 

Dixon B, Santamaria JD, Reid D, CoUins M, Rechnitzer T, Newcomb AE, et al. The association of blood transfusion with mortality after cardiac surgery cause or confounding (CME). Transfusion 2013 53(l) 19-27. 

Blood transfusion is frequently associated with mild allergic reactions more serious hemolytic transfusion reactions, transfusion-related acute respiratory distress syndrome, and even fatal acute hemolytic transfusion reactions are rare but do exist. Finally, administrative errors remain one of the main causes of transfusion-related morbidity and mortality. 

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." ... 

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 immune system is also compromised in uremia. That and the use of dialysis catheters and synthetic grafts, the frequent blood transfusions, the exposure to nosocomial organisms during repeated hospitalization, the presence of anemia and malnutrition, and the immunocompromised state associated with certain renal diseases (nephrotic syndrome, lupus erythematosus) all conspire to make infection a major cause of mortality, accounting for 15-20% of uremic deaths. Pyogenic infections are facilitated by impaired neutrophil adherence and chemotaxis (L7, S27), blunted antibody response (B15), and defective phagocytosis by macrophages due to decreased Fc-receptor activity (R19). 

Virases The risk of transfusion-related viral infection is significantly lower than the risk of bacterial infections [3 ]. Of all human herpesviruses, cytomegalovirus (CMV) is the most significant cause of transfusion-related morbidity and mortality. Because CMV may be associated with leukocytes in blood products, the incidence of transfusion-related CMV infection is significantly reduced after the use of leukocyte reduction techniques. The residual risks of transfusion-related infection with hepatitis B virus, hepatitis C virus, and HIV are respectively... 

In several studies, transfusion of older compared with fresh erythrocytes has been associated with increased mortality, prolonged hospitalization, intensive care treatment, mechanical ventilation, an increased risk of postoperative pneumonia, infection at any site, and multiorgan failure [21, 22 ]. However, most studies suffered from not adjusting the data for the number of units transfused. Patients who received old erythrocytes often received more cells on average than recipients of fresh erythrocytes. The amount of ceUs transfused reflects the severity of the illness, co-morbidity, and a poorer baseline prognosis [23 ]. A meta-analysis did not support the suspicion that old erythrocytes are associated with common adverse mor-bidity/mortality outcomes [24 ]. 

Observational studies In a retrospective cohort analysis, using an intensive care unit database, of the effect of antithrombin III compared with standard therapy on outcomes and erythrocyte transfusion rates in 545 postoperative surgical patients with severe sepsis, antithrombin III therapy was associated with a significantly higher frequency of erythrocyte transfusion (22 versus 9 units) there was no beneficial effect on mortality [37 ]. 

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. 

In 2599 consecutive patients undergoing cardiac surgery at one centre, 1016 patients were transfused erythrocytes, and transfusion was not associated with mortality [22 ]. In fact, blood transfusion was correlated with chest tube drainage, which did show a dose-dependent risk with mortality. 

Death Sixty-five patients with colorectal cancer and liver metastasis were studied in a case series [42 ]. Twenty-three received perioperative plasma transfusion, while 42 did not. In a multivariate analysis, plasma transfusion was associated with increased risk of mortality (RR=4.9,95% Cl=1.4-16.3, p=0.009). 

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. 

Hladik W, Pettett PE, Hancock J, Downing R, Gao H, Packel L, et al. Association between transfusion with human herpesvirus 8 antibodypositive blood and subsequent mortality. J Infect Dis 2012 206(10) 1497-503. 

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