Blood Transfusion Practices in Cardiac Anaesthesia

Overview

Journal Indian J Anaesth

Specialty Anesthesiology

Date 2014 Dec 24

PMID 25535425

Citations 1

Authors

Hanumantha Rao Mangu

Aloka Samantaray

Muralidhar Anakapalli

Affiliations

Soon will be listed here.

Abstract

The primary reasons for blood transfusion in cardiac surgery are to correct anaemia and to improve tissue oxygen delivery. However, there is a considerable debate regarding the actual transfusion trigger at which the benefits of transfusion overweight the risk. The association between extreme haemodilution, transfusion and adverse outcome after cardio pulmonary bypass (CPB) is not clear and the current available literature is not sufficient to provide a strong recommendation regarding the safe haematocrit range during CPB. There is no quality evidence to support use of fresh red blood cell except during massive transfusion or exchange transfusion in neonate. Overall concern regarding the safety of allogeneic blood transfusion resulted in the search for autologous blood transfusion and perioperative blood salvage. The aim of this review is to provide cardiac surgery specific clinically useful guidelines pertaining to transfusion triggers, optimal haemodilution during CPB, autologous blood transfusion and role of perioperative blood salvage based on available evidence.

Citing Articles

The correlation of post-operative acute kidney injury and perioperative anaemia in patients undergoing cardiac surgery with cardiopulmonary bypass.

Baranauskas T, Kauniene A, Svagzdiene M, Sirvinskas E, Lenkutis T Acta Med Litu. 2019; 26(1):79-86.

PMID: 31281220 PMC: 6586387. DOI: 10.6001/actamedica.v26i1.3959.

References

Karkouti K, Beattie W, Wijeysundera D, Rao V, Chan C, Dattilo K . Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg. 2005; 129(2):391-400. DOI: 10.1016/j.jtcvs.2004.06.028. View

. Practice Guidelines for blood component therapy: A report by the American Society of Anesthesiologists Task Force on Blood Component Therapy. Anesthesiology. 1996; 84(3):732-47. View

Boldt J, Kling D, von Bormann B, Zuge M, Scheld H, Hempelmann G . Blood conservation in cardiac operations. Cell separation versus hemofiltration. J Thorac Cardiovasc Surg. 1989; 97(6):832-40. View

Ranucci M, Conti D, Castelvecchio S, Menicanti L, Frigiola A, Ballotta A . Hematocrit on cardiopulmonary bypass and outcome after coronary surgery in nontransfused patients. Ann Thorac Surg. 2010; 89(1):11-7. DOI: 10.1016/j.athoracsur.2009.07.078. View

Ferraris V, Brown J, Despotis G, Hammon J, Reece T, Saha S . 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg. 2011; 91(3):944-82. DOI: 10.1016/j.athoracsur.2010.11.078. View

Sanders J, Patel S, Cooper J, Berryman J, Farrar D, Mythen M . Red blood cell storage is associated with length of stay and renal complications after cardiac surgery. Transfusion. 2011; 51(11):2286-94. DOI: 10.1111/j.1537-2995.2011.03170.x. View

DeFoe G, Ross C, Olmstead E, Surgenor S, Fillinger M, Groom R . Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group. Ann Thorac Surg. 2001; 71(3):769-76. DOI: 10.1016/s0003-4975(00)02393-6. View

Daane C, Golab H, Meeder J, Wijers M, Bogers A . Processing and transfusion of residual cardiopulmonary bypass volume: effects on haemostasis, complement activation, postoperative blood loss and transfusion volume. Perfusion. 2003; 18(2):115-21. DOI: 10.1191/0267659103pf647oa. View

Ranganathan P, Ahmed S, Kulkarni A, Divatia J . Appropriateness of perioperative blood transfusion in patients undergoing cancer surgery: A prospective single-centre study. Indian J Anaesth. 2012; 56(3):234-7. PMC: 3425281. DOI: 10.4103/0019-5049.98763. View

10.

Yap C, Lau L, Krishnaswamy M, Gaskell M, Yii M . Age of transfused red cells and early outcomes after cardiac surgery. Ann Thorac Surg. 2008; 86(2):554-9. DOI: 10.1016/j.athoracsur.2008.04.040. View

11.

Saczkowski R, Bernier P, Tchervenkov C, Arellano R . Retrograde autologous priming and allogeneic blood transfusions: a meta-analysis. Interact Cardiovasc Thorac Surg. 2008; 8(3):373-6. DOI: 10.1510/icvts.2008.195354. View

12.

Fang W, Helm R, Krieger K, Rosengart T, DuBois W, Sason C . Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery. Circulation. 1997; 96(9 Suppl):II-194-9. View

13.

Vonk A, Meesters M, Garnier R, Romijn J, van Barneveld L, Heymans M . Intraoperative cell salvage is associated with reduced postoperative blood loss and transfusion requirements in cardiac surgery: a cohort study. Transfusion. 2013; 53(11):2782-9. DOI: 10.1111/trf.12126. View

14.

Murphy G, Reeves B, Rogers C, Rizvi S, Culliford L, Angelini G . Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation. 2007; 116(22):2544-52. DOI: 10.1161/CIRCULATIONAHA.107.698977. View

15.

Middelburg R, van de Watering L, Briet E, van der Bom J . Storage time of red blood cells and mortality of transfusion recipients. Transfus Med Rev. 2012; 27(1):36-43. DOI: 10.1016/j.tmrv.2012.06.002. View

16.

Sun P, Ji B, Sun Y, Zhu X, Liu J, Long C . Effects of retrograde autologous priming on blood transfusion and clinical outcomes in adults: a meta-analysis. Perfusion. 2013; 28(3):238-43. DOI: 10.1177/0267659112474861. View

17.

Hajjar L, Vincent J, Galas F, Nakamura R, Silva C, Santos M . Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA. 2010; 304(14):1559-67. DOI: 10.1001/jama.2010.1446. View

18.

Gomathi G, Varghese R . Audit of use of blood and its components in a tertiary care center in South India. Asian J Transfus Sci. 2012; 6(2):189. PMC: 3439764. DOI: 10.4103/0973-6247.98952. View

19.

Habib R, Zacharias A, Schwann T, Riordan C, Engoren M, Durham S . Role of hemodilutional anemia and transfusion during cardiopulmonary bypass in renal injury after coronary revascularization: implications on operative outcome. Crit Care Med. 2005; 33(8):1749-56. DOI: 10.1097/01.ccm.0000171531.06133.b0. View

20.

Wiefferink A, Weerwind P, Heerde W, Teerenstra S, Noyez L, de Pauw B . Autotransfusion management during and after cardiopulmonary bypass alters fibrin degradation and transfusion requirements. J Extra Corpor Technol. 2007; 39(2):66-70. PMC: 4680668. View