TRANSFUSION ISSUES

Intraoperative transfusion of 1 u to 2 u packed red blood cells is associated with increased 30-day mortality, surgical-site infection, pneumonia, and sepsis in general surgery patients. J Am Coll Surg. 2009 May;208(5):931-937.e2. Epub 2009 Mar 26. Intraoperative transfusion of PRBCs increases risk for mortality and several morbidities in general surgery patients. These risks, substantial for even 1 U, remain after adjustment for transfusion propensity and numerous risk factors available in the American College of Surgeons National Surgical Quality Improvement Program. Transfusion for mildly hypovolemic or anemic patients should be discouraged in light of these risks.

BLOOD MANAGEMENT

Perioperative blood conservation. Eur J Anaesthesiol. 2009 May 14. [Epub ahead of print]. Review

Blood loss in surgical oncology: Neglected quality indicator? J Surg Oncol. 2009 May 22;99(8):508-512. [Epub ahead of print] Blood loss is a modifiable quality indicator for oncologic cancer surgery. Surgical oncologists need to alter their surgical technique to promote bloodless surgery and decrease the variability in reported blood loss and rates of blood transfusion

SURGICAL TECHNOLOGIES

[First robotic-assisted laparoscopic liver resection in Latin America.]Arq Gastroenterol. 2009 Jan-Mar;46(1):78-80. Portuguese Case report

TRANSFUSION ISSUES

Red blood cell supernatant potentiates LPS-induced proinflammatory cytokine response from peripheral blood mononuclear cells. J Interferon Cytokine Res. 2009 Jun;29(6):333-8 Packed red blood cell supernatant potentiates proinflammatory lipopolysaccharide-induced cytokine secretion from PBMCs. This response is accentuated with storage duration and partially attenuated with leukoreduction. These findings may partially explain the immune activation seen clinically after blood transfusion.

Cytomegalovirus infection in critically ill patients: a systematic review. Crit Care. 2009 May 14;13(3):R68. [Epub ahead of print] CMV infection occurs in 0-36% of critically ill patients, mostly between 4-12 days after ICU admission. Potential risk factors for CMV infection include sepsis, requirement of mechanical ventilation, and transfusions. CMV infection frequently occurs in critically ill immunocompetent patients and may be associated with poor outcomes

The association of perioperative red blood cell transfusions and decreased long-term survival after cardiac surgery. Anesth Analg. 2009 Jun;108(6):1741-6. Exposure to 1 or 2 U of RBCs was associated with a 16% increased hazard of decreased survival after cardiac surgery.

First transmission of human immunodeficiency virus Type 1 by a cellular blood product after mandatory nucleic acid screening in Germany. Transfusion. 2009 May 11. [Epub ahead of print] This case represents the first documented HIV-1 transmission by transfusion of red blood cells after mandatory introduction of HIV-1 NAT for blood screening in Germany. Low viral load and mismatches in the primer/probe region might explain the detection failure of the NAT screening assay. A certain risk remains that new virus variants contain mutations at positions critical for amplification or detection of viral genomes.

Swine flu concerns impact blood supply on Long Island
The threat of the swine flu has started affecting the blood supply on Long Island, N.Y., as several schools in the area canceled their blood drives when they were forced to close, and some potential donors declined to give blood for fear that it may weaken their immune systems. The Long Island Blood Services said it collected 3,000 fewer blood pints in April compared with the same month last year.

SURGICAL TECHNOLOGIES

The impact of robotics on practice management of endometrial cancer: transitioning from traditional surgery. Int J Med Robot. 2009 May 19. [Epub ahead of print] Robotics was associated with significantly less blood loss (p < 0.0001). Complication rates were significantly lower in the robotic group compared to the laparotomy group (p = 0.05).

Comparison of Robotic-assisted versus Retropubic Radical Prostatectomy Performed by a Single Surgeon. Anticancer Res. 2009 May;29(5):1637-42. Significant differences were found in blood loss (robotic-assisted laparoscopic radical prostatectomy 314 mL vs. retropubic radical prostatectomy 912 mL) and transfusion rates (RALP 13.3% vs. RRP 60%) between groups.

TRANSFUSION ISSUES

[TRALI and TACO: Diagnostic and clinical management.]. Transfus Clin Biol. 2009 May 11. [Epub ahead of print] French. Review

Red Blood Cell Supernatant Potentiates LPS-Induced Proinflammatory Cytokine Response From Peripheral Blood Mononuclear Cells. J Interferon Cytokine Res. 2009 May 14. [Epub ahead of print] Allogeneic blood transfusion has an immunomodulatory capacity on its recipients through accumulation of immunologically active substances with blood storage, and prestorage leukoreduction reduces many of these mediators

CELL SALVAGE

Cell salvage at caesarean section: the need for an evidence-based approach. BJOG. 2009 May;116(6):743-7 Haemorrhage, a leading cause of maternal morbidity and mortality, is frequently associated with caesarean section. Allogeneic blood is an increasingly rare and scare resource. Intraoperative Cell Salvage (IOCS) offers the possibility of improving outcome and reducing allogeneic blood transfusion in cases of haemorrhage at caesarean section. The available literature on the use of IOCS in obstetrics demonstrates that there is limited evidence to support or refute the use of IOCS at caesarean section.

COAGULATION

The role of thromboelastometry and recombinant factor VIIa in trauma. Curr Opin Anaesthesiol. 2009 Apr;22(2):281-8. Recent evidence encourages the early use of rFVIIa and thromboelastography in the severe trauma patient with hemorrhagic shock, as a component of the damage control strategy. rFVIIa may decrease short-term mortality and the rate of required blood components during resuscitation, with no apparent increase in thromboembolic complications. Thromboelastometry enables better and earlier recognition of the coagulopathy accompanying such trauma patients. In patients with traumatic brain injury and coagulopathy, rFVIIa may delay or even halt the need for surgery, with no proven decrease in mortality. In those who needed urgent neurosurgical intervention, rFVIIa may rapidly correct the coagulopathy, enabling earlier and safer surgical intervention.

BLOOD SUBSTITUTES

Glutaraldehyde-polymerized bovine hemoglobin and phosphodiesterase-5 inhibition. Crit Care Med. 2009 Apr 20. [Epub ahead of print] The HBOC used in this study resulted in pulmonary and systemic hypertension, reduced cardiac output, and oxygen delivery. These negative consequences of HBOC treatment can be largely overcome by combing HBOC treatment with a PDE5 inhibitor (sildenafil). Thus, these data support the continued investigation of combined HBOC and PDE5 inhibitor treatment in circumstances in which HBOC therapy is being considered.