Increased Demand for Blood Transfusion in Cardiac Surgery: Simple but Unsolved Common Problem

Mahnoosh Foroughi--- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,
Majid Golestani Eraghi--- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Elham Ahmadi Fard--- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,
Zahra Ansari Aval--- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,
Hanieh Majidi Tehrani--- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,
Masoud Majidi Tehrani--- Cardiovascular Research Center. Shahid Beheshti University of Medical Sciences, Tehran, Iran



Background: Despite the general concern about the safety of blood transfusion and mounting evidence exist for more restrictive practice; there is no national consensus guideline and uniformity of institutions for blood transfusion associated with coronary artery bypass graft surgery in Iran. The aim of this study is an assessment of current transfusion practice and compares it with one decade ago.

Method: The authors retrospectively analyzed the data of all patients undergoing elective surgery (first time operation) during one year, in two different decade interval (2003 and 2015) in a tertiary heart center.

Results: A total of 801 patients were evaluated and compared (n=249 in 2015, n=552 in 2003). There is a significant increase in use of blood transfusion in both operating room and at ICU than the last decade (60.6% vs. 42.4%, P<0.001, and 54.4% vs. 39.9%, P <0.001, respectively). The incidence of preoperative anemia was four times higher in patients who received transfusion, compared to those who did not, in both groups. With compared to the past, the patients are older, have less preoperative hematocrit, more diabetic, more need to intra-aortic balloon pump, shorter operation time, and less postoperative bleeding .

Conclusion: With advanced knowledge about transfusion complications and conservative approach to transfusion practice, the need to blood transfusion is increased in current cardiac operations in our center, due to association of more co-morbidities.


blood conservation, coronary artery bypass grafting, CPB

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Shehata N, Naglie G, Alghamdi A, Callum J, Mazer C, Hebert P, et al (2007). Risk factors for red cell transfusion in adults undergoing coronary artery bypass surgery: a systematic review. Vox sanguinis, 93(1):1-11.

Hajjar LA, Vincent J-L, Galas FR, Nakamura RE, Silva CM, Santos MH, et al (2010). Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA, 304(14):1559-1567.

McGill N, O'Shaughnessy D, Pickering R, Herbertson M, Gill R (2002). Mechanical methods of reducing blood transfusion in cardiac surgery: randomised controlled trial. BMJ, 324:1299.

Slight R, Bappu N, Nzewi O, Lee R, McClelland D, Mankad P (2006). Factors predicting loss and gain of red cell volume in cardiac surgery patients. Transfusion Medicine, 16(3):169-175.

Taneja R, Fernandes P, Marwaha G, Cheng D, Bainbridge D (2008). Perioperative coagulation management and blood conservation in cardiac surgery: a Canadian survey. J Cardiothorac Vasc Anesth, 22(5):662-669.

Brevig J, McDonald J, Zelinka ES, Gallagher T, Jin R, Grunkemeier GL (2009). Blood transfusion reduction in cardiac surgery: multidisciplinary approach at a community hospital. Ann Thorac Surg, 87(2):532-539.

Elmistekawy EM, Errett L, Fawzy HF (2009). Predictors of packed red cell transfusion after isolated primary coronary artery bypass grafting—the experience of a single cardiac center: a prospective observational study. J Cardiothorac Surg, 4-20.

Moskowitz DM, McCullough JN, Shander A, Klein JJ, Bodian CA, Goldweit RS, et al (2010). The impact of blood conservation on outcomes in cardiac surgery: is it safe and effective? Ann Thorac Surg, 90(2):451-458.

Bennett-Guerrero E, Zhao Y, O'Brien SM, Ferguson T, Peterson ED, Gammie JS, et al (2010). Variation in use of blood transfusion in coronary artery bypass graft surgery. JAMA, 304(14):1568-1575.

LaPar DJ, Crosby IK, Ailawadi G, Ad N, Choi E, Spiess BD, et al (2015). Blood product conservation is associated with improved outcomes and reduced costs after cardiac surgery. J Thorac Cardiovasc Surg, 145(3):796-804.

Warwick R, Mediratta N, Chalmers J, Pullan M, Shaw M, Mcshane J, et al (2015). Is single-unit blood transfusion bad post-coronary artery bypass surgery? Interact Cardiovasc Thorac Surg, 16(6):765-771.

Paone G, Likosky DS, Brewer R, Theurer PF, Bell GF, Cogan CM, et al (2014). Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality. Ann Thorac Surg, 97(1):87-94.

Nalla BP, Freedman J, Hare GM, Mazer CD (2012). Update on blood conservation for cardiac surgery. J Cardiothorac Vasc Anesth, 26(1):117-133.

Karkouti K, Wijeysundera DN, Beattie WS, Callum JL, Cheng D, Dupuis JY, et al (2007). Variability and predictability of large- volume red blood cell transfusion in cardiac surgery: a multicenter study. Transfusion, 47(11):2081-2088.

Bilgin Y, van de Watering L (2015). Complications after Cardiac Surgery due to Allogeneic Blood Transfusions. J Clin Exp Cardiolog S, S7: 005.

Varghese R, Myers ML (2010). Blood conservation in cardiac surgery: let's get restrictive. Semin Thorac Cardiovasc Surg, 22(2):121-126.

Rawn JD (2007). Blood Transfusion in Cardiac Surgery A Silent Epidemic Revisited. Circulation, 116(22):2523-2524.

van Straten AH, Bekker MW, Hamad MAS, van Zundert AA, Martens EJ, Schönberger JP, et al (2010). Transfusion of red blood cells: the impact on short-term and long-term survival after coronary artery bypass grafting, a ten-year follow-up. Interact Cardiovasc Thorac Surg, 10(1):37-42.

Ranucci M, Biagioli B, Scolletta S, Grillone G, Cazzaniga A, Cattabriga I, et al (2006). Lowest hematocrit on cardiopulmonary bypass impairs the outcome in coronary surgery: An Italian Multicenter Study from the National Cardioanesthesia Database. Tex Heart Inst J, 33(3):300-305.

Murphy GJ, Reeves BC, Rogers CA, Rizvi SI, Culliford L, Angelini GD (2007). Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation, 116(22):2544-2552.

Möhnle P, Snyder-Ramos SA, Miao Y, Kulier A, Böttiger BW, Levin J, et al (2011). Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients. Intensive care medicine, 37(1):97-109.

Whitson BA, Huddleston SJ, Savik K, Shumway SJ (2010). Risk of adverse outcomes associated with blood transfusion after cardiac surgery depends on the amount of transfusion. J Surg Res, 158(1):20-27.

Koch CG, Li L, Duncan AI, Mihaljevic T, Loop FD, Starr N J, Blackstone E H (2006). Transfusion in coronary artery bypass grafting is associated with reduced long-term survival. Ann Thorac Surg, 81(5):1650-1657.

Spahn D, Theusinger O, Hofmann A (2012). Patient blood management is a win-win: a wake-up call. Br J Anaesth, 108(6):889-892.

McKenny M, Ryan T, Tate H, Graham B, Young V, Dowd N (2011). Age of transfused blood is not associated with increased postoperative adverse outcome after cardiac surgery. Br J Anaesth, 106(5):643-649.

Koch CG, Li L, Sessler DI, Figueroa P, Hoeltge GA, Mihaljevic T, et al (2008). Duration of red-cell storage and complications after cardiac surgery.NEJM, 358(12):1229-1239.

Lelubre C, Vincent J-L (2015). Relationship between red cell storage duration and outcomes in adults receiving red cell transfusions: a systematic review. Crit Care, 17(2):R66.

Antonio G. Variations in the Use of Blood Transfusion in Patients with Coronary Artery Disease. US Cardiology;2009:6(1):89-91.

Dixon B, Reid D, Collins M, Newcomb AE, Rosalion A, Yap C-H, et al (2014). The operating surgeon is an independent predictor of chest tube drainage following cardiac surgery. J Cardiothorac Vasc Anesth, 28(2):242-246.

Ranucci M, Di Dedda U, Castelvecchio S, Menicanti L, Frigiola A, Pelissero G (2012). Impact of preoperative anemia on outcome in adult cardiac surgery: a propensity-matched analysis. Ann Thorac Surg, 94(4):1134-1141.

Shander A, Moskowitz D, Rijhwani TS (2005). The safety and efficacy of “bloodless” cardiac surgery. Semin Cardiothorac Vasc Anesth, 9(1):53-63.

Ferraris VA, Davenport DL, Saha SP, Austin PC, Zwischenberger JB (2012). Surgical outcomes and transfusion of minimal amounts of blood in the operating room. Archives of Surgery, 147(1):49-55.

Dixon B, Santamaria JD, Reid D, Collins M, Rechnitzer T, Newcomb AE, et al (2015). The association of blood transfusion with mortality after cardiac surgery: cause or confounding? Transfusion, 53(1):19-27.

LaPar DJ, Crosby IK, Ailawadi G, Ad N, Choi E, Spiess BD, et al (2015). Blood product conservation is associated with improved outcomes and reduced costs after cardiac surgery. J Thorac Cardiovasc Surg, 145(3):796-804.

Kulier A, Levin J, Moser R, Rumpold-Seitlinger G, Tudor IC, Snyder-Ramos SA, et al (2007). Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation, 116(5):471-479.

Bilgin YM (2012). Cardiac Surgery and Allogeneic Blood Transfusions. Perioperative Considerations in Cardiac Surgery. INTECH Open Access Publisher,147-166.

DeFoe GR, Ross CS, Olmstead EM, Surgenor SD, Fillinger MP, Groom RC, et al (2001). Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Ann Thorac Surg, 71(3):769-776.

Leahy M, Mukhtar SA (2012). From blood transfusion to patient blood management: a new paradigm for patient care and cost assessment of blood transfusion practice. Intern Med J, 42(3):332-338.

Ferraris VA, Brown JR, Despotis GJ, Hammon JW, Reece TB, Saha SP, et al (2011). 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg, 91(3):944-982.

Razavi SA, Carter AB, Puskas JD, Gregg SR, Aziz IF, Buchman TG (2014). Reduced Red Blood Cell Transfusion in Cardiothoracic Surgery after Implementation of a Novel Clinical Decision Support Tool. J Am Coll Surg, 219(5):1028-1036.



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