NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.
Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK.
Liver Int. 2016 Apr;36(4):522-9. doi: 10.1111/liv.12999. Epub 2015 Nov 26.
BACKGROUND & AIMS: Cirrhosis is a complex acquired disorder of coagulation and frequent indication for transfusion of blood components. We characterised blood component use in patients with cirrhosis and compared this to transfusion guidelines.
All National Health Service trusts with representation on the British Society of Gastroenterology membership list were invited to take part. Data were collected prospectively on consecutive, unselected, hospitalised admissions with cirrhosis over 28 days. Detailed information was recorded for patients receiving blood components including indication (for bleeding or prophylaxis), type of component, laboratory indices triggering transfusion, complications, thromboembolic events and clinical outcome to day 28.
Data on 1313 consecutive patients with cirrhosis were collected from 85 hospitals. A total of 391/1313 (30%) were transfused a blood component; in 238/391 (61%), this was for treatment of bleeding and in 153/391 (39%) for prophylaxis of bleeding. In 48/185 (26%) cases with bleeding, the haemoglobin threshold was >80 g/L prior to red blood cell transfusion. In the prophylaxis group, 238/391 (61%) received transfusion in response to an abnormal haematological value in the absence of any planned procedure. In patients transfused for procedural prophylaxis, 10/34 (29%) received fresh frozen plasma at an International Normalised Ratio lower than the threshold where a benefit would be anticipated. An in-patient thromboembolic event was recorded in 3% (35/1313) and 10% (138/1313) died by day 28.
One-third of hospitalised patients with cirrhosis were transfused. Strategies for Patient Blood Management should include ensuring transfusion practice is consistent with guidelines and greater emphasis on alternatives to transfusion.
肝硬化是一种复杂的获得性凝血障碍，常需要输血治疗。本研究旨在描述肝硬化患者的输血情况，并与输血指南进行比较。
邀请英国胃肠病学会会员名单中的所有国民保健服务信托机构参与研究。前瞻性收集 28 天内连续、非选择性住院肝硬化患者的资料。详细记录患者接受输血的情况，包括输血适应证（出血或预防出血）、输血类型、触发输血的实验室指标、并发症、血栓栓塞事件及 28 天内的临床结局。
共收集了 85 家医院 1313 例连续肝硬化患者的数据。共 391/1313 例（30%）患者输注了血液成分，其中 238/391 例（61%）为出血治疗，153/391 例（39%）为出血预防。在 48/185 例（26%）有出血的患者中，血红蛋白阈值>80g/L 才输注红细胞。在预防出血组中，238/391 例（61%）在没有计划进行任何手术的情况下，根据异常的血液学值进行了输血。在接受手术预防输血的患者中，10/34 例（29%）在国际标准化比值（INR）低于预期受益阈值时输注了新鲜冰冻血浆。3%（35/1313）的患者在住院期间发生血栓栓塞事件，10%（138/1313）的患者在 28 天内死亡。
三分之一的住院肝硬化患者需要输血。患者血液管理策略应包括确保输血实践与指南一致，并更加重视输血替代品。
