Simpson Jock D, Hopkins Adam, Amil Adilah, Ross Bryony, Enjeti Anoop K
Haematology Department, Calvary Mater Newcastle, Waratah, NSW, Australia.
School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
Vox Sang. 2019 Apr;114(3):216-222. doi: 10.1111/vox.12753. Epub 2019 Feb 7.
Transfusion-associated circulatory overload is a leading cause of transfusion-related adverse events. The frequency and risks for transfusion-associated circulatory overload in ambulatory haematology patients are not known.
A retrospective cohort analysis of ambulatory patients transfused in a tertiary haematology centre, using medical records and an electronic transfusion database, was undertaken between January and December 2014. Variables studied included age, gender, diagnosis, heart failure, kidney disease and details of transfusions. Transfusion-associated circulatory overload was defined according to proposed International Society of Blood Transfusion criteria. Patients with clinical evidence of hypervolaemia, not meeting the TACO definition and/or who were prescribed otherwise unscheduled diuretic agent, were collectively deemed to be at 'risk of clinically significant hypervolaemia' (ROCSH).
In the study period, 93 ambulatory patients (male = 49, female = 44, mean age = 75·89 ± 11·37 years) attended 715 transfusion encounters, totalling 1536 packed red cell units. No cases of TACO occurred whilst 'ROCSH' events occurred in 57/715 (8%) of transfusion encounters. In a univariate model, age was significantly associated with 'ROCSH', odds ratio = 1·05 (P = 0·017 95%, CI 1·01-1·09) and no factors were significant on multivariate analysis.
Transfusion-associated circulatory overload occurs infrequently haematology patients receiving ambulatory blood transfusions. To our knowledge, this is the first study to report on occurrence and risk factors for circulatory overload in ambulatory transfusions. This study provides vital baseline data for future prospective studies on this important aspect of haemovigilance.
输血相关循环超负荷是输血相关不良事件的主要原因。门诊血液学患者发生输血相关循环超负荷的频率和风险尚不清楚。
2014年1月至12月，利用病历和电子输血数据库，对一家三级血液学中心的门诊输血患者进行回顾性队列分析。研究变量包括年龄、性别、诊断、心力衰竭、肾脏疾病及输血细节。输血相关循环超负荷根据国际输血协会提议的标准定义。有血容量过多临床证据但不符合输血相关循环超负荷定义和/或接受非计划利尿剂治疗的患者，被统称为“有临床显著血容量过多风险”（ROCSH）。
在研究期间，93例门诊患者（男性49例，女性44例，平均年龄75.89±11.37岁）接受了715次输血，共输注1536单位浓缩红细胞。未发生输血相关循环超负荷病例，而“有临床显著血容量过多风险”事件在715次输血中有57次（8%）发生。在单变量模型中，年龄与“有临床显著血容量过多风险”显著相关，比值比=1.05（P=0.017，95%CI 1.01-1.09），多变量分析无因素显著。
门诊输血的血液学患者很少发生输血相关循环超负荷。据我们所知，这是第一项报告门诊输血中循环超负荷发生率和危险因素的研究。本研究为未来关于血液警戒这一重要方面的前瞻性研究提供了重要的基线数据。
