Shivhare Aaditya, Shastry Shamee, Murugesan Mohandoss, Doshi Karishma Ashwin, Baliga B Poornima
Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Department of Transfusion Medicine, Malabar Cancer Center, Kannur, Kerala, India.
Asian J Transfus Sci. 2019 Jan-Jun;13(1):17-22. doi: 10.4103/ajts.AJTS_76_18.
The use and benefit of fresh blood and leuco-reduced blood for critically ill patients has been inconclusive. In this study we have tried to observe the same, in patients admitted to intensive care unit.
Prospective study was done to observe the effect of transfusion in critically ill patients in a tertiary care hospital. Clinical condition in cases and controls was assessed with the help of Simplified Acute Physiology Score II scoring tool. Clinical outcome among patients who received blood was compared using two cutoffs, 14 and 21 days of shelf life to delineate fresh from old blood. Length of hospital stay, length of stay in ICU, number of days on ventilator and number of hospital acquired infections were used as the surrogate markers for morbidity.
Of the 558 critically ill patients admitted during the study period, 427 received (cases) while 131 did not receive the transfusion (controls). Mean SAPS II scores of cases and controls were comparable. We observed a significantly higher rate of mortality among patients who received RBC units over 21 days. However morbidity parameters were affected even when the cutoff of 14 days is considered. Buffy-coat reduced blood did not influence the outcome in the study group.
Critically ill patients may be prioritized for receiving fresher units of packed red cells preferably less than 21 days old. Transfusion is an independent risk factor for morbidity. Hence the risk to benefit ratio should be carefully assessed for every red cell transfusion in critically ill patients.
对于重症患者使用新鲜血液和去白细胞血液的益处尚无定论。在本研究中，我们试图在入住重症监护病房的患者中观察这一情况。
在一家三级医院进行前瞻性研究，以观察输血对重症患者的影响。借助简化急性生理学评分II评分工具评估病例组和对照组的临床状况。将接受血液输注的患者按照14天和21天的保质期这两个时间节点划分为新鲜血液组和陈旧血液组，比较两组患者的临床结局。住院时间、重症监护病房住院时间、机械通气天数和医院获得性感染数量被用作发病率的替代指标。
在研究期间收治的558例重症患者中，427例接受了输血（病例组），131例未接受输血（对照组）。病例组和对照组的简化急性生理学评分II平均分相当。我们观察到，接受保质期超过21天的红细胞单位的患者死亡率显著更高。然而，即使以14天为时间节点，发病率参数也受到了影响。去白细胞血液对研究组的结局没有影响。
重症患者优先输注保质期小于21天的较新鲜的浓缩红细胞。输血是发病率的独立危险因素。因此，对于每一例重症患者的红细胞输血，都应仔细评估风险效益比。
