Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
Division of Hematology-Oncology, Department of Medicine, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA.
Transfusion. 2021 Mar;61(3):708-712. doi: 10.1111/trf.16238. Epub 2020 Dec 29.
A patient's hemoglobin is typically expected to rise by 1 g/dL/unit transfused PRBCs. However, it has been theorized that mechanisms such as hyperbilirubinemia and splenomegaly might lead to either a direct lysis or sequestration of red blood cells that could decrease this proportionate response.
Patients with resolved GI bleeding but still requiring transfusion to correct anemia were compared in cirrhosis and control groups. A retrospective chart review between 2015 and 2020 was conducted at a single institution. Data collected included age, sex, BMI, GI bleed diagnosis, number of PRBCs transfused, presence of splenomegaly and spleen size, alcohol use history, type of cirrhosis, MELD-Na at admission, GFR, and pre-and post-transfusion labs: total bilirubin, ALT, hemoglobin, hematocrit. A logic regression was performed for each group looking at which factors were associated with a successful response (defined as >0.9 g/dL hemoglobin per unit transfused).
Mean change in hemoglobin was 0.77 g/dL in patients with cirrhosis compared to 1.46 g/dL in patients without (P < .001, N = 103). Odds ratios for presence of splenomegaly (0.22, N = 78) and female sex (4.39, N = 102) in predicting adequate response (>0.9 g/dL/unit) were both significant (P = .002) as well as portal hypertensive bleed diagnosis (0.28, N = 85, P = .0015). Factors that did not contribute included: age, race, BMI, alcohol use, GFR, change in ALT, and change in total bilirubin.
Patients with cirrhosis have an approximately 50% decreased response to transfusion with PRBCs after resolution of a gastrointestinal bleed in comparison to patients without cirrhosis. Risk factors included splenomegaly, portal hypertension, and male sex.
通常情况下，患者的血红蛋白每输注 1 个单位的 PRBC 就会升高 1g/dL。然而，有人认为，高胆红素血症和脾肿大等机制可能导致红细胞直接溶解或隔离，从而降低这种比例反应。
在一家单中心医院，对已解决胃肠道出血但仍需要输血纠正贫血的患者进行了肝硬化组和对照组比较。回顾性分析了 2015 年至 2020 年的病历。收集的数据包括年龄、性别、BMI、胃肠道出血诊断、PRBC 输注量、脾肿大和脾脏大小、饮酒史、肝硬化类型、入院时 MELD-Na、GFR 以及输血前后实验室检查：总胆红素、ALT、血红蛋白、血细胞比容。对每组进行逻辑回归分析，以确定哪些因素与成功反应（定义为每单位输血血红蛋白增加>0.9g/dL）相关。
与无肝硬化患者（1.46g/dL，N=103）相比，肝硬化患者血红蛋白的平均变化为 0.77g/dL（P<0.001，N=103）。脾肿大（0.22，N=78）和女性（4.39，N=102）存在的比值比（OR）在预测充足反应（>0.9g/dL/单位）方面均有统计学意义（P=0.002），门静脉高压性出血诊断（0.28，N=85，P=0.0015）也是如此。没有贡献的因素包括：年龄、种族、BMI、饮酒、GFR、ALT 变化和总胆红素变化。
与无肝硬化患者相比，胃肠道出血解决后，肝硬化患者对 PRBC 输血的反应大约降低了 50%。危险因素包括脾肿大、门静脉高压和男性。
