Lo Brian D, Cho Brian C, Hensley Nadia B, Cruz Nicolas C, Gehrie Eric A, Frank Steven M
Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Department of Pathology (Transfusion Medicine), The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Transfusion. 2021 May;61(5):1412-1423. doi: 10.1111/trf.16338. Epub 2021 Feb 25.
Though weight is a major consideration when transfusing blood in pediatric patients, it is generally not considered when dosing transfusions in adults. We hypothesized that the change in hemoglobin (Hb) concentration is inversely proportional to body weight when transfusing red blood cells (RBC) in adults.
A total of 13,620 adult surgical patients at our institution were assessed in this retrospective cohort study (2009-2016). Patients were stratified based on total body weight (kg): 40-59.9 (16.6%), 60-79.9 (40.4%), 80-99.9 (28.8%), 100-119.9 (11.3%), and 120-139.9 (2.9%). The primary outcome was the change in Hb per RBC unit transfused. Subgroup analyses were performed after stratification by sex (male/female) and the total number of RBC units received (1/2/≥3 units). Multivariable models were used to assess the association between weight and change in Hb.
As patients' body weight increased, there was a decrease in the mean change in Hb per RBC unit transfused (40-59.9 kg: 0.85 g/dL, 60-79.9 kg: 0.73 g/dL, 80-99.9 kg: 0.66 g/dL, 100-119.9 kg: 0.60 g/dL, 120-139.9 kg: 0.55 g/dL; p < .0001). This corresponded with a 35% difference in the change in Hb between the lowest and highest weight categories on univariate analysis. Similar trends were seen after subgroup stratification. On multivariable analysis, for every 20 kg increase in patient weight, there was a ~6.5% decrease in the change in Hb per RBC unit transfused (p < .0001).
Patient body weight differentially impacts the change in Hb after RBC transfusion. These findings justify incorporating body weight into the clinical decision-making process when transfusing blood in adult surgical patients.
虽然在给儿科患者输血时体重是一个主要考虑因素，但在给成人输血时通常不考虑体重因素。我们假设在给成人输注红细胞（RBC）时，血红蛋白（Hb）浓度的变化与体重成反比。
在这项回顾性队列研究（2009 - 2016年）中，对我们机构的13620名成年外科患者进行了评估。患者根据总体重（kg）分层：40 - 59.9（16.6%）、60 - 79.9（40.4%）、80 - 99.9（28.8%）、100 - 119.9（11.3%）和120 - 139.9（2.9%）。主要结局是每输注一个RBC单位时Hb的变化。按性别（男/女）和接受的RBC单位总数（1/2/≥3单位）分层后进行亚组分析。使用多变量模型评估体重与Hb变化之间的关联。
随着患者体重增加，每输注一个RBC单位时Hb的平均变化降低（40 - 59.9 kg：0.85 g/dL，60 - 79.9 kg：0.73 g/dL，80 - 99.9 kg：0.66 g/dL，100 - 119.9 kg：0.60 g/dL，120 - 139.9 kg：0.55 g/dL；p <.0001）。单因素分析显示，最低和最高体重类别之间Hb变化的差异为35%。亚组分层后也观察到类似趋势。多变量分析显示，患者体重每增加20 kg，每输注一个RBC单位时Hb的变化约降低6.5%（p <.0001）。
患者体重对输注RBC后Hb的变化有不同影响。这些发现证明在给成年外科患者输血时，应将体重纳入临床决策过程。
