Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Vox Sang. 2022 Mar;117(3):361-370. doi: 10.1111/vox.13188. Epub 2021 Aug 1.
Despite the broad utilization of component-based transfusion strategies that aim to reconstitute whole blood during acute traumatic haemorrhage, data for haemorrhage occurring outside of trauma and surgery are limited.
This is an observational cohort study of adults experiencing critical non-traumatic, non-intraoperative haemorrhage during hospitalization at an academic medical centre from 2011 to 2015. The primary goal was to evaluate differences in plasma and platelet to red blood cell (RBC) transfusion ratios across patient demographic, clinical and laboratory characteristics. Secondarily, associations between transfusion ratios and clinical outcomes were assessed.
Seven hundred nine patients were included: 498 (70.2%) medical and 211 (29.8%) post surgical. The gastrointestinal tract (36.7%) was the most common site of bleeding. Most patients received RBCs without plasma (35.5%) or platelets (54.2%). Among those receiving plasma, 82.3% received a plasma to RBC ratio < 1:1 at 24 h. For platelets, the most common ratio was 1-2:1 (52.9%). Transfusion ratios were generally consistent across comorbid disease severity, admission type and anatomic sites of bleeding. Higher plasma utilization was observed in the emergency department, while greater platelet utilization occurred in intensive care units. Higher transfusion ratios were observed in those with greater laboratory haemostatic abnormalities prior to the haemorrhagic event. Clinical outcome differences were limited, though greater platelet utilization in the first 24 h was associated with higher mortality and fewer hospital-free days.
Transfusion ratios for critical non-traumatic haemorrhage were primarily related to laboratory abnormalities preceding the haemorrhagic event and practice environments. Clinical outcome differences across ratios were limited.
尽管在急性创伤性出血期间广泛使用基于成分的输血策略来重建全血，但关于创伤和手术外出血的数据有限。
这是一项观察性队列研究，纳入了 2011 年至 2015 年在学术医疗中心住院期间经历非创伤性、非手术性危急出血的成年人。主要目标是评估患者人口统计学、临床和实验室特征在血浆和血小板与红细胞（RBC）输注比例方面的差异。其次，评估了输血比例与临床结果之间的关系。
共纳入 709 例患者：498 例（70.2%）为内科患者，211 例（29.8%）为外科手术后患者。胃肠道（36.7%）是最常见的出血部位。大多数患者接受 RBC 输注而不接受血浆（35.5%）或血小板（54.2%）。在接受血浆的患者中，82.3%在 24 小时内接受的血浆与 RBC 比例<1:1。对于血小板，最常见的比例是 1-2:1（52.9%）。输血比例在合并症严重程度、入院类型和出血解剖部位方面基本一致。在急诊科观察到更高的血浆利用率，而在重症监护病房中血小板利用率更高。在出血事件前实验室止血异常更严重的患者中观察到更高的输血比例。临床结局差异有限，但在前 24 小时内更高的血小板利用率与更高的死亡率和更少的无住院天数相关。
危急非创伤性出血的输血比例主要与出血事件前的实验室异常和实践环境有关。不同比例的临床结局差异有限。
