Evaluation of patients who received erythrocyte transfusion in the emergency department

Backgrounds: Decreased RBC count and decreased Hb concentration in the blood is defined as anemia. Anemia can be caused by acute excessive bleeding, hemolysis or inadequate production. If the patient is symptomatic, an immediate blood transfusion is required.Methods: A retrospective, single-center study was performed between April 2019 and April 2021 with non-traumatic, non-pregnant patients over 18 years of age, who had erythrocyte transfusion in the emergency department. For the laboratory parameters Hb, Ca and K, the initial levels from the blood analysis performed at admission to the emergency department were recorded as Hb1, potassium K1, and calcium Ca1, and the blood levels after the transfusion as Hb2, K2, and Ca2. Mortality of patients was recorded.Results: A total of 458 patients were included in the study. 44.3% of patients were male. The mean age was 66.33 ± 17.51/year. Mortality developed in 6.55%. There was a statistically significant difference in laboratory values between non-surviving and surviving patients. The mortality rate increased in patients with Hb1 values below 5.05g/dl and Hb2 values below 7.75g/dl, and patients with Ca1-2 values below 6.85mg/dl. It was determined that this increase in mortality rate was 3 to 6 times on average.Conclusions: Our findings reveal that the transfusion procedures in our clinic are in accordance with the new transfusion guidelines. It is important to use blood and blood products, the only source of which is human, for the right indication, at the right time, and in the right amounts.

Keywords:

Anemia, Emergency Erythrocyte Transfusion.,

PDF

___

1. Hare GMT, Cazorla-Bak MP, Ku SFM, Chin K, Mistry N, Sklar MC et al. When to transfuse your acute care patient? A narrative review of the risk of anemia and red blood cell transfusion based on clinical trial outcomes. Can J Anaesth. 2020;67:1576-94.
2. American Red Cross. A Compendium of Transfusion Practice Guidelines Edition 4.0. 2021. Available at: https://www. redcrossblood.org/content/dam/redcrossblood/hospital-pagedocuments/ 334401_compendium_v04jan2021_bookmarkedworking_ rwv01.pdf Accessed September 20, 2021
3. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. 2011. Available at: https://www.who.int/vmnis/indicators/haemoglobin.pdf Accessed May 20, 2020.
4. Yaddanapudi S, Yaddanapudi L. Indications for blood and blood product transfusion. Indian J Anaesth. 2014;58:538-42.
5. Carson JL, Guyatt G, Heddle NM, Grossman BJ, Cohn CS, Fung MK et al. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. JAMA. 2016;316:2025-35.
6. Goodnough LT, Levy JH, Murphy MF. Concepts of blood transfusion in adults. Lancet. 2013:381:1845-54.
7. Serious Hazards of Transfusion (SHOT) Working Expert Group. Annual SHOT Report. 2018. Available at: https://www.shotuk.org/ wp-content/uploads/myimages/SHOT-Report-2018_Web_Version-1. pdf Accessed May 21, 2020.
8. Maxwell MJ, Wilson MJA. Complications of blood transfusion. Continuing Education in Anaesthesia Critical Care & Pain 2006:6;225-9.
9. Franchini M, Marano G, Mengoli C, Pupella S, Vaglio S, Muñoz M et al. Red blood cell transfusion policy: a critical literature review. Blood Transfus. 2017;15:307-17.
10. Dugdale M. Anemia. Obstet Gynecol Clin North Am. 2001;28:363-81.
11. Vásquez-Velásquez C, Gonzales GF. Situación mundial de la anemia en gestantes [Global situation of anemia in pregnant women]. Nutr Hosp. 2019;36:996-7.
12. Teshale AB, Tesema GA, Worku MG, Yeshaw Y, Tessema ZT. Anemia and its associated factors among women of reproductive age in eastern Africa: A multilevel mixed-effects generalized linear model. PLoS One. 2020;15:e0238957.
13. Boureau AS, de Decker L. Blood transfusion in older patients. Transfus Clin Biol. 2019;26(3):160-163.
14. Mueller MM, Van Remoortel H, Meybohm P, Aranko K, Aubron C, Burger R, et al. Patient Blood Management: Recommendations From the 2018 Frankfurt Consensus Conference. JAMA. 2019;321(10):983- 997.
15. Levent A, Köse Ö, Linke P, Gehrke T, Çıtak M. Does tourniquet use decrease blood loss following primary total knee arthroplasty in Jehovah’s Witness patients? Jt Dis Relat Surg. 2020;31(3):419-425.
16. Wang JK, Klein HG. Red blood cell transfusion in the treatment and management of anaemia: the search for the elusive transfusion trigger. Vox Sang. 2010;98:2-11.
17. Bıçakçı Z, Olcay L. Citrate metabolism and its complications in non-massive blood transfusions: association with decompensated metabolic alkalosis+respiratory acidosis and serum electrolyte levels. Transfus Apher Sci. 2014;50:418-26.