Background
Overtransfusion of packed red blood cells is known to increase the risk of death in
stable patients. With the delineation of minimum transfusion ratios in hemorrhaging
patients complete, attention must be turned to the other end of the massive transfusion
spectrum—that of defining the maximum transfusion of packed red blood cells. We aimed
to define the ideal hemoglobin range 24 hours after anatomic hemostasis associated
with the lowest mortality.
Methods
Massive-transfusion patients (≥10 units packed red blood cells within 24 hours) were
reviewed from 2010–2013. The hemoglobin 24 ± 6 hours after anatomic hemostasis was
used to stratify patients into undertransfusion (<8.0 g/dL), hemoglobin transfusion
target (8.0–11.9 g/dL), and overtransfusion (>12.0 g/dL) groups; patients not surviving
to 24 hours were excluded.
Results
We identified 418 patients (351 [84%] in the hemoglobin transfusion target group,
38 [9%] in the undertransfusion group, and 29 [7%] in the overtransfusion group) with
an overall mortality of 18%. Undertransfusion patients had the greatest risk of death
(odds ratio 3.3; 95% confidence interval 1.6–6.7) followed by overtransfusion patients
(odds ratio 2.5; 95% confidence interval 1.1–5.6). Though pretransfusion hemoglobin
was similar (9.5 ± 2.2 g/dL vs 9.5 ± 2.3 g/dL), overtransfusion patients had greater
hemoglobin values during massive transfusion (8.3 ± 3.0 g/dL vs 6.9 ± 1.4 g/dL), persisting
until hospital dismissal/death (11.4 ± 2.3 g/dL vs 9.6 ± 1.1 g/dL). In total, 657.4
excess packed red blood cell units were transfused (1.9 ± 1.5 per patient).
Conclusion
Overtransfusion patients had increased mortality, comparable to undertransfusion patients,
despite younger age and fewer comorbidities. Shorter massive transfusion durations
foster a scenario in which patients are at greater risk of overtransfusion.
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Article info
Publication history
Published online: July 20, 2016
Accepted:
May 24,
2016
Footnotes
Supported by CTSA grant number UL1 TR000135 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
The authors declare no conflicts of interest relevant to this research.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
