The Relationship between Storage Time of Blood Products and Morbidity and Mortality after Coronary Artery Bypass Graft Surgery

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Anesthesiology and Critical Care, School of Medicine and Anesthesiology and Critical Care Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 General Practitioner, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Associate Professor, Department of Anesthesiology and Critical Care, School of Medicine And Anesthesiology and Critical Care Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran

5 Epidemiologist, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: There are some paradoxical results about complications of long time stored blood transfusion. In this research we surveyed these clinical complications and relationship between morbidity and mortality with time of storage.Methods: This cross-sectional study was preformed on 100 coronary artery bypass graft (CABG) candidates in Chamran Hospital, Iran, in 2010. We compared the complications of using old blood (with storage time more than 14 days) and fresh blood (with storage time less than 14 days). Renal complications were assessed by blood urea nitrogen (BUN) and creatine (Cr) levels. In addition, liver complications were evaluated based on prothrombin time (PT) and partial thromboplastin time (PTT). We also measured ICU stay, ventilation time and mortality in the two groups.Findings: Renal complications, bleeding after surgery, raised coagulation test values such as PTT were significantly more prevalent in old blood takers (P = 0.001, 0.003, and 0.007, respectively). However, there were no significant differences in hemoglobin (P = 0.001), hematocrit (P = 0.001), platelet count (P = 0.001) and mortality between the two groups. Conclusion: In accordance with previous research, the results of this study showed blood storage more than 14 days to increase complications after surgery. Therefore, fresh blood transfusion is recommended for CABG patients. 

Keywords

References

  1. Braunwald. Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia: Saunders; 2001.
  2. Sweeney JD. Risk of blood transfusion in surgery I, 10. Blood transfusion in surgery II. Clin Trans Med Landes Bioscience: 1999: 31-7.
  3. Robinson WP, III, Ahn J, Stiffler A, Rutherford EJ, Hurd H, Zarzaur BL, et al. Blood transfusion is an independent predictor of increased mortality in nonoperatively managed blunt hepatic and splenic injuries. J Trauma 2005; 58(3): 437-44.
  4. Malone DL, Dunne J, Tracy JK, Putnam AT, Scalea TM, Napolitano LM. Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma 2003; 54(5): 898-905.
  5. Taylor RW, Manganaro L, O'Brien J, Trottier SJ, Parkar N, Veremakis C. Impact of allogenic packed red blood cell transfusion on nosocomial infection rates in the critically ill patient. Crit Care Med 2002; 30(10): 2249-54.
  6. Koch CG, Li L, Duncan AI, Mihaljevic T, Cosgrove DM, Loop FD, et al. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 2006; 34(6): 1608-16.
  7. Koch CG, Li L, Duncan AI, Mihaljevic T, Loop FD, Starr NJ, et al. Transfusion in coronary artery bypass grafting is associated with reduced long-term survival. Ann Thorac Surg 2006; 81(5): 1650-7.
  8. Koch CG, Li L, Van Wagoner DR, Duncan AI, Gillinov AM, Blackstone EH. Red cell transfusion is associated with an increased risk for postoperative atrial fibrillation. Ann Thorac Surg 2006; 82(5): 1747-56.
  9. Kuduvalli M, Oo AY, Newall N, Grayson AD, Jackson M, Desmond MJ, et al. Effect of peri-operative red blood cell transfusion on 30-day and 1-year mortality following coronary artery bypass surgery. Eur J Cardiothorac Surg 2005; 27(4): 592-8.
  10. Leal-Noval SR, Rincon-Ferrari MD, Garcia-Curiel A, Herruzo-Aviles A, Camacho-Larana P, Garnacho-Montero J, et al. Transfusion of blood components and postoperative infection in patients undergoing cardiac surgery. Chest 2001; 119(5): 1461-8.
  11. Ranucci M, Pavesi M, Mazza E, Bertucci C, Frigiola A, Menicanti L, et al. Risk factors for renal dysfunction after coronary surgery: the role of cardiopulmonary bypass technique. Perfusion 1994; 9(5): 319-26.
  12. Zacharias A, Habib RH. Factors predisposing to median sternotomy complications. Deep vs superficial infection. Chest 1996; 110(5): 1173-8.
  13. Engoren MC, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ. Effect of blood transfusion on long-term survival after cardiac operation. Ann Thorac Surg 2002; 74(4): 1180-6.
  14. Zallen G, Offner PJ, Moore EE, Blackwell J, Ciesla DJ, Gabriel J, et al. Age of transfused blood is an independent risk factor for postinjury multiple organ failure. Am J Surg 1999; 178(6): 570-2.
  15. Mynster T, Nielsen HJ. Storage time of transfused blood and disease recurrence after colorectal cancer surgery. Dis Colon Rectum 2001; 44(7): 955-64.
  16. Offner PJ, Moore EE, Biffl WL, Johnson JL, Silliman CC. Increased rate of infection associated with transfusion of old blood after severe injury. Arch Surg 2002; 137(6): 711-6.
  17. Leal-Noval SR, Jara-Lopez I, Garcia-Garmendia JL, Marin-Niebla A, Herruzo-Aviles A, Camacho-Larana P, et al. Influence of erythrocyte concentrate storage time on postsurgical morbidity in cardiac surgery patients. Anesthesiology 2003; 98(4): 815-22.
  18. Purdy FR, Tweeddale MG, Merrick PM. Association of mortality with age of blood transfused in septic ICU patients. Can J Anaesth 1997; 44(12): 1256-61.
  19. Tinmouth A, Fergusson D, Yee IC, Hebert PC. Clinical consequences of red cell storage in the critically ill. Transfusion 2006; 46(11): 2014-27.
  20. US Department of Health and Human Services. The 2005 Nationwide Blood Collection and Utilization Survey Report. Bethesda MD: AABB; 2006.
  21. Wolfe LC. Oxidative injuries to the red cell membrane during conventional blood preservation. Semin Hematol 1989; 26(4): 307-12.
  22. Berezina TL, Zaets SB, Morgan C, Spillert CR, Kamiyama M, Spolarics Z, et al. Influence of storage on red blood cell rheological properties. J Surg Res 2002; 102(1): 6-12.
  23. d'Almeida MS, Jagger J, Duggan M, White M, Ellis C, Chin-Yee IH. A comparison of biochemical and functional alterations of rat and human erythrocytes stored in CPDA-1 for 29 days: implications for animal models of transfusion. Transfus Med 2000; 10(4): 291-303.
  24. Kirkpatrick UJ, Adams RA, Lardi A, McCollum CN. Rheological properties and function of blood cells in stored bank blood and salvaged blood. Br J Haematol 1998; 101(2): 364-8.
  25. Basran S, Frumento RJ, Cohen A, Lee S, Du Y, Nishanian E, et al. The association between duration of storage of transfused red blood cells and morbidity and mortality after reoperative cardiac surgery. Anesth Analg 2006; 103(1): 15-20.
  26. Koch CG, Li L, Sessler DI, Figueroa P, Hoeltge GA, Mihaljevic T, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 2008; 358(12): 1229-39.
  27. Buchwald H, Menchaca HJ, Michalek VN, Rudser KD, Rohde TD, O'Dea T, et al. Pilot study of oxygen transport rate of banked red blood cells. Vox Sang 2009; 96(1): 44-8.
  28. McKenna R, Bachmann F, Whittaker B, Gilson JR, Weinberg M. The hemostatic mechanism after open-heart surgery. II. Frequency of abnormal platelet functions during and after extracorporeal circulation. J Thorac Cardiovasc Surg 1975; 70(2): 298-308.
  29. Zimrin AB, Hess JR. Current issues relating to the transfusion of stored red blood cells. Vox Sang 2009; 96(2): 93-103.
  30. van de Watering LM, Brand A. Effects of Storage of Red Cells. Transfus Med Hemother 2008; 35(5): 359-67.
  31. van de Watering L, Lorinser J, Versteegh M, Westendord R, Brand A. Effects of storage time of red blood cell transfusions on the prognosis of coronary artery bypass graft patients. Transfusion 2006; 46(10): 1712-8.
  32. Almac E, Ince C. The impact of storage on red cell function in blood transfusion. Best Pract Res Clin Anaesthesiol 2007; 21(2): 195-208.
  33. Vamvakas EC, Carven JH. Length of storage of transfused red cells and postoperative morbidity in patients undergoing coronary artery bypass graft surgery. Transfusion 2000; 40(1): 101-9.
  34. Ho J, Sibbald WJ, Chin-Yee IH. Effects of storage on efficacy of red cell transfusion: when is it not safe? Crit Care Med 2003; 31(12 Suppl): S687-S697.
  35. Valeri CR, Collins FB. The physiologic effect of transfusing preserved red cells with low 2, 3-diphosphoglycerate and high affinity for oxygen. Vox Sang 1971; 20(5): 397-403.
  36. Jia L, Bonaventura C, Bonaventura J, Stamler JS. S-nitrosohaemoglobin: a dynamic activity of blood involved in vascular control. Nature 1996; 380(6571): 221-6.
  37. Tinmouth A, Chin-Yee I. The clinical consequences of the red cell storage lesion. Transfus Med Rev 2001; 15(2): 91-107.
  38. Hamasaki N, Yamamoto M. Red blood cellfunction and blood storage. Vox Sang 2000; 79(4): 191-7.
  39. Marik PE, Sibbald WJ. Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 1993; 269(23): 3024-9.
Journal of Isfahan Medical School
Volume 29, Issue 166 - Serial Number 166
November and December 2012
Pages 2289-2297

Files

History

  • Receive Date: 19 September 2011
  • Revise Date: 02 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics