Early autologous fresh whole blood transfusion leads to less allogeneic transfusions and is safe

Peter Rhee, Kenji Inaba, Viraj Pandit, Mazhar Khalil, Stefano Siboni, Gary Vercruysse, Narong Kulvatunyou, Andrew Tang, Anum Asif, Terence OKeeffe, Bellal Joseph

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: The practice of transfusing ones' own shed whole blood has obvious benefits such as reducing the need for allogeneic transfusions and decreasing the need for other fluids that are typically used for resuscitation in trauma. It is not widely adopted in the trauma setting because of the concern of worsening coagulopathy and the inflammatory process. The aim of this study was to assess outcomes in trauma patients receiving whole blood autotransfusion (AT) from hemothorax. METHODS: This is a multi-institutional retrospective study of all trauma patients who received autologous whole blood transfusion from hemothorax from two Level I trauma centers. Patients who received AT were matched to patients who did not receive AT (No-AT) using propensity score matching in a 1:1 ratio for admission age, sex, mechanism, type of injury, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, systolic blood pressure, heart rate, hemoglobin, international normalized ratio (INR), prothrombin time, partial prothrombin time, and lactate. AT was defined as transfusion of autologous blood from patient's hemothorax, which was collected from the chest tubes and anticoagulated with citrate phosphorous dextrose. Outcome measures were in-hospital complications, 24-hour INR, and mortality. In-hospital complications were defined as adult respiratory distress syndrome, sepsis, disseminated intravascular coagulation, renal insufficiency, and transfusion-related acute lung injury. RESULTS: Atotal of 272 patients (AT, 136; No-AT, 136) were included. Therewas no difference in admission age (p = 0.6), ISS (p = 0.56), head Abbreviated Injury Scale (AIS) score (p = 0.42), systolic blood pressure (p = 0.88), and INR (p = 0.62) between the two groups. There was no significant difference in in-hospital complications (p = 0.61), mortality (p = 0.51), and 24-hour postadmission INR (0.31) between the AT and No-AT groups. Patients who received AT had significantly lower packed red blood cell (p = 0.01) and platelet requirements (p = 0.01). Cost of transfusions (p = 0.01) was significantly lower in the AT group compared with the No-AT group. CONCLUSION: The autologous transfusion of the patient's shed blood collected through chest tubes for hemothorax was found to be safe without complications in this study. It also reduced the need for allogeneic transfusions and decreased hospital costs. This study demonstrates safety data that would help in designing larger prospective multicenter studies to determine whether this practice is truly safe and effective.

Original languageEnglish (US)
Pages (from-to)729-734
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume78
Issue number4
DOIs
StatePublished - Apr 4 2015
Externally publishedYes

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Autologous Blood Transfusions
Blood Transfusion
Hemothorax
International Normalized Ratio
Wounds and Injuries
Blood Pressure
Chest Tubes
Injury Severity Score
Prothrombin Time
Abbreviated Injury Scale
Propensity Score
Glasgow Coma Scale
Mortality
Hospital Costs
Acute Lung Injury
Disseminated Intravascular Coagulation
Trauma Centers
Adult Respiratory Distress Syndrome
Craniocerebral Trauma
Resuscitation

Keywords

  • Autologous transfusion
  • trauma
  • whole blood autotransfusion

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Early autologous fresh whole blood transfusion leads to less allogeneic transfusions and is safe. / Rhee, Peter; Inaba, Kenji; Pandit, Viraj; Khalil, Mazhar; Siboni, Stefano; Vercruysse, Gary; Kulvatunyou, Narong; Tang, Andrew; Asif, Anum; OKeeffe, Terence; Joseph, Bellal.

In: Journal of Trauma and Acute Care Surgery, Vol. 78, No. 4, 04.04.2015, p. 729-734.

Research output: Contribution to journalArticle

Rhee, P, Inaba, K, Pandit, V, Khalil, M, Siboni, S, Vercruysse, G, Kulvatunyou, N, Tang, A, Asif, A, OKeeffe, T & Joseph, B 2015, 'Early autologous fresh whole blood transfusion leads to less allogeneic transfusions and is safe', Journal of Trauma and Acute Care Surgery, vol. 78, no. 4, pp. 729-734. https://doi.org/10.1097/TA.0000000000000599
Rhee, Peter ; Inaba, Kenji ; Pandit, Viraj ; Khalil, Mazhar ; Siboni, Stefano ; Vercruysse, Gary ; Kulvatunyou, Narong ; Tang, Andrew ; Asif, Anum ; OKeeffe, Terence ; Joseph, Bellal. / Early autologous fresh whole blood transfusion leads to less allogeneic transfusions and is safe. In: Journal of Trauma and Acute Care Surgery. 2015 ; Vol. 78, No. 4. pp. 729-734.
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abstract = "BACKGROUND: The practice of transfusing ones' own shed whole blood has obvious benefits such as reducing the need for allogeneic transfusions and decreasing the need for other fluids that are typically used for resuscitation in trauma. It is not widely adopted in the trauma setting because of the concern of worsening coagulopathy and the inflammatory process. The aim of this study was to assess outcomes in trauma patients receiving whole blood autotransfusion (AT) from hemothorax. METHODS: This is a multi-institutional retrospective study of all trauma patients who received autologous whole blood transfusion from hemothorax from two Level I trauma centers. Patients who received AT were matched to patients who did not receive AT (No-AT) using propensity score matching in a 1:1 ratio for admission age, sex, mechanism, type of injury, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, systolic blood pressure, heart rate, hemoglobin, international normalized ratio (INR), prothrombin time, partial prothrombin time, and lactate. AT was defined as transfusion of autologous blood from patient's hemothorax, which was collected from the chest tubes and anticoagulated with citrate phosphorous dextrose. Outcome measures were in-hospital complications, 24-hour INR, and mortality. In-hospital complications were defined as adult respiratory distress syndrome, sepsis, disseminated intravascular coagulation, renal insufficiency, and transfusion-related acute lung injury. RESULTS: Atotal of 272 patients (AT, 136; No-AT, 136) were included. Therewas no difference in admission age (p = 0.6), ISS (p = 0.56), head Abbreviated Injury Scale (AIS) score (p = 0.42), systolic blood pressure (p = 0.88), and INR (p = 0.62) between the two groups. There was no significant difference in in-hospital complications (p = 0.61), mortality (p = 0.51), and 24-hour postadmission INR (0.31) between the AT and No-AT groups. Patients who received AT had significantly lower packed red blood cell (p = 0.01) and platelet requirements (p = 0.01). Cost of transfusions (p = 0.01) was significantly lower in the AT group compared with the No-AT group. CONCLUSION: The autologous transfusion of the patient's shed blood collected through chest tubes for hemothorax was found to be safe without complications in this study. It also reduced the need for allogeneic transfusions and decreased hospital costs. This study demonstrates safety data that would help in designing larger prospective multicenter studies to determine whether this practice is truly safe and effective.",
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T1 - Early autologous fresh whole blood transfusion leads to less allogeneic transfusions and is safe

AU - Rhee, Peter

AU - Inaba, Kenji

AU - Pandit, Viraj

AU - Khalil, Mazhar

AU - Siboni, Stefano

AU - Vercruysse, Gary

AU - Kulvatunyou, Narong

AU - Tang, Andrew

AU - Asif, Anum

AU - OKeeffe, Terence

AU - Joseph, Bellal

PY - 2015/4/4

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N2 - BACKGROUND: The practice of transfusing ones' own shed whole blood has obvious benefits such as reducing the need for allogeneic transfusions and decreasing the need for other fluids that are typically used for resuscitation in trauma. It is not widely adopted in the trauma setting because of the concern of worsening coagulopathy and the inflammatory process. The aim of this study was to assess outcomes in trauma patients receiving whole blood autotransfusion (AT) from hemothorax. METHODS: This is a multi-institutional retrospective study of all trauma patients who received autologous whole blood transfusion from hemothorax from two Level I trauma centers. Patients who received AT were matched to patients who did not receive AT (No-AT) using propensity score matching in a 1:1 ratio for admission age, sex, mechanism, type of injury, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, systolic blood pressure, heart rate, hemoglobin, international normalized ratio (INR), prothrombin time, partial prothrombin time, and lactate. AT was defined as transfusion of autologous blood from patient's hemothorax, which was collected from the chest tubes and anticoagulated with citrate phosphorous dextrose. Outcome measures were in-hospital complications, 24-hour INR, and mortality. In-hospital complications were defined as adult respiratory distress syndrome, sepsis, disseminated intravascular coagulation, renal insufficiency, and transfusion-related acute lung injury. RESULTS: Atotal of 272 patients (AT, 136; No-AT, 136) were included. Therewas no difference in admission age (p = 0.6), ISS (p = 0.56), head Abbreviated Injury Scale (AIS) score (p = 0.42), systolic blood pressure (p = 0.88), and INR (p = 0.62) between the two groups. There was no significant difference in in-hospital complications (p = 0.61), mortality (p = 0.51), and 24-hour postadmission INR (0.31) between the AT and No-AT groups. Patients who received AT had significantly lower packed red blood cell (p = 0.01) and platelet requirements (p = 0.01). Cost of transfusions (p = 0.01) was significantly lower in the AT group compared with the No-AT group. CONCLUSION: The autologous transfusion of the patient's shed blood collected through chest tubes for hemothorax was found to be safe without complications in this study. It also reduced the need for allogeneic transfusions and decreased hospital costs. This study demonstrates safety data that would help in designing larger prospective multicenter studies to determine whether this practice is truly safe and effective.

AB - BACKGROUND: The practice of transfusing ones' own shed whole blood has obvious benefits such as reducing the need for allogeneic transfusions and decreasing the need for other fluids that are typically used for resuscitation in trauma. It is not widely adopted in the trauma setting because of the concern of worsening coagulopathy and the inflammatory process. The aim of this study was to assess outcomes in trauma patients receiving whole blood autotransfusion (AT) from hemothorax. METHODS: This is a multi-institutional retrospective study of all trauma patients who received autologous whole blood transfusion from hemothorax from two Level I trauma centers. Patients who received AT were matched to patients who did not receive AT (No-AT) using propensity score matching in a 1:1 ratio for admission age, sex, mechanism, type of injury, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, systolic blood pressure, heart rate, hemoglobin, international normalized ratio (INR), prothrombin time, partial prothrombin time, and lactate. AT was defined as transfusion of autologous blood from patient's hemothorax, which was collected from the chest tubes and anticoagulated with citrate phosphorous dextrose. Outcome measures were in-hospital complications, 24-hour INR, and mortality. In-hospital complications were defined as adult respiratory distress syndrome, sepsis, disseminated intravascular coagulation, renal insufficiency, and transfusion-related acute lung injury. RESULTS: Atotal of 272 patients (AT, 136; No-AT, 136) were included. Therewas no difference in admission age (p = 0.6), ISS (p = 0.56), head Abbreviated Injury Scale (AIS) score (p = 0.42), systolic blood pressure (p = 0.88), and INR (p = 0.62) between the two groups. There was no significant difference in in-hospital complications (p = 0.61), mortality (p = 0.51), and 24-hour postadmission INR (0.31) between the AT and No-AT groups. Patients who received AT had significantly lower packed red blood cell (p = 0.01) and platelet requirements (p = 0.01). Cost of transfusions (p = 0.01) was significantly lower in the AT group compared with the No-AT group. CONCLUSION: The autologous transfusion of the patient's shed blood collected through chest tubes for hemothorax was found to be safe without complications in this study. It also reduced the need for allogeneic transfusions and decreased hospital costs. This study demonstrates safety data that would help in designing larger prospective multicenter studies to determine whether this practice is truly safe and effective.

KW - Autologous transfusion

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