Çoçukluk Çağı Kan ve Kan Ürünü Transfüzyonu Yapılan Hastaların Özellikleri, Transfüzyon Sıklığı, Eşik Değerleri ve Mortalite ile İlişkisi
Abstract
Amaç: Bu çalışmanın amacı; kan ve kan ürünleri transfüzyonları yapılan hastaların değerlendirilmesi, transfüzyon endikasyonları, transfüzyon yapılan eşik değerler, transfüzyon sıklığı ve transfüzyon sıklığının mortalite üzerine ilişkisini belirlemektir.
Gereç ve yöntemler: Çocuk Sağlığı ve Hastalıkları Anabilim Dalında 1 Ocak 2018-31 Aralık 2020 tarihleri arasında 28 gün-18 yaş arası kan ve kan ürünü transfüzyonu yapılan 419 hasta geriye dönük olarak incelendi.
Bulgular: Çalışmaya dahil edilen hastaların 224 (% 53.5)’ünün erkek, 195 (% 46.5)’inin kız, yaş ortalaması 5.3±5.5 yıl ve transfüzyon sıklığı 4.3±9.2 defa olduğu saptanmıştır. Hastalardan 338’ine eritrosit süspansiyonu, 124’üne trombosit süspansiyonu, 110’nuna taze donmuş plazma transfüzyonu yapılmıştır. Transfüzyon yapılan hastalardan transfüzyon öncesi eşik değerler hemoglobin için 7.1 g/dL, trombosit için 24379/mm3, INR için 1.6 olarak saptandı. Hastaların 261 (%62.3)’ine anemi, 96 (%22.9)’sına trombositopeni nedeni ile transfüzyon yapılmıştır. Hastaların transfüzyon sıklığı ile mekanik ventilatörde kalma süresi (r=0.201, p= 0.042), yoğun bakım yatış süresi (r=0.375, p<0.001) ve ölüm günü (r=0.421, p= 0.002) karşılaştırıldığında aralarında pozitif ve anlamlı ilişki bulundu. Transfüzyon sıklığı ile eksitus olan ve olmayan hasta grupları karşılaştırıldığında, eksitus olanlara 9.0 (5.0-14.0) defa, eksitus olmayanlara ise 1.0 (1.0-2.0) defa transfüzyon yapıldığı tespit edildi.
Sonuç: Transfüzyon yapılan hastalarda transfüzyon sıklığı ile mekanik ventilatörde kalma süresi, yoğun bakım yatış süresi ve mortalite oranı karşılaştırıldığında; sık transfüzyonun, hastalarda mekanik ventilatörde kalma ve yoğun bakımda yatış süresini uzattığı, mortalite için bir risk faktörü olduğu görülmüştür.
Keywords
Supporting Institution
Kahramanmaraş sütçü imam üniversitesi tıp fakültesi hastanesi
Project Number
15 karar numaralı
References
- Hillman RS, Kenneth AA: Blood Component Therapy. In: Hematology in Clinical Practice. 3rd edition; 2002. p.407-416.
- Demir G, Yıldız Ö. Tıbbi Transfüzyon Endikasyonları. Ülkü B, Soysal T. Herkes için Transfüzyon Tıbbı, 1. baskı, İstanbul, Aydoğan Basım, 2005;117-124.
- Vengelen-Tyler V. Noninfectious Complications of Blood Transfusion. In: Technical Manual. 12th ed. Bethesda; 1996. p.558-559.
- Hasler S, Kleeman A, Abrams R, Kim J, Gupta M, Krause MK, et al. Patient safety intervention to reduce unnecessary red blood cell utilization. Am J Manag Care, 2016;22 (4):295-300.
- Bassand JP, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernández-Avilés F, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart Journal 2007;28(13):1598-1660.
- Retter A, Wyncoll D, Pearse R, Carson D, McKechnie S, Stanworth S, et al. Guidelines on the management of anemia and red cell transfusion in adult critically ill patients. Br J Haematol 2013;160(4):445-464.
- Thachil J, Warkentin TE. How do we approach thrombocytopenia in critically ill patients? Br J Haematol 2017;177(1):27-38.
- Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossettias G. Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) Working Party. Recommendations for the transfusion of plasma and platelets. Blood Transfusion 2009; 7(2):132-150.
- Pantanowitz L, Kruskall MS, Uhl L. Cryoprecipitate Patterns of use. Am J Clin Pathol 2003;119:874-881.
- Mazer CD. Blood conservation in cardiac surgery: Guidelines and controversies. Transfus Apher Science 2014;50(1):20-25.
- Likosky DS, Al-Attar PM, Malenka DJ, Furnary AP, Lehr EJ, Paone G, et al. Geographic variability in potentially discretionary red blood cell transfusions after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2014;148(6):3084-3089.
- Bahadur S, Sethi N, Pahuja S, Pathak C, Jain M. Audit of Pediatric Transfusion Practices in a Tertiary Care Hospital. Indian J Pediatr. 2015;82(4):333-339.
- Karam O, Tucci M, Bateman ST, Ducruet T, Spinella PC, Randolph AG, et al. Association between length of storage of red blood cell units and outcome of critically ill children: a prospective observational study. Crit Care. 2010;14(2):57.
- Demaret P, Tucci M, Ducruet T, Trottier H, Lacroix J. Red blood cell transfusion in critically ill children (CME). Transfusion. 2014;54:365-375.
- Slonim AD, Joseph JG, Turenne WM, Sharangpani A, Luban NLC. Blood transfusions in children: a multi-institutional analysis of practices and complications. Transfusion. 2007; 48(1):73-80.
- Pedrosa AK, Pinto FJ, Lins LD, Deus GM. Blood Transfusion Reactions in Children: Associated Factors. J Pediatr Rio J. 2013;89:400-406.
- Bagcı M, Özcan PE, Şentürk E, Telci L, Çakar N. Kritik Hastalarda Anemi ve Kan Transfüzyonlarının Değerlendirilmesi. Türk Yoğun Bakım Derneği Dergisi 2014;12:45-50.
- Gauvin F, Spinella PC, Lacroix J, Choker G, Ducruet T, Karam O, et al. Association between length of storage of transfused red blood cells and multiple organ dysfunction syndrome in pediatric intensive care patients. Transfusion. 2010;50(9):1902-1913.
- Bateman ST, Lacroix J, Boven K, Forbes P, Barton R, Thomas NJ, et al, Pediatric Acute Lung Injury and Sepsis Investigators Network. Anemia, blood loss, and blood transfusions in North American children in the intensive care unit. Am J Respir Crit Care Med. 2008; 178:26-33.
- Arslanköylü AE, Akbaş B, Alakaya M, Bozlu G, Özdemir AA. Çocuk Yoğun Bakım Ünitesine Yatış Sırasındaki Hemoglobin Düzeyi ve İzlemde Eritrosit Transfüzyonu Gereksiniminin Mortalite Üzerine Etkisi. J Pediatr Emerg Intensive Care Med 2017;4:8-12.
- Kneyber MC, Hersi MI, Twisk JW, Markhorst DG, Plötz FB. Red blood cell transfusion in critically ill children is independently associated with increased mortality. Intensive Care Med. 2007;33(8):1414-1422.
- Blajchman MA. Immunomodulation and blood transfusion. American Journal of Therapeutics 2002;9(5):389-395.
- Raghavan M, Marik PE. Anemia, allogenic blood transfusion, and immunomodulation in the critically ill. Chest. 2005;127(1):295-307.
Features, Transfusion Frequency, Threshold Values, The Mortality Relationship of Patients With Childhood-Age Blood and Blood Product Transfusion
Abstract
Objective: The aim of the study is; evaluation of patients who received blood and blood products transfusions, transfusion indications, transfusion threshold values, transfusion frequency and the relationship between transfusion frequency and mortality.
Material and Methods: 419 patients between the ages of 28 days and 18 years, who underwent blood and blood product transfusion between January 1/ 2018, and December 31/2020, in the Department of Pediatrics, were retrospectively analyzed.
Results: It was determined that 224 (53.5%) of the patients included in the study were male, 195 (46.5%) were female, the mean age was 5.3±5.5 years, and the frequency of transfusion was 4.3±9.2 times. Of the patients, 338 received erythrocyte suspension, 124 received thrombocyte suspension, and 110 had fresh frozen plasma transfusions. The pre-transfusion threshold values were found to be 7.1 g/dL for hemoglobin, 24379/mm3 for platelets, and 1.6 for International Normalized Ratio (INR). Transfusion was performed in 261 (62.3%) patients due to anemia and 96 (22.9%) due to thrombocytopenia. A positive and significant correlation was found between the frequency of transfusion and the duration of mechanical ventilation (r=0.201, p= 0.042), length of stay in the intensive care unit (r=0.375, p<0.001), and day of death (r=0.421, p= 0.002). When the transfusion frequency was compared with the deceased and non-exited patient groups, it was determined that 9.0 (5.0-14.0) times were transfused to those who died and 1.0 (1.0-2.0) to those who were not.
Conclusion: When the frequency of transfusion, duration of stay on mechanical ventilator, length of stay in intensive care unit, and, mortality rate were compared in transfused patients; It has been observed that frequent transfusion is a risk factor for mortality, prolonging the duration of mechanical ventilator stay and, intensive care unit stay in patients.
Keywords
Project Number
15 karar numaralı
References
- Hillman RS, Kenneth AA: Blood Component Therapy. In: Hematology in Clinical Practice. 3rd edition; 2002. p.407-416.
- Demir G, Yıldız Ö. Tıbbi Transfüzyon Endikasyonları. Ülkü B, Soysal T. Herkes için Transfüzyon Tıbbı, 1. baskı, İstanbul, Aydoğan Basım, 2005;117-124.
- Vengelen-Tyler V. Noninfectious Complications of Blood Transfusion. In: Technical Manual. 12th ed. Bethesda; 1996. p.558-559.
- Hasler S, Kleeman A, Abrams R, Kim J, Gupta M, Krause MK, et al. Patient safety intervention to reduce unnecessary red blood cell utilization. Am J Manag Care, 2016;22 (4):295-300.
- Bassand JP, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernández-Avilés F, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart Journal 2007;28(13):1598-1660.
- Retter A, Wyncoll D, Pearse R, Carson D, McKechnie S, Stanworth S, et al. Guidelines on the management of anemia and red cell transfusion in adult critically ill patients. Br J Haematol 2013;160(4):445-464.
- Thachil J, Warkentin TE. How do we approach thrombocytopenia in critically ill patients? Br J Haematol 2017;177(1):27-38.
- Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossettias G. Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) Working Party. Recommendations for the transfusion of plasma and platelets. Blood Transfusion 2009; 7(2):132-150.
- Pantanowitz L, Kruskall MS, Uhl L. Cryoprecipitate Patterns of use. Am J Clin Pathol 2003;119:874-881.
- Mazer CD. Blood conservation in cardiac surgery: Guidelines and controversies. Transfus Apher Science 2014;50(1):20-25.
- Likosky DS, Al-Attar PM, Malenka DJ, Furnary AP, Lehr EJ, Paone G, et al. Geographic variability in potentially discretionary red blood cell transfusions after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2014;148(6):3084-3089.
- Bahadur S, Sethi N, Pahuja S, Pathak C, Jain M. Audit of Pediatric Transfusion Practices in a Tertiary Care Hospital. Indian J Pediatr. 2015;82(4):333-339.
- Karam O, Tucci M, Bateman ST, Ducruet T, Spinella PC, Randolph AG, et al. Association between length of storage of red blood cell units and outcome of critically ill children: a prospective observational study. Crit Care. 2010;14(2):57.
- Demaret P, Tucci M, Ducruet T, Trottier H, Lacroix J. Red blood cell transfusion in critically ill children (CME). Transfusion. 2014;54:365-375.
- Slonim AD, Joseph JG, Turenne WM, Sharangpani A, Luban NLC. Blood transfusions in children: a multi-institutional analysis of practices and complications. Transfusion. 2007; 48(1):73-80.
- Pedrosa AK, Pinto FJ, Lins LD, Deus GM. Blood Transfusion Reactions in Children: Associated Factors. J Pediatr Rio J. 2013;89:400-406.
- Bagcı M, Özcan PE, Şentürk E, Telci L, Çakar N. Kritik Hastalarda Anemi ve Kan Transfüzyonlarının Değerlendirilmesi. Türk Yoğun Bakım Derneği Dergisi 2014;12:45-50.
- Gauvin F, Spinella PC, Lacroix J, Choker G, Ducruet T, Karam O, et al. Association between length of storage of transfused red blood cells and multiple organ dysfunction syndrome in pediatric intensive care patients. Transfusion. 2010;50(9):1902-1913.
- Bateman ST, Lacroix J, Boven K, Forbes P, Barton R, Thomas NJ, et al, Pediatric Acute Lung Injury and Sepsis Investigators Network. Anemia, blood loss, and blood transfusions in North American children in the intensive care unit. Am J Respir Crit Care Med. 2008; 178:26-33.
- Arslanköylü AE, Akbaş B, Alakaya M, Bozlu G, Özdemir AA. Çocuk Yoğun Bakım Ünitesine Yatış Sırasındaki Hemoglobin Düzeyi ve İzlemde Eritrosit Transfüzyonu Gereksiniminin Mortalite Üzerine Etkisi. J Pediatr Emerg Intensive Care Med 2017;4:8-12.
- Kneyber MC, Hersi MI, Twisk JW, Markhorst DG, Plötz FB. Red blood cell transfusion in critically ill children is independently associated with increased mortality. Intensive Care Med. 2007;33(8):1414-1422.
- Blajchman MA. Immunomodulation and blood transfusion. American Journal of Therapeutics 2002;9(5):389-395.
- Raghavan M, Marik PE. Anemia, allogenic blood transfusion, and immunomodulation in the critically ill. Chest. 2005;127(1):295-307.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Araştırma Makaleleri |
| Authors | |
| Project Number | 15 karar numaralı |
| Early Pub Date | November 10, 2023 |
| Publication Date | November 20, 2023 |
| Submission Date | May 6, 2023 |
| Acceptance Date | June 5, 2023 |
| Published in Issue | Year 2023 Volume: 18 Issue: 3 |
