• Journal of Chest Surgery
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• v.45 no.5
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• pp.301-307
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• 2012

Background: Perioperative transfusion of red blood cell (RBC) may cause adverse effects. Bloodless-cardiac surgery has been spotlighted to avoid those problems. Off pump coronary artery bypass (OPCAB) surgery can decrease the transfusion. However, the risk factors of transfusions in OPCAB have not been investigated properly. Materials and Methods: One hundred and thirteen patients (male:female=35:78, mean age=$66.7{\pm}9.9$ years) who received isolated OPCAB were retrospectively analyzed from March 2006 to September 2007. The threshold of RBC transfusion was 28.0% of hematocrit. Bilateral internal thoracic arteries graft were used for 99 patients (87.6%). One hundred and three (91.1%) and 35 patients (31.5%) took aspirin and clopidogrel just before surgery. Results: Sixty-five patients (47.5%) received the RBC transfusion (mean $2.2{\pm}3.2$ units). Mortality and major complications were not different between transfusion and no-transfusion group. But, ventilator support time, intensive care unit stay and hospitalization period had been reduced in no-transfusion group (p<0.05). In multivariate analysis, patients risk factors for RBC transfusion were preoperative low hematocrit (<37.5%) and clopidogrel medication. Surgical risk factors were longer graft harvesting time (<75 minutes) and total operation time (<5.5 hours, p <0.05). Conclusion: We performed the transfusion according to transfusion guideline; over 40% cases could conduct the OPCAB without transfusion. There were no differences in major clinical results between transfusion and non-transfusion group. In addition, when used together with accurate understanding of transfusion risk factors, it is expected to increase the proportion of patients that do not undergo transfusions.

• Journal of Chest Surgery
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• v.25 no.7
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• pp.685-692
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• 1992

In spite of multiple technical advances, large amount of homologous blood transfusions usually required for open heart surgery. Because the complications associated with transfusion are increased as the number of homologous transfusion increase, especially as transfusion related acquired immunodeficiency syndrome has appeared in recent years, such risks have stimulated recent interest in the use of autologous blood. This is a report concerning 23 consecutive adult autologous donors[autologous group] who had elective cardiac surgery at the Yonsei Cardiovascular Center, Yonsei University College of Medicine, from march, 1990 to august, 1991. A similar group of 23 patients operated during the same periods without autologous blood donation was used for comparison [control group] to investigate the effect of predonated autologous blood in decreasing the need of homologous transfusion and to investigate predonation related adverse effect. Autologous group consisted of 15 men and 8 women. Control group consisted of 7 men and 16 women. There were no significant differences in mean age, hemoglobin, hematocrit, RBC count, platelet count and prothrombin time on admission between the two groups. The mean autologous blood donation in autologous group was 2.2 units. In 10[43.5%] of the 23 atuologous group patients, no homologous RBC products transfusion was required. However, all patients required homologous transfusion in control group. In autologous group, patients required less homologous RBC products than control patients[2.1 units versus 5.3 units; p<0.001]. There were no significant differences in hemoglobin, hematocrit, RBC count and platelet count between the two groups before discharge. There were no serious complications related to preoperative blood donation, although 3 patients complained of mild dizziness during donation We conclude that preoperative autologous predonation of blood is a safe and effective method for reducing homologous transfusion and is recomended in all patients undergoing elective cardiac surgery except limited contraindications such as severe aortic valve stenosis or unstable angina pectoris.

• Journal of Trauma and Injury
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• v.22 no.2
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• pp.218-226
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• 2009

Purpose: In multiple blunt trauma patients, transfusion may be a significant therapeutic adjunct to non-operative management. The blood products must be expedited and efficiently to patients in impending shock caused by hemorrhage or traumatic coagulopathy, but the decision to perform blood transfusion has been made empirically, based on the clinician' and has not been guided by objective parameters, but own opinion, that may result in an underestimate of or a failure to detect bleeding, in delayed transfusion, and in a reduced outcome. This article presents quickly assessable predictive factors for determining if a blood transfusion is required to improve outcomes in multiple blunt trauma patients admitted to the emergency room. Methods: In a retrospective review of 282 multiple blunt trauma patients who visited our emergency center by emergency rescuer during a 1-year period, possible factors predictive of the need for a blood transfusion were subjected to univariate and multivariate logistic regression analysis. Results: Of blunt trauma patients, 9.2% (26/282), received red blood cells in the first 24 hours of care. Univariate analysis revealed significant associations between blood transfused and heart rate (HR) > 100 beats/min, respiratory rate (RR) > 20 breaths/min, Glasgow Coma Scale (GCS) < 14, Revised Trauma Score (RTS) < 11, white blood cell count (WBC) < 4000 or > 10000, and initial abnormal portable trauma series (Cspine lateral, chest AP, pelvis AP). A multiple regression analysis, with a correction for diagnosis, identified HR > 100 beats/min (EXP 3.2), GCS < 14 (EXP 4.1), and abnormal trauma series (EXP 2.9), as independent predictors. Conclusion: In our study, systolic blood pressure (SBP) < 90 mmHg, old age > 65 years, hemoglobin < 13g/dL, mechanism of injury were poor predictors of early blood transfusion. Initial abnormal portable trauma series, HR > 100 beats/min, and GCS < 14 were quickly assessable useful factors for predicting a need for early blood transfusion in blunt trauma patients visiting the emergency room.

• Journal of Trauma and Injury
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• v.28 no.1
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• pp.1-8
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• 2015

Purpose: The purposes of this study are finding the elements for a fast determination of the need for a transfusion to a multiple trauma patient arriving at this clinic in the initial stage establishing objective bases for a doctor in an emergency department to determine the need for a transfusion immediately after a patient has arrived at the emergency department, and providing treatment by considering various factors based on the nine criteria suggested in the emergency room transfusion score (ETS). Methods: This study was conducted on 375 multiple-trauma patients who visited the Chosun University Hospital Emergency Medical Center and activated the Emergency Trauma Team from January 2010 to December 2013. The patients were divided into the transfused group and the non-transfused group by retrospectively analyzing their medical records. Subsequently, the medical records were examined using the nine items suggested by the ETS and the results were analyzed. Results: Three hundred seventy-five patients with multiple traumas visited the Chosun University Hospital Emergency Medical Center and activated the Emergency Trauma Team. Among them, 258 died and 117 recovered and left the hospital. The deceased patients consisted of 182 males and 76 females with an average age 45. Of the 375, 165 were transferred from other hospitals, and 245 were blunt trauma patients. One hundred sixty-nine patients were injured in traffic accidents, and 119 of those 169 who had systolic blood pressure less than 90 mm Hg died. Two hundred twenty-six (60.3%) out of the 375 patients with multiple traumas received an emergency blood transfusion and their average age was 48. The 375 patients consisted of 156 males, 151 who had been transferred from other hospitals, 218 who presented with blunt trauma, 134 who had been injured in traffic accidents, 156 who had a systolic blood pressure less than 90 mm Hg, 134 who scored higher than 9 points on the GCS, and 162 who had a stable pelvic fracture of these 143 died. Conclusion: During this study, 226 (60.3%) out of the patients with multiple traumas received an emergency blood transfusion. After analyzing the results related to emergency blood transfusion by using ETS, we found that an emergency blood transfusion had to be prepared quickly when patients were transferred from other hospitals when the systolic blood pressure was less than 90 mmHg. when abnormalities had been detected by ultrasonography and when the patient presented with a stable pelvic fracture.

• Journal of the Korea Society for Simulation
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• v.5 no.1
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• pp.13-27
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• 1996

The management of blood inventory is very important within the medical care system. The efficient management of blood supplies and demands for transfusion is of great economic and social importance to both hospitals and patients. Fro any blood type, there is a complex interaction among the optimal inventory level, daily demand level , daily supply level, transfusion to crossmatch ratio, crossmatch release period, issuing policy and the age of arriving units that determine the shortage and outdate rate. In this paper, we develop an efficient decision rule for blood inventory management in a hospital blood bank which can support efficient hospital blood inventory management using simulation, The primary use of the efficient decision rule will be to establish minimum cost function which consists of inventory levels , period in inventory, outdate and shortage rate for whole blood and various component inventories for a hospital blood bank or a transfusion service, If the adminstrator compute the mean daily demand for each blood type, the mean daily supply for each blood type, the length of the crossmatch release period and the average transfusion to crossmatch ratio , then it is possible to apply the efficient decision rule to compute the optimal inventory level, inventory period , outdate and shortage rate. This rule can also be used as a decision support system that allows the blood bank adminstrator to do sensitivity analysis related to controlled blood inventory parameters.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.3
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• pp.163-181
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• 2017

In the field of orofacial surgery, a red blood cell transfusion (RBCT) is occasionally required during double jaw and oral cancer surgery. However, the question remains whether the effect of RBCT during the perioperative period is beneficial or harmful. The answer to this question remains challenging. In the field of orofacial surgery, transfusion is performed for the purpose of oxygen transfer to hypoxic tissues and plasma volume expansion when there is bleeding. However, there are various risks, such as infectious complications (viral and bacterial), transfusion-related acute lung injury, ABO and non-ABO associated hemolytic transfusion reactions, febrile non-hemolytic transfusion reactions, transfusion associated graft-versus-host disease, transfusion associated circulatory overload, and hypersensitivity transfusion reaction including anaphylaxis and transfusion-related immune-modulation. Many studies and guidelines have suggested RBCT is considered when hemoglobin levels recorded are 7 g/dL for general patients and 8-9 g/dL for patients with cardiovascular disease or hemodynamically unstable patients. However, RBCT is occasionally an essential treatment during surgeries and it is often required in emergency cases. We need to comprehensively consider postoperative bleeding, different clinical situations, the level of intra- and postoperative patient monitoring, and various problems that may arise from a transfusion, in the perspective of patient safety. Since orofacial surgery has an especially high risk of bleeding due to the complex structures involved and the extensive vascular distribution, measures to prevent bleeding should be taken and the conditions for a transfusion should be optimized and appropriate in order to promote patient safety.

• Journal of Chest Surgery
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• v.31 no.6
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• pp.581-585
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• 1998

Postoperative autotransfusion is known as an effective method for blood conservation. We tried to examine whether the autotransfusion of shed mediastinal blood in patients with unstable angina would be valuable for reducing postoperative homologous transfusion by observing the hourly tendency of bleeding and transfusion. Between August and October, 1997, 26 patients with unstable angina underwent coronary arterial bypass surgery by a single surgeon at Asan Medical Center. In retrospective analysis, we found 90% of the patients received homologous transfusions and 85% of them were in the intensive care unit at the same day after operation. In many patients, the cause of transfusion was not anemia but volume replacement. Mean bleeding through the chest tubes was 340 cc for the first 5 hours and 69%(18 pts) showed more than 200 cc of bleeding, the amount generally considered as a initiating point for autotransfusion. Despite the adoption of multiple methods for blood conservation, 90% of the patients needed homologous transfusion. Moreover, many of them had received unnecessary transfusions. We conclude that some kind of blood for transfusion is needed during the immediate postoperative period, and the adoption of postoperative autotransfusion may help in reducing homologous transfusion.

• Journal of Veterinary Clinics
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• v.34 no.5
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• pp.356-358
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• 2017

A dog (neutered male Schnauzer, 11 years old, 8 kg) presented with recurrence of immune-mediated hemolytic anemia. Rapid whole blood transfusion was initiated, and then sudden tachycardia and dyspnea were observed. Invasive arterial blood pressure, arterial blood gas analysis, and thoracic radiograph indicated transfusion-associated circulatory overload (TACO). Persistent high blood pressure of 160-205 mmHg was observed; the thoracic radiograph revealed interstitial infiltration and a fissure line, which suggested pulmonary edema and pleural effusion. Despite furosemide administration and nasal oxygen supplementation, hypertension and respiratory distress were not completely controlled. Finally, cardiac arrest occurred and the patient expired due to TACO 24 hours after the transfusion.

• Parasites, Hosts and Diseases
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• v.58 no.5
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• pp.565-569
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• 2020

This report describes the first clinical case of a transfusion-associated Mycoplasma haemocanis infection in a dog in Korea. A 6-year-old male Maltese underwent a red blood cell transfusion for idiopathic immune-mediated hemolytic anemia. Eighteen days after the blood transfusion, the recipient's packed cell volume decreased and basophilic organisms were found on erythrocytes. A polymerase chain reaction and sequential analysis showed that both the donor dog and recipient dog had M. haemocanis. Six weeks after doxycycline administration, no organisms were detected and the recipient's anemia had improved.

• Journal of Korean Clinical Nursing Research
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• v.16 no.1
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• pp.177-196
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• 2010

Purpose: This study was conducted to develop the nursing process based performance measurement tool and the evidence based care standards for nursing care in medication management and blood transfusion. Methods: The care standards and performance measurement tool were drafted through comprehensive review of relevant literature, national guidelines, hospital protocols, and standards of recognized international accrediting bodies. The proposed care standards and performance measurement tool were reviewed by the panel of experts and refined based on the panel's suggestions. Final care standards and performance measurement tool were validated by surveying the hospital nurses. Results: All items of the performance measurement tool for medication management and blood transfusion were evaluated appropriate. All contents of care standards and the measurable elements except the evaluation of discharge education were appropriate. The performance measurement tool developed in this study was found to be acceptable as a tool to evaluate quality of nursing care in medication management and blood transfusion. Conclusion: The outcomes of this study including the performance measurement tool and evidence based care standards would be the important indicators to monitor whether necessary nursing care is implemented and be the useful primary resources to improve quality of nursing care services.