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| |  Blood Transfusions During Cardiac Surgery Can Cause Complications CHIGAGO, IL -- November 29, 1999 -- Researchers for the first time have shown that patients who receive blood transfusions during heart surgery had a significantly enhanced inflammatory reaction and more postoperative complications than patients who don’t receive such transfusions, according to a study published in the November issue of CHEST, the monthly peer-reviewed journal of the American College of Chest Physicians.
Dr. Jos Maessen, of the Department of Cardiopulmonary Surgery, University Hospital Maastricht, the Netherlands, along with four associates, studied 114 consecutive adult patients who underwent coronary artery bypass surgery and/or valve surgery with a bypass. During their procedure, 36 persons received at least one allogeneic packet red cell until during surgery. The 78 control patients did not receive blood. The patients who were given transfusions spent almost twice as much time in the cardiac surgical intensive care unit as others in the study (89 hours as contrasted to 45 hours). Also, the patients receiving transfusions averaged 42 hours on a ventilator as compared to 22 hours for the control group. In addition, postoperative hospitalization was significantly longer (10.6 days versus 7.2 days). The administration of donated blood is a common procedure during cardiac surgery, according to the authors. Seventeen individuals received one unit of packed red blood cells; eight received two units; ten received three units; and one received four units. All blood came from the Dutch Red Cross Bloodbank. The authors show that, as a result of the transfusion, bioactive substances are released into the circulation, including inflammatory mediators interleukin 6 (IL-6) and bacterial permeability increasing protein. IL-6 is a sensitive marker of inflammatory response "This study provides evidence that the well-known inflammatory response to cardiac surgery, which historically has been associated with cardiopulmonary bypass, is strongly affected by the administration of packed red cells during surgery," said Dr. Maessen. "In patients undergoing cardiac surgery," he continued, "surgical trauma induces a noninfectious systemic inflammatory response which plays a role in the development of postoperative complications. However, in our patients who received transfusions, bioactive substances served as a secondary inflammatory reaction, which amplified the initial response." According to Dr. Maessen, that process can lead to damage of otherwise healthy cells and organs and to poorer postoperative recovery. In an editorial also in the November CHEST, Dr. Howard L. Corwin, Section Chief of Critical Care Medicine and Medical Director of the Intensive Care Unit, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, wrote: "It is clear that the transfusion of red blood cells may not only not help, but may in fact do harm to the critically ill patient. The evidence of the negative effects of allogenic blood suggests that, if possible, routine blood transfusions should be avoided. It is possible that other means to increase hemoglobin levels without blood transfusion, such as erythropoietin, might be of benefit. Erythropoietin therapy, in contrast to blood transfusion, has been shown to improve extractable oxygen in patients undergoing open heart surgery." Because of the research team’s results, Dr. Maessen suggested that findings of any previous studies on the release of inflammatory mediators in response to cardiac surgery or to cardiac bypass procedures that did not take into consideration the results of packed red blood cell transfusions on patients be "reconsidered."
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