Document Detail

Advance targeted transfusion in anemic cardiac surgical patients for kidney protection: an unblinded randomized pilot clinical trial.
MedLine Citation:
PMID:  22354243     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: : Acute kidney injury (AKI) is a serious complication of cardiac surgery, and preoperative anemia and perioperative erythrocyte transfusion are important risk factors. Prophylactic erythrocyte transfusion in anemic patients may, therefore, protect against AKI.
METHODS: : In this unblinded, parallel-group, randomized pilot trial, 60 anemic patients (hemoglobin 10-12 g/dL) undergoing cardiac surgery with cardiopulmonary bypass were randomized (1:1) to prophylactic transfusion (2 units of erythrocytes transfused 1 to 2 days before surgery (n = 29) or standard of care (transfusions as indicated; n = 31). Between-group differences in severity of perioperative anemia, transfusion, and AKI (more than 25% drop in estimated glomerular filtration rate) were measured. The relationships between transfusion, iron levels, and AKI were also measured.
RESULTS: : Perioperative anemia and erythrocyte transfusions were lower in the prophylactic transfusion group--median (25th, 75th percentiles) for nadir hemoglobin was 8.3 (7.9, 9.1) versus 7.6 (6.9, 8.2) g/dL (P = 0.0008) and for transfusion was 0 (0, 2) versus 2 (1, 4) units (P = 0.0002)--but between-group AKI rates were comparable (11 patients per group). In 35 patients with iron studies, perioperative transfusions were directly related to postoperative transferrin saturation (correlation coefficient 0.6; P = 0.0002), and high (more than 80%) transferrin saturation was associated with AKI (5/5 vs. 8/30; P = 0.005), implicating transfusion-related iron overload as a cause of AKI.
CONCLUSIONS: : In anemic patients, prophylactic erythrocyte transfusion reduces perioperative anemia and erythrocyte transfusions, and may reduce plasma iron levels. Adequately powered studies assessing the effect of this intervention on AKI are warranted.
Keyvan Karkouti; Duminda N Wijeysundera; Terrence M Yau; Stuart A McCluskey; Christopher T Chan; Pui-Yuen Wong; Mark A Crowther; Siroos Hozhabri; W Scott Beattie
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  116     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-22     Completed Date:  2012-04-10     Revised Date:  2012-11-13    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  613-21     Citation Subset:  AIM; IM    
Department of Anesthesia and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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MeSH Terms
Acute Kidney Injury / etiology*,  prevention & control*
Anemia / complications*,  therapy*
Cardiac Surgical Procedures / adverse effects*
Erythrocyte Transfusion / methods*
Middle Aged
Pilot Projects
Time Factors
Grant Support
//Canadian Institutes of Health Research
Comment In:
Anesthesiology. 2012 Mar;116(3):513-4   [PMID:  22261797 ]
Anesthesiology. 2012 Oct;117(4):919-20; author reply 921-2   [PMID:  22990193 ]

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