[HSF] More Bad News About Trasylol

Michael Firstenberg msfirst at gmail.com
Sun Oct 1 17:09:23 EDT 2006 

Beat me to the punch.

Dr Koch is a smart doctor (a full-time anesthesiologist I might add)  
and knows her stuff  She and I often debate some of these kind of  
issues in the OR and I think a lot of it has to do with 2 things 1)  
pts who need blood products post-op might have been a little sicker  
pre-op (anemia of chronic disease, normal Cr but impaired renal  
function, sitting or lying around the hospital longer before surgery,  
assorted problems that are difficult to glean from the papers) and 2)  
I think we are familiar with the association between bleeding and  
blood product use (patients who a little oozy post-op stay intubated  
a little longer, maybe need a little more pressors, might go back for  
re-ops, lung injury from products -> right heart failure/dysfunction - 
 > longer ICU stay).  All little things that add up to increased M&M,  
but I think (IMvHO) the amount of cell transfusion is the easiest  
common denominator to measure and might just be an universal marker  
for "sicker" patients (either pre or post-op) beyond the usual  
indices that are use to defined risks.  Come on (and Dr Koch agrees)  
- do we really think that a simple CABG in a "relatively  
healthy" (whatever that is these days) will really have that much of  
a defined increased risk from 1 unit of packed cells?


Michael



On Sep 30, 2006, at 11:58 PM, Ben Bidstrup wrote:

> Prasanna,
> Here they are.
>
> 1.	Koch, C.G., et al., Transfusion in coronary artery bypass  
> grafting is associated with reduced long-term survival. Ann Thorac  
> Surg, 2006. 81(5): p. 1650-7.
>
> 2.	Koch, C.G., et al., Morbidity and mortality risk associated with  
> red blood cell and blood-component transfusion in isolated coronary  
> artery bypass grafting. Crit Care Med, 2006. 34(6): p. 1608-16.
>
> 3.	Koch, C.G., et al., Persistent effect of red cell transfusion on  
> health-related quality of life after cardiac surgery. Ann Thorac  
> Surg, 2006. 82(1): p. 13-20.
>
> There is also one from UK last year.
>
> Kuduvalli, M., et al., Effect of peri-operative red blood cell  
> transfusion on 30-day and 1-year mortality following coronary  
> artery bypass surgery. Eur J Cardiothorac Surg, 2005. 27(4): p. 592-8.
>
>
>> Ah Michael I  had a feeling you will jump in !! Can you give the  
>> Cleveland clinic quote - (wrt to the 7 % blood transfusion risk) - 
>> I cannot seem to get hold of it.
>> Dr Levinson, I still feel pdf files should be allowed. I think  
>> that copyright laws still allow us too circulate them privately  
>> for educational prurposes. This is freely done in the critical  
>> care list and Gas net (the Anesthesiologists list). In fact now  
>> many journals allow open access after say 6 months to a year after  
>> publications.
>> Prasanna
>> Michael Firstenberg wrote:
>>> Hal,
>>> Since I am always on the other side of your coin.  What about all  
>>> of the risks of blood transfusions?  There is plenty of data that  
>>> relates blood product usage to increased risk of adverse  
>>> outcomes. How do you respond to the Catfish type that say - "if  
>>> you had used aprotinin/amicar/etc then my client would not have  
>>> gotten ......"?
>>>
>>> Michael
>>>
>>> for my Bentall - give me Amicar.
>>> for my redo infected Bentall - hmmm, might take the risk......
>>>
>>>
>>> On Sep 30, 2006, at 2:17 PM, Hgrmd at aol.com wrote:
>>>
>>>> Prasanna,
>>>>   We haven't heard from Claudia, our in house hematologist, in   
>>>> awhile.
>>>> Perhaps she can comment.  However, my impression is that the  
>>>> blood bank, at least
>>>> in the U.S., is about as safe as it has ever been.  I  agree  
>>>> that new blood
>>>> borne diseases may arise in the future, but the risk of  
>>>> aprotinin-associated
>>>> ATN is immediate and real.
>>>> Hal
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>
> -- 
> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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