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Is fresh, leucodepleted, whole blood transfusion superior to blood component transfusion in pediatric patients undergoing spinal deformity surgeries? A prospective, randomized study analyzing postoperative serological parameters and clinical recovery
Vasan PK, Rajasekaran S, Viswanathan VK, Shetty AP, Kanna RM
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2021;:1-7
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Abstract
PURPOSE To compare the effectiveness of fresh whole blood (FWB) and blood component transfusion in improving clinical outcome and serological parameters in the early postoperative period following spinal deformity surgery. METHODS Patients undergoing major spinal deformity surgeries involving ≥ 6 levels of fusion and expected blood loss ≥ 750 ml between September 2017 and August 2018 were included in the study. The patients were randomized into two groups: FWBG and CG, receiving fresh whole blood and component transfusions, respectively. RESULTS A total of 65 patients with spinal deformities of different etiologies were included. The mean age was 14.0 and 14.9 years in FWB and CG, respectively. All other preoperative parameters were comparable. The mean fusion levels and surgical time were 11.1 and 221.20 min in FWB, as compared with 10.70 and 208.74minutes in CG, respectively. Intraoperative blood losses were 929 ml (FWBG) and 847 ml(CG), and the mean volumes of transfusion were 1.90 (FWBG) and 1.65 units (CG). FWBG was significantly superior to CG in the following clinical and laboratory parameters: duration of oxygen dependence [36.43 (FWBG) vs. 43.45 h (CG); P = 0.0256], mean arterial pH [7.442 (FWBG) vs. 7.394 (CG); p < 0.001], interleukin-6 [30.04 (FWBG) vs. 35.10 (CG); p < 0.019], mean duration of HDU stay [40.6 hours (FWBG) vs 46.51 hours (CG); p = 0.0234] and postoperative facial puffiness [7/30 in FWBG vs. 18/35 (CG) (P < 0.02)]. CONCLUSION FWB transfusion can potentially improve the immediate postoperative outcome in patients undergoing major spinal deformity surgeries by reducing the duration of intensive care unit stay and oxygen dependence. The other potential benefits of this practice, based on our study, include a reduced inflammatory response (reduced lactate and IL-6) and postoperative facial puffiness. However, further large-scale validation studies in future are necessary to precisely determine the role of FWB in spine surgeries. LEVEL OF EVIDENCE II Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
PICO Summary
Population
Paediatric patients undergoing spinal deformity surgery (n= 65).
Intervention
Fresh whole blood: FWBG group (n= 30).
Comparison
Component transfusions: CG group (n = 35).
Outcome
The mean fusion levels and surgical time were 11.1 and 221.20 min in FWB, as compared with 10.70 and 208.74 minutes in CG, respectively. Intraoperative blood losses were 929 ml (FWBG) and 847 ml (CG), and the mean volumes of transfusion were 1.90 (FWBG) and 1.65 units (CG). FWBG was significantly superior to CG in the following clinical and laboratory parameters: duration of oxygen dependence, mean arterial pH, interleukin-6, mean duration of high dependency unit stay and postoperative facial puffiness.
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Effectiveness and safety of batroxobin, tranexamic acid and a combination in reduction of blood loss in lumbar spinal fusion surgery
Mn R, Shetty AP, Dumpa SR, Subarmaniam B, Kanna RM, Shanmuganathan R
Spine. 2017;43((5):):E267-E273
Abstract
STUDY DESIGN A prospective randomized double blind placebo controlled trail OBJECTIVE.: To evaluate and compare the efficacy and safety of Batroxobin (botropase),Tranexamic acid(TXA) and their combination in reduction of perioperative blood loss in lumbar spine single level fusion surgeries. SUMMARY OF BACKGROUND DATA Spinal surgeries are associated with significant blood loss leading to perioperative anaemia and increased need for allogenic transfusion. TXA competitively inhibits plasmin and batroxobin converts fibrinogen to fibrin and theoretically their combination is synergistic .Though TXA is widely studied in controlling blood loss,there is little information on use of batroxobin and their combination. Thus we aimed to study effect and safety of individual drugs and their combination in controlling blood loss in spinal surgery. METHODS Hundred patients were randomised into 4 groups. Group B- receive batroxobin,group T - receive TXA,group BT - receive batroxobin and TXA and group P - receive placebo. Outcomes assessed are intraoperative and postoperative blood loss, haemotocrit, Allogenic blood transfusion and deep vein thrombosis(DVT) postoperatively. RESULT Mean intraoperative blood loss in Group B, T, BT, and P were 268.32 +/- 62.92 ml, 340.72 +/- 182.75 ml, 256.96 +/- 82.64 ml and 448.44 +/- 205.86 ml respectively. Postoperative surgical site drain collection in Group B, T, BT, and P were 218.00 +/- 100.54 ml, 260.40 +/- 100.85 ml, 191.00 +/- 87.84 ml and 320.00 +/- 125.83 ml respectively. Intraoperative blood loss of Group P was statistically higher than Groups B and BT (p < 0.001). Mean postoperative surgical site drain collection was statistically significant (p < 0.001). No statistically significant differences in fluid administration (p = 0.751), blood transfusion (p = 1.000), preoperative and postoperative haemoglobin (p = 0.090, p = 0.134 respectively) and deep vein thrombosis (p = 1.000). CONCLUSION Batroxobin and combination of batroxobin with tranexamic acid significantly reduced perioperative blood loss when compared to placebo. LEVEL OF EVIDENCE 2.