title: The use of a blood conservation device to reduce red blood cell transfusion requirements: a before and after study.
abstract: BACKGROUND
  Anaemia and the associated need for packed red blood cell (PRBC) transfusions are common in patients admitted to the intensive care unit (ICU). Among many causes, blood losses from repeated diagnostic tests are contributory.
  
  
  METHODS
  This is a before and after study in a medical ICU of a university hospital. We used a closed blood conservation device (Venous Arterial blood Management Protection, VAMP, Edwards Lifesciences, Irvine, CA, USA) to decrease PRBC transfusion requirements. We included all adult (> or =18 years) patients admitted to the ICU with indwelling arterial catheters, who were expected to stay more than 24 hours and were not admitted for active gastrointestinal or any other bleeding. We collected data for six months without VAMP (control group) immediately followed by nine months (active group) with VAMP. A restrictive transfusion strategy in which clinicians were strongly discouraged from any routine transfusions when haemoglobin (Hb) levels were above 7.5 g/dL was adopted during both periods.
  
  
  RESULTS
  Eighty (mean age 61.6 years, 49 male) and 170 patients (mean age 60.5 years, 101 male) were included in the control and active groups respectively. The groups were comparable for age, gender, Acute Physiology and Chronic Health Evaluation (APACHE) II score, need for renal replacement therapy, length of stay, and Hb levels on discharge and at transfusion. The control group had higher Hb levels on admission (12.4 +/- 2.5 vs. 11.58 +/- 2.8 gm/dL, P = 0.02). Use of a blood conservation device was significantly associated with decreased requirements for PRBC transfusion (control group 0.131 unit vs. active group 0.068 unit PRBC/patient/day, P = 0.02) on multiple linear regression analysis. The control group also had a greater decline in Hb levels (2.13 +/- 2.32 vs. 1.44 +/- 2.08 gm/dL, P = 0.02) at discharge.
  
  
  CONCLUSIONS
  The use of a blood conservation device is associated with 1) reduced PRBC transfusion requirements and 2) a smaller decrease in Hb levels in the ICU.
authors.affiliation: Department of Medicine, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. amartya.mukherjee@gmail.com
authors.forename: Amartya
authors.initials: A
authors.lastname: Mukhopadhyay
authors.forename: Hwee S
authors.initials: HS
authors.lastname: Yip
authors.forename: Dimple
authors.initials: D
authors.lastname: Prabhuswamy
authors.forename: Yiong H
authors.initials: YH
authors.lastname: Chan
authors.forename: Jason
authors.initials: J
authors.lastname: Phua
authors.forename: Tow K
authors.initials: TK
authors.lastname: Lim
authors.forename: Patricia
authors.initials: P
authors.lastname: Leong
mesh_terms: D018806:APACHE; D001800:Blood Specimen Collection / Q000295:instrumentation*; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins