Epidemiology of massive transfusion: A BI-national study from Sweden and Denmark

M. A. H. Halmin, F. C. Chiesa, S. K. V. Vasan, A. W. Wikman, R. N. Norda, K. R. Rostaard, O. P. Vesterager Pedersen, C. E. Erikstrup, K. R. N. Nielsen, K. T. Titlestad, H. U. Ullum, H. H. Hjalgrim, G. E. Edgren

Publikation: Bidrag til tidsskriftKonferenceabstrakt i tidsskriftForskningpeer review

Resumé

Background: In recent years, massive transfusion protocols have received increasing attention. The potential risks associated with massive transfusion have been discussed and associations with both increased morbidity and mortality have been reported. However there is a paucity of comprehensive data on massively transfused patients and their long-term outcomes. A better characterization of the epidemiology of massive transfusion is warranted to improve clinical decision making and to guide future studies. Aims: The aim of this study was to estimate the incidence of massive transfusion and to describe characteristics and mortality of massively transfused patients. Methods: We performed a retrospective cohort study based on the Scandinavian Donations and Transfusions (SCANDAT2) database, linking data on blood donation, blood components and transfused patients with inpatient- and population-registers. We included all patients receiving 10 or more red blood cell (RBC) transfusions in up to 2 calendar days, in Sweden 1987-2010 and in Denmark 1996-2010. The patients were followed throughout 2012. Descriptive statistics were used to characterize the patients and the indications for massive transfusion. Post-transfusion mortality was expressed as crude 30-days mortality and long-term mortality was estimated using the Kaplan-Meier method and as standardized mortality ratios. Results: 53,836 patients were included. Of all blood components transfused during the study period, 7.7% constituted massive transfusion. The incidence of massive transfusion was higher in Denmark (2.5 per 10,000), than in Sweden (2.1 per 10,000). The most common indications for massive transfusion were major surgery, including cardiac/vascular- (34.8%), cancer- (10.8%) and other surgery (22.8%), followed by trauma (15.6%). Massive transfusion due to obstetrical bleeding constituted 2.6%. Median age at massive transfusion was 67 years and two thirds of the patients were male. The median number of blood components transfused per massive transfusion episode was 22. RBCs formed the majority of blood components transfused. However, the proportion of plasma increased slightly over time, being 33.3% in the most recent time-period (2006-2010). The overall 5-year mortality was high, 51.7%, but with large differences between indications, ranging from 84.7% among patients transfused for malignant disease who did not undergo surgery, to 1.4% among women transfused for obstetrical bleeding. Mortality increased gradually with age and among all patients massively transfused at age 80 years, only 26% were alive [TABLE PRESENTED] after 5 years. The relative mortality, early after transfusion, was high and decreased with time since transfusion. However it remained elevated throughout even 10 years after transfusion. Summary/Conclusions: This large-scale study based on nation-wide data from Sweden and Denmark describes the incidence, indications and mortality associated with massive transfusion. We report a non-negligible incidence and a high both absolute and relative mortality. The general pattern is similar for Sweden and Denmark and we believe that similar patterns would be found in other high resource countries. The study provides important information for clinicians and researchers designing future studies in this field.
OriginalsprogEngelsk
Artikelnummer5A-S33-02
TidsskriftVox Sanguinis
Vol/bind109
Udgave nummerS1
Sider (fra-til)71-72
ISSN0042-9007
DOI
StatusUdgivet - 2015
Begivenhed25th Regional Congress of the International Society of Blood Transfusion in Conjunction with the 33rd Annual Conference of the British Blood Transfusion Society - London, Storbritannien
Varighed: 27. jun. 20151. jul. 2015

Konference

Konference25th Regional Congress of the International Society of Blood Transfusion in Conjunction with the 33rd Annual Conference of the British Blood Transfusion Society
LandStorbritannien
ByLondon
Periode27/06/201501/07/2015

Emneord

  • *society *blood transfusion *Sweden *Denmark *transfusion *epidemiology human patient mortality blood component bleeding surgery morbidity population hospital patient risk blood donor plasma data base neoplasm cohort analysis register clinical decision making male standardized mortality ratio Kaplan Meier method major surgery injury statistics scientist female erythrocyte transfusion

Citer dette

Halmin, M. A. H., Chiesa, F. C., Vasan, S. K. V., Wikman, A. W., Norda, R. N., Rostaard, K. R., ... Edgren, G. E. (2015). Epidemiology of massive transfusion: A BI-national study from Sweden and Denmark. Vox Sanguinis, 109(S1), 71-72. [5A-S33-02]. https://doi.org/10.1111/vox.12304
Halmin, M. A. H. ; Chiesa, F. C. ; Vasan, S. K. V. ; Wikman, A. W. ; Norda, R. N. ; Rostaard, K. R. ; Vesterager Pedersen, O. P. ; Erikstrup, C. E. ; Nielsen, K. R. N. ; Titlestad, K. T. ; Ullum, H. U. ; Hjalgrim, H. H. ; Edgren, G. E. / Epidemiology of massive transfusion : A BI-national study from Sweden and Denmark. I: Vox Sanguinis. 2015 ; Bind 109, Nr. S1. s. 71-72.
@article{87483f290b5c450d9bd7ae97537f6058,
title = "Epidemiology of massive transfusion: A BI-national study from Sweden and Denmark",
abstract = "Background: In recent years, massive transfusion protocols have received increasing attention. The potential risks associated with massive transfusion have been discussed and associations with both increased morbidity and mortality have been reported. However there is a paucity of comprehensive data on massively transfused patients and their long-term outcomes. A better characterization of the epidemiology of massive transfusion is warranted to improve clinical decision making and to guide future studies. Aims: The aim of this study was to estimate the incidence of massive transfusion and to describe characteristics and mortality of massively transfused patients. Methods: We performed a retrospective cohort study based on the Scandinavian Donations and Transfusions (SCANDAT2) database, linking data on blood donation, blood components and transfused patients with inpatient- and population-registers. We included all patients receiving 10 or more red blood cell (RBC) transfusions in up to 2 calendar days, in Sweden 1987-2010 and in Denmark 1996-2010. The patients were followed throughout 2012. Descriptive statistics were used to characterize the patients and the indications for massive transfusion. Post-transfusion mortality was expressed as crude 30-days mortality and long-term mortality was estimated using the Kaplan-Meier method and as standardized mortality ratios. Results: 53,836 patients were included. Of all blood components transfused during the study period, 7.7{\%} constituted massive transfusion. The incidence of massive transfusion was higher in Denmark (2.5 per 10,000), than in Sweden (2.1 per 10,000). The most common indications for massive transfusion were major surgery, including cardiac/vascular- (34.8{\%}), cancer- (10.8{\%}) and other surgery (22.8{\%}), followed by trauma (15.6{\%}). Massive transfusion due to obstetrical bleeding constituted 2.6{\%}. Median age at massive transfusion was 67 years and two thirds of the patients were male. The median number of blood components transfused per massive transfusion episode was 22. RBCs formed the majority of blood components transfused. However, the proportion of plasma increased slightly over time, being 33.3{\%} in the most recent time-period (2006-2010). The overall 5-year mortality was high, 51.7{\%}, but with large differences between indications, ranging from 84.7{\%} among patients transfused for malignant disease who did not undergo surgery, to 1.4{\%} among women transfused for obstetrical bleeding. Mortality increased gradually with age and among all patients massively transfused at age 80 years, only 26{\%} were alive [TABLE PRESENTED] after 5 years. The relative mortality, early after transfusion, was high and decreased with time since transfusion. However it remained elevated throughout even 10 years after transfusion. Summary/Conclusions: This large-scale study based on nation-wide data from Sweden and Denmark describes the incidence, indications and mortality associated with massive transfusion. We report a non-negligible incidence and a high both absolute and relative mortality. The general pattern is similar for Sweden and Denmark and we believe that similar patterns would be found in other high resource countries. The study provides important information for clinicians and researchers designing future studies in this field.",
keywords = "*society *blood transfusion *Sweden *Denmark *transfusion *epidemiology human patient mortality blood component bleeding surgery morbidity population hospital patient risk blood donor plasma data base neoplasm cohort analysis register clinical decision making male standardized mortality ratio Kaplan Meier method major surgery injury statistics scientist female erythrocyte transfusion",
author = "Halmin, {M. A. H.} and Chiesa, {F. C.} and Vasan, {S. K. V.} and Wikman, {A. W.} and Norda, {R. N.} and Rostaard, {K. R.} and {Vesterager Pedersen}, {O. P.} and Erikstrup, {C. E.} and Nielsen, {K. R. N.} and Titlestad, {K. T.} and Ullum, {H. U.} and Hjalgrim, {H. H.} and Edgren, {G. E.}",
year = "2015",
doi = "10.1111/vox.12304",
language = "English",
volume = "109",
pages = "71--72",
journal = "Vox Sanguinis",
issn = "0042-9007",
publisher = "Wiley-Blackwell",
number = "S1",

}

Halmin, MAH, Chiesa, FC, Vasan, SKV, Wikman, AW, Norda, RN, Rostaard, KR, Vesterager Pedersen, OP, Erikstrup, CE, Nielsen, KRN, Titlestad, KT, Ullum, HU, Hjalgrim, HH & Edgren, GE 2015, 'Epidemiology of massive transfusion: A BI-national study from Sweden and Denmark', Vox Sanguinis, bind 109, nr. S1, 5A-S33-02, s. 71-72. https://doi.org/10.1111/vox.12304

Epidemiology of massive transfusion : A BI-national study from Sweden and Denmark. / Halmin, M. A. H.; Chiesa, F. C.; Vasan, S. K. V.; Wikman, A. W.; Norda, R. N.; Rostaard, K. R.; Vesterager Pedersen, O. P.; Erikstrup, C. E.; Nielsen, K. R. N.; Titlestad, K. T.; Ullum, H. U.; Hjalgrim, H. H.; Edgren, G. E.

I: Vox Sanguinis, Bind 109, Nr. S1, 5A-S33-02, 2015, s. 71-72.

Publikation: Bidrag til tidsskriftKonferenceabstrakt i tidsskriftForskningpeer review

TY - ABST

T1 - Epidemiology of massive transfusion

T2 - A BI-national study from Sweden and Denmark

AU - Halmin, M. A. H.

AU - Chiesa, F. C.

AU - Vasan, S. K. V.

AU - Wikman, A. W.

AU - Norda, R. N.

AU - Rostaard, K. R.

AU - Vesterager Pedersen, O. P.

AU - Erikstrup, C. E.

AU - Nielsen, K. R. N.

AU - Titlestad, K. T.

AU - Ullum, H. U.

AU - Hjalgrim, H. H.

AU - Edgren, G. E.

PY - 2015

Y1 - 2015

N2 - Background: In recent years, massive transfusion protocols have received increasing attention. The potential risks associated with massive transfusion have been discussed and associations with both increased morbidity and mortality have been reported. However there is a paucity of comprehensive data on massively transfused patients and their long-term outcomes. A better characterization of the epidemiology of massive transfusion is warranted to improve clinical decision making and to guide future studies. Aims: The aim of this study was to estimate the incidence of massive transfusion and to describe characteristics and mortality of massively transfused patients. Methods: We performed a retrospective cohort study based on the Scandinavian Donations and Transfusions (SCANDAT2) database, linking data on blood donation, blood components and transfused patients with inpatient- and population-registers. We included all patients receiving 10 or more red blood cell (RBC) transfusions in up to 2 calendar days, in Sweden 1987-2010 and in Denmark 1996-2010. The patients were followed throughout 2012. Descriptive statistics were used to characterize the patients and the indications for massive transfusion. Post-transfusion mortality was expressed as crude 30-days mortality and long-term mortality was estimated using the Kaplan-Meier method and as standardized mortality ratios. Results: 53,836 patients were included. Of all blood components transfused during the study period, 7.7% constituted massive transfusion. The incidence of massive transfusion was higher in Denmark (2.5 per 10,000), than in Sweden (2.1 per 10,000). The most common indications for massive transfusion were major surgery, including cardiac/vascular- (34.8%), cancer- (10.8%) and other surgery (22.8%), followed by trauma (15.6%). Massive transfusion due to obstetrical bleeding constituted 2.6%. Median age at massive transfusion was 67 years and two thirds of the patients were male. The median number of blood components transfused per massive transfusion episode was 22. RBCs formed the majority of blood components transfused. However, the proportion of plasma increased slightly over time, being 33.3% in the most recent time-period (2006-2010). The overall 5-year mortality was high, 51.7%, but with large differences between indications, ranging from 84.7% among patients transfused for malignant disease who did not undergo surgery, to 1.4% among women transfused for obstetrical bleeding. Mortality increased gradually with age and among all patients massively transfused at age 80 years, only 26% were alive [TABLE PRESENTED] after 5 years. The relative mortality, early after transfusion, was high and decreased with time since transfusion. However it remained elevated throughout even 10 years after transfusion. Summary/Conclusions: This large-scale study based on nation-wide data from Sweden and Denmark describes the incidence, indications and mortality associated with massive transfusion. We report a non-negligible incidence and a high both absolute and relative mortality. The general pattern is similar for Sweden and Denmark and we believe that similar patterns would be found in other high resource countries. The study provides important information for clinicians and researchers designing future studies in this field.

AB - Background: In recent years, massive transfusion protocols have received increasing attention. The potential risks associated with massive transfusion have been discussed and associations with both increased morbidity and mortality have been reported. However there is a paucity of comprehensive data on massively transfused patients and their long-term outcomes. A better characterization of the epidemiology of massive transfusion is warranted to improve clinical decision making and to guide future studies. Aims: The aim of this study was to estimate the incidence of massive transfusion and to describe characteristics and mortality of massively transfused patients. Methods: We performed a retrospective cohort study based on the Scandinavian Donations and Transfusions (SCANDAT2) database, linking data on blood donation, blood components and transfused patients with inpatient- and population-registers. We included all patients receiving 10 or more red blood cell (RBC) transfusions in up to 2 calendar days, in Sweden 1987-2010 and in Denmark 1996-2010. The patients were followed throughout 2012. Descriptive statistics were used to characterize the patients and the indications for massive transfusion. Post-transfusion mortality was expressed as crude 30-days mortality and long-term mortality was estimated using the Kaplan-Meier method and as standardized mortality ratios. Results: 53,836 patients were included. Of all blood components transfused during the study period, 7.7% constituted massive transfusion. The incidence of massive transfusion was higher in Denmark (2.5 per 10,000), than in Sweden (2.1 per 10,000). The most common indications for massive transfusion were major surgery, including cardiac/vascular- (34.8%), cancer- (10.8%) and other surgery (22.8%), followed by trauma (15.6%). Massive transfusion due to obstetrical bleeding constituted 2.6%. Median age at massive transfusion was 67 years and two thirds of the patients were male. The median number of blood components transfused per massive transfusion episode was 22. RBCs formed the majority of blood components transfused. However, the proportion of plasma increased slightly over time, being 33.3% in the most recent time-period (2006-2010). The overall 5-year mortality was high, 51.7%, but with large differences between indications, ranging from 84.7% among patients transfused for malignant disease who did not undergo surgery, to 1.4% among women transfused for obstetrical bleeding. Mortality increased gradually with age and among all patients massively transfused at age 80 years, only 26% were alive [TABLE PRESENTED] after 5 years. The relative mortality, early after transfusion, was high and decreased with time since transfusion. However it remained elevated throughout even 10 years after transfusion. Summary/Conclusions: This large-scale study based on nation-wide data from Sweden and Denmark describes the incidence, indications and mortality associated with massive transfusion. We report a non-negligible incidence and a high both absolute and relative mortality. The general pattern is similar for Sweden and Denmark and we believe that similar patterns would be found in other high resource countries. The study provides important information for clinicians and researchers designing future studies in this field.

KW - society blood transfusion Sweden Denmark transfusion epidemiology human patient mortality blood component bleeding surgery morbidity population hospital patient risk blood donor plasma data base neoplasm cohort analysis register clinical decision making m

U2 - 10.1111/vox.12304

DO - 10.1111/vox.12304

M3 - Conference abstract in journal

VL - 109

SP - 71

EP - 72

JO - Vox Sanguinis

JF - Vox Sanguinis

SN - 0042-9007

IS - S1

M1 - 5A-S33-02

ER -

Halmin MAH, Chiesa FC, Vasan SKV, Wikman AW, Norda RN, Rostaard KR et al. Epidemiology of massive transfusion: A BI-national study from Sweden and Denmark. Vox Sanguinis. 2015;109(S1):71-72. 5A-S33-02. https://doi.org/10.1111/vox.12304