Abstract
We analyzed perioperative packed red cell blood transfusion (RBC-TF) in surgery for esophageal carcinoma to improve the usage of blood products.
Methods: From 1993 to 2002, 52 patients (mean, 63.5 years) underwent esophagectomy for esophageal cancer. By stage, there were 13 cases of stage 0 disease (25%), 11 stage 1 (21%), 12 stage 2 (23%), 9 stage 3 (17%) and 7 stage 4 (14%).
Results: Irradiated red cell products (Ir-RBC) were used in 12 patients (22%) for intraoperative bleeding (mean 1,187 ml), whereas no RBC-TF was performed in 40 patients (609 ml; p<0.001). Operation time did not differ statistically between the two groups (452 min vs 426 min). RBC-TF was often performed intraoperatively in patients with episodes of low blood pressure (<80 mmHg) during anesthesia, although their blood loss was less than 500 ml. Fresh frozen plasma (FFP) was used in parallel with RBC-TF during surgery, whereas plasma protein fraction (PPF) was used in no relation to blood loss. RBC-TF was performed postoperatively in 17 of 40 patients (43%) with no intraoperative RBC-TF and in 11 of 12 patients (92%) with intraoperative RBC-TF. Multivariate analysis revealed that blood loss and water imbalance in body fluid were independently correlated with postoperative RBC-TF. Serum sodium (Na) level in body fluid decreased from 142 mEq/l (mean) to 135 mEq/l after surgery. Postoperative pneumonia and anastomotic leakage occurred in patients with RBC-TF at the ratio of 10% (p<0.198) and 28% (p<0.0009), respectively, whereas these complications did not occur in patients without periperative RBC-TF.
Conclusion: The use of RBC-TF often appeared excessive. Proper management of BTF therapy is necessary.
