ORCID Profile
0000-0001-8488-6280
Current Organisations
Flinders University
,
Department for Health & Ageing
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Publisher: Ferrata Storti Foundation (Haematologica)
Date: 28-02-2019
Publisher: Unpublished
Date: 2014
Publisher: Springer Science and Business Media LLC
Date: 26-05-2023
DOI: 10.1007/S00404-023-07082-W
Abstract: Intraoperative cell salvage is central to Patient Blood Management including for lower segment caesarean section. Prior to April 2020, we initiated intraoperative cell salvage during caesarean section based on risk assessment for hemorrhage and patient factors. As the pandemic broadened, we mandated intraoperative cell salvage to prevent peri-partum anemia and potentially reduce blood product usage. We examined the association of routine intraoperative cell salvage on maternal outcomes. We conducted a single-center non-overlapping before-after study of obstetric patients undergoing lower segment caesarean section in the 2 months prior to a change in practice (‘usual care = selective intraoperative cell salvage’, n = 203) and the 2 months following (‘mandated intraoperative cell salvage’, n = 228). Recovered blood was processed when a minimal autologous reinfusion volume of 100 ml was expected. Post-operative iron infusion and length of stay were modelled using logistic or linear regression, using inverse probability weighting to account for confounding. More emergency lower-segment caesarean sections occurred in the Usual Care group. Compared to the Usual Care group, post-operative hemoglobin was higher and anemia cases fewer in the Mandated intraoperative cell salvage group. Rates of post-partum iron infusion were significantly lower in the Mandated intraoperative cell salvage group (OR = 0.31, 95% CI = 0.12 to 0.80, P = 0.016). No difference was found for length of stay. Routine cell salvage provision during lower segment caesarean section was associated with a significant reduction in post-partum iron infusions, increased post-operative hemoglobin and reduced anemia prevalence.
Publisher: Ferrata Storti Foundation (Haematologica)
Date: 05-10-2017
Publisher: Wiley
Date: 18-04-2021
DOI: 10.1111/VOX.13109
Abstract: Anaemia is common in the elderly and is recognized as a risk factor for several adverse outcomes in older adults, including hospitalization, morbidity and mortality. The study aims were to examine the prevalence of anaemia in elderly patients at discharge from the intensive care unit (ICU) and hospital. Patient randomized under the INFORM trial and with an ICU admission were included. Two cohorts, Cohort 1 patients who were alive on discharge from ICU and Cohort 2 patients who were discharged alive from hospital to home. Prevalence of significant anaemia defined as haemoglobin levels, less than 100 g/l was measured at ICU and hospital discharge. Overall, 76·5% (683/893) of elderly admissions in Cohort 1 had a haemoglobin g/l, and 44·1% (395/893) had a haemoglobin g/l on ICU discharge. Nadir haemoglobin during ICU stay, length of stay in ICU and transfusion during ICU stay was associated with significant anaemia at ICU discharge. At hospital discharge, in Cohort 2, 54·8% (263/480) of elderly ICU admissions had Hb 100 g/l, and 23·4% (112/480) had Hb 90 g/l. Male gender, haemoglobin level at ICU discharge, and length of stay and nadir Hb between ICU and hospital discharge were associated with anaemia at hospital discharge. Significant anaemia is highly prevalent in elderly patients on discharge from ICU and to a lesser degree at hospital discharge.
Publisher: Wiley
Date: 21-03-2013
DOI: 10.1111/TME.12022
Abstract: A massive transfusion response (MTR) was introduced in 2007 to provide blood and blood products in a timelier manner. Aim of this study was to determine whether implementation of the MTR was associated with a change in clinical practice or mortality. All MTR activations from 2008 to 2011 were included in the study. Patients who had received a massive transfusion (MT ≥ 10 units RBC in 24 h) as part of the MTR (MT-MTR) were compared with a historical group of MT patients (MT-Pre-MTR) from 2004 to 2006. Blood product usage including fresh frozen plasma (FFP) : RBC and platelet : RBC ratios and mortality were compared between the two groups. Out of 169 MTR activations, 13 patients (8%) did not use any blood products, 73 (43%) used <10 units of RBC in a 24-h period and 83 received a MT. The median number of units of FFP and platelets transfused in the MT-MTR group were 10 [interquartile range (IQR) 7-17] vs 6 (5-10) [P < 0·001] and 3 (IQR 2-4) vs 2 (IQR 1-3) [P < 0·001] in the MT-Pre-MTR group of patients, respectively. The MT-MTR group received a higher 24-h FFP : RBC ratio (1 : 1·4 vs 1 : 2·4, P < 0·001). Overall mortality between the MT-MTR and MT-Pre-MTR groups (29% vs 23%, P = 0·43) and 90-day mortality was 25% vs 29% (P = 0·40), respectively. Although there has been a significant change in transfusion practice in MT patients using a MTR, no change in mortality could be documented using such a protocol.
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.TRANSCI.2011.07.016
Abstract: This retrospective study evaluates changes in transfusion practice and modified blood product utilisation that occurred over the course of eleven years in patients receiving massive transfusion. The mean number of fresh frozen plasma units transfused increased from 9.0 ± 7.9 in 1998 to 11.3 ± 6.7 in 2008 (p=0.03). The mean number of platelet units increased from 1.9 ± 1.3 in 1998 to 2.6 ± 1.7 in 2008 (p=0.02). The proportion of cryoprecipitate increased from 0.03 ± 0.19 in 1998 to 1.3 ± 1.6 in 2008 (p=0.001). Along with these changes was a trend toward decreased mortality (p=0.05).
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/AH10957
Abstract: Objectives. In 2006 South Australia had a red cell issue rate, measured as product issues per 1000 population, 22.4% higher than the national average. A pilot study was undertaken to investigate the disparity in issue rates between SA and the national average with a secondary aim of establishing information on SA red cell use. Methods. A linked electronic database was developed using clinical, epidemiological and red cell transfusion data within hospitals in the SA public sector. Aggregated red cell use across the SA public health sector was analysed by clinical variables such as Diagnosis Related Group (DRG), including speciality related groups (SRGs) and major diagnostic categories (MDCs). The DRGs that were associated with blood use were identified and applied to national hospital separations data in order to derive comparative blood utilisation rates for SA and Australia. Results. Although blood issue and usage by population measure showed a significant difference of 22.4 and 22.0% respectively between SA and Australia, when measured against weighted separations the differences reduced to 7.4 and 7.1% respectively. Conclusion. This study showed the importance of analysing blood issues and utilisation on an activity adjusted basis rather than a raw per capita basis. What is known about the topic? Transfusion practice can be monitored by various methods such as retrospective review of medical records and blood orders, prospective audits and analysis of blood usage by DRG classification. Blood utilisation studies have been used to describe the use of blood for a whole population or hospitals in order to understand the clinical reasons for transfusion. These studies also help to describe current practice, assess variability in practice and suggest areas where improvements in transfusion practice could be achieved. What does this paper add? This study enabled an analysis of red cell usage in South Australia and the factors that can influence blood utilisation rates. This study also emphasised the fact that blood usage is better represented on a hospital activity basis rather than by raw population. What are the implications for practitioners? The major implications for health practitioners would be the key findings related to red cell usage patterns. Firstly, older patients ( years) represented 36.5% of admissions and received 56.9% of the total red cells transfused. This has huge implications for future red cell use as an ageing population will both drive up demand and also result in a decreasing red cell donor pool. Secondly, high use of red cells in medical diagnoses such as haematology, medical oncology and gastroenterology confirms the current trend towards increasing use of red cells in medical diagnoses. This implies the need to focus on reducing reliance on blood use for medical patients and improve transfusion practice by regular audits, dissemination of guidelines and education.
Publisher: Wiley
Date: 25-04-2011
DOI: 10.1111/J.1423-0410.2011.01482.X
Abstract: Primary resuscitation for massive haemorrhage often occurs in emergency departments or operating theatres, with ongoing resuscitation in the intensive care unit (ICU). The aim of the study was to retrospectively review transfusion practice in the pre-ICU phase and ICU for patients with massive haemorrhage. From 1998 to 2006, we developed an electronically linked database of blood and blood product usage and laboratory data with clinical outcome. All patients who received 10 or more units of red cells and required ICU admission were included. Of 238 patients who required massive transfusion, 40 died early (within 24 h of massive transfusion), out of which 16 died in pre-ICU and 24 died in ICU. Comparatively this group of patients presented in the pre-ICU phase and on ICU admission, respectively, with coagulopathy (median international normalized ratio 1.6 and 2.1) and acidosis (median base deficit -11.5 and -14 mmol/l). These patients had median ratios of fresh frozen plasma (FFP) to red blood cells of 1:3.3 and 1:1.3 in the pre-ICU and ICU phases, respectively. Severity of coagulopathy indicated by INR at ICU admission [P = 0.04 area under receiver operator curve (ROC) = 0.69] and RBC transfused (P = 0.01) in 24 h associated with mortality. Patients who died early were coagulopathic before and on ICU admission and did not correct their coagulopathy. This study also shows that coagulopathy is associated with an increased risk of mortality. Early and aggressive correction of coagulopathy for patients presenting with coagulopathy may be effective in improving mortality.
Publisher: Wiley
Date: 02-04-2014
DOI: 10.1111/VOX.12121
Abstract: The type and clinical characteristics of patients identified with commonly used definitions of massive transfusion (MT) are largely unknown. The objective of this study was to define the clinical characteristics of patients meeting different definitions of MT for the purpose of patient recruitment in observational studies. Data were extracted on all patients who received red blood cell (RBC) transfusions in 2010 at three tertiary Australian hospitals. MT patients were identified according to three definitions: ≥10 units RBC in 24 h (10/24 h), ≥6 units RBC in 6 h (6/6 h) and ≥5 units RBC in 4 h (5/4 h). Clinical coding data were used to assign bleeding context. Data on in-hospital mortality were also extracted. Five hundred and forty-two patients met at least one MT definition, with 236 (44%) included by all definitions. The most inclusive definition was 5/4 h (508 patients, 94%) followed by 6/6 h (455 patients, 84%) and 10/24 h (251 patients, 46%). Importantly, 40-55% of most types of critical bleeding events and 82% of all obstetric haemorrhage cases were excluded by the 10/24 h definition. Patients who met both the 5/4 h and 10/24 h definitions were transfused more RBCs (19 vs. 8 median total RBC units P < 0·001), had longer ventilation time (120 vs. 55 h P < 0·001), median ICU (149 vs. 99 h P < 0·001) and hospital length of stay (23 vs. 18 h P = 0·006) and had a higher in-hospital mortality rate (23·3% vs. 16·4% P = 0·050). The 5/4 h MT definition was the most inclusive, but combination with the 10/24 h definition appeared to identify a clinically important patient cohort.
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.TRANSCI.2017.05.013
Abstract: A previous review of transfusion practices in our institution between 1998 and 2008 showed a trend of high ratios of red cells (RC) to plasma (FFP) and platelets to RC towards the later years of review period. The aim of the study was to further evaluate transfusion practices in the form of blood product usage and outcomes following massive transfusion (MT) METHODS: All adult patients with critical bleeding who received a MT (defined as ≥10 units of RC in 24h) in 2008 and between January 2010 and December 2014 were identified. Blood and blood products transfused, in-hospital mortality, 24h and 90-day mortality were analysed for the period 2010-2014. Blood and blood product usage, massive transfusion protocol (MTP) activation and use of ROTEM between 2008 and 2014 were compared. A total of 190 MT including surgical (52.1%), gastro-intestinal bleeding (25.3%), trauma (11.6%) and obstetric haemorrhage (5.8%) episodes were identified between 2010 and 2014. The overall in-hospital mortality was 26.7% with a significant difference in 24h (p=0.04) and 90-day mortality (p=0.02) between diagnostic groups. Comparing 2008 (n=33) and 2014 (n=23), there was no significant difference in median RC, FFP and platelet units, cryoprecipitate doses and RC:FFP ratio however there was an increase in number of patients who used cryoprecipitate (54.5% vs 87%, p=0.01). Aligned with haemostatic resuscitation, the trend continues in the form of increased use of plasma and higher RC:FFP transfusion ratios including an increase in number of patients receiving cryoprecipitate.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2017
DOI: 10.1097/ALN.0000000000001709
Abstract: Preoperative anemia is a significant predictor of perioperative erythrocyte transfusion in elective arthroplasty patients. However, interactions with other patient and procedure characteristics predicting transfusion requirements have not been well studied. Patients undergoing elective primary total hip arthroplasty or total knee arthroplasty at a tertiary hospital in Adelaide, South Australia, Australia, from January 2010 to June 2014 were used to identify preoperative predictors of perioperative transfusion. A logistic regression model was developed and externally validated with an independent data set from three other hospitals in Adelaide. Altogether, 737 adult patients in the derivation group and 653 patients in the validation group were included. Binary logistic regression modeling identified preoperative hemoglobin (odds ratio, 0.51 95% CI, 0.43 to 0.59 P & 0.001 for each 1 g/dl increase), total hip arthroplasty (odds ratio, 3.56 95% CI, 2.39 to 5.30 P & 0.001), and females 65 yr of age and older (odds ratio, 3.37 95% CI, 1.88 to 6.04 P = 0.01) as predictors of transfusion in the derivation cohort. Using a combination of patient-specific preoperative variables, this validated model can predict transfusion in patients undergoing elective hip and knee arthroplasty. The model may also help to identify patients whose need for transfusion may be decreased through preoperative hemoglobin optimization.
Publisher: Unpublished
Date: 2014
No related grants have been discovered for Romi Sinha.