Overview :

Cirasino et al studied factors that could be used to identify patients undergoing lung resection for lung cancer who need allogenic blood transfusion. A person likely to use blood perioperatively might benefit from measures to reduce the need for allogenic units such as autologous blood collection, erythropoietin, and/or hemodilution. The authors are from Milan and Pavia in Italy.

Thresholds for transfusion used in study:

(1) intraoperative hemoglobin < 10 g/dL

(2) postoperative hemoglobin < 8 g/dL

(3) other clinical factors (ischemia, etc.)

Parameters associated with transfusion as identified by logistic regression:

(1) type of surgery: limited vs extensive

(2) erythrocyte sedimentation rate (ESR) in mm/h

(3) age in years

Type of surgery (from Table 2, page 1229):

(1) limited resection:

(1a) atypical lung segmental or nodular resection

(1b) lobectomy

(1c) lobectomy with atypical lung segmental or nodular resection

(1d) bi-lobectomy

(2) extensive resection:

(2a) pneumonectomy

(2b) lobectomy with costal resection

(2c) lobectomy with costal and lung segmental resection

(2d) pneumonectomy with costal resection

Z score =

= SUM(points for all 3 parameters) – 0.99

where:

• (-0.99) is a constant.

probability of transfusion estimated from Figure 3, page 1232

probability of transfusion =

= 1 / (1 + EXP((-1) * (Z score))

The person most likely to need transfusion is an adult <= 64 who is having an extensive resection and who has a high ESR.

Cirasino L, Barosi G, et al. Preoperative predictors of the need for allogenic blood transfusion in lung cancer surgery. Transfusion. 2000; 40: 1228-1234.