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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
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Parameter
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Finding
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Points
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type of surgery
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limited resection
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-2.44
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extensive resection
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2.44
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ESR
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<= 20 mm/h
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-1.29
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> 20 to 45 mm/h
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-1.05
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> 45 mm/h
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2.35
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age
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<= 64 years
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1.6
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> 64 years
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-1.6
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Z score =
= SUM(points for all 3 parameters)– 0.99
where:
• (-0.99) is a constant.
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Age
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Surgery
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ESR in mm/h
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probability transfused
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Z score
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<= 64
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extensive
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> 45
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100%
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5.40
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<= 64
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extensive
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> 20– 45
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88%
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2.0
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<= 64
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extensive
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<= 20
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85%
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1.76
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<= 64
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limited
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> 45
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62%
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0.52
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<= 64
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limited
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> 20– 45
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6%
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-2.88
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<= 64
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limited
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<= 20
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4%
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-3.12
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> 64
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extensive
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> 45
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90%
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2.2
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> 64
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extensive
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> 20– 45
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22%
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-1.2
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> 64
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extensive
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<= 20
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19%
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-1.44
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> 64
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limited
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> 45
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8%
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-2.68
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> 64
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limited
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> 20– 45
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1%
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-6.08
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> 64
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limited
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<= 20
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0%
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-6.32
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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.
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