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
|
Parameter |
Finding |
Points |
|---|---|---|
|
type of surgery |
limited resection |
-2.44 |
|
|
extensive resection |
2.44 |
|
ESR |
<= 20 mm/h |
-1.29 |
|
|
> 20 to 45 mm/h |
-1.05 |
|
|
> 45 mm/h |
2.35 |
|
age |
<= 64 years |
1.6 |
|
|
> 64 years |
-1.6 |
Z score =
= SUM(points for all 3 parameters) – 0.99
where:
• (-0.99) is a constant.
|
Age |
Surgery |
ESR in mm/h |
probability transfused |
Z score |
|---|---|---|---|---|
|
<= 64 |
extensive |
> 45 |
100% |
5.40 |
|
<= 64 |
extensive |
> 20 – 45 |
88% |
2.0 |
|
<= 64 |
extensive |
<= 20 |
85% |
1.76 |
|
<= 64 |
limited |
> 45 |
62% |
0.52 |
|
<= 64 |
limited |
> 20 – 45 |
6% |
-2.88 |
|
<= 64 |
limited |
<= 20 |
4% |
-3.12 |
|
> 64 |
extensive |
> 45 |
90% |
2.2 |
|
> 64 |
extensive |
> 20 – 45 |
22% |
-1.2 |
|
> 64 |
extensive |
<= 20 |
19% |
-1.44 |
|
> 64 |
limited |
> 45 |
8% |
-2.68 |
|
> 64 |
limited |
> 20 – 45 |
1% |
-6.08 |
|
> 64 |
limited |
<= 20 |
0% |
-6.32 |
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.
Purpose: To predict the probability of needing blood transfusion following surgical resection for lung cancer using the method of Cirasino et al..
Specialty: Clinical Laboratory, General Surgery, Anesthesiology, Emergency Medicine, Critical Care
Objective: criteria for diagnosis, severity, prognosis, stage, differential diagnosis and mimics, red flags, selection
ICD-10: C34, D02.2, D62, Z51.3,
