Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.652786
Title: Studies of the clinical epidemiology and pathophysiology of anaemia and blood transfusion in elective orthopaedic and critically ill patients
Author: Ibrahim, E. E. S. M.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2005
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Abstract:
Anaemia commonly complicates surgery and critical illness. This thesis comprised five studies of this important clinical problem. The first study was a retrospective study based in a major teaching hospital Intensive Care Unit (ICU). Three existing datasets were merged to provide a study dataset that described the demographics and severity of illness for a cohort of critically ill patients (n = 489). The epidemiology of anaemia during ICU admission to death or discharge home from hospital was described. The second study was a prospective observational study that further investigated blood transfusion practice in a cohort of patients (n = 185) after ICU discharge. 72.2% of these patients were discharged home anaemic; 83% had normocytic normochromic blood indices at hospital discharge. These data confirmed the retrospective analysis. The third study measured red blood cell 2,3-diphosphoglycerate (2,3-DPG) levels and P50, which both reflect the ability of red cells to deliver oxygen to tissues, in a prospective cohort of 111 patients admitted to the ICU. Factors that were associated with 2,3-DPG and P50 were investigated. The data showed that critically ill patients have lower levels of 2,3-DPG compared with normal healthy controls. Red cell 2,3-DPG during critical illness had a strong association with patients’ acid base status. Academia was strongly associated with low DPG concentrations, which was counterintuitive. 2,3-DPG concentration had the strongest association with P50 raising the possibility that oxygen unloading could be impaired in critically ill patients. The fourth study investigated red cell function following transfusion of stored red cells to critically ill patients. Red cell 2,3-DPG was measured after red cell transfusion in a cohort of critically ill patients. The data found no major alterations to whole blood red cell 2,3-DPG after stored red cell transfusion. The fifth study merged several large existing databases to document the incidence, patterns, and likely aetiology of anaemia in patients presenting for elective major orthopaedic surgery.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.652786  DOI: Not available
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