Acute Transfusion Research Articles

Prevalence of Acute Complications of Transfusion in Children with β-thalassemia Major in Southeast Iran: A Prospective Study

Background: Acute complications of transfusion are among the leading causes of morbidity and mortality in chronically transfused patients. One of the main goals of blood transfusion is to reduce complications and improve blood safety and patient health care worldwide. The present study aimed to investigate the prevalence of acute complications of transfusion beta-thalassemia major (TM) patients in Southeast Iran. Methods: In a prospective study, 23882 transfusions were evaluated in TM patients of a thalassemia clinic for acute reactions during a two-year period. Data were collected by forms to record the information related to blood transfusion at the time of reaction occurrence. Results: The assessment of the data revealed that 228 TM patients (0.95%) had acute complications of transfusion. Among 23882 TM patients undergoing transfusion, 211 (0.87%) developed allergic reactions, 11 (0.04%) were diagnosed with febrile non-hemolytic reaction, and one patient (0.004%) had experienced acute hemolytic transfusion reaction. Conclusion: The results of the current study support preventive measures for the reduction of these complications to improve patients’ health. Acute complications occurred may be due to insufficient ability to perform blood bank tests, lack of standard operating instructions, and lack of necessary monitoring during the transfusion process. The best way to reduce the risk of blood transfusion reactions is to provide special care to the patients during the first 24 hours after transfusion. Creating a consistent and continuous education system with standard operating instructions and establishing an error reporting system leads to improve knowledge about transfusion guidelines and best practices.

Transfusion reaction: A blind spot in autopsy

Although blood transfusion is generally safe, there are adverse events with varying severity even that can lead to death including Acute Haemolytic Transfusion Reaction (AHTR), anaphylaxis, bacterial sepsis, Transfusion Related Acute Lung Injury (TRALI) and Transfusion Associated Circulatory Overload (TACO). Transfusion Associated Graft vs Host Disease (TAGVHD) is a delayed type of reaction that can lead to death. Ascertaining the cause of death is complicated in such situations and multidisciplinary investigations are needed.Serological investigations should be performed in the transfusion laboratory to detect haemolysis, immunological incompatibility, and bacterial contamination. In the postmortem examination AHTR can be diagnosed with serological investigations and presence of incompatible red cells can be identified in postmortem tissue samples by immune-histochemical methods. Detection of HLA antibodies in the respiratory tract tissues and intended donor investigations can confirm the diagnosis of TRALI. In a case of suspected bacterial contamination isolation of same organism in the postmortem blood and in the intended pack can conclude the diagnosis. In anaphylaxis, inflammation of the respiratory tract with eosinophilia can be seen and measuring the serum tryptase level is useful. In TAGVHD host tissue necrosis and lymphocyte infiltration are +seen and that can be confirmed by showing the DNA chimerism by PCR analysis.Further studies are recommended to establish protocols and guidelines for postmortem examination following a transfusion reaction.

Incidence of acute haemolytic transfusion reaction among ABO-incompatible recipients transfused with A3 blood: A case series.

ABO antigens are among the most immunogenic, but the haemolytic risks of ABO incompatibilities involving a donor with a weak ABO phenotype are little documented. This retrospective case series assessed the incidence of acute haemolytic transfusion reaction (AHTR) among ABO-incompatible recipients of A3 blood in Québec (Canada). Transfusion safety officers reported laboratory AHTR indicators measured ≤24 h pre- and post-transfusion. Because the AHTR case definition of Québec's Hemovigilance System (QHS) leaves significant room for clinical judgement, a two-step approach was used to assess potential cases: Step 1 consisted in a highly sensitive-but unspecific-initial screen that identified all candidate cases per QHS case definition, and Step 2 consisted in a detailed review of candidate cases by two haematologists. Nine donors initially typed as Group B (N = 1) or O (N = 8) were subsequently found to display an A3 B or A3 O phenotype. Eighty-one recipients received ABO-incompatible blood, including 53 (65.4%) with interpretable data. Of these, 29 (54.7%) were classified as candidate cases after Step 1. Following Step 2, no conclusive evidence of AHTR was found: Abnormal pre- versus post-transfusion changes appeared modest, within normal range, insufficient to ascertain AHTR, or were consistent with a pre-existing condition unrelated to AHTR. Two candidate cases had a QHS-reported transfusion reaction; both were unrelated to AHTR. In this case series, no conclusive evidence of serious AHTR was found among ABO-incompatible recipients who were inadvertently transfused with A3 blood.

Retrospective evaluation of indications, transfusion protocols, and acute transfusion reactions associated with the administration of lyophilized canine albumin: 53 cases (2009-2020).

To describe the administration of lyophilized canine albumin (LCA) and determine the increase in serum albumin concentrations post-LCA transfusion. To describe the incidence and types of acute transfusion reactions (TRs) and associated outcome in dogs presenting to a veterinary teaching hospital. Retrospective and descriptive study from 2009 to 2020. University teaching hospital. Fifty-three client-owned dogs included in the study if they received an LCA transfusion and had vital sign monitoring recorded for at least for 4hours after starting the LCA transfusion. None. The 53 dogs available for study inclusion received 64 LCA transfusions. Signalment; underlying disease; indications for LCA transfusion; pre- and posttransfusion serum albumin concentration; volume, concentration, and dose of LCA; duration of transfusion; administration of other blood products or synthetic colloids; occurrence, timing, and type of TR; length of hospitalization; and outcome were recorded. Serum albumin concentrations increased post-LCA transfusion, with a median dose of 0.56g/kg and a median posttransfusion serum albumin increase of 3g/L (0.3g/dL) (P=0.008). TRs occurred in 13 of 64 (20.3%) transfusion events. Volume per kilogram, dose (g/kg), concentration, duration of transfusion, and additional administration of synthetic colloids were not associated with TRs. Three (23%) TRs were classified as febrile nonhemolytic transfusion reaction, 5 (38.5%) as transfusion-associated dyspnea (development of respiratory distress and limited diagnostics), and 5 (38.5%) had clinical signs that could not be defined by any 1 TR category. Six (46.1%) of 13 events were nonsevere, 5 (38.5%) were severe, and 2 (15.4%) were life-threatening. Administration of LCA can be used to increase serum albumin concentrations, although the clinical implications of this increase are unknown. Acute TRs associated with LCA are relatively frequent and can be life-threatening. Careful monitoring is vital.

Study of the incidence and profile of acute transfusion reactions in children

Background: Blood is a vital human tissue and a precious health resource. Use of these components may be associated with adverse events, which compromise the efficiency and safety of blood transfusion. The incidence of adverse transfusion reactions has declined with modern facilities like improved screening and transfusion practices, but some are still observed due to alloimmunization, bacterial contamination, immunomodulation, etc. Aims and Objectives: To study the incidence and profile of acute blood transfusion reactions (ATR) in pediatric patients at our center. Materials and Methods: We monitored ATRs in patients receiving blood components among the age group of 1 month–18 years, during September 2021–August 2022. A detailed proforma was used to collect data from patients developing ATR. Results: ATRs were observed among 329 patients (3.9%) out of 9501 transfusions. In decreasing order of frequency, febrile nonhemolytic transfusion reactions (3.3%), allergies (0.5%), hemolytic reactions (0.1%) were observed. ATRs were most commonly observed with red cell concentrate transfusions (90.6%) followed by platelets (7%) and then plasma (2.2%) (P=0.059). Most of the reactions occurred within 1st 2 h (82.4%) of transfusion and the most common symptom recorded was fever (61.5%) followed by chills and rigors (20.9%). We found a significant association between ATRs and previous history of blood transfusion (81.8%) (P<0.00001) and also with storage of blood components for more than 3 days (88.8%) (P=0.019). Conclusion: The prevalence of ATR was 3.9% among pediatric patients in our setup. Knowledge of risk factors associated with transfusion reaction will help in improving transfusion practices.

Long-term clinical outcomes and healthcare utilization of sickle cell disease patients with COVID-19: A 2.5-year follow-up study.

This study investigated whether patients with sickle cell disease (SCD) had elevated risk of worse long-term clinical outcomes and healthcare utilization 2.5 years post-SARS-CoV-2 infection. This study consisted of 178 patients with SCD who tested positive for COVID-19 between February 1, 2020 and January 30, 2022 in a major academic health system in New York City. The control cohort consisted of two-to-one matches of 356 SCD patients without a COVID-19 positive test. The last follow-up was July 18, 2022. The primary outcome was mortality. Secondary outcomes were annualized emergency department visits due to pain, pain hospital admission, length of stay due to pain, acute chest syndrome, episodic transfusion, and episodic exchange transfusion. There was no significant difference in mortality between SCD patients with and without COVID-19 (p > .05). There were no significant differences in secondary outcomes between pre- and postpandemic (p > .05). There were also no significant differences in these outcomes between SCD patients with and without COVID-19 (p > .05). SCD care utilization was not significantly associated with COVID-19 hospitalization status (p > .05). SCD patients with SARS-CoV-2 infection incurred no additional risk of worse long-term outcomes compared to matched controls of SCD patients not infected by SARS-CoV-2.

Spectrum of Hemolytic Transfusion Reactions from Tertiary Cancer Center Over a 1-year Period

Background and Objectives: Acute hemolytic transfusion reactions (HTRs) one of the serious adverse events manifesting within 24 h of blood transfusion. To review the adverse transfusion reactions in our cancer center over a 1-year period, especially HTR and its causation to find the ways of mitigating the same. Methods: This was a retrospective analysis of HTR in tertiary care cancer center from South India. Patients who developed HTR in 2022 were included for discussion. Results: A total of six HTRs observed in five patients during 1 year. Case 1 was an acute presentation of HTR due to Anti Jka antibody. Case 2 was a nonimmune HTR associated with leukodepleted irradiated packed red blood cells transfusion. Case 3 was an incidental finding of passive hemolysis due to ABO incompatible platelet transfusion in patient clinically manifesting febrile and transfusion-associated dyspnea. Case 4 presented as an HTR with inconclusive evidence suggestive of HTR, with an impression of hemolysis as a part of the underlying disease. Conclusion: While the incidence of HTR due to ABO-incompatible transfusion reactions has been minimized, the other potential causes for acute HTR are still a concern. An effective hemovigiliance and strict adherence to standards in blood component practice may help to mitigate any form of transfusion reaction.

Retrospective study of canine blood xenotransfusion compared with type-matched feline blood allotransfusion to cats: indications, effectiveness, limitations and adverse effects.

Xenotransfusion is the transfusion of blood from one species to another. With varying availability of allogenic feline blood (AFB) and in emergency conditions, circumstances occur when canine blood is transfused to cats. This study aimed to characterise the indications, effectiveness, limitations, and acute and late transfusion-related adverse effects of canine blood xenotransfusion compared with matched AFB to anaemic cats, and their survival and longer-term outcome. This retrospective study (2013-2020) examined cats receiving canine blood xenotransfusions or AFB. The study included 311 cats (xenotransfusion [X-group], n = 105; allotransfusion [A-group], n = 206). Xenotransfusion was more frequent among cats sustaining haemorrhage than in those with haemolysis (P <0.01) or hypoproliferative anaemia (P <0.001). Financial constraints were the most common reason to elect xenotransfusion (49%). The post-transfusion mean packed cell volume was higher (P <0.001) in the X-group (22%) compared with the A-group (18%), and also higher (P <0.001) at 48-96 h post-transfusion (23% vs 18%, respectively). Transfusion-related adverse effects (TRAEs) were more frequent (P = 0.001) in the X-group (37.1%) compared with the A-group (19.4%), as were delayed haemolytic transfusion reactions (85% vs 42.5%, respectively; P <0.001). Acute transfusion reactions (ATRs) were more frequent (P <0.001) in the A-group (60%) compared with the X-group (20%). TRAEs were unassociated with survival to discharge. The survival to discharge rate of the X-group (55%) was lower (P = 0.007) than in the A-group (73%), while post-discharge survival rates to 30 days of cats surviving to discharge were 90% and 88%, respectively (P = 0.85). Canine blood xenotransfusions to cats might save lives in emergency conditions when AFB is unavailable or blood typing is infeasible. The survival to discharge rate of the X-group was lower than that of the A-group. The longer-term survival rate of cats administered xenotransfusions and surviving to discharge from the hospital was good.

Role of antibody screening in high titre group O donors

Red Cells, Fresh Frozen Plasma (FFP) and Platelets (RDP/SDP) prepared from donors with group O may have high titers of anti-A, anti-B and/or anti-A,B antibodies. When such components given to non-group O patients, this high titre can result in haemolytic transfusion reactions (HTRs). Such group O donors are generally termed ‘high-titer group O donors. Significant amounts of ABO antigen being present on the platelet surface and anti-ABO iso-agglutinins being present in the donor’s plasma, Platelet transfusions need to take into account the issues. Although relatively rare, but acute intravascular haemolytic transfusion reaction has been caused by passive transfer of anti-A and anti-B antibodies, present in group O donors. This study aimed to identify the prevalence of high titre antibodies in group O donors. Thus, titre are performed in randomly selected group O donors from different gender and age group to identify best available source of products for Platelet and follow up transfusions.: Randomly selected 100 O blood group donors were included in the study. Samples from these donors were tested for ABO antibody (both IgM and IgG) titres using conventional tube technique at RT and 37°C at Indirect Antiglobulin phase. Statistical analysis was performed using two sample t-test and anova test.Donors included in the present study were mainly male (85%) donors. ABO antibody titres ranged from 0 to 2048. In the present study, Anti-B (IgG) titer is significantly higher than other antibodies in both genders.There are a large proportion of group O donors having high titres of antibodies and hence a routine pretransfusion screening for such antibodies can prevent the development of hemolytic transfusion reaction by issuing only low titre components for out of group transfusions.Each Blood Transfusion Service should establish a policy for testing and issue of group O platelets to non-O group recipient to avoid chances of development of adverse transfusion reaction.

Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement forhip, pelvic and long bone fractures.

Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement forhip, pelvic and long bone fractures.

Smokeless Tobacco Use is Associated With Worse Medical and Surgical Outcomes Following Total Hip Arthroplasty

Studies have demonstrated increased complication risk after total hip arthroplasty (THA) in patients who smoke cigarettes. However, it is unclear if smokeless tobacco use confers a similar impact. The purpose of this study was to (1) evaluate rates of postoperative complications after THA in smokeless tobacco users and people who smoke as compared to matched controls, and (2) compare rates of postoperative complications in smokeless tobacco users versus people who smoke. A retrospective cohort study was conducted using a large national database. For patients who underwent primary THA, smokeless tobacco users (n = 950) and people who smoke (n = 21,585) were matched 1:4 with controls (n = 3,800 and 86,340, respectively), and smokeless tobacco users (n = 922) were matched 1:4 with people who smoke (n = 3,688). Rates of joint complications within 2 years and medical complications within 90 days postoperatively were compared using multivariable logistic regressions. Within 90 days of primary THA, smokeless tobacco users demonstrated significantly higher rates of wound disruption, pneumonia, deep vein thrombosis, acute kidney injury (AKI), cardiac arrest, transfusion, readmission and longer length of stay compared to tobacco naïve controls. Within 2 years, smokeless tobacco users demonstrated significantly higher rates of prosthetic joint dislocations and overall joint-related complications compared to tobacco naïve controls. Smokeless tobacco use is associated with higher rates of medical- and joint-related complications following primary THA. Smokeless tobacco use may be under-diagnosed in patients undergoing elective total hip arthroplasty. Surgeons may consider delineating between smoking and smokeless tobacco use during preoperative medical optimization.

Clinical outcomes of patients with cancer before the SARS COV2 pandemic vs during the pandemic: A nationwide analysis.

e18569 Background: The novel SARS COV2 pandemic has disrupted cancer treatment, both preventive as well as treatment services. We aimed to study the clinical outcomes of cancer patients who were hospitalised before and during the pandemic. Methods: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2016-2020 was queried to identify adult patients (Age &gt; 18 years) with a diagnosis of cancer using the ICD-10 (International Classification of Diseases) codes. Study population was stratified based on the year of admission- 2016 to 2019 vs 2020 (the pandemic year). Primary outcomes included mortality, length of stay (LOS), and total hospitalization charges (THC). Secondary outcomes included prevalence of pulmonary embolism (PE), ICU admission, acute respiratory failure (ARF), blood transfusion, and sepsis. Statistics were performed using multivariate linear and logistic regression using STATA v17. Results: There were 18 million admissions in adults with cancer from 2016-2020. Among them 14.6 million (81.1%) were hospitalised during 2016-2019 (pre pandemic) whereas 3.4 million (18.9%) were hospitalized in 2020 (pandemic). There was no significant difference in the mean age of both groups, pandemic group had higher charlson comorbidity burden (66.4 vs 63.7%, p &lt; 0.01). Pandemic group had higher rates of DM (26 vs 24%), CHF (15 vs 13.8%), CKD (18 vs 16.5%), dyslipidemia (36.4 vs 33%), PEM (15 vs 13%), anemia (44 vs 42) all p &lt; 0.01. A total of 835,065 cancer patients died during the study period, the mortality rate in the pre-pandemic and pandemic years was 4.5% and 5% respectively (p &lt; 0.05). After adjusting for confounders, the all-cause mortality was increased in the pandemic group (aOR 1.10, 95% CI 1.05-1.12, p &lt; 0.01). The adjusted LOS was decreased by 0.1 days (95% CI: 0.06- 0.20, p &lt; 0.01)). The adjusted total hospitalization charges was increased by $12,891 (95% CI: 9745-16,035, p &lt; 0.01). Pandemic group had higher odds of sepsis (7.8 vs 6.5%), mechanical ventilation (4 vs 3%), pressor requirements (1.5 vs 1%), acute kidney injury (10 vs 7%) and acute respiratory failure (10 vs 7%), all p &lt; 0.01. Conclusions: During the COVID-19 pandemic, cancer patients with a high prevalence of medical comorbidities were more likely to be admitted to the hospital with COVID infection. The higher mortality in these patients was likely the result of higher secondary complications, also likely leading to earlier death explaining the lower LOS and higher hospitalization charges. Cancer patients with medical comorbidities should take higher preventive measures from COVID including encouraging continued primary vaccinations and regular boosters.

Racial disparities and clinical outcomes among cancer patients admitted with SARS-CoV-2 infection: A nationwide analysis.

e18568 Background: The novel SARS COV2 pandemic highlighted existing racial disparities in US healthcare. The impact was further amplified in the cancer community. We studied the racial disparities in the clinical outcomes of cancer patients who were hospitalised with COVID-19 infection. Methods: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2020 was queried to identify adult patients (Age &gt; 18 years) admitted for COVID with underlying cancer using the ICD-10 codes. Study population was stratified based on race (White vs African Americans vs Hispanics). Primary outcomes included mortality, length of stay (LOS), and total hospitalization charges (THC). Secondary outcomes included prevalence of pulmonary embolism (PE), ICU admission, acute respiratory failure (ARF), blood transfusion, and sepsis. Statistics were performed using multivariate linear and logistic regression using STATA v17. Results: There were 53,465 adult admissions for COVID in cancer patients. Among them 30,605 (58.8%) were White (WH), 9580 (18.4%) were African Americans (AA), 8225 (15.8%) were Hispanics (HISP). HISP and AA were significantly younger compared to WH (61.7 vs 65.8 vs 72.4, p &lt; 0.001). HISP had lowest Charlson comorbidity index (CCI) compared to whites (50.4% vs 67.7%, p &lt; 0.001). AA had highest rates of all medical comorbidities except dyslipidemia and COPD which was higher in WH. Of the 8135 (15.2%) patients that died during the admission, 60% (N = 4880) were WH, 17.1% (N = 1390) were AA whereas 13.5% (N = 1100) were HISP. Compared to WH, HISP had a higher odds of mortality (aOR 1.24, 95% CI 1.03-1.48; p = 0.022), there was no difference in the odds of mortality between WH and AA. The LOS was increased for AA and HISP compared to WH (9.1 vs 9.44 vs 7.78 days, p &lt; 0.001). The total hospitalization charges was also higher for AA and HISP compared to WH ($90,680 vs $123,894 vs $74,126, p &lt; 0.001). HISP patients had higher odds of requiring intubation, blood transfusion, shock and sepsis than WH. Conclusions: Despite being significantly younger with lower comorbidity burden, HISP, had an increased odds of mortality compared to WH patients. Contrary to reported literature (PMID: 35344045), there was no significant difference in the odds of mortality between WH and AA. Further studies are needed to explore the reasons for high mortality in HISP patients. [Table: see text]

Blood Transfusion Complications and Associated Factors Among Blood-Transfused Adult Patients at Debre Markos Comprehensive Specialized Hospital, Ethiopia: A Cross Sectional Study.

Blood transfusion is the infusion of whole blood or its components into the veins of the patient to improve tissue oxygenation and maintain hemostasis. Besides its clinical use, it can pose a risk of transfusion complications with different factors. The aim of this study was to assess blood transfusion complications, and associated factors among transfused adult patients at Debre Markos Comprehensive Specialized Hospital, North West Ethiopia, 2022. An institution-based cross-sectional study design was conducted on a total of 182 patients from March 20 to June 15, 2022. Patients were enrolled in the study using consecutive sampling method. The socio-demographic and clinical data were collected using a structured questionnaire and data extraction sheet, respectively. About 3 ml of anti-coagulated blood and 30 ml of urine samples were collected to assess transfusion complications. CBC and Coombs test were performed from blood and urinalysis from urine, respectively. Chi-square, Fisher's exact test, and binary logistic regression were done using SPSS version 25. P-values less than 0.05 are declared as statistically significant. An acute transfusion reaction (ATR) was encountered in 12 (6.6%) patients. It was 4.13, 7.78 and 3.96 times more likely to occur among patients with a previous history of transfusion, abortion, and transfused blood stored for more than 20 days compared to their counterparts, respectively. In addition, the odds of developing ATR increase by 2.07 as the number of transfused blood units increases by 1 unit. The incidence of acute transfusion reactions was high. During transfusion, clinicians should closely monitor patients who had history of transfusion, abortion, transfused old blood and more than 1 unit.

Evaluating the inventory impact of utilizing low titer platelets in regional hospitals.

As a result of constrained supply, it is sometimes necessary to provide patients with ABO-mismatched platelets. Such practices increase the risk of acute hemolytic transfusion reaction (AHTR). Providing patients with platelets suspended in O plasma having low-titer Anti-A and Anti-B antibodies (LtABO) could reduce the incidence of AHTR. However, natural scarcity limits the number of such units that can be produced. In this paper we present a study to evaluate strategies for deploying LtABO at regional hospitals in Canada. Regional hospitals often experience demand for platelets on an irregular basis. They are, however, required to stock some number of platelets (typically one A-unit and one O-unit) for emergencies; outdates are common, with discard rates sometimes >>50%. A simulation study was completed to determine the impact of replacing a (1A, 1O) inventory with 2 or 3 units of LtABO at regional hospitals. A significant decreases in wastage and shortage can be expected by replacing a (1A, 1O) inventory policy with 2 units of LtABO. In tested cases, a 2-unit LtABO dominated a (1A, 1O) policy, resulting in statistically fewer outdates and instances of shortage. Holding 3 units of LtABO, increases product availability, but results in an increase in outdates when compared to a (1A, 1O) policy. Providing LtABO platelets to smaller, regional hospitals will lower wastage rates and improve patient access to care, when compared to existing (1A, 1O) inventory policies.

Robotic-Assisted Bariatric Surgery Is Associated with Increased Postoperative Complications Compared to Laparoscopic: a Nationwide Readmissions Database Study.

Robotic-assisted (RA) bariatric surgery has been increasingly used without consistent benefit over a laparoscopic approach (LA). We compared intra- and post-operative complications and 30- and 90-day all-cause readmissions between RA and LA using the Nationwide Readmissions Database (NRD). We identified hospitalizations with adult patients who underwent RA or LA bariatric surgery from 2010 to 2019. Primary outcomes included intra- and post-operative complications and 30- and 90-day all-cause readmissions. Secondary outcomes included in-hospital death, length of stay (LOS), cost, and cause-specific readmissions. Multivariable regression models were estimated; analyses accounted for the NRD sampling design. A total of 1,371,778 hospitalizations met inclusion criteria with 7.1% using RA. Patient demographic and clinical characteristics were mostly similar between groups. Adjusted odds of complication were 13% higher for RA (adjusted odds ratio [aOR]: 1.13, 95% CI: 1.03-1.23 p = .008); aORs differed across bariatric procedures. The most common complications included nausea/vomiting, acute blood loss anemia, incisional hernia, and transfusion. Adjusted odds of 30- and 90-day readmission were 10% higher for RA (aOR: 1.10, 95% CI: 1.04-1.17, p = .001 and aOR: 1.10, 95% CI: 1.04-1.16, p <.001, respectively). LOS was similar (1.6 vs. 1.6 days, p = .253); although, hospital costs were 31.1% higher for RA ($15,806 vs. $12,056, p < .001). RA bariatric surgery is associated with 13% higher odds of complication, 10% higher odds of readmission, and 31% hospital costs. Subsequent studies are required using databases that can include additional patient-, facility-, surgery-, and surgeon-specific characteristics.

Biological investigations of transfusion reactions: Contribution of symptom-based decisional algorithms.

While transfusion is a common and safe therapeutic procedure in health care facilities, transfusion reactions can occur, whether acute or delayed, mild or life-threatening. In face of these reactions, the biological analysis laboratory plays a central role in their diagnosis. The objective of this article is to develop decisional algorithms for laboratory tests to be performed according to the clinical symptoms developed by the patient during or after transfusion. Based on the information collected by reviewing the literature and the procedures used in our hospital, we then developed biological investigation algorithms according to the symptoms presented by the patient, rather than the presumed reaction. We have developed symptom-based algorithms for acute transfusion reactions management that streamline laboratory testing and simplify the differential diagnosis.

Guideline on the investigation and management of acute transfusion reactions.

Guideline on the investigation and management of acute transfusion reactions.

5613294 BASELINE PATIENT CHARACTERISTICS FROM A UK EARLY ACCESS TO MEDICINES SCHEME (EAMS) WITH VOXELOTOR, A HBS POLYMERIZATION INHIBITOR, FOR THE TREATMENT OF HEMOLYTIC ANEMIA DUE TO SICKLE CELL DISEASE

Background: Standard of care for patients with sickle cell disease (SCD) typically includes blood transfusions and treatment with hydroxyurea (HU). Voxelotor, a first-in-class oral treatment, inhibits sickle hemoglobin polymerization, the molecular basis of red blood cell sickling. Voxelotor is approved in the United States for the treatment of SCD in patients aged ≥4 years and in the European Union, Great Britain, United Arab Emirates, Kuwait, and Oman for patients aged ≥12 years. Voxelotor has been provided to eligible patients with SCD in the United Kingdom (UK) through a Medicines and Healthcare Products Regulatory Agency – approved Early Access to Medicines Scheme (EAMS) and through a company Named Patient Program (NPP), both of which allow patients to receive new, unlicensed medicines when there is a clear unmet need. Aims: To describe the UK patient population participating in the voxelotor EAMS and NPP for the treatment of hemolytic anemia due to SCD. Methods: Patients aged ≥12 years with hemoglobin (Hb) ≤10.5 g/dL received voxelotor. The EAMS permitted patients to receive a stable dose of HU for 3 months prior to starting voxelotor, whereas NPP allowed patients who were ineligible or intolerant to HU, had a poor/no response to HU, or had stopped taking HU. Data on demographics, comorbidities, concomitant medications (including blood transfusions), adverse events, markers of hemolysis, vaso-occlusive crises (VOCs) requiring treatment and/or hospitalization, and discontinuation of therapy were collected. Results: As of August 22, 2022, 90 patients (61 in the EAMS and 29 in the NPP) were enrolled. Overall, the mean age (range) was 37.82 years (12-66), 53.33% (48/90) were female, 75.56% (68/90) were of African or Afro-Caribbean origin, and the most common genotype was HbSS (97.78%, 88/90) (Table). At baseline, mean (SD) [range] Hb was 7.54 (1.43) [4.6-10.8] g/dL. At baseline, 45.9% (28/61) of patients were taking HU, and 18.03% (11/61) had discontinued previous use of HU; 1.64% (1/61) had been treated with crizanlizumab, and 50.82% (31/61) reported having simple and/or exchange transfusions. In the 12 months before initiating voxelotor, the mean (SD) number of VOCs requiring hospitalization was 0.84 (1.52). Other reasons for hospitalization included admission for VOC (24.59%, 15/61), acute chest syndrome (4.92%, 3/61), transfusion (9.84%, 6/61), hyperhemolysis (3.28%, 2/61), and other (9.84%, 6/61). A total of 9.84% (6/61) of patients reported ≥3 emergency department (ED) admissions, and alloimmunization was reported in 19.67% (12/61) of patients. Summary/Conclusion: The UK EAMS and NPP provide voxelotor to patients with SCD with limited treatment options. Clinical measures, ED visits, and hospital admission rates of patients participating in the voxelotor EAMS and NPP demonstrate the characteristics of patients selected for the early access scheme and highlight the unmet treatment needs among representative patients with SCD in the UK. Baseline hemolytic parameters and Hb levels are critical not only for defining patient eligibility, but as follow-up measures for patients while receiving voxelotor treatment. Data on the impact of voxelotor on clinical outcomes are forthcoming. Funding: This study was supported by Global Blood Therapeutics.Reference 1. Medicines and Healthcare Products Regulatory Agency. Voxelotor: treatment protocol: information on the pharmacovigilance system. Updated August 5, 2022. Accessed August 28, 2022. https://www.gov.uk/government/publications/voxelotor-in-the-treatment-of-sickle-cell-disease/voxelotor-treatment-protocol-information-on-the-pharmacovigilance-system

Resultados intrahospitalarios tras tratamiento percutáneo frente a quirúrgico en pacientes con estenosis aórtica y enfermedad arterial coronaria concomitante

Introduction and objectivesConcomitant coronary artery disease (CAD) is prevalent among aortic stenosis patients; however the optimal therapeutic strategy remains debated. We investigated periprocedural outcomes among patients undergoing transcatheter aortic valve implantation with percutaneous coronary intervention (TAVI/PCI) vs surgical aortic valve replacement with coronary artery bypass grafting (SAVR/CABG) for aortic stenosis with CAD. MethodsUsing discharge data from the Spanish National Health System, we identified 6194 patients (5217 SAVR/CABG and 977 TAVI/PCI) between 2016 and 2019. Propensity score matching was adjusted for baseline characteristics. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were in-hospital complications and 30-day cardiovascular readmission. ResultsMatching resulted in 774 pairs. In-hospital all-cause mortality was more common in the SAVR/CABG group (3.4% vs 9.4%, P <.001) as was periprocedural stroke (0.9% vs 2.2%; P=.004), acute kidney injury (4.3% vs 16.0%, P <.001), blood transfusion (9.6% vs 21.1%, P <.001), and hospital-acquired pneumonia (0.1% vs 1.7%, P=.001). Permanent pacemaker implantation was higher for matched TAVI/PCI (12.0% vs 5.7%, P <.001). Lower volume centers (< 130 procedures/y) had higher in-hospital all-cause mortality for both procedures: TAVI/PCI (3.6% vs 2.9%, P <.001) and SAVR/CABG (8.3 vs 6.8%, P <.001). Thirty-day cardiovascular readmission did not differ between groups. ConclusionsIn this large contemporary nationwide study, percutaneous management of aortic stenosis and CAD with TAVI/PCI had lower in-hospital mortality and morbidity than surgical intervention. Higher volume centers had less in-hospital mortality in both groups. Dedicated national high-volume heart centers warrant further investigation.