Neoadjuvant Radiation is Causally Linked to Increased Operative Time and Perioperative Blood Transfusion in Pancreatic Ductal Adenocarcinoma.

Association of body mass index and length of stay in patients undergoing minimally invasive surgery for uterine cancer: a National Surgical Quality Improvement Program (NSQIP) study.

Institutional analysis of crossmatch-to-transfusion ratios at a tertiary hospital.

Adverse perinatal outcomes associated with macrosomia in nulliparous women: A multicenter cohort study.

Sustainable plateletapheresis in a LMIC blood service: Namibia's five-year experience with the Trima Accel™ Automated Blood Collection System.

Maternal and Fetal Outcomes Among Pregnant Women Developing Pemphigoid Gestationis.

To examine the impact of frailty on 30-day outcomes of open reduction internal fixation (ORIF) alone or ORIF + total hip arthroplasty (THA) (fix-and-replace) for the treatment of acetabular fractures. . Retrospective Cohort. A total of 700 hospitals in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Included were patients aged 60 years or older undergoing ORIF ± THA for OTA/AO type 62 A-C fractures from 2015 to 2020. Preoperative frailty was assessed by the revised Risk Analysis Index (not frail: <21, prefrail: 21-30, frail: 31-40, severely frail: >40) and the 5-Item Modified Frailty Index factor. All outcome measures were in-hospital or within 30 days postoperatively, including the "favorable outcome," defined as no readmission, length of stay (LOS) < cohort median, and no major complication or death. There were 585 patients included [ORIF (88%): mean age-70.5 ± 14.2, sex-41.4% female; ORIF + THA (12%): mean age-77.0 ± 13.4; sex-65.7% female]. Frail patients (n = 353, 65.5%) were more likely to experience a complication [OR: 3.31, CI: (1.83-5.96)] and mortality (3.7% vs. 0.0%). ORIF + THA had higher association with postoperative transfusion [OR: 2.70, CI: (1.63-4.48)] but lower association with LOS >3 days [OR: 0.41, CI: (0.24-0.72)] and nonhome discharge [OR: 0.52, CI: (0.27-0.98)] than ORIF. Prefrail and frail patients undergoing ORIF + THA were more likely to achieve favorable outcomes than those nonfrail or severely frail [OR: 9.69, (3.40-27.57)]. Surgical intervention for acetabular fractures carried a 30-day complication risk of 12%-19% for frail patients. Frailty had similar predictability to age for early morbidity after surgery to treat acetabular fractures. Open reduction and internal fixation with the addition of an acute THA was associated with a higher rate of blood transfusion and shorter hospital LOS in frail patients with acetabular fractures. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Identification strategy for patients with ABO blood typing difficulties caused by IgM autoantibodies.

Anaesthetic considerations for patient blood management in cancer surgery: a narrative review.

Introduction: Blood donation is vital part of any blood transfusion services in healthcare. There are various Adverse Donor Reactions (ADRs) associated with blood donation. These reactions affect blood donation and, in terms supply of blood. Understanding the prevalence and nature of ADRs is crucial for improving the overall donor experience, so that the present study was done to estimate the incidence of ADRs among blood donors, along with typing such donors with reactions according to the National Blood Donor Vigilance Programme (Haemovigilance Program of India - HvPI). Aim: The present study was conducted to find out the incidences and types of ADRs among whole blood and apheresis donors. Materials and Methods: The present prospective observational cohort study was conducted at a blood centre attached to Tertiary Care Government hospital of South Gujarat, India, from February 2021 to December 2024, according to guidelines given by the Department of Biologicals, Government of India, under the National Haemovigilance Programme. During the present study analysis of ADRs among whole blood donors and apheresis donors, along with effect of gender, site of donation, and type of donation on ADRs. The analysis was done using two-tailed Chi-square test and odds ratios at 95% confidence interval. Results: Among total of 34,202 blood donations during the study period, the overall incidence of ADRs was 168 (0.49%). Majority of ADRs were Vasovagal Reactions (VVR), constituting 96.42% of all types. Most ADRs (56.54%, i.e., 95 out of 168 ADRs) occurred in donors aged 18-30 years, with first-time donors exhibiting a higher prevalence of 52.38%. Notably, ADRs were more frequent in females than in males (0.74% vs. 0.48%). Outdoor donation camps showed a higher rate of ADRs compared to in-house donations (0.51% vs. 0.38%), although these findings were not statistically significant (p-value &gt;0.05 at 95% confidence interval). Conclusion: The present study highlighted the importance of age, gender, donation type, and donation site in relation to ADRs. Effective donor counselling and observation, especially for first-time donors, are crucial in minimising ADRs and enhancing donor safety. Understanding the factors influencing ADRs can be helpful to improve donor recruitment and retention, ultimately contributing to a safer and more sustainable blood donation system.

Survey of the current status of blood transfusion in remote areas in Japan.

Postoperative thrombocytopenia in patients with acute type A aortic dissection (AAD) necessitates platelet transfusions and is associated with higher morbidity and mortality. This retrospective study aimed to evaluate the effects of recombinant human thrombopoietin (rhTPO) on AAD patients who experienced severe postoperative thrombocytopenia (platelet count nadir <20 × 109/L). We retrospectively evaluated 43 AAD patients who underwent open aortic repair surgery with subsequent severe thrombocytopenia at the Second Hospital of Shandong University between June 2019 and June 2022. We compared patient outcomes between rhTPO-treated patients (n = 20) with nontreated patients (n = 23). The primary outcome was to evaluate the association of the rhTPO treatment with postoperative platelet count response. The secondary outcomes included transfusions of blood components and length of hospital stay. Compared with nontreated controls, significantly higher levels of platelet count were observed in rhTPO-treated patients on POD7 (110.1 ± 18.1 vs 83.6 ± 19.1 [×109/L]; P < 0.001). The time required for the platelet count to increase to >100 × 109/L was significantly less in rhTPO-treated patients compared with controls (6.8 ± 0.85 vs 8.5 ± 1.5 days; P < 0.001). The rhTPO treatment was significantly correlated with the reductions in perioperative plasma transfusion (1435 ± 114 vs 1743 ± 206 mL; P < 0.001) and days of hospital stay (P = 0.003). We concluded that rhTPO treatment was significantly associated with increased platelet count recovery in postcardiac surgery AAD patients suffering from severe thrombocytopenia. Besides, the rhTPO therapy appeared to be correlated with reduced blood transfusions and length of hospital stay.

Preoperative blood transfusion is an independent risk factor for postoperative infection, readmission, and mortality following surgery for femoral shaft fractures

Chen et al's research provides valuable data supporting the cautious use of transfusions during gastric cancer surgery. However, to interpret causality, it must be acknowledged that recent tend-adjusted studies have consistently shown that the independent effect of transfusions may be smaller than that shown in unadjusted analyses. Future research should employ the following approaches: (1) Extended temporal characterization; (2) Functional immunological assessment; (3) Prospective designs incorporating detailed transfusion data; (4) Machine learning methods; and (5) Mechanistic studies. The relationship between transfusions and cancer treatment outcomes goes far beyond simple immunosuppression or inflammation. It reflects a complex interplay between patient vulnerability, surgical factors, and immune responses, requiring a comprehensive study across multiple biological levels and temporal dimensions.

PurposeKetorolac is commonly cautioned with a possible effect of bleeding. The safety and efficacy of Ketorolac has not been examined in children who have undergone general surgery procedures.MethodsA single institution retrospective cohort study examining children ages 0-18 from 2017-2022 with and without Ketorolac <24hours after the following operations: laparoscopic appendectomy, laparoscopic cholecystectomy, laparoscopic or open inguinal hernia repair, umbilical hernia repair, and ventral hernia repair. Demographics were reported using bivariate inferential statistics. A Cox proportional hazards model identified associations between Ketorolac and time to pain score ≤3. Logistic regression measured odds of opioid use in morphine equivalents 24-hour after surgery.Results5455 patients were identified. Children who received Ketorolac after surgery were more likely to be older (11.5 vs 7.0 years, P < .0001). Compared to Whites, Asian Americans (OR .50, CI .36-.63, P < .0001) and African Americans (OR .22, CI .13-.37, P < .0001) were less likely to receive Ketorolac. Patients receiving Ketorolac were more likely to have a high pain score (>5) after surgery (40% vs 23%, P < .0001) when receiving Ketorolac vs opioid alone (P < .0001). Patients receiving Ketorolac had 40% decreased odds of receiving opioid after surgery (OR .90, 95% CI: .87-.94, P < .0001). Blood transfusions were less common in patients that received Ketorolac (0.2% vs 0.7%, P = 0.005).ConclusionKetorolac does not increase the risk of bleeding requiring transfusion and decreases opioid administration. Ketorolac is efficacious in this patient population either alone or in combination with opioids and improves pain control compared to opioids alone.

Beta Thalassaemia Major is a hereditary disorder characterised by defective protein synthesis in the beta-globin chain, leading to chronic anaemia. As a consequence of repeated blood transfusions used to manage anaemia, excessive iron accumulation occurs, primarily in the liver and other vital organs, leading to organ damage. To determine the correlation between liver iron concentration and iron accumulation in the liver due to blood transfusions in paediatric patients diagnosed with Beta Thalassaemia Major, using shear wave elastography and liver magnetic resonance imaging apparent diffusion coefficient measurements. A prospective study was conducted from January 2025 to April 2025 on 77 paediatric patients diagnosed with Beta Thalassaemia Major, utilising liver shear wave elastography, liver apparent diffusion coefficient, T2* values and serum ferritin levels. Descriptive statistics for the continuous variables of the patients: elasticity median (10.39 ± 4.39 kPa), velocity median (1.81 ± 0.36 m/s), liver ADC (0.52 ± 0.42), liver T2* (4.93 ± 5.15), LIC (9.45 ± 5.7). The median elasticity values differed significantly across the iron overload severity groups (p = 0.006). A post hoc analysis was performed to identify the groups responsible for this difference. The analysis revealed that the differences originated from comparisons between the mild (9.58 ± 3.62) and severe (14.44 ± 5.91) groups, the moderate (9.47 ± 3.24) and severe (14.44 ± 5.91) groups and the severe (14.44 ± 5.91) and normal (8.16 ± 2.44) groups (pac < 0.001; pbc < 0.001; pcd = 0.003). We demonstrated a correlation between liver shear wave elastography and liver apparent diffusion coefficient values with MRI T2* and LIC in the group of paediatric patients diagnosed with Beta Thalassaemia Major who had a high liver iron burden.

Beyond HLA: An adaptive nanopore sequencing assay for simultaneous HLA and blood group profiling in transplantation.

The optimal treatment for 2-3cm renal stones requires balancing efficacy with minimal invasiveness. While mini-percutaneous nephrolithotomy (mPCNL) is a standard approach, retrograde intrarenal surgery with a Flexible and Navigable Suction Sheath (FANS-RIRS) has emerged as a promising alternative. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of these two procedures. A systematic search of PubMed, Embase, Web of Science, and CENTRAL was conducted through August 2025 to identify RCTs comparing FANS-RIRS and mPCNL for 2-3cm renal stones. Primary outcomes included stone-free rates (SFRs), perioperative variables, and safety profiles, including hemorrhagic and infectious complications. Evidence was synthesized using random-effects models, and certainty was assessed with the GRADE framework. Three high-quality RCTs enrolling 1020 patients were included. Final SFRs were comparable between FANS-RIRS and mPCNL (OR 0.80, 95% CI 0.51-1.24; P = 0.31). However, FANS-RIRS was associated with significant advantages in safety and recovery, including a smaller hemoglobin decline (MD - 5.36g/L), lower rates of hemorrhage (OR 0.08) and blood transfusion (OR 0.14), a shorter hospital stay (MD - 1.75 days), and less postoperative pain (all P < 0.05). Operative time, auxiliary procedure rates, and infectious complications did not differ significantly between groups. The certainty of evidence for outcomes was rated as moderate to low due to the small number of studies and heterogeneity. Current evidence from randomized trials suggests that for 2-3cm renal stones, FANS-RIRS may provide efficacy comparable to mPCNL but with a potentially superior safety profile and faster patient recovery. While promising, these findings are based on a limited number of RCTs, and FANS-RIRS appears to be a viable option, particularly for patients who have a high bleeding risk or prioritize a quicker return to normal activities. This study was prospectively registered in PROSPERO (CRD420251136058).

Venetoclax plus azacitidine or decitabine is approved in the US for treatment of newly diagnosed patients with acute myeloid leukemia (AML) aged ≥ 75years or who have comorbidities precluding use of intensive chemotherapy. As novel targeted regimens expand treatment options for AML, this study evaluated the budget impact of adopting venetoclax combinations for this population from a US third-party payer perspective to inform affordability and access at the health plan level. The model estimated the 3-year budget impact of adopting venetoclax combinations in a hypothetical US health plan with 1 million members (60% commercial, 40% Medicare). Eligible patients were estimated using public data. Market share projections assumed venetoclax + azacitidine or decitabine captured a 53% and 15% share, respectively, from existing treatments (azacitidine, low-dose cytarabine [LDAC], decitabine, ivosidenib, gemtuzumab ozogamicin, glasdegib + LDAC, and ivosidenib + azacitidine). The model considered costs associated with drug acquisition/administration, adverse events, hospitalization, disease monitoring, blood transfusions, and subsequent AML management (2024 USD). Clinical inputs for venetoclax combinations were informed by final VIALE-A and M14-358 data, respectively. Incremental budget impact was calculated as per-member-per-month (PMPM), with one-way sensitivity analyses performed. In a 1-million-member health plan, 48 patients were eligible for venetoclax combinations. Annual costs of venetoclax + azacitidine ($258,498) or decitabine ($259,921) were lower than those of the highest-cost comparators, ivosidenib + azacitidine ($477,520) and ivosidenib ($404,869). Drug acquisition costs of adopting venetoclax combinations were offset by lower subsequent AML management costs, resulting in savings of $0.0476 PMPM in years 1-3. Results remained robust in sensitivity analyses. In a 100% Medicare scenario, 117 patients were eligible for venetoclax combinations, with savings of $0.1137 PMPM over years 1-3. Inclusion of venetoclax combinations for newly diagnosed patients with AML aged ≥ 75years or with comorbidities precluding intensive chemotherapy reduced the budget impact, providing potential financial benefits for US payers.

Abstract The Warshaw-type distal pancreatectomy is a surgical technique that preserves the spleen by ligating the splenic vessels while maintaining perfusion through the short gastric vessels and the left gastroepiploic artery. Although generally safe, it may lead to the development of left-sided (sinistral) portal hypertension, with the formation of perigastric collateral circulation and the appearance of gastric varices. While these varices are often asymptomatic, a minority of patients may develop complications such as upper gastrointestinal bleeding. We present the case of a 38-year-old woman previously treated with a Warshaw-type distal pancreatectomy for mesenteric fibromatosis, who presented with hematemesis and syncope. Endoscopic evaluation revealed gastric varices, and imaging studies confirmed this diagnosis, demonstrating perisplenic collaterals associated with interruption of the splenic venous axis, consistent with postsurgical left-sided portal hypertension. The patient received initial treatment with cyanoacrylate injection, somatostatin infusion, and blood transfusion, followed by initiation of beta-blocker therapy as secondary prophylaxis. She remained hemodynamically stable without further bleeding. Due to her postoperative vascular anatomy, radiological embolization and other shunt procedures were not feasible. Given the presence of significant thrombocytopenia, elective splenectomy was indicated as definitive treatment, resulting in complete resolution of the condition. This case highlights a rare but potentially serious complication of the Warshaw technique and underscores the importance of considering sinistral portal hypertension as a cause of gastrointestinal bleeding, even many years after surgery. Individualized management and a multidisciplinary approach are essential for optimal outcomes.