Concentrated Red Blood Cells Research Articles

The Relationship of PCLR Therapy on Hemoglobin Levels in Anemia Patients at BDRS MMC Jakarta (January-April 2022)

Anemia is generally characterized by a decrease in hemoglobin levels. In terms of function, a decrease in hemoglobin causes a reduction in the body's need for oxygen in sufficient quantities. PCLR (Packed Red Cell Leukoreduced) is a concentrated red blood cell product obtained through the process of reducing leukocytes, so PCLR transfusion is expected to increase Hb levels in anemia patients. This study aims to determine the relationship between PCLR administration and hemoglobin levels in anemia patients and to determine the increase in hemoglobin levels after PCLR transfusion at MMC Hospital Blood Bank (BDRS MMC) Jakarta. Quantitative (analytical) research methods. The sample in this study was 140 data from anemia patients who underwent PCLR transfusion (January-April 2022). Data analysis was carried out univariate and bivariate. The research was carried out at MMC Jakarta Hospital in July 2022. Research results: the majority of patients were elderly (56-<65 years) 67 people (47.9%), the majority gender was female 82 people (58.6%); there was an increase in Hb levels after PCLR transfusion, namely 1.89 gr/dL with an average use of 2 bags; and there is a relationship between PCLR administration and hemoglobin levels in anemia patients at BDRS MMC Jakarta. Suggestion: to achieve an increase in hemoglobin in anemia patients, PCLR can be used as a blood component of choice for transfusion at the right dose.

Ten Years of Experience on the Effectiveness and Efficiency of the Cleanfield Device in Cardiothoracic Surgery

AbstractThe process of blood management and treatment from the surgical field to produce concentrated red blood cells (RBC) is crucial in the context of cardiothoracic surgery and in other branch of surgery. The role of autotransfusion reservoir is not well described in the literature in terms of superiority suction for hemolysis prevention. In this context, we presented a ten-year single-center retrospective analysis on suction, filtering, and blood collection from surgical field through the use of the Cleanfield Autotransfusion Reservoir (Eurosets SRL, Medolla, Italy) in terms of performance, effectiveness, and safety. From January 2013 to January 2023 were collected and analyzed the consecutive uses of Cleanfield Autotransfusion Reservoir in a single cardiothoracic surgery center Anthea Hospital Gvm Care & Research, Bari, Italy. For single procedure, the number of cleanfield disposable used, the relative maximum blood volume filtered and collected, the suction pressure from devices through vacuum meter and the electronic suction pressure measurements in the devices for suctions and the presence and the incidence of adverse events during the use (implosion, clot formation, inability to cell saver use, inability to suction during the use) were analyzed. 5202 Cleanfield disposable autotransfusion reservoir were analyzed for blood volume suction, filtering and collection on 5199 cardiac surgery procedures, the maximum blood volume filtered and collected was 1997 ± 123 ml, the mean suction pressure measured from the device with vacuum meter during suction use was 38 ± 3 mmHg, the mean suction pressure measured in the device during suction use was 38 ± 2 mmHg, no presence of adverse event was reported for implosion, clot formation, inability to cell saver use, and inability to suction during the use. In our retrospective report, the use of Cleanfield autotransfusion reservoir (Eurosets SRL, Medolla Italy) in cardiothoracic surgery context was safe and effective for blood volume suction, filtering, and collection.

Intrauterine transfusion under fetal analgesia: the evaluation of perinatal outcomes.

Intrauterine transfusion is the treatment for fetal anemia resulting from maternal alloimmunization, infections (parvovirus B19 and cytomegalovirus), single demise of a monochorionic twin, chorioangioma, and other rare conditions. Fetal analgesia is mandatory to reduce movement and pain perception during the procedure. This study aims to evaluate perinatal outcomes for such procedures, following the routine use of fetal analgesia in our clinical practice. Retrospective analysis of cases from 2009 to 2022, including all confirmed fetal anemia with fetal blood sampling. After fetal analgesia, Rh-negative concentrated red blood cells were transfused, with ultrasonographic follow-up 24 h and 1 week later. In case of suspected brain lesion, magnetic resonance imaging was performed. Elective delivery was considered in case of persistent anemia after 34 weeks. Post-natal follow-up and comprehensive obstetric and perinatal outcomes data were collected. Altogether 59 anemic fetuses were included, with 34 (57.6%) being hydropic. The causes of anemia were maternal alloimmunization (22, 37.3%), infections (13, 22%), monochorionicity (10, 16.9%), rare conditions (9, 15.3%), and two chorioangiomas (3.4%). The median gestational age at the procedure was 25.2 weeks (18-32 weeks), with no related preterm premature rupture of membranes (<48 h), or side effects from fetal analgesia. Gestational age at delivery was 33 weeks (26-41 weeks), with survival rate of 90%. There were four fetal demises, two termination of pregnancies, and eight neonatal deaths due to persistent severe anemia after preterm delivery. The main contributors to adverse outcome were the type of anemia, and the management with a preterm delivery. Intrauterine transfusion of red blood cells under analgesia is safe, with low incidence of obstetric complication.

Porcine Normothermic Isolated Liver Perfusion.

Porcine models of liver ex situ normothermic machine perfusion (NMP) are increasingly being used in transplant research. Contrary to rodents, porcine livers are anatomically and physiologically close to humans, with similar organ size and bile composition. NMP preserves the liver graft at near-to-physiological conditions by recirculating a warm, oxygenated, and nutrient-enriched red blood cell-based perfusate through the liver vasculature. NMP can be used to study ischemia-reperfusion injury, preserve a liver ex situ before transplantation, assess the liver's function prior to implantation, and provide a platform for organ repair and regeneration. Alternatively, NMP with a whole blood-based perfusate can be used to mimic transplantation. Nevertheless, this model is labor-intensive, technically challenging, and carries a high financial cost. In this porcine NMP model, we use warm ischemic damaged livers (corresponding to donation after circulatory death). First, general anesthesia with mechanical ventilation is initiated, followed by the induction of warm ischemia by clamping the thoracic aorta for 60 min. Cannulas inserted in the abdominal aorta and portal vein allow flush-out of the liver with cold preservation solution. The flushed-out blood is washed with a cell saver to obtain concentrated red blood cells. Following hepatectomy, cannulas are inserted in the portal vein, hepatic artery, and infra-hepatic vena cava and connected to a closed perfusion circuit primed with a plasma expander and red blood cells. A hollow fiber oxygenator is included in the circuit and coupled to a heat exchanger to maintain a pO2 of 70-100 mmHg at 38 °C. NMP is achieved by a continuous flow directly through the artery and via a venous reservoir through the portal vein. Flows, pressures, and blood gas values are continuously monitored. To evaluate the liver injury, perfusate and tissue are sampled at predefined time points; bile is collected via a cannula in the common bile duct.

Non invasive hemodynamic monitoring for fluids and blood resuscitation during placenta praevia accreta cesarean delivery: a retrospective observational study

BackgroundWe carry out a retrospective observational analysis of clinical records of patients with major placenta praevia who underwent cesarean section surgery over a period of 20 months in our hospital. Out of a total of 40 patients, 20 were subjected to Goal-Directed Therapy (GDT) implemented with non-invasive hemodynamic monitoring using the EV1000 ClearSight system (Group I) and 20 to standard hemodynamic monitoring (Group II). Given the risk of conspicuous blood loss, this study evaluate the impact on maternal and fetal health of GDT relative to standard hemodynamic monitoring.ResultsAverage total infusion of fluids was 1600 +/− 350 ml. Use of blood products occurred in 29 patients (72,5%), of which 11 had a hysterectomy and 8 were treated with Bakri Balloons. For 2 patients > 1000 mL of concentrated red blood cells were used. When stroke volume index SVI dropped below 35 mL/m2/beat, it responded well to the infusion of at least 2 crystalloid boluses (5 ml/kg) in 7 patients. Cardiac index (CI) increased in 8 patients in concomitance with a reduction in medium arterial pressure (MAP), but the use of ephedrine (10 mg iv) re-established acceptable baseline values. Group I means are higher than Group II means for MAP, lower for RBC usage, end-of-surgery maternal lactates and fetal pH, and for LOS. Statistical analysis determines that the null hypotheses of equalities between Groups I and II can be rejected for all measures apart from MAP at baseline and induction. Proportions of serious complications in Groups I and II are respectively 10% and 32% and Boschloo’s test rejects the null of equality of proportions against the alternative hypothesis of lower proportion of occurrence in Group I than in Group II.ConclusionsHypovolemia can lead to vasoconstriction and inadequate perfusion with decreased oxygen delivery to organs and peripheral tissues and ultimately cause organ dysfunction. Despite the small sample size due to the rarity of the pathology, our statistical analysis finds evidence in favor of more favorable clinical outcomes for patients who received GDT implemented with non-invasive hemodynamic monitoring infusion relative to patients who received standard hemodynamic monitoring.

Pengaruh Sentrifugasi Spesimen Darah Anemia Terhadap Derajat Aglutinasi Pemeriksaan Golongan Darah Metode Slide

Anemic patients often have low hemoglobin and red blood cell level, which on the slide method and ABO system blood type test is used to obtain low degree of agglutination. Addition of treatment of a centrifugation was used to obtain a stronger degree of agglutination. The purpose of this research was to determine the difference degree of agglutination between centrifuged and uncentrifuged blood specimens in anemic patients. Quasi experimental research with non-equivalent control group design was conducted in March 2022 at the Hematology Laboratory, Universitas Muhammadiyah Semarang. The research sample were 16 specimens of anemic patients for slide method and ABO system blood type test. All samples were checked for blood type test before being centrifuged, then re-checked after the centrifugation there only concentrated red blood cell deposit were taken with only a small amount of plasma. The data from the test were analyzed using the Kruskal Wallis method. Comparison anti-A, anti-B, and anti-AB between centrifuged and uncentrifuged blood specimens there was a significant difference (p value &amp;lt; 0,005 means p = 0,002). The result showed that there were effect by centrifugation for the degree of agglutination improved better in centrifuged if compared with uncentrifugedanemicpatients blood specimens on blood type test slide method.

Predictive value of D-dimer for deep venous thrombosis of lower extremity in adult burn patients

Objective: To investigate the predictive value of D-dimer for deep venous thrombosis (DVT) of lower extremity in adult burn patients. Methods: A retrospective case series study was conducted. The clinical data of 3 861 adult burn patients who met the inclusion criteria and were admitted to the Department of Burns of Zhengzhou First People's Hospital from January 1, 2015 to December 31, 2019 were collected. The patients were divided into DVT group (n=77) and non-DVT group (n=3 784) according to whether DVT of lower extremity occurred during hospitalization or not. Data of patients in the two groups were collected and compared, including the gender, age, total burn area, D-dimer level, with lower limb burn and inhalation injury or not on admission, with sepsis/septic shock, femoral vein indwelling central venous catheter (CVC), history of surgery, and infusion of concentrated red blood cells or not during hospitalization. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test. The indicators with statistically significant differences between the two groups were analyzed with multivariate logistic regression analysis to screen the independent risk factors for DVT of lower extremity in 3 861 adult burn patients. The receiver operating characteristic (ROC) curve of the independent risk factors predicting DVT of lower extremity in 3 861 adult burn patients were drawn, and the area under the curve (AUC), the optimal threshold value, and the sensitivity and specificity under the optimal threshold value were calculated. The quality of the AUC was compared by Delong test, and the sensitivity and specificity under the optimal threshold value were compared using chi-square test. Results: There were no statistically significant differences in gender, occurrence of sepsis/septic shock or history of surgery during hospitalization between patients in the two groups (P>0.05), while there were statistically significant differences in age, total burn area, D-dimer level, lower limb burn and inhalation injury on admission, and femoral vein indwelling CVC and infusion of concentrated red blood cells during hospitalization between patients in the two groups (t=-8.17, with Z values of -5.04 and -10.83, respectively, χ2 values of 21.83, 5.37, 7.75, and 4.52, respectively, P<0.05 or P<0.01). Multivariate logistic regression analysis showed that age, total burn area, and D-dimer level were the independent risk factors for DVT of lower extremity in 3 861 adult burn patients (with odds ratios of 1.05, 1.02, and 1.14, respectively, 95% confidence intervals of 1.04-1.06, 1.00-1.03, and 1.10-1.20, respectively, P<0.05 or P<0.01). The AUCs of ROC of age, total burn area, and D-dimer level for predicting DVT of lower extremity in 3 861 adult burn patients were 0.74, 0.67, and 0.86, respectively (with 95% confidence intervals of 0.68-0.80, 0.60-0.74, and 0.83-0.89, respectively, P values<0.01), the optimal threshold values were 50.5 years old, 10.5% total body surface area, and 1.845 mg/L, respectively, the sensitivity under the optimal threshold values were 71.4%, 70.1%, and 87.0%, respectively, and the specificity under the optimal threshold values were 66.8%, 67.2%, and 72.9%, respectively. The AUC quality and sensitivity and specificity under the optimal threshold value of D-dimer level were significantly better than those of age (z=3.29, with χ2 values of 284.91 and 34.25, respectively, P<0.01) and total burn area (z=4.98, with χ2 values of 326.79 and 29.88, respectively, P<0.01), while the AUC quality and sensitivity and specificity under the optimal threshold values were similar between age and total burn area (P>0.05). Conclusions: D-dimer level is an independent risk factor for DVT of lower extremity in adult burn patients, its AUC quality and sensitivity and specificity under the optimal threshold value are better than those of age and total burn area, and it has good predictive value for DVT of lower extremity in adult burn patients.

Estimation of Thrombocyte Concentrate (TC) in PMI Gresik using unscented and square root Ensemble Kalman Filter

Ministry of Health established the Indonesian Red Cross (PMI) as an organization to anticipate the need for blood by obligation to provide enough proper blood for use. Its process of delivering information related to blood donation requires the public always come to PMI. In such way it is less efficient and effective. In addition, there is no system for estimating blood stock to anticipate the blood supply needed in the next period. Blood transfusion is needed in terms of both quality and quantity by patients suffering from various health problems. Due to the urgency of blood transfusion, maintaining the stability of blood stock is a must so as not to cause blood loss due to excessive of the blood stock. To minimize such loss, blood stock prediction is needed. The objective of this study was to estimated the blood demand for blood type of Thrombocyte Concentrate (TC) or concentrated red blood cells at PMI Gresik by applying the method of Unscented Kalman Filter (UKF) and Square Root Ensemble Kalman Filter (SR-EnKF). The simulation results showed that both methods have high accuracy with an error of less than 3%.. The best simulation showed that the error between the real data and the simulation with SR-EnKF was in the order of 0.0023574 with generated 300 ensembles. Where as that with UKF was some 0.025566.

The Third Trimester Bleeding at the Department of Obstetrics and Gynecology of the Teaching Hospital Souro Sanou of Bobo Dioulasso. About 105 Cases and Review of Literature

Objective: To learn the epidemiological, clinical, paraclinical, therapeutical aspects and prognosis of haemorrhage of the third trimester during pregnancy. Methodology: It is about a transversal and descriptive study, realized at the department of obstetrics and gynaecology from January 1st to June 30th 2020. Was included in the study any pregnant patient showing the third trimester bleeding (≥28 Weeks gestation) received for bleeding during our study period and has been taken in charge in our department. The parameters studied were on the socio-demographic characteristics, the clinical and para clinical aspects, the noted diagnosis, the therapeutic aspects, maternal and perinatal prognosis. The information was collected from an inquiry document, the clinical files, the register of delivery room and childbirth, surgery protocols. The type and the analysis of the data were done by the softwares Word, Excel 2013 and Epi Info version 7.2.3. Results: We registered 2159 deliveries and 105 cases of third trimester bleeding, so a frequency of 4.86%. The average age was 30.14 ± 6.57 [16 - 49 years old] and the average parity was 3 [0 - 10]. Married women represented 87.62% of all. They were in a bad condition in 41.90% of cases. Fetal heart-sound was absent in 65.76% of cases. The diagnosis checked was abruptio placenta, placenta previa and the uterus rupture. A blood transfusion of concentrated red blood cells Isogroup and Isorhesus was performed to 45.72% of cases. Caesarean section was performed in 54.29% of cases. Complications were observed in 74.28% of cases. The maternal lethality rate was 13.33% with a perinatal mortality of 74.77%. Conclusion: The third trimester bleeding is frequent in developing countries because of poor obstetric coverage in this country. The perinatal prognosis is often bad because of late diagnosis, difficult access to Health Center with adequate technical platforms, miss of blood products and miss of qualified staff to take in charge these emergencies.

An In Vitro Pilot Study Comparing the Novel HemoClear Gravity-Driven Microfiltration Cell Salvage System with the Conventional Centrifugal XTRA™ Autotransfusion Device.

Background In 2013, the World Health Organization reported a shortage of 17 million red blood cell units, a number that remains growing. Acts to relieve this shortage have primarily focused on allogeneic blood collection. Nevertheless, autologous transfusion can partially alleviate the current pressure and dependence on blood banking systems. To achieve this, current gold standard autotransfusion devices should be complemented with widely available, cost-efficient, and time-efficient devices. The novel HemoClear cell salvage device (HemoClear BV, Zwolle, Netherlands), a gravity-driven microfilter, potentially is widely employable. We evaluated its performance in the cardiac postoperative setting compared to the centrifugal XTRA™ autotransfusion device. Methods In a split-unit study (n = 18), shed blood collected 18 hours after cardiothoracic surgery was divided into two equal volumes. One-half was processed by the XTRA™ device and the other with the HemoClear blood separation system. In this paired set-up, equal washing volumes were used for both methods. Washing effectivity and cellular recovery were determined by measuring of complete blood count, free hemoglobin, complement C3, complement C4, and D-dimer in both concentrate as filtrate. Also, processing times and volumes were evaluated. Results The HemoClear and XTRA™ devices showed equal effectiveness in concentrating erythrocytes and leucocytes. Both methods reduced complement C3, complement C4, and D-dimer by ≥90%. The centrifugal device reduced solutes more significantly by up to 99%. Free hemoglobin load was reduced to 12.9% and 15.5% by the XTRA™ and HemoClear, respectively. Conclusion The HemoClear device effectively produced washed concentrated red blood cells comparably to the conventional centrifugal XTRA™ autotransfusion device. Although the centrifugal XTRA™ device achieved a significantly higher reduction in contaminants, the HemoClear device achieved acceptable blood quality and seems promising in settings where gold standard cell savers are unaffordable or unpractical.

The Bata Analysis of Surgical Changes Based on the Computer Aided Analysis of the end of the Cleaning Autotransfusion Technique

Objective: to explore the application and nursing strategy of flushing transfusion technique in orthopedic surgery by computer aided information analysis. Methods : 63 patients underwent orthopedic surgery with autologous blood collection device were treated with concentrated red blood cells. Preoperative nursing, intraoperative nursing, postoperative observation and follow-up were performed during the treatment. Results: the results of computer-aided data analysis and postoperative observation were as follows: the intraoperative blood transfusion volume of 63 patients was 500-1800 mL, with an average of 650 mL. All patients had no complications such as transfusion reaction, allergy, hemolysis and infection. Postoperative blood routine examination, coagulation function, electrolytes and urine routine were normal, and no patients needed blood transfusion. Conclusion: flushing autotransfusion is safe and effective in orthopedic surgery. Meticulous care is the key to a successful operation.

Transfusions in the Emergency department: More than a blood transfusion

Increasing haemoglobin and haematocrit levels with blood transfusions has been the gold standard for treating severe anaemia; however, the indication for transfusing concentrated red blood cells is based merely on a few laboratory markers, such as haemoglobin and haematocrit levels, rather than based on the symptoms according to clinical practice guidelines, the implementation of legal regulations and the consensus achieved by the hospitals’ transfusion committees. The aim of this multicentre study was to reassess the suitability of the indication for transfusing concentrated red blood cells and the volumes transfused in emergency departments. We established an observational, multicentre, cross-sectional design with 2 participating centres: the La Paz University Hospital and the Hospital of Salamanca. In total, we obtained data from 381 patients, 220 (57.74%) of whom were men with an average age of 71.4±14.0 years and 161 (42.26%) of whom were women with an average age of 75.3±15.3 years (P<0.001). The most prevalent underlying diseases in the patients who underwent transfusions were heart disease, which included haemorrhaging due to antiplatelet or anticoagulant therapy (57.7%), haematooncologic (15.3%) diseases and neurological disease. Only 54.9% (209/381) of the prescriptions for transfusion were considered appropriate, with significant differences according to the indication.

Occurrence of deep venous thrombosis in adult burn patients and its risk factors

Objective: To investigate the occurrence and risk factors of deep venous thrombosis (DVT) in adult burn patients. Methods: The clinical data of 1 219 adult burn patients admitted to the Department of Burns of Zhengzhou First People's Hospital from January 1, 2015 to August 31, 2016, conforming to the study criteria, were analyzed retrospectively by the method of case-control study, including 811 males and 408 females, aged 18-102 years. According to whether DVT occurred during hospitalization or not, the patients were divided into group DVT (n=12) and non-DVT group (n=1 207). The incidence of DVT, the diagnosis time of DVT, affected limbs, and DVT classification were counted and recorded. The gender, age, total burn area, D-dimer, lower limb burn, full-thickness burn, femoral vein indwelling central venous catheter (CVC) , inhalation injury, sepsis/infection shock, surgical operation, and infusion of concentrated red blood cells of patients between the two groups were compared with chi-square test, and then the indicators with statistically significant differences between the two groups were processed by multivariate binary logistic regression analysis to screen the independent risk factors of DVT in the adult burn patients. Results: (1) The incidence of DVT of adult burn patients was 0.98% (12/1 219), and DVT was diagnosed 24-138 days after injury, with a median of 61.5 days. DVT occurred in the right lower limb of 2 patients, left lower limb of 8 patients, and bilateral lower limbs of 2 patients, and DVT classification included 6 cases of mixed type and 6 cases of peripheral type. (2) There were no statistically significant differences in gender, age, and full-thickness burn of patients between the two groups ( χ(2)=1.524, 0.021, 3.115, P>0.05). There were statistically significant differences in total burn area, lower limb burn, inhalation injury, sepsis/infection shock, D-dimer, femoral vein indwelling CVC, surgical operation, and infusion of concentrated red blood cells among patients between the two groups (χ(2)=17.975, 6.206, 3.987, 8.875, 5.447, 15.124, 10.735, 14.031, P<0.05 or P<0.01). (3) Total burn area, D-dimer, and femoral vein indwelling CVC were independent risk factors for DVT in adult burn patients (odds ratio=10.927, 4.762, 9.394, 95% confidence interval=3.078-38.789, 1.197-18.934, 2.631-33.540, P<0.05 or P<0.01). Conclusions: The incidence of DVT in adult burn patients is relatively low, and the diagnosis time of DVT is 3 weeks after burn, with DVT classification of mixed type and peripheral type. The total burn area, femoral vein indwelling CVC, and D-dimer are independent risk factors for predicting DVT in adult burn patients.

Caso Clínico: Citopénia Autoinmune como complicación inmunológica de Trasplante Alogénico de Donante no emparentado, en paciente pediátrico con Anemia Drepanocítica

Introducción: La enfermedad de células falciformes es una condición heredada en la que se produce una hemoglobina anómala que desfavorece a la oxigenación tisular, crisis vaso-oclusivas y reacciones hemolíticas. Los pacientes con esta enfermedad presentan una activación anómala de la vía del complemento llevándolos al aumento en frecuencia de infecciones y enfermedades autoinmunes. Presentamos un caso de asociación de una enfermedad autoinmune en un paciente con enfermedad de células falciforme.&#x0D; Caso clínico: Niño de 10 años con Anemia drepanocítica (2009) con esplenectomía y crisis veno-oclusivas recurrentes, fue sometido a trasplante Alogénico en abril del 2019 fuera de la institución con donante isogrupo O+ no emparentado (10/10). Tratado con: Fludarabina – Busulfan, Timoglobulina+ y Metotexate. Desarrolló Bicitopenia autoinmune y síndrome febril al día +165 post TPH. Glóbulos blancos: 360 uL, neutrófilos: 14 %, hemoglobina: 7.90 g/dL, plaquetas: 25000 uL, ferritina: 4695 ng/ml, IgG total: 9.88 gr/l, LDH: 190 UI/l. Proteína C reactiva: 2.79 mg/dL, procalcitonina 0.13 ng/mL.&#x0D; Evolución: posterior a descartar infección viral, se completó un tratamiento antibiótico de amplio espectro y se realizó la suspensión del tratamiento inmunosupresor por sospecha de toxicidad, sin respuesta. Se realizó un estudio medular por citometría de flujo determinando una disminución de la línea linfoide B, y se concluye Citopénia autoinmune como complicación inmunológica del trasplante.&#x0D; Desenlace: recibió terapia transfusional (plaquetoferesis + glóbulos rojos concentrados). Se utilizó metilprednisolona IV por 3 días y prednisona 30 mg por 14 días con reducción posterior gradual para inicio de Rituximab y ciclosporina. Se completó el tratamiento con Imnunoglobulina 6g IV por 5 días. Al alta glóbulos blancos: 5080 uL, neutrófilos: 67%, hemoglobina: 9.20 g/dL, plaquetas: 20000 uL, después de 18 días de ingreso hospitalario.&#x0D; Conclusión: Los resultados con el tratamiento en este caso sugieren que puede ser razonable considerar las citopenias autoinmunes como una manifestación hematológica diagnóstica de la EICH crónica. Alternativamente, es posible que el tratamiento de citopenia inmune con esteroides, rituximab y otros inmunosupresores.

The use of tranexamic acid in elective lung surgery: a single-center experience

ContextAcute pulmonary embolism (PE) is a lethal sequela of venous thromboembolism (VTE). Surgical trauma injures the tissue directly, releasing a large number of tissue agent. The frequency of re-exploration owing to bleeding after lung surgery is between 1 and 3.7%, whereas the need of allogenic blood transfusion spans from 20 to 52%.AimsTo assess the role of tranexamic acid (TXA) in reducing the need of allogenic blood transfusion in patients undergoing elective lung surgery.Patients and methodsThis retrospective study was conducted on 140 patients who underwent elective lung surgery. Patients were allocated into two groups. Group I patients received TXA at the end of procedure, and group II patients received blood and/or blood product transfusion.Statistical analysisQualitative variables are expressed as mean±SD. Quantitative variables are compared by using the Student’s t test.ResultsThe patients comprised 80 males and 60 females in our series. All cases in group II needed transfusion of one or more of the following: concentrated red blood cells, whole blood, fresh frozen plasma, and platelets. There was an obvious decrease in the postoperative hemoglobin level between groups, in favor of blood transfusion group (group II), and this was statistically significant.ConclusionsElective thoracic surgery patients have a low incidence of VTE and PE (2.85 and 2.14%, respectively). Hence, TXA helps in minimizing not only transfusion-related hazards but also operative cost.

Transfusión en Urgencias: algo más que una transfusión de sangre

Increasing haemoglobin and haematocrit levels with blood transfusions has been the gold standard for treating severe anaemia; however, the indication for transfusing concentrated red blood cells is based merely on a few laboratory markers, such as haemoglobin and haematocrit levels, rather than based on the symptoms according to clinical practice guidelines, the implementation of legal regulations and the consensus achieved by the hospitals’ transfusion committees. The aim of this multicentre study was to reassess the suitability of the indication for transfusing concentrated red blood cells and the volumes transfused in emergency departments. We established an observational, multicentre, cross-sectional design with 2 participating centres: the La Paz University Hospital and the Hospital of Salamanca. In total, we obtained data from 381 patients, 220 (57.74%) of whom were men with an average age of 71.4±14.0 years and 161 (42.26%) of whom were women with an average age of 75.3±15.3 years (P<.001). The most prevalent underlying diseases in the patients who underwent transfusions were heart disease, which included haemorrhaging due to antiplatelet or anticoagulant therapy (57.7%), haemato-oncologic (15.3%) diseases and neurological disease. Only 54.9% (209/381) of the prescriptions for transfusion were considered appropriate, with significant differences according to the indication.

Effects of different hemoglobin concentrations on lung injury in a rabbit model of hemorrhagic shock and resuscitation

Objective To evaluate the effect of different hemoglobin (Hb) concentrations on the lung injury in a rabbit model of hemorrhagic shock and resuscitation (HS-R). Methods Fifty healthy male New Zealand rabbits, aged 2 months, weighing 1.9-2.4 kg, were divided into 5 groups (n=10 each) using a random number table method: control group (group C), HS-R group (group H), and three HS-R plus infusion of concentrated red blood cell groups group R1 (60 g/L≤Hb<80 g/L), group R2 (80 g/L≤Hb<100 g/L) and group R3 (100 g/L≤Hb<120 g/L). The animals were sacrificed at 3 h after resuscitation, lung tissues were obtained for examination of the pathological changes with a light microscope, and lung tissues were obtained again for determination of wet to dry weight ratio (W/D ratio), neutrophil myeloperoxidase (MPO), NO level and cell apoptosis (by TUNEL). Results Compared with group C, the levels of MAP and NO, W/D ratio and apoptosis index were significantly increased in the other groups (P 0.05). Conclusion Maintaining Hb 80-100 g/L after HS-R reduces acute lung injury in rabbits. Key words: Shock, hemorrhagic; Cardiopulmonary resuscitation; Hemoglobins; Acute lung injury

Prediction of Availability of Packed Red Cells (PRC) at PMI Surabaya City Using Ensemble Kalman Filter as Management of Blood Transfusion Management

Blood transfusion in terms of both quality and quantity is needed by patients with various health problems they experience. Along with the increased need for blood transfusion, the management of blood transfusion arrangements (blood collection from donors, selection, distribution, storage), and the ability of nurses to provide transfusion to patients is needed. If there are a lot of mistakes in both the ability of management and the ability of nurses, it can not only lead to a fatal impact on a patientbut also increase amount of need for blood transfusion. Due to the importance of blood transfusion, maintaining the stability of blood stock must be done so as not to cause blood loss due to exces of the blood stock. To minimize such loss, blood prediction is needed. The objective of this study is to predict blood demand for blood type of Packed Red Cells (PRC) or concentrated red blood cells at PMI Surabaya by using the method of Ensemble Kalman Filter (EnKF) and Ensemble Kalman Filter Square Root (EnKF-SR). The simulation results show that both methods have high accuracy with an error of less than 1% and RMSE of EnKF-SR. The best simulation exhibited the error between the real data and the simulation with EnKF-SR was in the order of 0.0023574, whereas with EnKF was some 0.025566 with generated 400 ensembles.

Discovering Novel Antimicrobial Peptides using High-Throughput Screening and Rational Variation

Antimicrobial peptides (AMPs) have long been attractive drug candidates for the next generation of clinical antibiotics due to their potent antimicrobial activity and low propensity for inducing resistance in pathogens. However, due in part to toxicity concerns and activity loss in vivo, AMPs have yet to have any impact clinically. Our lab hypothesized that the presence of host cells could cause depletion of free peptide available to target bacterial cells and showed this to be true for some AMPs using concentrated human red blood cells (RBCs) as a model eukaryotic cell. To solve this problem, we synthesized a combinatorial peptide library based on the potent AMP, ARVA, and screened the library for activity in the presence of concentrated RBCs. We isolated nine unique, but similar sequences from the screen. We designed a consensus sequence based on the nine peptides and synthesized it using only D-isomer amino acids to form D-NOGCON. D-NOGCON displays excellent antimicrobial activity against multiple human pathogens in the presence and absence of concentrated RBCs, causes very little hemolysis, and is not susceptible to cleavage by cellular or plasma proteases. D-NOGCON also has high activity against bacterial biofilms and does not readily induce leakage. In this work, we created rational variants of D-NOGCON with truncations, insertions and mutations to test various hypotheses about the basis for highly potent antimicrobial activity with low hemolysis and low toxicity against nucleated cells. In the near future, we will use this information to design a next generation combinatorial peptide library based on D-NOGCON that will be screened for i) clinically relevant antimicrobial activity in the presence of serum and concentrated red blood cells, ii) negligible hemolysis, and iii) negligible toxicity against nucleated cells.

Transfusion dans l’autogreffe et l’allogreffe de cellules souches hématopoïétiques chez l’adulte et l’enfant : recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC)

The recommendations of the French Health and Drug Safety Authorities (HAS/ANSM-Haute Autorité de santé/Agence nationale de sécurité du médicament) are known, but there are always new developments underway. With regards to CMV suppression, there is the introduction of platelet glycoprotein Ia and the Intercept (Amotosalem+UVA) inactivation method which addresses bacterial risk. The irradiation of platelets is included in the recommendations to ensure HEV-negative plasma post allograft. In terms of blood transfusion safety, these measures as well as the broader spectrum of Ia, particularly for arboviruses, are a real breakthrough. The survey conducted in clinical services and the services providing blood products for transfusion along with a literature review have shown that several improvements need to be made. The first is a reduction of transfusions of concentrated red blood cells with introduction at a threshold of 7g/dL during hospitalization of patients without a fragile clinical status. The second improvement would address transfusion of refractory thrombocytopenia, encouraging an increase in discussion between clinicians and those conducting the transfusion in order to consider different etiologies and to identify appropriate care protocols. Third would be the need for the transmission of information between the transplantation doctors and blood transfusion specialists in order to define an approach to transfusion care adapted to the patient's situation. It is important to inform and educate patients about transfusion protocols post allotransplant or autotransplant. It must be clearly communicated to patients that they should always have on their person their blood group documentation. This is especially true when receiving care for a hemopathy or an autologous transplant. If undergoing an allogeneic transplant, patients should also carry transfusion guidelines post autotransplant or post allotransplant along with the phone numbers for the stem cell transplantation department and the blood transfusion center responsible for their care.