Correction Of Anemia Research Articles

Risk Factor Targeted Perioperative Care Reduces Anastomotic Leakage after Colorectal Surgery: The DoubleCheck study.

The DoubleCheck study aimed to introduce pre- and perioperative interventions minimizing exposure to modifiable risk factors and determine its effect on CAL. Colorectal anastomotic leakage (CAL) is a severe complication. In order to predict and prevent its occurrence, the LekCheck study identified intraoperative modifiable risk factors for CAL: anemia, hyperglycemia, hypothermia, incorrect timing of antibiotic prophylaxis, administration of vasopressors and epidural analgesia. This international open-labelled interventional study was performed between September 2021 and December 2023. An enhanced care bundle consisting of anemia correction, glucose measurement, attaining normothermia, antibiotics administration within 60 to 15 minutes preoperatively, refraining from vasopressors and epidural analgesia was introduced. Primary outcome was the occurrence of intraoperative risk factors just prior to the anastomosis creation. Secondary outcomes were CAL and mortality. Univariate and multivariate regression analysis were performed to establish the relationship between the enhanced care bundle, exposure to the six factors and CAL. The historical LekCheck group consisted of 1572 patients versus 902 in the DoubleCheck. The LekCheck group had a mean of 1.84 risk factors versus 1.63 in DoubleCheck ( P <0.001). In the DoubleCheck significantly less patients had ≥3 risk factors ( P <0.001). CAL was significantly lower in the DoubleCheck group (8.6% vs. 6.2%, P =0.039). The reduction of CAL was associated with the enhanced care bundle in multivariate regression analysis (OR 1.521, 95% CI 1.01-2.29, P =0.045). The mortality rate did not differ significantly (1.3%, vs. 0.8%, P =0.237). The DoubleCheck study showed that optimization of modifiable risk factors reduced CAL in colorectal surgery.

A Cross-sectional Study of Anemia Among Medical Students and its Impact on Learning, Physical and Emotional Well-being

Objective: To measure the prevalence of anemia and its effect on physical activity, learning skills and social, emotional impact in medical students. Background: Anemia is a general health issue which severely affects young adults during an intense growth period. The vast nature of medical curriculum demands hard efforts and hectic study schedule medical students at risk of anemia due to irregular eating habits which affects their learning skills and physical activity. Methodology: A cross-sectional study was conducted among medical students (1st year and 2nd year) of Hazrat Bari Sarkar (HBS) Medical College), Islamabad, by administering a structured questionnaire. This was a year study from August 2023 to July 2024. Data was collected using a structured questionnaire, along with venous blood samples. An automated hematology analyzer located in the Department of Pathology was used to measure hemoglobin. Data Analysis was performed by appropriate statistical tests, and statistical significance was set at P-values &lt;0.05. Conclusion: More than half the students in our medical school were anemic and had a negative impact on their learning, physical and social well-being. This could possibly be due to their poor eating habits. The memory and academic performance of students can be improved by correction of anemia.

Anemia predictive indicator (API). how can we predict in three days the anemia that will develop in three months? case report

The Anemia Predictive Indicator (API) includes the analysis of the reticulocyte count, the reticulocyte hemoglobine content (HCr) and immature reticulocyte fraction (IRF). API reflects erythropoietic activity and allows immediate detection and correction of iron deficiency anemia, and the response can be observed on the second and third day after starting treatment. In this case report, a 79-year-old woman after a total knee replacement, API provided predictability at the onset of anemia, allowed the follow-up of anemia and its treatment, collaborated in clinical and medical decision, contributed to preventive actions and improve the patient's quality of life.

Assessing the Efficacy of Bovine Lactoferrin to Correct Iron Deficiency Anaemia in Women of Reproductive Age: A Double Blind Randomized Controlled Trial in Mirpur, Dhaka

Assessing the Efficacy of Bovine Lactoferrin to Correct Iron Deficiency Anaemia in Women of Reproductive Age: A Double Blind Randomized Controlled Trial in Mirpur, Dhaka

EAES/SAGES evidence-based recommendations and expert consensus on optimization of perioperative care in older adults

BackgroundAs the population ages, more older adults are presenting for surgery. Age-related declines in physiological reserve and functional capacity can result in frailty and poor outcomes after surgery. Hence, optimizing perioperative care in older patients is imperative. Enhanced Recovery After Surgery (ERAS) pathways and Minimally Invasive Surgery (MIS) may influence surgical outcomes, but current use and impact on older adults patients is unknown. The aim of this study was to provide evidence-based recommendations on perioperative care of older adults undergoing major abdominal surgery.MethodsExpert consensus determined working definitions for key terms and metrics related to perioperative care. A systematic literature review and meta-analysis was performed using the PubMed, Embase, Cochrane Library, and Clinicaltrials.gov databases for 24 pre-defined key questions in the topic areas of prehabilitation, MIS, and ERAS in major abdominal surgery (colorectal, upper gastrointestinal (UGI), Hernia, and hepatopancreatic biliary (HPB)) to generate evidence-based recommendations following the GRADE methodology.ResultOlder adults were defined as 65 years and older. Over 20,000 articles were initially retrieved from search parameters. Evidence synthesis was performed across the three topic areas from 172 studies, with meta-analyses conducted for MIS and ERAS topics. The use of MIS and ERAS was recommended for older adult patients particularly when undergoing colorectal surgery. Expert opinion recommended prehabilitation, cessation of smoking and alcohol, and correction of anemia in all colorectal, UGI, Hernia, and HPB procedures in older adults. All recommendations were conditional, with low to very low certainty of evidence, with the exception of ERAS program in colorectal surgery.ConclusionsMIS and ERAS are recommended in older adults undergoing major abdominal surgery, with evidence supporting use in colorectal surgery. Though expert opinion supported prehabilitation, there is insufficient evidence supporting use. This work has identified evidence gaps for further studies to optimize older adults undergoing major abdominal surgery.

MDB-82. TRANSFUSION-RELATED IRON OVERLOAD MIMICKING METASTATIC DISEASE IN A PEDIATRIC PATIENT WITH MEDULLOBLASTOMA ON A RADIATION-DELAYING CHEMOTHERAPY REGIMEN

Abstract BACKGROUND Transfusion-related iron overload (TRIO) is a known complication of administering numerous packed red blood cell (pRBC) transfusions in pediatric oncology patients undergoing myelosuppressive therapy. Infant medulloblastoma regimens attempt to avoid or delay radiation and its adverse effects in this population, with intensive myelosuppressive chemotherapy. We report a case of TRIO first suspected as hepatic metastatic disease at time of CNS recurrence in a young patient with medulloblastoma after completion of a high-dose chemotherapy protocol. METHODS Case Report RESULTS A five-year-old male presented with four months of headaches, dizziness, imbalance, and emesis. MRI revealed a posterior fossa mass with near total resection of the mass confirming classic medulloblastoma, non-WNT, non-SHH. The patient received five cycles of induction chemotherapy. This was followed by a single cycle of high-dose chemotherapy (HDCSCR) with autologous stem cell rescue. During therapy, he received 26 pRBC transfusions to correct severe anemia. CNS recurrence occurred 19 months after therapy. Abdominal imaging revealed enlarging hepatic lesions concerning for metastases. Ferritin was 1,268 ng/mL (normal: 7-142 ng/mL) and MRI of liver revealed severe iron load with LIC of 11 mg Fe/g dry weight (dw) (normal: 0.4-2.2 mg Fe/g dw). Ultimately, hepatic lesions were thought to be non-cancerous, and he proceeded with craniospinal irradiation. He was diagnosed with TRIO. He underwent phlebotomy for 33 months with ferritin and MRI liver LIC within normal limits. CONCLUSION This case illustrates an occurrence of TRIO presenting as hepatic lesions concerning for metastatic disease during CNS recurrence in a patient who underwent an infant medulloblastoma regimen with HDCSCR. Our patient required phlebotomy for nearly 3 years to return ferritin and LIC to normal limits. Further investigation on the prevalence of TRIO in medulloblastoma survivors treated with radiation delaying/sparing protocols is necessary to improve outcomes and avoid end organ damage due to iron overload.

Neoadjuvant chemotherapy-induced hemoglobin decline as a prognostic factor in osteosarcoma around the knee joint: a single-center retrospective analysis of 242 patients

PurposeAnemia is relatively common in cancer patients, and is associated with poor survival in patients with various malignancies. However, how anemia would affect prognosis and response to neoadjuvant chemotherapy (NAC) in osteosarcoma (OS) is still without substantial evidence.MethodsWe retrospectively analysed 242 patients with stage II OS around the knee joint in our institute. Changed hemoglobin (Hb) levels (before and after NAC) were recorded to assess the prognostic value in DFS (disease-free survival) and tumor response to NAC. Univariate and multivariate analyses were conducted to identify prognostic factors related with outcome in OS patients.ResultsThe mean Hb level significantly decreased after NAC (134.5 ± 15.3 g/L vs. 117.4 ± 16.3 g/L). The percentage of mild (21%), moderate (4.2%) and severe (0%) anemia patients markedly increased after NAC: 41%, 24% and 4.1% respectively. There was higher percentage of ≥ 5% Hb decline in patients with tumor necrosis rate < 90% (141 out of 161), compared with those with tumor necrosis rate ≥ 90% (59 out of 81). Further univariate and survival analysis demonstrated that Hb decline had a significant role in prediction survival in OS patients. Patients with ≥ 5% Hb decline after NAC had an inferior DFS compared with those with < 5% Hb decline.ConclusionIn osteosarcoma, patients with greater Hb decrease during neoadjuvant treatment were shown to have worse DFS and a poorer response to NAC than those without. Attempts to correct anemia and their effects on outcomes for osteosarcoma patients should be explored in future studies.

Exploring the Prospects of Antenatal Microcoil Embolization of Giant Placental Chorioangioma: Case Report and Review of Literature

AbstractGiant placental chorioangiomas, which measure more than 4 cm, are associated with adverse maternal, fetal, and neonatal outcomes, with an estimated perinatal mortality of 30 to 40%. Early diagnosis, close prenatal surveillance, intrauterine intervention, and timely delivery would play a vital role in improving pregnancy outcomes. Using conventional treatment options like amniodrainage to reduce intrauterine pressure and intrauterine blood transfusion to correct fetal anemia fails to tackle the underlying pathophysiology. Interventions aimed at devascularizing the tumor, such as injection of alcohol or surgical glue, use of bipolar cautery, placement of vascular clips, interstitial laser, and radiofrequency ablation, have had mixed results due to their invasive nature and associated complications. In this case report, we discuss a minimally invasive, percutaneous, extraamniotic method of focal occlusion accomplished by microcoil embolization of the feeding vessel. The combination of slow blood flow and endothelial vessel damage due to the presence of coils stimulates thrombogenic mechanisms, contributing to the formation of a clot and leading to the cessation of blood flow to the chorioangioma, thereby treating the primary pathology.

Prevalence of pre-operative anemia in elective surgical patients: A retrospective, observational study at a university hospital

BackgroundAnemia is the most hematological condition found in surgical patients. Pieces of empirical evidence shows that pre-operative anemia accounts for one- third of surgical patients. Yet, pre-operative anemia & blood transfusion for surgical patients has been associated with many complications such as lengthy hospital stay, post operation surgical wound infections, mortality and morbidity. PurposeThis Pilot preliminary study sought to determine the prevalence of pre-operative anemia in elective surgical patients and to assess health workers’ awareness and knowledge regarding patient blood management in Saudi Arabia. Material and methodsA questionnaire was used to collect data from the 129 healthcare workers in a selected hospital in Saudi Arabia. Additional data was obtained from the hospital electronic data records regarding the incidences of pre-operative anemia. Therefore, the study applied both retrospective and cross-sectional designs. The collected data was then analyzed using the Statistical Package for Social Services [SPSS]. ResultsThis study established the prevalence of pre-operative anemia in elective surgical patients to be 30 % (291 out of 970). In addition, 129 participants completed the questionnaires, from different hospital departments. From the questionnaire, it was noted that 74.2 % of the of physicians had the knowledge about patient blood management while 65 % (n = 50) were aware of the written protocol for the management of pre-operative anemia. This study also found out that 48.1 % of physicians rarely get to meet their patients assessed for possible anemia 4–8 weeks prior surgical operation. In addition, a relatively high number of physicians (42.6, n = 55 rarely investigate the cause of anemia after it has been established while 45.7 % confirm to rarely transfer their patient to pre-operative clinic for anemia management. Low intervention in correction of anemia of low iron origin by the physicians was established to be 44.2 %, and the most preferred hematology analyzer for point of care management was CBC Analyzer Sysmex (79.8 %). ConclusionThis study finds a significant lack of knowledge about pre-operative anemia management in line with the patient blood management protocol. Also, majority of physicians fail to follow the guidelines for anemia management despite the high incidence.

#2361 The influence of glucose biocompatible solutions to the clinical outcomes of patients treated with continuous ambulatory peritoneal dialysis

Abstract Background and Aims The use of biocompatible glucose solutions is associated with longer preservation of residual renal function and less frequent occurrence of complications in patients on peritoneal dialysis. The aim of this study was to examine the influence of conventional and biocompatible glucose solutions to laboratory parameters and clinical outcomes of PD patients during a four-year period at Zvezdara University Medical Center. Method This retrospective study included 25 incident patients treated with continuous ambulatory peritoneal dialysis (CAPD) during the follow up period from 2018 to 2022. During 2018/2019 these patients used conventional solutions (Dianeal PD4) containing lactate as a buffer, while due to the change in solution production technology in 2020/2021, all patients were transferred to a biocompatible solution (Physioneal 40) with lactate and bicarbonate as a buffer. Clinical outcomes were compared in relation to the administered solution: pain during infusion (measured by a Visual Analogue Scale—VAS), correction of anaemia and bicarbonate, average annual 24h diuresis and 24h ultrafiltration, occurrence of CAPD peritonitis. The statistical significance of the differences between the two periods was checked using the SPSS. Results The average age of 25 patients was 61 ± 14 years, of which 59.1% were male and 40.9% female. The average BMI was 28.5 ± 5.30 kg/m2, and the most common comorbidities were HTA and DM. No statistically significant difference was found for the values of Le, albumin, Hb, PTH, bicarbonate, and K (p ˃ 0.05). During the use of biocompatible solutions, patients had statistically significantly lower Na values (138.84 ± 2.63 vs 137.17 ± 2.41 mmol/l, p = 0.0116, 95% CI 137.15– 138.84) and lower CRP values (15.3 ± 3.3 mg/l vs 7.7 ± 3.2, p = 0.0003, 95% CI 18.60-4.50). Although the dialysis exposure was longer, the rate of peritonitis was lower during the use of biocompatible solutions, but without a statistically significant difference (0.40 episodes per patient-year, vs 0.31 episodes per patient-year, p ˃ 0.05). No statistical significance was found in 24h diuresis value (900 ml vs 750 ml, p = 0.167.95% CI 686.90–1203.31) but the value is expected to be lower due to dialysis duration. Conclusion Our study showed that patients treated with the CAPD method while using a biocompatible solution have statistically significantly higher values of 24h ultrafiltration, lower Na and CRP values and less occurrence of pain during infusion, which significantly affects the quality of life. Although this may indicate better preservation of the peritoneal membrane, a prospective and randomized study is needed to clarify these potential differences.

#884 Do parenteral iron therapies preserve or deteriorate kidney functions

Abstract Background and Aims Treatment of Chronic Kidney Disease (CKD) is based on preserving renal functions. Since renal anemia is frequently detected, We use par enteral iron treatments in patients with Chronic Kidney Disease (CKD). However, there are no clear and sufficient studies on the effect of these treatments on the rate of decrease in Glomerular Filtration Rate (GFR). Therefore, we conducted a study comparing the rates of change in renal function in patients who had used parenteral iron for a five years at least. Method Our study is a retrospective cohort study, and 180 patients with CKD (86 women, 94 men, mean age 63.5±11.4 years) who had been followed and treated in Nephrology Outpatient Clinics for at least 5 years and met the study criteria were included into the study. Patients divided into three groups for receiving iron therapy: not received iron therapy, receiving iron carboxy maltose (ICM) and receiving iron sucrose (IS) par enterally . Each group consists of 60 people. The first and last creatinine, GFR values were compared for a 5-year follow-up in each group. Results There was no significant difference between the two groups, those using and not using iron, in terms of creatinine increase and GFR decrease rate. Additionally, no significant difference was detected in the GFR decline rates of patients using ICM and IS. Conclusion We concluded that anemia treatment with iron carboxy maltose and iron sucrose are renally safe in predialysis CKD patients. This study reduces concerns that correction of anemia through parenteral iron therapy in patients with CKD may harm renal function.

Reduction of red blood cell transfusion with a patient blood management protocol in urological and visceral surgery: a before-after study

BackgroundAlthough Patient Blood Management (PBM) is recommended by international guidelines, little evidence of its effectiveness exists in abdominal surgery. The aim of this study was to evaluate the benefits of the implementation of a PBM protocol on transfusion incidence and anaemia-related outcomes in major urological and visceral surgery. MethodsIn this before-after study, a three-pillar PBM protocol was implemented in 2020–2021 in a tertiary care centre, including preoperative correction of iron-deficiency anaemia, intraoperative tranexamic acid administration, and postoperative restrictive transfusion. A historical cohort (2019) was compared to a prospective cohort (2022) after the implementation of the PBM protocol. The primary outcome was the incidence of red blood cell transfusion intraoperatively or within 7 days after surgery. ResultsData from 488 patients in the historical cohort were compared to 499 patients in the prospective cohort. Between 2019 and 2022, screening for iron deficiency increased from 13.9% to 69.8% (p < 0.01), tranexamic acid administration increased from 9.5% to 84.6% (p < 0.01), and median haemoglobin concentration before transfusion decreased from 77 g.L−1 to 71 g.L−1 (p = 0.02). The incidence of red blood cell transfusion decreased from 11.5% in 2019 to 6.6% in 2022 (relative risk 0.58, 95% CI 0.38−0.87, p = 0.01). The incidence of haemoglobin concentration lower than 100 g.L−1 at discharge was 24.2% in 2019 and 21.8% in 2022 (p = 0.41). The incidence of medical complications was comparable between the groups. ConclusionThe implementation of a PBM protocol over a two-year period was associated with a reduction of transfusion in major urological and visceral surgery.

#1194 Roxadustat in ESA converted patients with anemia of chronic kidney disease on dialysis: a secondary analysis of ROXSTAR Registry

Abstract Background and Aims Anemia is associated with increased morbidity &amp; mortality in chronic kidney disease (CKD) patients. Around 20% of patients experience erythropoiesis-stimulating agent (ESA) hypo-responsiveness and can't achieve hemoglobin (Hb) treatment target even with a high dose. Higher ESA dose is associated with undesirable outcomes. Roxadustat has demonstrated efficacy and safety in ESA converted CKD anemia patients. We conduct this secondary analysis of ROXSTAR registry (ChiCTR2100046322) to evaluate the Hb response to roxadustat in ESAs converted dialysis-dependent (DD) patients with prior weekly ESA dose ≥10000 U and &amp;lt;10000 U respectively. Method This study used existing data collected in the ROXSTAR Registry. DD patients converted from ESA treatment who received at least one dose of roxadustat, and had at least one post baseline Hb were included. We described the Hb response to roxadustat treatment in patients converted from higher ESA dose (≥10,000 U per week) and from lower ESA dose (&amp;lt;10,000 U per week) at enrollment. The changes from baseline to week 12 &amp; week 24 in Quality of Life (QoL) assessed by SF-36 Vitality &amp; Physical Function subscales, and Rapid Assessment of Physical Activity (RAPA) Strength &amp; Flexibility scores were also analyzed respectively. Results Total 666 ESA converted DD patients were included. For the higher ESA dose group, there were 426 patients (257 male [60.3%]) with a mean (standard deviation [SD]) age of 49.5 [13.1] years, the median (mix, max) dialysis duration was 31.7 (0.2, 307.8) months. For the lower ESA dose group, 240 patients (141 male [58.8%]) with a mean age of 49.7 [13.0] years were enrolled, and median dialysis duration was 36.4 (0.4, 266.1) months. The mean baseline Hb was 98.0 (14.5) g/L in the higher ESA dose group and 102.2 (12.6) g/L in the lower ESA dose group. The median prior weekly ESA dose was 10000 (10000, 50000) U and 6000.0 (300, 9000) U in higher &amp; lower ESA dose groups (Table 1). Mean weekly roxadustat dose during the first 12 weeks (correction phase) was maintained around 300 mg and then decreased to around 260 mg during 12-52 weeks (maintenance phase) for the higher ESA dose group; the dose started from around 300 mg and decreased to 270 mg during the correction phase and then gradually decreased to around 230 mg during the maintenance phase in the lower ESA dose group. The mean Hb change from baseline averaged over weeks 24-36 &amp; 36-52 was 12.1 [95% CI: 10.5, 13.7] g/L &amp; 12.3 [95% CI: 10.7, 13.9] g/L for the higher ESA dose group and 9.9 [95% CI: 8.0, 11.8] g/L &amp; 10.2 [95% CI: 8.3, 12.1] g/L for the lower ESA dose group, respectively. The proportion (%) of patients with mean Hb ≥100 g/L at the same period were 82.3% [95% CI: 78.1%, 86.6%] &amp; 83.6% [95% CI: 79.3%, 87.9%] in the higher ESA dose group and 88.4% [95% CI: 83.6%, 93.1%] &amp; 89.0% [95% CI: 84.3%, 93.7%] in the lower ESA dose group. There was no clinical meaningful change of QoL observed in either group. Conclusion ESA-converted DD patients responded well to roxadustat in terms of anemia correction and Hb maintenance to treatment target, regardless of prior ESA dose. Similar starting doses of roxadustat were used for both groups and then gradually decreased during the maintenance phase (week 12-52) compared to the correction phase (week 1-12) while the magnitude of dose decrease was greater in the lower ESA dose group.

Опыт включения Гамавита и Фоспренила в схему терапии гемоплазмоза кошек для повышения эффективности коррекции анемии – ретроспективный анализ

This study includes clinical data collected from 2016 to 2023. In total, hemoplasmosis was detected in 102 cats (63 females and 39 males) aged from 5 months to 8 years. Of these, 34 cats were diagnosed with a severe form of the disease, and 68 with a mild one. In cats with severe hemoplasmosis, in 45 % of cases, the disease was complicated by chronic renal failure. Also, 5 % of them were chronic carriers of toxoplasmas. Most of the animals were taken from shelters, or were homeless. One of the leading clinical signs of hemoplasmosis is anemia, which develops as a result of mass hemolysis of infected red blood cells. The aim of this work was to eliminate anemia and accelerate the normalization of hematopoiesis in cats with hemoplasmosis. For the treatment of 45 animals (control group), a standard therapy regimen was used, which included antibiotics and glucocorticoids, whereas for therapy regimen of remaining 57 cats (experimental group) Gamavit and Phosprenyl were added. Using this therapeutic scheme, early relief of anemia, stimulation of erythropoiesis, restoration of blood formula and normalization of liver function were noted as well as acceleration of clinical recovery of sick animals which occurred faster by 4…5 days.

Body composition analysis using dual-energy x-ray absorptiometry in an Egyptian pediatric sickle cell disease cohort.

Growth failure is commonly encountered in sickle cell disease (SCD). Tissue compartment growth and development are subsequently likely to be altered in such patients. We aimed to analyze body composition in an Egyptian pediatric SCD cohort using dual-energy x-ray absorptiometry (DEXA), one of the most comprehensive and noninvasive assessment methods available. Forty children with SCD ≤18years and 40 healthy youngsters age- and gender-matched were enrolled. Patients' demographic, clinical, and laboratory parameters were obtained from their archived files. All patients and controls were subjected to body composition assessment using a MedixDR-Whole Body DEXA System. In SCD patients; weight and height relative to age Z scores were significantly lower (p<.001), total body lean was significantly higher (p=.006), and total body fat percentage was lower, yet the difference was not statistically significant (p=.09). There were no statistically significant variations in bone mineral density or content, basal metabolic rate, subcutaneous adipose tissue, android/gynoid fat ratio, and visceral adipose tissue. There were no significant gender disparities between SCD patients and controls. Faltering growth in children with SCD should be addressed with a multidisciplinary approach including nutritional support, correction of anemia, and proper medical care. Body composition parameters assessed using DEXA were comparable between cases and controls apart from total body lean. Further clinical studies are needed with multicenter cooperation and a larger sample size to assess the usefulness of DEXA as an assessment tool for body composition in children with SCD.

Nephrotransplantectomy Using Radiosurgical Techniques

Introduction. Aſter the loss of kidney transplant function, patient curation can be a difficult task. Nephrotransplantectomy (NTE) is the method of choice between reduction of immunosuppression with the abandonment of a non-functioning kidney transplant and embolization. This is an operation with potentially significant indicators of blood loss, complications and mortality. Along with traditional NTE, we began to use endovascular isolation of the allograſt as a method of preoperative preparation before its removal.The aim of the work is to investigate the effect of the use of radiosurgical minimally invasive techniques on the surgical tactics of nephrotransplantectomy, the degree of blood loss, the frequency of complications and blood transfusion.Materials and methods. A retrospective analysis of the data of 52 patients aſter NTE was performed. Depending on the method, patients are divided into two groups. In group 1 (main, n = 22), the operation was performed with pre-performed endovascular embolization of the graſt arteries (EEAT), in group 2 (control, n = 30) — without EEAT. The analysis of the results of the examination, intra- and postoperative indicators in patients by groups was carried out.Results. In group 1, intraoperative blood loss was 10–80 ml, on average (35.4±19.9) ml; in group 2 — from 100 to 600 ml, on average (289.7±138.4) ml (p &lt; 0.001). In group 2, damage to the main vessels occurred more oſten (n = 4) (13.3 % vs. 0 %), hemotransfusion was performed in 53.3 % of cases (n = 16) to correct posthemorrhagic anemia. Postoperative complications in the control group were recorded in 8 patients (26.7 %).Discussion. Preventive endovascular embolization of the arteries of a kidney transplant significantly reduces the frequency ofintra- and postoperative complications, allows nephrectomy to be performed on a planned basis andin a delayed manner.

Correction of hyperphosphatemia in a patient with end-stage chronic kidney disease and a complex case of anemia. A clinical case

Iron supplements and/or blood transfusions in combination with recombinant human erythropoietin injections are routinely used to correct renal anemia, which is a common complication of end-stage renal disease. However, massive blood transfusions and inadequate intravenous iron supplementation can lead to iron overload syndrome, and anemia is not always nephrogenic. A rare clinical case of a patient with end-stage chronic kidney disease with complex genesis of anemia, who is on hemodialysis, is presented. The case is interesting because the prescription of first-line drugs was life-threatening in nature, and sevelamer was the drug chosen for the correction of mineral-bone disorders.

Iron Management and Anemia in Patients on the Active Kidney Transplant List

IntroductionIron metabolism disorders and anemia are one of the main complications of end-stage renal disease that may affect the evaluation process for kidney transplantation. The study aimed to assess the iron metabolism in hemodialysis patients in relation to waiting list status. Study MethodThe study included 5068 hemodialysis patients, including those on the active waiting list (N = 449) and those who were not eligible for the waitlist (N = 4619). Demographic and biochemical data, Charlson's comorbidity index, duration of hemodialysis therapy and, respectively, hemoglobin, ferritin, and transferrin saturation levels were compared in both groups of patients. ResultsPatients on the active waiting list were significantly younger −53.2 vs 67.2 years (P < .001), with a lower Charlson comorbidity index score: 3.33 vs 4.42 (P < .001). The duration of hemodialysis therapy was similar: 66.0 vs 63.2 months (P = .416), the incidence of anemia according to World Health Organization (90.6%, vs 91.2%) and KDIGO (72.4% vs 70.4%). The degree of anemia correction in terms of hemoglobin concentration and transferrin saturation was comparable in both groups and amounted to an average of 10.9 g/dL (P = .349) for hemoglobin concentration and 32.7% vs 33.4% (P = .513) for transferrin saturation. However, there was a statistically significant difference in ferritin concentration: 554 ug/L vs 733 ug/L (P = .001). ConclusionsPatients on the active list have significantly lower ferritin levels despite similar duration of hemodialysis treatment and comparable hemoglobin values. This may be due to lower inflammation, and less frequent blood transfusions, and lead to a lower risk of immunization and an increased chance of potential kidney transplantation.

Severe BCG immune reconstitution inflammatory syndrome lymphadenitis successfully managed with pre-antiretroviral counseling and a non-surgical approach: a case report

BackgroundBacillus Calmette-Guérin (BCG) reactions are the most common cause of immune reconstitution inflammatory syndrome (IRIS) in HIV-positive infants who initiate antiretroviral therapy (ART). There is limited evidence regarding the incidence of BCG-IRIS; however, reports from outpatient cohorts have estimated that 6–9% of infants who initiated ART developed some form of BCG-IRIS within the first 6 months. Various treatment approaches for infants with BCG-IRIS have been reported, but there is currently no widely accepted standard-of-care.Case PresentationA 5-month-old male HIV-exposed infant BCG vaccinated at birth was admitted for refractory oral candidiasis, moderate anemia, and moderate acute malnutrition. He had a HIV DNA-PCR collected at one month of age, but the family never received the results. He was diagnosed with HIV during hospitalization with a point-of-care nucleic acid test and had severe immune suppression with a CD4 of 955 cells/µL (15%) with clinical stage III disease. During pre-ART counseling, the mother was educated on the signs and symptoms of BCG-IRIS and the importance of seeking follow-up care and remaining adherent to ART if symptoms arose. Three weeks after ART initiation, he was readmitted with intermittent subjective fevers, right axillary lymphadenopathy, and an ulcerated papule over the right deltoid region. He was subsequently discharged home with a diagnosis of local BCG-IRIS lymphadenitis. At six weeks post-ART initiation, he returned with suppurative lymphadenitis of the right axillary region that had completely eviscerated through the skin without signs of disseminated BCG disease. He was then started on an outpatient regimen of topical isoniazid, silver nitrate, and oral prednisolone. Throughout this time, the mother maintained good ART adherence despite this complication. After 2.5 months of ART and one month of specific treatment for the lymphadenitis, he had marked mass reduction, improved adenopathy, increased CD4 count, correction of anemia, and resolution of his acute malnutrition. He completely recovered and was symptom free two months after initial treatment without surgical intervention.ConclusionsThis case details the successful management of severe suppurative BCG-IRIS with a non-surgical approach and underlines the importance of pre-ART counseling on BCG-IRIS for caregivers, particularly for infants who initiate ART with advanced HIV.

Management of peri-surgical anemia in elective surgery. Conclusions and recommendations according to Delphi-UCLA methodology

IntroductionPreoperative anemia affects approximately one third of surgical patients. It increases the risk of blood transfusion and influences short- and medium-term functional outcomes, increases comorbidities, complications and costs. The “Patient Blood Management” (PBM) programs, for integrated and multidisciplinary management of patients, are considered as paradigms of quality care and have as one of the fundamental objectives to correct perioperative anemia. PBM has been incorporated into the schemes for intensified recovery of surgical patients: the recent Enhanced Recovery After Surgery 2021 pathway (in Spanish RICA 2021) includes almost 30 indirect recommendations for PBM. ObjectiveTo make a consensus document with RAND/UCLA Delphi methodology to increase the penetration and priority of the RICA 2021 recommendations on PBM in daily clinical practice. Material and MethodsA coordinating group composed of 6 specialists from Hematology-Hemotherapy, Anesthesiology and Internal Medicine with expertise in anemia and PBM was formed. A survey was elaborated using Delphi RAND/UCLA methodology to reach a consensus on the key areas and priority professional actions to be developed at the present time to improve the management of perioperative anemia. The survey questions were extracted from the PBM recommendations contained in the RICA 2021 pathway. The development of the electronic survey (Google Platform) and the management of the responses was the responsibility of an expert in quality of care and clinical safety.Participants were selected by invitation from speakers at AWGE-GIEMSA scientific meetings and national representatives of PBM-related working groups (Seville Document, SEDAR HTF section and RICA 2021 pathway participants).In the first round of the survey, the anonymized online questionnaire had 28 questions: 20 of them were about PBM concepts included in ERAS guidelines (2 about general PBM organization, 10 on diagnosis and treatment of preoperative anemia, 3 on management of postoperative anemia, 5 on transfusion criteria) and 8 on pending aspects of research. Responses were organized according to a 10-point Likter scale (0: strongly disagree to 10: strongly agree). Any additional contributions that the participants considered appropriate were allowed. They were considered consensual because all the questions obtained an average score of more than 9 points, except one (question 14).The second round of the survey consisted of 37 questions, resulting from the reformulation of the questions of the first round and the incorporation of the participants' comments. It consisted of 2 questions about general organization of PBM programme, 15 questions on the diagnosis and treatment of preoperative anemia; 3 on the management of postoperative anemia, 6 on transfusional criteria and finally 11 questions on aspects pending od future investigations.Statistical treatment: tabulation of mean, median and interquartiles 25–75 of the value of each survey question (Tables 1, 2 and 3). ResultsExcept for one, all the recommendations were accepted. Except for three, all above 8, and most with an average score of 9 or higher. They are grouped into:1.- “It is important and necessary to detect and etiologically diagnose any preoperative anemia state in ALL patients who are candidates for surgical procedures with potential bleeding risk, including pregnant patients”.2.- “The preoperative treatment of anemia should be initiated sufficiently in advance and with all the necessary hematinic contributions to correct this condition”.3.- “There is NO justification for transfusing any unit of packed red blood cells preoperatively in stable patients with moderate anemia Hb 8−10g/dL who are candidates for potentially bleeding surgery that cannot be delayed.”4.- “It is recommended to universalize restrictive criteria for red blood cell transfusion in surgical and obstetric patients.”5.- “Postoperative anemia should be treated to improve postoperative results and accelerate postoperative recovery in the short and medium term”. ConclusionsThere was a large consensus, with maximum acceptance,strong level of evidence and high recommendation in most of the questions asked. Our work helps to identify initiatives and performances who can be suitables for the implementation of PBM programs at each hospital and for all patients.