Hemoglobin Decline Research Articles

Efficacy of transdermal delivery of liposomal micronutrients through body oil massage on neurodevelopmental and micronutrient deficiency status in infants: results of a randomized placebo-controlled clinical trial

BackgroundMicronutrient deficiency is a known cause of adverse neurodevelopment and growth. Poor adherence to oral regimes of micronutrient supplements is a known challenge during the implementation of supplementation programs. The present study evaluates the benefits of liposomal encapsulated micronutrient fortified body oils (LMF oil) that can be used for infant body massage in terms of neurodevelopment and prevention of deficiency.Study designDouble-blind randomized clinical trial.MethodsA total of 444 healthy infants aged 4-7 weeks were randomized to receive either LMF oil (containing iron, vitamin D, folate, and vitamin B12) or placebo oil for gentle body massage till 12 months of age. Blood samples were collected at 6 and 12 months for transferrin saturation (TSAT), hemoglobin, and 25-hydroxy vitamin (25-OH-D) levels. Mental and motor development was assessed at 12 months using developmental assessment for Indian Infants (DASII).ResultsA total of 391 infants completed the study. There was no significant improvement in the hemoglobin in the intervention group at 12 months of age as compared to the placebo group [− 0.50 vs.-0.54 g%]. There was a marginally significant improvement in 25-OH-D at 12 months in the LMF oil group [+ 1.46vs.-0.18 ng/ml, p = 0.049]. In the subgroup of infants with moderate anemia, the intervention prevented the decline in hemoglobin at 12 months of age [adjusted mean change + 0.11vs.-0.51 g%, p = 0.043]. The mental or motor developmental quotients in the intervention group were not significantly different from those in the placebo group.ConclusionUse of LMF oil for prevention of nutritional deficiency did not offer significant protection against nutritional anemia but prevented vitamin D deficiency to some extent with improvement in 25-OH-D at 12 months. In the subgroup of infants with moderate anemia, the intervention prevented the decline in hemoglobin at 12 months of age. The intervention did not result in significant improvement in mental or motor development. Further evaluation with increased doses needs to be undertaken.Trial registrationCTRI no: CTRI/2017/11/010710; dated 30/11/2017.

A Signal Processing Method for Target Phase Stimulation in Neural Regulation

We aimed to evaluate factors associated with time to return to OR in children presenting with post-tonsillectomy hemorrhage to a tertiary children's hospital.Retrospective study of pediatric patients presenting to a single institution from January 2012 to January 2020, with post-tonsillectomy hemorrhage (PTH) requiring surgical intervention for control of bleeding. Correlation, univariate, and multivariate analysis were conducted.Of 15,984 tonsillectomies performed at our institution during the study period, 144 required return to the OR for bleeding control, in addition to 15 other children whose tonsillectomy had been performed at an outside institution. Mean time to the OR was 119.7 min (SD 101.5) in the morning, 77.4 min (SD 60.6) in the afternoon, 55.6 min (SD 34.8) in the evening, and 49.4 min (SD 26.4) overnight (ANOVA p < 0.0001). The mean hemoglobin decline from pre-to post-tonsillectomy was 1.3 g/dl (SD 1.7). Primary hemorrhages had a mean time to OR of 62.39 min (SD 63.42) while secondary hemorrhages mean time to OR was 85.54 min (SD 76.21) (p = 0.0064). There was no significant difference in time to OR among race/ethnicity (p = 0.928), insurance status (p = 0.359), weekday (p = 0.557), surgeon seniority (p = 0.8104) or by hemoglobin drop (p = 0.2773). When controlling for each of these variables, multiple linear regression showed that only time of day had significant correlation with time to OR (p = 0.0003).At a tertiary children's hospital, patients presenting with PTH requiring revision surgery waited the longest to get to the OR in the morning versus all other times of day.These results can aid in individualization of anticipatory guidance in order to reduce morbidity and mortality from complications requiring revision in the operating room.

Hemoglobin and Clinical Outcomes in the Vericiguat Global Study in Patients With Heart Failure and Reduced Ejection Fraction (VICTORIA)

In the VICTORIA trial (Vericiguat Global Study in Patients with Heart Failure with Reduced Ejection Fraction), anemia occurred more often in patients treated with vericiguat (7.6%) than with placebo (5.7%). We explored the association between vericiguat, randomization hemoglobin, development of anemia, and whether the benefit of vericiguat related to baseline hemoglobin. Anemia was defined as hemoglobin <13.0 g/dL in men and <12.0 g/dL in women (World Health Organization Anemia). Adverse events reported as anemia were also evaluated. We assessed the risk-adjusted relationship between hemoglobin and hematocrit with the primary outcome (composite of cardiovascular death or heart failure hospitalization) and the time-updated hemoglobin relationship to outcomes. At baseline, 1719 (35.7%) patients had World Health Organization anemia; median hemoglobin was 13.4 g/L (25th, 75th percentile: 12.1, 14.7 g/dL). At 16 weeks from randomization, 1643 patients had World Health Organization anemia (284 new for vericiguat and 219 for placebo), which occurred more often with vericiguat than placebo (P<0.001). After 16 weeks, no further decline in hemoglobin occurred over 96 weeks of follow-up and the ratio of hemoglobin/hematocrit remained constant. Overall, adverse event anemia occurred in 342 patients (7.1%). A lower hemoglobin was unrelated to the treatment benefit of vericiguat (versus placebo) on the primary outcome. In addition, analysis of time-updated hemoglobin revealed no association with the treatment effect of vericiguat (versus placebo) on the primary outcome. Anemia was common at randomization and lower hemoglobin was associated with a greater frequency of clinical events. Although vericiguat modestly lowered hemoglobin by 16 weeks, this effect did not further progress nor was it related to the treatment benefit of vericiguat. Registration: URL: https://www.clinicaltrials.gov: Unique identifier: NCT02861534.

Association between aspirin‐induced hemoglobin decline and outcome after acute ischemic stroke in G6PD‐deficient patients

AimsThe risk of hemoglobin decline induced by low‐dose aspirin in glucose‐6‐phosphate dehydrogenase (G6PD) deficiency remains unknown, and its influence on stroke outcome remains to be investigated. This study aimed to evaluate the effect of G6PD deficiency on hemoglobin level during aspirin treatment and its association with outcome after acute ischemic stroke.MethodsIn total, 279 patients (40 G6PD‐deficient and 239 G6PD‐normal) with acute ischemic stroke treated with aspirin 100 mg/day from a cohort study were examined. The primary safety endpoint was a hemoglobin decline ≥25 g/L or 25% from baseline within 14 days after aspirin treatment. Poor outcomes were defined as a modified Rankin Scale score ≥2 at 3 months. The χ 2 test was used to compare stroke outcomes, and multivariate logistic regression analyses were performed to analyze the association between hemoglobin level and outcomes.ResultsThe G6PD‐deficient group had lower baseline hemoglobin and tended to develop comorbid pulmonary infection more frequently (p < 0.05). The proportion of patients with hemoglobin decline ≥25 g/L or 25% from baseline (15.0% vs. 3.3%; p = 0.006) and anemia (30.0% vs. 14.6%; p = 0.016) after aspirin treatment was higher in the G6PD‐deficient group, which was accompanied by a more significant bilirubin increase. The rate of poor functional outcomes at 3 months after acute ischemic stroke was higher in the G6PD‐deficient group (Risk ratio = 1.31 [95% confidence interval (CI) = 1.10–1.56]; p = 0.017). Confounder‐adjusted analysis showed that lower hemoglobin levels (odds ratio = 0.98 [95% CI = 0.96–0.99]; adjusted p = 0.009) increased the risk of poor functional outcomes.ConclusionHemoglobin decrease with bilirubin increase after aspirin treatment in patients with G6PD deficiency suggests hemolysis, which may influence stroke prognosis. The risk of hemoglobin decline should be carefully monitored in G6PD‐deficient patients with ischemic stroke taking aspirin.

The hematological diversity of human parvovirus B19 infection after allo-hematopoietic stem cell transplantation in pediatric patients

目的探讨异基因造血干细胞移植（allo-HSCT）患儿造血重建后人类细小病毒B19（HPV-B19）感染的血液学表现。方法对9例allo-HSCT后合并HPV-B19感染的患儿进行回顾性分析。结果9例患儿占同期接受allo-HSCT患儿的8.04％（9/112），男8例，女1例，中位年龄9（3～13）岁，均采取清髓性预处理方案。HPV-B19感染中位时间为移植后61（36～114）d。allo-HSCT并发HPV-B19感染患儿血液学表现具有异质性，9例患儿以血红蛋白伴网织红细胞下降为主要特点，7 d内网织红细胞比例、绝对值下降幅度中位数分别为90.4％（24.7％～98.7％）、90.7％（18.6％～99.0％）。除常见红系造血停滞表现外，allo-HSCT后合并HPV-B19感染的患儿还具有非红系的血象及骨髓变化：5例患儿外周血出现中性粒细胞下降，但骨髓涂片未见粒系增生受抑；6例患儿骨髓涂片查见巨核系增生减低，其中5例患儿外周血血小板下降。同时，allo-HSCT造血重建后合并HPV-B19感染的患儿骨髓红系受抑并非必要表现，9例患儿虽然均出现血红蛋白下降，但仅5例患儿骨髓红系增生减低。结论血液病患儿allo-HSCT造血重建后合并HPV-B19感染的血液学表现具有异质性，血红蛋白伴网织红细胞下降对HPV-B19感染早期诊断可能具有重要意义。

Incidence of bleeding in patients on different anticoagulants and antiplatelet therapies undergoing thoracentesis

IntroductionThoracentesis is one of the most commonly performed procedures in the inpatient setting. Although coagulation profile is usually evaluated prior to thoracentesis, bleeding is a rare complication, occurring in less...

Prevention of Morbidity in Sickle Cell Disease Phase II (Improvement of Cognition in children with Sickle Cell Disease with Auto-adjusting Continuous Positive Airways Pressure: Phase II) (POMS 2b paediatric cohort)

▪Background: Complications in sickle cell anemia (SCA, HbSS) include neurocognitive difficulties in attention and processing speed associated with low daytime and night-time oxygen saturation. These effects can be compounded by obstructive sleep apnea (OSA).However, there is concern that oxygen supplementation in SCA may lead to bone marrow suppression. Continuous Positive Airways Pressure (CPAP) is an accepted treatment for OSA in the general population and prevents dips in oxygen saturation.. The aim of this single-blind, randomised, controlled phase II trial is to compare Auto-adjusting CPAP (APAP) with standard care to standard care alone in subjects with HbSS to determine whether the intervention is safe and improves Cancellation, a measure of selective attention and processing speed.Methods: Eligibility criteria included ability to provide informed consent, age >8 and <16 years, diagnosis of HbSS and mean overnight saturation of <90% for <30% of the night. Key exclusion criteria were overnight respiratory support, respiratory or decompensated cardiac failure, chronic transfusion or contra-indications to APAP therapy or MRI.Minimisation/stratification factors were age group (8-11, 12-15 years), silent infarction on MRI, minimum overnight oxygen saturation >90% or <90%, and hydroxyurea (HU) use.APAP adherence was defined as using APAP for an average of 4 hours a night for >50% of the time and was recorded using software documenting hours of use each night. Participant support in terms of appropriate facemask and facilitating adherence were provided by an unblinded sleep physiologist.Full blood counts were obtained at baseline, 2 weeks, 3 months and 6 months.Data were analysed by intention-to-treat. The primary outcome is change in the Cancellation subtest from the Wechsler scales, and secondary outcomes include general cognitive functioning, assessed at baseline and after 6 months of treatment by assessors blind to treatment assignment. Analysis of Covariance (ANCOVA) models, adjusted for minimisation factors, were used to calculate least-square mean changes from baseline to 6 months.Results: 30 children (18 boys; median age 12.5; range 7.9-16 years) with SCA were randomised to standard care + APAP (n=15) or standard care alone (n=15) for 6 months. One child in the standard care alone arm withdrew after 6 weeks, and 8 children in the APAP arm were not adherent to treatment. Increase in cancellation score was numerically greater in the APAP arm (mean 1.46, SE 0.59 vs 1.01, SE 0.61) but this was not significant (mean difference 0.44, 95% CI: -1.42; 2.31; p=0.626). Increase in Cancellation score was greater (mean 2.63; 95%CI: 0.95, 4.30) in those whose adherence was in the highest quartile (> 2.4 hours/night) compared with the other 3 quartiles (mean 0.71, 95%CI: -0.32, 1.75; mean difference 1.91, 95%CI: -0.06, 3.88; p=0.057). In subjects assigned to APAP, cancellation scores were significantly higher with hydroxyurea use (p=0.01). There was no evidence of decline in haemoglobin in either group; hydroxyurea use was associated with an increase in haemoglobin (p=0.01). There were 7 subjects with serious adverse events in the standard care alone arm, compared to 3 in the APAP + standard care arm, all related to hospital admission for pain.Discussion: APAP for 6 months is feasible and safe in children with SCA. Alhough >50% were not adherent by the pre-defined definition, those who were compliant appeared to have more benefit in terms of improvement in attention/processing speed. There appears to be an interaction with HU use, consistent with the importance of oxygen supply and carriage for brain function. If delivery of the intervention can be improved, avoidance of oxygen desaturation with overnight respiratory support alongside HU use may play a role in improving cognition in SCD. DisclosuresNo relevant conflicts of interest to declare.

Prevention of Morbidity in Sickle Cell Disease Phase II (Improvement of Pain and Quality of Life in Children with Sickle Cell Disease with Auto-adjusting Continuous Positive Airways Pressure: Phase II) (POMS 2b pediatric cohort)

▪AbstractBackground: In addition to pain, sickle cell anaemia (HbSS) complications include neurocognitive difficulties in attention and processing speed associated with low daytime and night-time oxygen saturation. These effects can be compounded by obstructive sleep apnoea (OSA). Continuous Positive Airways Pressure (CPAP) is an accepted treatment for OSA in the general population. However, supplementary oxygen therapy in SCA may lead to bone marrow suppression. The aim of this single-blind, randomised, controlled phase II trial is to compare Auto-adjusting CPAP (APAP) with standard care to standard care alone in subjects with HbSS to determine whether the intervention is safe and improves attention and processing speed and brain structure.Methods: Eligibility criteria included ability to provide informed consent, age >8 and <16 years, diagnosis of HbSS and mean overnight saturation of <90% for <30% of the night. Key exclusion criteria were overnight respiratory support, respiratory or decompensated cardiac failure, chronic transfusion or contra-indications to APAP therapy or MRI.Minimisation factors were age group (8-11, 12-15), silent infarction on MRI, minimum overnight oxygen saturation > or < 90%, and hydroxyurea (HU) use.APAP adherence was defined as using APAP for an average of 4 hours a night for >50% of the time and was recorded using software documenting hours of use each night. Participant support in terms of appropriate facemask and facilitating adherence were provided by an unblinded sleep physiologist.Full blood counts were obtained at baseline, 2 weeks, 3 months and 6 months.Data were analysed by intention-to-treat. The primary outcome is change in the cancellation subtest from the Wechsler scales, and secondary outcomes include general cognitive functioning, assessed at baseline and after 6 months of treatment by assessors blind to treatment assignment. Analysis of Covariance (ANCOVA) models, adjusted for minimisation factors, were used to calculate least-square mean changes from baseline to 6 months.Results: 30 children with HbSS were randomised to standard care + APAP (n=15) or standard care alone (n=15) for 6 months. One child in the standard care arm withdrew after 6 weeks, and 8 children in the APAP arm were not adherent to treatment. There was no difference in hemoglobin change between the arms, but hydroxyurea use was associated with an increase in haemoglobin (p=0.01). Increase in cancellation score was numerically greater in the APAP arm (mean 1.46, SE 0.59 vs 1.01, SE 0.61) but this was not significant (mean difference 0.44, 95% CI: -1.42; 2.31; p=0.626). Increase in cancellation score was greater (mean 2.63; 95%CI: 0.95, 4.30) in those whose adherence was in the highest quartile (> 2.4 hours/night) compared with the other 3 quartiles (mean 0.71, 95%CI: -0.32, 1.75; mean difference 1.91, 95%CI: -0.06, 3.88; p=0.057). In subjects assigned to APAP, cancellation scores were significantly higher with hydroxyurea use (p=0.01). There were 7 subjects with serious adverse events in the placebo group, compared to 3 in the APAP group, all related to SCD pain. There was no evidence of decline in haemoglobin in either group.Discussion: APAP for 6 months is safe, and feasible in children with SCA but although >50% were not adherent by the pre-defined definition, those who were compliant appeared to have more benefit in terms of attention/processing speed. If delivery of the intervention can be improved, avoidance of oxygen desaturation with overnight respiratory support may play a role in improving cognition in SCD.Trial registration: ISRCTN 46012373 10th July 2015Protocol Version: 6.0 Date: 24th December 2015Sponsor: University Hospital Southampton Sponsor's protocol code: RHMCHIOT53Keywords Sickle Cell Anaemia; haemoglobin oxygen saturation; Auto-adjusting Continuous Positive Airways Pressure; Cancellation; Attention; Processing speed DisclosuresNo relevant conflicts of interest to declare.

Comparison of conventional methods with commercially available topical hemostat surgical snow (oxidized cellulose) for achieving hemostasis in canine model of partial splenectomy

Spleen is highly vascularized organ and bleeding control during partial splenectomy is a big challenge. In this study conventional methods of electrocautery, absorbable suturing and advance methods of topical hemostat Surgicel® were compared to control bleeding during partial splenec- tomy. Twelve healthy dogs (n=4) were divided in A, B and C groups. After partial splenectomy Surgicel®, electrocautery and absorbable horizontal mattress sutures were used to control hemor- rhages in group A, B and C respectively. Bleeding time and loss of blood volume was evaluated during surgery. In addition, blood samples were taken on day 0 pre-surgery and on days 3, 10 and 17 post-surgery to evaluate changes in biochemical parameters after the application of dif- ferent hemostatic techniques. Ultrasonography was also performed at alternative days to check any gross changes in the spleen. Dogs in group A showed minimum bleeding time and loss of blood volume as compared to group B and C. Drop in red blood cells count was compared be- tween group A, B and C showing significant change (p≤0.05) at day 3, 10 and 17, while a sig- nificant decline in hemoglobin was found in group C followed by groups B and A at 3rd and 10th day. There was no difference between platelet counts in various groups. Ultrasonography showed no significant changes in the spleen parenchyma. It was concluded that Surgicel® was an effective material for controlling hemorrhage in veterinary patients.

Continuous Perioperative use of Aspirin as Single Therapy during Percutaneous Nephrolithotomy

Introduction: The rates of heart disease and nephrolithiasis continue to increase in the United States, and aspirin is increasingly prescribed for varying indications. Current recommendations in the urologic literature are to stop aspirin before percutaneous nephrolithotomy (PCNL); however, this is based on expert opinion. This study aims to determine the safety of PCNL performed on patients who took aspirin in the perioperative period. Methods: This study was a retrospective review of 27 consecutive PCNLs for patients who took aspirin in the perioperative period (January 2013-September 2016). Pre- and postoperative hemoglobin was recorded, as were age, sex, BMI, operative duration, skin-to-stone distance, stone size, aspirin dose, aspirin indication, number of blood transfusions, and Clavien-Dindo complication classification. Correlations between hemoglobin and explanatory variables were then explored with linear regression and the Wilcoxon rank-sum test. Results: Of the 199 PCNLs performed, 27 procedures on 23 patients were conducted without discontinuing aspirin perioperatively. Coronary artery disease was the most common indication for aspirin use (81%). Patients experienced a median hemoglobin decline of 1.4 g/dl perioperatively. No significant associations were found between hemoglobin decline and age, sex, BMI, operative duration, skin-to-stone distance, or stone size. There were no Clavien-Dindo grade III or higher complications, and no patients required a blood transfusion or angio-embolization. There were no thrombo-embolic or cardiac events in our series. Conclusions: In our single-center experience, PCNLs performed on patients taking aspirin perioperatively were not associated with the need for blood transfusion nor the occurrence of high-grade complications.

Hematological Abnormalities in Patients With COVID-19: An Emerging Approach to Differentiate Between Severe COVID-19; Compared With NonSevere Forms of the Disease

The 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a pandemic threat from December 2019. Coronavirus can cause varying degrees of illness that range from mild to severe or fatal disease. The exact mechanism on hematopoiesis induced by this coronavirus is not yet well understood, but scientific evidence indicates that COVID-19 can cause hematological changes in infected patients. The present study summarized pieces of literature regarding hematologic findings of COVID-19 and their correlation with disease severity. Finally, we offered some laboratory abnormalities which help to differentiate severe COVID-19 from non-severe forms of the disease. Among hematological parameters, decreased hemoglobin rather than anemia, leukocytosis, lymphopenia, neutrophilia, and thrombocytopenia have been observed in conducted studies in some patients with COVID19. Furthermore, as the disease progresses to severe COVID-19, hemoglobin decline, leukocytosis, lymphopenia, neutrophilia, and thrombocytopenia continue to exacerbate. In addition, the neutrophil-tolymphocyte ratio is also considered as an independent risk factor for severe infection in COVID-19 patients.

Mild thrombocytopenia prior to elective cesarean section is an independent risk factor for blood transfusion.

Thrombocytopenia is the second most common hematological disorder in pregnancy and complicates approximately 10% of all pregnancies. The data regarding the association of mild thrombocytopenia in women undergoing cesarean section and risk of bleeding or bleeding-related complications are scarce. Thus, the aim of the current study was to assess the association of mild thrombocytopenia with hemorrhage-related morbidities, among patients undergoing elective cesarean section. We performed a retrospective cohort study, in a single tertiary university-affiliated medical center, between 1 January 2012 and 31 May 2019. Medical charts of women who underwent elective cesarean section at term (37+0/7-41 + 6/7weeks of gestations) were retrieved and analyzed. We compared women with mild thrombocytopenia (platelet count of 100-149 × 103/μL) to women with normal platelet count (150-450 × 103/μL). The primary outcome was the need for red blood cell transfusion during the index admission. A secondary outcome was severe bleeding not requiring blood transfusion defined as postpartum hemoglobin decline of ≥ 3g/dL as compared to the prepartum levels. During the study period, 1577 women were included in the final analysis, of them 396 (25.11%) had mild thrombocytopenia prior to delivery. As compared to the control group, women with mild thrombocytopenia had higher rates of blood transfusion (3.79 vs. 1.52%, p = 0.01), and had a significant decline in hemoglobin levels. In a multivariable logistic regression model, mild thrombocytopenia was independently associated with blood transfusion with adjusted OR of 2.34 (95% CI 1.10-4.96, p = 0.03). Preoperative mild thrombocytopenia is associated with an increased risk of blood loss and blood transfusion in women undergoing elective CS. More studies are required to assess those observations in context of urgent cesarean sections and whether any preventive measures can reduce the risk for bleeding.

550 Autotransfusion of vaginally shed blood during obstetric hemorrhage: a matched cohort atudy

Cell salvage and autotransfusion (AT) has gained acceptance as an effective tool for management of hemorrhage during cesarean delivery. However, most obstetric hemorrhage (OBH) occurs following vaginal delivery. Given concern for contamination of vaginally shed blood, AT for management of OBH following vaginal delivery has not been as widely adopted. We aimed to determine the efficacy and safety of AT for vaginal deliveries complicated by OBH. This is a single center retrospective matched cohort study of vaginal deliveries complicated by OBH from 2014-2020. Patients that received AT for OBH following vaginal delivery were each matched to 4 controls that delivered vaginally with an EBL within 200 mL. Our cohort was limited to EBL below 2400 mL, because cell salvage was consistently utilized above this threshold. The primary outcome was allogeneic transfusion of packed red blood cells (RBCs). Unadjusted analyses were performed using Fisher’s exact test and Student’s paired t test. Adjusted analyses were performed using multivariable logistic and linear regression. During the study period, 36 AT patients were matched to 144 unexposed controls. AT patients were more likely to be a patient of MFM, identify as Non-Hispanic Black, have preeclampsia, and use tobacco. There was no significant difference in transfusion of packed RBCs when AT cases were compared to controls (OR 1.2; 95% CI 0.6-2.7, p=0.5, AT referent). No AT patients were transfused ≥ 4 units of packed RBCs compared to 3.3% of controls (n=6; p=0.601). Notably, AT patients had a less drastic decline in hemoglobin compared to controls across all values of EBL (p=0.003; Figure 1). There were no detectable differences in venous thromboembolism events or rates of individual or composite infectious, pulmonary or renal complications (Table 1). Our data suggest that cell salvage and autotransfusion of vaginally shed blood is a safe and effective tool for management of obstetric hemorrhage following vaginal delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

432 To determine the rate of decline of fetal hemoglobin following an intrauterine blood transfusion

Hemolytic disease of the fetus and newborn (HDFN) is characterized by fetal anemia, secondary to maternal alloantibody-mediated fetal erythrocyte destruction. While RhD immunoprophylaxis has reduced the requirement for intrauterine blood transfusion (IUT), this procedure remains the cornerstone of treatment for severe fetal anemia. The objective of this study was to calculate the rate of daily decline in fetal haemoglobin (FHb) following IUT for fetal anemia. This was a retrospective review of all patients who underwent IUT for fetal anemia at the National Maternity Hospital, Dublin, a tertiary referral centre, over a 10-year period (2011-2020). Data was analysed and the rate of daily decline was calculated for those after one, two and three IUT procedures. Results are presented in Table 1. A total of 98 intrauterine blood transfusions were performed in 46 fetuses, of which 31/98 (67%) and 16/98 (34.7%) required a second and a third IUT, respectively. The median gestational age (GA) at first IUT was 29+1 weeks (range 17+2-34+5 weeks), and the median GA at second IUT was 29+2 weeks (range: 22+0-34+4 weeks). The median rate of decline in FHb between first and second IUT was 0.442g/dl/day (range: 0.12-1.03g/dl/day). The median GA for a third IUT was 32 weeks (range: 26+2-34+5 weeks). The rate of decline in FHb level between the second and third IUT was 0.291g/dl/day (range: 0.16-0.43g/dl/day). Only 5/98 (10.8%) of cases required a fourth IUT at a median GA of 31+4 weeks (range 30+0-34+0 weeks), with a rate of decline of 0.26g/dl/day (range 0.217-0.317g/dl/day). No fetal or maternal mortality was observed in our series. This study provides guidance as to the rate of FHb decline post a varying number of IUT procedures, and observed a reducing rate of decline following successive transfusions. It also highlights the significant range of decline that exists between patients. Careful fetal monitoring between transfusions must remain a vital part of the management of HDFN.

RETRACTED: Peak systolic velocity of fetal middle cerebral artery to predict anemia in Red Cell Alloimmunization in un-transfused and transfused fetuses

Abstract objectiveTo assess the accuracy of middle cerebral artery peak systolic velocity (MCA-PSV) in prediction of severe fetal anemia resulting from Red Cell Alloimmunization (Anti-D) in un-transfused and transfused fetuses. In addition to comparing the accuracy of MCA-PSV and the estimation of the daily decline of fetal hemoglobin (Hb), to determine the appropriate time of subsequent transfusions. Study designThis was a retrospective study of a series of 84 anaemic fetuses due to Red Cell alloimmunization. During each in-utero transfusion session, measurements of (1)MCA-PSV, (2)pre- and (3)post-transfusion Hb levels were recorded. Receiveroperating characteristics (ROC) curves, negative and positive predictive values of MCA-PSV in predicting severe fetal anemia were calculated. Regression analysis assesses the correlation between fetal HB and MCA-PSV, and between observed and expected fetal hemoglobin levels. ResultsEighty four anemic fetuses were included in the study and had an in-utero transfusion. The positive predictive value (PPV) of MCAPSV decreased sharply from 86.0 % at the first IUT, to 52.0 % and 52.1 % at the second and third IUTs respectively. According to the ROC curves, setting the cut-off at 1.70 MoM would provide the best performance of MCA-PSV with respect to the timing of the second and third IUT. Setting a higher threshold of 1.70 MoM for the 2nd and 3rd transfusions would increase the PPV from 52.0 % to 96.4 % at the second IUT, and from 52.1%–99.8 % at the third IUT. ConclusionIn this study we suggest that a higher MCA-PSV (MoM 1.7 in compared to 1.5MOM) can accurately predict the recurrence of severe fetal anemia requiring serial IUTs. In transfused fetuses, MCAPSV accuracy to detect severe anemia decline slightly with increase number of IUT. In addition to that, the mean projected daily decrease in fetal hemoglobin has a similar accuracy to MCA-PSV in predicting moderate to severe fetal anemia.

Yüksek Tibial Osteotomi Hastalarında Traneksamik Asit ve Kanama Parametreleri: Gözden Geçirme ve Meta-analiz

Objective: To clarify and elucidate the real correlation between tranexamic acid administration and post-operative bleeding parameters in high tibial osteotomy (HTO) patients. Material and Methods: Articles published in PubMed, Embase, and Cochrane Library were searched and included in our analysis under the eligibility criteria. Information related to bleeding parameters among HTO patients treated with tranexamic acid and placebo was collected and analyzed using random or fixed-effect models. Results: A total of five papers were included in our study. Our pooled calculations found that tranexamic acid was associated with reduced bleeding parameters in HTO patients including drainage volume on the first day (mean diff=1.47 [95% CI=0.33-2.65], p=0.0120), hemoglobin decline on the second day (mean diff=0.79 [95% CI=0.59-1.00], p=0.0000), and total blood loss (mean diff=2.25 [95% CI=0.59-3.91], p=0.0080) compared to control group. However, we failed to elucidate the correlation between tranexamic acid administration and hemoglobin decline on the first day among patients with HTO. Conclusion: Tranexamic acid is associated with reduced drainage volume on the first day, hemoglobin decline on the second day, and total blood loss among HTO patients.

A study on association of age, gender, and body mass index with hematological parameters

Introduction: Hematologists have always had a keen interest in researching the pathophysiology and clinical relevance of hematological parameters in various populations. Factors that may affect hematological and serum biochemical parameters might include gender, age, body mass index (BMI), season, and nutrition. Aim: The aim of this study was to determine the association of hemoglobin, red blood cell (RBC) count, white blood cell (WBC) count, and platelets with the age, gender, and BMI of patients who came to the hematology section of the department in the regular outpatient department (OPD) services. Materials and Methods: We had selected 300 patients randomly who came to the hematology section of the department in the regular OPD services. We had calculated height and weight of the patient after their consent and calculated their BMI. The selected patients were categorized into five age groups from Group A to Group E (20–30 years, 31–40 years, 41–50 years, 51–60 years, and 61–70 years), into males and females (Group A and Group B), also according to BMI into four groups (Group A – BMI <18.5 kg/m2, Group B – BMI <18.5–25 kg/m2, Group C – BMI >25 kg/m2, and Group D – BMI >30 kg/m2). Blood sample was collected from each patient in an ethylenediaminetetraacetic acid anticoagulant and was analyzed using a hematological autoanalyzer. Results and Discussion: A decline in hemoglobin (HB) levels and RBC count was observed above 30 years, and it decreased more in females. The mean age of obese subgroup was found to be significantly more among males. Whereas, underweight and overweight were found to be significantly more among females. HB, RBC, and platelet count did not show any significant difference among the subgroups of BMI category, but WBC count was found to be adequate in majority of the subjects with normal weight. Conclusion: In our study, we found an age-dependent decline in HB levels in the age group above 30 years. RBC and platelet count did not show any significant difference among the subgroups of BMI category, but WBC count was found to be adequate in subjects with normal weight.

Short-Term Haematogical Effects of Androgen Deprivation and Radiotherapy in Prostate Cancer Patients

Androgen deprivation therapy (ADT) is known to cause a decline in hemoglobin (Hgb), but the effect on other blood parameters is less well studied. In the lab, androgen manipulation has an effect on leukocyte counts. We evaluated the effects of androgen ablation alone on Hgb, white blood cell (WBC), granulocyte, and lymphocyte counts in 99 prostate cancer patients. In addition, since radiation therapy decreases those counts, we evaluated whether the addition of ADT makes it worse, comparing 162 patients receiving both radiation and ADT to 149 patients with radiation alone. ADT alone did significantly (but minimally) cause a drop in the Hgb (~0.5 g/dl), the WBC (-0.39 × 103/μl) and granulocyte (-0.32 × 103/μl), but not the lymphocyte counts. The combination of ADT with radiation did cause a greater decline in the Hgb levels at the end of treatment, but at follow up there was no difference. There was no additional effect on WBC, granulocytes or lymphocyte counts. Our results confirm clinically that ADT alone has minimal effect on WBC and its components and that there is no synergistic detriment of androgen ablation on the effects of radiation therapy on those cells.

Pre-Operative Parameters Predicting Hemoglobin Decline Related to Percutaneous Nephrolithotomy.

Objectives:Percutaneous nephrolithotomy (PNL) for upper urinary tract stones is a minimally invasive, effective treatment modality. Despite its high success rates, its potential complications pose a risk. In this study, we aimed to determine the risk factors associated with bleeding which is one of PNL’s most important complications.Methods:The data of patients who underwent PNL between January 2017 and December 2018 were retrospectively analyzed. The median reduction in post-operative hemoglobin levels compared to preoperative levels was found to be 1.6 g/dl, which was accepted as the threshold value. The patients with hemoglobin decrease above the threshold were assigned as Group 1, and below the threshold as Group 2. Pre-operative, perioperative data, and stone characteristics of the patients were recorded.Results:169 patients, 85 patients in Group 1 and 84 patients in Group 2 were included in the study. The mean age of Group 1 was significantly higher (47.4±7.9 and 32±9.4 years, respectively, p=0.001) Sixteen in Group 1 (18.8%) and six in Group 2 (7, 1%) had a diagnosis of hypertension (HT) and a significant difference was found (p=0.038). The average stone burden was 2733±1121.3 mm3 in Group 1, and 2326.5±975.6 mm3 in Group 2. It was observed that there was a significantly higher stone burden in Group 1 (p=0.001). There was a significant difference between the groups in terms of mean operation time (84.4±7 and 76.2±9.9 min, respectively, p<0.001). When the complication rates were analyzed, complications were observed in 25 (29.4%) patients in Group 1 and 12 (14.2%) patients in Group 2, and a significant difference was found between both groups (p=0.019). Age and HT were found to be significant independent risk factors associated with hemoglobin decline in multivariate analyzes (p<0.001 and p<0.027, respectively).Conclusion:In this study; advanced age, presence of HT, and high stone burden were found to be predictive of reductions in hemoglobin levels. Furthermore, a correlation of decreased hemoglobin levels was detected with operative times and occurrence of complications.

Factors influencing time to operating room in children presenting with post-tonsillectomy hemorrhage

ObjectivesWe aimed to evaluate factors associated with time to return to OR in children presenting with post-tonsillectomy hemorrhage to a tertiary children's hospital. MethodsRetrospective study of pediatric patients presenting to a single institution from January 2012 to January 2020, with post-tonsillectomy hemorrhage (PTH) requiring surgical intervention for control of bleeding. Correlation, univariate, and multivariate analysis were conducted. ResultsOf 15,984 tonsillectomies performed at our institution during the study period, 144 required return to the OR for bleeding control, in addition to 15 other children whose tonsillectomy had been performed at an outside institution. Mean time to the OR was 119.7 min (SD 101.5) in the morning, 77.4 min (SD 60.6) in the afternoon, 55.6 min (SD 34.8) in the evening, and 49.4 min (SD 26.4) overnight (ANOVA p < 0.0001). The mean hemoglobin decline from pre-to post-tonsillectomy was 1.3 g/dl (SD 1.7). Primary hemorrhages had a mean time to OR of 62.39 min (SD 63.42) while secondary hemorrhages mean time to OR was 85.54 min (SD 76.21) (p = 0.0064). There was no significant difference in time to OR among race/ethnicity (p = 0.928), insurance status (p = 0.359), weekday (p = 0.557), surgeon seniority (p = 0.8104) or by hemoglobin drop (p = 0.2773). When controlling for each of these variables, multiple linear regression showed that only time of day had significant correlation with time to OR (p = 0.0003). ConclusionAt a tertiary children's hospital, patients presenting with PTH requiring revision surgery waited the longest to get to the OR in the morning versus all other times of day.These results can aid in individualization of anticipatory guidance in order to reduce morbidity and mortality from complications requiring revision in the operating room.