Erythrocyte Suspensions Research Articles

ДИНАМИКА ИЗМЕНЕНИЙ ПОКАЗАТЕЛЕЙ ОКИСЛИТЕЛЬНОГО ГОМЕОСТАЗА В ПРОЦЕССЕ РЕПЕРФУЗИИ ПЕЧЕНИ КРЫС ПОСЛЕ ВАСКУЛЯРНОЙ ЭКСКЛЮЗИИ

Changes in the state of the antioxidant protection system and the intensification of free radical processes are the leading pathobiochemical mechanism for the development of reperfusion damage to cells. The aim of this paper is to determine the features of changes in markers of oxidative stress at different periods of development of the acute reperfusion after total vascular exclusion of rat liver. The study was carried out on 100 white nonlinear sexually mature male rats weighing of 200-250 grams. The animals of the experimental groups were simulated with a 20-minute vascular isolation of the liver. Blood in a volume of 2-3 ml was taken from the inferior vena cava for 5, 15, 30, 60, 120, 180 minutes, 8 hours and a day after the restoration of blood flow. The results of the study showed that in the early stages of the reperfusion period (5-60 minutes), changes are observed due to cytolysis of hepatocytes during the period of organ ischemia and leaching of cell contents into the blood. The level of radical sorption of ABTS by blood plasma briefly increased by 20% by the 5th minute of the reperfusion period; at the same period, an increase in glutathione peroxidase activity by 2.5 times was noted. The total antioxidant activity, determined by the iron-reducing method, was increased by 2 times within the period of 15-30 minutes after the restoration of blood flow. The main manifestations of reperfusion damage to the liver developed in 60 minutes after the restoration of blood flow and were characterized by a sharp decrease in total AOA by 1.5-2 times and the concentration of reduced glutathione by 20%. The system of antioxidant protection of blood plasma was the first to react to the spread of the pathological process at the systemic level and its changes persisted one day after liver ischemia. A 20-minute vascular exclusion of the liver was accompa- nied by changes in the antioxidant balance in the erythrocyte suspension, but these changes returned to normal a day after the restoration of blood flow. The data obtained make it possible to distinguish between the contribution of ischemic and reperfusion injuries to the development of oxidative disorders, which is important from the standpoint of assessing the possibilities of anti- oxidant therapy.

How has the COVID-19 pandemic changed the diagnosis of rectus sheath hematoma and its follow-up?

There has been an increased incidence of rectus sheath hematoma (RSH) due to chronic cough attacks and anti-coagulant therapy due to the COVID-19 pandemic. The present study aims to determine, in which parameters differ before and during the diagnosis of RSH in COVID-19 patients and what may be expected during diagnosis and follow-up. Thirty-five patients diagnosed with RSH were evaluated retrospectively between March 2016 and March 2021. The COVID-19 group comprised 11 patients. Various information including patient history and time of discharge/death were retrieved and compared between the experimental groups. The rates of hypotension on admission (p=0.011) and the rates of defense and rebound (p=0.030) were higher in the patients with COVID-19 than in those without. Although there was no difference in terms of bleeding width, there was a greater decrease in the hemoglobin levels (p=0.009) in the COVID-19 patients and the need for erythrocyte suspension (p=0.040) increased significantly in that group. The present study constitutes the first evaluation of RSH in COVID-19 patients. The clinical situation is serious due to high rates of hypotension, defense or rebound, and decreases in hemoglobin levels in COVID-19 patients. This makes the clinical management of RSH more difficult, resulting in longer hospitalization. Despite these difficulties, COVID-19 infection does not increase morbidity or mortality.

Evaluation of snake bites at an emergency department

This study aimed to explore the epidemiology, clinical stage, treatment modality, complications and prognosis of cases presenting to the emergency department with a complaint of snakebite. Snakebite patients admitted to the emergency department between January 2012 and January 2021 were analyzed retrospectively. We retrieved epidemiological-demographic data of patients, procedures carried out in the emergency room, biochemical tests, final outcomes of inpatients, treatments administered during hospitalization, and complications. A total of 123 snakebite cases were detected in the emergency department medical records from this period. 16 cases were excluded from the study, and the remaining 107 cases were examined retrospectively. 15.9% (n=17) of snakebite cases were categorized as stage 0. Local symptoms were observed in all stages, except for five patients; systemic complications were observed only in advanced stages. The most common local complication was pain (n=99, 91.6%), while the systemic complication rate was 8.4% (n=9)Antivenom therapy was not administered to 14 (13.1%) patients, but it was applied to a total of 93 (86.9%) patients, with 74 (69.9%) receiving it in our center and 19 (17.8%) in external health centers. Antibiotherapy was administered to 93 (96.6%) of the patients, immobilization to 42 (39.3%), erythrocyte suspension to 1 (0.9%), fresh frozen plasma to 2 (1.8%), and 1 (0.9%) fasciotomy. No adverse outcomes were observed at 6-month or 1-year follow-up. Complications should be evaluated based on the type of toxin and clinical stage, and then appropriate treatment should be commenced without any delay. This approach should reduce or prevent the development of complications.

Clinical efficacy of extracorporeal and intravascular hemocorrection methods in psoriasis

study of the influence of methods of extracorporeal and intravascular hemocorrection (plasmapheresis, ultraviolet blood irradiation, ozone therapy and their combination) on the course of the skin process and the quality of life of patients with widespread psoriasis vulgaris. Material. 253 patients with widespread psoriasis aged 18 to 72 years were examined. Treatment was assessed using the PASI (Psoriasis Area and Severity Index) and dermatological quality of life index (DQLI). Results. The inclusion of efferent-quantum methods and ozone therapy in the complex ofpsoriasis treatment contributes to a faster and more pronounced positive dynamics of the skin process, improving the quality of life. The most effective was the use of plasmapheresis and its variants with photomodification or ozone treatment of the returned erythrocyte suspension. Plasmapheresis and its modifications should be used in the complex treatment of patients with severe psoriasis. Conclusion. It seems promising to further study the methods of efferent-quantum medicine and ozone therapy and their wider use in the treatment of psoriasis and other chronic dermatosis.

TOTAL KNEE ARTHROPLASTY: UNILATERAL, SIMULTANEOUS BILATERAL OR STAGED BILATERAL IN ADVANCED AGE?

Introduction: Most people with arthritic knees often present with symmetrical joint involvement, a condition often requiring surgery for both knees. There are, however, some disagreements concerning whether or not total knee arthroplasty should be performed simultaneously or in stages. This study aimed to evaluate the length of hospital stay, the need for erythrocyte suspension transfusion, the need for intensive care, and the mortality rates of the patients who underwent unilateral, simultaneous bilateral, and staged bilateral total knee arthroplasty. Materials and Methods: This retrospective study included 1,129 patients, who were divided into three groups based on whether they underwent unilateral, simultaneous bilateral, or staged bilateral total knee arthroplasty, and they were evaluated in terms of hospital stay, erythrocyte suspension transfusion needs, intensive care needs, and mortality rates. Results: Of all the patients, 85.5% were women, with the mean age of 67.58±7.23 years; and 75.6% of them underwent unilateral, 19.9% underwent simultaneous bilateral, 4.5% had staged bilateral total knee arthroplasty, 8.8% required ICU care, and 5 patients died. The need for erythrocyte suspension transfusion and length of hospital stay were highest in those who underwent staged bilateral knee arthroplasty surgery, while it was lowest in those who underwent simultaneous bilateral total knee arthroplasty surgery (all p<0.001). There was no statistically significant difference in terms of the need for intensive care need, length of stay in intensive care unit and mortality rates between patients who underwent unilateral, simultaneous bilateral, and staged bilateral total knee arthroplasty. Conclusion: Simultaneous bilateral total knee arthroplasty may be preferred in younger patients with bilateral knee osteoarthritis but without risky comorbidities, just as we practiced in our clinic. Keywords: Osteoarthritis, Knee; Arthroplasty, Replacement, Knee; Mortality

Abdominal lateral wall hematoma developed due to enoxaparin in a Covid-19 patient

A 43-year-old male patient without any additional disease, surgery or anticoagulant use admitted to the emergency department. After evaluation with computed tomography (CT), pulmonary findings were consistent with COVID-19 pneumonia. The patient was hospitalized and enoxaparin sodium 60 mg / 0.6 ml (two subcutaneous injections per day) was initiated for prophylactic purpose. In the 16th day after admission, his hemoglobin level decreased to 7.4 g/dL. On CT scan, a right flank hematoma reaching approximately 10 cm in width, starting from the subcostal level and continuing to the inguinal canal level, was seen. Anticoagulant therapy was stopped. Erythrocyte suspension (ES), totally 10 units, were given to keep the hemoglobin level above 7 g/dL. On the 32th day after admission, the patient was discharged because his hemoglobin value, which was 10.2 g/dL at that point, had not decreased, his vital signs were stable, and his treatment for COVID-19 was completed.

Peroxidase activity of erythrocytes hemoglobin under action of low-frequency vibration

Background. Hemoglobin is a hemoprotein which in the presence of oxidative equivalents, such as H2O2, can act as peroxidase with a very high oxidative potential. Hemoglobin oxidation is accompanied by generation of highly oxidized forms of iron and globin radicals that have high oxidative activity and are toxic to cells. In addition, peroxidase activity may indicate structural changes that occur in the hemoglobin molecule as a result of chemical modification. Materials and Methods. Erythrocyte suspension was subjected to vibration for 3 h within the frequency range from 8 to 32 Hz with amplitudes of 0.5 ± 0.04 and 0.9 ± 0.08 mm. At certain intervals, hemoglobin peroxidase activity was determined together with the content of its ligand forms in the hemolysates of cells. Additionally, experiments were performed to investigate the mechanism and calculate the kinetic parameters of peroxidase reaction. Results and Discussion. Experimental data on low-frequency vibrations effect on erythrocyte hemoglobin peroxidase activity were analyzed. The kinetics of the oxidation reaction of p-phenylenediamine by hemoglobin in erythrocytes was studied. It was found that peroxidase oxidation has a ping-pong mechanism. The kinetic parameters of the peroxidase reaction involving hemoglobin were determined. The change of kinetic parameters after two-hour exposure to the incubation medium and low-frequency vibration was studied. A possible mechanism of action of hemoglobin in oxidation reactions involving H2O2 was proposed. Conclusion. Any effect that initiates the formation of methemoglobin leads to an increase in the peroxidase activity of hemoglobin due to the involvement of the latter in the pseudoperoxidase cycle and the formation of toxic reactive globin radicals. The high content of oxyhemoglobin in the cell, observed under vibrations within the frequency range of 16–32 Hz with an amplitude of 0.9 ± 0.08 mm, can prevent its oxidation and involvement in the pseudoperoxidase cycle.

Transfusion Strategy for Rare Anti-LW Antibody Autoimmune Hemolytic Anemia Patients with Neonatal Hemolytic Disease

To analyze the causes of positive irregular antibody screening test and incompatibility of cross matching in one patient with autoimmune hemolytic anemia complicated with neonatal hemolytic disease, and to accurately identify the type of antibodies in patients, and to select a reasonable strategy for blood transfusion. One children was enrolled, blood group positive and reverse typing, Rh typing, direct anti-human globulin test, free test, dispersal test and cross matching test were carried out by test tube method and microcolumn gel card; irregular antibodies were identified by the reaction of DTT treatment and untreated panel cells with patients' plasma. The blood group of the patient was RhD positive B and irregular antibody screening positive, while the blood group of the mother was RhD positive O and irregular anti-screening negative, the result showed that the anti-LW detected in the plasma of the patient was autoantibody and ABO neonatal hemolytic disease (ABO-HDN) was present. Both O type RhD positive washing RBCs and B type RhD negative RBCs were transfused effectively. Irregular antibodies in patients are anti-LW antibodies, and transfusion of homotype RhD negative suspended erythrocytes after the exclusion of ABO-HDN shows a better effect.

Stability of Erythrocyte-Derived Nanovesicles Assessed by Light Scattering and Electron Microscopy.

Extracellular vesicles (EVs) are gaining increasing amounts of attention due to their potential use in diagnostics and therapy, but the poor reproducibility of the studies that have been conducted on these structures hinders their breakthrough into routine practice. We believe that a better understanding of EVs stability and methods to control their integrity are the key to resolving this issue. In this work, erythrocyte EVs (hbEVs) were isolated by centrifugation from suspensions of human erythrocytes that had been aged in vitro. The isolate was characterised by scanning (SEM) and cryo-transmission electron microscopy (cryo-TEM), flow cytometry (FCM), dynamic/static light scattering (LS), protein electrophoresis, and UV-V spectrometry. The hbEVs were exposed to various conditions (pH (4–10), osmolarity (50–1000 mOsm/L), temperature (15–60 °C), and surfactant Triton X-100 (10–500 μM)). Their stability was evaluated by LS by considering the hydrodynamic radius (Rh), intensity of scattered light (I), and the shape parameter (ρ). The morphology of the hbEVs that had been stored in phosphate-buffered saline with citrate (PBS–citrate) at 4 °C remained consistent for more than 6 months. A change in the media properties (50–1000 mOsm/L, pH 4–10) had no significant effect on the Rh (=100–130 nm). At pH values below 6 and above 8, at temperatures above 45 °C, and in the presence of Triton X-100, hbEVs degradation was indicated by a decrease in I of more than 20%. Due to the simple preparation, homogeneous morphology, and stability of hbEVs under a wide range of conditions, they are considered to be a suitable option for EV reference material.

The efficacy, safety, and cost-effectives of combined administration of Intravenous and Local Tranexamic Acid in the management of Patients Undergoing Primary Total Hip Arthroplasty: A prospective, blinded and randomized clinical study.

The aim of this study was to compare the efficacy, safety, and cost-effectiveness of combined administration of intravenous and local tranexamic acid with those of either intravenous or local administrations in patients undergoing primary total hip arthroplasty (THA). This prospective, blinded, and randomized clinical study was performed on patients undergoing unilateral primary THA from September 2018 to December 2019. A total of 90 patients were included and prospectively allocated to one of three groups: the combined group (n= 30, 14 male, 16 female; mean age = 54.9 ± 12 years), intravenous (IV) group (n = 30, 13 male, 17 female; mean age = 54.9 ± 12.3 years), and local group (n = 30, 13 male, 17 female; 50.3 ± 12.3). Tranexamic acid was used systemically by IV application (15mg/kg) in IV group, locally in the surgical field (2g) in local group as well as combined systemic and local together in combined group. The amount of blood loss, number of erythrocyte suspension transfusion, and changes in hemoglobin and hematocrit levels were documented accordingly. The estimated mean tranexamic acid and erythrocyte suspensions cost, extra nurse care, monitoring and laboratory costs associated with blood transfusion, and total hospital costs were compared among groups. No differences existed in hemoglobin and hematocrit levels after surgery among the groups. The combined group required fewer blood transfusion compared to the local and IV groups, and the total amount of ES was statistically significantly lower (P = 0.039) in the combined group. Although the medication cost was higher in the combined group than in the other groups (P < 0.001), combined group was more cost-effective (P < 0.001) when the total costs related to blood loss were evaluated. No occurrence of deep vein thrombosis or pulmonary embolism was found in the study. Combined administration of IV and local tranexamic acid seems to be more effective in reducing the requirement and amount of blood transfusion without increasing the risk of thromboembolic complications in primary THA compared to IV or local administrations. Despite increasing the prophylaxis costs, combined administration of TXA can result in lower total hospitalization costs by decreasing blood loss and consequent treatment costs in primary THA. Level I, Randomized Controlled Trial.

Hemorheological study on erythrocyte aggregation in patients with type 2 diabetes mellitus without cholesterol and with hyper cholesterol

BackgroundThe aggregation of erythrocytes has been studied in many pathological conditions like diabetes mellitus, malaria, jaundice, hyper cholesterol, etc. Different types of erythrocyte aggregation occur in different pathological conditions. Enhanced aggregation was found in pathological conditions compared to control subjects. ObjectiveThis research aims to study the aggregation of erythrocytes in type 2 diabetes mellitus subjects without cholesterol and with cholesterol and to compare such subjects with healthy subjects. MethodsAggregation of erythrocytes was determined using an online erythrocyte aggregometer based on sequential analysis of transmitted laser light intensity after passing through the erythrocyte suspension in plasma. The aggregation mechanism was determined in terms of several aggregation parameters such as aggregation size index (ASI), aggregation sedimentation time index (ASTI), and the total number of fluctuations (TNF) of erythrocyte aggregates. These parameters were used to describe the dynamic nature of the aggregation process under gravitation quantitatively. There were a total of 45 subjects (control subjects (n = 10)), diabetes with normal cholesterol (n = 24), and diabetes with hyper cholesterol (n = 21) in this study. ResultsThe aggregation parameter total number of fluctuations (TNF) was 1634 ± 397 in normal subjects, 1539 ± 197 in group 1, and 1096 ± 180 in group 2. The aggregation sedimentation time index (ASTI, Fig. 2) indicates the time taken by the aggregates to sediment (28–32 min for normal, 24–28 min for group 1, and 16–20 min for group 2 subjects). The aggregation parameters decreased in diabetes with normal cholesterol and were significantly decreased in diabetes with hyper cholesterol compared to controls. The results show that in patients with diabetes with normal cholesterol, the aggregation of erythrocytes is increased and in patients with diabetes with hyper cholesterol, the aggregation increased significantly. ConclusionsThe significant increase in aggregation in diabetes with hypercholesterol may increase the microcirculatory complications compared to diabetes with normal cholesterol.

DEVELOPMENT OF APPROACHES TO LABORATORY CONTROL OF «BIOTESTLAB» LTD TO ENSURE QUALITY OF VETERINARY PREPARATIONS

The article presents the development of approaches to laboratory control and the results of research related to the standardization of methods at Ltd "BIOTESTLAB" to ensure the quality of veterinary drugs. Attention is paid to the methods of biological quality control of veterinary drugs: microbiological purity, hemagglutination reaction (HAR), determination of infectious activity of embryonic vaccines. Because such methods are characterized by low automation, low accuracy, the impact on the result of error due to personnel performing operations manually, the lack of regulatory approaches to validation of methods. The influence on the reliability of the obtained results on determining the titer of infectious activity of the virus of the following factors: quality and concentration of the applied suspension of erythrocytes of a rooster, duration of cultivation of a virus, technique of performance by the controller of each operation of a technique is investigated. Studies on the influence of these factors were conducted on the example of determining the titer of infectious activity of Newcastle disease virus. Approaches to accounting for the obtained results by the method of qualitative HAR, namely visual control of hemagglutination reaction on glass and on a plate are established. A comparative characterization of the results for the detection of hem agglutinin of Newcastle disease virus on glass (using 2% suspension of erythrocytes) and on the plate (using 1% suspension of erythrocytes). The results of inter-laboratory comparative tests of microbiological methods conducted to verify the qualification and reliability of the results are presented. It is demonstrated that the proper organization of laboratory control in measures to confirm the results of control of quantitative methods and evaluation of biological material by standardizing methods, conducting internal laboratory testing and participation in inter-laboratory comparative tests ensures and guarantees the quality of veterinary drugs.

Comparative effectiveness of "liberal" and "restrictive" modes of intraoperative infusion-transfusion therapy in lung transplantation

Introduction. Recently, researchers have paid considerable attention to the strategy of intraoperative infusiontransfusion therapy in traumatic surgical interventions. The choice of a “restrictive” regimen during surgery in many studies has reduced the incidence and severity of intra- and postoperative complications.Objective. Comparison of the effectiveness of "liberal" and "restrictive" intraoperative infusion-transfusion therapy in lung transplantation.Material and methods. The study included 58 patients who underwent bilateral lung transplantation at N.V. Sklifosovsky Research Institute for Emergency Medicine in the period 2012-2019. The patients were divided into 2 groups: the comparison group included 31 patients, the total volume of intraoperative infusion-transfusion in whom was 14386.9 ± 1310.0 ml (16.5 ml/kg/h). Group II consisted of 27 patients; their total volume of intraoperative infusion-transfusion during surgery was 10251.3 ± 740.1 ml (12.9 ml/kg/hour). The analysis we performed included the volume and composition of intraoperative infusion-transfusion therapy, the volume of blood loss, clinical and laboratory data, the duration of mechanical ventilation, the frequency of intraoperative use of veno-arterial extracorporeal membrane oxygenation and the duration of its use after surgery, mortality.Results. When using the "restrictive" fluid therapy for lung transplantation, we observed a decrease in the volume of intraoperative blood loss by 1.3 times, the volume of transfusion of blood components, including fresh frozen plasma by 37%, erythrocyte suspension by 3.1 times, and instrumental reinfusion of autoerythrocytes by 1.56 times. At the same time, we revealed a decrease by 2.7 times in the duration of the mechanical ventilation use, a decreased frequency of using veno-arterial extracorporeal membrane oxygenation during surgery by 1.3 times, and a decreased duration of using veno-arterial extracorporeal membrane oxygenation after surgery by 2.3 times. Mortality was 38.7% in group I, and 30.7% in group II.Conclusion. The “restrictive” approach to intraoperative infusion-transfusion therapy in lung transplantation seems a promising new trend requiring further study and gaining the experience.

A Rare Case of Anemia Caused by Retroperitoneal Hematoma

Introduction: Retroperitoneal hemorrhage has been reported with enoxaparin therapy. İn this article, spontaneous retroperitoneal hemorrhage developed in a patient using enoxaparin due to deep vein thrombosis is discussed. Case Report: A seventy-six-year-old male patient was admitted to the emergency department with the complaint of fatigue. On deeper introspection, our patient had, in the recent past, been used enoxaparin for deep vein thrombosis. In the physical examination was natural except subcutaneous minimal hematoma in the upper extremity bilateral enoxaparin area. İn laboratory tests, hemoglobin: 4.6 g / dl, urea: 158 mg / dl and creatinine were determined as 1.86 mg / dl. Abdominopelvic computed tomography imaging were performed and retroperitoneal hemorrhage reaching a depth of 4 cm adjacent to the right psoas muscle was detected. The patient, who did not develop additional complications after FFP and erythrocyte suspension replacement during the intensive care follow-ups and did not need surgical treatment, was discharged on the 17th day of his hospitalization in good health. Conclusion: When patients under enoxoparine treatment present with the complaint of fatigue, major bleeding may be seen when anemia is detected. One should be vigilant in terms of retroperitoneal bleeding as the bleeding focus in these patients.

Risk factors of cerebral complications after Stanford type A aortic dissection undergoing arch surgery

To explore the risk factors of cerebral neurological complications after surgery for Stanford type A aortic arch surgery. One hundred sixteen patients who received Stanford type A aortic dissection from January 2012 to December 2019 were recruited. All patients received surgery under deep hypothermic circulatory arrest (DHCA) and general anesthesia. They were grouped by degree of postoperative cerebral neurological complication. The related factors of cerebral neurological complications were analyzed by single-factor analysis and multi-factor logistic regression. Postoperative neurological complications were observed in 31 cases (26.72%). Two groups were identified: permanent neurological dysfunction (PND) was observed in seven cases, and temporary neurological dysfunction (TND) was observed in 24 cases. In-hospital mortality was 9.48% (11/116), with six in the cerebral complication groups and five in the non-complication group. Single-factor analysis showed the associated factors were age, stroke history, carotid plaque or stenosis, emergency surgery, renal dysfunction, hypotension, aortic clamping time, deep hypothermic circulatory arrest time, postoperative hypoxemia, postoperative low cardiac output and plasma transfusion >800ml, and erythrocyte suspension transfusion >6 U. Multi-factor logistic analysis showed the independent predictive factors were DHCA time >40min, plasma transfusion >800ml, erythrocyte suspension transfusion >6 U, history of stroke, and carotid plaque or stenosis. The factors independently associated with neurological complications are DHCA time >40min, plasma transfusion >800ml, erythrocyte suspension transfusion >6 U, history of stroke, and carotid plaque or stenosis. Our findings suggest that patients with these risk factors should receive intervention during treatment to reduce cerebral neurological complications.

Does heated erythrocyte suspension transfusion with medical devices containing phthalates increase DEHP and MEHP levels?

It is commonly known that stored blood and blood products are heated before transfusion to prevent hypothermia, which leads to increased di-(2-ethylhexyl) phthalate (DEHP) content leaching into the blood and blood products and thereby causes greater conversion of DEHP to mono (2-ethylhexyl) phthalate (MEHP). However, there has been no study in the literature reporting on the amount of toxic phthalates in blood following the erythrocyte suspension (ES) transfused via warming. In this study, we aimed to investigate the DEHP and MEHP content in blood following the heated ES transfusions administered by DEHP-containing and DEHP-free infusion sets. The study included 30 patients that were randomly divided into two groups with 15 patients each: group I underwent ES transfusion via DEHP-containing infusion sets warmed with blood-fluid warmers, and group II underwent ES transfusion via DEHP-free infusion sets warmed with blood-fluid warmers. DEHP and MEHP levels were measured both before and after transfusion. DEHP-free infusion sets led to no increase in the phthalate content, whereas DEHP-containing infusion sets significantly increased the DEHP and MEHP, where the DEHP level increased almost four times (P=.001). DEHP-containing products lead to toxicity. Therefore, using DEHP-free medical devices may prevent toxicity in patients undergoing ES transfusion.

EVALUATION OF BLOOD AND BLOOD PRODUCTS TRANSFUSIONS IN DICLE UNIVERSITY FACULTY OF MEDICINE RESEARCH HOSPITAL EMERGENCY DEPARTMENT

This study was designed prospectively to investigate the demographic data of the patients who had blood and blood products in Dicle University Medical Faculty Research Hospital Emergency Service between 01 November 2014- 01 November 2015, also to investigate the indications for blood products used, the amount and the type of the products used. When we look at the diagnosis of patients who underwent transfusion in the emergency department; It was determined that 26.2% were transfused for malignancy, 32.6% for anemia, 18.3% for trauma, 12.5% for GIS bleeding, and 10.4% for other reasons. The patients who had blood product transfusion were 623; 53.8% were male and 46.2% were female. The mean age of the patients was determined 47.87±23.66. The percentage of transfused blood products were as following: 83.6% erythrocyte suspension (ES), 17.3% fresh frozen plasma (FFP), 17.3 % platelet suspension(PS), 0.6% whole blood(WB), %4.3 other blood components (OBC). As a result, we can say that in our study, a large number of transfusions were performed in the emergency department, a specific protocol was not adhered to in determining the indication, and transfusion was performed in support of patients who were mostly under outpatient follow-up. Emergency transfusion decisions should be performed with true emergency indication, follow-up with clinical response rather than laboratory response, and consciousness about the aim of transfusion.

Analysis of economic efficiency of iron deficiency anemia therapy in patients with malignant tumors

Introduction. Correction of iron deficiency anemia in patients with malignant neoplasms is an important aspect affecting the quality of life and the effectiveness of special treatments. At the same time, the therapy of comorbid conditions significantly increases the cost of treating cancer patients.The aim of the study was to conduct a comparative pharmacoeconomic analysis of the two most common methods for correcting iron deficiency anemia in cancer patients: transfusion of erythrocyte suspension and intravenous iron preparations using iron carboxymaltose as an example.Materials and methods. An observational, analytical, cohort study was carried out, which included 120 cancer patients. The patients underwent laboratory examination. The tests were assessed: a general blood test with an assessment of the morphological characteristics of erythrocytes, serum iron, ferritin, CRP, total protein. An analysis of the costs of iron deficiency anemia therapy was carried out, taking into account the procurement cost of drugs.Results. It is economically more profitable to use intravenous iron preparations in comparison with transfusion of erythrocyte suspension for the treatment of iron deficiency anemia in patients with malignant neoplasms. The cost of correcting iron deficiency anemia per patient was: when treated with carboxymaltosate iron (Ferinject): 7943.96 rubles, with transfusion of erythrocyte suspension: 16856.40 rubles.Conclusion. In the treatment of anemia in patients with malignant neoplasms with blood preparations (erythrocyte suspension), an improvement in hematological parameters is noted earlier and to a greater extent than with the use of iron preparation carboxymaltozate («Ferinject»). Nevertheless, the duration of the clinical effect when using erythrocyte suspension is lower than that of a parenteral iron preparation.

Mesane ve prostat kanseri olan yaşlı ve komorbid hastalarda dirençli hematüride minimal invaziv bir yöntem, transkateter bilateral süperselektif arter embolizasyonu

Objective: In this article, we aimed to share our experience with superselective vesical and prostatic artery embolization applied by transarterial microcatheter method as a treatment option for recurrent resistant hematuria due to bladder and prostate cancer in elderly and comorbid patients. Materials and Methods: Bilateral transarterial microcatheter method was used for superselective vesical or prostatic artery embolization in 10 patients whose follow-up treatment was continued in our clinic with macroscopic hematuria due to bladder and prostate cancer diagnoses and could not be treated with other palliative and radical surgical methods due to comorbidity and high surgical operative risk. Before and after embolization treatment; hemoglobin (Hb) and hematocrit (Hct) values of the patients, the amount of transfusion of blood and blood products, postoperative complications, urethral foley catheter removal times and patient satisfaction were evaluated. The patients were followed up with controls intermittently for an average of 15 months. Results: The mean age of the patients included in the study was 77.5 (69-86) years. The average hemoglobin value before and after the embolization procedure was 8,16 mg/dL and 9,48 mg/dL, respectively. The average hematocrit value before and after the embolization procedure was 25,5 and 30,4 , respectively. The average amount of blood products (erythrocyte suspension) transfusion was 2.1 (1-3) units before the procedure, and there was no need for blood transfusion in the follow-up after the procedure. The urethral catheters of all patients were removed on the 5th day (3-7 days) after the urine color became completely clear. There were no major complications, recurrent urethral catheterization or mortality, morbidity related to the treatment after the embolization procedure. Conclusion: Superselective vesical and prostatic artery embolization treatment applied by transarterial microcatheter method is an effective and reliable alternative in the case of resistant hematuria due to bladder or prostate cancer that cannot be controlled with other palliative methods due to the high risk of anesthesia in elderly patients with comorbidities. Keywords: persistent hematuria, bladder cancer, superselective vesical artery embolization

Analysis of Risk Factors for Rectus Sheath Hematoma.

To evaluate the risk factors for developing rectus sheath hematoma (RSH). An observational study. Department of General Surgery, Hitit University School of Medicine, Erol Olcok Training and Research Hospital, Turkey; from January 2018 to April 2020. Patients with RSH were studied. Those with other pathologies in rectus sheath, and repeat studies, were excluded. Demographic data, presenting symptoms, comorbidities, medications administered containing anticoagulant drugs, imaging results, laboratory findings, coagulation parameters, length of hospital stay, treatments administered, type of RSH, morbidity, mortality and risk factors of increased bleeding diathesis, were recorded. Of the 61 studied patients, 56 (91.8%) had at least one chronic disease, and 77% were receiving anticoagulation therapy. RSH size was significantly larger for patients taking acetylsalicylic acid than for patients taking other anticoagulants, and an RSH area less than1,924 mm2 was associated with increased length of hospital stay. Binary logistic regression analysis showed that a unit increase in gender was associated with a 1.5-fold increase in the risk of greater RSH size, and that female gender was associated with a 45.3-fold risk of increase in the risk of RSH. Notably, if up to 4 units of erythrocyte suspension replacement is not applied for conservative treatment of RSH, RSH size may increase by 23.5 times. Risk factors of RSH include chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, atrial fibrillation, asthma, hypertension, diabetes mellitus, chronic renal failure, prior abdominal surgery, female sex, older age, anticoagulant drug use and cancer-related immunosuppression. Key Words: Rectus sheath hematoma, Conservative treatment, Anticoagulant treatment.