History Of Blood Transfusion Research Articles

Role of Hepcidin in Pediatric Chronic Kidney Disease with Anemia

Introduction: Anemia is a frequent complication of chronic kidney disease (CKD) in children and it causes an increase in morbidity, mortality and accelerates the rate of progression of CKD. Inflammation and impaired kidney clearance increase plasma hepcidin, inhibiting duodenal iron absorption and sequestering iron in macrophages. However, the role of hepcidin in increasing the risk of anemia in children with CKD is still uncertain. This study aimed to investigate the association between hepcidin levels and anemia in children with pre-dialysis CKD. Methods: A cross-sectional study was conducted at Dr. Soetomo Academic Hospital from December 2018 to February 2019. Children with pre-dialysis CKD were enrolled in this study. The subject had no history of erythropoietin administration and blood transfusion 3 months before the blood sample were withdrawn. A complete blood count, ferritin serum, transferrin saturation (TSAT) and hepcidin serum were performed. The correlations between Hepcidin and ferritin level, between ferritin level and anemia, and between TSAT and anemia were analyzed using Spearman correlation and the Mann-Whitney test.
 Results: A total of 47 children, 27 boys and 20 girls, ranged in age from 3 months to 18 years old. There was a significant correlation between hepcidin and ferritin levels (p=0.006) and the value of the Spearman correlation was r=0.392. While the correlation between ferritin level and anemia showed a significant result, p=0.001. However, TSAT did not show any significant correlation with anemia (p=0.230).
 Conclusion: There was an indirect association between hepcidin level and anemia by increasing ferritin level that induces anemia in pre-dialysis CKD children.

Seroprevalence and risk factors for hepatitis B and hepatitis C in three large regions of Kazakhstan.

Kazakhstan has implemented comprehensive programs to reduce the incidence of Hepatitis B and Hepatitis C. This study aims to assess seroprevalence and risk factors for HBsAg and anti-HCV positivity in three large regions of Kazakhstan. A cross-sectional study was conducted in three regions geographically remote from each other. Participants were randomly selected using a two-stage stratified cluster sampling and were surveyed by a questionnaire based on the WHO STEP survey instrument. Blood samples were collected for HBsAg and anti-HCV testing. A total of 4,620 participants were enrolled. The seroprevalence was 5.5% (95%CI: 3.6%-8.4%) for HBsAg and 5.1% (95%CI: 3.5%-7.5%) for anti-HCV antibodies. Both were more prevalent in the western and northern regions than in the southern. A history of blood transfusion was significantly associated with anti-HCV presence, with odds ratios (ORs) of 2.10 (95%CI: 1.37-3.21) and was borderline associated with HBsAg 1.39 (95%CI: 0.92-2.10), respectively. Having a family member with viral hepatitis was also borderline associated (2.09 (95%CI: 0.97-4.50)) with anti-HCV positivity. This study found a high-intermediate level of endemicity for HBsAg and a high level of endemicity for anti-HCV antibodies in three large regions of Kazakhstan. We found that history of surgery was not associated with HbsAg neither with anti-HCV seropositivity rates. Blood transfusion was associated with anti-HCV seropositivity, however, to investigate effectiveness of the introduced comprehensive preventive measures in health care settings, there is a need to conduct further epidemiological studies.

Effects of Lifestyle and Environmental Factors on the Risk of Acute Myeloid Leukemia: Result of a Hospital-based Case-Control Study

Background: Acute myeloid leukemia (AML) is a common malignancy in adults. A vast variety of environmental and lifestyle factors play a role in AML incidence. This study aimed to assess the factors related to AML. Study design: A case-control study. Methods: This case-control study was performed on 137 AML cases during 2018-2021 at Beheshti Hospital in Hamadan, Iran, and 137 gender/age-matched controls. A questionnaire including 12 items was used to obtain information about lifestyle and environmental factors. A univariate and multiple variate logistic regression was used to estimate the odds ratios (OR), and a 95% confidence interval (CI) was used to investigate the relationship between the studied variables and the incidence of AML. Results: Based on findings, 62 (45.3%) out of the 137 leukemic cases were male and 75 (4.7%) were females. A statistically significant increased risk for AML was found with regard to prior usage of cytotoxic agents (OR: 8.00, 95% CI 1.01, 63.9, P =0.050), family history of malignancies (OR: 3.62, 95% CI: 1.65, 7.92, P =0.001), exposure to electrical power (OR: 3.22, 95% CI: 1.52, 6.81, P =0.002), and history of mental diseases (OR: 8.50, 95% CI: 3.64, 19.80, P =0.001). It was found that the AML incidence had no association with age, gender, radiation therapy, cigarette smoking, prior chemotherapy, congenital disorders, exposure to chemical agents, history of infectious mononucleosis, exercise, and blood transfusion ( P >0.05). Conclusion: The current results suggested that cytotoxic agents, family history of malignancy, mental disorders, and exposure to electrical power could play a role in AML incidence.

Haemoglobin, Serum Iron Level and Cardiovascular Status in Advanced Stages of Chronic Kidney Disease Patients admitted in A Tertiary Care Centre

Background: Anaemia due to advanced stages of chronic kidney disease increases morbidity of patients. Early detection and correction of anaemia may be helpful in preventing the progress of the disease & its cardiovascular outcomes. The objective of this study was to evaluate hemoglobin, serum iron level and cardiovascular status in advanced of CKD patients. Methods: This was a cross sectional observational study on 150 cases of diagnosed advanced stages (3B,4 &5) of CKD patients in indoor of department of medicine of Mitford Hospital, Dhaka from July 2019 to January 2020. Convenience sampling was done. Data were analyzed with SPSS 26. Results: Total number of patients were 150. Male were 93 (62%) and female were 57 (38%). The mean (±SD) age was 55.22 (±10.30) years (range 33 - 75 years). Among the study subjects 38% had history of blood transfusion, 60% had history of iron supplementation and 12% subjects received erythropoietin. Mean (±SD) haemoglobin level was 7.61 (±2.54) g/dl. Seventy percent of the study subjects had haemoglobin level < 9 g/dl and rest had ³9 g/dl. Significant difference was found in between these two groups (p = 0.036). In the present study, mean (±SD) serum iron level was 15.59 (±07.39) μmol/l. In 46% of the study subjects, iron level was 7.3μ mol/l and 52% had iron level between 7.3 to 23.6 μmole/ lit. Mean (± SD) ferritin level of the study subjects was 155.22 (±92.32) ng/ ml. In 58% of the study subjects ferritin level was < 100ng/ ml and 42% had >100 ng/ml. Significant difference was found in between these two groups (p = 0.041) (Table-IV). Ferritin level had significant positive relationship with blood transfusion, iron and erythropoietin supplementation on logistic regression analysis. Haemoglobin and serum ferritin level was positively correlated with eGFR of the study subjects. Statistical analysis showed significant relationship between eGFR with haemoglobin and serum ferritin. Forty six percent of the study subjects had Transferrin saturation (TSAT) level below 20%. Fifty four percent subjects had a TSAT level above 20%. Significant difference was found in between these two groups (p = 0.001). In correlation analysis, haemoglobin, serum ferritin and TSAT level in the study subjects had negative relationship with duration of CKD in years. Relationship of haemoglobin and TSAT level with duration of CKD was statistically significant. In correlation analysis, serum TIBC level had negative relationship with haemoglobin level which was statistically significant. Serum iron, ferritin and TSAT level in the study subjects were positively correlated with haemoglobin level. Relationship of haemoglobin with serum iron level and TSAT level was statistically significant. Twenty percent of the study subjects had peripheral vascular disease, 111 (74%) of the study subjects had hypertension, 66 (44%) had ischaemic heart disease, 27 (18%) had a history of acute myocardial infarction, 24 (16%) had chronic heart failure, 93 (62%) had dyslipidemia and 27 (18%) patients had history of stroke. Conclusion: In this study it was observed that TSAT appears to be a more useful indicator for measuring the frequency of iron deficiency than serum iron, TIBC and serum ferritin. The cardiovascular comorbidities plagued significant number of patients with advanced CKD. Bangladesh J Medicine July 2022; 33(1) : 34-39

Trends in the Prevalence of Hepatitis C Virus Infection based on the Insurance Status in the United States from 2013 to 2018.

With the recent improvement in the treatment of hepatitis C virus (HCV) infection, a better understanding of the infection burden is needed. We aimed to (a) estimate the trends in the national prevalence of HCV infection based on the type of health insurance coverage and (b) identify at-risk populations for HCV infection in the United States (US) general population. Population-based analyses using the National Health and Nutrition Examination Survey (2013-2018) were performed with a focus on HCV infection. We analysed the prevalence of HCV infection based on the health insurance status before the direct-acting antiviral (DAA) era (2013-2014) and during the DAA era (2015-2018). The age-adjusted prevalence of active HCV infection (HCV RNA [+]) was 0.92% (95% confidence interval, 0.71%-1.19%) in the US non-institutionalized civilian population. Although the prevalence of active HCV infection has remained stable, the prevalence of resolved HCV infection has increased after the introduction of DAA. In terms of health insurance coverage, the prevalence of active HCV infection decreased, and the prevalence of resolved HCV infection increased among individuals who had health insurance, especially private health insurance. The independent risk factors of active HCV infection were 40-69years group, male, less than high school education, unmarried, below poverty status, being born in the US, history of blood transfusion and not having private health insurance. The burden of active HCV infection has decreased among individuals who had health insurance, especially private health insurance, during the DAA era.

The Blood Group Serology Combined Irregular Antibody Prenatal Screening Strategies for RhD-Pregnant Women in Xiamen

To investigate the distribution of Rh phenotype, irregular antibodies screenting and postpartum follow-up of RhD- pregnant women in Xiamen. The samples of 313 RhD- pregnant women from June 2018 to May 2020 were collected. Rh serotype phenotypes were identified by tube physiological saline method, irregular antibodies were screened and confirmed by DiaMed Low ion indirect anti-human gel card. By recording the medical，the pregnant women production process and the occurrence of HDN were investigated. The Rh serological phenotypes of 313 RhD- pregnant women were ccdee 180 cases (57.51%), Ccdee 97 cases (30.99%), ccdEe 10 cases(3.19%), CCdee 21 cases (6.71%), CcdEe 5 cases (1.60%), the ccdee and ccdee were the most common in the serological phenotype. Eleven irregular antibodies were detected in 313 RhD- pregnant women, accounting for 351% of the total. There were 8 cases of anti-D antibody, 1 case of anti-E antibody, and 2 cases of anti-D combined with anti-C antibody. The medical records of 21 RhD- pregnant women were reviewed, 19 cases of RhD+ and 2 RhD- newborns were successfully delivered, in which 2 cases developed RhD-HDN, 1 case developed RHE-HDN, and the remaining 18 cases did not develop HDN. The Rh serological phenotype of RhD- pregnant women in Xiamen area is mainly for ccdee. Maternal history and blood transfusion history are the main causes of irregular RhD- pregnant antibodies. It is recommended that serological phenotype combined with irregular antibody screening should be applied for RhD- pregnant women in clinic, to reduce the risk of RhD-HDN and ensure the safety of RhD- blood transfusion.

Change in Hemoglobin with Androgen and Low Dose Erythropoietin Versus Erythropoietin Alone in Patients of Anemia of Chronic Kidney Disease

Objectives: To determine the mean rise in hemoglobin with androgen and low dose erythropoietin versus erythropoietin alone in patients of anemia of chronic kidney disease. Methodology: A randomized control trial was conducted at a tertiary care hospital between October 2019 to April 2020. Both male and female from age >17years to 70 years with anemia of CKD as per operational definition were included. Patients with a history of blood transfusion in the last three months. Patients already on Erythropoietin therapy or those with uncontrolled hypertension BP >190/105 mm Hg at the time of study were excluded. Relevant data including demographic details, baseline hemoglobin was noted. Patients were randomly assigned to group A or group B by lottery method. Patients in group A were given 100mg of androgen (Nandrolone Decanoate) intramuscularly once weekly plus low dose of erythropoietin (2000 units twice weekly) subcutaneously for 6 months and patients in group B were given standard dose of erythropoietin (4000 units twice weekly) subcutaneously for 6 months. Rise in hemoglobin was recorded as per operational definition. Follow up was ensured by taking telephone contact. Data was recorded on pre-designed proforma. Results: Mean Hb levels after treatment were calculated as 12.48+1.20 in Group-A and 11.12+1.32 in Group-B, p value was calculated as 0.0001 showing a significant difference between the two groups, comparison of mean increase in Hb levels after treatment were calculated as 3.0+0.09 in Group-A and 1.72+0.67 in Group-B, p value was calculated as 0.0001 showing a significant difference between the two groups. Conclusion: We concluded that there was significantly greater rise in the mean hemoglobin with androgen plus low dose erythropoietin as compared to erythropoietin alone in treatment of anemia of chronic kidney disease. Nevertheless, further large-scale and multi-center studies will be needed to further explore the long-term efficacy and adverse effects of androgens among patients of anemia of chronic kidney disease. Keywords: Chronic kidney disease, anemia, androgen and low dose erythropoietin versus erythropoietin alone, mean increase

Growth and neurodevelopmental status in patients with retinopathy of prematurity treated with intravitreal bevacizumab: a case\u2013control study

BackgroundThe current study aimed to evaluate growth and neurodevelopmental status in patients with retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB).MethodsThis historical cohort study was conducted on neonates with ROP who were treated with IVB and age and birth weight-matched controls who did not need IVB. Apgar score less than five, history of blood transfusion and history of infectious diseases were among exclusion criteria. Indirect ophthalmoscopic examinations were performed till complete retinal vascularization. Growth and neurodevelopmental status were evaluated by Age and Stages Questionnaire (ASQ) at the ages of 6, 12, and 18 months. Developmental milestones were assessed in five areas (gross motor, fine motor, personal-social status, problem-solving, and relationship) and overall issues.ResultsA total of 34 cases and 36 controls were included in the present study. Birth weight and corrected gestational age were not statistically different between the groups. In a follow-up period of 18 months, bevacizumab was effective as a primary treatment in the treatment of severe cases of ROP. There was no significant difference between the two groups regarding the five areas and overall issues in follow-up intervals (P > 0.05).ConclusionsThe obtained results did not show any growth and neurodevelopmental differences between treatment-naïve infants and those receiving IVB for the treatment of ROP.

Prevalence and Risk Factors Associated with Hepatitis B and Hepatitis C Infections among Patients Undergoing Hemodialysis: A Single-Centre Study in Somalia.

Introduction Hemodialysis patients have the highest risk for developing hepatitis B virus (HBV) and hepatitis C virus (HCV) than the general population. There is no study available for HBV and HCV in this population in Somalia. The main objective of this study is to determine the prevalence and risk factors of HBV and HCV infections among hemodialysis patients in Somalia. Methods A cross-sectional assessment of hemodialysis patients from January 2021 to June 2021 was used in this study. 220 patients were included in this study. Age, sex, duration of hemodialysis, number of hemodialysis sessions per week, history of blood transfusion, HbsAg, and anti-HCV antibodies were examined. Results Out of the 220 patients, males were predominant (113 (51.4%)). The mean age of the participants was 52.70. The prevalence of HBV was 7.3% (16 respondents), while the prevalence of HCV was 3.2% (7 respondents). 1 respondent (0.5%) had both HBV and HCV. There is a positive correlation between the duration of hemodialysis and the prevalence of HBV and HCV (r(218) = 0.298, p value <0.001), blood transfusion and prevalence of HBV and HCV (r(218) = 0.347, p value <0.001), and the number of hemodialysis sessions per week and prevalence of HBV and HCV (r(218) = 0.402, p value <0.001). The regression model of the combined predictors of history of blood transfusion, duration of hemodialysis, and number of dialysis sessions per week is R2 = 0.25, which indicates a 25% variance in the prevalence of HBV and HCV with a significance of F (3,216) = 23.67, p < 0.001. Conclusions The prevalence of HBV and HCV among hemodialysis patients in this study was 7.3% and 3.2%, respectively. 0.5% of the respondents had both HBV and HCV. History of blood transfusion, duration of hemodialysis, and number of hemodialysis sessions per week appear to have a strong correlation with the prevalence of HBV and HCV.

Relationship Between Hemoglobin and Blood Pressure Levels in the Context of Chronic Morbidity Among Older Adults Residing in a Developing Country: A Community-Level Comparative Cross-Sectional Study

Objectives: The objective of this study is to assess the association between hemoglobin (Hb) and blood pressure (BP) levels among community-dwelling older adults.Materials and Methods: This comparative cross-sectional study was conducted in April 2021 in West Bengal, India. Individuals who are receiving treatment for hypertension, or had a history of blood transfusion, or had a history of intake of iron and vitamins were excluded from the study. A total of 81 and 106 individuals were recruited in “Group 1” (no self-reported comorbidity) and “Group 2” (self-reported comorbidity present), respectively.Results: The mean (SD) age of the participants (n = 187) was 67.4 (7.4) years; 54% (n = 101) were males; and 45.4% (n = 85) were obese. We found a significant association of Hb level with systolic blood pressure (SBP) (r = 0.22, p = 0.04) and mean arterial pressure (MAP) (r = 0.22, p = 0.04) in “Group 1”. The quantum of increases in SBP, diastolic blood pressure (DBP), pulse pressure (PP), and MAP with one gram/dl change in Hb level were 3.24 (95% CI: -0.75 to 7.24) mmHg, 1.17 (95% CI: -0.84 to 3.20) mmHg, 2.06 (95% CI: -0.67 to 4.81) mmHg, and 1.87 (95% CI: -0.65 to 4.39) mmHg, respectively, in “Group 1” after adjustment for age, gender, and body mass index. The findings were inconsistent in “Group 2”, and the changes in Hb level were 0.5 (95% CI: -3.77 to 2.77) mmHg, 0.92 (95% CI: -0.72 to 2.75) mmHg, -1.42 (95% CI: -4.09 to 1.24) mmHg, and 0.45 (95% CI: -1.05 to 2.40) mmHg, respectively.Conclusion: Hb level has a positive correlation with SBP and MAP only in those without comorbidities.

Prevalence of HBV and its Associated Risks Factors among Patients Accessing Care at a Secondary Health Facility in Ekiti State, Southwest, Nigeria

Viral hepatitis is a serious disease of the liver that can have grim prognosis in the absence of early and appropriate medical intervention. Globally, an estimated two billion people are reported to have been infected with hepatitis B virus (HBV) and out of this, more than 350 million are said to have chronic(long term) liver infection. The likelihood that Hepatitis B Virus infection will become chronic depends upon the age at which a person becomes infected. Young children who become infected with HBV are most likely to develop chronic infection. About 25% of adults who become chronically infected during childhood die from HBV related liver cancer or cirrhosis. According to WHO ranking of hepatitis prevalence, ≤ 1.9%, 2-7.9% and ≥ 8% are low, moderate and high prevalence respectively. Hepatitis is endemic in Ekiti State, there is therefore the need to know its prevalence in the major cities of Ekiti State. Since Ikere-Ekiti is the second major city of Ekiti State, therefore this study set out to know the prevalence of HBV-caused hepatitis in Ikere-Ekiti and its associated factors,. One hundred participants were enrolled- at the State specialist Hospital, Ikere-Ekiti- into the study after obtaining their informed consent. Consecutive sampling was used. Thirty-three (33%) of the subjects were males while 67 (67%) were females. Thirty-seven (37%) , 30 (30%) and 33 (33%) respectively fell were in the ≤26 years, 27-36 and ≥37 age-brackets. Fifty-two (52 %) were singles while 48 (48%) were married. Ninety-three (93%) were Christians while 7 (%) were Muslims. Structured self-administered questionnaires were served on the subjects. Five millilitres of blood were collected from each subject using venepuncture method. The samples were screened for the presence or otherwise of antibodies to HBsAg using a rapid test kit that worked on the principle of immunochromatography. An overall prevalence of 8% was discovered. Five (5%) of the positive subjects were males while 3 (%) were females (p=0.064). Half (50%) of the positive subjects were within the ≤26 years age-bracket, the 27-36 age-bracket had the least number of positive subjects (p=0.512). Two out of the positive subjects had a history of blood transfusion (p=0.748), one had history of surgery (p=0.580). The imports and implications of these are here discussed. Since viral hepatitis is vaccine-preventable and herd immunity can only be achieved when the vast majority of a society acquires immunity against a particular infectious disease, the government is advised to strive to vaccinate at least 70% of the populace against viral hepatitis- a disease which is endemic, not only in Ekiti State, but in many parts of Nigeria.

Hyperhemolysis Syndrome in SCD Patient: Reminder of a Rare but Life-Threatening Complication of Blood Transfusion

Background: Sickle cell disease (SCD) patients are at risk of developing multiple complications from transfusions, including alloimmunization to red blood cell (RBC) antigens, delayed hemolytic transfusion reactions, and hyperhemolysis syndrome (HS). HS is a serious complication of transfusion characterized by the destruction of both transfused and autologous RBCs with resulting severe anemia and post transfusion hemoglobin lower than pretransfusion levels. We report the case of a middle age female patient with known SCD who developed severe HS following a blood transfusion. We aim to remind physicians of the importance of conservative blood transfusions in SCD patients in order to avoid serious transfusion-related complications.Case report: A 57-year-old African American patient, with known history of SCD who was doing well with a baseline hemoglobin (Hgb) of 6-7 g/dl. Transfusion history included 4 units of Packed Red Blood Cell (PRBC) during the 5 years prior to this presentation, all of which for mild, non-resolving vaso-occlusive pain crisis. Her most recent transfusion was 7 days prior to her presentation, she received 1 unit of PRBC for a Hgb level of 6.3 g/dl, associated with mild musculoskeletal pain and fatigue. She presented to the Emergency Department 4 days later with worsening fatigue, decreased oral intake and dark urine. On presentation, she was normotensive, afebrile and mildly tachycardic. She had increasing oxygen requirements to maintain O2 saturation above 94%. Her blood work showed a Hgb of 2.8 g/dl (12-15 g/dL), hematocrit 8.3 % (36-46 %), RBC count 0.87 M/uL (4.15-5.55 M/uL), Mean Corpuscular Volume 95.5 fl (80-100 fl), elevated White Cell Count at 28.4 K/uL (3.8-10.6 K/uL), and platelet count 125 K/uL (150-450 K/uL). Hemolysis labs showed low haptoglobin of < 30 mg/dl (30-200 mg/dl), elevated Lactate Dehydrogenase at 3420 IU/L (< 250 IU/L), total bilirubin 2.7 mg/dl (< 1.2 mg/dl), direct bilirubin 0.6 mg/dl (0-0.3 mg/dl), and reticulocyte count 3.5% (0.5-1.5 %; reticulocytopenia relative to degree of anemia). A disseminated intravascular coagulation (DIC) panel showed fibrinogen of 263 mg/dL (200-450 mg/dL), D-dimer greater than 20 ug/mL (< 0.50 ug/ml), prothrombin time of 19.8 seconds (s) (11.5-14.5 s), and partial thromboplastin time of 32 s (22-36 s). High sensitivity troponin was elevated at 650 ng/L (< 19 ng/L). Antibody screen and direct antiglobulin test (DAT) were negative. Peripheral blood smear showed severe anemia with marked anisopoikilocytosis including numerous blister cells, occasional sickle cells and numerous nucleated red blood cells. The recent history of blood transfusion and the current laboratory workup were consistent with HS.Patient was admitted to the intensive care unit (ICU) for management; she initially received 1g intravenous iron dextran and intravenous immunoglobulin (IVIG) 0.4 g/kg for 5 days. She was also started on erythropoietin, folic acid, and vitamin B12. Her reticulocyte count improved to 19%. Given no improvement in Hgb levels, systemic steroids were started after ruling out infectious etiologies. She initially received methylprednisolone 125mg daily for 2 days, followed by oral prednisone 60mg daily for 7 days. Patient had increased oxygen requirements during admission, had an elevated lactate to 4 mmol/L, and had a drop in Hgb to 2.1 g/dL. She was still managed conservatively with oxygen supplementation and intravenous crystalloid fluids. The decision was to avoid transfusions unless they were life-saving. Patient remained in the ICU unit for 5 days, then was transferred to the hematology floor where she remained hospitalized for 7 days. Oxygen requirements and patient's symptoms steadily improved, hemolysis labs trended down, and reticulocyte count improved. Hgb levels improved gradually to highest of 5.7 g/dl prior to discharge. Patient was then discharged to follow up with her hematologist in the outpatient setting.Conclusion: This case aims to highlight the importance of early recognition of HS to avoid wrong management with RBC transfusion. Our patient had severe anemia and was managed with transfusion-free approach with good outcome. This case is also meant to remind physicians of the importance of conservative blood transfusions in SCD patients in order to avoid serious and life-threatening transfusion-related complications. DisclosuresNo relevant conflicts of interest to declare.

Frequency of Hepatitis C Virus and Hepatitis B Virus among Children undergoing multiple Blood Transfusions

Objective: To evaluate the frequency of hepatitis C virus and hepatitis B virus among children underwent multiple blood transfusions at tertiary care Hospital. Methodology: This cross-sectional retrospective study was conducted at paediatrics department of Liaquat University of Medical and Health Sciences. All the children below the age of 12 years, both gender and presented with history of multiple blood transfusions due different hematological disorders at paediatrics department were included. After taking complete medical history, all the children underwent screening for hepatitis B virus and hepatitis C virus. After taking verbal informed consent a 3 ml or 5ml blood sample was taken from each case and sent to the Hospital diagnostic Laboratory for the HCV and HVB screening. All the data was collected by the self-made study proforma. Data analysis was done using SPSS version 20. Results: A total of 102 children were studied. The mean age of the children was 8.57+2.97 years and average hemoglobin level was 9.26+2.91. Males were in the majority 74(72.5%). Most of the children 42(41.2%) had thalassemia. The frequency of HBV was 5.9% and HCV was 33.3% among children of multiple blood transfusions. The frequency of HCV and HBV were insignificant according to gender (p-&gt;0.05) and statistically significant according to numbers of blood transfusion (p-&lt;0.05). Conclusion: It was concluded that the frequency of HCV infection was high among children of multiple blood transfusions. Key words: TTI, HCV, HBV, seropositivity

Frequency and Severity of Thrombocytopenia with Liver Cirrhosis

Background and Aim: Thrombocytopenia is a major complication of liver disease that impairs liver cirrhosis treatment by restraining administrative therapy and surgical or diagnostic planning delaying which in turn increases the bleeding risk. The present study aimed to evaluate the frequency and severity of thrombocytopenia in liver cirrhosis patients. Materials and Methods: This cross-sectional study was carried out on 88 liver cirrhosis patients in the department of Gastroenterology, Shaikh Zayed Hospital, Lahore from November 2020 to June 2021. Individuals with cirrhosis disease were evaluated for the severity of thrombocytopenia. All the cirrhosis patients with age&gt;14 years of either gender were enrolled while aplastic anemia cases, idiopathic thrombocytopenic purpura, drug therapy patients, osteopetrosis, cases of repeated blood or platelet transfusion history, myelodysplastic syndrome, and refusal to informed consent were all excluded. The demographic details, clinical examination, and treatment plan were assessed. A platelet count test was performed on all cirrhosis patients. Thrombocytopenia severity was divided into three categories: mild thrombocytopenia (50,000/l), moderate thrombocytopenia (20,000/l), and severe thrombocytopenia (10,000/l). SPSS version 20 was used for descriptive analysis. Results: Of the total 88 cirrhosis patients, 62 (70.5%) were male and 26 (29.5%) were females. All the cirrhosis patients were assessed for thrombocytopenia. The overall mean age was 39.41±11.56 years. Out of 88 cirrhosis patients, the prevalence of thrombocytopenia was 63 (71.2%). Of the 63 thrombocytopenia diagnosed cirrhosis patients, 41 (65%) were male and 22 (35%) were females. The prevalence of mild, moderate, and severe thrombocytopenia was 21 (33.3%), 23 (36.5%), and 19 (30.2%) respectively. Conclusion: Our study concluded that thrombocytopenia prevalence was 71.2% in liver cirrhosis patients. The assessment and monitoring of platelet count identified the thrombocytopenia among liver cirrhosis. Moreover, the severity of bleeding episode that might cause fatality were reduced. Keywords: Thrombocytopenia; Liver Cirrhosis; Severity; Platelet

Prevalence and risk factors of hepatitis b infection in HIV infected children seen at national hospital Abuja

&#x0D; &#x0D; &#x0D; Background: Human immunodeficiency virus infection remains a global pandemic. Co infection with hepatitis B virus leads to rapid progression to AIDS if not diagnosed and promptly treated or better still prevented. The study aims at determining the prevalence and risk factors of hepatitis B infection in HIV infected children being followed up at the Paediatric HIV clinic.&#x0D; Patients and methods: A cross-sectional study of 261 HIV infected children aged eight months to fourteen years to determine the prevalence of Hepatitis B infection and pattern of hepatitis B vaccination was carried out between July and October 2012 at the Paediatric HIV clinic of National Hospital Abuja. Ethical approval was obtained from Ethical Committee of the hospital. Vaccination and transfusion history were obtained from the parents and guardians of the subjects using a proforma after signed informed consent. Blood samples were collected for Hepatitis B surface antigen screening and Hepatitis B screening in those with HBsAg positive blood samples.&#x0D; Results: Only 3 (1.15%) of the 261 HIV infected children had Hepatitis B infection. All the children less than 5 years old in this cohort received hepatitis B vaccination and none of them had Hepatitis B infection. The HIV/HBV co infected children were older than ten years (p = 0.047) and history of blood transfusion (p = 0.003) was also significant. However, scarification (p = 0.996), local circumcision (p = 0.928); uvulectomy (p = 0.898) were not significant risk factors in this cohort.&#x0D; &#x0D; &#x0D; Conclusion: There is need to intensify routine hepatitis B vaccination and routine screening of blood before necessary transfusion. This would further lead to a low prevalence of Hepatitis B in HIV infected children and the general populace at large.&#x0D; &#x0D; &#x0D;

A discrepancy of blood group A with missing antigen in anorectal malformation patient at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia

Background: Blood group discrepancy is a discrepancy in the results of the cell grouping with serum grouping examination. The source of discrepancy is from technical errors or a patient's medical status such as age, disease, history of blood transfusion and medication, pregnancy. This case study aims to evaluate a discrepancy of blood group A with missing antigen in anorectal malformation patient at Dr. Wahidin Sudirohusodo Hospital, Makassar, IndonesiaCase Presentation: A male baby, 6 months 19 days old, was unable to defecate since birth post-colostomy. Physical examination reveals anemia. A routine blood test showed a hemoglobin level of 8.8 g/dL. The diagnosis was high position anorectal malformation post colostomy suspect Hirschsprung Disease, with 110 cc Packed Red Cell (PRC) transfusion plan. A routine pre-transfusion procedure was performed. It was found a discrepancy of blood group A with missing antigen. Crossmatching with blood groups O and A both gave compatible results. Examination of peripheral blood smear after PRC blood group A transfusion found no signs of hemolytic.Conclusion: Blood group discrepancy, in this case, was due to missing antigen, which was caused by the possibility of gastrointestinal bacterial infection.

Fetal hydropsia: challenges in etiologies

Introduction: Fetal hydrops is defined as the presence of abnormal fluid collections in two or more extravascular fetal compartments and body cavities. There are about 150 different underlying causes known today potentially leading to this fetal alteration. Objective: To analyze the etiologies involved in the occurrence of cases of fetal hydrops. Methods: A systematic literature review was carried out using the MedLine, Pubmed and Scielo databases, from 2015 to 2021, using the expressions: "fetal, hydrop, etiologies." Discussion: Fetal hydrops is divided into immune and non-immune. Immune results from anemia secondary to erythroblastosis by alloimmunization, so when there is maternal exposure to fetal antigens, it generates an immune response that results in the production of antibodies. History of blood transfusions, previous births, trauma and a history of alloimmunization are characterized as risk factors. Thus, immunoprophylaxis with anti-D immunoglobulin is indicated for all RhD negative pregnant women, with RhD positive male partner, with abundant fetal maternal hemorrhage during childbirth or events with potential sensitizer in the prenatal period. Conclusion: For an effective treatment, it is essential to identify the type of fetal hydrops in the patient and then the etiology of the disease, which is quite variable in Non-Immune Fetal Hydrops.

Splenic Uptake in 99 mTc-Methylene Di-Phosphonate Scan in a Pediatric Patient with Acute Lymphocytic Leukemia.

An 12-year-old boy with relapse of acute lymphocytic leukemia and suspected skeletal involvement underwent mTc-Methylene Di-Phosphonate skeletal scintigraphy, which revealed a lytic “cold” lesion in the pelvis and diffuse splenic uptake. There was no active splenic infiltration in cross-sectional imaging. However, the patient had a history of multiple blood transfusions, which is a rare cause for diffuse splenic uptake.

Case of Hemolytic Disease of the Newborn due to a Rare Red Cell Antibody.

Case of Hemolytic Disease of the Newborn due to a Rare Red Cell Antibody.

The prevalence of human immunodeficiency and of hepatitis B viral infections is not increased in patients with sickle cell disease in Tanzania

BackgroundTanzania ranks as the fourth country in the world with respect to the number of sickle cell disease (SCD) births; it is also endemic to the human immunodeficiency virus (HIV) and the hepatitis B virus (HBV). This study was done to determine the prevalence of HIV and HBV infections among SCD patients in Dar es Salaam, Tanzania.MethodsA multicenter hospital-based descriptive cross sectional study was carried out among participants aged ≥ 16 years with a proven diagnosis of SCD. Socio-demographic and clinical data were recorded. Blood samples were drawn for HIV and HBV diagnosis. All categorical variables were summarized into frequencies.ResultsThere were 185/325 (56.9 %) females. The mean age (SD) was 23.0 ± 7.5 years. The prevalence of HIV was 1.8 %; the prevalence of HBV was 1.2 %.ConclusionsThe prevalence of both HIV and HBV in SCD patients is no greater than in the general population of Dar es Salaam or Tanzania. For associations, a large study would be needed. From a detailed blood transfusion history of SCD patients we found no evidence that HIV or HBV infection was transmitted through blood transfusion.