History Of Blood Transfusion Research Articles

MO796: Short-Term Effect of Roxadustat Combined With Erythropoiesis Stimulating Agents (ESAS) Treatment for Anemia in Patients Undergoing Hemodialysis With ESA Resistance

Abstract BACKGROUND AND AIMS Renal anemia is a common complication of chronic kidney disease (CKD) that can decrease the quality of life of patients, especially for patients with maintenance hemodialysis (MHD). The current standard treatment for renal anemia consists of iron plus erythropoiesis-stimulating agents (ESAs). However, high-dose ESA supplementation may cause an increase in blood pressure and induce cardiovascular events and death [1]. Roxadustat (FG-4592) is a new small-molecule oral medication for the treatment of renal anemia that may improve anemia by increasing endogenous erythropoiesis, transferrin receptor expression, and iron absorption [2]. Currently, the use of roxadustat in the treatment of renal anemia is still being explored. Our study aimed to observe the short-term efficacy of roxadustat combined with ESAs on renal anemia in MHD patients with ESA resistance. METHOD This retrospective study included patients with renal anemia using roxadustat for the first time at West China Hospital of Sichuan University from September 2019 to March 2021. Study inclusion criteria: (1) MHD for >3 months (thrice weekly), (2) basal Hb ≤ 100 g/L and (3) ESAs therapy for >2 months, and the first time use of rosadustat for at least 1 month. We excluded those without hemoglobin data and those with a history of blood transfusion within the first month. Patients treated with roxadustat combined with ESAs were as an observation group, and those treated with roxadustat alone were included as a control group. RESULTS A total of 31 MHD patients were included, the baseline data was shown in Table 1. A total of 15 patients were treated with roxadustat combined with ESAs, and 16 patients were treated with roxadustat alone. In the first month, the mean hemoglobin level was significantly increased in the combined group (1.89 ± 1.45 g/dL) but decreased in the alone group (–0.25 ± 1.32 g/dL). According to an analysis of covariance (ANCOVA), after adjusting for basal hemoglobin levels, the combination therapy improved the hemoglobin level better than therapy alone (F = 6.329, P = .018). We defined the Hb response as: hemoglobin change from baseline ≥ 1 g/dL for patients with basal Hb >8.0 g/dL or ≥ 2.0 g/dL for patients with basal Hb ≤8.0 g/dL. Among the 15 patients treated with roxadustat combined with ESAs, 14 patients showed an increase in hemoglobin within the first month and 8 patients get the Hb response, with the Hb response rate of 53.3%. For the 16 patients treated with roxadustat alone, 7 patients showed an increase in hemoglobin, only 2 patients get the Hb response, with the Hb response rate 12.5%. Patients treated with roxadustat combined with ESAs had a higher Hb response rate (P = .023) than those with roxadustat alone within the first month. CONCLUSION Roxadustat combined with ESAs treatment might be more beneficial to improve renal anemia in MHD patients with ESA resistance during the first month of roxadustat therapy replacement.

MO521: Paricalcitol Direct Increases Hemoglobin Levels. A Repurposing Possibility for Treating Renal Anemia

Abstract BACKGROUND AND AIMS The anti-inflammatory properties of the paricalcitol have been related to benefits in renal anemia; however, in chronic kidney disease (CKD) patients, the presence of secondary hyperparathyroidism (SHPT) represents a bias for determining the real effect of paricalcitol in hemoglobin levels. Whether the paricalcitol directly increases hemoglobin regardless of SHPT should be considered an opportunity for treating renal anemia, where the current treatments have safety concerns. To determine the effect of the oral paricalcitol on hemoglobin levels administered in different types of patients. Group A: n = 10, CKD patients not on dialysis under erythropoietin stimulating agents (ESA), Group B: n = 37, CKD patients not receiving ESA. A sub-group of patients without SHPT (Group C, n = 20) and glomerulonephritis patients without CKD (Group D, n = 18). Seven patients had hyperparathyroidism without CKD (plasma creatinine <1,2 mg/dL) and five CKD patients without SHPT (iPTH: 24–100 pg/mL). We also evaluated the effect of the paricalcitol according to Hb at baseline (≤10, ≤11 and ≤ 12 g/dL). METHOD A total of 52 consecutive patients were included and followed up by 6 months. Exclusion criteria were bleeding or recent blood transfusion history. No changes in ESA doses and iron supplements were required for inclusion. The mean paricalcitol dose was 6 mcg/week (min: 2–max: 7). RESULTS Age: 71(14) years, female 21(40%). As a whole, hemoglobin [mean: 95% confidence interval (CI)] increased 0.8 g/dL (0.4–1.2), partial η2: 0.24, P < .001. In group A: Hb increased 0.9 (0.2–1.6) g/dL, partial η2: 0.15, P = .015; in group B: 1.0 (0.4–1.5) g/dL, partial η2: 0.32, P < .001; in group C: 0.7 (0.2–1.2) g/dL, partial η2: 0.31, P = .008 and in group D: 0.4 (−0.02–0.9) g/dL, partial η2: 0.18, P = .06. In the seven patients only with hyperparathyroidism, Hb increased 1.3 (0.4–2.1) g/dL, partial η2: 0.67, P = .012 and in the five patients only with CKD the hemoglobin change 0.5 (−0.3–1.3) g/dL, partial η2: 0.40, P = .174. Interestingly, according to the baseline hemoglobin levels: ≤10, ≤11 and ≤ 12 g/dL, it significantly increased to 2.6, 2.3 and 1.2 g/dL, respectively. CONCLUSION The paricalcitol significantly increased the hemoglobin levels independently of ESA therapy, the renal function and the degree of hyperparathyroidism. A greater effect was observed in patients with lower baseline hemoglobin levels. Our results suggest that paricalcitol is a potential repurposing drug for treating renal anemia.

Unexpected antibody against the high-prevalence P antigen before cardiac surgery.

P is a high-prevalence antigen present in 99.9 percent of the population and is fully developed at birth. P- individuals form naturally occurring antibodies against P, which are often of immunoglobulin (Ig)M and/or IgG type, very potent in complement activation, and able to cause serious intravascular hemolytic transfusion reactions. Some people with anti-P have the rare P1 k phenotype, which lacks P in the presence of P1 and Pk. Blood transfusion in patients with anti-P is challenging, as is described here. A male patient without a history of blood transfusion was admitted for a planned cardiac surgery. The preoperative ABO blood group could not be determined because of unexpected reactions in the reverse grouping, and all red blood cells (RBCs) in the antibody detection test were positive, except for the autocontrol. Further analysis of the patient's sample confirmed the presence of the P1 k phenotype, and anti-P was identified. If transfusion was needed, P- blood would be required, and the only P- RBCs available were at the national Sanquin Bank of Frozen Blood. These units are limited, expensive, and only available for 48 hours after thawing. In the case of massive blood loss, first ABO and Rh-compatible units should be transfused, followed by P- units after the bleeding stops. In our case, the surgery was conducted without transfusion. This case illustrates the importance of preoperative ABO blood group testing and antibody screening in cases where blood loss can be expected. In recent years, more focus has been put on patient blood management. A good collaboration between the local laboratory, surgery department, and dedicated blood transfusion laboratory is critical to prevent unnecessary incompatible blood transfusions with potentially serious outcomes.

Targeted next-generation sequencing revealed a novel homozygous mutation in the LRBA gene causes severe haemolysis associated with Inborn Errors of Immunity in an Indian family.

ABSTRACT Objectives LPS-responsive beige-like anchor protein (LRBA) deficiency abolishes LRBA protein expression due to biallelic mutations in the LRBA gene that lead to autoimmune manifestations, inflammatory bowel disease, hypogammaglobulinemia in early stages, and variable clinical manifestations. Materials and methods Mutational analysis of the LRBA gene was performed in Indian patients using targeted Next Generation Sequencing (t-NGS) and confirmed by Sanger sequencing using specific primers of exons 53. Then, bioinformatics analysis and protein modeling for the novel founded mutations were also performed. The genotype, phenotype correlation was done according to the molecular findings and clinical features. Results We report an unusual case of a female patient born of a consanguineous marriage, presented with severe anaemia and jaundice with a history of multiple blood transfusions of unknown cause up to the age of 5 yrs. She had hepatosplenomegaly with recurrent viral and bacterial infections. Tests for hemoglobinopathies, enzymopathies, and hereditary spherocytosis were within the normal limits. The t-NGS revealed a novel homozygous missense variation in exon 53 of the LRBA gene (chr4:151231464C > T; c.7799G > A) (p.C2600Y), and the parents were heterozygous. The further immunological analysis is suggestive of hypogammaglobulinaemia and autoimmune haemolytic anaemia. The bioinformatics tools are suggestive of deleterious and disease-causing variants. Conclusion This study concludes the importance of a timely decision of targeted exome sequencing for the molecular diagnostic tool of unexplained haemolytic anaemia with heterogeneous clinical phenotypes.

Early Detection and Management of Venous Thrombosis in Skull Base Surgery: Role of Routine Doppler Ultrasound Monitoring.

Venous thromboembolism (VTE), encompassing deep venous thrombosis (DVT) and pulmonary embolism (PE), causes postoperative morbidity and mortality in neurosurgical patients. The use of pharmacological prophylaxis for DVT prevention in the immediate postoperative period carries increased risk of intracranial hemorrhage, especially after skull base surgeries. To investigate the impact of routine Doppler ultrasound monitoring in prevention and tiered management of VTE after skull base surgery. We retrospectively analyzed a large cohort of consecutive adult patients who were prospectively and uniformly managed with routine monitoring by Doppler ultrasound for DVT after resection of a skull base tumor. A total of 389 patients who underwent 459 surgeries for intracranial tumor resection were analyzed. Skull base meningioma was the most common pathology. Forty-four (9.59%) postoperative VTEs were detected: 9 (1.96%) with PE with or without DVT and 35 (7.63%) with DVT alone. Four cases of subsegmental PE were diagnosed without evidence of lower extremity DVT, possibly in the setting of peripherally inserted central catheters maintenance. One patient had a preoperative proximal DVT and underwent a prophylactic inferior vena cava filter but expired from PE after discharge. Prior history of VTE (risk ratio [RR] 5.13; 95% CI 2.76-7.18; P < .01), anesthesia duration (RR 1.14; 95% CI 1.03-1.27; P = .02), and blood transfusion (RR 1.95; 95% CI 1.01-3.37; P = .04) were associated with VTE development on multivariate analysis. Routine postoperative venous ultrasound monitoring detects asymptomatic DVT guiding management. This is an alternative strategy to prescribing pharmacological VTE prophylaxis immediately after lengthy surgeries for intracranial tumors. Peripherally inserted central catheters were associated with subsegmental PE.

Systematic review and meta-analysis of the risk factors of surgical site infection in patients with colorectal cancer.

BackgroundSurgical site infection (SSI) influenced the result of surgical treatment, which was known as the second most prevalent hospital-based infection. But, the factors of SSI are not uniform. The purpose of this study was to identify the risk factors of SSI in patients with colorectal cancer. We conducted a meta-analysis of epidemiological research to provide a scientific basis for the prevention of SSI.MethodsThe PubMed, Medline, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang databases were independently searched by 2 researchers to identify all relevant studies. Studies were selected if they met the selection criteria, which was defined according to the PICOS principles. The quality of the evidence was assessed using Egger’s P value, study heterogeneity, and sample size. Studies were categorized into 3 groups as follows: low quality (Class 4), moderate quality (Class 2/3), and high quality (Class 1). The meta-analysis was performed using RevMan 5.3 software.ResultsA total of 17 studies involving 61,611 patients were included in the meta-analysis. The results identified 7 patient-related risk factors of SSI, including male gender, obesity, diabetes mellitus, American Society of Anesthesiologists (ASA) score, cigarette smoking, tumor location, and serum albumin level, and 5 treatment-related risk factors, including laparoscopic surgery, operation time, blood loss, blood transfusion, and abdominal surgical history. Age was not directly related to SSI in colorectal cancer.ConclusionsIt is possible that patients can be treated effectively by identifying these factors of SSI.

Epidemiology of Hepatitis C virus infection among incarcerated populations in North Dakota.

This retrospective cohort study was conducted to determine the prevalence of HCV infections among individuals incarcerated in a state prison system and identify potential contributing factors to HCV infection. North Dakota Department of Corrections and Rehabilitation (NDDOCR) data from 2009 to 2018 was used and period prevalence was calculated for this 10-year time period. The period prevalence of HCV infection was (15.13% (95% CI 14.39-15.90) with a marginally significant (p-value: 0.0542) increasing linear trend in annual prevalence over this period. Multivariate logistic regression analysis was used to identify risk factors associated with HCV infection. The main significant independent risk factors for HCV infection in this incarcerated population were age >40 years [OR: 1.78 (1.37-2.32)]; sex [OR: 1.21 (1.03-1.43)]; race/ethnicity [OR: 1.97 (1.69-2.29)]; history of intravenous drug use (IVDU) [OR: 7.36 (6.41-8.44)]; history of needle or syringe sharing [OR: 7.57 (6.62-8.67)]; and alcohol use [OR: 0.87 (0.77-0.99)]. Study limitations include uncollected information on sexual history, frequency or duration of injection drug use and blood transfusion history of the incarcerated population. Considering the high prevalence of HCV infection and its associated risk factors, it is important to implement prevention programs such as syringe/needle exchanges and counsel with imprisoned IVD users.

Prevalence of Hepatitis E Virus Infection among Pregnant Women Attending the Ante-Natal Clinic of a Tertiary Health Care Centre

Hepatitis E virus (HEV) is the most common cause of viral hepatitis in developing countries. HEV is particularly problematic in pregnancy due to the vulnerability of pregnant women to infections and often causes spontaneous abortion, premature delivery, maternal (≤ 20%), and infant mortality. While pregnant women attending ante-natal clinics are mandatorily screened for some infections, Hepatitis E, except in endemic areas, is not included in the protocol, even though the prevalence of Hepatitis E globally is increasing. This study aimed to determine the presence and prevalence of Hepatitis E among ante-natal clinic attendees at the Ladoke Akintola Teaching Hospital, Osogbo, Osun State. A total of 100 consenting individuals were enrolled in the study between ages 20 and 45. Twenty-one percent of the participants enrolled were in the first trimester of their pregnancy, 33% in the second trimester, and 46% were in the third trimester of pregnancy. A structured questionnaire was administered to extract information on the participants’ demography and clinical history. A volume of 5ml of blood sample was collected from each consenting participant, and the obtained serum, stored at -20°C until ready for analysis. A double antibody sandwich HEV-ELISA technique was performed to analyze the sera for HEV antigen, using an ELISA Kit. Of the 100 samples analyzed, 8% (χ2=12.164, df=1, P=0.019) were positive for HEV Ag. The study only showed an association between the number of positive cases and a history of blood transfusion whereas, there was no such association with age, pregnancy stage, and educational status of the participants. Being an index study in Osun State, this study showed an 8% HEV prevalence rate, which is considered statistically significant.

Assessment of prevalence of Hepatitis B virus and its associated factors among pregnant women from Wolaita Sodo, Ethiopia

ObjectiveHepatitis B virus (HBV) is a highly contagious virus. It occurs worldwide and constitutes a serious public health problem. However, studies on the prevalence of HBV infection in Ethiopia are limited. Therefore, the objective of this study was to assess the prevalence of HBV infection and associated risk factors among pregnant women from Wolaita Sodo, Ethiopia. MethodA cross-sectional study was conducted from February to May 2020 among pregnant women attending ante-natal care (ANC) at Wolaita Sodo Teaching and Referral Hospital. A total number of 252 pregnant women were included in the proposed study. Respondents were asked to complete the questionnaires and offered testing for Hepatitis B surface antigen (HBsAg) detection. Chi-square and odds ratios were used to determine the association between dependent and independent variables. ResultsAmong all studied pregnant women the prevalence of HBV infection was 7.5%. Most of the studied risk factors like history of blood transfusion, multiple sexual partners, hospital admission, genital mutilation, surgical procedure, body tattooing, history of previous birth delivery were not statistically significant for HBV infection. ConclusionsRegular screening for HBV infection and vaccination against HBV targeting this population group may reduce the prevalence and mother to child transmission of HBV infection.

Incidence of and risk factors for perioperative blood transfusion in infants undergoing index pediatric surgery procedures

BackgroundThere is a paucity of data on the frequency of transfusion during pediatric surgery index cases and guidelines for pretransfusion testing, defined as type and screen and crossmatch testing, prior to operation are not standardized. This study aimed to determine the incidence of perioperative blood transfusions during index neonatal operations and identify risk factors associated with perioperative blood transfusion to determine which patients benefit from pretransfusion testing. MethodsA retrospective review of infants who underwent index neonatal cases between 2013 and 2019 was performed. Data were collected for patients who underwent operations for Hirschsprung's disease, esophageal atresia/tracheoesophageal fistula (EA/TEF), biliary atresia, anorectal malformation, omphalocele, gastroschisis, duodenal atresia, congenital diaphragmatic hernia (non-ECMO) or pulmonary lobectomy. Infants under 6 months were included except in the case of lobectomy where infants up to 12 months were included. ResultsAnalysis was performed on 420 patients. Twenty-five (6.0%) patients received perioperative blood transfusion. Patients who received perioperative transfusion most commonly underwent EA/TEF repair. Patients who received perioperative transfusion had higher rates of structural heart disease (52.0% vs 17.7%, p<0.001), preoperative transfusion (48.0% vs 8.9%, p<0.001), and prematurity (52.0% vs 25.6%, p = 0.005). Presence of all three risk factors resulted in a 48% probability of requiring perioperative transfusion. ConclusionsBlood transfusion during the perioperative period of neonatal index operations is rare. Factors associated with increased risk of perioperative transfusion include prematurity, structural heart disease, and history of previous blood transfusion. Level of EvidenceIII

Seroprevalence of HBV Infection in a Tertiary Care Hospital in Bangladesh

An estimated 1 million people die each year from HBV infection. This investigation aimed to determine the frequency, distribution, and risk factors for HBV infection in a healthy Bangladeshi community. A cross-sectional study among the general population was conducted in Dhaka Medical College Hospital. A series of 100 patients with the chronic liver disease between 18 to 49 years. Diagnosed based on clinical and biochemical parameters were collected. All medicine units of Dhaka Medical College Hospital have been analyzed regarding the seroprevalence of HBsAg and its correlation with the demographic pattern. Among 100 cases of liver disease, the number of CLD patients was 85, of which 56 (65.88%) were HBsAg positive 29 (34.11%) were HBsAg negative. The number of patients with acute viral hepatitis was 15, of which 4(26.66%) were HBsAg positive, 11(73.33%) were HBsAg negative, and the overall seroprevalence was 60%. The age incidence was more below 40 years (83%) less above the age of 40(17%). Males had higher seropositivity (70.31%) than females (41.66%). People of all ages are susceptible, particularly the farmers (21.66%) and manual laborers (13.33%). Most of the patients belong to the poor (62.79%) and middle class (62.22%). Urban people were more (60.93%) susceptible than rural people (58.33%). Married persons were more (70.27%) prone than unmarried (30.76%). Seroprevalence of HBsAg was more in those people who had a history of blood and blood product transfusion (84.61%). Illiterate persons were more (75%) susceptible than literate (59.37%). Seroprevalence of HBsAg was more in those who had a history of instrumental tooth extraction (68.42%) than those who had not (58.02%). People who cut their beards and mustache in the barbershop were more susceptible (73.91%) than those who got it by themselves (68.29%). Among female persons, those who underwent instrumental delivery were more susceptible than those who delivered their baby by normal vaginal delivery.

Assessment of thyroid function status in transfusion dependent thalassemic children

Background: Frequent blood transfusions have been associated with serum iron overload, which may result in hypothyroidism and other endocrine abnormalities in transfusion dependent thalassemic patients. Thyroid dysfunction has been reported in a number of studies on these pts. The aim of the study is to assess the thyroid function status among the transfusion dependent thalassemic children.Methods: This was a cross sectional study conducted in the department of transfusion medicine, department of Pediatric hematology and oncology and department of hematology, Bangabandhu Sheikh Mujib medical university (BSMMU), Dhaka for a period of 18 months. A total number of 86 children with transfusion dependent thalassemia who met the inclusion and exclusion criteria were studied. Demographic data as well as history of blood transfusion and chelation therapy were collected. Thyroid function and iron load status were evaluated by measuring serum FT4, TSH and ferritin levels.Results: Out of 86 thalassemia patients, euthyroid patients were 77 (89.5%) and hypothyroid patients were 9 (10.5%). Eight (9.3%) patients were compensated and 1 (1.2%) was uncompensated hypothyroidism. Statistically significant association was found between number of blood transfusion and serum ferritin level (≥2000 ng/ml) with development of hypothyroidism in thalassemic patients. Mean ferritin level was higher in hypothyroid (4797.8±2027.4 ng/ml) group than in euthyroid (3628.8±2448.5 ng/ml) groups.Conclusions: Frequency of hypothyroidism was 10.5% (compensated 9.3% and uncompensated 1.2%). Number of blood transfusion and ferritin level were found significantly associated with the development of hypothyroidism in thalassemic patients.

Transfusion-Related Hemochromatosis Involving Pituitary Gland in a Patient of Beta-Thalassemia Major

Introduction: Hemochromatosis of the pituitary gland is a form of iron overload disease which occurs in different clinical conditions related to multiple blood transfusions. Case Presentation: We present a case of secondary hemochromatosis involving the pituitary gland and choroid plexus in an eightyear-old female with imaging findings and a review of the relevant literature. Our patient has had a history of cessation of growth in height for the last 1 year. She was diagnosed with a thalassemia major at the age of 6 months. She has been on regular blood transfusions since then. Magnetic resonance imaging (MRI) revealed evidence of iron deposition in the pituitary gland. Conclusion: This diagnosis should be suspected on clinical presentation and history of multiple blood transfusions. It can be confirmed based on characteristic imaging findings. The patient should be strictly monitored with serum iron levels, and a tailored iron chelation therapy should be initiated.

Overview of blood-borne viral infections in hemodialysis patients: hepatitis B, hepatitis C, human immunodeficiency virus infections

Aim: This study aimed to examine the blood-borne viral infections such as hepatitis B, hepatitis C and human immunodeficiency virus (HIV) and to determine the risk factors in hemodialysis patients.&#x0D; Material and Method: The datas of patients who underwent hemodialysis in the hemodialysis unit of our hospital between March 1, 2020 and March 1, 2021 were reviewed retrospectively. Their sociodemographic characteristics, habits, underlying diseases and virological indicators related to hepatitis B, hepatitis C and HIV were obtained from patient files and hospital data processing system.&#x0D; Results:A total of 96 patients were included in the study. Of them, 43.8% (n=42) were female and 56.2% (n=54) were male. Their mean age was 62.61±18.11 years, ranging from 17 to 92. The duration of dialysis was less than 3 months for 46.9% (n=45) of the patients, between 3 months and 3 years for 19.8% (n=19), and 3 years and above for 33.3% (n=32). Thirty patients (31.3%) had diabetes mellitus. In addition, 1% (n=1) of the patients had HBsAg positivity, 3.1% (n=3) had anti-HCV positivity, 59.4% (n=57) had Anti- HBs positivity and 2.1% (n=2) had anti-HIV positivity. No statistically significant difference was found between the patients’ HBsAg, anti-HCV and anti-HIV positivity according to gender, duration of dialysis, dialysis application site, alcohol use, surgical intervention and blood transfusion history (p&gt;0.05).&#x0D; Conclusion: Hemodialysis patients may be at risk for hepatitis B, hepatitis C and HIV infection if infection control guidelines are not followed strictly. In addition to complying with these guidelines, both health workers and patients should be trained constantly, patients’ virological indicators should be tested regularly and hepatitis B vaccine should be administered to hemodialysis patients without seroconversion.

DETECTION OF TORQUE TENO VIRUS ANTIGEN AND ASSOCIATED RISK FACTORS AMONG HEMODIALYSIS PATIENTS

The aim: To determine the prevalence of TTV in patients undergoing hemodialysis and to evaluate the possible risk factors. Materials and methods: This study was conducted in 93 patients, attending hemodialysis unit at AL-Imammain AL-Kadhimain Medical City Hospital for a period from November 2020 to March 2021. The demographic and clinical characteristics including age, sex, underling medical condition, hepatitis B and C status and laboratory tests such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline Phosphatase (ALP) and total serum bilirubin (TSB) were obtained from the record of the patients in hemodialysis unit in the hospital. Direct detection of TTV-Ag was done by enzyme linked immunosorbent assay (ELISA). Results: TTV-Ag was detected in 38 out of 93 (40.9%) hemodialysis patients. Demographic, clinical and risk factors i.e. sex, age, history of diabetes, history of hypertension, history of blood transfusion, number of blood transfusion, the hemodialysis duration, history of surgery and liver enzymes levels did not show significant relation (P&gt;0.05). Conclusions: This study showed high prevalence of Torque Teno virus in hemodialysis patients, however, TTV did not play a role in liver injury among these patients.

An analysis of proposed etiological factors for sudden spike in mucormycosis infection during COVID-19 pandemic at a tertiary hospital of North India

Aim: The aim is to analyze various possible etiological factors for the sudden outbreak of mucormycosis. Methods: A prospective observational study involving consecutive individuals with proven mucormycosis was undertaken at a tertiary care teaching hospital in North India from May 2021 to July 2021. A total of 88 patients with mucormycosis were studied for the demographic profile, COVID-19 status, various risk factors, COVID-19 immunization status, clinical staging of disease, and outcome of patients. Results: Out of 88 patients, 54 (61%) were males and 34 (39%) were females. The mean age of male patients was 50.5 ± 13.8 and female patients was 52.1 ± 14.1. Most of the patients were in stage two, i.e., 45 (51.1%) and 26 (29.5%) in stage three of the disease. Past history of diabetes was present in 49 (55%) patients. Forty-one (46.6%) patients had documented Reverse Transcription Polymerase Chain Reaction (RTPCR) reports in favor of COVID-19 and others had clinical features consistent with COVID-19. Only 1% of patient took COVID-vaccination. Of the total 88 patients, 42 (47%) were on oxygen therapy, 72 (81%) had history of blood transfusion, and 48 (54%) were given steroids. Conclusions: No conclusive etiological factor was identified although few recommendations are suggested for prevention, early diagnosis, and prompt management of mucormycosis in hospitalized COVID-19 patients.

Rare Anti-Cw Antibody

Introduction: Anti-Cw is a low-frequency antibody against Cw (Rh8) antigen, a low incidence antigen of the Rh system. Anti-Cw antibody may cause mild to moderate hemolytic disease of the fetus and newborn (HDFN) and mild to severe immediate or delayed hemolytic transfusion reactions (HTR). The antigenic frequency of Cw in the Indian population is 1.25%. Two cases of Anti-Cw antibody are being reported which were detected during routine antibody screening, one an oncology patient and the other a healthy blood donor. Case 1: A 30-year-old male, known case of acute myeloid leukemia, with previous history of induction chemotherapy and blood transfusion was admitted for further management and chemotherapy. When three cell antibody screening was performed using an automated platform, the screen was positive with +2 reactions. Antibody identification using 14 cells suggested the presence of an Anti-Cw antibody. On further testing, the patient red blood cell (RBCs) were negative for Cw antigen. Case 2: A 20-year-old male, first-time, voluntary blood donor, with no history of blood transfusion donated whole blood. On performing three cell antibody screening using automated platform, screen was found to be positive with +3 reactions. Antibody identification performed using 14 cell panel suggested the presence of Anti-Cw antibody. On further testing, the donor RBCs were negative for Cw antigen. Conclusion: Antibody screening and identification is recommended in pretransfusion testing, especially in multi-transfused patients and patients belonging to the reproductive age group, so that antibody to low-frequency antigen can be detected and its potential to cause HTR and HDFN can be assessed.

Epidemiological correlates of hepatitis C infection- A case control analysis from a tertiary care hospital.

ABSTRACTBackground:Hepatitis C virus (HCV) infection is considered one of the growing public health problems. Identification of HCV-associated risk factors is pivotal for developing appropriate prevention strategiesObjectives:To determine the epidemiological variables of HCV infection in a tertiary care hospitalMethods:This hospital-based case-control study was conducted in a tertiary care hospital in Punjab on 320 subjects, including 160 cases and controls each. Cases and controls were matched by age (±5 years), gender, and residence. A patient ≥18 years of age fulfilling the biomarker criteria with or without clinical criteria diagnosed in the last 1 month was considered as a case. The information on socio-demographic characteristics and previous exposures to selected risk factors was collected through detailed interviews of the subjects. Analysis was performed using SPSS 20 statistical software. Odds ratio (OR) with 95% confidence interval (CI) was calculated to measure the strength of association between cases and controls for each risk factorResults:Odds of having HCV infection was significantly higher among those with a history of blood transfusion (OR: 2.30, 95%CI: 1.14–4.63), dental procedure (OR: 4.82, 95%CI: 2.38–9.77) and intravenous injection/infusion from quacks (OR: 3.26, 95%CI: 1.47–7.19), injectable drug use (OR: 26.69, 95%CI: 3.55–200.24), non-injectable drug use (OR: 2.37, 95%CI: 1.44–3.90), tattooing (OR: 7.91, 95%CI: 2.31–27.08), and piercing from street hawkers (OR: 2.25, 95%CI: 1.18–4.29). Multivariate analysis identified history of blood transfusion, dental procedure, intravenous injection/infusion from quacks, injecting drug use, and piercing as independent risk factors for HCV infectionConclusion:The study identified multiple risk factors for acquiring HCV infection and suggest appropriate interventions targeting high-risk populations.

Epidemiological profile of viral hepatitis infection in the population treated at a reference hospital in Alagoas.

Viral hepatitis are widely spread infectious diseases caused by a variety of etiological agents that displays liver tropism as a common characteristic. A descriptive, cross-sectional, observational and retrospective study was conducted through the analysis of viral hepatitis medical records treated and diagnosed from 2010 to 2015. The relationship between the variables were made through the chi-square test. 632 viral hepatitis medical records were analyzed. The highest number of cases happened in 2011. Hepatitis A virus (HAV) infection was predominant. The most affected age group was < 20 years and the highest number of cases observed in this age group was related to HAV (p<0.001). The acute clinical form was predominant, with 70.2% of the cases. 92.3% of which corresponded to HAV infection (p<0.001). Most of the cases occurred in the brown race and male gender. Moreover, regarding the probable source/mechanism of infection, the contact with suspicious water/food for hepatitis A cases was highlighted. The sexual form predominated in HBV infection and previous history of blood transfusion in cases of hepatitis C. Most cases were spotted in the mesoregion of Eastern Alagoas, especially in the capital Maceió. It must be observed the importance of knowing the profile of this disease in order to understand its dissemination and thus have subsidies for the creation of actions and strategies to combat the infection.

Retinal nerve fiber layer thickness in children with β-thalassemia major

Background β-thalassemia major, a disease of defective globin β-chain synthesis, is characterized by anemia caused by a combination of hemolysis, ineffective erythropoiesis, and iron overload. Children with β-thalassemia major are liable to impairments in the retinal microvasculature. The progressive retinal and retinal pigment epithelium pathologies caused by deferoxamine may lead to visual loss.Purpose The aim of this study was to measure the retinal nerve fiber layer (RNFL) thickness in children with β-thalassemia major and to compare it with a healthy control group.Patients and methods This is a cross-sectional study that included 15 patients with β-thalassemia major and 15 healthy children as a control group, who were recruited from the Pediatric Department, Menoufia University Hospital, Shebin El Kom, Menoufia, Egypt, from March 2020 to December 2020. All children were subjected to a standard ophthalmological examination. The RNFL thickness measurements were performed by Spectralis Heidelberg optical coherence tomography.Results The mean hemoglobin level was statistically significantly less in the β-thalassemia major group (6.79±0.69 g/dl) compared with the control group (13.67±0.57 g/dl) (P<0.001). The serum ferritin level was significantly increased among the β-thalassemia major group (4280.0±1250.83 ng/ml) compared with the control group (60.70±92.46 ng/ml) (P<0.001). The mean blood transfusion history among patients with β-thalassemia was 1.07±3.37/month. The nasal superior, nasal inferior, and nasal sectors were significantly thinner in patients with β-thalassemia major than in the control group (P<0.05). In patients with β-thalassemia major, the average RNFL thickness and each individual quadrant RNFL thickness (temporal, temporal inferior, and nasal inferior) were not statistically significantly correlated with serum ferritin and serum hemoglobin (P>0.05). On the contrary, the nasal superior sector was significantly correlated with serum hemoglobin, whereas the temporal superior and nasal sectors were significantly correlated with serum ferritin (P<0.05).Conclusions The RNFL was thinner in patients with β-thalassemia major compared with the control group. The RNFL thickness was positively correlated with the decreasing hemoglobin level.