Multiple Blood Transfusions Research Articles

Hepatitis C Infection in Hemodialysis Patients, Makkah, Saudi Arabia

Hepatitis C virus (HCV) infection is the most common cause of chronic liver disease in the world and evaluation of the epidemiology of HCV infection was made possible by the development of a serological assay to detect antibodies to epitopes of HCV. Hemodialysis (HD) is considered to be one of the main risk factors of HCV transmission. The prevalence of antibodies to HCV (anti-HCV) in patients undergoing maintenance dialysis therapy (MDT) was found to be one of the highest among different risk groups and there is wide variation in the prevalence of HCV infection among different dialysis units and countries. Therefore, the prevalence of anti-HCV was studied in patients undergoing MDT. The current study is a cross section one, where a sample of 361 HD patients were selected randomly from HD centres in three governmental hospitals in Makkah city and they were subjected to assessment for the prevalence of anti-HCV by using questionnaires in addition to clinical measurements. The overall prevalence of anti-HCV among HD patients was 49.9% according to clinical measurements and questionnaires. The overall prevalence of anti-HCV among HD patients in Makkah city (49.9%) was comparable to that reported from other parts of the Kingdom of Saudi Arabia (KSA) and it is almost similar to the already reported positivity rate of (43.2%) from the eastern region of KSA and southern regions of KSA (45.5%). However, Strict adherence to universal precautions as recommended by the Centre for Diseases Control (CDC), meticulous regular disinfection of HD machines, Strict isolation of HCV-positive patients, dedicated dialysis machines and nursing staff at new dialysis set-up could possibly be the reasons of relatively low anti-HCV positivity at the current study than that reported by Shaheen et al., from four centres in the western region of KSA, (72.3%) and that by Huraib et al., in their multi-centre study in KSA, (68%) as well as the mean national rate. On the other hand, the use of more sensitive third generation enzyme - linked immunosorbent assay (ELISA) technique, long duration on HD, multiple blood transfusions, patients with dialysis treatment in multi-centres, factors related to infrastructure, environment and operational system might be responsible for the high prevalence of anti-HCV found in this study than that reported by Saeed et al., from Riyadh and those observed in the central region of KSA. Although routes of transmission are still unclear, early detection of all infected patients is mandatory for HCV prophylaxis in HD patients. Furthermore, an intensive educational program for staff members, HD patients and proper evaluation of the HD situation are needed. Thus, observation of appropriate preventive measures by all HD-centres is paramount.

Antibody Screening, Identification and Red Cell Alloimmunisation Analysis in Multi-Transfused Patients at a Tertiary Care Hospital, Amritsar, India

Introduction: Alloimmunisation to red blood cell antigens, resulting from genetic disparities between donors and recipients, is one of the risks associated with blood transfusions. Antibody screening cells are used to detect unexpected antibodies. The risk of alloimmunisation is higher in patients who have undergone multiple blood transfusions. Aim: To estimate the frequency of various Red Blood Cell (RBC) alloantibodies and to determine the types of antibodies present in repeatedly transfused patients. Materials and Methods: This cross-sectional study was conducted on 200 patients with a history of multiple blood transfusions from October 1, 2019, to April 30, 2021, at the blood centre of Sri Guru Ram Das Institute of Medical Sciences and Research (SGRDIMSR), Amritsar, Punjab, India. Antibody detection and identification were performed, and the results were recorded. The data was statistically analysed using the Statistical Package for Social Sciences (SPSS) version 26.0 to draw relevant conclusions. The observations were tabulated in the form of numbers and percentages. Categorical data was analysed using the Chi-square test. The level of significance was determined as p≤0.05. Results: The study included 200 patients who were on multiple transfusions. The most common blood group among the patients was B positive (39%), followed by O positive (26%). The majority of patients (73.50%) had solid malignancies, followed by 28 (14%) thalassemia patients and 25 (12.50%) patients with chronic kidney disease. Solid malignancies included patients with breast cancer, cervical cancer, ovarian cancer, prostate cancer, and liver cancer. Alloantibodies were found in 15 patients (7.50%), of which 11 had solid malignancies and 4 had thalassemia. The most frequent antibody detected was the anti-K antibody (40%). Alloantibody formation was observed in both males and females. However, no statistical significance was found between gender and alloimmunisation (p=0.940). Conclusion: The effect of alloimmunisation can be avoided by routine RBC antibody screening before blood transfusion, especially in patients with a history of multiple blood transfusions. These measures decrease the incidence of red blood cell alloimmunisation and delayed hemolytic transfusion reactions in multi-transfused patients.

Hepatic Failure and Hyperbilirubinemia Secondary to Hemolytic Disease of the Newborn

Anti‐D antibody is the most common cause of hemolytic disease of the newborn (HDN). Other antigens have emerged, causing significant damage to the newborn. We report a case of a 31‐week dichorionic diamniotic twin born emergently to a mother with anti‐C and anti‐D antibodies who required multiple percutaneous umbilical cord blood sampling (PUBS) and transfusions. Extensive resuscitation at birth was required due to severe anemia, hypovolemia, and prematurity. Ensuing liver damage occurred with subsequent profound coagulopathy, transaminitis, and direct hyperbilirubinemia that required significant support. This patient developed several unique findings including the inability to monitor oxygen saturations due to dermal bilirubin deposits and staining of baby teeth. This case report highlights the importance of early identification of additional Rh antibodies due to concern for development of more severe forms of HDN.

Pancreatitis associated with Mycoplasma felis infection in a cat

Case summary A 7-year-old domestic shorthair cat was presented for periuria, apathy, fever, inappetence, diarrhoea and vomiting. A complete blood count and biochemistry analysis revealed severe thrombocytopenia, severe azotaemia, moderate panhypoproteinemia, mildly elevated DGGR lipase activity and mildly elevated liver enzyme activity. Abdominal ultrasound showed a hypoechoic pancreas with surrounding hyperechoic fat demonstrating dirty shadowing and ascites (protein-poor transudate). The cat was treated medically for pancreatitis with fluid therapy, antiemetics and pain medication. During the hospitalisation period, the cat developed severe anaemia and received multiple whole blood transfusions yet showed no signs of clinical improvement. A repeat ultrasound examination performed after 8 days showed progressive pancreatic lesions and ongoing ascites. Analysis of the free abdominal fluid revealed neutrophilic inflammation despite low protein and cell concentration, with the presence of numerous very small, coccoid, basophilic inclusions within neutrophils, raising the concern for a septic peritonitis due to Mycoplasma species. Quantitative PCR (qPCR) confirmed the presence of Mycoplasma felis. After 10 days of hospitalisation, the cat developed refractory septic shock and was euthanased. Necropsy revealed severe necrotising pancreatitis with systemic changes consistent with sepsis and microthrombi. qPCR testing for M felis in pancreatic tissue also yielded a positive result. Relevance and novel information Although pancreatitis is a common disease in cats, this case report presents the first documented occurrence of M felis as the suspected primary pathogen causing pancreatitis in a cat.

Pretransfusion Testing and Daratumumab: Assessing Interference Risks and Developing Solutions

ABSTRACT Daratumumab is a monoclonal antibody; anti-CD38 is used for the treatment of multiple myeloma and other hematological disorders. Daratumumab, binds to CD 38 on red blood cells (RBCs), interfering with pretransfusion testing. This interference can lead to cross match incompatibility and panreactive indirect Antiglobulin tests (IAT).Panreactive IAT can mask presence of underlying clinically significant alloantibodies, especially in patient with history of multiple blood transfusions. This can lead to delays in transfusion, increased risk of transfusion reaction and potential risk for transfusion recipients. Daratumumab induced potential serological interference needs to be resolved by using appropriate methodologies like dithiotheritol (DDT) and enzymatic treatment of reagents or donors cells to overcome these incompatibilities. Effective communication between clinical practitioners and blood centre before starting daratumumab therapy can prevent unnecessary workload and delay in transfusion. Here, we describe the case of interference in prretransfuison testing caused by Daratumumab in the red cell compatibility testing of a patient with severe aplastic anemia and strongly positive DSA levels.

Management of Delayed Hemolytic Transfusion Reaction in a Patient with Sickle Cell Disease: A Case Report

Background: Sickle cell disease (SCD) is a group of inherited blood disorders characterized by abnormalities in hemoglobin (Hb), leading to distortion in shape of red blood cells (RBCs) and their breakdown, potentially blocking blood flow and resulting in pain and anemia. This can significantly impact the patient’s quality of life. Patients often require multiple blood transfusions to prevent complications associated with SCD by reducing the concentration of damaged hemoglobin. However, one of the significant complications of blood transfusions is Delayed Hemolytic Transfusion Reaction (DHTR), which occurs due to RBC alloimmunization (i.e., formation of antibodies against donor RBC antigens). DHTR can manifest as a sudden decrease in hemoglobin levels, which may progress to rapid multiorgan failure and death. Thus, prompt diagnosis is crucial for timely management. This case report highlights the diagnosis and management of a 56-year-old African American female with SCD who presented with bilateral severe knee pain and low Hb levels. Case Presentation: The patient’s symptoms, past medical history, and investigation findings led to a diagnosis of DHTR. Management was conducted within the framework of Bloodless Medicine, incorporating strategies to minimize blood loss and optimize erythropoiesis. Treatment included the use of erythropoietin (EPO) to manage hemoglobin levels and the administration of opioids and supplemental oxygen for symptom relief. Conclusion: Our case report highlights the challenges and various management strategies employed in treating DHTR in SCD patients. It emphasizes the importance of early recognition of the complication and compares the risks and benefits of additional blood transfusions in such patients. By presenting this case, we aim to contribute to the growing literature on DHTR in SCD patients and highlight the need for further research and optimized management strategies in this population.

Risk factors for red blood cell alloimmunization in multi-transfused oncology patients at Moi Teaching and Referral Hospital, Kenya

Background : Multiple blood transfusions may result in the production of alloantibodies against one or more red blood cell antigens which might make it more challenging to execute subsequent transfusions. Despite age and gender being risk factors for transfusion and being associated with alloimmunization frequency, they are not routinely taken into account before transfusion. This study assessed red blood cell alloimmunization and its association with risk factors among multi-transfused oncology patients at Moi Teaching and Referral Hospital Cancer Centre, Kenya.
 Methodology : The study employed a cross-sectional study design and focused on multi-transfused oncology patients at the Moi Teaching and Referral Hospital Cancer Centre. A sample size of 162 was used in the study based on Fisher's exact test formulae and a consecutive sampling technique was applied. The gel-based antibody screening and identification were performed with "ID-Diacell I-IIIII®" panel cells. The frequency, mean, median, and dispersion of descriptive statistics were shown and the association between alloimmunization with the number of transfusions, age and sex were determined by Spearman's correlation analysis. Statistical significance was established at P< 0.05 and statistical tests were run at a 95% level of significance.
 Results : This study established no association between alloimmunization and the number of transfusions (P= 0.753). There was also no association between alloimmunization and age (P= 0.159). However, there was a significant positive association between alloimmunization with gender (P= 0.01). The study had a 6.2% prevalent rate of red blood cell alloimmunization, females had a greater prevalent rate than male patients. Anti-E and anti-K were the most prevalent alloantibodies.
 Conclusion and Recommendation : There is a need to improve current blood grouping and cross-match practices in most Kenyan hospitals by performing antibody screening and antibody identification tests. This study suggests routinely assessing alloimmunization in patients getting several transfusions while taking gender into account.

Predictors of Intensive Care Admission Among Adult Patients with Sickle Cell Disease in Eastern Province of Saudi Arabia.

Sickle cell disease (SCD) comprises a complex group of hematologic disorders that are collectively the most common monogenic disorder and are associated with increased risk of intensive care unit admission (ICU). The purpose of this study is to investigate factors that predict admission of adult patients with SCD to the ICU. This was a cross-sectional study that enrolled adult patients with SCD from Saudi Arabia. A total of 107 patients with SCD, with a median age 31.9±12.1 years, were evaluated retrospectively. Regarding predictors of ICU admission, patients who indicated a history of blood transfusions were at 8.047-fold higher risk of ICU admission (OR=8.047; 95% CI=2.392-27.07; p=0.001). Patients who started hydroxyurea were at least 3.071 times more likely to be admitted than those who did not (OR=3.071; 95% CI=1.164-8.104; p=0.023). We also observed three or more hospitalizations per year to be associated with increased risk of ICU admission (OR=3.393; 95% CI=1.285-8.960; p=0.014), with those making 3 to 5 visits annually having at least 10.4 times higher risk (OR=10.38; 95% CI=10.098-98.19; p=0.041) and those with 6 to 10 ER admissions having 18 times higher risk (OR=18.00; 95% CI=2.149-150.8; p=0.008). Finally, patients with high WBC were predicted to have at least 3.34 times higher risk of ICU admission (OR=3.337; 95% CI=1.131-9.846; p=0.029). SCD is a multi-systemic disease associated with increased morbidity and mortality. Recognition of high-risk features in patients helps to eliminate subjectivity in ICU referral decision. Frequent hospitalization and emergency visits, multiple blood transfusions, and elevated white blood cell count were significantly associated with a higher rate of ICU admission despite hydroxyurea usage.

Cervical lacerations: A case series

Cervical laceration (CL) after vaginal delivery is one of the uncommon side effects with significant morbidity if undetected and unattended to promptly. This is however one of the common causes for postpartum haemorrhage. There are several documented risk factors for CL such as previous interventions on the cervix, induction of labour, use of Prostaglandins for induction, precipitate labour, operative vaginal deliveries and birth weight of more than 3500gm.In this article we have described a series of eleven women who were detected to have CL following vaginal delivery. One of whom had delivery of the baby through a bucket handle cervical tear with a non-dilated cervical os. Almost all of them needed multiple blood and product transfusions in view of postpartum haemorrhage with one of them developing acute kidney injury subsequently. This necessitates the need for prompt identification of CL and its needed intervention.

Abstract 13671: A Case of Diffuse Alveolar Hemorrhage While on Systemic Anticoagulation for Impella

A 57 year old male with PMH of non-ischemic cardiomyopathy (EF 30%), atrial fibrillation, and VT s/p ICD was admitted to the cardiac intensive care unit for cardiogenic shock. His condition deteriorated necessitating Impella 5.5 implantation as bridge to cardiac transplant. Systemic heparin was started per Impella protocol with a lower anti-Xa goal of 0.2 - 0.3 given post-op bleeding at the R axillary Impella site. Five days post Impella placement he developed bloody secretions from the endotracheal tube requiring multiple blood transfusions and discontinuation of systemic heparin, while maintaining heparin purge. Labs were notable for anti-Xa 0.22, hemoglobin 9.7, and platelets 221. CT Chest demonstrated parenchymal opacities concerning for diffuse alveolar hemorrhage (DAH) which was confirmed via bronchoalveolar lavage; he had no known history of lung disease. High-dose corticosteroids were administered as a high ANA titer (1:128) and low C3 suggested capillaritis. However, decreasing ANA (1: 320) and a negative autoimmune workup decreased the likelihood of a rheumatologic cause for DAH and steroids were discontinued. DAH secondary to acquired von Willebrand syndrome (aVWS) was considered, but factor VIII and vWF activity levels were normal. The bloody secretions improved with inhaled thromboxane and systemic heparin was restarted. Orthotopic heart and kidney transplant was performed with subsequent Impella removal 104 days after Impella placement. Discussion: We present the first documented case of DAH with isolated Impella 5.5 support. Previously reported cases of DAH post-Impella were observed in patients with concurrent ECMO or RVAD. As autoimmune and coagulopathic causes of DAH were excluded, bland DAH secondary to systemic anticoagulation is most likely in this case. This raises a question about how to balance the risk of bleeding with the risk of device thrombosis, stroke and embolic events and when to switch from heparin to sodium bicarbonate purge.

Updates on Management of transfusion induced Iron Overload: A Systematic Review

Multiple blood transfusions lead to an excess iron buildup in the body's organs, which damages the organs. This systematic review investigated the recently published approaches to manage transfusion-induced iron overload. PubMed, SCOPUS, Web of Science, Science Direct, and Cochrane Library were systematically searched to include the relevant literature. Rayyan QRCI was used throughout this systematic approach. Our results included eleven studies with a total of 1635 patients diagnosed with transfusional iron overload. Iron excess is a major challenge in patients with chronic anemia who require frequent transfusions. Evidence from numerous clinical trials has shown that giving chelation therapy to individuals with transfusion-induced iron overload clearly reduced their iron burden and improved organ function. We found that Amlodipine, lupatercept, and chelating agents are safe and effective options for transfusion dependant thalassemia (TDT) patients. Additionally, Amlodipine or lupatercept combined with chelating agents are more efficient in lowering serum ferritin and o regularly drank green tea experienced significant reductions in iron accumulation. Deferiprone (DFP) has provided sickle cell disease (SCD) patients with a new therapeutic choice. The effects of this oral iron chelator were equivalent to those of deferoxamine (DFX) given subcutaneously in terms of reducing transfusional iron excess. In line with what had previously been seen in thalassemia syndrome patients, DFP showed a tolerable safety profile.

Frequency of Red Cell Alloimmunization in Patients with Thalassemia Major: A Report from the Southwest of Iran

Background: The mainstay of managing severe β-thalassemia remains lifelong blood transfusion. Mismatched red blood cell phenotypes between donors and recipients in multiple blood transfusions can result in the development of alloimmunization in recipients. The aim of this study was to determine the frequency of major and subgroup antigens and their phenotypes in thalassemia major patients.
 Materials and Methods: This cross-sectional descriptive study was performed on 105 patients with thalassemia major who referred to Baghaei Hospital in Ahvaz in 2021. Their alloimmunization to erythrocyte antigens was determined with standard tubular antibody search kits.
 Results: Among the thalassemia major patients participating in the study, 51 were female (48.45%). The mean age of the participants was 21.10 ± 5.8 years. Out of the 105 patients studied, 26 had detectable alloantibodies in the serum (24.7%). The two groups of patients with positive and negative alloantibodies were significantly different in terms of Rh and C blood groups (P-values of 0.03 and 0.05, respectively). There was no significant association between the existence alloantibody and age, gender, spleen condition and the time of first transfusion (P > 0.05).
 Conclusion: It was concluded that red blood cell matching, at least for Rh and C groups, is necessary to prevent alloimmunization in thalassemia major patients.

FRI699 Hyperphosphatemia In The Setting Of Sodium Hypochlorite Use

Abstract Disclosure: K. Champagne: None. A.D. Mooradian: None. N. Gupta: None. M.J. Haas: None. G.Y. Gandhi: None. M.M. Jurado-Flores: None. Introduction: Acute elevation of serum phosphorous occurs for various reasons, including cellular injury (hemolysis, rhabdomyolysis, tumor lysis syndrome), decreased excretion (acute renal injury), or increased absorption/intake. Case Description: A 20-year-old woman presented as a pedestrian struck by a car after a motor vehicle accident. She sustained significant injury to the left leg, including degloving injury, femur, and tibia fracture requiring intramedullary nailing, skin graft, and multiple debridements. A review of systems was positive for chronic constipation. Physical exam was remarkable for several large, deep wounds on the left leg with a wound vac. Her wound was treated with sodium hypochlorite 0.25% solution. Laboratory results revealed that serum CK was 2,903 U/L on admission, and serum phosphorous level was normal and only started to rise one month after admission. She was transfused for blood loss and received IV fluids intermittently. Serum ionized calcium was low on admission at 0.90 mmol/L, calcium supplement was started, and hypocalcemia resolved. GFR dropped twice (at 46 and 62 mL/min/1.73M2) during admission but recovered to normal within a day. Serum phosphorous was elevated and ranged from 4.7-8.0 mg/dL, magnesium level fluctuated between 1.5-2.5 mg/dL, the parathyroid hormone was low at 7.0 pg/ml, 25-hydroxy vitamin D was low at <5.0 ng/ml, 1,25-dihydroxy vitamin D was low at <5.0pg/ml, FGF-23 was high at 616 RU/ml. Sevelamer was given for 9 days and discontinued. Sodium hypochlorite 0.25% solution and calcium supplement were discontinued, and vitamin D supplementation was initiated. The fractional excretion of phosphorous calculated from spot urine phosphorous and creatinine was low at 3.03%. Seven days later, plasma phosphorous levels normalized. Discussion: Sodium hypochlorite is a strong alkali (pH ∼11) and is the active ingredient of bleach. When exposed to water, it forms hypochlorous acid that generates superoxide radicals, leading to oxidative injury and cell death. This solution is bactericidal and may cause some tissue injury as well. It is used in healthcare settings to disinfect dialysis machines and tunneled catheters, surgical equipment, wound cleaning, hand hygiene, and root canal sterilization. It may increase the risk of hyperphosphatemia when used in a patient with immobilization, bone fractures, hypoparathyroidism, low vitamin D, multiple blood transfusions, and wound debridements. There have been rare reports of acute kidney injury with an intravenous bleach injection. Presentation: Friday, June 16, 2023

THU537 A Case Of Aggressive NET With Extensive Bone Marrow Metastasis Presenting With Hypercalcemia

Abstract Disclosure: G. Kela: None. A.S. Gill: None. F. Kussaga: None. O. Olarinmoye: None. Introduction: A metastatic cancer that has no identifiable site of origin despite a thorough workup is termed cancer of unknown primary (CUP). Neuroendocrine tumors of unknown primary (NUP) are rare, making up less than 5% of all CUPs. This case demonstrates a rare presentation of a well-differentiated neuroendocrine tumor (NET) of an unclear primary site with extensive metastasis to the bone that initially presented with hypercalcemia of unclear cause. Case: We report a case of a 76-year-old-female with a history of depression and hypertension who was initially admitted for evaluation of hypercalcemia with a corrected calcium of 11.9, low normal PTH of 14.2, and PTHrP of 18, treated with zoledronic acid who presented again 3 months later with a 30lb weight loss for 2 months and bright red blood per rectum for one day. The patient had petechiae and flat dry purpura across her upper and lower extremities, lymphadenopathy, hepatosplenomegaly, and jaundice. Labs revealed a hemoglobin of 8.4g/dl (normocytic normochromic) and platelet count of 61,000/cm3, compared to 14.5g/dl and 269,000/cm3 respectively 4 months before admission. Colonoscopy and barium enema revealed internal hemorrhoids as the bleeding source. Laboratory workup for thrombocytopenia revealed no distinct etiology. Further workup with a right iliac bone marrow biopsy revealed a well-differentiated NET. The tumor cells expressed keratin 7, chromogranin, and synaptophysin, & variably expressed INSM1. CT scan of the chest, abdomen, & pelvis revealed a left thyroid nodule measuring 2.4 cm, suspicious for a NET on an octreotide scan. Biopsy of the left thyroid nodule, however, revealed follicular neoplasm which is not a NET. The patient was started on Lanreotide with no significant improvement. She remained severely anemic requiring multiple blood transfusions despite undergoing a hemorrhoidectomy. A repeat CT scan and MRI of the head done for increased confusion and disorganized speech 2 months later showed extensive metastatic disease involving the brain and skull. The patient could not tolerate further workup or cytotoxic chemotherapy and wished to proceed with hospice care. Discussion: NETs can arise from neuroendocrine cells located in any part of the body, most commonly in the gastrointestinal tract, lungs, or pancreas, and on extremely rare occasions from the bone. Conventionally, these tumors are indolent and accompanied by carcinoid symptoms. In this case, the bone biopsy was positive for tumor markers suggesting various primary sites including small bowel, stomach, and pancreas. However, despite extensive workup, the primary localization of the tumor was unsuccessful. The combination of the absence of a site of origin, the predominance of hematologic pathology (pancytopenia), and the highly invasive nature of this patient’s malignancy are suggestive of a well-differentiated NET with extensive metastasis into the bone. Presentation: Thursday, June 15, 2023

Lipid Profile Abnormalities in ß-Thalassemia Patients with Multiple Blood Transfusions

Objective: To determine lipid profile abnormalities in ß -thalassemia patients with multiple blood transfusions in tertiary care hospital. Study design and setting: This cross-sectional study was conducted in Chemical Pathology section, Pathology department Sheikh Zayad Medical College and Hospital Rahim Yar Khan from 1st July 2022 to 31st October 2022. Methodology: 110 patients aged 1 to 18 years from both genders enrolled in Thalassemia center of Sheikh Zayed Hospital with multiple blood transfusions were included in study using convenient sampling technique. Patients with cardiac disease, diabetes mellitus and family history of lipid disorders were excluded. Blood samples collected from thalassemia patients were subjected to estimation of serum total cholesterol, serum triglycerides, HDL-C, and LDL-C. Data was recorded on predesigned performa. Post stratification t test was applied and p value <0.05 was considered significant. Results: Mean age of the patients was 7.77±3.846 years. Mean serum cholesterol, serum triglyceride, HDL-C and LDLC were 89.15±20.33mg/dl, 211.00±77.78mg/dl, 21.01±6.554mg/dl and 29.79±17.02 respectively. Mean triglyceride and LDL-C level was higher in patients with weekly transfusion than patients undergoing monthly transfusion with statistically significant difference of triglycerides and LDL-C between two groups with p=0.002 and 0.023 respectively. Conclusion: We found that frequent blood transfusion causes lipid profile abnormalities in thalassemia patients. Lipid profile abnormalities should be screened frequently in ß-thalassamia patients with multiple blood transfusions.

ESTIMATION OF PREVALENCE OF HEPATITIS C VIRUS INFECTION BY SEROLOGICAL TEST AND REAL TIME RT-PCR TEST AMONG SUSPECTED VIRAL HEPATITIS CASES ATTENDING TERTIARY CARE HOSPITAL, KOLKATA

Objective: Hepatitis C virus (HCV) infection is a major public health problem in India and worldwide. Majority remain asymptomatic until they develop serious complications like liver cirrhosis or hepatocellular carcinoma with fatal outcome. Hence, early diagnosis of active HCV infection and prompt initiation of treatment is important. Treatment with directly acting antivirals (DAAs) resulted in high sustained virological response (SVR) rates of >95% globally. This study was done to estimate seroprevalence and prevalence of active HCV infection among study population. After initiation of treatment, SVR rates were estimated. Methods: This was hospital-based, cross-sectional, and observational study. Screening was done by third-generation Enzyme-linked immunosorbent assay to detect anti-HCV antibody, then confirmatory real-time reverse transcription-polymerase chain reaction (RT-PCR) test was done for detection of active cases and determining their viral load. Treatment of 12-week duration was initiated by DAAs and followed up to estimate SVR by doing real-time RT-PCR after 12 weeks of treatment completion. Result: Among 17,752 consecutive non-repetitive blood samples, seroprevalence was 1.78%. The prevalence of active cases was 1.52%. HCV active infection was prevalent more among male (64.21%) and among 40–60 years age group. History of multiple blood transfusion (58%) was the most common risk factor, followed by multiple sex partners (13.3%). Coinfections with Hepatitis B virus and Human immunodeficiency virus were seen in 13.65% of cases. About 92% of patients completed their treatment. SVR was 97.87%. Conclusion: High SVR of 97.87% is evidence-based data that support that proper treatment can eliminate HCV infection. Detection by real-time RT-PCR and highly effective DAA has made a paradigm shift to approach of HCV diagnosis and management in recent times

A rare case of duodenal Dieulafoy’s lesion managed by endoscopic band ligation

Dieulafoy's lesion is an uncommon but important cause of recurrent upper gastrointestinal bleeding. Extragastric location of Dieulafoy's lesion is rare. We report a case of duodenal Dieulafoy's lesion which was successfully managed by banding. Fifty-year-old presented with recurrent upper gastrointestinal (GI) bleed and severe anemia with history of multiple blood transfusions and OGD scope showed dieulafoy’s lesion in the second part of duodenum (D2), which was successfully managed by banding. Endoscopic diagnosis of extragastric Dieulafoy's lesion can be difficult because of the small size and obscure location of the lesion. Increased awareness and careful and early endoscopic evaluation following the bleeding episode are the key to accurate diagnosis. Banding is one of the safest, cost effective endoscopic modalities for control of bleeding.

Lead, Mercury, and Cadmium Concentrations in Blood Products Transfused to Neonates: Elimination Not Just Mitigation.

Lead (Pb), mercury (Hg), and cadmium (Cd) are identified as potent developmental neurotoxicants. Neonates are the main group receiving multiple blood transfusions. The exposure of neonates to these heavy metals (HMs) can occur through blood transfusions. This study aimed to determine the concentrations of lead (Pb), mercury (Hg), and cadmium (Cd) in various blood products (plasma, platelets, packed red blood cells (pRBCs), and whole blood (WB)) to explore the probability of concurrent exposure of these HMs and to identify the metal load per transfusion with risk assessment. Residual bloods from blood bank bags were collected after neonatal transfusion. Pb, Hg, and Cd concentrations were determined in 120 samples of blood products by inductively coupled plasma mass spectrometry (ICP-MS). Pb and Cd levels were over the normal levels in 19.2 and 5.9% of all blood units, respectively. In 35 and 0.8% of blood units, the Pb and Cd concentrations, respectively, were higher than that recommended for transfusions in premature neonates. The anticipated safe value was surpassed by 2.5% for Cd of all transfusions, primarily because of WB. However, Hg was detected only in 5.8% of all samples and their concentrations were within the normal range. The concurrent neonatal exposure to Pb, Hg, and Cd was statistically significant. Hazard quotients of Hg and Cr were >1 and Pb cancer risk was 2.41 × 10-4. To the best of our knowledge, this study is the first report examining Pb, Hg, and Cd in blood products other than WB and pRBCs using ICP-MS. This study demonstrated the exposure of neonates to Pb, Hg, and Cd during transfusion with a considerable amount of Pb. It confirms the significant concurrent exposure to the three HMs, which maximize their potential developmental neurotoxicity with a high probability of developing non-carcinogenic and carcinogenic health effects.

Massive transfusion protocol

Hemorrhage from trauma, surgery, obstetric emergencies, and gastrointestinal bleeds remain a cause of potentially preventable deaths for patients. However, transfusions of large amounts of blood products may lead to complications. The development of Massive Transfusion Protocols (MTP), a proactive treatment protocol to manage profound blood loss, has shown improved outcomes for patients requiring immediate and multiple blood transfusions. These guidelines help to recognize hemorrhagic patients in need of an MTP as well as how to best manage this complex protocol.

Recurrent upper gastrointestinal bleeding in chronic pancreatitis since childhood: a case report

Chronic pancreatitis is a progressive inflammatory disease of the pancreas. Causes of gastrointestinal (GI) bleeding in chronic pancreatitis are bleeding into the pseudocyst, pseudoaneurysm of peripancreatic vessels, and thrombosis of portal vein and splenic vein. We are presenting a rare case presentation of recurrent GI bleed in chronic pancreatitis since childhood and its management. A seventeen-year-old female patient presented with recurrent attacks of upper abdominal pain, hematemesis, bleeding per rectum, and melena since 1 month of age. She was diagnosed with a case of chronic calcific pancreatitis with pseudoaneurysm of common hepatic artery, and portal vein thrombosis with splenomegaly at the age of 2 years. She underwent angioembolization of the common hepatic artery pseudoaneurysm at the age of 2 years. However, she continued to have recurrent episodes of upper GI bleeding which required multiple hospital admissions and blood transfusions in the past. Contrast-enhanced computed tomography of abdomen was suggestive of chronic calcific pancreatitis with status post coil embolization of common hepatic, gastroduodenal, and proper hepatic arteries. She underwent modified Frey’s procedure in view of recurrent symptoms. Currently, the patient is doing well after 18 months of follow-up, with no further episodes of GI bleed. Angioembolization or surgical ligation of pseudoaneurysm of involved vessels in chronic pancreatitis can control GI bleed. However, in cases where the source of bleeding is not localized by imaging/ endoscopy, drainage of pseudocyst or local resection of pancreatic tissue can reduce inflammation in and around the pancreas and prevent further GI bleed in chronic pancreatitis.