Necessity For Blood Transfusion Research Articles

Safety and Efficacy of Preoperative Embolization in Giant Intracranial Meningiomas Compared with Resection Surgery Alone

Background: Endovascular embolization of intracranial meningiomas is commonly performed as an adjunct to surgical resection and may reduce intraoperative blood loss and surgical time. However, it remains unclear whether preoperative embolization improves the surgical outcomes of meningioma patients. Objectives: This study aimed to assess the safety and efficacy of preoperative embolization in patients with giant intracranial meningiomas. Methods: This retrospective cohort study included patients diagnosed with cranial meningiomas who underwent surgical treatment. The population group was subdivided into 2 categories: Surgery alone and preoperative meningioma embolization. Outcome variables included the degree of devascularization, intraprocedural complications, intraoperative complications, intraoperative blood loss, surgical time, postoperative complications, and the necessity of blood transfusions. Results: In this study, a total of 189 patients with meningiomas were enrolled. Among them, 22 patients underwent preoperative tumor embolization. The tumor volume was significantly larger in the combined treatment group compared to the surgery-alone group (P = 0.002). Additionally, there was a significant difference in tumor location between the groups (P < 0.001), with more meningiomas being situated deeper in the combined group. In the subgroup analysis of giant meningiomas, intraoperative blood loss was significantly lower in embolized patients compared to non-embolized patients (P = 0.034), while no difference in surgical time was observed (P = 0.570). Conclusions: Preoperative embolization in appropriately selected patients with giant intracranial meningiomas, especially those in deeper locations, was safe and feasible, showing a substantial degree of tumor devascularization with an acceptably low rate of complications. This may have had a positive effect on intraoperative blood loss and the duration of surgery.

Comparison of the effects of general and regional anesthesia on mortality and hospital length of stay in geriatric hip fractures.

In this study, we sought to compare the effects of general and regional anesthesia techniques on the length of hospital stay and morbidity-mortality in geriatric patients who have had hip fractures and underwent surgical treatment. A total of 331 patients who were 65 or older and had had surgical treatment for elective or urgent hip fractures were classified into two groups; regional and general anesthesia. Recorded variables were: age, sex, American Society of Anesthesiologists (ASA) score, comorbid disease, length of stay at the clinic, mortality, morbidity, intraoperative loss of blood, the necessity of blood transfusion, and type of fracture. These variables were compared in the control groups and evaluated retrospectively. For the regional anesthesia group, length of stay in the clinic, loss of blood, and necessity of blood transfusion were significantly lower compared to the general anesthesia group (p<0.05). Additionally, we found general anesthesia mortality and morbidity rates were significantly higher than regional anesthesia (p<0.05). Finally, we determined that increased age and number of comorbid diseases increased the morbidity and mortality rates significantly (p<0.05). This study evaluated regional anesthesia's advantages over general anesthesia when treating geriatric hip fractures. This includes reduced morbidity-mortality rates, bleeding, and shorter length of hospital stay.

Clinical and immunohematological characterization of autoimmune hemolytic anemia in children

Autoimmune Hemolytic Anemia (AIHA) in childhood is uncommon and estimated to be three per million annually under 18 years of age. Detailed immunohematological and clinical characterizations are essential for correct diagnosis of the disease and its management. In this study we described AIHA in children with regards to patient demography, underlying etiology, disease classification, antibody characterization, clinical features, degree of in vivo hemolysis and transfusion management. The prospective observational study was conducted over a period of 6 years and included 29 children with newly diagnosed AIHA. Patient details were obtained from the hospital information system and patient treatment file. The median age of the children was 12 years with a female preponderance. Secondary AIHA was observed in 62.1% patients. The mean hemoglobin and reticulocyte were 7.1 gm/dL and 8.8 percentages respectively. The median polyspecific direct antiglobulin test (DAT) grading was 3+. Red cell bound multiple autoantibodies were found in 27.6% children. Free serum autoantibodies were present in 62.1% patients. Twenty six of the 42 units transfused were “best match” or “least incompatible”. Follow-up of 21 children showed clinical and laboratory improvement with DAT still positive at the end of 9 months. AIHA in childhood requires advanced and efficient clinical, immunohematological and transfusion support. Detailed characterization of AIHA is important, as they determine degree of in vivo hemolysis, disease severity, serological incompatibility and necessity of blood transfusion. Although blood transfusion in AIHA is a challenge but it should not be withheld in critically ill patients.

Addition of carfilzomib as a third agent in lenalidomide-refractory multiple myeloma: Switching from doublet to triplet.

e20002 Background: Carfilzomib is an epoxyketone proteasome inhibitor of second generation, proved to be effective and safe in relapsed and refractory Multiple Myeloma (rrMM), in combination with dexamethasone or lenalidomide and dexamethasone. In this retrospective observational trial, it has been evaluated efficacy and safety of carfilzomib, in combination with lenalidomide-dexamethasone (KRD) as salvage regimen in patients with rrMM, refractory to lenalidomide, where lenalidomide-based regimens have no proven efficacy. Methods: 41 patients (23 M/18 F), with rrMM, median age at diagnosis 63.7 years (r. 43-82), median age at start of treatment 67 years (r. 48-84) previously treated with several lines of treatments (median 3, r. 2-11), underwent to KRD regimen (ASPIRE trial schedule) for a median treatment cycles of 8 (r 2-18). ISS was equally distributed, and all patients had previously been treated with bortezomib and IMIDs, and were refractory to this agents. 61% (19/31) of them had undergone at least to a single ASCT. Results: According to IMWG criteria, after a median follow-up of 9 months (r. 2-18), ORR was 68,2% (28/41: 9 CR, 12 VGPR, 7 PR) with 5 progressive diseases (PD) and 8 patients in stable disease (SD): this can be considered as an impressive result in this subset of rrMM patients, refractory to lenalidomide. In particular, for 11 patients, KRD was, after having achieved at least a PR, a bridge to second/third autologous SCT. Median time to response was 1.3 months (r.1-4), median OS from diagnosis was 62 months (r. 9-170), median OS from start of Carfilzomib was 11 months (r. 2-18). Carfilzomib was well tolerated, with grade 2 anemia in 39%(16/41) of patients, successfully managed by ESAs, without necessity of blood transfusions; 29% (12/41) grade 3-4 neutropenia (pegfilgrastim in primary prophylaxis was given, no ospedalization was required, no septic shocks were observed); 34% (14/41) grade 2, 21% (9/41) grade 3 and 12% (5/41) grade 4 thrombocytopenia, without hemorrhagic events and transfusion-dependency. Moreover, it was observed pneumonia in 39% (16/41) of patients, treated by common antibiotic drugs and always solved. A cardiac monitoring was performed for all patients: hypertension (grade 2-3) in 34% (14/41) of patients; fatigue in 39% (16/31) of patients. Conclusions: Carfilzomib-Lenalidomide-Dexamethasone has shown significant efficacy in a particularly severe setting of patients, relapsed and refractory to all available therapeutic resources, also lenalidomide, and it could be considered as a bridge to a second autologous or allogenic SCT. Clinical trial information: A108.

Subjective and Objective Outcomes of Ankle Joint Arthrodesis with Either Ilizarov or Internal Fixation

After arthroplasty, arthrodesis of the ankle joint is the most common method to treat advanced ankle osteoarthritis. The goal of the study was to assess the subjective and objective outcomes in 2 different types of fixation for ankle joint arthrodesis. We retrospectively assessed 47 patients who had undergone ankle joint arthrodesis with fixation either via an Ilizarov apparatus (group 1) (n=21) or cannulated screws (group 2) (n=26). The outcomes were measured by: (1) the quantity of analgesics administered, (2) the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, (3) general patient satisfaction, (4) the patients' decision to undergo the same procedure given another chance, and (5) the necessity of blood transfusion during hospitalization. Data was collected at the last postoperative follow-up visit. The AOFAS scores in group 1 and group 2 patients were 73.9 ± 13 and 72.7 ± 14.3, respectively. In group 1, 17 patients (81%) were very satisfied with the results, while in group 2, 19 patients (73%) were very satisfied with the results (p=.043). Two group 1 patients (10%) and four group 2 patients (15.3%) reported that they were satisfied with the outcomes (p=.035). Two patients (10%) from group 1 and three patients (11%) from group 2 were fairly satisfied. Seventeen patients (81%) after arthrodesis with Ilizarov fixation and 21 patients (81%) after arthrodesis with internal fixation would choose the same procedure given the opportunity to choose again. In group 1 there were no patients who required blood transfusion; in group 2 one patient (4%) required blood transfusion; the difference was statistically significant (p=.039). Nineteen group 1 patients (90%) were administered an analgesic preoperatively, while postoperatively only 6 (29%) required analgesics. In group 2, 24 patients (92%) were administered analgesics preoperatively, with 8 (31%) of them still requiring analgesics postoperatively. Ankle arthrodesis patients from both group 1 and group 2 achieved good subjective and objective results of treatment. We noted slightly better results in the Ilizarov apparatus group.

Tranexamic acid reduced blood transfusions in acute burn surgery: A retrospective case-controlled trial

ObjectiveEarly excision and grafting of burn wounds are key for reducing prevalence of infection and sepsis. However, it is associated with massive blood loss and patients frequently require large numbers of blood transfusions. This study aimed to evaluate the effect of tranexamic acid (TXA) on blood transfusion requirements in acute burn surgery. MethodsPatients admitted to the burn intensive care unit between January 2018 and May 2021 and received TXA before first surgery for wound excision and grafting were matched in a 1:2 ratio to patients that did not receive TXA (confounders age,sex,total body surface area (TBSA) burned). Primary endpoint of the analysis was the total number of transfused units of red blood cells (RBC) intra- and postoperatively up to 48 h. Fresh frozen plasma (FFP) and platelets were evaluated. Endpoints were compared between groups using van Elteren tests adjusting for strata variable age, gender, TBSA. ResultsTwenty-six TXA patients were matched with 52 control patients resulting in similar distributions of gender (77.9%(TXA)vs. 82.7%(control) males, p=0.542), age (51.7±21.3vs.48.3 ±17.4years,p = 0.459) and %TBSA burned (33.5%(IQR34)vs. 38.5% (IQR 30.5),p = 1.000). TXA group received significantly less RBC units intraoperatively (2.5(IQR 2.0)vs.4.0 units (IQR4.0), p = 0.038) and in total (4.0(IQR3.0)vs.6.0(IQR4.0),p = 0.017). TXA patients also received less blood products in general (RBC, FFP, platelets) in each period and in total. We found no significant difference in length of stay (24.0(IQR26.0)vs.33.0 days (IQR 0.5),p = 0.367) or mortality (15.4%vs.21.2%, p = 0.542). DiscussionThis study shows that necessity for blood transfusions in acute burn surgery may be reduced significantly by administration of TXA perioperatively. Randomized-controlled trials are needed to prove these findings.

THE PREDICTIVITY OF RISK SCORES IN UPPER GASTROINTESTINAL BLEEDINGS

Upper gastrointestinal bleedings are still a challenge for gastroenterologists as well as for physicians in the emergency departments. They are one of the most frequent causes for admission in the world. As a result, numerous risk assessment scores were described, some including accessible variables, some others including the need for upper gastrointestinal endoscopy to quantify the risk of mortality, the implementation of emergency endoscopy, the risk of rebleeding, and the necessity of blood transfusion.

Carfilzomib-Lenalidomide-Dexamethasone in the Management of Lenalidomide-Refractory Multiple Myeloma

Carfilzomib is an epoxyketone proteasome inhibitor of second generation, proved to be effective and safe in relapsed and refractory Multiple Myeloma (rrMM), in combination with dexamethasone or lenalidomide and dexamethasone.In this retrospective observational trial, it has been evaluated efficacy and safety of carfilzomib, in combination with lenalidomide-dexamethasone (KRD) as salvage regimen in patients with rrMM, refractory to lenalidomide, where lenalidomide-based regimens have no proven efficacy.41 patients (23 M/18 F), with rrMM, median age at diagnosis 63.7 years (r. 43-82), median age at start of treatment 67 years (r. 48-84) previously treated with several lines of treatments (median 3, r. 2-11), underwent to KRD regimen (ASPIRE trial schedule) for a median treatment cycles of 8 (r 2-18). ISS was equally distributed, and all patients had previously been treated with bortezomib and IMIDs, and were refractory to this agents. 61% (19/31) of them had undergone at least to a single ASCT.According to IMWG criteria, after a median follow-up of 9 months (r. 2-18), ORR was 68,2% (28/41: 9 CR, 12 VGPR, 7 PR) with 5 progressive diseases (PD) and 8 patients in stable disease (SD): this can be considered as an impressive result in this subset of rrMM patients, refractory to lenalidomide. In particular, for 11 patients, KRD was, after having achieved at least a PR, a bridge to second/third autologous SCT. Median time to response was 1.3 months (r.1-4), median OS from diagnosis was 62 months (r. 9-170), median OS from start of Carfilzomib was 11 months (r. 2-18). Carfilzomib was well tolerated, with grade 2 anemia in 39%(16/41) of patients, successfully managed by ESAs, without necessity of blood transfusions; 29% (12/41) grade 3-4 neutropenia (pegfilgrastim in primary prophylaxis was given, no ospedalization was required, no septic shocks were observed); 34% (14/41) grade 2, 21% (9/41) grade 3 and 12% (5/41) grade 4 thrombocytopenia, without hemorrhagic events and transfusion-dependency. Moreover, it was observed pneumonia in 39% (16/41) of patients, treated by common antibiotic drugs and always solved. A cardiac monitoring was performed for all patients: hypertension (grade 2-3) in 34% (14/41) of patients; fatigue in 39% (16/31) of patients.Carfilzomib-Lenalidomide-Dexamethasone has shown significant efficacy in a particularly severe setting of patients, relapsed and refractory to all available therapeutic resources, also lenalidomide, and it could be considered as a bridge to a second autologous or allogenic SCT. DisclosuresMartinelli: Jazz Pharmaceuticals: Consultancy; Stemline Therapeutics: Consultancy; Astellas: Consultancy, Speakers Bureau; Celgene /BMS: Consultancy, Speakers Bureau; Abbvie: Consultancy; Daichii Sankyo: Consultancy; Roche: Consultancy; Pfizer: Consultancy, Speakers Bureau; Incyte: Consultancy.

Short-term outcomes of anatomic right anterior liver sectionectomy for hepatocellular carcinoma with Glissonean pedicle approach

Hepatocellular carcinoma (HCC) is a common malignant disease in Vietnam with a high mortality rate. Anatomic right anterior liver sectionectomy is the prior choice for HCC which locates in this area if we can't perform right or central liver resection. The extrafascial approach are recognized as the Glissonean pedicle approach. When the Glissonean pedicles are ligated, anatomical hepatectomy area reveals. Forty-seven patients with diagnosis of HCC who underwent anatomic right liver anterior sectionectomy with Glissonean pedicle approach from March 2017 to March 2020 in our Department. Two techniques were used including extrafascial and extrafascial-transfissural approach (when the tumor locates near the right anterior glissonean pedicle). The mean age was 56.7 ± 11.82 year olds with male:female ratio is 10.75:1. Positive rates for hepatitis B is 74.5%. Selective control of Glissonean pedicle was successful in all cases: 35 cases (74.47%) with extrafasical approach and 12 cases (25.53%) with extrafascial-transfissural approach. There are 40 cases (85.1%) having intermittent clamping in a manner of 15minutes of ischemia and 5minutes of reperfusion repetitively and 7 cases (14.9%) having continuous hemihepatic vascular inflow clamping. The mean amount of intraoperative blood loss was 200 ± 120 mL and no transfusion. The mean operation time was 182.23 ± 54.07 minutes. The median postoperative hospital stay is 7.52 ± 2.25 days. No patients had necessity for blood transfusion. There was 1 case having liver failure and no mortality. Anatomic right anterior liver sectionectomy for HCC with Glissonean pedicle approach is feasible, safe, and effective procedure.

Short-term outcome of laparoscopic left lobe liver resection for hepatocellular carcinoma in Vietnam National Cancer Hospital

Hepatocellular carcinoma (HCC) is a common malignant disease in Vietnam with a high mortality rate. The use of laparoscopic liver resection (LLR) has progressively spread in the last 5 years in our country. Althought treatments are dependent primarily on the stages of disease, locations, sizes, and number of tumors. In addition, laparoscopy leads to less post-operative abdominal adhesions and improving operative outcomes. Evaluationshort-term outcome of patients with diagnosis of HCC who underwent laparoscopic left lobe liver resection totally from August 2018 to August 2019 at our Department. There were 11 male (84.6%) and 2 female (15.4%), with a male to female ratio of 5.5:1; mean age 58.46 ± 8.67 years; positive rates fos hepatitis B is 30.8%; all child's class A cirrhotics; 53.8% of cases had tumors located in segment 2 and segment 3 and 84.6% has a single tumor; the mean tumor size is 51.6 ± 26.7 mm; The operation time is 163.08 ± 14.94 minutes; the median postoperative hospital stay is: 7.54 ± 1.15 days; no patients had necessity for blood transfusion; the complication rate and mortality rate is 0%. Laparoscopic left lobe liver resection for HCC is safe and feasible procedure.

Association between red blood cell transfusions and adverse effects after transcatheter aortic valve replacement- a meta analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background-Transcatheter aortic valve replacement (TAVR) is associated with periprocedural bleeding , mainly driven by vascular complications leading to blood cell transfusion. Additionally, anemia is highly prevalent in this population. The decision regarding the necessity for blood transfusion in patients undergoing TAVR is challenging. Methods-Electronic databases (Medline, Embase, Scopus, Cochrane) were searched from inception to December 16th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p &amp;lt; 0.05.The primary outcomes of interest were all-cause mortality, myocardial infarction(MI), Stroke(CVA), and acute kidney injury(AKI). Results- A total of six studies with 6701 participants (Transfusions = 1505, Non-Transfusions = 5196) were included in our analysis. Average follow-up duration was 30 days. Mean age was 82.4 and 81.5 in the Transfusions and Non-transfusions group respectively. RBC transfusion was associated with higher 30-day mortality (OR-4.08; 95%CI 2.29-7.27; p &amp;lt; 0.00001; I2 = 77) as well as increased risk of acute kidney injury (AKI) (OR 2.97;95%CI 2.07-4.26; p &amp;lt; 0.00001; I2 = 77) and stroke (OR 2.44; 95%CI 1.78- 3.34; p &amp;lt; 0.00001,I2 = 0) However, there was no significant difference in the incidence of MI (OR 1.15;95%CI 0.50-2.64; p = 0.74,I2 = 0) Conclusion- RBC transfusion is a correlate and an independent predictor of all-cause mortality, acute kidney injury and stroke in this patient population and should be used with caution Abstract Figure.

The clinical evaluation of internal iliac arteries balloon occlusion for placenta accreta spectrum.

To evaluate the balloon occlusion of the internal iliac arteries during a caesarean section in the group of patients with placenta accreta spectrum. We analysed 29 pregnant women with placenta accreta spectrum. The study group consisted of 15 patients, who underwent a caesarean delivery with temporary bilateral internal iliac artery occlusion. In the control group, we examined 14 women who had a standard caesarean delivery without any radiologic procedure. We compared pre- and post-operative haemoglobin level, necessity of blood transfusion, intraoperative blood loss, intensive care requirement, complications, duration of surgery, anaesthesia and hospital stay. The history and obstetric outcomes were similar in both groups. The study group required fewer blood transfusions than the control group (p = 0.0176). We administered less packed red blood cells and fresh frozen plasma. Complications were more frequent in the control group (p = 0.0014). Complications related to occlusion of the internal iliac arteries did not occur. The intensive care unit transfer was more frequent in the control group (p = 0.0329). The duration of surgery and hospital stay did not differ between groups. The anaesthesia time was longer in a study group, which related to the radiologic procedure. Caesarean delivery for placenta accreta spectrum with bilateral balloon occlusion of the internal iliac arteries requires fewer transfusions. It contributes to a decrease in the complication rate and maternal morbidity.

Effect of Aspirin Consumption on Hematuria and Cardiovascular Complications After Transurethral Resection of Prostate

Objectives: This study aimed to evaluate the effects of aspirin on hematuria and cardiovascular events after transurethral resection of the prostate (TURP). Methods: This case-control study was conducted at Sina hospital, an affiliated hospital of Tehran University of Medical Sciences, in 2018. We assessed 132 patients with benign prostatic hyperplasia (BPH) who underwent TURP in two groups (66 patients in each group). In the first group, aspirin was withdrawn 5 - 7 days before the surgery. In the second group, aspirin was given without discontinuation before the surgery. Both groups were followed for 30 days to be compared regarding hematuria, duration of hospitalization, Hb decline rate, the necessity for blood transfusion, secondary hematuria, duration of Foley catheter fixation, and cardiovascular complications after TURP. Results: The duration of Foley catheter fixation, Hb decline rate, and duration of hospitalization were significantly associated with aspirin consumption (P value &lt; 0.05) while blood transfusion, secondary hematuria, and cardiac complications did not correlate with aspirin usage. Conclusions: Aspirin consumption might be a risk factor for Foley catheter fixation duration, blood loss, and length of hospital stay.

Carfilzomib-Lenalidomide-Dexamethasone in the Management of Lenalidomide-Refractory Multiple Myeloma

Background Carfilzomib is an epoxyketone proteasome inhibitor of second generation, proved to be effective and safe in relapsed and refractory Multiple Myeloma (rrMM), in combination with dexamethasone or lenalidomide and dexamethasone. Aims In this retrospective observational trial, it has been evaluated efficacy and safety of carfilzomib, in combination with lenalidomide-dexamethasone (KRD) as salvage regimen in patients with rrMM, refractory to lenalidomide, where lenalidomide-based regimens have no proven efficacy. Methods 41 patients (23 M/18 F), with rrMM, median age at diagnosis 63.7 years (r. 43-82), median age at start of treatment 67 years (r. 48-84) previously treated with several lines of treatments (median 3, r. 2-11), underwent to KRD regimen (ASPIRE trial schedule) for a median treatment cycles of 8 (r 2-18). ISS was equally distributed, and all patients had previously been treated with bortezomib and IMIDs, and were refractory to this agents. 61% (19/31) of them had undergone at least to a single ASCT. Results According to IMWG criteria, after a median follow-up of 9 months (r. 2-18), ORR was 68,2% (28/41: 9 CR, 12 VGPR, 7 PR) with 5 progressive diseases (PD) and 8 patients in stable disease (SD): this can be considered as an impressive result in this subset of rrMM patients, refractory to lenalidomide. In particular, for 11 patients, KRD was, after having achieved at least a PR, a bridge to second/third autologous SCT. Median time to response was 1.3 months (r.1-4), median OS from diagnosis was 62 months (r. 9-170), median OS from start of Carfilzomib was 11 months (r. 2-18). Carfilzomib was well tolerated, with grade 2 anemia in 39%(16/41) of patients, successfully managed by ESAs, without necessity of blood transfusions; 29% (12/41) grade 3-4 neutropenia (pegfilgrastim in primary prophylaxis was given, no ospedalization was required, no septic shocks were observed); 34% (14/41) grade 2, 21% (9/41) grade 3 and 12% (5/41) grade 4 thrombocytopenia, without hemorrhagic events and transfusion-dependency. Moreover, it was observed pneumonia in 39% (16/41) of patients, treated by common antibiotic drugs and always solved. A cardiac monitoring was performed for all patients: hypertension (grade 2-3) in 34% (14/41) of patients; fatigue in 39% (16/31) of patients. Conclusions Carfilzomib-Lenalidomide-Dexamethasone has shown significant efficacy in a particularly severe setting of patients, relapsed and refractory to all available therapeutic resources, also lenalidomide, and it could be considered as a bridge to a second autologous or allogenic SCT. Disclosures Lucchesi: Incyte: Honoraria; Novartis: Honoraria; Pfizer: Honoraria. Martinelli:Amgen: Consultancy; Celgene: Consultancy, Speakers Bureau; Jazz: Consultancy; Incyte: Consultancy; Pfizer: Consultancy, Research Funding, Speakers Bureau; Roche: Consultancy; Daichii Sankyo: Consultancy, Research Funding; AbbVie: Consultancy, Research Funding; Janssen: Consultancy.

Predictive model of preoperative blood preparation for transfusion in isolated coronary artery bypass graft surgery

<h3>Introduction</h3> Patients undergoing isolated coronary artery bypass graft (CABG) at our heart centre require two packed red blood cells (RBC) pre-operatively based on the data from Maximum Surgical Blood Order Schedule (MSBOS). Transfusion-related mortality and morbidity have been shown to be dose dependent, suggesting that the lowest effective number of units should be transfused. Pre-operative identification of patient's characteristic requiring blood transfusion during procedure will allow for better utilization of blood, reduce wastage and increase cost efficiency. We aim to define a set of parameters to indicate necessity for blood transfusion hence, consideration will be given to supply one instead of two packed RBC to patients who do not require transfusion. <h3>Methods</h3> This cross-sectional study obtained integrated data-set from the hospital information system and clinical database (Cardio thoracic Surgery Registry) from January 2015 to December 2018. A total of 4,646 patients who underwent isolated CABG were included in this study and 28 independent predictors associated with transfusion were identified and analyzed. A predictive model for preoperative requirement of blood transfusion was developed using logistic regression and machine learning approach ie; Decision tree, Logistic Regression, KNN, Naïve Bayes, Gradient Boosted Tree, and Random Forest using RapidMiner. <h3>Results</h3> In 2015-2018, only 25.7% of patients utilized two packed RBC's whereas 20.2% utilized only one for blood transfusion during procedure. The remainder 54.1% of non-utilized blood were returned to the blood bank within 48 hours. Logistic regression and machine learning algorithm unveiled similar significant predictors to predict the requirement of blood transfusion pre-operatively. There are 24 significant predictors identified from the highest accuracy algorithm which is Random Forest (99.78%), as compared to others machine learning approaches particularly the Decision Tree 79.55%, Logistic Regression 85.25, KNN 75.35%, Naïve Bayes 79.76%, and Gradient Boosted Tree 83.32%. <h3>Discussion</h3> A clinical predictive model was developed for preoperative risk stratification of patients requiring blood transfusion and to further assist clinicians for better utilization of blood bank resources. Variables significantly associated with blood transfusion were female gender, EF<50%, BMI<30, age>40 serum creatinine>100mmol/L, and previous cardiac procedures. This tool may prospectively optimize the ordering of blood with the potential to reduce adverse events and costs related to transfusion in the future. However, for the consideration to supply only one packed RBC in retrospect to patients who do not require transfusion, more data and predictors should be added in this study.

MM-385: Carfilzomib-Lenalidomide-Dexamethasone in the Management of Lenalidomide-Refractory Multiple Myeloma

Background Carfilzomib is an epoxyketone proteasome inhibitor of second generation, proved to be effective and safe in relapsed and refractory Multiple Myeloma (rrMM), in combination with dexamethasone or lenalidomide and dexamethasone. Aims In this retrospective observational trial, it has been evaluated efficacy and safety of carfilzomib, in combination with lenalidomide-dexamethasone (KRD) as salvage regimen in patients with rrMM, refractory to lenalidomide, where lenalidomide-based regimens have no proven efficacy. Methods 41 patients (23 M/18 F), with rrMM, median age at diagnosis 63.7 years (r. 43-82), median age at start of treatment 67 years (r. 48-84) previously treated with several lines of treatments (median 3, r. 2-11), underwent to KRD regimen (ASPIRE trial schedule) for a median treatment cycles of 8 (r 2-18). ISS was equally distributed, and all patients had previously been treated with bortezomib and IMIDs, and were refractory to this agents. 61% (19/31) of them had undergone at least to a single ASCT. Results According to IMWG criteria, after a median follow-up of 9 months (r. 2-18), ORR was 68,2% (28/41: 9 CR, 12 VGPR, 7 PR) with 5 progressive diseases (PD) and 8 patients in stable disease (SD): this can be considered as an impressive result in this subset of rrMM patients, refractory to lenalidomide. In particular, for 11 patients, KRD was, after having achieved at least a PR, a bridge to second/third autologous SCT. Median time to response was 1.3 months (r.1-4), median OS from diagnosis was 62 months (r. 9-170), median OS from start of Carfilzomib was 11 months (r. 2-18). Carfilzomib was well tolerated, with grade 2 anemia in 39%(16/41) of patients, successfully managed by ESAs, without necessity of blood transfusions; 29% (12/41) grade 3-4 neutropenia (pegfilgrastim in primary prophylaxis was given, no ospedalization was required, no septic shocks were observed); 34% (14/41) grade 2, 21% (9/41) grade 3 and 12% (5/41) grade 4 thrombocytopenia, without hemorrhagic events and transfusion-dependency. Moreover, it was observed pneumonia in 39% (16/41) of patients, treated by common antibiotic drugs and always solved. A cardiac monitoring was performed for all patients: hypertension (grade 2-3) in 34% (14/41) of patients; fatigue in 39% (16/31) of patients. Conclusions Carfilzomib-Lenalidomide-Dexamethasone has shown significant efficacy in a particularly severe setting of patients, relapsed and refractory to all available therapeutic resources, also lenalidomide, and it could be considered as a bridge to a second autologous or allogenic SCT. Disclosures Lucchesi: Incyte: Honoraria; Novartis: Honoraria; Pfizer: Honoraria. Martinelli: Amgen: Consultancy; Celgene: Consultancy, Speakers Bureau; Jazz: Consultancy; Incyte: Consultancy; Pfizer: Consultancy, Research Funding, Speakers Bureau; Roche: Consultancy; Daichii Sankyo: Consultancy, Research Funding; AbbVie: Consultancy, Research Funding; Janssen: Consultancy.

Evaluation of the potential complications of surgical wound drainage in primary total hip arthroplasty: a prospective controlled double-blind study.

The routine use of postoperative wound drainage following total hip arthroplasty (THA) to avoid the creation of excessive haematomas is controversial because of the potential risk of blood loss and wound infection. In a prospective double-blind controlled study, 2 groups of patients with hip joint osteoarthritis were operated with primary THA, 1 with surgical wound negative pressure drainage (Group 1 - 635 patients) and the other without (Group 2 - 527 patients). Postoperative blood haemoglobin and haematocrit levels, the necessity for blood transfusion, values of the potential infection markers (serum C-reactive protein values and erythrocyte sedimentation rate), postoperative pain level (according to the VAS scale) and functional outcome (according to Harris Hip Score [HHS] and SF-36 scores) at 12 months postoperatively were compared. A significantly higher drop in blood haemoglobin and haematocrit values was observed in the Group 1 patients (mean drop of 2.2 gr/dl ± 0.25 vs. 1.6 gr/dl ± 0.35 and mean drop of 16% ± 4.0 vs. 11% ± 3.0, respectively, p < 0.01, paired t test). The need for blood transfusion was significantly higher in the Group 1 patients (4.9% vs. 3.9%, p < 0.05, t test). The severity of pain (VAS scale) on the first day after the operation was significantly lower in the Group 1 patients (p < 0.05, t test), but overall, in both groups it was of low intensity (VAS <3). A similar postoperative wound infection rate was observed in both groups (0.4%). HHS and SF-36 scores were similar in both groups. The drainage of surgical wounds following primary THA due to hip osteoarthritis has a low added value and might cause an increased requirement for blood transfusion.

Peri-Operative Factors Affecting Blood Transfusion Requirements During PCNL: A Retrospective Non-Randomized Study.

BackgroundPercutaneous nephrolithotomy (PCNL) is accepted as the gold standard of care for the treatment of large renal calculi. Kidney hemorrhage, which requires blood transfusion, is one of the most common complications after percutaneous kidney stone surgery.ObjectiveTo evaluate perioperative factors associated with transfusion requirements during PCNL.Materials and MethodsA total of 226 patients with kidney calculi undergoing PCNL between January 2011 and December 2019 were reviewed retrospectively. We analyzed the impact of perioperative clinical factors on the necessity of blood transfusion during PCNL.ResultsThe overall blood transfusion rate was 9.29%. Multiple perioperative determinants were significantly correlated with the application of packed red blood cells (PRCs), including larger stone size (p = 0.006), multiple tract punctures (p = 0.029), presence of staghorn calculi (p = 0.026), and long operative time (OT; p = 0.017). Multivariate analysis demonstrated that only multiple tract punctures independently affected blood transfusion requirements during PCNL (p = 0.038).ConclusionIn accordance with the present study, only the multiple tract punctures were associated with blood transfusion requirements in PCNL.

Ectopic Cervical Pregnancy: Treatment Route.

Background and objectives: Cervical pregnancy (CP) is a rare form of ectopic pregnancy (EP) in which the embryo implants and grows inside the endocervical canal. Early diagnosis is essential in order to allow conservative medical and surgical treatments. Although many treatment approaches are disponible, the most effective is still unclear. The aim of this study is to evaluate the efficacy of hysteroscopic management in early CP in order to preserve future fertility. Materials and Methods: This is a retrospective observational case series. Five patients with a diagnosis of CP, hemodynamically stables and managed conservatively between 2014 and 2019 at the Institute of Child and Maternal Health Burlo Garofolo in Trieste, Italy, were included. Four patients, with βhCG levels > 5000 mUi/mL were managed by hysteroscopy, with or without a previous systemic Methotrexate (MTX). One case with βhCG levels < 5000 mUi/mL was treated using MTX combined to Mifepristone and Misoprostol. Results: In one patient treated by hysteroscopy alone it occurred a profuse vaginal bleeding with necessity for blood transfusion. Haemorrhage was controlled by a second hysteroscopic procedure. No complications, such as vaginal bleeding, were recorded in the other cases. Serum β-hCG levels become undetectable in a range of 15–40 days after hysteroscopic management; after medical treatment it become undetectable after 35 days. Serum βhCG levels had a faster drop the day after hysteroscopy than post medical management. The onset of a spontaneous pregnancy at the normal implantation site occurred after five months in one case treated by hysteroscopy. Conclusions: Many therapeutic approaches are effective for CP treatment. Hysteroscopy, alone or in combination with MTX, may provide a greater effect on the descent of βhCG, leading to a reduction of the hospitalization stay, decreasing costs and period for attempt pregnancy. Further prospective studies on larger samples are needed to define therapeutic protocols for CP management.

Effect of gestational thrombocytopenia on negative fetal and maternal outcomes in low-risk pregnancies

Objective: Thrombocytopenia, expressed as platelet counts lower than 150 × 10 9 /L, is a common hematological anomaly seen in 6.6% of the pregnancies. Incidental thrombocytopenia of the pregnancy, commonly referred to as gestational thrombocytopenia, accounts for 70%–80% of cases. This study aimed to elucidate the effect of gestational thrombocytopenia on negative fetal and maternal results in low-risk pregnancies. Method: The patients were divided into two groups. The control group ( n = 240) consisted of healthy pregnant women with normal platelet count, and the study group ( n = 80) consisted of pregnant women with gestational thrombocytopenia. Results: Maternal age, pre-pregnancy body mass indexes, parity, and previous cesarean history rates were similar in both groups. Gestational age during delivery, fetal weight, delivery induction, amniotic fluid stained with meconium, hyperbilirubinemia, admission to neonatal intensive care unit, transient tachypnea of the newborn , respiratory distress syndrome, hypoxic–ischemic encephalopathy, necrotizing enterocolitis, intraventricular hemorrhage, and 5-min Apgar scores of <7 were not different between the groups ( P = 0.056, P = 0.233, P = 0.582, P = 0.798, P = 0.711, P = 0.859, P = 0.634, P = 1, P = 1, P = 1, P = 1,and P = 1, respectively). Spontaneous vaginal delivery, necessity for emergency cesarean delivery, postpartum hemorrhage , abnormal hemorrhage during cesarean , necessity for blood transfusion, and postpartum hysterectomy rates did not differ between the groups ( P = 0.530, P = 0.752, P <0.001, P <0.001, P = 0.758, P = 1, P = 1,and P = 1, respectively) . Despite being within normal limits, discharge time after C/S and spontaneous vaginal delivery was longer in the gestational thrombocytopenia group than in the control group. Conclusions: The results of the study showed that gestational thrombocytopenia did not pose a risk for both the mother and the fetus in low-risk pregnancies.