Need For Blood Transfusion Research Articles

The Effect of Preeclampsia on Adverse Maternal Outcomes in Women With Placental Abruption at a Large Urban Hospital in Tennessee From 2019 to 2022 [ID 2683655

INTRODUCTION: Placental abruption is associated with increased pregnancy-related morbidity and mortality. Few studies have explored the effect of individual risk factors for placental abruption on outcomes. Our study evaluates the association of preeclampsia and maternal morbidity in patients with placental abruption. METHODS: We conducted a retrospective case–control study to evaluate the association of preeclampsia with adverse maternal outcomes in the setting of placental abruption. Univariate analyses were used to determine the relationship between preeclampsia and known adverse maternal outcomes of placental abruption. Multivariate logistic regression was then used to evaluate the relationship between preeclampsia and each significantly associated outcome, adjusting for factors including body mass index, gestational age, mode of delivery, race, trauma, diabetes, placental location, cocaine and tobacco use, prior cesarean sections, year of delivery, and parity. Significance was assessed at an alpha of 0.05. RESULTS: Of 147 singleton pregnancies complicated by placental abruption from 2019 to 2022, 37 (25.2%) were complicated by preeclampsia. No significant differences were found between groups in incidence of acute kidney injury, disseminated intracellular coagulation, cesarean delivery, fetal demise, preterm birth, or low birth weight. On adjusted multivariable regression, we found preeclampsia increased the odds of maternal transfusion requirement (adjusted odds ratio [aOR] 3.55; 95% CI: 1.2, 10.4) and postoperative hospital stay greater than 2 days (aOR 4.05; 95% CI: 1.5, 11.2). CONCLUSION: Preeclampsia was an independent predictor of need for blood transfusion and increased duration of hospital stay in patients with placental abruption. Recognition of preeclampsia as an independent risk factor for these outcomes may allow medical optimization, increased preparedness, and lead to decreased pregnancy-related morbidity.

STONE Score: A Predictor for Need of Blood Transfusion in Percutaneous Nephrolithotomy.

To determine if the STONE score is a predictor of blood transfusion and if patient-related factors, i.e., the presence of comorbidities such as urinary tract infection and obesity, can predict blood transfusion post-percutaneous nephrolithotomy. A cross-sectional descriptive study. Place and Duration of the Study: Department of Urology, The Aga Khan University Hospital, Karachi, Pakistan, between March 2022 and 2023. All patients admitted for percutaneous nephrolithotomy (PNCL) were included in the study. STONE score and patient related factors were assessed. Chi-square or Fisher's exact test was applied to check the association between the dependent variables (blood transfusion) and the independent variables. Logistic regression analysis was applied to compare the variables responsible for the outcome. Results: During the study period, 150 patients underwent PCNL. After exclusion, 89 patients were included in the study. The mean STONE score was 7.87, and the total number of transfusions was 8 (8.9%). BMI (body mass index) >25kg/m2 and STONE score were found to be significant factors predicting the need for transfusion with p-values of 0.02 and 0.03, respectively. On multivariate analysis, only BMI was found to be a significant contributing factor for blood transfusion. High BMI and STONE score are significant predictive factors for blood transfusion post-PCNL. Blood product arrangements should be restricted to obese patients. STONE score, Body mass index, Blood transfusion.

Comparison of the Adjunctive Effect of Tranexamic Acid and Infusion Oxytocin on Blood Loss at Caesarean Section - A Randomised Study

Background: Postpartum haemorrhage is a major complication at caesarean section. Tranexamic acid and oxytocin infusion have been used for prophylaxis. Aim: To compare the effectiveness of prophylactic adjunctive use of Tranexamic acid and oxytocin infusion at caesarean section to reduce blood loss. Method: A randomised study at ABUTH, Zaria, in which 144 women, scheduled for elective or emergency caesarean section at term, were sequentially randomised into two groups of 72 each. The Tranexamic acid group received 1g intravenous and 500ml of Normal saline as placebo while the oxytocin group received placebo and 500ml of Normal saline containing 20IU of oxytocin after delivery of the neonate. Both adjunctive groups received 10IU Oxytocin as part of AMTSL. Trial registry: PACTR 202004568331645. Ethical approval: ABUTHZ/HREC/D37/2018. Result: There was no significant difference in parity, gestational age and indication for caesarean section in both groups p<0.287, 0.270 and 0.095 respectively. There was no significant difference in primary outcome with mean blood loss 561.06 ± 209.23ml versus 567.78 ± 205.91ml in the Tranexamic acid and oxytocin group respectively, p<0.847. Need for additional uterotonic agent and side effect profile were significantly reduced in the Tranexamic acid group. There was no significant difference in need for blood transfusion and haemodynamic status of parturient in both groups. There was no significant difference in mean blood loss at emergency versus elective caeserean section, 565.83± 205.51ml versus 567.97± 217.42ml respectively, p<0.921.Blood loss in those with 1 previous CS was comparable in both groups 537.75± 209.69ml versus 522.05± 176.43ml respectively, p<0.374, however, for those with 2 or more CS, while there was a clinical (reduction) difference of 80ml in the Tranexamic acid group, it was not statistically significant. 594.55± 0.91ml versus 674.06± 1.99ml respectively, p<0.476. Conclusion: There is comparative adjunctive efficacy of Tranexamic acid and oxytocin infusion at caesarean section. Keywords: Caesarean delivery, Oxytocin infusion, Tranexamic acid, Postpartum haemorrhage

Acute Normovolemic Hemodilution (ANH) impacts postoperative coagulation profile and bleeding in Adult Cardiac Surgery

Introduction: The coagulation profile of cardiac surgery patients is impacted by pro-inflammatory effects caused by procedures involving cardiopulmonary bypass. In order to counteract these effects, pharmacological therapies and allogeneic blood transfusions are required. The strategy of Acute normovolemic hemodilution also known as “intraoperative autologous donation” is also a viable option to address these negative effects. The theoretical basis for ANH is that the removed blood of a patient’s own self is shielded from the inflammatory response of blood cells to the bypass circuit. ANH is an infrequently practiced strategy at various cardiac surgery institutes within Pakistan to enhance coagulation profile, decrease the need for blood transfusions despite being an established approach abroad. Aims and Objectives: The objective of our study is to compare the effect of ANH on patients undergoing adult cardiac surgery in a sample group versus a control group with the primary endpoint of postoperative drain output as a measure of effectiveness of blood coagulation profile. Blood coagulation profiles were also compared between the two groups as secondary variables. Place and Duration of study: The study was conducted at the Faisalabad Institute of Cardiology from December 21st, 2023 to February 13th, 2024. Material and Methods: A randomized controlled trial involving 60 patients over the age of 12 years who were to undergo adult cardiac surgery was conducted. An online research randomizer software randomly selected them into two equal groups, sample and control (n=30). The ANH volume retrieved from the patient's central vein in the sample group was used to fill the CPD blood transfusion bags after administering anesthesia. After the patients in both groups were weaned off CPB and protamine administered to neutralize heparin, ANH blood was infused back into the patients in the sample group whereas the control group received allogenic blood only. Chi square test was applied to all qualitative variables and Independent Samples t-test for all quantitative variables. The results were analyzed using SPSS version 25, and a p-value ? 0.05 was considered statistically significant. Results: Hemoglobin (12.9±0.90 g/dL in ANH and 11.8±1.00 g/dL in non-ANH) and aPTT levels (34.2±6.06 seconds in ANH and 54.2±10.95 seconds in non-ANH) were statistically significant (p-value <0.01). In the ANH group, the mean value (623.3±86.28 mL) of postoperative drain output significantly decreased by approximately 220mL compared to the non-ANH group (842.3±99.26 mL) (p-value <0.01). Conclusion: ANH positively conserves most of the coagulation profile parameters. It assists in reducing postoperative bleeding and the volume of allogeneic blood required perioperatively in cardiac surgery.

Feto-Maternal Outcome in Pregnancy With Thrombocytopenia and Abnormal Platelet Indices.

Platelet count and its associated indices like mean platelet volume (MPV) and platelet distribution width (PDW) are cost-effective biomarkers that are easily accessible and have a potent role in the diagnosis and management of thrombocytopenia.Since anaemia and thrombocytopenia often go together in pregnancy, it is advisable to utilise these indices for feto-maternal benefit. The study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care centre in New Delhi from July 2022 to December 2023 whereinpregnant womenof age 18-40 years, period of gestation >28 weeks with thrombocytopenia or abnormal platelet indices were enrolled. Women with pancytopenia, bone marrow suppression or past or current SARS-CoV-2 positive status were excluded. A total of 150 women were enrolled in the study. The mean age of study population was 25.33 ± 2.90 (range 19-34) years. Subjects were divided into three groups - Group A (mild thrombocytopenia) 24.6%, Group B (moderate thrombocytopenia) 64.6% andGroup C (severe thrombocytopenia) 10.6% based on thrombocytopenia severity. Analysing the risk factors, Group C was found to have a significantly higher number of patients with anaemia (p=<0.001), fever (p=0.031), abnormal liquor volumes (p=0.004) and need for blood and platelet transfusion (p=0.077). On correlation of thrombocytopenia with abnormal platelet indices, it was observed that manual platelet count (MPC) and MPV were indirectly correlated (p=0.027). PDW wasfound to be directly associated with severe thrombocytopenia and indirectly associated with moderate thrombocytopenia. Conclusion: Thrombocytopenia in pregnancy is directly correlated to factors like maternal fever and anaemia, fetal growth restriction, abnormal liquor, blood products and platelet transfusions. It was also concluded that platelet indices like PDW and MPV play an important role in predicting the feto-maternal outcome and hence timely interventions can be done to improve the same.

Modified Technique to Protect the Superior Sagittal Sinus in Cranial Vault Reconstruction for Scaphocephaly

AbstractScaphocephaly remains the most prevalent form of isolated single-suture synostosis. In most Pediatric Neurosurgery Centers, the treatment consists of extensive calvarial reshaping operations which are performed in relatively late ages. We described a modified open technique of cranial vault reconstruction for scaphocephaly and we report the anesthetic approach and how it influences our results and enables the performance of this surgery at earlier ages. A total of 47 patients with an average age of 11 ± 2.72 months underwent to the same surgical technique. Blood transfusion during the surgical intervention was needed in 25 patients (53%), and 22 patients (46.8%) did not need blood transfusion. None of the 14 patients who used tranexamic acid (TXA) needed blood transfusions. We reported a statistically significant association between the use of TXA and blood transfusion (p &lt; 0.0001), with a decreased need for blood transfusion with the use of TXA. Besides sagittal suturectomy, we create new parasagittal sutures by replacing the prematurely fused one, and 1.5 cm of the anterior segment of bone of those 2 rectangular structures are cut before fixation, to enable the immediate shortening of the anteroposterior (AP) diameter of the skull. Finally, we put a mesh plate (SonicWeld Rx, KLS Martin Group, Tuttlingen, Baden-Wuerttemberg, Germany) over the superior sagittal sinus (SSS), which is fixed anteriorly and posteriorly with pins (SonicPins Rx, KLS Martin Group). This procedure enables an immediate reduction of the AP diameter of the skull, with no further therapies needed, and promotes a wide decompression and remodeling of the skull. With an experienced surgical team and an anesthesiologic protocol, we were able to perform this surgery at early ages, requiring no blood transfusions.

Comparative effectiveness of combined peri-articular and intra-articular injection versus intravenous and intra-articular injection of tranexamic acid in total knee arthroplasty: a randomized controlled trial study.

Tranexamic acid (TXA) administration is supported by numerous evidence in reducing blood loss after total knee arthroplasty (TKA). The combination of intravenous (IV) and intra-articular (IA) TXA administration revealed good result in blood loss reduction with less evidence of venous thromboembolism event (VTE). Several literature reviews portray that peri-articular (PA) administration yields similar hemostasis in comparison to IV route. However, there is no report on the clinical effect of combining PA + IA TXA in blood loss reduction and its complications, compared to combining IV + IA TXA after TKA. We conducted a double-blind, randomized controlled trial comparing the use of PA + IA TXA administration and IV + IA TXA administration in 70 patients who were scheduled for unilateral primary TKA. Thirty-five patients were assigned for PA + IA injection (Group 1) and anoter 35 patients were assigned for IV + IA injection (Group 2). Primary outcomes included total blood loss at 48h, and the need for blood transfusion. Secondary outcomes included thigh and leg circumference, degree of knee flexion, and postoperative complications. The calculated blood loss at 48h showed no difference between Groups 1 and 2 (617ml vs. 632ml, p = 0.425). The total hemoglobin and hematocrit changes were not different (1.89g/dL vs. 1.97g/dL, p = 0.371 and 5.66% vs. 5.87%, p = 0.391). There was no need for blood transfusion in either group. However, lower thigh swelling was significant in Group 1 (2.15cm vs. 2.79cm, p = 0.04). Leg circumferences at 48h was also lower in Group 1(42.12cm vs. 42.77cm, p = 0.04). There was no significant difference in knee flexion decrease between the two groups (38° vs. 37°, p = 0.425). There were no VTE complications or infections found in either group. Combined PA + IA TXA administration had similar efficacy in blood loss reduction and blood transfusion when compared to combined IV + IA TXA. The first group displayed less soft tissue swelling. The combination of PA + IA TXA administration can be used as an alternative regimen to avoid IV TXA administration.

Combination of a TGF-β ligand trap (RAP-GRL) and TMPRSS6-ASO is superior for correcting β-thalassemia.

A recently approved drug that induces erythroid cell maturation (luspatercept) has been shown to improve anemia and reduce the need for blood transfusion in non-transfusion-dependent as well as transfusion-dependent β-thalassemia (BT) patients. Although these results were predominantly positive, not all the patients showed the expected increase in hemoglobin (Hb) levels or transfusion burden reduction. Additional studies indicated that administration of luspatercept in transfusion-dependent BT was associated with increased erythropoietic markers, decreased hepcidin levels, and increased liver iron content. Altogether, these studies suggest that luspatercept may necessitate additional drugs for improved erythroid and iron management. As luspatercept does not appear to directly affect iron metabolism, we hypothesized that TMPRSS6-ASO could improve iron parameters and iron overload when co-administered with luspatercept. We used an agent analogous to murine luspatercept (RAP-GRL) and another novel therapeutic, IONIS TMPRSS6-LRx (TMPRSS6-ASO), a hepcidin inducer, to treat non-transfusion-dependent BT-intermedia mice. Our study shows that RAP-GRL alone improved red blood cell (RBC) production, with no or limited effect on splenomegaly and iron parameters. In contrast, TMPRSS6-ASO improved RBC measurements, ameliorated splenomegaly, and improved iron overload most effectively. Our results provide pre-clinical support for combining TMPRSS6-ASO and luspatercept in treating BT, as these drugs together show potential for simultaneously improving both erythroid and iron parameters in BT patients.

A Prospective Study to Evaluate the Efficacy of Trenexamic Acid in Addition to Oxytocin for Prevention of Post Partum Hemorrhage

Background: One of the most prevalent causes of maternal mortality worldwide is postpartum hemorrhage which can be prevented by early prompt action. Active control of the third stage of labor is one such intervention that is strongly recommended.Methods: Prospective, randomized, comparative study conducted in Department of Obgyn in MY Hospital, Indore, with comparative groups of 500 each. One group received oxytocin alone and other group received oxytocin and trenexamic acid both.Results: The mean age in group I was 23.73 ± 3.53 years and in group II it was 23.83 ± 3.34 years, showing a comparable mean age between the two groups. The incidence of anemia was 9.6%, PPH was 6.0% and hemorrhagic shock was 0.6% in group I and in group II it was 8.0, 5.4 and 0.8%, respectively. The incidence of anemia and postpartum hemorrhage was higher in group I in comparison to group II. The mean blood loss in group I was 257.04 ± 139.17 mL, while in group II it was 242.60 ± 120.89 mL, showing a significantly lower blood loss in group II in comparison to the group I shows that trenexamic acid shows decrease and blood loss and anemia and occurance of PPH.Conclusions: Analysis concluded that tranexamic acid tended to minimize blood loss and the need for blood transfusions during childbirth during caesarean sections and vaginal deliveries and appeared safe and efficient for prevention and control of bleeding during pregnancy.

A retrospective cohort study: evaluating the efficacy of standard versus tubeless percutaneous nephrolithotomy (PCNL) in pediatric patients up to 18 years old.

Percutaneous nephrolithotomy (PCNL) is an endourological method applied as the standard or tubeless method for kidney stone treatment. In a retrospective cohort study, 88 surgery units involving 75 children up to 18years old with kidney stones who underwent the surgery for 8years in Shahid Beheshti and Boo-ali hospitals in Hamadan with one of the two methods of standard or tubeless PCNL were evaluated and compared considering the success rate of operation, hemoglobin, hematocrit drop, need for medications, need for blood transfusion, duration of surgery, and the length of hospital stay. Among the 88 units studied, 47 cases were operated with the standard PCNL and 41 cases by tubeless method. In children operated by standard and tubeless PCNL, the complete success rate of operation was 87.2% and 100% (P = 0.006), the need for blood transfusion was 2.1% and 0% (P = 1.00), the need for opioids was 27.7% and 14.6% (P = 0.134), the decrease in hemoglobin was -1.82 ± 0.94 and -1.30 ± 0.98mg/dl (P = 0.024), the decrease in hematocrit was -5.40 ± 2.66 and -3.52 ± 3.11mg/dL (P = 0.003), the mean surgery duration was 109.30 ± 53.27 and 101.46 ± 31.92min (P = 0.414), the duration of postoperative hospitalization was 3.38 ± 1.76 and 2.46 ± 1.27days (P = 0.007), and the frequency of fever was 23.4% and 7.3% (P = 0.04), respectively. The success rate of kidney stone surgery in children with the tubeless PCNL is higher than the standard method, and its complications are lower.

Safety and efficacy of thalidomide in treatment of gastrointestinal bleeding secondary to angioectasias: a systematic review and meta-analysis

Background Thalidomide has been used for angioectasia-associated refractory gastrointestinal bleeding (GIB), with studies showing variable efficacy and side effects profile. We conducted a meta-analysis to reconcile the data. Methods Online databases were searched for studies evaluating thalidomide in patients with refractory/recurrent GIB due to angioectasias. The outcomes of interest were cessation of bleeding, rebleeding, need for blood transfusion, hospitalization and adverse events. Pooled proportions for incidence, and odds ratios (OR) for comparison with control were calculated along with 95% confidence interval (CI). Results A total of seven studies with 346 patients (n = 269 thalidomide, n = 77 control) were included. Thalidomide dose was usually started at 50–100mg/day. The mean age was 65 years, 45% patients were men, and mean follow-up was 1.8 years. The pooled clinical outcomes with thalidomide were: cessation of bleeding 42.2% (95% CI 36.02 to 48.41), rebleeding 30%, need for blood transfusion 20.1%, hospitalization 40% and adverse events 55.9%. When compared with the control group in 2 studies, patients on thalidomide had significantly higher odds of cessation of bleeding (OR 21.40, 95% CI 5.78 to 79.29, p < 0.00001) and adverse events, with lower need for blood transfusion and hospitalization. Discussion In patients with angioectasias-related refractory/recurrent GIB, the use of thalidomide results in significantly decreased bleeding risk and may play a role in the management of such patients.

120 Venous Thromboembolism Prophylaxis in Burn Patients

Abstract Introduction Venous thromboembolism (VTE) is extensively studied in trauma patients, but burn patients require special consideration due to their unique pathophysiology and management strategies. Currently, there are no specific prophylaxis recommendations to help mitigate VTE in burn patients. Methods The US National Trauma Data Bank (NTDB) was analyzed to identify patients with burn encounters from 2017-2021 using ICD-10 event codes. Our primary outcome measure was incidence of VTE, which included deep venous thrombosis and pulmonary embolism. Secondary outcome measures included need for blood transfusion and need to return to the operating room due to hemorrhage from skin/soft tissues/extremities. Multivariable regressions were conducted to evaluate the relationship between various VTE prophylaxis types and timing of VTE prophylaxis and VTE incidence while controlling for age, sex, %TBSA and inhalation injury. Results A total of 326,614 patients with burn injuries were identified in the NTDB during the study period, of whom 5,604 (1.7%) had a VTE event during their hospital admission. The majority of patients did not receive VTE prophylaxis (54.1%). Of those that did, the most commonly used VTE prophylaxis was LMWH (37.9%), followed by unfractionated heparin (4.1%). When controlling for age, sex, inhalation injury, and %TBSA, unfractionated heparin and LMWH were significantly associated with an increased risk of VTE (heparin: OR=1.8 95% CI 1.3-2.5, p &amp;lt; .001; LMWH: OR=1.5 95% CI 1.2-1.8, p &amp;lt; .001). Longer time to VTE prophylaxis was significantly associated with increased odds of VTE when controlling for the same covariates (OR=1.04 95% CI 1.03=1.07, p &amp;lt; .001). Neither VTE prophylaxis type nor timing of VTE prophylaxis administration was significantly associated with an increased need for blood transfusion. Heparin was the only VTE prophylaxis type significantly associated with increased odds of returning to the OR for a bleeding-related complication (p &amp;lt; .001). Conclusions A majority of burn patients in the NTDB did not receive VTE chemoprophylaxis, and counterintuitively, patients who received VTE chemoprophylaxis had higher rates of VTE than patients who did not, despite controlling for known VTE risk factors. In patients who did get chemoprophylaxis, unfractionated heparin is associated with a higher rate of VTE and surgical bleeding complications when compared with LMWH. Delayed initiation of VTE prophylaxis correlates with a higher likelihood of VTE occurrence. These findings underscore the importance of better studying and developing specialized VTE prevention guidelines for burn patients to enhance their care and outcomes. Applicability of Research to Practice Prompt initiation of VTE prophylaxis is essential to reduce the risk of VTE among burn patients, highlighting the importance of timely interventions. Developing specialized VTE prevention guidelines for this population can enhance their care and outcomes.

Perioperative Transfusion and Mortality for Cardiovascular Surgery: A Cohort Study Based on Population in Republic of Korea.

Objective:This study aimed to evaluate the rate of transfusion for cardiovascular surgeries between 2010 and 2019 in Republic of Korea and the association between blood transfusion and postoperative mortality. Methods: Data were extracted from the National Health Insurance Service database in Republic of Korea. This study includes adult patients who underwent cardiovascular surgery between 1 January 2010 and 31 December 2019. The endpoints were in-hospital mortality and the 1-year all-cause mortality. Results: The analysis included 62,794 cases, with transfusions used in 88.8% of cases. Multivariable logistic regression revealed that older age, comorbidities, hospital admission through the emergency room, aortic procedures (versus coronary artery bypass grafting), cardiopulmonary bypass, repeat procedures, and supportive therapies during the intensive care (extracorporeal membrane oxygenation and mechanical ventilation) were risk factors for blood transfusion. Female sex was associated with a lower risk of transfusion. Perioperative blood transfusion was associated with a 6.87-fold increased risk of in-hospital mortality (odds ratio [OR]: 6.87, 95% confidence interval [CI]: 3.95, 11.93; p < 0.001) and a 3.20-fold increased risk of 1-year all-cause mortality (OR: 3.35, 95% CI: 2.75, 3.93; p < 0.001). Conclusions: Blood transfusion is used at a high rate in cardiovascular surgeries, and it was associated with increases in the risk of in-hospital and 1-year all-cause mortality. However, these correlations should be viewed with caution as emergent phenomena rather than causative. Understanding factors associated with the need for blood transfusion can assist surgeons in predicting the outcomes of cardiovascular surgery and in tailoring procedures as needed to optimize outcomes.

Micronutrients supplementation and the outcome in preterm neonates in a tertiary health centre

Approximately 15 mil[1]lion babies are born preterm each year.1 Preterm infants commonly experience postnatal growth failure due to insufficient intake of micro[1]nutrients. We aim to determine the outcome of preterm neonates that received micronutrients. Methods: The study subjects com[1]prised of 210 preterm neonates admitted to (SCBU) of Federal Medical Centre, Brinin kebbi, Kebbi State from 1st June 2020 to 30st May, 2022. The subjects were randomized into two groups; 100 preterm neonates (Study group) received micronutrients (Reload; Reload Brands, LLC, Salt Lake City, Utah, USA) while, 110 preterm neonates (Control group) did not receive micronutrients. Biodata and other important information were obtained. All the babies (210) received the usual treatment protocol of preterm admitted to our SCBU. Ethical ap[1]proval was obtained from the Research and Ethics Committee. Results: Birth weights of the 210 neonates ranged from 800grams to the highest 2500grams with mean CC –BY 4.0 birth weight of 1.54kg ±0.95. Av[1]erage daily weight gains in 71% of the study subjects ranged from 25grams to a maximum of 29 grams per day while, in the non- micronutrients group, 54% had daily weight gain range of 10- 14grams per day (p = 0.001). Twelve (12%) of the Micronutrient group (MG) and 30% 0f the Non-Micronutrient group (NMG) had need for blood transfusion respectively (p = 0.002). The average ho sp ital stay wa s 22.95±9.68; hospital stay for the MG was 8 to 21 days while that of the NMG was 22 to 42 days (p = 0.001). C o n c l u s i o n s : M i c r o n u t r i - ents intake were in consistent with optimal weight gain, shorter hospital stay and lower need for blood transfusion in preterm newborns. Recommendations: We recommend early commencement of mi c r o n u t r i e n t s u p p leme n t (Reloads) in preterm babies.

EVALUATING THE BLOOD-SPARING EFFICACY AND SAFETY OF TRANEXAMIC ACID IN TOTAL KNEE ARTHROPLASTY

Objectives: Tranexamic acid (TXA) is an antifibrinolytic agent that effectively reduces bleeding both during and after surgery. The purpose of our study was to assess the effectiveness and safety of TXA use in reducing blood loss in uncomplicated primary total knee arthroplasty (TKA) without complications. Methods: This is a prospective, open-label, comparative study that includes patients who are undergoing unilateral primary TKA. The patients were divided into two groups: Group I, which is a control group, did not receive any doses of TXA, and Group II received three doses of intravenous TXA: 15 mg/kg TXA was administered 30 min before incision, followed by post-operative doses of 10 mg/kg TXA at 3 and 6 h. The primary objectives of the study were to measure the total blood loss (TBL) and Hemoglobin (Hb) drop, which were calculated preoperatively and on the third post-operative day. The secondary objectives were to determine transfusion rates, incidences of symptomatic deep vein thrombosis, and thromboembolic events (TE). Results: In this study, a total of 57 patients underwent unilateral TKA. The TBL in Group I was 861.67±167.65 mL, compared to 780.05±158.05 mL in Group II (p&lt;0.001). The study also found that the Hb drop was significantly lower (2.78±0.36 vs. 2.3±0.37) with IV TXA. Furthermore, neither group required transfusions, nor were any thromboembolic complications noted for up to 6 months post-operation. Conclusion: Our study supports the use of TXA in TKA, as it effectively reduces perioperative blood loss, decreases the need for blood transfusions, and does not increase the risk of TE.

Tranexamic acid reduces intraoperative red blood cell transfusion rates in craniosynostosis surgery: a 6-year retrospective analysis

Surgery for craniosynostosis in children is associated with substantial intraoperative bleeding and the need for blood transfusions. Recent studies have supported the efficacy of tranexamic acid (TXA) in reducing blood loss and transfusion requirements. The records of 72 patients under 18 months of age who had undergone 113 surgeries for non-syndromic craniosynostosis in a single institution for 6 years were retrospectively analyzed. The transfusion requirements in infants with and without TXA administration were compared. The concept of patient blood management before and after TXA implementation in practice was also examined. The rate of intraoperative packed red blood cells (PRBC) transfusion was significantly lower in the TXA than in the non-TXA group (26.7% vs. 83%, p < 0.001). The volume of intraoperatively transfused PRBC was also lower in the TXA group compared to the non-TXA group (mean 68.25 mL vs. 101.91 mL, p < 0.001), as was the weight-adjusted volume (mean 11.2 mL/kg vs. 15 mL/kg, p = 0.002). There were no significant differences in the rate and volumes of postoperative PRBC transfusion between groups. The volume of intraoperatively transfused PRBC was dependent on TXA administration, but not on the affected suture and type of intervention. We found that while in the pre-TXA period all patients were transfused intraoperatively, the frequency of intraoperative transfusions in the post-TXA period was reduced by 40.9% even in the patients who had not received TXA. TXA seems to effectively reduce the intraoperative transfusion requirements in children undergoing craniosynostosis surgery. The optimal blood management in this patient population remains to be further evaluated.

No Difference in Clinical and Hospital Quality Outcomes in Treatment of Reverse Obliquity Intertrochanteric Hip Fractures (AO/OTA 31.A3) Based on Cephalomedullary Nail Length

IntroductionThe purpose of this study was to evaluate outcomes following reverse obliquity (RO) intertrochanteric hip fractures based on the use of short cephalomedullary nails (CMNs) compared to long CMNs for fixation. MethodsAn IRB-approved prospectively collected hip fracture registry at an urban academic medical center was queried for all AO/OTA 31A3.1-3 reverse obliquity intertrochanteric (RO) fractures. One hundred and seventy patients with age > 55 years old and minimum 6-month follow-up were identified for analysis. Data was collected for patient demographics, injury details, intraoperative radiographic parameters, perioperative physiologic parameters, hospital quality measures, and outcomes including radiographic time to healing, need for reoperation, nonunion, and mortality. Comparative analyses were conducted between cohorts. Additional multivariable binary logistic and linear regression analyses were performed to evaluate for factors independently associated with short and long nail usage. ResultsThe mean age of the entire cohort was 80.91±10.09 years: 103 patients had a long CMN implanted, and 67 patients had a short CMN implanted. There were no demographic differences or differences in radiographic time to healing, rates of mortality, readmission, nonunion, and need for reoperation. Univariable analysis revealed that short CMN had lower intraoperative blood loss (111.19±83.97mL vs 176.72±161.45mL, p=0.002), decreased need for transfusion (37% vs. 55%, p=0.022), and shorter procedures (118.67±57.87min vs. 148.95±77.83min, p=0.002. Multivariable analysis revealed that short nail usage was associated with decreased intraoperative blood loss, decreased need for transfusion, and shorter operative times. ConclusionNail length does not affect healing or hospital quality outcomes in the treatment of RO hip fractures. The use of short CMNs for these fractures did correlate with lower intraoperative blood loss, operative time, and need for blood transfusion, with non-inferior outcomes and similar hospital quality measures when compared to long CMNs.

Aetiology and predictors of major bleeding events in patients with heart failure with reduced ejection fraction undergoing percutaneous coronary intervention

ObjectivesWe sought to determine the relationship between the degree of left ventricular ejection fraction (LVEF) impairment and the frequency and type of bleeding events after percutaneous coronary intervention (PCI).DesignThis was...

Tranexamic Acid and Tourniquet: Which Combination Reduces Blood Loss Most Effectively?

Blood loss during and after total knee arthroplasty (TKA) can lead to substantial morbidity and the need for blood transfusions. There are several methods to minimize blood loss and decrease transfusion rates in patients undergoing TKA. Tranexamic acid, an antifibrinolytic agent with known efficacy for achieving these goals, is combined with tourniquets to reduce bleeding in arthroplasty surgeries. Our study investigated the effects of various combinations of tranexamic acid and tourniquet use on bleeding in knee arthroplasty in 558 patients. We aimed to determine the method that would provide the least blood loss and transfusion need in knee arthroplasty surgery. Between January 2018 and December 2022, 558 patients aged between 55 and 85 years underwent TKA surgery for grade 4 gonarthrosis in our clinic, and their decrease in hemoglobin value and whether they were transfused or not were analyzed. The patients were divided into four groups based on use of tranexamic acid and tourniquet. Demographic variables and patient data (body mass index, INR values, and preoperative hemoglobin values) were recorded. There were 558 patients with a mean age of 68.19 (67 ± 6.949) years. In group 1, tranexamic acid was not used in 128 patients and tourniquet was used only during cementation; in group 2, in 132 patients, tranexamic acid was not used and tourniquet was used throughout the surgery; in group 3, in 158 patients, tranexamic acid was used and tourniquet was used throughout the surgery; in group 4, in 140 patients, tranexamic acid was used and tourniquet was used only during cementation. The decrease in hemoglobin value and transfusion rate was lowest in group 3 and highest in group 1. Besides, there was a greater decrease in hemoglobin value in group 2 than in group 4 and the transfusion rate was similar. This clinical study showed that using tranexamic acid and a tourniquet throughout surgery significantly reduced the decrease in hemoglobin value and the need for transfusion.

219 A Proposed Technique for Early Venous Sacrifice as an Alternative to Standard Yasargil Technique for Resection of Cerebral AVM's

INTRODUCTION: This study introduces an alternative technique to the standard Yasargil resection of AVMs. METHODS: This 20-year prospective observational study compared the outcomes of 510 consecutive patients undergoing resection of AVM using either the early venous sacrifice technique (test group, n = 206) or a historical control group who underwent AVM resection using standard technique (Yasargil Technique, n = 304). RESULTS: The test group had significantly more Grade II (35% vs 30.3%) and Grade III (45.1% vs 38.8%) AVMs, while the control group had significantly more Grade I (40.4% vs 7.8%) AVMs. There was no difference in the number of Grade IV or Grade V AVMs. Overall, the test group presented with higher grade AVMs than the control group. Outcomes analyzed included post-operative stroke (CVA), death, modified Rankin Scale (mRS) score, need for blood transfusion, and incomplete obliteration of the AVM. Patients in the test group were 58% less likely to require blood transfusion compared to control (5.8% vs 13.8%, 58% RRR, NNT = 12.5, p = 0.004). Although not statistically significant, there was a trend toward reduced risk of CVA (RRR = 26%), post-operative mRS = 3 (RRR = 30%), and death (RRR = 51%) in the test group relative to the traditional Yasargil technique. CONCLUSIONS: In the proposed technique the number of patients requiring blood transfusions was reduced by 1 for every 12.5 patients treated with the standard technique. The number of patients experiencing poor mRS (&gt;3) was reduced by 1 for every 48.7 patients treated. The number of patients experiencing post- operative CVA was reduced by 1 for every 58 patients treated.