Neonatal Blood Transfusion Research Articles

Transfusion rates and disease spectrum in neonates treated with blood transfusion in China.

This study aimed to investigate blood transfusion rates and spectrum of diseases in hospitalized neonates treated with blood transfusion in China to provide supporting data for future studies on neonatal blood transfusion.Data on hospitalized neonates were obtained from more than 100 experts from the Department of Neonatology of 55 hospitals in China between January 1, 2012 and December 31, 2016, using a standardized survey. A statistical analysis was conducted to evaluate the data collected, including the blood transfusion rates, blood component transfused, spectrum of diseases, and spectrum of major diseases.Between 2012 and 2016, 541,128 neonates were hospitalized in the 55 hospitals surveyed. There were 70,433 neonates who received blood transfusion, with an average transfusion rate of 13.02%. The rates of red blood cell transfusion, platelet transfusion, and plasma transfusion were 9.44%, 0.66%, and 4.77%, respectively. The neonatal blood transfusion rate was 17.99% in Northeast China, 9.74% in Northwest China, and between 10.60% and 16.22% in other regions. The neonatal blood transfusion rate was 12.3% in general hospitals and 13.8% in women and children's hospitals. The top 10 diseases identified in hospitalized neonates treated by blood transfusion were, in rank order, as follows:prematurity,pneumonia, hyperbilirubinemia, bacterial sepsis, respiratory distress syndrome, anemia, hemolytic disease, asphyxia, hemorrhage, and necrotizing enterocolitis.The neonatal blood transfusion rate in China is 13.03%.The rank order in the disease spectrum of the hospitalized neonates and that in hospitalized neonates treated with blood transfusion are different.

Are there gender-specific differences in pregnancy outcome and placental abnormalities of pregnancies complicated with small for gestational age?

Adaptations to pathological intrauterine environment might differ in relation to fetal gender. We aimed to study sex-specific differences in placental pathology of pregnancies complicated by small for gestational age (SGA). The medical records and placental histology reports of all neonates with a birth-weight ≤ 10th percentile, born between 24 and 42weeks of gestation, during 2010-2018, were reviewed. Composite neonatal outcome was defined as one or more of early following complications: neonatal sepsis, blood transfusion, phototherapy, respiratory morbidity, cerebral morbidity, necrotizing enterocolitis, or death. Results were compared between the male and female groups of neonates. Placental lesions were classified into maternal and fetal vascular malperfusion (MVM and FVM) lesions, maternal and fetal inflammatory responses (MIR and FIR), and villitis of unknown etiology (VUE). The male SGA group (n = 380) and the female SGA group (n = 363) did not differ in regard to maternal age, BMI, smoking, associated pregnancy complications, gestational age, and mode of delivery. Neonates in the SGA male group had increased birth-weight and increased respiratory morbidity as compared to the female SGA group (p = 0.007, p = 0.005, respectively). There was no between-group differences in the rate of placental lesions. By multivariate logistic regression analysis, male gender (aOR 1.55, 95% CI 1.05-2.30, p = 0.025), FIR (aOR 4.83, 95% CI 1.07-13.66, p = 0.003), and VUE (aOR 1.89, 95% CI 1.03-3.47, p = 0.04), were found to be independently associated with adverse composite neonatal outcome. Male gender as well as placental FIR and VUE are independently associated with adverse neonatal outcome in SGA neonates.

The association between isolated oligohydramnios at term and placental pathology in correlation with pregnancy outcomes

IntroductionIsolated term oligohydramnios (ITO) is an obstetrical complication of which the etiology, management, and clinical importance are controversial. In attempt to deepen our understanding, we aimed to study placental pathology and pregnancy outcomes in pregnancies complicated by ITO. Materials and methods– Maternal demographics, neonatal outcomes, and placental histopathology reports of all pregnancies complicated by ITO at 370/7 to 410/7 weeks were reviewed. Excluded were cases complicated by hypertensive disorders, intrauterine fetal growth restriction, placental abruption, and deliveries of undiagnosed small for gestational age neonates. Results were compared between the ITO group and a control group matched for gestational age and mode of delivery. Placental lesions were classified according to the current “Amsterdam” criteria. Composite adverse neonatal outcome was defined as one or more of the following early complications: neonatal intensive care unit admission, sepsis, blood transfusion, phototherapy, respiratory morbidity, cerebral morbidity, necrotizing enterocolitis, or death. ResultsThe study group included 108 patients with ITO that were compared to matched controls. Placentas from the ITO group were characterized by higher rates of placental weights <10th centile (p < 0.001), abnormal cord insertion (p < 0.001), and maternal vascular malperfusion (MVM) lesions (p < 0.001). Neonates from the ITO group had lower birth weights (p < 0.002), and worse composite adverse neonatal outcome (p = 0.028) compared to controls. Conclusion– The current study demonstrates higher rates of placental MVM lesions, and worse neonatal outcome in pregnancies complicated by ITO. These novel findings suggest that ITO should be seen as part of the “placental insufficiency” spectrum.

Assement Efficacy and Complication of the Distance between Phototherapy Lamps and Neonate’s Body Level on Serum Bilirubin Decrease and Phototherapy Complications in Neonatal Hyperbilirubinemia

Background: Jaundice is one of the most leading causes of neonate hospitalization (51.8%) during the first four weeks of life, and phototherapy is one of the most common and safest methods for the treatment of jaundice. Different results have been obtained from the studies conducted on the investigation of factors affecting increased phototherapy effect on the reduction of neonatal jaundice. However, there still exist many questions concerning the methods that maximize the effect of phototherapy.The current research aimed to determine the effect of the distance between phototherapy lamps and neonate's body on the reduction of serum bilirubin and phototherapy complications in the neonates with physiologic jaundice.Methods: The study was carried out on 60 newborns with jaundice. The neonates in the intervention group were put under phototherapy within a distance of 20 cm, and the ones in the control group underwent phototherapy within a distance of 40 cm. Daily bilirubin was measured at times 0, 12, and 24, and the neonates were examined in terms of serum bilirubin reduction and phototherapy complications.Results: The obtained results revealed that phototherapy within the distance of 20 cm causes more reduction in the total bilirubin 12 and 24 hours after phototherapy. However, there was no significant difference between bilirubin 48 hours after phototherapy and phototherapy duration and the complications between the two groups.Conclusion: Based on the results, the method of phototherapy distance reduction could be used as a safe and effective way for the quicker reduction of serum bilirubin level, prevention of hyperbilirubinemia complications and complications of blood transfusion in neonates with physiologic jaundice.

Blood transfusion in neonates- An audit study

Abstract Introduction: Audit of blood transfusion practices is essential to monitor appropriate use of blood components. Many of the studies related to audit of blood components are based on adult population. There are very few studies addressing the audit of transfusion practices exclusively in pediatric population. Therefore present study was conducted to perform audit of transfusion practices, in order to study the appropriate and inappropriate usage of blood and its different components in neonatal population. Materials and Methods: This study was carried out in a tertiary care hospital with an FDA approved blood bank for duration of two year. Total 290 neonates from birth to 28 days and who were admitted to the NICU were chosen and data obtained from cross matching, issuing of blood products to successful transfusion and any problems that might arise including but not limited to transfusion reactions. Results: Out of total patients, 104 patients were transfused and 186 were not transfused. The total number of products issued from the blood bank and transfused was: PC transfused was 142 (including 13 whole blood), platelets 126 and FFP 19. The cross match to transfusion ratio was 2.42 and is within target ratio of ?2.5. The appropriateness of transfusions for PC and platelets was 87.5% and 78.9% respectively, is also a significantly higher number which is an indicator of optimum transfusion practice by NICU. Individual laboratory investigations had a statistically significant rise post transfusion. There was only one transfusion reaction reported which was minor allergic, non-hemolytic and non-febrile. Conclusions: Both blood bank and NICU are utilizing the available resources for adequate and timely treatment of patients which leads to demonstrable betterment in the clinical outcome and are following the national and the international guidelines for transfusion. Keywords: Audit, Transfusion, Blood, Neonates, Platelets, Cross match to transfusio

Neonatal Outcomes Associated with Umbilical Cord Milking in Preterm Multiple Gestations.

Our aim was to evaluate the effect of umbilical cord milking on outcomes for preterm multiples. We implemented a policy of cord milking in neonates born at less than 30 weeks' gestation in September 2011. We compared cord milking in multiples with a historical cohort. Multivariable logistic regression models estimated the effect of cord milking on a composite neonatal adverse outcome. Secondary outcomes were hematocrit at birth, need for blood transfusion, and inotrope use. We identified 149 neonates (120 twins, 29 triplets), 51 historical controls, and 98 neonates with cord milking. Cord milking was associated with a lower rate of adverse composite neonatal outcome in univariable analysis (odds ratio [OR]: 0.36; 95% confidence interval [CI]: 0.15-0.84). However, in multivariable modeling, the effect was not significant (adjusted OR [aOR]: 0.54, 95% CI: 0.23-1.28). Hematocrit was 4.6 unit % (95% CI: 2-7.3) higher in the cord milking group, and cord milking was associated with a lower rate of blood transfusion (aOR: 0.28; 95% CI: 0.1-0.74; p = 0.01). There was no difference in inotrope administration. Umbilical cord milking was not associated with a decrease in composite neonatal adverse outcome. However, we observed an increase in hematocrit and decreased need for blood transfusion in neonates with cord milking.

Maternal predictors of blood transfusion among neonates in the Neonatal Intensive Care Unit of Ahmadu Bello University Teaching Hospital Zaria, Nigeria

Background: Maternal health and healthcare accessibility are important determinants of neonatal survival. Pregnancy-related complications may lead to maternal anemia and, maternal micronutrient deficiency, conditions which could result in neonatal anemia necessitating transfusion. Objectives: To determine maternal predictors of neonatal blood transfusion. Methods: We conducted a case–control study on mother–infant pairs of cases and controls. A semi-structured questionnaire was used to collect information. Logistic regression was used on maternal predictors, and the level of significance was set at ≤0.05. Results: The overall mean (±standard deviation) age of mothers in both case and control groups was 21.79 ± 10.71 years, respectively. The likelihood of neonatal transfusion was increased by parity of ≥5 [odds ratio (OR): 3.1, 95% confidence interval (CI) = 1.26–7.39], while age of ≥18 years at first marriage, attainment of at least secondary school, four antenatal care (ANC) visits before delivery, birth interval of ≥2 years, and hematinics use during pregnancy were associated with reduced neonatal blood transfusion (OR: 0.36, 95% CI = 0.14–0.96), (OR: 0.66, 95% CI = 0.32–1.37), (OR: 0.70, 95% CI = 0.25–1.99), (OR: 0.55, 95% CI = 0.19–1.62), and (OR: 0.63, 95% CI = 0.17–2.36), respectively. Conclusion: We found that high parity, teenage mothers, inadequate ANC visits, short birth interval, and hematinics noncompliance during pregnancy were all associated with increased need of blood transfusion among neonates.

Reducing incidence of red cell transfusion among preterm babies in a tertiary care neonatal intensive care unit: A retrospective observational study

Background: Preterm neonates in the neonatal intensive care unit (NICU) receive a greater number of red cell transfusions (RCTs) than any other hospitalized group. Iatrogenic anemia, secondary to blood draws, increases the need for transfusions in preterm neonates. Blood transfusions are related to transfusion reactions and risk of transmitting infection. Objective: This retrospective study was done to find the incidence of RCT in neonates born less than or at 32+0 weeks of gestation and to establish whether requirement of blood transfusions could be further decreased. Methodology: A retrospective study of all intramural births less than or at 32+0 weeks of gestation who were admitted and discharged from the NICU of Fortis La Femme, GK-II, New Delhi, from February 1, 2017, to January 31, 2018, was done, and the data were analyzed by statistical software IBM SPSS Statistics for Windows, Version 21.0. Results: Forty-three babies were studied, of which 16 were female. The mean gestation age was 29.49 ± 2.35 weeks, and the mean birth weight was 1234.93 ± 368.737 grams. Seventeen (39.5%) neonates required RCT during their hospital stay, of which 11 (64.7%), 2 (11.7%), 3 (17.6%), and 1 (5.8%) neonate received 1, 2, 3, and 6 unit of RCT, respectively. The incidence of RCT was significantly higher in babies with sepsis and babies who received surfactant. RCTs were observed to be significantly higher in babies who were managed with invasive methods such as mechanical ventilation and use of peripherally inserted central catheter/central lines for administration of total parenteral nutrition. The number of RCTs required also correlated with the number of ventilated days and days on continuous positive airway pressure. Conclusion: Majority of the neonates born less than or at 32+0 weeks can be managed without the requirement of RCT. A restrictive blood transfusion policy, judicious use of blood investigation, use of microsampling and point of care investigations such as capillary blood gas, early initiation of enteral feeds and iron supplementation, prevention of sepsis, judicious use of venous/arterial lines and noninvasive management protocols has helped reduce blood transfusion in preterm neonates.

Successful outcome birth in full term pregnancy velamentous insertion of the umbilical cord – vasa previa

Disclosure of incident on our successful outcome childbirth in term pregnancy velamentous insertion of the umbilical cord – vasa previa. Pregnant firstborn with free individuals and obstetrical history covering the 39th week of pregnancy is introduced in Maternity Clinic of our with symptomatology of automatic start birth. Sudden and to thoroughly grade vaginal hemorrhage found immediately after technical rupture of fetal membranes accompanied by decelerations of the fetal heartbeat raised the possible diagnosis of velamentous insertion of the umbilical cord – vasa previa and the interest undergone emergency cesarean section. After removal of the fetus and placenta was there synovial adherence cord. The caesarean section was performed smoothly with physiological loss blood. There was no need for blood transfusion in neonates, as well as it did not take neonatal support. Following a smooth postoperative course left together with the postpartum at fifth day of hospitalization. At this paper on the basis of current data a brief literature review of rare disease entities this respect mainly the diagnosis, treatment and prognosis.

Use of autologous umbilical cord blood transfusion in neonates undergoing surgical correction of congenital cardiac defects: A pilot study.

Background:Blood transfusion requirement during neonatal open heart surgeries is universal. Homologous blood transfusion (HBT) in pediatric cardiac surgery is used most commonly for priming of cardiopulmonary bypass (CPB) system and for postoperative transfusion. To avoid the risks associated with HBT in neonates undergoing cardiac surgery, use of autologous umbilical cord blood (AUCB) transfusion has been described. We present our experience with the use of AUCB for neonatal cardiac surgery.Designs and Methods:Consecutive neonates scheduled to undergo cardiac surgery for various cardiac diseases who had a prenatal diagnosis made on the basis of a fetal echocardiography were included in this prospective observational study. After a vaginal delivery or a cesarean section, UCB was collected from the placenta in a 150-mL bag containing 5 mL of citrate–phosphate–dextrose–adenine-1 solution. The collected bag with 70–75 mL cord blood was stored at 2°C–6°C and tested for blood grouping and infections after proper labeling. The neonate's autologous cord blood was used for postcardiac surgery blood transfusion to replace postoperative blood loss.Results:AUCB has been used so far at our institute in 10 neonates undergoing cardiac surgery. The donor exposure in age and type of cardiac surgery-matched controls showed that the neonates not receiving autologous cord blood had a donor exposure to 5 donors (2 packed red blood cells [PRBCs], including 1 for CPB prime and 1 for postoperative loss, 1 fresh frozen plasma, 1 cryoprecipitate, and 1 platelet concentrate) compared to 1 donor for the AUCB neonate (1 PRBC for the CPB prime). Postoperative blood loss was similar in both the groups of matched controls and study group. Values of hemoglobin, total leukocyte count, platelet counts, and blood gas parameters were also similar.Conclusions:Use of AUCB for replacement of postoperative blood loss after neonatal cardiac surgery is feasible and reduces donor exposure to the neonate. Its use, however, requires a prenatal diagnosis of a cardiac defect by fetal echo and adequate logistic and psychological support from involved clinicians and the blood bank.

In Response to "Use of autologous umbilical cord blood transfusion in neonates undergoing surgical correction of congenital cardiac defects: A pilot study".

In Response to "Use of autologous umbilical cord blood transfusion in neonates undergoing surgical correction of congenital cardiac defects: A pilot study".

Transfusion support in preterm neonates &lt;1500 g and/or &lt;32 weeks in a tertiary care center: A descriptive study

BACKGROUND:Lack of recent studies focusing on indications, pattern, and benefits of transfusions in low birth weight (B.Wt) and low gestational age (GA) preterm neonates prompted us to undertake this study.AIM:To estimate the transfusion requirements and outcomes in preterm neonates <1500 g and/or <32 weeks.SETTINGS AND DESIGN:This is a cross-sectional study conducted over a period of 2 years in a tertiary care center.MATERIALS AND METHODS:This study was conducted with 101 preterm neonates <1500 g and/or <32 weeks who received blood transfusions in the Neonatal Intensive Care Unit. Restrictive pattern of transfusion was followed. Demographic details and antenatal, neonatal, laboratory, and transfusion parameters were collected.STATISTICAL ANALYSIS USED:Statistical analyses were performed using SPSS 16.RESULTS:The study participants received 311 transfusions. Transfusion requirements decreased with increasing GA and B.Wt. Majority of blood transfusions occurred during the first 2 weeks of life. Packed red blood cells (PRBCs) were the most frequent blood components transfused. Ninety-six percent of the study population had an uneventful transfusion. Mean hemoglobin improvement after PRBC transfusions was 2.3 ± 2.1 g/dl. Improvement in apnea occurred in 76% PRBC transfusions. Infants with sepsis, patent ductus arteriosus, bronchopulmonary dysplasia, disseminated intravascular coagulation, and dyselectrolytemia received more number of transfusions.CONCLUSION:This study would serve as an audit for neonatal blood transfusion therapy. Close adherence to neonatal transfusion policy and restrictive transfusion guidelines helps reduce inappropriate use of blood products and adverse transfusion reactions.

Preoperative Blood Transfusions in Neonates Are Associated with Increased Postoperative Morbidity and Mortality

Dukleska, Katerina MD; Vinocur, Charles D. MD; Dirnberger, Daniel MD; Berman, Loren MD Author Information

The management of neonatal transfusion therapy: brief introduction of evidence-based recommendations of neonatal transfusion therapy in Italy

Blood transfusion therapy is one of the commonly used intervention in newborn infants.Red blood cell transfusion is the only treatment for most cases of neonatal anemia, but the indications of application and implementation strategy are not yet perfect, and the benefits, adverse outcomes and potential risk of transfusion remains to be evaluated.There are many uncertain problems in transfusion management.This paper mainly introduces the evidence-based recommendations of neonatal blood transfusion released by Italian Society of Transfusion Medicine and Immuno-haematology and Italian Society of Neonatology Working Group for reference of domestic clinicians. Key words: Infant, newborn; Blood transfusion; Management

Experimental Study on Neonatal ABO or RhD Compatible Blood Transfusion

To investigate the safety and effectiveness of neonatal ABO or Rh(D) by using compatible blood transfusion through retrospective analysis of data from cases received compatible blood transfusion and type matched blood transfusion. The clinical data of 26 cases of neonatal compatible blood transfusion in Chinese Nanchang area from January 2014 to October 2016 were collected, and 26 cases of neonatal type-matched blood transfusion were selected according to ratio of 1:1 cases. The efficiency and safety index of 26 patients compatible blood transfusion were compared with that of type-matched blood transfusion. The efficiency indexes included: patients' basic characteristics, red blood cell (RBC) count, hemoglobin (Hb) level, hematocrit (Hct), and the safety indexes contain Hb level and indirect bilirubin (IBiL) value before and after blood transfusion, irregular antibody screening, direct antiglobulin test (DAT) results and the adverse reactions of blood transfusion. The age, sex, days of hospitalization between compatible blood transfusion and type matched blood transfusion were not statistically significantly different (P>0.05). The Hb level before transfusion, blood transfusion volume and the increase of Hb, Hct and RBC were not statistically significantly different between two groups (P>0.05). The values of Hb, Hct and RBC in 2 groups significantly increased at the day 1 after blood transfusion (P<0.05). No blood transfusion adverse reaction occurred in 2 groups. The IBiL value significantly decreased in compatible blood transfusion patients at the day 1 after blood transfusion (P<0.05). No new irregular antibodies had been detected after transfusion in all patients, and the others' DAT and screening for irregular antibodies were negative except 22 patients with neonatal hemolysis. The values of Hb and IBiL statistically significantly differenence were not in 12 patients between 1d, 3d, 7d after blood transfusion (P>0.05). The efficiency and safety between compatible blood transfusion and type matched blood transfusion are the same in neonatal blood transfusion. Compatible blood transfusion is a safe and effective in clinical blood transfusion.

Nurses' knowledge of blood transfusion in neonate.

To analyze nurses' knowledge of blood transfusion in neonates in a neonatal intensive unit care. A descriptive and exploratory qualitative study conducted in two hospitals in the city of Belo Horizonte, Minas Gerais. The participants were 15 nurses who performed their activities in the neonatal intensive unit care, from August to December 2014. Data was subjected to thematic content analysis. The category created was divided into the following sub-categories, namely: nurses' care during blood transfusion: care during blood transfusion monitoring; a different perception of nurses regarding responses to blood transfusion and notification: the essence of care. The identification of nurses' knowledge of blood transfusion, it is possible to promote their capacity for quality and safety of care related to the transfusion process in newborns.

Preeclampsia and the Risk of Bronchopulmonary Dysplasia in Preterm Infants Less Than 32 Weeks' Gestation.

Objective Angiogenesis is essential for normal lung development. The objective of our study was to test the hypothesis that preeclampsia, an antiangiogenic state, is a risk factor for bronchopulmonary dysplasia (BPD). Design Prospective cohort study of infants less than 32 weeks' gestation born to mothers with preeclampsia between January 2007 and June 2010 at a single tertiary care center. Their BPD outcome was compared with infants born to the next two normotensive mothers with a ± 1 week gestational age difference. BPD was defined as oxygen dependency at 36 weeks' postmenstrual age. Multivariable binary regression was used to estimate the risk ratio (RR) of BPD with preeclampsia exposure and adjust for confounders. Results Of 102 infants in the preeclampsia group, 23 (23%) developed BPD and of the 217 infants in the normotensive group, 56 (26%) developed BPD. On multivariable binary regression modeling, preeclampsia was not a risk factor for development of BPD (RR: 0.5, 95% confidence interval [CI]: 0.20-1.20). Surfactant use, Score for Neonatal Acute Physiology Perinatal Extension-II score, sepsis, blood transfusion, and intrauterine growth restriction (IUGR) were significant risk factors for BPD. Conclusion In our cohort, preeclampsia was not a significant risk factor for BPD. IUGR infants of preeclamptic and normotensive mothers were at higher risk for BPD.

A Model Practice Template for Hydrotherapy in Labor and Birth.

A Model Practice Template for Hydrotherapy in Labor and Birth.

Placental histopathology lesions and pregnancy outcome in pregnancies complicated with symptomatic vs. non-symptomatic placenta previa

BackgroundThe mechanisms involved in bleeding in cases of placenta previa (PP) and the effect on pregnancy outcome is unclear. ObjectivesWe aimed to compare pregnancy outcome and placental histopathology in pregnancies complicated with symptomatic (bleeding) vs. non-symptomatic PP, and to study the effects of the co-existence of histopathological retro-placental hemorrhage (RPH) in cases of symptomatic PP on neonatal and maternal outcomes. Study designLabor and maternal characteristics, neonatal outcome and placental histopathology lesions of pregnancies with PP, delivered between 24 and 42weeks, during 2009–2015, were reviewed. Results were compared between PP who had elective cesarean delivery (CD) (previa group) and PP with bleeding necessitating emergent CD (symptomatic previa group). Placental lesions were classified to lesions consistent with maternal malperfusion or fetal thrombo-occlusive disease (vascular and villous changes), and inflammatory lesions. ResultsCompared to the previa group (n=63), the symptomatic previa group (n=74) was characterized by older patients (p<0.001), higher rate of smokers (p=0.005), thrombophilia (p=0.038), and preterm deliveries (p<0.001). Placentas within the symptomatic previa group were smaller, with higher rates of weight<10th% (p=0.02), RPH (p<0.001) and villous changes related to maternal malperfusion (p=0.023). As compared to symptomatic PP without RPH, co-existence of RPH was associated with higher rate of adverse neonatal outcome (p<0.001) and maternal blood transfusion (p=0.02). On multivariate regression analysis, composite adverse neonatal outcome was found to be dependent on coexisting RPH (OR=2.8, 95%CI 1.2–11.7, p=0.03), and low gestational age (OR=3.1, 95%CI 1.6–4.9, p=0.02). ConclusionsSymptomatic placenta previa is associated with increased placental malperfusion lesions suggesting an association of maternal malperfusion with abnormal placental separation. The coexisting finding of RPH with symptomatic placenta previa can be seen as a marker for more extensive/severe placental separation, hence the association with maternal transfusion requirements and poorer fetal outcome.

John Dique: dialysis pioneer and political advocate.

John Dique (1915-1995) epitomized the internationalism of medicine, the intellectual and manual dexterity of many pioneers of dialysis, and the social concern evinced by many nephrologists. Born in Burma of French, German, British and Indian ancestry; educated in India; an Anglo-Indian who described himself as British without ever having visited Britain; he moved to Australia in 1948 to escape the murderous inter-ethnic conflict that befell multicultural India as it and Pakistan became independent. Settling in Brisbane, he pioneered several novel medical techniques. After inventing some simple equipment to facilitate intravenous therapy, he established a neonatal exchange blood transfusion programme. Then, between 1954 and 1963, he personally constructed and operated two haemodialysis machines with which to treat patients suffering from acute renal failure, the first such treatment performed in Australasia. His patients survival results were, for the era, remarkable. He subsequently helped found the Royal Australasian College of Pathologists and went on to establish a successful private pathology practice. The latter years of his life, however, saw him become a social and political advocate. He fiercely opposed the emerging ideologies of multiculturalism and social liberalism that, he predicted, would seriously damage the national fabric of Western society. Public vilification ensued, his medical achievements disregarded. It does seem likely, however, that in none of the areas that he touched - whether medical, social, or political - has the last word yet been said.