Packed Red Cells Research Articles

PB2084 ERYTHROPOIETIN IN LOW RISK MDS: DIFFICULT TO CONVINCE FOR SAFETY DUE TO AFFORDABILITY; AN EXPERIENCE FROM PAKISTAN

Background:Myelodysplastic syndromes (MDS) represent a diverse group of hematopoietic stem cell disorders characterized by ineffective hematopoiesis, morphological dysplasia and tendency for leukemic transformation. MDS being considered a relatively uncommon disorder in our region is presumed to be an incurable disease with majority of patients conventionally being treated by blood product support only. Most of the patients are unable to receive standard treatment due to financial reservations and presumed to have worst outcomes. To achieve better outcome erythropoietin administration is one of the better option to raise hemoglobin levels and avoid transfusion. Therefore the study was planned to evaluate the outcomes of mds patients treated with erythropoietin versus pack cell transfusion.Aims:The aim of the study was to assess outcomes in mds patients given erythropoietin versus those who received pack cell transfusion.MethodsIt was an observational study conducted at National institute of blood diseases and bone marrow transplantation, Karachi from June 2010 to December 2018. Approval from institutional ethics committee was obtained prior to the study. Patients were risk stratified according to IPSS scoring and included low and intermediate‐1 risk MDS patients requiring red cell transfusion. Division in two groups was made i.e. those who received erythropoietin and those who received pack cell transfusion. Baseline investigations were done including complete blood counts,bone marrow biopsy and cytogenetics. Analysis of variables was done by using SPSS version 23.0.Results:Out of 177 MDS patients enrolled at our hospital,108 (61%) patients were offered erythropoietin. Only 26 (24%) chose to get treated by erythropoietin and rest 82 (76%) opted for pack red cell transfusion. The average erythropoietin dose administered per week was 30,000IU and mean blood transfusion was 2 units pack red cells per month. The mean hemoglobin (Hb) level at baseline of erythropoietin and transfusion group was 4.95 ± 1.48 mg/dl and 5.1 ± 1.27 mg/dl respectively. Outcome was evaluated, 16 (61.5%) patients in erythropoietin group and 36 (46.3%) in transfusion group were alive and 10 (38.4%) and 46 (57%) died respectively. Leukemic transformation was observed in 06 patients in transfusion group while in only 1 patient in erythropoietin group. The mean rise of hemoglobin in erythropoietin group was 4.95 ± 1.48 mg/dl to 9.2 ± 2.1 mg/dl while in transfusion group average 1gm/dl increment in hemoglobin level was observed after transfusion.Summary/Conclusion:Our findings are suggestive of the fact that erythropoietin has an influential impact on hemoglobin levels. However, limited number of patients chosen erythropoietin as their treatment considering it costly as compared to transfusion. Evidence by our statistics suggested that in our region cost of erythropoietin is same what comparable as that of transfusion which includes replacement donors, transfusion and day care expenditures. Moreover, hazards and potential risks associated with transfusion can also be minimized. Further studies with large sample size are needed to evaluate outcomes of treatment options in MDS.

ANALYSIS OF LACTIC AND HEMATOCRIT LEVELS OF BLOOD STORAGE IN DR. WAHIDIN SUDIROHUSODO GENERAL HOSPITAL BLOOD BANK

The components of Packed Red Cells (PRC) are transfused to patients in order to repair oxygen transportation to tissues. The blood is stored at 2-6oC to delay red blood cells metabolism during storage. Red blood cells undergo structural and functional changes biochemically which affect their viability and function. This is a prospective cohort study with time series design. Samples were taken from fresh blood PRC which were moved to transfer bag for approximately 20 mL, then stored in the refrigerator. Lactic acid and hematocrit levels were assessed with spectrophotometry and flow cytometry methods on day 1, day 4, and day 8 of storage in the Dr. Wahidin Sudirohusodo General Hospital Blood Bank. Statistical tests used were Friedman and Wilcoxon. Statistical results are significant if p < 0.05. Total samples were 15 fresh blood PRC. Friedman statistical test showed a significant difference in lactic level (p < 0.001) and hematocrit level (p=0.012) on day 1, day 4, and day 8 of storage. Wilcoxon test showed significantly higher lactic level between day 4 and day 1 (p < 0.01); day 8 and day 1 (p < 0.01); day 4 and day 1 of storage (p < 0.01). Hematocrit level between day 4 and day 1 (p < 0.05); day 8 and day 1 (p < 0.05) were significantly higher; day 8 and day 4 of storage (p > 0.05) showed insignificant difference. Results showed that lactic and hematocrit levels of PRC stored blood were increased according to storage duration. Packed red cells blood is recommended to be given in < 6 days for lower acidosis risk. Further studies are also recommended with a shorter interval of assessment and a bigger sample size.

Thalassemia Carriers among Healthy Blood Donors

Thalassemia is a common hereditary anaemia in Southeast Asia which may also be found among healthy blood donors. The established screening method is less sensitive and can miss donors with clinically silent Thalassemia. The Thalassemia screening tests may help in selection of truly healthy blood donors, hence providing the most functional red cell concentrates for blood transfusion. This is an extension study from our previous work, aiming to detect thalassemia trait among clinically asymptomatic blood donors. We performed Thalassemia screening in 738 healthy blood donors who were allowed for blood donation using full blood count and haemoglobin (Hb) analysis. After screening analyses using high performance liquid chromatography, capillary zone electrophoresis and agarose gel electrophoresis, 85 samples were excluded from the study due to inadequate volume for DNA analysis. Five hundred twelve (512/653; 78.4%) samples were within normal limit and 74 (74/653; 11.3%) samples with Hb less than 12.5 g/dl. Thirty eight donors were found to have Thalassemia and/or haemoglobinopathies by Hb analysis. The remaining 105 blood donors samples with value of MCV less than 80 fl and/or MCH lower than 27 pg with no detectable abnormal pattern from Hb analysis subjected to multiplex PCR that was capable of detecting deletional and nondeletional of the α-globin gene. Majority (79/653; 2.1%) of them had no identified mutation while 23 (23/653; 3.5%) of them had heterozygous α-3.7 deletion, 2 (2/653; 0.3%) had heterozygous α--SEA deletion and only one (1/653; 0.1%) had heterozygous α-4.2 deletion. This data indicates that 74 (74/653; 11.3%) of our blood donors were anaemic, 64 (64/65; 39.8%) had haemoglobinopathies and 79 (79/653; 12.1%) were presumptively had iron deficiency anaemia based on red blood cell indices. Provision of best quality pack red cells should be selected for patients who require regular blood transfusion in order to maintain appropriate Hb level.

Hubungan jenis packed red cell (PRC) yang ditransfusikan dengan reaksi transfusi febrile non haemolytic transfusion reaction (FNHTR)

Background: One of the components of blood cells are often used for transfusions is Packed Red Cell (PRC). Blood components transfusion may continues with rapid or delayed transfusion ractions. The most transfusion reactions was fever (55%) or febrile non haemolytic transfusion reaction (FNHTRs). The cause of these events is associated with allogenic leucocytes (the ability to differentiate self cells and non-self cells based on the human leukocyte antigen (HLA) on the cell surface) and release of proinflammatory cytokines such as IL-1, IL-6, IL-8, TNFα, Cell-free DNA (cfDNA), histone and the duration of blood storage. Methods: Cross-sectional study on 41.177 patients who received a PRC transfusion with the FNHTR transfusion reaction in Hospital Blood Bank Dr. Kariadi Semarang, during January 2017 to July 2018. Pearson Chi Square test for expected frequency more than 5. The Kolmogorov smirnov and Shapiro-wilk test were used to evaluate normality of the data. Mann-Whitney test to analyze the difference, p < 0,05 was considered as significant.Results: The incidence of FNHTR was lower in patients who received leukodepleted PRC (11 patients) than non leukodepleted PRC (124 patients). There were differences in body temperature in the incidence of FNHTR between the two groups 38.10 C (38-39) VS 38.40 C (38 – 39.2) with p = 0,046.Conclusions:There were relationship between the incidence of FNHTR with the transfusion with leukodepleted PRC and non leukodepleted PRC.

Prediction of Availability of Packed Red Cells (PRC) at PMI Surabaya City Using Ensemble Kalman Filter as Management of Blood Transfusion Management

Blood transfusion in terms of both quality and quantity is needed by patients with various health problems they experience. Along with the increased need for blood transfusion, the management of blood transfusion arrangements (blood collection from donors, selection, distribution, storage), and the ability of nurses to provide transfusion to patients is needed. If there are a lot of mistakes in both the ability of management and the ability of nurses, it can not only lead to a fatal impact on a patientbut also increase amount of need for blood transfusion. Due to the importance of blood transfusion, maintaining the stability of blood stock must be done so as not to cause blood loss due to exces of the blood stock. To minimize such loss, blood prediction is needed. The objective of this study is to predict blood demand for blood type of Packed Red Cells (PRC) or concentrated red blood cells at PMI Surabaya by using the method of Ensemble Kalman Filter (EnKF) and Ensemble Kalman Filter Square Root (EnKF-SR). The simulation results show that both methods have high accuracy with an error of less than 1% and RMSE of EnKF-SR. The best simulation exhibited the error between the real data and the simulation with EnKF-SR was in the order of 0.0023574, whereas with EnKF was some 0.025566 with generated 400 ensembles.

Safety and Putative Benefits of Tracheostomy Tube Placement in Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience.

Patients supported with extracorporeal membrane oxygenation (ECMO) have been reported to have increased sedation requirements. Tracheostomies are performed in intensive care to facilitate longer term mechanical ventilation, reduce sedation, improve patient comfort, secretion clearance, and ability to speak and swallow. We aimed to investigate the safety of tracheostomy (TT) placement on ECMO, its impact on fluid intake, and the use of sedative, analgesic, and vasoactive drugs. Prospective data were collated for all ECMO patients over a 5.5-year period. Data included the cumulative dose of sedatives and analgesics, fluid balance, inotrope and vasopressor requirements, and number of packed red cell (PRC) units transfused. Data were analyzed to determine the differences in the aforementioned between 5 days pre-TT and post-TT insertion. Thirty-one (22.1%) of 140 patients underwent TT while on ECMO in the study period. Inotrope and vasopressor use was significantly less in the post-TT period compared to pre-TT dose (P value = .01). This was in the setting of Sequential Organ Failure Assessment scores the day before TT placement being significantly greater than those on days 2, 3, and 4. There was a trend toward reduction in analgesic usage in the post-TT period. No major complications of TT were reported. There was no significant difference (P value = .46) in the amount of PRC used post-TT. These data indicate that TT may result in a reduction in vasopressor and inotropic requirement. Data do not suggest increased major bleeding with placement of TT in patients on ECMO. The potential risk and benefits of inserting a TT in ECMO patients need further validation in prospective clinical studies.

Rational use of blood components in children with dengue by using WHO and NVBDC guidelines

Background: Dengue fever has become a major public health concern. The disease is now endemic in more than 100 countries with very high case fatality rate and children are the most affected age group worldwide. During explosive outbreaks, there is sudden surge in demands of blood components. Hence the aim of present research was to study the rational use of blood components in children with dengue by using WHO 2012 and NVBDCP 2015 (GOI) guidelines.Methods: Total 219 children of age ˂12 years, who has been diagnosed to have dengue and received blood component therapy during 12 months of study period, were included in the study. The transfusions of blood components [packed red cells (PRC), platelets and fresh frozen plasma (FFP)] were being given to the cases accordance to the WHO and NVBDCP guidelines. The patients’ demographic data, diagnosis, details of blood component therapy used the reason for transfusion was recorded.Results: Out of 219 children, 12(5.4%) children received platelet transfusion, 4(1.8%) children received PRC transfusion and 5(2.2%) children received FFP transfusion. One transfusion (4.7%) out of 12 platelet transfusion was inappropriate and all PRC and FFP transfusions were appropriate according to WHO and National Vector Born Disease Control Programme (GOI) guidelines.Conclusions: The need for platelet transfusion is often overemphasized and the fact is that the platelet count alone is not a predictor of bleeding. Unnecessary and empirical use of platelets should be completely avoided.

Blood Transfusion Requests: An Audit in a Blood Transfusion Wing of a Referral Laboratory

Introduction: Transfusion of blood and its components such as Packed Red Cell (PRC), Platelet Rich Plasma (PRP) and Fresh Frozen Plasma (FFP) play an important role as a supportive therapy in patients admitted to a hospital.
 Objective: To conduct an audit of blood transfusion requests regarding demographic data of the recipients, the component therapy, blood groups of the issued units, cross-match transfusion ratio, expiry of the transfusion units, pattern of blood components usage and transfusion reaction for which blood was returned back to blood bank.
 Materials and Methods: This retrospective crosssectional study was conducted at the transfusion wing of a referral laboratory over a period of three months from January 2013 to March 2013 upon 3015 episodes of transfusion units of whole blood and different blood components.
 Results: Out of total 3015 episodes of transfusion unit in 1926 recipients, 930 were male and 996 female. About 41.0% requests of transfusion units received from the department of Obstetrics and Gynaecology (OBG) followed by the department of Surgery of about 28.7%. The most commonly used transfusion units was whole blood (55.3%) followed by platelet rich plasma (27.2%). Most of the recipients (62.3%) received single transfusion units and 37.7% recipients of ≥2 units. Out of 3769 cross-match, 3015 transfusion units were issued. In 12 (0.4%) cases, there were minor febrile and allergic reactions. During the study period, shelf life of six transfusion units had expired.
 Conclusion: This study suggests that either systems audit or medical practice audit of blood and blood component orders can help to reduce the inappropriate or indiscriminate transfusions and may be an important educational tool for the ordering physicians as well as for residents in training
 Journal of Armed Forces Medical College Bangladesh Vol.11(2) 2015: 3-6

GLUCOSE LEVEL ANALYSIS ON STORED PACKED RED CELLS

The main source of energy for red cell metabolism is glucose via glycolytic pathway. Red cells metabolism slows down during storage at 2–6OC. Biochemical changes during storage are called storage lesions, i.e. decreased pH, glucose, and ATP, lactic acid accumulation, and loss of red cells function. Samples taken from the tip of PRC bags in CPDA-1 of the same code are divided into four sections, and stored in the blood bank refrigerator at 2–6OC. Glucose level is measured using ABX Pentra 400 (Horiba, Japan) on storage day 3 as a control, day 7, day 14, and day 21. Glucose levels during storage decreased significantly between day 3, and day 7 (p < 0.001), between day 7, and day 14 (p < 0.001), and between day 14, and 21 (p < 0.001). Glucose levels of Packed Red Cells (PRC) decrease during storage. Glycolysis occurs during storage although metabolism slows down.

DIFFERENCES IN CHANGES OF HEMOGLOBIN BETWEEN 6-12 HOURS AND 12-14 HOURS AFTER TRANSFUSION

Each year more than 41,000 blood donations are needed every day and 30 million blood components are transfused. Blood products that can be transfused include Packed Red Cells (PRC), Whole Blood (WB), Thrombocyte Concentrate (TC), Fresh Frozen Plasma (FFP). Monitoring Hemoglobin (Hb) after transfusion is essential for assessing the success of a transfusion. The time factor after transfusion for Hemoglobin (Hb) examination needs to be established, analyze to judge the success of a blood transfusion which is performed. The aim of this study was to analyze the differences in changes of hemoglobin between 6-12 hours, and 12-24 hours after-transfusion. This study was retrospective observational using secondary data. The subjects were patients who received PRC, and WBC transfusion. At 6-12, and 12-24 hours after-transfusion, hemoglobin, RBC, and hematocrit were measured. Then the data were analyzed by unpaired t-test. The collected data included the results of the Hb pre-transfusion, 6-12, and 12-24 hours after-transfusion. The subjects of this study were 98 people. The administration of transfusion increased by 10-30% in hemoglobin concentration at 6-12 hours after-transfusion. While at 12-24 hours after-transfusion, hemoglobin after-transfusion increased 15-37% from the baseline. Hemoglobin values were not different at any of the defined after-transfusion times (p = 0.76 (p>0.05)). Hemoglobin values were not different at 6-12 hours, and 12-24 hours after-transfusion. Keywords: Hemoglobin, measurement, after-transfusion

Blood Bank Services at Tertiary Care Center

Background: Audit is one mechanism for evaluating the effectiveness of the total quality system. Transfusion medicine or blood bank audit embraces all procedures from blood procurement to the long term consequences of transfusion. Aims and Objectives To understand the problems arising in day to day working of blood bank and to ensure the appropriate indication for issuing blood and blood components to different departments. Materials and methods Present audit of blood bank is retrospective study done for a year in tertiary care center in central region of India. Data collection of donors and whole blood issue is done for one year from 1st January 2016 to 31st December 2016. Component separation had started from August 2016, so audit of component separation and its usage has been done for one year from 1stAugust 2016 to 31stJuly 2017. Results In year 2016, total blood units collected were 6131 and issued were 5897. Majority of blood issue was to surgical wards 3790 compared to non-surgical wards 2107. Out of 6109, 203 were positive for transfusion transmitted infections (TTI). 20 transfusion reactions were reported in 2016. From 1st August 2016 to 31st July 2017, total 1060 Packed Red Cells (PRC) were prepared and 1009 were utilized , 1120 units of FFP were prepared, out of which 778 were utilized and 817 platelet concentrates were prepared but only 205 is utilized. Conclusion Results obtained from these types of retrospective studies will provide opportunity for finding strategies in improving the blood bank services.

THE MORPHOLOGICAL FEATURES OF ERYTHROCYTES IN STORED PACKED RED CELLs

Morfologi eritrosit Packed Red Cells (PRC) akan mengalami perubahan selama penyimpanan di suhu 2°–8°C. Eritrosit dalammempertahankan viabilitasnya membutuhkan adenosine triphosphate (ATP). Apabila kadar ATP intraseluler menurun, terjadi kerusakanlipid membran, penumpukan Natrium dan Kalsium intraseluler, penurunan kadar Kalium dan air intraseluler, dehidrasi sel, membranmenjadi kaku dan bentuknya berubah dari cakram menjadi sel krenasi, sferosit dan bite cell. Penelitian ini bertujuan untuk melihatpersentasi bentuk eritrosit crenated cell, sferosit dan bite cell PRC simpan pada hari ke-3 yang digunakan sebagai pembanding, hari ke-7,ke-14 dan ke-21 dari tanggal aktaf kantong darah. Penelitian observasional dengan pendekatan kajian kohort dilakukan pada bulanAgustus 2015 di BDRS RSUP Dr. Wahidin Sudirohusodo Makassar. Sampel sebanyak 30 selang kantong darah menjadi 120 hapusandarah slide. Dari 30 sampel kantong darah dengan golongan darah A 26,6%, B 13,3%, AB 16,6% dan O 43,3%, didapatkan peningkatanpersentase jumlah crenated cell, sferosit dan bite cell setelah penyimpanan hari ke-3, ke-7, ke-14 dan ke-21. Penyimpanan hari ke-3dijadikan pembanding. Data diolah dengan menggunakan uji Fiedman dan Wilcoxon dengan nilai kemaknaan p<0,001. Terdapatpeningkatan persentase perubahan morfologi eritrosit (crenated cell, sferosit dan bite cell) seiring dengan lamanya penyimpanan darahPRC. Pemakaian darah PRC dianjurkan tidak boleh melebihi 21 hari penyimpanan.

KADAR KALIUM DI PACKED RED CELLS SIMPANAN

Blood transfusion, is not only transferring the blood cells to the recipient, but also transferring other components such as: glucose,lactate, and potassium. When the blood is stored, many alterations occur in its cmponents, particularly a decrease of adenosine5-triphosphate (ATP) and pH, hemolysis, and an increase of potassium levels as well. One of the transfusion complications that should beavoided is hyperkalemia due to the accumulation of potassium that leaks during the storage. However, hyperkalemia related to transfusiondepends not only on the potassium level in the blood unit, but also on its volume and the rate of its blood administration as well. Theaim of this study was to know the potassium levels in stored Packed Red Cell (PRC). A cohort study was done from May–July 2010. Theresearchers used 48 samples from 16 PRCs derived from 16 donors. The samples were drawn from the of PRC hose's plasma that had beensealed. The potassium levels were measured on the first day, 10th day, and 20th day of the blood collection. The mean potassium levelon the first day was 3.79 mmol/L, 10th day was 12.22 mmol/L and 20th day was 19.77 mmol/L. Comparison of the potassium levelsbetween the first and 10th day, between first and 20th day, and between 10th and 20th day showed a significant difference (p=0.00). Theincrease of potassium levels in the PRC coincide with the storagetime.

Appropriateness of Routine Crossmatch in Elective Caesarean Section for Low Risk Postpartum Hemorrhage Pregnancies

Objective: The objective of this study is to evaluate appropriateness of the blood ordering practice and transfusion for elective caesarean section in low risk postpartum hemorrhage. Materials and methods: A prospective descriptive study of routine cross-matching for elective caesarean section in low risk postpartum hemorrhage was conducted in Department of Obstetrics and Gynaecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand from 26 July 2016 to 31 March 2017. Data including patient demographics (maternal age, body mass index and gestational age) and operative findings (indications for caesarean section, levels of surgeon, amount of blood loss and blood transfusion, Hb change at 24 h after surgery, operation time and fetal weight) were collected. PPH rate and transfusion utilization indices (Crossmatch to Transfusion ratio (C/T ratio), Transfusion probability (%T) and Transfusion index (Ti)) were calculated. Results: From 169 eligible participants, there were 2 cases excluded because of pre-operative undetected placenta adherent. There were five patients having PPH (3%). From 334 units of packed red cell (PRC) prepared for 167 patients, there were 6 units transfused to 5 patients. Only one patient received 2 units of PRC. Transfusion utilization indices (C/T ratio, %T, Ti) were 55.67, 2.99 and 0.03, respectively. Total cost for the cross matching process was 90,180 baht, but the actual transfusion cost was 2,700 baht. Conclusions: Routine two units of cross matched PRC for elective caesarean section in low risk PPH was seemingly shown inappropriate and over ordering. It led to unnecessary expenses and time consuming.

Is Preoperative Fibrinogen Testing Associated With Total Blood Loss in Adolescent Idiopathic Scoliosis Correction?

Study DesignRetrospective analysis. ObjectiveThis study sought to investigate the potential association between preoperative fibrinogen, bleeding, and transfusion requirements in adolescent idiopathic scoliosis (AIS) corrections. Summary of Background DataBlood loss after major spinal reconstruction increases the risks and costs of surgery. Preoperative fibrinogen levels may predict intra- and postoperative blood loss. MethodsData were collected from clinic charts and hospital medical records of all 110 of a single surgeon's consecutive AIS patients undergoing greater than three-level deformity correction surgeries from January 2011 to December 2013. Pearson test was used to investigate the correlation between bleeding and clinical variables, with level of significance set at α = 0.05. ResultsMean total bleeding volume was 488 (±356) mL. Overall, mean preoperative fibrinogen concentration was 188.6 ± 32.8 mg/dL. Preoperative platelet counts, prothrombin time (PT), and activated partial thromboplastin time (aPTT) did not correlate significantly with preoperative fibrinogen concentration (p > .05). Both packed red cells (PRC) and packed red blood cells (PRBC) correlated significantly with preoperative fibrinogen (p < .05). The correlation between PRC and preoperative fibrinogen was −0.042. There was a negative correlation between PRBC and preoperative fibrinogen (r = −0.46). Overall mean thromboelastography (TEG) values were within normal range in both males and females and both had comparable TEG parameter values. All the TEG variables (G, K, and Angle) correlated significantly with preoperative fibrinogen (p < .05) but not with total blood volume (p > .05). The correlation coefficient between these TEG variables and preoperative fibrinogen were 0.51, 0.59, and 0.54, respectively. The total bleeding volume and % estimated blood volume correlated significantly with both PRC (r = 0.352, r = 0.376; p < .05) and PRBC (r = 0.621, r = 0.614; p < .05). ConclusionsIn our cohort undergoing correction of AIS, preoperative fibrinogen levels exhibited a significant negative logarithmic correlation with total blood loss. TEG variables also correlated significantly with preoperative fibrinogen levels. Efforts should be made to incorporate this measure in perioperative blood management program for AIS corrections. Level of EvidenceLevel IV.

Generic Direct Acting Antivirals in Treatment of Chronic Hepatitis C Infection in Patients of Thalassemia Major

There is no published data of treating hepatitis C in thalassemia major patients with any sofosbuvir based direct acting antivirals (DAAs). This study was performed to determine the efficacy and safety of these regimes using generic drugs in the thalassemia major population. In this observational study, 902 patients of thalassemia major from five transfusion centres in Mumbai were screened for HCV antibody. Of the 120 positive patients, HCV RNA was detected in 50%. The first 29 patients were enrolled for evaluating the efficacy and safety of generic sofosbuvir based DAAs. The 29 patients' had a mean age of 24 years with genotype 1 in 17, genotype 3 in 11patients, while 1 patient's genotype could not be classified. Six patients had compensated cirrhosis and 8 patients were treatment experienced. SVR 12 was achieved in 100% of patients. There was significant increase in PRC (packed red cell) requirements (P=0.0003) during treatment. At 12 weeks post-treatment, PRC requirements returned to baseline with a significant fall in serum ferritin (P=0.03). Headache, fatigue and diarrhoea were the most common side effects. The difference in side effects including anaemia between patients who received ribavirin (19/29) and those who did not receive ribavirin (10/29) was not significant. Presence of diabetes, splenectomy, high ferritin or liver or heart iron overload on MRI T2* did not affect the efficacy of treatment. Generic DAAs are safe in thalassemia major patients with hepatitis C with efficacy of 100%. Serum ferritin falls significantly after treatment despite an increase in transfusion requirements during treatment.

L’association fer intraveineux et acide tranexamique permet-elle de réduire le besoin transfusionnel ? Une étude comparative non randomisée

ObjectivesTo evaluate if the association of injectable iron and tranexamic acid allows a significant saving in transfusion, in cases of myomectomies and hysterectomies. Patients and methodThis is a prospective, non randomized study done over 8 months (from January 2013 to August 2013). Were included, patients undergoing hysterectomy or myomectomy who had a hemoglobin level greater than or equal to 8g/dl and less than 12g/dl. Two groups were compared: group A consisting of patients for whom a pack red cells was ordered and the group B which patients received intravenous iron preoperatively and tranexamic acid perioperatively. The level of hemoglobin, pre- and postoperative, the average number of blood units per patient and estimated blood loss was compared. The transfusion economy was evaluated. ResultsDuring this period, 87 patients with a mean age of 40±9 years (range: 23 and 70years) were included according to our criteria: 44 patients in group A and 43 patients in group B. Initial mean hemoglobin in both groups was 9.1±0.7g/dl. In group B, after iron administration, the mean hemoglobin was 11.3±0.7g/dl. The average number of red blood cells received intraoperative patient in group A was 1.54±0.51. The estimated blood loss was significant greater (P=0.0002) in group A (571.6±237.1ml) than in group B (213.7±131.7ml). No transfusion was performed in group B. ConclusionThe association intravenous iron and tranexamic acid resulted in the reduction of transfusion requirements in our setting. It could be integrated in the strategy for sparing blood transfusion in scheduled surgery with hemorrhagic risks.

Profile of alanine aminotransferase and hepatic iron accumulation in thalassemic patients with or without anti-hepatitis C virus

Background Repeated blood transfusions in thalassemic patientscause iron accumulation in tissues and might impair organ func-tion. Other peril of blood transfusion is hepatitis C virus infection.Objectives This study aimed to find out the proportion of increasedalanine aminotransferase (ALT), increased transferrin saturation(TS), and positive anti hepatitis C virus (anti-HCV) among thalas-semic patients and to get the profile of ALT among thalassemicpatients who have increased TS and positive anti-HCV.Methods This cross-sectional descriptive study was conductedon β- and β-HbE-thalassemic patients at the Thalassemia Outpa-tient Clinic, Department of Child Health, Medical School, Univer-sity of Indonesia–Cipto Mangunkusumo Hospital in May 2002.Results Subjects were 57 homozygous β-thalassemic and 33 β-HbE-thalassemic patients. No one had regular desferoxamine orhistory of splenectomy. Proportions of increased ALT, TS, and posi-tive anti-HCV were 76%, 78%, and 6%, respectively. Duration ofillness, total volume of packed red cell (PRC) transfusions, TS level,and positive anti-HCV seemed to have role in the increased pro-portion of subjects with increased ALT, whereas duration of illnessand total volume of PRC seemed to have role in the increased TS.Conclusion Factors that seem to have a role in the increasedproportion of subjects who had increased ALT and TS were (1)duration of illness, total volume of PRC transfusion, TS, and posi-tive anti-HCV; 2) duration of illness and total volume of PRC trans-fusion, respectively

Preoperative anaemia is associated with increased allogeneic pack red cell transfusion in revision hip and knee joint arthroplasty: a retrospective analysis of 5387 patients over a 10‐year period at a single high volume centre

To estimate the prevalence of preoperative World Health Organization (WHO) defined anaemia in patients presenting for revision hip and knee arthroplasty and its association with transfusion of allogeneic packed red blood cells (PRBC). Studies have mainly investigated the prevalence of preoperative anaemia in primary and not revision hip and knee joint arthroplasty. An analysis of a prospectively collected patient data for 5387 patients having revision hip or knee arthroplasty over a 10-year period at a single high volume centre was conducted. Logistic regression was used to assess whether the presence of WHO defined preoperative anaemia as well as other risk factors were associated with inpatient allogeneic PRBC transfusion. There were 5387 patients assessed of which 3021 (56·01%) patients had revision total hip replacements and 2366 (43·09%) had revision total knee arthroplasty. Of these patients 1956 (36·03%) had preoperative WHO defined anaemia. A total of 2034 (37·08%) patients received at least one unit of allogeneic PRBC during their primary hospital admission. In the final model preoperative WHO defined anaemia was independently associated with allogeneic PRBC transfusion in hip and knee revision surgery OR 4·042 (4·012-4·072 95% CI) CONCLUSIONS: Preoperative anaemia is common in patients presenting for revision hip and knee arthroplasty and independently associated with transfusion of allogeneic PRBC.

Impact of pretransplant red cell transfusion on outcome after allogeneic stem cell transplantation in adult patients with severe aplastic anemia.

The aim of this study was to evaluate the impact of pretransplant transfusion of packed red cells (PRCs) on outcome after allogeneic stem cell transplantation (SCT) in severe aplastic anemia (SAA). A total of 221 adult SAA patients receiving allogeneic SCT were analyzed. The patients were divided into two groups according to the amount of pretransplant transfusion before SCT: the low transfusion group (⩽32 PRC units, n=164) and the high transfusion group (>32 PRC units, n=57). The incidence of engraftment failure was not different between the two groups. The incidence of acute GvHD (grades II-IV) was higher in the high transfusion group than in the low transfusion group (P=0.04), and the incidences of chronic extensive GVHD were not significantly different (P=0.136). The high transfusion group had higher 5-year transplant-related mortality (TRM) (24.8% vs 6.8%, P<0.001) and lower overall survival (OS) (72.3% vs 91.9%, P<0.001) than those in the low transfusion group. Multivariate analysis revealed that the high transfusion group and unrelated donor type were independent prognostic factors affecting OS. These results indicate that a history of higher pretransplant transfusion of PRCs was associated with increased TRM and decreased OS, suggesting that iron overload had a negative impact on outcome after SCT in SAA.