Packed Red Cells Research Articles

Difficultés de la prise en charge de l’allo-immunisation anti-public

Alloimmunization against high-frequency erythrocyte antigens is a problematic situation in terms of laboratory diagnosis, transfusion and obstetrical management. We report the case of a pregnant woman alloimmunized against public Ag. We detail the difficulties of alloantibody (Ab) identification and transfusion management of the deliveries. A 29-year-old pregnant woman was hospitalized in gynecology and obstetrics departments at 36 weeks of gestation for assessment of hydrops fetalis. Antibody identification test revealed the presence of a pan-reactive antibody. Investigations realized in CNRGS (Paris) concluded in anti-GE2+anti-RH3+autoantibody. The red cell phenotype was GE: –2,3. A therapeutic interruption of the pregnancy was indicated. A program of autologous transfusion was organized with withdrawal of 2 units of blood. The 2nd pregnancy took place normally. Before delivery, an autologous blood reserve consisting of 2 red cell packs and 2 fresh frozen plasma was withdrawn and transfused after delivery. The management of anti-public alloimmunization poses several problems. The first one is of diagnostic nature with, on the one hand, the difficulty of Ab identification by the available red cell panels and, on the other hand, the possible presence of alloantibodies of transfusional or obstetric interest masked by anti-public Ab. The second is represented by transfusional care of these patients. In the absence of a national reserve of frozen rare blood, the autologous transfusion remains the only alternative. However, it can answer only a limited number of indications and only in case of moderate blood loss.

G121(P) Service evaluation of management of term neonates with major perinatal blood loss

Aims Clear guidelines exist for the management of major haemorrhage in adults. These include a strong emphasis on early transfusion of Fresh Frozen Plasma (FFP) in conjunction with Packed Red Cells (PRC) in order to avoid/treat possible accompanying coagulopathy. Current practice within the local neonatal population is to await clotting profiles and administer FFP if coagulation is found to be abnormal. This practice may lead to a significant delay in treatment. The aim of this service evaulation was to identify whether term neonates with major haemorrhage around the time of delivery required support with coagulation factors. This may support the use of prophylactic FFP alongside RBC transfusion prior to results becoming available helping to stabilise the infant sooner. Methods Data was requested from our local blood transfusion laboratory for all requests for blood products made for patients on the neonatal unit between April 2011 to December 2013. Further details regarding antenatal and neonatal course were then taken from the Badger database on all babies that were identified to have received blood products on their date of birth or following day. Babies born at less than 37 weeks were excluded. Results We identified 7 term babies with a clear history of major perinatal blood loss. 5/7 (71%) required transfusion of FFP in addition to PRC on the basis of abnormal clotting profile. All babies receiving FFP needed extensive resuscitation at birth followed by intensive care support, whereas the 2 babies that were not transfused were clinically stable. One of the babies not receiving FFP did not have their clotting profile checked. All babies received Vitamin K post delivery as standard. Conclusion Term infants with a clear history of perinatal blood loss who are compromised at delivery and require packed red cell transfusion should be considered for early transfusion of FFP without awaiting coagulation profiles.

Effect of Storage Time on Cumulation of Platelet-related Growth Factors in the Supernatant of Leukoreduced Packed Red Cells and Tumor Cell Proliferation In Vitro

To investigate the effect of storage time on accumulation of platelet-related growth factors in the supernatant of leukoreduced packed red blood cells (LR-pRBC) and on tumor cell proliferation in vitro. LR-pRBC were quartered and stored at 2 °C-6 °C. The supernatant of pRBC was obtained by centrifugation with 1 006 × g for 10 min at day 0, 14, 21 and 35 d. The enzyme-linked immunosorbent assay (ELISA) was used to detect the expression of platelet-derived growth factor(PDGF) and vascular endothelial growth factor (VEGF). After HepG2 cells was cultured with the supernatant of LR pRBC at day 0 and day 35 together for 48 hours, methylthiazoliltetracolium (MTT) method was used to measure the proliferation of tumor cells in vitro. The concentrations of 2 cytokines were still increased with the storage time prolonging. As compared to LR-pRBC at day 0 [611.84 (95%CI, 356.45-867.23) pg/ml], the level of VEGF reached 900.16 (95% CI, 552.26-1248.07) pg/ml (P<0.05). There was a similar tendency in PDGF level with less increment in the supernatant of LR pRBC at day 35 [2.23 (95% CI, 0-5.37) ng/L vs 5.66 (95% CI, 0-12.48), P=0.073], but there was no significant statistical difference. Likewise, in vitro study of HepG2 cell proliferation showed that the LR-pRBC at day 35 promoted more proliferation of tumor cells with OD value 0.40 (95% CI, 0.38-0.42) (P<0.05). The residual platelets in LR-pRBC were activated, disintegrated and released the dense granules and α-granules which induce the accumulation of VEGF and PDGF. It seemed that the supernatant of LR-pRBC promoted the proliferation of tumor cells in vitro.

Use of prothrombin complex concentrate as an adjunct to fresh frozen plasma shortens time to craniotomy in traumatic brain injury patients.

The use of prothrombin complex concentrate (PCC) to reverse acquired (coagulopathy of trauma) and induced coagulopathy (preinjury warfarin use) is well defined. To compare outcomes in patients with traumatic brain injury without warfarin therapy receiving PCC as an adjunct to fresh frozen plasma (FFP) therapy compared with patients receiving FFP therapy alone. All patients with traumatic brain injury coagulopathy without warfarin therapy who received PCC (25 IU/kg) in conjunction with FFP or FFP alone at our Level I trauma center were reviewed. Coagulopathy was defined as an international normalized ratio >1.5. The groups (PCC + FFP vs FFP alone) were matched using propensity score matching on a 1:2 ratio for age, sex, Glasgow Coma Scale score, Injury Severity Score, head Abbreviated Injury Scale score, and international normalized ratio (INR) on presentation. The primary outcome measure was time to craniotomy. Secondary outcome measures were blood product requirements, cost of therapy, and mortality. A total of 1641 patients were reviewed, 222 of whom were included (PCC + FFP, 74; FFP, 148). The mean ± standard deviation age was 46.4 ± 21.7 years, the median (range) Glasgow Coma Scale score was 8 (3-12), and the mean ± standard deviation INR on presentation was 1.92 ± 0.6. PCC + FFP therapy was associated with an accelerated correction of INR (P = .001) and decrease in overall pack red blood cell (P = .035) and FFP (P = .041) administration requirement. Craniotomy was performed in 26.1% of patients (n = 58). Patients who received PCC + FFP therapy had faster time to craniotomy (P = .028) compared with patients who received FFP therapy alone. PCC as an adjunct to FFP decreases the time to craniotomy with faster correction of INR and concomitant decrease in the need for blood product requirement in patients with traumatic brain injury exclusive of prehospital warfarin therapy.

Anaesthesia and Intensive Care Management of Face Transplantation

Sedaghati-Nia, A.*; Gilton, A.*; Liger, C.*; Binhas, M.*; Cook, F.*; Ait-Mammar, B.*; Scherrer, E.*; Hivelin, M.†; Lantieri, L.†; Marty, J.*; Plaud, B.* Author Information

A multivariate analysis to assess the effect of packed red cell transfusion and the unit age of transfused red cells on postoperative complications in patients undergoing cardiac surgeries.

Background:Transfusion of blood components and age of transfused packed red cells (PRCs) are independent risk factors for morbidity and mortality in cardiac surgeries.Materials and Methods:We retrospectively examined data of patients undergoing cardiac surgery at our institute from January 1, 2012 to September 30, 2012. Details of transfusion (autologous and allogenic), postoperative length of stay (PLOS), postoperative complications were recorded along with other relevant details. The analysis was done in two stages, in the first both transfused and nontransfused individuals and in the second only transfused individuals were considered. Age of transfused red cells as a cause of morbidity was analyzed only in the second stage.Results:Of the 762 patients included in the study, 613 (80.4%) were males and 149 (19.6%) were females. Multivariate analysis revealed that factors like the number and age of transfused PRCs and age of the patient had significant bearing upon the morbidity. Morbidity was significantly higher in the patients transfused with allogenic PRCs when compared with the patients not receiving any transfusion irrespective of the age of transfused PRCs. Transfusion of PRC of over 21 days was associated with higher postoperative complications, but not with in-hospital mortality.Conclusion:In patients undergoing cardiac surgery, allogenic blood transfusion increases morbidity. The age of PRCs transfused has a significant bearing on morbidity, but not on in-hospital mortality. Blood transfusion services will therefore have to weigh the risks and benefits of providing blood older than 21 days in cardiac surgeries.

Brief communication (Original). Anesthesia for cesarean section in parturients diagnosed with placenta previa in a Thai university hospital: a retrospective analysis of 562 consecutive cases

Abstract Background: Anesthesia for cesarean delivery in parturients diagnosed with placenta previa remains controversial. Objectives: To investigate factors correlated with choice of anesthesia in these parturients and their outcomes. Methods: Retrospective analysis of patients with placenta previa and cesarean delivery at King Chulalongkorn Memorial Hospital. Peri operative anesthetic and complication data were collected using a structured collection form. Univariate analysis and multivariate logistic regression were used. P &lt; 0.05 was considered significant. Results: Among 50,237 deliveries from July 1, 2005 to June 30, 2011, there were 562 cesarean sections in diagnosed cases of placenta previa. Cesarean deliveries (479) were performed under spinal anesthesia (81%), epidural anesthesia (1.8%), and if the effects spinal anesthesia dissipated, general anesthesia (2.3%). Among 46 cases of cesarean hysterectomy, 27 patients (58.7%) received regional anesthesia. However, 6 of 10 patients with planned cesarean hysterectomy underwent general anesthesia, while 1 of 4 of a group with regional anesthesia needed conversion to general anesthesia. There was no serious anesthesia-related complication. Factors related to general anesthesia were: a higher American Society of Anesthesiologists (ASA) physical status OR 2.7 (95% CI 1.7-4.3) P &lt; 0.001; presentation with bleeding OR 1.8(95% CI 1.0-3.1) P = 0.033; anterior site of placenta OR 1.8 (95% CI 1.1-3.2) P = 0.025; heart rate &gt;125 bpm OR 5.6 (95% CI 1.5-214) P = 0.01; and pack red cell transfusion OR 3.4 (95% CI 2.0-5.7) P &lt; 0.001. Conclusions: Most parturients received regional anesthesia. Neuroaxial anesthesia and general anesthesia are safe.

Syndrome de défaillance respiratoire aiguë sévère au cours d’un syndrome thoracique aigu chez une enfant drépanocytaire de 8 ans : bénéfice potentiel de l’association précoce échange transfusionnel et décubitus ventral

We report the case of an 8-year-old sickle cell anemia child admitted for acute respiratory failure complicating acute chest syndrome. Because of threatening respiratory failure, tracheal intubation was performed immediately after ICU admission. The patient met the criteria for ARDS with a PaO2/FiO2 ratio of 94mmHg. An exchange transfusion was performed immediately after admission. HbS fraction failed from 69 % to 30 %. Fluid resuscitation with crystalloids and continuous norepinephrine infusion was needed because of arterial hypotension. Due to persistent severe hypoxemia with PaO2/FiO2 ratio below 100, the patient was placed in prone positioning 16hours after admission, for a total duration of 14hours. A second 12-hour session of prone positioning was performed 41h after admission and PaO2/FiO2 ratio reached 300mmHg after. Treatment also included transfusion of two red-cell pack on day 1 and 2 after admission in order to maintain hemoglobin level above 8g/dL, and a daily folic acid supplementation. The control of hyperthermia was achieved by a systematic parenteral administration of paracetamol. Cefotaxime and erythromycine were continued until day 7 despite the negative results of all bacteriological samples. The outcome was favorable from day 3 and the patient met the criteria for extubation on day 5. A first attempt of extubation was performed on day 5, but re-intubation was required because of laryngeal edema. Steroids were given for 48h and the patient was successfully extubated on day 7. She was discharged from the ICU on day 8, and from the hospital on day 12. We discuss the various treatments available for the management of acute chest syndrome and their actual relevance in acute respiratory distress syndrome in the absence of strong evidence-based guidelines in pediatric ARDS.

Transfusion requirements in living donor liver transplantation – Role of laboratory assessment and Model For End Stage Liver Disease (MELD) score

Introduction and aimsLiver transplant surgery is often associated with considerable bleeding. This study was undertaken to analyse the average blood component consumption and the effectiveness of preoperative laboratory assessment and Model For End Stage Liver Disease (MELD) score in the estimation of transfusion requirements in Living Donor Liver Transplantation (LDLT). Material and methodsUnivariate and stepwise regression analysis were employed to establish the significance of correlation of the preoperative laboratory variables, including haematocrit, platelet count, INR, total bilirubin, serum creatinine, blood urea and MELD score with the total consumption of Packed Red Cells (PRCs), cryoprecipitates, aphaeresis platelets and Fresh Frozen Plasma (FFP). Stepwise discriminant analysis was used to identify those preoperative factors which have a significant predictive value for the total consumption of each blood component and these results were employed to construct separate prediction models for the utilization of each blood component and the respective R square values were determined. ResultsA total of 509 patients were included. On an average, 8.44 units (SD = 6.11) of PRCs, 2.58 units (SD = 2.95) of cryoprecipitates, 0.81 units (SD = 1.16) of aphaeresis platelets and 2074.85 ml (SD = 1240.20) of FFP were consumed per LDLT. The blood component prediction models could be employed to accurately predict the total utilisation of PRCs, cryoprecipitates, FFP and aphaeresis platelets in 23, 22.6, 17.8 and 20.7 per cent of our patients, respectively. ConclusionWe have been able to identify those preoperative factors which can be employed to predict the consumption of various blood components in living donor liver graft recipients. These variables were further employed to construct prediction models, separately for each blood component. We also identified those preoperative variables which significantly influence the in hospital mortality and PLOS in LDLT recipients.

Anesthesia for cesarean section in parturients diagnosed with placenta previa in a Thai university hospital: a retrospective analysis of 562 consecutive cases

Background: Anesthesia for cesarean delivery in parturients diagnosed with placenta previa remains controversial. Objectives: To investigate factors correlated with choice of anesthesia in these parturients and their outcomes. Methods: Retrospective analysis of patients with placenta previa and cesarean delivery at King Chulalongkorn Memorial Hospital. Peri operative anesthetic and complication data were collected using a structured collection form. Univariate analysis and multivariate logistic regression were used. P Results: Among 50,237 deliveries from July 1, 2005 to June 30, 2011, there were 562 cesarean sections in diagnosed cases of placenta previa. Cesarean deliveries (479) were performed under spinal anesthesia (81%), epidural anesthesia (1.8%), and if the effects spinal anesthesia dissipated, general anesthesia (2.3%). Among 46 cases of cesarean hysterectomy, 27 patients (58.7%) received regional anesthesia. However, 6 of 10 patients with planned cesarean hysterectomy underwent general anesthesia, while 1 of 4 of a group with regional anesthesia needed conversion to general anesthesia. There was no serious anesthesia-related complication. Factors related to general anesthesia were: a higher American Society of Anesthesiologists (ASA) physical status OR 2.7 (95% CI 1.7-4.3) P 125 bpm OR 5.6 (95% CI 1.5-214) P = 0.01; and pack red cell transfusion OR 3.4 (95% CI 2.0-5.7) P Conclusions: Most parturients received regional anesthesia. Neuroaxial anesthesia and general anesthesia are safe. Keywords: Cesarean delivery, choice of anesthesia, complication, neuraxial anesthesia, placenta previa, spinal anesthesia

Anaesthesia and intensive care management of face transplantation

The face-grafting techniques are innovative and highly complex, requiring well-defined organization of all the teams involved. Subsequent to the first report in France in 2005, there have been 17 facial allograft transplantations performed worldwide. We describe anaesthesia and postoperative management, and the problems encountered, during the course of seven facial composite tissue grafts performed between 2007 and 2011 in our hospital. The reasons for transplantation were ballistic trauma in four patients, extensive neurofibromatosis in two patients, and severe burns in one patient. Anaesthesia for this long procedure involves advanced planning for airway management, vascular access, technique of anaesthesia, and fluid management. Preparation and grafting phases were highly haemorrhagic (>one blood volume), requiring massive transfusion. Median (range) volumes given for packed red cell (PRC) and fresh-frozen plasma (FFP) were 64.2 ml kg−1 (35.5–227.5) and 46.2 ml kg−1 (6.3–173.7), respectively. Blood loss quantification was difficult because of diffuse bleeding to the drapes. The management of patients with neurofibromatosis or burns involving the whole face was more difficult and haemorrhagic than the patients with lower face transplantation. Average surgical duration was 19.1 h (15–28 h). Postoperative severe graft oedema was present in most patients. Most patients encountered complications in ICU, such as renal insufficiency, acute respiratory distress syndrome, and jugular thrombosis. Opportunistic bacterial infections were a feature during the postoperative period in these highly immunosuppressed patients.

Wie viel Blut und welche seiner Bestandteile benötigt der Mensch intra- und perioperativ? – neue wichtige Aspekte für den Allgemein-(Viszeral-)Chirurgen aus der Transfusionsmedizin und Hämostaseologie

By the optimised availability of less expensive and safe red cell packs and other blood products over the last 20 years, numerous surgical interventions have become possible without any demand for comments on the precise need. However, a number of publications indicates that blood transfusion may also induce disadvantageous effects on the postoperative course by immunomodulation, which requires a rather restrictive indication for transfusion. Furthermore, demographic development leads to a decrease in that portion of the population with the potential for blood donation accompanied simultaneously by an increase of the percentage of older patients with more need of blood products during medical treatment. This makes blood-sparing measures necessary. In addition, costs for red cell packs have increased, in particular, for the generally compatible blood group 0 - an extra amount for rhesus negative blood. The present narrative review highlights, therefore, important news from the clinical transfusion medicine, immunohaematology and haemostaseology and their impact on daily transfusion practice. In this context, "blood management" is considered as one of the very effective blood-sparing measures, which focusses especially i) on the substitution of iron in case of depressed preoperative haemoglobin as well as ii) to elucidate disorders of coagulation by structured medical history and, subsequently, to balance possible need by a specific plan for substitution. Simultaneously, prospective studies are initiated to investigate how far the transfusion trigger of a patient can be lowered down to a still appropriate level. As far as consolidated findings are already available, they are described with regard to the single blood components and taking into account the cross-sectional guidelines of the "Bundesärztekammer" (Federal Physicians Chamber). Finally, initial evidence is provided characterising patient- and blood donor-specific, blood group-dependent features of a reasonable haemotherapy.

The effect of retrograde autologous priming on intraoperative blood product transfusion in coronary artery bypass grafting

Retrograde autologous priming (RAP) of the cardiopulmonary bypass (CPB) circuit could reduce the degree of haemodilution associated with priming with acellular solutions. However, there is no strong evidence to prove that the practice of RAP reduced intraoperative packed red cell (PRC) or blood product transfusion. To evaluate the effect of RAP on intraoperative PRC usage in coronary artery bypass grafting (CABG). This study is a prospective, observational study on patients who underwent first-time, isolated CABG using CPB between April 2012 and July 2012. Two groups of patients were identified: 1. Non-RAP group (n=128) and 2. RAP group (n=73). The primary outcome for the study was the amount of PRC and blood product usage between the induction of anaesthesia and the cessation of CPB. Use of PRC and blood products in the operating room was comparable in both groups. Univariate logistic regression showed that RAP was not an independent predictor of PRC or blood product transfusion (p=0.43). Multivariate logistic regression showed that CPB time, preoperative haemoglobin (Hb) levels and creatinine clearance were independent predictors of blood product transfusion. Practising RAP with mean volumes of 300 ml does not necessarily reduce PRC and other blood product transfusion requirements during CABG. In our practice, RAP was performed, aiming at displacing CPB circuit prime volume with which the perfusionist felt comfortable and dictated by haemodynamic parameters prior to commencing CPB. We presume this is the case in many units around the world. This practice, in our opinion, is not enough to achieve the benefits of RAP, if any, in the form of a reduction of packed red cell transfusion requirements. The true advantages of RAP in cardiac surgery need to be studied in a prospective, randomized, controlled trial.

Blood transfusion practices in the ICU of a level 1 trauma centre and tertiary cardiac unit

Blood transfusions are associated with longer ICU and hospital inpatient durations, and an increase in mortality [1]. This study was undertaken to investigate whether the practice of packed red cell (PRC) transfusions in the ICU was in accordance with the best clinical evidence. A number of studies, most notably the TRICC study [2], have shown that indications for ICU blood transfusions are a haemoglobin (Hb) level of <7 g/dl or evidence of acute haemorrhage [3]. These criteria were therefore employed.

Blood transfusion therapy for traumatic cardiopulmonary arrest

Background:Blood transfusion therapy (BTT), which represents transplantation of living cells, poses several risks. Although BTT is necessary for trauma victims with hemorrhagic shock, it may be futile for patients with blunt traumatic cardiopulmonary arrest (BT-CPA).Materials and Methods:We retrospectively examined the medical records of consecutive patients with T-CPA. The study period was divided into two periods: The first from 1995-1998, when we used packed red cells (PRC) regardless of the return of spontaneous circulation (ROSC), and the second from 1999-2004, when we did not use PRC before ROSC. The rates of ROSC, admission to the ICU, and survival-to-discharge were compared between these two periods.Results:We studied the records of 464 patients with BT-CPA (175 in the first period and 289 in the second period). Although the rates of ROSC and admission to the ICU were statistically higher in the first period, there was no statistical difference in the rate of survival-to-discharge between these two periods. In the first period, the rate of ROSC was statistically higher in the non-BTT group than the BTT group. However, for cases in which ROSC was performed and was successful, there were no statistical differences in the rate of admission and survival-to-discharge between the first and second group, and between the BTT and non-BTT group.Conclusion:Our retrospective consecutive study shows the possibility that BTT before ROSC for BT-CPA and a treatment strategy that includes this treatment improves the success rate of ROSC, but not the survival rate. BTT is thought to be futile as a treatment for BT-CPA before ROSC.

Preoperative predictors of blood component transfusion in living donor liver transplantation

Context:Extensive bleeding associated with liver transplantation is a major challenge faced by transplant surgeons, worldwide.Aims:To evaluate the blood component consumption and determine preoperative factors that predict the same in living donor liver transplantation (LDLT).Settings and Design:This prospective study was performed for a 1 year period, from March 2010 to February 2011.Materials and Methods:Intra- and postoperative utilization of blood components in 152 patients undergoing LDLT was evaluated and preoperative patient parameters like age, gender, height, weight, disease etiology, hemoglobin (Hb), hematocrit (Hct), platelet count (Plt), total leukocyte count (TLC), activated partial thromboplastin time (aPTT), international normalized ratio (INR), serum bilirubin (T. bilirubin), total proteins (T. proteins), albumin to globulin ratio (A/G ratio), serum creatinine (S. creatinine), blood urea (B. urea), and serum electrolytes were assessed to determine their predictive values. Univariate and stepwise discriminant analysis identified those factors, which could predict the consumption of each blood component.Results:The average utilization of packed red cells (PRCs), cryoprecipitates (cryo), apheresis platelets, and fresh frozen plasma was 8.48 units, 2.19 units, 0.93 units, and 2,025 ml, respectively. Disease etiology and blood component consumption were significantly correlated. Separate prediction models which could predict consumption of each blood component in intra and postoperative phase of LDLT were derived from among the preoperative Hb, Hct, model for end-stage liver disease (MELD) score, body surface area (BSA), Plt, T. proteins, S. creatinine, B. urea, INR, and serum sodium and chloride.Conclusions:Preoperative variables can effectively predict the blood component requirements during liver transplantation, thereby allowing blood transfusion services in being better prepared for surgical procedure.

Impact of autologous blood transfusion on the use of pack of red blood cells in coronary artery bypass grafting surgery

To evaluate the impact of Cell Saver autologous blood transfusion system (CS) on the use of packed red blood cells (pRBC) in coronary artery bypass grafting (CABG) surgery. We carried out a retrospective cross-sectional study in 87 patients undergoing primary elective CABG with miniaturized cardiopulmonary bypass (miniCPB), divided in two groups: 44 without-CS and 43 with-CS. We investigated the necessity of absolute use and the volume of packed red blood cells (pRBC) in each group, as well as cardiovascular risk factors, presurgical variables and intraoperative surgical parameters. All data were collected from medical records and there was no randomization or intervention on group selection. Statistical analysis was performed with Student t-test, Mann-Whitney U-test and χ² test, with a 5% significance level. There were no significant differences between the two groups in terms of cardiovascular risk factors and pre and intraoperative variables. Evaluating the absolute use of pRBC during surgery, there was a statistically significant difference (P=0.00008) between the groups without-CS (21/44 cases; 47.7%) and with-CS (4/43 cases; 9.3%). There was also a statistically significant difference (P=0.000117) in the volumes of pRBC between the groups without-CS (198.651258.65 ml) and with-CS (35.061125.67 ml). On the other hand, in the early postoperative period (up to 24h) there was no difference regarding either the absolute use or the volumes of pRBC between both studied groups. Autologous erythrocyte transfusion with CS use reduces the use of intraoperative homologous pRBC in coronary artery bypass grafting surgeries associated with miniCPB.

The Effect of Eclampsia on Gamma-Glutamyl Transferase Activity and some Bichemicals

The research included estimation of gamma-glutamyl transferase activity and total protein, albumin, globulin, heamoglubin, packed red cell volume ratio and electrolytes sodium, potassium in (30) pregnant women complication Eclampsia within gestational period first, second and third trimester, aging between (15-45) years, as well as in (30) pregnant women as control with similar age. The results showed significant decrease in the activity of gamma-glutamyl transferase in the second and third trimester, and significant decrease in concentration of total protein, albumin, haemoglubin, pack red cell volume and sodium at first, second and third trimester comparison to control group. According to correlation coefficient, the result showed that direct significant correlation between gamma-glutamyl transferase activity and protein concentration in the first trimester and direct significant correlation between gamma-glutamyl transferase activity and concentration of sodium level in the second trimester.

255 Survey on Threshold for Packed Red Cell Transfusion in Neonatal Units Across the UK

AimNeonatal blood-product transfusion practices and policies vary widely among different institutions. The aim of this survey was to evaluate the threshold for packed red cell (PRC) transfusion for non-haemolytic neonatal...

An Elderly Patient on Warfarin With Rectal Bleeding

Question: An 83-year-old woman was admitted to the hospital with rectal bleeding. She complained about pain in her lower back because of a heavy fall at home 2 weeks before. Owing to atrial fibrillation and low cardiac output, she had been under constant treatment with phenprocoumon. On rectal examination, a soft mass was felt dorsal on supine position. Laboratory studies revealed abnormal coagulation tests with a prolonged prothrombin time (international normalized ratio, 2.5) and a slightly prolonged partial thromboplastin time of 38 seconds (normal, 24–36). The platelet count was within the normal range, and her serum creatinine was elevated (4 mg/dL). Because of severe anemia (hemoglobin, 7.5 g/dL), she received a pack of red blood cells. Ileocolonoscopy revealed massive diverticulosis of the entire colon and a 3-mm opening to the dorsal rectal wall with discharge of blood (Figure A). Computed tomography without contrast enhancement because of impaired renal function was performed, revealing a 7 × 7-cm round, liquid mass (Figure B) that could also be demonstrated by rectal endosonography (Figure C). Correlating her clinical and imaging findings, what is your diagnosis? Look on page 270 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Colonoscopy suggested a fistula of the rectum, and computed tomography showed a large presacral, retro-rectal mass consistent with a hematoma. Next, contrast-enhanced fluoroscopy was performed using a catheter inserted into the presumed rectal fistula by flexible rectoscopy, demonstrating connection of the hematoma with the rectum. Phenprocoumon was stopped, and vitamin K was given leading to normalization of the prothrombin time. The patient was started on ceftriaxone and metronidazole and underwent surgery 2 days later. Transrectal evacuation of the hematoma and irrigation with saline were performed, and the perforation site was closed by transanal suture. A corrugated drain was inserted into the rectal space and removed 5 days later. The further course was uneventful, and the patient was discharged. Anticoagulation with phenprocoumon was resumed. Systemic anticoagulation is a frequent cause of gastrointestinal bleeding, especially if predisposing conditions are present.1Ahsberg K. Höglund P. Kim W.H. et al.Impact of aspirin, NSAIDs, warfarin, corticosteroids and SSRIs on the site and outcome of non-variceal upper and lower gastrointestinal bleeding.Scand J Gastroenterol. 2010; 45: 1404-1415Crossref PubMed Scopus (56) Google Scholar However, most studies have focused on the upper gastrointestinal tract. According to the available data, up to 40% of patients with lower gastrointestinal bleeding were under anticoagulant and/or antiplatelet therapy. The most common cause of colorectal bleeding in these patients is diverticulosis, accounting for >50% of cases. Other causes of lower gastrointestinal bleeding in patients under long-term anticoagulation include in addition, polyps, arteriovenous malformations, hemorrhoids, colorectal cancer, ulceration, and colitis/proctitis. Perirectal hematoma after rectal stapled mucosectomy for hemorrhoids and rectus sheath hematoma associated with abdominal trauma and/or anticoagulation therapy has been described previously.2Hidalgo G.L.A. Heredia B.A. Fantova M.J. et al.Perirectal haematoma and hypovolaemic shock after rectal stapled mucosectomy for haemorrhoids.Int J Colorectal Dis. 2005; 20: 471-472Crossref PubMed Scopus (18) Google Scholar, 3Klingler P.J. Wetscher G. Glaser K. et al.The use of ultrasound to differentiate rectus sheath hematoma from other acute abdominal disorders.Sur Endosc. 1999; 13: 1129-1134Crossref PubMed Scopus (83) Google Scholar To our knowledge, however, this is the first report of a perirectal hematoma leading to severe lower gastrointestinal bleeding.