Patients Received Blood Transfusion Research Articles

Whole Blood Resuscitation for Injured Patients Requiring Transfusion: A Systematic Review, Meta-Analysis, and Practice Management Guideline from the Eastern Association for the Surgery of Trauma.

Whole blood resuscitation has reemerged as a resuscitation strategy for injured patients. However, the effect of whole blood-based resuscitation on outcomes has not been established. The primary objective of this guideline was to develop evidence-based recommendations on whether whole blood should be considered in civilian trauma patients receiving blood transfusions. An EAST working group performed a systematic review and meta-analysis utilizing the GRADE methodology. One PICO question was developed to analyze the effect of whole blood resuscitation in the acute phase on mortality, transfusion requirements, infectious complications, and ICU length of stay. English language studies including adult civilian trauma patients comparing in-hospital whole blood to component therapy were included. Medline, Embase, Cochrane CENTRAL, CINAHL Plus, and Web of Science were queried. GRADEpro was used to assess quality of evidence and risk of bias. The study was registered on PROSPERO (#CRD42023451143). A total of 21 studies were included. Most patients were severely injured and required blood transfusion, massive transfusion protocol activation, and/or a hemorrhage control procedure in the early phase of resuscitation. Mortality was assessed separately at the following intervals: early (i.e., ED, 3-, or 6-hour), 24-hour, late (i.e., 28- or 30-day), and in-hospital. On meta-analysis, whole blood was not associated with decreased mortality. Whole blood was associated with decreased 4-hour RBC (mean difference -1.82, 95% CI -3.12 to -0.52), 4-hour plasma (mean difference -1.47, 95% CI -2.94 to 0), and 24-hour RBC transfusions (mean difference -1.22, 95% CI -2.24 to -0.19) compared to component therapy. There were no differences in infectious complications or ICU length of stay between groups. We conditionally recommend WB resuscitation in adult civilian trauma patients receiving blood transfusions, recognizing that data are limited for certain populations, including women of childbearing age, and therefore this guideline may not apply to these populations. Level III, Guidelines.

Analysis of the incidence and risk factors of blood transfusion in total knee revision: a retrospective nationwide inpatient sample database study

ObjectiveThis study sought to determine the incidence and risk factors of blood transfusion among patients undergoing total knee revision (TKR) using a nationwide database.MethodsA retrospective data analysis was conducted based on the Nationwide Inpatient Sample (NIS), enrolling patients who underwent TKR from 2010 to 2019 with complete information. The patients were divided into two groups based on whether they received blood transfusion or not. The demographic characteristics (race, sex, and age), length of stay (LOS), total charge of hospitalization, hospital characteristics (admission type, insurance type, bed size, teaching status, location, and region of hospital), hospital mortality, comorbidities, and perioperative complications were analyzed. Finally, we conducted univariate and multivariate logistic regression to identify factors that were associated with TKR patients to require blood transfusion.ResultsThe NIS database included 115,072 patients who underwent TKR. Among them, 14,899 patients received blood transfusion, and the incidence of blood transfusion was 13.0%. There was a dramatic decrease in the incidence over the years from 2010 to 2019, dropping from 20.4 to 6.5%. TKR patients requiring transfusions had experienced longer LOS, incurred higher total medical expenses, utilized Medicare more frequently, and had increased in-hospital mortality rates (all P < 0.001). Independent predictors for blood transfusion included advanced age, female gender, iron-deficiency anemia, rheumatoid disease, chronic blood loss anemia, congestive heart failure, coagulopathy, uncomplicated diabetes, lymphoma, fluid and electrolyte disorders, metastatic carcinoma, other neurological diseases, paralysis, peripheral vascular disorders, pulmonary circulation disorders, renal failure, valvular disease, and weight loss. In addition, risk factors for transfusion in TKR surgery included sepsis, acute myocardial infarction, deep vein thrombosis, pulmonary embolism, gastrointestinal bleeding, heart failure, renal insufficiency, pneumonia, wound infection, lower limb nerve injury, hemorrhage/seroma/hematoma, wound rupture/non healing, urinary tract infection, acute renal failure, and postoperative delirium.ConclusionsOur findings highlight the importance of recognizing the risk factors of blood transfusion in TKR to reduce the occurrence of adverse events.

Disease Management and Outcomes in Patients with Paroxysmal Nocturnal Hemoglobinuria: A Retrospective Analysis of Observational Data from the United States

Background: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hemolytic disease characterized by complement-mediated hemolysis, thrombophilia, bone marrow failure (BMF), and renal disease. PNH is clinically heterogeneous, and hospitalization and regular blood transfusions may be needed. Treatment with currently approved C5 inhibitors (C5i), eculizumab and ravulizumab, have shown efficacy in intravascular hemolysis control and reduction in thrombosis risk. Yet, in routine clinical practice, a limited number of patients receive C5i in the United States. Moreover, less than 70% of patients treated with eculizumab continue to receive treatment 1 year following PNH diagnosis. If the disease is managed inadequately, patients may experience prolonged morbidity, increased frequency and severity of symptoms, and early mortality. There is limited real-world evidence available on PNH disease management. Aim: To better understand the disease management and consequences of PNH. Methods: In this retrospective observational study, we analyzed 1227 patients aged ≥18 years in the TriNetX network who were diagnosed with PNH on or after 1 January 2007 and had ≥180 days of post-diagnosis follow-up data (97% were based in the United States). Patients were followed from 1 January 2007 to 6 May 2023. Disease management and outcomes were analyzed for all patients, including those with chronic anemia who were complement-inhibitor naïve. Chronic anemia was defined as hemoglobin &amp;lt;10 g/dL without any hemoglobin measure of ≥10 g/dL between 3 months prior to PNH diagnosis (index date) and 6 months after diagnosis. PNH-related hospitalization was defined by specific International Classification of Diseases codes. The baseline period was defined as 1 year prior to PNH diagnosis. Event rates were estimated for hospitalization (recurrent), transfusions (recurrent), BMF, and death. Rates are adjusted for exposure time (time between diagnosis and end of follow-up) and reported as per person-year with 95% confidence intervals (CIs). Results: In the overall cohort, 58% of patients were female, and the median (interquartile range) age was 56 (38-68) years. During a median 35 (19-62) months of follow-up, 322 (26%) patients received blood transfusions and 172 (14%) patients received C5i. Median time to C5i initiation since diagnosis was 1 (0-10) month with a median treatment duration of 14 (0-49) months. Out of 1227 patients, 50 (4%) had chronic anemia and were complement-inhibitor naïve. The median length of follow-up in this subgroup was 14 (7-43) months. Most of these patients (96%) had PNH with bone marrow disorder subtype. Median hemoglobin and lactate dehydrogenase levels at baseline were 8 (7-8) g/dL and 313 (218-489) U/L, respectively. Out of these 50 patients, first-line treatment was initiated a median of 1 (1-6) month after diagnosis, with anticoagulants and corticosteroids being the most frequently prescribed. During follow-up, 32 (64%) of these patients experienced ≥1 hospitalization (rate 0.78, 95% CI 0.62-0.95) with a median of 3 (2-9) days stay for the first hospitalization. Anemia (42%), abdominal pain (36%), and infections (9%) were the leading causes of admission. In addition, 26 (52%) patients were transfusion dependent (rate 1.52, 95% CI 1.30-1.77) and 30 (60%) experienced BMF (rate 0.71, 95% CI 0.48-0.99). Moreover, 21 (42%) of these patients died during follow-up (rate 0.19, 95% CI 0.12-0.28). Discussion: These findings indicate that complement-inhibitor naïve patients with chronic anemia have substantial disease burden, including frequent hospitalization, high transfusion dependency, and early mortality. In addition, the results show that only a minority of patients in this cohort received C5i. Study limitations include that mortality is likely to be underestimated, as only in-hospital deaths are captured in these data. The small sample size limits the drawing of robust conclusions. However, overall, these findings support the need to address PNH disease burden and improve disease management.

Monitoring Changes in Plasma Proteome in AML Patients Receiving Blood Transfusion Products

Background: Hemato-oncological patients, and in particular patients with acute myeloid leukemia (AML) in the remission induction treatment phase frequently receive transfusion products. These products include platelet- and red blood cell- concentrates and are administered in order to prevent and treat bleeding complications and anemia. During this treatment, patients are constantly monitored by clinical laboratory tests, however, additional studies could add nuanced information about the patients' status. Different studies have shown that plasma proteins change and their patterns' characteristics could be key to illustrate the patients' healthy and/or disease status. Importantly, changes in the plasma proteome in AML patients receiving transfusion products have not yet been studied. Thus, defining protein profiles during this phase is vital to use as a point of reference prior to tracing patients' treatments and their responses. Aim: In light of this, we aim to delineate the baseline plasma proteome in AML patients during their treatment phase. Methods: We employed unbiased mass spectrometry (MS)-based proteomics to gain insight in treatment-induced changes of the plasma proteome (Figure 1A). We included samples derived from 11 healthy donors and 11 AML patients who received chemotherapy and platelet, and red blood cell transfusions. AML patients without a previous transplant or platelet transfusion were included in this study. Results: We identified over 400 proteins in each plasma sample and found associations between proteins and clinical laboratory data, exemplified by a high correlation between Pro-Platelet Basic Protein (PPBP) and platelet incounts (r = 0.7, p-value &amp;lt; 0.001). We observed 169 significantly different proteins between AML patients and healthy controls, amongst the most significant changes we captured a strong signature of inflammation with an increased abundance of proteins involved in the acute-phase response pathway (i.e. SAA1 and CRP) and a decreased abundance of proteins involved in innate immune response (i.e. DEF1 and CAMP). Interestingly, we also found an increased abundance of proteins from the complement pathway (i.e. C9 and CFHR) and decreased abundance in proteins enriching for plasma lipoprotein particle remodeling (i.e. APOA1 and PON1) (Figure 1B). Furthermore, by building correlation networks we analyzed differences in the dynamics of plasma proteins in AML patients compared to healthy controls. This analysis showed several changes in associations between proteins, including alterations in known interactions such as the gain of correlation between APOA1 and GPLD1 as well as a loss of correlation between PLG and KNG1. Conclusion: These results highlight an imbalance in lipid metabolism and innate defense mechanisms, such as the coagulation pathway and complement system, in AML patients during their transfusion-dependent window. The plasma proteome studied in this pilot can serve as the basis to further explore changes induced in specific subgroups of patients, for example patients with and without bleeding complications. Follow up studies to analyze the changes observed here in larger cohorts are currently running (ALPHABET, trial registration NL9204) and they would be key to explore their potential association with clinical outcome in AML patients receiving transfusion products. Figure 1.- Exploring proteome changes in AML patients during their transfusion treatment phase. A) Graphical summary of the study, and B) Proteins with contrasting dynamics when comparing AML patients in treatment phase to healthy controls. Box plots depict median with its upper and lower limits representing the first (25th) and third (75th) percentiles, respectively. Box plot whiskers extend up to the highest or lowest value within 1.5 x IQR.

Prevalence of Anti-HLA Antibodies in Multiply Transfused Patients with Hematologic Malignancy

Background: Human leukocyte antigen (HLA) alloimmunization can be induced by exposure to non-self HLA molecules, such as foreign tissue during transplantation, pregnancy, and blood products. Antibodies against HLA lead to serious complications in patients receiving blood transfusions. Objective: The present study aimed to determine the prevalence and risk factors for HLA alloimmunization in multiple transfused patients with hematologic malignancies at Siriraj Hospital. Materials and Methods: The present research was a cross-sectional study. The samples comprised 100 cases of hematologic malignancy patients who had a history of at least three episodes of transfusion with cellular blood components. All patients were tested for anti-HLA class I and class II antibodies by Luminex assay. Results: The overall prevalence of HLA alloimmunization in multiple transfused patients with hematologic malignancies was 40%. Anti-HLA class I, class II, and both class I and class II antibodies were detected in 35%, 30%, and 25% of the patients, respectively. Factors related to the development of anti-HLA antibodies were previous pregnancy (OR 4.82, 95% CI 1.62 to 14.35, p=0.005), five or more transfusions (OR 7.82, 95% CI 2.22 to 27.55, p=0.001), and diagnoses with myelodysplastic syndromes (MDS) antibodies (OR 5.88, 95% CI 1.98 to 17.47, p=0.001). Conclusion: Patients with hematologic malignancies who required long-term blood transfusion support could be at high risk for the development of anti-HLA antibodies. Important risk factors are pregnancy, multiple transfusions, and MDS. Keywords: HLA alloimmunization, Anti-HLA antibodies, Blood transfusions, Hematologic malignancy

Are Data Driving Our Ambulances? Liberal Use of Tranexamic Acid in the Prehospital Setting.

Current data on tranexamic acid (TXA) supports early administration for severe hemorrhagic shock. Administration by EMS has been facilitated by developing protocols and standing orders informed by these data. In this study, patterns of TXA use by EMS agencies serving a large level 1 trauma center were examined. We hypothesized that current widespread TXA use often includes administration outside of data-driven indications. The trauma registry at a level 1 trauma center was queried for patients who received TXA. To determine the practice patterns and appropriateness of administration of TXA, patients' physiologic state in the prehospital environment based on EMS records, physiologic state on arrival to hospital, and interventions performed in both settings were examined. Over 20 separately managed EMS systems that administer TXA transport patients to this trauma center, allowing for a broad survey of practices. From 2016 to 2021 1089 patients received TXA, 406 (37.3%) having treatment initiated by EMS services. Of these, the average prehospital systolic blood pressure (SBP) was 108.2mmHg and initial ED SBP was 107.8mmHg. Only 58.4% of these patients received blood transfusion after arrival to this trauma center. Compliance with standard indications was low with only 14.6% of administrations meeting any data-driven SBP indication. Similar levels of compliance were seen across high volume EMS services. Tranexamic acid use has become common in trauma and has been adopted by many EMS systems. These results indicate TXA in the prehospital setting is over-used as administration is not being limited to indications that have shown benefit in prior data.

Correlation of serum ferritin with parathyroid hormone level in patients with transfusion-dependent thalassemia

Introduction: Thalassemia is a rare hereditary condition that causes hemoglobin synthesis deficiency. Recurrent blood transfusion in transfusion-dependent thalassemia (TDT) individuals results in iron overload and deposition in body tissues, leading to endocrine malfunctions, including parathyroid. This study aimed to determine the correlation between the level of serum ferritin and parathyroid hormone level in TDT patients. Methods: A cross-sectional study was conducted among adult TDT patients receiving blood transfusions at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia from January to June 2023. Serum ferritin was measured using an enzyme-linked fluorescence assay (ELFA), while parathyroid hormone was quantified using an enzyme-linked immunosorbent assay (ELISA). The Spearman correlation analysis was used to identify the correlation between the level of serum ferritin with parathyroid hormone. Results: A total of 46 TDT patients were enrolled in the study, with a median age of 25 years old and represented predominantly by males (56.5%). The median levels of serum ferritin and parathyroid hormone were 5,672.90 ng/mL (min-max: 596.80–24,014.58 ng/mL) and 29.80 pg/mL (min-max: 10.61–97.01 pg/mL), respectively. The Spearman correlation analysis suggested a statistically insignificant negative correlation between serum ferritin and parathyroid hormone in TDT patients (r = -0.166; p=0.270). Conclusion: Serum ferritin was inversely, but not significantly, correlated with parathyroid hormone in TDT patients, suggesting that impaired parathyroid function might be associated with the increment of plasma iron.

Late Open Semi-conversion with Endograft Preservation for (Type II) Endoleaks with Late Aneurysm Sac Enlargement after EVAR - Indications, Method and Results in Our Own Patient Collective

EVAR (endovascular aortic repair) is the most common method for treating an abdominal aortic aneurysm, but according to the latest findings it carries the risk of subsequent complications. These can be caused by (late) aneurysm sac growth. If conservative and surgical therapies fail to treat the aneurysm sac growth, open conversion is necessary to prevent aneurysm rupture. There are several options for open conversion, in which the EVAR prosthesis can be completely preserved or is (partially) removed. Late open semi-conversion with complete in-situ preservation of the EVAR-prosthesis and gathering of the aneurysm sac are a less invasive method than complete conversion and may be performed instead for selected patients. The aim of the present work is to present the surgical method, including indications and technical information, as well as the presentation of the results in our recent patient collective.All patients semi-converted in our department of vascular surgery and phlebology due to (type II) endoleak were included. All data are presented as n (%) or median (range).Between 6/2019 and 3/2023, 13 patients underwent semi-conversion 6 (2-12) years (median, range) after the initial EVAR. The aneurysm sac diameter at the time of semi-conversion was 69mm (58-95mm), the operating time was 114min (97-147min), the blood loss was 100ml (100-1500ml). Five (38%) patients received blood transfusion intraoperatively and 2 (15%) postoperatively. The stay in the intensive care unit lasted 1 (1-5) days, the hospitalisation time was 8 (6-11) days. Postoperative complications were intestinal atony (3 [23%], 1 [8%] with nausea/emesis and gastric tube insertion), anaemia (2 [15%]), hyponatraemia (2 [15%]), delirium (1 [8%]), COVID-19 infection (1 [8%]) and 1 [8%] intra-abdominal postoperative bleeding with the indication for surgical revision and the transfusion of 8 erythrocyte concentrates.Semi-conversion is a safe and practicable surgical method with few severe complications for a selected group of patients, which should be considered as an alternative to more invasive methods with (partial) removal of the EVAR-prosthesis. Further long-term studies comparing semi-conversion to full conversion are needed to demonstrate its benefits.

Plasenta previa tanısı olan gebelerde hafif trombositopeni ile postpartum kanama ilişkisi

ABSTRACT&#x0D; Aim&#x0D; Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity. Although thrombocytopenia is one of the known risk factors for postpartum hemorrhage, little is known about the effect of mild thrombocytopenia on PPH. The current study aimed to investigate the relationship between postpartum hemorrhage and mild thrombocytopenia in pregnant women with placenta previa. &#x0D; Method&#x0D; We conducted a retrospective cohort study of pregnant women who underwent placenta previa surgery between October 1, 2019 and May 1, 2022. Women with mild thrombocytopenia (platelet count 100,000-149,999/ µl) comprised the study group. The women in the control group had normal platelet counts (platelet count 150.000- 450.000 / µl). The outcome was the incidence of postpartum hemorrhage which is a combination of one or more of the following: 1) the requirement for a transfusion of pRBC during the intraoperative or postpartum period; 2) a decrease in Hb levels of at least 3 gr/dL postpartum compared to prepartum.&#x0D; Results&#x0D; There were 170 women in the study; 30 were in the group with mild thrombocytopenia and 140 were in the control group. Mild thrombocytopenia was found to be associated with postpartum hemorrhage (adjusted odds ratio: 3.90 95% CI: 1.56-9.72). Also in the mild thrombocytopenia group, the number of patients receiving blood transfusion and Hb decline &gt;3 g/dL were significantly higher compared to the control group (p

SAFETY AND EFFICACY OF SEMI-RIGID URETEROSCOPE IN RETROGRADE INTRARENAL SURGERY FOR RENAL PELVIC STONES UPTO 2 CM

Objectives: To determine the efficacy and safety of RIRS with rigid URS for renal pelvis stone between 1 to 2cm. Materials and Methods: This is a prospective observational case series of 48 patients who under RIRS at Institute of Kidney Diseases, Peshawar during 1st January 2022 and 31st December The primary indication was single renal pelvic calculi of up to 2 cm diameter in patients with previously failed treatment modalities or as primary cases. Data was analysed regarding patient demographics, stone size, surgery time, complications and clearance rates within a 2 months follow-up period. Results: Total of Forty-eight patients with 29 (60.4%) males and 19 (39.6%) females in a ratio of 1.5 to 1. The mean age was 38.7 ± 10.8 years (range: 19 – 60 years). Mean stone diameter was 15.3 ± 2.6 mm. Early postoperative complications included fever, haematuria and retained stones. There were 12 (25%) cases of postoperative fever who resolved without any major sequelae, and 11 (22.9%) cases of early postoperative haematuria of which 4 (8.3%) patients received blood transfusions. The overall clearance rate after fi rst RIRS was 87.5% (n = 42) with a P value of 0.01 and is clinically signifi cant. Six (12.5%) patients were found to have stone fragments retained. The clearance rate after 2nd look RIRS was 95.83% (n = 46). Conclusion: Retrograde intrarenal surgery using semi-rigid ureteroscope for renal pelvic stones has favourable stone free rates and the results are comparable to percutaneous nephrolithotripsy. Complications requiring intervention are below ten percent and are non-fatal.

Patient Blood Management in Microsurgical Procedures for Reconstructive Surgery.

Introduction: The main purpose of reconstructive surgery (RS) is to restore the integrity of soft tissues damaged by trauma, surgery, congenital deformity, burns, or infection. Microsurgical techniques consist of harvesting tissues that are separated from the vascular sources of the donor site and anastomosed to the vessels of the recipient site. In these procedures, there are some preoperative modifiable factors that have the potential to influence the outcome of the flap transfer and its anastomosis. The management of anemia, which is always present in the postoperative period and plays a decisive role in the implantation of the flap, covers significant importance, and is associated with clinical and laboratory settings of chronic inflammation. Methods: Chronic inflammatory anemia (ACD) is a constant condition in patients who have undergone RS and correlates with the perfusion of the free flap. The aim of this treatment protocol is to reduce the transfusion rate by maintaining both a good organ perfusion and correction of the patient's anemic state. From January 2017 to September 2019, we studied 16 patients (16 males, mean age 38 years) who underwent microsurgical procedures for RS. Their hemoglobin (Hb) levels, corpuscular indexes, transferrin saturation (TSAT) ferritin concentrations and creatinine clearance were measured the first day after surgery (T0), after the first week (T1), and after five weeks (T2). At T0, all the patients showed low hemoglobin levels (average 7.4 g/dL, STD 0.71 range 6.2-7.4 g dL-1), with an MCV of 72, MCH of 28, MCHC of 33, RDW of 16, serum iron of 35, ferritin of 28, Ret% of 1.36, TRF of 277, creatinine clearance of 119 and high ferritin levels (range 320-560 ng mL-1) with TSAT less than 20%. All the patients were assessed for their clinical status, medical history and comorbidities before the beginning of the therapy. Results: A collaboration between the two departments (Department of Transfusion Medicine and Department of Reconstructive Surgery) resulted in the application of a therapeutic protocol with erythropoietic stimulating agents (ESAs) (Binocrit 6000 UI/week) and intravenous iron every other day, starting the second day after surgery. Thirteen patients received ESAs and FCM (ferric carboxymaltose, 500-1000 mg per session), three patients received ESAs and iron gluconate (one vial every other day). No patients received blood transfusions. No side effects were observed, and most importantly, no limb or flap rejection occurred. Conclusions: Preliminary data from our protocol show an optimal therapeutic response, notwithstanding the very limited scientific literature and data available in this specific surgical field. The enrollment of further patients will allow us to validate this therapeutic protocol with statistically sound data.

IRON NOF trial: IV iron for anaemic patients with femoral fracture

BackgroundPreoperative anaemia is associated with increased use of blood transfusions, a greater risk of postoperative complications, and patient morbidity. The IRON NOF trial aimed to investigate whether the administration of i.v. iron in anaemic patients during hip fracture surgery reduced the need for blood transfusion and improved patient outcomes. MethodsThis phase III double-blind, randomised, placebo-controlled trial included patients >60 yr old with preoperative anaemia undergoing surgery for femoral neck or subtrochanteric fracture across seven Australian Hospitals. Patients were randomly allocated on a 1:1 basis to receive either i.v. iron carboxymaltose 1000 mg or placebo (saline) at operation. The primary endpoint was blood transfusion use, with secondary endpoints of haemoglobin concentration at 6 weeks, length of hospital stay, rehabilitation duration to discharge, and 6-month mortality. Subgroup analysis compared outcomes in patients <80 yr old and patients >80 yr old. All analyses were performed by intention-to-treat. This trial was terminated early because of jurisdictional changes of more restrictive transfusion practices and changes in consent requirements. ResultsParticipants (n=143) were recruited between February 2013 and May 2017. There was no difference observed in the incidence of blood transfusion between the treatment group (18/70) (26%) compared with the placebo group (27/73) (37%) (odds ratio for transfusion if receiving placebo: 1.70; 95% confidence interval [CI] 0.83–3.47; P=0.15) and there was no overall difference in the median number of blood units transfused between groups (odds ratio 1.52; 95% CI 0.77–3.00; P=0.22). Patients receiving i.v. iron had a higher haemoglobin 6 weeks after intervention compared with the placebo group (Hb 116 g L−1vs 108 g L−1; P=0.01). No difference was observed in length of hospital stay, rehabilitation duration to discharge, or 6-month mortality. However, in younger patients without major bleeding, the use of placebo compared with i.v. iron was associated with an increased number of units of blood transfused (placebo transfusion incidence rate ratio 3.88; 95% CI 1.16–13.0; P=0.03). ConclusionsIn anaemic patients undergoing surgery for hip fracture, i.v. iron did not reduce the overall proportion of patients receiving blood transfusion. The use of i.v. iron may reduce the amount of blood transfused in younger patients. The use of i.v. iron is associated with increased haemoglobin concentrations 6 weeks after the operation. Clinical trial registrationACTRN12612000448842.

Efficacy of endoscopic therapy and long-term outcomes of upper gastrointestinal tumor bleeding in patients with esophageal cancer

Background Upper gastrointestinal bleeding (UGIB) from malignancies is associated with a poor outcome. Only a small number of studies on gastrointestinal tumor bleeding have been published so far, focusing mainly on bleeding from gastric cancer. Since the information on patients with UGIB from esophageal cancer appears insufficient, this study aimed to present clinical and endoscopic findings, treatment options as well as clinical outcomes such as rebleeding and survival of those patients. Methods This retrospective analysis included all patients admitted with UGIB from esophageal cancer at our university hospital during a 10-year period. Results 45 patients were analyzed of whom 26 (57.8%) already had cancer stage IV at index bleeding. 22 (48.9%) patients presented with hemodynamic instability and 30 (66.7%) patients received blood transfusions. Active bleeding was present in 24 (53.3%) patients, of whom 20 (83.3%) received endoscopic therapy. Successful hemostasis was achieved in 18 (90%) of 20 patients with Argon plasma coagulation used most frequently (52.4%). Early and delayed rebleeding occurred in 5 (12.5%) and 11 (27.5%) of all inoperable patients, respectively. Intake of anticoagulation or anti-platelet drugs were risk factors for delayed rebleeding and the median overall survival after index bleeding was 1.2 months. Conclusion UGIB from esophageal cancer occurred most frequently in advanced tumor stages and was associated with significant blood loss. Even though initial endoscopic therapy was effective, rebleeding occurred in a significant number of patients. Those taking anticoagulants or anti-platelet drugs should be closely monitored for rebleeding. The overall survival after index bleeding was poor.

Occurrence of Transfusion Transmitted Infections Among Transfusion Dependent Thalassemia Patients in A Tertiary Care Hospital in India

Background: Blood transfusion is an important treatment modality in the modern health care system; however, transfusion transmitted infections(TTI) could be fatal or life-threatening in some cases.Objective: To determine the occurrence of transfusion transmitted infections among transfusion dependent thalassemia patients and to study the socio-demographic characteristics of the recipients.Methods: This hospital-based descriptive longitudinal studywas conducted between February 2019 and June 2020, on 102 transfusion-dependentthalassaemic patients receiving blood transfusion at Bankura Sammilani Medical College &amp; Hospital, Bankura,West Bengal, India. They were tested for HIV, HBV, HCV, syphilis and malaria by ELISA (Enzyme Linked Immunosorbent Assay) Lisa Scan EM, Merilisa HBsAg, Merilisa HCV, RPR kit and Maleriscan malaria Pf/Pv.Results: Out of 102 patients, 5.90% were positive for TTI. The highest occurrence was found to be of HCV 3.90%. HBV and HIV showed similar occurrence of 0.98% and none came out positive for syphilis or malaria. The highest occurrence of TTI was found among females 66.7%. The average age of the participants was 7.97±3.27years. The average number of blood transfusion received per year was 11.95±2.71units. Majority of the participants belong to low socio- economic group family 62(60.8%). In respect to ethnicity 14.7%were tribal, while 85.3%were non-tribal population.Conclusion: The cause of high prevalence of HCV may be due to donors being asymptomatic in early stages and failure of detection due to window period of infection. More sensitive screening tests should be done for HIV, HBV, and HCV. All donors must be screened by NAT if not possible the patients must be screened for TTI regularly.Thalassemia patients being the most affected, premarital screening for thalassemia should be done.Every patient should be vaccinated with hepatitis B vaccine.International Journal of Human and Health Sciences Vol. 07 No. 02 April’23 Page: 171-175

Prognostic Significance of Degree of Anaemia and Blood Transfusions in Gastric Cancer Patients

Background: Anaemia is a common complication of many solid tumours and occurs in approximately 41 % of patients with advanced gastric cancer at the time of diagnosis. Studies have shown that anaemia is an independent prognostic factor in gastric cancer, however it is less clear if blood transfusion alters the outcome in these patients. Aim of this study is to evaluate the effect of anaemia and blood transfusion on survival in advanced gastric cancer patients at our institution. Methods: This is a retrospective review of electronic medical records of gastric cancer patients treated from January to December 2013. Patients' demographics and clinical data was collected and analysed in relation to various factors including level of haemoglobin and use of blood transfusion. Survival was calculated using Univariate, multivariate and Kaplan-Meier survival analysis. Results: A total of 112 patients were identified including 79 (70%) males and 33 (30%) females with a median age of 73 years. Vast majority (n=88, 79%) of patients had locally advanced (T4 or node positive) disease at initial presentation. Eighty-three patients did not proceed to surgery after neoadjuvant chemotherapy due to inoperable disease. Initial Haemoglobin was &gt;100 gram per litre in 28 (25%) patients. Nineteen patients had Haemoglobin of &lt;80 gram per litre. 96 (86%) patients received blood transfusion. Overall, 98 (87.5%) patients died. The estimated median overall survival was 12 months (95% CI=11-81; SD=17). The 1-, 3-, and 5-years OS were 55%, 30% and 10% respectively. The median progression free survival (PFS) with any treatment was 10 months (SD=20). Univariate analysis showed statistical significance of level of Hb and surgical resection to overall survival (P=0.0122 and P=0.0001). Multivariate analysis showed disease stage, surgical resection and Hb level as independent factors to the outcome. Conclusion: The point prevalence of anaemia in our gastric cancer patients during treatment had an effect on overall survival. The outcome couldn't be improved with blood transfusion. Our findings indicate the need for a consistent diagnostic and treatment approach to anaemia in this setting.

An interval of clinically silent gastrointestinal bleed in dysautonomic spinal cord injury: a case report

BackgroundGastrointestinal bleed (GIB) has high incidence in traumatic spinal cord injured (tSCI) patients and can frequently be life-threatening, especially early post-injury. Several risk factors often compound bleeding risk, some are unique to this patient population. Normally, clinical suspicion for GIB arises from symptoms like coffee-ground emesis, hematemesis, melena or even hematochezia. A hemoglobin drop may be a late sign. Due to tSCI, however, patients often experience neurogenic bowels and dysautonomia, which may delay symptom presentation and complicate timely diagnosis of GIB. We report a case of an almost clinically silent GI bleed in the context of acute cervical tSCI.Case presentationA 21-year-old female presented with cervical cord transection at C-7 in the setting of motor vehicle rollover, for which surgical decompression was performed. During the acute injury phase, she also received a 10-day course of dexamethasone for symptomatic COVID-19 pneumonia. Two weeks after injury, she underwent percutaneous endoscopic gastrostomy (PEG) placement which demonstrated normal gastric and duodenal anatomy. One week later, a large spike (10x) in blood urea nitrogen: creatinine (BUN: Cr) ratio raised concern for GIB, but hemoglobin remained stable, and stool color remained unchanged. The following day, a gastroenterology consult was requested under increased suspicion of GIB from a sudden 3.5 g/dL hemoglobin drop. The patient received blood transfusion and pantoprazole. An upper endoscopy was performed, revealing three small duodenal ulcers. Melanotic stool ensued afterwards.ConclusionsDue to dysautonomia, clinical presentation of GIB can be significantly delayed in the tSCI patient population, leaving them vulnerable to succumb to illness. This case illustrates the possibility of an interval in which the patient was bleeding, with the sole indicator being an elevated BUN. Our case calls for closer monitoring of and vigilance for tSCI patients, and possibly employment of different strategies to reduce the incidence and enhance early detection of GIB in tSCI patients to subsequently decrease the morbidity and mortality associated with it.

Transcatheter Mitral Valve-in-Valve Implantation Applying a Long Pre-Curved Sheath for Patients with Degenerated Bioprosthetic Mitral Valve

Backgrounds: Percutaneous transseptal transcatheter mitral valve-in-valve implantation (TMViV) has become an alternative minimally invasive treatment choice for patients with degenerated mitral bioprosthesis and high surgical risk. However, transseptal approach is more technically challenging than transapical approach in TMViV procedures. Objective: The objective of this study was to introduce the experience of applying long pre-curved sheaths in transseptal TMViV procedures and to evaluate the effect of long pre-curved sheath techniques in TMViV procedures. Methods: Between January 2020 and December 2021, 27 patients with degenerated bioprosthetic mitral valve underwent TMViV procedures using a balloon-expandable valve via the transseptal approach. The regular 14/16F expandable sheath were used for low-profile delivery in first 10 cases, and 22F long pre-curved sheath were used in the next 17 cases during procedures. We retrospectively reviewed the catheter techniques, perioperative characteristics, and prognosis. The median follow-up time was 12 (1–21) months. To further scrutinize our data, we divided the group into the early 10 patients using 14/16F expandable sheath and the subsequent 17 patients with long pre-curved sheath in order to assess the impact of different sheaths and procedural details on outcomes. Results: Procedural success was obtained in all patients with no in-hospital mortality. Seventeen patients received 26 mm prostheses; the remaining ten patients received 29 mm prostheses. Post balloon dilatation was performed in one case. Total procedure time was (96.1 ± 28.2) min, the fluoroscopic time was (27.4 ± 6.5) min, and total contrast volume was (50.7 ± 10.1) mL. One patient received blood transfusion because of hemorrhage at the femoral puncture site. One patient received a permanent pacemaker implantation due to high-degree atrioventricular block at postoperative day 3. There were no other major post-procedure complications and the median length of hospital stay was 4 days. Twenty-five (92.6%) patients improved by ≥1 New York Heart Association (NYHA) functional class at 30 days. In subsequent sub analysis, there were shorter procedural time [(85.2 ± 24.3) vs. (115.2 ± 25.6) min, p = 0.0048] and shorter fluoroscopic time [(24.3 ± 5.2) vs. (31.3 ± 5.1) min, p = 0.0073] in cases with the long pre-curved sheath than ones with regular expandable sheath. The iatrogenic atrial septal defect (ASD) closure was performed because of the transeptal large right to left shunt in 2 cases with regular expandable sheath, but no patient needed intraoperative ASD closure in cases with the long pre-curved sheath. Conclusions: Transseptal TMViV using long pre-curved sheath could simplify transseptal approach with reliable outcomes for patients of degenerated mitral bioprosthesis.

Analysis of Irregular Blood Group Antibody Distribution and Blood Transfusion Efficacy in Patients with Malignant Tumor

To investigate the distribution of irregular blood group antibodies in patients with malignant tumors, and to analyze the relationship between it and efficacy of blood transfusion in patients. 5 600 patients with malignant tumors treated in Shanxi Bethune Hospital from January 2019 to December 2021 were selected as the research subjects. All patients received blood transfusion, and cross matching test was conducted before blood transfusion, irregular antibody results of patients were tested; the irregular distribution of blood group antibodies was observed, and the relationship between it and efficacy of blood transfusion in patients was analyzed. Among 5 600 patients with malignant tumors, 96 cases were positive for irregular antibody, and the positive rate was 1.71%; the main blood group systems involved in the irregular antibody positive of 96 patients with malignant tumors were RH, MNSs and Duffy system, among which Rh blood group was the most common, and the proportion of anti-E was the highest; among the malignant tumor patients with positive blood group irregular antibody, the proportion of female was higher than that of male; the proportion of patients aged >60 years was the highest, followed by patients aged >40 and ≤50 years, and the proportion of patients aged 18-30 years was the lowest; the patients with positive blood group irregular antibody were mainly in blood system (including lymphoma), digestive system, reproductive and urinary system; the positive rate of irregular antibody of patients in the ineffective group was higher than that of patients in the effective group, the difference was statistically significant (P<0.05). Logistic regression analysis results showed that, irregular antibody positive was a risk factor for ineffective blood transfusion in patients with malignant tumor (OR>1, P<0.05). The irregular blood group antibody positive of patients with malignant tumor are mostly female, and the proportion of patients aged >60 is the highest, which is mainly distributed in malignant tumors of blood system, digestive system and urogenital system, and the positive blood group irregular antibody is related to the efficacy of blood transfusion in patients.

An Observational Pilot Study on Supine Percutaneous Nephrolithotomy: Initial Experience at a Single-Centre.

Objective To assess the surgical outcome of supine percutaneous nephrolithotomy (PCNL) in patients with co-morbidities. Materials and methods We retrospectively reviewed the data of 15 patients who underwent supine PCNL at our centre from September 2019 to May 2021. Preoperatively, a complete examination of the patients, along with biochemical and radiological investigations, was done. The data, which included patient demographics, comorbidities, complexity of renal calculi, complications, and stone clearance rate, were collected from the patients' medical records. Results Patients aged between 31 and 70 years were included in the study. The mean (SD) BMI was 26.01 (2.31). Twelve patients (80%) were overweight with a BMI of 25.3 to 29.3 kg/m2. The most common comorbidities were diabetes (33.3%) and hypertension (26.7%). In our study, six patients were American Society of Anesthesiologists (ASA) grade 3 (40%), followed by grade 2 in five patients (33.3%), grade 4, and grade 1 in two patients (13.3%) each. The Guy's Stone score was one in nine patients (60%) and two in six patients (40%). Complete clearance was achieved in 13 (86.7%) patients. Two patients (13.3%) had a stone clearance of more than 80%. Data analysis showed that 14 patients (93.3%) had no perioperative complications. Postoperative abdominal distension was noted in one patient (6.7%), which was managed conservatively (Clavien-Dindo grade 1). We did not encounter any cases of organ injury following supine PCNL. Postoperatively, none of our patients received blood transfusions. Conclusion Our study shows that supine PCNL is a good surgical option, especially for high-risk patients with good stone clearance and low complication rates.

Shock Index in predicting fluid resuscitation in patients with hypovolemic shock

Introduction: Hypovolemic shock is diagnosed by the signs of hemodynamic instability and when the source of volume loss is obvious. Among various types, hypovolemic shock is the most common which results either from the loss of blood from hemorrhage or from the loss of plasma alone due to extravascular fluid sequestration or gastrointestinal, urinary, and insensible losses. The objective of this research was to find the use of shock index in predicting fluid resuscitation in patients with hypovolemic shock. Methods: An analytical cross-sectional study was conducted among 120 patients with hypovolemic shock visiting to the Emergency department of College of Medical Sciences and Teaching Hospital from July 2022 to September 2022. Data was collected from patients and checked for completeness, accuracy and then entered and analyzed using SPSS-20. Data was analyzed using descriptive and inferential statistical tools. P-value &lt;0.05 was considered as statistically significant. Results: Out of 120 patients, majority of the patients were &gt;50 years. Minority of the patients only required blood transfusion. Among total patients 60% of the patients were admitted in ICU, 25% of them were admitted in ward and 4.17% of them were expired. In 60% cases shock index was &lt;1 while in 40% case shock index was ≥1. The number of patients receiving blood transfusion at ER increased with increase in shock index and that the number of patients with hypovolemic shock are admitted in hospital more in shock index category ≥1 as compared to shock index &lt;1 (p-value &lt;0.05). Conclusions: This study reveals that shock index is accurate in predicting the amount of fluid. The risk of all clinical complication is increased with increase in shock index.