Units Of Red Blood Cells Research Articles

Effect of major ABO blood group mismatched HSCT on blood transfusion and clinical outcomes in AA patients.

To investigate the impact of the ABO blood group major match type on stem cell engraftment, blood transfusion and clinical outcomes in aplastic anemia patients with hematopoietic stem cell transplantation (HSCT), we retrospectively analyzed the data of 361 aplastic anemia patients treated with HSCT, and found ABO major mismatched resulted in delayed red blood cells (RBCs) engraftment and ABO blood group conversion. The patients in the ABO major mismatched group required more units of RBCs and PLTs transfusions. Multivariate linear regression analysis showed that ABO mismatched, acute graft-versus-host disease (aGVHD), time to RBCs and PLTs engraftment and blood group conversion, and baseline hemoglobin were significantly associated with RBCs transfusion, the factors associated with PLTs transfusion were the PLTs, RBCs and neutrophils engraftment, graft rejection, baseline PLTs, aGVHD grade II-IV, and severe chronic GVHD. Multivariate analysis showed that the time to neutrophils engraftment, baseline hemoglobin, and aGVHD were independent poor prognostic factors to both overall survival and failure-free survival. Moreover, the major ABO-mismatched HSCT group were hospitalized more often. These findings suggest that it's better to select a donor with an ABO major match to reduce the burden of transfusion and the impact of hospitalization, if conditions permit.

Transfusion of Whole Blood Is Not Associated With Increased Rate of Hemolytic Transfusion Reaction.

Low-titer cold-stored whole blood (WB) transfusion provides multiple advantages over component therapy (CT) in resuscitation of the hemorrhaging patient. However, concern regarding the risk of hemolytic transfusion reaction (HTR) is a barrier for continued expansion of the use of WB. HTR is most often seen after transfusion of packed red blood cells (RBCs), and the rate of HTR after WB transfusion remains largely unknown. We sought to investigate the incidence of HTR after WB transfusion at our institution via a retrospective observational study. Given that the pathogenesis of HTR is often an immune-mediated response to RBC antigens, we hypothesized that the incidence of HTR in WB transfusion would not be higher than in CT. The institutional blood bank was queried for the total number of units transfused in the facility and all suspected transfusion reactions from CT (RBC, fresh-frozen plasma [FFP], or platelets) or WB between July 2020 and June 2023. A retrospective chart review was performed to determine the type and severity of reaction and the implicated product. The primary outcome was incidence of HTR. Secondary outcomes were incidence of severe transfusion reaction (including transfusion-associated cardiac overload, transfusion-related acute lung injury, and severe allergic reactions) and in-hospital mortality related to transfusion reaction. Two HTRs occurred out of 6,771 units of WB transfused (incidence 0.03%), compared to 6 HTRs out of 49,802 units of RBCs (incidence 0.012%, P = .25 via Fisher's exact test). One severe reaction occurred in the WB subgroup (0.01%); 8 occurred with RBC (0.02%). In patients with suspected transfusion reaction, there was no difference in mortality between WB (1, 0.01%) and RBC transfusion (7, 0.01%). No HTR was seen in patients who received prehospital transfusion of WB, RBC, or platelets (no patient received prehospital FFP). No HTR was seen with transfusion of platelets or FFP. This retrospective study found no difference in incidence of HTR, severe transfusion reaction, or mortality with transfusion of WB when compared to CT, in particular RBC. These findings underpin the assertion that WB is a safe method of resuscitation and supports the expanded utilization of WB in both in-hospital and prehospital settings, and has implications in both civilian and deployed settings.

Mortality in Critically Ill Patients with Liberal Versus Restrictive Transfusion Thresholds: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis

Background/Objectives: Anemia is common in critically ill patients, yet red blood cell (RBC) transfusion without active bleeding does not consistently improve outcomes and carries risks such as pulmonary injury, fluid overload, and increased costs. Optimal transfusion thresholds remain debated, with some guidelines recommending a restrictive target of 7 g/dL instead of a more liberal target of 9 g/dL. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines, searching PubMed, EMBASE, and LILACS from January 1995 to October 2024. Thirteen randomized controlled trials involving 13,705 critically ill adults were included, with 6855 assigned to liberal and 6850 to restrictive transfusion strategies. The risk of bias was assessed using the Cochrane Risk of Bias Tool 2, and the pooled effect sizes were estimated with a random-effects model. We registered the protocol in PROSPERO International Prospective Register of Systematic Reviews (CDR42024589225). Results: No statistically significant difference was observed in 30-day mortality between restrictive and liberal strategies (odds ratio [OR] 1.02; 95% confidence interval [CI], 0.83–1.25; I2 = 49%). Similarly, no significant differences emerged for the 90-day or 180-day mortality, hospital or intensive care unit (ICU) length of stay, dialysis requirement, or incidence of acute respiratory distress syndrome (ARDS). However, patients in the restrictive group received significantly fewer RBC units. The trial sequential analysis (TSA) indicated that the evidence accrued was insufficient to definitively confirm or exclude an effect on the 30-day mortality, as the required sample size was not reached. Conclusions: In conclusion, while our meta-analysis found no statistically significant difference in the short-term mortality between restrictive and liberal transfusion strategies, larger trials are needed to fully determine whether any clinically meaningful difference exists in critically ill populations.

Has the pendulum swung too far? Discretionary single-unit red blood cell transfusion in trauma is associated with infection, thromboembolic events, and mortality.

Studies in elective surgery report adverse outcomes with transfusion of a solitary unit of red blood cells (RBC). We quantified the effect of discretionary transfusion of one unit of blood in trauma patients with borderline transfusion indications. We hypothesized that transfusion of a discretionary unit of RBCs would increase complications. Admitted adults from the 2017-2021 American College of Surgeons Trauma Quality Improvement Program database were included if they had an injury severity score between 10 and 25 and a Glasgow Coma Scale >8: moderately to severely injured patients. Associations between single-unit RBC transfusion in the first 4 h (with no subsequent transfusion) and three primary outcomes (mortality, infection, thromboembolic event) were assessed using inverse probability-weighting propensity matching with regression adjustment. A total of 649,841 patients were included in the study. Approximately 4.2% received one unit of RBC. Propensity matching (with fractional weighting) for transfusion resulted in 307,840.7 cases and 342,000.3 controls. Transfusion of a solitary unit of RBC was independently associated with each outcome: mortality (adjusted odds ratio [aOR] 2.11, 95% CI 1.66-2.69), infection (aOR 3.92, 95% CI 2.91-5.27), and thromboembolic event (aOR 2.02, 95% CI 1.55-2.64). Transfusion of a single unit of RBC within the first 4 h of arrival in trauma patients with no subsequent transfusion during hospitalization was associated with an increased risk of mortality, infection, and a thromboembolic event. When weighing the decision to transfuse trauma patients with equivocal signs of hemorrhage, one needs to balance the potential harm against the likelihood that such transfusion is necessary.

Automated processing of Meryman-frozen red blood cells: A novel protocol for deglycerolization.

Many blood services maintain large inventories of red blood cell (RBC) units cryopreserved in glycerol using the Meryman method. With the discontinuation of the COBE® 2991 cell processor, an alternative thawing method is needed. We aimed to develop a deglycerolization protocol for Meryman-frozen units using the ACP® 215 cell washer. In the optimization phase, Meryman-frozen RBC units stored for 10 years were thawed, paired, and divided into two groups: one with a centrifugation step to remove glycerol before deglycerolization ("volume reduction") and one without. Biochemical and hematological parameters assessed included hemolysis, hematocrit, hemoglobin, ATP, pH, and osmolality. The protocol was then validated. Hemolysis rates were lower with than without volume reduction (0.4% vs. 0.6%). Centrifuged RBCs also showed higher recovery (72% vs. 63%), increased hematocrit (0.51 L/L vs. 0.40 L/L), and improved pH stability (6.17 vs. 6.11). In the validation phase, six RBC units deglycerolized using the volume reduction step met Canadian Standards Association requirements for hematocrit, hemoglobin, hemolysis, and sterility. We optimized and validated a new protocol leveraging the ACP® 215 cell washer to deglycerolize Meryman-frozen RBCs. This method yielded low hemolysis, acceptable pH, and satisfactory recovery, especially with prior glycerol removal by centrifugation. The protocol has been successfully implemented, and Meryman-frozen RBC units have since been reliably thawed, meeting regulatory standards and supporting hospital needs.

Is it possible to predict severe postpartum hemorrhage and the need for massive transfusion in placenta previa cases?

The aim was to construct a reliable working model for patients with placenta previa (PP) that aids in the prediction of postpartum bleeding potential with data from antenatal imaging studies using both ultrasound (US) and magnetic resonance imaging (MRI). Forty-three patients with PP were evaluated initially with the US and then by 3-Tesla MRI. The Placenta Accreata Index (PAI) was used during the US evaluation in order to define the risks. Uterine bulging, heterogeneous signal, dark placental bands, focal interruption of myometrium and tenting of bladder wall were regarded as predictive criteria in MRI evaluation. The correlation between the findings from US and MRI studies and subsequent haemorrhage, < 1000 mL, > 1000 mL and severe haemorrhage (> 2000 mL) and massive transfusion [> 5 units of red blood cells (RBC)] were used to build this predictive model. The findings from the imaging studies were also confirmed histopathologically. In the multivariate analysis of data from patients stratified by bleed size either < 1000 mL or > 1000 mL, none of the MRI and ultrasound findings were found to be predictive. The multivariate analysis was done using the second stratification cut-point of 2000 mL, in patients bleeding > 2000 mL PAI values [OR: 2.3 (1.4-3.8)] and overall MRI reported placenta accreata spectrum [OR: 4.9 (1.8-12.9)] were found to be predictive. While MRI findings were not discriminative between transfusion groups, grade 3 loculation on US examination was found to be predictive for the need of transfusion of > 5 units [OR: 67.5 (8.2-549.4)]. There were no cases needing hysterectomy. Ultrasound and MRI findings in cases of PP can be helpful in predicting postpartum bleeding.

Surgical procedure and retrospective comparative series of Microport's AnteriorPath® vs. AMIS® in total hip arthroplasty. Preliminary findings from a single institution.

In recent years, the paradigm of surgical approaches for total hip arthroplasty (THA) has evolved, with portal-assisted techniques emerging as a promising avenue for increasing precision and minimizing invasiveness. The purpose of this study was to compare early experience with the Microport anterior percutaneously assisted total hip arthroplasty (MAP) system, with the established AMIS direct anterior approach (DAA). A retrospective chart analysis was performed on 200 consecutive patients who underwent DAA or MAP at our institution in 2022. The research was conducted in accordance with the Declaration of Helsinki (as revised in 2013), and was approved by the institutional review board of the University Duisburg-Essen (23-11274-BO). Two hundred patients were enrolled (100 DAA and 100 MAP; time to follow-up 1.7 years ±88 days). The mean operative time was 81 minutes (MAP) and 67 minutes (DAA, p>0.05). The mean cup tilt angle was 39° (MAP) and 40° (DAA; p>0.05). The mean cup anteversion angle was 13° (MAP) and 16° (DAA; p>0.05). The mean postoperative hemoglobin (Hb) decrease was 2.6 mg/dL ±0.9 mg/dL (MAP) and 2.5 mg/dL ±0.9 mg/dL (DAA; p>0.05). No major complications were documented in any of the 200 cases during the observation period. Additional screw fixation was performed in 7 cases and hybrid stem cementation was performed in 3 cases due to lack of rotational stability. All 10 cases were in patients with DAA. In only one of the 200 cases, two units of RBC were transfused postoperatively in a DAA case after a postoperative decrease of 5.7 mg/dL Hb. Anterior Path® has been demonstrated to provide reliable results, despite the presence of a steep learning curve. The employment of a working cannula has been shown to enhance the surgeon's perspective during the preparation of the acetabulum. In relation to skin incision, the bikini line incision, which is regarded as advantageous due to its alignment with the cleavage lines, has been identified as a notable benefit that is acknowledged by the patient.

Implications of packed red bloods cells production and transfer on post transfusion hemoglobin increase.

Implications of packed red bloods cells production and transfer on post transfusion hemoglobin increase.

Transfusion quantities associated with 24-h mortality in trauma patients.

Data on the correlation between transfusion volumes and trauma mortality are limited. The association between the total number of red blood cell (RBC) and low titer group O whole blood (LTOWB) units, as well as the total volume of all transfused products that were administered up to 4-h after admission and 24-h mortality was determined. The Trauma Quality Improvement Program (TQIP) datasets from 2020 to 2022 were reviewed to identify patients aged ≥15 who received any volume of blood products. Receiver operating characteristic (ROC) were constructed along with the calculated area under the ROC curve (AUROC) to determine the association between the quantity of transfusion and 24-h mortality. There were 144,379 encounters that met inclusion, with 22,467 patients who died within the first 24 h. There was a 90% probability of 24-h mortality following the transfusion of 56 RBC/LTOWB units (AUROC 0.673), with the 90% specificity, Youden's index, and 90% sensitivity surrounding this probability occurring after the transfusion of 8, 4, and 2 units, respectively. In terms of the volume of transfusion, there was a 90% probability of 24-h mortality following the transfusion of 36,000 mL of all blood products combined (AUROC 0.662), with the 90% specificity, Youden's index, and 90% sensitivity surrounding this probability occurring after the transfusion of 4400, 2000, and 500 mL, respectively. Both the total number of RBC and LTOWB units transfused and the total volume of all blood products transfused demonstrated poor predictive association with the risk of 24-h mortality in the civilian trauma population.

Predictors of Short and Long-term Rebleeding in Patients With Overt Gastrointestinal Bleeding: A Prospective Study.

We aimed to identify predictors of rebleeding in patients with overt gastrointestinal bleeding (GIB) and to develop a rebleeding index. This was a prospective study of patients admitted with GIB from 2013 to 2023 at a tertiary care center. Rebleeding was defined as the recurrence of visible bleeding after initial stabilization, endoscopic evaluation, and/or hemostatic therapy, accompanied by a change in vital signs or a hemoglobin (Hgb) decrease of ≥2g/dL. Independent predictors were determined after adjusting for confounders. Seven hundred ninety-seven patients with GIB were recruited between 2013 and 2023 and were followed up until death or January 2023. In-hospital, 1-month, 1-year, and end of follow-up rebleeding rates were: 5.3%, 8.9%, 16.2%, and 21.8%, respectively. Sources of rebleeding were different from the original sources in 36% of patients. Predictors of 1-month rebleeding included need for ≥3 packed red blood cell (PRBC) units (HR=1.86; p=0.041), endoscopic stigmata of recent hemorrhage (SRH) (HR=1.99; p=0.007), and Hgb level (HR=0.82; p=0.018; lower Hgb predicts higher rebleeding risk). A rebleeding index based on SRH, Hgb level, and ≥3 PRBC units showed modest performance (AUC=0.68), with higher scores indicating increased rebleeding risk. At the end of follow-up, SRH remained a predictor (HR=1.61; p=0.003), whereas antiplatelets on admission or discharge appeared protective against rebleeding (HR=0.66; p=0.021; HR=0.63; p=0.026). Predictors of rebleeding after GIB were SRH, PRBC transfusion, and lowest Hgb. The novel index based on these predictors performed favorably compared with the GBS, Rockall systems for UGUB and ABC scores. These data will help guide management and risk stratification of patients with GIB.

Split red blood cell units contain defined extracellular K+ levels, which are improved by a washing procedure.

We should control free K+ during massive transfusion (>80 mL/kg) of red blood cells (RBCs) in small children. To manage this, several national and international guidelines recommend using RBCs stored only up to 7 days. We tested a washing step for RBCs in saline-adenine-glucose-mannitol (SAGM) with or without irradiation to reduce supernatant K+ levels, improve quality and potentially extend the shelf life of stored RBCs. RBCs of 240-330 mL were prepared from whole blood donations, then split into halves and stored in SAGM solution at 4 ± 2°C for 21 days. RBCs were split and washed on Days 1 and 8, and some were gamma-irradiated on Day 8. Glucose, lactate, lactate dehydrogenase (LDH), adenosine triphosphate (ATP), K+ and haemolysis were determined over 21 days. After washing on Day 1, only glucose and lactate improved, whereas after washing on Day 8, LDH and K+ also improved. Irradiation resulted in accelerated K+ accumulation and increased haemolysis. Mean extracellular K+ concentrations were 21.2 ± 1.03 mM after irradiation on Day 8 versus 1.12 ± 0.05 mM after irradiation plus wash on Day 8, and 38.80 ± 2.13 mM on Day 10 after irradiation on Day 8 and 16.6 ± 0.05 mM on Day 10 after irradiation plus wash on Day 8. K+ concentrations remained <25 mM within 8 days of storage. We recommend irradiation by Day 8 at the latest for neonatal transfusion. The shelf life may be extended by another 48 h if the RBCs are also washed.

Branched endovascular aortic aneurysm repair decreases platelet reactivity and platelet-rich thrombus formation – a prospective, cohort study

Appropriate platelet function determines both the perioperative haemostasis and the risk of postoperative thrombotic complications in patients undergoing branched endovascular repair (bEVAR) of thoracoabdominal aortic aneurysm (TAAA). We aimed to assess the effect of bEVAR on platelet function and the predictive value of preoperative platelet function for postoperative bleeding. We measured platelet function using impedance aggregometry and total thrombus-formation analysis system in 50 consecutive patients, with TAAA undergoing elective bEVAR. After bEVAR, platelet reactivity was assessed using ASPI test, ADP test and TRAP test and thrombus size decreased, whereas time to clot formation increased, compared to baseline (p ≤ .042 for all). Preoperative platelet reactivity in the TRAP test was lower in patients who experienced post-operative bleeding, defined as ≥3 red blood cell units transfusion, compared to those who did not (p = .038). Baseline hemoglobin level <13 g/dl and TRAP test result ≤29.5 AUC increased the odds of bleeding by 5.4-fold and 6.8-fold, respectively, independent of other clinical variables. We conclude that in patients with TAAA undergoing bEVAR, platelet reactivity and platelet-rich thrombus formation decreased directly after the operation. Preoperative hemoglobin level and platelet reactivity in the TRAP test were independent predictors of postoperative bleeding complications.

Extended Typing of Common Erythrocyte Antigens in Tunisian Blood Donors and Its Usefulness in Transfusion Immunology.

Extended RBC antigens typing is very valuable in transfusion immunology since it is highly recommended to ensure better transfusion practices and avoid transfusion-related complications and to establish registries for rare blood donors as recommended by the International Society of Blood Transfusion and World Health Organization. A group of 236 Tunisian blood donors were genotyped for 19 common blood loci using the Sequence-specific primers polymerase chain reaction (SSP-PCR) method. The statistical analysis was done using the HaploView Software. The study showed the dominance of the loci: RHCE*e, KEL*02, FY*02 and CO*01; and the absence of the homozygous state of the CO*02 allele. Furthermore, two complete linkage disequilibrium leading to the absence of the two alleles RHCE*C-RHCE*E (C-E) and FY*01N.01 (FY*Anull) were detected. Additionally, it appeared that approximately 91% of these blood donors are positive for the RHD gene; and all subjects who lacked the RHD exon 10 are homozygous for the RHCE*c and RHCE*e variants. The study also revealed that the RH1 negative blood cannot be universal to the Rh system because almost all RH1 negative donated blood is RH:-2,4,-3,5 (ccee), which may constitute a risk in some recipients carrying the anti-RH4 and/or anti-RH5 antibodies. Considering that some donated RBC units may contain blood with very immunogenic phenotypes, greatcautionisrequired when transfusing some subjects, especially in emergency situations because it can be a step towards subsequent complex or multiple alloimmunization.

HMGB-1 as a predictor of major bleeding requiring activation of a massive transfusion protocol in severe trauma

Massive bleeding causes approximately 50% of deaths in patients with major trauma. Most patients die within 6 h of injury, which is preventable in at least 10% of cases. For these patients, early activation of the massive transfusion protocol (MTP) is a critical survival factor. With severe trauma, high-mobility group box 1 (HMGB-1, i.e., amphoterin) is released into the blood, and its levels correlate with the development of a systemic inflammatory response, traumatic coagulopathy, and fibrinolysis. Previous work has shown that higher levels of HMGB-1 are associated with a higher use of red blood cell transfusions. We conducted a retrospective analysis of previous prospective single-center study to assess the value of admission HMGB-1 levels in predicting activation of MTP in the emergency department. From July 11, 2019, to April 23, 2022, a total of 104 consecutive adult patients with severe trauma (injury severity score > 16) were enrolled. A blood sample was taken at admission, and HMGB-1 was measured. MTP activation in the emergency department was recorded in the study documentation. The total amount of blood products and fibrinogen administered to patients within 6 h of admission was monitored. Among those patients with massive bleeding requiring MTP activation, we found significantly higher levels of HMGB-1 compared to patients without MTP activation (median [interquartile range]: 84.3 µg/L [34.2–145.9] vs. 21.1 µg/L [15.7–30.4]; p < 0.001). HMGB-1 level showed good performance in predicting MTP activation, with an area under the receiver operating characteristic curve of 0.84 (95% CI 0.75–0.93) and a cut-off value of 30.55 µg/L. HMGB-1 levels correlated significantly with the number of red blood cell units (rs [95% CI] 0.46 [0.28–0.61]; p < 0.001), units of fresh frozen plasma (rs 0.46 [0.27–0.61]; p < 0.001), platelets (rs 0.48 [0.30–0.62]; p < 0.001), and fibrinogen (rs 0.48 [0.32–0.62]; p < 0.001) administered in the first 6 h after hospital admission. Admission HMGB-1 levels reliably predict severe bleeding requiring MTP activation in the emergency department and correlate with the amount of blood products and fibrinogen administered during the first 6 h of hemorrhagic shock resuscitation.Trial registration: NCT03986736. Registration date: June 4, 2019.

Comparison of whole blood versus red blood cells and plasma to correct trauma-induced coagulopathy ex vivo.

Early resuscitation is based on platelet-poor components such as red blood cells and plasma (RBC + P), contributing to platelet dilution and worsening of trauma-induced coagulopathy (TIC). We aimed to compare the ability of cold-stored whole blood (WB) versus RBC + P as a single component to correct TIC. Blood samples were collected on admission from trauma patients who required activation of the major hemorrhage protocol at a single UK major trauma center in 2021/2022. Samples were spiked ex vivo with volumes equivalent to two, four, or eight units of WB or RBC + P stored for a maximum of 2 weeks. Thromboelastometry, platelet counting, and multiple electrode aggregometry (MEA) were performed. Samples from 20 adult trauma patients were analyzed. Median age was 32 years (27-42), 89% were male, 70% had platelet dysfunction (tissue factor-activated ROTEM [EXTEM]-tissue factor-activated ROTEM with cytochalasin D [FIBTEM] clot amplitude at 5 min [A5] ≤ 30 mm), 65% were coagulopathic (EXTEM A5 ≤ 40 mm), and 42% died. EXTEM-FIBTEM A5 was higher following spiking with WB than RBC + P (33 mm, 26-33, vs. 27 mm, 24-30, p < .001). WB-spiking corrected platelet dysfunction in 2 patient samples out of 20, whereas RBC + P increased the frequency of platelet dysfunction (1/20 sample) and TIC (4/20 samples). RBC + P was associated with a dose-dependent deterioration in rotational thromboelastometry (ROTEM) clot strength and dynamics, platelet count, and aggregation in response to multiple agonists compared with WB-spiking, which maintained or partially corrected these abnormalities. Compared with RBC + P, WB better preserves ex vivo platelet-related ROTEM parameters, platelet count, and aggregation, but does not fully correct these common derangements of TIC.

The impact of red cell storage age on transfused patients with sickle cell disease: protocol of a pilot randomized clinical trial to evaluate changes in inflammation and clinical transfusion efficacy.

Despite fulfilling all requirements for donor blood units as defined by the FDA, a number of patients with sickle cell disease (SCD) are transfused with red blood cell (RBC) units that are near the end of their storage life, exposing them to the potentially adverse components of the red cell storage lesion. Due to their chronically inflamed state, patients with SCD may be particularly susceptible to these components. We present here a pilot study protocol for testing the impact of fresh vs older red cell units in chronically transfused adults with SCD. This is a randomized, prospective, clinical trial. We aimed to recruit forty chronically transfused adults or adolescents with SCD who receive regular RBC transfusions for their clinical care and randomize these patients to receive either units greater than or equal to 30 days, or units less than or equal to 10 days for 3 consecutive outpatient transfusion events. The primary endpoint is the metabolic differences identified between units transfused that are greater than or equal to 30 days, and those units less than or equal to 10 days. The secondary endpoint evaluates the change in blood monocyte activation at 2 hours after transfusion between the two groups. Lastly, weevaluate unit RBC efficacy via changes in hemoglobin/day, hemoglobin A%/day, hospitalization rate, pain scores, and infections as documented via blood and urine cultures. This study promises to provide evidence as to whether metabolically older red cell units affect the quality and efficacy of chronic transfusion therapy for adults with SCD and has the potential to guide the need for future study on this important clinical issue.

Blood use and alloimmunization in myelodysplastic syndrome patients: A study of a hospital transfusion experience.

Blood use and alloimmunization in myelodysplastic syndrome patients: A study of a hospital transfusion experience.

Efficient quality improvement through the monitoring of Key Performance Indicators in the Quality management Review of a Blood Establishment (BE).

Efficient quality improvement through the monitoring of Key Performance Indicators in the Quality management Review of a Blood Establishment (BE).

Two Nonmyeloablative HLA-Matched Related Donor Allogeneic Hematopoietic Cell Transplantation Regimens in Patients with Severe Sickle Cell Disease.

Two Nonmyeloablative HLA-Matched Related Donor Allogeneic Hematopoietic Cell Transplantation Regimens in Patients with Severe Sickle Cell Disease.

2891 Persistent drop in haemoglobin after the insertion of an intramedullary nail following a neck of femur fracture

Abstract An 85-year-old male presented with a hip fracture following an accidental fall. His background included chronic kidney disease, hypertension, high cholesterol, and type 2 diabetes mellitus. He underwent a intramedullary nail for a subtrochanteric fracture. Post-op he had 4 units of red blood cells for post-op anaemia. Despite multiple transfusions, his haemoglobin levels gradually decreased and there was no evidence of visible bleeding from the wound or other sites. He complained of persistent swelling and pain limiting his mobility. Pelvic x-rays revealed stable fixation. Patient developed a deep vein thrombosis and was started on low molecular weight heparin. Further acute drop in his haemoglobin prompted for an ultrasound of his hip, which identified an intramuscular haematoma. This was confirmed on a CT angiogram which revealed an active haemorrhage within the right vastus intermedius muscle with associated haematoma, which appeared to arise from a branch of the profunda femoris. The patient underwent coil embolization under radiological guidance which successfully achieved complete haemostasis. It was also revealed that he had a large pseudoaneurysm arising from the descending branch of the right lateral circumflex artery. Post-procedure his haemoglobin remained stable, pain controlled adequately and tolerating anticoagulation without further drop in haemoglobin. Furthermore, his mobility improved and he was deemed medically fit to be discharged to rehabilitation. Although pseudoaneurysms are very rare, persistent drop in haemoglobin, pain, swelling and poor a stable fixation of an intrameduallary nail should raise suspicion of a haematoma, and requires further investigations with a CT angiogram.