Packed Red Cells Research Articles

Hubungan Kadar Komponen Besi Darah Pendonor terhadap Kualitas Packed Red Cells (PRC) di UDD PMI Provinsi Sumatera Selatan

Iron is the essential component of our body especially used to make Hemoglobin. If the intake of iron enters from our food less than issued, it makes our reserve iron will be used, and it can cause iron deficiency. There are three pathogenesis stages of iron deficiency, first marked by reduced iron reserve or the absence of iron reserved, ferritin levels decreased, while other parameters to determinate the presence of iron deficiency( Serum Iron, TIBC, Hb, Transferrin Saturation) are still normal. The purpose of this study was to analyze the relationship level of donor iron components and quality of Packed Red Cells (PRC) in UDD PMI Provinsi Sumatera Selatan. This research is an analytic observational study with a cross-sectional design. The result of the research was conducted in April 2021, using 86 blood samples from donors. It showed there were 15 samples with iron deficiency. Consisted of 9 samples with iron deficiency in the first stage and 6 samples in the second stage. It is known that there are 6 samples with poor PRC quality; all of them are iron deficiency in the second stage. In conclusion, there is a significant relationship iron component level of the donor and the quality of PRC p<0,05.

The relationship of blood group, blood components, and the age of patients with the degree of transfusion reaction at Dr. Wahidin Sudirohusodo, Makassar, Indonesia

Background: Transfusion is an additional therapy in the case of hematology and non-hematology. However, it can be detrimental due to its side effects ranging from mild to severe reactions. This study aimed to determine the relationship of blood types, blood components, and the age of patients with the degree of transfusion reaction. Methods: A retrospective study with secondary data of the patients experiencing transfusion reactions was conducted from January 2017 to December 2019. The population included all patients receiving a transfusion of blood products. The sample met the inclusion criteria, such as the medical records of patients who experienced transfusion reactions during and after the transfusion. The exclusion criteria were cryoprecipitate blood components. Data were analyzed using SPSS version 20 for Windows. Results: Among 228 subjects, there were a higher number (52.60%) of females than males (47.40%). The majority of patients ranged within 40-59 years old (52.70%). Most blood types were O (53.00%), while the dominant blood component was PRC (packed red cell) (50.30%). There was no significant relationship between blood types, blood components, and the age of patients with the degree of transfusion reaction (p>0.05).Conclusion: There was no significant relationship between blood types, blood components, and the age of patients with the degree of transfusion reaction.

Blood transfusion of the donor is associated with stage 3 primary graft dysfunction after lung transplantation.

The first aim of this study was to assess the association between stage 3 PGD and pre-donation blood transfusion of the donor. The secondary objectives were to assess the epidemiology of donor transfusion and the outcome of LT recipients according to donor transfusion status and massive donor transfusion status. This was an observational, prospective, single-center study. The results are expressed as absolute numbers, percentages, medians, and interquartile ranges. Statistical analyses were performed using Chi squared, Fischer's exact tests, and Mann-Whitney U tests (P<.05 was considered significant). A multivariate analysis was performed. Between January 2016 and February 2019, 147 patients were included in the analysis. PGD was observed in 79 (54%) patients, 45 (31%) of whom had stage 3 PGD. Pre-donation blood transfusion was administered in 48 (33%) donors (median of 3[1-9] packed red cells (PRCs)). On multivariate analysis, stage 3 PGD was significantly associated with donor blood transfusion (OR 2.69, IC (1.14-6.38), P=.024). Mortality at days 28 and 90 was not significantly different according to the pre-donation transfusion status of the donor. Pre-donation blood transfusion is associated with stage 3 PGD occurrence after LT. Transfusion data of the donor should be included in donor lung assessment.

Analysis on discard of blood and blood components in a tertiary care center

Introduction: In contemporary medicine management, it is evident that transfusion of blood and blood components has become an integral part of the patient. Human blood has no complete substitute to date. Blood is a perishable product and hence proper management of blood inventory is very crucial. Blood being a perishable commodity, efficient management of inventories is pivotal. The challenge that blood centers are facing is to keep sufficient stock to ensure an adequate supply of blood while minimizing losses. Aims and Objectives: The present study is designed to analyze various causes of discard of blood and blood components. Settings and Design: This is an analytical and retrospective type of study, carried out in the Department of Transfusion Medicine, from January 2019 to December 2019. Materials and Methods: Data were collected from blood bank records and confirmed from the master register. Data were then tabulated and analyzed. Statistical analysis used is as follows: Microsoft Excel database sheet was used for analyzing the results for the calculation of percentage and the χ2 test was used. Results: A total of 5,753 units were collected during the study period. A total of 13,913 components were prepared. Out of which, packed red cells (PRCs) were 5691, fresh frozen plasmas (FFPs) 5592, platelet concentrate (PC) 2531, and cryoprecipitate 99. The average discard rate for PRC, FFP, PC, and cryoprecipitate was 4.95%, 2.46%, 19.12%, and 3.03%, respectively. The most common reason for PRC and platelets discard was expiry followed by positivity for transfusion-transmitted infections (TTIs), whereas discard of FFPs was due to breakage in the case. Conclusion: The most common reason for the discard of PRCs and platelets in our study was expiry and positivity for TTI, whereas FFPs were mostly discarded due to breakage/leakage.

A cost-analysis study of using adult red cell packs and Pedi-Packs in newborn intensive care units in Southern Iran

Background and objectiveSaving blood products is an important public health issue especially in developing countries with limited financial resources. We aimed to suggest a new hypothetical model to make a change in the current blood transfusion policy in the newborn intensive care unit (NICU) to reduce wastage of blood supplies as well as the risk of exposure to multiple donors.MethodsIn this cross-sectional study, all transfused neonates (n = 70) who were admitted to NICU of Nemazee Hospital, a tertiary referral hospital in Southern Iran, were evaluated between March and June 2019. Based on the information of neonates’ transfusion during this study period and determined transfusion indices, a specific pediatric pack was suggested and the related total costs per transfusion, as well as the donor-exposure rate of the hypothetical and the current transfusion method, were compared.ResultsConsidering the mean number of transfusions per neonate: 4 and mean volume of transfused packed red cells: 20 ml per transfusion, the cost-analysis of pediatric and the adult pack was presented. Arithmetically, we proved a higher total cost per transfusion for using adult pack comparing to pediatric pack. Additionally, using a pediatric pack set leads to a 24% reduction in RBCs wastage per transfusion and a 68.13% reduction in donor-exposure rate.ConclusionsThe assignment of a dedicated pediatric pack for neonates will be able to improve the cost-effectiveness by a substantial reduction in donor-exposure rate and blood wastage. This finding should be taken into consideration to generate economic growth and make improvements in child health status.

Predictive score for immediate extubation after liver transplantation.

Evidence suggests that immediate extubation after liver transplantation provides graft and economic benefits without compromising patient outcomes. This study tried to determine the incidence of immediate extubation, demonstrate related factors, and develop a predictive model from the significant factors. This retrospective descriptive study included 240 out of 271 liver transplantation patients in the hospital liver transplant registry between 2004 and 2016. Extubated and non-extubated groups were statistically compared. The incidence of immediate extubation was 32.1%. It was associated with a MELD score≤25 (adjusted OR, 5.17; 95% CI, 1.64-16.24; p=.005); packed red cells (PRC) transfusion ≤1600ml (adjusted OR, 3.45; 95% CI, 1.82-6.53; p<.001); and no requirement for post-operative vasopressors (adjusted OR, 5.83; 95% CI, 2.30-14.77; p<.001). The immediate-extubation group had fewer complications and shorter hospital stays. A Siriraj Liver transplant Extubation Score (SLES) of 5 yielded the best prediction of safe immediate extubation. An incidence of 32.1% was found for immediate extubation following liver transplantation. Associated factors were a MELD score≤25, a lower amount of transfused blood, and no requirement for post-operative vasopressors. An SLES score of 5 predicted safe immediate extubation.

A Study of Frequency and Pattern of Adverse Transfusion Reactions at a Blood Bank in a Tertiary Care Hospital: Towards Hemovigilance

Background: Adequate and safe transfusion facility of blood and its components is necessary as blood transfusions are a part of life saving measures in medical and surgical emergencies. However, transfusion practice could result in non-fatal to fatal adverse transfusion reactions (ATR). Therefore, it is important to identify various adverse reactions so that steps can be taken to minimize such reactions and ensure safer transfusion being carried out.&#x0D; Methods: All ATRs reported to the blood bank from January 2013 to December 2016 were reviewed and analysed. The frequency of ATRs and its association with various component types were assessed.&#x0D; Result: During the study period, a total of 199106 units of blood were issued from the blood bank out of which there was an incidence of 77 (0.12%) transfusion reactions. Chills/rigors was the most common symptom (27.3%) of the symptomatic cases followed by pruritis (23.4%)&#x0D; Majority of the transfusion reaction were non haemolytic, 76 (98.7%) cases. One case was of haemolytic transfusion reaction. Among the non-haemolytic transfusion reactions, febrile non haemolytic transfusion reaction (FNHTR) constituted 28 (36.4%) and allergic reactions constituted 41(53.2%). Other transfusion reactions including hypotensive transfusion reaction (HTR), 1 (1.3%) case and transfusion associated dyspnoea (TAD), 6 (7.8%) cases were also seen. The frequency of ATRs was highest with packed red cells (PC) being 75.3% and least with platelet concentrate (PLTC) being 11.7%.&#x0D; Conclusion: The frequency of ATRs in our blood bank was found to be on a lower scale when compared to that of most of the similar studies. Allergic reactions and FNHTR were the most common ATRs seen, introduction of leukoreduction filters would help reduce FNHTRs.

Management of Autoimmune Hemolytic Anemia in the Midst of Coronavirus Disease 2019 Pandemic: A Case Report

&lt;p&gt;&lt;strong&gt;Introduction : &lt;/strong&gt;The novel coronavirus disease 2019 (COVID-19) has become a pandemic involving all people and can be severe and life-threatening in a certain population such as those with comorbidity. Autoimmune hemolytic anemia (AIHA) is an autoimmune hematologic disease characterized with antibodies production that binds to red cell surface antigens. In this pandemic, several concerns have been raised by autoimmune disease clinicians and patients regarding the use of immunosuppressive drugs. In this case report, we illustrate the problems of autoimmune hemolytic anemia patient when she got active case.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case Illustration : &lt;/strong&gt;A 28 years old lady was admitted to the hospital owing to fatigue and tiredness during exercise for two weeks. She had been diagnosed with autoimmune hemolytic anemia before and did not comply with the treatment. This patient has been reevaluated of having AIHA from the symptoms of fatigue, enlarged spleen, low hemoglobin, increased reticulocytes, signs of hemolytic in blood smear examination, increased indirect bilirubin, LDH and the Combs’ test result was given positive. She received methylprednisolone 2 mg/kg of body weight intravenously, washed packed red cells (PRC), calcium and proton pump inhibitor. She was discharged at the seventh day since admission and she was prescribed oral methylprednisolone equal to 1 mg/kg body weight.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion : &lt;/strong&gt;This is an educated case of non-compliance of AIHA that should be given high dose steroid and blood transfusion during hospitalization amid the COVID-19 pandemic. The recommendation of treatment for AIHA was still the same as before the pandemic occured.&lt;/p&gt;

The Glasgow Outcome Scale-Extended Pediatric Scores of Intracranial Bleeding Patients with Acquired Prothrombin Complex Deficiency Post Craniotomy and Duraplasty

Introduction: Surgical evacuation of intracranial bleeding in pediatric patients due to acquired prothrombin complex deficiency (APCD) is a life-saving surgery when conservative treatment insufficient and impending brain herniation. This study aimed to evaluate the Glasgow outcome scale-extended pediatric (GOS-ePed) score of the pediatric intracranial bleeding patients with APCD after craniotomy and duraplasty. Method: This was a retrospective study in the last 5 years of our experience. All of the pediatric patients with intracranial bleeding due to APCD who needed surgery were investigated. The data were collected from medical records after their parents have given their written informed concern and approved by the Ethics Review Committee, Faculty of Medicine, Universitas Kristen Indonesia. The inclusion criteria were patients who operated on by craniotomy and duraplasty. The patient with a second disease was excluded. Blood tests include hemoglobin, prothrombin time, activated prothrombin time, and platelets were investigated before and after intravenous vitamin K injection, transfusion packed red cells (PRCs), and fresh frozen plasma (FFP) administration. The Glasgow coma scale (GCS) pre- and postoperatively was evaluated using a modified GCS for infants and children. The outcome was evaluated by the GOS-ePed score. All data were analyzed with the normality test and paired t test. Results: There were 5 patients age between 37 and 60 days, and all patients did not get vitamin K prophylaxis after birth. The blood tests of all patients revealed anemia, prothrombin, and activated prothrombin time increased, but platelets were normal. All these values returned to normal after vitamin K injection, transfusion of PRCs, and FFP. The paired t tests were p < 0.05. The GCS of all patients before surgery was 8 or below. After surgery, the GCS of 4 patients was increased become 12 and 15. One patient did not change significantly. The GOS-ePed score showed 4 patients (80%) had upper or lower good recovery, and 1 patient (20%) was in a vegetative state. Conclusions: The GOS-ePed score of the pediatric intracranial bleeding with APCD after craniotomy and duraplasty was mostly in upper or lower good recovery.

Autoimmune Hemolytic Anemia as a Novel Complication of COVID-19 Infection in Sanglah General Hospital Bali, Indonesia

BACKGROUND: Clinical manifestation of coronavirus disease (COVID-19) could be asymptomatic, mild to severe, even mortality. Although various hematological complications associated with COVID-19 infection have been reported, the finding of autoimmune hemolytic anemia (AIHA) is a novel case. &#x0D; CASE REPORT: A 59-year-old woman was admitted to our emergency room because of a 5-day period of fever with cough and shortness of breath. At admission, she was takipnea, jaundice, and had an oxygen saturation of 60% on room air. Laboratory studies showed hemoglobin (Hb) 3.68 g/dL, high reticulocyte (14.4%), and hyperbilirubinemia. Chest X-ray showed bilateral pneumonia with positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test. Although she got packed red cell (PRC) transfusions in 7 days, her Hb remained low and bilateral infiltrate still increased. That’s why we considered direct Coombs test and it returned positive. AIHA was diagnosed and treatment with hydrocortisone 100 mg IV twice daily was given for the first 72 h. The maintenance dose with methylprednisolone 16 mg twice daily was continued for 7 days admission. Then, Hb value increased to 11.03 g/dL and she was discharged home without any compliments. &#x0D; CONCLUSION: In the current epidemiological situation, AIHA needs to be considered as a complication of COVID-19 infection in a patient who presents with jaundice and severe anemia without any underlying chronic disease, which is need blood transfusions, steroid medication use, or blood cancer.

S0611 Gastrointestinal Bleeding in Patients With COVID-19: Outcomes With and Without Endoscopic Evaluation

INTRODUCTION: With the onset of the COVID-19 pandemic, hospitals have restructured criteria for endoscopic procedures in order to reduce the number of aerosol-generating procedures and to minimize exposure of consultation services and staff to the virus and to preserve personal protective equipment. We aimed to evaluate outcomes of patients who were hospitalized for SARS-CoV-2 and experienced gastrointestinal bleeding (GIB). METHODS: We performed a retrospective review of patient charts with confirmed COVID-19 between 03/12 and 05/11/2020 across four hospitals for whom gastroenterology was consulted for GIB. We evaluated demographics, past medical history, anticoagulation use, number of units transfused, and mortality of patients who had GIB during hospital stay. Patients who underwent endoscopy and managed medically were compared with Wilcoxon Rank Sum, Chi-Square and Fisher’s exact test as appropriate. RESULTS: Of the total 68 patients with GIB, 14 underwent endoscopic evaluation (Group A) and 54 were managed medically (Group B). Only two patients underwent endoscopic hemostatic therapy. Age, gender and ethnicity were not significantly different between the two groups. ICU admissions accounted for 5 (35.7%) from Group A and 15 (27.8%) from the Group B. In terms of respiratory status, 21% in Group A compared to 48.7% in Group B required mechanical ventilation, BiPAP or high flow nasal canula. Patients who were not receiving any anticoagulation were more likely to undergo endoscopy, however this was not statistically significant (P = 0.069). In the medically managed group, 35 patients (64.8%) received packed red blood cell transfusion with a mean of 2.8 units whereas 11 (78.6%) patients in the endoscopically managed group received a mean of 4.2 units. Patients who underwent endoscopy had a mean hospital stay of 13.9 days whereas those treated conservatively had a mean of 12.6 days. Mortality was 21.4% (3/14) in the group receiving endoscopy and 42.6% (23/54) in the medically managed group (P = 0.22). CONCLUSION: Although not statistically significant, GIB patients who were medically managed had higher mortality rate than patients who underwent endoscopies. This is likely due to the severity of COVID-19, which was indicated by the patient's oxygenation requirement, and less likely from blood loss due to the lower mean units of pack red blood cell transfusion.Table 1.: Total number of procedures performed on patients with COVID-19 presenting with GI BleedTable 2.: Demographics of the two groups (Endoscopic Evaluation and Medical Management), severity of their disease indicated by oxygenation requirements and outcomes

Outcome of allogeneic hematopoietic stem cell transplantation in adult patients with paroxysmal nocturnal hemoglobinuria.

The safety and efficacy of allogeneic hematopoietic stem cell transplantation (HSCT) for paroxysmal nocturnal hemoglobinuria (PNH) remain unclear. Therefore, we retrospectively analyzed the outcomes of 42 adult patients with PNH who underwent allogeneic HSCT using the registry database of the Japan Society for Hematopoietic Cell Transplantation. The median patient age was 32.5years. The number of packed red cell (PRC) transfusions was < 20 times in 19 patients and ≥ 20 times in 16; 7 patients had missing data. Stem cell sources were bone marrow (N = 15) or peripheral blood (N = 13) from a related donor or bone marrow (N = 11) and cord blood (N = 3) from an unrelated donor. The cumulative incidence of neutrophil engraftment at day 40 was 81%. Six patients died before engraftment, and the 6-year overall survival (OS) was 74%. The OS of patients with < 20 pretransplant PRC transfusions was significantly higher than that of patients with ≥ 20 pretransplant PRC transfusions (95% vs. 63%; P < 0.05). Moreover, the OS of patients aged < 30years was significantly higher than that of patients aged ≥ 30years (90% vs. 59%; P < 0.05). Allogeneic HSCT for PNH could provide favorable survival; however, pretransplant transfusion burden and patient age should be considered when deciding the timing of allogeneic HSCT.

Hepatic Cytochrome P450 Profiles in Hemorrhagic Shock Model Rats After Transfusion With Stored Red Blood Cells

Red cell transfusions, which deteriorate in quality during storage, triggers several negative biological responses. However, little is known regarding the effects of stored red cell transfusion on cytochrome P450 (P450) profiles. To clarify this issue, we investigated hepatic P450 profiles in hemorrhagic shock model rats after resuscitation with stored packed red cells (PRC). The pharmacokinetics data for P450-metabolizing substrates showed that the clearance of substrates for Cyp1A2 and Cyp3A2 in the stored PRC resuscitation group were decreased compared to sham group. The protein expression, metabolic activity and mRNA expression of the P450 isoforms in the stored PRC resuscitation group were lower than the corresponding values for the sham group. However, these changes would be expected to have weak effects on the in vivo pharmacokinetics of the concomitant drugs based on the criteria stated in the guideline on drug interactions. In contrast, the results of these P450 profiles in the stored PRC and fresh PRC resuscitation group exhibited a similar trend. These results suggest that the stored PRC transfusion has an influence on the hepatic P450 profiles, but is of little clinical significance, not by the deterioration of the quality of red cells but pathophysiological alterations following the hemorrhage and transfusion.

Comparison of Early Clinical Outcomes between Intermittent Vascular Inflow Occlusion versus Intermittent Selective Hepatic Vascular Exclusion in Hepatic Resections for Cholangiocarcinoma Patients: A Prospective Randomized Controlled Trial Study

Background: There were reported benefits of selective hepatic vascular exclusion (SHVE) in reducing intraoperative blood loss (IBL), intraoperative packed red cell (PRC) transfusion, and perioperative complications over intermittent Pringle maneuver (IPM) in hepatectomies. However, there was lack of data regarding the use of SHVE in comparison with IPM in hepatectomies for cholangiocarcinoma (CCA) patients. Objective: To compare IBL, intraoperative PRC transfusion, total operative time (TOT), and perioperative complications between SHVE and IPM. Materials and Methods: Between October 2018 and September 2019, forty eligible CCA patients participated in the study. They were randomly allocated to the SHVE group (n=20) or the IPM group (n=20). Data regarding patient demographics, tumor characteristics, and the objectives of the study were gathered and analyzed with intention-to-treat principle. Results: The median IBL (range) 923.5 (101 to 4,979) versus 1,109 (413 to 5,305) ml; p=0.2, median intraoperative PRC transfusion (range) 112.5 (0 to 1,745) versus 296 (0 to 1,500) ml; p=0.22, and median TOT (range) 390 minute (220 to 915) versus 320 (240 to 930) minutes; p=0.55 between SHVE and IPM were not significantly different. There was no statistical difference in perioperative complications between SHVE and IPM. Conclusion: Routine use of SHVE during hepatectomies in CCA patients showed no significant difference in outcomes regarding the objectives of the study. Keywords: Selective hepatic vascular exclusion (SHVE), Hepatic vascular exclusion with preservation of caval flow (HVEPV), Hepatic resection, Cholangiocarcinoma, Intraoperative blood loss, Perioperative complications

High ureum and creatinine level in 18-year-old male: first diagnosed with chronic kidney disease

Introduction: Chronic Kidney Disease (CKD) needs to be rapidly diagnosed and treated correctly. The classic patient characteristics were anaemia, hypertension, oedema, albuminuria and decrease of renal function.  In a few cases, CKD can occur in an atypical patient, such as in young age.Case report: We herein report a case of an 18-year-old male with Renal failure. The patient noted to be anaemic, fatigue, oedema, hypertension which is consisted of features typical of Chronic kidney disease. Laboratory examination revealed low haemoglobin level, high ureum and creatinin, and albuminuria. The patient underwent hemodialysis and was given Packed Red Cell (PRC) transfusions.Conclusion: CKD had to be suspected of all age so that it can be rapidly diagnosed and treated correctly.

PENGAMBILAN KEPUTUSAN KOMPONEN DARAH DALAM PENGENDALIAN PERSEDIAAN DENGAN MENGGUNAKAN METODE AHP DI PMI KOTA BANDUNG

PMI Kota Bandung mengalami overstock. Persediaan darah yang overstock dan mengalami kadaluarsa harus dilakukan pemusnahan. Pada fase overstock setiap bulannya PMI Kota Bandung mengalami waste dan perlu dilakukan pengendalian persediaan. Pada darah terdapat enam komponen darah yang perlu dikendalikan persediaannya, namun diperlukan waktu yang cukup lama untuk menganalisis setiap komponen darah. Diperlukan penentuan komponen darah prioritas yang harus segera dikendalikan sehingga diharapkan dapat berpengaruh terhadap penurunan biaya pemusnahan darah kadaluarsa. Tujuan penelitian ini adalah untuk mengetahui komponen darah apa yang diprioritaskan untuk dikendalikan persediaannya. Penentuan prioritas komponen darah menggunakan pendekatan AHP (Analitycal Hierarchy Process). Metode AHP merupakan model pengambilan keputusan yang menguraikan masalah multi kriteria yang kompleks menjadi suatu hirarki. komponen darah yang prioritas untuk di kendalikan adalah kompoenen Packed Red Cell (PRC) sebesar 0,338. Nilai ini diperoleh karena dipengaruhi oleh bobot pada kriteria supply sebesar 0,709; demand sebesar 0,113; dan lifetime sebesar 0,179.

3207 An Unusual Metastatic Location of Colorectal Cancer

INTRODUCTION: Malignant neoplasms of the small bowel are rare, and mostly found as metastatic lesions from other neoplasms like lung cancer, renal cell carcinoma, breast cancer and melanomas. CRC is the 3rd cause of death associated to malignancies, and mostly metastasizes to liver, lung, and peritoneum. Duodenum as site of metastasis is rarely reported, reason why there is no specific prevalence of this entity and by 2017, there were less than cases reported in the literature. CASE DESCRIPTION/METHODS: We present a 52 yo man with a PMH of stage IIIB colon cancer s/p right hemicolectomy and chemotherapy, currently on remission. He had a recent normal colonoscopy 6 months prior this admission. The patient is admitted to the hospital complaining of abdominal discomfort, nausea, non-bloody vomiting, weight loss and melena for the past 2 weeks. His vital signs were stable. Laboratory results showed a hemoglobin of 6.6 g/dL and for this reason one pack of red blood cells was transfused. An EGD showed an ulcerated lesion on the duodenum (Figure 1). Biopsies were taken and these showed invasive, moderately differentiated adenocarcinoma. PET scan was done showing extensive metastatic liver and duodenal disease (Figure 2). The patient was referred to oncology for initiation of treatment with chemo and radiotherapy. DISCUSSION: Malignant tumors of the small intestine are very rare and involve only 1-2% of all gastrointestinal neoplasms. Metastasis from CRC has an unclear mechanism but is thought to be secondary to lymphatic spread or direct contact. Given its slow growth rate, duodenal tumors usually remain asymptomatic at onset. However, later in the course of the disease, the reported manifestations are melena, abdominal pain, and small bowel obstruction symptoms. Diagnosis is made through EGD and radiological studies. There is no stablished treatment, but surgery has been reported to be curative in some cases. Adjuvant chemotherapy can be used as a palliative option and survival rates have been reported to be 23% in 5 years. We report this case due to its rarity, since CRC tumors hardly metastasize to the duodenum. Furthermore, we would like to encourage expanding the research about treatment modalities, in order to improve prognosis in this entity.

Relationship Between Preoperative Plasma Fibrinogen Concentration, Perioperative Bleeding, and Transfusions in Elective Adult Spinal Deformity Correction

Study DesignRetrospective analysis. ObjectiveThis study sought to investigate the relationship between preoperative (preop) fibrinogen, bleeding, and transfusion requirements in adult spinal deformity corrections. Summary of Background DataBlood loss after major spinal reconstruction increases the risks and costs of surgery. Preoperative fibrinogen levels may predict intra- and postoperative blood loss. MethodsData were collected from clinic charts and hospital medical records of all 142 of a single surgeon's consecutive adult spine patients undergoing 7 or more levels deformity correction surgeries from January 2011 to December 2014. t tests were used to compare perioperative variables between patients with total blood loss in the upper quartile (≥1,000 mL) and the remaining patients. Similarly, patients receiving >2 units of packed red cells (PRCs) were compared with others. Analysis of variance was used to compare the blood loss between the patients' groups (quartiles) based on their preoperative fibrinogen concentration. ResultsMean total blood loss was 847.9 (±543.6) mL. Overall, mean preoperative fibrinogen concentration was 254.8 (±82.9) mg/dL. Patients with lower fibrinogen concentration (<193 mg/dL) experienced significantly higher blood loss than those with higher concentrations (p < .05). Patients with transfusion >2 units PRC had significantly greater number of spinal levels treated, higher mean operative time, total blood loss and lower mean preoperative fibrinogen than those transfused 2 or fewer units PRC (p < .05). Total blood loss correlated significantly with preoperative fibrinogen concentration (r = −0.51, p < .05). All the thromboelastography (TEG) variables (G, K, and Angle) correlated significantly with preoperative fibrinogen (p < .05). ConclusionsIn our cohort undergoing correction of adult spinal deformity, patients with preoperative fibrinogen level lower than 193 mg/dL had significantly higher bleeding than their counterparts. Perioperative transfusion requirements correlated moderately both with the blood loss and preoperative fibrinogen concentration. Incorporation of preoperative fibrinogen allows better prediction of total perioperative blood loss and may therefore guide the treatment team in use of ameliorating therapies. Level of EvidenceLevel IV.

Estimation of surgical blood loss and transfusion requirements in orthopaedic soft tissue tumor surgery: associated factors

Background: Over half of soft tissue tumor surgeries require intraoperative packed red cell (PRC) transfusion. Several factors that can be identified in the preoperative period have been associated with surgical bleeding and transfusion in soft tissue tumor surgery. This study aimed to determine factors associated with surgical blood loss and intraoperative PRC transfusion. Methods: A retrospective cohort was analyzed on 84 records of orthopedic soft tissue tumor surgery during 2014-2018. Data were analyzed by linear regression and multivariate analysis. Results: Most commonly found malignant tumor in this study was rhabdomyosarcoma (20 . 2 % ). Preop hemoglobin of 11.5 g/dL (p=0.013) and tumor size of =5 cm (p<0.001) are the two significant predictors for intraoperative transfusion. Conclusion: tumor size and preoperative Hb value were predictors of the probability of requiring intraoperative PRC transfusion.

Erythrocyte alloantibodies in chronic kidney disease patients receiving packed red cell transfusions in Sanglah General Hospital, Denpasar

Introduction: In Chronic kidney disease (CKD) patients, as the consequences of the pathogenesis, anemia due to the failure of erythropoietin production requires Packed Red Cell (PRC) transfusion. The presence of alloantibodies in CKD patients who routinely require transfusion in Bali has never been evaluated. This study aims to determine the erythrocyte alloantibodies of CKD patients who received PRC transfusions in Sanglah Hospital.Methods: This study was a cross sectional descriptive study in adult CKD patients with history of PRC transfusion more than twice.Results: A total of 50 patients with Chronic Kidney Disease consisting of 31 men and 19 women, mostly 46-65 years old (60%) and the most blood group were blood group O (44%). There were 3 patients with positive antibody screening and identification results, 2 male patients (66.67%) and 1 female (33.33%). Two patients 46-65 years (66.67%) while 1 person 18-45 years (33.33%), with 2 person with blood group A (66.67%) and one person with blood group O (33.37% ). These three patients presented multiple alloantibodies in the form of anti-K, anti-Kpa, anti-LuaConclusion: From  the CKD patients who received PRC transfusions in Sanglah Hospital, ±6% formed alloantibodies. All of the alloantibodies formed were multiple alloantibodies, in the form of anti-K, anti-Kpa and Lua.