Hospitalization Transfusions Research Articles

Red blood cell transfusion in a tertiary Haitian hospital’s emergency department: patient characteristics and availability challenges

BackgroundRed blood cell (RBC) transfusions are essential for many patients admitted to emergency departments (ED). However, accessibility to red cell transfusions is often limited, especially in low-income countries such as Haiti. This article aims to determine the proportion of patients requiring emergency transfusion, transfused patients’ characteristics, as well as the response rate and timeliness of blood product delivery for requests made.MethodsA retrospective study was conducted among all patients with RBC transfusion indications from January to June 2022 at the ED of Mirebalais Teaching Hospital. The parameters studied included transfusion indications, pre-transfusion hemoglobin levels, and delay from prescription to transfusion.ResultsDuring the study period, 3993 patients received treatment in the ED. The proportion of patients requiring RBCs was 7.69%, including 145 males and 117 females, with a median age of 43 [30–56] years. Only 21.7% of these patients received a transfusion. The average pre-transfusion hemoglobin level was 4.75 ± 1.68 g/dL. The most common transfusion’s indications were infection/sepsis (36.74%), trauma (23.48%), and cancer (21.57%). The median time delay from prescription to transfusion was 2.37 [0.97–4.93] days. The study identified significant associations between RBC transfusion probability and patient factors like hemoglobin levels, patient disposition, urgency of RBC request, and length of stay.ConclusionRBC transfusion requests are frequent in the ED of Mirebalais Teaching Hospital, with a relatively high transfusion delay. Further studies on the relevance of RBC requests and ways to reduce delay from prescription to transfusion would be beneficial to improve this situation.

Discharge within 1 day following elective single-level transforaminal lumbar interbody fusion: a propensityscore-matched analysis of predictors, complications, and readmission.

This was a retrospective case-control study using 8 years of data from a nationwide database of surgical outcomes in the United States. This study aimed to improve our understanding of the risk factors associated with a length of stay (LOS) >1 day and aid in reducing postoperative hospitalization and complications. Despite the proven safety of transforaminal lumbar interbody fusion (TLIF), some patients face prolonged postoperative hospitalization. Data were collected from the American College of Surgeons National Surgical Quality Improvement Program dataset from 2011 to 2018. The cohort was divided into patients with LOS up to 1 day (LOS ≤1 day), defined as same day or next-morning discharge, and patients with LOS >1 day (LOS >1 day). Univariable and multivariable regression analyses were performed to evaluate predictors of LOS >1 day. Propensity-score matching was performed to compare pre- and postdischarge complication rates. A total of 12,664 eligible patients with TLIF were identified, of which 14.8% had LOS ≤1 day and 85.2% had LOS >1 day. LOS >1 day was positively associated with female sex, Hispanic ethnicity, diagnosis of spondylolisthesis, American Society of Anesthesiologists classification 3, and operation length of >150 minutes. Patients with LOS >1 day were more likely to undergo intraoperative/postoperative blood transfusion (0.3% vs. 4.5%, p<0.001) and reoperation (0.1% vs. 0.6%, p=0.004). No significant differences in the rates of postdischarge complications were found between the matched groups. Patients with worsened preoperative status, preoperative diagnosis of spondylolisthesis, and prolonged operative time are more likely to require prolonged hospitalization and blood transfusions and undergo unplanned reoperation. To reduce the risk of prolonged hospitalization and associated complications, patients indicated for TLIF should be carefully selected.

Evaluating the effectiveness of three communication modes in promoting repeat voluntary donation behavior in first-time blood donors at a tertiary care blood center in North India

Abstract: INTRODUCTION: Due to rapid technological advancements, several new methods such as telephone (TP), e-mail, social media, WhatsApp (WA), and Short Message Services are being used as effectively among blood centers worldwide for postdonation communication with blood donors’ education and motivation to recruit and retain them as repeat and regular voluntary nonremunerated blood donors. The present study was aimed at determining the effectiveness of WA, TP, and personal communications (PCs) as modes of communication to recruit and retain first-time replacement blood donors to become repeat and regular voluntary blood donors. MATERIALS AND METHODS: This 1-year observational prospective study was conducted in the Post Graduate Department of Immunohematology and Blood Transfusion in Government Medical College and Hospital, Jammu. Three hundred first-time blood donors selected for the study were divided into three groups comprising 100 blood donors each as per the mode of communication strategy adopted, namely postdonation PC, TP, and WA groups. RESULTS: The repeat donation rate was highest in the TP group (61%), followed by the WA group (47%) and PC group (37%). The mean repeat donation was found to be significant in the TP group (P = 0.007) and WA group (P = 0.021) as compared PC group while there was no significant difference between the TP group and WA groups (0.751). CONCLUSION: In our study, it was found that of the three communication modes, namely personal, TP, and WA, telephonic communication with a repeat donation rate of 61% was the most effective mode of communication in for motivating and converting first-time blood donors into repeat regular voluntary blood donors.

Analysis of Plasma Metabolic Profile in Children with Transfusion-Dependent Thalassemia

To explore the plasma metabolomic characteristics of children with transfusion-dependent thalassemia (TDT), and reveal the changes of metabolic pattern in children with TDT. 23 children with TDT who received regular blood transfusion in Ganzhou Women and Children's Health Care Hospital in 2021 were selected, and 11 healthy children who underwent physical examination during the same period were selected as the control group. The routine indexes between children with TDT and the control group were compared, and then the metabolic composition of plasma samples from children with TDT and the control group was detected by liquid chromatography-mass spectrometry. An OPLS-DA model was established to perform differential analysis on the detected metabolites, and the differential metabolic pathways between the two groups were analyzed based on the differential metabolites. The results of routine testing showed that the indexes of ferritin, bilirubin, total bile acid, glucose and triglycerides in children with TDT were significantly higher than those in healthy controls, while hemoglobin and total cholesterol were significantly lower (all P <0.05). However there was no significant difference in lactate dehydrogenase between the two groups (P >0.05). Compared with the control group, 190 differential metabolites (VIP>1) were identified in TDT children. Among them, 168 compounds such as arginine, proline and glycocholic acid were significantly increased, while the other 22 compounds such as myristic acid, eleostearic acid, palmitic acid and linoleic acid were significantly decreased. The metabolic pathway analysis showed that the metabolic impact of TDT on children mainly focused on the upregulation of amino acid metabolism and downregulation of lipid metabolism. The amino acid and lipid metabolism in children with TDT were significantly changed compared with the healthy control group. This finding is helpful to optimize the treatment choice for children with TDT, and provides a new idea for clinical treatment.

Blood lactate after pre-hospital blood transfusion for major trauma by helicopter emergency medical services.

The appropriate use of blood components is essential for ethical use of a precious, donated product. The aim of this study was to report in-hospital red blood cell (RBC) transfusion after pre-hospital transfusion by helicopter emergency medical service paramedics. A secondary aim was to assess the potential for venous blood lactate to predict ongoing transfusion. All patients who received RBC in air ambulance were transported to a single adult major trauma centre, had venous blood lactate measured on arrival and did not die before ability to transfuse RBC were included. The association of venous blood lactate with ongoing RBC transfusion was assessed using multi-variable logistic regression analysis and reported using adjusted odds ratios (aOR). The discriminative ability of venous blood lactate was assessed using area under receiver operating characteristics curve (AUROC). From 1 January 2016 to 15 May 2019, there were 165 eligible patients, and 128 patients were included. In-hospital transfusion occurred in 97 (75.8%) of patients. Blood lactate was associated with ongoing RBC transfusion (aOR: 2.00; 95% confidence interval [CI]: 1.36-2.94). Blood lactate provided acceptable discriminative ability for ongoing transfusion (AUROC: 0.78; 95% CI: 0.70-0.86). After excluding patients with early deaths, a quarter of those who had prehospital RBC transfusion had no further transfusion in hospital. Venous blood lactate appears to provide value in identifying such patients. Lactate levels after pre-hospital transfusion could be used as a biomarker for transfusion requirement after trauma.

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.

The Association Between Red Cell Distribution Width (RDW) and All-Cause Mortality in Elderly Patients with Hip Fractures: A Retrospective Cohort Study.

Red cell distribution width (RDW) may be related to the prognosis of hip fractures. The purpose of this study was to evaluate the association between (RDW) and all-cause mortality in elderly hip fractures. Elderly patients aged ≥65 years who had a hip fracture were screened between January 1, 2015, and September 30, 2019. The age, gender of patients and other demographics, as well as history of allergy, injury mechanism, underlying illnesses at the time of admission, fracture classification, time from admission to operation, RDW, operation time, blood loss, infusion, transfusion, treatment strategy, and length in hospital stay and follow-up and other clinical characteristics were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between RDW and mortality in these patients. Analyses were performed using EmpowerStats and the R software. A total of 2587 patients were included in this retrospective cohort study. The mean follow-up period was 38.92 months. A total of 873 (33.75%) patients died due to all-cause mortality. The RDW was linearly associated with mortality in elderly patients with hip fractures. Linear multivariate Cox regression models showed that RDW was associated with mortality (hazard ratio [HR]=1.03, 95% confidence interval [CI]:1.02-1.05, P < 0.0001) after adjusting for confounding factors. The mortality risk increased by 3% when RDW increased by 1 fL. RDW is associated with mortality in elderly patients with hip fractures, and RDW could be considered a predictor of mortality risk. ChiCTR2200057323.

Therapeutic Efficacy of Platelet Transfusion and Analysis of Influencing Factors in 364 patients

Introduction: The aims of this study were to observe the therapeutic effect of platelet (PLT) transfusion and to analyze influencing factors for the sake of providing useful clues for improving the efficacy of PLT transfusion. Methods: Included in this study were patients who received PLT transfusion in the affiliated hospital of Nantong University. Patients’ sex, age, height, weight, PLT transfusion status, and 20–24-h PLT count before and after PLT transfusion were collected to calculate the PLT corrected count increment values before and after PLT transfusion. Solid-phase red cell adherence assay was used to determine PLT antibody. Statistical analysis was performed using SPSS25.0 Software. Results: A total of 364 patients received 1,060 PLT transfusions, including 728 successful transfusions and 332 unsuccessful transfusions. When the patients were grouped according to different etiologies, significant differences in PLT transfusion effectiveness were observed between these groups (χ² = 15.070, p < 0.05). Grouping of the 364 patients according to sex, blood type, and PLT transfusion frequency showed no significant difference in PLT transfusion refractoriness (PTR) between different age-groups and sexes (p > 0.05). With the number of PLT transfusions increasing, PTR increased gradually. PLT antibodies were detected of 364 patients, 67 of them were positive. Among them, 63 cases (94.02%) were positive for HLA class I antibody. Conclusion: To reduce PTR, multiple factors should be considered comprehensively when PLT transfusion therapy is to be implemented in clinical practice. PLT antibody is the main immune factor causing PTR.

Effectiveness of clinical decision support in controlling inappropriate red blood cell and platelet transfusions, speciality specific responses and behavioural change

BackgroundElectronic clinical decision support (CDS) within Electronic Health Records has been used to improve patient safety, including reducing unnecessary blood product transfusions. We assessed the effectiveness of CDS in controlling inappropriate red blood cell (RBC) and platelet transfusion in a large acute hospital and how speciality specific behaviours changed in response.MethodsWe used segmented linear regression of interrupted time series models to analyse the instantaneous and long term effect of introducing blood product electronic warnings to prescribers. We studied the impact on transfusions for patients in critical care (CC), haematology/oncology (HO) and elsewhere.ResultsIn non-CC or HO, there was significant and sustained decrease in the numbers of RBC transfusions after introduction of alerts. In CC the alerts reduced transfusions but this was not sustained, and in HO there was no impact on RBC transfusion. For platelet transfusions outside of CC and HO, the introduction of alerts stopped a rising trend of administration of platelets above recommended targets. In CC, alerts reduced platelet transfusions, but in HO alerts had little impact on clinician prescribing.ConclusionThe findings suggest that CDS can result in immediate change in user behaviour which is more obvious outside specialist settings of CC and HO. It is important that this is then sustained. In CC and HO, blood transfusion practices differ. CDS thus needs to take specific circumstances into account. In this case there are acceptable reasons to transfuse outside of these crude targets and CDS should take these into account.

Pattern of blood components utilization in Hayatabd medical complex

Objectives: The objective of the present study was to review the blood components acquisition patterns and practices of transfusion in a tertiary care hospital. Material and Methods: An observational cross sectional retrospective study was conducted in the blood bank of Hayatabad Medical Complex (HMC) Peshawar, for a period of six months. The requisition forms for blood components and details of patients acquiring blood products for transfusion recorded in HMC blood bank Blood components issue register were the sources of data. The data was analyzed using software SPSS version 20. Results: In the study period of six months a total 16025 blood components were transfused with an average of 2670 units per month. whole blood was the maximum blood product transfused and followed by RCC, platelets and FFPs are least utilized blood products. Among total patients 50 % were males while 50% were females. Pediatric units utilized maximum (21.2%) units followed by Gynae/Obs. (19.1%), Medical units demanded 16.7% , Accident and Emergency (A&amp;E) unit 14.1%, surgical units 8.8% , intensive care unit (ICU) 6.8%, Orthopedic units consumed 3.3% , cardiology 3.1%, gastroenterology 2.6 %, oncology 2.4% and endocrinology consumed 1.5 %.

Increment in hemoglobin and hematocrit levels after blood transfusion in a tertiary care hospital

Background: Blood transfusion is considered to be the first line of therapy for all types of anemia. One unit of blood transfusion is known to increase the hemoglobin level by 1g/dl and hematocrit by 3%. This study aims to analyze the mean increment in hemoglobin and hematocrit levels after 1-unit of blood transfusion in a tertiary care hospital. Materials and Methods: A retrospective study was done. 133 patients with 1-unit of blood transfusion (whole blood or packed red blood cells)having pre and post-transfusion hemoglobin and hematocrit values were enrolled in the study. Results: Patients of all diagnoses, who received blood transfusion were enrolled, with the highest proportion (27.1%) in the age group 18-35 years. Male predominance was seen (57.1%) and a majority of the patients were on hemodialysis (57.9%). The most common blood group was B positive (30%) and 90.9% were Rh positive. 48 patients were transfused with whole blood and 85 were transfused with packed red blood cells. The mean increment in hemoglobin and hematocrit levels were 0.75 ± 2.21 and 2.47 ± 6.84 respectively. A significant increment in post-transfusion parameters was seen compared with pre-transfusion parameters (p &lt;0.001). Conclusions: A mean increment in hemoglobin and hematocrit level was seen in patients after transfusion. However, the value of the increment is low in our study as compared to the literature. This may be due to varied reasons, ranging from a history of chronic disease, acute bleeding, the volume of other fluids administered, and the characteristics of the donor.

An audit to estimate the quality of practices followed during bedside blood transfusion in a tertiary care hospital and role of continuous medical education in it.

Blood transfusion is an integral component of the health Service system and it becomes imperative that its benefits, risks as well as prospective and viable alternatives of this common medical intervention are explained explicitly to the patients. Appropriate compliance to bedside blood transfusion practices can also help in avoiding adverse transfusion outcomes. At the same time, it is also crucial to document a patient's valid consent based on their decision after evaluation of the risk to benefit ratio. This audit aims to assess the compliance and adherence to bedside blood transfusion practices in a tertiary care hospital and role of Continuous Medical education (CME) on it. The study involved collection of data for blood transfusion services and practices in two periods, for adults and children, who received transfusion from the month of June 2021 to October 2021 and a re-audit beginning from November 2021 to February 2022 following few CMEs in between involving doctors and nurses. A total of 3240 transfusion procedures were assessed in this duration. In them 1500 (46.3%) took place before CME and remaining 1740 (53.7%) procedures took place after CME. There were statistically significant differences between pre-CME and post-CME bedside transfusion practices. During CME/training session, pre-training and post training knowledge has been evaluated by test which also showed statistically significant difference in knowledge of transfusion medicine & bedside transfusion practices. Our study recommends that there is a need of frequent audit on bedside transfusion practices to check the quality and standards associated with it and also points out the need of continuous medical education on this issue.

Study on the Investigation on Adverse Drug Reactions of Blood Transfusion in Hospital and Research on Preventive Measures

Study on the Investigation on Adverse Drug Reactions of Blood Transfusion in Hospital and Research on Preventive Measures

Obstetric red cell transfusion in a high-volume tertiary hospital: a retrospective cohort study.

Red cell transfusion is expensive and not without risks. Despite the availability of transfusion guidelines, studies report a wide interhospital variation in transfusion rates. This retrospective cohort study was conducted to define the incidence of red cell transfusion in a multi-ethnic obstetric population and to evaluate current transfusion practice with regard to indications and appropriateness. All parturients who delivered a live or stillbirth in the period 2014-2015 and who received allogeneic blood transfusion during pregnancy and up to six weeks postnatally were identified. Their medical records were reviewed to extract the relevant demographic, obstetric and transfusion data. Descriptive analysis of data was performed using IBM SPSS Statistics software. Out of 23,456 parturients who delivered in the study period, 760 were administered red cell transfusion, resulting in a transfusion rate of 3.2% or 32 in 1,000 maternities. A total of 1,675 red cell units were utilised in 863 transfusion episodes. Major indications for transfusion were anaemia in pregnancy (49.2%) and postpartum haemorrhage secondary to an atonic uterus. Transfusion was more frequently associated with caesarean than vaginal births (4.9% vs. 2.4%). About 14% of transfusions were initiated with pre-transfusion haemoglobin (Hb) ≥ 8.0 g/dL, whereas 37% of transfusions resulted in post-transfusion Hb > 9.0 g/dL. The incidence of red cell transfusion was 3.2% in a multiethnic obstetric population. Patient blood management strategies should focus on optimising antenatal anaemia, reducing blood loss during delivery and eliminating inappropriate transfusion.

Relationship Between Hemoglobin Level and the Expiration Date of Transfused Blood With the Death of Patients Admitted to the Intensive Care Unit

Background and Objectives In this study, we aim to investigate the relationship of the numbers of days until blood expiration and pre-transfusion hemoglobin level with mortality rate in patients admitted to the intensive care unit (ICU) and received packed red blood cell (PRBC) transfusion. Subjects and Methods This is a retrospective cross-sectional study that was performed in 2020 on 205 patients admitted to the ICU of Al-Zahra Hospital in Isfahan, Iran in the past year and received PRBC transfusion. Their demographic information as well as information about related to the blood such as the number of days until PRBC expiration and pre-transfusion hemoglobin level were extracted from the patient’s medical records. Results The mean pre-transfusion hemoglobin level of patients was 10.53±2.8 g/dL. Male patients had significantly higher hemoglobin level than female patients (P&lt;0.05). Of 205 patients, 55(26.8%) had a death outcome. The mortality rate was significantly higher in males than in females (P&lt;0.05). The number of days until PRBC expiration was 11.52±3.71 days. It was not significantly different between the deceased and surviving patients (P&gt;0.05). Also, the hemoglobin level of the deceased patients was significantly lower than that of surviving patients (P&lt;0.05). The patients with underlying diseases had significantly lower pre-transfusion hemoglobin level and higher mortality. Conclusion The mortality rate among ICU patients received PRBC transfusion in the study hospital is 26.8%.

Determination of ABO antibody titre and haemolysin test of group O whole blood used for exchanged transfusion in a teaching hospital

Background: Group O blood donor is more readily available and is frequently used as a universal red cell donor and emergency O whole blood (EM O) for exchange transfusion in neonates. Sera from group O donors contains two separable haemolysin antibodies, anti-A and anti-B, and a cross-reacting antibody called anti-A, B (mostly IgG). The presence of haemolysins in the donors may lead to haemolysis in the recipients. Objectives: This study aims to determine the prevalence of anti-A and anti B haemolysins and titer among group O donors that we screened for emergency group O (EM O) whole blood Methodology: A cross sectional study was done to determine the prevalence of anti-A and anti B haemolysin and titer among group O blood donors screened for EM O whole blood for exchange transfusion in neonates at a teaching hospital from January to December 2018. Samples of 350 voluntary group O regular donors were selected for ABO antibodies titration and haemolysin test using the conventional tube technique at room temperature. Donors were screened for titer of 1:50 and 1:100 only. ABO antibody titer of ≥1:100 was considered as a high titer and not suitable for exchange transfusion. Titer of ≤1:50 were labeled as EM O whole blood and will be suitable for exchange transfusion. Results: A total of 350 group O blood donors were screened for the anti A and anti B haemolysin and titer. The majority of blood group O donors were male (n=215, 61%) and were age from 18-30 years old (51%). Malay was the predominant group (83%). About 52.9% of the donors were low titer (≤1:50), and 47.1% were high titer (≥1:100). Low titer was seen predominantly among male donors (61.8%). The prevalence of haemolysins in group O donors was 5.4% (n=19). Anti A and anti B haemolysins were seen in 0.57% and 2.28% of the donors, respectively, while donors having both A and B haemolysins in their sera was 2.57%. Conclusion: Prevalence of anti-A and anti-B haemolysins were low among group O blood donors. However, a significant percentage of group O donors have high titer of anti-A or anti-B. Therefore, despite the labour intensiveness of haemolysis titration technique and the frequent transfusion of group O blood for exchange transfusion, there is the need to routinely screen our donors for haemolysins in order to identify those posing the greatest risk to recipients. Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 368-372

Clinical Validation of a Dynamic Obstetric Hemorrhage Risk Assessment Tool at an Urban Safety-Net Hospital

Obstetric hemorrhage is the leading cause of maternal mortality worldwide. There are emerging risk assessment tools with labor factors to guide prenatal pre-transfusion testing. In this study, we describe a dynamic risk assessment tool that includes antepartum and intrapartum risk factors, and assess its efficacy in predicting obstetric hemorrhage and hemorrhage requiring transfusion in an urban safety-net hospital.

Vitamin A and D Levels Correlate with Outcomes Following Acute Parvovirus B19 Infection in Children with Sickle Cell Disease

Background: Human parvovirus B19, a common childhood infection that typically causes mild disease in healthy individuals, causes life-threatening anemia due to transient red cell aplasia (aplastic crisis) in individuals with sickle cell disease (SCD). This complication often leads to hospitalization and red blood cell transfusions. Limiting the amount of transfusions is imperative to avoid alloimmunization. Strategies to mitigate complications from parvovirus B19 or reduce disease severity in SCD patients are needed. In this prospective observational study, we aim to describe the relationship between vitamin A and D levels and severity of symptoms during parvovirus B19 infection in pediatric patients with SCD.Methods: Twenty pediatric patients with SCD admitted to St. Jude Children's Research Hospital experiencing aplastic crisis and identified as having an active parvovirus B19 infection were under an IRB approved protocol (NCT02261480) and followed prospectively for 120 days post-infection. Acute parvovirus B19 infection was diagnosed by fever and a positive virus-specific IgM ELISA or PCR. Aplastic crisis was defined by worsened anemia without sufficient compensatory reticulocytosis in the setting of an acute parvovirus B19 infection. Virus-specific antibody responses were measured from sera or nasal washes (NW) by ELISA using parvovirus B19 virus-like particles (VLP) as target antigens. Peak serum antibody titers were defined (among measurements from Days 0, 7, 30, and 120). Total erythrocyte transfusion volumes required during the admission were quantified. Hematologic indices and vitamin A and D levels were obtained on Day 0. Vitamin A (retinol) was measured using UPLC and vitamin D (25[OH]D) was measured using a Roche Elecsys Vitamin D ELISA. Statistical analyses were performed with Spearman's rank correlation coefficient or Mann Whitney tests. We scored significance as p<0.05.Results: Twenty patients with different genotypes of SCD requiring hospital admission due to acute parvovirus B19 infection were sequentially enrolled (15 HbSS, 3 HbSC, 1 HbSD, 1 HbSβeta +thalassemia). Thirty-five percent (7/20) of patients were vitamin D deficient (VDD, defined here as <20 ng/mL) while 89% (17/19, one sample was not measured) of patients were marginally or severely vitamin A deficient (defined here as <20 μg/dL) on Day 0. Correlative analyses between vitamin levels and markers of disease severity are shown in figure 1. Lower vitamin D levels trended with lower hemoglobin (r=0.399, p=0.082) and there was a significant inverse correlation between transfused volume and vitamin D levels (r=-0.626, p=0.003, Figure 1B). There was a significant positive correlation of vitamin A levels on Day 0 with hemoglobin concentration (r=0.549, p=0.015, Figure 1D), and an inverse correlation between vitamin A levels and lactate dehydrogenase (r=-0.505, p=0.027, Figure 1F).Children with replete vitamin D levels exhibited significantly better peak virus-specific serum IgG (p=0.037) and IgA (p=0.011) responses (Figure 2A-B). Additionally, vitamin A, which plays an important role in mucosal immunity, correlated positively with virus-specific IgG (r=0.574, p=0.013) and IgA (r=0.480, p=0.044) in nasal passages on Day 30 (Figure 2C-D).Conclusions: In pediatric patients admitted to the hospital for acute parvovirus B19 infection, low vitamin A and D levels were associated with greater disease severity (greater hemolysis, lower hemoglobin concentration, and greater transfusion volumes). Higher vitamin levels were associated with better virus-specific antibody responses. While cause-effect relationships were not discerned in this study, we hypothesize that poor nutritional status contributed to poor outcomes and that efforts to improve nutrition may reduce the severity of parvovirus B19 disease in patients with SCD. [Display omitted] DisclosuresHankins: UpToDate: Consultancy; Vindico Medical Education: Consultancy; Global Blood Therapeutics: Consultancy; Bluebird Bio: Consultancy.

Impact of COVID-19 and lockdown regarding blood transfusion.

BackgroundThe outbreak of a SARS‐CoV‐2 resulted in a massive afflux of patients in hospital and intensive care units with many challenges. Blood transfusion was one of them regarding both blood banks (safety, collection, and stocks) and consumption (usual care and unknown specific demand of COVID‐19 patients). The risk of mismatch was sufficient to plan blood transfusion restrictions if stocks became limited.Study design and methodsAnalyses of blood transfusion in a tertiary hospital and blood collection in the referring blood bank between February 24 and May 31, 2020.ResultsWithdrawal of elective surgery and non‐urgent care and admission of 2291 COVID‐19 patients reduced global activity by 33% but transfusion by 17% only. Only 237 (10.3) % of COVID‐19 patients required blood transfusion, including 45 (2.0%) with acute bleeding. Lockdown and cancellation of mobile collection resulted in an 11% reduction in blood donation compared to 2019. The ratio of reduction in blood transfusion to blood donation remained positive and stocks were slightly enhanced.DiscussionReduction of admissions due to SARS‐CoV‐2 pandemic results only in a moderate decrease of blood transfusion. Incompressible blood transfusions concern urgent surgery, acute bleeding (including some patients with COVID‐19, especially under high anticoagulation), or are supportive for chemotherapy‐induced aplasia or chronic anemia. Lockdown results in a decrease of blood donation by cancellation of mobile donation but with little impact on a short period by mobilization of usual donors. No mismatch between demand and donation was evidenced and no planned restriction to blood transfusion was necessary.

Clinical value and limitations of the preoperative C‐reactive‐protein‐to‐albumin ratio in predicting post‐operative morbidity and mortality after deceased‐donor liver transplantation: a retrospective single‐centre study

Liver transplantation is still associated with a high risk of severe complications and post-operative mortality. This study examines the predictive value of the preoperative C-reactive-protein-to-albumin ratio (CAR) regarding perioperative morbidity and mortality in deceased-donor liver transplantation (DDLT) recipients. In total, 390 DDLT recipients between 05/2010 and 03/2020 were eligible. Predictive abilities of CAR were examined through receiver operating characteristic curve (ROC) analyses. Groups were compared using parametric and non-parametric tests as appropriate. Independent risk factors for morbidity and mortality were identified using uni- and multivariable logistic regression analyses. A good predictive ability for CAR was shown regarding perioperative morbidity (comprehensive complication index ≥75, Clavien-Dindo score ≥4a) and 12-month mortality, with an ideal cut-off of CAR=26%. Patients with CAR>26% had significantly higher median CCI scores (60 vs. 43, P<0.001), longer intensive care unit (ICU, 5 vs. 4days, P<0.001) and hospital (28 vs. 21days, P<0.001) stays and higher 12-month mortality rates (20% vs 6%, P<0.001). Multivariable analyses identified CAR>26%, pre-OLT inpatient hospitalization (including ICU) and post-operative red blood cell transfusions as independent predictors of severe cumulative morbidity (CCI≥75). Preoperative CAR might be a reliable additional tool to predict perioperative morbidity and mortality in DDLT recipients.