Need For Transfusion Research Articles

Management of Acute Myocardial Infarction with ST Segment Elevation. Narrative Review

Thromboembolic disease is a pathological condition that encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE). Obese individuals have a 2 to 3 times greater risk of developing venous thromboembolism (VTE); several pathophysiological mechanisms contribute to this correlation. The incidence of VTE in patients who have undergone bariatric surgery ranges from 0.1 to 3% and represents 20% of related mortality. The previous history of VTE, long surgical time (>3 hours) and the need for transfusion were the risk factors with the greatest impact on bariatric surgery. Thromboembolic risk stratification is essential to guide thromboprophylaxis. There are three tools specifically designed for bariatric surgery: The Cleveland Clinic calculator, BariClot and MBSC. Prophylaxis strategies include mechanical and pharmacological interventions. Various methods have been compared with the intention of identifying the most appropriate regimen for this patient population, however, evidence remains limited and results vary widely, so there is no consensus on the best treatment. This paper aims to carryout a narrative review of the most recent literature on thromboprophylaxis in patients undergoing bariatric surgery.

Incorporating the concept of overtransfusion into hemovigilance monitoring: An expert-based definition and criteria from the International HIT-OVER Forum.

Liberal or overtransfusion (OT) may be regarded as "inappropriate," but it is not reported as a transfusion-related adverse event. A definition of OT is lacking. OT may include overdosing of components, giving the incorrect component, or unnecessary administration without evidence of need for transfusion. OT can be associated with hypercoagulability, thrombosis, alloimmunization, increased mortality, longer hospital stay, increased infection rates, and adverse cardiocirculatory events. In 2023, an expert panel formed a hemovigilance international taskforce embedded in the German Interdisciplinary Taskforce for Clinical Hemotherapy (IAKH). The group was charged with proposing simple criteria to be used by hemovigilance systems to document instances of OT. This international initiative combined a narrative review of the literature for the rate and outcomes of OT with transfusion error reports to propose a definition for OT, including a definition for transfusion-induced hypercoagulopathy (TIH), three new codes for OT/TIH and subcodes A to G, three severity categories (serious adverse event, adverse event, near miss), and four incident codes (definite, probable, possible, not determinable). These codes can be used by hemovigilance systems to appropriately document instances of OT. Global adoption of these codes within hemovigilance systems would assist with the recognition and reporting of instances of OT, promote effective policies for adequate clinical administration techniques, and support technical guidelines for avoidance of OT. Thereby, incorporation of OT into hemovigilance strategies could support adequate use of blood products, increase patient safety, and facilitate blood supply and availability.

Effects of robotic surgery experience on open radical prostatectomy results: single centre & single surgeon experience

This study aimed to evaluate the effect of robotic surgery experience on open radical prostatectomy (ORP) outcomes. We retrospectively reviewed 100 patients who underwent an ORP for clinically localised prostate cancer (PCa) performed by the same experienced surgeon. The groups included the last 50 patients before (Group 1) and the first 50 patients after (Group 2) robotic surgery experience. A detailed history, peroperative, and oncological data were recorded. Continence status and erectile functions were evaluated before surgery and at 1, 3, 6, and 12 months postoperatively by daily pad count and an International Index of Erectile Function (IIEF) short form and were compared between groups. The demographics and preoperative data were similar. The preoperative and postoperative Gleason score was higher in Group 2 (p = 0.001, 0.033; respectively). The operation time (200 vs. 115 min), estimated blood loss (400 vs. 200 ml), peroperative transfusion rate (46% vs. 8%), drain removal time (4 vs. 3 days), hospital stay (5 vs. 4 days), and urethral catheter removal time (21 vs. 14 days) were significantly lower in Group 2 (p < 0.001). The continence rate was significantly higher in Group 2 in the first month (p = 0.027), but no significant difference was found at 3, 6, and 12 months. Erectile functions (mean IIEF: 9.47 vs. 11.18 at 12th month, p = 0.220) showed no significant difference between the groups in the first year after surgery. In addition to ergonomic benefits, robotic surgery provides a significant surgical procedure experience due to its great visualisation. The most important advantages that robotic surgery adds to our ORP experience were improved early continence; less bleeding and a decreased need for transfusions; and a shorter operation time, hospital stay, and urethral catheter removal time.

Minimizing Omental Bleeding Risk Following Sleeve Gastrectomy: Assessing the Double-line Sealing Technique.

Laparoscopic sleeve gastrectomy (LSG) has become the most commonly performed bariatric procedure due to its technical simplicity and effectiveness. While stapler line reinforcement has significantly reduced hemorrhagic complications, postoperative bleeding remains a concern, particularly from omentum or unidentified sources. The LigaSure device, known for sealing vessels successfully up to 7mm in diameter, may face challenges in obese patients due to excessive omental fat. This study introduces a double-sealing technique as a simple solution aimed at reducing postoperative bleeding related to patient-specific factors. This study conducts a retrospective analysis to evaluate the double-line omental sealing technique in LSG, an intervention aimed at reducing the incidence of postoperative bleeding. We compared outcomes from 222 patients using the double-line sealing (DLS) technique and 297 patients with standard dissection. DLS technique involves creating 2 adjacent rows of seals on the omentum during dissection, aiming to minimize bleeding risks. Patient demographics, including age, sex, body mass index, and comorbidities, were examined, alongside operative time, length of hospital stay, and instances of reoperation. Special attention was given to identifying cases of severe postoperative bleeding, primarily determined by the need for blood transfusion. No demographic differences emerged between the groups. The study group, which utilized DLS, demonstrated a significantly lower incidence of intraperitoneal severe bleeding (0.45%) compared with the control group (3%). Reoperations were significantly reduced, with only 2 cases (0.67%) in the control group and none in the DLS group. It also correlates with reduced length of hospital stay but increased operative time. DLS in LSG shows promise in reducing severe postoperative bleeding. Despite these positive initial findings, further studies with larger sample sizes are recommended to fully ascertain the efficacy and safety of this technique.

Tranexamic Acid With Acid Suppression Versus Acid Suppression Alone as Therapy for Upper Gastrointestinal Bleeding: A Meta-Analysis of Randomized Controlled Trials.

Studies have reported the benefits of tranexamic acid (TXA) in controlling bleeding across various conditions. However, the effect of TXA in upper gastrointestinal bleeding (UGIB) remains controversial, and its therapeutic impact when combined with acid suppression, particularly proton pump inhibitors (PPIs), which are considered first-line therapy for bleeding peptic ulcers, has not been reported. We systematically searched PubMed, Embase, and Google Scholar from January 1987 to June 2024 using predefined keywords to identify RCTs meeting our inclusion criteria, including details of TXA dosage, route of administration, and choice of acid suppressants. Data from selected trials were extracted, and a meta-analysis was performed using random-effects modeling. Six trials with 709 participants were included. Baseline patient characteristics in the selected trials were balanced. The rebleeding rate, mortality, need for blood transfusion, units of blood transfused, and need for salvage therapy were compared. The TXA with acid suppression group significantly reduced the risk of rebleeding (RR: 0.63, 95% CI: 0.41-0.96), units of blood transfused (mean difference: -1.08, 95% CI: -1.44 to -0.71), and the need for salvage therapy (RR: 0.28, 95% CI: 0.12-0.64). No significant difference was observed in mortality rate (RR: 0.74) and need for blood transfusion (RR: 1.01) between the two groups, but outcomes favored the TXA and acid suppression group. We suggest combining TXA with acid suppression as a first-line therapy for UGIB patients. Further trials should be conducted to determine the optimal dose and route of TXA administration for better care.

Laparoscopic resections for stage IV colorectal cancer - safety and effectiveness of the method as a guarantee for an uncomplicated postoperative period and optimal pharmacotherapeutic results

Introduction: Primary tumor resection can prevent future tumor-related complications in patients with stage IV colorectal cancer. This may influence the quality of life and prevent colostomies associated with the emergency surgery. Laparoscopic approach plays an important role in attempts to reduce perioperative complications in this specific group of patients. Purpose: The aim is to assess early perioperative results in a group of 17 patients with stage IV colorectal cancer—multiple incurable liver metastases and/or pulmonary/peritoneal metastases of the disease. On the other hand, postoperative complications may delay administration of chemotherapy and influence survival. Materials and methods: We analyze retrospectively the perioperative results in a group of 17 patients with laparoscopic palliative colorectal resections for stage IV colorectal cancer. Assessment includes perioperative complications, median hospital stay, perioperative blood loss, need for blood transfusion, operative time, and type of surgical procedure. Results: We performed totally laparoscopic 10 sigmoid resections, five left colectomies, and two right colectomies. Fourteen simultaneous liver biopsies were performed during laparoscopy. No perioperative deaths were registered. Perioperative mortality rate is 0%. Perioperative morbidity rate is 0%. No perioperative complications. The median perioperative stay is 5.3 days. Median blood loss is 47.9 mL. Overall, three units of blood were transfused. The median transfusion rate is 0.17 units per patient. The median operative time is 130.2 minutes. Conclusion: The laparoscopic approach is associated with very good perioperative results in patients with stage IV colorectal cancer and palliative resection of the primary tumor. Early hospital discharge and minimal operative trauma may not influence early administration of chemotherapy.

Does Frequent Use of Advanced Energy Devices Improve Hysterectomy Outcomes?

Background and Objectives: The objective of this study was to assess the efficient use of advanced energy devices by examining the impact of their usage frequency on surgical outcomes of total laparoscopic hysterectomies. Materials and Methods: A retrospective study was conducted between 2020 and 2023 by a single surgeon. The patients’ medical records and surgical videos were reviewed. Cases were categorized into three groups based on the frequency of usage of advanced energy devices: Group 1 (≤10 uses), Group 2 (11–20 uses), and Group 3 (≥21 uses). The differences in blood loss, surgery time, and surgical outcomes among these groups were analyzed. This study was conducted as a single-center retrospective analysis. It included 126 patients who underwent total laparoscopic hysterectomy and provided informed consent for video recording. To evaluate the usage of advanced energy devices, anonymized surgical videos were reviewed, and outcomes were analyzed based on the frequency of usage of advanced energy devices. Results: The time required for surgery differed significantly among the three groups (p = 0.006). However, no significant differences were observed in the changes in hemoglobin levels or estimated blood loss (p = 0.255 and 0.053, respectively). Additionally, the application of hemostatic agents, the need for intraoperative or postoperative transfusions, and the use of intravenous hemostatic agents postoperatively showed no notable variation. Complication rates, including rates of hematoma, urinary tract injury, gastrointestinal injury, and infections necessitating reoperation, were also comparable. Conclusions: The findings suggest that the prudent and strategic use of advanced energy devices, rather than their frequent application, may improve surgical efficiency without increasing the risk of complications.

Efficacy and safety of preoperative intravenous iron versus standard care in colorectal cancer patients with iron deficiency anemia: a systematic review and meta-analysis.

Anemia, particularly iron deficiency (ID) anemia, is common in colorectal cancer (CRC) patients, affecting up to 58% of individuals. This study aimed to compare the effectiveness and safety of preoperative intravenous iron (IVI) with standard care (no iron or oral iron) in CRC patients with ID anemia. A systematic search across multiple databases identified studies comparing IVI versus no iron or oral iron in CRC patients with ID anemia. Pooled data were analyzed for changes in hemoglobin (Hb) levels, need for red blood cell transfusions (RBCT), overall mean number of transfused RBC units, overall survival (OS), disease-free survival (DFS), and complications. The authors analyzed data from 11 studies with 2024 patients and found that IVI significantly increased Hb levels at crucial time points: preoperative (MD=1.17, 95% CI [0.95-1.40], P<0.01), postoperative day one (MD=1.32, 95% CI [0.89-1.76], P<0.01), hospital discharge (MD=0.76, 95% CI [0.28-1.24], P=0.002), and 30 days postoperative (MD=1.57, 95% CI [1.27-1.87], P<0.01). IVI significantly decreased the overall need for RBCT, particularly in the postoperative period (RR=0.69, 95% CI [0.52-0.92], P=0.01). It also reduced the mean number of transfused RBC units, total complications, and wound dehiscence. However, there were no significant differences in total death, hospital stay, infections, paralytic ileus, OS, or DFS. Preoperative IVI significantly increased Hb levels at critical time points and markedly reduced the overall need for RBCT, complications, and wound dehiscence. To further validate these findings and ensure robust conclusions, more well-designed randomized controlled trials are warranted.

Impact of aspirin on the outcome of upper limb AVF placement in hemodialysis patients: Discontinuation or not.

There is limited research on the consumption of aspirin and its effects on bleeding during arteriovenous fistula (AVF) placement surgery and associated complications in end-stage renal disease (ESRD) patients. Regarding the potential risks imposed on cardiac patients by discontinuing aspirin, the aim of the study was to determine whether aspirin should be discontinued prior to AVF placement surgery. This prospective study was carried out at two referral medical centers from 2023 to 2024. The patients were included as 30 patients who routinely took 80 mg of aspirin daily and 30 patients who did not take aspirin. The primary outcomes included the amount of blood loss, and the secondary outcomes included AVF success and maturation time. The amount of bleeding was assessed by the ΔHb (Hb1-Hb2), ΔHCT (HCT1-HCT2), and intraoperative hemorrhage volume. Aspirin consumption did not significantly affect any of the examined parameters, including operation duration, hemoglobin decrease, hematocrit decrease, intraoperative hemorrhage, AVF success rate, maturity time, need for blood transfusion, postoperative bleeding, hematoma and thrombosis, hospitalization, and re-Operation (p > 0.05). Aspirin did not have any significant or negative effects across any of the parameters examined. Based on the findings of this study, there is no need to discontinue aspirin in patients prior to upper limb AVF placement surgery, but further studies are recommended.

Hypovolaemic phlebotomy to reduce the need for perioperative transfusion: a price worth paying?

Hypovolaemic phlebotomy to reduce the need for perioperative transfusion: a price worth paying?

Severe neonatal hyperbilirubinaemia in European and Indian subcontinent descendent newborns: a retrospective cohort study

Neonatal hyperbilirubinaemia is more common in Asian-descendent populations, but differences in disease severity are poorly reported. Our study aimed to compare neonatal hyperbilirubinaemia severity between European and Indian subcontinent descendent newborns. We conducted a single-centre retrospective cohort study including newborns admitted with unconjugated hyperbilirubinaemia (January 2016 to December 2021). Patients were followed during admission, comparing those with European ancestry (control group) and Indian subcontinent ancestry (India, Pakistan, Bangladesh and Nepal) (study group). The primary outcome was severe hyperbilirubinemia (TSB > 25 mg/dL, phototherapy > 6 h or need for exchange transfusion [ET]), and the secondary was TSB levels. Adjusted analysis for potential confounding factors was performed using binary logistic regression models. Of 110 newborns included, 27 (24.5%) had Indian subcontinent ancestry. Occurrence of TSB > 25 mg/dL was significantly higher in the study group (22.2% vs. 4.8%, p = 0.006), while no differences were noted in exposure to phototherapy > 6 h and ET therapy. Logistic regression models for confounding factors adjustment showed Indian subcontinent ancestry as an independent risk factor for TSB > 25 mg/dL (OR 7.49, CI 95% [1.23–45.50]). The study group revealed also higher absolute values of TSB both at admission (22.0 mg/dL vs. 19.6 mg/dL, p = 0.013) and at discharge (13.6 mg/dL vs. 11.4 mg/dL, p = 0.005). Conclusion: Our findings suggest that newborns with Indian subcontinent ancestry might show a higher risk for the development of severe hyperbilirubinemia compared to European ancestry newborns. Implementing earlier treatment thresholds in this subset of patients may help prevent severe hyperbilirubinemia. What is Known:• Indian subcontinent descendent populations have high incidence of neonatal hyperbilirubinaemia but data regarding its severity are scarce.What is New:• This article shows that, compared to European descendent newborns, Indian subcontinent descendent newborns might be at higher risk for severe hyperbilirubinaemia.

LIMITED USE VERSUS TOTAL USE OF TOURNIQUET IN PRIMARY TOTAL KNEE ARTHROPLASTY

Background: Tourniquets are used during total knee arthroplasty for better surgical fields and improved cementation. The functional benefits of tourniquet application for limited periods compared with total duration applications during total knee joint arthroplasty (TKA) surgery have not been well explored. Aim of the study: To evaluate and compare the outcomes of limited use of a tourniquet (LT) for a shorter duration (just before cement application) with total use of a tourniquet (TT) for a longer duration (from skin incision to the completion of surgery). Patients and method: A sum of 100 patients who undertook primary total knee arthroplasty were involved in this study, they were allocated randomly into two groups according to whether a limited or total tourniquet was used during the surgery. Both groups underwent the same surgical procedures with a digital tourniquet applied to all patients using the same technique. Intraoperative and postoperative assessment of blood loss, knee functional society score (KSS), visual analogue score (VAS) for thigh pain and knee pain evaluation, surgical complications like deep vein thrombosis (DVT), wound infections and nerve injuries are the main factors evaluated in the study. Results: Patients with LT required more intraoperative blood transfusion compared with those with TT who required more blood transfusion postoperatively. There were no significant differences in KSS, VAS for thigh pain and knee pain evaluation, and surgical complications like DVT, wound infections and nerve injuries. Conclusion: Limited tourniquet application from starting of cementing is associated with a higher need for intraoperative blood transfusion, but the use of a TT throughout surgery is associated with a higher need for postoperative blood transfusion.

Incidence and risk factor of blood transfusion after abdominal radical hysterectomy for cervical cancer: a 10-year retrospective study of the US nationwide inpatient sample.

With the rising prevalence of abdominal radical hysterectomy, the need for perioperative blood transfusion has emerged as a significant clinical challenge. Independent risk factors for blood transfusion during abdominal radical hysterectomy remains limited, and identifying these factors is needed. A retrospective analysis of data was performed using the Nationwide Inpatient Sample (NIS), focusing on patients who underwent abdominal radical hysterectomy between 2010 and 2019. Patients were categorized into two groups based on whether they received a blood transfusion. The analysis encompassed various demographic factors, including race, sex, and age, as well as length of stay (LOS), total hospitalization charges, hospital characteristics (admission type, insurance type, bed size, teaching status, geographic location, and hospital region), hospital mortality rates, comorbidities, and perioperative complications. Subsequently, both univariate and multivariate logistic regression analyses were employed to ascertain factors associated with abdominal radical hysterectomy patients requiring blood transfusions. Blood transfusions occurred in 14.84% of patients between 2010 and 2019, with a downward trend over time. Receiving a transfusion was associated with several negative outcomes, including a longer length of stay, higher total charges, and complications like thrombocytopenia, acute myocardial infarction, pneumonia, and so on. Additionally, patients who received transfusions were more likely to experience postoperative delirium, deep vein thrombosis, and wound infection. Independent risk factors for blood transfusion include Black race, Asian or Pacific Islander race, non-elective surgery, hospitalization in a rural setting, pre-existing medical conditions like coagulopathy, chronic blood loss anemia, deficiency anemia and others. Conversely, patients with private insurance, residing in the West, or Midwest/North Central regions were less likely to require a blood transfusion. Our study highlights the concern of perioperative blood transfusion in radical hysterectomy, linked to significant complications. Reducing intraoperative blood loss and optimizing care based on patient factors are crucial for improving outcomes.

Iron overload in acquired sideroblastic anemias and MDS: pathophysiology and role of chelation and luspatercept.

Besides transfusion therapy, ineffective erythropoiesis contributes to systemic iron overload in myelodysplastic syndromes with ring sideroblasts (MDS-RS) via erythroferrone-induced suppression of hepcidin synthesis in the liver, leading to increased intestinal iron absorption. The underlying pathophysiology of MDS-RS, characterized by disturbed heme synthesis and mitochondrial iron accumulation, is less well understood. Several lines of evidence indicate that the mitochondrial transporter ABCB7 is critically involved. ABCB7 is misspliced and underexpressed in MDS-RS, due to somatic mutations in the splicing factor SF3B1. The pathogenetic significance of ABCB7 seems related to its role in stabilizing ferrochelatase, the enzyme incorporating iron into protoporphyrin IX to make heme. Although iron-related oxidative stress is toxic, many patients with MDS do not live long enough to develop clinical complications of iron overload. Furthermore, it is difficult to determine the extent to which iron overload contributes to morbidity and mortality in older patients with MDS, because iron-related complications overlap with age-related medical problems. Nevertheless, high-quality registry studies showed that transfusion dependency is associated with the presence of toxic iron species and inferior survival and confirmed a significant survival benefit of iron chelation therapy. The most widely used iron chelator in patients with MDS is deferasirox, owing to its effectiveness and convenient oral administration. Luspatercept, which can reduce SMAD2/SMAD3-dependent signaling implicated in suppression of erythropoiesis, may obviate the need for red blood cell transfusion in MDS-RS for more than a year, thereby diminishing further iron loading. However, luspatercept cannot be expected to substantially reduce the existing iron overload.

Reducing Blood Loss From Phlebotomy in Adult Neurocritical Care Patients: An Evidence-Based Practice Project.

BACKGROUND: Blood loss from phlebotomy is a significant cause of hospital-acquired anemia. Use of small-volume (Pedi) tubes in adult patients reduces blood loss by 40% and does not increase need for repeated labs. Although this practice is evidencebased, it has not been widely implemented. Using Pedi tubes for phlebotomy is a key component of blood management programs to decrease the incidence of hospital-acquired anemia and blood transfusions in the intensive care unit (ICU). Our aim was to implement the use of Pedi tubes for labs in the adult neurocritical care unit to demonstrate feasibility in this population. METHODS: This was a pre-/postintervention quality improvement project. All consecutive patients admitted to the neurocritical care unit from April 10, 2023, to October 10, 2023, aged 18-99 years, were included in the project. During the intervention period from July 10, 2023, to October 10, 2023, Pedi tubes were used for all laboratory draws except admission and crisis labs. A retrospective chart review from April 10 to July 9, 2024, established standard practice for comparison. We recorded hospital and ICU admission, nadir, and discharge hemoglobin, length of stay, number of rejected specimens, number of blood transfusions, discharge disposition, and 30-day readmission for all subjects. RESULTS: Pedi tube use was successfully implemented with significantly less need for repeat laboratory collections in the postintervention cohort (P = .001). Although no difference was noted in hemoglobin levels, there was a decrease in both ICU and hospital length of stay by 1 day in the intervention arm. Fewer transfusions were required in the intervention cohort. CONCLUSIONS: Small-volume tube use for phlebotomy in adult neurocritical care patients is feasible and can lead to decreased blood transfusion need in the ICU.

A phase 2 clinical trial of luspatercept in non-transfusion-dependent patients with myelodysplastic syndromes.

Luspatercept has shown durable clinical efficacy for the treatment of anemia in transfusion-dependent patients with lower-risk myelodysplastic syndromes (LR-MDS). We report the results of a prespecified primary analysis of a phase 2 trial of luspatercept in non-transfusion-dependent (NTD) Japanese patients with anemia due to LR-MDS. Luspatercept (starting dose 1.0mg/kg) was administered subcutaneously once every 3weeks. The primary endpoint was the proportion of patients who achieved hematological improvement-erythroid (HI-E) response (≥ 1.5g/dL increase in hemoglobin level for 8weeks) without transfusions within the first 24weeks of treatment. At the primary analysis data cutoff, 21 patients had been enrolled/treated; 17 and 10 patients had completed 24 and 48weeks of treatment, respectively. HI-E response occurred within 24weeks in 10 patients (47.6%; 95% confidence interval, 25.7-70.2; P < 0.0001), which was significantly higher than the predefined threshold (10%). By week 48, HI-E response occurred in 12 patients (57.1%) and 17 patients (81.0%) remained NTD. Luspatercept was well tolerated. Three patients (14.3%) had grade 3-4 treatment-related treatment-emergent adverse events. Luspatercept resulted in statistically and clinically significant improvements in hemoglobin levels, and may help delay the need for transfusions in NTD patients with LR-MDS.

Sickle Cell Disease and Sickle Cell Trait on Curaçao: Pregnancy‐Related Outcomes and Complications: A Retrospective Cohort Study From a Single Centre

ABSTRACTObjectivesTo describe the pregnancy‐related outcomes and complications as well as neonatal outcomes among patients with sickle cell disease (SCD) and sickle cell trat (SCT) on Curaçao over the past half decade.MethodsA retrospective cohort study was conducted. Patients with SCD and SCT were included who gave birth from 1 December 2016 to 9 November 2019 in St. Elisabeth Hospital and from 10 November 2019 to 1 November 2023 in Curaçao Medical Center, Curaçao. Various data regarding participant characteristics, pregnancy‐related outcomes and complications and neonatal data were gathered and analysed. Descriptive statistics were utilized and p values calculated.ResultsThe most common pregnancy‐related complications in patients with SCD were pre‐eclampsia (4; 23.5%), vaso‐occlusive crisis (10; 58.8%), anaemia (15; 88.2%) and urinary tract infection (6; 35.3%). Intrauterine growth restriction was recorded in four (22.2%) pregnancies, five (29.4%) patients delivered preterm and eight (44.4%) neonates had a birth weight below 2500 g. The need for blood transfusion was significantly higher in patients with HbSS compared to patients with HbSC (88.9% HbSS vs. 12.5% HbSC, p = 0.002) and significantly more neonates from patients with HbSS were admitted to the neonatal intensive care unit (66.7% HbSS vs. 11.1% HbSC, p = 0.016). Regarding SCT, anaemia occurred in 78 (25.2%) patients and 73 (23.5%) times the amniotic fluid was stained with meconium.ConclusionThe data of this study support the results of previous studies, displaying a high rate of maternal and neonatal complications and adverse outcomes during pregnancy in patients with SCD. Close observation and a multidisciplinary approach are essential. SCT does not appear to be associated with adverse effects on maternal or foetal outcomes and complications, except for a high rate of meconium‐stained amniotic fluid.

Agreement of point-of-care and laboratory lactate levels among trauma patients and association with transfusion.

In the setting of trauma and suspected critical bleeding, indications to commence blood transfusions remain unclear, with high rates of potentially avoidable transfusions. Prehospital blood lactate measurements could help predict the need for blood transfusions. The aim of this study was to compare measurements detected by a point-of-care (POC) lactate device with laboratory measured lactate levels. This was a cross-sectional study conducted in the emergency department. Eligible patients were those with suspected major trauma and critical bleeding. Venous or arterial blood samples were collected. POC measurements of lactate levels were conducted using a StatStrip Xpress® lactate meter and compared with laboratory values. Among 70 patients, the mean difference between the POC and laboratory lactate results was -0.19 mmol/L, with limits of agreement at -1.9 and 1.5. Most measurements (n = 66; 94.3%) were within the limits of agreement. A POC lactate level of >3.3 mmol/L had >90% specificity for transfusion, whereas a level <1.4 mmol/L had 90% sensitivity to rule out a transfusion. The level of agreement of POC lactate with the laboratory lactate was high. Research on clinical decision rules for pre-hospital transfusion that incorporate POC lactate measures is therefore feasible.

Comparison of total blood loss between limited tourniquet use and conventional tourniquet use in total knee arthroplasty: a randomized controlled trial

BackgroundThis study examined the differences in total blood loss, the need for blood transfusions, length of hospital stay, wound grading scores, incidence of venous thromboembolism (VTE), and reoperation rates between conventional and limited tourniquet use during unilateral primary total knee arthroplasty (TKA).MethodsThis double-blind, randomized controlled trial included 90 patients undergoing unilateral primary TKA. Forty-five patients were allocated to the limited tourniquet use group (LIM-TKA), and 45 to the conventional tourniquet use group (CON-TKA). The study analyzed differences in total blood loss, the need for blood transfusions, wound grading scores, incidence of VTE, length of hospital stay, and reoperation rates.ResultsThe mean total blood loss in the LIM-TKA group was 589.55 ± 238.2 ml, significantly lower than the 692.31 ± 276.15 ml observed in the CON-TKA group (P = 0.031). Significantly poorer wound grades were seen in the CON-TKA group compared to the LIM-TKA group, with 23 vs. 34, 15 vs. 11, 5 vs. 0, 1 vs. 0 and 1 vs. 0 patients, respectively, having grade 1, 2 A, 2B, 2 C and 3 A wounds according to the Southampton Scoring System (P = 0.032). Patients in the LIM-TKA group also had a shorter hospital stay versus the CON-TKA group (5.6 ± 1.28 vs. 7.2 ± 4.06 days, P = 0.006). The rates of blood transfusion, VTE complications, and reoperation were similar between both groups.ConclusionLIM-TKA results in significantly lower total blood loss and improved wound grading scores, as well as a decreased length of hospital stay compared to CON-TKA. LIM-TKA could be a suitable option for surgeons aiming to minimize tourniquet-related adverse outcomes while maintaining a dry bone surface during TKA cementation.Clinical trial numberThis study was retrospectively registered at Thai Clinical Trials Registry (thaiclinicaltrials.org) on July 28, 2024. Clinical trial number: TCTR20240728002.

A 5-years cross-sectional study of risk-factors feto-maternal outcomes in placenta accreta spectrum at single tertiary care centre in South India

: PAS is an abnormal placental trophoblastic invasion into the myometrium, serosa and surrounding structures causing severe maternal morbidity and mortality due to massive obstetric hemorrhage (MOH). The incidence of PAS is on the rise due to increasing rate of Cesarean Section (CS) worldwide. : This study aimed to assess the risk factors associated with Placenta accreta spectrum (PAS) and to compare the feto-maternal outcomes in elective and emergency delivery in PAS.This is a 5 years single centre cross-sectional study from 1st January 2018 to 31st December 2022. All diagnosed cases of PAS beyond 28 weeks of gestation were included. A total of 38 cases of PAS were studied. Chi-square test and T-test were used to compare the categorical variables with p value 0f &amp;#60;0.05 as statistically significant.The incidence of PAS was 1.85/1000 deliveries. Advanced maternal age, previous CS, placenta previa in current pregnancy were major risk factors. MOH was the commonest complication. The blood loss, increased operative time and need for blood transfusions was mainly dependent on the placental location. Prematurity and low birth weight were the most important perinatal outcomes. Adequate blood and blood products prior to surgery is important as even in expert hands blood loss can be massive. Early referral and specialized regional team to manage PAS at tertiary care are needed. Future studies should emphasize on easy and early detection of PAS.