Transfusion Therapy Research Articles

β-Thalassemia gene editing therapy: Advancements and difficulties.

β-Thalassemia is the world's number 1 single-gene genetic disorder and is characterized by suppressed or impaired production of β-pearl protein chains. This results in intramedullary destruction and premature lysis of red blood cells in peripheral blood. Among them, patients with transfusion-dependent β-thalassemia face the problem of long-term transfusion and iron chelation therapy, which leads to clinical complications and great economic stress. As gene editing technology improves, we are seeing the dawn of a cure for the disease, with its reduction of ineffective erythropoiesis and effective prolongation of survival in critically ill patients. Here, we provide an overview of β-thalassemia distribution and pathophysiology. In addition, we focus on gene therapy and gene editing advances. Nucleic acid endonuclease tools currently available for gene editing fall into 3 categories: zinc finger nucleases, transcription activator-like effector nucleases, and regularly interspaced short palindromic repeats (CRISPR-Cas9) nucleases. This paper reviews the exploratory applications and exploration of emerging therapeutic tools based on 3 classes of nucleic acid endonucleases in the treatment of β-thalassemia diseases.

Survival of transfused red blood cells from a donor with alpha-thalassemia trait in a recipient with sickle cell disease.

Post-transfusion survival of donor red blood cells (RBCs) is important for effective chronic transfusion therapy in conditions including sickle cell disease (SCD). Biotin labeling RBCs allows direct in vivo measurement of multiple donor RBC units simultaneously post-transfusion. In an observational trial of patients with SCD receiving monthly chronic transfusion therapy, aliquots of RBCs from one transfusion episode were biotin-labeled and infused along with the unlabeled RBC units. Serial blood samples were obtained to measure RBC survival. Donor units were tested for RBC indices, hemoglobin fractionation, and glucose-6-phosphate dehydrogenase (G6PD) enzyme activity. For microcytic donor RBCs (MCV < 70 fL), HBA1 and HBA2 genetic testing was performed on whole blood. We present one recipient, a pediatric patient with SCD and splenectomy who received two RBC units with aliquots from each unit labeled at distinct biotin densities (2 and 18 μg/mL biotin). One donor unit was identified to have microcytosis (MCV 68.5 fL after biotinylation); whole blood sample obtained at a subsequent donation showed 2-gene deletion alpha-thalassemia trait (ɑ-3.7kb/ɑ-3.7kb) and normal serum ferritin. G6PD activity was >60% of normal mean for both. The RBCs with alpha-thalassemia RBC had accelerated clearance and increased surface phosphatidylserine post-transfusion, as compared with the normocytic RBC (half life 65 vs. 86 days, respectively). Post-transfusion RBC survival may be lower for units from donors with alpha-thalassemia trait, although the impact of thalassemia trait donors on transfusion efficacy requires further study.

Perinatal outcomes of fetoscopic selective laser photocoagulation for spontaneous twin-anemia polycythemia sequence.

Antenatal management of monochorionic pregnancies complicated by twin anemia polycythemia sequence (TAPS) remains sub-optimally defined. Our objective was to evaluate the safety and efficacy of fetoscopic selective laser photocoagulation with respect to fetal and neonatal survival. A case series is reported with patients referred to the Texas Children's Fetal Center for evaluation and management of suspected spontaneous TAPS without concomitant twin-to-twin syndrome from 2014 to 2023. All evaluations were performed by our team and patients with stage II-IV TAPS were offered expectant management, intrauterine transfusion, or laser therapy. Cases of post-laser TAPS were excluded from this study. Pregnancy and neonatal outcomes were obtained from electronic medical records. During a 10-year time period, 18 patients presented to our center for the management of TAPS. Thirteen patients had stage II-IV TAPS (13/18, 72%) and elected to proceed with laser photocoagulation. All procedures were completed, and "solomonization" was performed for 12/13. Normalization of middle cerebral artery Dopplers in both fetuses was noted after all cases. There was one intrauterine fetal death of the 26 viable fetuses after laser treatment, which was complicated by selective growth restriction. Most patients (12/13) were delivered by Cesarean section at a mean gestational age of 29±3weeks. Subsequently, there was one ex-donor neonatal death in an infant who had prenatal hydrops. Overall, 30-day postnatal survival was 24/26 fetuses (92.3%). In the setting of spontaneous TAPS, laser therapy is feasible and appears to be an effective approach with overall favorable perinatal outcomes.

Addressing Thalassaemia Management from Patients' Perspectives: An International Collaborative Assessment.

Background and Objectives: The effective management of chronic diseases, particularly hereditary and rare diseases and thalassaemia, is an important indicator of the quality of healthcare systems. We aimed to assess healthcare services in different countries for thalassaemia patients by using publicly available health indicators and by surveying thalassaemia patients and their caregivers. Materials and Methods: We reviewed official worldwide databases from the WHO, World Bank, and scientific resources, and we used a structured patient-tailored self-completed questionnaire to survey thalassaemia patients and their caregivers in 2023. Results: A total of 2082 participants were surveyed (mean age, 27 years; males, 42%). About 1 in 4 respondents did not complete high-school education, while 24% had a bachelor's degree. About a third of respondents were married and were in either full- or part-time employment. The vast majority (~80%) had initiated transfusion therapy between 1 and 4 years of age. Only 42% reported no delays in receiving blood transfusion, while 47% reported occasional delays and 8% serious delays. About half of patients reported being very satisfied (11%) or satisfied (38%) with the quality of services provided, while 1 in 3 patients reported being unsatisfied or very unsatisfied, and that their access to treatment was difficult or very difficult due to traveling expenses and the high cost of treatment. Conclusions: Important improvements in the care of thalassaemia patients have been documented during the past few decades. Nevertheless, additional focus is required through national healthcare systems to effectively address the many unmet needs revealed by our recent survey, as well as to achieve satisfactory patient outcomes.

Peripheral perfusion index stratifies risk in patients with intraoperative anemia: A multicentre cohort study

Study objectiveEvidence for red blood cell (RBC) transfusion thresholds in the intraoperative setting is limited, and current perioperative recommendations may not correspond with individual intraoperative physiological demands. Hemodynamics relevant for the decision to transfuse may include peripheral perfusion index (PPI). The objective of this prospective study was to assess the associations of PPI and hemoglobin levels with the risk of postoperative morbidity and mortality. DesignMulticenter cohort study. SettingBispebjerg and Hvidovre University Hospitals, Copenhagen, Denmark. PatientsWe included 741 patients who underwent acute high risk abdominal surgery or hip fracture surgery. InterventionsNo interventions were carried out. MeasurementsPrincipal values collected included measurements of peripheral perfusion index and hemoglobin values. MethodsThe study was conducted using prospectively obtained data on adults who underwent emergency high-risk surgery. Subjects were categorized into high vs. low subgroups stratified by pre-defined PPI levels (PPI: > 1.5 vs. < 1.5) and Hb levels (Hb: > 9.7 g/dL vs. < 9.7 g/dL). The study assessed mortality and severe postoperative complications within 90 days. Main resultsWe included 741 patients. 90-day mortality was 21% (n = 154), frequency of severe postoperative complications was 31% (n = 231).Patients with both low PPI and low Hb had the highest adjusted odds ratio for both 90-day severe postoperative complications (2.95, [1.62–5.45]) and 90-day mortality (3.13, [1.45–7.11]).A comparison of patients with low PPI and low Hb to those with high PPI and low Hb detected significantly higher 90-day mortality risk in the low PPI and low Hb group (OR 8.6, [1.57–162.10]). ConclusionHigh PPI in acute surgical patients who also presents with anemia was associated with a significantly better outcome when compared with patients with both low PPI and anemia. PPI should therefore be further investigated as a potential parameter to guide intraoperative RBC transfusion therapy.

Acute respiratory distress syndrome in pediatric practice, diagnosis, and intensive care: A review

Acute respiratory distress syndrome is one of the main causes of life-threatening complications and deaths in pediatric intensive care units. This study aimed to analyze the current features of epidemiology, risk factors, and outcomes of acute respiratory distress syndrome in children aged 1 months according to the literature. The analysis included 100 publications extracted from eLibrary and PubMed abstract databases. The search was performed using the following keywords: acute respiratory distress syndrome, epidemiology, pediatric, outcome, and control mechanical ventilation. After the initial study of abstracts, 64 articles containing previously published information were excluded from the review. The recommendations of the Pediatric Acute Lung Injury Consensus Conference, which were published in April 2023, were taken as the main source. The review presents current definitions, risk factors, and criteria for the severity of acute respiratory distress syndrome in pediatric practice, discusses in detail the features of invasive ventilation and adjuvant therapy, and pays special attention to infusion and transfusion therapy, nutrition, and sedation. One of the sections is devoted to monitoring the patient’s condition, assessing the effectiveness of gas exchange and hemodynamics, and emphasizing the importance of a dynamic assessment of delirium in patients and the readiness for extubation. The recommendations of Pediatric Acute Lung Injury Consensus Conference-2 for the treatment of acute respiratory distress syndrome in children make it possible to more accurately stratify the severity of the pathological process, identify patients at risk with a high probability of developing this syndrome, and begin timely protective respiratory support to restore lung parenchyma and optimize oxygen delivery and consumption.

Impact of human leucocyte antigen class II polymorphism on anti-red blood cell antibody development: Correlations and indications.

Blood transfusion therapy is vital for many patient groups. They can cause many complications, and the development of anti-red blood cell (RBC) antibodies is of significant importance. Molecules of class II human leucocyte antigens (HLA) are one of the several factors that influence antibody development in patients. In this study, we investigated 108 patients who developed antibodies against different erythrocyte antigens and 115 patients on multiple transfusion therapies who did not develop anti-RBC antibodies. The HLA loci HLA-DRB1 and HLA-DQB1 were typed using commercial molecular assays routinely used in HLA laboratories. An increased frequency of the HLA-DRB1*04 allele group was observed in patients who developed antibodies. Additionally, HLA-DRB1*09 was also significant for anti-E development and in patients with multi-specific alloimmunization. It was found that the HLA-DRB1*07 allele group is associated with antibodies to antigents of the Rh and MNS systems but also lacks an association with anti-K development. The HLA-DRB1*11 and -DRB1*01 allele groups displayed a protective mechanism for anti-E development, similar to that of HLA-DQB1*02 for anti-K. There is an association between various HLA class II alleles and anti-RBC development.

Study of Alloimmunization in Transfusion-dependent Thalassemia Patients at a Tertiary Care Hospital

Abstract: BACKGROUND: Alloantibodies against donor red blood cells (RBCs) are developed by patients with transfusion-dependent thalassemia (TDT), which causes the donor RBCs to hemolyze. This decreases the transfusion’s efficacy and increases the risk of adverse effects like iron overload. MATERIALS AND METHODS: Two hundred and five TDT patients with an average age of 11 ± 6 years enrolled in this study underwent the Direct Coombs Test (DCT) to determine the frequency of alloimmunization. RESULTS: Most cases were of thalassemia major (TM) (76.09%), followed by thalassemia intermedia (TI) and (21.95%). Most of the cases were diagnosed and started on regular blood transfusion therapy between the ages of 1 and 10 years. Majority of the cases were born of parental consanguinity. Only 13.17% of the patients underwent splenectomy, of which TM cases were the majority. Even though O-positive was the most frequent blood type, most of the operated and alloimmunized cases belonged to the B-positive blood type. Only 10.24% of the patients had alloimmunization, with 51.85% of them developing it after splenectomy. Among all study participants, no correlation was found between the blood group and the type of thalassemia, alloimmunization, or splenectomy. Among TDT cases, there was a significant correlation (P &lt; 0.0001) between alloimmunization and splenectomy. Alloimmunization and splenectomy correlated significantly with the total number of transfusions, the volume of blood transfused, and the transfusion initiation age. CONCLUSION: Our findings emphasize the significance of antigen typing in TDT patients before the first transfusion.

Impact of Red Blood Cell Transfusion on Subsequent Cardiovascular Events in Patients with Acute Heart Failure and Anemia.

Red blood cell (RBC) transfusion therapy is often performed in patients with acute heart failure (AHF) and anemia; however, its impact on subsequent cardiovascular events is unclear. We examined whether RBC transfusion influences major adverse cardiovascular events (MACE) after discharge in patients with AHF and anemia.We classified patients with AHF and anemia (nadir hemoglobin level < 10 g/dL) according to whether they received RBC transfusion during hospitalization. The endpoint was MACE (composite of all-cause death, non-fatal acute coronary syndrome/stroke, or heart failure readmission) 180 days after discharge. For survival analysis, we used propensity score matching analysis with the log-rank test. As sensitivity analysis, we performed inverse probability weighting analysis and multivariable Cox regression analysis.Among 448 patients with AHF and anemia (median age, 81 years; male, 55%), 155 received RBC transfusion and 293 did not. The transfused patients had worse clinical features than the non-transfused patients, with lower levels of nadir hemoglobin and serum albumin and a lower estimated glomerular filtration rate. In the propensity-matched cohort of 87 pairs, there was no significant difference in the MACE-free survival rate between the 2 groups (transfused, 73.8% vs. non-transfused, 65.3%; P = 0.317). This result was consistent in the inverse probability weighting analysis (transfused, 76.0% vs. non-transfused, 68.7%; P = 0.512), and RBC transfusion was not significantly associated with post-discharge MACE in the multivariable Cox regression analysis (adjusted hazard ratio: 1.468, 95% confidence interval: 0.976-2.207; P = 0.065).In conclusion, this study suggests that RBC transfusions for anemia may not improve clinical outcomes in patients with AHF.

Risk factors associated with in-hospital complications for pediatric sickle-cell disease-associated moyamoya syndrome: a nationwide cross-sectional study.

Sickle-cell disease-associated moyamoya syndrome (SCD-MMS) carries a high risk for recurrent strokes and cerebrovascular morbidity in children. However, few data are available about complications that occur in children hospitalized with SCD-MMS. The purpose of this analysis was to determine the risk factors for in-hospital complications in pediatric SCD-MMS admissions, and thus aid physicians in optimizing future treatment plans. A national database of pediatric hospital admissions was examined across the years 2003-2019. ICD-9 and ICD-10 diagnosis codes were analyzed to identify discharges with a primary diagnosis of SCD-MMS and identify in-hospital complications, defined as complication-associated diagnostic codes logged during the same admission. Patient demographics, comorbidities, and hospital characteristics were examined using univariate and multivariate logistic regression analyses to determine associations with in-hospital complications. In total, 274 admissions with a primary diagnosis of SCD-MMS were identified. During 64 (23.4%) admissions, transfusion therapy was given, and in 86 admissions (31.4%), surgical revascularization was performed. In 10 admissions (3.6%), a total of 11 in-hospital complications were identified. After multivariate regression, both comorbid chronic lung disease (adjusted OR 5.3 [1.1, 26.9], P = 0.04) and surgical revascularization (adjusted OR 10.2 [2.0, 52.4], P = 0.006) were associated with development of complications. In this nationwide database of pediatric SCD-MMS hospitalizations, comorbid chronic lung disease and surgical revascularization were associated with development of in-hospital complications. Patients with comorbid chronic lung disease or who are admitted for revascularization may warrant closer monitoring and greater medical optimization during the hospitalization.

A rare case of bleeding in diverticular disease of the small intestine

The article describes a clinical case of bleeding from diverticula of the small intestine in patient E. 1957, who entered the State Budgetary Institution RO OKB on 10/03/2023. with clinical picture gastrointestinal bleeding of unspecified etiology. In the result of a diagnostic study, collection of anamnestic data and clinical picture, a diagnosis was made: gastrointestinal intestinal bleeding of unspecified origin. After FGDS and no visible sources of gastric bleeding, and lack of positive effect from conservative therapy, increasing hypotension, deterioration of general condition with hemoglobin 82 g/l. a decision was made to perform a blood transfusion and combined hemostatic therapy. Conservative treatment turned out to be ineffective, and therefore it was accepted decision on emergency surgical treatment. Urgent patient a diagnostic laparotomy was performed. During revision of the abdominal organs cavity, the source of bleeding was identified. A section of the small intestine was resected at a distance of 15 cm from the ligament of Treitz over a distance of 70 cm with multiple diverticula. An interintestinal side to side anastomosis. In the postoperative period, data for relapse. There is no gastrointestinal bleeding. On day 9 the patient was discharged under the supervision of a surgeon at the place of residence in satisfactory condition.

Transfusion Therapy in HIV: Risk Mitigation and Benefits for Improved Patient Outcomes

Transfusion therapy is a pivotal aspect of healthcare, especially for individuals living with Human Immunodeficiency Virus (HIV). This comprehensive review aims to dissect the intricate landscape of transfusion therapy in HIV patients, emphasizing the delicate balance between risks and benefits to achieve enhanced patient outcomes. With advancements in blood safety measures and antiretroviral therapy (ART), navigating the complexities of transfusion therapy in HIV management becomes paramount for healthcare professionals. The review consolidates current knowledge and emerging trends, encompassing challenges, benefits, risks, and strategies to optimize transfusion therapy for improved patient care. The paper delineates key areas, including blood safety measures such as nucleic acid testing (NAT) and pathogen reduction technologies, emphasizing their role in ensuring safer blood products for transfusion in HIV patients. Furthermore, it explores the impact of HIV on hematological disorders, delving into transfusion-transmitted infections and strategies to mitigate these risks. Additionally, it scrutinizes the therapeutic benefits of transfusion therapy in managing hematologic complications in HIV, while addressing potential risks, including immune reactions and adverse effects. Optimizing transfusion therapy in HIV necessitates personalized approaches, considering the individual patient's HIV status, comorbidities, and specific transfusion needs. The role of ART in reducing transfusion requirements and associated risks is highlighted, alongside emerging trends like novel therapies and alternative transfusion practices. Keywords: Transfusion therapy, HIV, blood safety, antiretroviral therapy, risks, benefits, patient outcomes, transfusion-transmitted infections, personalized treatment, hematology, blood products

An Optimized Human Erythroblast Differentiation System Reveals Cholesterol-Dependency of Robust Production of Cultured Red Blood Cells Ex Vivo.

The generation of cultured red blood cells (cRBCs) ex vivo represents a potentially unlimited source for RBC transfusion and other cell therapies. Human cRBCs can be generated from the terminal differentiation of proliferating erythroblasts derived from hematopoietic stem/progenitor cells or erythroid precursors in peripheral blood mononuclear cells. Efficient differentiation and maturation into cRBCs highly depend on replenishing human plasma, which exhibits variable potency across donors or batches and complicates the consistent cRBC production required for clinical translation. Hence, the role of human plasma in erythroblast terminal maturation is investigated and uncovered that 1) a newly developed cell culture basal medium mimicking the metabolic profile of human plasma enhances cell growth and increases cRBC yield upon erythroblast terminal differentiation and 2) LDL-carried cholesterol, as a substitute for human plasma, is sufficient to support erythroid survival and terminal differentiation ex vivo. Consequently, a chemically-defined optimized medium (COM) is developed, enabling robust generation of cRBCs from erythroblasts of multiple origins, with improved enucleation efficiency and higher reticulocyte yield, without the need for supplementing human plasma or serum. In addition, the results reveal the crucial role of lipid metabolism during human terminal erythropoiesis.

A cross-sectional study: caregiver burden and related determinants of adult patients with β-thalassemia major in mainland China

BackgroundThe informal caregivers of adult patients with β-thalassemia major (β-TM) bear not only physical but also emotional and economic pressures of providing care. This study is the first to evaluate the caregiver burden by Zarit Burden Interview (ZBI) of adult patients with β-TM in mainland China and to identify predictors of caregiver burden.MethodsIn this cross-sectional study, we conducted an online survey with snowball sampling covering seven provinces between September 1, 2021, and January 31, 2022, of patients aged ≥ 18 years with β-TM and their informal caregivers. Caregiver burden was assessed using the ZBI. Data on patient demographics, disease and therapy characteristics, and informal caregivers’ demographic characteristics were collected and analysed using independent t-tests, analysis of variance, Spearman’s correlation and multiple linear regression.ResultsOf 75 included patients, more than half (50.7%) were male. The mean patient age was 24.69 ± 5.59 years. The mean age of the informal caregivers was 50.60 ± 9.16 years, with women (74.7%) being predominant. The ZBI score was 38.00 ± 17.02. Multiple linear regression analysis showed that patients with interrupted blood transfusion therapy and informal caregivers required to care of others were positively associated with caregiver burden (p < 0.05). Age of informal caregivers were borderline significant positively associated with caregiver burden (p < 0.1). Married informal caregivers were negatively associated with caregiver burden (p < 0.05).ConclusionsThe informal caregivers of adult patients with β-TM in mainland China experienced a moderate-to-severe level of caregiving burden. The caregiver burden was higher in patients with a history of interrupted blood transfusion therapy or in informal caregivers who were older or needed to care for others. Additionally, married informal caregivers experienced lower burdens compared to non-married informal caregivers. These findings provide a reference to identify informal caregivers with higher burdens among patients with β-TM.

Coagulation Function Testing Clinical Demand and Current Status in China

Diseases or symptoms related to coagulation function are widely present in clinical daily work, as coagulation function plays a central role in maintaining homeostasis in the internal environment. Therefore, coagulation dysfunction often leads to serious harm to patients. At the same time, coagulation related treatments such as the use of anticoagulants or transfusion therapy have potential serious side effects, even leading to patient death. For many years, balancing the bleeding or embolism caused by anticoagulants has been a challenge that clinical workers have to face, which poses great challenges to clinical work. Therefore, monitoring coagulation function is very important for clinical diagnosis and treatment. The rapid and accurate completion of coagulation function diagnosis conclusions and early transmission to clinical workers are important guarantees for patient life. However, at present, due to technical limitations and the complexity of the detection process, this demand cannot be met. At present, in China, coagulation function testing is mostly concentrated in laboratory departments, and the limitation of distance may affect the timeliness of coagulation function testing. Therefore, many clinical departments of institutions tend to conduct coagulation function testing themselves, which has led to many new demands for coagulation function testing, such as fast and convenient POCT coagulation function testing and coagulation function testing of cell models that are more in line with clinical needs, More joint detection of coagulation markers and so on, of course, these needs must be established on the premise that clinical testing equipment and laboratory testing results are consistent. However, in order to meet the needs of miniaturization and rapid testing, the coagulation function testing equipment used in clinical departments often has significant methodological differences from laboratory testing equipment, which further leads to differences in testing results. Based on this situation, many new technologies, including microfluidic technology, as well as more detection techniques, have been widely and deeply applied to clinical coagulation function testing, which has brought a lot of good news to clinical coagulation function diagnosis to a large extent.

Transfusion in hemoglobinopathies and red blood cell alloimmunization: data from Sicily, Sardinia and Malta.

Hemoglobinopathies are a group of diseases that include those due to globin gene mutations, such as thalassemia major (TM) and thalassemia intermedia (TI) or due to alteration of hemoglobin structure such as sickle cell disease (SCD), as well as a combination of these conditions such as thalasso-drepanocytosis (TD). They constitute the most frequent hereditary anemias requiring blood transfusion. In April 2022, a questionnaire was sent to the Transfusion Services (TS) of Sicily, Sardinia and the Maltese National Blood Transfusion (MNBT) service. The questionnaire was divided into a generic part including the number of patients followed and the type of hemoglobinopathy, and a section relating to transfusion therapy, including the number of units transfused, whether red blood cells (RBC) were washed and, finally, a section relating to the presence or absence of alloantibodies and their identification. Data was retrieved for 2,574 patients: 68.6% TM, 15.4% TI, 10.3% TD, 4.1% SCD, and 1.6% other hemoglobinopathies (OHA). The number of RBC units transfused was 76,974, equivalent to 24.5% of all the RBCU transfused from the total number of patients followed. The number of washed RBCU was 21.1% of all the units used; 337 patients (37%) were diagnosed with alloantibodies, the majority of which were patients with SCD (20.6%). Of the 485 alloantibodies found, 90.3% were identified. The antibodies found most frequently were related to the Kell system (41.7%) followed by antibodies to the Rhesus system (37.9%); 29.7% of patients had more than one antibody. From our study, certain indications can be formulated: complete the National Registry for patients with hemoglobinopathies; create a Registry of alloimmunized patients to ensure transfusion therapy is as safe as possible, considering antibody evanescence; and 3) increase the recruitment of blood donors of diverse ethnicities.

Dengue hemorrhagic fever with rectus sheath hematoma: A case report

Rationale: Acute pain is a medical emergency that requires prompt abdominal evaluation and management. Dengue, a mosquito-borne arboviral infection, can lead to complications such as acute abdominal pain. Patient concerns: A 72-year-old hypertensive female presented with high-grade intermittent fever with chills and rigors for four days. She was diagnosed with dengue fever (NS1Ag-reactive) the day before admission. A contrast-enhanced computed tomography of the abdomen showed a hematoma along the rectus sheath which was managed conservatively as per surgical opinion. Diagnosis: Dengue hemorrhagic fever with rectus sheath hematoma. Interventions: Blood transfusion and fluid therapy. Outcomes: Ten days after discharge, the patient reproted no pain in the right iliac fossa and the size of the hematoma was significantly reduced. Lessons: Although it is rarely seen as a cause of acute abdomen, complaints of adnominal pain should never be ignored in critical or convalescent phase of dengue fever. Radiological investigations should be promptly conducted as hematoma is often difficult to be diagnosed clinically. Delay in diagnosis of rectus sheath hematoma can be fatal.

Nursing Care For Patients Uterine Prolaps and Severe Anemia: Case Study

Uterine prolapse is a condition where the uterus herniates into the vagina as a result of ligament failure and fascial support. Uterine prolapse often occurs together with prolapse of the vaginal wall, which involves the bladder or rectum. menopausal women. If uterine prolapse is not treated immediately, it can cause other health problems such as bleeding which can cause severe anemia. The purpose of this study was to describe nursing care that can be carried out in patients with uterine prolapse with severe anemia. The method used is a descriptive method with a case study approach, while the instrument used is an observation format at the Bandung City Hospital and an assessment format from the Unpad Faculty of Nursing. The sample in this study was one patient with uterine prolapse with severe anemia. The nursing diagnoses found in patients are the risk of shock, acute pain, and risk of infection. The implementation provided is in the form of shock management which includes blood transfusion therapy, tranexamic acid therapy, and monitoring of vital signs. Management of uterine prolapse in the form of Kegel exercises and placing a pessary, pain management, as well as prevention of infection. As a result, it was found that there was an improvement in the Hb value from 7 gr/dL to 10 gr/dL, complaints of weakness and pain decreased, and the patient had been placed with a pessary type pessary ring with support. The existence of uterine prolapse is necessary to increase awareness to prevent the incidence of uterine prolapse and to minimize the impact that occurs due to uterine prolapse, as well as to increase patient awareness to conduct examinations to health services.

TRANSFUSION AND INFUSION THERAPY FOR MASSIVE BLOOD LOSS. PART 3. PHYSIOLOGICAL PREREQUISITES AND LIMITATIONS WHEN USING PLASMA AND PLATELETS FOR HAEMOSTATIC RESUSCITATION

Haemotransfusion for massive bleeding (MB) should be used according to the principles of hemostatic resuscitation and simultaneously restore both oxygen transport (which we wrote about in detail in our previous publication) and compensate for the deficiency of coagulation factors and platelets. Coagulation factors (especially fibrinogen) and platelets are passively lost with the bleeding and are consumed during clot formation. Although the principles of haemostatic resuscitation are known and actively promoted already after a decade, the logistical problems with the availability of single-group fresh frozen plasma (FFP) and, even more so, platelets and cryoprecipitate at the stage of the beginning of resuscitation, are still not resolved. Poor logistics of blood product supply and organizational issues interfere with implementing the principles of haemostatic resuscitation into the routine clinical practice of treating MB in Ukraine. A deficiency of blood components at the initial stage of resuscitation pushes some doctors to transfuse crystalloid and even colloid solutions, which in MB can increase coagulopathy due to blood dilution. In this article, we present the pathophysiological rationale for early recovery of coagulation factors by performing balanced haemostatic transfusion therapy using FFP and cryoprecipitate. With MB, there is often a need for rapid correction of coagulopathy, and when the patient's blood group has not yet been determined, or when single-group FFP is still not ready for transfusion, then the urgent need for FFP transfusion from a universal AB donor (IV group). Creation of reserves of FFP from a universal donor AB (IV) is advisable in the admission of medical institutions, especially those where, in the case of MK or the numerous and mass occurrence of patients, the occurrence of a deficiency of FSP of another blood group is likely. In the absence of sufficient components and blood products containing coagulation factors and platelets, the possibility of transfusion of warm whole blood or cold whole blood should be considered.

Concurrent Streptococcus equi subsp. equi infection, purpura haemorrhagica and immune‐mediated myositis in a Quarter Horse filly

SummaryThis report describes a 2‐year‐old Quarter Horse filly that was diagnosed with concurrent Streptococcus equi subsp. equi infection, purpura haemorrhagica, and immune‐mediated myositis. The filly was presented for evaluation of fever of unknown origin, rapid weight loss and inappetence after exposure to strangles that was initially unknown. Over the course of hospitalisation the filly developed mandibular lymphadenopathy, guttural pouch empyema, and mucosal petechiation and ecchymoses. The presence of Streptococcus equi subsp. equi was confirmed via PCR and culture of a lymph node aspirate and biopsies of the skin confirmed leukocytoclastic vasculitis, consistent with purpura haemorrhagica. Genetic testing confirmed that the filly had one copy of the MYH1 mutation (N/My). Following therapy with systemic corticosteroids, plasma transfusion and antimicrobial therapy the filly improved and was discharged. Communication with the owner 11 months later confirmed that filly appeared healthy but remained poorly muscled. This report is the first to the authors' knowledge describing concurrent Streptococcus equi subsp. equi infection, purpura haemorrhagica, and immune‐mediated myositis.