Underwent Blood Transfusion Research Articles

Effectiveness of an Educational Program on Improving Nursing Care for Thalassemia Patients Undergoing Blood Transfusion

Background: Thalassemia is a genetic disorder that disrupts hemoglobin production, leading to severe anemia. Beta-thalassemia major patients often require lifelong blood transfusions. Nurses play a crucial role in managing these transfusions, but gaps in knowledge and practice can lead to complications. This study assessed the impact of an educational program on nurses' knowledge and skills regarding thalassemia and blood transfusion protocols. Methods: A quasi-experimental study was conducted at the Jin Pediatric Hematology-Oncology Center in Duhok City, Iraqi Kurdistan. The sample included 20 nurses. The program consisted of four sessions (two theoretical and two practical). Data collection instruments included a socio-demographic sheet, a knowledge questionnaire, and a skills checklist. Pre- and post-intervention knowledge and practice scores were analyzed using paired t-tests and chi-square tests. Results: The educational program significantly improved nurses' knowledge of thalassemia (P < 0.00) and transfusion protocols, with the mean knowledge score increasing from 5.2 ± 2.09 to 8.05 ± 1.82. Practice scores also showed statistically significant improvements (P < 0.002). Correlations between total knowledge and practice scores, as well as with nurses' experience and educational level, were statistically significant. Conclusion: The study demonstrated that an educational program can enhance nurses' knowledge and practices in managing thalassemia patients undergoing blood transfusions. Continued education and targeted interventions are essential to improving the quality of care for these patients.

Associations between transfusion reactions and thromboembolism development in blood-transfused patients: A retrospective cohort study.

Blood transfusion (BT) may be associated with an increased risk of thromboembolism. The associations between transfusion reactions (TRs) during BTs and potential risk factors for the development of thromboembolism in patients underwent blood transfusion have not been analyzed. Therefore, this study aimed to compare risk factors associated with the development of venous thromboembolism (VTE) or pulmonary embolism (PE) between patients underwent blood transfusion with and without TRs. The retrospective study was conducted between April 1, 2017, and March 31, 2020, at a medical center in Taiwan. Blood-transfused patients were grouped into two cohorts as follows: those who experienced TRs and those who did not experience TRs. Both cohorts were subjected to follow-up until March 31, 2021. The endpoints for both groups were the occurrence of VTE or PE or the date of March 31, 2021. To investigate between-cohort risk differences, a Kaplan-Meier survival analysis and multiple Cox proportional hazard model was used. A total of 10,759 patients underwent 59,385 transfusion procedures, with 703 patients in the TR group, and 10,056 patients in the non-TR group. The risk of VTE or PE was twice as high in the TR group than in the non-TR group (adjusted hazard ratio 2.53, 95% confidence interval 1.49-4.29, p = .001). Meanwhile, age, female sex, transfusion frequency increment, and being nondiabetic was associated with an increased risk of developing thromboembolism. TRs are associated with increased long-term thromboembolism risk in patients underwent blood transfusion. It is imperative for clinicians to acknowledge this and maintain rigorous follow-up.

Acute hemolytic transfusion reaction caused by anti-M antibodies: a case report and literature review.

We report a rare case of acute hemolytic reactions caused by immunoglobulin (Ig)M anti-M antibody and present a literature review. A 61-year-old male patient who underwent blood transfusion developed fever, chills, soy sauce-colored urine, and changes in laboratory test results, including persistently decreased hemoglobin levels, neutrophilia, elevated lactate dehydrogenase level, acute kidney injury, mild acute liver injury, and activation of the coagulation system, indicating acute hemolytic transfusion reaction (AHTR). Antibody screening and major crossmatching results indicated weak positive at 37°C for both posttransfusion and pretransfusion sample. Subsequent serological examinations indicated the presence of IgM anti-M antibodies in plasma but the direct antiglobulin and elution tests were negative. Antibody hemolytic activity assay confirmed AHTR caused by anti-M. The transfused red blood cells were MM and the patient is NN. These signs and symptoms disappeared rapidly and required no additional interventions before discharge. The accurate diagnosis of anti-M antibody-mediated acute hemolysis is essential for guiding treatment decisions.

HEART FAILURE WITH PRESERVED EJECTION FRACTION (HFPEF) IN A PATIENT WITH RECENT TAVI AND NUMEROUS CORONARY FISTULAS OF THE LEFT CORONARY ARTERY DRAINING INTO THE VENTRICULAR CAVITY

Abstract Coronary fistula is a rare form of congenital heart disease and is defined as an abnormal connection between a coronary branch and a cardiac chamber or a large intrathoracic vessel without the interposition of the capillary circulation. The right coronary artery is the most common site of origin for coronary fistula. Other sites include the left anterior descending artery and left circumflex artery. The clinical presentation and the natural history can be extremely variable depending on the patient‘s age, fistula size, and anatomy. Small to medium–sized coronary fistulas may be asymptomatic. Large fistulas can manifest with angina pectoris due to myocardial ischemia secondary to the coronary steal phenomenon. Shunting through large fistulas can have hemodynamic consequences secondary to volume overload in the pulmonary or systemic circulation, leading to symptoms and signs of heart failure. We describe the case of an 83–year–old woman recently undergoing TAVI and suffering from primary myelofibrosis requiring periodic transfusions. Pre–TAVI coronary angiography showed coronary vessels free from significant hemodynamic lesions and multiple coronary–ventricular fistulas draining into the left ventricle. Total body aortic CT angiography did not reveal other abnormal vascular connections. One month after the aortic valve correction procedure, the patient presented with heart failure (HfpEF). At a recent follow–up visit, diuretic therapy was discontinued due to the successful correction of aortic valve disease and normal ejection fraction. Due to further anemization from the underlying hematologic condition, the patient underwent blood transfusion with worsening of dyspnea despite correction of hemoglobin levels. Discontinuation of diuretic therapy and transfusion of red blood cell units resulted in volume overload with worsening clinical condition. The presence of multiple coronary fistulas precluded an interventional approach, but therapeutic optimization and reintroduction of diuretic therapy restored the patient‘s hemodynamic compensation. Usually fistulas drain into the low–pressure venous circulation like right ventricle and right atrium. This case represents a rare instance of multiple left coronary fistulas draining into the left ventricle (only 3% of cases). Aortic valve correction may have further reduced left ventricular telediastolic pressures, worsening the shunt of coronary fistulas resulting in heart failure due to volume overload.

Definition, risk factors, and outcome analysis of prolonged mechanical ventilation in children.

This study aims to explore the time threshold for defining prolonged mechanical ventilation (PMV) in children, along with its risk factors and outcomes. A prospective cohort study was conducted on children aged 29 days-18 years, who were consecutively admitted to two Pediatric Intensive Care Units (PICUs) at Children's Hospital of Chongqing Medical University, from October 2020 to June 2021. The study included patients receiving mechanical ventilation (MV) for more than 2 days (each day >6 h). Participants were divided into five groups based on the duration of MV (2-7 days, 8-14 days, 15-21 days, 21-30 days, >30 days) to compare rates of extubation failure, all-cause mortality one month post-discharge, incidence of ventilator-associated pneumonia, tracheotomy rates, total hospital stay, PICU stay, and overall hospital costs. The most clinically and statistically significant outcome variables were selected. The Youden index was used to determine the MV duration with the most significant impact on overall outcomes, defining this as PMV. Baseline characteristics, treatment information, and outcomes were compared between PMV and non-PMV groups. Univariate and multivariate logistic regression analyses were used to identify risk factors for PMV occurrence. A total of 382 subjects were included in the study. The distribution of children across the five MV duration groups was 44.2%, 27.7%, 10.7%, 8.9%, and 8.4% respectively. The rates of at least one extubation failure in each group were 5.9%, 10.4%, 41.5%, 41.2%, and 46.9% (p < .05). Statistically significant differences were observed among groups in terms of tracheotomy rates, all-cause mortality at 1 month postdischarge, median total hospital stay, median PICU stay, and hospital costs (p < .05). Defining PMV, the most appropriate time point calculated was 12.5 days, based on at least one extubation failure and/or death within 1 month postdischarge. Higher PIM-3 scores, weight for age <-2SD, admission for respiratory distress/insufficient ventilation and/or hemodynamic instability/shock/arrhythmia, noninvasive ventilation on the first day, and undergoing blood transfusion treatment were identified as risk factors for PMV (p < .05). In children, MV for ≥13 days significantly increases mortality rates, extubation failure and tracheotomy rates, duration of PICU and total hospital stay and costs. We suggest defining PMV as MV ≥13 days, particularly for children undergoing MV for respiratory illnesses. This definition can assist clinicians in developing appropriate treatment strategies by focusing on risk factors and providing reliable prognostic consultation to patients' families.

Quality of life and thalassemia in India: A scoping review.

In recent years, a multitude of studies have been conducted to investigate the assessment of quality of life (QoL) among individuals affected by thalassemia. This scoping review aimed to examine the existing knowledge regarding the QoL and its associated factors among individuals with thalassemia in India. Databases, such as PubMed, SCOPUS, Web of Science, and the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines, were searched. A total of nine articles were included in the review. The included studies mainly investigated children. The Pediatric Quality of Life Inventory (PedsQL) is the most common instrument used most often. Overall, the research findings indicate that individuals who underwent blood transfusion exhibited a lower QoL than those who did not receive blood transfusion. Additionally, it was observed that children diagnosed with thalassemia reported a lower QoL than adults. Nevertheless, the studies exhibited notable methodological deficiencies that constrained the validity and generalizability of the results. Hence, it is imperative to undertake comprehensive QoL research encompassing all regions of India and various thalassemia populations within the country to bridge this evidentiary void.

Development and validation of a novel risk classification tool for predicting long length of stay in NICU blood transfusion infants

Newborns are as the primary recipients of blood transfusions. There is a possibility of an association between blood transfusion and unfavorable outcomes. Such complications not only imperil the lives of newborns but also cause long hospitalization. Our objective is to explore the predictor variables that may lead to extended hospital stays in neonatal intensive care unit (NICU) patients who have undergone blood transfusions and develop a predictive nomogram. A retrospective review of 539 neonates who underwent blood transfusion was conducted using median and interquartile ranges to describe their length of stay (LOS). Neonates with LOS above the 75th percentile (P75) were categorized as having a long LOS. The Least Absolute Shrinkage and Selection Operator (LASSO) regression method was employed to screen variables and construct a risk model for long LOS. A multiple logistic regression prediction model was then constructed using the selected variables from the LASSO regression model. The significance of the prediction model was evaluated by calculating the area under the ROC curve (AUC) and assessing the confidence interval around the AUC. The calibration curve is used to further validate the model’s calibration and predictability. The model’s clinical effectiveness was assessed through decision curve analysis. To evaluate the generalizability of the model, fivefold cross-validation was employed. Internal validation of the models was performed using bootstrap validation. Among the 539 infants who received blood transfusions, 398 infants (P75) had a length of stay (LOS) within the normal range of 34 days, according to the interquartile range. However, 141 infants (P75) experienced long LOS beyond the normal range. The predictive model included six variables: gestational age (GA) (< 28 weeks), birth weight (BW) (< 1000 g), type of respiratory support, umbilical venous catheter (UVC), sepsis, and resuscitation frequency. The area under the receiver operating characteristic (ROC) curve (AUC) for the training set was 0.851 (95% CI 0.805–0.891), and for the validation set, it was 0.859 (95% CI 0.789–0.920). Fivefold cross-validation indicates that the model has good generalization ability. The calibration curve demonstrated a strong correlation between the predicted risk and the observed actual risk, indicating good consistency. When the intervention threshold was set at 2%, the decision curve analysis indicated that the model had greater clinical utility. The results of our study have led to the development of a novel nomogram that can assist clinicians in predicting the probability of long hospitalization in blood transfused infants with reasonable accuracy. Our findings indicate that GA (< 28 weeks), BW(< 1000 g), type of respiratory support, UVC, sepsis, and resuscitation frequency are associated with a higher likelihood of extended hospital stays among newborns who have received blood transfusions.

Transurethral bipolar enucleation using a TUEB loop for large benign prostatic hyperplasia: a retrospective cohort study.

We aimed to assess the efficacy and safety of transurethral enucleation with bipolar system (TUEB) regardless of the prostate size using a specially developed TUEB loop. A total of 251 patients who underwent TUEB were categorized into two groups depending on the prostate volume (PV): small-PV (≤ 80mL) group, 133 patients; large-PV (> 80mL) group, 118 patients. Comparisons of background information and treatment outcomes were performed between the groups. Operation (113.5 vs 166.4min), enucleation (49.4 vs 68.1min), and morcellation (11.4 vs 26.4min) times were longer and hemoglobin decreased significantly (0.84 vs 1.30g/dL) in the large PV group. However, the enucleation efficiency (enucleated weight per enucleation time; 0.71 vs 0.97g/min) and prostate-specific antigen reduction rate (24.6% vs 16.1%) were significantly better in the large-PV group, with similar enucleation rates (enucleated weight per transitional zone volume; 82% vs 81%). The International Prostate Symptom Score, uroflowmetry maximum flow rate, and post-void residual urine in both groups improved at 3, 6, and 12months compared with baseline. No patient underwent blood transfusion. There were no differences in the frequency of postoperative clot retention, urethral stricture, or stress incontinence at 3, 6, and 12months. TUEB using a TUEB loop resulted in high levels of satisfaction regarding the enucleation efficiency, efficacy, and safety for BPH surgery regardless of the prostate size. TUEB should be considered one of the best treatment options for large BPH that is uncontrollable with medication.

Comparing the Cerebral Resistive Index Using Doppler Ultrasound in Neonates before and after Transfusion of Red Blood Cell – A Prospective Observational Study

ABSTRACT Background and Objectives: Anemia is a common morbidity seen in neonates, having an impact on cerebral circulation. Commonly, severe anemia is managed with red blood cell transfusion. This study was done to determine the cerebral hemodynamic change occurring in neonates before and after packed red blood cell transfusion. Methods: Neonates who had undergone blood transfusions were prospectively studied using cerebral Doppler ultrasonography. Cerebral blood flow (CBF) velocity of the middle cerebral artery was calculated before and after PRBC transfusion. Results: Twenty neonates of median gestational age 34 weeks (interquartile range: 24–40 weeks) with a mean birth weight of 1670 g were enrolled. Pre and post transfusion mean resistive index (RI) were 0.7 and 0.67, respectively, with confidence interval (−0.04–0.09) (P = 0.40). There was a decrease in peak systolic velocity and an increase in end diastolic velocity, though not statistically significant. Conclusion: The study concluded that there was no statistically significant difference in the CBF velocities, including RI pre and post PRBC transfusion.

IN-HOSPITAL MORTALITY OF OLDER ADULT PATIENT WITH PROXIMAL FEMORAL FRACTURE TREATED SURGICALLY DURING THE COVID-19 PANDEMIC.

Evaluate the prevalence of hospital mortality in older adult patients with femoral fracture undergoing surgical treatment during the COVID-19 pandemic period, and to evaluate whether COVID-19 infection, clinical, and orthopedic factors interfered with mortality. A retrospective study was conducted by reviewing medical records. Patients over 60 years of age with proximal femoral fracture undergoing surgical treatment were included. Overall mortality was calculated, as well as mortality whose primary or secondary cause was COVID-19 infection, to determine if infection influenced patient mortality. Clinical and orthopedic factors that interfered with mortality were evaluated. Categorical variables were compared using the Chi-square test or Fisher's exact test. Both unpaired t-test (parametric variables) and Mann-Whitney test (non-parametric variables) were used. The Kaplan-Meier mortality curve was constructed. The mortality of older adult patients with femoral fracture undergoing surgical treatment during the COVID-19 pandemic was 4.2%. Male sex, older age, and those who underwent blood transfusion had higher mortality rates. COVID-infected patients had ten times more chance of death and died twice as fast as the non-infected population. Level of Evidence II, Retrospective Study.

Frequency of red blood cell allo-immunization in patients undergoing blood transfusion at the Uganda Cancer Institute.

There is limited data on red blood cell (RBC) alloimmunization in patients with cancer in sub-Saharan Africa (SSA). We examined the frequency of RBC alloimmunization in transfused patients with cancers in Uganda. A randomized control trial was conducted on participants at the Uganda Cancer Institute. Eligible participants were age ≥15 years and required blood transfusion. Participants were randomized to receive either leucoreduced or non-leucoreduced blood transfusion. Participants' plasma samples were screened for RBC alloantibodies at enrolment and 3-4 weeks after blood transfusion using a 2-cell panel of reagent group O RBCs using the tube method. Antibody identification was performed using a 10-cell panels of reagent RBCs. Participants were considered alloimmunized if antibodies to RBC antigens were identified. A total of 277 participants were randomized (leucoreduced blood, n=137; non-leucoreduced blood, n=140). Overall, the most represented diagnoses were gynaecological cancers (n=88, 31.8%), acute leukaemia (n=35, 12.6%), and gastrointestinal cancers (n=25, 9.0%). Concomitant HIV infection was present in 26 (9.4%) participants. Most participants received <5 units of blood during the study. No study participant developed allo-antibodies. There was no RBC alloimmunization in participants with cancers. Routine RBC allo-antibody screening in all patients with cancer in SSA requires further research.

Carbon-Ion Radiotherapy for Postoperative Locoregional Recurrence of Pancreatic Cancer

To evaluate the efficacy and safety of carbon-ion radiotherapy (CIRT) for patients with locoregional recurrence after surgery for pancreatic cancer. A total of 32 patients, who underwent CIRT for locoregional recurrence after surgery for pancreatic cancer between January 2015 and July 2022, were retrospectively analyzed. The total dose of CIRT was 55.2 Gy (RBE) in 12 fractions. Concurrent chemotherapy included gemcitabine for 17 patients and S-1 for 3 patients. The overall survival (OS), local control (LC), progression free survival (PFS), and toxicity were evaluated. The median follow-up time from the initiation of CIRT was 21.4 months. The 1- and 2-year OS were 84.2 and 55.3%, respectively. The median survival were 24.2 months. The 1- and 2-year PFS were 40.7 and 14.8%, respectively, with a median PFS of 9.9 months. The 1- and 2-year LC were 100 and 50.2 %, respectively. 4 patients experienced grade 3 acute toxicities: hematologic toxicity in 2 patients, anorexia in 1 patient and gastric ulcer/bleeding in 1 patient. The patients with grade 3 gastric ulcer/bleeding underwent blood transfusion and recovered quickly. There was no grade 4 or 5 acute toxicity. In terms of late toxicity, no grade 3 or greater toxicity was observed. CIRT for postoperative locoregional recurrence of pancreatic cancer resulted in relatively long survival with acceptable toxicity. CIRT may be one of the choices of treatment for patients with this disease.

Effect of Benson's relaxation technique versus music intervention on physiological parameters and stress of children with thalassemia during blood transfusions: A randomized controlled trial

BackgroundChildren with thalassemia are generally dependent on blood transfusions and face a lot of stress and alteration in their physiological parameters through the procedure. AimThis study aimed to investigate the effect of Benson's relaxation technique versus music intervention on physiological parameters and stress of children with thalassemia during blood transfusions. DesignA randomized, controlled trial with three parallel groups. MethodsOne hundred and twenty preschool-age children with thalassemia who underwent blood transfusions were randomly assigned to three groups. Children of the control group received only routine hospital care through blood transfusions. Music intervention group children listened to recorded Mozart's music and children of Benson's relaxation group received relaxation intervention before and during the blood transfusions. Outcome measures were physiological parameters and behavioral distress levels. SettingHematology outpatient clinic of the Children's University Hospital at El-Shatby in Alexandria from October 2022 to February 2023. ResultsThe mean total score of children's behavioral responses to stress before the blood transfusions procedure was 19.32 ± 4.08, 14.20 ± 0.93, and 16.92 ± 4.74 in the control, music, and Benson groups, respectively. Beyond that, there was a decline in their physiological parameters and behavioral stress response during and after procedure among groups of study (P = 0.005 & <0.001, respectively). ConclusionMusic and Benson's relaxation interventions had a helpful effect on stabilizing the physiological parameters and reducing behavioral distress levels in children with thalassemia undergoing blood transfusions. Practice implicationsThis study directs paediatric nurses to apply Benson's relaxation and music interventions for children with thalassemia to enhance their responses.

Correlation and Regression Analysis Applied for Types and Number of Blood Transfusions Versus Transfusions Induced ADR Among Pediatric Haemato-Oncology and Thalassemia Patients.

Introduction: Blood transfusion is a remedial intercession and a fundamental fragment of Current medical services framework. As indicated by the WHO the bonding is an action of moving blood or blood-items taken from a giver into the vasculature and in this manner the flowing blood of the recipient, done by embeddings an IV Needle/Catheter in the patient and followed by use of blood or the blood-items. In any case, the dangers of non-irresistible difficulties have gotten more obvious. These nonirresistible complexities called as adverse transfusion reactions (ATRs) can either be intense in nature or follow a postponed course. Transfusion reaction is any unanticipated impact that happens in a patient during or subsequent to accepting blood and the blood-items. These can be agreed as intense transfusion responses, happening inside 24 hours of transfusion and deferred bonding responses happens inside the space of days or long periods of bonding. Intense and moderate responses can be additionally classified as insusceptible interceded and non-immune-intervened. Methodology: The prospective and observational study was carried at Department of Pediatric Oncology & Thalassemia unit for a period of 6 months. The population required for the study includes patients undergoing blood transfusions. Results: In study data out of 83 units, 61 units of PCV was transfused (73.49%), 6 units of Platelet was transfused (7.22%), 14 units of Whole Blood was transfused (16.86%), 1 units of Fresh Frozen Plasma was transfused (1.20%), and 1 units of RBC was transfused (1.20%). The chance of an ADR occurrence with every transfusion is 0.4. The P value is less than .05 so it is statically significant. It is positively correlated, having a high impact on the number of transfusion and rate of incidence of ADR. Conclusion: While a Blood transfusion is given for unavoidable situation the important factors to be kept under consideration are ADR following transfusion which can be the common complication observed. The study also concludes that the rate of incidence of ADR is increased significantly as the number of transfusion increases.

Time from kidney failure onset to transplantation and its impact on growth in pediatric patients.

In children with kidney failure, the longer the duration of dialysis the greater the impact on growth deficit, quality of life, and life expectancy. The aim of this research is to test whether there was a shortening of treatment time from kidney failure to transplantation in pediatric patients and whether this time interval impacted height. Observational retrospective cohort study from 2005 to 2018. The first outcome variable was time to transplantation in years, while the second was height/age standard deviation score (SDS) at transplantation. Cox regression models were used to analyze time from disease to transplantation and linear regression was employed to test the association of the year of kidney failure onset with height. A total of 780 children were evaluated and 517 underwent kidney transplantation after a median time of 1.9 years (IQR=1.0-4.0). The variables significantly associated with time to transplant were: year of kidney failure onset (HR=1.07; 95% CI: 1.05-1.10; p< .001), age at kidney failure onset <12 years (HR=0.59; 95% CI: 0.49-0.71; p< .001), living in different state as transplant center (HR=0.63; 95% CI: 0.53-0.77; p< .001), and undergoing blood transfusion before transplantation (HR=0.63; 95% CI: 0.53-0.75; p< .001). Regarding growth, for each 1-year increase in the epoch of kidney failure onset, a 0.05 SDS raise in height/age is expected (p< .001). Children with recent kidney failure onset had significantly lower time to the outcome and this reduction was associated with a less severe growth deficit.

COMPARATIVE STUDY OF AUTOMATED CELL COUNTER HISTOGRAM AND PERIPHERAL BLOOD SMEAR IN DIAGNOSIS OF ANEMIA

Introduction: Over the past few years, complete blood count, RBC histogram and peripheral blood smear have become the important diagnostic tools to diagnose various haematological conditions. Major public health burden worldwide is anemia with high prevalence in developing countries like India1. Red blood cell and histogram are indispensable for diagnosis and management of anemia2. The major diagnostic tool for work up of most commercial laboratories has been analysing the blood lm routinely. The aim AIM: of the study is to compare between automated cell counter histogram and peripheral smear nding in diagnosis of anemia. Material and method: A prospective comparative study of RBC histogram and peripheral blood smear in diagnosis of anemia was done on 100 patients of HB&lt;14gm%, over six month time span (June2022-Nov2022) in the central laboratory of Saraswathi Institute of Medical Sciences Hapur, (UP) India. This study included all the age groups. All cases of anemia that have undergone blood transfusion is excluded from this study. In Result: our study it was observed that on peripheral blood smear, the most common type of anemia was microcytic hypochromic anemia followed by normocytic normochromic anemia, when we compared with automated cell counter generated histogram most common type of anemia was normocytic normochromic followed by microcytic hypochromic anemia. In our study female population were more than males. The mean age was(32.4yr). Automated cell counters generated CBC histograms and peripheral blood smears Conclusion: plays a major role in diagnosis and management of red cell disorder. Our study observed that histogram patterns and their conrmation by peripheral blood smear along with clinical history gives accurate and conrmed diagnosis of various haematogical conditions. There is much improvement in accuracy and precision 3 reducing the subjective errors .

The potential role of vitamin E in patients with glucose-6-phosphate dehydrogenase deficiency: A systematic review and meta-analysis.

As an antioxidant, vitamin E (VitE) may benefit the erythrocytes by protecting glutathione from oxidation by free radicals and peroxide-generating processes. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines when reporting this systematic review. We searched 6 electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) until May 8, 2022. We included all relevant studies. According to the study design, the Cochrane assessment tool (Risk of Bias 2), Risk Of Bias In Non-randomized Studies - of Interventions checklists, and National Institutes of Health tools were used to assess the risk of bias.Continuous data were pooled as a mean difference (MD) with a relative 95% confidence interval. The protocol was registered on PROSPERO (CRD42022333848). Six studies were included in the meta-analysis with a total of 181 patients. Compared with the control group, VitE significantly improved the hemoglobin level for chronic hemolysis (MD = 2.72 g/dL, P < .0001) and for acute hemolysis (MD = 1.18 g/dL, P < .0001). It also decreased the reticulocyte level for chronic hemolysis (MD = -1.39 P < .0001) and for acute hemolysis (MD = -1.42%, P < .0001). For before and after studies, the use of VitE significantly improved the level of packed cell volume (MD = 0.56%, P < .00001), red blood cell half-life (MD = 2.19 days, P < .0001), and decreased the reticulocytes level (MD = -1.41%, P < .00001). Among patients with glucose-6-phosphate dehydrogenase deficiency, VitE might provide benefits such as increasing the hemoglobin, packed cell volume levels, red blood cell half-life, and decreasing the reticulocyte level, so reducing hemolysis. Further high-quality, well-designed randomized controlled trials are recommended.

Üçüncü Basamak Hastanede Obstetrik ve Jinekolojik Nedenlerle Yapılan Kan Transfüzyonlarının Değerlendirilmesi

Blood transfusion is defined as the delivery of blood components and coagulation factor concentrates to a patient. About half of transfusions between the ages of 20 and 35 are performed in Obstetrics and Gynecology Clinics. Electronic file records of 137 patients who underwent blood transfusion in Muğla Training and Research Hospital, Gynecology and Obstetrics Clinic between January 2014 and December 2018 were reviewed retrospectively. The demographic information of the patients, Hgb and Hct (before and after transfusion) values, and applied blood products and their amount were recorded. Of the patients who received blood transfusion, 79 were obstetric and 58 were gynecological patients. In obstetric cases, blood transfusion was most frequently performed after cesarean section (56.6%). Among the causes of transfusion, 43 (54%) patients had iron deficiency anemia, 10 (12.6%) patients had anemia after Dilatation/Curettage (D/C), and 5 (6.32%) patients had uterine atony. Diagnostic D/C and total abdominal hysterectomy were performed in 12 (20.68%) of 58 patients, who were transfused for gynecological reasons, with the diagnosis of menometrorrhagia, while myomectomy was performed in 10 of these patients (17.24%), total laparoscopic hysterectomy was performed in 9 (15.51%) patients, urogynecological surgery and laparoscopic cystectomy were performed in 5 (8.62%) patients, and medical treatment was given with the diagnosis of menometrorrhagia. The preparation and use of blood and blood products should be approached in a multidisciplinary manner, covering many branches, especially Gynecology and Obstetrics and Hematology. Anemia prophylaxis should be initiated beforehand and post-operative transfusion should be reduced in pregnant women and patients who will undergo surgery. Unnecessary transfusions should be avoided in order to avoid complications that may occur during and after transfusion.

Peripheral blood smear diagnosis of G6PD deficiency in an 83-year-old man.

An 83-year-old male was admitted to the emergency department for abrupt onset of jaundice and asthenia. Vital signs were in range, and physical examination was unremarkable except for jaundice and hyperchromic urine. Full blood count on admission showed his hemoglobin concentration to be 81 g/L with no alteration in white blood cell (WBC) or platelets count. Biochemical tests were significant for high bilirubin level 417.07 μmol/L (indirect bilirubin 369.53 μmol/L) and abnormal lactate dehydrogenase level 1520 μmol/L. The hypothesis of hemolytic anemia was confirmed by further laboratory tests, which showed undetectable haptoglobin and increased reticulocyte count 196 × 109/L. Direct and indirect Coombs tests were both negative, suggesting a Coombs-negative hemolytic anemia. A first blood smear did not show schistocytes and the coagulation profile was in order. Medical history was negative for oxidant drugs assumption, prosthetic heart valves, and liver and kidney diseases. Chest radiography was normal, and a complete abdominal echography did not show hepatomegaly or splenomegaly. Meanwhile, the patient clinical course was complicated by pain and tightness in the chest and dizziness and an electrocardiogram was compatible with a non-ST-segment elevation myocardial infarction. A new set of lab tests showed severe anemia with 66 g/L of hemoglobin, and the patient undergone blood transfusion. In the suspicion of a hemolytic crisis in the context of glucose-6-phosphate dehydrogenase (G6PD) deficiency, an accurate anamnesis was collected and the patient confirmed the assumption of fava beans 3 days earlier after a long time. G6PD levels could not be assessed overnight, but a second blood smear was significant for bite, blister, and ghost cells (Figure 1 A and B), which are findings compatible with G6PD deficiency. Testing for G6PD was performed as soon as available and it revealed a significant G6PD deficiency (2.7 U/g Hb, normal range 8–14 U/g Hb, overestimated because of low Hb concentration). This is a case of G6PD deficiency diagnosed in 83-yer-old patient with no previous similar event in an unfavorable setting (emergency department by night). It highlights the necessity of high clinical suspicion of G6PD deficiency in the context of Coombs-negative hemolytic anemia, even in elderly patients. It is worth noting that different species of fava beans have a different capacity in inducing oxidative stress. Lastly, blood smear can still provide useful morphological data in supporting the diagnosis, regardless the immediate availability of G6PD test. Fabio Giglio conceived the study; D. Sannipoli, D. T. Clerici, and Fabio Giglio provided all clinical and hematological data; A. Boletini and P. Ronchi performed and analyzed morphology; D. Sannipoli and Fabio Giglio wrote the paper. All authors approved the paper. The authors declare no conflict of interest. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Laporan Kasus Manajemen Kegawatdaruratan Trauma Jaringan Lunak Wajah Pada Anak Penderita Talasemia

Facial soft tissue trauma is a common case in the emergency department. Handling this case requires special attention because the face is a prominent part and a marker of identity. Thalassemia is a blood disorder that causes the sufferer to experience anemia, where thalassemia patients must undergo blood transfusions for life. This case will describe a 14-year-old girl who came to the Emergency Department of Hasan Sadikin Hospital Bandung with complaints of bleeding on the eyelids due to a motorcycle accident, from the patient's history it is known that the patient is a thalassemia patient who routinely undergoes transfusions every month. As a result of this hemorrhage caused a significant decrease in hemoglobin value in the patient, so that emergency management was carried out, namely suturing the patient's traumatized eyelid and blood transfusion. Emergency management of facial soft tissue trauma in children with thalassemia must be done carefully to control bleeding and restore the function and aesthetics of traumatized facial tissues, besides that we also collaborate with pediatric colleagues for the management of anemia due to thalassemia in this patient.