Units Of Blood Transfusion Research Articles

Association of Clinical and Paraclinical Factors with Pain Crisis Severity in Sickle-Thalassemia Patients in Iran

Objectives: This study aimed to evaluate the effects of several factors, including hospitalization frequency, inflammatory and hemolytic markers, and the numbers of blood transfusions and crises, on the severity of pain crises in sickle-thalassemia patients. Methods: Of all patients visiting hematologists in university-affiliated hospitals and clinics, only 75 sickle cell disease (SCD) and sickle-thalassemia patients met the inclusion criteria for this study. Disease severity was measured based on pain crises per year and laboratory markers, including hemolytic and inflammatory indicators, outpatient or inpatient status, the number of hospital admissions, and the number of blood units transfused over one year. Results: In sickle cell patients, a significant correlation was observed between hospital admission and WBC (0.01), ALP (0.001), MCHC (0.001), ferritin (0.021), and ESR (0.006). Additionally, pain crises were positively correlated with transferrin saturation (TS) (+0.28) and the number of transfused blood units (+0.49) and negatively correlated with Hb (-0.30) and total iron binding capacity (TIBC) (-0.23). Blood unit transfusions showed a positive correlation with serum iron (+0.44), RDW (+0.36), ferritin (+0.39), pain crises (+0.49), and TS (+0.49), along with a negative correlation with Hb (-0.75) and MCHC (-0.33). When categorizing pain crises into two groups, patients experiencing more frequent crises generally exhibited lower hemoglobin levels and a higher number of blood units transfused. Hemoglobin also showed a significant negative correlation with lactate dehydrogenase (LDH) level in both groups: -0.604 (P = 0.005) in patients with ≥ 3 crises per year and -0.368 (P = 0.006) in patients with < 3 crises per year. Patients with hemoglobin levels of 7.5 or higher tended to maintain an LDH level below 1000. Among patients referred with pain crises, hemoglobin was negatively correlated with hemolytic markers such as LDH (-0.41) and retic (-0.29). Conclusions: Hemoglobin and LDH can serve as follow-up markers, as they are routinely measured in all sickle cell patients and, in this study, hemoglobin levels of 7.5 or higher and LDH levels below 1000 were associated with fewer and less severe pain crises. Regular monitoring of hemolytic markers may help in pain crisis prevention, as this study found that hemolytic crises frequently coincided with pain crises. Further research is needed to provide conclusive evidence in this area.

Midwife-Led Versus Obstetrician-Led Perinatal Care for Low-Risk Pregnancy: A Systematic Review and Meta-Analysis of 1.4 Million Pregnancies

Background: The optimum model of perinatal care for low-risk pregnancies has been a topic of debate. Obstetrician-led care tends to perform unnecessary interventions, whereas the quality of midwife-led care has been subject to debate. This review aimed to assess whether midwife-led care reduces childbirth intervention and whether this comes at the expense of maternal and neonatal wellbeing. Methods: PubMed, Scopus, Cochrane Library, and Web of Science were systematically searched for relevant studies. Studies were checked for eligibility by screening the titles, abstracts, and full texts. We performed meta-analyses using the inverse variance method using RevMan software version 5.3. We pooled data using the risk ratio and mean difference with the 95% confidence interval. Results: This review included 44 studies with 1,397,320 women enrolled. Midwife-led care carried a lower risk of unplanned cesarean and instrumental vaginal deliveries, augmentation of labor, epidural/spinal analgesia, episiotomy, and active management of labor third stage. Women who received midwife-led care had shorter hospital stays and lower risks of infection, manual removal of the placenta, blood transfusion, and intensive care unit (ICU) admission. Furthermore, neonates delivered under midwife-led care had lower risks of acidosis, asphyxia, transfer to specialist care, and ICU admission. Postpartum hemorrhage, perineal tears, APGAR score < 7, and other outcomes were comparable between the two models of management. Conclusions: Midwife-led care reduced childbirth interventions with favorable maternal and neonatal outcomes in most cases. We recommend assigning low-risk pregnancies to midwife-led perinatal care in health systems with infrastructure allowing for smooth transfer when complications arise. Further research is needed to reflect the situation in low-resource countries.

A retrospective study of Quality Control of Fresh Frozen Plasma (FFP) using Factor VIII levels in Central Blood Transfusion Services Indonesian Red Cross

Background: According to a report from the Ministry of Health of the Republic of Indonesia, there are 470 blood transfusion units in Indonesia (235 units managed by PMI, 220 units managed by the government, four units of health services provinces, nine units of vertical hospital BTUs, two unit’s Indonesian police and army hospital) distributed in 38 provinces. With so many BTUs spread throughout Indonesia, each BTU must have the same quality standards to maintain and improve blood services. Therefore, it is necessary to carry out Quality Control of the blood component products produced. Quality control is critical in safely and effectively processing blood and other components. A quality concept comprises quality control, assurance, and management. The laboratory service should have a quality control system. Quality testing and monitoring of blood components for transfusion have led to manufacturing or development. Factor VIII levels are internal quality control parameters required for quality analysis of Fresh Frozen plasma (FFP). As per international standard guidelines and government national regulations (PMK 91/2015) for quality assurance of FFP, 1% of all the units prepared, or four units per month, are tested for stable coagulation factors, including Factor VIII levels. Objective: This study aims to evaluate factor VIII levels in each units FFP to ensure the availability of high-quality products with maximum therapeutic and minimal risk to recipients. Methods: The retrospective data were collected from Research and Development CBTS Indonesian Red Cross archives from 1 January 2019 to 30 April 2023. Out of total 284 units FFP collected from Blood Transfusion Unit Indonesian Red Cross from Sumatera Island (Lampung Province, Palembang City, Pekanbaru City), DKI Jakarta Province (CBTS IRC), Jawa Barat Province (Depok City, District of Bekasi City, District of Bogor City), Banten Province (Tangerang City, District South of Tangerang City), Government Hospital (Fatmawati Hospital BTU), Army Hospital (RSPAD Gatot Soebroto BTU) were tested Quality Control with semi-automated Sysmex CA50 and automated Sysmex CA620 to determine of factor VIII levels in each unit FFP. Results: A total of 284 units of FFP were tested, and mean factor VIII levels were 1,2 IU/mL with a range of 0,3 IU/mL-5,3 IU/mL, the normal range measure being > 0,7 IU/mL. Only 4,9 % (14/284) FFP units were inappropriate from the standard, while 95,1 % (270/284) FFP units could be accepted criteria standard. Conclusion: We conclude that there are still those below-standard Quality FFP products from blood transfusion units; it is necessary to increase the processing of blood components so that the coagulation factors are maintained. From taking blood collecting, transporting, and shipping, it is required to carry out quality control to produce products that meet national and international standards.

Prevalence and risk factors for blood-borne viruses among multi-transfused patients in Sana'a City, Yemen

Background: Blood-borne viruses (BBVs), like hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) among multi-transfused patients (MTPs), remain a major public health problem in Yemen. This study aimed to determine the seroprevalence of BBVs and associated risk factors among MTPs. Methods: A cross-sectional study was conducted on MTPs at the Yemeni Society for Thalassemia, National Oncology Center, and Al Kuwait University Hospital in Sana’a City. Data were collected through face-to-face interviews using a predesigned questionnaire. Blood samples were drawn and tested for HBsAg, anti-HCV, and HIV-1,2 by using an electrochemiluminescence immunoassay technique. Results: Among 361 MTPs, the overall seroprevalence of BBVs was 6.8%; seropositivity of HBsAg, anti-HCV, and anti-HIV-1,2 was 3.9%, 2.9%, and 0.0%, respectively. An increase in family size and low income were significantly associated factors with HBV infection. In addition, increases in age and blood transfusion units were found to be significant predictors for HCV (p<0.05). Conclusion: Although the seroprevalence of BBVs is low, it remains a major problem among MTPs. The most frequent infection was HBV, followed by HCV, with a significantly higher rate among leukemia patients. Regular mentoring for viral markers and mandatory implementation of HCV antigen-antibodies testing as well as advanced technology in blood screening are highly recommended.

Tranexamic acid with vitamin K mixture decreases bleeding of total hip arthroplasty in a Jordanian population

Background: Bleeding of total hip arthroplasty has severe consequences on postoperative recovery. 75–90% of early bleeding after surgery and during surgery is caused by operative technical issues. tranexamic acid decreases bleeding of arthroplasty. vitamin k has late and dose sensitive effect in clotting. Methods: This retrospective investigation included subjects of middle age and of both genders scheduled for primary hip replacement at Queen Alia hospital, Jordanian Royal medical services, between March 2022 and June 2023. Subjects were classified into two groups. Group I subject were administered intravenous mixture of Tranexamic acid 10 mg/kg with vitamin K1 of 10 mg 5 min pre-skin incision followed by an infusion of Tranexamic acid 1 mg/kg/h and vitamin K1 0.2 mg/kg/h, until skin closure. Group II subjects were administered only intravenous vitamin K1 of 10 mg, 5 min pre- skin incision followed by infusion of 0.2 mg/kg/h until skin closure. Hemoglobin, packed cell volume, platelet count, prothrombin time, partial thromboplastin time and fibrinogen were tested. Bleeding and blood transfusion were remarked. Results: Group I demonstrated a remarkable less modifications in blood tests and less bleeding than group II. Group II demonstrated less bleeding after surgery. The average Hb in group I demonstrated a remarkable less reduction after surgery compared to group II. (p<0.005). No blood transfusion after surgery was needed in group I. Nine (15%) patients in group II needed one unit of blood transfusion during surgery. Conclusion: Intravenous administration of Tranexamic acid with vitamin K mixture in total hip arthroplasty decreased bleeding during and after surgery and decreased the requirement for blood transfusion.

8144 Hypertension in Sheehan Syndrome: A Diagnostic Challenge

Abstract Disclosure: E. Ahsan: None. F.F. Foo: None. C. Lesniak: None. M. Akula: None. K. Hu: None. R. Ong: None. K. Chalasani: None. J. Cheng: None. S. Holland: None. Introduction: Postpartum pituitary necrosis, commonly known as Sheehan syndrome (SS), is the term used to describe the necrosis of anterior pituitary gland cells that occurs after significant postpartum bleeding, hypovolemia, and shock. This typically occurs after delivery, during which the mother suffers significant blood loss. The pituitary gland fails to produce hormones due to this blood loss. Depending on the degree of tissue damage, SS can have an acute or chronic course, and patients may present with a wide range of clinical symptoms at diagnosis. Acute SS is associated with postpartum pituitary infarction, which can result in hypotension, shock, hypoglycemia, hyponatremia, headache, vision disturbances, unconsciousness, and an inability to lactate. We present a rare case of SS where the patient experienced hypertension instead of classic hypotension due to postpartum preeclampsia. Clinical Case: A 40-year-old female with no significant medical history presented to the hospital for scheduled induction of labor for polyhydramnios and underwent vacuum-assisted vaginal delivery and postpartum hysterectomy due to severe postpartum hemorrhage secondary to DIC. The postpartum course was also complicated by preeclampsia with severe features. Patients developed features like excessive fatigue, hypoglycemia, hyponatremia, hypothyroidism, polyuria, and failure of lactation, which were consistent with panhypopituitarism secondary to Sheehan syndrome. However, the patient was hypertensive to 145/91 before steroids were given. Labs were significant for serum sodium 116 mmol/L (135-145 mmol/L), FSH <0.7 mIU/mL (Follicular Phase: 2.5-10.2, Mid-cycle Peak: 3.1-17.7, Luteal Phase: 1.5-9.1, Postmenopausal: 23.0-116.3), LH <0.2 mIU/m (Follicular Phase: 1.9-12.5, Mid-Cycle Peak: 8.7-76.3, Luteal Phase: 0.5-16.9, Postmenopausal: 10.0-54.7), Prolactin: 2.4 ng/mL (Non-pregnant: 3.0-30.0, Pregnant: 10.0-209.0, Postmenopausal: 2.0-20.0), PM Cortisol on admission: 1.10 ug/dL (3.44-16.76 ug/dL), plasma ACTH 7 pg/mL( 6 - 50 pg/mL), TSH 0.430 uIU/mL (0.550 - 4.780 uIU/mL), FT4 0.59 ng/dL - 1.76 ng/dL). MRI of the brain pituitary showed- A 1.5 cm region of hypoenhancement and an additional 2 mm focus of hypoenhancement in the sella, findings represent evolving pituitary necrosis. The patient received 24 units of blood transfusion and hormone replacement therapy, followed by outpatient endocrinology follow-up. Clinical lessons: Although considerable blood loss causes hypotension in patients with SS, additional postpartum medical issues can sometimes result in atypical presentations. In our patient, postpartum preeclampsia caused hypertension. Identifying the atypical symptoms of SS is just as vital as identifying its typical features to prevent potentially fatal consequences. Presentation: 6/2/2024

Increasing public awareness through education and the implementation of routine blood donations

This community service program aims to increase public awareness and participation in blood donation activities through education and the regular implementation of blood donation. Adequate blood availability in blood transfusion units is critical to saving lives, but community participation in blood donation is still low in some areas. Through this activity, counselling was carried out to the community about the benefits of blood donation, health requirements, and the importance of blood donation continuity for medical emergency needs. This program collaborates with the Indonesia Red Cross (PMI) and local health facilities to organize routine blood donation activities every three months. It is hoped that with this program, community participation in blood donation will increase significantly, and sustainable awareness about the importance of sharing and helping others through blood donation will be created. The results of this activity were measured through an increase in the number of blood donation participants and an evaluation of community knowledge after counselling was carried out

Evaluation of the efficacy of perioperative tranexamic acid in patients with pelvic and acetabular fractures: A systematic review and meta-analysis.

Tranexamic acid (TXA) is commonly used to reduce perioperative bleeding in various surgeries, including acetabular and pelvic fractures treated with open reduction and internal fixation (ORIF). However, research on TXA's effectiveness and safety in this context is conflicting. To address this, we conducted a systematic review and meta-analysis on TXA's efficacy and safety in patients with acetabular and pelvic fractures undergoing ORIF. We systematically searched Cochrane, PubMed, and EMBASE databases until August 30, 2023. Our evaluation of TXA focused on 6 domains: estimated blood loss (EBL), blood transfusion units, transfusion rates, thromboembolic events, other complications, and surgery duration. Data from these studies were analyzed using RevMan Manager 5.4. This study included 4 randomized controlled trials with 179 patients with acetabular and pelvic fractures treated with TXA. The analysis showed that TXA did not significantly reduce EBL, packed red blood cell transfusion units, blood transfusion rates, or surgery duration. There was no significant difference in thromboembolic events or other postoperative complications, like surgical wound issues, pneumonia, heterotopic ossification, and sciatic nerve injuries, between the TXA and control groups. TXA did not demonstrate a significant benefit in reducing perioperative bleeding or complications in patients treated with ORIF for acetabular and pelvic fractures. The utilization of TXA in such clinical scenarios remains a topic necessitating further rigorous investigation to delineate its role in this clinical setting.

Impact of the COVID-19 Pandemic on Blood Transfusion among Hospitalized Patients with Chronic Kidney Disease.

Background and Objectives: Hematological disorders, especially chronic anemia and coagulation disorders, are common in patients with chronic kidney disease (CKD). Severe anemia is associated with increased cardiovascular morbidity and mortality in this special group of patients and is also responsible for decreased hope and quality of life. Despite the use of appropriate iron therapy and erythropoietin-stimulating agents, red blood cell transfusion is occasionally required, usually in the setting of acute bleeding or for correction of perioperative anemia. The COVID-19 pandemic has accelerated the progression of chronic diseases and worsened the outcomes for patients with nephrological conditions. As a precautionary measure against infections, patients' access to hospitalization for their procedures has been reduced and their chronic complications, including hematological abnormalities, have gotten out of control. Materials and Methods: Our retrospective observational study was designed to evaluate the impact of the COVID-19 pandemic on blood transfusion for the patients with chronic kidney disease hospitalized in our emergency county medical unit, over a period of four years (2019-2022) who were admitted or at least referred for evaluation to the Nephrology department. We also followed the measures adopted to ensure the necessary blood products during this time. Results: Between 2190-2022, a total of 24,096 hospitalized patients were transfused at the Emergency County Clinical Hospital in Constanta, Romania. Meanwhile, in the nephrology and other medical or surgical wards of our medical unit, 1590 CKD patients were transfused with different blood derivatives. During the pandemic years, as expected, the number of transfused patients and transfused blood units decreased by 4% and 7%, respectively, in comparison with the pre-pandemic year, 2019. Unlike the general trend of transfusion activity, more patients with CKD transfused in 2022 (580) than before the pandemic (414 in 2019), and the number of blood units was higher in 2022 than in 2019 for red blood products and plasma. Between 2020-2022, from the total number of transfused patients in our study, 254 with CKD patients (16%) and 798 non-CKD (4%) died in-hospital. Conclusions: The adaptive strategies implemented to ensure the necessary blood products in the hospital during the COVID-19 pandemic mainly included restrictive transfusion and limitation of elective surgical procedures. The subject matter of the article is important as blood shortages are a problem that healthcare workers may encounter in future pandemics.

The Diagnostic Performance of Serum Glycosylated Ferritin in Patients Undergoing Regular Blood Transfusion: An Indicator of Iron Overload to Initiate Iron Chelation Therapy.

Background and objective Serum ferritin concentration and transferrin saturation are commonly employed to estimate body iron but are non-specific to iron overload. Glycosylated ferritin may be primarily elevated in cases of iron overload in patients undergoing regular blood transfusions. In this study, we aimed to estimate glycosylated ferritin and determine its cutoff values for iron overload in patients receiving blood transfusions regularly. We also endeavored to the examine correlation between serum ferritin and glycosylated ferritin in patients receiving regular blood transfusions. Methods We conducted a cross-sectional study involving 17 patients undergoing regular blood transfusions in the Department of Medical Oncology/Hematology, who had already received ≥10 transfusions without any iron chelation therapy or acute inflammation. All participants were evaluated based on a questionnaire to gather relevant medical details. Serum iron, ferritin, glycosylated ferritin, and unsaturated iron-binding capacity (UIBC) were estimated. Total iron-binding capacity (TIBC) and transferrin saturation were also calculated. Results Participants were divided into two groups based on transferrin saturation (≥50% as a reference for iron overload). The group with transferrin saturation ≥50% had significantly higher levels of serum ferritin, glycosylated ferritin, and iron, compared to the group with transferrin saturation <50%. Glycosylated ferritin showed a positive correlation with ferritin (rho=0.80) and transferrin saturation (rho=0.64), which was statistically significant. UIBCand TIBCshowed a negative association with glycosylated ferritin. The correlation of glycosylated ferritin with units of blood transfusion (Spearman's rho=0.60) was found to be better than that of serum ferritin (Spearman's rho=0.52). Conclusions Based on our findings, glycosylated ferritin could be a potential marker for transfusion-related iron overload. The optimal cutoff value for iron overload using serum glycosylated ferritin level was >587.55 ng/mL. Further extensive studies withlarger sample sizes will substantiate the role of glycosylated ferritin in predicting post-transfusion iron overload.

Evaluation of the use of tranexamic acid in the postoperative period in patients with scoliosis undergoing posterior fusion.

Scoliosis is the most prevalent type of spinal deformity, with a 2-3% prevalence in the general population. Moreover, surgery for scoliotic deformity may result in severe blood loss and, consequently, the need for blood transfusions, thereby increasing surgical morbidity and the rate of complications. Several antifibrinolytic drugs, such as tranexamic acid, have been regarded as safe and effective options for reducing blood loss. Therefore, the present study aimed to analyse the effectiveness of this drug for controlling bleeding when used intraoperatively and in the first 48h after surgery. A prospective randomized study of a cohort of patients included in a mass event for scoliosis treatment using PSF was performed. Twenty-eight patients were analysed and divided into two groups: 14 patients were selected for intraoperative and postoperative use of tranexamic acid (TXA), and the other 14 were selected only during the intraoperative period. The drainage bleeding rate, length of hospital stay, number of transfused blood units, and rate of adverse clinical effects were compared. All the patients involved had similar numbers of fusion levels addressed and similar scoliosis profiles. The postoperative bleeding rate through the drain did not significantly differ between the two groups (p > 0.05). There was no significant difference in the number of transfused blood units between the groups (p = 0.473); however, in absolute numbers, patients in the control group received more transfusions. The length of hospital stay was fairly similar between the groups, with no statistically significant difference. Furthermore, the groups had similar adverse effects (p = 0.440), with the exception of nausea and vomiting, which were twice as common in the TXA group postoperatively than in the control group. No significant differences were found in the use of TXA during the first 48 postoperative hours or in postoperative outcomes.

Incidence and risk factors for coronavirus disease 2019-associated pulmonary aspergillosis using administrative claims data.

Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is one of the noticeable complications of COVID-19 and its incidence varies widely. In Japan, research on the incidence, risk factors and mortality associated with CAPA is limited. This study aimed to explore the incidence and potential risk factors for CAPA in patients with severe or critical COVID-19 and evaluate the relationship between CAPA and mortality of patients with severe or critical COVID-19. We investigated the incidence of CAPA in patients with severe and critical COVID-19 using administrative claims data from acute care hospitals in Japan. We employed multivariable regression models to explore potential risk factors for CAPA and their contribution to mortality in patients with severe and critical COVID-19. The incidence of CAPA was 0.4%-2.7% in 33,136 patients with severe to critical COVID-19. Age, male sex, chronic lung disease, steroids, immunosuppressants, intensive care unit admission, blood transfusion and dialysis were potential risk factors for CAPA in patients with severe to critical COVID-19. CAPA was an independent factor associated with mortality. CAPA is a serious complication in patients with severe and critical COVID-19 and may increase mortality.

Dose-response relationship between perioperative allogeneic blood transfusion and surgical site infections following spinal surgery

BACKGROUND CONTEXTPerioperative allogeneic transfusion was generally considered to be safe. However, there had been some literatures reporting a potential association between surgical site infections (SSI) and blood transfusion. PURPOSETo determine whether perioperative blood transfusion increased the risk of SSI and to further explored whether there was a dose-response relationship. DESIGNRetrospective nested case-control study. PATIENT SAMPLEWe retrospectively analyzed consecutive patients who underwent spinal fusion surgery at our institution between July 2011 and July 2021. OUTCOME MEASUREIn the current study, the primary outcome measure was SSI. METHODSAll consecutive patients who underwent elective spinal surgery at our institution between July 2011 and July 2021 formed the retrospective cohort. Electronic patient record and radiographic data were reviewed retrospectively in our electronic database. To examine the effects of mismatched variables, we further adjusted for possible confounding factors using conditional logistic regression models. Then, we explored the nonlinear relationship between perioperative blood transfusion and SSI by a smoothed curve, with the adjustments for potential confounders. If a nonlinear relationship was observed, a two-piecewise regression model would be performed to calculate the threshold effect. RESULTSThe average time from surgery to diagnosis of SSI was 20.5 days. We matched 248 controls to 124 SSI cases. Of the 124 patients who developed SSI, 84 patients (67.7%) had deep SSI, 40 patients (32.3%) had superficial SSI. In the fully adjusted model, the risk of SSI increased by 27% for each additional unit of blood transfusion. It can be seen from the curve fitting plot that the risk of SSI has a greater increase after blood transfusion >3U. Subsequent piecewise regression identified an inflection point of 3U. CONCLUSIONWe determined that 3U was a threshold volume of allogeneic blood transfusion that shifted the risk of SSI following spinal surgery, and there was a dose-response effect.

Racial/ethnic disparity in severe maternal morbidity among women who conceived by in vitro fertilization

BackgroundIn vitro fertilization (IVF) as a fertility treatment is associated with adverse perinatal outcomes. Racial/ethnic disparity in severe maternal morbidity (SMM) in women who conceived by IVF is understudied. ObjectiveTo examine differences in the association between race/ethnicity and SMM between women who conceived spontaneously and those who conceived using IVF. MethodsWe included all singleton live births and stillbirths in the United States, 2016–2021; data were obtained from the National Center for Health Statistics. Maternal race/ethnicity included non-Hispanic White (NHW), non-Hispanic Black (NHB), American Indian and Alaska Native (AIAN), Asian, Pacific Islander (PI), Hispanic, and mixed-race categories. The SMM composite outcome included eclampsia, uterine rupture, peripartum hysterectomy, blood transfusion, and intensive care unit (ICU) admission. We used logistic regression to adjust for potential confounders (such as age, education, parity, prepregnancy body mass index, smoking during pregnancy, chronic hypertension, and preexisting diabetes) and to assess modification of the association between race/ethnicity and SMM by IVF. ResultsThe study population included 21,585,015 women: 52% were NHW, 15% NHB, 0.8% AIAN, 6% Asian, 0.2% PI, 24% Hispanic, and 2% were of mixed race. IVF was used by 183,662 (0.85%) women; the rate of the SMM composite outcome was 18.5 per 1000 deliveries and 7.9 per 1000 deliveries in the IVF and spontaneous conception groups, respectively (unadjusted rate ratio 2.34, 95% confidence interval [CI] 2.26–2.43). In women with spontaneous conception, NHB, Asian and mixed-race women had elevated odds of SMM compared with NHW women (adjusted odds ratio [aOR]=1.39, 95% CI 1.37–1.41; aOR=1.04, 95% CI 1.02–1.07; and aOR=1.42, 95% CI 1.38–1.46, respectively). Racial/ethnic disparities in SMM and its components were not different between the IVF and spontaneous conception groups for the mixed-race category. NHB and Hispanic women had significantly higher aORs for uterine rupture/intrapartum hysterectomy compared with NHW women in the IVF group, while Asian women had a higher aOR for ICU admission compared with NHW women in the IVF group. ConclusionWomen who conceived by IVF have a greater than two-fold higher risk of SMM and this higher risk is evident across all racial/ethnic groups. However, NHB and Hispanic women who conceived by IVF had a higher risk of uterine rupture/hysterectomy, and Asian women who conceived by IVF had a higher risk of ICU admission. Our results warrant further investigation examining pregnancy and postpartum care issues among racial/ethnic minority women who conceive using IVF.

Evaluating hemoglobin thresholds for blood transfusions in oncology patients admitted in the intensive care unit.

e23319 Background: Current guidelines recommend transfusing at a hemoglobin (Hb) threshold of 7g/dl. There is a lack of evidence to support a specific threshold for transfusion in patients with active malignancy admitted to the Intensive Care Unit (ICU). This study attempts to determine an evidence-based threshold for blood transfusions in cancer. Methods: A retrospective study was done to study 561 patients with an active cancer diagnosis admitted to Northeast Georgia Medical Center ICU between 2017 and 2023 that received at least one unit of blood transfusion. Chi-Square test of association with Bonferoni correction was applied to the top five common cancers seen in ICU: Leukemia, Lymphoma, Brain tumors, Lung cancers, and GI cancers. It compared three thresholds of transfusion and looked for any change in mortality risk, readmissions, need for multiple transfusions, prevalence of new onset or recurrent heart failure, development of altered mental status, or cardiac arrest. The three thresholds for transfusions that were studied were &lt; 7g/dL, &lt; 8 g/dL, and &gt; 8 g/dL. The studied cancer types were further divided into either hematologic or solid tumors. Results: There was a decrease in overall cancer readmissions compared to expected over 30 days by 64%, 60 days by 44%, and 90 days by 47.5% when transfused for a Hb threshold of &lt;8 g/dL compared to an increase of 22.8%, 18.2%, and 18.8% in 30-, 60-, and 90-day readmissions when transfused for a Hb threshold of &lt;7 g/dL. When divided by cancer types, there was a significant decrease from expected by 30%, 47.5%, and 56% in 30-, 60-, and 90-day readmissions for patients with solid tumors for a Hb threshold of &lt; 8 g/dL. Mortality risk decreased by 50% and the need for multiple transfusions decreased by 21% when transfused for a Hb threshold of &lt; 8 g/dl. Of note, there was no significant association between transfusion levels and associated reactions. There was a decrease of 82% in altered mental status when transfused for threshold of Hb &lt;8 g/dL. Finally, significant association was not found with AKI, cardiac arrest, or heart failure and any Hb transfusion thresholds. Conclusions: Based on these results, there is a significant mortality benefit and decreased length of stay for cancer patients admitted to ICU when blood transfusion is undertaken at a hemoglobin threshold of &lt;8g/dL. These results should be further investigated in a randomized controlled trial.

Alpha globin gene alterations modifying the phenotype of homozygous beta thalassaemia.

The phenotype of β-thalassemia varies widely. The primary determinant is the type of beta-globin gene mutation; however, there are secondary and tertiary modifiers also as associated alpha mutations, polymorphisms, as well as coinheritance of mutations affecting other related systems. Co-inheritance of alpha thalassemia mutations is known to ameliorate the severity of HbE-β thalassemia. However, the role of alpha globin gene alterations (deletions and triplication) is not well illustrated in homozygous β-thalassemia. Here we evaluated the role of alpha globin gene alterations in 122 β-thalassemia patients having IVS1-5 (G>C) homozygous mutation. β-thalassemia mutations were detected by ARMS PCR and alpha mutations by GAP-PCR. Gene expression by qRT-PCR. Out of 122 cases, 15 patients had alpha 3.7 triplications (ααα3.7anti), 24 had alpha 3.7kb deletion (-α3.7) mutation and three patients had 4.2kb deletion (-α4.2). Patients were divided into two groups, requiring less than 8 units (NTDT) and more than 8 units (TDT) of blood transfusion per year (≥8U BT/year). The percentage of alpha deletion was significantly (p=0.0042) high in NTDT (42.1%) as compared with TDT (13.2%). Conversely, the proportion of alpha triplication is high in the TDT as compared with NTDT. Even mean serum ferritin level was found to be significantly high in patients having alpha triplication as compared with those having alpha deletions (p=0.0184) and normal alpha gene (p=0.0003). α/β globin ratio was highest in TDT patients with alpha triplication and lowest in NTDT patients with alpha-del. The results show that concurrent inheritance of alpha gene alterations influences the phenotypic severity of homozygous β-thalassemia.

Total Endoscopic or Endoscope-Assisted Excision of Non-embolized Advanced Juvenile Nasopharyngeal Angiofibroma: A Clinical Case Series.

Background Surgical excision is the primary treatment for juvenile nasopharyngeal angiofibroma (JNA), but this procedure is challenging due to its high vascularity and local aggressiveness. Moreover, preoperative embolization is a subject of debate. Objective The objective of this study is to assess the efficacy, safety, and feasibility of endoscope-assisted excision as a surgical intervention for non-embolized advanced JNA. Materials and methods This case series involved six male patients (mean age: 16 years) with JNA, classified as stages Ⅱc to Ⅲb according to the Radkowski classification. None underwent preoperative embolization. Results Two stage Ⅱc cases underwent total endoscopic endonasal excision. One patient with stage Ⅲa and another with stage Ⅲb underwent surgery via an endoscope-assisted sublabial approach. Two patients, one with stage Ⅱc JNA and another with Ⅲb, underwent a two-stage procedure. Postoperative CT scans showed no residual disease at the six-month mark. On average, each procedure required 1.5 units of blood transfusion. One patient experienced intraoperative bleeding, whereas the remaining patients were free of any major complications. The mean operation duration was 175 minutes per procedure. The mean length of stay at the hospital was 3.75 days per procedure. Conclusion Endoscope-assisted or purely endoscopic approaches can be safely and effectively employed for the complete excision of non-embolized advanced JNAs.

PENGARUH LAMA PENYIMPANAN DARAH TERHADAP JUMLAH TROMBOSIT PADA WHOLE BLOOD SEBELUM DAN SESUDAH DISIMPAN SELAMA 3 HARI DI UNITDONOR DARAH PMI KOTA MEDAN

Blood transfusion is a series of blood transfer process from a donor to a recipient. Blood is stored in the refrigerator with temperature 2-8 °c. In the blood storage process will experience changes in blood components such as platelet count. The researcher aims to determine the effect of long blood storage on platelet count on whole blood before and after being stored for three days at PMI Medan Blood Donor Unit. This research was done by descriptive method of Hematology Analyzer presented in table form. This research took place from 21-23 May 2018 at the Laboratory of Blood Transfusion Unit of Indonesian Red Cross Medan. Thenumber of samples used for the research is 10 samples. The result is the effect of storage duration on the decrease of platelet count where there is a decrease of platelet count in all donor blood samples stored for three days at PMI Medan Blood Donor Unit.Based on existing conclusions, then the suggestion that can be taken is every blood donor unit always do repeat examination for blood component level which will be transfused. For patients who will melaksanakna transfuse, you should use fresh blood. Blood should not be taken out frequently and blood refrigerator do not often open the lid. It is recommended for the same researchers in the future to increase the number of samples so that the results can be more accurate

The influence of work motivation on employee performance at the Indonesian Red Cross blood transfusion unit, Makassar City

This research aims to determine and analyze the influence of work motivation on employee performance in the Indonesian Red Cross Blood Transfusion Unit, Makassar City. The type of research used is quantitative descriptive. The population in this study were all employees of the Indonesian Red Cross Blood Transfusion Unit in Makassar City. This research used a saturated sampling technique with a sample size of 95 respondents. The data collection technique uses a questionnaire technique. The data analysis technique used to test the hypothesis is simple linear regression and t-test (partial test) which is processed using statistical calculations via the Statistical Package for the Social Science (SPSS) version 26. The results of the study show that work motivation has a positive and significant effect on employee performance. at the Indonesian Red Cross Blood Transfusion Unit in Makassar City as evidenced by the Work Motivation coefficient (X) value of 0.414 and the calculated t value of 3.859 &gt; t table 1.661 with a significant value of 0.000 &lt; 0.05. So it can be concluded that Work Motivation has a positive and significant effect on Employee Performance At the Indonesian Red Cross Blood Transfusion Unit, Makassar City

Seroepidemiologi Antibodi Anti HIV berdasarkan Karakteristik Demografi pada Pendonor Darah di UDD PMI Kabupaten Probolinggo

Background: One of the indicators of HIV virus contamination in donor blood is the presence of anti-HIV antibodies. According to Probolinggo Blood Transfusion Unit, there are 55 blood donors screened reactive for anti-HIV antibodies in 2013-2018. Infected Blood by HIV virus causes a risk to donor recipients, especially the transmission of infection through blood transfusions. The purpose of this study is to describe the seroepidemiological trends of anti-HIV antibodies in blood donors. Methods: Descriptive research using annual data from Probolinggo Blood Transfusion Unit. The samples used in this study were all blood donors in 2013-2019 (29,421 blood donors). Blood donors were screened using Murex Ab/Ag Combination Diasorin UK Branch. Data were analyzed using descriptive statistics. Result: There were 0.19% anti-HIV antibodies reactive in the blood of donors with the characteristics of blood donors were males, O blood types, voluntary and recurrent donors and conducting blood donor Kraksaan District. Conclusion: Based on the results of this study, Probolinggo has a relatively low number of anti-HIV antibody findings. Nonetheless, the results show there has been an increase in the results of reactive screening for anti-HIV antibodies over the past 6 years in Probolinggo. Therefore, it is very necessary to maintain the quality of the screening that has been done and coordinate with the Probolinggo DHO to follow up on this problem.