Urgent Blood Transfusion Research Articles

Oxytocin infusion is a safe uterine bleeding controller alternative to blood transfusion in patients undergoing abdominal myomectomy

Background & objective: Uterine bleeding is a notable complication that can occur after the surgical removal of uterine fibroids, and oxytocin infusion has been a commonly used method to control blood loss in such cases. The objective of this study was to evaluate the effectiveness of oxytocin infusion in managing surgical bleeding following abdominal myomectomy, as an alternative to immediate blood transfusion.
 Methodology: The study population consisted of 120 patients who experienced acute blood loss following abdominal myomectomy. These patients were divided into two groups: Group A, which included 50 patients who received an oxytocin infusion, and Group B, which included 60 patients who received a placebo. All myomectomies were conducted according to department protocols, and various variables related to the study were recorded. Postoperative hemoglobin levels were checked in every patient.
 Results: In Group A, the average blood loss was 470.02 ± 81.65 ml, while in Group B, it was 721.42 ml ± 63.55 ml (P < 0.0001). The need for urgent blood transfusion was significantly lower in Group A (3.3%) compared to Group B (20.0%), (P = 0.044). Postoperative hemoglobin levels also showed a significant difference between the two groups, with Group A demonstrating better results than Group B.
 Conclusion: Oxytocin infusion can be safely used for managing blood loss in patients undergoing abdominal myomectomy. However, in cases where oxytocin is unable to effectively control the bleeding, blood transfusion may be needed as a means to compensate for the blood loss.
 Key Words: Uterine leiomyomas; Myomectomy; Surgical blood loss; Oxytocin
 Citation: Nasief H, Hassan A, AlDardeir N, Khadawardi K, Alwazzan AB, Alothmani H, Hammad Z. Oxytocin infusion is a safe uterine bleeding controller alternative to blood transfusion in patients undergoing abdominal myomectomy. Anaesth. pain intensive care 2024;28(1):05−09; DOI: 10.35975/apic.v28i1.2298
 Received: October 05, 2023; Reviewed: October 17, 2023; Accepted: November 19, 2023

Adrenal haemorrhage in new born presenting as severe neonatal jaundice

Neonatal adrenal haemorrhage is a relatively uncommon. Most often associated with difficult labour, birth trauma, hypoxia, sepsis. Clinical manifestations may vary from asymptomatic to life threatening Addisonian crisis. We present a case of right subacute adrenal hematoma confirmed on MRI abdomen. Risk factor being birth asphyxia. He presented with neonatal jaundice and was managed successfully by conservative methods. Treatment depends on the clinical features and severity. Most of the cases are asymptomatic and managed conservatively. Infants with acute haemorrhage might need urgent blood transfusion. Laparotomy is indicated when haemorrhage seems to be continuing, especially when the exact site of haemorrhage is in doubt. Adrenal haemorrhage usually takes 3 weeks to 6 months to resolve completely. Our case was clinically and hemodynamically stable, so he was managed conservatively and discharged after a week. This case emphasizes the importance high degree of suspicion in evaluation of neonate presented with late onset jaundice and importance of ultrasonography in diagnosis and conservative management.

Prediction of anemia using facial images and deep learning technology in the emergency department.

According to the WHO, anemia is a highly prevalent disease, especially for patients in the emergency department. The pathophysiological mechanism by which anemia can affect facial characteristics, such as membrane pallor, has been proven to detect anemia with the help of deep learning technology. The quick prediction method for the patient in the emergency department is important to screen the anemic state and judge the necessity of blood transfusion treatment. We trained a deep learning system to predict anemia using videos of 316 patients. All the videos were taken with the same portable pad in the ambient environment of the emergency department. The video extraction and face recognition methods were used to highlight the facial area for analysis. Accuracy and area under the curve were used to assess the performance of the machine learning system at the image level and the patient level. Three tasks were applied for performance evaluation. The objective of Task 1 was to predict patients' anemic states [hemoglobin (Hb) <13 g/dl in men and Hb <12 g/dl in women]. The accuracy of the image level was 82.37%, the area under the curve (AUC) of the image level was 0.84, the accuracy of the patient level was 84.02%, the sensitivity of the patient level was 92.59%, and the specificity of the patient level was 69.23%. The objective of Task 2 was to predict mild anemia (Hb <9 g/dl). The accuracy of the image level was 68.37%, the AUC of the image level was 0.69, the accuracy of the patient level was 70.58%, the sensitivity was 73.52%, and the specificity was 67.64%. The aim of task 3 was to predict severe anemia (Hb <7 g/dl). The accuracy of the image level was 74.01%, the AUC of the image level was 0.82, the accuracy of the patient level was 68.42%, the sensitivity was 61.53%, and the specificity was 83.33%. The machine learning system could quickly and accurately predict the anemia of patients in the emergency department and aid in the treatment decision for urgent blood transfusion. It offers great clinical value and practical significance in expediting diagnosis, improving medical resource allocation, and providing appropriate treatment in the future.

Severe Microcytic Hypochromic Anemia Masquerading as Conversion Disorder: A Case Report

Conversion disorder is a psychiatric illness in which an affected person experiences signs and symptoms of voluntary motor or sensory dysfunction in absence of any underlying neurological or medical condition. According to recent studies, fewer people initially labelled with a diagnosis of conversion have subsequently been found to have an organic disorder. We report a case of 13-year-old female, with a provisional diagnosis of conversion disorder later on, after detailed evaluation came out to be a case of severe anemia. Patient was transferred to the Psychiatry Department in view of the possibility of conversion symptoms. Detailed assessment of routine blood work (complete blood count with general blood picture) yielded severe microcytic hypochromic anemia (hemoglobin = 4.1 gm/dL). The patient was advised accordingly and an urgent blood transfusion was advised. It is mandatory that before labelling someone as having conversion disorder, rule out all essential and possible organic etiologies which can explain the clinical presentation, as it can be life-threatening.

Attitudes of American adult women toward accepting RhD-mismatched transfusions in bleeding emergencies.

There is an increasing literature demonstrating the benefits of prehospital and early in-hospital transfusions. RhD-positive products might only be available during these phases, which could pose consequences for future pregnancies if D-alloimmunization occurs. This survey measured the willingness of females to accept urgent but incompatible transfusions in light of the potential for future pregnancy complications. A survey was designed to assess the willingness of females ≥18 years of age to accept urgent incompatible transfusions when different absolute risk reductions in maternal mortality were presented along with a static rate of 0.3%-4.0% risk of harm to future pregnancies. The survey was sent electronically to women who are part of the Washington University Research Enhancement Core database. A total of 4896 delivered survey email invitations were distributed and 325 (6.6%) responses were received; 16 responses were excluded leaving 309 responses for analysis. Most of the responding women were White, college-educated, and lived in Missouri. At least 90% of the respondents would accept an urgent incompatible transfusion when the absolute risk reduction in maternal mortality was ≥4%. Women without a college degree, who lived in Illinois, who were not able to have children appeared to be less willing than their counterparts to receive an incompatible transfusion when the absolute risk reduction in maternal mortality was low. This survey demonstrated that adult women are highly likely to be open to accept urgent incompatible blood transfusions during a bleeding emergency when the absolute risk reduction in maternal mortality was ≥4%.

Admission hypocalcemia in pediatric major trauma patients-An uncommon phenomenon associated with an increased need for urgent blood transfusion.

Hemorrhage is a leading cause of death among children. Recent data from adult trauma suggests that early, transfusion-unrelated, hypocalcemia is common and that it is associated with an increased need for blood transfusion, mortality, and coagulopathy. The objectives of this study are to evaluate the prevalence of admission hypocalcemia in severely injured children and its correlation with urgent blood transfusion. This is a retrospective cohort study of all severely injured (Injury Severity Score [ISS] > 15) pediatric (<18 years) trauma patients admitted to Rambam Health Care Campus, Israel between 2012 and 2020. We excluded patients transferred from other facilities and those who received blood before determining calcium levels. Severe hypocalcemia was defined as ionized calcium (Ca++ ) < 1.0 mmol/L and mild hypocalcemia as 1.0 mmol/L ≤ Ca++ < 1.1 mmol/L. The primary outcome was urgent blood transfusion (transfusion in the emergency department [ED]). Six hundred seventy-three severely injured children were admitted from the field. Ca++ levels were determined before blood transfusion in 457 patients. Severe hypocalcemia was found in three patients (0.7%) and mild hypocalcemia in additional 21 patients (4.6%). Hypocalcemic patients required more urgent blood transfusion (29.2% vs. 6.5%, p< .001) and had higher ISS (29 [interquartile range, IQR: 22-35] vs. 25 [IQR: 19-34], p= .05). Multivariable logistic regression analysis identified Ca++ < 1.1 mmol/L as an independent predictor of the need for blood transfusion, odds ratio 5.44 (95% confidence interval 1.44-20.58), p= .01. Contrary to adults, admission hypocalcemia is uncommon in severely injured children. However, it may be associated with an increased risk of blood transfusion in the ED.

Effectiveness of massive transfusion protocol activation in pre-hospital setting for major trauma

IntroductionHemorrhage in major trauma is life-threatening and the activation of the Massive Transfusion Protocol (MTP) was found to reduce the time to transfusion and mortality. The purpose was (i) to verify whether MTP activation identifies patients that require massive transfusions once admitted to the Emergency Department (ED), (ii) to establish whether pre-hospital MTP activation reduces the time to transfusion on arrival at the ED, (iii) to identify the variable that best predicts MTP activation. Materials and methodsThis is a retrospective, single-center study. The MTP was implemented at the end of 2012; it was activated for major trauma in pre-hospital setting on the basis on established criteria. Pre-hospital MTP activation aimed to make blood products available prior to the patients’ arrival at the ED. The blood products are transfused when the patient arrives at the hospital. ResultsThe MTP was activated in pre-hospital setting in 219 patients. On arrival at the hospital, the Trauma Team Leader confirmed MTP activation in 146 (66.7%) patients. Patients with MTP criteria received a higher amount of blood products than the patients without MTP criteria, median 7 (IQR 2–13) units versus 2 (0–6) units, respectively (P < 0.001). At the same time, patients with a Shock Index ≥ 0.9 received more transfusions (5.5 [2–13] units) compared with patients characterized by a lower SI (2 [0–7.25] units, P = 0.009). 146 patients were transfused in the first hour of ED admission. Poisson's multiple regression shows that the SI is the variable that better predicted MTP activation compared to age, gender and the number of injured sites. ConclusionsPre-hospital MTP activation is useful to identify patients that require an urgent blood transfusion on arrival at the ED. Further analysis should be considered to evaluate the implementation of the Shock Index as a criterion to activate MTP.

O-EGS04 Is group and save necessary for all patients undergoing emergency cholecystectomy: A 6-year retrospective audit

Abstract Background Emergency cholecystectomy (EC) has a low perioperative bleeding risk. There is no current national guideline to suggest routine preoperative Group and Save (G&amp;S) is necessary. Our Trust guideline recommends preoperative G&amp;S for all EC operations. In 2018, a Trust-wide policy was adopted based on an audit, which concluded that routine preoperative G&amp;S is unnecessary for elective cholecystectomy. All G&amp;S require 2samples taken separately, which can delay surgery. The cost to process one sample for G&amp;S is £28. Therefore, a study was set up to assess the need for routine G&amp;S in patients undergoing EC. Methods This retrospective observational study was based on a prospectively collected hospital database from March 2015 to March 2021 using MS-Excel. All patients who underwent EC (laparoscopic and/or open) within 10 days during index admission were included. All elective cholecystectomies were excluded. Patients were divided into GS-patients (patients with G&amp;S) and NGS-patients (patients without G&amp;S). The primary outcome is the difference between the incidence of ‘Perioperative blood transfusion’ (PBT) between the studied groups. The overall cost-effectiveness is considered as a secondary outcome. The categorical data were analysed using the Chi-square test; a p-value &amp;lt;0.05 is considered statistically significant. Results In this 6year period, 2210patients underwent cholecystectomy. Of these, 496patients (22.4%) who underwent EC were included. 447patients (90.1%) were in GS group and 49patients (9.9%) were in the NGS group. None from the NGS group required PBT, whereas 3patients (0.6%) in the GS group received blood transfusion. However, PBT was truly indicated in 1patient due to the associated cardiovascular comorbidities. On the contrary, 2patients did not fit the ‘restrictive transfusion threshold’ criteria of JPAC. There was no statistically significant difference in PBT requirement between the studied groups (p = 0.331). Deferring routine G&amp;S for EC could have saved our institution £24,976. Conclusions Our study has demonstrated that preoperative G&amp;S is not indicated for all emergency cholecystectomies. It takes approximately 1 hour for G&amp;S to be processed unless crossmatching is required. Group O-negative or O-positive blood can be provided to patients when urgent blood transfusion is needed depending on their age and gender. Thus, we conclude that G&amp;S should be restricted to patients with low preoperative haemoglobin, bleeding and clotting disorders, those known to have abnormal blood antibodies and significant cardiovascular comorbidities.

Detection and Implementation of Blood Group and Hb Level by Image Processing Techniques

In an emergency, an urgent blood transfusion from a person to the patient is required and blood group identification is the first process to do so. In addition, a hemoglobin test is often required to make decisions about blood transfusion as well as to check anemia. Hemoglobin testing is also required for complete blood count and monitoring a number of diseases. These blood tests are almost difficult in rural areas where lab facilities are not sufficient. Researchers proposed a number of methods to identify blood groups using computer vision techniques. However, no study was conducted to identify blood group and hemoglobin level in a work using image processing techniques and an android mobile application which shows high detection accuracy. In this paper, manual clinical experiments have been replaced by an android app using image processing techniques to detect blood groups and hemoglobin levels except users require using antigen before taking samples. The proposed technique is divided into two portions. The first portion is blood group detection, which is done by taking a blood sample and performing the grayscale conversion, binary conversion, segmentation, edge detection, and computation to make the decision. The second section describes how to determine hemoglobin levels by comparing a blood sample image to a hemoglobin color scale (HCS). Here, the Hemoglobin value is determined from their RGB values. It has been discovered that the proposed approaches are capable of detecting hemoglobin levels and blood groups in a cost-effective and error-free manner. As a result, the tests can be conducted in a remote area without adequate lab facilities and the proposed work can solve major steps in blood transfusion difficulties and anemia.

Age- and Severity-Related In-Hospital Mortality Trends and Risks of Severe Traumatic Brain Injury in Japan: A Nationwide 10-Year Retrospective Study.

Traumatic brain injury (TBI) is the major cause of mortality and morbidity in severely-injured patients worldwide. This retrospective nationwide study aimed to evaluate the age- and severity-related in-hospital mortality trends and mortality risks of patients with severe TBI from 2009 to 2018 to establish effective injury prevention measures. We retrieved information from the Japan Trauma Data Bank dataset between 2009 and 2018. The inclusion criteria for this study were patients with severe TBI defined as those with an Injury Severity Score ≥ 16 and TBI. In total, 31,953 patients with severe TBI (32.6%) were included. There were significant age-related differences in characteristics, mortality trend, and mortality risk in patients with severe TBI. The in-hospital mortality trend of all patients with severe TBI significantly decreased but did not improve for patients aged ≤ 5 years and with a Glasgow Coma Scale (GCS) score between 3 and 8. Severe TBI, age ≥ 65 years, fall from height, GCS score 3–8, and urgent blood transfusion need were associated with a higher mortality risk, and mortality risk did not decrease after 2013. Physicians should consider specific strategies when treating patients with any of these risk factors to reduce severe TBI mortality.

Warm Reactive Anti-A1 Agglutinin in an A2B individual: A Rare Case with Review of Literature

The prevalence of the major subgroup of A as A&lt;sub&gt;1&lt;/sub&gt; in almost 80% of the A group population is a known fact. A&lt;sub&gt;2&lt;/sub&gt; and the remaining subgroups such as Aend, Am, Ax etc comprise the remaining population, based on erythrocyte agglutinability and various serological reactions. These A subgroups can often result in an ABO typing discrepancy. Anti-A&lt;sub&gt;1&lt;/sub&gt; antibody often appears as an irregular cold agglutinin in the sera of A&lt;sub&gt;2&lt;/sub&gt; or A&lt;sub&gt;2&lt;/sub&gt;B individuals who lack the corresponding antigen. Rather notably, the literature suggests that 1% to 8% of A&lt;sub&gt;2&lt;/sub&gt; and 22% to 35% of A2B individuals possess an allo-anti-A&lt;sub&gt;1&lt;/sub&gt; in their sera, which reacts at a temperature below 25°C. Although routinely, it does not pose any problem either during or post blood transfusion, however, the literature reports of hemolysis happening in procedures that are performed at lower temperatures, particularly in hypothermic situations. We report herein, a case of a massively bleeding A&lt;sub&gt;2&lt;/sub&gt;B Indian lady after the expulsion of her dead fetus and an underlying uterine fibroid having a warm reactive allo-anti-A&lt;sub&gt;1&lt;/sub&gt; agglutinin that warranted an urgent blood transfusion management.

Transcatheter arterial embolisation is efficient and safe for paediatric blunt torso trauma: a case-control study

BackgroundIt remains unclear whether transcatheter arterial embolisation (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports. The study aimed to compare the efficacy and safety of TAE performed in paediatric (age ≤ 15 years) and adult patients with blunt torso trauma.MethodsThis was a single-centre, retrospective chart review study that included blunt torso trauma patients who underwent TAE in the trauma centre from 2012 to 2017. The comparative study was carried out between a ‘paediatric patient group’ and an ‘adult patient group’. The outcome measures for TAE were the success of haemorrhage control and complications and standardised mortality ratio (SMR).ResultsA total of 504 patients with blunt torso trauma were transported to the trauma centre, out of which 23% (N = 114) with blunt torso trauma underwent TAE, including 15 paediatric and 99 adult patients. There was no significant difference between the use of TAE in paediatric and adult patients with blunt torso trauma (29% vs 22%, P = .221). The paediatric patients’ median age was 11 years (interquartile ranges 7–14). The predicted mortality rate and SMR for paediatric patients were lower than those for adult patients (18.3% vs 25.9%, P = .026, and 0.37 vs 0.54). The rate of effective haemorrhage control without repeated TAE or additional surgical intervention was 93% in paediatric patients, which was similar to that in adult patients (88%). There were no complications in paediatric patients at our centre. There were no significant differences in the proportion of paediatric patients who underwent surgery before TAE or urgent blood transfusion (33% vs 26%, P = .566, or 67% vs 85%, P = .084).ConclusionsIt is possible to provide an equal level of care related to TAE for paediatric and adult patients as it relates to TAE for blunt torso trauma with haemorrhage in the trauma centre. Alternative haemorrhage control procedures should be established as soon as possible whenever the patients reach a haemodynamically unstable state.

In-Hospital Mortality Risk of Transcatheter Arterial Embolization for Patients with Severe Blunt Trauma: A Nationwide Observational Study.

This study investigated the risk factors for in-hospital mortality of severe blunt trauma patients who underwent transcatheter arterial embolization (TAE). We analysed data from the Japan Trauma Data Bank from 2009 to 2018. Patients with severe blunt trauma and an Injury Severity Score (ISS) ≥ 16 who underwent TAE were enrolled. The primary analysis evaluated patient characteristics and outcomes, and variables with significant differences were included in the secondary multivariate logistic regression analysis. In total, 5800 patients (6.4%) with ISS ≥ 16 underwent TAE. There were significant differences in the proportion of male patients, transportation method, injury mechanism, injury region, Revised Trauma Score, survival probability values, and those who underwent urgent blood transfusion and additional urgent surgery. In multivariable regression analyses, higher age, urgent blood transfusion, and initial urgent surgery were significantly associated with higher in-hospital mortality risk [p < 0.001, odds ratio (OR), 95% confidence interval (CI): 1.01 (1.00–1.01); p < 0.001, 3.50 (2.55–4.79); and p = 0.001, 1.36 (1.13–1.63), respectively]. Inter-hospital transfer was significantly associated with lower in-hospital mortality risk (p < 0.001, OR = 0.56, 95% CI = 0.44–0.71). Treatment protocols for urgent intervention before and after TAE and a safe, rapid inter-hospital transport system are needed to improve mortality risks for severe blunt trauma patients.

Ten-Year in-Hospital Mortality Trends among Paediatric Injured Patients in Japan: A Nationwide Observational Study.

Injury is a major cause of worldwide child mortality. This retrospective nationwide study aimed to evaluate the characteristics of paediatric injured patients in Japan and their in-hospital mortality trends from 2009 to 2018. Injured patients aged <17 years were enrolled. Data were extracted from the Japan Trauma Data Bank. In the Cochran-Armitage test, in-hospital mortality significantly decreased during the study period (p < 0.001), except among patients <1 year old, and yearly reductions were observed among those with an Injury Severity Score ≥16 and survival rate ≥50% (p < 0.001). In regression analyses, patients who underwent urgent blood transfusion within 24 h after hospital admission (odds ratio (OR) = 3.24, 95% confidence interval (CI) = 2.38–4.41) had a higher in-hospital mortality risk. Higher survival probability as per the Trauma and Injury Severity Score was associated with lower in-hospital mortality (OR = 0.92, 95% CI = 0.91–0.92), a risk which decreased from 2009 to 2018 (OR = 6.16, 95% CI = 2.94–12.88). Based on our results, there is a need for improved injury surveillance systems for establishment of injury prevention strategies along with evaluation of the quality of injury care and outcome measures.

Genotyping of Duffy Blood Group by Microchip Capillary Electrophoresis

To explore a method for rapidly screening the Duffy blood group genotypes and to establish an information bank of rare blood type donors. The microfluidic capillary electrophoresis system and PCR-SSP method were used to analyze the Duffy genotype of 3 936 unrelated O-type blood donors in our center from December 2014 to September 2018. The serologic identification and typing of other blood type system phenotypes for FYa-negative specimen were performed. The Fy (a-b-) specimen was sequenced for genotyping. The phenotypes of FYa-negative specimens were consistent with the genotyping results of the microfluidic capillary electrophoresis system. The results of Duffy phenotyping in 3 936 specimens were follows: Fy (a+b-) 3 564 (90.54%), Fy(a+b+) 353 (8.97%), Fy(a-b+) 18 (0.46%), Fy (a-b-) 1 (0.03%). The gene frequency was FY*A (95.03%), FY*B (4.94%), and FY*Null (0.03%). The bank of rare blood types of 19 FYa-negative specimens was established. Microfluidic capillary electrophoresis system is suitable for Duffy blood group genotyping screening. It can be used to establish a bank of rare blood type, so as to solve the problem of urgent blood transfusion in patients with rare blood type, and to improve blood transfusion safety.

In the Era of Tranexamic Acid, are Type and Screens for Primary Total Joint Arthroplasty Obsolete?

BackgroundAdvances in technique and perioperative blood management have improved transfusion rates following unilateral primary total joint arthroplasty and led some centers to change their preoperative blood ordering protocols. The purpose of this study is to determine whether deleting type and screens (T&S) from preoperative order sets was safe for patients undergoing primary total knee (TKA) and total hip arthroplasty (THA) and to identify patients who required allogenic blood transfusion. MethodsProspectively collected data were reviewed to identify any patient with a hemoglobin (Hgb) drawn within 30 days of surgery who received a transfusion following a unilateral primary TKA or THA. ResultsA total of 1255 patients met inclusion criteria. Of the total, 682 (54%) were TKAs and 573 (46%) were THAs. The mean preoperative Hgb was 11.5 g/dL with an average delta Hgb of 3.6 g/dL on postoperative day 1. No patient required an intraoperative transfusion. Fourteen patients (mean age and body mass index, 67.9 and 29.0) required a transfusion (1.1%) for postoperative blood loss anemia. Of those transfused, 13 (93%) of the patients underwent THA with the mean estimated blood loss of 378.6 mL. The total cost for a patient obtaining a T&S is $191.27. ConclusionIn our series, the risk of blood transfusion was rare (1.1%) and occurred only secondary to postoperative blood loss anemia. There were no cases of intraoperative complication requiring urgent or emergent blood transfusion. Removing T&S from standard order sets for patients undergoing primary TKA or THA appears to be a safe and cost-effective practice.

Hereditary hemolytic anemia in newborns: clinical significance of genetic diagnosis

Hereditary hemolytic anemia (HHA) is a group of monogenic diseases arising from the increased destruction of circulating erythrocytes. HHA is caused by germline mutations in genes encoding components of the red blood cell membrane, hemoglobin, and enzymes. Comprehensive gene analyses have identified various HHA-associated germline defects. However, early HHA diagnosis can be difficult in newborns because they present with hydrops and severe jaundice, which require urgent blood transfusions. Considering neonatal physiological hemolysis and pediatric infection, we select efficient diagnostic procedures following the exclusion of "syndromic hemolytic diseases". Clinical sequencing is performed for atypical cases, although phenotypic and laboratory tests remain essential for the verification of pathogenicity when certain variants are identified. The diagnostic gene panel can also be useful for predicting prognosis and determining treatment options. Although transfusion-dependent adult patients with HHA are rare in Japan, their management remains challenging. Clinical trials of new drugs and genetic controls are ongoing in other countries. However, the long-term management of a small group of patients with severe HHA must still be addressed in Japan. Here, we review the strategy and clinical significance of using genetic diagnostic methods for HHA in newborns.

Validating the ATLS Shock Classification for Predicting Death, Transfusion, or Urgent Intervention

BackgroundThe Advanced Trauma Life Support (ATLS) shock classification has been accepted as the conceptual framework for clinicians caring for trauma patients. We sought to validate its ability to predict mortality, blood transfusion, and urgent intervention. Materials and methodsWe performed a retrospective review of trauma patients using the 2014 National Trauma Data Bank. Using initial vital signs data, patients were categorized into shock class based on the ATLS program. Rates for urgent blood transfusion, urgent operative intervention, and mortality were compared between classes. Results630,635 subjects were included for analysis. Classes 1, 2, 3, and 4 included 312,404, 17,133, 31, and 43 patients, respectively. 300,754 patients did not meet criteria for any ATLS shock class. Of the patients in class 1 shock, 2653 died (0.9%), 3123 (1.0%) were transfused blood products, and 7115 (2.3%) underwent an urgent procedure. In class 2, 219 (1.3%) died, 387 (2.3%) were transfused, and 1575 (9.2%) underwent intervention. In class 3, 7 (22.6%) died, 10 (32.3%) were transfused, and 13 (41.9%) underwent intervention. In class 4, 15 (34.9%) died, 19 (44.2%) were transfused, and 23 (53.5%) underwent intervention. For uncategorized patients, 21,356 (7.1%) died, 15,168 (5.0%) were transfused, and 23,844 (7.9%) underwent intervention. ConclusionsAlmost half of trauma patients do not meet criteria for any ATLS shock class. Uncategorized patients had a higher mortality (7.1%) than patients in classes 1 and 2 (0.9% and 1.3%, respectively). Classes 3 and 4 only accounted for 0.005% and 0.007%, respectively, of patients. The ATLS classification system does not help identify many patients in severe shock.

Low plasma haptoglobin is a risk factor for life-threatening childhood severe malarial anemia and not an exclusive consequence of hemolysis

Severe Malarial Anemia (SMA), a life-threatening childhood Plasmodium falciparum malaria syndrome requiring urgent blood transfusion, exhibits inflammatory and hemolytic pathology. Differentiating between hypo-haptoglobinemia due to hemolysis or that of genetic origin is key to understand SMA pathogenesis. We hypothesized that while malaria-induced hypo-haptoglobinemia should reverse at recovery, that of genetic etiology should not. We carried-out a case-control study of children living under hyper-endemic holoendemic malaria burden in the sub-Saharan metropolis of Ibadan, Nigeria. We show that hypo-haptoglobinemia is a risk factor for childhood SMA and not solely due to intravascular hemolysis from underlying schizogony. In children presenting with SMA, hypo-haptoglobinemia remains through convalescence to recovery suggesting a genetic cause. We identified a haptoglobin gene variant, rs12162087 (g.-1203G > A, frequency = 0.67), to be associated with plasma haptoglobin levels (p = 8.5 × 10−6). The Homo-Var:(AA) is associated with high plasma haptoglobin while the reference Homo-Ref:(GG) is associated with hypo-haptoglobinemia (p = 2.3 × 10−6). The variant is associated with SMA, with the most support for a risk effect for Homo-Ref genotype. Our insights on regulatory haptoglobin genotypes and hypo-haptoglobinemia suggest that haptoglobin screening could be part of risk-assessment algorithms to prevent rapid disease progression towards SMA in regions with no-access to urgent blood transfusion where SMA accounts for high childhood mortality rates.

The public's risk perception of blood transfusion in Saudi Arabia.

BackgroundHuman beings may face many circumstances, such as surgery, trauma, and anemia, in which they could require an urgent blood transfusion. However, only a few studies have examined people’s risk perception of blood transfusion. Therefore, this study aims to evaluate the public’s risk perception of blood transfusion in Saudi Arabia, and to identify factors associated with their risk perception.MethodsSelf-reported questionnaires on blood transfusion risk perception were distributed to the public during a Saudi national festival in Riyadh. Data were analyzed using mean, SD, Student’s t-test, and linear regression.ResultsThe overall percentage mean score±SD of risk perception was 59.8±16.1. Male participants were significantly more likely to perceive blood transfusion negatively, both in terms of the dread/severity domain (β=−0.23, p=0.003) and their overall risk perception score (β=−0.17, p=0.028). Older participants were considerably more likely to have a more negative perception (β=0.12, p=0.041) of the benefits of blood transfusion compared with younger participants. Study participants who received blood in the past had a significantly better perception (β=−0.13, p=0.029) of the benefits of transfusion. Additionally, participants who had previously donated blood had a considerably more positive perception in the dread/severity domain (β=−0.18, p=0.017) and their overall score (β=−0.15, p=0.045).ConclusionSaudi males are more likely to perceive blood transfusion as a high-risk procedure. Similarly, older Saudis will probably have a more negative perception of the benefits of blood transfusion. Previous recipients and donors will likely have a better perception of the benefits of blood transfusion and a more positive overall risk perception.